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Mental health can be affected by many factors. Diseases can affect mental health as well. Since obesity has become a common disease nowadays, it affects mental health of many people all over the world. Commonly, overweight and obese people experience depression because they are not happy with their body weight, shape and the way they look.
The number one medication to cure obesity and lose extra weight is Phentermine. This anti-obesity drug helps people to stop eating huge amounts of food that is high in calories. Phentermine is a stimulant and it works in the central nervous system. If you suffer from depression or any other mental disorder and you have to take special medications, make sure you consult a doctor before using Phentermine diet pills. Please note that Phentermine pills must never be combined with MAO inhibitors, like Neuralex, Iproniazid, Adepren or any others.
These two types of drugs – appetite suppressant and monoamine oxidase inhibitor can interact, causing severe side effects, like extremely high blood pressure (hypertension). However, if your doctor thinks you need to take some sedatives, like Sertraline, Paroxetine or any other, he should adjust a safe dose for you. Otherwise, this drug interaction may cause severe headache, seizures or overanxiety.
Many overweight people have a common disorder like overeating or even bulimia. So they cannot cope with it on their own. Phentermine diet pills can successfully solve this problem, by suppressing the appetite and helping obese people to keep a low-calorie diet. The term bulimia differs from simple overeating. Bulimia is a state when a person wants to eat even if he is not hungry, while increased appetite is obviously a brain signal that the body needs "fuel".
Speaking of bulimia, it is mostly associated with mental disorders, like depression. It is not recommended to take Phentermine slimming pills if you have severe depression and you are using antidepressants. Being the CNS stimulant, Phentermine drug can provoke severe reactions in the body of an obese patient, who suffers from depressive disorder. But if you have mild depression, Phentermine diet pills may actually help you. When you lose extra kilograms and your body becomes slimmer, your mood improves and depression symptoms are weakened. Having familiarized with this and other information about slimming pills and depression, you can order Phentermine diet pills whenever you need. Online pharmacies provide prices that are lower than at ordinary pharmacies. So, if your doctor prescribed you these slimming pills, you can buy cheap Phentermine online and save some money on postal services.


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I reported a year ago the list of the books I had read during 2010. I'll do the same again for 2011 in hopes of turning this into a habit. The key to developing a habit, or so I'm told, is to do it seven (or some other number) times, but I'm not sure how well that works with something that's done only on an annual basis.
I've kept roughly the same book count as last year, mid thirties, while continuing my other reading. Every week C and I read the New York Time on the weekends, and Time and New Yorker magazines. I also read a half dozen monthly magazines, mostly motorcycle related, and the occasional magazine I pick up in an airport. And I spend too much time reading blogs and other web content. Mid summer I spent a lot of time reading the PMBOK® Guide to study for a project management certification, and lately I've been reading some ham radio manuals. I make all of this possible by hardly ever watching TV; at least four or five evenings a week are wholly spent reading.
Several months ago I bought myself a Kindle, mostly for the purpose of reading while traveling and while on airplanes where carrying multiple books (I'm usually reading three or four at any one time) is impractical. I previously had a Nook but was terribly disappointed with its slow performance and selection of books; the later Kindle has worked out quite well. But I always have to make the decision of whether to buy a physical copy or an electronic copy of a new book. My rule has evolved into buying an e-book for just plain ol' reading, and physical copies for books I intend to read again later — or especially one that requires referencing or a lot of flipping back and forth or underlining. I had started one book (White's History, below) in electronic form, and tried using the highlighting function, but after making just a few notes, and attempting to go back to check something previously read, I decided that this was a book that demanded a physical copy.
Since I've been lusting after an Apple iPad for the past couple of years my wonderful wife C bought me one for Christmas last week. And of course there'a a Kindle app I can use to read my Kindle books on this device. So while I still have the same rule for whether to buy an e-book or a p-book, I now have the additional decision of which device to carry with me. It's undoubtedly going to be the iPad, as there's lots of other things that it can do, and while the Kindle e-ink screen is a bit easier on the eyes I haven't been bothered by the hundreds of pages that I've read on the iPad so far. So I may have an extra, unused Kindle gathering dust soon.
As was the case last year I've read a lot of Hitchens (RIP, Christopher; I will miss you), and I started the year by reading quite a bit of Neal Gaiman. A business trip to Florence and a visit to the Galileo Museum has inspired me to read some works by the great scientist as well as accounts of the conflict of church and science, and I've recently been reading some Waugh, which while I don't read a lot of novels I'm greatly enjoying.
As far as my favourites for the year, I'll select The Information by James Gleick, Arguably by Hitchens, History of the Warfare of Science and Theology by White, and finally two by Gaiman, Good Omens (with Terry Pratchett and featuring the unforgettable image of the Four Horsemen of the Apocalypse now riding motorcycles) and American Gods (I know that Mr. Wednesday was supposed to be Scandinavian, but throughout the book I pictured him as Morgan Freeman).
And finally (drum roll, please) on to the list:
- Good Omens – Gaiman, Pratchett
- Packing for Mars – Roach
- American Gods – Gaiman
- Diary of Samuel Pepys (Modern Library Abridgement)
- Samuel Pepys: The Unequaled Self – Tomalin
- Anansi Boys – Gaiman
- Moby Dick – Melville
- Big Sur and the Oranges of Hieronymous Bosch – Miller
- A Guide to the Good Life: The Ancient Art of Stoic Joy – Irvine
- Neverwhere – Gaiman
- Fragile Things – Gaiman
- The Information – Gleick
- Diary of Samuel Pepys (unabridged), vol.1 1660
- Hero: The Life and Legend of Lawrence of Arabia – Korda
- The Infinities of Lists – Eco
- Guns, Germs, and Steel – Diamond
- The Friar and the Cipher – Goldstone
- The Quotable Hitchens – Hitchens
- The Color of Magic – Pratchett
- A Connecticut Yankee in King Arthur's Court – Twain
- Complete Hitchhiker's Guide (5 novels) – Adams
- The Believing Brain – Shermer
- Mrs. Fry's Diary – Fry
- This is Not the End of the Book – Eco, Carriere
- Driven to Distraction – Clarkson
- Arguably – Hitchens
- Moab is My Washpot – Fry
- History of the Warfare of Science and Theology in Christendom (vol 1) – White
- Scoop – Waugh
- Collected Writings of Galileo
- Jeeves Collection – Wodehouse
- Brideshead Revisited – Waugh
- Complete Stories – Waugh
Happy reading for 2012!!

subset: commoncrawl


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Forget about the boring old bathrooms you're used to. Whites, greys, occasional blacks… This is the perfect room that could use some decoration and attention. What better way to add color to your home than with oodles of bold colors in the bathroom?
1. Green. Perhaps the easiest way to add a nice splash of refreshing color is to paint a wall or two.
2. Pink. For a slightly more daring touch, add a few bright porcelain fixtures in your desired color. Add the right light fixture in the same shade, and you're done!
3. Yellow. To take this dedication to color to the next level, add a gorgeously contrasting sense of sunshine with black and white porcelain, contrasted against a sunny yellow backdrop. It'll never fail to perk you up!
4. Cyan. Go all out and match the walls with the bathtub in a bright homey look with gorgeous details hand painted onto the walls, and warm brown wooden wainscoting. This pretty look has a handcrafted quality to it.
5. Red. Bold red tiling, wooden accents and white contrast in tile make for a modern look that will give you an unmistakeably unique look. Give yourself a splash of energy with the bold shade.
6. Blue. Go for a classic color that is strong yet calming. Paint the walls a bold bonny blue and take on an ornate look with silver mirror frames and a beautiful blue claw foot tub.
7. Purple. Take a walk on the wild side and let your glamorous ideas flow. A mixture of black fittings, chandelier, a bold purple accent wall and a zebra print bath tub comes together in an undeniably attractive package.
8. Go all out, and dress your bathroom like it were a luxurious living room. Ornament the walls in swirls of gorgeous color, add a chandelier, and porcelain features to tie in harmoniously with this composition that makes a statement.
How do you add color to your home? Tell us in the comments!
Image Sources:


