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Dairy calcium intake and lifestyle risk factors for bone loss in hiv-infected and uninfected mediterranean subjects
HIV and co-infections
Despite the reported high prevalence of osteoporosis in the human immunodeficiency virus (HIV)-population, there have been no previous studies examining dairy calcium intake and bone mineral density (BMD) in HIV-subjects.
We assessed the prevalence of low BMD in HIV-infected and uninfected subjects and analyzed the effects of calcium intake, lifestyle and HIV-related risk factors on BMD.
One hundred and twelve HIV-infected subjects were consecutively enrolled. Seventy- six HIV-uninfected subjects matched for age and sex were enrolled as the control group. The HIV-subjects were interviewed about lifestyle habits and completed a weekly food-frequency questionnaire to estimate calcium intake. HIV-RNA, CD4+ T-cell count and data on antiretroviral therapy were also recorded. Both biochemical bone turnover markers and BMD, assessed by dual-energy radiographic absorptiometry (DXA) were recorded in the HIV-cases and controls. We also calculated the 10-year fracture risks using the WHO FRAX equation.
Osteoporosis prevalence was significantly higher in the HIV-cases than controls (
BMI values were significantly correlated with dairy intake quartiles (
Among the foods rich in calcium, yogurt was a protective predictor of BMD in HIV-subjects. HIV/HCV co-infection, nadir CD4 + T-cell count < 200 cells/μL and drug addiction were independent predictors of severe BMD. Promoting behavioral changes in food intake and lifestyle, aimed at the primary prevention of bone disease in the chronically-infected subjects seems to be essential for implementing medical intervention in these cases.
Osteoporosis and its resulting fractures are becoming major public health issues due to population ageing and the world-wide increase in long-term chronic conditions
However, fractures in different populations considered at low risk of osteoporosis and with low-normal bone mineral density (BMD) have also been reported
Low BMD has emerged as a significant problem in chronically-infected patients, such as the HIV-infected population
In addition to the traditional risk factors (i.e. older age, female sex, menopause, corticosteroid therapy, low BMI) attention has recently been centered on the importance of following a diet rich in calcium, other minerals and vitamin D associated with physical activity, which is recommended to maintain not only a healthy bone structure but also an acceptable BMD
Since general risk factors and HIV-related factors affect both bone turnover and BMD, the aim of our study was to assess the prevalence of low BMD in HIV-infected subjects and controls and to analyze the effects of calcium intake and other environmental risk factors in order to increase current interest in the management of bone disease in the HIV-population through appropriate dietary and lifestyle interventions. We also estimated the 10-year fracture risk.
Study population
The study participants were Caucasian HIV-infected patients, consecutively enrolled between January 2011 and January 2012, who were being followed-up prospectively at the AIDS Center of the University of Palermo.
BMD was measured in all subjects by dual X-ray absorptiometry (DXA)
Data on age, gender, drug addiction, antiretroviral therapy (ART), protease inhibitors (PI) and non-nucleoside reverse-transcriptase inhibitor (NNRTI) exposure were all recorded in a database designed for this study. Specific tenofovir exposure > 1 year was also recorded. Exposures to ART and PI were graded 0 (no exposure) to 3 (1: < five years; 2: from five to nine years; 3: ≥ ten years).
Body mass index (BMI) was calculated as weight (in kg) divided by height squared (m2). Subjects were considered underweight when BMI was ≤ 18.5 kg/m2, normal weight when BMI was between 18.6-24.9 kg/m2, overweight when BMI was between 25–29.9 kg/m2 and obese when BMI was ≥ 30 kg/m2.
Diabetes mellitus was defined in accordance with the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus criteria
Seventy-six HIV-uninfected subjects referred by family doctors to our Center for laboratory and BMD assessment were enrolled as the control group. Age and sex of these subjects were comparable with the patients and the same exclusion criteria were applied.
