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Dandona, Lalita,b,c; Kumar, SG Prema,b; Kumar, G Anila,b; Dandona, Rakhia,b,c
aGeorge Institute for International Health – India
bHealth Studies Area, Administrative Staff College of India, Hyderabad, India
cSchool of Public Health and George Institute for International Health, University of Sydney, Sydney, Australia.
Received 15 August, 2008
Revised 29 October, 2008
Accepted 4 November, 2008
Correspondence to Professor Lalit Dandona, George Institute for International Health – India, 839C, Road No. 44A, Jubilee Hills, Hyderabad 500 033, India. E-mail: firstname.lastname@example.com, firstname.lastname@example.com
Objective: To conduct composite economic analysis of HIV prevention interventions to inform efficient utilization of resources in India.
Methods: We obtained output and economic cost data for the 2005–2006 fiscal year from a representative sample of 128 public-funded HIV prevention programmes of 14 types in Andhra Pradesh state of India. Using data from various sources, we developed a model to estimate the number of HIV infections averted. We estimated the additional HIV infections that could be averted if each intervention reached optimal coverage and the associated cost.
Results: In a year, 9688 HIV infections were averted by public-funded HIV prevention interventions in Andhra Pradesh. Scaling-up interventions to the optimal level would require US$38.8 million annually, 2.8 times the US$13.8 million economic cost in 2005–2006. This could increase the number of HIV infections averted by 2.4-fold, if with higher resources there were many-fold increases in the proportional allocation for programmes for migrant labourers, men who have sex with men and voluntary counselling and testing, and reduction of the high proportion for mass media campaigns to one-third of the 2005–2006 proportion of resource utilization. If the proportions of resource allocation for interventions remained similar to 2005–2006, the higher resources would avert 54% of the additional avertable HIV infections.
Conclusion: The recent four-fold increase in public funding for HIV/AIDS control in India should be adequate to scale-up HIV prevention interventions to an optimal level in Andhra Pradesh, but the prevention would be suboptimal if additional investments were not preferentially directed to some particular interventions.
India is estimated to have 2–3.1 million persons living with HIV, one of the highest in the world [1–3]. A budget of US$2.6 billion has been assigned for India's National AIDS Control Programme (NACP-III) during 2007–2012, which is a four-fold increase in annual funding versus the last year of the NACP-II budget [4]. It is anticipated that the major portion of NACP-III funding would be spent on HIV prevention [5]. Prevention of new HIV infections is central to the control of HIV, which is considered to be deficient at the global level [6]. The emphasis on prevention in the next phase of India's AIDS Control Programme is, therefore, justified. However, the best use of the available resources should be informed by economic analyses of various HIV prevention interventions and the current coverage of these interventions relative to the optimal need [7,8]. Such analyses are not readily available for India [9]. Lack of such data from India and other low-income and middle-income countries has led to the use of average data for regions in recent global economic analysis of HIV prevention [10]. Although very important for a global or regional perspective, these data are not adequate to prioritize HIV prevention interventions at national and subnational levels. The need to enhance the evidence base for an informed and efficient use of resources for HIV control has received major emphasis recently [7].
India with a population of over a billion has a wide variation in the HIV burden among different states, with the 80 million population of the south Indian state of Andhra Pradesh estimated to have the highest burden [2]. We undertook economic analysis of the entire range of public-funded HIV prevention interventions in Andhra Pradesh to inform the best use of additional available resources to prevent HIV.
Among the 14 types of public-funded HIV prevention interventions implemented in Andhra Pradesh in the 2005–2006 fiscal year, a representative sample of 128 programmes from across the state was selected (Table 1). The sample for each intervention was mostly stratified by the three regions of the state, and also in some cases stratified by subtype of intervention when applicable, to obtain representation proportional to the actual distribution. Data were collected during 2006–2007 by trained investigators using procedures described previously, which included piloting and quality control [11–15].
The 14 types of public-funded HIV prevention interventions are facilitated by the Andhra Pradesh State AIDS Control Society. Four are based in clinical settings, that is, voluntary counselling and testing (VCT) centres, sexually transmitted infection (STI) clinics, prevention of parent to child transmission (PPTCT) centres and blood banks. Eight are implemented by nongovernmental organizations targeting groups at relatively high risk of HIV, that is, women sex worker programmes, men who have sex with men (MSM) programmes, truckers programmes, composite programmes, workplace programmes, migrant labourer programmes, street children programmes and prisoner programmes. Two are state-wide programmes implemented by the Andhra Pradesh State AIDS Control Society, that is, information, education and communication (IEC) programme for the general public (mass media campaigns) and condom promotion programme. Data on the HIV prevention services provided by each programme during the April 2005–March 2006 fiscal year were documented from written records and interviews of programme staff [11–15].
Data on economic costs for implementing the HIV prevention programmes were collected under five categories: personnel, recurrent goods, recurrent services, capital goods and office space rentals [11–15]. These costs included expenditures, resources used and donated inputs. Personnel costs included salaries of programme staff and payments made to peer-workers for some interventions. Common examples of recurrent goods were male condoms, HIV test kits, medications and materials for behavioural change communication; of recurrent services were travel and utilities; and of capital goods were computers, furniture and equipment. Available records were used for costing goods and services, and if records were unavailable, quotes were obtained to estimate cost. If a programme was not paying office space rental due to location in a public sector hospital, economic cost for rent was estimated on the basis of local rates. Similar costing methods were used for all programmes. Generally, personnel and recurrent goods made up the highest proportion of costs for the interventions. Costs in Indian Rupees (INR) were converted into US$ using the average exchange rate of INR 44.27 in the April 2005–March 2006 fiscal year [16].
The majority of interventions target sex behaviour for which the base scenario of the probability of HIV infection without intervention in a group that would be the beneficiary of the intervention was estimated using the Weinstein formula that is used widely including UNAIDS [17,18].
where Pr is the probability of HIV infection in uninfected, P is the average HIV prevalence among sex partners of the group for which probability is being estimated, R is the risk of HIV acquisition per act of unprotected sex, F is the fraction of sex acts in which condom is used, E is the effectiveness of condoms, N is the average number of sex acts per partner and M is the average number of sex partners. In order to estimate the probability of new HIV infection in an entire group, Pr was multiplied by (1 – I), where I is the proportion in the susceptible group that is already infected with HIV. Probabilities were calculated separately for acquisition of HIV by the group that would receive the prevention intervention and for their sex partners, and the number of new infections from these added to obtain the total new HIV infections. For women sex worker intervention, this also included acquisition of HIV by the other women sex partners of clients of sex workers, and for MSM intervention, this included acquisition of HIV by women sex partners of MSM.
The probabilities of HIV acquisition per act of unprotected sex were adapted from the literature [18–21]. For groups at high risk of HIV, in the absence of STI, we used a probability of 0.0014 for receptive vaginal sex, 0.0007 for insertive vaginal sex, 0.01 for receptive anal sex, 0.001 for insertive anal sex and 0.0004 for receptive oral sex. These probabilities were considered three times higher in the presence of STI [18,21]. For IEC intervention for the general public, 30% lower probabilities of HIV acquisition per act of unprotected sex were used assuming less risky sex as compared with other groups at higher risk [21]. The effectiveness of condom in reducing HIV transmission in vaginal sex was taken as 80%, in anal sex as 70% and in oral sex as 90% [22,23]. The values for HIV prevalence, fraction of sex acts in which condom was used, average number of sex acts per partner and the average number of sex partners were adapted from population-based and other surveys [23–29] and programme data.
To assess the effect of interventions in reducing HIV in the groups that they serve, the estimated impact of interventions on reducing condom nonuse, number of partners and STI nontreatment from a recent global report on low-income and middle-income countries were adapted for use – we mostly used medium values from this source [10,30]. For impact values not available from this source for certain interventions, estimates were adapted from comparable interventions using assumptions informed by understanding of local trends in Andhra Pradesh. On the basis of these most plausible impact values (Table 2), the Weinstein formula was applied to the with-intervention situation with changed values for condom use, number of partners and risk of HIV transmission per act of unprotected sex (because of impact on STI treatment) for an estimate of the number of HIV cases averted per 1000 persons receiving an intervention. These estimates took into account the effect of overlapping target groups by different interventions and of overlapping sex partners within an intervention.
The base scenario and intervention effect for PPTCT were based on data on pregnant women receiving PPTCT and the proportion of HIV positive receiving nevirapine, assuming an HIV transmission rate without treatment as 25% and a reduction in this transmission by 40% with nevirapine treatment [31]. The base scenario and intervention effect for blood banks were based on the proportion of blood units that tested HIV positive and an estimated 92% risk of HIV transmission from infected blood [32].
