text:
How might the world end? Some have considered cataclysms like the sun exploding or a meteor hitting the earth. Much more likely is that humans will poison and destroy the planet. A short list of today's environmental concerns reads like an enumeration of ten modern plagues.
Pharaoh of old knew that the ten plagues spelled the doom of Egyptian civilization. He therefore agreed, at last, to let the children of Israel go. We, likewise, must free ourselves from the spheres of moral and physical contamination in order to save our world. Unlike Pharaoh, we dare not harden our hearts, lest we drown in our own pollution.
The Jewish tradition places the responsibility for preserving the purity and integrity of the environment upon humanity. "The earth is the Eternal's and all that it holds" (Psalms 24:1) implies that humanity is the guardian and protector of nature, obliged to cherish and preserve God's works. The biblical law ba'al tashhit states that an army besieging a city must not destroy its fruit trees (Deuteronomy 20:19-20). The Rabbis of the Talmud expanded this law to prohibit unbridled destruction of any natural resources. Indeed, the law prohibits the wanton destruction of anything that may be useful to others. This alone is enough to condemn deforestation, pollution, and the willful destruction of plants and animals!
Later authorities affirmed the classic rabbinic view of ba'al tashhit. Rabbi Shneur Zalman in the eighteen century wrote, "This biblical commandment prohibits the spoiling of any object from which humankind may benefit," and Rabbi Samson Raphael Hirsch in the nineteenth century wrote,? Under the concept of ba'al tashhit the purposeless destruction of anything at all is taken to be forbidden, so that our text becomes the most comprehensive warning to human beings not to misuse the position that God has given them."
We now turn to brief explanations of ten specific ecological problems – our modern plagues. The first four plagues describe the destruction of various parts of our earth because of human waste products, poisons, and contaminants. "I shall strike the water in the Nile with the rod that is in my hand and it will be turned into blood; and the fish in the Nile will die. The Nile will stink so that the Egyptians will find it impossible to drink the water of the Nile" (Exodus 7:17-18).
1. Water Pollution
Water is an essential resource for life. Yet pesticide run-off, municipal sewage, manufacturing by-products, and mining waste threaten both ocean and freshwater supplies. A few examples will suffice: High levels of bacteria, caused mostly by human waste dumping, were responsible for more than 2,000 ocean beach closings and advisories against swimming in the 12 American coastal states that monitor beach water quality (of 22 total), according to the National Resources Defense Council. In rural northwestern Arkansas, chicken and livestock wastes have severely polluted nearly half of the 600 miles of streams. Finally, in the western United States, the use of cyanide in the gold mining industry has poisoned thousands of miles of rivers.
The Great Lakes – which contain some 20 percent of the world's fresh water – are an exemplary study of how water pollution occurs. First, manufacturing cities along the lake shore have for decades used the lakes for their waste disposal. Second, air currents bring pesticides, including DDT (now banned in the United States), to the Great Lakes from as far away as Central America. Industrial chemicals and metals also find their way to the lakes via the atmosphere. (Approximately 90 percent of the highly toxic PCB's – polychlorinated biphenyls – in Lake Superior drift there on air currents.) According to the International Joint Commission, a United States and Canadian advisory group responsible for the boundary waters, 362 toxic chemicals now affect the lake ecosystems – the water, plants, fish, and other animals that live there. Many of the 35 million people living in the Great Lakes region are warned not to eat the local fish. And although progress is being made in cleaning up the mess – phosphate levels, for instance, have dropped considerably because of improved wastewater treatment – it will be a long time before the Great Lakes will be environmentally sound.
The same pollutants that fouled surface waters make their way underground, where they endanger drinking water. In addition, underground gasoline tanks may be leaking petroleum products. A study by the National Wildlife Federation found that American community water systems (which serve more than 40 million people) had violated federal water quality standards over 100,000 times between October 1986 and September 1987.
2. Air Pollution
At present, over 150 million Americans live in communities that do not meet federal ambient air quality standards. Some of the worst culprits in polluting the air are listed below:
Suspended particulates are actual pieces of ash, soot, dust, or liquid droplets released to the air by the burning of fuel, industrial processes, agricultural practices, and by some natural causes. Larger particles tend to settle out of the air fairly quickly, but the smaller particles can remain aloft for a long time. When inhaled, these small particles can lodge in the lungs and contribute to respiratory disease.
Smog forms when nitrogen oxides and volatile organic compounds escape to the atmosphere. (Nitrogen oxides result from the burning of fuel, with cars and trucks contributing 72 percent of emissions. Volatile organic compounds result from the unburned hydrocarbons of automobile fuel tanks and from a wide variety of commercial processes.) In the presence of sunlight and heat, these chemicals combine to form a mixture of 100 different compounds. The result is the hazy, dirty brown air known as smog. The most important compound in smog is ozone, a toxic gas that causes eye irritation and respiratory problems. Ozone is also toxic to plants, damaging leaves and slowing growth; it is thought to reduce crop yields in the United States by 5 to 10 percent.
Sulfur dioxide is a gas that is released when fuels such as coal and oil are burned. Like the pollutants listed above, it is implicated in respiratory disease. Furthermore, sulfur dioxide is a major source of acid rain.
Carbon monoxide is released when fuel doesn't burn completely. This poisonous gas has no odor; once inhaled, it interferes with the body's ability to absorb oxygen and causes drowsiness, headaches, and ultimately death. As a component of air pollution, carbon monoxide exacerbates heart disease and respiratory problems. Cars and trucks are the main source of carbon dioxide, responsible for 68 percent of emissions.
Toxic air pollutants include a wide variety of chemicals that are hazardous to health. Refineries, chemical plants, and dry cleaning establishments are frequent sources. Cars burning leaded gasoline are another source. The volume of toxic air pollutants emitted is very small compared to the forms of air pollution listed above, yet their potential impact on human health is disastrous.
3. Pesticides and Other Agricultural Chemicals
Many of the pesticides now is use were initially developed for the purpose of war fare in World War II. There are many types of pesticides: insecticides (kill insects and mites); fungicides (kill mildew, mold, and other fungus); herbicides (kill weeds and other plants); nematicides (kill worms); and rodenticides (kill rats and other rodents). The Environmental Protection Agency reports that over 845 million pounds of pesticides are used for agriculture in the United States each year. Additional agricultural chemicals are growth regulators and synthetic fertilizers. Pesticides and other agricultural chemicals are used by farmers to maintain or increase crop yields, to improve the appearance of foods, and to prolong shelf life.
These chemicals, though they may contribute to short-term agricultural successes, have devastating long-term impacts. First, chemical use is a treadmill of addiction: As plants and pests adjust to the chemicals, even more chemicals must be used to achieve past results. Thus, American farmers today lose roughly the same percentage of their crops to pests – 33 percent – as they did in the 1930's before the advent of pesticides. Clearly, many pests have mutated to become immune to the very chemicals produced to kill them.
Second, the chemical runoff from farms contaminates streams, rivers, and underground aquifers, severely compromising drinking water quality. The Environmental Protection Agency considers farming the primary non-industrial source of water pollution.
Third, the application of the chemicals by farm workers leads to illness and even death, especially in the developing world, where farm workers receive little, if any, training in pesticide use and usually wear no protective clothing. (One fourth of the pesticides exported by American companies are restricted for use in the United States because of the threats they pose to human beings and the environment.)
Finally, pesticide residue on foods are believed to negatively affect human health. We actually know little about pesticides and other agricultural chemicals. The Environmental Protection Agency states that complete health data are lacking for about 80 percent of pesticides currently in use. Only about 10 percent have been adequately tested for their ability to cause genetic mutations; only about 40 percent have been adequately tested for their ability to cause birth defects; and only about 20 percent have been adequately tested for their ability to cause cancer.
4. Toxic Chemicals
Production of chemicals has surged worldwide since World War II. OF these, large proportions are toxic. Rachel Carson, in Silent Spring, vividly describes the irreversible effects of toxic chemicals on the environment. Certain chemicals have long been used without an adequate understanding of their consequences. Vinyl chloride, for instance, had been widely used since the 1940's to produce polyvinyl chloride (the main ingredient in plastic bottles), but only in 1973 was it shown to produce a rare form of liver cancer.
Each year, American industry generates some 80 million tons of toxic waste, and only about one-tenth of it is safely disposed of. The Congressional Office of Technology Assessment has identified over 31,500 hazardous waste sites. Indeed, during the 1980's, 15 industrial accidents took place in America in which the toxicity and amounts of chemicals released to the environment were greater than those released at Bhopal, India, where 5,000 people were killed. Only luck prevented similar results in the United States.