Interview data
At the start of the study, the HIV-infected subjects filled in a health and lifestyle questionnaire considering medical and drug abuse history, lifestyle habits (including smoking status, alcohol consumption, Italian espresso coffee drinking, physical activity) and bone fractures. Smoking status was categorized as non-smokers, former smokers and current smokers. Alcohol intake > 20 g per day either at the time of the study or in the past as well as Italian espresso coffee intake > 4 cups per day were also recorded. Physical activity was defined as either non-occupational or occupational when physical exercise was performed during free time or at work, respectively. Non-occupational physical activity was considered active when > 2 sessions of 20 minutes per week were performed. Occupational physical activity was defined as heavy when manual work was carried out.
In order to assess calcium intake, the consumption of foods representing the major sources of daily calcium intake in the Italian diet, such as typical Italian aged cheese (i.e. Parmesan), ricotta cheese and yogurt was recorded in a weekly food-frequency questionnaire, in accordance with the tables of nutrient values issued by the Italian National Institute of Nutrition
Laboratory methods
In all the HIV-patients CD4+ T-cell count (most recent value and nadir) and plasma HIV-RNA levels were assessed as previously reported
Vitamin D assessment was performed in the sunnier months from April through October, since it is known that vitamin D formation is not possible or inadequate
Bone mineral density assessment
For both HIV-infected cases and uninfected controls, BMD was assessed at baseline by DXA, using a QDR Discovery Hologic DXA in the femoral neck and DXA in the lumbar spine by total body DXA
We calculated the 10-year fracture risks according to the standardized WHO FRAX equation, computed with BMD (T-score) at the femoral neck
Statistical analysis
Data were expressed as mean ± standard deviation when distribution was Gaussian. Differences were calculated using Student's t-test. Otherwise, data were expressed as median and range and analyzed with the Mann–Whitney U test. Fisher's exact and χ2 tests, Pearson's correlation and Spearman's rank correlation were used where appropriate. Multiple logistic regression analysis was performed to estimate the independence of the association between lumbar spine and femoral neck T-scores as well as variables significant at univariate analysis in the HIV-infected subjects. Variables contributing significantly to fit the logistic equation were then selected by a step-wise procedure.
All analyses were performed using the SPSS software package (version 16.0; Chicago, IL, USA).
The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki.
The study was approved by the local Ethics Committee and informed consent was obtained from all subjects.
Characteristics of the HIV-infected population
The main characteristics of the 112 HIV-infected and control subjects are shown in Table
The average age of the recruited patients was 47 ± 9.7 years. Sixty-three individuals were male (56%). Among the 112 subjects, 28 (25%) were overweight, 6 (5%) were underweight (BMI < 18.5) and 7 (6%) were obese. As regards smoking status, drug addiction and Italian espresso coffee drinking we found that half of the study subjects regularly smoked cigarettes, one third drank coffee > 4 times a day and one third used cocaine and/or heroin.
About half of this population did physical activity in their free time and had a higher level of education.
Concerning eating habits, the median daily calcium intake was 454 mg/die, range (96–1359). More than half of the participants interviewed reported that they drank a glass of milk in the morning, whereas yogurt intake was less frequent. Parmesan cheese intake, according to our definition, was reported in about 90% of subjects.
Most subjects were on ART (93%), seventy-five (67%) had nadir CD4+ T-cell count < 200 (cells/μL) and 41 (36.6%) were co-infected with hepatitis C virus (HCV) (Table
Prevalence of osteopenia and osteoporosis in HIV-infected and uninfected subjects
Osteopenia was present in 38 (34%) HIV-infected vs 19 (25%) HIV-uninfected subjects (
Osteoporosis was present in 34 (30.3%) HIV-infected vs 8 (10%) HIV-uninfected subjects (
In the setting of HIV-infection osteoporosis was present in 9 subjects at both the lumbar and femoral sites.