The validity of this model to estimate the number of new HIV infections, and from that the infections averted with intervention, was assessed using information available on the magnitude and trend of HIV burden in Andhra Pradesh [2,33]. Published literature, unpublished population-based and programme data and assumptions based on our understanding of local trends were used to estimate the range of plausible values for each variable. Using random values between these plausible ranges, sensitivity analyses for the intervention effects were performed based on the Monte Carlo simulation principle with 100 000 iterations using the @Risk software (Palisade Corporation, Newfield, New York, USA) to obtain the 5th and 95th percentile values of the number of HIV infections averted by each intervention. Using the intervention effect calculations, including the sensitivity analysis results, the number of HIV infections averted by each intervention were calculated based on the services provided by all public-funded HIV prevention programmes in Andhra Pradesh in the 2005–2006 fiscal year.
On the basis of the total target group served and the cost of the sampled programmes, the unit cost for each target person served or unit service by the HIV prevention programmes was calculated for the 2005–2006 fiscal year. Using unit costs and the total public-funded HIV prevention services provided in Andhra Pradesh in the 2005–2006 fiscal year, the total economic cost for each intervention was calculated. The coverage of each intervention in 2005–2006 as compared with the optimal coverage required, defined as the total needed coverage of public-funded interventions, was estimated using the best available data from various sources as explained in the results. The number of HIV infections that could be averted with optimal coverage was estimated applying the intervention effect to that coverage and assuming relative reduction of effect for some interventions at the higher end of the coverage as explained in the results. Sensitivity analysis for this number was done with the @Risk software using the 5th–95th percentile range of intervention effects calculated previously and modified for the assumed reduced effect of some interventions at higher coverage. The total cost of each intervention was then calculated for the optimal coverage, assuming that the unit cost would change for some interventions based on our previous longitudinal assessment [15] and using assumptions that seemed most plausible to us as explained in the results. From this, the required investment in each intervention was calculated as a percentage of the total investment needed for optimal coverage. We also assessed the number of HIV cases that would be averted through public-funded HIV prevention interventions in Andhra Pradesh if the increased available resources were distributed in the same proportion for the interventions as in 2005–2006 for comparison with preferential resource allocation to certain interventions aimed at an overall maximum reduction of HIV.
The highest number of HIV infections averted per 1000 persons receiving an intervention was for MSM and women sex worker programmes, followed by STI clinics and blood banks, whereas the lowest was for IEC for the general public (Table 2). In the 2005–2006 fiscal year, the public-funded HIV prevention interventions in Andhra Pradesh together were estimated to have averted 9688 HIV infections (Table 3), sensitivity analysis range 6624–16 898. The highest proportion among this was by STI clinics (23.9%), blood banks (18.1%), women sex worker programmes (13.7%) and VCT centres (13.5%) that incurred 13.9, 1.2, 9.5 and 6.3% of the total economic cost of public-funded HIV prevention interventions, respectively. The IEC programme for the general public incurred 38.6% of the total cost and was estimated to have averted 5.1% of the HIV infections (Table 3).
Our transmission model for estimating the number of HIV infections averted, taking into account the interventions in place, estimated that there were 55 396 new infections in Andhra Pradesh in the 2005–2006 fiscal year. This is quite plausible on the following basis. Andhra Pradesh was estimated to have about 550 000 persons living with HIV in 2006, and sentinel surveillance data suggest that HIV prevalence as a whole has plateaued in Andhra Pradesh [2,33]. Assuming a 10-year duration from HIV infection to death without antiretroviral treatment in India [34], coupled with the fact that most persons with HIV/AIDS were not on antiretroviral treatment in Andhra Pradesh in 2005–2006, an HIV incidence of about 10% of the estimated prevalence could be expected for a stable HIV prevalence, which is close to the incidence estimated by our model. Of the estimated 55 396 new HIV infections in Andhra Pradesh in 2005–2006, the groups at high risk that accounted for the largest proportions were MSM and their sex partners (9608, 17.3%), women sex workers, their clients and the other women sex partners of clients (7659, 13.8%) and migrant labourers (3853, 7%), whereas 27 195 (49.1%) of the new infections occurred in the general population.
The coverage of some public-funded interventions in the 2005–2006 fiscal year was very low as compared with the estimated optimal coverage, for example, VCT (12%), migrant labourer programmes (13%) and MSM programmes (18%), whereas that for some interventions was reasonably high, for example, blood banks (98%), IEC for the general public (96%), trucker programmes (85%) and prisoner programmes (84%) (Table 4) [35–40]. With optimal coverage of all interventions, the number of HIV infections averted could increase 2.4-fold to 22 916 (sensitivity analysis range 14 506–37 318) resulting in an additional 13 228 (sensitivity analysis range 7138 to 27 968) infections averted as compared with 2005–2006. This would be associated with a 2.8 times increase in total economic cost of HIV prevention interventions from US$13.8 million to US$38.8 million annually, which could be accommodated by the recent four-fold rise in public funding for HIV control in India [4]. To achieve optimal increase in the number of HIV infections averted, the proportion of resource allocation to migrant labourer programmes, VCT centres and MSM programmes would have to increase to 20.5, 18.4 and 6.2% of the total economic cost for optimal coverage (Table 4) from the 2005 to 2006 fiscal year allocations of 3.2, 6.3 and 1%, respectively. To accommodate these increases in relative resource allocations, the proportion of allocation to IEC for the general public would have to drop to 14% of total economic cost from the 38.6% allocation in the 2005–2006 fiscal year. With the overall 2.8-fold increase in resources needed for optimal coverage, no intervention would have an absolute reduction in resource allocation even if they had a decrease in the proportional allocation as compared with 2005–2006 (Table 4). If our projected changes in unit costs of interventions at optimal coverage were not applied, and the 2005–2006 unit costs were applied to the optimal coverage, the highest proportional increases in resource allocation would still be needed for VCT, migrant labourer and MSM programmes.
If the proportion of total economic cost allocated for the interventions with 2.8-fold higher resources were to remain similar to that in 2005–2006, 16 858 HIV infections could be averted (Table 5). As compared with the HIV infections averted in 2005–2006, the additional 7170 HIV infections averted with this allocation would be 46% less than the 13 228 additional HIV infections that could be averted with the optimal proportion of resource allocation for interventions.
This analysis suggests that the four-fold recent increase in public resources made available for the AIDS Control Programme in India [4] should generally be adequate to scale-up interventions to an optimal level in Andhra Pradesh. However, if the proportional allocation of increased resources to the various prevention interventions in Andhra Pradesh were to remain similar to the proportion of resources utilized in the 2005–2006 fiscal year by each intervention, only about half the additional avertable HIV infections would be averted as compared with a preferential higher resource allocation to some interventions, that is, migrant labourer programmes, VCT and MSM programmes. A higher relative and absolute allocation to these programmes at the new higher level of available resources for HIV control would not require any intervention to have an absolute reduction even if its proportional allocation were reduced from the 2005–2006 level to achieve optimal overall coverage.
Over the past 2 years, there has been a move to provide VCT and PPTCT services in the same facility in public hospitals in India referred to as integrated counselling and testing centres [41]. The potential advantages of these combined services would have to be assessed with increasing experience [14]. There has been a major recent proportional increase in the public resources allocated to the combined VCT and PPTCT services in Andhra Pradesh (unpublished data). It is necessary to ensure that this allocation leads to several-fold increase in the number of VCT and is not utilized overwhelmingly for PPTCT alone. A recent large study in Andhra Pradesh has highlighted the high risk of HIV among MSM and their women sex partners [23,28]. The Gates-funded Avahan AIDS Initiative has HIV prevention among MSM as a major focus in Andhra Pradesh [37]. However, allocation of public resources for MSM programmes also needs to be enhanced as indicated by our analysis.
Migrant labourers are recognized to play an important role in the spread of HIV in India [5,42]. HIV prevention programmes for this group are among the least developed in India. Our analysis suggests that major increases in resource allocation are needed for these programmes. If this resource allocation and the evidence base for how prevention in this group could be made effective do not develop rapidly, this may turn out to be the Achilles heel of HIV prevention in Andhra Pradesh.
The IEC mass media campaigns for the general public utilized almost two-fifths of the public HIV prevention resources in 2005–2006. Their relative proportion has come down in the past 2 years in Andhra Pradesh (unpublished data). Although this trend is consistent with our findings, it is important that the pendulum does not swing excessively to the other side with extreme reductions in this allocation. IEC mass media campaigns remain important as they have wide coverage of the general population and groups at high risk, which enhances receptivity to a variety of prevention interventions, thereby contributing broadly to HIV prevention including reduction in stigma. We estimate that one-seventh of the public HIV prevention resources for IEC mass media campaigns with a three-fold increase in total resources from the 2005 to 2006 level would be optimal.
