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The Open AIDS Journal, 2010, 4, 123-131 123 1874-6136/10 2010 Bentham Open Open Access Adaptation of a Couple-Based HIV Intervention for Methamphetamine-Involved African American Men who have Sex with Men Elwin Wu*,1, Nabila El-Bassel1, L. Donald McVinney2, Yves-Michel Fontaine1 and Leona Hess1 1Social Intervention Group, Columbia University School of Social Work, New York, NY, USA 2Harlem United, New York, NY, USA Abstract: In the U.S., incidence of HIV infection among men who have sex with men (MSM) has steadily increased since the 1990s. This points to a need for innovation to address both emerging trends as well as longer-standing disparities in HIV risk and transmission among MSM, such as the elevated rates of HIV/STIs among African American MSM and methamphetamine users. While couple-based sexual risk reduction interventions are a promising avenue to reduce HIV/STI transmission, prior research has been almost exclusively with heterosexual couples. We sought to adapt an existing, evidence-based intervention—originally developed and tested with heterosexual couples—for a new target population consisting of African American MSM in a longer-term same-sex relationship where at least one partner uses methamphetamine. The adaptation process primarily drew from data obtained from a series of focus groups with 8 couples from the target population. Attention is given to the methods used to overcome challenges faced in this adaptation process: limited time, a lead investigator who is phenotypically different from the target population, a dearth of descriptive information on the experiences and worldviews among the target population, and a concomitant lack of topical experts. We also describe a visualization tool used to ensure that the adaptation process promotes and maintains adherence to the theory that guides the intervention and behavior change. The process culminated with an intervention adapted for the new target population as well as preliminary indications that a couple-based sexual-risk reduction intervention for African American, methamphetamine-involved male couples is feasible and attractive. Keywords: HIV, prevention, adaptation, men who have sex with men, African American, methamphetamine, couples. INTRODUCTION the earlier decades of the epidemic, transmission has plateaued at about 56 thousand new infections per year [1, 2]. The limited decrease in HIV incidence during recent years highlights a need for continued vigilance as well as novel preventive intervention programs. However, the plateau in overall incidence belies a concern particularly for men who have sex with men (MSM): not only does male-to-male sexual contact continue to represent the major conduit of HIV transmission in the U.S. (53% of all new infections and 72% among male cases in 2006) [2], but inspection of the data reveals that incidence rates for MSM have been increasing steadily since the 1990s [1]. Following a decrease in HIV incidence in the U.S. during reduction among MSM stems not only from a shared risk behavior (e.g., sex without barrier protection), but also because the physiological and immunological sequelae of STIs can fuel the transmission of HIV [3]. There has been a recent increase in incidence of STIs among MSM [4], who are already overrepresented among STI cases. In New York City (the locale for the current study), annual rates of major reportable STIs have increased since 2005 [4]. The need for sexually transmitted infection (STI) risk *Address correspondence to this author at the Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, USA; Tel: 212.851.2397; E-mail: firstname.lastname@example.com needed to counter the aforementioned trends in HIV and STI transmission among MSM. While MSM clearly shoulder a large burden of the HIV epidemic, epidemiological research strongly points to additional subpopulations of MSM with elevated rates of HIV infection in the U.S.: African Americans [4-6], methamphetamine users [7, 8], and men in longer-term (vis-à-vis casual) relationships [9, 10]. That smaller subpopulations carry a proportionally higher load of the HIV epidemic has led to recommendations to focus prevention efforts on populations at highest risk for infection as a "pressing public health and humanitarian imperative" [11]. It is possible that unique dynamics are leading to higher rates of infection among these populations. For example, the likelihood of unrecognized HIV infection may decrease as main partners transition into longer-term partners (or vice versa), but the presumably lower risk may be offset by a higher frequency of unprotected receptive anal intercourse and fears that introducing condom use would elicit mistrust or suspicions/acknowledgement of extradyadic partners [9]. Another possibility is that past/current prevention (and outreach) efforts are not resonating or consonant/compatible with the context in which these individuals live, especially for those at multiple risks. Altogether, these considerations prompted formative work to develop a novel behavioral sexual risk reduction with content tailored for those at the nexus of populations at elevated risk for HIV and STIs: African American men in longer-term, same sex intimate Innovative approaches to sexual risk reduction are
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124 The Open AIDS Journal, 2010, Volume 4 Wu et al. relationships in which at least one partner is using methamphetamine (herein referred to as "African American, methamphetamine-involved male couples"). Couple-Based Interventions for Sexual Risk Reduction: Meeting the Need for Innovation individuals, MSM have fewer population-specific HIV interventions with scientific evidence of efficacy reported in the scientific literature as of 2002 compared to other major risk categories [12, 13]; this situation does not appear to have changed substantially if at all [14]. While a growing body of evidence underscores the promise of a couple-based approaches in promoting sexual risk reduction among populations at elevated risk for HIV [15], the focus has been almost exclusively on heterosexual couples. No couple-based interventions specifically for MSM have been identified in meta-analyses and systematic reviews of HIV preventive intervention trials with stronger scientific design (e.g., randomized clinical trial) [16, 17]. Couple-based HIV/STI prevention directly addresses the elevated risk among MSM in longer-term relationships as noted above and may bring innovation to renewed reductions in HIV transmission among MSM. Despite being the largest group of HIV-infected strategy for engaging individuals who have been out of reach of the prevention outreach and health services system. A couple-based approach can start with recruitment of the partners of hard-to-reach individuals; in our experience, the partners often want the difficult-to-reach individual to engage in services and positive behavioral change, and the partners can be very compelling in recruiting/engaging the hard-to-reach individuals because of the conjoint delivery of the intervention [18]. Thus, a couple-based approach can start with recruitment of methamphetamine users, but who may be in an intimate relationship with a methamphetamine user who is not currently engaged with services. A couple-based approach may also be particularly useful MSM who are not A Starting Point: The Connect HIV/STI Preventive Intervention sexual risk-reduction for mixed-gender couples, has been demonstrated to be efficacious at 3-months and 12-months post-intervention [19, 20] and has been selected for inclusion in the CDC's Compendium of HIV Prevention Interventions with Evidence of Effectiveness. The 6-session Connect intervention combines content related to safer sex practices and prevention of HIV and STIs, with an emphasis on sexual communication and negotiation skills. The intervention cultivates responsibility and ability to protect oneself, one's intimate partner, and fundamentally, one's intimate relationship. The process is facilitated by a focus on a positive future orientation and risk reduction as a sign of caring, as opposed to focusing on past risky behavior and condom use as a sign of mistrust. The intervention also works to empower participants to act as health advocates who are enhancing the future well-being of communities hardest hit by HIV/AIDS. The Connect intervention, a couple-based HIV/STI delivered to African American, methamphetamine-involved male couples naturally involves scrutinizing content that reflects an assumed relevance and/or central importance of potentially heteronormative content (e.g., knowledge of female anatomy, traditional gender norms); however, it may be equally heterocentrist to assume that such information is irrelevant for all male couples. These concerns, their underlying considerations, and the concomitant challenges are exacerbated by the dearth of information in the empirical knowledge base regarding relationship and couple-dynamics among men of color in longer-term, same-sex relationships. HIV prevention researchers have put forth models for rigorous, formal adaptation of existing interventions for new target populations [21, 22]; these can be multi-stage endeavors that impose considerable requirements on time, resources to evaluate/compare existing evidence-based interventions, dedicated staff to collect new information and implement revisions, and knowledgeable experts on the new target population. However, communities have pressing needs that may benefit from swifter progression interventions. Furthermore, community-based organizations may not have the information, technology and staffing resources to evaluate a number of existing evidence-based interventions, or an agency may be structured/staffed to deliver a particular intervention [for a different target population]. Furthermore, for hidden or disenfranchised populations, there may be an inadequate level of existing knowledge or few experts, especially if the problem is emerging. These constraints were in place with respect to sexual risk reduction methamphetamine-involved male endeavored to develop and implement an adaptation procedure that seeks to maintain a high level of scientific rigor in the face of these challenges. Revision of the Connect intervention in order to be existence of multiple in developing promising for African couples. American, Thus, we METHODS Design risk and protective factors and dynamics among African American, methamphetamine-involved male couples was accomplished using qualitative methods, i.e., focus groups., with couples from the target population. Given the very limited existing research on couple-based HIV prevention with male same-sex couples, especially MSM of color, we felt that holding a series of focus groups with the same couples would be more efficient at covering a large number of issues/topics in greater depth than the alternative of multiple focus groups with different couples. Thus, couples were asked to return and participate in up to six focus groups. Earlier focus groups were designed to elicit participants' worldviews and experiences about the challenges African American, methamphetamine-involved male couples experience regarding general well-being, methamphetamine use, and HIV risk/protection. Later focus groups presented existing intervention activities and study protocols in order to solicit and elicit participant feedback and ideas on how to enhance the relevance, engagement, and Obtaining in-depth, contextual information regarding the
