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Authorities say R&B singer R. Kelly has posted bail and will be released from a Chicago jail within the hour.
Cook County Sheriff's Office spokeswoman Sophia Ansari said Monday that Kelly posted his $100,000 bail after spending the weekend in jail.
The R&B singer's bail amount was 10 percent of the $1 million bond set by a judge Saturday.
During a hearing earlier Monday, Kelly's lawyer pleaded not guilty on his behalf to all 10 counts of aggravated séxual abuse that he faces. Prosecutors allege that the singer sexually abused four women, including three who were minors at the time.
Kelly, one of the best-selling music artists of all time, was arrested Friday. Kelly entered the courtroom Monday wearing an orange jail jumpsuit after spending the weekend in Chicago's 7,000-inmate jail.
A judge on Saturday set bond at $1 million. The Grammy Award-winning singer is required to pay 10 percent of the bond, and his attorney said Kelly's confidants were trying to pay $100,000 to get him released as he awaits trial.
Among the conditions of release is that Kelly have no contact with females younger than 18.
Kelly's case was assigned to Cook County Associate Judge Lawrence Flood, who will preside over the trial. His next court date is March 22.
Defense attorney Steve Greenberg told The Associated Press on Sunday that coordination of the bail payment is complicated. But he said Kelly could be released as early as Monday or Tuesday.
"He has to rely on others acting on his behalf," Greenberg said. "And it's just not that easy — because Kelly's in jail."
Attorney Michael Avenatti, who said he represents two of Kelly's victims, said his legal team will give prosecutors a second video on Monday that he alleges shows Kelly sexually assaulting a minor. Avenatti has said he recently gave prosecutors video evidence of the singer having sex with an underage girl.
In arguing for bail within the singer's ability to pay, Greenberg told a judge over the weekend that Kelly wasn't wealthy despite decades of success creating hit songs. The lawyer blamed mismanagement, bad contracts and other issues for his client's financial woes.
There are multiple logistical issues that could have thwarted Kelly's efforts to pay over the weekend, said Joseph Lopez, a criminal defense attorney in Chicago not connected to the Kelly case. He said court officials must be able to talk to bank officials directly to confirm that an amount written on a check is covered, and that's not possible when banks are closed.
Details of the allegations against Kelly emerged Saturday when the prosecution released four detailed documents — one for each accuser — outlining the basis for the charges. The allegations date back as far as 1998 and span more than a decade.
According to the documents, a girl who attended Kelly's child pornography trial in 2008 got his autograph after a court session. He later invited her to his home in the Chicago suburb of Olympia Fields, where they had sex multiple times starting the following May, when she was 16, according to the documents, which said he also slapped, choked and spit on the girl.
In 1998, another girl reported meeting Kelly at a restaurant where she was having a 16th birthday party. Kelly's manager gave her the singer's business card and suggested she call Kelly. The girl's mother heard the exchange, took the card and told the manager her daughter was 16.
But her daughter later retrieved the card from her mother's purse. She contacted Kelly, who told her to take a cab to his studio, where they had sex, periodically, for a year, the documents said. After the first encounter, she was given an envelope of cash.
In early 2003, a Chicago hairdresser told prosecutors that she thought she was going to braid Kelly's hair, but he pulled down his pants and instead tried to force her to give him oral sex. The woman, who was 24, was able to pull away, but Kelly ejaculated on her and spit in her face, the documents said.
Prosecutors also described a witness who had access to videotapes showing Kelly having sex with a 14-year-old girl. The witness turned a tape over to authorities and identified the girl, who repeatedly stated her age on the footage, according to the documents.
Kelly's DNA was found on one of the accuser's shirts, and his semen was found on a shirt worn by another accuser that was submitted for DNA testing, Cook County State's Attorney Kim Foxx said. It was not clear when the accusers turned the shirts over to authorities — whether it was shortly after the abuse or more recently.
At the bond hearing, Greenberg said his client is not a flight risk. He told the judge, "Contrary to the song, Mr. Kelly doesn't like to fly." One of Kelly's best-known hits is "I Believe I Can Fly."
After the hearing, Greenberg told reporters that Kelly did not force anyone to have sex.
"He's a rock star. He doesn't have to have nonconsensual sex," Greenberg said.
The judge ordered Kelly to surrender his passport, ending his hopes of doing a tour of Europe in April. Kelly scheduled concerts in Germany and the Netherlands despite the cloud of legal issues looming over him. Greenberg denied that any tour was planned.
The recording artist, whose legal name is Robert Kelly, has been trailed for decades by allegations that he violated underage girls and women and held some as virtual slaves. Kelly has consistently denied any sexual misconduct.
Kelly broke into the R&B scene in 1993 with his first solo album, "12 Play," which produced such popular sex-themed songs as "Your Body's Callin'" and "Bump N' Grind." He rose from poverty on Chicago's South Side and has retained a sizable following. Kelly has written numerous hits for himself and other artists, including Celine Dion, Michael Jackson and Lady Gaga.
In 2008, a jury acquitted Kelly of child pornography charges that centered on a graphic video that prosecutors said showed him having sex with a girl as young as 13. He and the young woman allegedly seen with him denied they were in the 27-minute video, even though the picture quality was good and witnesses testified it was them, and she did not take the stand. Kelly could have been sentenced to 15 years in prison.
Charging Kelly now for actions that occurred in the same time frame as the allegations from the 2008 trial suggests the accusers are cooperating this time and willing to testify.
Because the alleged victim 10 years ago denied that she was on the video and did not testify, the state's attorney's office had little recourse except to charge the lesser offense under Illinois law, child pornography, which required a lower standard of evidence.
Each count of the new charges carries up to seven years in prison, and the sentences could be served consecutively, making it possible for him to receive up to 70 years. Probation is also an option.
The walls began closing in on Kelly after the release of a BBC documentary about him last year and the multipart Lifetime documentary "Surviving R. Kelly," which aired last month. Together they detailed allegations that he held women against their will and ran a "sex cult."
Source: Associated Press


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WHA's Jennifer Frank Honored for Her Leadership and Service by AHA and Hospital Associations
February 05, 2019
WHA Vice President of Education and Marketing Jennifer Frank was recently awarded the A2E Health Care Leadership and Service Award. This award recognizes an individual who has devoted their professional time and effort to strengthening the goals and objectives of A2E and its respective members through dedicated service and outstanding leadership.
"Health care is a dynamic and changing industry, and it is critical that our educational programming and partnerships remain relevant and impactful in order to deliver value for our members. In leading WHA's Education Department, Jennifer demonstrates so many of the attributes that are recognized and celebrated by the A2E Health Care Leadership and Service Award," said Eric Borgerding, WHA President and CEO. "Jennifer is a valued and respected colleague, who works closely with her teammates at WHA, our members, and our partner organizations to deliver impactful and relevant educational programming that results in better care for Wisconsin patients and their families."
Among the many examples of Frank's excellent work and commitment is WHA's annual Advocacy Day, which brings more than 1,000 hospital advocates to Madison for education and citizen lobbying. Frank also provides exemplary support and service to WHA and its members, including many of WHA's key allied and partner organizations, such as the Partners of WHA and the Wisconsin Organization of Nurse Leaders, among others. Jennifer also serves as the lead staff to the WHA Foundation.
This story originally appeared in the
February 05, 2019 edition of WHA Newsletter

subset: commoncrawl


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Magazines on E-paper E-reader Displays 'Approaching the Tipping Point,' Says Expert
A recent report issued by research and advisory firm mediaIDEAS projects sales of e-readers to grow from nearly 6 million units in 2010 to 115 million units in 2013, largely due to falling prices and rapidly advancing technology. "The E-Paper E-Reader Phenomenon" outlines the dramatic growth of these display devices over the next 10 years into a $25 billion market. Nick Hampshire, who authored the report, told Publishing Executive Inbox that magazine publishers must recognize the looming shift in the way consumers read content and realize that the "e-reader threat" has arrived and actually presents publishers with a real opportunity. The full report is available at www.mediaideas.net.
INBOX: What are the most significant takeaways from the results of your research?
NICK HAMPSHIRE: The most significant finding of our research has been the rapid future growth of the market. Since the first e-paper e-reader came onto the market in 2004, these devices, with their "green" credentials of reducing paper consumption, have already proven very popular with consumers, and the market for them is booming. By 2006, there were three types of devices available, by 2007, there were five, and currently there are over 40. This number will more than double in the next 12 months. Unit sales are also booming. In 2008, 1.1 million e-paper display-based e-readers were sold, in 2010 that number will rise to about 6 million, and by 2020 global annual e-reader sales will reach 446 million units with a value of over $25 billion.
Another significant result is that the market for e-paper e-readers will divide into four marketplaces by 2020, each with different device specifications and markets. Two of these will feature under 9-inch displays: the "roll-able/foldable" e-reader, similar to a communications device, with sales of 27 million units valued at $3.8 billion in 2020, and the "e-book" e-reader with sales of 115 million units valued at $6.5 billion in 2020. The other two will feature over 9-inch displays, and some significantly larger: first, a monochrome screen-based "paper replacement/newspaper" e-reader with sales of 24 million units valued at $1.2 billion in 2020, and subsequently the high-quality color display-based "magazine" e-reader with sales of 280 million units valued at $14 billion in 2020.


