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Randomized trials have examined short-term effects of lifestyle interventions for diabetes prevention only among high-risk individuals. Prospective studies have examined the associations between lifestyle factors and diabetes in healthy populations but have not characterized the intervention. We estimated long-term effects of "hypothetical" lifestyle interventions on diabetes in a prospective study of healthy women, using the parametric g-formula.
Using data from the Nurses' Health Study, we followed 76,402 women from 1984 to 2008. We estimated the risk of type 2 diabetes under 8 "hypothetical" interventions: quitting smoking, losing weight by 5% every 2 years if overweight/obese, exercising at least 30 minutes a day, eating less than 3 servings a week of red meat, eating at least 2 servings a day of whole grain, drinking 2 or more cups of coffee a day, drinking 5 or more grams of alcohol a day and drinking less than 1 serving of soda a week.
The 24-year risk of diabetes was 9.6% under no intervention and 4.3% when all interventions were imposed (55% lower risk [95% confidence interval= 47% to 63%]). The most effective interventions were weight loss (24% lower risk), physical activity (19%) and moderate alcohol use (19%). Overweight/obese women would benefit the most, with 10.8 percentage points reduction in 24-year risk of diabetes. The validity of these estimates relies on absence of unmeasured confounding, measurement error, and model misspecification.
A combination of dietary and non-dietary lifestyle modifications, begun in mid-life or later in relatively healthy women, could have prevented at least half of the cases of type 2 diabetes in this cohort of US women.
Diabetes is a major cause of death and disability worldwide,1,2 and its prevalence has increased substantially in most regions of the world in the last three decades.3 Complications of diabetes put a major economic burden on health systems in both developed and developing countries.4-6 Primary prevention of type 2 diabetes, which constitutes more than 90% of cases, is a major concern for health systems worldwide.
Several randomized trials have examined the effect of physical activity, smoking cessation, weight loss and healthy diet on the incidence of type 2 diabetes in high-risk participants over relatively short periods of about 3 years.7-15 Overall, these randomized trials reported about 50% reduction in the incidence of type 2 diabetes after intensive lifestyle modifications.16-18 Prospective observational studies have mostly examined the long-term association between lifestyle and type 2 diabetes incidence19-22 in relatively healthy populations, but these studies did not specify the corresponding interventions or the time of their initiation.
Devising an informed policy for diabetes prevention requires estimating the effect of lifestyle interventions initiated in mid-life or later (as randomized trials did) over long periods and in relatively healthy populations (as observational studies did). We applied the parametric g-formula to data from the observational Nurses' Health Study to estimate the 24-year risk of type 2 diabetes under various hypothetical lifestyle interventions that start in mid-life or later.
The Nurses' Health Study is a prospective cohort study that started in 1976 by enrolling 121,700 US female nurses aged 30 to 55 years. A questionnaire was mailed to collect data on sociodemographic, lifestyle and dietary factors and on history of diseases and treatments. Biennial questionnaires have been mailed since then to update information on risk factors and disease incidence. More details on this cohort are available elsewhere.23
We used the 1984 questionnaire as baseline, because a detailed 131-item food frequency questionnaire (FFQ) was distributed in that year. Women were excluded from our analysis if they had a diagnosis of diabetes before 1984 or did not have information on diabetes diagnosis date. In addition, we excluded participants who left more than 70 items blank on the baseline FFQ, or who reported unusual total energy intakes (i.e., energy intake <500 or >3500 kcal/day). We also excluded participants without baseline information on date of birth, body weight and height, smoking status, physical activity, and dietary variables, and those who had cancer or cardiovascular disease at baseline (see eFigure 1 for a flowchart of participant selection). After these exclusions, 76,402 women were available for the analysis. Women were followed until the occurrence of type 2 diabetes, death, incomplete follow-up (i.e. not returning a questionnaire), or administrative end of follow-up in June 2008, whichever happened first.
Diet was measured using a semi-quantitative FFQ in 1984, 1986 and every 4 years afterwards. The FFQ asked about the usual intake of various food items, including alcoholic drinks, during the past 12 months. The reproducibility and validity of the questionnaire have been shown elsewhere. 24 Dietary data recorded in the 1980 questionnaire was used to adjust for pre-baseline diet. Physical activity was reported in 1980, 1982, 1986, 1988 and every 4 years thereafter, using a validated questionnaire25 on type, frequency and intensity of each activity. We summed the duration of moderate or vigorous activities per week (i.e. requiring at least 3 Metabolic Equivalent of Task [MET] scores/hour, including brisk walking). Body weight was self-reported in each biennial questionnaire and height was self-reported in 1976.
We truncated the values of dietary risk factors, body mass index (BMI) and physical activity in each period at the 99th percentile to prevent implausible values from affecting our analyses. Sensitivity analyses using various thresholds based on expert knowledge, or setting values above the 99th percentile to missing and carrying the last observed value forward, did not change the results materially.
Details of diabetes ascertainment has been described elsewhere.26 Briefly, a supplementary questionnaire was mailed to participants who reported a diagnosis of diabetes. A case of type 2 diabetes was considered confirmed if, according to the National Diabetes Data Group criteria,27 at least one of the following was reported on the supplementary questionnaire: 1) one or more classic symptoms plus fasting plasma glucose levels of ≥ 7.8 mmol/L or random plasma glucose levels of ≥ 11.1 mmol/L; 2) at least two elevated plasma glucose concentrations on different occasions (fasting plasma glucose ≥ 7.8 mmol/L, random plasma glucose levels of ≥ 11.1 mmol/L, or concentrations of ≥ 11.1 mmol/L after two hours or more shown by oral glucose tolerance testing) in the absence of symptoms; or 3) treatment with insulin or oral hypoglycaemic agents. The diagnostic criteria changed in June 1998: according to the American Diabetes Association criteria,28 a fasting plasma glucose of 7.0 mmol/L instead of 7.8 mmol/L was considered the threshold for the diagnosis of diabetes. Only confirmed cases were included in the analysis. We excluded cases designated as gestational or secondary diabetes. The validity of the supplementary questionnaire has been previously documented by reviewing medical records and assessing undiagnosed diabetes in a random sample of women.26,27,29 Deaths were identified by reports from next of kin or postal authorities, or by searching the National Death Index. At least 98% of deaths among the study participants were identified.30
We considered 8 hypothetical interventions and their combinations, based on the evidence from both randomized trials and observational studies on their potential effect for diabetes prevention:19,20,31-35 quitting smoking, losing 5% of BMI every 2 years if overweight or obese (defined as BMI ≥ 25 kg/m2), exercising at least 30 minutes a day (moderate or vigorous), eating at least 2 servings of whole grain per day, drinking at least 2 cups of coffee per day, drinking at least 5 grams of alcohol per day, eating at most 3 servings of red meat per week (including unprocessed and processed), and drinking at most 1 serving of soda per week. All interventions started at baseline in 1984 and continued until the end of follow-up. Except for the weight loss intervention, which imposed a gradual decline in body weight, all other interventions imposed a minimum or maximum threshold on the level of a risk factor. For these interventions, values beyond the threshold were set to the threshold level.
The intensities of the interventions were chosen to match current public health guidelines (e.g. Center of Disease Control and Prevention guidelines for physical activity, World Health Organization definition of overweight and obesity) or were selected to reflect feasible public health interventions. We estimated the effects of more intensive interventions for weight loss and physical activity in sensitivity analyses.
We used the parametric g-formula,36 a generalization of standardization for time-varying exposures and confounders, to estimate the 24-year risks of type 2 diabetes under the selected lifestyle interventions. The parametric g-formula has been previously used to estimate the effect of multiple lifestyle interventions on the risk of coronary heart disease.37 If all time-varying confounders have been correctly measured and modeled at all time-points, the g-formula can be used to consistently estimate the standardized risk of type 2 diabetes under hypothetical interventions. We used a Kaplan-Meier estimator that incorporates censoring by death and loss to follow-up.38 For the exact formula see electronic appendix eText.
A simplified description of the process of estimating risks using parametric g-formula is as follows: we start by fitting regression models for all potential confounders and for the disease outcome using data on the entire study population. We then use these models to simulate the risk of the disease under various interventions in five steps: (1) take the observed joint distribution of covariates at baseline; (2) estimate the joint distribution of time-varying covariates at the next time-point using the parametric models; (3) "intervene" by setting the values of some covariates to values determined by the hypothetical interventions; (4) estimate the predicted probability of the outcome using these new values; (5) repeat steps 2 through 4 for the entire duration of follow-up to estimate the predicted risk of the disease under the selected interventions. See papers by Taubman et al39 and Young et al40 for a more detailed description.