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Adapting an HIV Intervention for Male Couples The Open AIDS Journal, 2010, Volume 4 125 safety for risk reduction behavior change among African American, methamphetamine-involved male couples. and the investigative team's institution approved all protocols, materials, and information used in this study. All participants provided full informed consent prior to the focus groups. The Institutional Review Boards of the funding agency Sample in the focus group if they both met the following eligibility criteria: Individuals and their partners were eligible to participate (1) Be male identified; (2) At least 18 years old; (3) Report having a "primary main male partner" operationalized as: (a) a male with whom he has had an ongoing sexual relationship over the prior 6 months, (b) a male with whom he has the intention to remain together with for at least 12 months, and (c) a male with whom the participant has an emotional relationship/bond more than any person; (4) Self-identify as African American and/or Black, or identify having a main partner who self-identifies in this manner (Note: for multiracial participants, they must state their primary race/ethnicity is "African American" or "Black" to be eligible); (5) Have had unprotected anal sex with a man who is a non-main partner in the past 2 months (or, regardless of awareness, has a main partner who meets this criterion); (6) Report using methamphetamines at least once in the past 60 days (or, regardless of awareness, has a main partner who meets this criterion); (7) Reports not being either in or seeking drug treatment (in-patient, out-patient, support groups, AA, etc); and (8) Identifies each other as their main partner. analogous to the investigative team's prior HIV intervention research studies with [heterosexual] couples, drug-involved couples, and African American couples [19, 23] except for the following: eligibility criteria 3c and 7 were agreed upon and used by all of the sites participating in the Cooperative Agreement that provided funding for this study. Since the intervention is designed to be delivered conjointly to both members of a couple, an additional requirement was that both partners had to be willing to attend the focus group together. Many of these criteria have been used and/or are Procedures Recruitment "Active" methods included study staff conducting outreach Recruitment was conducted in a variety of manners. and recruitment activities at local service agencies, bars, clubs, commercial and public sex environments, and community events frequented by MSM and located in the multiple neighborhoods and boroughs of New York City. "Passive" referral was also used, whereby referrals were made through local agencies and organizations that provide programs and services for methamphetamine-involved, minority MSM (e.g., AIDS service organizations, health clinics, dental clinics), project community advisory board members, current participants, and individuals/couples who screen out of other ongoing studies but who may be eligible for this study. couple who may be eligible, that individual was asked to invite his main [male] partner to participate. Potential participants were given a letter addressed to their partners that introduces the study, describes its purpose, describes reimbursement for participation, and contains a contact telephone number. Only after a partner contacted study staff would any recruitment, screening, or enrollment procedures be initiated with that partner. In no case did study staff share any information provided by the first individual to his partner. If study staff recruited/contacted only one member of a Focus Groups research institution. The co-facilitators—the lead author who is the Principal Investigator of the study and the Project Director who was an African American MSM—followed a semi-structured interview guide constructed for each of the six focus groups. Focus groups were held weekly and lasted 90-120 minutes. They were audio recorded and one or two note-takers from the study staff were also present. Each participant was compensated $40 (i.e., $80/couple) for his time and information. All focus groups were held in a private room at the qualitative data and themes presented in this article have been selected based on their relevance to the adaptation process. Space constraints prohibit providing verbatim or detailed description of qualitative data related to more general matters regarding the experiences of African American, methamphetamine-involved MSM in longer relationships; we have endeavored to present such information in other venues [24, 25] as well as in a separate, forthcoming manuscript. Since this report is focused on the adaptation process, RESULTS Characteristics of the Study Sample groups with the target population. Two of the couples were recruited via referral from local service providers; the remaining couples were recruited by outreach staff over six recruitment outings conducted in the evenings and lasting about 3-4 hours each. The age of participants ranged from 29 to 48 years old (mean = 42.3 years). All but three of the participants identified as African American/Black; one interracial relationship was with a Caucasian (European-American) and the other two interracial relationships A total of eight couples participated throughout the focus
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126 The Open AIDS Journal, 2010, Volume 4 Wu et al. consisted of an African American and a partner who identified as biracial (African American/Latino). Six of the couples consisted of only one partner who met the methamphetamine use criterion, though it became apparent that the other partner in many of these couples had used methamphetamine in the past. Only 1 of the couples had accessed/received any services together as a couple (couples therapy). missed a single meeting. Of those two meetings where an entire couple was missing, one was planned due to a prior engagement and only one was an unanticipated "no show." In one other instance, one participant attended while his partner could not due to a planned prior engagement. All other couples were willing and succeeded in attending scheduled sessions [together]. Across the six focus group meetings, only two couples Adaptation Process Eliciting Information Needed for Adaptation guide that contained a series of open-ended questions designed to elicit participants' worldviews, experiences, and understanding/insights in four primary areas: (1) influence of methamphetamine on sexual risk behavior; (2) core components of the intervention; (3) barriers to participation in an HIV preventive intervention study; and (4) ethical issues. A separate guide was created for each focus group such that earlier group meetings tended to have a greater proportion of questions designed to elicit data on experiences and worldviews among the couples, and later groups focused more on obtaining feedback on intervention activities/ content. Table 1 presents some example interview guide questions for each of the four areas. In addition to sharing their experiences and perceptions, participants were prompted to respond to each other's comments and/or indicate agreement/differing opinions. Finally, as a topic was concluding, participants were often asked, "What about other couples you may know?" The focus group co-facilitators followed an interview Capturing Lived Experiences of African American, Methamphetamine-Involved Male Couples longer-term same-sex relationships, combined with the recognition that literature on methamphetamine use among African American MSM is limited compared to other populations, prompted a significant amount of focus group questions and time to be dedicated to collecting background and contextual information about the lives of African American, methamphetamine-involved male couples. The process of eliciting, analysis, and inference about the experiences and worldviews was guided by a relationship-oriented ecological perspective [26]. This couple-based, multi-level framework organizes the broad range of proximal and distal factors that shape human behavior and interpersonal relationships. Furthermore, by characterizing the different analytic levels of organization as nested, the The paucity of research on African American MSM in relationship-oriented ecological perspective acknowledges that factors reciprocally interact and influence each other both within and across analytic levels. Table 2 lists the analytic levels and examples of specific factors within each analytic level posited to shape the lives—including HIV/STI risk and protective behaviors—among African American, methamphetamine-involved male couples. Table 1. Sample Questions from the Focus Group Interview Guide Methamphetamine and Sexual Risk Behavior • What are some of the challenges that African American/Black men who have sex with men face in having healthier, longer-term intimate relationships? • How does the use of methamphetamine interfere with safer sex practices? • In what ways does this differ with your main partner versus casual or outside partners? • In what situations do you engage in unprotected sex? Could you describe the event? Were you under the influence of methamphetamine and/or other drugs? Core Components of the Intervention • What do you think about the [activity/content presented or demonstrated]? • What aspects of the activity/intervention would you like to see different when considering this is specifically for African Americans? For men in methamphetamine use is an issue? • How comfortable do you feel with the content, homework assignments, etc.? same-sex relationships where Barriers to Study and Intervention Participation • What might prevent you from attending the intervention sessions? From completing the "homework" assignments? • What are ways that we could help you to overcome these issues? Ethical Issues • Would you feel comfortable bringing intervention materials home? • What concerns do you have related to participating in the intervention? In a study? • How can we best address these concerns? are unique to one's developmental history and experiences. One prominent theme was how the level of comfort with identity, sexuality, and presentation were shaped by earlier life experiences, particularly rejection or acceptance of non-heteronomativity among one's family of origin. Several participants described growing up with families located in southern regions of the U.S. and more heavily involved with religion as negative experiences themselves. Another topic noted by many focus group participants was the sexualizing and sexual stereotyping of African American men. When asked to discuss methamphetamine use, the psychological disinhibition, cognitive dissociation, and physiological effects were thought to reflect a means of coping with prevalence of sexual difficulties (both psychological and physiological) that arose and/or varied depending upon the different levels of accepting/rejecting experiences. The ontogenetic level refers to the personal factors that
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Adapting an HIV Intervention for Male Couples The Open AIDS Journal, 2010, Volume 4 127 Table 2. A Relationship-Oriented Ecological Framework Applied to Sexual Risk Behavior Among African American, Methamphetamine-Involved Couples Male Ontogenic Level • HIV/STI knowledge • Perceived threat of HIV/STIs • Race/ethnicity: HIV, sexual identity • Condom use self-efficacy • Condom use outcome expectancies • Condom use intentions • Methamphetamine use outcome expectations • Methamphetamine use outcome expectancies Microlevel • Couple condom negotiation-efficacy • Couple sexual communication skills • Couple sexual satisfaction • Couple sexual decision-making power • Race/ethnicity and the relationship w/MSM partner • Impact of methamphetamine use and sexual risk on relationship Exolevel • Social support for risk reduction • Peers/community treatment regarding race/ethnicity and sexual identity • Peer norms about the threat of HIV • Peer norms about safer sex/condom use • Peer norms about methamphetamine Macrosystem • Sex and methamphetamine/drug use culture among MSM • Anti-racism: e.g., race-based oppression, disenfranchisement, and stigma • Anti-heterocentrism: e.g., sexuality-based oppression, disenfran-chisement, stigma, and invisibility factors that are part of the immediate intimate relationship context in which sexual activity and risk and protective behaviors take place. By far the most noted and discussed were the impact of differences between partners. Frequently mentioned areas of differences between partners included: experiences of being accepted/rejected by family (e.g., "We are constantly comparing our childhood."); level of comfort being "out" as an individual and in an intimate relationship with each other; past sexual experiences; and use of drugs and or stage of recovery. While these differences were often focal points of difficulties/disputes in the relationship, participants noted how methamphetamine use and sexual behaviors [that increase HIV risk] could be a means to cope or address the differences. For example, attending or arranging a methamphetamine and sex party was noted as a solution to the desire to connect sexually with one another, despite being fully aware of risk of disease transmission and/or the potential paradox arising from sexual non-monogamy. The microlevel also encompasses a noted dynamic of how a partner who is not HIV-positive nor using drugs/methamphetamine is "left out while he [the HIV-The microlevel consists of the interactional and structural positive/methamphetamine using partner] gets the attention [of service providers and programs]." relationship and likelihood of engaging in risky behavior. A common theme was how intimacy and interaction with one's partner was impacted and often undermined by social settings and community-level factors, most of which could threaten the quality and sustainability of the relationship itself. For example, many participants noted or described a hypervigilance about being seen as non-heterosexual and not being able to show affection towards their partners in public, mostly mentioning places around their residence and work (e.g., "I would want to give him [partner] a kiss, but he would lean away and say 'No, this is where I live.'"). Of particular note was several participants noting that African Americans may be less likely to live in historically gay-friendlier sections of New York City. Methamphetamine use was noted to be a means to connect with other MSM as well as a occurring in safer places/venues where they could be intimate with their partner. Interestingly, one participant did note that in contrast to seeing gay-friendlier neighborhoods as predominantly