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Efficacy of oral pre-exposure prophylaxis (PrEP) in prevention of HIV acquisition has been evaluated using a daily regimen. However, adherence to long term daily medication is rarely perfect. Intermittent regimen may be a feasible alternative. Preclinical studies have demonstrated effectiveness of intermittent PrEP in SHIV prevention among animals. However, little is known about intermittent PrEP regimens.
Seventy two HIV-uninfected volunteers in HIV serodiscordant couple relationships in Uganda were randomly assigned to receive daily oral Tenofovir/Emtricitabine (TDF/FTC-Truvada) or placebo, or intermittent (Monday, Friday and within 2 hours after sex, not to exceed one dose per day) oral TDF/FTC or placebo in a 2:1:2:1 ratio. Volunteers and study staff were blinded to drug assignment, but not to regimen assignment.
Volunteers were followed for 4 months after randomization, with monthly clinical and laboratory safety assessments and comprehensive HIV risk reduction services. Adherence was monitored using medication event monitoring system (MEMS) and self-report. Sexual activity data were collected via daily short text message (SMS) and self-report. HIV-specific immune responses were assessed by IFN-γ ELISPOT.
Both daily and intermittent oral TDF/FTC regimens were well tolerated. Median MEMS adherence rates were 98% (IQR: 93-100) for daily PrEP regimen, 91% (IQR: 73-97) for fixed intermittent dosing and 45% (IQR: 20-63) for post-coital dosing. SMS response rate was 74%, but increased to 80% after excluding server outages; results may have been affected by the novelty of this measure. The majority of volunteers expressed willingness with no particular preference for either regimen.
Both daily and intermittent oral PrEP dosing regimens were safe. Adherence was high for daily and fixed intermittent dosing; post-coital dosing was associated with poor adherence. Fixed intermittent PrEP regimens may be feasible especially if a minimum effective drug concentration correlating with HIV prevention can be achieved with this dosing.
Clinicaltrials.gov number NCT00931346
Citation: Kibengo FM, Ruzagira E, Katende D, Bwanika AN, Bahemuka U, Haberer JE, et al. (2013) Safety, Adherence and Acceptability of Intermittent Tenofovir/Emtricitabine as HIV Pre-Exposure Prophylaxis (PrEP) among HIV-Uninfected Ugandan Volunteers Living in HIV-Serodiscordant Relationships: A Randomized, Clinical Trial. PLoS ONE 8(9): e74314. https://doi.org/10.1371/journal.pone.0074314
Editor: Javier R. Lama, Asociacion Civil Impacta Salud y Educacion, Peru
Received: January 21, 2013; Accepted: July 30, 2013; Published: September 26, 2013
Copyright: © 2013 Kibengo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The study was funded by the International AIDS Vaccine Initiative (www.iavi.org)with support in form of study medication (both active drug and placebo) provided by Gilead Sciences. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: Gilead Sciences provided the study drug and placebo tablets at no cost. Co-author James Rooney is employed by Gilead Sciences. Gilead Sciences developed and is marketing the study drug, Truvada, for treatment of HIV infection. Co-author Burc Barin is employed by the EMMES Corporation, and does not have any relevant declarations relating to consultancy, patents, products in development or marketed products. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.
Most adult HIV infections in Africa are due to heterosexual transmission [1], and being in a stable HIV discordant sexual relationship is associated with a 10-fold higher risk of HIV transmission than being in a concordant HIV-negative relationship [2,3]. HIV-uninfected individuals in discordant couple relationships are therefore among the most at risk populations (MARPs). HIV serodiscordant couples enrolled in an HIV vaccine feasibility study in Masaka, Uganda, had an HIV incidence rate of 4.3 and 4.4 per 100 person years (PY) in men and women respectively [4].
At the peak of the HIV epidemic, Uganda adopted the promotion and dissemination of several prevention strategies to control HIV transmission including abstinence, being faithful to one's partner, reducing the number of sexual partners, treatment of sexually transmitted infections (STI), HIV voluntary counseling and testing (plus sharing of results with partners) and consistent and correct use of condoms [5]. These strategies helped to reduce HIV prevalence [6]; however, they have limitations. HIV prevention programs that focus on reducing the number of sexual partners, use of condoms during casual sex and increased fidelity among married partners are not likely to directly decrease the risk of HIV transmission among persons already living in HIV serodiscordant relationships [3]. Therefore, research into new approaches to HIV prevention particularly in HIV discordant couples remains critical.
Recently, several trials of antiretroviral pre-exposure prophylaxis have shown major reductions in HIV acquisition. In the Pre-exposure Prophylaxis Initiative (iPrEx) study - a randomized multinational clinical trial among men who have sex with men (MSM) - daily fixed dose combination regimen of tenofovir disoproxil fumarate combined with emtricitabine (TDF/FTC), reduced HIV acquisition by 44% overall [7]. Efficacy correlated with adherence and detectable drug levels. Pill use on 90% or more of days was associated with 73% efficacy, while detectable drug levels were associated with 92% efficacy. Subsequent pharmacokinetic modeling of the iPrEx data suggest that 7 days per week dosing could achieve 99% efficacy in prevention of HIV infection among MSM, while 4 days per week could still lower risk by 96% [8]. In the TDF2 study – a randomized trial conducted in Botswana among young HIV-uninfected men and women - daily use of TDF/FTC reduced HIV acquisition by 62% [9]. In the Partners PrEP trial – a randomized multinational trial in HIV discordant couples in Kenya and Uganda - daily PrEP of either TDF alone or combined as TDF/FTC reduced the risk of HIV acquisition by 67-75% [10]. Having detectable plasma tenofovir levels was associated with 86 and 90% reduction in HIV acquisition, for the TDF and TDF/FTC groups respectively [11]. Interestingly, two other randomized PrEP trials in at-risk women failed to find a reduction in risk of HIV infection in the treatment group. The FEM-PrEP trial of oral TDF/FTC in at-risk African women was halted early due a likelihood of being unable to demonstrate difference in HIV seroconversion based on interim data safety monitoring board determination, as was the case for oral and vaginal tenofovir arms of the VOICE study [12,13]. The explanations for these contradictory results are not fully understood; however, low adherence appeared to play an important role. In the FEM-PrEP trial, adherence by self-report and pill counts were high, but plasma drug levels revealed that only 15-26% of samples from HIV seroconverters actually had tenofovir detected, as well as only 26-38% of non-seroconverting controls [14]. Thus, study medication adherence was too low to assess its protective effect in the trial. In 2012, the US Food and Drug Administration approved daily Truvada for HIV prevention in individuals at high risk of sexual HIV infection [15].
The above trials all included daily oral regimens which may be challenging as a population-level HIV prevention method. Daily PrEP may be limited by adherence challenges, as well as acceptability, toxicity and cost concerns, although most of the blinded large efficacy trials have shown it to be acceptable and safe. An intermittent dosing regimen may be an alternative strategy if able to achieve adequate drug levels required for HIV prevention. The biological characteristics of TDF and FTC favour usage of an intermittent PrEP regimen. Both TDF and FTC are phosphorylated to active forms that have long half-lives in plasma and peripheral blood mononuclear cells (PBMCs) of ≥60 and 39 hours respectively [16,17]. Additionally, in studies using macaques as animal models, intermittent PrEP, given 2 hours before and 24 hours after each weekly virus challenge, protected animals against SHIV as well as daily PrEP [18].
In this randomized, double-blind study, we evaluated safety, acceptability and adherence to an intermittent PrEP regimen with TDF/FTC compared to a daily regimen among men and women living in HIV serodiscordant couple relationships. The intermittent regimen was defined as twice weekly dosing (Mondays and Fridays) plus a coitally-dependent dose, but not exceeding one pill per day. This regimen was selected based on primate challenge data described above, which suggested that having steady state drug levels in addition to dosing soon after exposure was important for protection [18].
This study was conducted and completed before the release of any PrEP efficacy studies referenced above. A parallel study with the same design was conducted in Kenyan MSM and female sex workers (FSW) and results published elsewhere [19].
The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1 and Protocol S1.
The study was conducted at the MRC/UVRI Uganda Research Unit on AIDS' Masaka site in South Western Uganda. The site had an active HIV serodiscordant couple prospective cohort from which volunteers were recruited for this study. In this cohort, every 3 months, volunteers were provided with a comprehensive HIV prevention package including couple HIV/STI testing, and risk reduction counseling, male and female condoms, treatment of STIs, referral for adult medical male circumcision and for ART initiation when indicated per Ugandan national guidelines. Eligible HIV-uninfected volunteers were healthy adults aged 18-49 years in cohabiting HIV serodiscordant relationships who had reported any episodes of unprotected vaginal sex with their partner in the past 3 months and the infected partner not using ART. Volunteers with chronic hepatitis B infection (HBsAg-positive) or with creatinine clearance <80mL/min or pregnant or lactating mothers were excluded from the study due to possible drug toxicity concerns. Women of childbearing potential were required to use a non-barrier form of contraception (hormonal contraception or intrauterine device) during the study. In addition, condoms were provided to all volunteers for protection against HIV and STIs. Both partners in the HIV serodiscordant couple were enrolled in the study, but only the HIV-uninfected partner was randomized to receive study drug. After randomization, volunteers would be discontinued from study medication if creatinine clearance was ≤ 50mL/min by Cockcroft-Gault formula.
Community stakeholder consultations
The site conducts regular community stakeholder consultations on new and ongoing research and has an active community advisory board (CAB). The CAB reviewed the study aims and patient information materials for the protocol and provided feedback on potential community concerns.
Both members of the couple were aware of each other's HIV status and gave written informed consent to participate in the study. The study was approved by Uganda Virus Research Institute Science and Ethics Committee (UVRI-SEC), Uganda National Council for Science and Technology (UNCST) and the National Drug Authority (NDA).
The objectives of the study were (1) to evaluate the safety of daily and intermittent dosing of TDF/FTC; (2) to compare the acceptability of and adherence to daily and intermittent regimens; (3) to evaluate changes in HIV-associated risk behaviour; (4) to evaluate HIV-specific immune responses in volunteers randomized to TDF/FTC and placebo.
The main outcome measures were: (1) clinical adverse events including mild, moderate and greater severity renal toxicities and serious adverse events (2), adherence rates to daily and intermittent dosing (3), willingness to use the study regimen, if shown to be effective (4) change in HIV-associated risk behaviour during trial participation (5), the proportion of volunteers with HIV-specific immune responses as measured by interferon-γ ELISpot.
Study procedures
Volunteers were randomized to daily TDF/FTC or placebo, or intermittent (fixed dose on Mondays, Fridays and post-coital dose within 2 hours after sex, not to exceed 1 dose per day) TDF/FTC or placebo in a 2:1:2:1 ratio, and were followed monthly with standardized adherence and HIV risk reduction counseling, HIV testing, and safety evaluation for 4 months. HIV risk reduction strategies included provision of male and female condoms, treatment of STIs, referral for adult medical male circumcision and for ART initiation when indicated per Ugandan national guidelines. STI testing was conducted at screening and thereafter whenever infection was suspected. The primary measure of adherence was the medication event monitoring system (MEMS; Aardex, Switzerland), in which a microchip in the cap covering the pill bottle electronically recorded every time the bottle was opened and closed. Data were uploaded monthly. Adherence was also assessed using monthly self-report per a timeline followback calendar [20-22]. In brief, the calendar is used to prompt recall of recent behaviour and has been used successfully in other behavioural studies (e.g. alcohol use). Self-report of openings without removing pills ("curiosity openings") and of removing multiple pills at one opening ("pocket doses") were collected each month. Sexual activity data were collected via daily short message service (SMS) text message queries as well as through the timeline followback face-to-face risk assessment with a one-month recall period (collected concurrently with the adherence data). SMS queries prompted volunteers to enter a password and then asked in the volunteers preferred language, 'Did you have vaginal sex with your main partner in the last 24 hours?', 'Did you use a condom?, 'Did you have vaginal sex with any other partner in the last 24 hours?', 'Did you use a condom?' Volunteers were provided with free mobile phones, SIM cards and call credits for every successful response. Given the novelty of SMS surveys in collecting adherence data, post-coital adherence was also calculated using follow-back self-report data; however, the SMS responses were the primary measure of sexual activity/behaviour and were used to calculate overall intermittent dosing adherence and specifically post-coital adherence. Hematologic and biochemical evaluations were performed monthly. Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at www.plosone.org.
Sample size
Seventy-two volunteers were randomized to active daily and intermittent TDF/FTC regimens or respective placebos (24 active and 12 placebo recipients per group). Because this was an exploratory study to evaluate safety, adherence and acceptability of intermittent PrEP, it had limited power to rule-out small differences in safety and adherence. For example, with 24 volunteers assigned to either daily or intermittent TDF/FTC, observing no medication-related serious toxicity would result in an exact, two sided 95% confidence interval of 0-14.3% for the corresponding true incidence. Therefore, observing no medication-related severe toxicities provided 97.5% confidence that the true incidence was no more than 14.3%. With 36 volunteers (combining active and placebo for each regimen), the study had 51% power to detect a true adherence rate of 90% for each regimen. Assuming condoms were used always or frequently (more than half the time) by 60% of volunteers at baseline, the study had >80% power to detect a 50% decrease in condom usage by treatment group (n=24).
Randomization and blinding