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- Research article
- Open Access
- Open Peer Review
Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study
- Wytske W Geense1Email author,
- Irene M van de Glind1,
- Tommy LS Visscher2 and
- Theo van Achterberg1
© Geense et al.; licensee BioMed Central Ltd. 2013
- Received: 26 April 2012
- Accepted: 5 February 2013
- Published: 9 February 2013
The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study.
This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews.
All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients' motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from 'ignorer' to 'nurturer'. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive.
GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs.
- Life styles
- Family practice
- Family nursing
- Implementation
- Qualitative study
- Attitude
Chronic noncommunicable diseases, like diabetes, cardiovascular diseases and chronic lung diseases, are the leading cause of death and disabilities worldwide [1]. Besides aging of the population, an unhealthy lifestyle plays an important role in the increasing prevalence of chronic diseases. Health promotion and prevention, such as the discouragement of smoking, alcohol abuse and obesity are necessary to reduce the personal and societal consequences [2]. Several studies have shown that general practitioners (GPs) are, among others, capable to fulfil these tasks because they have relatively many patient contacts, they are perceived to be the most reliable formal source of information and can identify patients who are at risk at an early stage [3–5]. In recent decades practice nurses (PNs) have taken an increasing role in general practice as well as in providing lifestyle counselling to certain patients groups like diabetics. Health promotion activities and lifestyle advice given by GPs and PNs [6–9] can lead to a decrease in alcohol use [5], smoking cessation [3, 10], increased physical activity [11, 12] and weight reduction [13]. Few evidence-based health promotion activities are carried out in Dutch general practice [14–18], thus indicating the need to look into barriers and facilitators in this field of healthcare practice.
Various quantitative studies have been conducted into barriers GPs experience and their attitudes pertaining to health promotion activities in general practice [6, 11, 19–21]. However, qualitative studies, leading to more understanding of relevant factors and covering both subjects are limited [8, 22–26] or conducted abroad [8, 22, 25, 27, 28].
Our pilot study aimed to explore which health promotion activities Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promotion activities. These topic areas will be identified for a future, larger scale study.
Five health regions [29] in the Netherlands were selected from which GPs and PNs were invited to be interviewed. The selection of these regions was based on regional spread of health promotion research institutes and on contact through related previous research performed by Van de Glind and Heinen et al. (2012) [30]. Purposive sampling was used to include at least three GPs (preferably one in a solo practice, one in an healthcare centre and one in a general practice) and one PN (in a general practice or health care centre) in every region. Firstly we sent emails to professors of general practice medicine and to umbrella GP organizations to obtain names of relevant GPs. In case of limited or no response, the second strategy was to approach PNs in general practices and ask them if they wanted to participate and if they knew relevant GPs. Additionally, letters were sent to GPs and PNs and after one week reminders were conducted by phone. Anonymity and confidentiality was ensured. Verbal informed consent was obtained.
The Central Committee on Research Involving Human Subjects (CCMO), the Nationwide committee supervising al regional committees in the Netherlands, provides a very clear instruction on when to present research plans to medical ethics committees. It is encouraged that researchers check these instructions first. In our case, the national instructions very clearly indicate how this was not a study subject to the Medical Research Involving Human Subjects Act (WMO).
- 1.Health promotion activities in general practice
Activities used in general practice pertaining to a healthy diet, physical activity, losing weight, stop smoking and reducing alcohol use
Origin of activities
Since when are activities carried out
Patient groups
Related costs
Changes in activities
Results / effects of activities
- 2.Barriers and facilitators
Barriers pertaining to the delivering of health promotion activities
Facilitators pertaining to the delivering of activities
Requirements/ fittings for the future
- 3.Attitude of the GP or PN
Attitude of GP/ PN pertaining to their role in health promotion
Knowledge and skills pertaining to carrying out health promotion activities
Attitude of GP/ PN pertaining to the patient's responsibility
Balance between promotion of health and interfering in someone's life
Firstly, using structured questions, the GPs and PNs were separately asked what they do to reduce the use of alcohol, smoking cessation, to promote a healthy diet, physical activity and losing weight. The selection of these lifestyle subjects was based on the priorities of Dutch public health policy [31].
Secondly, open questions were used to ask GPs and PNS about the barriers and facilitators they experienced. Thirdly, their attitudes towards their role, pertaining to health promotion activities in general practice, were asked using open-ended questions.
All interviews were audio-taped and transcribed verbatim by WG. The first five interviews were both read by WG and IvdG in order to refine questions. The last question about the balance between promotion of health and inferring in someone's life was added after the first five interviews.
Data analysis
The transcripts of the interviews were coded by WG using ATLAS.ti 6x. To increase validity and to reach consensus, the first seven transcripts were also coded by IG. At the end, IvdG checked all the codes and discussed them with WG.
Characteristics and the health promotion activities in general practice were analysed using fixed codes based on the topic list.
Influencing factors were categorised using open coding. Codes were connected to themes and subthemes. An example of a theme is the requirements of health care insurance companies that GPs have to meet to receive reimbursements. The subthemes within this theme were for example the time consuming registration, and accredited courses PNs have to attend. (Sub)themes were subdivided into barriers and facilitators regarding the delivering of health promoting activities. Only barriers and facilitators mentioned by more than two participants were reported in this study. To further structure the identified barriers and facilitators, five different categories were used (category of patients, general practice, attitude of the GP and PN, health promotion programs and health care system) and these were discussed in the research team again.
Attitudes were categorized using open coding as well. Related codes were connected to (sub)themes. In the first way, codes of attitudes were divided into hindering and facilitating attitudes. However, it was not possible to subdivide all the attitude codes into barriers or facilitators; it did not yield satisfying results. Therefore, transcripts of GPs and PNs were read again to find patterns, similarities and differences in their attitudes that corresponded to the codes and themes. Then, a pattern of six types of attitudes of GPs was identified. This study adheres to the RATS guidelines on qualitative research [32].
Characteristics of included GPs and PNs
Practice (N=17)
General practice (N=8)*
Health care centre (N=8)**
Therapeutic centre (N=1)***
Function (N=25)
Gender (N=25)
GP Female (N=8)
PN Female (N=9)
GP Male (N=8)
Working status (N=25)
GP Part-time (N=6)
PN Part-time (N=8)
GP Fulltime (N=10)
PN Fulltime (N=1)
The majority of the GPs and minority of the PNs worked fulltime and two thirds of the participants are women. Seventy-five GPs did not want to participate in this study due to a lack of time (N=68), lack of interest (N= 6) or pregnancy (N=1).
Health promotion activities in general practice
Most often mentioned activities to promote a healthy lifestyle and of related patient groups
Actions among GPs an PNs (N=17)
Related patient groups
Alcohol reduction
Give advice (N= 17)
Alcoholics (N= 16)
Give a referral to addiction treatment (N=15)
Diabetics (N=10)
Individual lifestyle counselling by GP (N=4)
Cardiovascular patients (N=9)
Stop smoking
Give advice (N=17)
COPD patients (N=14)
Individual lifestyle counselling by PN (N=15)
Diabetics (N=13)
Prescribe medication (N=13)
Cardiovascular N=12)
Promotion exercise
Give advice (N=14)
COPD patients (N=12)
Give a referral to exercise program physiotherapist (N=12)
Diabetics (N=11)
Refer to physiotherapist (individual) (N=10)
Cardiovascular patients (N=10)
Promotion healthy diet
Give advice (N=16)
Overweight/ obese patients (N=15)
Give a referral to dietician (N=15)
Cardiovascular patients (N=12)
Individual lifestyle counselling by PN (N=13)
Diabetics (N=10)
Losing weight
Give advice (N=16)
Overweight/ obese patients (N=17)
Give a referral to dietician and physiotherapist (N=13)
Diabetics (N=4)
Give a referral to surgeon (N=2)
As one PN stated: "I discus what is healthy or accepted, and If a patient drinks too much I try to find out the underlying reason".
If patients are motivated to change their behaviour, GPs and/or PNs give advice about the options how to change their unhealthy behaviour and try to help them. Most of the PNs said they use motivational interviewing. The information they provide is based on the national general practitioner guidelines.
Besides this, GPs or PNs said they refer patients to other disciplines, for instance, to the dietician, physiotherapist, psychologist or addiction care. As one GP expressed:
"'I have to say, I give a referral quite easily to Iriszorg (addiction care). In the past I tried to counsel alcoholics myself, but it was very disappointing'."
Some of the GPs mentioned giving patients referrals to nationally disseminated health promotion programs. Others said they had referred patients to these programs in the past, but due to lack of proven effectiveness and reimbursements they stopped referring. Moreover, GPs expressed they prefer to offer health promotion programs in their own practice, especially exercise programs in collaboration with physiotherapists, instead of national programs outside their practice. They stated it is easier accessible and more familiar for patients.
The activities of the PNs are listed in Table 2 as well. PNs reported they give lifestyle counselling to chronically ill patients in general practice, mainly to patients with diabetes, COPD and cardiovascular diseases. PNs actively ask these patients about their lifestyles and give them lifestyle advice. Furthermore, PNs said they give lifestyle counselling for patients who want to quit smoking.
Barriers and facilitators experienced by GPs and PNs
Barriers and facilitators for delivering health promotion activities
Lack of patients' motivation to change unhealthy behaviour *
Results are difficult to measure
Patients do not appreciate it when GPs of PNs discuss their lifestyles
Lack of proven effectiveness of health promotion programs
The hours of PN are not fully compensated financially
Unhealthy lifestyle is socially accepted, especially drinking alcohol
Lack of skills among GPs and PNs to discuss lifestyle and develop health promotion programs
Group sessions seems to be more effective compared with individual counselling, but most of the health promotion programs in general practice are individual
Lack of overview of health promotion programs
Lack of reimbursements and subsidies to start new health promotion programs in general practice
Patients deny or lie about their actual lifestyles
Lack of time among GPs to discuss lifestyle with patients and develop health promotion programs
GPs state discussing lifestyles is a waste of time
Lack of continuity of health promotion programs, due to short-term reimbursements and subsidies
GPs have to meet too many strict requirements of healthcare insurance companies, to receive reimbursement and subsidies (e.g. registration, accredited courses)
Patients are unaware of their unhealthy lifestyles
Dietician and addiction care consultant disappear due to lack of patients
Consultation hours are more focused on treatment instead of on prevention
Not all patients can be reached in general practice
Lack of trust among GPs and PN in reimbursement and subsidies due to continuous changes
Patients experience barriers to live a healthy lifestyle (e.g. co-morbidity, lack of time)
GPs do not give patients referrals and motivate their patients as much as they can
GPs are sceptical about the effects and results of discussing lifestyle
Programs are not accessible, due to narrow inclusion criteria and affordability of programs
Contradictory policy of Dutch government (e.g. expensive healthy food, inconsistent smoking policy)
Behavioural change is a complex process for patients, especially when the environment does not change
Due to unhealthy behaviour of GPs and PNs (especially alcohol use) it is difficult to discuss lifestyles with patients
GPs think lifestyle is not important
Lack of health promotion programs
GPs and patients have to find out reimbursement and subsidies from insurance companies themselves
Letting patients pay contribution for health promotion programs does not work, especially not among low SES patients
Motivation of GPs and PNs decrease due to disappointing results
Programs are not accessible for patients due to waiting lists
Lack of collaboration between hospital and general practices with regard to health promotion activities
Due to stigma patients are not going to addiction care
Lack of collaboration between disciplines
Health promotion activities in general practice are not rewarded
Patients do not go to health promotion programs due to geographical barriers (E.g. distance to program)
Lack of room and housing
Contradictory information from insurance company towards patients
GPs forget to ask about lifestyles
Patients who are aware of their own lifestyles and who are motivated to change their lifestyles is a motivation for GPs and PNs
Availability of PNs in general practice: he/she has more time than GPs and plays a central role
GPs thinks it is worthwhile to discuss lifestyle with patients
Health promotion programs in general practice are familiar for patients
Reimbursements and subsidies determine participation and development of health promotion programs
Let patients do what they want to do; there is a bigger chance they will succeed
More collaboration and feedback due to availability of physiotherapist and dietician in general practice
GPs state it is part of their job to promote a healthy lifestyle
Easy accessible health promotion programs due to broad inclusion criteria and affordability
Umbrella of GP organization develop health promotion programs and clear policy
Patients are more motivated when they have insight in their results (e.g. blood sugar level)
Sufficient staff for developing and conducting lifestyle programs
GPs and PNs think they are skilled to discuss lifestyle with patients
Continuity of health promotion programs
Patients are more motivated to participate in a lifestyle program when they have to pay contribution
Familiarity between patients and GP and PNs is an advantage to discuss lifestyle
Healthy lifestyle of GP and PNs is a role model for patient
Best way to discuss lifestyle is in an open manner, not by using a protocol
Sufficient room and accommodation
Proven effectiveness of health promotion programs
Enthusiastic colleagues to develop and deliver lifestyle programs
Overview/ social map of disciplines and health promotion programs
Structured registration and labelling of patients at risk provide an overview for GPs
Availability and collaboration with sport facilities
Firstly, GPs and PNs mentioned barriers regarding their patients: patients were not motivated to change their unhealthy lifestyles and deny and lie about their behaviour. Furthermore, some patients were said to not appreciate discussing their lifestyles and GPs and PNs stated that an unhealthy lifestyle is socially accepted, especially drinking alcohol.
Secondly, GPs and PNs experienced barriers related to their own practice: they stated they have a lack of time in their consultations to discuss lifestyle issues with their patients. Moreover, they mentioned there is a lack of corporation with other disciplines.