The next three plagues involve disruptions of natural processes – rain, temperature, and the sun's radiation. All three result from large-scale emissions of industrial and other gases. These gases, in their interactions with environmental processes, result in malfunctions of the natural order. "So Moses held out his rod toward the sky, and the Eternal sent thunder and hail, and fire streamed down to the ground, as the Eternal rained down hail upon the land of Egypt. The hail was very heavy – fire flashing in the midst of the hail – such as had not fallen on the land of Egypt since it had become a nation. Throughout the land of Egypt the hail struck down all that were in the open, both human and beast; the hail also struck down all the grasses of the field and shattered all the trees of the field" (Exodus 9:23-25).
5. Acid Rain
Acid rain results from industrial emissions of sulfur dioxide and nitrogen oxides. These dissolve in the rain, making it strongly acidic. Acid rain has corrosive effects upon buildings and monuments, and it also affects soil and bodies of surface water. Acidity has caused some streams and lakes to become inhospitable to indigenous fish. For example, in 1989, the New York Department of Environmental Conservation announced that 25 percent of the lakes in the Adirondacks were too acidic to support fish. Acid rain also attacks trees, and has thus far caused the deterioration of forests in Central and Northern Europe. In Poland, for instance, 75 percent of the forested land has been damaged by acid rain. The same scourge now affects large areas of forests in the eastern United States and Canada.
6. Global Warming or the Greenhouse Effect
The timing and amount of global temperature variations are the subject of vigorous scientific debate, yet most scientists agree that the greenhouse effect is altering the planet's balance.
Carbon dioxide (CO2) and methane are the primary greenhouse gases. Released into the atmosphere, they trap heat – creating a greenhouse effect – and thus threaten to warm the planet. Virtually all the greenhouse gases come from burning fuels: wood, coal, oil, and natural gas. Methane levels have doubled since pre-industrial times, and carbon dioxide levels have risen 25 percent and continue to rise every year.
In the United States, more than 50 percent of carbon dioxide emissions are from cars, trucks, and buses. Livestock are an important source of methane. Ruminant animals release perhaps 80 million tons of the gas each year in belchs and flatulence, and animal waste at feedlots and factory-style farms emits another 35 million tons. (Manure that falls in fields decomposes without releasing methane.)
The greenhouse effect may have already committed the earth to a temperature increase averaging 1.8 to 2.7 degrees Fahrenheit. Even a nominal rise in global temperature may be magnified in cities, where high energy use and the absorption of solar radiation by asphalt, concrete, and black roofing tar creates a "heat island" effect, which facilitates the production of smog.
7. Ozone Destruction
The upper-atmosphere ozone layer acts as a shield to block ultraviolet (UV) radiation from reaching the earth. Thinning of the ozone shield occurs through the release into the atmosphere of chlorofluorocarbons and other chlorine compounds. When these chemicals reach the upper atmosphere, UV rays break them apart. The resulting chlorine atoms react with the ozone molecules and destroy them. As the ozone shield thins, more UV radiation reaches the earth.
Chlorofluorocarbons and other chlorine compounds are used in air conditioners, refrigerators, foam products, and as industrial solvents. Military use of ozone-depleting chemicals is, however, the single greatest threat to the ozone layer, as a 1992 study by the National Toxics Campaign Fund found.
Near the the South Pole, where the annual ozone hole occurs in the winter months, scientists are finding decreased production of ocean phytoplankton (floating plants), the basis of the ocean food web. In 1992, Earth Summit Secretary General Maurice Strong noted that UV radiation in South Africa and Chile was already 28 times the normal background level.
The ozone layer above the entire earth has thinned significantly over the last twenty years. Scientists predict that increased UV radiation exposure will cause millions of skin cancer cases, as well as cataracts and blindness. Increased UV radiation also leads to increased smog and respiratory diseases. Furthermore, greater UV radiation adversely affects plants, causing crop sand forest destruction, while in the oceans; UV radiation contributes to the decay of coral reefs.
The last three plagues result from environmental interventions as old as humanity itself. With contemporary technology however, the effects of these interventions – which in themselves would seem almost benign – are magnified to an unprecedented degree. "Locusts invaded the land of Egypt and settled within all the territory of Egypt in a thick mass; never before had there been so many, nor will there ever be so many again. They hid all the land from view, and the land was darkened; and they ate up all the grasses of the field and all the fruit of the trees which the hail had left so that nothing green was left, of tree or grass of the field, in all the land of Egypt" (Exodus 10:14-15).
8. Soil Erosion
The primary causes of soil erosion are deforestation and agriculture. Other important causes are construction, urbanization, war, and mining. Soil erosion has serious implications for soil productivity, as it reduces available water capacity, reduces the depth to which root development can occur, and removes nutrients from the soil. Furthermore, erosion leads to compaction and crusting; both are unfavorable to germination and seedling establishment.
In the early 1960's, the United States Soil Conservation Service's guidelines for soil loss tolerance set a maximum of 5 tons per acre per year. In actual practice, soil losses 10 times as great are common throughout the country. In many other countries, rates of soil loss are just as great, and in tropical regions with intense rainstorms and sloping terrain the loss can be even greater.
9. Deforestation
In tropical regions, the conversion of forest to cropland is the leading cause of deforestation. Virgin tropical forests are rich in nutrients because of the extraordinarily rapid growth and rapid decay of organic matter; the soil itself, however, is low in nutrients. A few years after the forest is cleared and farming has begun, the soil becomes so depleted that still more forest tracts must be cleared. In the past, depleted tropical soils had been able to regenerate over time, but today the pressure for new land is so great that the forest has no chance to grow back.
Commercial logging is also responsible for rainforest destruction, particularly in South America, Southeast Asia, and the Asian Pacific Islands. If the current rate of deforestation continues unabated, most of the world's tropical forests will have disappeared by the year 2000.
The burning of trees and the decomposition of organic matter, which occur when virgin forest soil is cleared by fire and cultivated, result in the release of carbon dioxide into the atmosphere – a major factor in the greenhouse effect. Clearing of tropical forests has been estimated to account for 20 percent of the total global emissions of carbon dioxide.
10. Loss of Biological Diversity and the Destruction of Habitat
The diversity of plants and animals is believed to be nature's basis for success. Over 1.4 million different species have been identified, and many scientists now believe the total number of the earth's species to be between 10 and 80 million. Biological diversity maintains natural ecosystems. For example, predators driven to extinction no longer keep populations of rodents or insects in check; earthworms or termites killed by pesticides no longer aerate soils; mangroves cute for firewood no longer protect coastlines from erosion.
Genetic variation within a species affords resistance to epidemics and limits the difficulties associated with inbreeding. The disappearance of thousands of local food crops and subtypes of edible plants means that farmers rely on an increasingly uniform genetic base, so that pests and diseases pose greater threats than ever before.
Mass extinction has already begun. Deforestation alone condemns at least one species of bird, mammal, or plant to extinction daily. Tropical forests are particularly diverse, with many plants and animal species that have great potential for medicine and agriculture. Yet these forests are disappearing at a phenomenal rate. Seed banks have been established to preserve plant diversity, but the ability of the seeds to survive outside of their natural environments is itself doubtful.
Over-fishing and the deterioration of both ocean and freshwater environments have led to the loss of many fish species. The picture for invertebrates is even grimmer. Harvard biologist Edward O. Wilson estimates that nearly 140 invertebrate species become extinct each day!
Loss of animal and plant species results from the destruction of the habitats in which they live, from the draining of swamps to the unintended growth of deserts. According to the National Resources Defense Council, the virgin forests of the eastern United States are almost entirely gone, as are 90 percent of the forests of the Pacific Northwest. In the Midwest, less than 1 percent of the tall grass prairie remains.
Wetlands cover only 6 percent of the world's land surface, yet many are more productive biologically than even the most intensively managed agricultural fields. Coastal wetlands support flora and fauna ranging from plankton to reeds, from cypresses to mangroves, and from shrimps to bass. Wetlands serve as the spawning grounds for fish and the breeding grounds for waterfowl. Today, many wetlands are menaced by drainage, development (agricultural, industrial, and urban), peat mining, and pollution. It is estimated that in the United States, more than half of the original wetlands have been lost since European settles first arrived. The remaining wetlands are disappearing at a rate of about 1 percent annually.
Coral reefs – in many ways the undersea equivalents in biological diversity of tropical forests – are deteriorating because of coastal pollution from soil erosion, fertilizers, and sewage, as well as direct damage from fishing and tourism.


