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Entrepreneurs may be all smiles when they get an offer on 'Shark Tank,' but the deals aren't set in stone. And some contestants do in fact walk away.
At Lodge Manufacturing, America's only maker of cast iron cookware, quality and family are mission-critical beliefs.
The rate of startups by older Americans has outpaced other age groups in the last few years, but are down from their peak six years ago as baby boomers age.
Going paperless may be a good way to reduce costs, increase productivity and improve security.
Round House Jeans has grown from ranchers and cowboys to free spirits and trendy people around the world. All along it's stayed committed to quality.
GoDaddy pulls its Super Bowl ad in which a little, lost pup braves the elements, finds its way home, only to be sold online and shipped off to a new home.
Eli and Sher Valenzuela started First State Manufacturing in their tiny garage. Today, the company has major clients such as Amtrak and the U.S. Government.
The factory floor of Globe Manufacturing may seem like your average textile manufacturing space. But the work being done here is anything but ordinary.
A sneaker-loving teen is using the footwear to get a different kind of kick -- he's opened a pawnshop that uses high-end athletic shoes as collateral.
America's family-owned businesses are thinking positive in 2015. A deeper look shows why that is correct, and possibly not.
TMCO started in 1974 in a small shed, and its latest building is bigger than a football field. Its staff all along the way embodies the American Dream.
Banks can be stingy with loan money nowadays, but some companies are doling out cash for practically anything you want.
The growth in 3-D printing suggests a shiny future for Puris and its production of titanium powder with its one-of-a-kind atomizer.
Three childhood friends turn California dreaming into a fledgling business involving yerba mate, a traditional energy-booting tea.
Town and Country Surf is just miles away from one of the surf world's hottest spots, and that makes all the difference in their manufacturing process.
LendingClub has lots of copycats, offering low interest rates for personal, student and small-businesses loans.
A new family is leading the reinvention of Gamse Lithographing, a Maryland printer that had rethink how it does business in the Internet age.
At Brahms Mount in Maine, making blankets for a modern world still means using 70-year-old looms.
A decades-old boiler manufacturer and some young entrepreneurs strike up success with BattleBells for Mississippi State football fans.
A Kickstarter project for the Sonic Decanter says it can accelerate the aging process of wine by using ultrasonic soundwaves that break down preservatives.
How one small circuit board manufacturer changed its entire business model and weathered the Great Recession.
One man took a chance on reviving a dated textile mill in Rhode Island, and hasn't regretted his choice since. Here's the story of Colonial Mills.
One man took a chance on reviving a dated textile mill in Rhode Island, and hasn't regretted his choice since. Here's the story of Colonial Mills.
You have to break some eggs to make an omelet and, according to a lawsuit from the maker of Hellmann's, the same goes for mayonnaise.
Small-business optimism rose in October as more owners said they planned to invest in their companies and were having a harder time filling job openings.
New social toys from the Netherlands called New Born Fame let babies post to Instagram and tweet from the crib.
Small businesses boosted borrowing in September, pushing a key index to its highest level in more than 7 years, fresh data show.
Entrepreneurs must wear many hats, and one of the most important is money manager. Here's how to avoid six common mistakes.
You're just as likely to find Tabasco on a street cart in Taipei as in the U.S. Here's why the famous Louisiana hot sauce is famous worldwide.
Tabasco hot sauce seems simple enough, but the story behind this spicy condiment is much deeper than most could imagine.
To win against Amazon, small shops can focus on personal service, become experts in a well-defined niche and merchandise around the needs of core customers.


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quote: You can also get pork shanks from ready portions if you think the veal is too spendy.
quote:I'm working 70 hours a week right now. I can afford a splurge meal here and there.
quote:Well I like the tomato based. Brown nicely then add whatever you want and cover and cook about 300 slow, about 2.5-3 hours. They should be tender but not falling off the bone.
quote: Just remember this tip when the overtime at the plant is no longer available, you operators, that plant mentality dies hard. /
quote:no cream necessary
quote:where did you get the veal from?
quote: I can afford a splurge meal here and there.

subset: commoncrawl


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Phantom Shadow Entertainment
50 ReviewsDisc Jockeys, PhotoBooths, Uplighting & Unique Things
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Phantom Shadow Disc Jockey Entertainers, Kingdom PhotoBooths/Lounges, LED Uplighting, and Event Decor servicing Pennsylvania, Maryland, West...(more)
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It is our goal to create a unique and memorable wedding day for you, that is about you, and includes everything you want. When we meet with a...(more)
Party Booths has emerged as the largest and most distinguished provider of photo booth rental services in the entire nation simply because we...(more)
Event Central can help make your wedding day truly unforgettable. If you are looking for the perfect color swatch to match any elements included in...(more)
Cherry Lane Photobooths is the perfect addition to your wedding or special event! Your guests simply jump in the booth, choose color or black and...(more)
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When you contract with Cherry Lane Photobooths as well as Amanda Souders Photography for your wedding photography, you will receive $100.00 off of the rental.
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concert audio please?
concert audio please?
Well, mine has shipped, but has to travel across the country. I'm very much looking forward to watching!
It will make it on the web soon enough...
Daft Punk is playing at my house!
The footage is pretty good, I probably have a lower opinion of it than I should because the only other concert film I've ever seen is Stop Making Sense and that is just phenomenal. But the sound is amazing, they did a top notch job mastering this.
my copy arrived yesterday! haven't had a chance to watch any of it yet.
This should probably be in the confession thread . . .
I was watching an episode of Married to a Jonas and a commercial for The Soup came on. James was throwing his hands to the roof in the background.
Get a job, JIMMY!!! Or better yet, go back to your old one.
You can pre-order (12/18 release date) a beautiful coffee table photo book here!
Amazon $18.59: http://www.amazon.com/LCD-Ruvan-Wije...=IY2LCR8IADUM3
From 2004 to the day they quit, photographer Ruvan Wijesooriya navigated through both private and public moments with the influential, Grammy-nominated, NYC indie band. Ruvan was a fan, first and foremost, and quickly became a fly on the wall and instigator who brought new meaning to the term, "I'm with the band." His access and friendship with LCD is something rare in the commercialized and controlled music industry of today, and this close relationship can be seen in the rapport between photographer and subject. The locations include Hyde Park in London, various New York institutions, Coachella, Rick Rubin's recording mansion in the Hollywood Hills, Way Out West festival in Sweden, Miami Art Basel and more. In addition, the scope of the book goes beyond just photography and features various album art and original interviews with members of the band and showcases an exciting design by James Timmins, art director of Dossier magazine. A handful of these photographs were featured in the recent LCD film, Shut Up And Play The Hits, and others have appeared in Rolling Stone, Spin, The New York Times Magazine, and The New Yorker, but the vast majority have never been shown before, making this the ultimate must-have for every fan to remember the band.
ps DVD is super cheap on Amazon: $17: http://www.amazon.com/Shut-And-Play-...I2JY9DBJ6F26PM
audio of full show.
I didn't make this. Got it from Tumblr.
2 links in case 1 doesn't work.
hey. will you guys help me win? plz?
12.01 Dan Deacon @ The Echoplex
12.03 Benoit & Sergio @ TBA
12.09 Avery Tare @ The Center for the Arts Eagle Rock
12.17 Baths/DNTEL @ The El Rey
04.13-15 COACHELLA @ The Polo Fields
Voted for you. I like you are third at -6.
Can anyone ID the song in this video I took at James Murphy last year:
I want the DVD for Christmas, which one should I tell my husband to get. Are there different box sets? Is there one with a t-shirt? I know I could do the research, but you guys are a much more reliable source than the Internet.
There is only a DVD and Blu Ray version. Both contain the movie and the full concert I believe.
Weren't there some box sets with books and/or t-shirts? I really want a t-shirt.
you should probably ask for a t-shirt instead then.
I WANT IT ALL!!!! In fact, wrap James in some candy cane paper and put him under my tree.
There was a website that had tiered packages: http://www.pledgemusic.com/projects/lcdsoundsystem
Some came with a book, some a shirt, some a poster, some pictures, etc.
But in stores it's just the DVD or Blu Ray versions.
My opinion: The movie was just OK; but the audio for shut up and play the hits was horrible. Maybe I had to be there. What a way to end a lackluster, but momentarily exciting career.
Whiskey Sour
2 oz blended whiskey
Juice of 1/2 lemon
1/2 tsp powdered sugar
1 cherry
1/2 slice lemon
Shake blended whiskey, juice of lemon, and powdered sugar with ice and strain into a whiskey sour glass. Decorate with the half-slice of lemon, top with the cherry, and serve.
I somehow met rage patton at James Murphy in Vancouver last night. That was weird haha. Good to meet you dude!