Thirdly, GPs and PNs stated they experience problems regarding the content of health promotion programs. According to them, there is a lack of proven (long-term) effectiveness, and next to this, there is no overview of existing programs in the neighbourhood.
Fourthly, respondents stated that reimbursement of the programs is a barrier: a lot of health promotion programs are not financed or only financed for a short period. Due to that, there is lack of continuity, there are no long- term programs and therefore there is uncertainty and lack of trust to implement new initiatives.
As one GP said:
"'This is the second year that we offer this program to our patients. Now, the program is granted…as long as it lasts'."
Moreover, programs are not always accessible for patients with a low socio-economic status (SES) and if a general practice receives a reimbursement, they have to meet strict and time-consuming requirements from insurance companies or research institutes. Examples are the registration of performed activities, the inclusion of patients and the required education and skills of practice nurses to take certified courses and training.
At last, contradictory policy of the government is an experienced barrier as well: for instance GPs mentioned the inconsistent smoking policy (in 2008 smoking was banned in all restaurants, clubs and hotels but this was overturned in 2012).
As one GP expressed:
"'We are glad, because we get support and reimbursements to motivate people to stop smoking. However, when I heard on the radio "It is allowed to smoke in small cafes again", I thought; "What do they want?!"'"
Most cited facilitators are the availability of PNs in general practices, reimbursement of lifestyle programs, having programs in their own practice, the development of programs by umbrella GP organizations and collaboration with several disciplines in general practice, like dieticians, physiotherapist and psychologist (see Table 3).
Remarkably, there are some contradictions in the mentioned barriers and facilitators. With respect to the contribution patients have to pay for certain health promotion programs, some GPs and PNs stated this is a barrier because programs are not accessible for everyone, especially not for patients with a low SES. However, others think it is a facilitator, because if patients have to pay for a program they will be more motivated to change their behaviour. Another contradiction is whether GPs and PNs own healthy behaviour will influence health promotion activities positively or not. It could be a barrier, especially with regard to drinking alcohol, as one GP expressed:
"'We do very little about reducing alcohol intake by patients, but it might have something to do with the fact that the doctor drinks alcohol as well'"
But it could also be a facilitator:
"'I was a smoker. I have stopped. If I can do it, you can do it too'."
Attitude of GPs and PNs
Attitude of GPs toward discussing lifestyle with patients: a typology of GPs
Limited role of GP pertaining to the promotion of a healthy lifestyle. It is the task of the government to promote a healthy lifestyle. Reimbursement is a strong motivational factor for the delivering of intervention in general practice.
Health promotion and prevention are part of the job of a GP. Although GPs state their consulting hours are more focused on treatment instead of prevention, they think it is worthwhile to spend time on health education and counselling. But in the end patients make their own choices.
Self management among patients is very important in general practice. The PN has a central role to educate and counsel patients. The GP confirms the importance of healthy lifestyle and supports progress of behaviour change of patients.
The general practice carries out a lot of lifestyle programs. However the GP is sometimes sceptical about the effects. Nevertheless, they are sure that they can help at least some patients.
GP discusses lifestyle even if the patient has no related symptoms. They confront their patients with their unhealthy lifestyle. These GPs have a lot of lifestyle programs in general practice.
The role of the GP is like the role of a teacher/ educator or nurturer. GP's have to educate their patients.
The GP imposes standards of a healthy lifestyle also to his/her own life, to set a good example.
'Those lifestyle interventions are not that important, in my opinion'.
'Yes, eventually the patient is responsible; however as a GP I can provide patients with information'.
'The plans for behaviour change are made between patient and PN (…). Our role is just to support and consolidate this. Even if they come with a cold, I say 'You want to lose some weight. Well done!'
'You want to create an atmosphere in which you radiate that and eventually it works somehow. Even if it is for later generations'.
'If you see cigarettes in the patients' breast pocket, do you have to say something about it or not? (.) If I am well acquainted with the patient, I do'.
'You have to raise your patients and teach them how to deal with health in their life'.
'I can improve very little at the individual level'.
'Patients are doing a lot of simple primitive things wrong (…) I may discuss that with my patients'.
'I think I am a health adviser'.
'You must go on. On the one hand because there are (minimal) results and on the other hand because it is professional motivation. It is like 'Médecins Sans Frontières' an (international humanitarian organization); they go to a warzone, yes… and later on there is a new front. Shouldn't they have gone out and help over there? You have to do something. You will help at least some individuals'.
'I put all of them (fat ladies, WG.) on a weighing scale and I say: What do you think of it? (…) It's a wakeup call. They don't like it, but it has to be done, right?'
'I think it makes sense to tackle bad lifestyle habits in order to prevent. And that we can say: well if you are not stupid, you have to get smart'.
'I would never discuss the importance of exercise etcetera if there is no policy on a national or regional level'.
'Advisory, not mandatory. I give advice and patients can do with it what they want. It is their responsibility'.
'We try to motivate patients, using the power of repetition and the fact we are a team'.
'Sometimes I lay my hand on one of those pot bellies and say: When is the baby coming?'
'I will change my working method if the insurance company offers me a reimbursement'.
The 'ignorers' stated that their role as a GP in health promotion activities, is limited and that the government should take more responsibilities. The 'advisers' mentioned that health promotion is part of their job and think it is worthwhile to spend time on giving lifestyle advices. The 'confirmers' emphasized the importance of the PNs and as a GP they confirm and support the plans made between the PN and patients. The 'evangelists' stated that even though they are sceptical about the effects, they are sure that they can help at least some patients. The 'interferers' discussed lifestyle with their patients by confronting them, even if there are no lifestyle related symptoms. The 'nurturer' stated that the GPs' role is like the role of a teacher, to raise and educate their patients. In most cases a GP fits into one role. However, sometimes a GP fits into several roles, depending on the lifestyle factor she/he has to deal with. For example, a nurturer can become ignorer when there is a patient with alcohol problems. It may depend on the lifestyle topic, the problem, the patient and/ or the situation in which role a GP fits.
The PNs were also asked about their attitudes. They were unanimous. PNs stated that patients are always responsible for their own lifestyle and they quit giving support if a patient does not want to change or does not appreciate it when his or her lifestyle is discussed. The patient can come back when he or she is ready for it. Despite the fact they cannot help all patients and the results are minimal, PNs think discussing lifestyle is worthwhile. As one PN expressed:
"'Lifestyle is more important than all the other things I do'."
The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topic are with respect to attitudes towards health promotion activities.
GPs and PNs said that they advice and counsel their patients or refer them to other disciplines. They said that they perceive health promotion activities as part of their job. However, there were several topic areas identified as barriers to deliver health promotion activities. These barriers are related to the patient, the GP and the practice, attitudes, health promotion programs and the healthcare system. Six different and provisional types of GPs were identified, reflecting the main topics that are related to six different attitudes to health promotion activities. Topics brought up by PNs that are related to attitudes were practically unanimous and positive.
The main topic areas as barriers in this study are consistent with results of other studies. Most cited barriers mentioned in the literature are: lack of time [11, 28, 33], lack of confidence in providing advice and effectiveness of interventions [6, 22, 33], lack of reimbursements [11, 19, 28] and lack of patient compliance or motivation [11, 21, 22]. The lack of skills to discuss lifestyle is a major experienced barrier in the literature [28, 34]. Participants in our pilot study only reported a lack of discussion skills regarding alcohol intake and specific diets. Another interesting finding is the fact that Lambe [28] recommends a national program in his study, due to the inequity of access. However, GPs and PNs in this study state the opposite; they prefer programs in their own practice instead of national programs outside their practice. The themes regarding attitudes that we identified in this study correspond with the existing literature. A study by Lambe [28] concluded that GPs think their practice is an ideal setting to deal with lifestyle behaviour and Douglas [11] described most GPs think health promotion is an important part of their job. However, not all studies have found positive attitudes among GPs. Jacobsen [22] concluded that GPs are frustrated due to the excessive expectations on the part of health policymakers. This was also a topic in our study, GPs said that they did not experience optimal support of the government either. Lawlor [8] stated that GPs are sceptical because they doubt their ability to be effective and mentioned that social, cultural and environmental factors are the most important determinants of population health. This vision corresponds with the vision of the GP type 'ignorer', one of six types identified in this pilot study.
Although our pilot study is small and explorative, we found a variation of topic areas. We categorized these different themes in types of GPs, but this categorisation is not stringent. Since this is a explorative pilot study, other types can be added to this categorisation as well. In the literature different types of GPs were also described. For instance Bucks [35] who identified five different clusters of GPs, varying from the GPs who is traditional in his/ her approach but at the same time speculative in taking risks, to the GP who is doctor centred in approach, but who is not prepared to take risks with patients health, preferring caution and prevention. Laws [23] describes four different roles of GPs ('outside of professional role', 'the gatekeeper', 'the informer' and 'helper') and how they influence the implementation of lifestyle risk factors. There are similarities with our findings, for instance the first role corresponds with the role 'ignorer' and the third one with 'adviser'. However, in our study we found a wider range of different attitudes.
In this pilot study the topics brought up by PNs were more the same, which has also been found in some other studies. Steptoe [36] for example concluded that the majority of the GPs and PNs endorsed the statement that PNs are the most appropriate people to carry out health promotion.
This study has certain limitations. We used purposive sampling to find GPs and PNs, but we did not find GPs in solo practices who were willing to participate. Not only because the number of solo practices is declining, but also because of non-response and lack of time, we could not spend more time on finding solo practices. Therefore, only GPs in healthcare centres and general practices were interviewed.
Also, selection bias could have resulted from a non-response. It may be that GPs and PNs who participated in this study are more engaged in addressing lifestyle issues than participants who did not participate. The response rates among Dutch GPs in studies is generally low, probably because of the extension of their tasks, limited time to participate in studies and 'research tiredness' [37]. However, low response rates in GPs is not typically Dutch, Templeton, Creavin and Kaner also concluded it is becoming difficult to encourage GPs to participate in studies [38–40].
Due to the limited time of the GPs it was not only difficult to find general practices, but also to conduct in depth interviews of 60 minutes. Therefore we conducted interviews of 30 minutes. However, we did find a great variety in answers. No new themes were identified in the last three interviews so we assume that saturation was reached or almost reached. Yet, socially desirable answers or recall bias with respect to attitudes and barriers and facilitators is still possible.
Implication for future research and clinical practice
In this study we highlighted 41 barriers mentioned by GPs and PNs with respect to health promoting activities in general practices. Future studies will be necessary to explore how (national) health promoting programs could be optimally implemented in general practices. Moreover, more studies are needed to assess the role of the GP umbrella organizations with respect to the development, dissemination and implementation of lifestyle interventions, because GPs and PNs stated they can advocate and spread proven effective health promotion programs in general practices on a continuous base. Furthermore, this was a small explorative pilot study. More in depth interviews are necessary to provide more insight in the different types of attitudes of GPs and PNs.
It is difficult to find solutions for the identified barriers in this study. Investing in collaboration between different disciplines in general practice and addressing the advocating role that umbrella GP organisations can have to promote lifestyle interventions could be strategies to increase health promotion activities. Next to this, a consistent national health policy to promote healthy behaviours is necessary. Furthermore, in this study enthusiasm of PNs to carry out lifestyle interventions was identified as a facilitator. The role and position of PNs should be further explored to gain the most benefit from them.
GPs and PNs all say they discuss lifestyle issues with their patients. Referring patients to dieticians and physiotherapists was mentioned as an important activity to promote a healthy lifestyle. The number and the origin of health promotion activities that are organized and offered from within the general practice itself varies. Several barriers and facilitators with respect to health promotion were identified. The attitudes of GPs regarding health promotion were categorized as ignoring, advising, confirming, evangelising, interfering and nurturing. This explorative pilot study points out that, in general, GPs and PNs do carry out health promotion activities, but they experience barriers to fulfil this task.
The authors gratefully acknowledge the general practitioners and practice nurses for taken part of this study.
Authors' Affiliations
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Pre-publication history
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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|Sorry for this horrible picture!
Vegan Pizza Eggs
1 slice leftover vegan pizza (mine was Seitan Bacon Ranch--see my previous post), cut into small squares
6 oz extra firm tofu, pressed and crumbled
1 tsp Vegg powder
1/4 cup water
Combine pizza and tofu in a skillet and cook over medium heat for just a minute so some of the moisture in the tofu evaporates and the edges are beginning to brown. In a mini blender or food processor, mix Vegg powder and water. Pour the Vegg mixture over the tofu and cook until everything is hot and the Vegg thickens.
As a review, it was really good, but I'm not a huge fan of the Vegg. I think it would be just as good (maybe better) using a generous amount of nutritional yeast (with an optional pinch of black salt) in place of the Vegg