More formally, the standardized cumulative risk estimated by the g-formula is a weighted average of the risks of type 2 diabetes conditional on the specified intervention values and the observed confounder history. The weights are the probability density functions of the time-varying confounders, which are estimated via parametric regression models. We approximated the weighted average by using a Monte Carlo simulation of 10,000 individuals with the baseline values of covariates sampled from their empirical distribution. The values of time-varying covariates for each 2-year interval were drawn from the distribution estimated via the regression models after setting the values of lifestyle factors to those specified by the interventions.
To increase comparability, the models included calendar year for each period and the following potential baseline confounders: age, history of diabetes in first-degree relatives, smoking and oral contraceptive use prior to 1980, marital status, education, husband's education, employment, and stress in daily life and work, as well as pre-baseline values of the variables corresponding to the 8 selected intervention (i.e. BMI, smoking, exercise, and intake of meat, whole grain, coffee, alcohol and soda). These latter adjustments enabled us to estimate the effect of changes in lifestyle in middle-aged women as opposed to the life-long effect of a healthy lifestyle.
We modeled the distribution of 20 time-varying covariates: multivitamin use, aspirin use, statin use, post-menopausal hormone use, smoking, physical activity, soda intake, coffee intake, red meat intake, whole grain intake, alcohol use, BMI, high blood pressure, high serum cholesterol, coronary heart disease, stroke, angina or coronary artery bypass graft, cancer, menopause and osteoporosis (see eTable 1).
We compared the estimated risks under various interventions with the risk under no intervention to calculate the population risk ratio and population risk difference. The population attributable risk is one minus the population risk ratio. To estimate the 95% confidence intervals (CIs), we used non-parametric bootstrapping with 500 samples.41 We also computed the proportion of women who were hypothetically intervened on in any period and the average proportion of women intervened on in each 2-year period. The latter measures overall adherence in the observed data to the hypothetical intervention among those following the intervention up until the previous period. We examined the possibility of effect modification by conducting the analysis separately in subsets of the study population defined at baseline according to age, BMI, and family history of diabetes. All analyses were conducted using SAS 9.2 (Cary, NC). The SAS macro and its documentation are available at http://www.hsph.harvard.edu/causal/software.
Table 1 shows the baseline characteristics of the 76,402 women who met all eligibility criteria in 1984. Mean age was 49.9 years and mean BMI was 24.4 kg/m2; 25% of women were current smokers and 19% had a family history of diabetes. During 24 years (1.4 million person-years) of follow-up, there were 6,044 cases of type 2 diabetes and 8,260 deaths. 17,690 participants did not reach the end of follow-up (i.e. did not return a questionnaire). The models collectively performed very well in estimating the risk-factor distributions under no intervention. For example, the mean difference between the observed and simulated number of cigarettes smoked per day was less than 0.4 cigarettes during follow-up; similarly, the point estimate of the ratio of the observed to simulated BMI was never smaller than 0.99 or larger than 1.00 (see eFigures 2-9). More importantly, the simulated 24-year risk of diabetes was the same as the observed risk at 9.6%, which is a necessary condition for no model misspecification. The coefficients of the models used in the simulations are presented in eTable 2.
Table 2 shows the 24-year risk of diabetes under various hypothetical lifestyle interventions. Among the non-dietary lifestyle interventions, weight loss was estimated to reduce the risk by 24% (95% CI= 22% to 26%), exercise by 19% (6% to 30%), and quitting smoking by 0% (-1% to 2%) compared with no lifestyle intervention. Among the selected dietary interventions, drinking at least 5 grams of alcohol a day was estimated to reduce the risk by 19% (12% to 23%), eating less than 3 servings of red meat per week by 8% (5% to 11%), and drinking at least 2 cups of coffee a day by 3% (0% to 6%). The mean alcohol intake under the hypothetical intervention "drink at least 5 grams of alcohol a day" ranged from 9.2 to 11.7 grams a day during follow-up, which is equivalent to 1 drink a day.
We estimated that the 24-year risk of type 2 diabetes would be reduced by 39% (29% to 47%) under the 3 non-dietary interventions, by 29% (21% to 35%,) under the 5 dietary interventions, and by 55% (47% to 63%) under all 8 interventions. The estimated 24-year risk of type 2 diabetes under all interventions was 4.3% (3.6% to 5.1%). Of all participants, 25% maintained a BMI of 25 kg/m2, fewer than 11% followed each of the dietary interventions, and 0% followed all 8 interventions for the whole duration of follow-up (9% followed all 8 interventions at some point during follow-up).
Table 3 presents the results of the analyses for more extreme weight-loss interventions. We estimated that reducing BMI at 5% per 2-year period down to 23 kg/m2 would reduce the risk of diabetes by 53% (51% to 56%), while reducing BMI at a faster pace of 10% every 2 years would reduce the risk by 60% (57% to 63%). Combining this latter intervention with the 7 other lifestyle interventions would reduce the risk of type 2 diabetes by 72%. We estimated a risk reduction of 16% (8% to 22%) under a hypothetical intervention in which participants exercise for 30 minutes/day if they have a normal BMI (i.e., BMI < 25 kg/m2) and 1 hour/day if they are overweight or obese (i.e., BMI ≥ 25 kg/m2). A more intensive intervention to engage in at least 1 hour/day of moderate or vigorous activity, regardless of BMI, would reduce the risk of type 2 diabetes by 15% (7% to 22%).
To evaluate the sensitivity of the estimates to our analytic decisions, we conducted analyses that varied the ordering of the variables measured in each questionnaire, estimated censoring due to incomplete follow-up, considered a different intervention on alcohol where women would drink 5 to 10 grams/day of alcohol, and included women who did not return 1 or 2 questionnaires by carrying their last reported values forward. The estimates of relative risks and risk differences did not change materially.
The effects of lifestyle interventions were stronger in younger women (< 50 years old) and those who were overweight or obese at baseline, in both the risk ratio and risk difference scales (Table 4). For all 8 interventions combined, the 24-year risk of type 2 diabetes would be reduced by 10.8 percentage points in women who were overweight or obese compared with only 1.9 percentage points in women who had a BMI of < 25 kg/m2 at baseline (Table 4). Women with a family history of diabetes were also estimated to benefit more from these interventions: the risk difference for all 8 interventions in this group was 7.3% versus 4.8% in those without a family history of diabetes.
Our results suggest that, in this cohort of US women, 55% of cases of type 2 diabetes could have been prevented by a combination of dietary and non-dietary lifestyle modifications. Our estimates are particularly relevant for health policy because they quantify the 24-year impact of lifestyle interventions that start in mid-life or later in relatively healthy women.
A beneficial effect of lifestyle modification on diabetes risk had been previously found in several randomized trials. However, these studies were designed to evaluate a short-term effect (over approximately a 3-year period) in overweight participants with impaired glucose tolerance. Both the Diabetes Prevention Program7 and the Diabetes Prevention Study8 found that a combined intervention on diet and physical activity reduced diabetes risk by 58% compared with general guidance or written advice. The risk of diabetes in the control group was 29% at 3 years in the Diabetes Prevention Program and 23% at 4 years in the Diabetes Prevention Study, which are much higher than our 9.6% risk at 24 years in a population of healthy US women.
Our estimates may not be generalizable to other populations with different distributions of risk factors, as the g-formula standardizes the risk to the distribution of risk factors in the particular population under study. For example, we estimated no reduction in risk of type 2 diabetes if all women had quit smoking but only 25% of women in our population were smokers. When we compared the risk had everyone been "forced" to smoke 20 cigarettes a day to the risk had everyone quit smoking, the estimated population risk ratio was 1.1. Also, the magnitude of our estimates is specific to the set of interventions that was considered. Though our results are generally consistent with previous analyses of prospective studies,34,35,42,43 differences do exist because previous studies did not specify the time of initiation of the lifestyle interventions and considered more extreme weight loss.19-22 For example, a previous analysis of the Nurses' Health Study cohort classified women as low-risk if they met 5 criteria (BMI < 25 kg/m2, diet high in cereal fiber and polyunsaturated fat and low in trans-fat and glycemic load, at least half an hour/day of moderate-to-vigorous physical activity, no current smoking, at least a half-serving of an alcoholic beverage/day) between 1986 and 1996. Compared with the rest of the cohort, women in the low-risk group had an average two-year relative risk of diabetes of 0.09 (95% CI= 0.05 to 0.17). The authors estimated that some hypothetical intervention (different from the ones we considered here) on the above 5 factors could have prevented 91% of diabetes cases.
