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Abayomi O. Akanji, MD, PhDKuwait University, Safat, KuwaitJoshua I. Barzilay, MDKaiser Permanente of Georgia Atlanta, GA
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W. Timothy Garvey, MD University of Alabama at Birmingham Birmingham VA Medical CenterBirmingham, AL
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Olga T. Gupta, MDUT Southwestern Medical Center Dallas, TX
Fawaz G. Haj, DPhil University of CaliforniaDavis, CA
Pawan Hari, MD, MPHPark Nicollet ClinicSaint Louis Park, MNSushil K. Jain, PhDLouisiana State University Health Sciences CenterShreveport, LA Peter T. Katzmarzyk, PhD, FACSM Pennington Biomedical Research Center Baton Rouge, LA
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Marcus G. Pezzolesi, PhD, MPHJoslin Diabetes CenterHarvard Medical SchoolBoston, MA
Stephen S. Rich, PhDUniversity of VirginiaCharlottesville, VASusan L. Samson, MD, PhD, FRCPC, FACE Baylor College of MedicineHouston, TX
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Congratulations to music student Calvin Hanson! He'll soon be on his way to Texas to hear his composition performed at the Jack Stone Music Concert April 24 at Northwest Vista College.
Calvin is the winner of the Jack Stone Award in Northwest Vista College's third annual musical-score contest for
community college students and his composition was one of three chosen from across the United States to be performed at the concert.
The concert will feature professional performers Eileen Mack on the clarinet, Eleonore Oppenheim on the double bass,
and William Smith on the piano.
The second place winner is Kenji Oh from Los Angeles City College in California and the third place
winner is Connor Helms from Rock Valley College in Illinois.
All three students receive recognition and cash prizes, but Calvin brings home the Jack Stone Award! Congrats, Calvin! Go Tritons!

subset: commoncrawl


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PAPDI JAYA held a 3-day scientific meeting entitled "Jakarta Internal Medicine in Daily Practice" (JIM DACE) in Jakarta.
This scientific meeting consisted of workshops at five different hospitals on Aug 31, followed by 2-day symposium at Flores Ballroom, Borobudur Hotel, North Jakarta. The topics of discussions were varied from renal anemia (presented as general lecture), current approach to upper gastrointestinal disorders, new paradigm in type-2 diabetes mellitus, the art of initiating insulin therapy for outpatients, to 'astaxanthin' as a new anti-aging supplement.
I could never thank my boss enough for giving me the rare opportunity to attend the event (for free!). As a recent graduate doctor of medicine, I literally couldn't afford such expensive symposium by myself yet I was too ashamed to have my mom backed me up. *blushing*
Anyways, I've learnt lots of new things and tried to apply them in my (upcoming) practice. I believe I have to give my best to my patients at all time. As for you my loyal readers, I will share my practice knowledge in the upcoming posts. Hope you'll find it useful. Have a good day!


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Main Forums > Living With HIV
The third time's the charm
<< < (3/3)
--- Quote from: whizzer on June 16, 2006, 09:00:56 PM ---Gee, I've never had a nurse or NP draw blood. It's always one of the phlebotomists at the lab - and they are very, very good.--- End quote ---Same here. Some are so good that sometimes I really can't tell they're doing anything. I had blood taken at the Health Dept once and it was horrible. I have nice, big, juicy veins and this lady just jabbed that needle in my arm. It made a pop and felt like she hit something (a nerve?) in there. I almost hit at her as a reaction/ reflex 'cause it hurt like hell. My partner was there and was really surprised how she did that. A large part of my arm was bruised from that lady. David
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Paint Rock Baptist members able to meet many needs comment (0)
October 10, 2013
By Anna Keller
Paint Rock is a small, tight-knit community of just more than 200 people in North Alabama, and the Putnam family has been a part of the town for decades. Harvey Putnam grew up in Paint Rock attending Paint Rock Missionary Baptist Church, and when he married his wife, Betty, she also became a member. When the Putnams' children, Paige and Lance, were born, they began attending Paint Rock Baptist as well.
According to Pat King, the wife of Paint Rock's pastor, Charles, the Putnam family is a "bedrock of this community." They have given their time and resources over the years to lend a hand to anyone in need, she said.
So when Lance Putnam was diagnosed with acute leukemia earlier in 2013, the church family was ready to help.
While he is insured, his medical bills began piling up after chemo, an abdominal surgery and a stem cell transplant. The church held a fundraising auction at the church's family life center, and at any given time, 400 to 500 people were present bidding on everything from Brunswick stew to homemade cakes to household items. Be The Match also had a booth set up where people could register to be added to the bone marrow transplant list.
"In everything we did, God really did pour out His favor and establish the work of our hands," Pat King said. "It was like loaves and fishes."
Lance Putnam says he and his family — wife Jenny and children Sydney and Sawyer — are so thankful for the church's support.
"The people of Paint Rock and the surrounding areas are some of the kindest and most giving people I know," he said.
But that is just who the congregation is, Betty Putnam noted.
"The church has helped cultivate our gifts and to work with others to better serve our Lord," she said. "It's always been a very giving church. Even though it's small, we're able to meet many needs."


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Lester Bowles Pearson images now on Flickr
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Gatineau, April 24, 2012
— Library and Archives Canada (LAC) is pleased to announce that a
new set of images
featuring Canada's 14th Prime Minister, Lester Bowles Pearson, is now available on Flickr.
Lester Bowles Pearson was born in Newton Brook (Toronto), Ontario in 1897. During the First World War, he served as a medical orderly in Greece and then started training as a pilot in England. However, he was struck by a bus during a black out and was sent back to Canada in 1918. He studied at the University of Toronto and at Oxford University before joining the Canadian foreign service in 1927.
Pearson's diplomatic career spanned 23 years. He served as the first secretary at the Canadian High Commission in Britain from 1935 to 1941; and then moved to the Canadian Embassy in Washington in 1942. Three years later, he served as the Canadian Ambassador to the United States, attending the conference which founded the United Nations in 1945.
Pearson began his political career as a Cabinet Minister for External Affairs under Prime Minister Louis St. Laurent. In 1956, Pearson recommended to the United Nations that an international peacekeeping force supervise the withdrawal of British, French and Egyptian forces from the Suez Canal. Canada acted as one of the supervisory forces. He was awarded the Nobel Peace Prize in 1957 for these efforts that averted another global conflict.
In 1958, Pearson succeeded Louis St. Laurent as leader of the Liberal Party and was elected Prime Minister in 1963. He retired from politics in 1968 and returned to the academic world. Pearson died in 1972.
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Items where Journal is "Journal of English for Academic Purposes"
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|Jarvis, H 2004, 'Investigating the classroom applications of computers on EFL courses at higher education institutions' , Journal of English for Academic Purposes, 3 (2) , pp. 111-137. Item not available from this repository.


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Hawks 120, Timberwolves 113 - Despite 43 points and 19 rebounds from Kevin Love, Atlanta got by Minnesota. Kyle Korver scored 24 points for the Hawks, including 12 in the 3rd quarter.
· Cold winter fires up fuel prices
· Marietta, Smyrna police find missing woman
· GOP Senate hopefuls differ on national defense
· What the superintendents said about staying open
· On their own, drivers and teachers turned hero