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For years, Precision Engineered Products has supplied the transportation industry's need for critical engineered components. Through continuous improvement, we have demonstrated our commitment to customer satisfaction — on-time deliveries, excellent quality, competitive pricing and prompt customer service.
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Memory Training
|What's the bottom line?
After all is said and done, there are a number of things anyone can do to keep their brains healthy and fit. Like with anything else, eating right and doing "healthy" things will improve your general functioning. However, when it comes to your brain, staying physically healthy is important but not the only factor that will keep your thinking sharp and intact. Of course, you need to do all the common sense things to keep your brain healthy—but when it comes to you brain, exercise, both physical and mental, is what will make a difference in the long run.
One of the more important things to keep in mind is that there are many myths concerning the brain, especially how the brain functions as people age. While we may feel that our memories are going downhill as we get older, we actually can do a lot to make sure we keep our thinking sharp and tight, just like a well-toned muscle.


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SAN FRANCISCO-- A top Defense Department official said today that the U.S. military should "extend" a technological shield used to protect its own networks to important private sector computers as well, which could sweep in portions of the Internet and raise civil liberty concerns.
William Lynn, the deputy secretary of defense, proposed at the RSA Conference extending "the high level of protection afforded by active defenses to private networks that operate infrastructure" that's crucial to the military or the U.S. economy.
What Lynn refers to as "active defenses" were pioneered by the National Security Agency. In an essay last year, Lynn likened them to a cross between a "sentry" and a "sharpshooter" that can also "hunt within" a network for malicious code or an intruder who managed to penetrate the network's perimeter.
But the power to monitor civilian networks for bad behavior includes the ability to monitor in general, and it was the NSA that also pioneered a controversial warrantless wiretapping program under the Bush administration. NSA director Keith Alexander was named head of the U.S. Cyber Command last year, an idea that Lynn had championed.
Concerns about privacy are likely to turn on the details, including whether the military merely provides source code for defensive and offensive technologies -- or if it includes actual authority and oversight. Another open question is whether Web sites like Google.com and Hotmail.com could be considered "critical infrastructure," or the definition would be narrowed to facilities like power plants.
Lynn, who has been speaking frequently about cybersecurity threats in the last year, didn't elaborate. "Securing military networks will matter little if the power grid goes down or the rest of the government stops functioning," he said.
That echoes comments made by Sens. Joseph Lieberman (I-Conn.) and Susan Collins (R-Maine), who have pledged to reintroduce a controversial bill handing President Obama power over privately owned computer systems during a "national cyberemergency," with limited judicial review. It's been called an Internet "kill switch" bill, especially after Egypt did just that.
At the moment, the Pentagon is responsible only for defending .mil computers, and the Department of Homeland Security has responsibility for other governmental networks. Lynn said the military (and remember, the NSA is part of the Defense Department) is aiding DHS, much like it provides troops and helicopters to aid after a natural disaster
"The military provides support to DHS in the cyber domain," Lynn said. Like equipment and troops provided to FEMA, he added, military "cyber" support will be "available to civilian leaders to help protect the networks that support government operations and critical infrastructure...These resources will be under civilian control and be used according to civilian laws."
"Through classified threat-based information and the technology we have developed to employ a network defense," he said, "we can significantly increase the effectiveness of cybersecurity practices that industry is carrying out."
Homeland Security hinted at this during an interview with CNET last year at the RSA conference. The department said at the time that it might eventually extend its Einstein 3 technology, which is designed to detect and prevent in-progress cyberattacks by sharing information with the NSA, to networks operated by the private sector.
Xbox boss confirms Project Scarlett will have a disc drive: Here's what else we know about the upcoming console, including 8K graphics, 120 fps and SSD.
Watch every E3 video game trailer from Square Enix, Ubisoft, Bethesda and Microsoft's E3 conferences: All the trailers you need to see are right here!