Haha. Totally weird! But it was great to meet ya. I hope I didn't make an ass out of myself. I was pretty wasted last night.
Also, the James Murphy DJ Set was a lot of fun. Pretty much all disco with some house thrown in. It was a great atmosphere too. Met lots of really great people a pretty much everyone was talking about their various best LCD Soundsystem memories. All in all a great night.
Everyone was good and messed up that night. Definitely a fun time!
I really like LCD but how everyone acts about this temporary breakup annoys the fuck out of me.
Caribou @The Fillmore 03/01/15
The Pop Group @ GAMH 03/11/15
Swans @ Terminal West 03/28/15
Electric Wizard @ Slims 04/17/15
Acid Mother Temple @ BOTM 04/18/15
Faith No More @ the Warfield 04/20/15
John Zorn @ UCLA 05/02/15
Will Bulter @ Slims 05/26/15
Neutral Milk Hotel @ Pappy & Harriets 05/30/15
Mariah Carey @ Caesars palace 06/11/14
I just do not believe it.
Caribou @The Fillmore 03/01/15
The Pop Group @ GAMH 03/11/15
Swans @ Terminal West 03/28/15
Electric Wizard @ Slims 04/17/15
Acid Mother Temple @ BOTM 04/18/15
Faith No More @ the Warfield 04/20/15
John Zorn @ UCLA 05/02/15
Will Bulter @ Slims 05/26/15
Neutral Milk Hotel @ Pappy & Harriets 05/30/15
Mariah Carey @ Caesars palace 06/11/14
Arcade Fire's manager Scott Rodger:
They're in with James Murphy on three or so songs, plus Markus Dravs who is a long-time collaborator. They write too many songs - that's a good problem to have. There's around 35 songs with Arcade Fire, two albums'-worth for sure.
that is not an appropriate use of this thread.


text:
Well, you say all that, but in the end, we're going to write it the way we want to anyway. We're not taking fan suggestions yet, if at all. In fact, you telling us what you want to see us write is the equivalent of going to a comic-book convention, stopping by the Action section, and telling the artists they should do more "Pretty Girl" or "Shojo" genres to get your attention. Doesn't that seem a little arrogant?
stopping by the Action section, and telling the artists they should do more "Pretty Girl" or "Shojo" genres to get your attention
If you don't like the way I write, by all means, lend some criticism. I'm open to discovering my weak points.
Here, the Machine is not trying to kill either of the girls. It wants to control them.
So, we're being as original as we can. It's hard to come up with a new idea that's never been done before, especially when you DON'T KNOW what's original and what's not.
do you have more specific critiques in mind, and especially critiques regarding the arrangement of the words themselves?
That cult would never die till the stars came right again, and the secret priests would take great Cthulhu from His tomb to revive His subjects and resume His rule of earth. The time would be easy to know, for then mankind would have become as the Great Old Ones; free and wild and beyond good and evil, with laws and morals thrown aside and all men shouting and killing and revelling in joy.
He took off her reading glasses and rubbed her eyes in contemplation.
Q.U. wrote:So it does update eventually.
Many poetic retardations, which isn't really my forte, since I'm not a good reader and sometimes lose track of the plot. But interesting nonetheless. And "General"? It's unlucky that we get no intro on who is who and doing what, all left for speculations. And narration swiftly retreating to behavioural whenever we see people whose intentions and motives are to be kept secret for the time being.
Blood Lord wrote:Not bad Ruff.
Although the poetic descriptions played hell with my ability to keep track off things.
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4 Best Move Launch TitlePhiluk19 | 09/10/2010 | See all Philuk19's reviews (6)Sports Champions is the must buy Move launch game. If your picking up Move you need this game or be disappointed with other lack luster titles.The main reason sports champions is so good is that it uses the hardware properly, when set up right it works a dream and you feel you have full control.Their are 6 sports and they range in quality, the best of the bunch being Gladiator Duel, Table Tennis, Archery. Disc Golf, boules and volley ball can be fun but very dull at points. Gladiator Duel is bags of fun and you feel right in the action and breaking a sweat a few fights in. The worst game boules its just too boring and the creators really missed a trick by not including bowling and boxing.The downsides of this game are that its a very bare bones package, their is little variety and seems fairly generic. At least 10 sports should have been included but will most likely be added with DLC.A perfect use of the Move controller and alot of fun to be had, but don't expect a game packed with content.4/5
5 BRILLIANT !!peckers | 17/09/2010 | See all peckers's reviews (60)This game is so much fun, all of the events are just great. The playstation move is OUTSTANDING.
5 Best thing about the Movejoeriddell16 | 16/10/2010 | See all joeriddell16's reviews (58)Similar style game to Wii Sports. Archery, Table Tennis, and Bocce are my particular favourites. Really enjoyable game, and fun to play with others. The Bocce makes you feel like you're actually playing it, and the power which you put onto the throw equates to what you actually see on the screen. The distance can change with the slightest of touches too.A very enjoyable game.
5 @ Crazypossesufy1000 | 26/09/2010 | See all sufy1000's reviews (4)The navigation controller is not compatible with this game. You'll need two motion controllers for Gladiator Duel.
5 FantasticMonkeyFud | 18/09/2010 | See all MonkeyFud's reviews (4)Works perfectly with theMoove, much bette rthan anything on the nintendo Wee. Great game, the gladiator game will get you hot and sweaty, the Bowls game will let you chill and the archery in brilliant! If you are unsure which game too get for the Move first, get this.Also, if you have the old EYE PET GAME, you can download a FREE UPGRADE tomake it Move compatiblle from the Playstation Network store!


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World Market® Breakfast Blend Coffee, 12 oz.
Great hostess gift!
I've enjoyed many different flavors of coffee from WM for years and the Breakfast Blend is right there at the top. I was so sad when the store located an hour from me closed and now the closest store is 3 hours away! However the only purchase was quick and easy and I had free shipping! My hostesses truly enjoyed the 'Coffee Basket" we gave them!
September 13, 2013
Good Coffee
We like this coffee and the french roast as well. We usually buy both and switch off.
I love the size of the package, great to stay fresh.
I especially love when they go on sale buy one get one free :)
I usually stock up.
We are members of the World Market Explorer, coffee club which is great, you buy so many and they will send you a coupon for another one free. Great deal and for something like this that we use daily makes it a terrific reward.
This is high quality coffee. Would highly recommend. Nice to make gift baskets as gifts with as well.
January 23, 2013
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RSA provides funding to the National Clearinghouse for Rehabilitation Training Materials to link people looking for jobs with state vocational rehabilitation agencies with job openings. In addition, the link allows graduates who received scholarships under an RSA grant to post their availability for review by state vocational rehabilitation agencies and providers of services to state vocational rehabilitation agencies. Click the button below to enter the job link website and find out more about these services. While RSA provides funds for this effort, it cannot ensure the accuracy and validity of the information provided at that site. Clicking the button will also take you out of the RSA, OSERS and U.S. Department of Education's Web site (you may want to bookmark this site before leaving).
Enter National Rehab Job-Link


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HIV Testing and Counseling as Prevention
I. Definition of the Prevention Area
As a stand-alone intervention, HIV testing and counseling (HTC) contributes to prevention of HIV transmission by identifying and informing individuals, partners and couples, and families of their HIV status and counseling them to develop appropriate sexual, injection, or other risk-reduction measures. These measures differ according to the serostatus of the individual or of couples, be they seroconcordant (both partners test either HIV-positive or HIV-negative) or serodiscordant (one partner tests HIV-positive and the other tests HIV-negative).
HTC is also a prerequisite to accessing such services as antiretroviral therapy, prevention of mother-to-child transmission, and voluntary medical male circumcision. Successful linkages to clinical and community-based prevention, care and support, and treatment services are important for any effective HTC program.
II. Epidemiological Justification for the Prevention Area
The evidence on whether HTC directly affects HIV incidence is mixed. However, studies show that HTC may have the greatest effect on sexual transmission of HIV for two population groups in particular: adult individuals who test HIV-positive and serodiscordant couples. In addition, some studies show a reduction in sexual risk behaviors for HIV-negative concordant partners who are tested together using couples HTC. Other studies suggest reductions in risk behaviors after HTC (e.g., reduction of unprotected sex or in number of sexual partners).
Studies on HTC among people who inject drugs are usually conducted in the context of other services--such as detoxification or drug treatment centers, and needle and syringe exchange--and reveal mixed results. Findings suggest that safer injection practices following HTC may occur when HTC is available in the context of other harm reduction services. Serosorting, when HIV-positive persons seek sexual partners who are HIV-positive, is another demonstrated behavior following HIV testing. The literature is strongest among men who have sex with men, but recent discussions suggest that individuals in generalized epidemics may also use this strategy.
