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Tafsir Ibn Kathir
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3. Al-'Imran (The Family of Imran, 200 verses)
3.1. Alif. Lām. Mīm.
3.2. God, there is no deity but He,, the All-Living, the Self-Subsisting (by Whom all subsist).
3.3. He sends down on you the Book in parts with the truth, confirming (the Divine origin of, and the truths still contained by) the Revelations prior to it; and He sent down the Torah and the Gospel,
3.4. In time past, as guidance for the people; and He has sent down the Criterion to distinguish between truth and falsehood, and the knowledge, and power of judgment to put it into effect. Those who disbelieve in the Revelations of God, for them is a severe punishment. God is All-Glorious with irresistible might, Ever-Able to Requite.
3.5. Surely God – nothing whatever on the earth and in the heaven is hidden from Him.
3.6. It is He Who fashions you in the wombs as He wills. There is no deity but He, the All-Glorious with irresistible might, the All-Wise.
3.7. It is He Who has sent down on you this (glorious) Book, wherein are verses absolutely explicit and firm: they are the core of the Book, others being allegorical. Those in whose hearts is swerving pursue what is allegorical in it, seeking (to cause) dissension, and seeking to make it open to arbitrary interpretation, although none knows its interpretation save God. And those firmly rooted in knowledge say: "We believe in it (in the entirety of its verses, both explicit and allegorical); all is from our Lord"; yet none derives admonition except the people of discernment.
3.8. (They entreat God:) "Our Lord, do not let our hearts swerve after You have guided us, and bestow upon us mercy from Your Presence. Surely You are the All-Bestowing.
3.9. "Our Lord, You it is Who will gather humankind for a Day about (the coming of) which there is no doubt. Surely God does not fail to keep the promise. "
3.10. Those who disbelieve, neither their wealth nor their offspring will avail them at all against God; they are fuel for the Fire.
3.11. It is just as that which happened to the court (the court and military aristocracy) of the Pharaoh, and those before them. They denied Our Revelations, and so God seized them for their sins. God is severe in retribution.
3.12. Say (O Messenger) to those who disbelieve: "You will soon be overpowered and gathered into Hell!" – How evil a cradle it is!
3.13. There has already been a manifest sign (of the truth of God's way) and lesson for you in the two hosts that encountered (at the Battle of Badr): one host fighting in God's cause, and the other disbelieving, who saw with their very eyes (the host of the believers) as twice their actual number (during fighting). God confirms with His help and victory whom He wills. Surely in that is a lesson for those who have insight
3.14. Made innately appealing to men are passionate love for women, children, (hoarded) treasures of gold and silver, branded horses, cattle, and plantations. Such are enjoyments of the present, worldly life; yet with God is the best of the goals to pursue.
3.15. Say (to them): "Shall I inform you of what is better than those (things that you so passionately seek to obtain)? For those who keep from disobedience to God in due reverence for Him and piety there are, with their Lord, Gardens through which rivers flow, wherein they will abide, and spouses purified, and God's good pleasure (with them). God sees the servants well:
3.16. Those (the God-revering, pious) pray: "Our Lord, we do indeed believe, so forgive us our sins and guard us against the punishment of the Fire";
3.17. Those who are persevering (in misfortune and steadfast in fulfilling God's commandments, and in refraining from sins), and truthful (in their words and actions, and true to their covenants), and devoutly obedient, and who spend (out of what God has provided for them, in His way and for the needy), and who implore God's forgiveness before daybreak.
3.18. God (Himself) testifies that there surely is no deity but He, and so do the angels and those of knowledge, being firm in upholding truth and uprightness: (these all testify that) there is no deity but He, the All-Glorious with irresistible might, the All-Wise.
3.19. The (true) religion with God is Islam. Those who were given the Book before differed only after the knowledge (of truth) came to them because of envious rivalry and insolence among themselves. Whoever disbelieves in the Revelations of God (should know that God is swift at reckoning.
3.20. If they still remonstrate with you, say (to them, O Messenger): "I have submitted my whole being to God, and so have those who follow me. " And ask those who were given the Book before, and the common folk who know nothing about the Book: "Have you also submitted (to God)?" If they have submitted, then they are indeed rightly guided; but if they turn away, then what rests with you is only to convey the Message fully. God sees the servants well.
3.21. Those who disbelieve in the Revelations of God, and frequently kill the Prophets (sent to them) against all right, and who kill those who advocate and try to establish equity and justice – give them the glad tidings of a painful punishment.
3.22. Those are the ones whose works have been wasted in both this world and the Hereafter, and they have no helpers (to restore their works to their benefit and save them from punishment).
3.23. Do you not consider those who were given a portion from the Book? They are called to the Book of God to judge between them, and then (after the judgment was given), a party of them turn away in aversion.
3.24. (They venture to do so) because they claim: "The Fire will not touch us at all, except for a certain number of days. " (The false beliefs) that they used to invent have deluded them in their religion.
3.25. How then will they fare when We gather them all together for an (awesome) Day about (the coming of) which there is no doubt, and when every soul will be repaid in full for what it earned (while in the world), and none will be wronged?
3.26. Say: "O God, absolute Master of all dominion! You give dominion to whom You will, and take away dominion from whom You will, and You exalt and honor whom You will, and abase whom You will; in Your hand is all good; surely You have full power over everything.
3.27. "You make the night pass into the day, and You make the day pass into the night (and so make each grow longer or shorter); You bring forth the living out the dead, and You bring the dead out of the living, and You provide whomever You will without reckoning. "
3.28. Let not the believers take the unbelievers for friends, guardians, and councilors in preference to the believers. Whoever does that is not on a way from God and has no connection with Him, unless it be to protect yourselves against them and take precautions (against the danger of being persecuted and forced to turn away from your Religion or betray your community, or of losing your life). And God warns you that you beware of Himself; and to God is the homecoming.
3.29. Say (to the believers): "Whether you keep secret what is in your bosoms or reveal it, God knows it. He knows whatever is in the heavens and whatever is on the earth. God has full power over everything. "
3.30. The Day when every soul will find whatever good it has done brought forward, and whatever evil it has done, it will wish that there were a far space between it and that evil. God warns you that you beware of Himself; and God is All-Pitying for the servants.
3.31. Say (to them, O Messenger): "If you indeed love God, then follow me, so that God will love you and forgive you your sins. " God is All-Forgiving, All-Compassionate.
3.32. Say (again): "Obey God, and the Messenger. " If they still turn away, (then know that only the unbelievers turn away from this call, and let them know that) God does not love the unbelievers.
3.33. (They refuse belief in you and some of the Prophets because you did not appear among them, but God favors whomever He wishes with Messengership, and) God made pure Adam and Noah and the House of Abraham and the House of 'Imrān, choosing them above all humankind,
3.34. As descendants of one another (and they were following the same way. Therefore, do not, in respect of believing in them as Prophets, make any distinction between the Prophets and do not think or speak ill of God's preference). God is All-Hearing, All-Knowing.
3.35. (Remember) when the woman (from the House) of 'Imrān entreated: "My Lord, I have dedicated that which is in my womb to Your exclusive service. Accept it, then, from me. Surely You are the All-Hearing, the All-Knowing. "
3.36. When she was delivered of it, she said: "My Lord, I have given birth to a female. " – God knew best of what she was delivered, (so she did not need to be sorry, because) the male child (she expected) could not be the same as (the) female child (whom We bestowed on her and would honor with a great favor). – I have named her Mary, and commend her and her offspring to You for protection from Satan eternally rejected from God's Mercy. "
3.37. (In response to her mother's sincerity and purity of intention in dedicating the child,) her Lord accepted her with gracious favor and enabled to her a good growth (upbringing), and entrusted her to the care of Zachariah. Whenever Zachariah went in to her in the Sanctuary, he found her provided with food. "Mary," he asked, "how does this come to you?" "From God," she answered. Truly God provides to whomever He wills without reckoning.
3.38. At that point, Zachariah turned to his Lord in prayer and said: "My Lord, bestow upon me out of Your grace a good, upright offspring. Truly, You are the All-Hearer of prayer. "
3.39. It was when, after some time, he stood praying in the Sanctuary that the angels called to him: "God gives you the glad tidings of John, to confirm a Word from God, and as one lordly, perfectly chaste, a Prophet, among the righteous. "
3.40. "Lord," said he (Zachariah), "How shall I have a son when old age has overtaken me, and my wife is barren?" "Just so," he (the angel) said, (quoting God): "God does whatever He wills. "
3.41. "Lord," he (Zachariah) entreated, "appoint a sign for me. " "Your sign," He said, "is that you will not be able to speak to people for three days except by gesture. And (meanwhile) remember and mention your Lord much, and glorify Him in the afternoon and the early hours of morning. "
3.42. And (in due time came the moment) when the angels said: "Mary, God has chosen you and made you pure, and exalted you above all the women in the world.
3.43. "Mary, be devoutly obedient to your Lord, prostrate and bow (in the Prayer and devotion to Him) with those who bow!"
3.44. (O Messenger:) that is of the tidings of the things of the unseen (the things that took place in the past and have remained hidden from people with all their truth), which We reveal to you, for you were not present with them when they drew lots with their pens about who should have charge of Mary; nor were you present with them when they were disputing (about the matter).
3.45. And (remember) when the angels said: "Mary, God gives you the glad tidings of a Word from Him, to be called the Messiah, Jesus son of Mary,, highly honored in the world and the Hereafter, and one of those near-stationed to God.
3.46. "He will speak to people in the cradle and in manhood, and he is of the righteous. "
3.47. "Lord," said Mary, "how shall I have a son seeing no mortal has ever touched me?" "That is how it is," he (the Spirit who appeared before her) said, (quoting God): "God creates whatever He wills; when He decrees a thing, He does but say to it 'Be!' and it is.