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Academic Rigor
Dorm Life
Food and Dining
Bang for the buck
Clubs and Activities
Campus Safety
RPI is a wonderful place to learn. The academics are rigorous here, but the hard work pays off. Although it's a technological institute, there are lots of fields you can pursue, including biology, architechture, management, information technology, computer science, astronomy, psychology, electronic arts, or even the arts/humanites.
To find more tips for prospective students, what to do for fun and whether this school is great for a particular type of student read the 72 reviews for Rensselaer Polytechnic Institute
Curious about something that isn't answered here? Feel free to ask Rensselaer Polytechnic Institute a question
this school makes for an awesome experience on and off the fields of a student-athlete, friendships are forever and classes are all very thorough and intensive, campus is gorgeous and the view from empac hill is unforgetfulRead More
rpi has a rigorous workload, but it's highly satisfying at the end of each semester! every professor i have had has been overly passionate about what they are teaching, and they really enjoy their work. also, there are many opportunities for on-campus research.Read More
rpi offers a great workload for its students regardless of your major. the social scene isn't so good. there are a good amount of activities to participate in.Read More
I have read reviews from multiple sources saying this is a low party school which is what I have been searching for in an institute! The students here understand that grades are a priority and take school seriously. I hope I get accepted here because the campus is gorgeous, it has all my intended majors, the size is small, and it has high academic rigor.Read More
Good stem.Read More
Excellent academics, and good classes sizes. Beautiful campus, although it seemed very large. People on campus seemed very friendly, they offered to help my family get from place to place and they were very enthusiastic about the school.Read More
RPI is a great engineering school with the prefect combo of old and new. The campus has a nice feeling and the students and very helpful. Amazing education paired with a great campus, student body, and a good surrounding town.Read More
The academics are very difficult but rewarding. The professors know their stuff and are very accessible outside of class room hours. The students are all brilliant but are typically quite socially though less so than other major tech universities.Read More
Rensselaer is perfect for my major as an architect. As a college they are working on diversifying the school with minorities and women. It helps and supports the students in the academic and financial level.Read More
One of the best schools that has a truly interdisciplinary program for a mix between computer science and business.Read More


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Saturday 03 Dec 2016
Funds lacking to help victims of domestic violence, advocates say
November 2, 2014
In a single day last year, 215 requests for domestic violence services went unmet in Maryland
Read the rest of this entry
O'Malley administration unveils website to help unaccompanied immigrant childrenSeptember 17, 2014
"We're a welcoming place, and we want them to know that help is available."
Maryland campaign-finance complaints stack up as election day nearsSeptember 9, 2014
"We see candidates appearing at events for their super PACs."
O'Malley asks Latino lawyers for help with state's refugee childrenSeptember 9, 2014
"When unaccompanied children fleeing violence in Central America arrive at our doorstep, it is not only for their good, but for our good and the good of the nation that our children will share with them that our nation should act hospitably and revere the human dignity and the courage that those children have possessed."
Some fracking commissioners think report won't be ready by deadlineMarch 16, 2014
According to one study, surface water contamination and groundwater contamination are among the high risks Maryland would face if fracking occurred.
Democratic gubernatorial candidates push for emissions reductionsMarch 16, 2014
With 7,700 miles of coastline, Maryland is particularly vulnerable to rising sea levels. The Chesapeake Bay is rising at two to three times the rate of worldwide sea levels. It rose more than a foot over the past 100 years and is expected to rise 2 to 5 feet within this century.


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You limited your search to:
Partner: UNT Libraries
Country: Australia
State: Hawaii
Collection: Environmental Policy Collection
Creating Impact - Feed-In Tariff Laws: Making clean energy a reality for all
Date: March 2009
Creator: World Future Council
Description: The brochure describes evidence from fifty governments that Feed-In Tariff (FIT) policy speeds the transition to clean energy production and use.
Contributing Partner: UNT Libraries
Heading for 100 % renewable urban transport: Policy recommendations
Date: unknown
Creator: Gust, Iris & Meusel, Titus
Description: The brochure promotes urban transportation policy to increase the use of renewable energy to 100%. Seen globally, transport is one of the main sources of greenhouse gas emissions. Yet fossil fuels are becoming scarce, will become increasingly expensive and will eventually stop being viable as transport fuels. Before this happens, climate change will have begun to have a serious impact on human lives. The authors believe that it is crucial to replace fossil fuels with renewable energy as soon as possible, especially in the transport sector. Making urban transport independent of fossil fuel is a great challenge, but the authors cite growing evidence that it can be achieved.
Contributing Partner: UNT Libraries


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A New Glarus woman was injured in a single-vehicle crash Saturday night on Highway N in the town of New Glarus, according to a report.
Green County sheriff's deputies responded to reports of a one-vehicle crash on Highway N south of Highway NN around 7 p.m., officials said.
Investigators said a vehicle being driven by Anastasia K. Werner, 18, was northbound when she lost control while negotiating a curve.
Werner's vehicle entered the ditch and hit a fence, according to the release. She sustained injuries and was transported to Meriter Hospital. She was wearing her seat belt.
Snow-covered, slippery roads contributed to the crash, officials said. The vehicle sustained moderate damage and was towed from the scene.
No citations were issued for the crash.


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Order by phone (1) 800.925.3674
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This heavy duty dual-action pump inflates or deflates on both the up and down stroke. Features lightweight, non-corrosive plastic and new locking system to avoid hose unfastening from pump.
Call (1) 800.925.3674 or e-mail firstname.lastname@example.com for more information or a quote.


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A February trial has been scheduled for a southeast Iowa man suspected of killing his pregnant wife.
Seth Techel has pleaded not guilty to charges of first-degree murder and nonconsensual termination of a human pregnancy in the death of Lisa Techel. She was shot in May at their home near Agency in southeast Iowa.
The Ottumwa Courier reports that the trial is scheduled to begin on Feb. 19.
Both Techels worked in law enforcement. Lisa Techel was a reserve deputy with the Wapello County Sheriff's Office. Seth Techel was a jailer.
He remains jailed pending $750,000 bail.


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Economics Departments, Institutes and Research Centers in the World
Barcelona Institute for Political Economy and Governance (IPEG)Location: Barcelona, Spain
Homepage: http://barcelona-ipeg.eu/
Phone: + 935421763
Postal: Ramon Trias Fargas, 25-27, Barcelona, 08005
Handle: RePEc:edi:bipeges
Areas or Functions: Public Economics, Political Economy
Additional details:
People who have registered with RePEc and have claimed to be affiliated with this institution:Find all publications of all authors listed below conveniently compiled on IDEAS. Authors with publications are listed below with . We have lost contact with authors marked with ?, and they do not count towards the ranking of this institution.
This listing is provided to you by EDIRC at the Economic Research Department, Federal Reserve Bank of St. Louis.
Please send additions and corrections to Christian Zimmermann.


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What the new Ohio Graduation Test represents - a move toward accountability and standards in education - is fine with Ohio Federation of Teachers President Tom Mooney.
It's the timing of requiring the test for high school diplomas, Mr. Mooney said, that bothers him.
"We're trying to move way too fast to make this a high-stakes test," he said yesterday.
Mr. Mooney is hoping the OFT's 250 union delegates, who begin a four-day meeting in Toledo today, will adopt a resolution calling for a delay in the adoption of the Ohio Graduation Test for high school graduation. Such action would require legislative action.
"I do understand their concerns," said Bob Bowers, Ohio's deputy superintendent of public instruction at the Ohio Department of Education. "But from our standpoint, we're ready now."
Passage of Ohio's five-subject graduation test will be required of this year's high school freshmen. When the students take the test as sophomores next March, their results will count on districts' report cards.
The state board of education will look at the results of pilot tests - English and math sections administered last year and all five subjects this year - to set passing standards at the panel's July meeting, Dr. Bowers said.
Mr. Mooney said the timeline has been too short both for redeveloping classroom lessons to include appropriate material and for knowing what score is needed to pass.
The state board of education adopted academic content standards in December, 2001, for language arts and math and a year later for science and social studies. But the panel had not fully adopted model curricula, which cover material for the tests, until earlier this month.
Dr. Bowers said the state has provided districts with the standards and a "curriculum alignment tool" to help match existing lesson plans to the test. The state also mailed directly to teachers' homes information about the new test and has held workshops.
Francine Lawrence, president of the Toledo Federation of Teachers and a member of the OFT executive committee, said she supports the planned resolution.
"We need additional time to prepare students to have the opportunity to succeed and the standards need to be equitable," Mrs. Lawrence said.
If OFT adopts the resolution, Mr. Mooney said the group will move quickly to gather support before taking the issue to the state superintendent, board of education, and the legislature.
Contact Sandra Svoboda at:
or 419-724-6171.