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Hospital Visit as Opportunity for Prevention and Engagement for HIV-Infected Drug Users (CTN0049)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT01612169
Recruitment Status : Completed
First Posted : June 5, 2012
Last Update Posted : March 14, 2016
|Tracking Information
|First Submitted Date ICMJE
|June 4, 2012
|First Posted Date ICMJE
|June 5, 2012
|Last Update Posted Date
|March 14, 2016
|Study Start Date ICMJE
|July 2012
|Actual Primary Completion Date
|June 2015 (Final data collection date for primary outcome measure)
|Current Primary Outcome Measures ICMJE
|HIV Viral Suppression [ Time Frame: 12 months ]
The primary outcome variable is binary: HIV viral suppression (<= 200 copies/ml), as determined by blood draw at/near the 12 month follow-up versus presence of viral load > 200 or death (all-cause mortality). We are aware that, for patients on therapy, the goal of antiretroviral therapy is achieving a viral load "below the limit of detection of the assay" which currently is usually < 40 copies/ml. However, we have chosen to define "suppression" as <= 200 copies/ml to be consistent with the January 2011 Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.
|Original Primary Outcome Measures ICMJE
|HIV Viral Supression [ Time Frame: 12 months ]
The primary outcome variable is binary: HIV viral suppression (< 200copies/ml), as determined by blood draw at the 12 month follow-up versus presence of viral load > 200 or death (all-cause mortality). We are aware that, for patients on therapy, the goal of antiretroviral therapy is achieving a viral load "below the limit of detection of the assay" which currently is usually < 40 copies/ml. However, we have chosen to define "suppression" as < 200 copies/ml to be consistent with the January 2011 Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.
|Change History
|Complete list of historical versions of study NCT01612169 on ClinicalTrials.gov Archive Site
|Current Secondary Outcome Measures ICMJE
|Original Secondary Outcome Measures ICMJE
|Current Other Pre-specified Outcome Measures
|Not Provided
|Original Other Pre-specified Outcome Measures
|Not Provided
|Descriptive Information
|Brief Title ICMJE
|Hospital Visit as Opportunity for Prevention and Engagement for HIV-Infected Drug Users
|Official Title ICMJE
|NIDA CTN Protocol 0049. Project HOPE -- Hospital Visit as Opportunity for Prevention and Engagement for HIV-Infected Drug Users
|Brief Summary
Primary Objective: This study will evaluate the most effective strategy in achieving HIV virologic suppression among HIV-infected substance users recruited from the hospital setting who are randomly assigned to one of three treatment conditions: 1) Patient Navigator (PN); 2) Patient Navigator + Contingency Management (PN+CM); and 3) Treatment as Usual (TAU).
Primary Hypothesis: The rate of viral suppression (plasma HIV viral load of <= 200 copies/mL) relative to non-suppression or all-cause mortality in the 3 study groups will differ from each other at the 12 month follow-up.
Sub-hypothesis 1. The rate of virologic suppression (plasma HIV viral load of <= 200 copies/mL) in the PN+CM group will be greater than that in the TAU group.
Sub-hypothesis 2. The rate of virologic suppression in the PN+CM group will be greater than that in the PN group.
Sub-hypothesis 3. The rate of virologic suppression in the PN group will be greater than that in the TAU group.
Secondary Objectives:
|Detailed Description
This study is a 3-arm randomized, prospective trial in which HIV-infected inpatients who report substance use at screening will be randomized in 1:1:1 ratio to Patient Navigator (PN) vs. Patient Navigator + Contingency Management (PN+CM) vs. Treatment as Usual (TAU). Randomization will occur after screening, informed consent, baseline assessment and collection of biological (blood) specimens. Participants assigned to the PN and PN+CM groups will meet (ideally at bedside if the participant is still hospitalized at the time of randomization) with the Patient Navigator interventionist and will complete up to 11 intervention sessions over the 6-month-long intervention period. Participants assigned to the TAU group will receive care as it is typically offered in the inpatient setting. Follow-up visits will be conducted at approximately 6 and 12 months post-randomization.
To minimize patient and staff burden, sites may implement a pre-screening procedure with permission from their respective IRBs to determine which inpatients would meet the study's AIDS-defining illness/CD4 count/viral load inclusion criteria. Pre-screening, screening, enrollment, assessment, randomization and the initial intervention visit will (ideally) occur during the participant's stay at an inpatient facility. Recognizing that participants may be recruited at various stages of illness during their inpatient visit, however, this may not be possible. To allow maximum flexibility, all activities that occur after the screening informed consent may be completed after the patient has been discharged from the hospital. The intervention duration will be 6 months with sessions ideally occurring weekly during the first month, bi-weekly during months 2 and 3 and monthly during months 4- 6. Follow-up visits will occur at approximately 6 and 12 months post-randomization. Therefore, the total duration of individual participation in the study is approximately 12 months.
Prior to approaching patients to recruit them into the study, members of the medical teams within each hospital (i.e., attending physicians, fellows, residents and nurse practitioners) who are involved in patient care and who know the patients' HIV-infected status will assess the medical stability of the patients. If a patient has expressed interest in potentially participating in research and is deemed medically stable, then a study staff member will meet with the patient at bedside to discuss the study. Strict ethical guidelines regarding professional conduct and confidentiality will be enforced for all study staff.
Prior to screening individuals to determine their eligibility to participate, the research staff will briefly explain the study purpose, procedures, potential risks and benefits and voluntary nature of participation. Individuals willing to be screened to determine eligibility will provide written informed consent, including providing HIPAA authorization for medical record abstraction. After signing the consent and HIPAA forms, participants will be offered copies of the forms to keep for their records.
After the enrollment process (providing written informed consent and completing a locator form) is complete and a brief rapport-building discussion between the interviewer and participant has taken place, the research interviewer will administer the baseline assessment through a handheld Computer Assisted Personal Interview (CAPI) device. The CAPI system displays each assessment question on a computer monitor, allowing the interviewer to read the questions and then enter the participants' responses directly into the computer. The baseline assessment will include, but not be limited to questions on participant demographics, HIV care, medication adherence, substance use and co morbid conditions such as hepatitis, depression, etc.
Collection of Biologic Specimens:
We will collect blood specimens at the baseline, 6-month and 12-month follow-up visits to evaluate the primary outcome, HIV virologic suppression, as well as to measure CD4 count, and complete blood count (CBC). Blood specimen processing will be done by sites' local laboratories. In the event that a blood specimen cannot be collected for any reason (e.g., vein is "dry", participant is lost to follow-up, etc.) or the result of a collected specimen is not available (e.g., not enough specimen drawn, lab processing error, etc.), the study team may abstract and use non-study lab results for the purpose of evaluating the HIV virologic suppression outcome and measuring CD4 count and CBC. Participants randomized to the intervention groups may also provide urine for drug screening.
Participants will be randomized in a 1:1:1 fashion to one of the 3 treatment groups. Randomization will be stratified by site. The randomization procedure will be conducted in a centralized process through the Data and Statistical Center (DSC2). After the baseline assessment is successfully completed, a designated study staff member will perform the randomization. Randomization for each participant is done over the Internet using the Enrollment Module in AdvantageEDC (the study electronic data capture system).
Study Interventions:
The 3 treatment conditions/study groups are: 1) Patient Navigator intervention (PN), 2) Patient Navigator plus Contingency Management (PN+CM) intervention and 3) Treatment as Usual (TAU).
The patient navigator (PN) approach includes five functions: 1) establishing an effective working relationship; 2) encouraging identification and use of strengths, abilities and assets; 3) supporting client control over goal setting and the search for needed resources; 4) viewing the community as a resource and identifying informal sources of support; and 5) conducting case management as an active community based activity. Specifically, patient navigators will provide the following to all study participants randomized to the PN group: 1) four initial meetings, ideally having the first one during hospitalization and three within the first 3 weeks of hospital discharge, and 2) after the initial four meetings, patient navigators will meet with the PN group participants ideally twice monthly during months 2 and 3 and once during months 4 - 6.
Study participants randomized to the patient navigator plus contingency management (PN+CM) group will receive the patient navigation (PN) intervention as outlined above and in Section 11.2 of the sponsor protocol combine with contingency management (CM). For participants randomly assigned to the PN+CM study group, patient navigators will: 1) effectively communicate the incentive plan to the participant, 2) track each of the seven target behaviors that may earn participant incentives, 3) verify occurrence of the target behaviors, 4) deliver incentives according to the protocol, and 5) maintain a record of incentives delivered.
Participants assigned to the treatment as usual (TAU) group will receive the standard treatment provided at participating sites for linking patients to HIV and substance use care.
Follow-up visits will be conducted at approximately 6- and 12-months post-randomization and will involve follow-up CAPIs and blood collection.
|Study Type ICMJE
|Study Phase ICMJE
|Not Applicable
|Study Design ICMJE
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Condition ICMJE
|Intervention ICMJE
|Study Arms ICMJE
|Publications *
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Information
|Recruitment Status ICMJE
|Actual Enrollment ICMJE
|Original Estimated Enrollment ICMJE
|Actual Study Completion Date ICMJE
|June 2015
|Actual Primary Completion Date
|June 2015 (Final data collection date for primary outcome measure)
|Eligibility Criteria ICMJE
Inclusion Criteria
Participating individuals must:
Exclusion Criteria
Individuals will be excluded from the study if they:
|Sex/Gender ICMJE
|Ages ICMJE
|18 Years and older (Adult, Older Adult)
|Accepts Healthy Volunteers ICMJE
|Contacts ICMJE
|Contact information is only displayed when the study is recruiting subjects
|Listed Location Countries ICMJE
|United States
|Removed Location Countries
|Administrative Information
|NCT Number ICMJE
|Other Study ID Numbers ICMJE
U10DA013720-11 ( U.S. NIH Grant/Contract )
|Has Data Monitoring Committee
|U.S. FDA-regulated Product
|Not Provided
|IPD Sharing Statement ICMJE
|Responsible Party
|Lisa Metsch, Columbia University
|Study Sponsor ICMJE
|Columbia University
|Collaborators ICMJE
|Investigators ICMJE
|PRS Account
|Columbia University
|Verification Date
|March 2016
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