3.48. "And He will teach him the Book and the Wisdom – and the Torah and the Gospel,
3.49. "(And He will make him) a Messenger to the Children of Israel (saying to them, by way of explaining his mission): 'Assuredly, I have come to you with a clear proof from your Lord: I fashion for you out of clay something in the shape of a bird, then I breathe into it, and it becomes a bird by God's leave. And I heal the blind from birth and the leper, and I revive the dead, by God's leave. And I inform you of what things you eat, and what you store up in your houses. Surely in this is a clear proof for you (demonstrating that I am a Messenger of God), if you are sincere believers (as you claim. )
3.50. 'And confirming (the truth contained in) the Torah that was revealed before me, and to make lawful for you certain things that had been forbidden to you. Be sure that I have come to you with a clear proof (demonstrating that I am a Messenger of God) from your Lord. So keep from disobedience to God in due reverence for Him and piety, and obey me.
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Results 1 - 50 of 200
Foreword, Intro, Glossaries and Appendix
( 7 items )
1. Al-Fatiha (The Opening, 7 verses)
( 7 items )
2. Al-Baqarah (The Cow, 286 verses)
( 286 items )
4. An-Nisa (The Women, 176 verses)
( 176 items )
5. Al-Ma'idah (The Dinner Table, 120 verses)
( 120 items )
6. Al-An'am (The Cattle, 165 verses)
( 165 items )
7. Al-A'raf (The Elevated Places, 206 verses)
( 206 items )
8. Al-Anfal (The Accessions, 75 verses)
( 75 items )
9. At-Taubah (The Immunity, 129 verses)
( 129 items )
10. Yunus (Jonah, 109 verses)
( 109 items )
11. Hud (The Holy Prophet, 123 verses)
( 123 items )
12. Yusuf (Yusuf, 111 verses)
( 111 items )
13. Ar-Ra'd (The Thunder, 43 verses)
( 43 items )
14. Ibrahim (Abraham, 52 verses)
( 52 items )
15. Al-Hijr (The Rock, 99 verses)
( 99 items )
16. An-Nahl (The Bee, 128 verses)
( 128 items )
17. Al-Isra' (The Children of Israel, 111 verses)
( 111 items )
18. Al-Kahf (The Cave, 110 verses)
( 110 items )
19. Maryam (Marium, 98 verses)
( 98 items )
20. Ta-Ha (Ta Ha, 135 verses)
( 135 items )
21. Al-Anbiya (The Prophets, 112 verses)
( 112 items )
22. Al-Hajj (The Pilgrimage, 78 verses)
( 78 items )
23. Al-Mu'minun (The Believers, 118 verses)
( 118 items )
24. An-Nur (The Light, 64 verses)
( 64 items )
25. Al-Furqan (The Distinction, 77 verses)
( 77 items )
26. Ash-Shu'ara (The Poets, 227 verses)
( 227 items )
27. An-Naml (The Ant, 93 verses)
( 93 items )
28. Al-Qasas (The Narratives, 88 verses)
( 88 items )
29. Al-Ankabut (The Spider, 69 verses)
( 69 items )
30. Ar-Rum (The Romans, 60 verses)
( 60 items )
31. Luqman (Luqman, 34 verses)
( 34 items )
32. As-Sajdah (The Adoration, 30 verses)
( 30 items )
33. Al-Ahzab (The Clans, 73 verses)
( 73 items )
34. Saba (The Saba, 54 verses)
( 54 items )
35. Fatir (The Originator, 45 verses)
( 45 items )
36. Ya-Sin (Yasin, 83 verses)
( 83 items )
37. As-Saffaat (The Rangers, 182 verses)
( 182 items )
38. Saad (Suad, 88 verses)
( 88 items )
39. Az-Zumar (The Companions, 75 verses)
( 75 items )
40. Al-Mumin (The Believer, 85 verses)
( 85 items )
41. Fussilat (Ha Mim, 54 verses)
( 54 items )
42. Ash-Shura (The Counsel, 53 verses)
( 53 items )
43. Az-Zukhruf (Ornaments of Gold, 89 verses)
( 89 items )
44. Ad-Dukhan (The Smoke, 59 verses)
( 59 items )
45. Al-Jathiyah (The Kneeling, 37 verses)
( 37 items )
46. Al-Ahqaf (The Sandhills, 35 verses)
( 35 items )
47. Muhammad (Muhammad, 38 verses)
( 38 items )
48. Al-Fath (The Victory, 29 verses)
( 29 items )
49. Al-Hujuraat (The Chambers, 18 verses)
( 18 items )
50. Qaf (Qaf, 45 verses)
( 45 items )
51. Adh-Dhariyat (The Scatterers, 60 verses)
( 60 items )
52. At-Tur (The Mountain, 49 verses)
( 49 items )
53. An-Najm (The Star, 62 verses)
( 62 items )
54. Al-Qamar (The Moon, 55 verses)
( 55 items )
55. Ar-Rahman (The Beneficent, 78 verses)
( 78 items )
56. Al-Waqi'ah (The Event, 96 verses)
( 96 items )
57. Al-Hadid (The Iron, 29 verses)
( 29 items )
58. Al-Mujadilah (She Who Pleaded, 22 verses)
( 22 items )
59. Al-Hashr (The Banishment, 24 verses)
( 24 items )
60. Al-Mumtahana (The Examined One, 13 verses)
( 13 items )
61. As-Saff (The Ranks, 14 verses)
( 14 items )
62. Al-Jumu'ah (The Congregation, 11 verses)
( 11 items )
63. Al-Munafiqun (The Hypocrites, 11 verses)
( 11 items )
64. At-Taghabun (The Mutual Deceit, 18 verses)
( 18 items )
65. At-Talaaq (The Divorce, 12 verses)
( 12 items )
66. At-Tahrim (The Prohibition, 12 verses)
( 12 items )
67. Al-Mulk (The Kingdom, 30 verses)
( 30 items )
68. Al-Qalam (The Pen, 52 verses)
( 52 items )
69. Al-Haqqah (The Inevitable, 52 verses)
( 52 items )
70. Al-Ma'arij (The Ways of Ascent, 44 verses)
( 44 items )
71. Nuh (Nuh, 28 verses)
( 28 items )
72. Al-Jinn (The Jinn, 28 verses)
( 28 items )
73. Al-Muzzammil (The Wrapped Up, 20 verses)
( 20 items )
74. Al-Muddathir (The Covered One, 56 verses)
( 56 items )
75. Al-Qiyamah (The Resurrection, 40 verses)
( 40 items )
76. Al-Insan (Time, 31 verses)
( 31 items )
77. Al-Mursalaat (The Sent Forth, 50 verses)
( 50 items )
78. An-Naba (The Great Event, 40 verses)
( 40 items )
79. An-Nazi'aat (The Draggers, 46 verses)
( 46 items )
80. Abasa (He Frowned, 42 verses)
( 42 items )
81. At-Takwir (The Folded Up, 29 verses)
( 29 items )
82. Al-Infitaar (The Cleaving, 19 verses)
( 19 items )
83. Al-Mutaffifin (The Deceivers in Measuring, 36 verses)
( 36 items )
84. Al-Inshiqaq (The Rending Asunder, 25 verses)
( 25 items )
85. Al-Buruj (The Celestial Stations, 22 verses)
( 22 items )
86. At-Tary'q (The Nightly Visitant, 17 verses)
( 17 items )
87. Al-A'la (The Most High, 19 verses)
( 19 items )
88. Al-Ghaashiyah (The Overwhelming Calamity, 26 verses)
( 26 items )
89. Al-Fajr (The Daybreak, 30 verses)
( 30 items )
90. Al-Balad (The City, 20 verses)
( 20 items )
91. Ash-Shams (The Sun, 15 verses)
( 15 items )
92. Al-Lail (The Night, 21 verses)
( 21 items )
93. Ad-Duha (The Brightness, 11 verses)
( 11 items )
94. Ash-Sharh (The Expansion, 8 verses)
( 8 items )
95. At-Tin (The Fig, 8 verses)
( 8 items )
96. Al-'Alaq (The Clot, 19 verses)
( 19 items )
97. Al-Qadr (The Grandeur, 5 verses)
( 5 items )
98. Al-Baiyyinah (The Clear Evidence, 8 verses)
( 8 items )
99. Az-Zalzalah (The Quaking, 8 verses)
( 8 items )
100. Al-'Aadiyaat (The Chargers, 11 verses)
( 11 items )
101. Al-Qari'ah (The Calamity, 11 verses)
( 11 items )
102. At-Takaathur (Vying in Abundance, 8 verses)
( 8 items )
103. Al-'Asr (The Age, 3 verses)
( 3 items )
104. Al-Humazah (The Slanderer, 9 verses)
( 9 items )
105. Al-Fil (The Elephant, 5 verses)
( 5 items )
106. Al-Quraish (The Qureaish, 4 verses)
( 4 items )
107. Al-Maa'un (Alms, 7 verses)
( 7 items )
108. Al-Kauthar (The Abundance of Good, 3 verses)
( 3 items )
109. Al-Kaafirun (The Disbelievers, 6 verses)
( 6 items )
110. An-Nasr (The Help, 3 verses)
( 3 items )
111. Al-Masad (The Flame, 5 verses)
( 5 items )
112. Al-Ikhlaas (The Unity, 4 verses)
( 4 items )
113. Al-Falaq (The Dawn, 5 verses)
( 5 items )
114. An-Naas (The People, 6 verses)
( 6 items )
[ Back ]
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August 23, 2012
The Sacramento-Yolo Mosquito and Vector Control District announced today that
The Sacramento-Yolo Mosquito and Vector Control District announced today thataerial treatment for adult mosquitoes that may carry the potentially fatal West Nile virus is scheduled for two consecutive nights starting Thursday, August 23rd from approximately 8:00 pm to midnight over the City of Woodland in Yolo County. "Our surveillance efforts indicate high infection rates in this area," said David Brown District Manager. "In the last few days many mosquito samples and dead birds have tested positive for disease and its necessary to act quickly in order to reduce the numbers of infected adult mosquitoes and reduce the risk of human infections" added Brown.
The aerial applications will cover almost 15,000 acres in the City of Woodland from Churchill Downs Ave. and County Rd. 19B on the north to County Rd. 25A on the south and from County Road 97 on the west to County Road 103 on the east. For exact spraying locations please refer to the attached map or visit www.FIGHTtheBITE.net. Treatments will be made using Sumithrin, a synthetic pyrethroid and Trumpet, an organophosphate both registered for use in mosquito control by the US Environmental Protection Agency (EPA) and California EPA. While attempts are made to notify the public, the District may postpone or cancel a scheduled application due to unfavorable weather conditions or other reasons. The District will also conduct ground treatments to supplement these aerial applications.