III. Core Programmatic Components
HTC is available through a wide variety of delivery models. HTC can be accessed through providers or can be initiated by clients. Provider-initiated HTC uses "opt-out" testing, which is when all adults and adolescents (with or without symptoms) are tested for HIV as part of their overall health care unless the patient declines. Informed consent is stressed for this method. Client-initiated HTC is when an individual wants to get tested and searches for the best HTC center for him or her. This could include a stand-alone voluntary counseling and testing site, provider-initiated HTC site, or a community-based HTC site such as a mobile or workplace HTC.
HTC should be specific to the type of epidemic, population, and level of risk. In concentrated epidemics, offering HTC at specific sites, such as outreach centers or mobile facilities, may be the most effective way to reach hard-to-reach populations. The World Health Organization (WHO) states that provider-initiated HTC should be considered for sexually transmitted infection and tuberculosis clinics, for services for most-at-risk populations, and for childbirth, antenatal care, and postpartum services for concentrated and low-level epidemics. In generalized epidemics, WHO recommends providing provider-initiated HTC at all clinical settings, including services for sexually transmitted infections, tuberculosis, and antenatal care, as well as in- and outpatient services. Offering stand-alone, mobile, and home-based testing for harder-to-reach populations--such as rural or higher-risk groups--in generalized epidemics has also demonstrated increased uptake of HTC. For mixed epidemics, HTC programming can use a range of these options based on the epidemiological and social context of the country.
HTC minimum standards follow international guidance and include pre- and post-test counseling or information as well as referral and linkage to HIV prevention, care, support, and treatment services. The type of test (e.g., rapid testing with same-day results) also affects how successful HTC is in delivering high-quality test results and services. WHO guidelines recommend that post-test counseling be provided regardless of test result and should include an explanation of the test result, advice on risk reduction, and the provision of condoms and referrals. For those testing HIV-positive, counseling should also include emotional support, discussion of the patient's safe disclosure to others of his or her HIV status, and referral of the patient's partners and children for testing
IV. Current Status of Implementation Experience
To resolve questions about the impact of community- versus clinic-based HTC on the behavior of HIV-negative individuals, the U.S. National Institute of Mental Health sponsored Project Accept, the first randomized controlled study to determine whether behavioral changes encouraged by HTC reduce HIV incidence. The study was conducted in 14 communities in Thailand and 34 communities in sub-Saharan Africa. Each community was randomized to receive both community- and clinic-based HTC or clinic-based HTC alone. The study ended in 2011. Incidence data are not yet available, but interim results show that uptake of first-time testers is greater in the community- and clinic-based HTC sites compared to clinic-based HTC alone. WHO is also coordinating the MATCH Study, a multi-country, mixed-methods study of HTC models evaluating a range of variables, including service quality, uptake, health behavior, and equity. In 2011, data collection was ongoing in four countries: Burkina Faso, Kenya, Malawi, and Uganda.
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This study used data from 600 young people aged 18 to 24 years collected using a 10-year, retrospective life history calendar. It found that 64 percent of females and 55 percent of males had tested for HIV at least once in the previous decade, and that 40 percent of the females were pregnant in the month of their first test. Among women who had ever been pregnant, a recent HIV test was associated with lower odds of unprotected sex, whereas among those who had never been pregnant, it was associated with higher odds of risky and unprotected sex. Among males, a recent HIV test was associated with increased likelihood of concurrent sexual partners. However, repeated HIV tests were associated with lower likelihood of concurrent partners or risky sex six months later. The authors conclude that while HIV testing and counseling (HTC) may not have any immediate impact on behavior, repeated HTC over the long-term may increase the adoption of safer sex practices. A primary weakness of the study was that authors did not know the HIV status of the respondents, which could have shed additional light on the sexual and HTC practices among these youth.
This systematic review and meta-analysis of 19 studies assessed whether positive prevention programs in developing countries are effective and looked at the ways in which such programs differ from those targeted at HIV-negative individuals. Nearly all the studies reviewed were conducted in sub-Saharan Africa and examined HIV testing and counseling interventions, including HIV-positive and HIV-negative individuals and serodiscordant couples. Four pooled studies including over 4,000 participants found that condom use increased among HIV-positive individuals, but no change was evident among HIV-negative people. Among interventions targeting HIV-positive people, seven combined studies of 1,800 people found a strong and significant effect on condom use, with the greatest effect on serodiscordant couples. The researchers concluded that positive prevention indeed impacts HIV risk behavior, particularly in serodiscordant couples. Study limitations included few randomized trials, primarily self-reported outcomes, and studies that were generally not very rigorous. Furthermore, all but one study only included heterosexual couples, thus neglecting many important high-risk populations.
This study assessed behavioral outcomes after provider-initiated, routine HIV testing and counseling (HTC) while people were seeking care in an outpatient center of a rural hospital. The 245 participants underwent routine HTC and were followed up after three months, when they completed an interview about their sexual behavior since they were tested. Regardless of their own HIV status, at follow-up participants were significantly more likely to know their partners' HIV status than at baseline, but still only a third knew their partners' HIV status. Married or cohabitating individuals were more likely to find out their partners' HIV status, but women were two times less likely than men to know their partner's status after HTC. While HTC had an effect on risky and safe sexual behaviors among certain groups in this study, it was not statistically significant and reached only 4 percent across all study participants, with half of all participants still engaging in risky sex. The authors conclude that provider-initiated HTC has the potential to increase testing, especially among first-time testers. This study only followed participants for six months, limiting the degree to which the findings can be generalized.
This article presents the long-term findings from a prospective study of the pre- and post-test sexual behavior of 801 participants, of whom 151 were infected with HIV. It found that among women in this subgroup, the percentage who reported any unprotected sex in the previous month dropped from approximately three-quarters before they were diagnosed to just over half 12 to 16 months after diagnosis. This change occurred due to a reduction in overall frequency of sexual intercourse and also an increase in condom use. However, uninfected women did not report a change in their behavior pre- and post-test. One of the report's strengths is that its results are more generalizable to African women compared to previous research, which has focused on high-risk populations. However, the self-reported nature of the data means that it may be subject to bias.
This paper argues that serosorting, whereby people select their sexual partners so that that they share the same HIV status, should be included in evaluation studies on the impact of HIV testing and counseling (HTC). Serosorting as a HIV prevention strategy is typically associated with men who have sex with men, and sexual behavior surveys are not designed to detect this activity in generalized epidemics. The omission of this information so far has undermined the findings of HTC evaluations for two reasons, the authors state. First, it creates a bias by omitting a significant variable, as seroconcordant couples may not take precautionary measures. Second, concentrating on the impact of HTC on individual behavior ignores the potential benefits at the level of sexual networks and populations. Including serosorting in evaluations could overcome this limitation. If serosorting was included in the evaluation process, the impact of HTC interventions on behavioral change could be more accurate, the authors conclude.
This paper reviewed the evidence for HIV testing and counseling (HTC) as prevention in developing countries/emerging economies between 1990 and 2005. Seven studies met the inclusion criteria for the meta-analysis. HTC had no effect on the number of sex partners among three pooled studies, but a statistically significant modest reduction in unprotected sex among seven pooled studies. Most of the people adopting condom use were HIV-positive individuals and serodiscordant couples. These studies all had a year or less of follow-up, took place before antiretroviral therapy became widely available, and were not very rigorously designed. The authors conclude that their analysis provides moderate evidence for HTC as an intervention strategy. However, there was no evidence that HTC caused an increase in risky behaviors.
This study assessed integrating HIV testing and counseling (HTC) into two rural and one urban government primary health care centers in Kenya. Among 401 adults successfully followed up, there was a significant decrease in sexual partners among those who had two or more sex partners six months after the study. While unprotected sex with any partner decreased significantly from baseline, rates remained high at 89 percent. Although the mean number of sexual encounters remained the same for primary and nonprimary partners alike, there was a trend for increased condom use with nonprimary partners at follow-up. Like all studies using self-reported behavior, there is potential for misreporting, and this study would have been stronger had it used biological endpoints. Furthermore, people who obtain HTC may be different from the general population, limiting the generalizability of the findings. The authors conclude that HTC can be a valuable component in HIV prevention efforts in primary health care health centers.