Comparison between lumbar spine and femoral neck DXA T-scores and biochemical parameters in HIV-infected and uninfected subjects
Lumbar spine DXA T-score were significantly lower in HIV-infected (−1.4 range −5.2 to 1.6) than in uninfected subjects (−1 range −4.4 to 2.7) (
Serum bone alkaline phosphatase was significantly higher in HIV-infected (54.7 range 19–170 IU/L) than uninfected subjects (28.2 range 5–84 IU/L) (
Calcium and parathyroid hormone levels were not significantly different in the two groups of patients (data not shown).
Correlation between lumbar spine and femoral neck DXA T-scores with demographic and environmental risk factors and calcium intake in HIV-infected subjects
The correlations between the studied risk factors and lumbar spine and femoral neck DXA T-scores are presented in Table
No correlation was found between daily calcium intake (specifically milk), Parmesan, weekly consumption or quartile calcium intake and BMD measured in either the lumbar spine or femoral neck. Yogurt intake was positively correlated with BMD measured in the lumbar spine (
By stratifying patients into two groups (milk or milk + yogurt) we found that osteopenia and osteoporosis were significantly higher in the patients with milk only than in those with milk + yogurt (χMH=2 5.6;
As regards biochemical markers, increasing values of bone alkaline phosphatase were negatively correlated with lumbar spine and femoral neck DXA T-scores (
Correlation between lumbar spine and femoral neck DXA T-scores and characteristics of HIV- infection
Duration of HIV-infection was negatively correlated with BMD in the femoral neck (
The mean of the 10-year risk of fracture, calculated in 76 HIV-infected subjects, was 1.2% for hip fracture and 4.7% for major osteoporotic fracture.
Figure 1
Correlation between BMI and dairy intake quartiles (times/week)
Correlation between BMI and dairy intake quartiles (times/week). The figure shows the significant Spearman's correlation between BMI values and dairy intake quartiles (1: ≤8, 2: 9–10, 3: 11–14, and 4: ≥15) in the HIV-infected subjects (ρ = 0.36;
No correlations between calcium intake and overall fracture risk at 10 years (r = −0.12;
At multiple linear regression analysis, age and HIV/HCV co-infection were negatively correlated with BMD measured in the lumbar spine (
To our knowledge, this is the first investigation on calcium intake and its relationship with BMD in adult subjects with HIV-infection. Previous studies in this area focused on calcium intake and its potential metabolic impact in HIV-subjects, or on its link with BMD in the subset of a HIV- pediatric population
Parmesan cheese could be included in the "Mediterranean diet group" of foods because it is usually added to pasta and pizza. In fact, in our study interview Parmesan (25 g = 300 mg calcium) was regularly consumed in 90% of the HIV-subjects.
Among the various dairy foods available we considered yogurt, which contains live active cultures and a substantial amount of calcium and vitamin D. Interestingly, we found that weekly yogurt intake was a protective independent predictor of BMD in the lumbar spine.
When the patients were divided into two groups the analysis showed a more favorable relationship between yogurt plus milk and BMD than milk alone. No previous study has examined the relationship between yogurt intake and BMD in HIV-infected subjects and only Sahni et al.
Probiotic microorganisms have considerable immunomodulatory effects in the gut-associated lymphoid tissue
In the present study the prevalence of osteoporosis was significantly higher in HIV- infected than in uninfected subjects, a result similar to previous meta-analyses
Currently, more intensive investigations have been made to better understand whether HIV infection
Several HIV-related factors were correlated with BMD on univariate analysis in both the lumbar spine and femoral neck in our HIV-infected subjects. The correlation between time of HIV diagnosis and BMD in the femoral neck as well as nadir CD4+ T-cell count < 200 cells/μL and BMD in both the lumbar spine and femoral neck and the finding that nadir CD4+ T-cell count < 200 cells/μL was an independent predictor of low BMD, suggest that HIV infection
On the other hand, we found a significant negative correlation between longer duration of ART, especially PI exposure, and both lumbar spine and femoral neck BMD on univariate analysis.
How to strike a balance between the various aspects to be considered when providing ART, (such as when treatment should be commenced or the classes of drugs to be used, its influence on the progression of HIV disease and, in the present case, its effects on BMD) in order to maximize its benefits is an ongoing debate. In this respect, while Grund et al.