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The wide range of sporting activities on offer at the Forte Village well and truly qualifies it as a recognised Sports Resort.
Our Sports Academy offers the professional training, enthusiasm and experience of great international champions, and by taking part you will benefit from personalised training sessions, and useful advice on how to improve your team and individual skills. In addition, as you play, you will be given the extraordinary opportunity of being observed by top professionals.
Our courses provide everything you need to improve your skills, surpass your limits and enjoy a totally unique experience.
Want to learn the finer skills of the world's most elegant sport? Seize this unmissable opportunity to train with real cricket legends.


text: This is a well hidden little Italy restraint. Once you walk in you feel like you are transported to the land of olives and pizza. The food is rich in fresh spices and taste like a blast of flavour every time your fork reaches your mouth. The price is reasonable and portions are very fair. This is a great place for a nice romantic night out to a little unknown place for good food and a lovely night.


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It's early morning in September 2012, nearly 7,000 feet up in the Idaho wilderness. Three intrepid hunters are stealthily tracking a bugling bull elk when they lose track of the beast. The morning is eerily silent, the elk not having called for nearly half an hour. The hunters pause, listening intently for any sign of the creature. Follow along on this exciting bow hunt as Bowhunting.com's Patrick Durkin describes what happens next:
I nodded toward a small lodge-pole pine 40 yards ahead where the forest faded into an aspen meadow. Turning to White I whispered over my shoulder: "Sneak up to that pine and get ready. I'll drop back and give a cow call." But before we could separate, White hissed, "There he is." Sheesh! So much for that plan. The big bull was crossing the meadow, its broad chest cleaving young aspens and tall grass as it headed straight at us. Then it stopped about 50 yards away and stared. We held our breath, slumped like stumps, hoping our camouflage clothing and face nets blended with the background. Just when we thought the bull would whirl and flee, it resumed walking. When it was 30 yards away on a parallel course, I noticed White lifting his bow to draw. "Wait!" I cautioned quietly, fearing the bull's peripheral vision would spot the motion. The bull never slowed. It passed us at 25 yards, giving White a slightly quartering-away shot. "Draw," I whispered, hoping I sounded calm and helpful. Remember, this was only the third day of White's first elk hunt. In fact, he hadn't yet arrowed a deer since taking up bowhunting a few years ago. The last thing he needed was some old guy – well-meaning or not — increasing the pressure. As excited as I felt, I couldn't imagine what he was feeling.
Photos: Bowhunting.com


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Where Ravens' home win streak ranksHere's what the other ESPN experts are predicting: : Steelers : Ravens : Ravens : Ravens : Ravens : Ravens : Ravens : Ravens : Ravens : Ravens : Ravens : RavensUgh. It ended the Ravens' three-game winning streak against Pittsburgh and stopped Baltimore's … (more)
The Schmuck Stops Here: Ravens in the rear viewOK, let's get all the perspective stuff out of the way right up front.
Sports Blitz: Ravens' locker room felt weird after loss to SteelersMaybe this is what happens when you've won 16 straight games in your own house and then another team gums things up by having the nerve to knock you off, as the Pittsburgh Steelers did Sunday with their surprising 23-20 win over the Ravens at M&T Bank
Coffee Companion (12/3): your daily Ravens fixEvery morning, Monday through Friday, blogger Matt Vensel will hook you up with reading material -- mostly on the Ravens but with some other Baltimore sports stuff, too -- to skim through as you slug down coffee and slack off at the start of your workda…
How Ravens can clinch on SundayFour teams could have clinched playoff berths in the AFC on Sunday. The only team that failed to do so was the Baltimore Ravens. The New England Patriots and Denver Broncos won their divisions, and the Houston Texans earned a postseason spot. The Ravens…
Wake-up: Ravens losing grip on division?It's a strange Sunday in the AFC North when the only team that loses in the division is the one leading the division. The Ravens watched their cushion in the AFC North shrink after the Steelers beat them with Charlie Batch and the two Ohio teams (Bengal…
Matchup: Steelers vs. RavensGerry Dulac breaks down Round 2 of the rivalry for 2012.
On the Steelers: Ravens have the edgeYou call this a rivalry? The Ravens might call it a turkey shoot.
Heading into this weekend, Ravens riding streak of home winsOver the last 727 days, M&T Bank Stadium has been the site of last-second field goal makes and misses, stirring comebacks and thorough beatdowns, historic offensive performances and dominant defensive ones.
Steelers vs. Ravens previewThe Steelers face the Ravens for the second time in 3 weeks. And once again, Ben Roethlisberger won't be starting at quarterback. Ordinarily, I wouldn't be concerned about playing the Ravens without Big Ben. But after the performances that we sawSource: steelerstoday.com
This year, Ravens make their own magicThe question came at John Harbaugh from a thicket of cameras and microphones, one of those existential-type deals football coaches hate.
Ravens scouting report Ravens vs. SteelersPASSING GAME: Quarterback Joe Flacco couldn't get much done against the Pittsburgh Steelers two weeks ago as he completed 20 of 32 passes for 164 yards and no touchdowns. Pittsburgh cornerback Ike Taylor held Torrey Smith, the Ravens' top downfield thre…
Steelers played it safe with Ravens return specialist Jacoby JonesAfter Jones returned a 63-yard punt return for touchdown in first meeting, Pittsburgh was intent on limiting his opportunities SundayIn the first meeting between the Ravens and the Pittsburgh Steelers, the Ravens escaped with a 13-10 win on the strength…
Report Card: Steelers earn a A+ against the RavensGerry Dulac grades the Steelers' effort Sunday in their win against the Baltimore Ravens.
Instant Analysis on Ravens' 23-20 loss to the SteelersHow our columnists, reporters and editors viewed the Steelers' 23-20 win over the Ravens:Sources: baltimoresun.com post-gazette.com
Batch from the Dead: Steelers Rally Behind 3rd String QB for Stunning 23-20 Win Over RavensStill think Charlie Batch can't get it done? Think again. Sunday in Baltimore, the Steelers, like an old prize fighter backed in the corner late in a fight, fought tooth and nail with a team that was supposed to dominate them, and in the end used a ShauSource: steelersgab.com
Rapid Reaction: Steelers 23, Ravens 20BALTIMORE -- My thoughts on the the Pittsburgh Steelers' 23-20 victory at the Baltimore Ravens: What it means: On Shaun Suisham's 42-yard game-winner as time expired, the Steelers (7-5) stayed in the thick of the AFC playoff race by upsetting the Ravens…
Game-by-game look at the Ravens' current winning streak at M&T Bank StadiumThe Ravens have won an NFL-best 16 consecutive games at M&T Bank Stadium, including the playoff victory last January. Here is how they've gotten to this point.
Ravens mindful of Antonio Brown's returnSteelers wide receiver is back from ankle injuryThe return of Pittsburgh Steelers wide receiver Antonio Brown from a high-ankle sprain that sidelined him for three games creates a matchup issue for the Ravens.
Steelers Gab 2012 Week 13 NFL Preview — Pittsbugh at BaltimoreUgh. The Steelers are losers of two in a row, and now all that awaits is a trip to the hornets nest — Baltimore, without QB Ben Roethlisberger. The team could get a couple big players back in Antonio Brown and Troy Polamalu, but is it enough to best theSource: steelersgab.com
ESPN experts predict Steelers-RavensIn the video, Marcellus Wiley and Jerry Rice make their predictions for the Steelers at the Ravens. Here's what the other ESPN experts are predicting: Eric Allen: Steelers Mike Golic: Ravens Merril Hoge: Ravens Ron Jaworski: Ravens Chris Mortensen: Rave…
Related Articles
• For Pittsburgh Steelers, no Ben Roethlisberger means no wins vs. Baltimore Ravens: AFC North Nuggets
• With Steelers' Big Ben Roethlisberger out of commission, Cleveland Browns hope it's their time to shine