A random allocation sequence was generated by an external data coordinating center. The study product was randomly assigned to volunteers in mixed blocks of 3 and 6, and dosing schedules randomly assigned within study product using a block size of 2. Investigators at the study site enrolled volunteers via an electronic enrollment system, where allocation codes were assigned consecutively to eligible volunteers at the time of first dispensation of study drug. Allocation to TDF/FTC or identical placebo tablet was blinded to study volunteers, all research staff and the study sponsor. Allocation to daily or intermittent dosing was not blinded.
Laboratory methods
Screening and follow-up clinical laboratory safety procedures were performed on-site following Good Clinical Laboratory Practices (GCLP) in laboratories accredited by Qualogy, UK [23]. Interferon-γ ELISpots were performed on frozen peripheral blood mononuclear cells (PBMCs) at MRC/UVRI laboratories and IAVI Human Immunology Laboratory on baseline and follow-up specimens as described previously [24]. A positive ELISpot was defined as (1) an average background (mock)-subtracted count per peptide greater than 38 spot forming units (SFU) per 106 PBMCs with the coefficient of variation no greater than 70%, (2) mean count greater than 4x mean background (mock), and (3) mean background (mock) below 50 SFU/106 PBMCs.
Statistical methods and adherence calculations
Comparisons of categorical and continuous variables were conducted using Fisher's exact test and Wilcoxon rank-sum test, respectively. A two-sided p-value of less than 0.05 was considered to indicate statistical significance. Statistical analyses were performed with the use of SAS software, version 9.2 (SAS Institute, Cary, NC, USA). The following adherence definitions were used:
Primary analyses
Unadjusted monthly MEMS adherence for the daily group.
The number of MEMS events in 28 days was divided by 28 days.
Adjusted monthly MEMS adherence for the daily group.
The number of curiosity openings was subtracted from the number of MEMS openings, while the number of pocket doses was added to the number of MEMS openings. Estimates were calculated over a 28-day interval.
Unadjusted monthly MEMS adherence for the intermittent group.
The sum of days when volunteers were adherent to fixed dosing (Mondays and Fridays with a MEMS event, and non-Mondays and non-Fridays on which neither sexual activity nor a MEMS event occurred) plus post-coital dosing (other days on which sexual activity was reported by SMS and a MEMS event occurred), divided by 28.
Adherence to fixed doses.
The number of MEMS events on Mondays and Fridays in a 28-day interval was divided by 8 days.
Adherence to post-coital doses.
The number of MEMS events on sexual event days in a 28-day interval was divided by the number of sexual event days per SMS.
Secondary analyses
Adjusted monthly MEMS adherence for post-coital dosing in the intermittent group.
Intermittent dosing was adjusted for extra pills taken out, with all pills assigned to post-coital dosing.
Alternate definitions of post-coital dosing.
Because SMS response rates varied (see below), adherence to post-coital doses was also calculated as the number of MEMS events on days with timeline followback reported sexual events divided by the number of days with timeline followback reported sexual events. Adherence to post-coital doses within 2 hours of sex was also calculated as the number of days on which post-coital dosing occurred within 2 hours of sex by timeline followback report divided by the number of days on which sexual events occurred by timeline followback report.
Acceptability of PrEP was assessed by a 4-value Likert scale after 16 weeks in the study. Volunteers with missing responses for acceptability questions were excluded from the denominator.
Participant flow
A total of 133 HIV serodiscordant couples were screened, of which 72 (36 HIV-uninfected males and 36 HIV-uninfected females) were enrolled and randomized into the study from October 2009 through March 2010. Sixty-eight volunteers (94%) completed the study (Figure S1). Having abnormal laboratory parameters was the commonest reason for study ineligibility, 34/61 (56%). Among those ineligible for enrollment due to baseline laboratory abnormalities (n=34), creatinine clearance of <80mL/min by Cockcroft-Gault formula and proteinuria on urine dipstick were the most common (77% and 18% respectively). The other major category for exclusion was study being fully enrolled by the time lab results needed for verification of volunteer eligibility became available (n=16). The trial ended when the last enrolled volunteer completed the study follow-up schedule.
Baseline data
Baseline demographic and HIV risk characteristics were similar among the groups (Table 1). 83% of volunteers had 1 sex partner and the remaining 17% had > 1 sex partner in the past month prior to enrollment. Fifty seven volunteers (79%) reported always using a condom with the HIV-infected partner. Alcohol use before sex and use of street drugs were uncommon.
|Daily(24) n(%)
|Intermittent(24) n(%)
|Daily(12) n(%)
|Intermittent(12) n(%)
|Total(72) N(%)
|Male gender
|12 (50)
|13 (54)
|4 (33)
|7 (58)
|36 (50)
|Age – yr (mean (range))
|33 (20-47)
|33 (22-48)
|33 (26-47)
|33 (27-46)
|33 (20-48)
|Drank alcohol before sex
|2 (8)
|2 (8)
|2 (17)
|6 (8)
|Used any street drugs
|1 (2)
|0 (0)
|1 (3)
|0 (0)
|1 (1)
|Genital sore or discharge
|2 (8)
|1 (4)
|3 (25)
|2 (17)
|8 (11)
|Number of sex partners past month
|23 (96)
|17 (71)
|12 (100)
|8 (67)
|60 (83)
|1 (4)
|6 (25)
|4 (33)
|11 (15)
|1 (4)
|1 (1)
|Number of HIV-infected partners past month
|1 (8)
|1 (1)
|24 (100)
|23 (96)
|12 (100)
|11 (92)
|70 (97)
|1 (4)
|1 (1)
|Condom use with HIV-infected partners
|Not Applicable
|1 (8)
|1 (1)
|1 (4)
|1 (1)
|3 (13)
|2 (8)
|1 (8)
|1 (8)
|7 (10)
|1 (4)
|4 (17)
|1 (8)
|6 (8)
|19 (79)
|18 (75)
|10 (83)
|10 (83)
|57 (79)
Participants analyzed
Analysis for safety, adherence, acceptability, and change in risk behaviour included all randomized volunteers who were HIV-1 negative at the time of randomization and for whom study medication was dispensed.
Outcomes and estimation
Ninety-nine percent (227/228) of the non-serious adverse events (AE) were mild or moderate, with 214 (94%) judged unlikely related or not related to study drug. The proportion of volunteers with moderate or above AEs did not differ significantly by regimen (daily: 50%, intermittent: 53%, p=1.00), or treatment groups (active: 44%, placebo: 67%, p=0.08). The proportion with mild or above AEs was also not different by regimen or treatment group (Table 2).
|Assignment Schedule
|Maximum AE Severity
|Very Severe
|2 (8)
|12 (50)
|10 (42)
|0 (0)
|0 (0)
|1 (4)
|12 (50)
|11 (46)
|0 (0)
|0 (0)
|3 (6)
|24 (50)
|21 (44)
|0 (0)
|0 (0)
|0 (0)
|4 (33)
|8 (67)
|0 (0)
|0 (0)
|1 (8)
|2 (17)
|8 (67)
|0 (0)
|1 (8)
|1 (4)
|6 (25)
|16 (67)
|0 (0)
|1 (4)
The percentage of volunteers with gastrointestinal complaints was not significantly higher in the active treatment group (33%) than the placebo group (29%) (p=0.79). Two volunteers on active regimen had elevated serum creatinine, one mild (1.1-1.3 times the upper limit of normal) and one moderate (1.4-1.8 times the upper limit of normal), which resolved spontaneously while continuing study medication. Seven cases of reduced creatinine clearance occurred; five in active and two in placebo recipients, all of which resolved spontaneously without interruption of study medication. No other renal dysfunction was found. One placebo recipient had an isolated neutropenia, graded as very severe, which resolved spontaneously and did not require discontinuation of study medication. There were no drug-related serious adverse events (SAEs) and no HIV infections detected. Three pregnancies occurred resulting in one normal live birth (daily placebo group), one spontaneous abortion at 6 weeks of pregnancy (daily active group), and a molar pregnancy (intermittent placebo group) which was treated and resolved without sequela.
There was no difference in adherence rates between active and placebo groups, thus these 2 groups were combined for the adherence analyses (Table 3). Median unadjusted MEMS adherence rates were 97% [IQR: 92-100] for daily dosing and 91% [IQR: 73-97] for fixed intermittent dosing (p=0.02), while adherence to any post-coital doses based on sexual events per SMS reporting was much lower than the previous two rates: 45% [IQR: 20-63] (p<.0001). Adherence rates did not differ by gender. MEMS adherence rates did not change when adjusted for curiosity openings when no pills were taken out or when adjusted for extra openings and extra pills taken out. In a post-hoc analysis, intermittent dosing was adjusted for extra pills taken out, as defined above, with all pills assigned to post-coital dosing (which may or may not have been the case). Median MEMS adherence rate for post-coital dosing did not change after this adjustment 46% [IQR: 23-67]. The median number of days per week of PrEP use according to MEMS data was 6.8 [IQR 6.5-7.0] in the daily group and 2.8 [IQR 2.3-3.3] in the intermittent group. Three volunteers required replacement of MEMS caps due to loss or damage during the study; no data was lost.
|Adherence parameter
|DAILY ADHERENCE RATE Median % [IQR]
|Overall unadjusted
|98 [89-100]
|96 [95-99]
|97 [92-100]
|98 [92-100]
|98 [95-99]
|98 [93-100]
|INTERMITTENT ADHERENCE RATE Median % [IQR]
|80 [74-86]
|78 [67-86]
|80 [73-86]
|Fixed doses
|91 [78-102]
|88 [69-94]
|91 [73-97]
|Post-coital doses (MEMS events and sexual events per SMS)3
|40 [23-58]
|53 [15-79]
|45 [20-63]
|Post-coital doses- (MEMS events and timeline follow back self-report sexual events)4
|39 [29-56]
|31 [21-59]
|37 [25-56]
|Post-coital doses within 2hrs (timeline followback self report and sexual events per SMS)5
|110 [67-129]
|93 [68-113]
|101 [67-129]
|Post-coital doses within 2 hrs (self-report of doses and sexual events per timeline follow-back calendar)6
|100 [94-100]
|100 [85-100]
|100 [93-100]
SMS response rates and sexual activity.
The median daily SMS response rate was 74% (range, 0-95), increasing to 80% (range, 0-100) when days with major SMS server outages (>2 hour of network outage per day) were excluded. Major server outages occurred on 8/251 (3.2%) days. Loss of mobile phones was rare with only 2 phones reported as lost during the study. The median number of days per week when sex occurred by SMS reporting was 1.4 (IQR: 1.0-1.9) in the daily group and 1.6 (IQR: 0.8-2.4) in the intermittent group, and by timeline followback interview it was 1.7 (IQR: 1.0-2.3) and 1.7 (IQR: 0.9-2.4) respectively. In secondary analyses in which MEMS adherence was combined with timeline followback data for sexual activity, the median MEMS adherence rate for post-coital dosing was 37% (IQR: 25-56) (Table 3). Using timeline followback adherence with SMS for reporting of sexual activity data, adherence for post-coital doses within 2 hours of sex was 101% [IQR: 67-129]. Using timeline followback data for both adherence and sexual activity data, adherence rate was 100% [IQR: 93-100].
The most common reasons cited for missing a pill dose were: volunteers not having pills with them (6%), being away from home (5%), and forgetting to take pill (5%). There were no differences in reasons for missing a pill dose between daily and intermittent groups. All volunteers denied sharing pills.
Ninety-nine percent (71/72) of participants would be willing to use the pill regimen most or all of the time if it was shown to be safe, effective and inexpensive or free. There was no difference in acceptability between daily and intermittent groups (100% vs. 97%), or between active and placebo groups (100% vs. 96%). MEMS acceptability was high with 98% (71/72) reporting it was somewhat or very easy to use.
HIV behavior change.
The median number of sexual partners in the past month remained at 1 [IQR: 1-1] during the trial. No other HIV risk behaviors reported at baseline changed during the trial (data not shown).
HIV-specific immune responses.
Minimal HIV-specific immune responses were detected by IFN-γ ELISPOT at baseline; one of 58 (1.7%) volunteers with specimens available for ELISPOT testing had a positive IFN-γ ELISPOT response at baseline, to an Env peptide pool. Three of 50 (6.0%) volunteers with post-baseline ELISPOT data had a response to one or more peptides at a single time point. One volunteer each in the daily and intermittent active treatment groups responded to an Env peptide pool at week 16. One volunteer assigned to the daily placebo treatment group had positive IFN-γ ELISPOT responses to all pools at week 16. The IFN-γ ELISPOT responses were generally low magnitude.
In this study of both daily and intermittent PrEP regimens among HIV serodiscordant couples, intermittent PrEP was found to be acceptable and safe. Adherence to daily and fixed intermittent dosing was high, but significantly lower for post-coital dosing. To our knowledge, this is the first study to report on safety, adherence and acceptability of an intermittent oral PrEP regimen among heterosexual HIV serodiscordant couples.
Both intermittent and daily PrEP regimens were well tolerated, with a similar proportion of volunteers reporting mild and moderate adverse events in each regimen group. This observation is in agreement with reports from other larger oral daily PrEP studies [7,9,10,12,25,26]. There were similar proportions of volunteers with gastrointestinal complaints among active and placebo, and between daily and intermittent groups in the study. This differed from the iPrEx study that reported more frequent moderate (grade 2 and above) nausea and unintentional weight loss in the active group [7]. This difference could have been due to a shorter follow-up period and fewer volunteers involved in the current study. A few volunteers in the active group had self-limited elevated creatinine (mild to moderate), and several volunteers in both active and placebo groups had reduced creatinine clearance. This finding was similar to reports from other PrEP trials [7,9,26].
Median adherence rate as measured by MEMS for daily use was significantly higher than that for fixed doses within the intermittent regimen; whereas adherence to coitally-dependant dosing was considerably worse. Despite the statistical difference between daily and intermittent fixed arm, adherence rate was in the 90's for each. There was no change in adherence after adjusting for reported curiosity openings or pocket doses. Based on MEMS data, volunteers in the daily group took the pill on almost every day of the week. This high adherence is similar to that reported in Partners PrEP trial (92-99% as measured by clinic-based pill counts, unannounced pill counts and MEMS) [27] – (Haberer in press) and higher than that reported in iPrEx (89-95% by clinic count and self-report) [7]. In contrast, adherence to both the daily and fixed component in the same intermittent regimen was lower among MSM and FSW in a parallel trial in Kenya. Median MEMS adherence rates were 83% (IQR: 63-92) for daily dosing and 55% (IQR: 28-78) for fixed intermittent dosing, while adherence to any post-coital doses was 26% [IQR: 14-50] [19]. The higher adherence in the current study may be due to providing PrEP in the context of stable, socially supported relationships as well as the uninfected partner's hope of maintaining good health while at the same time preserving their serodiscordant relationship, as proposed within the Partners PrEP study [28]. These factors may be less likely to play a role in the MSM population studied in the Kenyan trial [29].
Intermittent fixed dosing, at least in this discordant couple population, appears to have comparable adherence to daily dosing, suggesting that intermittent PrEP regimens may be feasible in certain populations. However, the number of doses per week necessary for >90% efficacy is likely to be greater than the 2 doses evaluated in this study. Using data from the iPrEx study, pharmacokinetic modeling suggested 97% efficacy for 4 doses per week, which dropped to 76% with 2 doses per week [8]. These data, derived from protection against HIV infection in MSM, may not be readily applicable to heterosexual transmission. Comparable data on efficacy of less than daily dosing for heterosexual transmission are not available yet, but are anticipated from the Partners PrEP study.
