text:
For deletion of kangaroos from menu
Completly DELETE Kangaroos meat in Australia and all over the world
Welcome . Bogusz Banderski - activist , fighting for ; ... , actions for ; human rights , animal rights , ecology , other issues .
Completly DELETE Kangaroos meat in Australia and all over the world
We are animal rights activist against vivisection ... this ours protest is one of the protests and is based on the
Purrect Pets charity just relocated to a mall and spent money for renovations.Their landlord is now closing the mall.
LES MÉTHODES ALTERNATIVES EXISTENT ET SONT AU POINT !PIGEONNIER CONTRACEPTIF :"Moins de pigeons dans nos villes, et
The $2 billion dollar-a-year South Korean dog and cat meat industry, which extinguishes the lives of approximately two
We must end ' torture for profit ' this is horrific abuse on innocent animals. Testing on animals is morally abhorrent,


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Is it normal to get pimples near your vagina? Not in it, but around where I shave?
- Kelsea*
When girls, or guys, shave their pubic hair, it's not uncommon to get ingrown hairs. Pubic hair tends to be curlier than arm or even head hair, which can lead to ingrown hairs. These pesky ingrown hairs can then cause pimples. If a pimple seems to be getting redder, bigger, more tender, or warm, it could be a sign of infection, and you should see a doctor or nurse practitioner.
To reduce the likelihood and frequency of ingrown hairs, avoid dry shaving, use shaving gel or cream, and shave in the direction your hair grows rather than against it to prevent irritation.
Not every bump is a pimple or an ingrown hair, however. For example, bumps that are red and tender, even at their base, might be herpes sores. These can be tender before they appear, painful once they do, and then disappear some days later. They might return from time to time, or never again. Genital herpes is a viral infection, usually transmitted sexually.
If there is any concern, have your doctor or nurse check out these bumps.
Reviewed by: Julia Brown Lancaster, MSN, WHNP-BC
Date reviewed: January 2015
*Names have been changed to protect user privacy.
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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subset: commoncrawl


text:
Hamid Karzai and U.S. at Odds Over Security Deal
U.S. National Security Advisor Susan Rice tells Karzai to sign agreement or American troops start packing
Kerry and Karzai Reach Tentative Deal, But Uncertainty Looms
The U.S. Secretary of State held talks this weekend in Kabul with Afghan President Hamid Karzai over the terms of the continued U.S. presence in the country...
Karzai: Increasingly Problematic Ally in Afghanistan
Last weekend, when Afghan President Hamid Karzai called for reduced military operations and an outright end to night raids by U.S.-led forces, he made one person...
Karzai Supports But Delays Pact With U.S.
Afghan president says he doesn't trust American leaders
Karzai Refuses to Budge on Security Pact
Afghan President Hamid Karzai vented his frustration over continuing civilian casualties and home raids during NATO operations on Saturday, reiterating that he...
Obama and Karzai: A Relationship in Progress
"Last question" had already been called in the conference room on Air Force One high above the Caspian Sea, Sunday, on its secret journey to Kabul. But a...
Karzai Demands End to U.S. Military Operations, Airstrikes
As precondition to 2014 security pact
Intelligence Chief Says Afghanistan Leader Unlikely to Sign Security Pact
James Clapper says Hamid Karzai probably won't strike a deal for U.S. troops to stay
New Afghan President Sworn In After Disputed Vote
"We want to be held accountable. I am your leader but I am no better than you. If I make mistakes, you should hold me accountable"
Obama Warns Afghanistan Leader of U.S. Withdrawal
Unless a so-called Bilateral Security Agreement is reached soon
Karzai Wants Security Firms Out of Afghanistan
Afghan President Hamid Karzai's decree ordering private security companies operating in Afghanistan to leave the country by year's end complicates U.S. strategy...
Hamid Karzai Welcomes Chuck Hagel to Kabul—His Own Way
The Afghan president went on a tirade supposedly about how the Taliban were virtually in collusion with the U.S.—just in …
The Moment
The Obama administration's realism was on display during Afghan President Hamid Karzai's visit to Washington. The American ambassador to Kabul once famously...
Obama's Visit with Karzai: No Pat on the Back
The details of President Barack Obama's weekend conversation with Afghan President Hamid Karzai remain shrouded in secrecy, but it's unlikely that Obama would...
Karzai's Delayed Peace Jirga: Any Chance of Success?
Afghan President Hamid Karzai's heavily trumpeted peace "jirga" — a proposed grand assembly meant to build national consensus toward a path of reconciliation...