There are limitations of our analysis. This economic analysis focuses mostly on resources at optimal scale with only a passing reference to the quality of HIV prevention services. Our previous longitudinal analysis has shown that unit cost can increase substantially with improved quality as we found for the women sex worker intervention, or the unit cost can decrease with increasing scale if quality remains the same as we found for VCT [11]. We assumed implications of improved quality and higher scale on the unit costs at optimal coverage for several interventions, as longitudinal data are not yet available for all HIV prevention interventions. Also, our analysis included interventions that are currently being implemented. As new interventions are proven to be effective and feasible for Andhra Pradesh, this analysis would have to be updated accordingly.
In the absence of actual data on the effectiveness of HIV interventions in India [9], we developed a model to estimate the number of HIV infections averted by various interventions using the best available data and assumptions based on a deep understanding of HIV prevention in Andhra Pradesh. The known HIV trend in Andhra Pradesh supported the validity of this model. Although our estimates and model can be refined as more data become available, especially on how the interplay among interventions manifests in reality [43], this is the most comprehensive understanding of the entire range of currently implemented HIV prevention interventions in any Indian state, which provides practical guidance to policy makers for resource allocation in the immediate timeframe. As the new phase of NACP-III has just started, decisions on resource allocation for optimal HIV prevention should be based on local data and robust analysis.
Our composite economic analysis of the entire range of public-funded HIV prevention interventions in Andhra Pradesh, the state with the highest burden of HIV in India, provides the following policy-relevant messages. First, it points to the acute need to substantially enhance both the resource allocation for and understanding of how to make migrant labourer programmes more effective. Second, it highlights the need for more public resource allocation for MSM programmes. Third, it supports the move in Andhra Pradesh to increase relative resource allocation for integrated counselling and testing centres where VCT and PPTCT services are offered with the caveat that the VCT component needs a particular boost. Fourth, it points to the need for a balanced approach to IEC mass media campaigns for the general public requiring reduction in the proportional allocation of resources from the 2005 to 2006 levels, but not absolute reduction with the recent four-fold increase in total resources available for HIV control. Finally, it suggests that similar economic analysis would be useful in other major HIV states in India and also other low-income and middle-income countries. This effort would contribute to strengthening of the evidence base for HIV/AIDS control, which should aim to not only help make immediate decisions, but also contribute to long-term planning taking into account the evolving knowledge about and options for HIV prevention [3,7,9,42–44].
We thank the Andhra Pradesh State AIDS Control Society and its Technical Support Unit for facilitating this study, the staff of the HIV prevention interventions for participating in this study, our research staff and the participants involved in the various studies from which data were utilized for the analysis presented in this paper. The views expressed in this paper are those of the authors and do not necessarily reflect the views of the organizations that facilitated this study or the institutions with which the authors are affiliated.
L.D. conceived this study, led the design, analysis and interpretation and drafted the manuscript. S.G.P.K., G.A.K. and R.D. contributed to the design, analysis and interpretation. All authors approved the final version of the manuscript.
We declare that we have no conflicts of interest.
cost analysis; economics; HIV; prevention; resource allocation
© 2009 Lippincott Williams & Wilkins, Inc.
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Eric R. Rogge, 92, of Canyon died Wednesday, Dec. 29, 2010, in Amarillo.
Memorial services will be at 10 a.m. Wednesday in Seville Estates with David Green, chaplain of Hospice Care of the Southwest, officiating. Burial will be in St. Paul Lutheran Cemetery by Brooks Funeral Directors.
Eric was born April 27, 1918, in Randall County to Fredrick "Fritz" and Ida Scholz Rogge. He was a farmer and rancher and was a man of many talents. He was a lifelong member of St. Paul Lutheran Church.
The family wishes to thank the staff of Seville and Hospice Care of the Southwest.
He was preceded in death by his parents; a brother, Gerhart Rogge; and a sister, Hardine Roberts.
Survivors include three nieces, Pat, Janice and Lori; and two nephews, Don and Gerry, all of Oregon.
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Sign the online guest book at www.brooksfuneral.com.
Amarillo Globe-News, Jan. 2, 2011


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by Birthday girl / 01/06/2013 at 12:59am / United States (North Dakota) / Miscellaneous
Today, I was doing a presentation in front of my boss. On the last slide, someone had put a picture of a man's cock. I later found out it was my boss who did it. It was his "good reason" to fire me. FML
by golfstar11 / 12/10/2012 at 9:05pm / United States (Georgia) / Work
Today, I was visiting family in Oregon. I did not know it was illegal to pump your own gas; the cops were involved. FML
by Anonymous / 11/12/2012 at 1:14am / United States / Transportation
Today, my parents gave me a sock and card for my eighteenth birthday. The card said, "Now that Dobby is free, get out." FML
by Anonymous / 10/15/2012 at 9:19pm / United States (Indiana) / Miscellaneous
Today, while I was using my computer, my cat ran up to the power strip, looked me in the eyes, and hit the power switch, turning everything off. She does this quite often. FML
by stop it ninja / 10/14/2012 at 3:00am / United States (Virginia) / Animals
Today, just for old time's sake, I decided to jump on my bed. I ended up hitting my head on the spinning fan and knocking myself unconscious. FML
by lalalalainie / 10/13/2012 at 2:45am / United States (California) / Health
Today, my boyfriend picked me up from school. It was an unusually sweet gesture from him, and I was flattered. That is, until he told me to sit my ass in the back, so his dog could ride in front with him. FML
by Anonymous / 09/21/2012 at 3:10pm / United States (Massachusetts) / Love
Today, I turned on the TV just in time to see my picture on the news. I have no idea what they said about me. FML
by masterman / 08/27/2012 at 2:45am / Canada (Alberta) / Miscellaneous
Today, I returned home to my parents' house, drunk. Hungry, I grabbed a slice of bread and some butter and took two mouthfuls. Five hours later, my mother woke me up and dragged me to the kitchen. In the middle of the table was a buttered, half-eaten sponge. FML
by Bontempi / 07/19/2012 at 2:55pm / France / Miscellaneous
Today, at work, my mouse cursor kept randomly moving all over the screen, and messed up an entire day's attempted work. As I was leaving, I overheard one of my co-workers saying he'd plugged a wireless mouse adapter into my computer, and had been trolling me all day. FML
by tech_support / 11/04/2011 at 12:05pm / Sweden (Vastra Gotaland) / Work
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About frostie : Studying in the greatest country in the world, CANADA!
Wish everyone could live here :P
I joined this website so i can just post "lol" at the hilarious comments that are posted, and to cheer up the people who posted the FML stories . Hey everyone wants someone to cheer them up when their having a shitty day, sure as hell i would want to.
Some FML users can be assholes to people who post the fml stories, which is why i wish there was a 'vote ban' button :/
I love playing pc games but my crappy pc cant run the games out there. Some gamer i am, when i cant even play a video game xD (loser?)
About frostie : Studying in the greatest country in the world, CANADA!
frostie's FML badges
How depressing, no badges acquired at all. :/
frostie's favorite FMLs
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Christ Fellowship Church, Royal Palm Campus (in Florida) recently upgraded its sound reinforcement system featuring WorxAudio Technologies loudspeakers.
With its congregation spread across multiple campuses, sermons are transmitted via fiber optic to a large video display above the stage/altar area in the Royal Palm sanctuary.
Burlington, NC-based Boone Audio Inc., was contracted to upgrade the church's sound system, electing to utilize WorxAudio Technologies TrueLine line arrays. In total, the arrays include14 TrueLine V8i-P self-powered installation elements and two TrueLine V8DF-P powered downfill elements, joined by two TrueLine TL218SS subwoofers for low-frequency support.


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We at Badass Book Reviews are very excited to welcome author Ellery Adams! You might know Ellery as Jennifer Stanley or J.B. Stanley, but she writes two cozy mystery series under her Ellery Adams pen name. Her "A Book by the Bay Mystery" series currently has four books published and her "A Charmed Pie Shoppe Mystery" series currently has two books. Her newest release, Peach Pies and Alibis, is the second book in the "Charmed" series, and Ellery was nice enough to stop by and chat with us about it. Be sure to order your copy and to stop back by the blog on Sunday, 10 March, for our featured review. You can also check out our review of the first book, Pies and Prejudice. Finally, for all you readers that love free stuff, keep reading below for your chance to enter and win a copy of Peach Pies and Alibis and an adorable Peachy Prize Pack!
A Magically Delicious Chat with Ellery Adams
BadassBookReviews: Welcome to our blog, Ellery. Is there anything special that you do to celebrate when you have a new release?