Median post-coital adherence as measured by MEMS was low at 45%. Post-coital dosing among MSM and FSW in the Kenyan study was even lower at 26% [19]. These findings are consistent with the incomplete adherence observed with a pre- and post-coital dosing strategy for vaginally administered tenofovir microbicide gel in the CAPRISA 004 microbicide trial. In that study, which observed a 39% reduction in HIV incidence in the tenofovir group compared to the placebo group, the median adherence was 60%, and 42% of the women were classified as having <50% adherence to two doses of gel for self-reported sex acts in the last 30 days [30]. The low post-coital adherence in the current study could have been due to behavior and/or measurement error. It may be easier to remember to take pills daily, because a routine behaviour is established. Unfamiliarity with use of SMS to collect sexual behaviour data coupled with technical difficulties (network outages and a user interface with multiple questions) may have affected post-coital adherence monitoring even though the technology appeared to be relatively well accepted by study volunteers. Quantitative data collected such as reasons for missed pills, travel away from home and pill sharing did not explain why post-coital dosing adherence was lower. Qualitative data from a parallel trial of daily and intermittent PrEP among MSM and FSW in Kenya identified several factors influencing post-coital dosing adherence: alcohol use around the time of sex, moving locations frequently and transactional sex work [28].
Qualitative data collected during focus group and individual interviews in the present trial may be informative and are being prepared for publication.
Measurement of adherence is challenging with self-report often providing overestimates when compared to objective measures, such as electronic monitoring, unannounced home-based pill counts and random drug levels [31-36]. Indeed in this study, adherence to post-coital dosing as measured by the self report calendar and SMS report of sexual events alone (without MEMS) was very high in comparison with MEMS. MEMS adherence, however, is also limited by the fact that it records bottle opening rather than actual medication use. Therefore, the low rate of post-coital pill use as measured by MEMS in this study could reflect low adherence to PrEP or the inaccuracy of the methods used to measure it. Other PrEP trials have also found discrepancies between conventional methods such as self-report and biologic measures [7,34]. Adherence rate in the iPrEx trial as measured by clinic pill count and self report was high at 93%, yet drug levels showed that only 50% of volunteers were actually swallowing the pills. Subsequent analyses found low levels of drug detection, with only 18% of volunteers with drug levels reflective of daily use [37]. In addition, self-report and clinic pill counts were poorly predictive of drug exposure [36].
Testing for drug levels was included in this study and the findings will be published when available. Participants' actual use of trial interventions is often considerably lower than their reported use hence, raising the issue of social desirability. Low adherence is likely to compromise potential efficacy of the intervention and may make interpretation of trial data difficult; since intent-to-treat efficacy and as-treated efficacy will be different. Low adherence may also limit detection of adverse events therefore, misrepresenting safety concerns.
The main reasons given for missing pills were volunteers not having pills with them while away from home and forgetfulness, and these reasons were similar for both daily and intermittent regimen groups. These reasons are similar to those cited in a phase 2 oral PrEP trial conducted in West Africa [38].
Acceptability of oral PrEP was high with 99% of participants reporting willingness to use the pills most of the time or all the time if PrEP was shown to be safe, effective, inexpensive or free. There was no significant difference between those willing to use intermittent (97%) and daily regimens (100%).
There was no change in HIV sexual risk behaviour during the study. Although it is theoretically possible that individuals may feel protected and abandon condom use and other protective measures, none of the oral or topical PrEP trials to date have observed increased HIV risk behavior that would suggest risk compensation [7,9,10,14,30]. Despite encouraging data from animal studies, we found no evidence of HIV-specific immune responses as measured by a validated IFN-γ ELISPOT in volunteers on PrEP It is possible that a longer duration of PrEP and/or more intensive mucosal exposures are necessary to develop these responses, or that too few volunteers were exposed to HIV in this trial. Alternatively, if PrEP-related protective responses do exist, they may be located in the mucosa and may not be evaluable with T-cell assays in PBMCs such as IFN-γ ELISPOTs.
Our study demonstrated that FTC/TDF was safe when taken either daily or intermittently for HIV pre-exposure prophylaxis by HIV-uninfected volunteers living in coupled serodiscordant relationships. Adherence was high to both daily and fixed intermittent dosing, but not for coitally-dependent dosing, the measurement of which may have been imperfect. These data, together with findings from the Kenyan intermittent PrEP trial [19], suggest that post-coital dosing adherence will be difficult to measure accurately. If the low post-coital adherence observed in these two studies is accurate, post-coital dosing is unlikely to be effective in these populations.
The study was limited by the short follow-up period and relatively small number of volunteers which hamper generalizability of results. Volunteers with creatinine clearance <80 ml/min were not eligible for enrollment. Seventy-three percent of ineligible volunteers were excluded for lab abnormalities, with creatinine clearance <80 ml/min accounting for 43% of these exclusions. The percentage of all screened volunteers who were excluded due to decreased creatinine clearance was 20%; this may limit the generalizability of the results in part to populations with high creatinine clearance. Study volunteers were blinded to their active drug or placebo assignment and at the time of conduct of the study, PrEP had not yet been shown to be effective. Adherence, acceptability, risk compensation behavior and other outcomes may differ when PrEP which is known to be effective is available in the community. Volunteers were recruited from a pre-existing HIV serodiscordant couple cohort in which participants received regular couple and individual HIV risk reduction counseling and other preventive measures. Consistent HIV testing and counseling offered during HIV biomedical intervention studies has been perceived by volunteers to affect their risk behaviour in a positive way, by giving them knowledge and awareness of their HIV-negative status, hence added motivation to negotiate and use condoms more regularly [39]. Therefore, their behaviour may not reflect that of the general population.
Supporting Information
Figure S1.
Flow of participants.
Checklist S1.
CONSORT Checklist.
Protocol S1.
Trial Protocol.
We would like to acknowledge the contributions of the study participants to this research. We would like to thank the study staff. Lorna Clark conducted and Josephine Cox oversaw the IFN-γ ELISPOT analyses at the IAVI Human Immunology Laboratory.
Author Contributions
Conceived and designed the experiments: AK JEH DRB BB PF FHP DM. Performed the experiments: FMK ER DK UB ANB PC. Analyzed the data: BB. Contributed reagents/materials/analysis tools: DM JFR. Wrote the manuscript: FMK ER DK ANB UB AK JEH DRB BB JFR PF FHP. N/A.
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text:
Escape Winter Storm Jonas With Some Great Caribbean Travel Packages
Hotel & Resort Brian Major January 21, 2016
PHOTO: Packages at the Viceroy Anguilla feature cocktails at the resort's Sunset Lounge. (Photo by Brian Major)
There's never a bad time for a Caribbean getaway, but winter's grip on the U.S. provides another motivation for travelers to escape to a sunny island framed by white-sand beaches and brilliant blue waters. Several top Caribbean resorts are also offering early-season packages targeted to romantic couples, families and anyone looking to leave winter's frost in the rear-view mirror.
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Nightly rates for attendees start at begin at $660 per room, per night, double occupancy for travel from Jan. 6 through April 30. The 76-room beachfront hotel is located within walking distance of the Limegrove Lifestyle Centre, where a portion of the festival will take place. Activities include use of an on-site health and fitness club, nightly entertainment and water sports including water skiing, kayaking, snorkeling, and wakeboarding are available.
READ MORE: 7 Destinations for Satisfying the Chocolaty Sweet Tooth
The Bahamas' Abaco Beach Resort and Boat Harbour Marina is offering a "Just Us Two" weekend getaway package featuring a private couples' massage by the Sea of Abaco, a three-course romantic dinner for two on the beach, daily breakfast and champagne upon arrival. Packages start at $885 per person, double occupancy for stays from Feb. 10 to 14, which must be booked by Feb. 7.
Memories Resorts & Spa is offering a two-week sale on 2016 family getaways at two of its properties: Memories Splash Punta Cana in the Dominican Republic and Memories Grand Bahama in the Bahamas. Travelers who book stays from now through Jan. 31 will save 65 percent off standard rates, with free accommodations for kids age 12 and under. Rates start $105 per person, per night.
Memories Punta Cana features Splash Park, one of the Caribbean's largest waterparks, plus five mouthwatering restaurants, three pools, two swim-up bars, plus access to the casino and Royal Spa at the neighboring Royalton Punta Cana Resort & Casino.
Located on Lucaya Beach outside of Freeport, the family friendly, all-inclusive Memories Grand Bahama features a unique pool built around a stone sugar mill, with water tubes, slides and a wave pool. Adults can drive, pitch and putt for free at the Reef Club Golf Course, designed by Robert Trent Jones. The resort also features a 35,000-square-foot casino.
Both properties feature all-inclusive packages including meals, accommodations, resort-wide Wi-Fi, non-motorized sports, entertainment and recreation. Guests seeking an enhanced experience, guests can upgrade to Memories' Diamond Club level, featuring a accommodations in a dedicated Diamond Club section, an exclusive beach area, personalized check-in and check-out, selected premium drinks, hors d'oeuvres, and desserts in the Diamond Club Lounge.
In Puerto Rico, Dorado Beach, a Ritz-Carlton Reserve is offering a new four-night Dorado Escape packages featuring one free night's stay; a $100 spa credit for the open-air Spa Botanico; daily breakfast for two at Mi Casa, with cuisine directed by celebrity chef Jose Andres.Packages are available from now through December 2016, with nightly rates starting at $1,599.
READ MORE: Seven Celebrity Chefs With Eateries At Sea
Dorado Beach Ritz-Carlton Reserve suites all feature ocean views with beach access, outdoor terraces, soaking tubs, indoor and outdoor rain showers, and dedicated "embajadores" service. Guests can also enjoy ocean-side dining options, cooking classes at La Cocina Gourmet Culinary Center, and play at Robert Trent Jones-designed golf courses.
The Viceroy Anguilla luxury resort is offering an "Anguilla Love" package offering couples a daily $300 resort credit, daily continental breakfast and cocktails at the resort's Sunset Lounge and a special welcome amenity. Rates start at $850 per night, double occupancy for a two-night minimum stay.
Located on a cliff between two of Anguilla's most beautiful beaches, Viceroy Anguilla offers an intimate and exclusive amenities ranging from private guestroom plunge pools to relaxing couples' treatments at the resort's award-winning spa. Launched in time for Valentine's Day getaways, the packages are also valid throughout the year.
For more information on Caribbean
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Kedleston Country House Hotel - opening event
PUBLISHED: 00:00 14 November 2015
Ashley Franklin Photography
Over 200 VIP guests and dignitaries attended the highly anticipated opening of The Kedleston Country House on the outskirts of Derby
Kedleston Country House Hotel opening
Ribbon cutting Lady Scarsdale (centre) with Kes, Trevor, Paul and Leanne Harris (directors of Derby Brewing Co)
Andrew Cochrane, Mark Vinecombe and Paul Harris
Pierre and Jean-Pierre Hourlier
Mark and Catherine Wellings
Nicola Wilson and Kate Neale of CAMRA
Jean Allcock, Judy Dyer, Alan Shanks, Shelia McDonald, Phyllis Alderson
The Kedleston Country House Garden
David and Karen Higginbotham
Ashby Croquet Club Members Chris Jackson, Derek Buxton, Eileen Buxton, Bob Thompson, Patricia Duke-Cox, Lawrence Whittaker
Laurence and Philippa Beardmore of York Coffee Emporium
John and Ann Thompson and Lesley Thellusson
The Rt Hon James Curzon with Cllr Alan and Louise Grimadell
Detlef Mielke, Head Brewer at Derby Brewing Co
The Rt Hon Richard Curzon
John and Susan Vickers (front) with Sam and Caroline Rush
Mayor of Amber Valley, Cllr Trevor Ainsworth with his wife Jennifer and David Knight of Quarndon Parish Council with his wife Lyn
Mayor of Derby, Cllr Paul Pegg
John Forkin and Carl Bridge
Nigel Barker, Cllr Robin Wood, Andy Flint
Sally Montague and Sally McDonald
The guests, including the Rt Hon James and Rt Hon Richard Curzon, Sam Rush and John Vickers of Derby County, and Mayor Paul Pegg and Mayor Trevor Ainsworth, mingled in the newly landscaped Georgian garden, sipping on custom-designed Kedleston punch – just one of a range of Georgian inspired cocktails created by the Kedleston Country House team. Lady Helen Scarsdale officially opened the venue, wishing the Harris family and Derby Brewing Company every success with the venture. Guests were then invited to explore the Robert Adam designed, Grade II* listed building.
The five-year project has included adding a Georgian-inspired Orangery, reinstating the elegant Dining Room, and restoring original features such as decorative cornicing, a fireplace and beautiful square doorways to the Snug, Parlour, Bar and Hidden Study.
Interiors have been sympathetically modernised, in partnership with British interiors company, Plum & Ashby, whose representative, Vicky White, spoke of the design philosophy behind the renovation. Group Executive Chef, Gary Nock, introduced guests to the fresh, locally sourced or home-grown taste partnerships on the modern British menu, serving tasty canapés. Pierre and Jean-Pierre Hourlier of Pierre Hourlier Wines provided a tasting of some of the 85 hand-selected wines available and guests left with a miniature sample of a bespoke Kedleston Country House Gin.
Derby Brewing Company Director, Paul Harris said, 'The project has been many years in the making and we are thrilled to finally share our vision for the Kedleston. We all hope everyone likes what we have created and that we have returned the iconic Kedleston Country House back to something Derby will enjoy for years to come.'
His father Trevor added: 'It's fantastic to finally get drinks flowing once again and see all our hard work come to fruition.'