Wide-Open Afghan Presidential Race Kicks Off
(KABUL, Afghanistan) — Afghanistan's presidential race kicked off Monday as election authorities began accepting the nominations of would-be candidates, the...
Hagel: Afghan Security Deal Will Be Signed Before End of the Year
Karzai has so far refused to sign post-2014 U.S. troop agreement
Karzai Said to Have Secret Talks with Taliban
The Afghan president reportedly tried to reach a peace deal without the involvement of American and Western allies
Afghanistan Frees 65 Suspected Militants, Angering U.S.
The United States says the prisoners could now pose a security threat to Afghan and international troops


text:
TePe Oral Health Care, Nova Toothbrush, Soft (Discontinued Item)
By TePe Oral Health Care6 Reviews
Shipping Weight:?0.06 lbs (0.03 kg)
Shipping Weight
The Shipping Weight includes the product, protective packaging material and the actual shipping box. In addition, the Shipping Weight may be adjusted for the Dimensional Weight (e.g. length, width & height) of a package. It is important to note that certain types of products (e.g. glass containers, liquids, fragile, refrigerated or ice packed) will often require protective packaging material. As such, these products will reflect a higher Shipping Weight compared to the unprotected product.
- Product Code: TEP-00143
- UPC Code: 845822001435
- Package Quantity:
- Dimensions: 0.05 x 1.6 x 9 in, 0.05 lbs (0.02 kg)
Product Overview
- Made in Sweden
- Developed in Collaboration with Swedish Dental Expertise
Suggested Use
Tip for maximum access. A user-friendly non-slip handle with thumb-pad, a tapered brush-head for excellent access and end-rounded filaments for gentle cleaning. Neck can be bent to desired angle.
Hold the toothbrush at 45° angle against both gum and tooth, clean gently with small circular movements.
iHerb Customer Reviews
손잡이가 날씬해서 특히 그립감이 좋아요. 칫솔모도 단단하고 칫솔이 작아서 입안 구석 구석 닦기가 편해요^^


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March 16, 2013
Mini dulce de leche cheesecakes by Within the Kitchen are a Mexican inspired dessert. These handheld cheesecakes are so easy to bake especially with the help of a muffin tin. The batter is made by combining store bought dulce de leche with cream cheese, eggs, and sugar. The crust is a traditional graham cracker crust however, you can get creative and use a chocolate or gingersnap crust instead. For full recipe instructions, click here.
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In remarks to a TV presenter on CBC, the private station that airs his program, Youssef said on Saturday that his program does not insult Islam but aims to expose those who "distort" it.
"We don't insult religion. What we do is expose those so-called religious and Islamic stations which have offended Islam more than anyone else," he said. "If anyone is to be investigated for insulting religions, it should be all those who use Islam as a weapon and a political tool to swallow the others using religion."
When asked if programs in Egypt should be less scathing than those of the West, Youssef said: "We will give (the West) an example of how freedoms are respected after the revolution," he said of the 2011 uprising that ousted longtime authoritarian leader Hosni Mubarak.
After turning himself in for questioning, Youssef first tweeted a series of quips from the prosecutor's office.
"They asked me the color of my eyes. Really," one said.
A news broadcaster at a TV station affiliated with the Muslim Brotherhood, Misr 25, accused Youssef of "mocking" the investigation. His tweets later were erased and he wrote that some reports from inside the interrogation room were "incorrect."
Amr Moussa, a former presidential candidate, called the warrant for Youssef's arrest a "provocation to Egyptians who are known for their love of what is funny."
"There is nothing odious about criticizing the president," he said in an emailed statement. "This humanizes the president."
Gamal Eid, a rights lawyer, said accusing Youssef of insulting religion — as opposed to just the president — is a tactic aimed at increasing public sympathy for the investigation.
"The accusation of insulting religion would mobilize more people against him," Eid said.
Gamal Heshmat, a lawmaker from the Muslim Brotherhood's political party, dismissed the opposition's claims of an intimidation campaign as an "exaggeration," adding that many critics of Morsi and his group are responsible for instigating violence and "offending" many in the public.
"What is the problem with abiding by the law? No one was detained and there were no extra-legal measures," he told the AP, describing the media as "chaotic," with numerous attacks against Morsi but few prosecutions.
"It is offensive ... Let the judiciary decide," he said.
A prosecution official said Youssef was to pay a bail of 15,000 LE ($2,200), pending the completion of an investigation. Youssef tweeted that the bail is for three separate cases.