subset: commoncrawl


text:
1C, 16 Bridge Street Aberdeen, AB11 6JJ
Aspc ref: 345028
Fixed price £165,000
Arrange a viewing
- 07815 891624
- (Mr Davidson)
- Below Home Report Valuation
3 Bdrm 2nd flr Flat. Hall. Lounge/Kitch on open plan. 3 Bdrms. 2 shower rms (CT band - C). Fixed price £165,000 Entry by arr. Viewing Mr Davidson 07815 891624. Below Home Report Valuation (EPC band - F).
We are pleased to offer for sale this spacious THREE BEDROOM SECOND FLOOR FLAT, which has an HMO licence, set within a traditionally built apartment block and situated within the heart of the City centre. The accommodation is neutrally decorated throughout with all furniture to remain as part of the sale and enjoys the comforts and benefits of electric panel heating and a secure entry system.
The accommodation comprises: a hallway which has a high level meter cupboard and provides access to all rooms; a well proportioned lounge is on open plan with the modern fitted kitchen which has beech effect wall and base units, marble effect work tops, white tile splash back, integrated electric hob with oven below, stainless steel sink, under counter washing machine and a free standing fridge freezer; three well proportioned double bedrooms are situated to the front of the property, one of which has a built in wardrobe which houses the hot water tank; there are two separate shower rooms which both include shower cubicles with electric shower within, hand basin and WC.
The property is a stones throw from Aberdeen's city centre and Union Square with its thriving and busy shops, shopping malls, offices, restaurants and leisure amenities. Also conveniently situated for Aberdeen's College and University's, and only a bus ride to the busy industrial and commercial area of Tullos and Altens with train and bus stations also close at hand.
Directions: From Union Street turn down Bridge Street and No.16 is a few hundred yards down Bridge Street on the right hand side.
Arrange a viewing
- 07815 891624
- (Mr Davidson)
- Below Home Report Valuation
James & George Collie
450 Union Street (Sales) Aberdeen AB10 1TR
- +441224572777 01224-572777
- Contact solicitor
- Visit their Website
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The foregoing particulars are being distributed on behalf of the Selling Solicitors by Aberdeen Solicitors' Property Centre Ltd. of 40, Chapel Street, Aberdeen AB10 1SP (Tel: 01224 632949). Whilst the particulars have been prepared with care and are believed to be accurate, no liability for any errors or omissions therein or the consequences thereof will be accepted by the Selling Solicitors or Aberdeen Solicitors' Property Centre Ltd. © Aberdeen Solicitors' Property Centre and Selling Solicitors.
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This is a short piece written in response to a writing prompt on my writers group. The prompt originally specified that the finished writing be fewer than five hundred words, and this has a few things left in that I cut for the finished piece, and has a couple of things added.
She snapped the clasps shut on the guitar case. It had seen better days, and the hinges clattered, ready to give way at any moment. Now clad in jeans and a softly worn t-shirt that smelled of better times, she stuffed her stage clothing into a backpack and put one of the straps over her shoulder. She rattled the tip jar and then counted its contents… fifteen dollars and eighty-six cents. Almost minimum wage.
She carried her bag and her guitar out to the front of the house and dropped them next to an empty stool. She perched there, and prepared to enjoy the free cocktail that the entertainment agreement with the venue had promised her.
"What'll you have?" The bartender had a shaggy haircut that seemed popular among those in their twenties these days, but an earnest look in his eyes.
"Gin gimlet, please."
"You got it."
The ice clattered into the glass like soothsayer's bones… a sound that seemed, in the patternicity of hindsight, to occur at linchpin moments in her life.
"That was a great set," he said. He stirred the drink, provoking a soft echo of that portentous noise, and then tasted what remained on the spoon thoughtfully. He nodded, and pushed the drink toward her.
"Thanks." She took a drink. "This drink isn't bad either."
The bartender shrugged. "It's kinda hard to fuck up," he said with a half smile. "So, you got somewhere to stay tonight?"
"Oh, I was just going to park up and sleep in my van… save a few dollars."
"Nah, why don't you crash on my couch? I guarantee it's more comfortable than a van."
She considered the offer for a moment, chewing on her straw.
"Yeah, okay. Sure."
"Cool. I'll keep drinks coming while I close, if you like."
At two AM on the dot, she was feeling just warm and loose, without the jangling chaos that comes with overconsumption. She slid into the passenger side seat of his old dingy Camry. It was a short drive, somewhere in between five and ten minutes.
"We're here," he said. She climbed out of the car, grabbed her backpack and her guitar. They walked upstairs, and stopped at a door marked 207. The hallway was dim, but she heard him fiddling with his keys. He unlocked the door and opened it.
"Hold on, let me get the lights…"
He reached inside and flipped the light switch, and the sudden glare illuminated the happy faces of a dozen strangers. As they all yelled "surprise!" a sweat broke out down her back.
"Happy birthday!" said the shaggy bartender with a huge grin.
She opened her mouth to speak, but nothing came out. She looked at all the people, all the faces to remember, all the names…
"Well, you sure look surprised…" he said, the grin fading. The strangers inside the apartment were starting to look at one another uncomfortably. She heard murmurs.
"I don't even know you people," she whispered, turning toward him with wide eyes.
"Your boyfriend called the bar a few days ago. He wired me the money to have a party for you. For your birthday." He tried a smile again, but was looking unsure.
"I," she said through gritted teeth, "am going to kill him."
"No, look… it's your birthday. This is your party." The bartender was starting to lean toward her, and was speaking clearly and urgently, as if to a hyperactive child. "There's drinks and snacks…"
"No." She was feeling overwhelmed, and longed for the safety of solitude. It couldn't be more than a couple of miles back to her van…
"I don't have a boyfriend," she said to him with a ragged voice. "We broke up months ago. He's not supposed to know where I am, and he's definitely not supposed to be throwing parties for me."
"Oh." The smile melted from his face. "Wow, I'm really sorry. This must be super uncomfortable for you."
"Look, I have to go." She turned to face the whispering crowd inside the apartment. "I'm sorry, everyone, I gotta go."
"At least let me drive you back," the bartender said, looking to make amends. She looked at his outstretched hand, but she knew that she couldn't take his offer. Her ex touched every part of her life… now even this part, and she just wanted something that was her own, even if it was the sidewalk pushing back up against her feet and the relatively cool evening air. Even if it was the soreness in her back from sleeping in the van. This represented the length of his determined reach, the breadth of his sphere of influence. He had touched this, and now it was soiled.
"No. I have to go. Thank you for all your trouble," she said quietly, and walked quickly and quietly back down the stairs, fading into the darkness.


text:
Hindustan Copper Limited Recruitment 2016 – Apply Online
Company Name: Hindustan Copper Limited (HCL)
Name of the post: Trainee Welder
Maximum age(below): PWD-UR : 30 yrs PWD-SC/ST : 35 yrs PWD-OBC:33 yrs PWD Ex.S/M
Qualification: HS or Equivalent + ITI or equivalent technical/professional certificate like certificate issued by DGMS, Dhanbad
Selection Procedure
The selection procedure for post shall be Written Test followed by Trade Test of the shortlisted candidates.
i) Candidates are advised to submit their Applications well in advance without waiting for the closing date.
ii) Candidates should note that the details provided by them in their application are taken on their face value and the onus of proving the correctness and authenticity of the same as and when required lies with the applicant.
iii) No Travelling Allowance shall be paid.
iv) In case of variation in name / surname / name spelling mentioned in the application with that in the respective certificates pertaining to Qualification / Caste etc., the applicant shall be required to submit an affidavit swornin before judicial magistrate/ appropriate authority to this effect along with the respective documents at the time of Trade Test failing which the candidature shall be liable to be cancelled.
v) Candidates employed in Government / Semi-Government / Public Sector Undertaking are required to send their applications through proper channel. They may, however, submit a copy of their Application to their present employer for forwarding the same through Proper Channel or alternatively, produce a No Objection Certificate from their present employer at the time of Trade Test failing which they shall not be allowed to sit for the Trade Test.
How to Apply:
Interested candidates may send their neatly typed application on plain paper strictly as per the following prescribed format alongwith self attested copies of Certificates & testimonials and 3 Nos. recent Passport size Photographs so as to reach on or before 31.07.16. The applications received after 31.07.16. or incomplete in any respect will be summarily rejected.
Last Date for Application: 31.07.2016.
About Us:
Hindustan Copper Limited (HCL), a public sector undertaking under the administrative control of the Ministry of Mines, was incorporated on 9th November 1967. It has the distinction of being the nation's only vertically integrated copper producing company as it manufactures copper right from the stage of mining to beneficiation, smelting, refining and casting of refined copper metal into downstream saleable products.