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The National Coalition on Health Care, in tandem with Best Doctors, has released results of a nationwide survey of 400 leading cancer specialists, focused on what doctors feel are the most significant barriers in efforts to accurately diagnose cancers; the types of cancer they believe are most often misdiagnosed; and the tools and improvements they most need to combat misdiagnosis.
Scroll down and click the survey image to read summary and full survey results.
An overview of the landmark survey, "Exploring Diagnostic Accuracy in Cancer"
Click below to see survey results:


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This speaker was a visiting speaker who delivered a talk or talks on the date(s) shown at the links below. This speaker is not otherwise associated with Lawrence Berkeley National Laboratory, unless specifically identified as a Berkeley Lab staff member.
Mr. Kuhne serves as Chief Operating Officer for PureChoice, Inc. He has over 15 years in the wireless telecommunications industry. Mr. Kuhne served as Vice President and General Manager for the Central Minnesota region for PriCellular Corporation, a publicly held wireless carrier based in White Plains New York. As Vice President he was instrumental in launching the newly acquired market. In addition to managing operations for the region he participated in the company's successful public financing efforts to fund initial operations and subsequent Merger and Acquisition activity. Previously Mr. Kuhne served as Regional Manager for McCaw Communications.


text:
Hollander appoints vp, Karen Neuburger line
Gallion named to newly created position
September 2, 2002-- Home Textiles Today,
Hollander Home Fashions has appointed Loretta Gallion to the position of vp of the Karen Neuburger product line.
In this newly created position, Gallion is responsible for the sales and marketing of the brand for both fashion and basic product lines, with a role in product development for the expanding division.
Prior to joining Hollander, Gallion was the national sales manager for Jia Li Textiles, where she was responsible for creating in excess of $10 million of sales.
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Ord, Nebraska
Flight Training and Flying Lessons
near Ord, Nebraska
Flight Schools are Available near Ord, Nebraska Now!
Ord, Nebraska (68862)
Learn to Fly in Ord, Nebraska Today!
Related Keywords & Searches: Ord Flight Schools, Ord Pilot Training, Flying Lessons in Ord, Ord Pilot School, Flight Schools in Ord, Ord Flying Lessons, Pilot Training in Ord, Learn to Fly in Ord, Become a Pilot in Ord, Ord Discovery Flight, Pilot Training in Ord, Ord Helicopter Flying Lessons, Pilot License in Ord, Ord, Nebraska


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Software assists with HIPAA (Health Insurance Portability and Accountability Act or Kassebaum-Kennedy) compliance.
HIPAA Training Program is a cost effective alternative to train your employees concerning the Privacy and or Security Rule requirements under HIPAA. This inexpensive program lets you create your own training program if desired.
HIPAA Security Rule Assistant provides HIPAA covered entities a program to learn and understand the HIPAA Security Rule. It contains Risk Analysis worksheet, sample policy templates, sample disaster recovery plan and Incident Report form, and more.
Not yet HIPAA compliant? You need Interactive HIPAA! Software so simple, you're HIPAA compliant in a matter of hours. With Interactive HIPAA you produce a completely customized Policy and Procedure manual and begin your HIPAA training in just 4-6 hours.
HEALTHsuite is a fully HIPAA compliant claims processing and healthcare administration software application designed specifically for health plans and benefit administrators.
The HIPAA-Repository approach represents the suggested overall HIPAA EDI processing strategic approach for the organization. While many approaches are "translator centric", the this approach limits the dependency on the translator product and emphasizes the translation process. The difference is...
HLMS is a patient mailing management software for HIPAA complicance. The application is targeted for healthcare professionals who perform fundraising throgh patient mailings.
The HIPAA Employee Training Program will educate, test, and document every staff member on pertinent HIPAA Privacy Rule requirements.


text:
Red, White And Blueberry Trifle
- Prep Time: 45 min
- Cook Time: 30 min
- Ready Time: 195 min
- Yield: 12 servings
- 1 (4.6 oz.) package vanilla pudding and pie filling mix (not instant)
- 3 cups skim milk
- 2 pints (4 cups) blueberries
- 1/3 cup sugar plus 3 tbsps., divided
- 1/4 cup orange juice plus 2 tbsps., divided
- 1 pint (2 cups) raspberries
- Crisco® Original No-Stick Cooking Spray
- 1 package Pillsbury™ Moist Supreme® White Premium Cake Mix
- 1 1/4 cups water
- 1/3 cup Crisco® Pure Vegetable Oil
- 4 large egg whites
- 1 cup heavy cream
- 2 tablespoons powdered sugar
Preparation Directions
- COMBINE pudding mix and milk in medium saucepan. Prepare as directed on package. Cover; refrigerate until cool while preparing fruit.
- RESERVE 1/2 cup blueberries for garnish. Combine remaining 3 1/2 cups blueberries, 1/3 cup sugar and 1/4 cup orange juice in medium nonmetal bowl; stir to mix, crushing berries slightly. Set aside.
- RESERVE 1/2 cup raspberries for garnish. Combine remaining 1 1/2 cups raspberries, 3 tablespoons sugar and 2 tablespoons orange juice in separate medium nonmetal bowl; stir to mix, crushing berries slightly. Set aside.
- HEAT oven to 350°F. Spray two 8 or 9-inch round cake pans with no-stick cooking spray. Prepare cake mix as directed on package, using water, oil and egg whites. Pour batter evenly into prepared pans.
- BAKE 32 to 36 minutes or until toothpick inserted in center comes out clean. Cool in pans on wire racks 15 minutes. Remove cakes from pans; cool 30 minutes or until completely cooled.
- CUT cakes in half horizontally to make 4 layers. Place 1 layer in bottom of clear 2 1/2 quart soufflé dish or glass trifle bowl, trimming sides of cake to fit if necessary. Spread with half of crushed blueberry mixture; top with 1/3 pudding. Top with second cake layer, trimmed if necessary, all of the crushed raspberry mixture and 1/3 pudding. Top with third cake layer, trimmed if necessary, remaining crushed blueberry mixture and remaining pudding. Top with fourth cake layer. Cover; refrigerate at least 1 hour before serving.
- BEAT cream in medium bowl until soft peaks form. Gradually add powdered sugar; beating until stiff peaks form. Top trifle with whipped cream. Sprinkle with reserved blueberries and raspberries. Store in refrigerator.
High Altitude (Above 3500 ft.):
- SEE cake mix package for directions.
Nutritional Information Per Serving
Serving Size (1/12 of recipe), Calories 440 (Calories from Fat 160), Total Fat 18g (Saturated Fat 7g, Trans Fat 0g), Cholesterol 30mg, Sodium 430mg, Total Carbohydrate 68g (Dietary Fiber 3g, Sugars 48g), Protein 5g; Percent Daily Value*: Vitamin A 10%, Vitamin C 20%, Calcium 10%, Iron 6%.
*Percent Daily Values are based on a 2,000 calorie diet.
* Ensure all recipe ingredients are gluten free by referencing the ingredient labels, as products may vary. If uncertain, contact the ingredient manufacturer.