Eid, the rights lawyer, said the release on bail means all options are open.
"The prosecution could continue investigation, put the case aside or send it to trial."
Meanwhile, in Egypt's second largest city, Alexandria, 11 people detained on Saturday including five lawyers accused of attacking a police station were released without charges.


text:
Vessel Length Work Start From To
MSC Melissa 997 0800 Le Havre Freeport`
Nedlloyd Barentsz 912 1900 Savannah Miami
Carnival Fantasy 855 0600 Nassau Freeport
Star Juventas 649 1300 Portocel Baltimore
Rickmers Hamburg 632 0700 Savannah Philadelphia
Rickmers Singapore 633 0700 Houston Morehead City
CMA CGM Tarpon 964 0800 Jacksonville Kingston
Philadelphia Express 798 0700 Bremerhaven Pott Everglades
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We Make It Easier To Buy Green
RPD was created to provide practical ways for any company to buy renewable electricity. As climate action becomes more urgent, we know that leading businesses want to reduce their greenhouse gas footprints —they just need better options.
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Anise Tea Cookies
19 Jul 2010
|All purpose flour
|2 1⁄2 Cup (40 tbs)
|1⁄2 Teaspoon
|1⁄4 Cup (4 tbs), finely chopped
|Anise seeds
|1 Tablespoon
|Salad oil
|2⁄3 Cup (10.67 tbs)
|Powdered sugar
|3⁄4 Cup (12 tbs)
|Orange juice
|2 Tablespoon
|Vanilla extract
|1⁄2 Teaspoon
Combine flour and salt.
Stir in nuts and anise seed.
Add salad oil and mix very well.
Combine sugar, orange juice and vanilla extract: add to salad oil-flour mixture and mix well.
Mixture will appear somewhat dry and crumbly.
Shape with hands into rolls about 3/4 inch in diameter and 2 inches long, leaving rolls straight or curving them into crescent shapes.
Place on ungreased cookie sheets.
Bake at 350° for 20 to 25 minutes, or until lightly browned.
If desired, roll warm cookies In powdered sugar.
Cookies improve with storage.
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Anise Tea Cookies Recipe


text: Hugh Panaro is The Phantom and Sierra Boggess is Christine in the 25th anniversary cast of The Phantom of the Opera on Broadway. Joan Marcus hide caption itoggle caption Joan Marcus Music Articles 25 Years Strong, 'Phantom Of The Opera' Kills And Kills Again January 27, 2013 Invited guests packed the Majestic Theater on Saturday night to celebrate the longest-running Broadway musical ever. Times have changed, but the Phantom, that tortured genius who haunts the Paris Opera House, creating havoc and causing the chandelier to fall, has endured. Listen Loading… 4:04 Playlist Download Embed Embed Close embed modal <iframe src="http://www.npr.org/player/embed/170377703/170385144" width="100%" height="290" frameborder="0" scrolling="no">


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The big news for iOS 8.4 is Apple Music, but there's a long list of tweaks and fixes to iBooks and more in the latest iOS update.
The Pebble Time adds a few key improvements and a color screen compared to previous Pebble watches, but owners of previous Pebble watches may not see a need to upgrade yet.
Fancy a fancier Pebble Time watch? This all-steel version is coming this summer, and smart straps with sensors are on the way too. We tried it on in Barcelona.
As long as you don't need expert-level features, the 2013 AirPort Time Capsule is an excellent backup/file server for Apple fans -- especially for those with 802.11ac-enabled Macs.
Starting July 1, smartphones sold in the state must come with software that lets users lock a stolen phone so it can't be used, making it harder to resell. Crime statistics show the tech is already working.
Growlanser: Wayfarer of Time weaves a complex and captivating tale, but the combat doesn't pull its weight.
Finally, people born in 1980 have something amazing over those young'ins who came into the world in the year 2000 or on a Leap Day.
Sly Cooper: Thieves in Time completely nails the style and feel of the original trilogy, but doesn't do much to separate itself as a reimagined franchise.
A new version of Apple's mobile operating system and Beats 1 radio station is set to debut Tuesday morning, says former Beats CEO and current Apple exec.
Technically Incorrect: In a Facebook Q&A, Mark Zuckerberg's intellect is tested by one of the world's great minds.