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Russ McHenry's Hole in One
Russ McHenry hit a 171-yard hole in one using a Pitching Wedge on the 3rd hole at Players Club in Omaha. The ace was reported on Aug. 18, 2011. Witnesses: Mike Owens.
Know more about this ace? Share the details and we'll post them on this page.


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PILOTIS SIDE TABLE by Malgorzata Bany
Pilotis Side Table, Malgorzata Bany.
Malgorzata Bany's gently rounded Pilotis side table is inspired by architectural pilotis that traditionally lift a building above ground or water.
The table is hand-crafted in white Jesmonite, a durable manmade material produced with a mineral base and water-based acrylic resin. The polished surface is smooth and tactile.
Magorzata Bany describes her pieces as being "somewhere between design and sculpture".
An outdoor version of the Pilotis side table is available upon request.
- Height : HT46cm
- Diameter : D35cm


text: Another View on Credit Card Rating Infographic… by Simpson Michael J. Another View on Credit Card Rating Infographic Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related See more Previous article Personal Loans: How To Get Up To $40K Cash in UNDER 24 Hours! All Credit. Next article Foreclosure Rescue Plan is Released on 3-4-2009 by the Obama Administration – What Can it Do For You Leave a Reply Cancel replyYour email address will not be published. Required fields are marked *Comment Name * Email * Website Save my name, email, and website in this browser for the next time I comment. Notify me of follow-up comments by email. Notify me of new posts by email.