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Plan a virtual visit with a provider through your PC or mobile device:
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( † Disclaimer: This search is powered by PubMed, a service of the U.S. National Library of Medicine. PubMed is a third-party website with no affiliation with Cleveland Clinic.)
Todd Coy, DMD, received his dental degree from Case Western Reserve University School of Dental Medicine and completed a general practice residency at the Cleveland Clinic. He joined the Staff in 2006, served as Program Director for the General Practice Residency until 2013, and now serves as the Section Head of Dentistry.
Dr. Coy provides general restorative dental care, with a special interest in dental care for medically complex patients as well as treatment of traumatic dental injuries. He maintains membership in professional societies including the American Association of Hospital Dentists, American Dental Association, Greater Cleveland Dental Society and the Academy of Dental Sleep Medicine.
Dental Management of Head and Neck Cancer Patients, Obstructive Sleep Apnea, Sports Dentistry
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The Milford Health Department, in collaboration with the Boys & Girls Club of Milford, will be providing flu shots on Saturday, from 11 to 4 p.m. at the 3rd Annual Pumpkins on the Pier event at Walnut Beach.
Flu shots will be available at the clinic to individuals age 9 and older. The Centers for Disease Control & Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) have recommended that all individuals age 6 months or older get a flu vaccination.
"Influenza and its complications cause an average of 36,000 deaths and 226,000 hospitalizations every year in the U.S." said Dr. A. Dennis McBride, the Milford health director.
The cost of the seasonal flu shot is $20, payable by cash or check. The Milford Health Department will also offer Fluzone High Dose for individuals 65 years of age and over at the event.


text:
The integral has sense in the region:
Hi there, I have this iterated integral , and the thing is, does it define a solid? because I think that as it is given it doesn't, but I'm not sure. I think that the cylindric paraboloid never cuts the x axis, and thats why I think this integral doesn't define any solid.


text:
Last season, Leonte Carroo hauled in 48 passes for 1,107 yards and 18 touchdowns in Don Bosco Prep's spread offense. It's that production that helped the 6-foot-1, 205-pound wide receiver from Rams...
Carroo waiting on Irish
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Part of World Tableware's Brandware® collection, Heavy Weight Windsor flatware is a perfect solution for high-volume, fast pace dining. World Tableware Heavy Weight Windsor flatware will set a great table in your dining room. World Tableware offers high quality flatware and is perfect for the foodservice industry. The Heavy Weight Windsor pattern has a smooth slightly tapered handle that is easy to hold. Add Glassware to finish your tabletop. These go well with the Kingsmen White Dinnerware.
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El canto del cisne del periodismo o la muerte del sueldo
Una respuesta a cebrian9
Thanks , I've recently been looking for info approximately this topic for a long time and yours is the best I have found out till now. But, what in regards to the bottom line? Are you certain concerning the supply?


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When diamonds are thought of, generally we can't help but think beautiful, pure, rare , bold. Diamonds are all of these things, and more. When we shop for diamonds we often times are not buying "perfect" diamonds. Most of them have internal and external flaws called inclusions and can sometimes affect the clarity of the diamonds. From the popular round diamond to emerald shape diamonds the inclusions are not always very obvious to spot and most jewelry stores will say they don't affect the value or vulnerability of the stone to shatter. Let's take a look at some of the different types of inclusions.
Crystal & Mineral inclusions
Some diamonds have minerals and crystals and even other diamonds that are embedded into them. This look usually resembles a diamond within a diamond and most are not visible to the naked eye. Those that have larger inclusions that can be seen with the naked eye can affect the clarity of the diamond and in some cases even the life of the stone by making it more vulnerable to chip or even shatter. Some mineral and crystal inclusions may even add to the look and character of the diamond. Sometimes the presence of a colored stone such as a garnet or ruby can appear and make the stone that much more beautiful.
Pinpoint Inclusions
These are the most common types of inclusion in diamonds. Often called minute crystals, they resemble a small point of light in the diamond. These types of inclusions usually do not affect the clarity of the diamond. However, when large clusters (usually three or more) of minute crystals are present they can create a "cloudy" look to them.
Feathers are cracks in the diamond that resemble a feather. These usually do not affect the clarity unless the feather starts running up to the top of the diamond where the stone is more prone to crack.
Usually caused by a deep internal strain on the diamond, these inclusions are straight cracks without the appearance of feathering. These inclusions are more prone to cracking, especially when and if being placed in the prongs of a ring, pendant, etc. These types of inclusions should be avoided if possible and carefully inspected.
Etch Channel
These types of inclusions are created when the diamond is forming deep in the earth. While the diamond is making its way to the earth's surface the high temperature fluids etches on the diamonds crystalline structure. These usually leave parallel line or uneven shaped tunnel looking configuration.
These are just a handful of different types of diamond inclusions. There are many more. The complex makeup of the diamond is quite intriguing. There are so many things you can say about a diamond and still have left out so much at the same time. We often times do not go this in-depth when shopping for the perfect diamond ring but it's always good to have a little insight on what you may be looking at the next time you walk into a jewelry store on even a pawn shop.
A typical brick-n-mortar pawn shop uses a 10 timer to assess a diamonds offer price or loan value, and the individual doing the evaluating is not properly trained. At online pawn shop PawnBahn.com, we have GIA certified gemologists that assess the value of your diamonds that take each and everyone of these types of inclusions into consideration or lack thereof. Taking all the 4cs into consideration as well. This is what sets PawnBahn apart from all brick-n-mortar pawn shops. You will always get the best possible offer on your diamond from us and know its true value, with, or without a gemological certification. In 99% of all cases, you will always get more for your diamond at PawnBahn than you would in any other pawn shop.


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9 Tips for Online Reputation Management during Back To School Season
Written by Nicolette Beard and published
Growing up in Michigan, the Alice Cooper anthem School's Out for Summer actually meant something to me — a full three solid months of vacation. School age kids did not think of laboring until after Labor Day.
Not so in Nashville, Tenn., the home of Raven HQ. A coworker mentioned "child school angst day," referring to the first day of school for his kids — August 4!
That got me thinking about stories that surface when students post stuff online they'll come to regret. Angst now has an outlet, and it's called the Internet.
Reputation management evolved as a branch of traditional public relations primarily for brands wanting to clean up a tarnished image. Companies have been prey to hijacked Twitter accounts, for example, and people have bought domain names to embarrass unresponsive corporations, e.g. ComcastSucks.com.
Today, online reputation management (ORM) extends to students and college graduates and even younger. No amount of wishing will change what's posted online. And Google's advice on preventing personal information from showing up on the first page is not particularly helpful.
Here are 9 quick tips to show you and your clients how to avoid becoming a cautionary tale.
How To Protect Your Reputation Online
- Be smart about what you share. Most future employers won't think your half drunk or naked photos are funny.
- Be proactive. In other words, manage your name (or brand) before you need to. Create and promote content and links associated with your name. I met one law degree graduate who posted on a Reddit subdirectory (known as subreddits) frequently when he couldn't get hired as an attorney. His passionate social commentary actually led to a position with a search marketing firm.
- Register domain names, both positive and negative. This keeps anyone from hijacking your "name space." If you are a high profile individual, take advantage of Google autocomplete to see which terms are paired with your name. Google derives this information from its own algorithm, so it's a good bet people are searching those terms.
- Do not repeatedly search for your name or click on links you find in search results. This is hard data that Google uses in its algorithm. (See No. 3)
- Build profiles on social business sites. These include LinkedIn and Quora.
The above applies to businesses too. Think of how long it took for your business to build a solid customer base. Now, think again how quickly your reputation can be lost based on one rogue employee or an old lawsuit surfacing. (Good luck to Pizza Hut, which is looking to hire a Twintern. What do they expect?) Read how using Raven helped save one business's reputation in this case study.
How To Protect Your Client's Reputation Online
Every online marketing agency should be familiar with the basics of reputation management, if they want to be proactive with their clients. Why? Because you are the first line of defense in case your client's business reputation takes a hit.
It can be something as simple as a negative review on Yelp to a full blown international crisis where you need to build a stand alone website overnight to present information outside the normal news cycle.
Effective tactics for reputation management
- Own your "name space." Take the time to educate your clients about how search engines work and why appearing on the first page of the search engine results pages (SERPs) can be both a blessing and a curse. To own your name space means to go beyond the first page of results. You want your business name or the names of key executives to appear in the first few pages. You want to actively build links over time, so that when crisis strikes, you can manage the negative publicity with more links and positive mentions that push the not-so-good links off the front page. It takes times to earn your way to the first 30-40 positions in Google. Remember, results fluctuate, so be patient.
- Claim your brand's social media profiles, even if you don't think you'll need them. You don't need to create profiles on hundreds of social media platforms, but claiming your profile on the top trafficked social networks, like Twitter, Facebook, Google+, YouTube, SlideShare, Flickr, Pinterest, Vine, and Tumblr, plus industry-specific forums and blogs, will help you capture positions within the first 30 listings in the SERPs. You can use a service like KnowEm.
- Blogging is still an important marketing channel and one that helps with the SERPs. According to eMarketer, 52% of marketers say their company blog is an important channel for content marketing. While blogging is valuable for lead generation and sales, it also keeps your links being crawled, which is the first step to ensuring your content displays in search results.
- Have a content marketing plan in place that includes consumer generated content as well as content written by subject matter experts (SMEs). Publish and promote on high-profile sites and search engines, like YouTube, for maximum exposure to both the media and in the SERPs.
Top tools to monitor your client's brand
Beyond knowing what's being said about your client, it's important to know if the overall trend of online conversation is positive or negative. Raven's Social Monitor pulls brand name mentions from social media sites, blogs and forums and aggregates them in a handy report giving you a quick snapshot of customer sentiment.
You set the date range for when you want to pull the keyword data, i.e. brand name. A report is generated which tabulates the total volume of mentions: positive, negative and neutral. Links to individual mentions are listed that you can add to Link Manager for outreach. Then, just click the handy gear icon for quick recognition of the social site the mention originated from and other social monitoring options.
Of course, tools can only help so much.
The best way for a person or company to manage an online reputation is to actually perform good deeds and create real news that attracts the attention of quality websites and news portals. Then, monitoring your brand will be less a cringe-worthy task and more a feel-good exercise.
Feel free to share your reputation management successes in the comments below.
Photo Credit: Caitlinator via Compfight cc