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Shield off to play golf at Princeton
Tony Cimmarrusti - Special Writer
South 2014 graduate Tenley Shield, left, poses with Detroit Red Wings head coach Mike Babcock after winning the Miss Hockey honor in late winter. Photo courtesy of Mickey Shield
August 07, 2014
Grosse Pointe South's Tenley Shield recently walked off the links with a smile on her face and a jump in her step, despite a sluggish start in the 2014 Michigan PGA Women's Open.
The Academic All-State award winner in both hockey and golf has plenty of reasons to be optimistic.
She is especially grateful to be headed to Princeton University later this month, where she will be joining its highly touted golf team.
Shield is one of the most decorated student-athletes to ever walk the halls at South.
She achieved an eye-popping 4.35 grade point average, while also garnering All-State status five times in hockey and golf.
Shield led her teams to three state finals in hockey (winning twice), a Michigan team title in golf as a sophomore, and was recently selected Women's Athlete of the Year at Grosse Pointe South.
"My happiest memory at South was my sophomore year in golf," Shield said. "It was great to win the state title, but what really made it special was playing with my cousins, Ella and Lily Pendy, as well as our good friend Claire Boyle. That was really memorable and fun."
Shield, who was named Miss Hockey as both a junior and senior, also was selected as the top scholar-athlete in Michigan for girls' hockey. She shared about her passion for the game, "I'm really going to miss playing hockey. I'm toying with the idea of trying out for the hockey team at Princeton, but will probably just try to find some pick-up games or intramurals. We will have to see how it goes academically. I know I am going to miss playing."
Shield loved playing for head coach Joe Provenzano.
"Coach Provenzano is awesome and I am really going to miss all the coaches and the team," she said.
She also singled out her teammates as being the thing she will miss the most about her days at South.
Shield comes from a long line of outstanding athletes.
Her mother, Mickey, swam for the boys' team at South, before a girls' team existed. Mickey swam at the University of Michigan, where she met her husband Bill, a wrestler and football player.
Dow anxious for college to begin
Kirck prepared for KZoo softball
Wittwer shines
Kish preps for baseball at Hope
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You can now invite anyone to meet at your favorite Starbucks.
Limited-time feature
40 year old man | Beech Grove, IN, USA | Seeking women 25-33 within 50 miles of Fishers, IN
Active within 24 hours
Please read: If I winked at you, then I'm very...
Please read: If I winked at you, then I'm very interested; winks are just more efficient than a lengthy email that you might not even read. ... Serious inquiries only! I'm here because I don't want to be here; I am looking for a great relationship. So, if that's what you're looking for as well and would appreciate a guy like me, please continue reading. Timing is everything, isn't it? At one time, none of us were ready to jump into the deep end of the pool, weren't ready to hop into a car and drive it, and didn't know enough to perform well at our job. Yet, at some point, we all became brave enough, competent enough and experienced enough to take all of those leaps and experience something new. So, we ventured out, took that extra step or moved ahead of our former selves. I am at that point where it pertains to relationships. I'm ready to be with someone special. I'm ready to build a lasting relationship. I'm ready to go all in. No, don't get me wrong; I'm not here to simply find anyone. Absolutely not. I'm here to find someone special. I'm a healthy, grounded, fun, athletic, diverse, driven individual. I can occupy myself for the rest of my life with my wide array of interests, hobbies and ambitions, so I am not looking to simply be with anyone. I'm looking for someone who's not perfect, but who's perfect for me. I'm looking for someone to take my other season ticket to my football team (not necessarily all the time). I'm ready to have someone to hang out with in the evenings and on the weekends. I'm ready to plan nights that are fun, exciting, and romantic and ones that end with the two of us going home to spend even more time together. I'm ready to plan vacations together, plan date nights weeks in advance and think about the future. I'm ready for all of that and more. I want it! And honestly, I expect it to happen pretty quickly. Come at me hard and fast and you'll stand a good chance. That does not necessarily mean I'm on a fast track to marriage, kids, retirement, etc. I'm still looking to have fun with that special someone. . So, I am not operating on a set schedule here. I want to have fun with that special someone and not just now, but for now and for a long, long time. Ideally, my match would be a sexy, fun, athletic, intelligent and happy woman in her 20s to early-30s. (And if you're concerned with any age difference, think in terms of life experiences rather than simple numbers and give it shot.) She would be adventurous and active, but still with a list of TV shows she enjoys. I would love for her to be amenable to the things I like to do, but with enough attitude and confidence to persuade me to do things she likes (and that aren't necessarily at the top of my list). If you've made it this far and are still interested, here's some basics about me: I have many varied interests. I like to do a lot of different things. But, honestly, day-to-day, I'm an ordinary guy. I wake up (slowly), get ready, and go to a good job. I listen to music in my car. I use my TV for noise, mostly (comedies, cartoons, movies, etc.). I come home and usually eat something I cooked (yes, I can cook – my tastes just need to be expanded). I then try to workout, hit the driving range, or work on a hobby of mine. Occasionally, I play a strategy game on my computer. I keep my house quite clean and tidy (but not obsessively so). On weekends, I take many road trips to see family (especially my nephew), attend live football games, and see friends. Beyond that, I'm up for just about anything. What do you have??? I have done days in the infield at a NASCAR race and I have put on a tux to go to the symphony, and I've been happy as a clam at both. I've jumped out of a perfectly good airplane, I've swum with dolphins and sharks, I've flown completely across the country on a moment's notice, and I do have a passport. …Again, what do you have???