white, there was a more recent trend of African American non-heterosexual youth congregating in such areas presenting an image they did not want to be associated with (e.g., "Those homothugs you see in Chelsea, I can't stand that." "Those homothugs aint ever going to amount to nothing."). The same participant suggested that this provided an answer when his associates would ask, "Why you use that white boys' drug?" The exolevel refers external stressors or buffers on the and belief systems that shape and interact with all of the other analytical levels. Participants noted that the centrality of family and religion they felt was prominent among African Americans often exacerbated the rejection and stigma originating from their family members. The spectrum of responses to such dynamics among focus group participants varied: some felt they had reconciled, many were still struggling, others accommodated (selective passing, "don't ask, don't tell"), and some rejected and/or disenfranchised themselves from those social institutions. The macrosystem encompasses the broad cultural values the investigative team's deliberate choice to use of an anti-racist framework in considering macrosystem factors. The anti-racist ideology rejects "race-" or "color-blind" rhetoric; instead, the approach is to recognize, acknowledge, and address the varied lived experiences and perceptions among different races/ethnicities [27]. The anti-racist framework may be optimal for the following reasons. First, rather than needing to achieve expert understanding of African American/Black experiences, the approach is to foster participants to understand, analyze, and share the impact of race for themselves. Second, it does not seek to impose or presume a unifying framework upon African Americans (e.g., the Afrocentric paradigm or Afrocentricity [28]); because African American disenfranchisement from families of origin (e.g., "Being gay, my mother and father hated me.") and/or the African American communities (e.g., "We [gay men] are not This range of responses underscores the importance of MSM may experience
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128 The Open AIDS Journal, 2010, Volume 4 Wu et al. accepted in the Black community."), we felt was important to provide for a wider range of worldviews to be expressed, explored, and acknowledged. The anti-racist perspective expands upon notions of cultural competence and cultural humility [29] by explicitly paying attention to race-based power, privilege, and oppression. Such issues can not be ignored as they underlie the social and structural factors that drive the health disparities, such as HIV, shouldered by African Americans. Finally, the anti-racist perspective also accommodates the varied phenotypes that may be represented among partners as well as the service providers and researchers working with the target population. Paralleling the anti-racist perspective, we pose and employ an anti-heterocentrist ideology; this perspective affirms and accepts different sexual identities and labels (especially those beyond gay and bisexual), which is particularly relevant given the attention paid to non-gay identities and labels for same-sex behaviors (e.g, "down-low") among African American MSM. Some participants stated they identify as gay and/or homosexual, some embraced subverting the derogatory nature of the term "faggot," and others noted referring to themselves or others as a "snow queen" or "Carlton." experiences to explore possible candidate "scenarios" used in intervention activities. Scenarios thought to have high relevance by participants regarding couple conflict/communication/ problem-solving include: "the call"—whereby an individual does not follow through on a promise or agreement to calling his partner if he was staying out/coming home late, going to drink or use drugs, etc.; not following through on abstaining or refraining from drug/methamphetamine use; and drugs/ methamphetamine during sex with each other. Participants also endorsed activities that encourage/enhance communi-cation about sex, sexual desires, inhibitions, and their possible origins (e.g., "the baggage makes free-flowing discussion about sex difficult"). Participants shared about conflicts about sex arising from [lack of] top/bottom versatility, whether sex is spontaneous or planned, watching pornography, and being intimate without intercourse. These types of information were incorporated into role-plays and areas for intervention facilitators to explore during sessions. Participants were also asked to reflect on lived Applying a Theory of Behavior Change group data needed to focus on how to enact risk reduction, specifically putative mediators of behavior change targeted by the intervention. The original Connect intervention was guided by Social Cognitive Theory (SCT) [30]. Thus, intervention activities are designed to increase the following among participants in order to enact risk reduction behavior: information and knowledge that underlie accurate appraisal of risks and risk behavior; outcome expectancies, which are perceived costs and benefits of certain behaviors; social and self-regulatory skills to recognize triggers of risk and enact risk reduction, including reinforcement of health-promoting behaviors; self efficacy, which is belief in one's ability to implement desired or chosen behaviors; and social support, which refers to reciprocal interpersonal influences that Beyond experiences and worldviews, analysis of focus increase, decrease, or sustain certain behavior and behavior patterns. Table 3 presents examples of how these SCT mediators are targeted in the context of couple-based HIV risk reduction for methamphetamine-involved couples. Table 3. Social Cognitive Theory Constructs in the Context of Couple-Based Intervention for Behavioral HIV Risk Reduction Information/Knowledge • HIV/STI knowledge • Psychopharmacological effects of methamphetamine use • Physiological and neuropsychological effects of methamphetamine use • Correct condom use Outcome Expectancies • Cost/benefit of sexual risk behaviors • Cost/benefit of methamphetamine use • Impact of methamphetamine use on the relationship Social and Self-Regulatory Skills • Recognize triggers for risk behaviors and ability to enact risk reduction • Recognize triggers for methamphetamine use and ability to avoid use • Reinforcement of health-promoting decisions and behaviors • Relationship-based regulatory skills (e.g., couple communication, joint problem-solving/reinforcement) Self-Efficacy • Perceived ability to refrain from risk and/or enact risk reduction • Perceived ability to abstain from methamphetamine use • Belief in ability to assist [or resist] partner's influence on behavior(s) Social Support • Increasing number and strength of contacts who promote and/or reinforce risk reduction and abstaining from methamphetamine use • Increasing number and strength of contacts who promote and/or reinforce risk reduction and abstaining from methamphetamine use • Increasing number and strength of contacts who nurture the well-being of African American MSM and their intimate relationships. Deconstruction and Reconstruction of the Intervention whereby each session also contains multiple exercises, presents a challenge due to the sheer number of activities that must be systematically and strategically revised. We developed a visualization Reconstruction Matrix—that captures the essence of adapting a theory-driven intervention. One dimension of the tool's matrix is the session number, while the other dimension is the theoretically posited mediators targeted by the intervention. Each activity/element in a session is then placed in the matrix based on the session during which the activity takes place as well as the mediator targeted by that activity. Fig. (1) depicts the essential structure and sample elements for the Deconstruction/Reconstruction Matrix for the original Connect intervention. Adapting an existing intervention with multiple sessions, tool—the Deconstruction/ enhances identification and tracking of all intervention The Deconstruction/Reconstruction Matrix not only
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Adapting an HIV Intervention for Male Couples The Open AIDS Journal, 2010, Volume 4 129 activities, but also helps ensure adherence to the theory behind how the intervention enacts behavior change. To adapt the Connect intervention, the matrix helped to make sure that the revised activity hit the same targets/mediators, with changes to information, content, and presentation that was more appropriate and compelling. For example, focus group participants' suggestion of using direct language for sexual orientation (e.g., "gay") instead of using a "generic" phrase like "men who have sex with men." This was further refined by the anti-heterocentrist macrosystem understan-ding, culminating with the intervention having facilitators asking for and using the identity label that the participants prefer. times in the same column of the matrix, indicating that some activities target multiple mediators. By intentional design, some sessions also do not have activities that target certain mediators. We also acknowledge that there may be activities that do not fit into the matrix (e.g., welcoming activities, graduation ceremony). Such activities may be related to clinically important issues such as engagement and termination; however, if the target of an activity is not or can not be determined, this may indicate that the purpose may need to be clarified, offering another opportunity to strengthen the intervention via revision or deletion. Of note is that some activities may show up multiple population may be strengthened by the addition of new activities into the intervention. New activities might be focus on issues and dynamics that have been overlooked or not play as significant an impact for the original target population compared to the new target population. For example, focus group participants suggested that sexual Adaptation of an existing intervention for a new target histories figured prominently in shaping sexual behaviors and communication among African American MSM. Thus, we added an activity—the "Couple Timeline"—designed to elicit more detailed sexual histories from participants and provide an interactive, visual presentation of the temporal sequence of event. Participants stated that this new activity allowed both partners to gain a greater appreciation and awareness of the impact of each of their personal histories in a more meaningful, interactive manner than the activities in the original intervention. Placing new activities into the Deconstruction/Reconstruction Matrix helps ensure that new/added activities are consistent with the theory that guided the original intervention, which is SCT for the Connect intervention. We then examined other intervention activities originally constructed before/without the Couple Timeline, and incorporated revisions that could leverage the information elicited or presented in the Couple Timeline activity (e.g., aligning drug use history with sexual history to foster insight on outcome expectances related to drug use and sexual [risk] behavior). Thus, additional passes through the matrix are possible and were performed as activities are added and consequently revised. The visualization tool also minimizes the chance that some mediators may inadvertently receive insufficient attention due to accommodating new activities or revisions. deconstructing the original intervention into component activities, each activity revised in a manner that adheres and promotes theoretical rigor, Comparing the matrix for the original intervention versus the matrix for the revised intervention provides a quick means to visualize the adaptation. Altogether, the adaptation process involved and then reconstructed. Intervention Session # 1 2 3 … 6 Information/ Knowledge • Introduce purpose of the intervention/study • Review of last session • HIV/STI 101 • Personal vulnerability • Speaker/listener intro • Goal-setting • Review of last session • Myth/facts about HIV/STIs • Alternatives to unsafe sex… • Recap & review • Social support network map Outcome Expectancies • Pros/cons of participating • Protecting ourselves and protecting our relationship • Speaker/listener review • Condom use skills • Goal-setting … • Relapse prevention & contingency planning Social & Self-Regulatory Skills • Commitment contract • Speaker/listener practice • Goal-setting … • Relapse prevention & contingency planning • Rewarding behaviors, ourselves, & relationship Self-Efficacy • Overcoming barriers to participating • Taking control of life • Communicating about sex … • Relapse prevention & contingency planning Social Cognitive Theory Construct Social Support • Couple-based approach • Speaker/listener intro • Speaker/listener practice • Communicating about sex • Commitment to relationship … • Social support network map • Relapse prevention & contingency planning Fig. (1). Example of a Deconstruction/Reconstruction Matrix used for the adaptation of the Connect intervention. Bulleted items represent activities conducted during the indicated session.