Ellery Adams: Honestly, I'm too busy working on the next book to do much celebrating. If the book does well enough to hit the Times List, well, that's a different matter. I'll make time to eat, drink, and be merry should that happen <grin>
BaBR: Can you give a short overview of the "A Charmed Pie Shoppe Mystery" world for any readers new to the series?
EA: The Charmed Pie Shoppe centers around a plucky, talented pastry chef in her early thirties. Ella Mae LeFaye has recently discovered that she possesses magical abilities. She is able to infuse the pies she makes with whatever feelings she wants. She uses her own memories to make her customers feel joyful, youthful, lustful, trusting, and yes, generous with their tips! However, being magical isn't always peachy. There are lots of rules and restrictions and Ella Mae is trying to figure out how to find happiness as an enchanted pastry chef in a town filled with remarkable villains and amazing family members and friends.
BaBR: How did you come up with the idea for the world of Havenwood? Originating from Georgia myself, I'm wondering if the setting is based on a real place. Is there anyone in your life that served as an inspiration for your characters?
EA: I envisioned a town that wasn't too far from Atlanta but was far enough to be isolated. When I began researching the first book, I read about little towns like Cartersville and Acworth (near Altoona Lake) because I needed to have a big lake in this series. The reason for this will become clearer as the books progress. And the characters are 100 percent fictional. I can see them and hear them as if they were in the room with me. Shows you how nutty I am, right?
BaBR: Haha, I think that just makes you sound creative! Without giving away too much, can you tell us about your favorite scene in Peach Pies and Alibis or maybe the one that was the most difficult to write?
EA: Oh, my favorite scene is actually quite moving and in some ways, rather terrible. I can't say much about it because readers will know exactly what I'm talking about when I get there, but Ella Mae suffers a loss. People ask me why I'm so mean to my characters, but bad things happen to good people and they also happen to my characters. In my opinion, my characters cannot grow without surviving adversity, and I've dealt poor Ella Mae a wallop in this book.
BaBR: Your main character is named Ella Mae LeFaye. That surname calls to another literary figure, Morgan le Fay. Since Ella Mae will be searching for the origin of her magical powers in this book, will we be seeing more mentions of the Arthurian legends? What made you decide to add the magical elements to these stories?
EA: You are so smart to make that leap! Yes, Arthurian legend will come into play regarding Ella Mae's origins. In fact, I'm flipping the traditional legend on its head by making Guinevere the scoundrel and Morgan le Fay the powerful, but misunderstood adversary. The origins of Ella Mae's kind are even older than this time period, but I'll leave the Greek and Egyptian myths for later books.
I decided to incorporate fantasy elements into this series as a test for myself. I like reading fantasy, and have always been impressed and a little daunted by it. When I consider Tolkien or Marion Zimmer Bradley or Mary Stewart and how multi-layered their stories are, I wondered if I could make a feeble attempt at a completely different world concealed within the one we already knew. I hope the blend has been successful. When I first told readers that I'd be combining mystery with a culinary novel with fantasy, I think they thought I'd lost my mind. Of course, that happened long before this series. <grin>
BaBR: In the first book, Pies and Prejudice, Ella Mae went through a lot of changes both personally and professionally. Will we see her more settled in this book or will she still be finding her place in Havenwood?
EA: She'll be more settled in a professional sense and the pie shop is flourishing, but I'm throwing several huge personal wrenches at her in Peach Pies and Alibis. She really learns how to use her gifts in this book, but she has to face one of the most unique villains I've ever created. I can't wait to hear what you think of this person's weapons!
BaBR: I can't wait to see what villian you've created to top the first book. Speaking of the first book, Ella Mae definitely has chemistry with her old crush Hugh Dylan, but have we seen the last of Chandler Knox? Will any other potential suitors be making an appearance in this book?
EA: Chandler isn't making an appearance in this book. I like him, but he's too wounded to compete with Hugh at this time. Someone from Ella Mae's past will appear in this book and cause her lots of trouble. But she needs to be resolve her feelings for Hugh or he'll gravitate back to Loralyn again.
BaBR: Oh, we don't want that! Just for fun, who would you cast as your main characters if the books were turned into a TV show? [side note: Yes, I can completely imagine this series as a wonderfully quirky weekly show a la "Pusing Daisies!"]
EA: I'd pick Delta Burke (just as she was on "Designing Women") for Aunt Verena, someone like Sissy Spacek for Aunt Dee, maybe Debra Messing for Aunt Sissy, Sela Ward for Adelaide, and Bryce Dallas Howard or Amy Adams to play Ella Mae. Maybe Reba McIntyre would play Reba!
BaBR: How many books do you have planned for the "Charmed" series?
EA: I have a contract for three. If Peach Pies and Alibis sells well, the publishers will probably ask me for another two books (fingers crossed!).
BaBR: You also write the "A Books by the Bay Mystery" series starring Olivia Limoges. Who would you say that you are more like, Olivia or Ella Mae?
EA: I am more like Olivia in my head, but act more like Ella Mae. I want people to like me and Olivia doesn't give a fig if people like her or not.
BaBR: Obviously Ella Mae is a killer baker; the recipes at the end of Pies and Prejudice were a nice touch. Is baking something that you like to do as well?
EA: I like to bake and I like to eat what I bake!
BaBR: Both of your series written as Ellery Adams feature dogs in the story and on the covers. Are you a dog person? Do you secretly have something against the felines of the world?
EA: I am an animal person. I grew up with a pack of large dogs, but I am currently owned by four cats and trust me, they are the most spoiled felines you'll ever meet. They have me well trained!
BaBR: Do you like to read mysteries while you are writing? If not, what other genres are you drawn to? What books are currently on your personal "To Be Read" pile?
EA: I don't read cozies when I'm working on a book because I want my narrative voice to be unique. However, I'll read other types of mysteries like those written by Michael Connelly or Tana French. I also love historical fiction and contemporary women's fiction. I just finished The Snow Child by Eowyn Ivey and loved it.
BaBR: After the release of Peach Pies and Alibis, what is next on your plate? Tell us what the rest of 2013 has in store for you.
EA: Insanity! I have to turn in a book April 1, August 1, and again on January 1 of 2014. I'm also thrilled to announce that I'll be writing an all-new series (coming in 2014) about a secluded resort for book lovers. Think Downtown Abbey stocked with thousands of books! I hope readers will love reading the first book in this series as much as I've loved writing it.
BaBR: Oh, that sounds like a wonderful new series. I can't wait to check it out! Thank you again for stopping by Badass Book Reviews, Ellery. We can't wait for your newest releases and wish you the biggest success with everything!
EA: Thanks so much for having me. Your questions are amazingly thoughtful and this blog is pure magic!
** Remember readers, Peach Pies and Alibis — the newest "A Charmed Pie Shoppe Mystery," released on March 5, 2013 and is now available for purchase at your favorite retailer. Be sure to come back on Sunday, 10 March, for our featured review as well! **
Use the Rafflecopter below for your chance to win a copy of Peach Pies and Alibis OR Pies and Prejudice in the format of your choice AND the Peachy Prize Pack pictured above. This giveaway is restricted to US entries only. Winner will be contacted on 14 Mar, 2013.
About the Author
Ellery Adams grew up on a beach near the Long Island Sound. Having spent her adult life in a series of landlocked towns, she cherishes her memories of open water, violent storms, and the smell of the sea. Ms. Adams has held many jobs including caterer, retail clerk, car salesperson, teacher, tutor, and tech writer, all the while penning poems, children's books, and novels. She now writes full-time from her home in Virginia.
Email: email@example.com
Website: http://www.elleryadamsmysteries.com/
© 2013 – 2014, Badass Book Reviews. All rights reserved.
35 Responses to "Author Interview and Giveaway: Ellery Adams"
My fav type of sweet would be anything with peanut butter or mint or both in it! 😀 I would love to be able to control the elements as my magical power! XD
Favorite sweet is actually gummy candy, specifically strawberry gummies and cola gummies. Yum! At this point, if I could have the 'power' to make my children listen, and do what they are told without a fight… what I wouldn't give for that power.
My favorite sweet would have to be cheesecake topped with cherries. If I could have a magical power it would have to be me being able to do something by wiggling my fingers, much like Samantha and her nose. My house would always be clean!
I would like the power to move from place to place with a nose wrinkle like Samantha on Bewitched. I love chocolate and mint together.
I love chocolate! I would love to have the power to heal! Thanks for this amazing giveaway – I would love to win!
I love series that tie in to legends. Great!
I have a sweet tooth so anything dessert with chocolate will probably be the first item I select. I like Hermione Granger's time power gadget. I would love that in order to get everything done.
My Grandma's Mince Meat Pie is my favorite
One of my favorite sweets is Lemon Meringue Pie. As to what magical power I could have I hadn't really thought about it but maybe healing.