Cooking , Dining out , Movies/Videos , Nightclubs/Dancing , Performing arts , Playing cards , Playing sports , Political interests , Travel/Sightseeing , Video games , Watching sports
Auto racing / Motorcross, Baseball, Basketball, Billiards / Pool, Bowling, Dancing, Football, Golf, Other types of exercise, Swimming, Tennis / Racquet sports, VolleyBall, Weights / Machines
I exercise 3-4 times per week.
Don't display my sign
I have Cats
I like Dogs, Fish
Some other viewpoint
I like variety. A night listening to a live local band, another night in a pub, and occasionally letting it loose. But, I enjoy getting out of town whether it's just a night in another city or a week in the Caribbean (my favorite).
Purdue University, West Lafayette, IN
I have a lot of favorites, but this area is too short to make a list. Feel free to ask.
I enjoy all kinds of sports from playing golf, basketball, volleyball, just about anything you need me for, to watching all kinds of sports especially football. I enjoy my share of TV, movies, games, museums, orchestras, theater, ...whatever you got.
I read select stories on the internet (I prefer to read what I want rather than have it printed and handed to me). The last book I read was The Fairtax Book... Other than my own work, at least.
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What he is looking for
|5'11" (180cms)
|5'0" (152cms) to 5'9" (175cms)
|Body type:
|Slender, Athletic and toned
|No preference
|Dark brown
|No preference
|Cigar aficionado
|No Way, Occasionally, Cigar aficionado
|Social Drinker
|Social Drinker, Moderately
|Sales / Marketing
|No preference
Marketing Manager
|I'll tell you later
|No preference
|Never Married
|Never Married
|Have kids:
|Wants kids:
|White / Caucasian
|White / Caucasian
|No preference
Like many of this country's founding fathers, I'm a Deist.
|Graduate degree
|Some college, Associates degree, Bachelors degree, Graduate degree, PhD / Post Doctoral
Bachelor's, MBA and 2 years of PhD work...


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Publisher: Amv Publishing ServicesBinding: PaperbackPages: 106Size: 2.36" wide x 55.12" long x 85.04" tall Weight: 319.000Language: English
Red Earth and Other Poems Adamu Ajunam Red Earth is a poet's conscious effort at capturing the character of the Nigerian society and the challenges faced by the country's citizens in the task of nation building. The many differences in tribe and tongue notwithstanding, the poet posits that lack of good leadership has been the malaise that has continued to plague this prosperous country, and which has brought the preponderant majority of its peoples to the brink of poverty in spite of the abundant human and natural resources the country has been blessed with. However, the spirit behind this collection of poems is positive - one of optimism, aspiration and hope - to awaken the giant within to redemption of self... to overcome the various forces that have held the nation down for so long and enable her scale new and hitherto unfathomable heights. The title poem "Red Earth" depicts and extols the beauty of the country. It underscores the necessity for Nigerians to begin to see through the facades of "civilization" and "globalization," to overcome their addictive and poisonous side-effects, to embrace the nation's rich cultural heritage and direct these and the homeland's abundant resources into uplifting the country and ensuring her genuine progress and development among the world's comity of nations. Most of the poems are written in free verse to capture the vibrancy, resilience and vitality of this great nation and her diverse peoples. Adamu Ajunam was born in Kaduna in 1950 and has travelled round the six geo-political zones of Nigeria and outside its shores pursuing his passion for photography. A successful engineer, he has to his credit two well-documented travel guides on Nigeria, Eko-the Navel of a Giant and Nigeria - A Harvest of Nature. Ajunam lives and works in Lagos.
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Phylogenetic Analysis of Mexican Cave Scorpions Suggests Adaptation To Caves Is Reversible
March 1, 2010
New evidence that specialized adaptations are not evolutionary dead ends.