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130 The Open AIDS Journal, 2010, Volume 4 Wu et al. Ancillary Activities and revising materials used for engagement, recruitment, and retention. Participants were also uniformly enthusiastic about the appeal and potential promise of a couple-based intervention for African American, methamphetamine-involved male couples. A prominent theme involved countering the experience of invisibility and isolation of African American MSM couples (e.g., "We're an endangered species…Show two Black men as a couple [on a flyer], that indicates 'We do exist.'"). Additional suggestions included leveraging African American MSM in the popular media such as the Noah's Arc television miniseries. Participants noted that positive experiences could be generated/facilitated by ensuring all intervention-related activities were "a safe place to be honest" and to "be welcoming no matter what [his sexual orientation and dis/comfort with non-heterosexual identity]." Finally, participants were also uniformly enthusiastic about the appeal and potential promise of a couple-based intervention for African American, methamphetamine-involved male couples (e.g., "Couples [intervention] stimulates new thoughts and ways of seeing things…we are not alone with these problems, and it is real.", "Participation shows others like ourselves that we really care about these issues and the community."). Additional developmental activities focused on adapting DISCUSSION literature regarding the adaptation of an evidence-based intervention originally designed for heterosexual couples to be revised specifically for male same-sex couples. Beyond the shift from heterosexuals to MSM, the study also focused on those residing at the nexus of several risk profiles—African Americans, methamphetamine users, and having longer-term intimate partners—the confluence of which presented additional challenges and considerations: (1) the dearth of existing research and attention paid to longer-term couple-dynamics among African American MSM and, to some extent, African American MSM and methamphetamine use; (2) a lead investigator who phenotypically does not match the target population; and (3) limitations on time, resources, and number/availability of topical experts. Service providers and researchers facing some or all of these challenges as they seek to adapt existing interventions for new target populations may benefit from the methods employed in this study: conducting multiple focus groups with the same participants; use of a theoretical framework that recognizes multiple, interacting domains of influence and accommodates different development/use of the Deconstruction/Reconstruction Matrix, a visualization tool that helps to ensure theoretical rigor, that intervention targets are maintained in the revision process, and tracking of the overall adaptation process. To our knowledge, this is the first report in the empirical worldviews; and combined with the positive feedback, may signify that the adaptation process was an attractive and feasible endeavor for members of the target population. These conclusions are reinforced based on subsequent review/approval from: a High attendance rates during the series of focus groups, panel of 8 service providers—who volunteered specifically for this study—from local community-based agencies serving African American MSM, methamphetamine users, and/or HIV-affected populations; a Program Review Panel consisting of 5 local community members who are charged with ensuring information/materials are understandable, accurate and appropriate; and a Community Advisory Board that provides input across a variety of HIV-related studies conducted at the research site. intentional decision to rely on a small number of focus group participants, leading to generalizability since the range of experiences and worldviews among the target population may not have been fully identified. Focusing on a narrow target population raises the concern about the generalizability and cost-effectiveness of this approach; it remains to be answered the extent to which these concerns are possibly countered by increased efficacy—presumably due to the highly tailored content—in conjunction with targeting a higher risk population. The anti-racist and anti-heterocentrist approach may also help temper these concerns about overspecification, yet may increase the requisite skill level of facilitators. Another limitation is the need to examine whether the adaptation process preserved effectiveness of the intervention. It is also noteworthy that when asking focus group participants to discuss concerns and issues of safety, they responded with information more related to notions of psychological and social "comfort." Despite repeated attempts, little information appeared to be elicited regarding participants' views on breaches of confidentiality (e.g., accidentally "outing" an individual) and other possible adverse events. The extent to which this latter issue reflects a shortcoming of the conduct of focus groups, a selection bias among the small sample of couples participating in the focus group (e.g., they were all comfortable identifying as gay), and/or is truly more generalizable to men/couples who meet the eligibility criteria remains unclear. A limitation of this work and the process include the ensuring caution about the efficacy and/or next steps. Specifically, the revised intervention will be pilot-tested with a small sample of African American, methamphetamine-involved preliminary evidence and insight regarding efficacy as well as feasibility (e.g., recruitment, retention). The pilot test will also include protocols for facilitators to monitor process and record untapped areas or unanticipated information—including adverse events—in order to make any necessary further revisions to enhance generalizability, training of facilitators, and participant safety. The pilot test will also generate needed information on the means and venues for reaching, engaging, and recruiting the target population. Both the adaptation process and subsequent pilot testing represent crucial first steps in the trajectory of providing service providers with a couple-based HIV preventive intervention backed by the highest standards of scientific rigor for methamphetamine-involved, African American MSM. The aforementioned limitations inform the anticipated male couples to obtain
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Adapting an HIV Intervention for Male Couples The Open AIDS Journal, 2010, Volume 4 131 ACKNOWLEDGEMENTS and Prevention (CDC) grant no. UR6PS000300. We thank Gordon Mansergh and Mahnaz Charania for their scientific guidance throughout the study. We also would like to acknowledge the contributions of Dale Frett and Jordan White, as well as the participants and couples who made this work possible. The content presented in this article is solely the responsibility of the authors and does not necessarily represent the official views of CDC, Harlem United, or the Columbia University School of Social Work. This study was supported by Centers for Disease Control REFERENCES [1] Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA 2008; 300(5): 520-9. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2007. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention; 2009. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999; 75(1): 3-17. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2007. Atlanta, GA: Department of Health and Human Services 2008. Centers for Disease Control and Prevention. HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men-Five U.S. cities, June 2004-April 2005. Morbid Mortal Wkly Rep 2005; 54(24): 597-601. Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 2007; 21(15): 2083-91. Colfax G, Shoptaw S. The methamphetamine epidemic: Implications for HIV prevention and treatment. Curr HIV/AIDS Rep 2005; 2(4): 194-9. Halkitis PN, Parsons JT, Stirratt MJ. A double epidemic: Crystal methamphetamine drug use in relation to HIV transmission among gay men. J Homosex 2001; 41(2): 17-35. Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS 2009; 23(9): 1153-62. Hart T, Peterson JL, Team CITfYS. Predictors of risky sexual behavior among young African American men who have sex with men. Am J Public Health 2004; 94(7): 1122-4. Global HIV Prevention Working Group. Behavior change and HIV prevention: (Re)Considerations for the 21st century: Global HIV Prevention Working Group 2008. Johnson WD, Hedges LV, Ramirez G, et al. HIV prevention research for men who have sex with men: A systematic review and meta-analysis. J Acquir Immune Defic Syndr 2002; 30(Suppl 1): S118-S29. [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] Semaan S, Kay L, Strouse D, et al. A profile of U.S.-based trials of behavioral and social interventions for HIV risk reduction. J Acquir Immune Defic Syndr 2002; 30(Suppl 1): S30-S50. Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: Review and synthesis of meta-analytic evidence. AIDS Behav 2008; 12(3): 335-53. Burton J, Darbes LA, Operario D. Couples-focused behavioral interventions for prevention of HIV: Systematic review of the state of evidence. AIDS Behav 10.1007/s10461-008-9471-4. Johnson WD, Holtgrave DR, McClellan WM, Flanders WD, Hill AN, Goodman M. HIV intervention research for men who have sex with men: A 7-year update. AIDS Educ Prev 2005; 17(6): 568-89. Herbst JH, Beeker C, Mathew A, et al. The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: A systematic review. Am J Prev Med 2007; 32(4 Suppl): S38-S67. Witte SS, El-Bassel N, Gilbert L, Wu E, Chang M, Steinglass P. Recruitment of minority women and their main sexual partners in an HIV/STI prevention trial. J Womens Health 2004; 13(10): 1137-47. El-Bassel N, Witte SS, Gilbert L, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health 2003; 93(6): 963-9. El-Bassel N, Witte SS, Gilbert L, et al. Long-term effects of an HIV/STI sexual risk reduction intervention for heterosexual couples. AIDS Behav 2005; 9(1): 1-13. McKleroy VS, Galbraith JS, Cummings B, et al. Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Educ Prev 2006; 18(4 Suppl A): 59-73. Wingood GM, DiClemente RJ. The ADAPT-ITT model: A novel method of adapting evidence-based HIV Interventions. J Acquir Immune Defic Syndr 2008; 47(Suppl 1): S40-S6. NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. Methodological overview of an African American couple-based HIV/STD prevention trial. J Acquir Immune Defic Syndr 2008; 49(Suppl 1): S3-14. Wu E. Novel HIV prevention methamphetamine-involved male couples Translating Research Into Practice; 2008 24 September 2008; Atlanta, GA: Centers for Disease Control and Prevention 2008. Wu E, El-Bassel N, McVinney LD, et al. A couples-based HIV risk reduction intervention for African American, methamphetamine-involved men in longer-term same-sex relationships. 2009 National HIV Prevention Conference; 2009; Atlanta, GA: Centers for Disease Control and Prevention 2009. NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. Eban HIV/STD risk reduction intervention: conceptual basis and procedures. J Acquir Immune Defic Syndr 2008; 49(Suppl 1): S15-27. Derman-Sparks L, Phillips CB. Teaching/learning anti-racism: A developmental approach New York: Teachers College Press 1997. Asante M. The Afrocentric idea. Philadelphia: Temple University Press 1998. Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved 1998; 9(2): 117-25. Bandura A. Social foundations of thought and action: A social and cognitive theory. Englewood Cliffs, NJ: Prentice-Hall 1986. [14] [15] [Online First]. 2008: DOI [16] [17] [18] [19] [20] [21] [22] [23] [24] for African American, [25] [26] [27] [28] [29] [30] Received: October 1, 2009 Revised: November 15, 2009 Accepted: November 25, 2009 © Wu et al.; Licensee Bentham Open. This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http: //creativecommons.org/licenses/by-nc/ 3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


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BP has an outstanding reputation for safety and the MMS can support claim. Offshore they go beyond what is required for safe operation. I know it sounds corny but i feel safer on a BP operated rig than I do at my own house. To even suggest that they cut corners indicates that you know nothing of how they operate in the Gulf of Mexico. This is an unfortunate terrible disaster like unto Hurricane Katrina that happens every 100 years.