The District reminds all residents that WNV activity is widespread throughout both Sacramento and Yolo counties and everyone should protect themselves from mosquito bites by always wearing an effective insect repellent and avoiding the outdoors especially at dawn and dusk when mosquitoes are most active. For a detailed map of all WNV activity in both counties, please visit: http://www.fightthebite.net/west-nile-virus-activitymap
Residents can subscribe to receive email notifications for mosquito treatments by zip code. To sign up, visit www.FIGHTtheBITE.net and go to Spray Notifications.
Information for current treatments planned is also available on the District website under Spraying Updates.


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Zucchini Cupcakes Recipe from Taste of Home
Try this fun family recipe from Taste of Home. Watch for exciting Metro Parent events that bring the popular food magazine to southeast Michigan!
Grandmas are often synonymous with comfort foods – and these Zucchini Cupcakes are no exception! Popular cooking magazine Taste of Home – which Metro Parent is bringing to town this October – awarded this Vermont family recipe (straight from Grandma, of course), which features spice and creamy caramel frosting.
Hungry for more? Metro Parent regularly brings Taste of Home to southeast Michigan! Join us for these fun and delicious two-hour presentations of exciting recipes, broken down step-by-step by culinary experts. Visit the Metro Parents Events page to learn about the latest – and, in the meantime, visit the Crumbs blog for more tasty recipes.


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One Online Source for 14 Technical Magazines
LOS ALAMITOS, Calif., 5 May, 2008 — The IEEE Computer Society is launching an aggregation portal to let visitors access multimedia, engage in community building, and discover the formidable resources of its 14 cutting-edge magazines in one convenient place.
Computing Now (http://computingnow.computer.org) consolidates new print and online content from the CS's peer-reviewed magazines, highlighting coverage of hot topics, such as computer games, social networking, green computing, robotics, and agile computing. Spanning all CS technologies and more than 50 identified subjects, Computing Now provides free access to select peer-reviewed articles and departments from each magazine—including Computer, the CS's flagship title.
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Led by an advisory board of subject-matter experts from academia and industry, Computing Now represents the CS's latest efforts to bridge the print and online worlds. Milojicic said Computing Now is intended to invigorate the technical publishing arena, and is poised to answer the questions: "Can we create two-way communication between the authors and the IEEE community? Can we develop a vibrant community where we all share our technical, academic, and practical knowledge and experience for the good of all—a Wikipedia for computer science services?"
About the Computer Society
With nearly 85,000 members, the IEEE Computer Society is the world's leading organization of computing professionals. Founded in 1946, and the largest of the 39 societies of the Institute of Electrical and Electronics Engineers (IEEE), the Computer Society is dedicated to advancing the theory and application of computer and information-processing technology, and is known globally for its computing standards activities.
The Computer Society serves the information and career-development needs of today's computing researchers and practitioners with technical journals, magazines, conferences, books, conference publications, and online courses. Its Certified Software Development Professional (CSDP) program for mid-career professionals and Certified Software Development Associate (CSDA) credential for recent college graduates confirm the skill and knowledge of those working in the field. The CS Digital Library (CSDL) is an excellent research tool, containing more than 250,000 articles from 1,600 conference proceedings and 26 CS periodicals going back to 1988.


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Helping Your Other Children Adjust to Your New Baby
If you have other children, bringing a new baby into their lives can often be upsetting. Just as you and your partner are adjusting to having a new member of the family, so are your older children. They may be jealous, more irritable than usual, or more demanding of your time.
There are also several things that you can do to involve your older children with the newest member of the family:
Most recent page update: 9/9/2010
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Checking up on your local hospitals' quality of care
ORLANDO — Hospitals are among the largest businesses in some communities, but they often get a pass when it comes to how well they are serving their customers — the patients in your area who use them.
Government data that have become available within the last few years enable journalists to compare hospitals' track records on patient survival and patient satisfaction, according to ProPublica senior reporter Charles Ornstein, who spoke at the Investigative Reporters and Editors Conference. He was a Pulitzer finalist for ProPublica in 2010 for a series with Tracy Weber called, "When Caregivers Harm: California's Unwatched Nurses."
He won the Pulitzer for Public Service in 2005, again with Weber, for a Los Angeles Times series about the troubles at King/Drew hospital.
Patient survival
Ornstein directed reporters to Hospital Compare, run by the U.S. Centers for Medicare and Medicaid Services. It includes information on whether patients died or had to be readmitted within 30 days of being treated at a hospital for heart failure, heart attack and pneumonia.
After the data are adjusted to take into account the severity of patients' illnesses, hospitals are rated as expected, better than expected or lower than expected. Ornstein said that the vast majority of hospitals fall in the expected category, so any hospitals that are outliers are worth talking to.
Patient satisfaction
In surveys, patients rate their overall hospital experience and also say whether they would recommend the hospital to a friend.
Current patient-survival and -satisfaction data can be downloaded into Access database software. Archived data are also available.
If you'd prefer to work with the data in Excel, the Association of Health Care Journalists keeps updated files, as well as the historic data, available on its site: healthjournalism.org. Ornstein, who is the group's president, said you must be a member ($60/year) to access it. The site also has primers on how to use the patient-satisfaction and survival data.
He recommended looking at changes in patient satisfaction over time for individual hospitals. There are 12 reporting periods worth of data since 2008.
Here are some other resources for working with this data:
- The Commonwealth Fund compares hospitals over time and against benchmarks.
- NetDoc.com allows you to look at the data on a Google map by ZIP code, but the stats may be somewhat out of date, Ornstein warned.
In Health care, Story ideas.


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I just purchased this. I'm African American and just relaxed my hair for the first time again after a year long hiatus (no chemicals on hair). I used a weave to grow my hair out and get it back healthy again. I was torn between keeping my hair natural and getting a relaxer again. In the end I decided to relax just for more versatility and manageability and because it's just what I am used to. I plan to take 'breaks' from chemicals twice per year (12 weeks at a time) with weaves. Weaves REALLY do help to grow out hair if you have a great stylist and take good care of your hair (don't get it too tight..keep your own hair moisturized and scalp cleansed). My hair was near my ear when I got one in for the first time last year and now it's below my shoulders! Healthy and beautiful.
Anyway, I was told by my stylist to do a protein treatment with my first wash (post relaxer) this week and she recommended the Emergencee from Nexxus. I was told that it's good to do the protein treatment once per month to keep my hair healthy and growing. I'm so happy to have read all of the reviews here.
AA women, it is possible for us to have long, healthy hair of our own. Just take good care of the hair you have whether it's natural or relaxed (we look beautiful either way). Get relaxers every 8-10 weeks only (NOT SOONER). Get good moisturizing products for your hair and scalp. Take breaks from relaxers a couple of times per year by using braids, weaves, or other 'protective' styles that will not require you to have to touch your own hair daily.
Anyway, I look forward to posting my review on the emergencee and will update soon.
8 out of 9 people found this review helpful. Did you? Yes No
Oh, I love this stuff!!! I love to color my hair and do so much damage to it, that I am often shocked I still have hair left. I do this treatment at least 1x a month and what a difference. Well worth the investment. A 3.3oz bottle will last a few months. I'm not a huge fan of all Nexxus products but this one has a follower (me!).
My dried, damaged, frizzy hair feels hydrated again. I bleach my hair and colour with at home-colour constantly so i didn't really believe that this product would work so well. I deserve a spanking for not trusting the MUA users - great reviews, for a great product.
I've used this 5 times, and the whole bottle is almost gone (100 ml), but i wanted to use it quite a bit before bleaching and will continue with only once before colourings the next time. I follow this up with biolage hydrating shampoo and conditioning balm, which smells great and works for my hair. I dont see anything SUPER special about the shampoo, but totally, and completely LOVE the hydrating balm.
Price? Ebay. I bought 6 bottles on ebay for 31.00 US + 7.00 shipping - 38.00 in total. Personally, i thought it was a fabulous deal, and definitely have enough to last me atleast 2 years.
A total winner!
2 out of 2 people found this review helpful. Did you? Yes No
Emergencee is a lifesaver!!! A month ago, I decided to perm my already dyed and highlighted hair (I've been dyeing and highlighting my hair for years and my last highlighting session was particularly hard on my hair). Needless to say, the results were disasterous. It was so horrible that the stylist felt forced to cut several inches away right after the perm because my hair was just so beyond repair. Some of you guys thought YOUR hair was damaged - but I'm guessing your hair would be considered "healthy" when compared to mine. It was VERY dry, brittle, porous, had that "mushy, spongy" feel when wet, and "crunched" when it was dry. Although I think my hair will never become "healthy" and normal again, this product got it as close to healthy as it's ever going to be. After using it twice, a week apart (I know the directions says to use every two weeks, I felt that my hair needed some extra treatment). I think the first time i used it, it just worked to strenghten my hair - i didn't see that much in extra moisture but i definitely felt that it was stronger. But the second time i used it - WOW. My hair actually felt hydrated for the first time since i permed my hair!!! it was soft and strong! I was amazed. Both times I left it in my hair for 20-30 minutes after shampooing. And then i deep conditioned with Aussie 3 minute DEEEP after washing it out. I didn't use the nexxus shampoo and conditioner per the directions but still used a moisturizing shampoo and conditioner.
Emergencee worked better than any of the other deep conditioners that I bought in an attempt to save my hair. If i had only known about this before spending $$$$$$ on all those deep conditioners, i would have saved a lot of money and had much better hair.
I just wished that it was cheaper and came in bigger bottles. I know that some reviewers found really big bottles but i can't seem to find it anywhere! It's hard enough to find the small bottle (kmart, target, ulta, all did not have it). But for what it's done for my hair, i'd gladly pay $15 for the small bottle.
2 out of 2 people found this review helpful. Did you? Yes No
This is the best protein reconstructer that I have ever used!