Thanks for much for posting the interview and giving me the chance to connect with fabulous new readers. I appreciate all the comments and support. Happy reading, friends!
What a great interview! And a neat giveaway as well. I have always been partial to chocolate pie. But cherry is nice too.
Everything is coming up Peachy for me. I love these prizes, and peach pie is my Favorite. Just ask my pups, they don't get one crumb of it. And I share alot with them.
I loved Pies and Prejudice and would love to see what is next for these fun characters!
Pecan Pie!
My favorite sweet is baklava. If I had a magical power it would be the ability to talk to the animals.
Turtle empanadas are the BEST. Really sorry that On the Border discontinued offering them on the menu. Now I'll have to figure out how to make 'em myself. Maybe my magical power should be zapping into existence every kind of delicious (and nutritious food) for whoever needs some?
Let's face it you can never go wrong with chocolate in any form. I really love a good truffle or a turtle.
Chocolate brownies with vanilla ice cream!
I would definitely fly. 🙂
My favorite pie is definitely pumpkin. I read Pies and Prejudice and loved it…A magical power would be invisibility.
My favorite type of sweet is magic shell on vanilla ice cream. Yummo. And if I had a magic power it would be for people not to have to struggle for basic needs.
I love, love, love Ellery Adams Charmed Pie Shoppe Mystery series! Pie and Ice Cream are two of my favorites, especially if I eat them together.. Ok, well Im weak for any type of sweets… Who am I kidding! I like them all! If I could have any power it would me mind control…. With just one look. LOL…"Kids clean your room" (THE LOOK) and BAM its done! LOL
Can't wait to read the books – thanks for the giveaway!
I can't pick a favorite sweet; I love them all!!
This sounds yummy… can't wait to start this series!
My favorite type of sweet is pie. I love the combination of flaky crust and fruit. If i could have a magical power, it would be to make others happy.
Love Ellery's books! and I love the peachy giveaway gifts. My color and they would see PLENTY of use in my kitchen!
I bought the first book not knowing how the blend of cooking and magic would work. But work it did, and beautifully! I have been looking forward to this book. Pies are sort of magic on their own!
I love all fruit pies, but my very favorite is my grandmother's mince meat pie for which no recipe exists.
My favorite sweet is 3 berry pies.. and if I could get my "Official" Harry Potter wand to work, I like the power to heal people of any disease.
My favorite type of sweet is fruit pies.
I really like peach pie with vanilla icecream. I wish I could fly!!


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If you want more leads to choose to do business with you then I can help. The absolute best resource available to you is in eazyleadz. It's a elite membership unlike any other. Here's part of what's inside:Free Premium business cards. The same premium real estate business cards I sell on other sites at premium prices I give free to my eazyleadz Plus Members. LiveDesigns is our breakthrough technology design platform where you can watch our designers build your graphics through screen sharing technology. Faster turnaround than anything out there. Better communication and better designs. Fun to watch. Print Advantage - "pennies on the dollar" promotional items from postcards to pens. Whatever I can get my hands on I pass the savings on to you! FB Timeline for Agents - facebook graphics & training videos to simply learn how to effectively use fb to post real estate listings and capture leads. We present a unique formula of find-capture-connect to find more leads, capture them into your community and connect/build relationships with them. Advanced Lead Trainings Tap into new lead sources that are difficult for your competition to find and tap into Easy self-branding to position yourself as the ONLY agent in town to do business with New strategies to develop client relationships & build trust when client's tolerances are changing Create deep commitments with clients to keep them through the close Deliver "life changing " high impact value to your clients Generate positive responses in your leads that get them to take action Create roadmaps your clients will hook into and get involved Stand out by presenting your service as an irresistible offer that leads will jump on Sort through the tech noise & focus just on what works much more….. Real Estate Agent Boot Camp Membership Training - 12 step by step video trainings & workbooks Seminars & Events - contact to schedule Private Coaching - contact to schedule
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Looking for a carrot cake recipe? This one is full of healthy nuts, fruit and vegetables and has a lovely lemon cream cheese frosting
- 325g (11oz) plain flour
- 125g (4�oz) wholemeal flour
- 1tbsp bicarbonate of soda
- 1tbsp ground cinnamon
- 300g (10oz) unrefined caster sugar
- 300ml (�pt) light vegetable oil or other flavourless oil
- 4 large eggs, lightly beaten
- 1tbsp pure vanilla extract
- 100g (4oz) chopped walnuts
- 100g (4oz) desiccated coconut
- 300g (10oz) carrots, cooked then pur�ed
- 250g (9oz) tinned pineapple chunks, drained and pur�ed
- 250g (9oz) Philadelphia cream cheese
- 200g (7oz) unrefined icing sugar, sifted
- 1tsp pure vanilla extract juice � lemon
You will need:
- Two 20cm (8in) deep sandwich tins, lightly oiled and the bases lined with baking parchment
Preheat the oven to 180 C, 160 C fan, 350 F, gas 4. Sift the dry ingredients then sugar into a bowl. Add the oil, eggs and vanilla. Beat, then fold in the nuts, coconut, carrots and pineapple. Bake for 45 mins or until lightly browned and a skewer comes out clean. Cool for 3 hours in the tin.
For the frosting, mix everything together and, using a palette knife, spread over one of the cakes before topping with the second one.
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We all like oppai. Who wouldn't? If you are a fan of Date A Live anime and love oppai, then all the more you should get yourself one of these oppai mousepad featuring characters from Date A Live. Now, you might be wanting a Yoshino and Kotori version. But let's face it, they are flat chested loli, they will never have a oppai mousepad version. Anyway, these things ain't cheap, it cost around 3,857 yen according to Amazon.
As for me, my current mousepad is starting to get old, so I might be getting myself either Tohka or Kurumi version.
By the way, for airheads out there who have no idea what is oppai. It is an informal term of "Breast" used by mostly Japanese anime or the people there in Japan.


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From Insight to Advantage
Market-driven, rapid ROI solutions to improve your business performance
Competitive Dynamics quickly understands your unique business and competitive environment to help you identify – and seize upon – market driven opportunities that improve your business performance.
With over 20 years of consulting and business building success, we go beyond just providing the powerful insights and ideas that create sustainable competitive advantage. We implement them.


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Insight Meditation of Cleveland provides a gathering place for those who wish to practice Insight (or vipassana) meditation. Insight meditation is a simple, direct practice, a moment-to-moment investigation of the mind/body process through calm and focused awareness.
Learning to observe experience from a place of stillness enables one to relate to life with less fear and clinging. Seeing life as a constantly changing process, one begins to accept beauty and
pain, fear and joy in all aspects of life with increasing equanimity and balance. As insight deepens, wisdom and compassion arise.
Insight meditation is a way of seeing clearly the totality of one's being and experience. Our growth in clarity brings penetrating insight into the nature of who we are and increased peace in our daily lives.
Welcome to Insight Meditation of Cleveland
Our Scheduled Meditations
The Shaker Heights group meets every Thursday from 7 - 8:30 PM at the First Unitarian Church of Cleveland.
The Brecksville group meets on the first and third Tuesday of each month at the Brecksville Human Services Center.
The Westside group meets on the second and fourth Tuesday of each month on the west side of Cleveland.
The Akron Area group meets on the fourth Tuesday of each month at the Crown Point Ecology Center in Bath.
Last Update:
September 12, 2016
News and Events
~ Our spring 2017 will be held at the Jesuit Retreat House in Parma over the weekend of April 28 - 30, 2017. More details and registration will be available after the first of the new year.


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Residents at Pineview Terrace Lodge wear masks as part of their laughter yoga.
It starts with a few fake, forced laughs, with residents imagining how a lion would laugh, and ends with everyone giggling for real.
"We had staff and volunteers involved and residents were laughing so hard they were crying," said Trina Chamberlain, recreation co-ordinator at Pineview Terrace Lodge, a special care home in Prince Albert.
Chamberlain was just trained in laughter yoga, a phenomenon that is spreading around the world, and she's bringing it to the residents at the home.
"It's a proven fact that laughter is the best medicine," she said.
During the summer, a volunteer group from the community came in to lead the residents in the breathing exercises, stretching and laughter.
"It's so good for everybody to do, especially the seniors because it helps get rid of that stale air for them," said Allison Marcotte, laugher yoga coach.
"It's the one exercise that can change you mentally, emotionally and physically."
Laughter yoga alleviates stress and makes you feel happier and healthier and improves breathing, said Chamberlain.
"Now that Trina has been trained with it . . . it's something she can incorporate in (the residents') everyday life at different times," Marcotte said.
With Chamberlain able to lead the laughter exercises, she plans on adding it to the residents' activities on a regular basis.
"Now we're tweaking it and adding it into the regular Monday exercise regime, where we do in-motion stretches, but we're going to incorporate the laughter into it, so it'll be laughing in motion," she said.