I point out the number of coal mine disasters we've had over the years. Last few weeks no exception. Last year there was a seemingly large uproar to increase safety in coal mines. Year later another coal mining disaster for a mine with 600 safety violations?! This week another human tragedy to meet our needs for energy. I doubt anything will change. Maybe a few blowhards in Congress will make a speech, other than that zip. Big Business runs this country whether its Banks, Industry, Mining, Manuf....
Hey, man, don't be lying to your own readers: "An oil spill near the site where Transocean Ltd.'s Deepwater Horizon rig caught fire April 20 and sank yesterday has spread over an area of 100 square miles in the Gulf of Mexico and is drifting northeast toward shore.
The spill measures 10 miles (16 kilometers) by 10 miles, about four times the area of Manhattan, and is comprised of a 'light sheen with a few patches of thicker crude,' U.S. Coast Guard Lieutenant Commander Cheri Ben-Iesau said today."
I like oil spills in my yard just as much as everyone else. Nothing to be ashamed about.
"GOM hand wrote: BP has an outstanding reputation for safety and the MMS can support claim"
What evidence are you using to support such an outrageous claim??
2005 Texas City Refinery disaster, 2006 Prudhoe Bay spill, 2007 Prudhoe Bay spill, criticized for human rights abuses, environmental and safety concerns.at Baku-Tbilisi-Ceyhan pipeline & Colombian pipeline, and now in the Gulf of Mexico.
Doesn't seem that fines they pay are large enough to incentivize a change in behavior.
All corporate fines should be increased 50 fold - instead of Toyota paying $16.4 million, their new fine would be $820 million (note: 2009 EBITDA was $8.61 billiion & 2009 Total Cash $43.47 billion)

subset: commoncrawl


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Tag: Biomimicry - Page 11
Underwater Bugs in Medicine - Caddisfly Silk Inspires Scotch Tape Solution for Surgeries
This is a caddisfly larva, or a rock roller as it is also known. It's a strange
Architects Could Learn A Lot From Termites
If only human architects could build so well. Philip Ball in the New Scientist describes how green and sophisticated it is:Its buttressed towers are built entirely from natural, biodegradable materials. Its inhabitants live
Scientists Unlock One Mystery of Photosynthesis
It is one of the mysteries that makes life on earth possible: plants can grab energy out of sunlight and convert it into chemical energy. This energy works its way up the food chain. Without it, we could
Ant Weight-Lifting 'Champ' Hoists 100x Its Own Weight
To a human, 500 milligrams is the size of a vitamin pill. But to an ant, it's 100 times its body weight, making lifting it the equivalent of the average American man hoisting 19,000 pounds -- with his teeth.
Migrating Insects Use Wind to Travel Efficiently at Speeds of up to 60 MPH
Photo: Wikipedia, CC What Can We Learn From The Highways in the Sky digg_url = 'http://www.treehugger.com/files/2010/02/migrating-insects-fast-winds-60mph-science-study-biomimicry.php';Science recently published a study titled "Flight Orientation
Spider Webs Offer Biomimetic Inspiration for Dew Catchers in Developing Countries
With the help of a scanning electron microscope, Chinese scientists have figured out the secret architecture to spiders' webs that make them incredibly effective at catching dew. Cracking into the mystery could mean
Airports Use Antacid to Fight Ice and Snow
Last week, the temporary closing of Frankfurt's airport in Germany, due to bad winter weather, affected 8000 people. In order to fight the ice and snow, the airport used 700.000 litres of antacid to get rid of the three-day snowfall. This is
Scientists Look to Cockroaches as Biomimicry Solution for Super Powered Running Robots
It's generally agreed that cockroaches are a feat of evolution, and they certainly move incredibly well on their six legs. Which is why researchers at Oregon State University are using them as a source of inspiration
Kangaroos May Inspire 'Anti-Cancer' Skin Cream
Photo: Public domain DNA Repair in a Pouch digg_url = 'http://www.treehugger.com/files/2009/12/kangaroos-anti-cancer-cream-dna-repair-enzymes.php';Getting some time in the sun is probably good for you since most of us are deficient in vitamin D, but it
Razor Clams are Inspiration for RoboClam, a Robotic Sand-Digging Anchor (Video)
Biomimicry is again at the heart of new technology, this time for a solution to creating a better anchor. "The best anchoring technology out there is an order or magnitude worse than the clam - most are two or three orders worse," says
Qualcomm's Upcoming e-Reader Will Mimic Butterfly Wings for Energy-Sipping Color Displays (Video)
One of the primary aspects of e-Reader devices that are driving competition against one another is the display, with manufacturers looking at how energy efficient, how easy on the eyes, how readable in daylight, and how colorful
How Insects Do Graphic Design
Yesterday the exhibition Bits 'n Pieces launched at Material Connexion in New York, a dialogue between the analog and the digital technologies within design in a post-digital era. What grabbed our attention in the busy space during the opening, were
Pollution-Patrolling Robotic Fish Have "Muscle" Movement Like Real Fish
Credit: G.L. Kohuth, Michigan State University digg_url = 'http://www.treehugger.com/files/2009/11/pollution-patrolling-robotic-fish-have-muscle-movement-like-real-fish.php'; We've heard a lot about robotic fish over the last year, including that
The Sahara Forest Project Is a Visionary "Do"
I recently returned from the Do Lectures in Wales, a collection of talks given by visionary people who've decided to put their ideas into action; to "do." I walked away inspired by nearly all of the lectures, but
Flapping Wind Turbine Inspired by Bumble Bee Wings
Images: Jetson Green Biomimicry is everywhere these days. It seems increasingly clear that design inspired by nature will play a great big role in our energy future. Case in point: Green Wavelength, an up-and-coming California engineering biz, has
Biomimicry in Medicine: Sharkskin-Inspired Material Stops Bacterial Breakouts
Sharklet Technologies, a Florida-based biotech company, has figured out a way to capitalize on shark skin - specifically on the way parasites and bacteria can't stick to sharks. The trick is in the pattern of the skin's surface.
Shrimps' Eyes Are Biomimetic Solutions to Better DVD Players
Mantis shrimp - giant shrimp living on Australia's Great Barrier Reef - are being eyeballed (har har) as holding solutions to creating a higher quality DVD player, and it's all because they have the most complex
Water Drops on Leaves Inspire Wind Turbine Coatings That De-Ice Themselves
There's lots of cool stuff going on with biomimicry these days and on Wednesday I got to see one of the coolest things I've seen in this arena in a while: Experimental superhydrophobic coatings for wind turbine blades.


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IIT JEE MAINS Mock Test
by: GPL4you | 217
by: GPL4you | 217
JEE MAINS Mock test is designed for students appearing for AIEEE (NOW JEE MAINS), JEE ADVANCED and AIPMT Test 2013.
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Tags: cet mock papers , jogos aiaee , ace aieee mock test
from 217 reviews
Free - V1.0 - 185K


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Random e-card from meh again! XD
I figure this is what someone would be thinking if they didn't know EXACTLY what to do in this situation. For me, I probably would be swing the sword widly around. In case you're worried, I won't be doing that when I cosplay as Saya this April. XD It would be fun though. *laughs evilly*
Yamis Pharaohess (eCard Portfolio) Figuring the Odds
Random e-card from meh again! XD
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Create and Send eCardTurn this simple card into a fun eCard to share with your friends or family. Brighten someone's day!
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Invisible driver pranks drive-thru workers
Pranks are always fun to watch, but when they're well done, they're great.