text:
Find a City Guide
Top Hostels in London
- RatingHostel
The Walrus Hostel
Hostel, London
London Essentials:
- How big is London?
- Greater London covers an area of 1,584 square kilometres. Even though it is Europe's largest city, it is the smallest of England's nine regions.
- How many people inhabit it?
- There are approximately 7.2 million people living in the English capital, making it one of the most densely populated areas in Europe. To put in perspective exactly how many people live there, just think that one in every eight of the UK's population lives there.
- What are the language and currency?
- Pretty much every language is spoken in London, but the most widely spoken language is English. Regardless of the language a person speaks, they all spend English pounds (sterling).
- Charing Cross Tube stop
Things to see in London
- What is London's number one attraction?
- The London Eye is the English capital's number one (paid) attraction. A 'flight' costs around £18 for an adult and it lasts approximately 30 minutes. There are some breathtaking views to be seen from the London Eye especially over the Houses of Parliament and Westminster from the top of the Eye. If you do decide to go on the London Eye, keep in mind that the best time of day to do so is before midday on a clear day. The most impressive views are to the west of the Eye so get on before the sun begins to settle, and thus glaring at you when you want to take photos.
- Anything else which shouldn't be missed?
- London is home to some of the finest museums and art galleries in the world and they are really worth checking out. The most popular gallery is the National Gallery, home to Van Gogh's 'Daffodils'. It's located on Trafalgar Square, just across from the National Portrait Gallery which is also worth an hour of your time. The city's most popular museum is the British Museum on Great Russel St (5 minutes from Oxford St). And if you happen to be around the Kensington area of London then pay a visit to the Natural History Museum and the Science Museum. Away from the museums, don't leave without visiting the electric circus that is Piccadilly Circus, the bright lights of Leicester Square and if the weather is nice make sure to bask in the sunshine in Hyde Park. Another big attraction in London is its many markets with Camden being one of the top locations. From the Inverness Street Market to the Camden Lock Market the area is a top spot for those looking to browse the market stalls and soak up the atmosphere.
- On average, how much does it cost to get into London's top museums/galleries?
- Good news – all of London's best museums and galleries are free. This includes all the above as well as the Tate Modern and the Museum of London plus many more.
- Where can you find London's finest architecture?
- London's best known buildings and most beautiful architecture can be found in Westminster, or the City of Westminster to be precise. This is where the Houses of Parliament, Westminster Abbey, Big Ben and Buckingham Palace all are. Just ten minutes away is No. 10 Downing Street although it's not much to look at considering it's just a black door. St Paul's Cathedral is located in the 'city', London's financial district.
Going out in London
- Is it expensive to go out in London?
- That depends really. If you follow the crowds and bright lights to London's West End you'll find it can be fairly pricy. This area encompasses areas such as Covent Garden, Soho, Leicester Square and the area around Piccadilly Square. Take the short trek to parts of London such as Islington in the north-east, Clapham in the south, and Camden which is pretty much still in the city centre and you'll find the price of drink isn't as expensive.
- Where are most of the bars found?
- Well the West End is heaving with them, particularly areas such as Covent Garden and Soho. The only thing is that bars around this area are a lot more expensive than in other parts of the city. As London is so big, each suburb is like a mini-city in itself. This means you don't have to go to the West End when you want to go out. Areas such as Islington in North East London, Clapham in South London and Camden, just north of the city centre, are good for a night out.
- Do I need to carry my ID with me when going out?
- The legal age limit in the UK is 18, so unless you look like you are just 18, you don't have to bring your ID with you.
- Is there anything to do that doesn't involve alcohol?
- London is home to one of the world's most celebrated theatre districts in the world. Just as in Broadway in New York, many of the world's finest actors have graced stages in various theatres around the city. The average ticket is around £30 but you can get cheap tickets on the same day as the performance in various booths around the city centre. The best-known one is the TKTS office in Leicester Square, although if you shop around the surrounding area you'll definitely find cheaper tickets.
Eating Out in London
- Is it expensive to eat out in London?
- Around the West End it is, although you'll definitely find a few 'all-you-can-eat' buffets Chinatown. Get down to Piccadilly Square any afternoon and you'll find somebody handing out flyers for some pizza establishments also specialising in these types of buffets. Just like in going out, the further you go from the city centre (unless you are in one of London's most exclusive areas like Chelsea), the cheaper it becomes to eat out.
- Where is the best selection of restaurants in the city?
- There seems to be restaurants every ten metres in Soho. A lot of them tend to be quite pricy though. For more affordable restaurants take a short tube ride to Old St in the area of Shoreditch. There are some great fusion restaurants around here. Islington, also in the north east, has nice cafés and restaurants. The East End is heaving with affordable Indians and other Asian restaurants, although it is a bit out.
- Are international cuisines well-represented?
- Are you being serious? London is one of the most multi-cultural cities in the world. No matter what type of gastronomy you are looking for, you'll find it London. A great place to get a range of all international cuisines side by side is around the market places such as the Stables Market in Camden/ Chalk Farm.
- What times do restaurants stay open until?
- Most restaurants in London will take their last orders around 11pm. If you end up going out afterwards, and work up an appetite once more, Leicester Square has loads of fast food booths. Good for when you feel like fattening up a little.
Transport in London
- What are the different types of transport in London?
- In Central London there are three - tube, bus and taxi. The tube is extremely easy to use and is instrumental in any traveller's quest in seeing as much of the city as possible. London's famous red double deckers can be seen all over the city and their destinations are written on the front of the bus. These buses are worth looking into as a means of night transport after a night out as the tubes stop around midnight. Many Londoners use night buses and are a handy and cheap way of getting home after a night out. Just as instantly recognisable as the buses are the city's black cabs. Always take these cabs as at night there are hundreds of rogue taxi drivers charging overpriced fares.
- Is there one ticket which covers tube and bus services?
- Yes - 'Travelcards'. A one-day travelcard costs £4.70. Well that's how much the 'off-peak' one costs. Off-peak means travelling after 9.30am. If you set off on a day's sightseeing before that the travelcard will cost £6. If you are there for more than one day it could be worth purchasing an Oyster card for £3 which you then top up as you go. You can use it whenever you go to the city and just top it up when you are running low on credit. Oyster cards can also be used on London buses and save you having to look for change all the time!
Make your trip go further with Hostels.com. We offer the most comprehensive selection of hostels on the internet with over 35,000 hostels in 180 countries. Bringing you great value and providing a service that is fuss free, reliable and frankly brilliant! Hostels.com the ultimate resource for great value accommodation all over the world.
- London Travel Video
- Comments: 0
5 Free Things to do in London
- City: London
Here are our suggestions of five free things to do in London so you can enjoy this great city while sticking to your budget.
- London Travel Video
- Comments: 0
5 Free Things to do in London
Video: 5 Free Things to do in London
Here are our suggestions of five free things to do in London so you can enjoy this great city while sticking to your budget.
Here are Hostels.com's 5 Free Things to do in London!
Museums and Galleries
London is probably one of the best capital cities around when it comes to museums and galleries. And what makes them even better is that they are free. There are so many museums and galleries all over the city to suit all tastes. These include the Natural History Museum, the National Gallery in Trafalgar Square, the Science Museum in Kensington and the Tate Modern on the South Bank to name but a few.
A great free thing to do in London is to visit one of the cities many parks. These public parks are a great way of escaping the busy city. You will find many public parks all over London which are home to some beautiful monuments, statues and walkways. Some great London parks include Hyde Park, which is one of London's largest green spaces. Kensington Gardens is home to the amazing Albert Memorial and has many great walkways and green spaces. And Victoria Tower Gardens is a smaller park that can be found in the shadows of Westminster by the River Thames with some great views of the riverside and South Bank.
Covent Garden
The area of Covent Garden is a popular spot for tourists visiting London. This is a very busy area where you can find many bars and restaurants, shops and street performers. Covent Garden is a great place to walk around as the atmosphere is always busy and electric here. You will find some great entertainment around Covent Garden as it is a popular location for the cities street performers and artists.
Covent Garden is also home to the London Transport Museum, as well as many markets selling all sorts of crafts.
Camden Markets
A visit to the neighbourhood of Camden is a must on your trip to London, particularly if you like markets. Camden is home to some of London's best markets and is also a colourful and funky area of the city. The area is busy during the day for markets, and also at night for its varied selection of pubs and restaurants. The popular Camden Town markets include The Camden Lock market which is by the canal with some great views and interesting seating. The Inverness Street market and Camden Market lie on opposite sides of the street. The Stables Market is on the Chalk Farm side of Camden and has some great artwork and statues, as well as an exciting atmosphere. Taking a walk around Camden and exploring all of these is a great free thing to do in Camden... so long as you are not tempted to buy any of the gifts and gadgets on sale here!
South Bank Walk
If you are looking for a nice walk that takes in a lot of London's top attractions, then take a walk down the South Bank. Start under the London Eye where you will get some great views of Big Ben and Westminster across the Thames. Southbank is a popular area for tourists as there is a lot happening around here. You will come across lots of street performers, take in some great views and you can also cross over into the city on one of many bridges such as the beautiful Millennium bridge. Along the way you will also pass the Tate Museum, the Southbank Centre, make your way to London Bridge and go even further to take in the Tower of London.
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Make your trip go further with Hostels.com. We offer the most comprehensive selection of hostels on the internet with over 35,000 hostels in 180 countries. Bringing you great value and providing a service that is fuss free, reliable and frankly brilliant! Hostels.com the ultimate resource for great value accommodation all over the world.
- London Podcast
London - All about Pasties
- City: London
- Adam Moutray of the West Cornwall Pasty Company in Covent Garden talks to Tracy Lynch about this historic English food. He talks us through the history of their popular restaurants and the pasty, as well as the atmosphere of working in Covent Garden.
Make your trip go further with Hostels.com. We offer the most comprehensive selection of hostels on the internet with over 35,000 hostels in 180 countries. Bringing you great value and providing a service that is fuss free, reliable and frankly brilliant! Hostels.com the ultimate resource for great value accommodation all over the world.
- Posted: Tuesday, February 23, 2010
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- Posted: Monday, January 25, 2010
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- Posted: Tuesday, June 16, 2009
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- Posted: Thursday, March 12, 2009
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- Posted: Tuesday, August 23, 2016
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Quirky London: hidden local gems
- Category: City Focus
- There are so many areas in London waiting to be explored. One of the best parts is that many people don't bother looking for the quirky places that you don't often hear about. They are usually tucked away behind buildings or in narrow alleyways. To save you time trying to look for them here are some of the quirky and offbeat hidden gems in this lively city.
- Read this blog post »
- Posted: Monday, February 4, 2013
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Travel Tip: Getting to and from London airports to the city
- Category: Travel Tips
- We have researched the quickest along with the cheapest means of travelling from the airport into London City, and back again.
- Read this blog post »
- Posted: Wednesday, January 9, 2013
- Comments: 0
Happy Birthday London Underground
- Category: Events & Holidays
- The lifeline of one of Europe's biggest and most popular cities turns 150 years old today, and all over the world people are tipping their hat in salute to this transport hub that carries tens of thousands of locals and tourists around the English capital daily.
- Read this blog post »
- Posted: Monday, May 21, 2012
- Comments: 0
Top tips for London Olympic Games 2012
- Category: Events & Holidays
- The 2012 London Olympic Games are almost upon us! London will be buzzing with athletes, visitors and many locals from July 27th to August 12th as the much anticipated London Olympics take place.
- Read this blog post »
- Posted: Thursday, July 14, 2011
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City Focus: London
- Category: City Focus
- This week we look at London for our City Focus. It's one of Europe's most popular cities as well as being the capital of England.
- Read this blog post »
- Posted: Tuesday, May 17, 2011
- Comments: 0
Travel Tip: London Museums
- Category: Travel Tips
- The city of London is packed full of art and culture with some of the world's top artists on display across London's museums.
- Read this blog post »
- Posted: Thursday, November 25, 2010
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Free things to in Europe: London, England
- Category: Free things to do
- London is always a popular choice for tourists from all over the world as the city has so much to offer.
- Read this blog post »
- Posted: Friday, October 29, 2010
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Book cheap London hostels for upcoming North London derby
- Category: Travel
- Chelsea and Arsenal currently occupy the top two places in the Premier League after nine games as they look to secure the title this season, with a Boxing Day clash between the two possibly going a long way to deciding who wins this battle.
- Read this blog post »
- Posted: Wednesday, March 10, 2010
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Ten years and still spinning - The London Eye
- Category: Events & Holidays
- We all love London because there really is so much to do and see over there, so much so that every time we go back we have a list of new things to do and places we want to see!
- Read this blog post »
- Posted: Friday, February 19, 2010
- Comments: 0
London Transport
- Category: Travel
- London is one of Europe's largest capital cities and covers a lot of ground so if you plan on doing a lot of sightseeing then make sure you do a little bit of research into transport around London.
- Read this blog post »
- Posted: Thursday, February 18, 2010
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London for free
- Category: On the road
- Having just spent the last few days visiting all the sights in a very cold London I thought I'd share some of my visit with you.
- Read this blog post »
- Posted: Wednesday, February 10, 2010
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Valentine's weekend away but hold the romance!
- Category: Events & Holidays
- February 14th can be the most romantic and loved-up day for all of those in couples as your significant other pulls out all the stops to make you feel special!
- Read this blog post »
- Posted: Monday, February 1, 2010
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Top Booked Hostel of the week: Smart Russell Square
- Category: Travel Destinations
- Our Top Booked Hostel on Hostels.com last week was one of our favourites, Smart Russell Square in London!
- Read this blog post »
- Posted: Thursday, January 28, 2010
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Cheap Hostels in London
- Category: Travel Destinations
- London can be an expensive city to visit so if you are looking for a good deal on accommodation why not book a cheap hostel in London town!
- Read this blog post »