Some days only a handful of people want to participate, but on others there are 18 to 20 laughing together. Since it began, Chamberlain said she's seen the residents with more energy and heard them comment about getting better sleep.
"We had one lady, she said, 'I can't believe how good I feel,' " said Chamberlain.
"Lets face it, if you are around someone who's laughing, doesn't it make you want to laugh and don't you want to be with them? It makes you feel good."
"I'm really glad it was introduced to me so I can share it with our residents."


text: Bicosoeca (bike-o-so-eek-a), one of only several genera of bicosoecid stramenopiles. This genus includes cells which live within loricae. The cell attaches to the lorica by the tip of a recurrent flagellum, the other flagellum extends out of the lorica and beats with an undulating beat. As with other stramenopiles, the (sub-microscopic) hairs on the flagellum draw a current of water towards the cell, and particles are intercepted by a shoulder, seen to the left of the top of this cell, and ingested. Phase contrast.


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Jewellery Making Using Color Bands For Young Fashonistas Supports Key Child Development Skills
How Every Parent Can Help Their Child To Succeed With A Rubber Band
(EMAILWIRE.COM, January 12, 2014 ) London, England -- The massive sale of color rubber bands prompts The Blossom Gallery to put together a video of instructions for the buyers of their Colorful Bandz boxes as instruction and to give away as gifts
Colorful Rainbow Loom Organizers
Colorful Rainbow Loom Organizers
"We have found that parents, grandparents, playschool and day care organizers wanted to have some way of showing children how to make the wonderful bracelets without having to go online. We wanted to make an instruction video and came up with the downloadable video which we also provide free of charge as a DVD with our Colourful Bandz boxes" said a spokesperson for The Blossom Gallery that sells the compartment organizers on Amazon.
The national craze of loom bracelet making has created an explosion of creativity across the young population of many countries. These fashionable rubber band jewellery is how a new generation of fashonistas are looking good this year. However the positive outcomes are not just from the sense of fashion. Loom making helps children with hand-eye co-ordination, concentration and sharing to name a few positive skills.
"Our instruction videos can be used to support learning in a fun way, at the end, the children and adults have bracelets, rings, necklaces etc that they can wear, swop or give away. This is popular creative project for kids that has a definite place to play in child development. We come from a background in child care and our craft and art supplies for children always have an education element" said the Blossom Gallery spoke person.
Carers have also noted a benefit from the activity by allowing children who may have behavioral needs or problems with sharing, to have their own Colorful Bandz box to keep their accessories in and in an ordered place. With the video as well there is a complete arts and crafts educational kit appropriate for many needs.
About The Blossom Gallery
The Blossom Gallery specializes in arts and crafts supplies for children and adults offering users instructional videos and information on many projects. They source cost effective accessories and supplies such as their Colorful Bandz Plastic Storage Organizers and instruction video.
Contact Information:
The Blossom Gallery
Emman Sioco
Tel: +44208 852 8881
Email us
This is a press release. Press release distribution and press release services by EmailWire.Com: http://www.emailwire.com/us-press-release-distribution.php.
The Blossom Gallery
Emman Sioco
Tel: +44208 852 8881
Email us
This is a press release. Press release distribution and press release services by EmailWire.Com: http://www.emailwire.com/us-press-release-distribution.php.


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Sheltered from the elements and tucked away on the Great Belt, West Zealand's coast is a calm and relaxed part of the country, perfect for family beach time.
West Zealand has a seemingly endless coastline. You can find many, family-friendly beaches with calm, shallow water along the Great Belt coast. Sejerø Bay on the Kattegat coast offers you some of Zealand's best beaches, with fine, white sand and dunes.
Near Isefjord, salt meadows intermingle with great beaches and shallow waters. No matter what the direction of the wind, you can always find a sheltered spot on West Zealand.
Read more about West Zealand.
Read more about Natural adventures in Denmark.


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I do try to nurse her more often. She just either doesn't want to wake up or isn't interested. Sometimes I do hear her swallowing, most of the time it seems more like I'm being used as a pacifier. I'm having to pump every 2-3 hours and not getting very much. Sometimes she is done sucking after 2 minutes or so and there is no milk at all in the shield. When she really latches and is hungry I can tell when she is getting milk. Sometimes she just doesn't seem interested in nursing at all.
I've been to 3 different doctors. I've been told to do 3 different things.
The lc is certified. She weighs my dd before and after a feed and concluded she was only taking an ounce every 3 hours. I'm scared for my daughter that she's not getting enough and it makes my supply so low. The nipple shield was recommended in the beginning and I wish I'd never used it!
I'm feeling so bad. I have not give her formula yet. I haven't given up yet but always worried about it. What should I do?
It can be very confusing when you get different advice, and very frustrating when things don't go well. I read back through some of the posts. I know you are feeling very confused, upset, and frustrated. Try to set just some small goals for yourself. Things might not be as bad as they seem. Let's revisit your baby's weight checks for minute. Do you have the dates the weight were taken? You always measure weight gain from the lowest weight, not the birth weight, so your baby has gained more than one pound. As one of the other posters said, average weight gain for a BF baby in the early months is 6 oz. per week. From the weights you've given, it seems that your baby is in that range. Now, you said that your baby has not had formula yet, but that you have given some expressed milk by syringe, correct? If this is correct, then it seems baby may be gaining fine on just the breastmilk. How much milk have you been giving by syringe? Try not to worry about getting off of the shield for the moment. Most women are able to wean off of it eventually without too much trouble. If baby wants the shield right now, go ahead and use it and focus on seeing whether or not baby is getting enough. Do you have another weight check scheduled? As a PP asked, how many wet and dirty diapers are you seeing in 24 hours?
DD does poopy diapers on and off all day. Only a couple are really loaded though. I counted 6 wet diapers yesterday.
I offered her formula once and she wouldn't take it. I syringe breastmilk to her. Sometimes she takes 2 ounces, but most of the time a bit less. I offer breast to her first though.
She woke up from a nap about 30 minutes ago. She was hungry and immediately started to suck, but only for 5 mins. I burped her, changed her and tried again but she's not interested. Fell asleep.
Her last weight check was on Thursday. Next one is this Thurs.
Thanks so much for your replies.
I don't want to write you a book (especially since I am NOT an expert by any means) but wanted to tell you to hang in there and keep at it. It should get better!
Some suggestions:
I didn't like the syringe. I ended up trying to feed my baby expressed milk by baby spoon and that works better. I sort of pour it in by small amounts. I'm less stressed, she's less stressed, but it takes a long time. See how you feel about it.
Have you tried breast compressions? There are some links around here and I think Dr. Jack Newman is the guy who specializes in it. It might help getting your daughter to suck more.
Experiment with different positions and see if there's one your daughter does better with. I wasn't confident enough at first to try the lying down position, but with time and some tweaking I think that's where she does best.
The worst advice I was given was to wake her up and feed her every 'x' hours. That just made us both frustrated and we both ended up crying. What worked for me was proposing food basically whenever her eyes were open. It's exhausting but in looking back it didn't last forever. Time will probably help, but in the meantime you might propose again. And again. And again. If you can listen to a book on tape or watch something relaxing, then maybe it would help to hang out, relax, and just keep trying without stressing too much.
It sounds crazy, but try telling her she needs to eat more. My baby will start sucking again a little, and every little bit helps I think. I try to say it in a firm, somewhat loud, 'Momma is telling you what you need to do' voice. Asking nicely gets us nowhere.
I have my hesitations in telling you this, but co-sleeping did help for a while. The problem for me is that we are both light sleepers and woke each other up all the time, so now I'll swaddle her, put her back in her crib, and feed her each time she wakes up. She sleeps better and I think that somehow helps her eat better, so co-sleeping is not a permanent fix for us. However, if she starts to lag in weight again I'll take her back to bed with me and feed her every time she moves.
I have some pediatricians that tell me she's fine with the weight gain and others who will say she's not gaining enough. In the end I just watch my baby, her 'output,' whether she's happy and her milestones. She's growing and smiling, so right now I'm continuing to give her breastmilk only and will evaluate at the next weight check. I can tell you, though, that scales and measurements are frustrating in such small increments and an early or late pee can make a big difference in weight.
Hang in there and do what you need to do for your baby. So far I haven't supplemented with formula but primarily because she won't take it. What did your LC say about her latch? Sometimes I wonder if my baby had trouble sucking at first and now is just getting better with time. What does she do if you give her your boob without the shield? Have you tried putting on those cups that keep your nipple poked out right before you feed? I wore those for a while at first but now am okay without them. Do you think she would suck for comfort without the shield?