Two weeks ago my long, platinum blonde hair was so dry, damaged and brittle that it was breaking and even after a flat iron it looked frizzy and course. I've always use good products on my hair- redken, kerastase, Biolage etc but my hair has been triple processed (that's bleached 3 times ladies, I like it white, lol), relaxed (which is soooooo bad, don't do it!), and heat styled (I always flat iron my hair) that I had pretty much given up on it ever looking good and I was just waiting for it to grow longer so I could hack it off : (
After the breakage started to occur I thought that I needed to at least try a protein reconstructor. I've used the redken antisnap before, but I had never tried Nexxus. So I got the Emergencee reconstructor as well as the super moisturizing shampoo and conditioner (therapee or whatever its called, it smells like pina coloda).
You are supposed to shampoo your hair, put on the reconstructor, leave it on for a few minutes, then shampoo again and then put on conditioner. Because protein treatments acually dry hair out you need to put that conditioner on for at least 10 minutes- if your hair is really fried, the longer the better. Like some of the other reviewers, I have also found that the reconstructor works even better the longer it's left on...20 minutes is great, then leave the conditioner on for another 20.
My results were miraculous! My hair went from looking like a dried out horses tail to being smooth, SOFT and shiny! My hair was sooooo soft, it was great! And I got a lot of comments on how great it looks!
Note: I also tried the reconstructor with Biolage moisture mask (their super deep conditioner, I can't remember the name) and it works EVEN BETTER with this stuff!!!! So try it girls!
8 out of 8 people found this review helpful. Did you? Yes No
More reviews by chiodancrgrl23
I really don't understand what the fuss is over this product. I don't really notice much of a difference after using it. If anything my hair is a little more lifeless. The Sulfonic Acid in this product is detrimental to hair as it will strip hair color. Wouldn't repurchase. **UPDATE:** Okay at first I used this without shampooing after. I only used conditioner afterwards which made my hair coated. I have used this twice in the past month or so and shampooed and contitioned afterwards with good results. My hair isn't as frizzy and is nice and shiny. I would repurchase after all. I don't notice any color fading afterwards, but this might be because I don't use it very often.
I can't tell if this has improved my hair or not. I've switched conditioners and used a clear gloss, so I can tell if the noticable improvement has come from all these three things or just this one. What I have definitly noticed is that the gold demi-permanent I just put in my hair faded dramatically faster after using this. I think that you are supposed to use this product before coloring, not after and I advise everyone else to be warry of that. That being said, protein treatments are supposed to help you get even color when you do apply it, so I'll update when I have more information. And my hair does look better, wether from this or the other products.
*update* all my gold color has been strippped. I used a demi-perm, with heat, and used a clear gloss over it. I waited to wash my hair, and then washed my hair only two times both with cold water (except for when I did the nexxus). The color should have lasted a month at least. The only thing I can of is this had to be the nexxus......my hair is shiny, but the color is bad.
* The color problem was unquestionably from the nexus after dying my hair with the same product without the nexus and they using then nexus again, I know for a fact the only thing I changed was trying the emergencee again. If you have particulary difficult hair colors I suggest you stay away. Using a clear gloss helps a lot for shine, so if you need a better solution (although it won't help with breakage) use that instead.
3 out of 3 people found this review helpful. Did you? Yes No
I was disgusted with how my hair looked and felt after my last highlight. I have long hair that dries out. I bought this based on the reviews and I'm glad I did. I've used a ton of hair products, but don't recall using a reconstructor. I left this on for 15 minutes and followed up with Redken Smooth Down intensive conditioner. Although it's not dramatic, I definitely have noticed an improvemen tin how my hair looks and behaves. It is more manageable, healthier looking and feeling. I had a hard time finding this - CVS, Target, Beauty Brands didn't have it, finally found it at Walgreen's for around $10. I will continue using this every week or two with a quality conditioner. Another deep conditioner I recommend is L'oreal Ferio conditioner which is available at Sally's for around $6-7. Thanks for the recommendations on this reconstructor!
Update: This really gives my long, tangly, highlighted hair new life. I feel an immediate difference when rinsing. I will definitely be buying this again.
3 out of 3 people found this review helpful. Did you? Yes No
I did not see any results. I hair is still falling for the root. I used it once thought. I did not cover with plastic wrap or gave any heat while using this product. I did not use nexxus shampoo and conditioner with this product. Is it important to use nexxus shampoo and condtioner with this product. I can't believe that I am so disappointed. I had high hopes for this stuff. I am willing to try this again. Please email me (email@example.com), if I did something wrong with this product. Do I see result after using certain times?????left with more questions and disappointment. Please reply.
I do this treatment about once every 2 months or before I get my hair highlighted. This product without a doubt strengthens my hair and makes it incredibly soft and shiny. Just remember to use a deep conditioner afterwards. This is the best protein treatment I have found. It works wonders on my long blonde hair.


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The Fine Arts Division Theatre Department will present Eve Ensler's drama Necessary Targets at 7:30 p.m. on Tuesday, Jan. 21, to Saturday, Jan, 25, with a 2 p.m. matinee on January 25, at the Lindhurst Theatre, Malibu. The play is recommended for mature audiences.
In Necessary Targets, two American women--a Park Avenue psychiatrist and an ambitious young writer--travel to Bosnia to help women refugees confront their memories of war. They emerge deeply changed as they confront their own fears in the face of violence, resiliency, and war.
Based on interviews conducted by Ensler with numerous women who survived the civil war in the former Yugoslavia, Necessary Targets is a timely reminder of how America struggles to define its relationship to the rest of the world.
Marya Mazor directs the Pepperdine student cast, which includes Chelsie Blackwell, Constance Egli, Madison Erceg, Arielle Fodor, Marina Moore, Lexie Tankersley, and Anna Tullis.
Pepperdine Theatre performed this piece at the Edinburgh Festival Fringe in 2006, but this is the first production of the play on the Malibu campus.
Necessary Targets is presented as part of Pepperdine's Mary Pickford-Stotsenberg Performances series. No late seating is allowed. There will be a talkback with the cast and director following the Wednesday performance.
For more information and to purchase tickets, visit the Fine Arts Division website.


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Open 365 days a year, the Singapore Zoo (commonly known as the Mandai Zoo) is a favorite among locals in Singapore and international travelers alike. Famous for its signature night safaris and its controversial "croc coaching" shows, the zoo has a great deal to offer.
Situated on approximately 60 acres of heavily forested land on the edge of Singapore's Upper Seletar Reservoir, the zoo's relatively short history dates to just 1973, but since its birth it has made rapid progress. Home to more than 300 species of animal, the zoo, along with the neighboring Jurong Bird Park, attracts a million and a half visitors each year. Among its many species, the Mandai is home to the largest captive colony of orangutans in the world, the famed group with whom primatologist Dr. Francine Neago lived inside a cage for six months in 1977.
Among the various attractions on hand is the "Breakfast with an Orangutan" program that allows visitors to meet and interact closely with the Zoo's group of friendly orangutans. Animal shows featuring token feedings with live commentaries by handlers are also a regular occurrence. Several notable conservationists and public figures have championed the zoo, including Steve Irwin, known as "The Crocodile Hunter", who advocated for adopting it as the 'sister zoo' to the Australia Zoo.
Three venues at the zoo, the Forest Lodge, Pavilion-By-the-Lake and Garden Pavilion are all available for private events as well as three cocktail bars. Visitors get around the sprawling complex by means of trams, boats, pony and horse carriage rides, as well as strollers, wagon and wheelchairs, all of which can be rented.
Planning a trip? Browse Viator's Singapore tours & things to do, top Singapore attractions, and top Singapore travel recommendations. Be sure to check out our Singapore Zoo Night Safari Tour with optional Buffet Dinner and Singapore Zoo Morning Tour with optional Jungle Breakfast amongst Orangutans for the ultimate Singapore Zoo experience. Searching on your phone? Bookmark our Singapore Night Safari mobile page for quick and easy access on the go.


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The Eat-and-Lose-Weight Meal Plan: Week 4
By Janis Jibrin, M.S., R.D. & Tracy Olgeaty Gensler, M.S., R.D.
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Friday's Menu:
Cereal and Fruit
Have 160 calories of a flaky, high-fiber cereal for instance, 1 1/3 cups Kashi Good Friends. (Check labels of other cereals for at least 5 grams fiber per serving.) Top with 1/2 cup blueberries and 2 tablespoons nuts (about 13 almonds or pecan halves). Drink a small glass (1 cup) fat-free milk (whatever you don't use on the cereal).
Sausage Pasta Fagioli with Spinach
Have one serving (left over from Thursday dinner). Have 1 tangerine or 2 apricots (or 4 apricot halves).
Pumpkin Muffin
Have 1 muffin left over from Monday's breakfast and a small glass (1 cup) of fat-free milk
Rotisserie Chicken and Vegetables
Buy half a cooked rotisserie chicken. Eat the breast, skin removed. Serve with corn (two 3-inch cobs of frozen corn or 1 fresh, boiled corn on the cob or 3/4 cup cooked corn) and 1 cup steamed vegetables. (Reserve rest of chicken for Saturday.) Have 3 Hershey's kisses (or 1/2 ounce of any chocolate or another 80-calorie treat of your choice).
Daily calories: 1,520
Fat: 41 g
Percent of daily calories from fat: 24%
Saturated fat: 9.3 g
Percent of daily calories from saturated fat: 6%
Carbohydrate: 218 g
Percent of daily calories from carbohydrates: 51%
Fiber: 40 g
Protein: 94 g
Percent of daily calories from protein: 25%
Cholesterol: 167 mg
Calcium: 1,036 mg
Sodium: 2,315 mg
Still hungry? Check out these low-cal snacks!
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Shredalicious - Slushy SundaysApr 10th 2014
Ep.3 is filmed in Geilo Snowpark´s and Hallingskarvet resort when we where at Krik Jibbecamp. Had a blast and filming 4 this episode has been one of the funniest
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Voted New Zealand Snowboard Association Resort of the Year for 2004, Snow Park NZ is proud to head into its third season with exciting new developments and a strong dedication to providing some of the worldââ¬â¢s best freestyle terrain in New Zealand.