This analysis compared HIV infection rates among employees in 22 Zimbabwean businesses randomized to intensive HIV testing and counseling (HTC) or standard HTC. Among nearly 3,000 participants initially testing negative, 71 percent underwent HTC in the intervention arm compared to only 5 percent being tested in the standard arm. Despite this significant difference, HIV incidence remained the same in both arms after about 5,000 person-years of follow-up. Limitations of this study that must be considered include virtually all male participants, no couples counseling, and the inability to assess whether HIV-positive individuals transmitted HIV to others. Because this was only the second randomized controlled trial on this subject at publication, the authors concluded that more data are needed to understand the impact of a negative HIV test result on risk behavior so that HTC programs can maximize benefits while minimizing the potential for harm.
This study assessed HIV testing and counseling acceptance and its impact on the sexual behavior of rural Zimbabweans. Baseline and follow-up data were collected for nearly 6,000 participants who reported having an HIV test two or three years prior to being interviewed. Women who received a positive HIV test reported a significant reduction in risky behaviors, including fewer partners and more condom use than at baseline. Participants with a negative result were significantly more likely to have a partner in the last month, multiple concurrent partners, and a greater total number of partners than they did in the previous year. Despite these self-reported changes in behavior, HIV incidence was the same among all groups. The authors hypothesize that a negative HIV test result may have the unintended consequence of being interpreted as permission for future risky behavior. However, the study is considered to be highly controversial because most of the findings were not statistically significant. Moreover, it is not clear from the paper whether or not partner reduction was a critical message in the counseling process, conducted between 1998 and 2000. To date, the evidence of risk compensation as a result of HIV testing and counseling is inconclusive.
This longitudinal cohort study of 1,220 men and women looked at whether HIV testing and counseling (HTC) had an impact on risky sexual behavior by comparing responses from those who underwent HTC and those who did not. Participants were asked about condom use in both paid and unpaid sexual encounters. Both groups reported increased condom use at four months versus baseline, and the HTC group reported further increases from four to six months. HIV-positive participants reported a greater increase in condom use. However, those in the non-HTC group only reported an increase from baseline to four months. Moreover, whereas both men and women in the HTC group reported more condom use, only men did so in the non-HTC group. The study was subject to several limitations--sample size was small when the data were broken down by gender, site, or HIV status, for example, and the HTC group was self-selected, making it subject to bias.
This prospective cohort study conducted in Chennai, India, looked at the effect of risk-reduction counseling on HIV incidence among 500 men and women at high risk of HIV infection. The criteria for being at high risk of HIV were five or more sexual partners in the past six months, history of sexually transmitted infections and/or sexual intercourse once a week with a HIV-positive partner of the opposite sex. The participants received risk-reduction counseling at baseline and again at 6 and 12 months. Both men and women reported reduction in the number of sexual partners and fewer sexual encounters with primary partners. Those with multiple partners and those who engaged in paid sex reported the greatest reductions. The authors conclude that such counseling is a useful tool for reducing risky sexual behavior, but they concede that other factors (timely management of sexually transmitted infections, free condoms, regression to the mean) may have been responsible for the change.
This study sought to assess the impact of involving partners in antenatal HIV testing and counseling (HTC) to see if this could overcome the reluctance of women who test HIV-positive to inform their partners and lead to increased uptake of perinatal interventions and condom use. The researchers offered women seeking antenatal care in a Nairobi, Kenya clinic information about HIV transmission and encouraged them to inform their partners about HTC. They were invited to return for HTC and other routine antenatal tests with or without their partner. Between 2001 and 2002, about 300 women and their partners went to the clinic for HTC. Although the majority chose individual counseling over couples counseling for their post-test results (62 percent vs. 38 percent), there were benefits to involving men either way: maternal nevirapine uptake, compliance with the nevirapine regimen, and avoiding breastfeeding were highest among those attending couples HTC, and rates were higher for those attending individual HTC than those whose partners did not come in for HTC. Furthermore, couples counseling was associated with a six-fold increase in condom use among HIV-positive women. Male uptake of HTC was poor in this study population, however, with less than one in seven partners coming in for testing.
This study looked at the impact of HIV testing and counseling (HTC) on knowledge of HIV and sexual practices in a cohort of tuberculosis patients in Abidjan, Côte d'Ivoire. After HTC, a significantly higher proportion of participants correctly identified modes of HIV transmission and prevention, and these improvements were sustained after four months. Reported consistent condom use during unpaid sex more than doubled to 24 percent among men, but there was no such change among women. HTC in the setting of a tuberculosis clinic was well accepted, the authors note. They recommend that similar programs should maximize the benefits by targeting subgroups with the lowest knowledge of HIV. The study findings were undermined by loss to follow-up, which was very high, perhaps due to lack of HIV counseling training for tuberculosis clinic staff.
This study of 963 HIV-discordant heterosexual couples in Lusaka, Zambia, looked at the effect of HIV counseling and testing on sexual behavior. The participants self-reported condom use and underwent clinical tests for sperm detected on vaginal smears, pregnancy, and four sexually transmitted infections (HIV, gonorrhea, syphilis, and Trichomonas vaginalis). Prior to HIV counseling and testing, less than 3 percent of couples reported using condoms, whereas the number exceeded 80 percent after. Those who reported 100 percent condom use had reductions in biological markers ranging from 39 to 70 percent. The markers were able to detect under-reporting (e.g., sperm, pregnancies, and HIV transmissions were all detected among couples who reported consistent condom use). DNA sequencing showed that almost 90 percent of new infections were acquired from the spouse. The study shows that biological markers can help identify under-reporting, the authors conclude, and they urge more work on strategies to encourage participants in future studies to honestly report their behavior.
To understand sexual risk behavior following HIV testing and counseling (HTC), over 3,000 individuals and nearly 600 couples in the capitals of Kenya, Tanzania, and Trinidad were randomized to HTC or information about HIV and condoms. At follow-up, approximately 7 and 14 months after baseline, couples and individuals in the HTC arm were both significantly less likely to have unprotected sex with nonprimary partners and less unprotected sex. Among HIV-negative participants, the proportion having unprotected sex fell by roughly a third for women and by a fifth for men, while among participants who were HIV-positive or who had HIV-positive partners, the reductions in unprotected sex were far more dramatic. Participants in the health information group who received HTC at first follow-up and were diagnosed as HIV-positive showed similarly reduced rates of unprotected sex at second follow-up. The authors conclude that HTC indeed helps motivate people to adopt protective behaviors and should be a standard component of HIV prevention strategies in developing countries.
Personalized cognitive counseling (PCC) targets the thoughts, attitudes, and beliefs that people employ when engaging in high-risk behaviors. This study of men who have sex with men attending publicly funded HIV testing and counseling sites in San Francisco assessed whether a single session of PCC was more effective than standard counseling in reducing unprotected anal intercourse among nonconcordant and nonprimary male partners. Men in the PCC arm reported statistically significant fewer episodes of high-risk sex at six months compared to baseline, with no change in the control group at this time. The PCC arm participants reported the same number of high-risk episodes at 12 months as they did at 6 months. Those in the control arm, however, reported a statistically significant decrease in high-risk sex acts from baseline. While the effectiveness of PCC needs to be validated among other populations, the authors posit that perhaps the emphasis of a specific, recent high-risk exposure was seen as more personally relevant. This may have offered participants the opportunity to understand something new about their decision making, prompting them to take action.
This study looked at whether the modest gains usually associated with interventions to reduce sexual risk taking among people who inject drugs were better over a longer timeframe. The study cohort comprised 800 HIV-negative people who inject drugs who were offered HIV testing and counseling and free condoms at regular intervals four times over a 16-month period. At each session, the participants self-reported their sexual behavior. There was no change in the proportion of participants--4 out of 10--who reported engaging in vaginal unprotected sex. However, participants who were identified as HIV-positive during the course of the study did report substantial increases in condom use with regular partners. There was an association between unprotected sex with casual partners and amphetamine use. The study shows that even over a longer timeframe, HIV testing and counseling does not reduce sexual risk taking among people who inject drugs, pointing to an urgent need for more effective interventions, the authors conclude.
This study of 1,800 people who inject drugs in Ukraine compared two models of HIV prevention: a standardized counseling and education intervention alone, or the intervention combined with individual outreach by former drug users. Both groups were interviewed using audio computer-administered self-interview to obtain information on demographics, health profile, use of drugs, and risk behaviors related to injection and sex. The participants were followed up after six months with a 90 percent recall rate. In both groups, there were significant reductions in needle and sexual risk behaviors, but younger people who inject drugs and those with a shorter history of injection drug use were more likely to engage in risky practices. While the findings were discouraging because they point to further escalation of the HIV epidemic among people who inject drugs in Ukraine, they were encouraging too because they proved that it is possible to implement community-based interventions in this setting.