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From Canada to an international destination - connecting through Montreal
Follow overhead signs to your next flight.
You will be required to show your Boarding Pass in order to enter the International Departure area.
Your checked baggage will be delivered to your final destination and will automatically be transferred by Air Canada during each connection, unless advised otherwise at check-in.
|View full size map
|Download the printable "Getting Around" [PDF] brochure which contains directions for all types of connections within this airport.


text: Two postdoctoral openings: 1. Study to test restoration of vision using channel-rhodopsin in primates. Experience with behavioral tasks in primates essential. 2. Study to perform two photon imaging in behaving primate, striate and parietal cortex. Experience with behavioral tasks in primate or two photon imaging in any species essential. Please contact Ralph Siegel axon at cortex.rutgers.edu with CV and possible times to visit at the 2008 SFN meeting. Ralph Mitchell Siegel, Ph.D. Professor axon at cortex.Rutgers.edu voice: 973-353-3261 or 973-353-1080 x3261 fax: 973-353-1270 cell: 973-801-6933 Center for Molecular and Behavioral Neuroscience Rutgers University 197 University Avenue Newark, NJ 07102 Web page: http://www.siegelweb.rutgers.edu Note: If you have not received a response to your email within three days, consider whether it might have been accidentally deleted through spam and write/call me again.


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Waiting on a long line that was seemingly "a mile long," according to Bernd Bönte, Managing Director of Klitschko Management Group, German fight fans purchased 30,000 tickets for the Wladimir Klitschko vs. David Haye world heavyweight championship fight on the first day of sales. Wladmir will put his IBF, WBO and IBO belts on the line against the number two ranked Haye on June 20. The Schalke Stadium, a soccer venue, has a capacity of 60,000. "We are absolutely sure that the fight will be sold out very soon," said Boente. The Veltins-Arena is the home field of German Bundesliga 04 Soccer Team.
Boxing News -- 24 hours/day - Reload often! | UPDATED TODAY
email@example.com updated all day, every day!
firstname.lastname@example.com updated all day, every day!
Boxing News
Klitschko-Haye a hot ticket!30,000 tickets sold on first day
April 18th, 2009
For all the latest boxing news, click here.


text:
Taiwan's Lu knocks Troicki out of Wimbledon 2nd round
- By Kwangyin Liu
- Publication Date: June 24, 2011
- Source: Taiwan Today
Taiwanese tennis star Lu Yen-hsun beat world No.12 Viktor Troicki of Serbia June 23 to move into the third round of the 2011 Wimbledon championship.
Lu won the match in straight sets, garnering a 7-6 (5), 6-4, 6-4 victory over Troicki, moving into the last 32 in the men's singles in just over two hours.
"Trocki is a very experienced and strong opponent," the 27-year-old Lu said after the match. The Serbian player is the No. 13 seed at the tournament, while Lu is seeded No. 78, and currently ranked 57th in the world.
Lu kept 75 percent of his first serves in, while Troicki suffered from a low first serve percentage. The Taiwanese ace also played very strongly at the net, scoring a perfect 10-for-10.
"I have to gear up for the following matches, as I'll certainly encounter tougher players very soon," Lu said. He next meets 19th seed Michael Llodra of France. The lefthander Llodra, a traditional serve-and-volley style competitor, defeated Brazilian Ricardo Mello in four sets.
This marks Lu's second victory at this year's grand slam event, after he dumped world No. 31 Tommy Robredo of Spain in a 6-4, 6-4, 6-1 win in the first round June 21.
"We are very proud of Lu's performance," said Steve Chang, chairman of Taiwan's Trend Micro Inc., which has been partnering with Lu in various advertising campaigns since 2010.
"He played like a master, maintaining control of the match with his serve, backhand and strong fundamentals."
Jenny Chen, Chang's wife, called on more Taiwanese entrepreneurs to sponsor local athletes so they can better represent Taiwan and win more titles.
Lu made the headlines at last year's Wimbledon when he knocked out former world No. 1 and tournament fifth seed Andy Roddick of the United States in the fourth round, becoming the first Asian since 1995 to reach the quarterfinals at the world's most prestigious tennis tournament.
His stellar victory last summer was selected as the biggest upset of the year in 2010 by the Association of Tennis Professionals. (THN)
Write to Kwangyin Liu at firstname.lastname@example.com


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Debunking Christianity
Does God Really Show That He Loves Us?
John W. Loftus
This is how God shows that he loves us. We're supposed to believe God expressed his love by sending his son to die for us based on 2nd, 3rd, 4th handed testimony found in manuscripts dated to the 4th century AD from a pre- scientific superstitious people in a remote part of the ancient world, who included forged texts in their holy book that reinforced their hindsight conclusions, who destroyed other texts that disagreed, and who subsequently killed off anyone who didn't accept those beliefs, despite the fact that this same God allows so much intensive ubiquitous gratuitous suffering in the world? Nope, not a chance. Not even close. Nada. Zip. Zilch.
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text:
The former editor of self-proclaimed "hip hop bible" The Source just got awarded $14.5M from her lawsuit with the magazine over her firing and sexual harassment.
A federal jury in
The jury needed only four hours to find that Osorio was fired in retaliation for complaining about the environment at the magazine. They also said that Benzino defamed her during a radio interview when he accused the single mom of bed-hopping with hip-hop honchos.
"This verdict shows that all women must be treated with dignity and respect, no matter what industry they work in," said Osorio's lawyer, Kenneth Thompson, who replayed a recording of a raunchy telephone call in which Scott called a music writer an "ugly butch pig" and a "slut monkey."
Hmmmmm, I just called a someone a "whore banana." Is that okay or am I gonna get sued?
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Tag Archives: Janadriyah Festival
Janadriya Festival Kicks Off with Colorful Start
The Custodian of the Two Holy Mosques, King Abdullah, yesterday inaugurated the National Heritage and Culture Festival at Janadriya village, 45 km north of Riyadh. In the first time of the Janadriya 25 year history, it has opened its doors to families, including women. The festival started with a camel race in which about 500 contestants took part in which King Abdullah handed prizes to the winners of the first … Continue readingPosted in Saudi Royals | Tagged Janadriyah Festival, King Abdullah bin Abdul Aziz, King Hamad, Sheikh Hamed bin Zayed | 1 Comment
Janadriya Festival Opens Doors
The 24th Janadriya Culture and Heritage Festival will be opened by King Abdullah, Custodian of the Two Holy Mosques on Wednesday the 4th. For the first time in the history of the Janadriya Festival, families will be allowed to visit the cultural and heritage event organized annually by the National Guard. At a press conference on Sunday, Dr.Abdulrahman Bin Subait Al-Subait, Undersecretary, National Guard and Executive Committee Chairman of the … Continue readingPosted in Saudi Royals | Tagged Janadriyah Festival, King Abdullah bin Abdul Aziz, Prince Miteb | 1 Comment