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Big things are awesome. Just look at my penis. LADIES ONLY. Okay, you can too fellas. I'll let everyone bask in the awesomeness. You know what else is awesome? Investing in small cap stocks. And my ass.
When it comes to investing, big stocks often get all the attention. Apple is more worshiped than Jesus and Allah put together. Dividend growth investors splooge over Johnson and Johnson. And hell, I'm sure we can all agree that the potato chips made by the snack division of Pepsico are better than kittens mixed with rainbows. Large cap stocks get all the attention, mostly because they're big enough that they're involved in our lives somehow.
Often, when investors look for individual stocks to invest in, they don't look past the biggest of the big companies. People seem to think that large cap stocks are somehow safer, that they won't go down in price. They also think that large companies are less likely to go bankrupt, kinda like Nortel, General Motors, Washington Mutual and Enron all avoided bankruptcy. Oops.
These days, when I do my research on picking stocks, I'll often put an upper limit on the market cap when I use a stock screener. (usually $500M for Canadian companies and $1B for American companies) I'm looking specifically at investing in small cap stocks, and I think you should too. Here's why.
Less Competition – Analysts usually stick to large cap stocks. Traders usually stick to large cap stocks, mostly because of size and liquidity. Most investors stick to large cap stocks, because of the perceived safety. What does this mean for you? It means you get your pick of the litter.
Think about it as hitting on the plain girl at the bar. Sure, she might not be as sexy as her friends, maybe her boobs aren't as big. But as you keep talking, you realize that she's smarter, funnier and has some really neat interests. If you were over talking to all the hot girls, you never would have found the diamond in the rough. This exactly how you'd be investing in small cap stocks. FINALLY, A HOT GIRL/INVESTING REFERENCE ON FINANCIAL UPROAR.
Less competition is a good thing as an investor. It allows you go get in on the bottom floor of good growth stories. It allows you to buy profitable companies for 50-75% of book value. It allows you to buy break-even companies for less than the cash on the balance sheet. Why haven't all sorts of other investors scoped out these bargains? Because they don't know these companies exist.
Better growth potential – Apple is the granddaddy of all stocks. It has a $600M market cap, sells like 10 million devices every quarter (all at a few hundred bucks a pop) and I'm pretty sure it could beat up every other stock in the S&P 500. It is a giant behemoth, but we'll all tell it that its ass totally doesn't look fat in those jeans.
Apple needs to come up with blockbuster products to keep growing their revenue and profits. If you were ever going to buy an Apple product, chances are you've already bought one. Or six. At some point, they're going to run out of magic and start the long, slow descent to mediocrity. I will laugh heartily when this happens, mostly because I'm a jerk who laughs at other people's pain.
What company is easier to grow – the one with $100M in annual revenue, or the one with $108B? Sure, there are a lot of variables involved, but if all things are equal, it's the smaller company. A smaller company can also easily exploit inefficiencies or find business that a larger competitor just might not bother to pick up.
Management – Most of the time, I really couldn't care less how much a company pays a CEO. When you compare the size of a CEO's pay package (aside: giggity) to the size of the company, it's usually small potatoes. Managers of small cap stocks get paid less, but it's usually a comparable percentage. Still, it is nice not to see a CEO get tens of millions of dollars in severance when he gets whacked.
Often, management of small cap companies own significant chunks of the company. As an investor, you should love this. If management owns a big chunk of the company, they're just as motivated to increase the share price as you are. They're also more likely to make good long term decisions, rather than just focusing on keeping their job. When I look at potential stocks, small cap names with large management ownership stakes get bonus marks.
Better capital gain potential – Most small caps trade under $5 per share. This is one of the things that scare off regular investors, since penny stocks always = crazy risk. Nothing could be further from the truth.
Like with any stock, small caps must first be analyzed. If you're buying $1 worth of assets for 50 cents. (which is much more likely to happen with a small cap stock) that automatically gives you a giant safety zone. If the company is profitable as well, that's always good, and so is a dividend. A low stock price doesn't automatically make a company risky, it always comes down to fundamentals. I feel like a basketball coach.
Mutual funds don't own them – Wait, what? Why is this a good thing?
Often, when a large cap stock gets beaten up, mutual funds will dump the stock, because they're kind of uniquely good at the whole buying high and selling low thing. When their quarterly reports come out, they don't want to show that they're holding the latest stock to hit the crapper. So they sell it, "window dressing" the portfolio to look better.
Small cap stocks, on the other hand, only have one direction to go, and that's up. If they ever go on a nice run and get picked up by a few mutual funds eventually, that would be a huge bonus for the stock and for the shareholders.
Just do it already. I'm bored.