Our analysis has several strengths. The Nurses' Health Study cohort has collected detailed data on usual dietary intakes, physical activity, body weight and smoking every 2-4 years, and diabetes diagnosis was validated. We included 24 years of follow-up and had a large number of cases, which allowed meaningful subgroup analyses. By applying the parametric g-formula39,44 we could estimate the effect of hypothetical interventions starting in middle-age or later while (i) appropriately adjusting for time-varying confounders affected by prior exposure, (ii) generating adjusted estimates of absolute risk and population attributable risk, and (iii) estimating effects of interventions individually and in various combinations.
Like other analyses of observational data, the validity of our results relies on the key assumptions of no residual confounding, no measurement error, and no model misspecification. The possibility of residual confounding cannot be logically excluded despite adjustment for many potential confounders. A certain degree of measurement error is expected for lifestyle variables and may have contributed to bias. We had to rely on self-reported weight and height; a validation study on a small sample of the study population showed a 0.96 correlation between self-reported and measured weight.45 Though the prediction of our models under the hypothetical interventions cannot be directly evaluated (0% of women followed all interventions during the entire follow-up), our models provided accurate predictions under no intervention, a necessary condition for no model misspecification.
We tried to simplify the public health interpretation of our estimates by comparing interventions with well-defined start times and exposure values, by using food items rather than dietary scores19 or the Healthy Eating Index,46 and by including total caloric intake in the models so that our hypothetical interventions imply replacing the selected food item with other foods that are usually taken as a substitute in the study population. However, the interpretation of our estimates for weight loss and exercise is complicated because there are multiple versions of the interventions. For example, participants may lose weight by reducing their caloric intake or by using weight loss medications; similarly, the selected duration and level of exercise may be achieved by increasing frequency or duration of different types of activities.47
In summary, our results suggest that 55% of cases of diabetes that occurred during 24 years of follow-up in this large prospective study of US women could have been prevented by 8 lifestyle interventions initiated in mid-life or later. The most effective intervention in this population was losing weight, followed by eating a healthy diet and engaging in regular moderate or vigorous physical activity.
We are grateful to Roger Logan and Jessica Young for their technical assistance, to Walter Willett and Meir Stampfer for their comments on a previous draft, and to the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and to all the women enrolled in the Nurses' Health Study.
Source of Funding: This work was funded through National Institute of Health (NIH) grants HL080644, DK58845, CA87969.
Conflicts of Interest: Authors have no conflicts of interest to declare.
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Hannah joined Farrer & Co in 2002 as a trainee solicitor and qualified into the charity and community team in 2004.
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Product Reviews
Not as Advertised
These chairs are small! Okay for breakfast nook or other small space. They were advertised as 39 inches tall but were only 35 inches. Not sturdy--very light weight.. They were inexpensive so I guess you get what you pay for.
- How did the color on site compare with the actual product? Okay
- Please tell us about the quality of the product. Cheap!
- How accurate was the on site description of the product? Chairs were advertised as 39 inches tall when in fact they are 35 inches tall.
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I am very happy with this purchase. I love the natural texture of the hemp and leather together. This rug is on our hardwood floor under our table. We need to get a pad under it because it does move around quite a bit as we move the chairs in and out. Good bargain for the money and great way to use scrap leather!
- How did the color on site compare with the actual product? The colors were what I expected from the description
- Please tell us about the quality of the product. The quality seems good but I have only had it on my floor for a month. If putting it on a hard wood floor I would highly recommend a rug pad as the rug will move around on you
- How accurate was the on site description of the product? The description on the site was accurate
Leather has odor to get used to...inherent with leather. I really needed a taupe fringe. Big, sturdy
It doesn't smell like mold or wet burlap....it smells like leather. Pottery Barn has a similiar rug for triple the price. If you are looking for a rustic type simple rug - then this is for you. I would recommend a rug pad to stay in place and give a better feel on your feet. My husband and boys love it. It looks great in our antique New England home.
Product arrived and although it does not have the odor that another reviewer left, it is not an attractive rug. The overall coloring of the rug is on the orange side even the fringe is on the orange side. I was expecting (from the picture) a very warm natural looking rug. The overall quality is not that great either. Product is being returned.
Nice looking inexpensive rug but has a horrible odor. The entire house now smells like wet, moldy burlap sacks. I'll give it a few days of airing out and hopefully the smell will go away. Not sure I'd recommend it because of the odor.
- How did the color on site compare with the actual product? Slightly lighter than photo
- Please tell us about the quality of the product. Just OK quality. What I expected for an inexpensive rug though.
- How accurate was the on site description of the product? accurate


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This job posting is no longer available on Indeed.
Find similar jobs:McKi Wireless Solutions jobs
McKi Wireless Solutions Ltd. is a technology advanced company leading the Wireless and Communication Industry for the Oil and Gas and various service sectors. We are a company dedicated to Customer Service and Product Quality.
POSITION PROFILE:-Minimal 2 to 3 years of experience in the Instrumentation, Electrical or Programming fields is an asset
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The following would be an asset:- Valid Safety Tickets, H2S Alive and First Aid- WHIMIS/TDG- Valid Driver's License- Oil & Gas Experience
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Hello everybody! So I downloaded the BabyCenter app a few weeks before trying to conceive just to try & get a good idea of how you ladies go through things.. But now I have a question... So I started my period on Sunday, April 14th. So that was 2 weeks ago as of Sunday, April 28th. But last Thursday, April 25th, I had started bleeding- slightly.. Like spotting- but it was brown. but then it started getting lighter, & more pinkish/orange. But then when I had woken up today, there was bllod.. It appeared as if I started my period. & it was pretty red. Today starts week 3 for me.. Just a little confused, & a little worried. We've already had 2 miscarriages, & so I believe I get a little more worried about things. I don't know if it helps,. but I also have had slight cramps- really nothing that's too noticable.
Thank you for your help, ladies!


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Overall score
would recommend to a friend.
Reviewer score
Would not recommend
Palms comes up short
Explain this to me. 1000 sq ft suite in the Ivory Tower and not 1 drawer in the entire 2 rooms to put clothes, personal items in. We had a closet but basically had to just throw our stuff on the floor or in the suitcase. And the shower didnt have
a tray, hook, nail, anything to put soap or shampoo on!! Room was pretty but not functional at all...
Service was terrible at the 24/7 cafe and worse at Alize.
It just seems like they don't really care. The poker room was removed months ago yet all the signs for the Poker are still there.
Would not stay here again.
Would recommend
weekend trip
Had a great time. Rooms were very clean, not real big. But the beds were so comfortable. Went to the pool on saturday, good music and atmosphere. Staff was very nice and attentive at out cabana. Loved the convenience of the shuttle that took us to
Caesars palace, wiyh it esn later into the night instead of 8pm.
fantastic getaway
the rooms are clean, the staff is friendly, everything about this place is awesome!
Last minute booking
Staff was friendly, room was spacious, clean, and very comfortable
Check in was fast. Room was clean. Casino and dining are fab
Pick a different hotel
Worst experience we've had at a hotel in Vegas. Hotel itself is underwhelming. Staff are rude when they even bother to acknowledge your existence. Front desk hung up on me. As the only ones in line, we waited over 10 minutes to be seated for
breakfast at 24/7- no hostess, servers didn't care. Just left. Will never stay there again. Horrible service. Vegas has soooo many great hotels; this is not one of them.
Great stay
A little off the strip but the free shuttle was convenient. Rooms are always clean and comfortable and some have fantastic views. It's not the coolest spot to stay and certainly not the most luxurious, but you can usually find a great deal and
spend that extra cash on gambling/dining/drinking/etc.
Always pay in cash in a taxi - the "voucher" fee is a $3 fee for using a credit card!
Dirty Room
We checked in at the palms front desk was great. When we got up to our room to our surprise the room was a mess... Bed was undone , open beer n soda cans, toilet was unflashed shoe prints on the pillows n the tv was on... Blood stains on the floor
:( yuk. So I picked up the room phone and tried to call the front desk, the phones didn't even work. Ugh
Immediately went down stairs with my luggage. Spoke with the front desk and they gave us another room but not a upgrade and $20 room credit!!! REALLY wt.....
So we tried to make this negative into positive we headed down to the cafe to eat dinner. We waited 2 hours for a salad and a turkey wrap :(
I don't recommend this hotel to anyone it's over price for a very poor low rating hotel.. The owner should be emberassed about his palms casino resort...
Resort fee!!???