Situated in Wanaka, New Zealand, Snow Park NZ is gearing up for a great 2005 season. We have a busy, dynamic events schedule which will attract many of the top professional freestyle skiers and snowboarders from around the world.
After the huge international acclaim and attention received last season, we made the covers three top international snowboarding magazines and featured articles in others. Presently we are ranked 19th by the prestigious Transworld Business Magazineââ¬â¢s Exposure Meter, and were honored to appear as the only New Zealand resort on the coveted list. This season we are looking forward to hosting an even greater number of top rated international guests and training camps.
Check www.snowparknz.com for pictures, video, and more information!
Ep.3 is filmed in Geilo Snowpark´s and Hallingskarvet resort when we where at Krik Jibbecamp. Had a blast and filming 4 this episode has been one of the funniest
James Woodsy (1st), Øystein Bråten (2nd) and Jossi Wells (3rd) were today's top qualifiers. See who else made the cut here!
Here's a look at how Total Fight at Snowpark El Tarter in Andorra and the USASA Nationals at Copper Mountain, Colorado affected the AFP World Rankings.
On Harenda slope in Zakopane, where on the 31st of January and 1st of February will take place 11th edition of The North Face Polish Freeskiing Open, work on the snowpark is in full swing. About 60 riders from 13 countries have already signed in to take part in the competition.


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Esther Marie Dehner, 83, a resident of Cleveland, passed away Tuesday, Nov. 6, 2012, in a local health care facility.
She was the daughter of the late John T. Dehner and Mary L. Henry Dehner. She was also preceded in death by her brother, the Rev. David L. Dehner; and two sisters: Sarah Brewster and Priscilla Bingham.
She had lived with her parents all of her life until her mother passed away, and then she lived with her brother and his wife in Lynch, Ky., and Covington, Ky., before moving to Cleveland.
She taught Sunday school and enjoyed singing in her family trio and sharing her beautiful soprano voice, and was a member of Westmore Church of God. She was a very loving and caring aunt to all of her nieces, nephews, great-nieces and great-nephews.
She is survived by three brothers: the Rev. Paul H. Dehner and his wife, Lehana, of Campbellsville, Ky., William Dehner and his wife, Audrey, of Lexington, Ky., and James Dehner and his wife, Rita, of Erlanger, Ky.; sister-in-law, Elain Dehner McClain of Cleveland; cousin, Belinda G. Jump of Cleveland; and several nieces, nephews, great-nieces and great-nephews.
The family will receive friends from 5 to 6 p.m. Saturday, Nov. 10, 2012, at the North Ocoee Chapel of Jim Rush Funeral Homes.
Interment and graveside services will be held at 2 p.m. Monday at Forest Lawn Memorial Park in Erlanger, Ky.
Please view and sign the guest book at www.jimrushfuneralhomes.com.


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Public Strain - Women
- Band Name: Women
- Record Label: Jagjaguwar
- Release Date: Sep 28, 2010
- Record Label: Jagjaguwar
- Genre(s): Pop/Rock, Indie Rock, Noise-Rock
- More Details and Credits »
Score distribution:
Positive: 17 out of 20
Mixed: 2 out of 20
Negative: 1 out of 20
Dec 16, 2010Women occupy a unique place in the indie rock spectrum. Their songs and makeup can put them nowhere else –- Public Strain would be a Deerhunter album if it weren't for that sneer in its lip- and yet their music is completely singular.
Sounds come and go but the inspiration and wherewithal to realize your own goal in tone is paramount. Women seem to know exactly what they stand for and in presenting it they've entirely outdone themselves, again.
In short, it's a triumph. Yes, it's still messy, and yes, Patrick Flegel's apathetic nasal vocals are too saturated, or buried in the mix, or both, but the intricate musicianship and songwriting take this from "yet another lo-fi garage album" to mini masterpiece.
The emotional impact of this music is sometimes disorientating or alienating, but that is probably the intention. It's mostly impossible to discern the lyrics or comprehend their themes. Somehow this doesn't matter, given the striking, weird and often turbulent music beneath.
Never willfully ramshackle or unfocused, Women tread the line between discord and delight with deceptive style. [Sep 2010, p.96]
At the surface, the temperature is icy. But like a cold lake's waters, the music of Public Strain becomes less drastic; comforting even, given time.
At its weakest, the album is merely boring with the lamely typical Can't You See, an album opener of distorted rumbling and vocals so low you'd strain to make them out. Arguably worse than a bland track is that the album actually offers some hope for a reasonably enjoyable experience.
Score distribution:
Positive: 3 out of 3
Mixed: 0 out of 3
Negative: 0 out of 3
Nov 12, 2010This is not just one of the best albums of the year, it is one of the best of the decade. It is beautiful and horrifying in equal measure. IfThis is not just one of the best albums of the year, it is one of the best of the decade. It is beautiful and horrifying in equal measure. If Women come up with a pretty,transcendent melody, they don't just play it- they flog it, push it around, drag it through the mud. I do not like abrasive sounding music, but the songs Women play cannot be imagined in any other form. But forget the whole 'Wow it's a Sonic Assault!' angle, it's the songwriting. Eyesore twists and turns and ambles until it breaks into a run- it's a beautiful, strange song that deserves at least one listen from everyone. Heart Distraction, Locust Valley and Narrow with the hall are the other immediately affecting songs. Pitchfork gave it an 8.0 (pretty low for this kind of a record) and didn't bnm it. A bnm would have really helped these guys get more attention. But they're doing pretty well. Buy the album. It is the best one you'll here this year.… Collapse
Oct 5, 2010A fantastic album by almost any metric, Public Strain is an engrossing and challenging listen, veering between delicate melodies and dissonantA fantastic album by almost any metric, Public Strain is an engrossing and challenging listen, veering between delicate melodies and dissonant sonic explosions. Women don't obfuscate their source material, but hone in on the most vital elements of their influences and arrange those elements in surprising ways. Familiar sounds subtly veer into unexpected territory, creating a tense but engaging listening experience. The overall effect is menacing, at times disorienting, but ultimately (especially by the last song) rewarding. The band's sense purpose and focus set them far apart from their lo-fi peers. Also, I can't remember the last time I heard a band do so much with such a short run time.… Expand
Oct 2, 2011I just recently acquired this awesome record. These guys have definitely nailed the dissonance vs. melody dynamic perfectly here. This typeI just recently acquired this awesome record. These guys have definitely nailed the dissonance vs. melody dynamic perfectly here. This type of record is not something that I typically listen to (punk derived rock), but the vocals are well done, the guitar playing is fun and inventive, and the songs are memorable and varied. I can only see myself liking this record more with time… Expand
|Led Zeppelin IV [Remastered] - Led Zeppelin
|Doolittle 25 - Pixies
|The Basement Tapes Complete: The Bootleg Series Vol. 11 - Bob Dylan
|The Velvet Underground [45th Anniversary Super Deluxe Edition] - The Velvet Underground
|Houses of the Holy [Remastered] - Led Zeppelin
|Bloodstone & Diamonds - Machine Head
|Black Messiah - D'Angelo
|Offering: Live at Temple University - John Coltrane
|Start Together [Box Set] - Sleater-Kinney
|Gentlemen At 21 [Deluxe Edition] - The Afghan Whigs
|Soul Mining (30th Anniversary Deluxe Edition) [Box Set] - The The
|From Parts Unknown - Every Time I Die
|Extra Painful - Yo La Tengo
|RTJ2 - Run the Jewels
|Anthology [Box Set] - The Clean
|Face the Music [Box Set] - Nils Lofgren
|Sun Zoom Spark: 1970 to 1972 [Box Set] - Captain Beefheart
|Foundations of Burden - Pallbearer
|Cadillactica - Big K.R.I.T.
|You're Dead! - Flying Lotus


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Grateful Bear Opens Office on Hometown Square
Yesterday I picked up the keys for a second office for my counseling practice. This one is a small one-room office on Marietta Square, two miles from my home. I'll be sharing the office with my friend Tim Franzen, a Certified Addiction Counselor who works primarily with adolescents and families. Tim is the founder of Cobb For Peace, so he is definitely a kindred spirit.
Having an office within easy driving distance of Atlanta will increase my referrals from attorneys who weren't comfortable asking their clients to drive all the way up to Canton. I've already spoken with several attorneys who were glad to hear I'm opening an office at a more convenient location. I'll continue to court-related evaluations, but I'm also hoping this new office location will increase my opportunities to do individual counseling with gay and lesbian clients in Metro Atlanta. My new business card includes both:
--Pre-Trial & Court-Related Assessments
--Counseling for Personal and Spiritual Growth
I've also added the line, "Counseling Rooted in Mindfulness and Respect," at the bottom of my business card. The respect part is especially important, I think. I've had many clients over the years tell me that in their dealings with the criminal justice system, I was the first person who treated them with dignity and respect. Unfortunately that's not a surprise, given that our criminal justice system is still strongly rooted in the puritanical concepts of shame and humiliation. Witness the new car tags here in Georgia labeled "DUI Car." The scarlet letter is alive and well.
As I wrote in a Letter to the Editor of the Atlanta Journal-Constitution back in 1999:
I am alarmed by the increasing use of shame and humiliation as a sentencing tool. As a counselor and former parole officer, I feel that when you attack a person's integrity, you attack the very foundation on which he or she can rebuild a positive, crime-free life. As a Christian, I believe that all people are created in the image of God. When we humiliate a person, we denigrate that sacred image and perpetuate the cycle of shame and crime.
Seven years later, unfortunately, not much has changed.


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HIV Treatment as Prevention
Treatment as prevention (TASP) is a term increasingly used to describe HIV prevention methods that use antiretroviral treatment to decrease the chance of HIV transmission.
People living with HIV often take treatment for their own health; ARVs decrease the amount of the virus in a person's bodily fluids, known as the 'viral load', thereby reducing the likelihood of AIDS-related illnesses. 1 An HIV-positive person's viral load is the single biggest risk factor in the transmission of HIV. 2 Therefore, taking treatment has the additional benefit of significantly decreasing this risk. The idea of 'treatment as prevention' is to use treatment as a prevention strategy that individuals could use to protect their sexual partners, or, on a large scale, to reduce HIV transmission among a population.