The study sought to examine the differences between stand-alone voluntary counseling and testing (VCT), VCT offered through integrated facilities (provider- and client-initiated testing), and VCT offered through prevention of mother-to-child transmission services with regards to the various levels of consent, confidentiality, and referral to care offered by each and to assess if they met quality standards based on World Health Organization and Centers for Disease Control and Prevention guidelines. The study was conducted in four countries--Burkina Faso, Kenya, Malawi, and Uganda--to examine the differences across various settings. A client survey was administered to individuals at facilities who had either accessed VCT or had not. The survey included variables on socio-demographic information, HIV testing and counseling attitudes, and testing status. Those who were tested were asked about their experiences with pre- and post-testing, follow-up care, interaction with providers throughout the process, disclosure, and stigma. Data from 2,116 participants were included in the analysis. It was found that the majority of testers received the necessary components to HIV testing that are within the international guidelines, but improvements could be made. No one type of HIV testing service was found to be significantly better than the others. The study did not find breaches of conduct in terms of consent and confidentiality. In conclusion, based on this study, different types of HIV testing services can be scaled-up in countries to increase knowledge of HIV status and provide referrals to other HIV services.
Voluntary counseling and testing (VCT) has long been seen as a critical component of HIV prevention strategies worldwide, both as a first step to care and treatment and as a catalyst for behavior change. This systematic literature review and quantitative assessment examined VCT's efficacy in promoting change in HIV-related risk behaviors in low- and middle-income countries over a 20-year period (1990 to 2010). The authors chose 17 studies for qualitative synthesis (8 of which also underwent meta-analysis); all had either collected data on study participants before and after undergoing VCT, or compared individuals who had received VCT to those who hadn't. Five HIV-related outcomes were analyzed: HIV incidence, prevalence and incidence of other sexually transmitted infections (STIs), positive and negative life events, condom use and protected sex, and number of sex partners. The authors found no statistically significant differences in HIV incidence or in incidence or prevalence of STIs between participants who received or did not receive VCT. Of the two studies on life events, the authors found that individuals who didn't undergo VCT experienced a significant increase in negative life events. Other findings show that those who received VCT were more likely to disclose their HIV status, were significantly more likely to reduce their number of sex partners, and were more likely to use condoms.
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The Project Accept randomized controlled trial tested the hypothesis that voluntary HIV counseling and testing together with community mobilization would shift community norms and reduce HIV incidence. This paper is a qualitative examination of the seven community mobilization strategies used in the trial. Using semistructured interviews, the study found that no single strategy (out of stakeholder commitment, community coalition formation, community engagement, participation or awareness raising, involvement of leaders and partnership building) was used alone. The study identified three elements that are crucial to the success of community mobilization efforts. First, strategies evolved over time and were adapted during the process of community involvement. It also took time for acceptance to develop in communities. In addition, each intervention site had unique characteristics requiring tailored community mobilization efforts. Involving lay community members was crucial, the study found.
This paper presents interim analysis of randomized controlled trial, Project Accept. The trial compared the impact on HIV incidence of clinic-based HIV testing and counseling (HTC) versus community-based HTC. The study covered 32 communities, 10 in Tanzania, 8 in Zimbabwe, and 14 in Thailand with the intervention running over three years from 2006 to 2009. Those in the community-based HTC areas had a mean 40 percent higher likelihood of undergoing their first HIV test, compared to those in the community-based HTC areas. Uptake increased 4-fold in Tanzania, 10-fold in Zimbabwe, and 3-fold in Thailand. Almost four times more cases of HIV were detected in the community-based HTC areas, even though HIV prevalence was higher in the clinic-based HTC areas. The study's ability to mobilize large numbers of people to get tested has important implications for future HIV programming, the authors conclude.
This paper reports the first year results of a unique study: an international, multisite, community randomized control trial of a multilevel HIV structural prevention intervention. This community-level approach had three strategies: (1) community mobilization to increase HIV testing and counseling (HTC); (2) community-based mobile HTC; and (3) comprehensive post-test services. The study assesses whether, compared to people living in communities with standard HTC, those living in communities where community-based HTC is offered will have lower incidence of HIV and experience less stigma, fewer risk behaviors, higher rates of HIV testing, and more accepting social norms related to HIV. It also assessed the cost-effectiveness of the intervention. In the first year of the intervention, about three times more members living in intervention communities in Tanzania and Thailand sought out HIV testing; in Zimbabwe, the increase was 10-fold. First-year data suggest that this community-level intervention can create changes in social norms about HIV, and because of its low cost, can be replicated in resource-poor settings.
This review looked for randomized and nonrandomized (e.g., cohort and pre-/post-test) controlled trials of home-based voluntary HIV testing and counseling (HTC) in the published literature; the authors found only two studies from developing countries, and none from developed countries, that met inclusion criteria. The randomized controlled trial compared optional location-based and clinic-based HTC, and found that uptake was substantially higher in the optional location group. The pre-/post-test study found similar results: uptake of home HTC was higher than facility-based HTC. The authors conclude that given the lack of methodologically sound evidence, more studies are needed to determine the efficacy and cost-effectiveness of clinic-based testing versus testing on other sites, including the home. The review gives a useful summary of the different modes of HTC, including mandatory, voluntary, opt-out, and home-based testing and counseling.
The Rwanda Zambia Research Group at Emory University has several research projects underway to understand factors related to HIV transmission. This webpage summarizes a five-year project to promote HIV testing and counseling among cohabitating couples in Kigali, Rwanda, and Lusaka, Zambia. The group planned two community-oriented interventions to increase couples HIV testing and counseling, and also studied psychosocial and structural factors influencing condom use, regular follow-up, and biological outcomes of unprotected sex in serodiscordant couples, including couple communication, alcohol use, intimacy, and gender roles. Links to the project's progress reports can also be found from this page.
This document lays out a policy framework for countries to increase access to HIV testing and counseling (HTC), a key element of attaining the goal of universal access to HIV care. The target audience includes policymakers, national AIDS program planners, health care providers, and nongovernmental organizations in the HIV field in Europe. It is built around 10 principles, such as the position that scaling up of HTC is not only a public health priority but must also be a part of broader HIV prevention, treatment, care, and support efforts, and that HTC must take diverse settings and populations into account. It spells out the need to increase uptake of HTC among most-at-risk populations, the importance of informed consent, confidentiality, and elimination of coercive testing. The document also makes detailed recommendations to World Health Organization member states for each of the principles covered.
This document provides policymakers, HIV program planners, care providers, nongovernmental organizations, and civil society groups with information on how health care providers can initiate HIV testing and counseling among people who inject drugs. Developed specifically for the Asia-Pacific context, it can be used to help most-at-risk populations know their HIV status and access treatment and care. The document balances medical ethics and clinical, public health, and human rights objectives for reaching this special population. The primary components of this guidance include recommendations for testing and counseling people who inject drugs; process and elements of HIV testing and counseling; and programmatic considerations.
This technical paper systematically reviews the literature to identify best practices and recommendations on HIV testing and counseling (HTC) in prisons and other closed settings. Due to a lack of documentation of this issue in many low-resource settings, the literature review was augmented by findings from a discussion among experts. In addition to providing the findings of the literature review, this document provides 11 recommendations on providing HTC to this population. Recommendations include scaling up HTC, key principles of informed consent, code of conduct for health personnel in prison systems, and continuity of care once prisoners are released back into the community.
In support of multiple approaches to help people find out about their HIV status, the World Health Organization has published guidance on implementing provider-initiated HIV testing and counseling in health facilities. The guidance is divided by category of HIV epidemic: generalized, concentrated, or low level. It discusses to whom providers should recommend HIV testing and counseling as standard of care. Furthermore, the document covers the enabling environment needed for such a program and provides guidance on post-test counseling, frequency of testing, HIV testing technologies, programmatic considerations, and monitoring and evaluation. Any level audience, from policymaker to health care provider, can find useful information in this document.
A home-based HIV testing and counseling (HBHTC) intervention was implemented in two sites in Kenya to determine the up-take of testing as well as to assess HIV prevalence and referral success rates. Individuals were offered voluntary counseling and testing through counselors and, if they consented, data was collected on any previous testing and access to care and treatment services. All adults received HIV test results in their homes as well as risk reduction counseling. Those who tested positive were counseled and provided information on HIV services, offered a free CD4 count test, referred to the nearest facility for free care and treatment, and visited by a counselor one month after the test. There was an 81.7 percent acceptance rate of HBHTC in the participating communities (19,966 accepted out of 24,450 offered). The motivation for testing by the majority (84.9 percent) of acceptors was their desire to plan for the future. HIV prevalence was 16.3 percent among the participants, and the majority of those found to be HIV-positive were first time testers. About a third (38 percent) of those reporting to be in a couple were counseled and tested together, and 84.3 percent were HIV-concordant negative. Half of those who tested positive were visited one month after their tests. About a half reported attending a patient support center. In conclusion, the intervention was successful in contacting individuals who had never been tested and in identifying newly diagnosed HIV-positive individuals and linking them to care and treatment services.