Picked the palms because It's a beautiful hotel snd the price was unbeatable.. But upon checking out I was a hit with an unexpected resort fee of 25$ a day?!!! Beware!
No words, its perfect, away from the Strip crowd , but near enough to enjoy all the Vegas Heat, great pool prty awsome restaurants, nice casino, and awesome suites for a good price. Love it 100% .
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iHerb Customer Reviews
Savings of: $3.63 (36% off)
Easy to use powder
Posted by 4644199777715580741 on May 02, 2016
Easy to just add a spoonful of powder to my dog's food. She doesn't seem to mind and has had no adverse reactions.
I used this to make toothpaste - great so far!
Posted by healthymuslimah on Feb 26, 2016
Calcium carbonate is one of the ingredients I needed to make homemade toothpaste (along with xylitol, bicarb and peppermint oil). Have to say I live it so far!
Posted by Anaterma on Jan 12, 2016
ok product. good for women since our body needs more calcium. cheap. could be sold in bigger package tbh, same for mag oxide.
Good product
Posted by 4724157641566165722 on Dec 16, 2015
Worked great in my tooth powder.
no good
Posted by mudanzas-valencia on Aug 17, 2015
this product is very simple and dont have enought quality kinesiology say is normal quality produuct
For homemade tooth powder
Posted by 5109294900389757371 on May 25, 2015
Bought this for homemade tooth powder where the other main ingredient is baking soda. It's used in commercial toothpastes as well as an abrasive and helps to tone down the effect of baking soda in my tooth powder, which can be harsh on its own. I don't know how much it contributes to the remineralisation of teeth because I haven't noticed any miracles but seems to work fine for my purpose. I don't use it internally so I can't comment on that.
Tooth powder ingredients
Posted by 5448879658818550705 on May 25, 2015
I used this as an ingredient in tooth powder. It has worked out well and my husband's cavity is disappearing!
Posted by Reviewer1876891 on Mar 25, 2015
Some people say that calcium citrate is a better absorbed calcium and to be honest I am not sure. As far as carbonate goes this is good. Large bottle, great price.
Works great
Posted by 5557751387322163256 on Mar 05, 2015
I use this to make home made toothpaste, and also as a supplement. It works great for both!
Great base for a homemade toothpaste
Posted by halfromanian on Feb 21, 2015
I'm always on the lookout for a natural toothpaste and I need a calcium carbonate as a starting base. It's very powdery, easily to blend in with the rest of the ingredients. I will definitely repurchase.


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Ranchi: Maoist zonal commander, carrying Rs 10 lakh reward, ar...A wanted Maoist Zonal Commander, Ram Mohan Singh Munda, and two of his associates have been arrested by the Jharkhand police. The arrested accused carried a cash reward of Rs 10 lakh on his head. He had nearly 50 cases, including murder of a ... Yahoo! India, 3 weeks ago
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When it comes to search marketing, SEO's are from Mars and PPC's are from Venus.
Just over a week following the release of our War on Free Clicks infographic, dozens of whiny SEO's have come out of the woodwork with ludicrous sob stories about how they purportedly tried and failed to get PPC to work for them and/or their client.
Sure, PPC isn't easy – I get that, and I've even written a few articles about how some small businesses are struggling with PPC.
But, seriously – compared to SEO?!! PPC is a total cakewalk. Like rolling off a log. Easy as pie.
SEO, on the other hand, has recently become a complete nightmare-circus – I'm talking about the keyword analytics "not provided" brouhaha, Panda, Penguin, unnatural links notifications, the increasingly ridiculous and never-ending SEO workflow, etc., etc., etc.
In my article today, I'll describe the 4 crucial differences between the PPC and SEO mindset. Hopefully by understanding the differences, you'll be more open-minded if PPC doesn't respond the way an SEO thinks it should!
PPC Strategy vs. SEO Strategy
PPC and SEO may occupy the same search engine results page, but their underlying success strategies are completely different, hence search marketers often pit organic vs paid against each other.
SEO strategy is generally about casting as wide a net as possible, trying to rank in the top organic spot for as many relevant keywords as possible. Incredibly, still to this day, the most common SEO metrics are still keyword rankings and the volume of organic search traffic to a site over time.
PPC strategy is pretty much the complete opposite – it's far more refined. The goal is usually to exploit a narrow portfolio of high-quality keywords that maximize click-through rate and cost per conversion, not just clicks. We even use things like negative keywords and match types to make our ads show up on fewer searches, not more. This is because the way AdWords works is that keywords with low click-through rates get dinged with super high costs and low exposure (or no exposure at all), and vice versa.
Miss-set expectations that arise as a result of failure to realize this key difference in strategy is by far the most common reason why most SEO's end up sucking at PPC.
When the PPC going gets tough, SEO's turn tail and run away. They say things like: "See boss? I tried, and I couldn't get it to work," and then regress back to their challenging SEO workflow. It's like they secretly want to fail.
It's remarkable when you contrast this low level of effort with the backwards somersaults they're willing to do for SEO, where you have Google actively trying to run SEO's out of town, inflicting all sorts of penalties designed to make their lives miserable, and yet they remain completely undeterred and focused on exploiting the next SEO loophole.
Come on, my fellow SEO's, buck up! As with anything else in life, you get out of PPC that which you put into it. If you can't get PPC to work on the first try, iterate and improve. Take advantage of killer AdWords features like sitelinks and remarketing, and run your account against the AdWords Grader. If any SEO applied even a tenth of their creative genius towards PPC marketing, he/she would be way ahead, and well on their way to achieving great success!
Not Being Completely Transparent About Costs
Does this sound familiar?
"We paid for 5,000 clicks this month, whereas over the same time period, we got 10,000 clicks from SEO for free!"
Well of course PPC looks expensive compared to "Free."
But let's be honest here. SEO isn't and wasn't ever free, and it's quickly becoming one of the most complex and costly forms of marketing out there. I'm talking about the cost of your time, the blogger, the link builder, the link clean-up guy, the social media guy, the SEO manager, the consultants, all of the cross-departmental overhead, etc.
By being less than fully transparent about the true costs of SEO, many organizations are deluding themselves about the relative efficacy of SEO vs. PPC, often declaring defeat in error.
Not Being Completely Transparent About Value
All of those "free" clicks from SEO aren't worth their weight in PPC clicks. Not by a long shot.
Take WordStream's own website for example. We generate a crap-ton of SEO traffic, but nearly half of WordStream's SEO traffic comes from countries that represent approximately 0% of our sales. And the search queries that generate the most traffic are informational keyword searches like 'what is google adwords?', or branded keywords which we probably would have gotten even if we did no SEO work.
If you compare SEO clicks vs. PPC clicks based on a more meaningful metric, such as cost per actual sale, the average value of an SEO click is generally nowhere close to PPC, which offers far more granular targeting options. Sadly, this kind of objective, thoughtful analysis is not always done.
Are You Saying PPC Really Can Work for My Business?
In my 10+ years of experience working with over a thousand small businesses, I've found that almost any kind of business can make PPC work for them – it's mainly a matter of finding a more narrow set of targeted, relevant, high-intent keywords that drive affordable leads and sales.
I doubt that your business is the one exception here.
Hopefully, now that you're armed with this insight about the differences between the SEO and PPC mindset, you'll have the added wisdom to change your approach in executing PPC rather than declaring PPC defeat!
IMPORTANT UPDATE: Read the follow-up article - The Long-Term Value of SEO: Does SEO Value Last Forever?.
About the Author
Larry Kim is the Founder & CTO of WordStream. Larry splits his time roughly 50/50 between developing WordStream's PPC management platform, and executing the company's SEO strategy.
Hit me up on Twitter:
There's people that think SEO is easier than PPC? I mean.. REALLY?I'm actually flabbergasted.
As a SEO-focused digital marketer that dabbles in PPC, I agree with parts of your argument, Larry. PPC and SEO do indeed require very different skills and mindsets and there are few complimentary aspects. But when you argue that PPC may be worth more bang for its buck, I fear I must respectfully disagree. Yes PPC can be incredibly effective in terms of ROI, with every click leading to a profit of some degree. With SEO that feedback loop is much harder to close, as good SEO has all kinds of complimentary side-effects. For example a site that is first discovered via a generic organic search (the result of SEO) can see return traffic on branded search, direct traffic, and even PPC. In the latter case PPC will get the full credit for the conversion, but the presence of the site in the earlier stages of the purchasing process (discovery, awareness) all contribute to that final conversion. The moment you stop your PPC ads, your revenue from PPC stops as well. Whereas with SEO, money spent today will reap rewards for months - if not years - down the line. So I would argue that the ROI of SEO is substantially greater than that of PPC, and enjoys more longevity to boot.