Drive-thru pranks are all the rage now — most involve traumatizing the employees — and a majority are full of cursing or executed poorly. Thankfully, this one has clean language and is well done.


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This job posting is no longer available on Indeed.
Find similar jobs:Project Coordinator jobs
- Kamengo jobs
POSITION: Project CoordinatorLOCATION: Richmond, BC
POST DATE: November 12/2012CLOSE DATE: Open until position is filled
DESCRIPTION AND KEY SKILLS: Kamengo is seeking a Project Coordinator to manage/organize every day office activities, take a lead role in our spare parts business unit, and support the delivery of major projects. The position, above all, demands someone who is obsessed with being organized, is computer savvy, and possess the leadership skills to take a frontline position in assisting the company to deliver complex, schedule-driven projects. Below are the challenges that await our new project coordinator:
1. Help keep the office running. The project coordinator will assist in everyday office activities, including filing GST, and monitoring company accounts payable and accounts receivable. In particular, the project coordinator will implement systems to organize the entry of payables. The project coordinator, after becoming comfortable with the company accounting system, will be tasked with supervising and directing the company bookkeeper, who is charged with making the rote entries into the accounting system.
2. Coordinate spare parts business unit. The project coordinator will work with senior management to develop systems to streamline our spare parts business. The project coordinator will also take a lead role in delivering spare parts orders, including: a) placing orders with sub-suppliers; b) preparing shipping documents such as NAFTA forms; c) coordinating the crating of equipment; d) shipping and tracking the delivery of spare parts orders; e) invoicing; and f) tracking business unit performance.
3. Support the delivery of major projects. Currently, Kamengo is delivering a handling system for an oil sands tailings remediation plant. The project coordinator will play a major role in helping to ensure that the project is delivered on-time. The project coordinator will work directly with the Project Manager to monitor the project schedule, coordinate/expedite the company's many sub-suppliers, support purchasing/sourcing of equipment and instruments, manage compliance with the company's quality assurance program, and assist with resource allocation. Above all, the project coordinator will organize and manage project documentation, tasks, and client correspondence.
The project coordinator position is intended to offer a willing candidate many opportunities to develop his or her project management and leadership skills. As described above, to be successful, the project coordinator will need to be: a) obsessed with being organized; b) adventurous and willing to step into realms in which he or she has limited expertise; c) computer savvy enough to engage with our accounting system and learn to navigate AutoCAD drawings; d) humble enough to view no task as too small - using every assignment as an opportunity to apply creative solutions to improving company performance; and e) a leader who brings a mission-oriented mentality that, with the support of the Project Manager, creates an environment for our engineers and sub-suppliers to meet the high demands of our clients.
Kamengo is small engineering firm based in Richmond, BC. Our office is a 5 minute walk from the Aberdeen Canada Line station. We have been in operation since 1991 and have developed a vast portfolio of projects, including supplying equipment for waste to energy, mining, marine and agriculture projects. To learn more about Kamengo, we invite you to visit our website at: www.kamengo.com.
To apply for this position, please send your cover letter and resume through indeed.com. We encourage interested candidates to submit their application early as the hiring process may be quick. We thank all candidates for their interest, however only qualified candidates will be contacted.
TERM: 3 month probationary contract with opportunity to extend for an additional year
RATE: Commensurate with experience
NOTICE TO RECRUITMENT / PLACEMENT FIRMS: Kamengo will not pay any fees for recruitment activities related to the hiring of a candidate unless a written service agreement has been established between a duly authorized representative of Kamengo and the recruitment/placement firm. At this time, Kamengo has no interest in acquiring such services.


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They say when you are missing someone that they are probably feeling the same, well it's absolutely not the case for 2015 edition of April Fool's Day!
Starring Sherlock Holmes, Dr. John Watson and Danny Nutcracker in the iconic roles of … themselves in Fifty Shades of Sherlock.
Please be warned, this video contains scenes that some viewers may find disturbing.


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- Description
DetailsYou can time up to four events simultaneously for up to twelve hours each. Make cookies while your bread rises and time all activities at once. You'll find multiple uses and follow more than one thing at a time.
- Additional Information
Additional Information
Weight 0.2500
- Reviews
Customer Reviews 1 item(s)
- This timer is extremely versitile.
- A friend had one of these. I wanted one & didn't know where to find it. Walked into Bob's & there it was. I use it for everything & it sits up or I can clip it to my pocket. I'm tempted to have 2 just to have one in the car.|It's compact, very easy to use & very versitile.


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Lives in United States
Joined on Nov 1, 2003
|Total: 4, showing: 1 – 4
As the Hasselblad spokesperson said there is market for these high MP systems in libraries, universities, museums and archives. These markets are more interested in resolution and colour accuracy than high ISO performance. It will be interesting to see how this camera performs in the lab/studio.
A-Frame: This lens is a portrait photographer's dream. $1,700 for a lens is not absurd to a professional or amateur photographer who knows the purpose and value of this lens. The so called experts here will always have something to complain about.
@Der Steppenwolf
Depending on the way the image was shot of course I can tell. Moreover an art director will show me a picture they want to emulate and often times they want a certain look to the out of focus areas. This is a fairly common situation in portrait and product commercial photography and something the amateur photographer may not encounter.
This lens is a portrait photographer's dream. $1,700 for a lens is not absurd to a professional or amateur photographer who knows the purpose and value of this lens. The so called experts here will always have something to complain about.
Archearer: For me as for architect and architectural photographer it's a GREAT news! Thank you Samyang! I'm sure I'll buy this lens at the first day it will be on sale in Russia. Nikon's 24 mm PC-E lens is tooooo expencive, even for professional shooting. Samyang engeneers, if you read this, please don't stop your work and also produce one more wide-angle lens – for interiors. I mean if you'll design something similar to canon's 17mm ts-e, but available for ALL systems – it will be BESTSELLER in interior photographers professional environment. Look: there is no similar products in Nikon's line, and in Sony's, and in Pentax's also. So at current time interior and landscape photographers HAVE to use canon ts-e 17mm or large format film cameras like Sinar, which are very heavy and slow operating. But I'd like to have possibility to shoot interiors on Nikon d800, because of it's awesome 36mp sensor and because I already have all Nikon's system of acessories.
IMO 17mm is too wide for architecture since it can distort foreground objects. It does have some use for very small interiors but if you have the space longer focal lengths create more balanced images. The 24mm and 28mm are the most useful focal lengths.
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Welcome to Centro d'Ompio
Lo spazio che non dimenticherete mai
Calendar 2016 will be out soon
actual opening times during season - start (up to end of march 2016)
We answer your call monday till friday 10am - 13.30pm
(phone)+39 0323 086 185 / (mobile)+39 327 203 69 05 / (fax)+39 0323 081 083
Centro Blog
Newsletter May 201511.05.15
In our latest Newsletter, we'd like to let tell you about two seninars this summer, that could be a wonderful opportunity for you to spend a special and transformative holiday at the Centro d'Ompio:
- Breathing Touch - Intensive Massage Training (12. - 18. July + 26. October - 01. November)
Feeding the Soul (18. – 21. Juni 2015)16.12.14
From the 18th to the 21st of June we will be hosting the Transpersonal Festival Feeding The Soul, connected to the Expo 2015 in Milano City, titled Feeding the Planet. The event is led and organized by transpersonal psychotherapist Pier Luigi Lattuada.
Feeding the Soul is aimed at acknowledging and celebrating the multiplicity of the manifestations of our true Self.
Centro d'Ompio is honored to be one of the main partners supporting this festival and we are happy to support its enthusiastic organizers, its founder Pier Luigi Lattuada, and to welcome all participants.
To register as a participant, please visit www.feedingthesoul.eu
The perfect place for your special event...16.12.14
Have you ever thought of celebrating your special occasions such as birthday or an anniversary with us here at Centro D'Ompio? We also welcome you to organize a festival, corporate events or other types of seminars. Whatever the occasion, we'll give our best to ensure you and your guests have a truly unforgettable experience. We can host events up to 150 people…
We're here to help you in the organization of your event. During the event you will be assisted by our dedicated team, intent on welcoming your participants, making them feel at home and creating the perfect space and atmosphere that will fit you and your guests.
We'd like to tell you a little bit more about what we can offer and why we think Centro d'Ompio could be the right place for your event…


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378 posts tagged with bike and bicycle.
Displaying 1 through 50 of 378. Subscribe:
Help Me Sell My Bicycle Ethically
I have a bicycle that I want to sell, but it breaks spokes constantly on the rear wheel. What are my options to maximize my price, but not be a jerk? [more inside]
the lazy bike commuter
I want to start biking to work regularly. The trip is about 2 miles each way, on flat ground, mostly through a nice park. What things can I do to make it as easy as humanly possible? [more inside]
Please help me not hate my bike's disc brakes
I've had a 2014 Brodie Argus for about a year. It's a hell of a bike and exactly what I was looking for. But I can't get the disc brakes to stop grinding and squeaking. Help? [more inside]
How can we transport two bicycles on/in a rental car?
We are renting a vehicle (probably a standard SUV) for our vacation. We want to transport two bikes, as well as a large dog, and rather a lot of luggage but we are running into problems. [more inside]
Checking a bike on an Amtrak
Has anyone successfully checked a bicycle on a long distance train (the Crescent) at New York Penn? [more inside]
How to use a soft rubber tubing hose for a bicycle valve
Many bicycle repair kits contain a short piece of ivory colored soft rubber tubing hose for use on a bicycle valve. How is this used? I've never seen it in or around a valve. [more inside]
Where can I rent a Dahon folding bike in New York City?