The intervention strove to increase the up-take of HIV testing through its mobile voluntary counseling and testing (MVCT) centers by implementing community mobilization (CM) activities. The intervention was implemented in communities in rural Thailand from 2006 to 2009. Communities were randomly selected as control or intervention sites and were similar on measures including ethnicity, livelihoods, and health care services. Community Working Groups were established at each intervention site to increase involvement and facilitate activities. For intervention rounds one to three in the intervention communities, the CM teams went door-to-door and conducted small meetings to educate individuals about HIV and inform them about the MVCT centers. The MVCT services followed a few days later. Since the number of participants accessing MVCT was decreasing, the project's strategy was modified to implement larger-scale events, coupled with MVCT, during the last rounds of the project. It was found that about 17,000 individuals were tested, with the majority first time testers (61.1 percent). The project identified 136 individuals who were HIV-positive, and the majority did not have any signs or symptoms of AIDS. Participation did increase during the last rounds of the project based on the change of the CM strategy. Participants were younger in the later phases as well. It was found that CM can help educate communities about HIV and reduce stigma. When coupled with MVCT, up-take of testing can increase the identification of new HIV cases.
Men access HIV counseling and testing (HCT) services less than women do. Innovative strategies are sought to increase the uptake of HCT services by men. Past studies have demonstrated success in attracting men when HCT services were coupled with a conditional case transfer program. The retrospective observational study combined the use of incentives with a mobile HCT clinic. It then compared the enhanced intervention to a non-incentivized mobile HCT site and a stationary non-incentivized HCT site to explore which service was most accessed by men. All services were operating in poor underserved peri-urban sites. The stationary site included all men who came for testing on their own initiative. The mobile non-incentive site did not advertise or actively recruit clients. The mobile incentive-based HCT partnered with a local organization that worked with unemployed or under-employed men to encourage them to access the services. The incentive to accessing HCT was receiving a food voucher worth about US$10.00. Only men were included in the data analysis. All women, young men under age 15, and those of known HIV status were excluded from the data analysis. A total of 9,416 first-time testers accessed one of the three HCT services, with a higher proportion of self-reported first-time testers using the incentivized site compared to the non-incentivized mobile site. It was found that HIV prevalence among testers was the highest among those who received testing from the incentivized site (16.5 percent) compared to the stationary clinic (10.2 percent) and the non-incentivized site (5.5 percent). The incentive-based mobile HCT was successful in reaching higher-risk men who have never tested for HIV.
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This handbook is a practical guide for those involved in the improvement of HIV testing and counseling (HTC) services. It describes the quality assurance cycle and how to construct a quality improvement framework. To meet the needs of both public health systems and nongovernmental organizations involved in the delivery of HIV services, it spans the whole process of HTC, from point of entry to successful onward referral. Of particular interest to program managers is the outline of the main components of quality improvement in HTC, whereas service providers can make use of its practical tools such as logbooks, interview forms, and site assessment forms. There are also examples of a quality monitoring system and illustrations of the framework in action at service delivery level. A bibliography of recommended core and additional resources, as well as an extensive glossary, completes the document.
This set of resources can help trainers and counselors provide high-quality HIV testing and counseling services. The authors emphasize evidence-based counseling strategies that may reduce HIV transmission and include focused guidance on working with drug users and other most-at-risk populations. The HIV counseling handbook is a comprehensive resource package providing HIV counselors easy reference to key basic counseling processes and procedures. The trainer's manual has everything needed for an eight-day training course, including seven classroom days and one day for site visits. It contains 16 modules with session plans and interactive sessions and learning activities for the trainees. The toolkit includes useful forms and protocols, client education charts, and screening/assessment tools that can be used while counseling patients.
Developed primarily for experienced HIV prevention counselors, this curriculum and materials can be adapted to various country contexts when providing couples HIV counseling and testing. There is a manual for participants in training and another for trainers. The materials cover essential topics and activities for those counseling couples, and include prevention messages tailored to couples' life stages, mitigating tension and diffusing blame, and creating an environment safe for HIV disclosure to partners.
This manual and related materials form the basis of a comprehensive training course for HIV counselors in positive prevention. The positive prevention program aims to reduce HIV transmission by building the capacity of service providers to scale up HIV prevention counseling skills, integrating family planning and reproductive health needs, and involving people living with HIV as partners in health. This 10-day course includes 8 days of classroom work and 2 days of practicum. Modules address topics such as disclosure counseling, sex and sexuality, counseling serodiscordant couples, alcohol and substance use, and adolescent counseling. Participants develop action plans for integrating positive prevention counseling into their workplace once they return. There are downloadable manuals for trainers and participants.
Counseling youth about HIV requires different knowledge and skills than when counseling adults. This manual is a resource of best practices for offering HIV testing and counseling (HTC) services to youth for service providers at all levels. There are chapters on the differences in counseling youth compared to adults and specifically on HTC. Sexually transmitted infections, pregnancy prevention, life skills, and creating a referral network are also covered. A training guide is also available with this manual for use in training experienced HIV counselors on offering HTC to youth. Among other tools, the training guide includes slides, interactive exercises, and practice sessions.
This toolkit contains resources for those setting up or scaling up HIV testing and counseling services. Developed for program managers, implementers, and their partners, the selected resources offer practical guidance on planning and implementing HIV testing and counseling services in resource-limited settings and also includes tools for monitoring and evaluation. This document will be updated regularly to keep resources current.
This set of tools was developed to guide the delivery of essential prevention of mother-to-child transmission (PMTCT) messages. Answering the need for more educational resources for resource-constrained settings, they were developed specifically for both clinical and nonclinical health care workers, program managers, and trainers in the field of PMTCT. The goal is to increase the uptake of HIV testing by pregnant women and also their partners, increase the number of women who are aware of their HIV status, and facilitate PMTCT interventions. There are flipcharts, wall charts, brochures, and a reference guide. There are specific support tools for antenatal, labor and delivery, and postnatal PMTCT support. The resources are available on CD-ROM and also for download in low, medium, and high resolution.
Can Couples Testing Contribute to Achieving the AIDS Transition?
Over, M. (2010).
This study examines couples counseling within the context of the economic theory of asymmetric information as well as epidemiologic findings on its efficacy. Using observational data from several different countries, it suggests that the primary hurdle to HIV prevention is the lack of couples counseling. The problem of asymmetric information, when two people engaging in a transaction have differing amounts of information, is a driver to the HIV epidemic, the authors argues. Not knowing one another's status discourages the formation and survival of monogamous partnerships. Based on data from studies that find lower HIV transmission rates among serodiscordant couples than among couples who do not know their partners' status and from studies that find the majority of people obtain HIV tests individually, couples testing should be a priority for helping reduce the HIV epidemic, the author writes. In addition, he states that more rigorous research is needed around this issue of couples testing.
Behavioural Strategies to Reduce HIV Transmission: How to Make them Work Better
Coates, T. J., Richter, L., & Caceres C. The Lancet (2008), Vol. 372 No. 9639, pp. 669-684.
This article argues that the radical behavioral change that is needed to reduce HIV transmission requires radical commitment. Reviewing 25 years of HIV prevention efforts, the authors identify successful HIV prevention efforts and ways to improve behavioral strategies to reduce HIV transmission. They argue for the need to combine behavioral, biomedical, and structural approaches to effectively fight HIV transmission. To date, behavioral changes have reduced HIV in certain countries, regions, or subpopulations due to significant behavior changes taking place among a majority of the population; a mix of communication channels providing clear, actionable risk reduction and health-seeking messages that people can choose from; and local involvement in developing, producing, and disseminating the right messages. Sustained changes in risk behavior, however, have not been found anywhere, they note. The authors conclude that behavioral strategies must take place combined with different approaches and at multiple levels of influence.
World Health Organization, Department of HIV/AIDS
World Health Organization. (n.d.).
This webpage of the World Health Organization's Department of HIV/AIDS lists all testing and counseling publications starting from 2000. Readers can link back from here to the department's main counseling and testing page, which includes policy and guidance, advocacy, training materials, data on HIV counseling and testing, and more.
Zimbabwe HIV Prevention e-Toolkit
K4Health, 2012.
The toolkit offers a selection of different materials including research papers, books, training materials, and behavior change communication materials across the spectrum of HIV prevention topics. Readers can access materials and resources on behavior change communication, condom use, family planning and HIV service integration, male circumcision, multiple and concurrent partners, prevention of mother-to-child transmission, and voluntary counseling and testing.