Thank you for your comment. It sounds like you are conceding here that the value of SEO is immesurable, yet conclude the ROI of SEO is substantially higher.
Sorry, where do I say it's 'immeasurable'? Have you ever used web analytics? Do you know what multi-channel attribution modelling is?Measuring the ROI of SEO is harder, but definitely achievable. And inevitably it shows higher ROI than pay per click. Your statements to the contrary are false and misleading.
Hi Barry, thanks for your comment. I'm glad that you're doing a great job at reporting and analytics.I've found however (and argued in the article), that most SEO's (not you) are far less interested in doing a realistic assessment of the true costs and value of SEO, as you have wisely done.
How is the value of SEO immesurable? Consider what x amount of clicks would cost you with PPC, compare to the clicks you get from SEO and you have your value of SEO. Keep in mind the clicks generated through SEO efforts will keep on coming whereas PPC you stop, clicks stop. If you want to estimate full cost of your SEO efforts, just add up all the costs involved (salaries, budgets, whatever it may be) and figure in how long it would take to run PPC ads to equal the amount you're spending on SEO.
This comment nicely highlights the difference in PPC/SEO mindsets that i was trying to call attention to.THe aproaches described above only takes into consideration the quantity of clicks (typically an SEO strategy), and not the value derived from those clicks (typically a PPC strategy).
100% agree with Barry on this - I think this comment sums up both SEO and investment in content:"with SEO, money spent today will reap rewards for months - if not years - down the line."The trouble starts only when trying to convince a client of the above when they all want to see results yesterday :-)
Following on from what Barry said, I too agree with a lot of this. The main similarities are clearly keyword research & conversion optimization. However, Once a PPC campaign completes, the traffic stops. That's not the case with organic listings where we have articles ranking for many years.For me, PPC has high yielding, short term value. Where as SEO has perhaps less conversion focused and sporadic traffic, but with long term gains. So the €1000 spent on SEO can go a long way and often convert more over time. SEO though is not all about ranking, and this is where i see the field migrating to in many ways. Our skill sets are broadening all the time, and we do indeed need to outsource a lot of jobs, as there simply are too many for one person to handle alone, especially for Enterprise level. Some of these new jobs we have aquired are:- Building sitewide link architecture & url structure- implementing Rich Snippets / Structured Data- Maximising PR- Page theming & optimization- Social Media integration for Referral marketingI see the SEO role as becoming consultant like in many ways. We fit between many departments such as the dev team, marketing, content team & social media. Like the dev guys, we are always looking forward and eager to implement new features & strategies. I'm not referring to grey or black hat one-upmanship on google, i simply mean trying to improve the website as well as its rankings. As that is what SEO these days is all about. conversion funnel: Social Media -> content -> ppc -> seo -> site
Hi Conor - thank you for the comment. I agree that it sounds exciting. (but also complicated and expensive).Please see my point in the article about not being fully transparent about the true costs of SEO.
I whole-heartedly disagree here. I started in production of SEO tasks, learning the trade from the bottom up, then moved to hands-on PPC management. I think this piece mischaracterizes not only the work of decent SEOs but also the apples-to-oranges comparison of PPC and SEO.I explain PPC to organic folks by saying "it's the same principles, just you pay for your position." Which is especially helpful for understanding quality score and how to evaluate keyword values. However, the user you're marketing to is a totally different creature. PPC is a much shorter sales funnel in most cases, where organic users tend to be more willing to poke around a site to find what they want exactly. This puts a greater focus on conversion optimization, certainly.But I think what's worse in this comparison is that SEOs aren't supposed to worry about conversions -- if that's the case, there's no way to calculate ROI and then... well, what's the point? If SEOs aren't looking at these factors, maybe it's more a matter of "What SEOs Can Learn from PPC Marketing," but I shudder to think what kind of marketing isn't focused on driving business...
There's a lot that SEO's and PPC's could learn from each other.SEO's could learn that it's the quality not the quantity of clicks that matter.PPC's on the other hand could learn a lot from the creative genius of SEO's.
Interesting view on the mindset of an SEO when it comes to PPC marketing. I myself started out more heavily in PPC and I think back in those days PPC was more complex than SEO. But as you mention Larry, SEO has become more than "just SEO", it includes email marketing, social, content marketing and all types of inbound.I think with all the types of inbound marketing that are included under SEO, they far outweigh the benefits of just PPC.When comparing SEO and PPC you really have to look at everything that contributes to "free traffic" to come up with a more accurate ROI for SEO. Content marketing for example helps build a brand's trust and authority with consumers and creates a bigger audience. Social Media helps brands build a personal relationship with their customers and again trust and authority. Emai marketing allows brands to sell to their customers over and over.The cost of SEO may be greater than PPC initially, but I think it far outweighs PPC in the long term.
Since when was email marketing part of SEO? Since when was social media part of SEO? If you are doing social media marketing to get more likes and +1s for SEO purposes primarily, you've got the wrong end of the stick.I used to do SEO and moved to PPC and I can testify as to how PPC is much more straightforward. With PPC, you work with Google; with SEO, you are trying to game Google who is trying to crush you all the time. The only difficult bit in PPC is trying to get the bid right all the time. It can also be an expensive road if the ROI is not there. Everyone bidding for the same high-traffic keywords can get some kicked out of the auction.But the advantage of PPC is that you have a tap that you can open and close for traffic and accurately select the kind of traffic. You can get traffic within minutes of getting your site up and running, no need to wait to get out of the sandbox or up the ranking. No need to optimise the site for SEO; it could be all in flash, images, etc. As long as you are making money out of PPC, why worry about stopping it?Many mention the long-term benefits of SEO. What happens if there is a change in Google's algorithm and your site's ranking tanks after all your years of labour? It happened to many out there with Panda and they still haven't recovered more than 1 year later.There's no Panda, Penguin or other monsters in PPC.
Buying the traffic I get from my target SEO keywords would cost me about £20,000. I've so far spent about £300.PPC's advantage is that its instant, scalable, and testable and refinable. SEO's advantage is that its dirt 'effin cheap, and the links can generate traffic beyond mearly through SERPS.And, lets be honest, neither is rocket science.
Barry and Douglas hit the nail on the head with various points which invalidate your points. As happens so often, you've taken your own experiences of SEOs (by the way there's no apostrophe in SEOs or PPCs) and applied them to the industry as a whole, and as a result you've inadvertently made yourself look naive. I work with blue chip brands who would loose serious revenue if it wasn't for our continued SEO efforts. There are certain high volume keywords that convert terribly within the SEO channel but we see significant drops in sales across other digital channels if we loose the number one ranking for those keywords. The main reason being brand consideration which is generated during the research phase. I'm sure you'd be shown the door if you included the above statements in a PPC pitch to this type of client. Google are not trying to run SEOs out of town. I was recently invited (with a selection of other SEOs from leading UK agencies) to a Google webmaster session where the official word from them was "we need SEOs to help big brands improve their websites". Picture 30+ SEOs sitting in Google, the first time SEOs from the UK have ever been invited to attend an event of that nature! That was a few months ago... I'm not sure if all your SEO bashing posts have been done to market your PPC services over other people's SEO offering - or what I suspect is that you're trying to be controversial - because that's great for SEO! Ironic...
Thanks for your comment matt.The point of this article is more about higlighting the differences in the PPC and SEO mindsets, and how those differences can quite often lead to misunderstandings and failure. It is less about the virtues of PPC vs. SEO.
Bulls***. This enitre article is about how 'silly SEOs should see the light and move to PPC' and how they're being misleading about the cost and value of their services. You clearly have a misperceived notion of the goals and work of seos. It's not about gaming the system to get "clicks" anymore. We're just as concerned about getting quality traffic and improving conversion rates as any PPC campaign, if not more, and you could just as easily calculate ROI. Good keyword targeting doesn't cast as wide a net as possible, it choose to optimize around terms that actually describe the content of your site and your business so you rank for the terms that you would actually want to be found for. There are plenty of bad SEOs out there just as there are plenty of bad PPC guys. I've seen agencies bid on the most ridiculous broad match terms that clearly drive no value for their site.The bottom line is that different channels work for different businesses.