I live in New York City, and I'm thinking of buying a folding bike. Where can I rent a Dahon folding bicycle so I can try it out? [more inside]
I've got 25 miles and a very sore bum [Long distance biking question]
Last year, I rode in a 25 mile charity ride and used a hybrid bicycle. It was one of the worst experiences because the shocks on the bike really made it hard to propel myself. I'd like to make cycling a part of my life, but am not ready (or able) to invest upwards of $500 for a decent bike. What are your recommendations for a good distance cycle for road riding? [more inside]
Help me help my bike
On my bike, the smallest cog on the rear cassette is spinning free from the rest of the cogs when I try to pedal. [more inside]
Bicycle! Bicycle! I want to decorate my bicycle!
I don't like the colour of my bike (a steel touring bike) but I don't want to pay to have it re-painted. I'd like to slap some nice, solid-coloured or patterned decals on the frame instead. Do people make these? Where would I find them? [more inside]
Selling my bike - how and how much?
I'm entering the era of modern bicycles and want to sell my "vintage" road bike. I'm unsure how to price it, and where to try selling it. [more inside]
Is this bike worth fixing?
Someone was taking this bike to the dump, but it looked like it had a nice frame still. It also looked a bit older, maybe something vintage. It needs a new front tire and a new cable and seat. Is this worth fixing? I don't know anything about the brand so I don't know what they go for new, and couldn't find one like it. All I know about it are the words "Alpine c/moly 3t". Thanks in advance. Here's the bike.
Great renter's insurance for a cyclist?
I've come to the realization that I'm stupid for not having renter's insurance. Mainly because I now have a collection of six bicycles that are very dear to me; a couple of them are even custom. I'm looking for renter's insurance that will protect me from theft (in home and out) and if possible, even damage from crashing. Ideally this would also cover the bikes at full value, not some bs depreciation. I'm in San Francisco, CA.
Need advice on sizing a rear bicycle rack
I have a pannier and bicycle, and I need to mount the one to the other. The bike is a ~1985 Schwinn and the pannier is a Blackburn EX. I've tried a Blackburn MTN rack, but my heels bump the bag. Ideally it'd be about 4-6 inches further back and still level along the top (currently tilts slightly back). Do racks come in different sizes I need to know? Are there some bike/bag combos that don't work? Do people shorten their cranks instead of moving the bags? Is there some crucial measurement I should learn?
First bike tour
I'm going to do my first little bike tour and although it's only a few days, I would love help understanding the mechanics of how this actually works. Advice and also recommendations for other books and online resources would be very helpful! [more inside]
Making your own totobobo filters?
I live in a city with lots of traffic and air pollution, and I cycle to work in heavy traffic. I started wearing a Totobobo face mask while cycling to reduce the amount of gross stuff I'm forced to breathe during my commute. Thing is, those damn little filters look the same as a cotton pad, but they are 10-20x more expensive. Has anyone tried making/DIYing their own Totobobo filters? [more inside]
Bike stolen in San Francisco - worth it to check flea markets?
Nice bike stolen in San Francisco - where to try to find it? [more inside]
What should I name my barber/indian head massage/henna tattoo business?
My friend wants a name for her new business that includes barbering, Indian head massage and henna tattooing. She liked the names "Barber on a Bike" and "The Tonsorial Artist" but these are both taken. Any further suggestions? We are in the UK.
How do I learn about bicycle design?
Later this year I hope to head up to Portland's UBI to take a frame building class. That will teach me the process of tube selection, cutting, welding, etc. In the meantime I'd like to learn as much as possible about the actual design process of a bicycle. Angles, fit, different materials, etc. Maybe even laying out the design in CAD (which I have no experience in). Seems to me this exists in a realm somewhere between product design and industrial engineering. Can anyone recommend some resources?
Best used ebike for my needs?
It's clear—maybe even more than with regular bikes—that rider and environmental factors are important in the selection process. So PLEASE all you ebike-savvy folks out there, share your wisdom! [more inside]
Best time of year to bicycle from NYC to SF?
I want to ride from NYC to SF in 2015. I have 8 to 10 weeks (maybe 12) to do it. When would be the best time of the year to do so? [more inside]
Help me become an informed commuter bike consumer?
I have started biking to work with the goal of getting into better shape, and I think I want to upgrade my (old, crappy, but still functional) bike. Let's talk options! [more inside]
Where to find a chain guard suitable for biking with a skirt?
I like to wear long skirts, and I like to ride my bike. Unfortunately, these two activities are appear to be incompatible -- is there a suitable chain guard I can install on my bike? [more inside]
Improve my bike commute
Should I get a different type of bike to handle more weight? Or change my current setup? [more inside]
Budget range - 4 month cycle trip through Europe
One thing that my wife and I would like to do soon is a longer bike trip. We have ideas about taking four months [may through august] to cycle across [mostly] western Europe. Can we afford to do this? [more inside]
How do you travel by bike to Whidbey Island in Puget Sound?
I'd like to travel to Whidbey Island via bicycle from Seattle. What is the most efficient and direct route? A ferry ride would be extra fun, but I am confused by the different schedules etc. The trip will be in mid September. I'll be staying a few days on the island. [more inside]
Two great tastes that taste great together
I'd like to start biking to my yoga studio. I need to bring my own mat. Talk to me about what works. Difficulty: trail-a-bike hitch precludes a cargo rack. Is there another way to carry it on my bike? I'm also open to mat bags that play nicely with riding a bike. [more inside]
Bicycle aficionados: Help me ID the logo on this bike part
I've googled all around, but can't find the brand of my triple chainring and pant guard. It's for a Trek hybrid, if that helps. Here's a closeup of the logo. It has an S with a three-point crown. It doesn't appear to be Suntour or Shimano, so I don't know. Thanks!
Bicycle Vanity
I have this bike. I need help finding panniers and clothes to go with it. [more inside]
Help me buy my first bike!
I've just learned to ride a bike for the first time as an adult, and now I'm trying to buy one. Catch: I know nothing about them. [more inside]
Selling a bike on Craigslist
I have a 2006 women's Schwinn Voyageur GS hybrid/comfort bicycle that has been gathering dust in my living room for the last six years. Is this even worth bothering trying to sell on Craigslist, or should I just donate it to the local bike rescue? [more inside]
Affordable LED bicycle light sets
I am looking to start a program within my community to distribute front and rear bicycle lights, hopefully free of charge, to anyone in need. Can anyone suggest a vendor or retailer that could/would offer wholesale prices on a single order to a person, organization, or entity that would distribute the lights, again, hopefully free of charge, but in the worst case scenario, at cost? [more inside]
Recommend an extra-large hybrid bike with an internal hub
I'm looking to purchase an extra-large hybrid bike with an internal hub. This would be for casual riding with my family, but ideally the bike is somewhat sporty for longer rides and something I can grow into. The bike will not be used for commuting. If the internal hub request makes this bike a unicorn, then recommend a good all-around hybrid.
What happens after a bike accident?
My husband got doored on his bike. There was a police report, the guy who hit him stayed on the scene and was actually on the job (delivery) when he opened his door into my husband, who was in the bike lane. The driver did have insurance and presumably the company insures, too. What happens now? [more inside]
Feasability of importing used Dutch / Danish / German bike to USA
Does anyone have experience with trying to import *used* Dutch bikes (or Danish, or German, etc) into the USA? I've only been able to find *new* bikes for sale, and they tend to cost much more than similarly priced American / Chinese / Taiwanese re-makes (Linus, WorkCycles, Etc). [more inside]
Biking numbness
I get numbness in my right hand after biking 5 to 10 miles. Now what? [more inside]
Help me ride my new bike
Cyclists of MeFi: I recently acquired a lovely new ride but wow, is it ever different from my daily commuter. Help me get used to drop bars and downtube shifters. [more inside]
how/where do I buy a used bicycle in Greater Boston?
I would like to purchase a beater bicycle. I will use it to go several miles along a maintained bike path to get to a subway station. My ideal scenario: I travel to a location where there are several shit bicycles. I select one of the shit bicycles, I hand someone a smallish amount of money, and I stop thinking about purchasing a bicycle. I don't care if it is a pink bicycle covered in swastikas provided that it works and is reasonably priced. Let's make this happen!
Help me decide what do about my bike situation
My once-loved 3 speed bike is no longer meeting my needs. Should I buy a brand new bike or try to upgrade what I have? [more inside]
Advice on ordering single-speed bike online
I'm looking into ordering a single-speed bike online (freewheel, not fixie). I'm a little hesitant to order something that I'll be using every day sight unseen. Anyone have any experience with Pure Fix, Retrospec, Republic, Solé or State Bicycles? Or Motobecane or Dawes single-speeds from Bikesdirect.com? What should I be aware of in general, ordering a bike online?
$220 for a service, or put that towards a new bicycle?
I have an 18 month old Trek 7.1FX hybrid bike ($450 new) that I use to commute 5 days, 120km per week. Should I spend half the cost of a new bike on a service, or put that towards a new bike? [more inside]
Cargo or longtail bike for my snowflakey family?
Is there a cargo bike that meets my needs? If so, which one? [more inside]
I Am Very Tall and Want a Bike
I'm 6' 8'' tall and want a bike mostly for riding around the city or longer bike path/road trips. What bike should I buy? [more inside]
Hexagonal bicycle tail light
Where can I get more of this hexagonal bike tail light? It has 6 LED's, a yellow on-button, and a clip in the back. No other identifying marks. Takes CR2032 or similar batteries. Would love to buy a whole bunch more!
Highway 101 between Portland and San Francisco by Bike - Side Trips?