We did not find a significant correlation between tenofovir exposure > 1 year and BMD in HIV-subjects, unlike previous reports
Moreover, no significant correlation was found between the small number of fractures reported in our HIV- subjects and BMD at either of the sites. In a recent Italian study, metabolic factors such as BMI and diabetes mellitus were independently correlated with vertebral fractures in HIV-infected patients
To improve the ability to predict subsequent fragility fracture in our patients, we used the WHO FRAX equation
Similar to other studies on enrolled HIV-infected subjects with a long duration of infection, we found that older age and BMI values had a negative or positive correlation with BMD, respectively
The results regarding the relationship between dairy product consumption and BMI are contradictory
However, the ideal daily calcium intake to prevent osteoporosis in HIV-positive subjects is not clear because it depends not only on known general and environmental risk factors but also on the patient's long-term immuno-virological course.
For most people, a daily calcium intake of between 1000 and 1300 mg is both safe and potent but we hypothesize that the dose should be reviewed in relation to ART and HIV-status.
Recent data have suggested that patients with AIDS and addicted to heroin might be at particular risk for bone loss
Another interesting result emerging from our study is the independent correlation between HIV/HCV co-infection and BMD.
Vitamin D deficiency was found in HIV/HCV co-infected patients
To our knowledge, this is the only study to date to evaluate calcium intake and low BMD in HIV-infected subjects. Two interesting findings emerge from our study, firstly, among the foods rich in calcium yogurt was an independent protective predictor of BMD in HIV-subjects; second, HIV/HCV co-infection, drug addiction and nadir CD4+ T-cell count < 200 cells/μL were independent predictors of severe bone disease. It seems essential to implement medical treatment by promoting behavioral changes in food intake and lifestyle in the primary prevention of bone disease in chronically-infected people.
HIV, human immunodeficiency virus; BMD, bone mineral density; TNF-α, tumor necrosis factor-α ART, antiretroviral therapy; PI, protease inhibitors; NNRTI, non-nucleoside reverse-transcriptase inhibitors; BMI, body mass index; DXA, dual-energy radiographic absorptiometry; AIDS, acquired immunodeficiency syndrome; Vs, versus.
Competing interests
The authors declare that they have no competing interests with respect to this article.
Authors' contributions
VLV and PDC designed the study and drafted the manuscript. MS participated in the design of the study and performed the statistical analysis. LG, GM, SLS, CC and SM set up and conducted the study in the field and contributed to the interpretation of the results. GC carried out the DXA. FT carried out the laboratory analysis. The ethics applications and funding applications were submitted by PM and PDC as principal investigators in the control group. GM and PDC conceived the study, and participated in its design and coordination. All authors read and approved the final manuscript.
Aging, human immunodeficiency virus, and bone health
Bone disorders in chronic liver diseases
Hepatic osteodystrophy
Prevalence of vertebral fractures in men with acromegaly
Vertebral fractures in males with type 2 diabetes treated with rosiglitazone
Paracrine regulation of osteoclast formation and activity: milestones in discovery
Osteopenia and osteoporosis in people living with HIV: multiprofessional approach
Genetic and environmental factors in human osteoporosis from Sub-Saharan to Mediterranean areas
Hypogonadism and hormone replacement therapy on bone mass of adult women with thalassemia major
The metabolic syndrome-a new worldwide definition
Effects of dietary calcium intake on body weight and prevalence of osteoporosis in early postmenopausal women
Food sources of nutrients of the diet of elderly Italians: II Micronutrients
Transmission of drug-resistant HIV type 1 strains in HAART-naive patients: a 5-year retrospective study in Sicily, Italy
Prospective evaluation of bone markers, parathormone and 1,25-(OH)2 vitamin D in HIV-positive patients after the initiation of tenofovir/emtricitabine with atazanavir/ritonavir or efavirenz
Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance
Assessment of fracture risk and its application to screening for postmenopausal osteoporosis
Application of the National Osteoporosis Foundation Guidelines to postmenopausal women and men: the Framingham Osteoporosis Study
Dietary intake of community-based HIV-1 seropositive and seronegative injecting drug users
Dietary calcium, dairy food intake and metabolic abnormalities in HIV-infected individuals
Predictors of bone mineral density in human immunodeficiency virus-1 infected children
Risk factors for hip fracture in Asian men and women: the Asian osteoporosis study
Pilot case–control investigation of risk factors for hip fractures in the urban Indian population
Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study
The gut microbiota regulates bone mass in mice
Effect of probiotic bacteria on microbial host defense, growth, and immune function in human immunodeficiency virus type-1 infection
The role of micronutrients in the diet of HIV-1-infected individuals
Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review
Severe deficiency of 1,25-dihydroxyvitamin D3 in human immunodeficiency virus infection: association with immunological hyperactivity and only minor changes in calcium homeostasis
Vitamin D deficiency in HIV-infected individuals: one more risk factor for bone loss and cardiovascular disease?