Woah what a hot debate! Matt, I think everyone's reading too much into the misleading title meant for controversy (classic comment bait).Want to know what would be truly ironic? A black hat SEO claiming that SEO's long term value excedes PPC. Remember guys, SEO comes in many shades and good ones are few and far between, so don't be so quick to generalize and say SEO is always better than PPC in the long run...I agree that value attribution to SEO has always been a tough task as it requires in-depth tracking (entry page, click-stream, to goal completion) and well defined agreements between marketing functions. Most companies don't have the coordination to set it up correctly, so I definitely applaud those who have been able to. However, please think about the SEO who starts out as a link-builder, content copy-writer, or social media 'expert'.... Think it's easy to determine the ROI of a link attained, a blog posted, or tweets back to a customer inquiry? PPC is definitely easier than SEO because it's a narrow, well-defined function with easily attributable ROI. Pair that up with the need for an SEO to coordinate with an e-mail marketer, content writer/video creative, social media expert, graphic/UX designer, link-builder/PR and PPC advertiser, and you've got a tough branding experience to get across to your customers (which you should have segmented and provide different experiences based on their needs - different messaging for different personas). If there's anything SEO's can learn from PPC's, it's that killer ability to send targeted content. But I digress... let's all hold hands and work together guys.Just like how the general sentiment about NBC's coverage of the Olympics is positive, but extremely negative on social media, I think we have the same situation here. Every SEO here who has commented about the long term benefits of SEO isn't offering Platinum $200 SEO packages with GUARANTEED #1 SERP on Google - you guys can see the forest beyond the trees. The real problem lies in those spammy SEO's who are equally bad at PPC.Re-read the whole passage by exchanging 'SEO' with 'black-hat SEO' for the lulz.
Personally try and encourage all my clients budget permitting to use SEO + PPC concurrently long term, for somesearches looking at 10 organic, 7 places+ listings not to mention the adwords, so doubling up on best keywordsmakes sense.Adwords using broad match for a test period also a great way of finding the types of keywords people actually searchfor which could then be used for SEO campaign as well.The one thing I would say about SEO keywords, is for some of them they do hold rank for a long time onceoptimisation ceases, needs a bit of luck and some keywords drop within weeks of optimisation ceasing, alsowith google adwords some areas are very expensive cost per click, pricing some clients out of the market.
Hi Larry,why did you change your title from "why SEOs usually..." to "sometimes". This is very unprofessional. One of the fundamental of principles writing and journalism is that you don't make any substantial after-the-fact changes on your article. You should stick to your original statement, not flip-flop.
Thank you for this article, I was just balancing between 2 different services and couln't choose the one that fits my purpose the most.I guess I'll pick PPC as it seems more effective and easy.I was offered bot services not once, by the way.
This is great. I would be interested to learn more about the Internet Marketing and how can do easily. Thanks for the information!
Good stuff...Although PPC works for business, still SEO is a nice way to get clicks form search engine where many of people like to click the nature result rather than Advertising content.
I really like the ability to automatically feed your blog into your email newsletter. However, is there a way to easily add custom content to each blast. In my email blasts, I would like to not only include the recent post on the blog, but some additional call to action.
Hi Larry & fellow SEO folks,Good contentious article to kick off the comments. Well done from a link bait point of view... :-)I got started in the online marketing industry about 8 years ago doing SEO but quickly took up and specialised in PPC not long after that.I kept up to date and active in the SEO side of things for about 4.5 - 5 years, but then my employment circumstances saw me totally focus on PPC from then on.So, a couple of comments about SEO vs PPC.1) SEO is MUCH MUCH tougher now than it every used to be. Back in the "old days" we had most of our links built by a team in the Phillipines submitting to a large list of directories, and also did a fairly large chunk of article publishing with a smattering of spinning involved to vary the links somewhat.Hardly what I would call scrupulously clean white hat now days, but that's what was done back there, and for the most part, it worked fine.Nowadays, I would NEVER consider doing that kind of sh*t. Talk about an invitation to have the big Goog give you a kick in the head for being an idiot!SEO is a TOUGH gig now. LOTS of hard work, creativity (as Larry mentioned) and long term thinking & planning.If you get it right, you can achieve some pretty darn good results.However, it's slow, hard to control and always in the back of your head should be the concern that Google is going to unleash another zoo animal on us and kill off all our hard work.Clients who got smashed with things like panda don't give a damn WHY it happened. Just that the big bucks they have spent on SEO has suddenly nose dived their traffic, leads and sales.I have LOTS of respect for quality WHITE hat SEOs who are killing it out there. You folks are rock stars and deserve lots of kudos.And let's be honest, it really is the dodgy black/gray hat SEOs who are screwing this up for the rest of us. If we could just ship them all to Sibera to suffer in the cold, life would be much better for the SEO market.Of course, that's not going to happen, so C'est la vie!Now, moving onto PPC.I admit it. I am totally biased. I lurv PPC. And there are LOTS of reasons for that.One of the main ones is that it's fast!I can have a campaign up and running in a day, with leads & possibly sales arriving pronto!Money loves speed, and when it comes to a client's money they are giving you to run their campaigns, they love speedy positive ROI even more!SEO can take months or even years to drive results in many (but not all) cases, so being able to produce traffic and leads/sales straight away is a buzz and keeps the clients happy.Secondly, it's massively more controllable than SEO.I can target new landing pages any time I want, change the keywords that drive those clients and split test things to maximise ROI til the cows come home with PPC.SEO struggles to do just about all of that, especially fast!Thirdly, PPC is a fabulous way to conduct market research, find what works best, and continually optimise your ROI for the campaign.Lastly, I don't need to outsource it to a team in the Phillipines 'cos I can do it myself. :-)Having said all that, I think the very best way to operate is to use both PPC *AND* SEO. They can do amazing things together.BTW, if you're an SEO who has not had much success with PPC, I highly recommend you start again. Get some quality training first and you'll find it a lot easier to achieve results.There's a variety of excellent books on Amazon on the topic, from authors like Perry Marshall, Brad Geddes, Howie Jacobsen and so forth.Roughly $20 will get you started on the correct path.Lastly, I wrote a fairly long article on this topic some months ago that some of you might hate (or enjoy ;-) ). Note that the majority of my negative 'trash talk' against SEO in this article is aimed squarely at black hat seo types. So you white hat folks are a much nicer breed of online marketer that I like hanging out with... :-)http://bit.ly/16TYBRgI agree with Larry that we can all learn something valuable from each other. The 2 disciplines are NOT mutually exclusive!OK, time to run. Thanks for stimulating the convo Larry and all you enthusiastic SEO disciples.


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This Week in CP Arts: Jeff Krulik, The Tea Party Project, Countdown to Zero
On the cover, Mike Riggs logs miles with Jeff Krulik, maker of the classic rock doc Heavy Metal Parking Lot, on the occasion of his latest opus, Heavy Metal Picnic. Chris Klimek wonders why there aren't more politically minded shows at Fringe. Kriston Capps maps a rare collaboration between a gallery and the Smithsonian. I interview D.C. instrumental duo Authorization about its post-punk tone poem "Full Flight." Dave Dunlap Jr. reviews a new anthology from lost '60s psych act Spur. Brent Burton reviews the new record by Castevet, an American black metal band that's making the Scandinavian genre its own. Film critic Tricia Olszewski reviews a documentary about nuclear weapons and the latest fiction from Alain Resnais, which is also something of a bomb. And Chris Klimek reviews Passing Strange at Studio Theatre, which he says does far more for the tired rock-musical genre than it probably deserves.
In City Lights picks: John Anderson reviews shows at G Fine Art and the McLean Project for the Arts, and Erin Petty reviews "Graphic Masters III" at the Smithsonian American Art Museum. Plus! Lorin Maazel conducts Stravinsky, Fool's Gold plays DC9, Next Reflect Dance Collective performs Electro Shutdown & the Pea at Dance Place, and Ariel Pink's Haunted Graffiti brings its damaged art pop to the Rock & Roll Hotel.
And don't forget: Fringe & Purge!


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University Writing Program
Welcome to the University Writing Program
Upcoming Events
Writing the Range: The Next Ten Years
The University of Denver's Writing Program is pleased to announce Writing the Range: The Next Ten Years, a day of interaction on scholarship, pedagogy, and the profession with a special emphasis on issues concerning the future of the front range writing community. Featured in this day-long symposium are keynote talks by Dr. Cheryl Ball and Dr. Kate Vieira, a research and pedagogy forum, and dynamic roundtable sessions.
April 29, 2016
Hosted by the University of Denver's Writing Program
For questions on the day of the event, please contact Blake Sanz - 303.408.0151
Directions to Campus and Parking Lot "L"
From I25: Exit onto S. University Blvd (exit #205). Continue south on S. University Blvd. Take a right onto E. Asbury Ave. Once you park, Anderson Academic Commons is located less than a quarter mile directly south, just on the other side of Evans Ave. Here is a map of campus with Lot L and Anderson Academic Commons (26) circled.