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"I'm still waiting for it to sink in - the reality of living and studying in Brisbane, Australia. Everything has run so smoothly that it all seems...
The University of Queensland
Ranked in the top 100 universities in the world* UQ is one of the finest higher education institutions in Australia. The University has:
- More awards for teaching excellence than any other Australian university
- Exceptional programme choice across a wide range of study areas at undergraduate, postgraduate and research higher degree levels
- Opportunities for students to gain practical experience and make valuable connections with prospective employers through internships and work placements
- A network of highly ranked partner institutions worldwide, giving students the chance to study part of their degree overseas
With campuses based in and around Brisbane, you will enjoy a diverse community of over 50,000 students, including over 11,000 international students from 140 different countries worldwide.
UQ's outstanding 215,000-plus alumni include a Nobel Laureate, the CEO of a Fortune 500 company, an Academy Award winner, and leaders in government, law, science, public service and the arts.
UQ is a founding member of the national Group of Eight, a leading group of Australian universities that conducts a significant portion of all university research in Australia. The University is also one of only three Australian members of Universitas 21, a global alliance that allows UQ to offer its students unique opportunities to participate in student exchanges and events all over the world. Through this international alliance, UQ students have taken part in events such as the Summer School programme in Mexico, the Undergraduate Research Conference in Japan and the Social Entrepreneurship programme in Guatemala.
*2015-2016; 46 QS World University Rankings|52 US News and World Report Best Global Universities | 60 Times Higher Education Rankings | 77 Academic Ranking of World Universities
What can I study?
UQ has nine world class research institutes and researchers whose work is having a global impact. Their innovations include the creation of a cervical cancer vaccine, protection of the world's food supply, and the installation of the largest photovoltaic solar panel in the southern hemisphere. As a UQ student you'll have the chance to be taught by and to work alongside these researchers.
The 2015 QS World University Rankings By Subject rank three of UQ's subject disciplines in the top 20 in the world – environmental sciences (11) agriculture and forestry (15) and psychology (18). A further 19 disciplines are among the world's top 50. These are: Development studies (21); education (21); chemical engineering (23); sociology (25); communication and media studies (26); accounting and finance (28); geography and area studies (35); architecture and built environment (37); biological sciences (37); English language and literature (43); chemistry (48); business and management studies (48); law (49); computer science and information systems (49); medicine (49) and linguistics (50).
UQ students enjoy a wide range of extracurricular activities during their studies. There are exchange opportunities to more than 185 partner institutions in 41 countries and access to more than 190 student clubs and societies, as well as sports and cultural facilities.
The UQ Advantage Award Programme
The UQ Advantage Award programme offers undergraduate students the opportunity to realise their aspirations and enhance their research, leadership and cultural communication skills to ensure that they are competitive in the employment market. It combines a range of co-curricular activities across three core categories – Global and Cultural Engagement, Research and Entrepreneurship and Social Responsibility and Leadership – and gives you access to a unique symposium series.
Where is UQ?
UQ has three main campuses in and around Brisbane, Queensland's capital. Brisbane is the third largest city in Australia, after Sydney and Melbourne, and has a multicultural population of around two million.
Brisbane has all the advantages of a large modern city, yet it retains the friendliness of a small regional town. The 2013 edition of the Lonely Planet Australia travel guide named it 'Australia's coolest city.'
Just an hour's drive south of the city are the golden beaches and theme parks of the Gold Coast. North you will find the Sunshine Coast beaches, national parks and rainforests while just off the coast lie pristine Stradbroke and Moreton Islands, both popular day trip and holiday destinations for locals and visitors alike.
Brisbane has hosted many large-scale cultural and sporting events, including the 2014 G20 leaders' summit, the Rugby World Cup and Commonwealth Games.
Student Testimonials
"I am obsessed with seeing new places and experiencing new cultures. After visiting Australia two years ago, I was completely captivated by the...


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The World Through Rembrandt's Window
November 2014
"Joseph and Potiphar's Wife" (1655): In this late painting, all the figures are fully clothed, including Potiphar's wife who is accusing Joseph (left) of attempted rape (image: Scala, Florence/Bildagentur Fur Kunst, Kulture Und Geschichte, Berlin)
Taking care not to trip on the ice-glazed pavements, Rembrandt van Rijn made his way through middle Amsterdam. As he turned into Sint Antoniesbreestraat, one of the city's most charming streets, he slipped his hand into the fold of his coat. The wind off the sea beyond chased his veins deeper into his body, but he was more concerned about finding the key that lay hidden in the swathes of wool that brushed his thigh. It had taken him years and a small fortune to obtain it, and he was not prepared to lose it now.
It was January 1639, and Rembrandt had pledged a monumental 13,000 guilders for a house on the Breestraat, as the wide street was known. As he fumbled in his pocket for the key, he could try to reassure himself that his extravagant purchase was worthwhile. The building was perfectly positioned in the artists' district to attract the business he required to pay the sum off in regular instalments. He knew that a house like this, red-brick, imposing, crowned with a glorious inset pediment, would mark him out as a man of means and good taste. As an artist of 32, with an armful of important commissions already to his name, he could never have imagined that he would be handing the house over to his creditors before two decades were out.
An exhibition that opened at the National Gallery last month and runs until January 18 shows how Rembrandt flourished as an artist in his late years, despite struggling beneath a growing tide of penury. Forced in middle age to declare himself bankrupt in the face of mounting house bills and the financial demands of a former lover, Rembrandt continued to produce paintings and drawings. His haemorrhage of savings appeared to do little to stem his creative output.
But this story of art triumphing over life was not confined to his final years. Rembrandt's first brush with poverty, which was in his case a relative term, happened decades earlier when he was still a young man. Certain habits he acquired during his early days on the Breestraat would prove to be prophetic of his later life. When — wrinkled, bankrupt and crestfallen — he faced the challenge of conquering the earthly realities of a more frugal life, it must have helped that he had already sought them out as a young artist in the city.
Rembrandt was born into a large milling family in Leiden, south-west of Amsterdam, in 1606, four years after the foundation of the Dutch East India Company. The Dutch Republic was waging war to gain independence from Spain, but booming trade had transformed it into a rich country. Immigrants, many of them having escaped the regions still under Spanish rule, filled Amsterdam and Leiden with skilled labour. Rembrandt arrived in Amsterdam in 1624 as a young student of the artist Pieter Lastman, whose studio was located on the Breestraat. The road ran through the Vlooienburg ("flooded") neighbourhood, a new addition to the desperately overcrowded city, constructed on former flood plains. It was cosmopolitan and bohemian, popular with artists, collectors and dealers.