When is it appropriate to use HIV treatment as prevention?
An individual may choose to initiate treatment earlier, if given this option, to help prevent the transmission of HIV to sexual partner(s). This can be appropriate if they are given sufficient counselling and guidance for their specific situation, and TASP is seen as one of various prevention options. 3
On a public health level, the use of treatment as prevention is still widely debated. 4 Initiatives should consider the rights of the individual. Antiretroviral treatment can cause serious side effects and can lead to drug resistance if not taken exactly as prescribed. Therefore an HIV-positive person has the right to decide whether or not to take the treatment by weighing up the potential disadvantages and benefits for their own health.
How is HIV treatment currently being used to prevent HIV infections?
Antiretroviral therapy is already used in several ways to prevent HIV from being transmitted. These uses are often cited in arguments that support the idea of treatment as prevention being utilised on a larger scale, to lower transmission rates among a population. 5 6
- Prevention of mother-to-child transmission (PMTCT): Across the world, HIV-positive pregnant women take antiretroviral drugs to reduce the chances of transmitting HIV to their baby. Without intervention there is a 20-45 percent chance that a baby born to an HIV-infected mother will become infected. 7 However, treatment for the mother during pregnancy significantly reduces this risk.
- Post exposure prophylaxis (PEP): In some countries if a person has been exposed to HIV they are offered a short course of antiretroviral drugs to reduce their chances of becoming infected with the virus. This is called post exposure prophylaxis, or PEP, and is used in both occupational and non-occupational settings. Health care workers are offered the treatment if they have received a needlestick injury or have been exposed to HIV through their work. A combination of studies have suggested that it may be effective in reducing the risk of HIV infection. 8 9 10
- Pre-exposure prophylaxis (PrEP): One possible prevention technique that is being researched is pre-exposure prophylaxis. 11 PrEP involves providing people who are not infected with HIV with antiretroviral drugs before possible exposure to the virus, to stop them from becoming infected. It has the potential to be useful for serodiscordant couples (couples where only one partner is living with HIV).
Countries are starting to implement treatment as prevention with various approaches. The United States recommends treatment for all people living with HIV regardless of CD4 count. Countries such as France, Uruguay and Algeria recommend or consider treatment for HIV-positive people without symptoms, with CD4 counts between 350 cells/mm3 and 500 cells/mm3. Many countries worldwide, such as Zambia, now implement TASP for serodiscordant couples. 12
What about the idea of HIV treatment as prevention for tackling the global AIDS epidemic?
Treatment as prevention could have various impacts on public health. On a community level, it has been seen that as the number of people taking more effective HIV treatment has risen, community viral load has decreased, resulting in a reduction of new HIV infections. 13 14 San Francisco was the first health authority in the world to offer treatment to all people diagnosed with HIV, regardless of cell count. 15 The increased access meant that the average viral load among people living with HIV fell by 40 percent between 2004 and 2008, and this coincided with new infections dropping by a third. 16 In Lesotho, there has been a recent decline in new infections, even though risk-taking behaviour has increased among some populations, suggesting that the drop is due to more people accessing treatment. 17
"an HIV positive person who is taking effective antiretroviral therapy, who has an undetectable viral load and is free from STDs, has a negligible risk of infecting others with the virus. "
In 2008 a group of Swiss scientists produced the first ever consensus statement that asserted that an HIV positive person who is taking effective antiretroviral therapy, who has an undetectable viral load and is free from STDs, has a negligible risk of infecting others with the virus. 18 Their conclusion was drawn from the results of studies that showed that if an effective treatment regimen were followed, a person living with HIV will not pass on the virus to their HIV-negative partner. (For more information on this issue read AVERT's HIV transmission and antiretroviral therapy briefing sheet).
Since the Swiss statement, various studies have emerged that have investigated the relationship between viral load and HIV transmission. For example:
- A large, randomised, placebo-controlled trial involving 3381 heterosexual African couples found antiretroviral therapy use by the HIV infected partner was associated with a 92 percent reduction in risk of HIV-1 transmission to their fellow partner. 19
- In 2011, the HPTN 052 study involving 1,763 HIV serodiscordant couples was completed. 20 21 Interim analysis of the results showed those who started antiretroviral therapy as soon as they were diagnosed significantly lowered the risk of HIV transmission to their sexual partners, compared to those starting treatment later, when their CD4 count had fallen below 250 cells/mm3. Of those who took part in the study and were infected from their partner, one person became infected from the early ARV group, versus 27 from the later ARV group, showing a 96 percent reduction in risk of transmission. 22
- The first study in a general population setting showed that in areas where there is higher (greater than 30 percent of the HIV positive population) uptake of antiretroviral therapy, people who do not have HIV are 38 percent less likely to acquire the virus than in areas of low uptake (less than 10 percent). 23 24
Taking into account the effect that access to ARVs has on a population's transmission rate, the 'Swiss statement' and these other studies, some advocates have argued that a way to reduce the global AIDS epidemic would be to test everyone in 'high risk' groups and areas of generalised epidemics, and then immediately treat all of those diagnosed positive, regardless of whether their immune system is damaged. 25 Various trials of the 'test and treat' strategy at a community level are currently being developed and implemented. 26 One trial is being tested on a large scale trial in KwaZulu-Natal, one of South Africa's provinces most affected by HIV and AIDS. The Treatment as Prevention (TasP) trial was launched in July 2011 and is hoped to last until 2015. 27 28
"researchers now enter a new era with a critical question to be answered: is the preventive effect of ART highly beneficial at the population level? Should this concept be proven, it would have major implications for the public health approach of prevention and treatment " Professor Jean-François Delfraissy, Director of ANRS, organisation supporting the study
In 2011, a group of more than twenty HIV organisations from around the world, as well as hundreds of individuals, signed a declaration calling for country governments, multilateral organisations, and civil society to begin to use the evidence from the HPTN 052 trial to actively work towards early access to HIV treatment. 29 The declaration also called for countries and donor programs to collect and monitor data in order to assess the feasibility and cost-effectiveness of increasing the treatment initiation threshold for people living with HIV from 350 cells/mm3, (the current WHO recommendation) to 500 cells/mm3.
"Now is the time to change the approach to the epidemic."
- 'We CAN End the AIDS Epidemic' Declaration 30
It has been observed that although on a national scale behaviour change programmes bring down infection rates in the first stages of an epidemic, the numbers of new HIV infections tend to stabilize. UNAIDS suggest that treatment as prevention could help to change this pattern and allow new infection rates to continue to decrease. 31
Would the 'test and treat' strategy work?
Granich et al have developed a mathematical model to calculate the possibility of the HIV epidemic being driven towards elimination through a 'test and treat' strategy. 32 They estimate that if this strategy was implemented in South Africa, where there is a generalised epidemic, after 2032 the cost of the epidemic would be less than under the current strategy.
However, whether the model would actually work within a community or population is debated. 33 34 Canada, the US and Europe have been cited as places where HIV transmissions have not been reduced through the roll-out of ARVs. 35 One study which looked at infections among serodiscordant couples in China did not find an association between HIV transmission and viral load, instead identifying duration of follow-up after being treated as the main factor affecting HIV transmission. The study concluded that prevention interventions for discordant couples should focus on support and education services and helping people to adhere to treatment. 36
When a person becomes infected with HIV it can take up to three months before the virus is detected by standard antibody tests. If a person is tested during this time they may receive a 'false negative' result, which means that even though the test is negative, they are in fact infected with HIV. It is also during this period of time when they are most infectious. Research suggests that up to two thirds of HIV transmission occurs during this period of 'acute HIV infection'. 37
Therefore even if everyone who tested positive for HIV were treated with antiretroviral therapy, there would still be a group of people who had received a false negative result and who could still transmit the virus to others. For 'test and treat' to work among those people who did test positive, all those on treatment would need to adhere to it, which may be unlikely. Additionally, it is possible for viral load to change even when treatment is adhered to. 38
What would be the effects on the individual?
The HPTN 052 study found benefits for the individual beyond the preventative benefit. Although early probability of death did not decrease significantly, early antiretroviral therapy was found to decrease chance of HIV-related clinical events by 41 percent. 39
However, once a person starts taking antiretroviral treatment, they have to take it exactly as prescribed, and for the rest of their life. If not, they significantly increase the risk of drug resistance. In addition, antiretroviral drugs often have unpleasant side effects and there are possible long-term effects of treatment, such as diabetes, body fat changes and potentially others that remain unknown. 40 These are some of the reasons why in most settings treatment is currently only recommended when HIV has attacked the immune system to an extent where, without treatment, the person's health will start to deteriorate. 41 For many people living with HIV this means not starting treatment for years. Starting treatment at an earlier stage could therefore potentially be detrimental to the individual's health.
The 'test and treat' strategy could be viewed as unethical on the basis that medical codes of practice should make the care of the individual patient the doctor's first concern. Individuals may refuse to take treatment if they didn't need to for their own health, and forcing them to against their will could be seen as an abuse of human rights. This issue has already emerged in the example of San Francisco, where gay men are encouraged to be tested for HIV every six months. Those with a positive diagnosis are recommended to start treatment immediately, under the health authority's strategy to reduce new infections by 91 percent over ten years. 42 However, it has been claimed that individuals are recommended early treatment for their own health, without clarity around how TASP is a strategy for the wider population / public health. In the UK, clinicians are advised to discuss the potential of HIV treatment to protect sexual partners, emphasising the choice of the person living with HIV. People living with HIV need to be informed truthfully about all factors relevant to beginning treatment. 43
Another potential issue is that if people become too confident in the preventative effects of treatment, they may be more likely to engage in high-risk behaviour. A study of MSM in Boston who were taking highly active antiretroviral therapy (HAART) found that 18 percent had HIV in their blood, and 50 percent had HIV in their semen. 44 The presence of the virus was strongly associated with the presence of genital infections and inflammation, as well as the individual having engaged in unprotected sex, showing that the chance of transmission for a person using treatment as prevention is still influenced by other factors.
There are also various concerns around the availability of TASP for individuals, for example those in serodiscordant relationships. These include the possibility of people living with HIV experiencing external pressure or compulsion to take treatment, either from partners or, as TASP becomes more widespread, from general society. 45
Is it feasible?