You must have a permit to park at the University of Denver. A permit should have been emailed to you upon registration. If you have not been emailed a permit, please contact Lauren Salvador at firstname.lastname@example.com or 303-871-7448.
You must print the emailed permit and bring it with you to access our designated event parking area. Lot L is a parking structure north of Ricketson Law Building, with entry off East Asbury Avenue. The barcode on the permit will give you access to the lot when you scan it at the gate. To prevent ticketing, display the permit on your dashboard, and avoid parking on the Recreation level.
Instructions for RPNF Participants
You should come to RPNF prepared to talk about your ideas/research/issue for about 5 minutes and bring copies of a one-page handout for each member of your table (4-5 people). You will have time to receive 10-15 minutes of feedback from your group. What participants choose to put on their handout varies quite a bit - some bring an assignment sheet, an assignment sequence, a research synopsis, or a research plan and short bibliography. It's completely up to you what you'd like to include on your handout, but consider what might be most useful or illuminating for your group to be able to take with them when the day is over.
Instructions for Roundtable Speakers
If you are speaking on a roundtable, please limit your individual presentation to 5 minutes. After all speakers present, the remaining time will be dedicated to questions and conversation with the audience. The rooms will have projector capabilities – please let the moderator know before the roundtable begins if you'd like to use the projector.
You can download the program or view it on the conference website.
The Tie That Binds
Carol Samson, a faculty member of The University Writing Program, has adapted Kent Haruf's first novel, The Tie that Binds, for stage performance at The SteamPlant Theatre in Salida, Colorado. Haruf was a resident of Salida. He died there in November 2014, and over the winter this year, an arts organization, The Friends of the SteamPlant, asked Carol to adapt a piece of Haruf's writing as a celebration of his work and as a benefit for the Haruf hospice organization, Sunset Home. While his late novels had been staged by the Denver Center for the Performing Arts, she was pleased to acquire the rights to adapt his first novel, The Tie that Binds, winner of the PEN/Hemingway award. She adapted the work into a two-hour theatre piece that will use 10 actors and 88 slide projections to tell the story of Edith Goodnough, a woman raised on the eastern plains of Colorado in Haruf's imagined town of Holt, Colorado. The novel is part Faulknerian gothic, part parable, and part cultural study. It is a poetic treatment of the land and the people who framed eastern Colorado, farmed in treeless and sand-filled acreage, and endured.
Professor Heather Martin received the University of Denver's award for "Service Learning Faculty Member of the Year," joining her colleague Liz Drogin, who received that same award two years ago. The entire Writing Program received the Community-Engaged Department of the Year Award in 2012.
First-year student Maggie Sava (far right) with members of her family at the Writing Program Composium, held May 14. Maggie discussed a piece she'd written about her grandmother (second from left) who served as an observer in the Denver Public Schools during the tumultuous school desegregation effort in the 1960s.
WRITLarge - Our Annual Magazine of Undergraduate Writing 2015
Please read our latest magazine of fine writing by University of Denver Undergraduates.
Creating a robust culture of writing on the DU campus, the Writing Program helps students and faculty develop complex writing abilities needed in contemporary academic, professional, and civic life.
The nationally recognized program provides a national model for colleges and universities seeking exemplary practices in teaching writing.


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Murdoch's skills are put to use when the master of a wealthy household is discovered face down in his morning porridge.
No results found.
No results found.
No results found.
Yannick Bisson
Detective William Murdoch
Helene Joy
Dr. Julia Ogden
Thomas Craig
Inspector Thomas Brackenreid
Jonny Harris
Constable George Crabtree
Paul Rhys
Dr. Llewllyn Francis
Dr. Ogden cleverly comes up with a way to make a mold of the death wound that, unlike Plaster of Paris, will not leave traces of its use: a nifty new gelatin dessert that's quickly becoming all the rage--Jell-O.
In 1845, Peter Cooper obtained the first patent for a gelatin dessert, but it was unflavored and not especially convenient to use. In 1897 Pearl B. Wait (don't let the name fool you; he was a he) came up with a fruit-flavored version of Cooper's gelatin, which his wife christened "Jell-0". It was available in strawberry, raspberry, orange, and lemon. Lacking money and sales experience, Wait was unable to market his product properly and sold the rights to Orator Francis Woodward. Jell-O still did not start to catch on until after the turn of the century; in 1902, Woodward began advertising in women's magazine, as well as sending salesmen to as many local social events as possible, offering to supply free Jell-O and demonstrating how easy it was to make.
The concoction that Dr. Ogden stirs up in a beaker is green. Lime Jell-O was not introduced until 1930.
S 8 : Ep 18
Aired 3/30/15
S 8 : Ep 17
Aired 3/23/15
S 8 : Ep 16
Aired 3/16/15
S 8 : Ep 15
Aired 2/23/15
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The HSPC Tech Station is a fast-access computer case - a hardware workbench that brings PC components within easy reach yet keeping them safe and secure.<
83-11159 - 80MM x 80MM x 25MM Enlobal Magentic Bearing Fan
Exclusive ENLOBAL bearing with magnetic-barometric design to run friction-free and noiseless
Nanotechnology for lowest abrasion and highest durability
Detachable fan blades for cleaning
Best wire management and 3 to 4 pin adaptor
83-12242 - Western Digital Blue 1TB 3.5" Desktop Hard Drive
Boost your PC storage with WD Blue drives, the brand designed just for desktop and all-in-one PCs. The WD Blue family now delivers data storage capacities up to 6 TB.
83-9689 - PC Screw Kit
The PC screw kit is a handy assortment of common PC fasteners for building,
repairing, and maintaining computer systems.
The kit includes 12 different fasteners all in a plastic carrying case with divided compartments. Includes 50 screws and fasteners in each of...
83-9946 - 20 in Serial ATA Hard Drive Cable
SATA drive cable
Heavy duty molded cable
Straight cable
20" Serial ATA drive cable
Quick shipping, quality products and reasonable prices. I've redone most of my home with MCM products. Very pleased.


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Wow, I have 1/4 million shares now. (God, what have I done!!)
Ask the Company how they can begin production when the mine is flooded?
Dude, there were only 100 shares traded on the 26th, so that was you. Maybe you have 250k but at 100 share lots hmmm.
Do you still own those shares? What is your price target?


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Bill and Erika at Summer in the Square! 7.5.13 Thanks for stopping by and spinning our prize wheel!
Bill Squire at The Islander Bar & Grille April 23rd!
Alan Cox at Around the Corner Friday April 22nd
Dieter at Wal-Mart Saturday April 23rd!
Bill Squire at Panini's in Kent Saturday April 16th!


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Activity Feed
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Congratulations! You've completed your Kongregate account!
Keep exploring Kongregate with more badges and games!
Hide the progress bar forever?
Super Crazy Guitar Maniac Deluxe 2
Jun. 16, 2014
Rating: 0
To mush muisic
Apr. 13, 2014
Rating: -2
thats awesome
Ninja Hamsters vs Robots
Mar. 28, 2014
Rating: -4
I"ll cellye
slip you into good
Rating: -6
hooooooooooooootttttttttttttttttttttttttrrrrrrrrr5rrrrrrr54rrrrrrrrrrrrrrrrrrrrrkolojjjjjjjjjjjjjjjjj6jjjjjjjk8jjj00kkkkpolo its hard
Mar. 01, 2014
Rating: 7
has anyone noticed the low pitched voice in toys & us sounds like it is saying butter?
Feb. 24, 2014
Rating: 4
oddest combo i have had yet was
a thief with a airtight alibi
Socrates Jones: Pro Philosopher
Feb. 20, 2014
Rating: 2
good game taught me philosophy would love a sequel 5/5
Feb. 14, 2014
Rating: 3
my only problem in the entire game is that some of the town descriptions are really sad & depressing like i.e. yorn and ediolie
Papa's Pastaria
Jan. 26, 2014
unlike many i love all the papa games and i would hate to see them go. i hope they last a long time!