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Christmas Day will be a little less sparkly this year as Sir Bruce Forsyth has had to pull out of hosting the Strictly Come Dancing Christmas Special due to health reasons.
The veteran presenter underwent keyhole surgery on an abdominal aortic aneurysm in mid-November and is still in recovery.
Sir Bruce Forsyth reunited with Tess Daly for Children in Need (Guy Levy/BBC)
The BBC released a statement saying: "The Strictly Christmas Special, which records next week, will be too early for Sir Bruce Forsyth to have made a full recovery from his recent operation.
"Due to the long studio hours, he is unable to host the show but will still play a part in the production.
"Sir Bruce will record a special video message for this year's celebrity line-up and the viewers at home, which will play out when the Strictly Christmas Special airs on BBC One on Christmas Day at 6:15pm."
Tess hosts the current series already with Claudia Winkleman (Kieron McCarron/BBC)
The BBC confirmed that Claudia Winkleman will host alongside Tess Daly in his stead.
Sir Bruce, 87, quit as Strictly's presenter in April 2014, but has returned for special episodes since. He was last seen taking the helm of the dancing competition on BBC's Children In Need on November 13.
This year's Christmas show has a star-studded line-up that features former winners model Abbey Clancy, McFly's Harry Judd, Holby City's Tom Chambers and war veteran Cassidy Little, who won the People's Strictly for Comic Relief.
Harry Judd won Strictly in 2011 (David Jones/PA)
TV presenter Alison Hammond and radio presenter Lisa Snowdon, who finished in third place, are the final two celebrities.
There will also be a special performance by Dame Shirley Bassey.