Continuous antiretroviral therapy decreases bone mineral density
Stable bone mineral density over six years in HIV-infected men treated with highly active anti-retroviral therapy (HAART)
Select HIV protease inhibitors alter bone and fat metabolism ex vivo
Bone metabolism in children with human immunodeficiency virus infection receiving highly active anti-retroviral therapy including a protease inhibitor
Relationship between low bone mineral density and highly active antiretroviral therapy including protease inhibitors in HIV-infected patients
Bone disease in HIV infection: a practical review and recommendations for HIV care providers
Increasing clarity on bone loss associated with antiretroviral initiation
Bone mineral density in HIV-negative men participating in a tenofovir pre-exposure prophylaxis randomized clinical trial in San Francisco
High prevalence of radiological vertebral fractures in HIV-infected males
An increased risk for fractures: another cause of frailty in HIV-infected subjects
Low bone mineral density, renal dysfunction, and fracture risk in HIV infection: a cross-sectional study
Longitudinal evolution of bone mineral density and bone markers in human immunodeficiency virus-infected individuals
HIV infection–a risk factor for osteoporosis
CLINICAL Review # : low body weight mediates the relationship between HIV infection and low bone mineral density: a meta-analysis
Associations between dairy consumption and body weight: a review of the evidence and underlying mechanisms
Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study
Prospective study of bone mineral density changes in aging men with or at risk for HIV infection
Serum vitamin D concentration and potential risk factors for its deficiency in HIV positive individuals
Vitamin D levels and IL28B polymorphisms are related to rapid virological response to standard of care in genotype 1 chronic hepatitis C
Viral hepatitis is associated with reduced bone mineral density in HIV-infected women but not men
Pre-publication history
The pre-publication history for this paper can be accessed here:


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Books Direct Blog
- "Colors of the Sun and Moon" by Talia Aikens-Nuñez
- "My Friends Are All Strange" by Margaret Lesh
- "The Fighter and the Baroness" by Sunniva Dee
- "The Jakkattu Vector" by P. K. Tyler
"Colors of the Sun and Moon" by Talia Aikens-Nuñez
Posted: 30 Nov 2016 12:00 AM PST
REVIEW and GIVEAWAY
Colors of the Sun and Moon
by Talia Aikens-Nuñez
Colors of the Sun and Moon, a multilingual children's book by Talia Aikens-Nuñez, is currently on tour with I Am A Reader. The tour stops here today for my review, an excerpt, and a giveaway. Please be sure to visit the other tour stops as well.
For another book by this author, please check out my blog post on OMG... I Did It Again?!.
Colors of the Sun and Moon is an English/Spanish STEM book which featuring an inquisitive young girl and her grandmother. The bright illustrations engage children and illuminate the science of the horizon with vibrant colors.