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One Business Phone System for Multiple OfficesBring all office locations together under a single VoIP Cloud Based Phone System. A Cost-effective, Reliable and Secure Business Solution for your various office location.
Best Multi-Site Company
One Virtual Phone System for All Office Locations
Cost Effective. Reliable. Dependable. Secure
Implementing a single phone system is one of the smartest things that your company can do, especially as you grow and expand into new locations. With one multiple office business phone system for all office locations, your company can run smoothly, improve the customer experience, and enjoy an affordable, secure and dependable service options.
Ring Groups
Create a hunt group, where staff can answer phone calls for a particular department, regardless of geography.
Voicemail and Fax
Phone Directory
Share one common phone directory between different office locations.
Time Based Routing
All calls can be routed to various office locations and personal mobile phones based on time and day.
Unlimited Extensions
Unlimited extensions between offices saves time and money, increasing work efficiency.
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Virtual receptionist welcomes clients with custom greetings and directs them to the right person in specific office location.
One Phone System for Multiple Office Locations. We develop custom-tailored solutions for your Business.
Improved Communication within Company
- Reaching team members in another office is same as reaching one in the same location or building.
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- It can help to improve the workflow, reduce miscommunications.
- Brings employees together as a united team, no matter what part of the country they're located in.
With one Multiple office business phone system we bring different office locations together helps create a smooth, seamless experience for your customers, irrespective of geography.
Instant Activation of Service, Pre-Configured Phones for All Offices
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Call us today for a free demo – No Strings Attached
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- Phone system is skillfully managed 24/7 by Cebod Telecom team
- Add/Delete staff members to existing systems with just a few clicks.
- Free automatic system upgrades.
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In situation of power outage or a disruption in service at one of the offices, your company can still take calls and assist customers from another location.
One comprehensive VoIP phone system is a smart, cost-effective, and efficient solution for any business that has multiple locations. Conduct business anywhere, anytime using a laptop or a smartphone..
Phone Service Plans and Pricing
What is the cost difference between onsite and cloud phone system?
What phone features come with multiple office business phone system?
Our business phone service empowers your office with the best enterprise level voice, shared lines, 3-way conference, sequential calling, rollover calls, cloud phone features, business PBX features and enhanced user experience. There are endless possibilities and ways of using 40+ all-inclusive PBX features. The wide range of phone service options at no extra cost allows a business to grow exponentially without ever investing again in a completely new phone system. Learn More
How will cloud based services help me connect different offices?
What expenses are associated with multiple office business phone system?
The costs associated with premise based phone system for each office is more than the initial capital expense of basic hardware and phone sets for all the offices. Some of the common costs are PBX hardware, initial licensing, maintenance, hardware, firmware and software upgrades, separate local and toll free numbers or Fax number. Learn More


text: Avatar coming december 09, by 'Titanic' director, James Cameron breaks apple movie trailer records. In addition to the tremendous buzz surrounding the movie, Cameron is even enjoying a record-breaking movie trailer. On Friday, 20th Century Fox said the trailer for Avatar became the most viewed trailer on Apple.com. According to the movie studio, Avatar was viewed more than 4 million times. Avatar pits humans against a planets indigenous population in a battle to save the population.


text:
Photographer Klaus Pichler shot these unstaged pictures in the basement storage rooms of Vienna's Museum of Natural History. The uncanny images reveal a world that is, as the artist puts it, "full of life, but dead nonetheless"
This article first appeared in Icon's October 2014 issue: Museums, under the headline "Skeletons in the closet". Buy back issues or subscribe to the magazine for more like this
Klaus Pichler


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SPATZQS+ PC Quality Assurance Software
Along with powerful and precise welding current sources, the SPATZQS+ PC quality assurance software constitutes another key element of a quality assurance concept for high-quality resistance-welded joints. This applies in particular when manufacturing products which are subject to high cost pressure as a result of large production quantities.
Apart from serving as a means of documenting and archiving welding process data for up and running production operations, the SPATZQS+ PC quality assurance software is also a particularly efficient tool for use in attaining and verifying the necessary machine and process capabilities in connection with commissioning and process optimisation measures.
Installed on the office PC, the SPATZQS+ PC quality assurance software permits offline analysis of the welding process data records recorded by the SPATZMulti04 weld recorder or the AutoSPATZ, DragSPATZ, ServoSPATZ and SPATZ welding systems.
The data records of the last 10,000 welds contain the complete process parameters for each individual weld. Data transfer to the PC is done via SD memory card with the SPATZMulti04 weld recorder and with the weld timer of the SPATZ series via the handheld programming device SPATZBG-02, a laptop with the AutoSPATZAS-01 software or a line PC with the AutoSPATZAS-32 software. Analysis and evaluation of all the data can be carried out at spread or concentrated intervals, according to either delivery batches or production time.
This means that welding process data can be assessed at time intervals ranging from a few seconds to days or weeks, or in quantities ranging from individual welds to thousands of welds.
The scope of assessment intervals enables factors and correlations to be identified which previously went unnoticed. All analyses can be printed out for documentation purposes. Additional comments can also be inserted into the analysis record in a special entry field.
Both logs with time stamps and quality control charts can be generated for all welding process parameters. The quality control charts contain all the key characteristics which are necessary for the purposes of statistical process control (SPC). In addition to analyse the total population of all welding data, it is even possible to carry out program related or spot related analysis. Independent analysis is possible for each welding program.
In addition the curve progressions recorded by the SPATZMulti04 weld recorder can be displayed in the SPATZQS+ software. Analysis of a single weld or comparison for example of the current and voltage curve progressions is easily possible.
|Technical Data
|SPATZQS+ software
|Analysis data
|RMS welding current, electrode voltage,
welding time, trigger angle, resistance,
energy, welding force, electrode displacement,
spot number, program number, time, date,
type ID, part ID, welding error code,
device error code, weld expulsions,
change of values
|Statistical information
|number of faults, mean value,
standard deviation, minimum value,
maximum value, range, cp-, cpk- value,
frequency distribution, histogram
|English, German, French
|Microsoft Windows 7 or higher
Download of a Demoversion
The demoversion of our SPATZQS+ PC quality assurance software can be found in our download area.