A group of 6-10 of us are going to be biking between Portland and San Francisco along Highway 101. What would be the best places to stop for day side trips? [more inside]
Brooklyn bike tune-up recommendations
Where should I take my bike in Brooklyn (preferably near Downtown/Cobble Hill/Carroll Gardens) for a tune-up? [more inside]
Bicycle for teen girl?
My niece would like a bicycle to get around - I have some old ones, but they would need tune-ups. What does she need, and am I better off having an old one worked on, or just getting a new one? [more inside]
Is my bike likely to get stolen?
I just got a job close enough to my home in Toronto that I can ride my bike to it. Yay! But is it likely to get stolen? [more inside]
wanted: bike. requirements: cute, huge.
Can a 6'1" tall Canadian lady ever find a mixte under $800? [more inside]
Cyclist visiting Tucson this week. What should I check out?
I'm visiting family in Tucson the 24th - 30th and I'm flying my road bike in from San Francisco. I'm intending to get a lot of riding done while I'm there since I've signed up to participate in the Rapha Festive 500. I'm looking forward to doing some great riding including Mt. Lemon (I'll be staying up in the Oro Valley area). While I'm there I'd love to also tap into any cool cycle-culture type stuff the city of Tucson may have to offer. Are there any great cycle coffee shops? Brew pubs? LBS's with some actual community to them? Any group rides or cycle clubs that really embody the Tucson community. While I'll only have my roadie with me I'm also into fixed gear riding in SF. I don't know if that's a thing in Tucson, but would love to know of stuff in regards to that too. I know there is a strong senior cycle community out there, but for what it's worth I'm a 31 year old male. Thanks!


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ProTec Classic Bucky Helmet
Pro-Tec took the original 1970's full-cut helmet and trimmed the ear covers off to create a helmet with style and flair. ProTec Classic Bucky BMX Helmet! Only available with the soft 2-stage foam liners that everyone loves for the comfort and lightweight feel.
HDPE is made up of a form-fitting, high-density, polyethylene shell, with flexibility to fit a broader range of head shapes. They are NOT certified to ASTM, CPSC or CE Safety Standards.
Approx Sizing:SM: Head Diameter at eyebrows 20.3 thru 22" or 54-56 CentimetersMED: Head Diameter at eyebrows 22 thru 22.8" or 56-58 CentimetersLG: Head Diameter at eyebrows 22.8 thru 23.6" or 58-60 CentimetersXL: Head Diameter at eyebrows 23.6 thru 24.4" or 60-62 Centimeters
Dan's Comp has a wide selection of BMX Safety Gear.


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Added by April Ward on December 29, 2015 at 11:00am — No Comments
Mom Tantrums. Yeah, it's a thing. In the battlefield of parenthood, do you ever look around and think, "Who made ME the adult around here?" I wanted to lose it just about every day this week. But for the most part, I reigned it in. On several occasions, I had elaborate fantasies of how I'd like to lose it and what I'd do.
On our next episode of MomCave LIVE,…Continue
Added by Jennifer Weedon Palazzo on December 11, 2015 at 8:08pm — 2 Comments
It takes a village to raise a child, they say. But today, in the midst of our busy life, do we still have villages to surround, teach and protect our children?…Continue
Added by Irina on December 1, 2015 at 12:52am — No Comments
Added by Dea Lenihan on October 4, 2015 at 8:11pm — No Comments
A wise person one told me just do it, you never know what will come of it.
I heard those words as a young person, and they stuck.
Yes, we should make the most out of every situation and try and look to the bright side, but I'm talking about looking at more than just one side of the thing you are doing.…
Added by Dea Lenihan on September 13, 2015 at 2:12pm — No Comments
They warn you about the pain of childbirth. They even express all the different means for managing said pain and in such depth that there are literally tons of books written on the topic! Ways to manage the pain often include Lamaze, water therapy, epidural, hypnosis, etc. I opted for hypnosis when this little lady graced us with her presence.…
Added by Kat Tom on September 9, 2015 at 11:25pm — 2 Comments
I'm Not Going To Try Anymore
I'm so tired of trying. It's a repetitive process that never moves me forward. It feels like doubt before I even leave the starting line. And that dangling carrot is always miles ahead of me. If I squint I can even see it smirking back at me. Imagine a smirking carrot. It's not intimidating, it's condescending. I want to sneak up behind it and bite off its root - its foundation.
But I know…
Added by Katherine Baron on July 7, 2015 at 11:47am — No Comments
Added by Jennifer Weedon Palazzo on February 11, 2015 at 10:52am — No Comments
Added by Jennifer Weedon Palazzo on November 21, 2014 at 9:55am — No Comments
Added by Jennifer Weedon Palazzo on November 6, 2014 at 11:26pm — No Comments
If you are looking for support or help with the Cry It Out Method, check out my tips:
Added by Jennifer on April 4, 2014 at 11:17am — No Comments
For some time now, I have thought about writing something in support (aka protest) for Moms WHO DO IT ALL!!!(or those that think they do). It wasn't until the other day that something in the news inspired me to get this going.
Let me backtrack for a moment, when I found out I was expecting my first child in 1999, I was twenty five years old; old enough to become a mother, but still young enough to be naïve about what it took to be successful parent.
Though I totally loved my…
Added by Lil Tux N Tiaras Event Sitters on April 1, 2014 at 12:16pm — No Comments
When your child starts teething, typically around 4 to 6 months of age, your baby will probably be…Continue
Added by Christy Garrett on March 13, 2014 at 4:31pm — No Comments
Yesterday afternoon when my son got into the car, he was asking his sister if she ever put salt on ice. I didn't realize that he was talking about putting the salt and ice combination on his skin. I just assumed that his science teacher was teaching them about temperature changes using salt and ice. Then this afternoon, I noticed a huge red spot…Continue
Added by Christy Garrett on January 14, 2014 at 4:00pm — No Comments
I cannot be the only one...who is relieved that this "holiday" week is over (and isn't afraid to say it). Between my part time job, shuffling Sonny Boy around, and the hubby off work for two extra days this week, I am ready for it all to go back to normal.
Here are some of the highlights (I use the word highlights loosely) from this past week of vacation:
While driving Sonny Boy to and from places, in between my driving to and from places for work, I wondered…Continue
Added by Janice Perry on December 1, 2013 at 8:43pm — No Comments
View the original post on my blog, Mama Chirps! Feel free to link-up!
Welcome to the first Whip It Up Wednesday at Mama Chirps, hosted by Naptime Is My Time! I've been really excited about this post because it's about a project I started months ago. Not lying. I started it,…Continue
Added by Danialle Birdwell on August 15, 2013 at 5:00pm — No Comments
Determining when you plan on taking maternity leave can be an overwhelming process since you don't know the exact date of your baby's arrival. However, it is very important that you find out what your rights and benefits are early in your pregnancy. The best place to find out your maternity rights are is to refer to your companies employee handbook, to determine if…Continue
Added by Christy Garrett on June 4, 2013 at 5:38pm — No Comments
Product and information was provided free of charge in exchange for this review and giveaway and does not affect my views or feedback of the product or service. This review is based solely on my personal opinion and experience and…
Added by Justine Caraway on June 2, 2013 at 11:08pm — No Comments
Added by Janeane Davis on March 15, 2013 at 2:57pm — No Comments
Child birth classes are designed to provide expectant mothers with information so that moms are prepared for labor and delivery. Every woman will have a different labor and delivery experience, but the techniques used to help minimize pain and prepare a mother for labor are similar.
I remember when I was a first time mom, I didn't feel that I really needed to attend a child birth class, I had it in my mind that I was going to have a natural birth and knew how…Continue
Added by Christy Garrett on December 21, 2012 at 10:23pm — No Comments


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These all-in-one classroom decorative kits contain everything a teacher needs to brighten up the classroom!
Details:108 pieces:• 1 blank chart• 1 incentive chart• 1 birthday chart• 1 blank monthly calendar• 52 calendar labels (months, dates, and special days)• 3 student medallions• 1 welcome sign• 3 hall passes• 2 blank cards• 3 door hangers• 8 trimmers• 32 name platesGrades: PreK-5
Orders for in-stock items ship for a flat-rate of $7.95 within the continental United States.
Orders with an in-stock subtotal of at least $79 ship for FREE!
Most manufacturer direct items (like rugs and cribs) ship for FREE!


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Greta Elizabeth
Clara Elizabeth
Reese Elizabeth
I like Clara too! Would it be a long a (like in bake) or will it make /ar/ sound (like in bar)? I like both ways better than the other two. Although, Greta isn't too bad. Reese is okay too, but I think people would assume you are naming her after the actress.
Married to Bob: 4/24/10
Allison: 3/1/11
Bobby: 4/26/13
*not like in bake, more like in air*
Married to Bob: 4/24/10
Allison: 3/1/11
Bobby: 4/26/13
Greta Elizabeth
Clara Elizabeth
Reese Elizabeth
DS Rylan EDD 2/14/99, Born 01/31/99
DD Lyla, EDD 4/02/13, Born 03/18/13
Check out my band, Apollo's Daughter!
I vote Greta - we have Gretchen on our girl list! :)
Andi (30), preparing to be a BFing, CDing, BWing momma to an intact little man, Amos Ryder (04.16.13)
Alana Rose born April 20th 2013 7lbs 8oz 20 1/2"
Jenson Patrick born November 19th 2014 6lbs 13oz 20"
I like Clara best :)
Married to my best friend
Samuel Thomas born April 27, 2013 @ 9:05 pm