An inquisitive young girl questions her grandmother about the science behind the colors of the sun and moon. With a forward by Spencer Christian. Colors of the Sun and Moon is the second book from the new multicultural, multilingual children's press, SundanceKid Press. The mission of SundanceKid Press is to promote cultural, ethnic/racial and linguistic diversity in children's literature. Each page includes the English text along with the Spanish translation.
As a young child, I was much like the little girl in this book – intensely curious about the wonders of the natural world – asking questions such as those put forth by young Gabriela, "Why is the sky blue; why are leaves green?" My search for answers took me on a fascinating path of discovery, which eventually led me to become a national TV weather forecaster.
If the child in you – or a child you know – finds the world to be a wondrous place, your path to discovery can be found in the pages of Colors of the Sun and Moon. Colors of the Sun and Moon is the story of 8-year-old Gabriela and her wise and loving grandmother – a grandmother who has the answers to all of her precious granddaughter's questions about the world of wonders they see around them. While Abuela's answers are simple enough for a young child to understand, they are factual and scientifically sound.
I applaud author Talia Aikens-Nuñez for giving her readers a story that is appealing on so many levels: it is educational, entertaining, and family-focused. What a rare combination of elements! As I read Colors of the Sun and Moon, images from my own childhood flashed in my mind, and I found myself smiling in amusement and amazement. I feel certain that the young reader and the not-so-young reader in your home will enjoy this book as much as I did.
– Spencer Christian, Weather Anchor for ABC 7/KGO-TV, San Francisco
My Review
By Lynda Dickson
Gabriela is a curious girl who always asks her Abuela (Grandmother) many questions. Abuela always seems to know the answers. Today, Gabriela asks her about the changing colors of the sun and the moon. Of course Abuela has all the answers.
The story's text is presented in both English and Spanish, providing young readers with an opportunity to learn to read the story in both languages. Other educational opportunities include teaching your child the different colors, as well as the science behind the changing colors of the sun and the moon. The illustrations by Amy Caringella are full of color and texture. The sequence of images showing the sunset and moonrise is particularly lovely. While the text is interesting, it ends abruptly, leaving the reader hoping for at least one more page. At some points in the text, Spanish is mixed in with English, which may lead to confusion. For example, Gabriela's grandmother is sometimes referred to as "Grandmother" and sometimes as "Abuela". This book could be improved by providing a summary of the facts learned in the story, as well as a list of some of the words (e.g., the colors) and their Spanish translations.
About the Author
Talia Aikens-Nuñez wanted to be a meteorologist, a politician and a lawyer. She never thought she would be a writer. It was the birth of her daughter that caused her to start writing. Raising a bilingual child inspired Talia to write lyrical children's books. Talia's family loves nature so much that she and her husband vowed that they will always try to live close to water. They live on a river in Connecticut with their kids.
Enter the tour-wide giveaway for a chance to win a $25 Amazon gift card or PayPal cash.
"My Friends Are All Strange" by Margaret Lesh
Posted: 29 Nov 2016 01:00 AM PST
REVIEW and GIVEAWAY
My Friends Are All Strange
by Margaret Lesh
My Friends Are All Strange by Margaret Lesh is currently on tour with Xpresso Book Tours. The tour stops here today for my review, an excerpt, and a giveaway. Please be sure to visit the other tour stops as well.
My friends are all strange.
Right now I'm living at Brookside, a place for people like me. I've met a kitty girl, a brooding beautiful boy, one who can't be touched, and others. My new friends. Strange people. People like me.
I've always been different, but lately, more so. My hands sometimes don't seem to be attached to the rest of me. I cut up all of my clothes. I'm hot, so hot, all of the time. If I sleep, a wizard haunts every dream. I don't sleep. Sometimes I want to run, but where do you run to when you're trying to escape your own mind? I don't know if I'll ever be the same. I'm smart. I'm nice, sometimes. I just want to be normal(ish). But, right now, my friends are all strange ... Like me.
Dark, funny, snarky, seventeen-year-old Becca struggles to cope with mental illness in My Friends Are All Strange, the gripping contemporary young adult companion novel to Normalish.