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February 17, 2010
A new book from an American Museum of Natural History anthropologist explores traditional spirituality in a rapidly developing world.
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Competition from other bears may threaten a polar bear population.
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Archive for Wednesday, April 9, 2003
Obit: Clint J. Luttrell
1927 - 2003
Memorial services for the Rev. Clint J. Luttrell were Sunday, April 6, at Edwardsville Assembly conducted by the Rev. Rick Burcham. Burial was in Chapel Hill Memorial Gardens, Kansas City, Kan. Visitation was before the funeral.
Mr. Luttrell, 76, died Thursday, April 3, at his home
Mr. Luttrell was born Feb. 11, 1927, in Brumley, Mo., son of Hamon Ellen and Ruby (Witt) Luttrell. He was married in 1947 to Eva M. Long.
Mr. Luttrell was an Army veteran of World War II. He lived in Edwardsville from 1950 to 1995. Rev. Luttrell worked for Inland Cold Storage in Kansas City, Kan., for 19 years until his retirement. He then moved to Brumley. Mr. Luttrell was an ordained minister for 45 years and pastored and helped build the Edwardsville Pentecostal Church of God. He was a member of the Tuscumbia Assembly of God Church, Tuscumbia, Mo.
Mr. Luttrell was preceded in death by two sons, Paul Joseph Luttrell and Gary Dennis Luttrell; his parents; Hamon and Ruby Luttrell, his stepmother, Zilphia Jane Reinhart; four brothers; Jackie, Ronnie, Okie and Dean Luttrell; and one sister, Bonnie Bowden.
Mr. Luttrell is survived by his wife, Eva M., of the home; one son, Jimmy L. Luttrell, Springfield; two daughters, Virginia C. Burcham, Perry; and Rebekah S. Tomlinson, Beeville, Texas; five brothers, Lynn Luttrell, Ovid Luttrell, and Donnie Luttrell, Brumley, Mo.; Terry Luttrell and Mike Luttrell, Montreal, Mo.; three sisters, Betty Johnston and Sharon Quem, Stoutland, Mo.; and Sally Durham, Springfield; seven grandchildren and 5 great-grandchildren.
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Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series
BMC Musculoskeletal Disorders 2004, 5:32 doi:10.1186/1471-2474-5-32
- Incorrect Assumptions
- In response to earlier comments
- Deficient implementation and/or reporting
- Consumer Responds
- In Response
- Skeptical about Chiropractic Benefit on Scoliosis
Incorrect Assumptions
Linda Racine (2006-09-18 10:54) Scoliosis Association of San Francisco
Ms. O'Connell's comments are incorrect on several points.
Yes, I do have a website (http://www.scoliosislinks.com). It is not an ecommerce website, and I do not make a single dollar from it. In fact, my scoliosis "hobby" costs me in the neighborhood of $3,000 a year.
And, while I am listed as a moderator on the National Scoliosis Foundation Forums website (http://www.scoliosis.org/forum), I do not have the authority or ability to change or remove posts. You can contact the President of that organization to verify that fact.
Let's get back to commenting on the topic and not on one another.
Competing interests
In response to earlier comments
Katie OConnell (2006-02-28 13:46) NV Me Design
I wish to point out that Linda Racine does in fact have a competing
interest. She runs a scoliosis information site which is biased against
alternative therapies.
To quote from her website: "Before you check out any alternative
treatment, I'd like your attention for a minute. It might save you some time
and money. Are you listening? THERE ARE A LOT OF CHARLATANS ON THE
INTERNET! I admit it. I'm more than a little skeptical about alternative
treatments for scoliosis. I'd like to point out that, unlike alternative
practitioners who stand to make a lot of money if they can convince you
to try their treatments, I have absolutely nothing to gain by warning
you about such treatments. Structural scoliosis cannot be cured. No one
has ever published a single case study of structural scoliosis curves
being permanently reduced by an alternative treatment".
She points out the amount of money they "stand to make", never once
considering the compensation an average spine surgeon makes. Furthermore,
she is a moderator for scoliosis.org, supposedly an "open to the public
forum" where she has the right and ability to delete posts from people
who tout their success from alternative care, should she choose.
Her dislike of alternative practionioners is such that her comments
simply cannot be considered those of only an "interested consumer".
Competing interests
My boyfriend is a Chiropractor.
I am a patient of Dr. Woggon who has corrected 11 degrees so far, so I am admittedly biased in favor of this study.