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Come hang out at our wooden beer bar and bring your growler to enjoy the 65 beers we have on tap. In addition, at The Beer Hog, we have more than 300 craft beers in bottles on the shelf. You won't find a selection like ours anywhere else. We want you to have fun drinking, whether you're enjoying our 50 inch televisions and free Wi-Fi™ or taking in the view on our outdoor patio.
At The Beer Hog in Pelham, Alabama, our founders are experienced restaurateurs, who have more than 25 years of experience running BBQ restaurants. They decided to open a beer bar because they saw that Shelby County doesn't have a place where you can get easy access to craft beers in one spot. Therefore, they decided to open The Beer Hog to share their passion for craft beers with the community. We also have a retail section that has even more beer and also T-shirts and accessories from which to choose.
Thank you for your interest. For questions or comments, please use the information listed here. We look forward to hearing from you soon.
Phone(205) 326-7151
Hours of OperationMonday - Wednesday: 2:00PM - 11:00PMThursday: Noon - 11PMFriday: Noon - MidnightSaturday: 11AM - MidnightSunday: Noon - 11:00PM
Address112 Bowling Lane, Pelham, AL 35124
Service AreaPelham


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My first experience of a nightclub was the leavers' party for the class of 1988 at Holden Lane High School.
We could have chosen any of a number of venues – Maxim's or Ritzy in Newcastle or perhaps even Chico's by the bus station up Hanley.
But it was another city centre nightspot on which the under-dressed girls and spotty oiks from my school descended.
I remember shuffling around on the dancefloor to tracks by Erasure and casting furtive glances over at the girl I'd never had the bottle to ask out.
Like generations before us we were making memories at The Place – a legendary Potteries nightspot where our parents had once danced, got drunk and perhaps even fallen in love.
Enjoying the same leavers' do with me that night was a 16-year-old called Carol who was to go on to develop a real affinity with a venue like no other in North Staffordshire.
Now a 41-year-old mum of one, Carol Cawley Holness has organised a huge reunion in the name of The Place which takes place tonight at a city centre nightspot just a stone's throw from the Bryan Street venue which had been a magnet for clubbers since the Sixties.
Carol, who lives at Norton Heights, explained what prompted her to organise tonight's event which is also raising hundreds of pounds for the Douglas Macmillan Hospice.
She said: "I love R&B and soul music and I travel all over the country for nights out which cater for fans. I go to other towns and cities like Preston and Manchester and Birmingham and one day someone said to me: 'Why isn't there a night like this in Stoke-on-Trent – it used to have a great club scene? That got me thinking.
"I didn't really have any idea whether or not it would be popular. I thought perhaps that most people would travel from outside the area – but I was wrong."
Working with her friend Helen Howell, Carol arranged The Place reunion at Jumping Jack's which is part of the Liquid nightclub.
She said: "We sold out three weeks ago and I think we honestly could have sold another 500 tickets. It's been so successful that we're now organising another event for December 14 and I'm looking at arranging three nights a year.
"We've got people coming from Blackburn, Manchester, Bristol, Leeds, Huddersfield and Surrey – among other places – but what has really surprised me is that of the 850 tickets sold more than 500 have gone to people living locally.
"I think it has caught the imagination of my generation who are perhaps fed up that there isn't a decent venue aimed at thirty-somethings who have had children but still like a good night out and want to enjoy the music they grew up with."
Carol, who has a 19-year-old son, has more reasons than most to look back fondly on The Place.
She worked there for seven years – between 1989 and 1996 – and that's where she met the man she went on to marry.
Carol said: "I think what I loved about The Place was the music and the people. It was my scene. If you wanted, say, house music – you'd go to Valley's (Valentino's nightclub) but for soul and R&B it was The Place.
"I think the Eighties and Nineties was a great era for soul and R&B. I absolutely loved the music and we were lucky to have someone like Trevor M – who was THE DJ at The Place – who had a real passion for it.
"The first thing I did when I started organising the reunion was to contact Trevor – who is very particular about the kind of gigs he does – and he was really supportive and came onboard straight away."
She added: "I think I will be quite nervous when people start to turn up tonight. I just want to make sure people have a good night and then once the doors close I can relax and start to enjoy it myself."
For details of future The Place reunions contact Carol on: 07854 141147.
Pick up a copy of the Weekly Sentinel every Saturday for 12 pages of nostalgia


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Welcome to our Australian Low Carb Forums. Join us for free support, information and recipes to help you with your low carb diet. We're a friendly bunch so please register and join in the fray, but most of all have fun! If you like us please share and spread the love!
oh this is an old thread, I forgo5 about this one, I probably should update as I'm sure there's other biscuit recipes here lik3 the macadamia shortbread which is my favourite.
Lindt $2.12 at Woolies!
I remember seeing this dough on instagram ages ago and meant to try it but haven't got around to it. Im not sure if I could get past the almond and coconut though in something savoury as I don't like fathead pizza, maybe with psyllium like the ostplatter? Looks really good!
I am not a breakfast eater but I used to like psyllium pancakes, cream cheese pancakes which I think the original recipe here is called easy peasy pancakes, oopsie rolls, cream cheese muffins and ostplatter. Many years ago I would also often have a piece of low carb cheese cake for breakfast. I've noticed when out shopping there's lots of low carb breads out there that may be an option. You might find some good cereal options too. We do have a breads recipe thread too.
I'm on board
Welcome Des keto should certainly help with the appetite reduction it brings
Urghh I need to update the sweetener!
Remember new month weigh in next week so you can start fresh!
Wow that's cheap!
yes when you went off track you were under 130
Rita years ago when I orinally lost weight on keto, I got down to 55 kgs now, I'm going by purely memory as I'm too lazy to look it up lol but if I recall 55kg was somewhere around 127lbs My thinking is you're at a pretty low weight for your age and your body is probably feeling pretty defensive and this is causing the binges. Make sure that you dont eat too little calories as your body will fight back even more. It might be time to experiment with where you can maintain your weight and feel hap…
That's a nice loss Rita, you managed to finish the month smaller then when you started!
That's awesome Rita, you must be very proud!
That's what maintenance is all about
You know what to do!
Hello to all
Welcome Cliff
Welcome back Rita, it will go quick. Hope you had a great time
Coles are $3 (last day today) and woolies are $2.50 starting tommorow.
Hm. Let me check, I think my partner got some from woolies at around $2.50


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Jennifer Aniston was spotted at Heathrow Airport in London, England wearing Current/Elliott Jeans. Jennifer was headed back to the States after spending the Thanksgiving weekend in Marrakesh, Morocco at the grand re-opening of the La Mamounia hotel. Jennifer always has classic great style! Buy these jeans at Singer22.
Photos Courtesy of Wenn.com


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In the transition away from gas, California must not leave low-income people behind.
CalMatters By Carmelita Miller and Matthew Tisdale California has passed dozens of laws designed to create a 21st Century clean energy economy, earning a reputation as a global climate leader in the process. But this work does not end with…
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Set photos of Mel Gibson shooting Edge of Darkness along with John Travolta and Jonathan Rhys Meyers on the set of From Paris With Love.
"The next 'Futurama' direct-to-DVD film, "Into the Wild Green Yonder", will feature none other than 'Family Guy' creator Seth McFarlane…" (full details)
"Colin Trevorrow will adapt Scott Christian Sava's graphic novel "Pet Robots" for Walt Disney Pictures. The high-tech comedy follows four students who get lost on a field trip at a toy company and bond with four military robots. Chris Bender and JC Spink will produce…" (full details)
"28 Days Later" director Danny Boyle has expressed interest in directing the third installment of the franchise: "I'd certainly like to. I feel the idea is quite a strong idea, and it could well involve directing it. Yeah, absolutely"…" (full details)
"Ennio Morricone has apparently agreed to score Quentin Tarantino's "Inglourious Basterds", a surprising change from previous Tarantino films which have generally used pre-existing songs for their scores…" (full details)
"Hilary Duff has signed a deal with NBC to star in a new series. Under the terms of the one-year talent and development deal, the network will develop a show starring Duff; the actress will also be tapped to guest star in various current NBC shows…" (full details)
"Pamela Anderson will make a cameo appearance in an upcoming episode of NBC's freshman comedy series "Kath & Kim," playing herself in a scene with celebrity-gossip obsessed characters Kath (Molly Shannon) and Kim (Selma Blair)…" (full details)
"Musician John Mayer will host a weekly variety show for CBS that could start as early as February. The format will be a music, variety and sketch show in the '60s mold…" (full details)
"Dexter star Julie Benz has officially joined the cast of Troy Duffy's "Boondock Saints II: All Saint's Day". Julie plays Unis Bloom, Paul Smecker's (played by Willem Dafoe in the original film) protege…" (full details)
"The Weinstein Company (TWC) have partnered with Cheech Marin, Tommy Chong, and their managers Ben Feigin and Josh Klein to produce a concert movie to memorialize the comic duo's reunion and first tour together in 25 years. The feature-length program, which will portray a live concert experience of the Cheech & Chong: Light Up America tour, is expected to make a major TV premiere, followed by the DVD release…" (full details)
"'It doesn't mean that he doesn't want to do it ever, but as of right now, he doesn't.' says a slightly too optimistic Joel Silver about Mel Gibson returning to do a fifth 'Lethal Weapon'…" (full details)


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Breaking News: IT Pro Cloud Essentials–Free cloud, education, and support!
This is big news! Today Microsoft is announcing a new subscription (but it's free!) for IT Professionals. The goal is to give IT Pros the tools they need to train, test, and eventually implement private and public cloud solutions. "Subscription? Sounds like TechNet is back!" Well, yeah, in a sense it is. It's no secret… Read more
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5 Easy Facts About clash of clans hack tool DescribedThere isn't any surveys to complete and no suspicious exe files to download that you should use this hack, it is convenient to use and all Clash of Clans gamers need to be capable of use it without any problems.
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This is the third year for the Japanese irises (iris ensata) in my garden. I began by using the irises along the dry stream. I am gradually dividing the clumps each fall. These divisions have been planted in groups along a garden path.
Of the three irises that I grow, my favorite is a lavender-blue, but the only one positively identified is the white 'Mount Fuji'. Although the blooms don't last very long, the foliage remains beautiful until fall. Most of the time, the irises are ignored by the deer, but an occasional bloom may be picked. I've not had sufficient damage to be deterred from growing the irises and consider the perennials to be deer tolerant.
Japanese irises prefer rich, moist soil, but mine easily survived drought, once they were established. Growing in full or partial sun in zones 4-9 and reaching heights of 24-36 inches, these are easy perennials to use in the garden.
The irises are great plants to use with coneflowers (echinacea) and bee balm (monarda) for a similar bloom time. I also use swamp milkweed (asclepias incarnata) for summer bloom and recently added joe pye weed (eupatorium dubium) as a fall bloom companion.
|Words and photos by Freda Cameron, Defining Your Home, Garden and Travel.