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Net-a-Porter's Holli Rogers Shares Beauty Favorites
Net-a-Porter's Holli Rogers Reveals Her Beauty Favorites
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While doctors may say that being "regular" in your bowel movements varies with the individual ― from once or more daily to just a few times a week ― the fact is, that the human body was designed to excrete waste after every meal. Read More
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Our Digestive Stimulator is designed to help with bowel regularity. One of the benefits (besides improving bowel function) is that it is also a good indicator of how much mucoid plaque may be in the colon. Improper hydration has created a sluggish environment in the large bowel that compromises the muscular contraction it is functionally designed to do in discarding wastes. 6-7 capsules is an indicator and should be doing no harm at the beginning stages of improving bowel functions.
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Injury reported in defensive line
Madison — The University of Wisconsin defensive line appears to have suffered another key injury.
According to a source, redshirt sophomore Louis Nzegwu, the team's No. 3 defensive end, has an injury to his right arm or shoulder and might not be ready for the opener Saturday against visiting Northern Illinois.
UW is already without redshirt freshman Brendan Kelly (groin), who should be ready to play Sept. 12 against Fresno State.
Nzegwu, from Platteville High School, missed much of spring practice after injuring the medial collateral ligament in his right knee but had played well in camp.
He appeared poised to get a significant amount of playing time, particularly as a third-down pass-rusher.
Redshirt freshman Anthony Mains, who moved up in the rotation when Kelly was hurt, likely will be the No. 3 end now. Senior O'Brien Schofield and sophomore J.J. Watt are the starters.
Moffitt, Nagy out
Coach Bret Bielema confirmed that junior center John Moffitt and junior guard Bill Nagy are not expected to play in the opener.
"There is a chance for John Moffitt," Bielema said. "But him and Billy Nagy will probably be on the bench this weekend."
Moffitt (pectoral muscle) and Nagy (right heel) missed all of camp. Moffitt was hurt lifting weights; Nagy was injured when his moped was struck by a car.
"Billy is going to get a new treatment tomorrow that hopefully will accelerate his process."
- Senior defensive tackle Dan Moore, who did not practice Tuesday or Wednesday, returned to practice Thursday and is expected to play Saturday.
- Freshman wide receiver Kraig Appleton has been slowed by another hamstring injury, and his status for the opener is uncertain. "He was out there practicing today," Bielema said. "Kind of see how he feels tomorrow to see how much (he) gets involved in Saturday's game plan.
- Bielema was asked Thursday if the players were anxious to give a better showing this season than last season, when UW finished 7-6. "The only people who talk about '08 is you," he said, referring to members of the media. "(Last season) is behind them. This team is very focused. . . . "
- Freshman quarterback Jon Budmayr, unable to throw for most of camp after suffering an unspecified arm injury, will redshirt this season. He hasn't thrown for almost three weeks and according to Bielema was told not to throw for six weeks. "No hurry," Bielema said. "He'll be a redshirt guy."