It is questionable whether the 'test and treat' strategy would work when people across the world do not have universal access to HIV testing, treatment and care.
HIV testing: Stigma, criminalisation and human rights abuses act as strong deterrents to accessing testing services, making it impossible to detect all HIV infections even in well-resourced countries. In the United States of America, for example, around one in five people living with HIV are unaware of their infection, 46 and many people are still only tested once they have been diagnosed with an opportunistic infection. It has been calculated that, for treatment as prevention to work on a public health level, at least 75 percent of HIV positive people must be diagnosed and treated. 47 Barriers that prevent people from getting tested would therefore need to be addressed.
HIV treatment: Many countries have rapidly increased the number of people accessing treatment in recent years. Today, 65 percent of people in need are receiving treatment and twelve low- and middle-income countries have reached universal access. 48 In many countries, however, access to treatment continues to be limited, and where treatment is available, many peole with HIV are not eligible to start antiretroviral treatment until their CD4 counts are already low. Cosequently, if treatment targets cannot be reached now, it is highly unlikely there would be enough funding to treat those whose HIV infection has not yet significantly damaged their immune system.
HIV care: Care is needed to ensure people living with HIV receive and adhere to effective antiretroviral therapy, to keep viral load to a minimum. In one review of access to HIV services in the USA, poor engagement in care was cited as a significant challenge to the idea of a 'test and treat' strategy for HIV prevention. 49 There would need to be a large increase in healthcare workers as treatment was expanded. Concerns have been raised around the feasibility of training the influx of staff in important issues such as the impact of stigma and avoiding the coercion of patients. 50
Other costs: The 'test and treat' mathematical model proposed by Granich and colleagues 51 has been criticised for substantially underestimating the actual costs that it would entail. 52 In addition to the cost of providing more antiretroviral drugs, there would be administrative and human resources obstacles. These include finding additional doctors and nurses to prescribe the drugs, extra counsellors for pre and post-test counselling, and staff to support and encourage adherence among those taking treatment. It would be extremely difficult for countries to find the money for these costs in addition to finding the money to provide universal treatment. However, it has been argued that although in the short term the 'test and treat' strategy would be very costly, it has the potential to be cost-effective in the long term. 53
Is there a future for treatment as prevention?
Using HIV treatment as prevention to tackle the global AIDS epidemic does have some advantages; it would significantly increase the number of people who are aware of their HIV status, and millions of people worldwide who are in immediate need of HIV treatment would receive it. However, for treatment as prevention to work on this level, each case needs to be assessed on its own merit. The rights of the individual to choose whether to be treated before they actually need treatment for their own health, would have to be paramount.
HIV treatment is already being used as a prevention method in the cases of PMTCT and PEP, and populations are already benefiting from the lowered rates of new infections that accompany more people taking antiretroviral therapy.
If an individual wishes to use treatment as their prevention method they need to be aware that risk is reduced not eliminated, and be fully supported with decisions around safer sex, condom use and viral load.
If treatment as prevention were utilised on a public health level, it would still need to be ensured that people living with HIV have access to appropriate advice on how different prevention techniques can be used to manage risk, in monogamous and non-monogamous relationships. 54 Treatment as prevention would need to be complemented by education, condom use and behaviour change - other prevention strategies that have in many cases been largely successful. 55 As the Joint United Nations Programme on HIV/AIDS state:
"UNAIDS strongly recommend a comprehensive approach to HIV prevention that plans and delivers an evidence informed and human rights based combination of programmes and policies, tailored to meet the needs of those most at risk, and including practical programmes to reduce underlying causes of vulnerability, such as gender inequality and HIV related stigma and discrimination... Antiretroviral therapy will play several roles in combination prevention strategies, along with other key strategies." 56
- 1. Williams B. et al (2010) ' Treatment as prevention: preparing the way' Journal of the International AIDS Society, 14 (1)
- 2. WHO (2012, July) ' Antiretroviral treatment as prevention (TASP) of HIV and TB: Programmatic Update'
- 3. NAT (2011, May) ' HIV Treatment as Prevention'
- 4. European Centre for Disease Prevention and Control (2012)'' Evaluating HIV treatment as prevention in the European context'
- 5. Williams B. et al (2010) ' Treatment as prevention: preparing the way' Journal of the International AIDS Society, 14 (1)
- 6. WHO/UNAIDS/UNICEF (2011) '' Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011'
- 7. De Cock et al (2000, March) 'Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice', JAMA 283(9)
- 8. Cardo, D.M et al (1997) 'A case-control study of HIV seroconversion in health care workers after percutaneous exposure', The New England Journal of Medicine, November 20, 1997: (21)337:1485-1490
- 9. Smith, D.K et al (2005) 'Antiretroviral post exposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States', MMWR, January 21, 2005 (54)1-20
- 10. BASHH (2006, February) 'UK guidelines for the use of post-exposure prophylaxis for HIV following sexual exposure', International Journal of STD & AIDS, 17:81-92
- 11. WHO/UNAIDS/UNICEF (2011) '' Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011'
- 12. WHO (2012, July) ' Antiretroviral treatment as prevention (TASP) of HIV and TB: Programmatic Update'
- 13. Das-Douglas, M et al (2010) 'Decreases in community viral load are associated with a reduction in new HIV diagnoses in San Francisco', Session 10-Oral Abstacts, Paper #33, 17th Conference on Retroviruses and Opportunistic Infections
- 14. Lima, V.D et al (2008) 'Expanded access to highly active antiretroviral therapy: A potentially powerful strategy to curb the growth of the HIV epidemic', The Journal of Infectious Diseases, 198:59-67
- 15. Cairns G. (2012) ' Treatment as prevention is starting to work in parts of Africa' National AIDS Manual, aidsmap
- 16. WHO/UNAIDS/UNICEF (2011) '' Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011'
- 17. UNAIDS (2011) ' UNAIDS World AIDS Day Report 2011'
- 18. Vernazza, P et al (2008) ' Les personnes séropositives ne souffrant d'aucune autre MST et suivant un traitement antirétroviral efficace ne transmettent pas le VIH par voie sexuelle' (pdf) Bulletin des médecins suisses 89 (5)
- 19. Donnell, D et al (2010, 27th May) 'Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis', The Lancet, DOI:10.1016/S0140-6736(10)60705-2
- 20. HPTN (2011, 12th May) 'Initiation of antiretroviral treatment protects uninfected sexual partners from HIV infection (HPTN study 052' Press release [PDF]
- 21. BBC News (2011, 12th May) 'Anti-retroviral drugs 'help reduce' HIV transmission'
- 22. Cohen M. et al (2011) ' Prevention of HIV-1 Infection with Early Antiretroviral Therapy' the New England Journal of Medicine (365).
- 23. Tanser F. et al (2012) ' Effect of ART Coverage on Rate of New HIV Infections in a Hyper-endemic, Rural Population: South Africa' 19th Conference on Retroviruses and Opportunistic Infections
- 24. UNAIDS (2012) ' UNAIDS welcomes further evidence of the positive impact of antiretroviral therapy on preventing new HIV infections'
- 25. Granich, R.M et al (2009) 'Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model', The Lancet, 2009; 373: 48-57.
- 26. Williams B. et al (2010) ' Treatment as prevention: preparing the way' Journal of the International AIDS Society, 14 (1)
- 27. Africa Centre, ANRS & University of KwaZulu-Natal (2010, 29th November) Press release: 'What would be the impact of universal Test and Treat on the HIV pandemic?' [PDF]
- 28. ANRS (2011) ' Le rapport du séminaire inaugural sur "le traitement comme prévention (TasP)" a été rendu public le 19 juillet 2011'
- 29. AVAC (2011, June 7th) ' We CAN End the AIDS Epidemic'
- 30. AVAC (2011, June 7th) ' We CAN End the AIDS Epidemic'
- 31. UNAIDS (2011) ' UNAIDS World AIDS Day Report 2011'
- 32. Granich, R.M et al (2009) 'Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model', The Lancet, 2009; 373: 48-57.
- 33. Cohen M. (2010) ' HIV Treatment as Prevention: To be or not to be?' Journal of Acquired Immune Deficiency Syndrome, 55 (2)
- 34. Nguyen V. et al (2011) ' Remedicalizing an epidemic: from HIV treatment as prevention to HIV treatment is prevention' AIDS, 25 (3)
- 35. Nguyen V. et al (2011) ' Remedicalizing an epidemic: from HIV treatment as prevention to HIV treatment is prevention' AIDS, 25 (3)
- 36. Lu Wang et al (2010, October 1st ) ' HIV transmission risk among serodiscordant couples: a retrospective study of former plasma donors in Henan, China' Journal of Acquired Immune Deficiency Syndrome, 55 (2)
- 37. Nguyen V. et al (2011) ' Remedicalizing an epidemic: from HIV treatment as prevention to HIV treatment is prevention' AIDS, 25 (3)
- 38. NAT (2011, May) ' HIV Treatment as Prevention'
- 39. Cohen M. et al (2011) ' Prevention of HIV-1 Infection with Early Antiretroviral Therapy' the New England Journal of Medicine
- 40. Kitahata M. et al (2011) ' Effect of Early versus Deferred Antiretroviral Therapy for HIV on Survival' the New England Journal of Medicine, 360 (18)
- 41. WHO (2009, 30th November) 'Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents'
- 42. NAT (2011, May) ' HIV Treatment as Prevention'
- 43. NAT (2011, May) ' HIV Treatment as Prevention'
- 44. Medical News Today (2012, 29th March) ' HIV-Infected Men At Risk For Spreading HIV Despite Taking HAART'
- 45. aidsmap / nam (2012, June 15th) ' If people who need HIV drugs aren't getting them now, why should the prevention benefit of treatment be the reason that the drugs become available?'
- 46. CDC (2010, July) 'HIV in the United States'
- 47. Nguyen V. et al (2011) ' Remedicalizing an epidemic: from HIV treatment as prevention to HIV treatment is prevention' AIDS, 25 (3)
- 48. WHO (2013, June) ' Global update on HIV treatment 2013: Results, Impact and Opportunities'
- 49. Gardner, E.M et al (2011) 'The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection', Clinical Infectious Diseases, 2011;52(6)793-800
- 50. aidsmap / nam (2012, June 15th) ' If people who need HIV drugs aren't getting them now, why should the prevention benefit of treatment be the reason that the drugs become available?'