Monster Slayers
Jan. 22, 2014
great game
Wake Up the Box 4
Nov. 28, 2013
fun game i loved 100% of the series but 5 is my fave
Oct. 17, 2013
Rating: 1
a suggestion add emergency funds you can use for running out of money
Sep. 19, 2013
argh the campy the man bear horn challenge is so hard 10 seconds wheelie is hard enough on its own!
the trikeserartops horn is awesome i wont spoil it but its worth the challenge
Sep. 16, 2013
something interesting Protagoras influenced Plato who influenced euthephphro and kant who helped influinced neiche also hobbes influinces locke who helped kant
Sep. 14, 2013
the way Protagoras says nonsense is awesome it is kind of odd in a good way it makes him sound like one of the Simpsons!
awesome game, want a sequel as soon as possible before this game i thought the only hobbs's were the tiger and the cruel dad from elf!
Wallace & Gromit: Top Bun
Sep. 11, 2013
i would love to see Wallace's job description read a newspaper while dog slaves away ? 5/5!
only a very small amount of problems great game otherwise for instance if adrianne thinks mill is the perfect philosopher why would she write possible problems
Sep. 10, 2013
the best part is that mill is impossible to get angry even though utillitary sounds like military
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you are viewing a single comment's thread.
All I care is that Sbux just innovates. Which the have done constantly. I think they have a great development team. They are smart and find new offerings. I think they do buy some other companies. I see them going into coffee booze. Could become the leader in coffee martinis!
Sentiment: Buy


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Hemoglobin Levels Topic Guide
Hemoglobin (Levels): Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs, to the body 's tissues, and returns carbon monoxide from the tissues back to the lungs. Hemoglobin values are related to a persons age and sex. Low hemoglobin levels in the blood is referred to as anemia. High hemoglobin levels in the blood are caused by cancer, lung diseases, bone marrow disorders, blood doping, living at a high altitude, and inappropriate use of the drug Epogen. Treatment of a high or low hemoglobin level depends on the cause.
Must Read Articles:
Colon Cancer The human colon is a muscular, tube-shaped organ measuring about 4 feet long. It extends from the end of your small bowel to your anus. Most colon cancers start as adenomatous polyps that turn into adenocarcinomas. Colon cancer is typically diagnosed through a colonoscopy or other type of endoscopic procedures. Treatment methods include surgery, radiation, and chemotherapy.
From WebMD
Healthy Resources
- How Is Atrial Fibrillation Affecting You?
- Men and Iron Supplements
- Are We Close to a Cure for Cancer?


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Your friendly neighborhood web-head is staying away from Earth's Mightiest Heroes. Those very same heroes make an all-too-brief appearance in a preview of an upcoming Super Bowl ad. Plus, see why Judge Dredd is simply too cool to be forgotten.
Put your Tights on and fly past the break for today's scattered comic book movie news!
God Speed, Spider-Man
During today's "Avengers" Twitter Q&A with director Joss Whedon and stars Samuel L. Jackson, Clark Gregg and Tom Hiddleston, the recent rumor of a Spider-Man cameo in Marvel's upcoming superhero extravaganza finally bit the dust. "There is no Spider-Man cameo," Whedon pledged. "But the Avengers do turn off the dark."
"Avengers" Assemble For Football
Even more important than Spider-Man's "Avengers" demise is the reveal of ten seconds of footage from the Whedon-directed superhero flick. The prized moment of the Twitter Q&A shows our heroes at their most battered, and even includes some high-flying enemies to boot. Click here to check it out, and tune into the Super Bowl on Sunday (February 5) for the full spot.
Russo And Sosenko Are "Too Cool To Be Forgotten"
Last we'd heard, "Role Models" director David Wain was circling the adaptation. Nearly two years have passed since that report, so his continued involvement is anyone's guess at this point.
Obey The Law
Presented without comment, an awesome new look at Karl Urban in "Dredd."
In Tights, we're bringing you all the odds and ends circling about the comic book movie sphere. From the bizarre Batman business to the spectacular Spider-Man scoops, consider this your one-stop shop for all the weirdness the wonderful world of comics-based movies has to offer.


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168 Miles
270 Km
2 hours 38 mins
111 Miles
179 Km
44 mins
7.78 Gallons
Fuel Needs
0.91 Pounds CO2 fp per miles
Distance from Clifton, AZ to Tucson, AZ is 168Miles or 270 Km. You can get this distance about 2 hours 38 mins. If you want to planning travel with plane, you can get this distance about 44 mins .
A car with an average MPG will needs 7.78 gallons of gas to get the route between these points.
The estimated cost of gas to get between Clifton, AZ and Tucson, AZ is $17.66.
During the route, an average car will release 152.43 pounds of CO2 to the atmosphere. Your carbon footprint is 0.91 pounds of CO2 per mile.
* Average US MPG used for calculations is 21.6 MPG.
* Average US gas price used for calculation is 2.27 per gallon.
* Coordinates of Clifton, AZ is 33.050899, -109.2957665 and coordinates of Tucson, AZ is 32.2216492, -110.9264792
All Rights Reserved. © 2010 - 2016 About Feedback


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|Stoner Sports
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|Your source for rookie cards, variations, autographs, limited editions, short-print autos, rare 1/1's, and bulk closeouts!
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|MOSTLY MINOR LEAGUE HOCKEY CARDS. See my E-Bay store and auctions for minor league hockey singles, sets, and mainstream NHL cards of players currently playing in the AHL, ECHL, UHL and European leagu...
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This item from Dollyology Vintage Dolls & Antiques / Collectibles is now in the Shop Backroom
More from Dollyology Vintage Dolls & Antiques / Collectibles
Dollyology Vintage Dolls & Antiques / Collectibles
Kate Eaton, Grass Valley, CA
Vintage GUERLAIN Chamade Eau de Cologne Perfume -- RARE Huge 900 ml Flacon
Incredible! HUGE Vintage bottle -- approx. 30 ounces -- 900 ml -- of Guerlain CHAMADE eau de Cologne. Vintage early 1960's by the box and label design.
Bottle comes SEALED -- NEW and never opened -- and with it's original box.
THIS IS NOT A FATICE... filled with the real enticing and alluring scent of CHAMADE.
This gorgeous bottle stands over 11" high and 8.5" wide. The perfume cologne is still a beautiful shade of gold -- showing it has been well cared for and preserved all these years.
I can only imagine the lovely fragrance this bottle holds for someone who is ready to finally open and enjoy... I have never seen this almost 2 PINT bottle in this scent.
See my other listing for same size bottle of SHALIMAR.
If you were the pending buyer of this item, go to My Account to view, track and check payment for this item.
Dollyology Vintage Dolls & Antiques / Collectibles
Kate Eaton, Grass Valley, CA
RARE Vintage & Collectible 1920-1950s MUSEUM QUALITY DOLLS --Tiny Tears, Betsy Wetsy, Dy-Dee & Compo
3 Payment Layaway (or more on larger ticket items) -- Buy a Lot -- Buy a Little -- Add to it.. Stack 'em up! RETIRING !!!
|Shipping & Handling :
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Aisthesis Model
RitualsPhotographer Male Breckenridge, Colorado, US
My Website: http://www.therituals.tumblr.comMy MM URL: http://www.modelmayhem.com/Rituals
Mayhem # 2705827
About MeIve been shooting for 7 or so years, over the past few started getting serious with it. I like shooting girls, shapes, whatever i see. Its more important to me that my images have more layers than just the image itself. Im leaving for san francisco in a few months to go the academy of art for photography.
Have you worked with Rituals? Add Credits for Rituals! >>
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Party Peeps is a dance club for kids, created with fun and safety in mind, by Joe Targove. Joe is a school teacher and has been working with children for almost 30 years. He is also an accomplished musician and songwriter. He recording and produces music, plays many instruments, and loves to entertain, emcee, and DJ.
The parties are for kids and adults ages 1- 99. Obviously, the songs and flavor of the parties changes to be age appropriate and our venue is both kid friendly and adult private,
Prices for kid's parties are:
$375 for a full 2 hour interactive party for kids. We dance with them, sing, make music videos on our stage w a green screen etc. We play music games and teach new dances at each party.
Our prices are for up to 25 kids, and each additional child is $10.00. We hold a max of 80 people. We include juice and bottled water, coffee, all paper goods and table settings in your choice of color. Pizza can be ordered through us for $12 a pie.
Add Ons:
We can create custom CDs of music as give aways with pictures of your child on the cover and the inside. You select up to 14 songs and we make a special CD for each guest! Thats only $3.00 each.
Costume characters range from $50- $100 for 2 hrs.
We also feature The Party Peeps Red Carpet Runway Modeling Shoot: All the kids hear their name called and walk the runway taking pictures as they go. They meet the birthday child on stage and take pictures with him or her. That is usually $50. mention this ad and get it for $4o!
Cotton Candy and face painting/ glamour make up etc.. also $40.