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When considering a wedding in France, one aspect that is sure to make it a wedding like no other, is the fine French cuisine on offer. More specifically today, I'd like to focus on the sweet delicacies set to captivate and tickle the tastebuds of your guests!
A Croquembouche, which literally means "crunch in the mouth" is the traditional French wedding cake. It is made by stacking cream puffs or choux in a conical shape and cementing them together with caramel. It is then typically decorated with an outer layer of spun sugar, edible flowers and sugared almonds, although it can also be adorned with drizzled chocolate, fresh fruit, ganache and macarons.
The croquembouche seems to date back to the late 1700s , when it was invented by French pastry chef Antonin Carême. It is one of a family of desserts known as pièces montées, or "mounted pieces."
Traditionally the Croquembouche was served by the bride and groom hitting it hard with a sword and the bridesmaids catching the pieces in a tablecloth. Personally, I love this idea but nowadays, many couples either break off a choux puff to feed each other or just pose for photos beside their croquembouche, before it is whisked off to the kitchen to be dismantled and served to the guests.
I do find the highly decorated croquembouches a little OTT and prefer a simple presentation on an antique silver platter with some fresh sprigs tucked in the sides, or larger flowers placed around the base.
An increasingly popular alternative to the croquembouche is a similarily shaped pyramid of macarons. These deliciously moreish treats may have been brought to France from Italy as early as 1533. These early macarons were made from a simple combination of ground almonds, egg whites, and sugar.
It wasn't until the 1900s that Pierre Desfontaines of Parisian pastry shop and café Ladurée decided to take two cookies and fill them with ganache. No longer a humble almond cookie, the macaron turned into a thin, light treat with a crust giving way to a layer of moist almond meringue followed by a center of silky smooth filling. Yummy! I just love having a selection of rainbow coloured macarons and the wonderful job of trying to decide which flavour I like best. It could be pistachio, but then what about raspberry? Let's not forget blackcurrant… Or the lemon….
Here are a selection of Ladurée's macaron flavours:
Macarons also make fantastic French-themed favours for your guests:
So don't miss out on a fabulous opportunity to make your "French Wedding" just that by ordering some delicious French cakes!


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Information About the Standards for Listing Services on Our Website
The New York Lactation Consultant Association (NYLCA) strives for accountability to help parents find higher quality care and to enhance recognition of those providers who provide that care. Individuals who are listed on our website must agree to abide by terms that NYLCA has established. Since both clients and lactation consultants have rights and responsibilities towards each other, NYLCA developed a Bill of Rights to clarify expectations.
All IBCLCs must abide by the code of ethics and the scope and standards of practice for this profession to maintain their board certification. IBCLCs recertify every five years.


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Apple's Obsession With Secrecy Grows Stronger
Hugh Pickens writes "The NY Times has a story on the culture of secrecy at Apple (registration possibly required). Secrecy is not just the prevailing communications strategy; it is baked into the corporate culture that had its origin in the release of the first Macintosh. 'It really started around trying to keep the surprise aspect to product launches, which can have a lot of power,' says marketing veteran Regis McKenna who advised Apple in its early days. Today few companies are more secretive than Apple, or as punitive to those who dare violate the company's rules on keeping tight control over information. Employees have been fired for leaking news tidbits to outsiders, and the company has been known to spread disinformation about product plans to its own workers and sue bloggers who cover the company. Apple's decision to severely limit communication with the news media, shareholders, and the public is at odds with the approach taken by many other companies, and many experts agree that the secrecy that adds surprise and excitement to Apple product announcements is not serving the company well in corporate governance. Some say that recent reports that Steve Jobs may have had a liver transplant, still not confirmed by the company, now makes one of Apple's assertions from January — that Jobs was suffering only from a hormonal imbalance — seem like a deliberate untruth."
Read more of this story at Slashdot.


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21 Higbie Road, Middlebury, CT 06763.
The South Farms Corn Maze overlooking the homestead's barnyard, features a farmland trailway leading along one of Litchfield County's most historic stonewalls built in 1895 by the gentleman farmer Sherriff Turkington, a sunflower garden entrance, and nearly 2-miles of GPS precision cut trails. From the sky, travellers will enjoy patterns of fall pumpkins and a giant South Farms logo etched into the cornfield landscape. The maze consists of two trails; a primary trail with 6-checkpoints for explorers to discover and a second smaller maze for younger children.
On Saturdays at the maze starting September 19th, the AmandaBakes Airstream food trailer will be onsite with offerings of hot cider, coffee, and cocoa in addition to Warm Apple Crisp with homemade whipped cream and made from scratch seasonal cookies. Regularly on Sundays, in addition to the AmandaBakes Airstream, corn maze guests can stop at The Morris Marketplace for a bite to eat at the Marketplace Grill and pick-up the freshest selection of foods at the areas farmers' market on a real working farm.
Hours, Details, and Directions
The maze opens for the season in the late summer. Special hours and private events can be arranged for larger groups during off-hours, by emailing firstname.lastname@example.com. Parking and ticketing for the maze is located at the South Farms "White Barn" parking lot at:
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Cosmetic Treatment in North Carolina
Winston-Salem Skin Care Expert – Dr. Anne White
Dr. Anne White of the Carolina Laser and Cosmetic Center is an experienced skin care expert that has been helping Winston-Salem patients achieve clearer, smoother skin for over 15 years. Dr. White has been trained by a number of industry specialists, including Dr. Jean Carruthers, in the latest non-invasive cosmetic dermatology treatments.
Dr. White is a renowned expert in the skin care field, having performed over 15,000 laser tattoo removals and 25,000 filler injections, and having achieved Gold Level Physician status in the BOTOX and Juvederm network. If you would like to learn more about cosmetic treatment in Winston-Salem, North Carolina with Dr. Anne White, schedule your skin care consultation at the Carolina Laser and Cosmetic Center today.