- 51. Granich, R.M et al (2009) 'Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model', The Lancet, 2009; 373: 48-57.
- 52. Wagner, B & Blower, S (2010, 18th September) 'Cost of eliminating HIV in South Africa have been underestimated', The Lancet, 376:953
- 53. Johnston, K.M et al (2010) 'Expanding access to HAART: a cost-effective approach for treating and preventing HIV', AIDS 2010, Jul 31;24(12):1929-35
- 54. NAT (2011, May) ' HIV Treatment as Prevention'
- 55. Venkatesh, KA. et al (2011, October) ' Is expanded HIV treatment preventing new infections? Impact of antiretroviral therapy on sexual risk behaviors in the developing world' AIDS 25(16)
- 56. UNAIDS (2009, 6th November) 'Antiretroviral treatment for prevention'


text:
Yesterday marked the 1-year anniversary–aka the bookiversary (new word!)–of Breed of Innocence! YAY!
I didn't want to do anything then because, a) I forgot until really late, and b) July 4th is about celebrating more important things than good books.
But, it's a new day, and with this new day comes a giveaway!
So, what am I giving away? Well, since I skipped other 1-year bookiversaries, I've decided to give away copies of Breed of Innocence, Twin Tied, and Shadow and Light. (The winners will each get all 3 books, in case that wasn't clear!)
How do you enter? Just comment. I hate jumping through hoops to try to win stuff, so that's my only 'hoop'. Just a comment. It can be as simple as "Hi, Lanie!" or as non-simple as "Hai, Lanie! I've never read your stuff, but I want free books. Gimmegimme!" I'm easy, y'all! (Just spare my feelings and make it nice, please! )
The giveaway is open from now until 11:59pm EST on Sunday (July 7th). I'll pick 5 winners on Monday using random.org.
(Note: Please include a valid email address so I can reach you in case you win!)
(Note 2: Copies are available in epub, mobi, or pdf.)
(Note 3: I worked a ridiculously long time on the Breed Cake even though it doesn't really look like one, but that's what it's supposed to be. Pretend, people!)
Comments for "Breed of Innocence 1-Year Bookiversary + Giveaway"Comments (8) Trackbacks
congratulations on one year bookiversary. I totally knew it was a cake thanks for the giveaway
Congrats on the Anniversary and all!
Woohoo, congrats on the one year book anniversary from a member of the Book Tart's court. I have Breed of Innocence in my to be read pile which I hope to get around to soon. Thankfully my to be read pile is bot as large as Kat's. Lol.
La Revenant (aka Rebekah)
Congrats on your one year anniversary! I have read Breed of Innocence and totally loved it! Thanks for the giveaway!
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text:
Those questions we all get: Helpful answers for the most common ones. A guide.
We get a lot of questions from the rest of the world about this D-life. Sometimes they infuriate us, sometimes they confound us. Sometimes they make us snort. So as a service to those who struggle with the answers, I've compiled this helpful list of suggested responses to questions you may get out in the wild. Feel free to adopt, share, tweak and use. And if you have some great answers, add them in the comments. This I the kind of public support and service the Diabetes Online Community is great for. Read on.
Question: "How are your/your child's numbers?"
Answer: Oh, thank you for asking. I'm finding that sometimes they are even numbers, and sometimes they are odd. Every once in a while they are divisible by three, but thankfully, they are almost never prime numbers. Ha ha – can you imagine a prime number? Oh-em-gee. One time last week she had numbers that were multiples of 10. Twice in one day! That's about where we are at.
Question: Are you/your child regulated?
Answer: Funny you should ask. I know the government is really into regulating commerce, and certainly the airlines. Or are they into de-regulating? Whatever … But in all the research I've done, I've not found a case of them regulating people with diabetes. If she is supposed to be regulated and I failed to do that, I sure hope we don't get caught! People with diabetes don't do well in prison … oh. Why? What did you mean?
Question: Should you/your child be eating that?
Answer: Absolutely not. After all, that could be sent to the Sudan to help a starving family. Or, it could be sent to a pre-school to be used as a cute craft for them to bring home for mommy to wear. Anyway, I'm pretty sure she's going to dribble some and stain that shirt and it's a hand wash shirt – I know why WHY WHY did I buy a hand wash shirt when I HATE hand washing – and when she dribbles I'm going to be the one who has to wash it. Plus, her aura is blue and I really, really don't like her eating orange foods like that because it messes with her aura. So, no: she really should not be eating that. But YOU explain that to her. Right after she boluses for what she's eating.
Question: Can I catch diabetes from you/your child?
Answer: Listen, buddy: I've seen you on the field. You are way more of a designated hitter. Don't even TRY to catch. Okay?
Question: Do you have the bad kind of diabetes or the good kind?
Answer: That's such a great question. I think I have the good kind. Because it never, every gets lazy and like … stops being all diabetes-ey on me. It's wicked good at diabetes. Wicked. So I think it's the good kind. Right?
Question: You were so young when you were diagnosed. You must be totally used to it by now. That's lucky.
Answer: Without saying a word, responder begins flicking the questioner, directly in the eyeball.
Questioner: Ouch! OW! OMG WHY ARE YOU DOING THAT? OUCH!
Answer: No worries. I'm going to do this all the time, and you're still pretty young. Before you know it, you'll be totally used to it, which is lucky!
Question/Comment: I totally get it. My cat has diabetes.
Answer: Did you consider putting your cat to sleep?
Response: OMG NO! WHY??
Answer: Because to be honest, when (child, loved ones, whoever name) was diagnosed, I considered it. I mean, it's such a pain! Right? And there are always more adoption days.
Question: So, if you have diabetes, how come you are so thin? Did you use to be really fat?
Answer: Well, not but I was pretty PHAT. I'll give you that. PHAT like Lil Kim PHAT. Lil Kim before the prison years I mean. Obviously.
Question (which is more like a statement begging for a reaction): OMG I could never give myself a shot/insert a pump site/prick my finger!
Answer: Yeah, I might just stop. I think dying quickly and painfully of hyperglycemia would be way better than these horrible shots. They suck.
Second answer choice: I know, right! THANKFULLY I had a syringe-based drug addiction before diabetes so this is all pretty normal for me.
Question: Do you know whose fault it is?
Answer: Yours. (and then stomp away and avoid them for months just to let it marinate).
Question: How are you/your child doing? Because my grandma's cousin had diabeetus and she lost her leg. But it took like … 10 years I think for her to lose it. So yeah, how are you doing? (If you are a parent, this is usually asked within the earshot of your child).
Answer: Not a word. Instead, laser beams shoot directly out of your eyes and reduce that moh-ron to dust. Right there in the coffee shop line. Nuff said.
I hope this guide serves you well. Practice your answers in front of a mirror. Own them. And share them with confidence. Education is a great thing.
Filed in: Advocacy • cool new diabetes tools • diabetes diagnosis • diabetes help • featured • General Health • Inspiration
Comments (18)
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I keep having new favorites.
This is great. I really wish I could print this out for all parents, and people with D.
And, what about addressing insane comments that aren't questions? Like the time my son's CCD (religious ed) teacher told him not to eat a snack in front of the other children, but "offer it up! It's never too soon to learn to suffer!"
I am sure you would have a better comeback than I did for that.
God I wish I could shoot laser beams out of my eyeballs! That would come in handy …
My favorite comment is "I don't know how you do it!" Really??!! Well I was thinking of giving her up for adoption after the diagnosis, but she's a pretty cute kid!! I mean what hell??!! How do we do it??!! What choice do we have??!! I have gotten that comment way too often!!
I love your answers to "I could never give myself a shot"!! That's my favorite one!!
I prefer flicking people in the eyeballs!!
There was a time about 4 months after dx, when Meredith was 2 that we were at a potluck. She went waaay low right before we ate. I quick grabbed juice and skittles and she proceeded to throw a screaming fit and refused to eat/drink. By now, all eyes were on us as we were coaxing life saving sugar down her throat. When the crisis subsided, a woman came over to me. I was still shaking and visibly upset. She told me she did not approve of us "rewarding our child's tantrum with sugar." I responded that I didn't approve of rewarding any behavior with sugar, but for today, I didn't want the paramedics to have to do it for me. I wish I thought of the eyeball flicking.
You made me laugh a lot, but you know what irritate me the most? People with diabetes in their child´s life and no taking the control and responsability of it, with a lot of stupid excuses… Thank you for sharing, I will try your answers the next time…
My son's favorite response when people ask him if the shots hurt…..it's better than being dead.
Jordan likes when people ask him what his pump or tester is. He looks at them seriously and says, "It's a bomb," then turns and walks away.
I love your sassy replies to stupid questions! Cassie & Michelle's answers are winners, too. I'm out of the age group of parents answering for their kids, but the laser beams & eye flicking are still options when people comment stupidly (i.e., Diabetes is better than cancer ~ You have 2 with diabetes? OMG, I don't know how you do that ~ I could never do all that you have to do ~ etc.).
I do find it funny to ask my kids in public "Are you high? How high are you?" and watch the reactions of those around me. The ones that smile, get it and the ones that give me funny looks, go right ahead & question me, I dare you!
I've been working on good answers for all these questions and now I have the perfect ones…thanks!! love it! I'm so tired of people telling me "I couldn't give my child a shot!" my newest reply is "give them a shot or let them die, you choose!"
Blythe was recently asked by a pageant judge to name one positive thing about having diabetes and one negative thing…I just wish I could have seen the look she gave him!
I had a good laugh at this, but I also think it's important not to turn into cynical responders. If we were not thrown into this illness with no choice, how much would we really know about it? Let's remember that a lack of education is merely a result of a lack of necessity.
I do! My comment was more of a check on a cynical inward response
I think the only question you didn't post was "won't she grow out of that?". My daughter was diagnosed at age 7 and b/c type 1 is often "juvenile" diabetes many get confused but I was shocked when my friend asked me that she'd grow out of it right?


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