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Reviewer: John Wilson, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: April 11, 2003
Authors: Adelstein D, Li Y, Adams G, et al.
Source: Journal of Clinical Oncology 2003; 21 (1): 92-98
Radiotherapy (RT) is the standard of care for unresectable squamous cell carcinomas of the Head and Neck, but the overall survival has been relatively poor, usually less than 25%. Efforts have been made to improve these results, including altered RT fractionation and using chemotherapy with RT, especially concurrently. There have been several studies looking at using cisplatin based chemotherapy concurrent with standard and altered fractionation RT, and they have shown promising results, with 4yr overall survival of 34-49%. Based on these studies, the authors started a study using a control arm of standard RT compared to two arms: standard RT with weekly high dose cisplatin, and split course RT with concurrent 5FU and cisplatin.
This study reports on a randomized trial investigating the use of chemotherapy in addition to radiation for unresectable squamous cell carcinomas of the head and neck. There was a significant survival benefit between the high dose cisplatin and control arm, but the study was underpowered and because of this used a one-sided p-value instead of the standard two-sided for their analysis. Therefore, this puts the survival benefit seen into some question.
The group C pts (split course with cisplatin/5FU) did not do as well as expected. One reason might be that during the break, not that many patients went to surgery, which was the main purpose of the break. It is known that doing split course radiotherapy is suboptimal in general, so this might have cancelled out any benefit that could be gained from surgery.
Before this study, high dose cisplatin was thought to be too toxic for oncologists to administer in a community setting, but this study shows the toxicity is manageable. This study and others support the belief that adding cisplatin to radiation is better than radiation alone. However, carboplatin is more widely used today (because of the decreased toxicity), without much supportive scientific evidence.
Jun 17, 2011 - Retreatment with concurrent chemotherapy and reirradiation may be a treatment option for a specific group of patients with recurrent or second primary head and neck cancer, although prior treatment with chemoradiotherapy is associated with worse overall survival, according to a study published online June 13 in Cancer.


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If you don't know what DECA is, well, you definitely missed out! DECA, which is previously known as Distributive Education Clubs of America, is a club on both the high school and collegiate levels for anyone interested in any form of business, whether it be marketing, distribution, accounting, economics, and more! I was a part of it during my senior year of high school, and I really regret not being a part of it before then. In fact, I've considered getting a group of friends of mine to start a Collegiate DECA chapter on campus!
It was actually this week of last year that I was able to attend the annual DECA International Career Development Conference (ICDC) in Salt Lake City, Utah! The week I spent in Salt Lake City at ICDC getting to network with members from other DECA chapters all around the world was awesome- and I revisit pictures, and even met a few people while I was at ICDC who were incoming freshman to Butler, too! Small world, right? I'm writing this as a "throwback" post because I currently have friend's at this year's ICDC, which is actually hosted in Anaheim, California, which is right outside of LA. Needless to say, I'm INCREDIBLY jealous, but I'm glad I got to experience Salt Lake City & all that DECA ICDC had to offer. Who knows, maybe ICDC will come to Indianapolis one day?


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Engineered for universal faces, mainly dedicated to men
The most versatile lens designed to adjust automatically to all light conditions. The lens darkens in solar conditions and returns to clear state in low light conditions. The photochromic lens offers the best vision in any kind of weather.
A silicon print applied in the internal part of the strap to have a smooth grip on the helmet
Double density PU foam (one for instant comfort and one for reactive support) with velvet layering for great skin contact
A valuable stretch woven strap for an attractive looking and matching with your helmet & beanie
A registered trademark, NXT® lenses. Spherical lens has a 3D rounded appearance, similar to human eye. Its sur-face is part of a sphere, which has the same radius horizontally and vertical-ly. It offers a wider peripheral angle of vision.
Over wide field of vision: greater field of vision thanks to the thickness reduction of the frame
Additionnal anti-scratch finishing with high resistance and long-lasting durability
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Barstool NYC Local Smokeshow of the Day – Faith
Introducing Faith from Warren, NJ. Faith. Such a beautiful name. And you better have a lot of faith in the Lord Jesus Christ for him to answer your prayers that you end up with a girl half as hot as Faith.
Not sure how many girls on the planet are hotter than Faith, but if you know any, email firstname.lastname@example.com with first and last names and a facebook profile link.


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Wooden Milk Container Set & Wooden Egg Set
- Overview
Our wooden food sets offer lots of options for crafting make-believe meals.
- Crafted of solid wood.
- Set of 6 eggs come in a crate and can be "cracked" to reveal a Velcro yoke center.
- Set of 4 milk bottles.
- Ages 3 and up.
- WARNING: CHOKING HAZARD – Click for details.
- Dimensions & Care
- Egg (6): 1.5" diameter, 2.5" high
- Crate: 4" wide x 5.5" deep x 2.5" high
- Milk (4): 1.5" diameter, 5" high
- Dust with a soft, dry cloth.
- Shipping Info
Please allow 5-7 business days for delivery. Delivery estimate includes monogrammed and gift-wrapped items.
International Customers: Items on this page are not eligible for Free Shipping. Please view our general guidelines for more information.
Wooden Milk Container Set
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Wooden Egg Set
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Peter Shumann Receives Activism Award
Peter Shumann Receives Activism Award
Goddard Videos
I extend my greetings and warm welcome to all the village that is in this room ‐‐ Goddard past, present and future. Before I present this award to Peter Schumann, I want to especially welcome and acknowledge Elka Schumann a woman who in her own right has touched and made a difference in the lives of so many.
Many of us here today share the experience of awe, vulnerability and gratitude, as we have looked skyward to see a man dancing fluidly, while perched precariously high above the fray, artfully cloaked in our national symbols.
On his, what appear to these eyes to be, 150 foot stilts Peter Schumann courageously and deftly navigates spaces where few of us dare to go ‐‐ a vantage point where he clearly and astutely sees the forest for the trees. The height to which he travels, the risks he takes in doing so, benefit us all as we are gifted with a critical perspective not easily accessed when living amidst the trees.
We are here today to celebrate, to honor and to thank artist, activist Peter Schumann for his willingness to risk these heights, few people are.
In preparing for this award ceremony I had the deliciously synchronistic pleasure of reading an essay by Chris Hedges titled How to Think. Hedges speaks eloquently about the vital role of artists in society to confront unexamined assumptions. He tells us that just as individuals do, human societies tend to see what they want to see. They create national myths of identity out of a composite of historical events and fantasy narratives that, if not challenged, lead to destruction.
Hedges asserts that Cultures that endure carve out a protected space for those who question and challenge national myths. Artists, writers, poets, activists, journalists, philosophers, dancers, musicians, actors, directors and renegades—that just about covers everyone in this tent tonight-- must be tolerated if a culture is to be pulled back from disaster. He points out that these artist renegades serve as prophets and are therefore dismissed, labeled by the power elites as subversive. Given the harsh realities of Peter's earlier life I would add that soicety's wrath does not stop at dismissing the voices of subversives, as we know about so many who have suffered at the hands of those who would silence them.
Reading Hedge's essay confirmed for me what we know here at Goddard and most particularly in this MFAIA program that visionary artists like Peter Schumann are our sharpest eyes, our keenest ears, our most adept linguists as they see that which has been made invisible or unwelcome, they hear the voices missing from our dominant narratives and they speak in languages that pierce unconsciousness and translate slick sound bites into nuanced and deeper understandings of our world.
In a cautionary voice Hedges also describes the threat of destruction to human societies that do not protect this sacred space. This space is essential particularly today in a polarized world of simplistic messages, where daily we are bombarded by glib words and images that can keep us from knowing the complexity of our individual and collective realities.
Schumann is a master creator of such spaces. His life has been devoted to nurturing, cultivating and demanding this sacred space in our society. He knows the imperative for doing so. He witnessed first hand the thin veneer of democracy give way to fascism.
He also knows the artist's impatience with what Hedge's terms the "stultifying halls of academia" where in places other than of course at Goddard, mediocrity is often triumphant. It is what led him to eschew the classroom of his youth and join the circus.
In fact, Peter created the circus--Bread and Puppet was "born" in 1963 and we are privileged that in 1970 they accepted the invitation to come to Goddard and be the College's first theater-in-residence.
Peter, you were so much more than that… Today we recognize the vital role that the circus, Bread and Puppet served in evolving Goddard's activist mission to take imaginative and responsible action in the world.
During their time at Goddard, hundreds of students participated in workshops, parades, demonstrations and toured with the Theater. As we begin to celebrate our 150th anniversary we honor the importance of your part in our evolution.
Many of our alumni still work with or have strong connections to the Theater. Your art has advanced Goddard's commitment to prepare an informed citizenry to hold dear and protect the space of a participatory democracy.