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Just dropping a quick reminder that I'll be completely offline Sunday, March 1.
I don't know exactly how long it's been since a day went by that I didn't touch the Internet at all, but it might be a decade or longer.
"See" everybody Monday.
Just dropping a quick reminder that I'll be completely offline Sunday, March 1.
I don't know exactly how long it's been since a day went by that I didn't touch the Internet at all, but it might be a decade or longer.
"See" everybody Monday.
Dad sent this poignant video of comedian/commentator Louis C.K. on Conan O'Brien my way a week or so ago.
I've written and said several times that one of the most tragic things about growing up is that it takes more and more to truly impress you. When the world loses its newness, it can take a little effort to rediscover the marvels of everyday life.
Isn't it worth it, though? Technological advances are easy to miss because they're gradual and ever-evolving, but take a snapshot of your life today and try to think back to a typical day of 20 years ago. There's a hard drive in your iPod that wasn't available for any computer at any price until very recently. When was the last time you considered how incredibly complex, yet freakishly reliable, your car is? Do you even remember what it feels like not to have access to a robust World Wide Web? I've written about that one before.
Louis C.K.'s comments on air travel really ring true with me. I don't care for all of the logistics of flying, and I really dislike the near-fully relinquished control. But wow, the actual act of sitting in that airplane and looking out the window still rocks me. Flying home from Atlanta—a common last leg of any trip that only takes about half an hour—I usually look out continuously. I don't expect I'll ever "get over" that, because I don't intend to.
The wonder isn't only looking up into the heavens, or feeling the ocean lapping at your toes, or gazing out across a tree-lined valley. Sometimes it's on an IC in your pocket. That wonder is just as genuine, if you remember to consider it.
We're waiting for what looks to be at least another inch of rain. I hope it hits right when I put my head on my pillow. "They" are sticking to their forecasts for snow tomorrow night. We're running out of winter. Might be our last shot.
I'm coaching Nathan's Upward team again tomorrow morning. Tomorrow afternoon Lea and her sister are taking the boys to the circus. I don't carry huge disdain for circuses around with me, and objectively I think I understand their appeal; they've just never been my thing. As a tot I went with my friend Edwin, who always tilted his head back to look at you because his mother never kept his bangs cut. My most vivid circus memory is having cotton candy nastiness all over my hands and face.
(Now cotton candy is something I can't believe anyone likes.)
I've got some cleaning up and cleaning out to do, so maybe I'll use some of tomorrow's alone time on that. I'm also the last person in the Western Hemisphere who hasn't seen The Dark Knight, and that's waiting for me on Blu-ray.
Oh, and along with unplugged Sundays, I went ahead and tossed alcoholic beverages on the Lent abstention pile. (Well, I did fudge just a bit; Charles and I hung out last night, so I started today. I'll go until Tuesday after Easter.) I'm sure I'll reliably miss them, which of course is a large part of the point. Plus, subbing diet ginger ale for beer in the evening ought to pay a side dividend in my waistline if I keep everything else the same, right?
Have a good weekend.
If you haven't known me for at least 15 years, you wouldn't believe how much better I am at not sweating the small stuff than I used to be. Recently more than one person has actually hung the word "easygoing" on me.
(I shall now pause so that the aforementioned long acquaintees have a chance to compose themselves after fits of generous laughter.)
I suppose the wisdom that generally trends upward with age gets some of the credit for that, but Lea gets more.
Anyway, today was a day of relentless mini-tragedies such as I have not experienced in quite some time. "SHIT HAPPENS," the bumper sticker glibly reports, and man, did it ever today. As I type, I am exhausted, exasperated, and just feeling fucked with in general.
When I sat down to write this post, it was to be a venomous diatribe against rudeness and lack of consideration. Each of my slights was to be magnificently detailed so that you could feel my rage, and many comments of solidarity would roll in. Funny thing happened, though. As I started, I rapidly lost interest, and realized I wouldn't be writing the post in my head after all.
When I'm asked for advice, I do a lot of preaching about choosing your reaction. I'm generally good about that myself, but I missed it for most of today. A few minutes ago I realized that my anger was probably a) excessive; and b) threatening to compromise a nice night with the boys while Lea is at stained glass class.
So I'm not telling you what happened to me today. Instead, I'm telling you that I'm considerably calmer now than I was when I started typing, and that I'm going to try hard to remember today as an example when I'm faced with future quotidian adversity.
Hug your children. Have a cookie.


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U. Chicago and DePaul: Promoting the Terrorist NarrativeBy Sara DoganSeptember 26, 2017Campus Leftists and Their Dirty Tricks By Jason Mattera May 19, 2008 DePaul's "1984" Moment By Nicholas G. Hahn III January 24, 2008 Can't We Talk About This? By Robert Spencer October 25, 2007 DePaul Prof. Aminah Beverly McCloud: Pushing "Islamophobia," Obscuring Islamism By Cinnamon Stillwell October 22, 2007 The Israel Lobby Destroys Academic Freedom? By Anthony Paletta October 19, 2007 The Passion of Norman Finkelstein By Steven Plaut September 17, 2007 The Next Piece of Housekeeping for DePaul? By Steven Plaut September 6, 2007 Finkelstein's Sexism By Alan M. Dershowitz June 26, 2007 The Fight Against the Israel-Haters in Academia By Asaf Romirowsky June 15, 2007 DePaul Denies Tenure to Finkelstein By Jewish Telegraphic Agency June 11, 2007 Go Ahead, Circle Your Wagons around Finkelstein By David French June 6, 2007 Radical Reverse Psychology By Alan M. Dershowitz June 4, 2007 Student Group Petitions against Finkelstein By Jewish Telegraph Agency June 4, 2007 An Unstable Academic Threatens Alan Dershowitz By Steven Plaut May 24, 2007 Taking the Bait By Alan Dershowitz May 21, 2007 Democracy Not! By Alan M. Dershowitz May 16, 2007 DePaul's Disgrace By Marty Peretz May 12, 2007 Professor McCloud and PBS By Candace de Russy May 10, 2007 Academic Questions By The Jewish Exponent May 10, 2007 Finkelstein's Bigotry By Alan Dershowitz May 4, 2007 The Unsolicited Outside Letter; A Regular Part of the University Tenure and Appointment Process By Emmet Trueman May 2, 2007 The Finkelstein Affair By Steven Plaut April 23, 2007 A Bitter Spat Over Ideas, Israel and Tenure By Patricia Cohen April 12, 2007 Will America's Largest Catholic University Give Tenure to a Fan of the Hezbollah? By Steven Plaut April 5, 2007 Harvard Law Professor Works to Disrupt Tenure Bid of Longtime Nemesis at DePaul U. By Jennifer Howard April 5, 2007 CAIR vs. DePaul By Thomas Ciesielka November 14, 2006 DePaul Professor 'Defames Catholic Education,' Group Says By Nathan Burchfiel October 13, 2006 Drive to Reinstate DePaul Pro-Israel Prof Gaining Ground By PRWeb July 25, 2006 DePaul University Appeasement Goes on Trial By FrontPageMagazine.com June 2, 2006 DePaul University Political Correctness Faces Trial By Thomas Lifson and Richard Baehr June 1, 2006 Presumed Guilty By Jonathan Cohen March 16, 2006 DePaul Censures Anti-Affirmative Action Group By Nathan Burchfiel February 23, 2006 DePaul U Confronts Amerikan "Empire" By Steven Plaut January 3, 2006 Campus Left to Christians, Conservatives: Shut Up! By Mark Tapscott December 24, 2005 FIRE Challenges 'Censorship' At DePaul University NewsMax December 22, 2005 Teaching and Terror at DePaul By Thomas Ryan May 12, 2005
DeNial at DePaul: The Thomas Klocek Affair By Steven Plaut April 18, 2005 Academic Witch-Hunt at DePaul University By Steven Plaut March 22, 2005 Muzzled by Muslims By Joel Mowbray March 11, 2005 Academic Freedom for Some By David French March 4, 2004
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The Global Massage Chair Market 2016-2021 industry mainly includes a number of stocks and companies operating and following a number of techniques such as production, manufacturing, distribution, and sales of the different varieties of consumer goods throughout the globe in order to meet the supply and demand chain of the consumers. Not only is the increasing demand and technological innovation but also many others factors that help propel the growth and development of the global Global Massage Chair Market 2016-2021 market. The growth of the Global Massage Chair Market 2016-2021 industry also depends on the growth opportunities provided by the major players in the various regions across the globe.
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