I have tried everything. I did manage to get her to take without the shield a few nights ago, but minutes later she became upset and flailing around so I put it back on. I have two feeds worth of breastmilk in the freezer for when I need it, but worry about my supply because I'm only getting 1-2 ounces off both breast every 2 1/2 hours. Some people breastfeed so easily. I'm jealous of friends who had no problem at all from the start and then they choose not to breastfeed anyway-but that is their decision and I'm not saying it's a bad one, I just wish I had a better shot at things. Thanks for you advice and I will try your suggestions.
I have another questions for you. Did you have a medicated birth? Sometimes that can make baby very sleepy. However, she WILL wake up eventually and realize she wants to eat. I would continue to keep a close eye on the diapers and keep having the weight gain monitored, but if it continues to fall in the 5-7 oz per week category than you are doing OK. Don't put too much value on your pumping output. Many women can't get much. 1-2 ounces at 5 weeks isn't all that bad truly. If you can get an extra 1-2 ounces in her (via syringe or whatever other method you try) that is great. Have you tried wearing her in a sling or even just staying in bed for a whole day and just nursing as much as she will let? Lots of skin to skin contact is good, even try nursing in the bath.
I too was annoyed that some people could bf so easily while I had multiple challenges. It is very difficult for many people so you are not alone. It seems like it should be so easy and natural but that is not the case for many moms and babies. I promise it will get easier. Keep doing what you are doing and keep us posted.
Anne- Mom to two active boys: Henry 10/06 and Jamie 4/09
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I had numerous problems too. Looking back now, I know that determination to breastfeed was the number one thing that got me through.
I am not going to repeat what everyone else has said. Try, try, until you find one of the (great) suggestions that works for you. You will be so glad that you did!! Keep trying.
• relax, relax, relax while you are feeding - like MicheleE said, listen to a book (or MP3s), watch something
• use a silicon shields and don't worry about weaning now
• do things to increase supply like:
- breast compressions
- frequently offering to feed
- frequently switch sides (as soon as her mouth stops moving, switch to the other side, then switch back, then switch back, as many times as necessary. It is the frequency with which a baby is put to breast, not the duration that increases supply)
- pump after each feeding, then try to syringe or spoon this too her after the feeding as well (or even better, have someone else do this part while you pump and relax)
• an older pediatrician told us that weight gain over a month matters more than over a week. She was supposed to gain a certain amount over a week and was gaining one-fifth of that. Then, the next day she gained that amount in one day. It really can change that fast.
• like MicheleE said as well - watch happiness, diaper output, other milestones. By three months our baby was chunk, even though at 5 weeks she was a bit gaunt (but happy). Stick with it and find encouragers!
Good luck!
- Just wanted to add that we weaned from the shield at 5 months without a problem. She just decided one day that she was done with it and that was that. However, I also had another friend who nursed a full 9 months with the shield. So don't worry about needing to wean.
I am having the exact same problem! I am using a nipple shield and my lo (who is 5 weeks) was not gaining enough weight. I am having to supplement w/ formula after each feeding. It has been very frustrating w/ mine not gaining weight, but now she's doing fine since we added the formula along w/ nursing. I did not want to supplement, but she has been a much happier baby since we started. I wonder if using a nipple shield has causes the milk supply to be low???


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Go! Daily Defence Chicken Stew Canned Cat Food, 5.5-oz, case of 24
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Go! Daily Defence recipes give your cat whole body preventative care for life. They are nutrient-packed and nutritionist-recommended to give your cats the preventative care they need to stay strong and healthy for life. This Chicken Stew is prepared with premium-quality chicken, antioxidant-rich fruits and veggies and essential omega oils.
Key Benefits
- Omega oils for healthy skin and coat
- Zero by-product meals, added growth hormones or artificial preservatives
- Zero beef, wheat, corn or soy
- Formulated for growth and maintenace
Item Number63558
Food TextureStew
Food FormWet Food
LifestageAdult, All Stages
Made inCanada
Special DietNo Corn No Wheat No Soy
Nutritional Info
- Chicken, Chicken Broth, Salmon Broth, Chicken Liver, Brown Rice, Dried Egg Whites, Potato Starch, Salmon, Carrots, Apples, Guar Gum, Oats, Red Peppers, Natural Flavor, Sodium Phosphate, Potassium Chloride, Flaxseed, Minerals (Iron Amino Acid Chelate, Zinc Amino Acid Chelate, Copper Amino Acid Chelate, Manganese Amino Acid Chelate, Sodium Selenite, Potassium Iodide), Salt, Vitamins (Vitamin E Supplement, Thiamine Mononitrate, Niacin Supplement, D-Calcium Pantothenate, Pyridoxine Hydrochloride, Riboflavin Supplement, Vitamin A Supplement, Biotin, Vitamin D3 Supplement, Vitamin B12 Supplement, Folic Acid), Choline Chloride, Cranberry Meal, Dried Kelp, Taurine, Dl-Methionine, Sunflower Oil (Preserved with Mixed Tocopherols), Yucca Schidigera Extract, Beta Carotene.
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Customer Reviews
Rated 4 out of 5 by 2 reviewers.
Rated 3 out of 5 by CatMamax7 Least favorite of Petcurean flavors All 7 of my cats love Petcurean foods, however, this flavor was not their favorite. While they all ate the food, it was obvious that they weren't crazy about it. I would recommend this food only because I think Petcurean is a good brand, but other flavors are much more welcomed here. April 16, 2015
Rated 5 out of 5 by Verified Reviewer My cat loves this particular particular one This particular one - Chicken & Vegtables has been discontinued but manufacturer and it is the only ne of this brand that our Manx ears every morsel. The quality of this brand is consistently fine quality. So happy that you had a supply that we could buy. August 23, 2013
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Gill, Richdeep S. MD*; Shi, Xinzhe MPH†; Al-Adra, David P. MD*; Birch, Daniel W. MD, MSc, FRCSC†; Karmali, Shahzeer MD, FRCSC†
Purpose: Acute appendicitis remains the common gastrointestinal emergency in adults. Single-incision laparoscopic appendectomy (SILA) has been proposed as the next evolution in minimally invasive surgery. SILA is postulated to reduce postoperative pain and enhance cosmesis, while effectively removing an inflamed appendix. However, the efficacy and benefits of SILA compared with conventional laparoscopic appendectomy (CLA) remain to be determined. Our objectives were to systematically review the literature comparing SILA with CLA for acute appendicitis and perform a pooled analysis on the efficacy of SILA.
Methods: Published English-language manuscripts were considered for review inclusion. A comprehensive search of electronic databases (eg, MEDLINE, EMBASE, SCOPUS, BIOSIS Previews, and the Cochrane Library) using broad search terms was completed. All comparative studies were included if they incorporated adult patients undergoing appendectomy for acute appendicitis by SILA. The primary outcomes of interest were operative time and length of hospital stay.
Results: From a total of 366 articles, 34 articles were identified. A total of 9 comparative studies were included for pooled analysis. There was no significant difference in operative time, length of stay, pain scores, and conversion or complication rates between SILA and CLA for acute appendicitis.
Conclusions: This systematic review and pooled analysis demonstrates that SILA is comparable to CLA for acute appendicitis in adults. However, this review identifies the need for randomized controlled trials to clarify the efficacy of SILA compared with CLA.
© 2012 Lippincott Williams & Wilkins, Inc.
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Tony Bennett Selling the Big Lie about Need for Hoosier Teacher Accountability
In 2010,
Tony Bennett and the Indiana Department of Education (IDOE) introduced relaxed teacher qualifications known as REPA. A slideshow presented by Bennett stated the need for REPA was a grade of "D" for "policies affecting teaching quality". This grade was given by the National Council for Teaching Quality (NCTQ).
The grade of "D" was endorsed by NCTQ's technical panel. Tony Bennett sits on the technical panel of NCTQ.
The NCTQ's report was described by the American Association of Colleges for Teacher Education (AACTE) as "so fundamentally flawed it is not worthy of your engagement." The AACTE went as far to call the report "unprofessional" in its obvious attempt to deteriorate traditional education.
Perhaps the NCTQ's report and Indiana's grade of "D" for teaching quality policies would have never gained much merit except for a strong endorsement that followed by a group known as Chiefs for Change.
The Chiefs for Change have only eleven members. Tony Bennett is one of them.
In sum, much of the turmoil surrounding the need for greater teacher accountability is because Bennett has said teachers need improvement and endorsed his own statement saying so.
Bennett has a history of disregarding public opinion, or even the law, for that matter, and forcing through his plan to dismantle public education. This also might explain language found here at the IDOE website:
Final RISE rubric ratings did not sufficiently differentiate teacher performance (61% Effective, 30% Highly Effective) or identify specific teacher strengths and weaknesses (67% of teachers received no rating lower than "effective" on all 19 RISE rubric competencies). When all the data is analyzed in the fall, these ratings are unlikely to accurately reflect actual teacher and student performance.