Over the course of its 50-year history, Bread and Puppet Theater has participated in thousands of protests, parades, marches, pageants and circuses across the globe. But more importantly through the powerful medium of art has woken up audiences all over the world to the subtle and not so subtle oppressions that continue to plague us. The company has inspired countless activists and artists to take imaginative action with the goal of creating a more just and sustainable future.
This award is more than a reflection of our gratitude. I hope it speaks loudly and clearly about the central importance of your life's commitments. You have protected "the" space in our society.
The space where art captivates our senses, bypassing well honed denial filters and helps us make meaning of that which we suffer and is not easily named.
The space in which sound wakes us up to listen beyond the noise,
The space in which vision sees behind the scrim.
The space where voice truth-speaks.
We are deeply grateful and honored by your presence today.
Before presenting the award I want to read from a letter I received from Governor Peter Shumlin in recognition of you, Peter and this day: "I was pleased to learn that you will be honoring Peter Schumann, founder of Bread and Puppet Theatre, with the second annual Presidential Award for Activism. For nearly 50 years, Peter Schumann and the Bread and Puppet Theatre have inspired generations with their artistry and activism. With exquisite puppets and commanding performances, Peter has used his powerful voice to entertain, educate and encourage meaningful action, Like Goddard College , Bread and Puppet theatre challenges us to use our imagination, ask questions and express ourselves."
On that high note let me invite Peter to stand at the podium for the presentation of the award .
Goddard Videos
Watch More Goddard Videos
MFA in Interdisciplinary Arts, Port Townsend
News & Events
Goddard College hosted an Interdisciplinary Arts conference in Plainfield, VT October 14-16, 2011. Here are clips from presenter Beth Nixon, keynote artist Ping Chong, Goddard MFA in... more
MFA in Interdisciplinary Arts, News & Events
Goddard College Presents Alchemy of the Word: Writers Talk About Writing One collection. Six genres. Twenty-five authors. A book by writers, for writers, that will teach, provoke, enlighten, and,... more
MFA in Creative Writing
Goddard College Presents Alchemy of the Word: Writers Talk About Writing One collection. Six genres. Twenty-five authors. A book by writers, for writers, that will teach, provoke, enlighten, and,... more
MFA in Creative Writing


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Drug Notes
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Chronic myelogenous leukemia (CML) is cancer that starts inside bone marrow. This is the soft tissue in the center of bones that helps form all blood cells.
CML causes an uncontrolled growth of immature cells that make a certain type of white blood cell called myeloid cells. The diseased cells build up in the bone marrow and blood.
CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic
Cause of CML is related to an abnormal chromosome called the Philadelphia chromosome.
Radiation exposure can increase the risk of developing CML. Radiation exposure can be from radiation treatments used in the past to treat thyroid cancer or Hodgkin lymphoma or from a nuclear disaster.
It takes many years to develop leukemia from radiation exposure. Most people treated for cancer with radiation do not develop leukemia. Most patients with CML have not been exposed to radiation.
CML most often occurs in middle-age adults and in children.
Chronic myelogenous leukemia is grouped into several phases:
The chronic phase can last for months or years. The disease may have few or no symptoms during this time. Most people are diagnosed during this stage, when they have blood tests done for other reasons.
The accelerated phase is a more dangerous phase. Leukemia cells grow more quickly. Common symptoms include fever (without infection), bone pain , and a swollen spleen .
Untreated CML leads to the blast crisis phase. Bleeding and infection may occur due to bone marrow failure.
Other possible symptoms of a blast crisis include:
A physical examination often reveals a swollen spleen. A complete blood count (CBC ) shows an increased number of white blood cells with many immature forms present and an increased number of platelets. These are parts of the blood that help blood clot.
Other tests that may be done include:
Medicines that target the abnormal protein made by the Philadelphia chromosome are usually the first treatment for CML. These medicines can be taken as pills.
Sometimes, chemotherapy is used first to reduce the white blood cell count if it is very high at diagnosis.
The blast crisis phase is very difficult to treat. This is because there is a very high count of immature white blood cells (leukemia cells).
The only known cure for CML is a bone marrow transplant , or stem cell transplant. Most patients, though, do not need a transplant because the targeted medicines are successful. Discuss your options with your oncologist.
You and your healthcare provider may need to manage many other issues or concerns during your leukemia treatment, including:
You can ease the stress of illness by joining a cancer support group . Sharing with others who have common experiences and problems can help you not feel alone.
Taking the targeted medicines have greatly improved the outlook for patients with CML. When the signs and symptoms of CML go away and blood counts and bone marrow biopsy appear normal, the person is considered in remission. Many persons can remain in remission for many years while on this medicine.
Stem cell or bone marrow transplant is usually considered in persons whose disease comes back or gets worse while taking the initial medicines. Transplant may also be recommend for patients who are diagnosed in accelerated phase or blast crisis.
Blast crisis can lead to complications, including infection, bleeding, fatigue, unexplained fever, and kidney problems. Chemotherapy can have serious side effects, depending on the drugs used.
Avoid exposure to radiation when possible.
Kantarjian H, Cortes J. Chronic myeloid leukemia. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2013:chap 101.
National Cancer Institute: PDQ Chronic Myelogenous Leukemia Treatment. Bethesda, Md: National Cancer Institute. Date last modified: Nov. 18, 2013. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/CML/HealthProfessional. Accessed: March 23, 2014.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Chronic Myelogenous Leukemia. Version 4.2013. Available at: http://www.nccn.org/professionals/physician_gls/pdf/cml.pdf. Accessed: March 23, 2014.
Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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TOURAcademy Junior Camps provide junior athletes of all ages and skill levels golf instruction from the country's top PGA instructors. Our Junior Camps are available at over 30 renowned PGA TOUR venues nationwide, including TPC Sawgrass, TPC San Antonio, World Golf Village, Omni La Costa Resort & Spa, and more.
Through a complete education, participants will leave the TOURAcademy Junior Camps with the tools necessary to improve their games. This is a direct product of the programs that comprise the four "Cornerstones of Improvement":
- Full Swing, Short Game and On-Course Instruction
- Club Fitting
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With an instructor roster that features past and present touring golf professionals, coaches, top collegiate players and nationally recognized "Top 100" instructors, our TOURAcademy teaching professionals have secured many of the highest credentials in the industry.
The TOURAcademy's primary goal for its juniors is to provide a positive and fun learning environment where students are able to flourish under the direction of experienced, motivated, and highly skilled instructors—all while having a great time!


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Explore the basics of Flickr, from posting, organizing, and editing photos to participating in the Flickr community.
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Navy Harper Bear Mobile
- Overview
Great hibernators, bears know a lot about sleep. That's why we've enlisted these sweet, fuzzy friends to help soothe your baby at bedtime. This musical mobile pairs with our Harper Nursery Collection.
- 9" diameter, 18" high
- Bears are made of soft polyester velboa.
- Frame is covered with pure cotton canvas.
- Plays the tune Hush, Little Baby.
- Mobile arm (sold separately) attaches to the crib.
- Dimensions & Care
- Overall: 9" diameter, 18" high
- Bear (4): 3.5" wide x 1.5" deep x 4" high
- Surface is washable with warm water and mild soap.
- Shipping Info
- Please allow 5-7 business days for delivery. Delivery estimate includes monogrammed and gift-wrapped items.


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Petite Zoe Boot Cut Pants in Mid Weight LOFT Scuba
Petite Zoe Boot Cut Pants in Mid Weight LOFT Scuba
$49 .88
Online Exclusive
 A perfect match for the changing seasons, we can't get enough of this boot cut pair that flaunts our mid weight LOFT scuba fabric—its textured stretch weave supports and smoothes for a flawless fit — but with a lighter weight. Fits straightest from the waistband to the hips. Zip fly with hook and bar closure. Belt loops. Front slash pockets. Back besom pockets with loop and button closure. 30" inseam.


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Hi, and welcome to my blog!
The blog is all about how I improved my eyesight naturally with a type of eye exercises to improve vision, that are not just eye exercises after all :)
I follow the Pure Vision Method and you can find out more about their system by clicking here.
This has been a fascinating journey through health, and I'd strongly encourage you to have a look at their course, if you can't stand your glasses and want to get rid of them long-term. It'll make a huge difference in how you feel each and every day as well.
So this blog is all about my account of my journey from myopia and astigmatism, to the freedom of glasses and contacts that I envisioned for myself.
Yes, I was told by my optometrist that I'm wasting my time and there there are no alternatives for glasses, contacts, or eye surgery. But luckily he was wrong.
There is, and I don't care, if he believes it or not :)