Deficient implementation and/or reporting
Ronald Feise (2004-12-14 23:41) Institute of Evidence-Based Chiropractic
Dear Editor,
I read with disappointment the retrospective case series study by Morningstar (2004). The study contains numerous shortfalls which contribute to fatal implementation and/or reporting flaws.
The aim of the study was not clearly defined. The authors wrote, "The purpose of the present study is to investigate any possible benefits from combining manipulative and rehabilitative techniques from a randomized sample collected from various chiropractic facilities." The term "randomized sample" means that a group of subjects all have an equal chance to be assigned to either a study intervention group or a control group(s). But this was an uncontrolled study, and no randomization could have occurred. I must assume that this was a mistake, and that the authors meant to write "a small convenience sample of patients," because later in the paper the authors inappropriately use the word "nonrandomized" to describe the patient selection. This is confusing and misleading.
The inclusion and exclusion criteria are poorly described. Scoliosis has many different operational definitions. How was the scoliosis defined? The selection of patients is poorly described. What was the sample frame? Did every scoliosis patient have an equal chance of selection? How many subjects were excluded and for what reasons? Because this was a retrospective study, were patients selected because of their beneficial results? Selection bias is likely and has not been properly addressed.
The study population was not well described. What were the presenting primary and secondary complaints? Was the entry visit of the scoliosis patients confounded by pain? Injury? Comorbidities? What was the classification of scoliosis curve (Lenke)? What was the Risser sign? Without Lenke and Risser data, a reader does not know the probability of curve progression. Over what period of time was the data collected? Did the patients provide consent? Patients who failed to perform home exercise were excluded from this study. How did the authors collect this data? Did they trust patients to provide the response, or did they use an electronic monitoring device?
The outcome measure process is poorly described. Was the observer blinded to the dates on the x-rays and the purpose of the study? Did the authors calculate intra-reliability coefficient so that readers could know the measurement error? Intra-examiner measurement error has been reported to be between 5 and 10 degrees (Morrissy 1990, Carmen 1990, Loder 1995). Were the pre- and post-x-rays all taken the same time of day? Because there is a clinically important increase of curve severity (5 degrees) in severe idiopathic scoliosis between morning and evening, the comparative x-rays should be taken at approximately the same time of day ( + one hour) as the entry x-ray (Beauchamp 1993).
In the discussion section the authors make another error when they write, "Given that the average curvature progression in idiopathic scoliosis is 7.03° per year [38] . . ." This is misleading, because progression depends upon patient variables such as Risser, Cobb angle, and age. One cannot make a statement about mean progression without clearly defining the specific population (Roach 1999, Lonstein 1988, Lonstein 1984, Bunnell 1988, Little 2000).
In conclusion, this paper should not have been published in its present form and represents poor implementation and/or reporting.
Ronald J. Feise, DC
Institute of Evidence-Based Chiropractic
Beauchamp M, Labelle H, Grimard G, Stanciu C, Poitras B, Dansereau J. Diurnal variation of Cobb angle measurement in adolescent idiopathic scoliosis. Spine 1993;18:1581-3.
Bunnell WP. The natural history of idiopathic scoliosis. Clin Orthop 1988;229:20-5.
Carmen DL, Browne RH, Birch JG. Measurement of scoliosis and kyphosis on radiographs: intra and inter-observer variation. J Bone Joint Surg 1990;72(A):328-33.
Morningstar MW, Woggon D, Lawrence G. Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskeletal Disorders 2004, 5:32
Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie H. Measurement of the Cobb angle on radiographs of patients who have scoliosis. J Bone Joint Surg 1990;72(A);320-7.
Little DG, Song KM, Katz D, Herring JA. Relationship of peak height velocity to other maturity indicators in idiopathic scoliosis in girls. J Bone Joint Surg [Am] 2000;82:685-93.
Loder RT, Urquhart A, Steen H, Graziano G, Hensinger RN, Schlesinger A, Schork MA, Shyr Y. Variability in Cobb angle measurements in children with congenital scoliosis.
J Bone Joint Surg Br. 1995 Sep;77(5):768-70
Lonstein JE, Carlson JM. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg [Am] 1984;66:1061-71.
Lonstein JE. Natural history and school screening for scoliosis. Orthop Clin North Am 1988;19:227-37.
Roach JW. Adolescent idiopathic scoliosis. Orthop Clin North Am 1999;30:353-65.
Competing interests
Consumer Responds
Linda Racine (2004-11-05 05:11) Just a Skeptical Consumer
Please call me Linda. May I call you Mark?