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I spent almost seven years in the aid and development sector. My role there demanded me to think biblically about good community development in poverty-stricken places around the world. I came to the conclusion that good community development work and poverty reduction projects must involve faithful embodiment of Christ's life, suffering, death, and resurrection. This can take many forms. But invariably it cannot be measured in terms of short-term success stories. Importantly, it cannot be measures in terms of what we in the West call "success."
Much can be said about this. But Matthew Maury's comments below provide us with a timely reminder of what good community development looks like.
Over the past 25 years, I have regularly been reminded that community development is not a predictable and linear process. This is something I find to be particularly true in communities struggling to overcome the worst forms of poverty and oppression. Development is typically complicated and often messy work, with progress at times hidden from immediate sight. Our work often epitomises the saying "two steps forward and one (or two) steps back". To achieve lasting positive change requires long-term commitment and can take many, many years.
The challenge . . . is to tell the true story of "messy development". This is particularly true in context in which development agencies try to "sell" their successes in order to convince donors to fund their work. Australian donors — the church included — have become addicted to (and demanding of) a narrative of easy and quick success for the cost of just a few dollars per month . . . While I also want to see my donations used as effectively and successfully as possible, I fear that our sector has created an unhealthy (and unrealistic) expectation about the core work that we do — messy development.
As Christians, we know that God doesn't call us to prioritise worldly success but rather to pursue lives of faithfulness. I believe this is equally true for . . . the essence of good development work. We are called to be faithful to the commands of Scripture. Commands which tell us to put all we have towards loving God and loving our neighbour. We are to pursue justice, love mercy, and walk humbly with our Lord (Micah 6:8). Commands which do not have easy-to-achieve three-year project proposals tied to them.
The title of this blog post is: As Christians, where should our support go to when it comes to poverty alleviation? I actually don't have a simply answer to this question. (In fact, I don't claim to be an expert in the field at all.) To do justice to the complexity of poverty and community development, we must not resort to simple answers. But what is clear, I think, is that we should not uncritically support organisations that major on selling simple success stories without explaining the complexity of poverty reduction. Instead, it is those people and agencies that honestly share their struggles in "messy development" that deserve our attention.
Source of citations above: Target Magazine, Issue 1, 2016 (TEAR Australia), page 2.


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The Beausejour Brokenhead Recreation Commission is overseen by a Board of Directors. You can apply to be on the Beausejour Brokenhead Recreation Commission Board of Directors by going to the Town of Beausejour Offices, or the RM of Brokenhead Offices. You must reside in the Town of Beausejour or the RM of Brokenhead to be on the board.
Current Board of Directors
RM of Brokenhead: Councillor Sean Michaels
Town of Beausejour: Councillor Ed Dubray
Sunrise School Division: Trustee Don Mazur
RM of Brokenhead Citizen Representatives: Luke Ingeberg; Gerry Liske; Kerry Fehr
Town of Beausejour Citizen Representatives: Florence Kraynyk; Jim Martinuk; Scotty Bodnarchuk
For more information and to view the Beausejour Brokenhead Recreation Commission's website, please click the link below:


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United States District Court, C.D. California
July 20, 2015
ANTHONY NIEVES, ET ALv.TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA, ET AL
Bradford Child, Attorneys Present for Plaintiffs.
Christine Cusick, Attorneys Present for Defendants.
CHRISTINA A. SNYDER, District Judge.
Proceedings: DEFENDANT'S MOTION TO ENFORCE COURT'S ORDER COMPELLING ARBITRATION, OR, IN THE ALTERNATIVE, TO SELECT A THIRD ARBITRATOR (Dkt. 65, filed June 24, 2015)
Plaintiffs Anthony Nieves, Five Star Home Health, Inc., and Convergence Investments LLC (collectively, "plaintiffs") filed this action against defendant Philadelphia Indemnity Insurance Company ("Philadelphia") and other insurer defendants (collectively, "defendants") on May 22, 2014, in Los Angeles County Superior Court. Dkt. 1. Defendants removed the case to this Court on July 16, 2014. Id . On September 29, 2014, the Court ordered plaintiffs and Philadelphia to arbitrate their dispute, as provided for in the arbitration clause of the relevant insurance policy. Dkt. 34. On June 24, 2015, following a disagreement between the parties about disclosure and neutrality requirements for party-appointed arbitrators, Philadelphia moved for an order compelling plaintiffs to direct their party-selected arbitrator to meet and confer and decide on a third arbitrator. Dkt. 65 In the alternative, Philadelphia requests that the Court unilaterally appoint a third arbitrator.[1] Id . The Court held a hearing on July 20, 2015. Having carefully considered the parties' arguments, the Court finds and concludes as follows.
This case arises from a dispute as to whether defendants breached their duty to defend insured plaintiffs when defendants declined to represent plaintiffs in an arbitration proceeding.
Defendant Philadelphia issued policy number PHPK627074, for the policy period October 1, 2010 to October 1, 2011, to named insured "Five Star Home Health, Inc." ("the policy"). The policy contains the following arbitration provision:
* * *
If we and the insured do not agree whether coverage is provided under this Coverage Part for a claim made against the insured, then either party may make a written demand for arbitration.
When this demand is made, each party will select an arbitrator. The two arbitrators will select a third. If they cannot agree within 30 days, either may request that selection be made by a ...
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There's been quite a bit of feedback in Medscape and the blogs. We've had 48 responses so far in the Medscape Physician Connect discussion thread. Consistent with every other poll I've seen published, participants overwhelmingly oppose a ban on industry support. 23 comments so far are in opposition to the ban, 4 are in favor and 21 are unclear, neutral or off topic.
There have been at least a couple of blog reactions. Predictably, the Carlat Psychiatry Blog was negative toward my position. But the entry was strangely titled "I'm a physician. I deserve nice things." My Medscape piece merely demanded evidence to justify restricting doctors' choices of educational content. What does that have to do with nice things?


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The Winners for Sustainable Development Goal Labs
Today we are delighted to announce the 10 SDG Labs for the International Conference on Sustainability Science and the Resilience 2017 conference.
Of the 331 lab proposals about half scored highly on our grading system and we shortlisted 60 to eventually arrive at a final list. We will contact the winning entries directly. In addition to these SDG Labs, a further 11 proposals scored highly but did not require any additional funding. We will endorse these proposals too. See full list below.
We will publish the full proposals of all endorsed projects on the this website very soon.
Given the success of the call, and the clear need for this type of initiative to catalyze innovation, we will explore options for further SDG Lab calls.
The 10 selected SDG Labs
- The Arctic Institute: The Future of Rural Energy: Macro Problems and Micro Solutions
- Department of Urban and Regional Planning, Bayero University Kano, Nigeria: MR CITY LAB (Millennials and Resilience: City, Innovation and Transformation of Youths Laboratory)
- PEARL Institute for Research on Socio-Economic Inequality, University of Luxembourg: Young Entrepreneurs to Advance Local Economies and Community Health in Africa
- Stockholm Resilience Centre, Stockholm University: Visualizing and Connecting Seeds of a Good Anthropocence
- Shoebill Solutions: Lusaka 2021- What if we all lived downstream?
- Altekio, S.Coop.Mad / Social-Ecological Systems Laboratory, Autonomous University of Madrid Collaborative: Thinking for a Greener City
- National Department of Environmental Affairs, South Africa, in partnership with DPME, DST, ODI, HSRC, UNISA, MISTRA and UNEP Regional Office in South Africa: Implementing the South African National Development Plan's sustainability transition through the domestication of the SDGs
- United Nations university -international institute for global health: Enhancing Planetary Health to meet the SDGs: Integrating Indigenous and Local Knowledge in human health decision-making and planning in Vanuatu
- Council for Scientific and Industrial Research (CSIR): Mainstreaming resilience into climate change adaptation and disaster risk planning.
- Univ. Massachusetts Boston, Iwokrama International Centre for Rain Forest Conservation, Biomimicry Roraima: Guyana: Forging a Transition to a 'Green Growth' Economy
Many submissions already had funding in place but wanted to become part of a larger network of innovation and ideas supporting the SDGs. The following projects received high ratings and required no additional funding. We are pleased to endorse these projects too.
The additional endorsed SDG Labs
- InfoDesignLab: The value of Design. Visualised.
- New Jersey Institute of Technology / Future Earth Knowledge-Action Group on Sustainable Consumption and Production: Transformation Beyond Consumerism
- Seoul National University (Seoul, Republic of Korea): Rural Systems Visioneering
- Innovation Centre Arts&Society, Hanze Univeristy of Applied Sciences: Arts&Crafts Panarchy Power
- Future Earth: New Interfaces for sustainable financial flow.
- The University of Queensland: Collaborative design of an interdisciplinary collaboration platform to advance sustainability.
- Stockholm Resilience Centre: Back to a local food system
- Rambøll Oslo: Urban Eco Labs
- University of Malaya, Malaysia: Water Warriors
- Centre for Sustainability Studies, LUCSUS, Lund University: BeerSustLab
- Future Earth Media Lab and Stockholm Resilience Centre: Immersive science for the SDGs