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Padian, Nancy S. MS, MPH, PhD*,†; Isbell, Michael T. JD‡; Russell, Elizabeth S. PhD§; Essex, M. DVM, PhD§
*Office of the Global AIDS Coordinator (OGAC), US President's Emergency Plan for AIDS Relief, Washington, DC
†University of California, Berkeley, School of Public Health, Berkeley, CA
‡Independent Health Policy Consultant, New York, NY
§Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA.
Correspondence to: M. Essex, DVM, PhD, Harvard School of Public Health AIDS Initiative, FXB 402, 651 Huntington Avenue, Boston, MA 02115 (e-mail: firstname.lastname@example.com).
The authors have no funding or conflicts of interest to disclose.
Abstract: In the decades since the emergence of HIV, numerous approaches to prevent transmission have been tested with varying degrees of success. Because a highly effective vaccine will not be available within the next decade, it is increasingly clear that preventing new HIV infections will require successful implementation of promising behavioral and biomedical interventions in combination. These prevention packages must be sufficiently flexible to include a variety of evidence-based interventions that serve each dynamic population they target, particularly those who are most vulnerable. To optimize the impact of combination intervention packages, well-designed implementation science studies are vital. Efficacy in a clinical trial does not necessarily translate to effectiveness at the population-level, and prioritized research studies should investigate programmatic implementation and operations scale-up and new methods to monitor and evaluate these processes both for organization and cost-effectiveness. With an estimated 2.7 million people becoming newly infected with HIV in 2010, the prevention of HIV remains an urgent global health priority. Since the emergence of HIV/AIDS more than 30 years ago, the evidence base for HIV prevention has expanded and evolved. Here we explore the status of evidence-based HIV prevention, describing both the continuing challenges and the emerging opportunities to reduce HIV incidence.
Soon after it was recognized that the HIV virus was transmitted by sexual contact and injection of blood, antibody tests were able to permit diagnosis of HIV infection, screening of blood supplies, and monitoring of epidemiological. About a decade later, highly active antiretroviral therapy (ART) was available to treat HIV/AIDS effectively in developed countries. The demonstration that timely use of antiretroviral drugs (ARVs) also reduced mother-to-child transmission reinforced emerging optimism in the response to HIV.1 The significant cost of the drugs narrowed their availability, and another decade would pass before ART programs expanded into developing countries, albeit only partially.
Expiration of drug patents, competition from generic manufacturers, and negotiated price reductions eventually offered the possibility of extensive prolongation of life even in regions, such as sub-Saharan Africa, with limited health care resources and the world's highest prevalence and incidence of HIV/AIDS. During the late 2000s, however, efforts to expand ART confronted "donor fatigue" and the global economic recession, raising concerns as to the sustainability of treatment programs. Although HIV incidence declined in many countries over the last 10–15 years, the number of people surviving for years after testing positive for HIV also increased as effective treatments became more widely available.
The paradox of falling incidence in the presence of increasing numbers of people who are surviving after HIV diagnosis as a result of treatment successes focused renewed emphasis on prevention strategies. In 2010, twice as many people were newly infected as initiated ART.2 Although vaccine development and other efforts to develop new prevention tools have been disappointing, other prevention interventions, such as male circumcision and the use of ARVs as prevention, have proven more encouraging.
Prevention strategies have traditionally been categorized as either behavioral or biomedical. Behavioral strategies include condom promotion and education to reduce number of sexual partners, especially multiple concurrent partners. More innovative indirect behavioral interventions are now being piloted with some success, including cash transfers to keep young women in school or to encourage them to choose partners close to their own age.3–5 Programs to directly incentivize remaining HIV negative in general populations have had lesser impact6 and highlight the need to understand why an intervention was successful and to limit scale-up to settings with similar populations and motivating factors.
Biomedical prevention strategies include the use of ARVs and vaccines (if and when available). In addition to prevention of mother-to-child transmission (PMTCT),7 treatment of the index case in discordant couples also confers a substantial prevention benefit, regardless of the patient's clinical status.8 ARVs have shown some promise in other uses—for example, as microbicides and pre-exposure prophylaxis9–12—but so far, efficacy has been unpredictable, likely due in part to different demographics in the study populations.13,14
Other promising interventions combine behavioral and biomedical elements, including treatment of concurrent sexually transmitted infections (with mixed results) and male circumcision, which has been repeatedly shown to reduce transmission.15–17 In reality, however, even strategies often considered strictly biomedical (such as ART) also have important behavioral elements, such as client motivation for early diagnosis, retention in care, and adherence to prescribed regimens.
In addition to the behavioral–biomedical categorization, prevention strategies have been characterized according to whether they reduce an uninfected individual's risk of infection (primary prevention) or reduce the amount of virus transmitted from an infected individual (secondary transmission). Male circumcision, behavior change, and pre-exposure prophylaxis fall within the former category, whereas PMTCT or ART taken by an infected person in an HIV-discordant couple fall into the latter. The remarkable success of ART to demonstrate the possibility of near elimination of secondary transmission in these settings has energized the prevention community and sparked extensive research into expanding the use of ART for prevention.
Despite the growing evidence that ARVs play a significant role in preventing new infections, important challenges remain. With the notable exception of PMTCT, little experience exists on which to base predictions as to prevention interventions' population-level effectiveness. For example, a disproportionate number of new infections may stem from transmission by individuals with acute or early infections,18,19 which may not be readily detectable by standard antibody tests or which may not be captured by "test and treat" programs that annually sample the population.
Another potential challenge to the effectiveness of ARV-based prevention is the transmission of drug-resistant variants of HIV, which has been described in up to 15% of men who have sex with men in San Francisco, where a large fraction of HIV-infected men are on ARVs.20 The use of the same drugs for both disease therapy and chemoprophylaxis raises additional concerns, as up to half of HIV-1C–infected women given nevirapine for PMTCT may develop drug resistance, as has been noted for even larger proportions of infants who became infected despite the use of PMTCT regimens by their mothers.21
As ARVs are increasingly incorporated into prevention strategies, it will be important to determine whether individuals prescribed drugs primarily to prevent transmission will show the same commitment as ART patients to adherence. The motivation to take ARVs to prevent one's death and preserve health may considerably differ from the motivation to take ARVs to keep from infecting sexual partners, which may be dependent on the nature of the relationships.
Long-term use of ARVs for HIV prevention, combined with their already substantial and increasing long-term use among people living with HIV, could potentially increase the incidence of chronic diseases, such as cancer, heart disease, and stroke. Epidemiological studies designed to evaluate such outcomes in patients on long-term ARV regimens will become increasingly important.
Although recent years have witnessed an encouraging expansion of prevention strategies, critical gaps continue to undermine our ability to intervene to prevent new infections.
In much of the world, especially sub-Saharan Africa, HIV disproportionately affects women and girls.22 Compared with men, physiological susceptibility to HIV is heightened in women, and entrenched gender norms often disempower them from controlling their choice of sexual partners or the circumstances in which sex occurs.23–25 Even female condoms (whose efficacy has not been unequivocally proven)26,27 require male acceptance. Accordingly, development of prevention methods that women can initiate and control remains an urgent priority.28 ARV-based prevention potentially addresses this gap, although studies are warranted to assess women's equal capacity to access and adhere to such regimens.
In the quest to expand prevention options for women, new research findings5,29 are noteworthy. In a randomized controlled trial in rural Malawi, Baird et al5 found that young women who received monthly cash payments (either without conditions or conditioned on their staying in school) were significantly less likely than girls who did not receive payments to be infected with HIV. The promising results strongly suggest that other economic interventions should be evaluated.
Although major clinical trials are ongoing, no stand-alone behavioral intervention to date has proven successful in reducing HIV incidence.30–32 Although the decline in new infections in many countries has undisputedly been driven by behavior change,33 how best to motivate behavior change remains unclear. Regardless, behavioral issues will remain central to the future of HIV prevention. A critical focus of implementation science (discussed below) is to build the evidence base as to how best to increase demand, uptake, retention, and adherence and prevent potential behavioral disinhibition (or risk compensation) as a result of emerging prevention methods.
Although ARV-based prevention methods will undoubtedly serve as a cornerstone of future HIV prevention efforts, such strategies cannot be implemented in isolation from other essential prevention interventions.31,32 Prevention science is increasingly focusing on evaluations of combination prevention packages. Under this paradigm, biomedical, behavioral, and structural interventions are implemented concurrently, with the aim of enhancing overall effectiveness by achieving synergies among multiple interventions.34,35
The United States President's Emergency Plan for AIDS Relief has pledged to intensify efforts to measure combination prevention packages in large randomized controlled trials, employing flexible methods to evaluate effectiveness, and including program impact pathways and monitoring and evaluation strategies in prevention programs in the field. In moving forward, an important priority is to assess large, complex, heterogeneous prevention programs comprising individual components of often-uncertain efficacy. Rigorous methods of evaluating impact will be required for such trials, underscoring the prominence of implementation science in future HIV-related research.36–38
Although data on the efficacy of treatment for prevention in discordant-couple trials may be unequivocal, the same cannot be said for the effectiveness of treatment for prevention at the population level. To build the evidence base for effective prevention strategies, the focus of prevention science has shifted from basic and clinical research (ie, what to do) to implementation science (ie, how to do it).30,36,39 To optimize program implementation, each step in the implementation cascade, from testing to care and retention, must be delineated and evidence-based strategies that are cost-effective, efficient, and effective need to be identified for each step.40–42 Due to persistent stigma and discrimination, special approaches must be considered among key high-risk populations.
HIV testing is the entry point for all prevention and care programs. Stigma associated with HIV and low rates of testing and counseling continue to impede prevention and care efforts. Testing coverage remains low, with a median 17% of women and 14% of men surveyed between 2005 and 2009 in generalized epidemics in sub-Saharan Africa ever having been tested and learned their results.43 To maximize impact, testing must be repeated with some regularity for uninfected people, requiring not only expanded services but also increased demand for knowledge of one's serostatus. The stigma associated with positive test results must be minimized, and new social norms must be forged, with knowledge of one's serostatus as the standard. Home-based, door-to-door testing, on-site rapid testing, and provider-initiated testing are all promising models.44,45
Rigorous evaluations must assess service delivery models that optimize linkage to care and treatment although protecting patient rights and confidentiality and ensuring retention in care and strong treatment adherence. In particular, implementation research needs to focus not only on ways to retain patients but also on ways to improve methods to measure retention and adherence.
Experience with HIV prevention programs in the field highlights why the research focus on implementation has increased. Several years after clinical trials found that voluntary medical male circumcision (VMMC) reduces the risk of female-to-male sexual HIV transmission by roughly 60%,15–17 the 14 countries prioritized for scale-up of VMMC have progressed only about 5% of the way toward the goal of 80% coverage.1 Likewise, more than a decade after a major international study demonstrated that single-dose nevirapine significantly lowers the odds of mother-to-child HIV transmission,46 more than half of all HIV-positive pregnant women still do not receive antiretroviral prophylaxis, even though the intervention builds on existing service systems and may be integrated into standard neonatal settings.
Effective programmatic implementation and scale-up involves considerations that are seldom addressed in efficacy trials. In the case of VMMC, for example, rollout pace and success are affected by such factors as commodity procurement and supply management, recruitment and organization of human resources, organization of clinical settings, choice of service delivery strategies, and generation of robust demand for services.47 Well-designed implementation research can enable program implementers to learn by doing, linking specific programmatic strategies with improved health outcomes.48
Particular efforts are needed to build the evidence base for ways to optimize programmatic efficiency. In the case of VMMC, efficiency-enhancing practices—for example, task-shifting and task-sharing in VMMC settings, faster surgical techniques, and organizing clinical settings to increase client flow and minimize health workers' idle time—increase by several orders of magnitude the number of VMMC clients that can be served by a single site in 1 day.49
At the broader systemic level, new analytic tools are needed to enhance the public health impact of limited prevention resources. Although national program planners are urged to allocate resources toward basic programmatic strategies that offer the greatest likelihood of long-term impact,50 a shortage of relevant data on the effectiveness and cost-effectiveness of standard HIV prevention interventions impedes national efforts to allocate resources most strategically.51 Moreover, with respect to the handful of largely biomedical prevention methods for which cost-effectiveness data are available, methodological approaches used to assess cost-effectiveness are not easily comparable, undermining national efforts to use limited resources most effectively.51 Intensified research and analysis on relative cost-effectiveness are needed to equip decision makers with the means to maximize programmatic results.
Although recent prevention science advances have generated optimism in the response to HIV, substantial challenges remain. Most notable is the challenge of translating evidence of efficacy into effective sustainable prevention programs. With the aim of expanding the evidence base for scale-up and cost-effectiveness, more implementation science studies are needed.
prevention; adherence; microbicides; antiretrovirals; behavioral interventions; biomedical interventions
© 2012 Lippincott Williams & Wilkins, Inc.
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