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L'Oreal Paris face Barbara Palvin serves fall beauty inspiration in this spread for the September 2016 issue of Harper's Bazaar UK. Photographed by Damon Heath and styled by Martha Ward, the brunette stunner wears stunning hair and makeup trends. From romantic waves to an elegant bun, hairstylist Syd Hayes creates Barbara's striking coifs. And makeup artist Neil Young offers up smokey eyeshadow and bold lip colors for the autumn. / Manicure by Sabrina Gayle
ICYMI: Barbara Palvin Named 2016 SI Swimsuit Rookie of the Year


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You have tried your best to get yourself a college education, and you've found this article. You may be wondering how to begin. Getting up to speed can be rough going when first getting there. The following article will help you to prepare for your college experience.
Pack your enough of your essential toiletries when you go off to college. These are critical for good hygiene. When you can, purchase these in bulk to save more money over the long term.
Bring a water bottle to school with you. Staying hydrated is important to your health and that can be hard when you are stuck in classrooms all day. This will help you to quench your thirst when you are hungry in between classes. Drinking water frequently during the day can help you remain focused and energized. Use water fountains to easily refill your water bottle.
It is vital that you apply for loan, scholarship and grant money as early as you can. When you work as hard on getting funding as you do your classes, you'll end up borrowing less in the end. Turn in everything well before it is due and focus on other things you need to take care of.
Seek out a student loan if you don't have the funds to cover your tuition and living expenses. College is a place that will help you get a high paying job later, and it's not a bad idea to get a loan that you can later pay off.
College Experience
Make the most out of your college experience. You've worked your tail off to get into college, and now you must work just as hard to stay there. Utilize the tips provided above to help with this. It's important that you get everything you can from your college experience, since it only comes around once.
Capstone College
HVAC Training Pasadena, Ca
Call Today: (626) 486-1000 – Capstone College
Monday through Friday: 8:00 am to 6:00 pm: Call for Night Class Hours
1200 N Fair Oaks Ave #32, Pasadena, CA 91103


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- Search for JobsSearch for Jobs
- Browse for JobsBrowse for Jobs
- Create a ResumeCreate a Resume
- Company DirectoryCompany Directory
Retail Janitorial Associate
Staples is focused on our customer and the community. As a **Safety Maintenance Concierge** (aka Retail Janitorial Associate), you will maintain the cleanliness, health, and safety of your store for both customers and associates. Your pride in your work will help create an inviting retail environment and positive impression on our customers and community.
We are investing in our people and our stores, empowering you to learn, grow and deliver. You will be positive, inclusive and collaborative in helping our customers and in maintaining your store. You will also be part of a fun, team-oriented retail culture at Staples.
**Get great perks because, you matter.**
+ Flexible full time hours/shifts and generous paid time off; hiring immediately
+ Associate store discount and more perks (discounts on mobile plans, movie tickets, etc.)
+ 401(k) plan with a company match, dental, vision and life insurance, short-term disability, and many more benefits
**Play an active role in helping your store win through an inviting, clean and presentable store.**
+ Use proper machines and materials to clean common areas including but not limited to the retail sales floor, restrooms, and office space
+ Partner with store leadership to maintain standards and protocol for health and safety of our customers and associates
+ Be flexible in performing various responsibilities as assigned (i.e. cashier, returns, reserving online pick-ups)
+ Adhere to all company policies procedures & safety standards
**Provide an exceptional customer experience.**
+ Greet, assist, and establish positive relationships with customers
+ Create an inviting environment for customers by maintaining a neat and clean store
+ Respond quickly to customer requests and concerns
**Essential skills and experience:**
+ Able to work a full-time flexible schedule
+ Able to perform cleaning and light maintenance, including the ability to learn and use commercial cleaning machines, cleaning processes and using of disinfectant /sanitization chemicals
+ Collaborate and work with other team members
+ Must be able to engage with and speak to customers
+ Ability to lift/move materials in the 10-50 pound range, climb ladders, stand and walk continuously
**Preferred skills and experience:**
+ Janitorial or Porter experience
+ Customer service experience in a retail environment
_Staples is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other basis protected by federal, state, or local law._
Be amazed by what's inside.
There's a whole lot more to Staples than you probably ever imagined. In fact, once you lift the lid on our business, you'll discover that we have many opportunities for your career.
As the world's largest office products company, 2nd largest eCommerce site and a trusted source of office solutions, we're a recognized name across more than 26 countries. Working all over the world has shaped our approach to business, and as we've grown, so has our commitment to the communities and environments where we work. Whether you join us in retail, online, one of our B2B units or our other businesses, you'll experience first-hand the unique energy and enthusiasm that makes us Staples.
This site will show you just how much goes into a career with Staples. If you want to become part of the team, simply use the job search tool – and it won't be long before you'll be saying, "that was easy" too.
Before you go...
Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.


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Most of the universe is empty space. Even you, no matter how big or small, are mostly empty space. But the universe get a bit self-conscious about all its unused space and creates what physicists call quantum foam. The empty space is, at the Planck scale, actually made up of particles that appear and disappear in a span of time that's long enough to be measurable — though this is quantum physics, so it's nanoseconds — but short enough to have absolutely no bearing on the existence of the universe.
It's called quantum foam because all of this exists in a similar structure to the way carbonation works in a pint of beer. A bubble exists for a time and then disappears and another one forms and vanishes somewhere else. It doesn't affect the beer in any way,* but it can be observed. The particles in empty space exist and then don't just as the carbonation bubbles exist and then don't. Except they do it on a very, very, very small scale. In a Planck scale of space and time (10^-35 metres and 10^-44 seconds).
And you — well, physicists — can actually see how quantum foam works in experiments using metal plates separated by a distance. Because the amount of foam between them is less than the amount surrounding them, the plates will eventually close the gap and come together.
For more, read here, here, and here.
*Well, technically speaking, it does in exactly the same way that quantum foam affects the universe, but we're not going into higher concepts of beer and physics here today.


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Called to the Philippines
Ashley and Paula were married in 1985 and have 5 children (one of which has passed away) and 8 grandchildren. They have been a part of the family at Centro Church, Ipswich QLD Australia, since 1996. Ashley went on his first mission trip to the Philippines in 1995 and by 1997 both Ashley & Paula knew they were called to the Philippines as full time missionaries. They both had been on many short term trips to the Philippines since that time. Although they knew in 1997 that they were to go to the Philippines full time, it was not until 2012 when all the doors that had been tightly closed began to miraculously open.
Their passion and a love for the Filipino people was very evident to those around them. They had a deep desire to empower those who have been marginalised & outcast by economic, physical and social circumstances, to transform their own communities through hope in Jesus. Ashley & Paula are both credentialed Pastors with Australian Christian Churches (formerly Assemblies of God in Australia) and their mission sending organisation is ACCI Missions & Relief, Melbourne Australia.
Ashley & Paula first left for the full time mission field in the Philippines in July 2014. Sadly after a very tragic set of circumstances Ashley passed away on the mission field on the 6th January 2015. He had unfortunately been misdiagnosed with Pneumonia & Tuberculosis. On returning his body to Australia his family were able to have an autopsy performed on Ashley. This revealed that he in fact had Cancer throughout much of his body.
After Ashley's death Paula returned to Australia on extended leave with her family. She spent the time healing and seeking God for what He would have her do next. The vision and the love for the Filipino people continued to burn like a fire in her belly and she felt God's call to continue the work that she and Ashley started in the Philippines. On seeking God, the council of friends and ACCI Missions & Relief (Paula's mission organisation) she decided to return to the Mission field in the Philippines.


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"I bring love and greetings from domestic workers, home care workers and family caregivers around the world who are marching today. We are the unsung heroines who help care for the most precious parts of our lives — our children, our aging loved ones, our loved ones with disabilities, and our homes. Many of us are immigrants and women of color.
We have a message to deliver to the White House and Congress: you will not, on the one hand, call us criminals and rapists, and then leave your children and your parents in our care. You will not call us violent but then characterize actual violent sexual assault as just "locker room talk." You will never make America Great by dismantling everything that makes us great."
-From the stirring speech that powerhouse Ai-jen Poo was to deliver during the Women's March on Washington (here in full)


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This post isn't particularly in keeping with the latest fresher news but it's been a while since i've been so excited over a new film release. The film in question is 'Godzilla', directed by Gareth Edwards to be released in May 2014. Most are aware of the story of a giant radioactively mutated lizard running rampant amongst a heavily populated city, destroying everything in its wake; a film that screams insipid hollywood blockbuster relying heavily on a mega-budget fuelled CGI spectacle with little else to offer. Most would have seen Roland Emmerich's 1998 version starring Matthew Broderick and Jean Reno – a film that's definitely enjoyable but feels rather predictable without providing any real character depth. After watching the teaser trailer for the story's latest incarnation, I believe that it might be a perfect example of how almost any film can be fantastic provided it is placed in the right hands.
The capable hands that I refer to belong to Gareth Edwards, the man behind the 2010 dystopian film 'Monsters' which was visually stunning thanks to Edwards' expertise in visual effects. He also shot the film on a low budget entirely on location in places where permission wasn't always granted, using local people that happened to be around at the time. Such an unorthodox approach is something that a story like Godzilla would benefit from heavily. Edwards had the dystopian aesthetic down to a T in 'Monsters' and the same can already be said for Godzilla, judging by the exquisitely detailed shots of the aftermath caused by the giant lizard in question. Edwards isn't the type to shy away from making a film that doesn't tick every box on the audience demographic; in the trailer we get a bird's-eye view of hundreds of dead bodies amongst the wreckage, foreboding a particularly gritty take on the classic disaster story with no intention of being family friendly. The trailer also features the famous 'Now I am Become Death' speech from J.Robert Oppenheimer, providing a chilling accompaniment to the scenes of destruction as well as tying in with Godzilla's links to nuclear power and destruction.
The film will star Bryan Cranston, who after his performance in Breaking Bad can probably have any role he so well pleases, but Cranston has always been a phenomenal actor in any role he's taken on so news of his involvement is very exciting. Added bonuses in the cast include Aaron Taylor-Johnson (of 'Kickass' fame), Ken Watanabe and Elizabeth Olsen.
Although we'll have to wait just over six months for the release, I'm incredibly excited about this film. I might've become hypnotised by a very impressive trailer, but I think the film has potential to be one of the best disaster movies made in a very long time mainly because of who's involved. Plus EVERYONE likes Godzilla, it's a story that has been soldified in worldwide pop culture ever since we first saw the giant lizard in Ishiro Honda's 1954 film.
I'd post the trailer on here but it's being swiftly taken down everywhere it is posted – do some googling and hopefully you'll find it, you WILL be impressed.