Bennett's mind is stuck in a bell curve; a percentage of students must always be failing, a percentage of teachers must therefore also be failing. Bennett's goal in Indiana is to continually fail a portion of students, teachers, and schools for the sake of privatization.
Teachers have not bought into the RISE evaluation system that creates:
· a detrimental "teach to the test" atmosphere.
· greater focus on only select students, especially "bubble" students.
· an environment of competition, not cooperation, among colleagues.
· teacher flight from schools most in need.
· less qualified teachers who do not stay in the profession.
The RISE evaluation has nothing to do with improving instruction. Bennett purposefully took away funding for advance degrees to create funds for merit pay. (Lest we forget, Bennett stood idly by while Daniels cut $300 million from Hoosier school budgets. This shortfall was felt most by teachers, who on average have taken huge pay cuts. In my district, teachers have taken between a 12% and 20% pay cut over the past three years.)
As one commenter said, (Bennett is) driving down teacher's salaries and forcing them to fight over what spare money is left. Then he is telling the public he rewards the best teachers with merit pay.
Perhaps that is why Bennett also had to include this on the IDOE webpage:
Increased collaboration and conversation promotes overall satisfaction with the new evaluation system and belief that the new system raises student achievement.
This quote is reminiscent of one attributed to Joesph Goebbels, Hitler's propaganda chief:
"If you tell a lie big enough and keep repeating it, people will eventually come to believe it."
Indiana, it is time for a change. How can Bennett think he is putting students first by continually putting teachers last? A teacher's working conditions are the student's learning conditions. Bennett's denigration of the Hoosier teacher results in the denigration of all public education students.
It will take years to fix the damage Bennett has wreaked on Hoosier schools. Four more years of Tony Bennett's policies and the damage may well be irreversible.
We need a new superintendent who will work with teachers, not against them. Glenda Ritz needs your support. She does not have the million plus dollar funding from huge corporations that will profit from Bennett's privatization efforts. For Ritz to claim victory, it will take a grass roots effort from every citizen who cares about public education in Indiana. Get out the vote for Glenda Ritz.


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Top Medical Colleges in Kolkata
Amrita Chakraborty
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Kolkata has produced brilliant minds over the years and this trend continues. This city is home to education, literature, art and music. And that's not all. Some of the reputed medical schools and institutes in the country are located in Kolkata. Students from across the globe come here to get the best education medical colleges offer. Each institute has various branches for specialization at the under-graduate and post-graduate level. Various medical colleges also offer nursing courses along with other medical courses.
Here are some of the popular
medical colleges
in Kolkata:
Medical College Kolkata
or popularly known as the Calcutta Medical College was established in 1835 as the first college of European medicine in Asia. This institute made its humble beginnings with just a handful of students in 1835 and has now grown to 150 students annually. The Medical College is affiliated to the West Bengal University of Health Sciences and its is run and managed by the Government of West Bengal. The institute offers medical courses at the under-graduate and post-graduate level in various branches of medicine. Medical College Kolkata has produced one of the finest professionals in the country and across the globe.
If you are looking at a private medical college then
KPC Medical College
is the perfect place to seek admission in. KPC Medical College is the first state of the art private medical college in West Bengal with a capacity of 150 students in the MBBS course. The college also offers four different types of paramedical courses which are recognised by the State Medical Faculty of West Bengal, India. This private institute is equipped with the latest state-of-art-infrastructure and modern facilities to deliver world-class medical training and education to students. The curriculum at KPC Medical College is set according to the directives of the Medical Council of India. The Institution places much emphasis on the ethical and moral aspects with a view to produce medical professionals fully committed to serve the society.
RG Kar Medical College
was set up in 1916 and is one of the oldest medical colleges in Kolkata. Founded by Dr. Radha Gobinda Kar, RG Kar Medical College was formerly known as the St. Car Michael Medical College. This college is affiliated to the West Bengal University of Health Sciences. The institute offers medical courses at the under-graduate and post-graduate level in various branches of medicine, nursing course and super speciality courses.
Calcutta National Medical College
made its foray in the field of medical education and training in 1948. This institute is a product of the historical non-cooperation movement which was inaugurated by Subhas Chandra Bose. The college is recognised by Medical Council of India (MCI) and has all the departments which is specified by the MCI. The institute has a capacity of 150 students in the MBBS course. And it also offers post-graduate degree and diploma courses to students. Admissions to the MBBS course is strictly based on the West Bengal Joint Entrance Examination (WBJEE) and All India Pre Medical Test (AIPMT) rankings. The college is equipped with the latest technology and amenities.
The life of medical students is often a tough one, yet the life-saving work done by them is remarkable. The main reason behind such dedicated and passionate service to society is not just a strong mind but also a good education background which these top institutions offer.
See here for more
medical colleges
in Kolkata.
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The Ultimate Non-Stimulant Metabolic Stimulator For Fat Loss!
ThyroZene improves the conversion of Thyroid hormones which supports natural thyroid function. Thyrozene is a revolutionary thyroid support formula designed to support proper thyroid function. ThyroZene's ingredients are specifically formulated to help support your thyroid gland, and produce healthy levels of thyroid hormones without any harsh chemicals.
ThyroZene has been associated with the following:
• Supports Healthy Energy Levels
• Supports Healthy Metabolic Rate
• Supports Healthy Muscle Metabolism
• Supports Healthy Mood
• Supports Healthy Memory Function
Supplement Facts
Serving Size: 1 Tablet
Servings Per Container: 90
Amount Per Serving
Proprietary Blend - 225mg
N-Acetyl-L-Threonine Sodium, Porcine Freeze-Dried Thyroid Powder, Guggulsterones 99%, Coleus Forskohlii Extract (Root), Bladderwrack Extract (Whole Plant), 3, 5-Diidotyrosine.
Other Ingredients
Microcrystalline Cellulose, Dextrose, Sodium Starch Glycolate, Magnesium Stearate, Stearic Acid, Silica, FD&C Red #40
Take 2-3 tablets daily. Take in divided doses throughout the day. Can be combined with other fat loss agents for a synergistic effect.


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9 posts tagged with baseball and obit.
Displaying 1 through 9 of 9. Subscribe:
Yogi Berra (1925-2015)
Yogi Berra, master Yankee catcher with goofy wit, dies at 90. I guess it's over now.
...the firm resolve of a determined soul.
Break Out The Rye Bread, Heaven.
Dave Niehaus, the longtime play-by-play announcer for the Seattle Mariners, has passed away at the age of 75. [more inside]
"If you don't like him, you don't like ice cream."
Legendary baseball manager George "Sparky" Anderson dead at 76. Ernie Harwell on Sparky. Interview on Santa Clarita community access. "Mr. President, I know you love those Cubs, but if you knew these Tigers, you'd love 'em more. Hall of Fame entry. He was a crummy player, though. Remembering Anderson's class. STAY CLASSY, SPARKY! The End of a Sparkling Life.
Nick Adenhart (1986-2009)
Four hours after his start against Oakland, his first time beginning the year with a major league team, Los Angeles Angels pitcher Nick Adenhart was killed in a hit and run by a van speeding through a red light.
John Brattain, Baseball Blogger, RIP (1965-2009)
People die and different folk celebrate and mourn in various ways. However, while it does seem as if everyone is blogging about baseball and boxing or UFC during these times that try men's souls'... not everyone can write about it for the CTV network. John will be missed by both Blue Jay and Expo fans and perhaps fight fans as well. Please take a moment of your time to click on some links, thank you.
Poena par sapientia
John C. Odom, the minor league baseball player made famous last year for being traded for ten bats, has met a tragic end.
"[They] had no idea what LSD was other than what they seen on TV with the hippies"
Dock Ellis, an American baseball pitcherprev, won more games for the champion 1971 Pittsburgh Pirates than anyone else that year. Of course, he was under the influence of the performance-enhancing drug known as LSD on at least one no-hit occasion. Ellis died yesterday at the age of 63. [more inside]
Arriverci, Scooter.
A shortstop extraordinaire, loan pitchman, vocal accompanist, announcing icon. and friend to yogi's ...has left the building. RIP, Scooter.
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It appears Apple has switched their hand model for the iPhone to someone with a bigger kung-fu grip. The iPhone hasn't changed at all, but this dude's sausage fingers makes it look smaller. Sneaky stuff, Apple.
The left picture is from the original ad campaign, while the one to the right is from the new one. Maybe they haven't switched their model and the guy has just gone through a rough patch and put on a few pounds. The world may never know.
Find all our iPhone stories here.
BoingBoing.net: Apple uses big-handed model to "shrink" iPhone