Regardless of the treatments you provide, there has never been a single treatment that has shown any promise to permanently reduce scoliosis curves. I agree that some amount of correction may be obtained from treatments such as yours, and even preserved, as long as the treatment is continued. But, as I mentioned in my original comment, just like a brace, when the treatment is discontinued, the curves will return.
Your comment that "your statement that a TLSO brace can do the same thing is not comparable" puzzles me. I did not compare your treatment to brace treatment. Your treatment might prove to be as effective as, or even more effective than, bracing. That doesn't mean that the patients in your cohort won't have their curves return once treatment is stopped.
I agree that the Weinstein study shows that the scoliosis patients in their cohort had pain more often than controls. It's not surprising to me, in that the mean age in the cohort was 66 years (range 54-80). (If I recall correctly, you did not mention the mean age in your study, but the age range was considerably younger.) Still, 23% of the scoliosis patients in the Weinstudy study reported no pain. Of those with pain, 68% reported only little to moderate back pain. To me, that's a fairly significant percent of people who are probably living fairly normal lives. (By the way, I'm sure you're famility with other studies that show that 80% of the entire adult population in the U.S. report at least occasional back pain.)
The bottom line in terms of this aspect of our little debate is that I believe the CONCLUSIONS section of the Weinstein study specifically supports my notion that many people with scoliosis live normal lives: "Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns."
Linda Racine
A Skeptical Consumer
Competing interests
None declared
In Response
Mark Morningstar (2004-11-02 22:27) Spinal Technologies Company
Ms. Racine,
I appreciate your interest in scoliosis and its multitude of proposed treatments. To reply specifically to your comment, there must first be clarification on some basic vocabulary. Your definition of chiropractic, as I infer it from your comment, is synonymous with spinal manipulation. The chiropractic profession at large contains many procedures, including spinal manipulation, along with several other common domain procedures. However, in our study, we performed the minimum amount of manipulation necessary to achieve the desired effect. We also used a bodyweighting system designed to change the global centers of gravity, so that predictable and corrective compensations are observed. This is not a commonly used procedure, and should only be considered chiropractic insofar as it is used by a chiropractor.
Furthermore, you mention that people with scoliosis can often lead a "normal" life, yet you did not define normal. Scoliosis has repeatedly shown to alter the quality of life in specific subsets of the general population. Recently Weinstein et al showed that people with scoliosis develop chronic back pain significantly more than controls. Other authors have shown connections with difficult labor, decrease of consortium, self-perception issues, decreased athletic performance, and others. Your notion that this population often leads "a normal life" is not strongly supported.
In terms of long-term prospects, you are correct. We are currently working on long-term follow-ups, but one has to start somewhere. However, your statement that a TLSO brace can do the same thing is not comparable. Braces must be worn the majority of the day every day to be clinically effective. There are significant psychological issues with brace treatment in terms of self-image. Our treatment only requires a total home care time of less than one hour per day. The purpose of this study was not to compare treatments. People with scoliosis must decide on their own which treatment they will undergo.
Mark W Morningstar, DC DAASP
Competing interests
See article
Skeptical about Chiropractic Benefit on Scoliosis
Linda Racine (2004-10-13 21:00) Just a Skeptical Consumer
While I applaud your effort to study the effectiveness of chiropractic on scoliosis, I see several problems with this study:
* Many of the references you used were not controlled for idiopathic scoliosis.
* Your cohort was 15-65 years of age, so your statement the the "average curvature progression in idiopathic scoliosis is 7.03 degrees per year" is useless. The vast majority of 15-65 year olds would be skeletally mature, so they would not be expected to have anywhere near 7.03 degrees of curvature per year, especially with average starting curves of 28 degrees.
* There is no proof that the correction noted by the subjects in your study will hold over time. A simple TLSO brace could be applied and would probably get more than 17 degrees of reduction in a skeletally mature population. However, when that brace is removed, the curves will return to their original position over time.
While chiropractic may help some people with the pain associated with large scoliosis curves, there is no evidence that it can influence the natural history of the disease. Patients with small to moderate scoliosis curves can be expected to live a normal life without the need to try to reduce their curves.
Linda Racine
- a skeptical consumer
Competing interests
None declared


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- Shopping Bag ( 0 items )
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Use of the law: Contradictions and dilemmas
Part II A model of anti-oppressive practice: Principles for action
Minimal intervention
Implications for practice
Part III Reframing practice in relation to legislation
Service user involvement


text:
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