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Using different energy sources lets you reduce home costs while helping the environment. For those who seek to make green energy changes within your home, read on and gather some great knowledge that will help you make those changes and reap the rewards.
Consider installing solar powered lamps for outdoor lighting. They are not only affordable, but they do not have to be hooked up to any power source, needing only good access to sunlight. This will end up saving you a lot of energy. Also, it will no longer be necessary to install wired outdoor lights.
Close the curtains or blinds before you leave the house. This cools the house and cuts energy costs. Typically windows on the southern side of the home receive the most sun. Cover all of these windows with curtains, blinds or roller shades.
Wear natural fabrics in the summertime instead of cranking up the air conditioner. Natural fibers like cotton can absorb moisture from your skin, helping you feel cooler. Wear lighter colors, as warmer colors make you feel warmer and more likely to put on artificial cold air.
Solar water heaters are an inexpensive and efficient way to heat your home's water. If you live in an area where freezing temperatures are not a problem, you can purchase a system that heats water through a heater that is solar before it pumps it in your home. Though you can use this system, it's best to have a regular water heater for backup purposes, just in case there is a day with little sunlight or more water usage than normal.
If you aren't using an appliance, turn it off. When you are ready to leave a room, go around and turn off appliances such as computers, televisions, and most importantly, the overhead light. Try using a power strip so you can turn off all of your electronics at once, instead of letting power be wasted in standby mode.
Wait until your dishwasher's full before running it. It consumes the exact same amounts of electricity and water even if it's not full. Also, use your dishwasher's energy-saver setting so that the load will air-dry.
Find out more about the different energy solutions in your community. Investigate costs for using those utilities, and be aware of any legislation about energy costs. You may find that switching to one or another may provide a reduction in energy use and cost.
Solar Energy
If you want to have hot water, but at a lower cost, then check into solar energy. Build a hot-water system based on solar energy. Research the benefits of an indirect versus direct circulation system. The indirect one is your best option if you have to worry about frozen pipes in the winter.
When putting in a new solar energy system, the batteries that store the power should be kept really close together to the cells. Power can be lost in long cables so this will reduce this possibility. It also lowers the possibility of shading the cable cells and lessening their output capacity.
A good way to conserve energy is to not use your dishwasher unless it is completely full. Properly loading the dishwasher prior to running it will save both energy and money. The amount of dishes that can be placed in a washer is astounding. Make sure you take time to place the dishes in properly so as to maximize the space available.
Replace your water heater and get a tankless model. While they do require energy to heat the water, they require only a small amount of energy to heat a smaller amount of water. You can find tankless heaters that either supply an entire house, or just a single faucet.
If you want to live greener and have a greener home, avoid running electric heaters during the winter. Ways to cut down on electricity include wearing warm clothing indoors and using a fireplace to heat your home. Also, it has been shown that people sleep better in cool environments.
Think of using a laptop computer instead of a desktop model to save on your electricity usage. You can reduce your energy use by three-quarters if you use the internet a lot or do a lot of word processing. Plus you can take your laptop anywhere.
If you are thinking of installing a solar power system in your home, you need to calculate the amount of power the system can produce using winter sunshine hours. As winter sunlight is much lower than summer, you will want to be able to plan for higher energy costs in winter. If you generate excess energy during the summer, with the right plan, your utility company will send you a check!
There are many renewable energy rebates offered by the government, so be aware of them. There are times when your utility company can offer discounts and rebates for your upgrade costs. In other instances, credit or tax deductions are offered by federal or state governments. These offers make installing and using a green energy system much more affordable.
Keep up with your watt usage. Use great gadgets such as the Kill-A-Watt or the Watt Minder to find out which fixtures and appliances use up the most energy. Plug the appliance into the device, and it can tell you the amount of energy it uses within an hour, month, or even a year. You'll be able to calculate how much each appliance costs you in electricity and replace those which are power hogs.
Instead of using standard lights for your next holiday season, make sure to use LED lights to decorate your tree and home. According to research by the United States Department of Energy stated that Americans could collectively reduce their energy consumption by over 2 billion kW/h if they all changed over to LED lights. To put this in perspective, that amount of power could supply the energy needs of 200000 homes for a whole year. You can save money on your electric bill.
If you're installing a solar energy system, be sure to place the batteries in close proximity to the cells. This avoids power loss in the cable. This also prevents long cables from casting shadows over the PV cells.
Carpooling doesn't have to be just for work. If you are a parent, carpool with other adults. If you have family or friends close to you, try going to the grocery store together and taking turns driving.
If you are not in a room, do not keep the lights on. You would be surprised how much energy you could end up saving over time if you get into the habit of turning off your lights. The money that you will save is an added bonus.
By developing good, environmentally friendly habits, you can start saving money now. As you have read in this article, it is not that difficult or costly to go green and the benefits are enormous. Try out some of these tips in your home for greater efficiency and taking better care of the environment today.
Be sure you maintain your refrigerator properly. Refrigerators take up lots of energy, so making sure they're in working order is always good to know. The heating coils should be cleaned regularly to remove the accumulated dust. Also ensure that the rubber seals around the doors are clean and making tight contact.


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After the fires up in Oak Glen this year I was very excited to hear that all the orchards were safe and that we would still be able to go on our field trip to Snowline. It was a beautiful day with such nice weather, and what was even better was that the girls were in a good mood. It made for a very pleasant morning.
Yummy Apples
Cranking the wheel and making apple cider.
Crush those apples Trevor!


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Admissions Future Students Campus Visit
We invite you to come take an in-depth look at what MACU has to offer. The Admissions Office recommends that students bring their families. Tuesday is the preferred visit day but we offer campus visits Monday thru Friday and one Saturday per month. Campus visit start times are either 9 am or 1 pm. Requests must be submitted 2 business days prior to the visit. Visits may include any of the following:
For additional questions please contact an Admissions Counselor.
MACU welcomes group visits from churches and other organizations. Here are some guidelines to use while planning your visit:
If you would like to plan a group tour, please contact the Admissions Office at email@example.com or 252-334-2076.


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The New HeadLiners 561
Meet the Barbers
William Wells
Your content goes here. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.
Call: (561) 429-4765
Email: email@example.com
Demani Robinson Sr.
Demani Robinson Sr. is an experienced barber and beautition at The New Headliners Barbershop. He has more than 25 years of experience in this industry. Mr. Robinson holds an expansive portfolio ranging from Hawaii to Miami with a diverse clientele. Mr. Robinson's satisfactory rate is sure to impress. He always welcomes new and dynamic clients with creative requests. Mr. Robinson is determined to make sure that every client's visit is met with the utmost customer satisfaction.
Call: (561) 429-4765
Email: firstname.lastname@example.com
Mark aka Polo barber extradonaire with a gift that I've been given from God to cut hair. I'm passionate about my work an performance and have worked along side some great guys in my days of barbering. Originally growing up in the streets of NYC I adapted to the demands and styles of the urban city streets. So I know what the people want and what to give them and on top of that just having a good connection with the community is key so I always try to keep up with what's new and trending. Thanks and I hope to see you at my work place @Headliners barbershop!
Call: (561) 429-4765
Email: firstname.lastname@example.com


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Isle Drive & Homestead Drive, Baxter, MN 56425
For Sale $475,000.00
Prime development site located just southwest of Super Wal-Mart near Baxter's fastest growing commercial neighborhood. Perfect site to build your office or essential services business – providing a great location to be close to big-box retailers, medical services and more.
- Purchase Price: $475,000.00
- Directions: From the Baxter Hwy 210/371 intersection - South on Hwy 371 to the stoplights at Glory/College Road - Right (west) on Glory Road to Isle Drive - Left (south) on Isle drive, around the bend, past Falcon Drive - Property is on the right (north) directly after Nystrom & Associates
- Lot Size (Sq. Ft): 288,367
- Lot Size (Acres): 6.62
- Lot Dimensions: Irregular - See Plat
- Road Frontage: Approx. 857' along Isle Drive and approx. 1,040' along the north and south edges of Homestead Drive
- Property Tax Year: 2019
- Annual Property Tax: $1,762.00
- Water: City
- Sewer: City
- Utilities Available: Natural Gas, Electricity, Internet, Cable & Phone
- Neighboring Businesses: Neighboring businesses include Nystrom & Associates, The Surgery Center, Baxter Essentia Clinic, McDermott Orthodontics, Crosby Regional Medical Center, Minneapolis Heart Institute, MMFCU, Super Wal-Mart, McDonald's, Riverstone Professional Centre, Discount Tire, JC Penney's, Olive Garden, Northwoods Plaza, Costco, Home Depot, Kohls, Fleet Farm plus numerous others.
- Traffic Counts: 11,200 - 20,400 on Hwy 371 and 12,000 on Hwy 210
- CC File #: 1384
- Zoning: Currently R1 - Low Density Residential - To be Re-Zoned to OS - Office Service
- Legal Description: Outlot A, Lots 1-5 Block 2, and Lots 4-8 Block 3, Perch Lake Estates (Legacy PID# 033220090A0009, 033220020010009-5009 & 033220030040009-80009)