[Want more? Click below to read a longer excerpt.]
Praise for the Book
"The beginning of the story gave me the feeling of It's Kind of a Funny Story, and then TFIOS. I highly recommend this book for YA fans."
"Becca's wit is sharp and incisive, and if you've ever felt like you're on the outside looking in, you'll appreciate it as much as I did. And really, this is a book about healing, about accepting one's weaknesses and treasuring our own uniqueness."
"Teen emotional problems and mental disorders are portrayed with a tremendous amount of skill ... in this believable, realistic, and memorable storyline."
"Lesh creates characters who could be sitting in my classrooms--and I appreciate her for giving me these insights and expanding my 'looking at things through someone else's shoes' empathy. A beautiful book, both for its content and design."
My Review
By Lynda Dickson
Becca is a high school senior who crumples under the pressure of school and the weight of her insomnia. She has always been a little off. As she herself says, "It's just one of those things. You don't know you're different for a while." But her father's death two years earlier and the absence of his reassurance has finally sent her over the edge. After an incident at school, Becca is admitted to Brookside, a psychiatric care facility, where she unexpectedly befriends some of her fellow inmates: Kat, the Hello Kitty-loving perpetual child with a tragic past; the seemingly normal Bobby, who lashes out unexpectedly; and Carrie, the germophobe. While they seem to have no real desire to leave Brookside, Becca looks forward to resuming a normal life at school and with her boyfriend Roman, who remains her staunch supporter throughout. But, just what is "normal"?
This book gives us an eye-opening glimpse into the lives of the young inmates of a mental care facility. They don't all have psychiatric disorders, but are people not unlike you are or me, who are under undue stress, have made bad choices, or are the victims of circumstance. It poses the question: "Are our mind's problems sometimes an escape from the terrible, traumatic things that happen to us in real life?"
Ultimately hopefully, this book is a good tool for starting a conversation about mental health with the young people in our lives.
About the Author
California native Margaret Lesh lives in a narrow canyon populated by herds of wild burro and packs of coyote. The canyon is also populated with her creative, handsome husband, her feisty mother-in-law, her not-brave-at-all Border Collie, Echo, and sometimes her son (who is away at college. And she is not quite sure how that all happened so fast).
She writes books to entertain young and not-so-young readers as well as herself. She believes tacos are magic.
Enter the giveaway for a chance to win an ebook copy of My Friends Are All Strange by Margaret Lesh. The prize will be sent out after 21 December.
"The Fighter and the Baroness" by Sunniva Dee
Posted: 29 Nov 2016 12:00 AM PST
EXCERPT and GIVEAWAY
The Fighter and the Baroness:
A Modern-Day Fairy Tale
by Sunniva Dee
The Fighter and the Baroness by Sunniva Dee has just been released. This book blitz and giveaway is brought to you by Xpresso Book Tours.
For more books by this author, check out Shattering Halos (read my blog post), Leon's Way (read my blog post), Adrenaline Crush (read my blog post), Cat Love (read my blog post), Walking Heartbreak (read my blog post), Dodging Trains (read my blog post), and In the Absence of You (read my blog post).
Victor Arquette knows the meaning of sacrifice. Destined to legendary status in mixed martial arts, his life is founded on it. Dedication equals sacrifice, and sacrifice means around-the-clock training, no partying, no junk food, no alcohol - and no women.
Helena von Isenlohe is the heiress to Kyria Castle. Due to her father's lack of financial prowess, the restoration of the ancient German estate rests on Helena's shoulders. A failed attempt leaves a wealthy man alone at the altar - and the fleeing bride on a plane to the United States.
A chance meeting, and Victor and Helena's chemistry is undeniable. Except, her presence clutters his focus. Victor shouldn't crave their nights, shouldn't be concerned where she is or with whom. And meanwhile in Germany, Kyria Castle deteriorates at a suspicious speed, indebting Helena further to the man she left behind.
Victor and Helena believe in duty. They embrace sacrifice. But when love strikes, it strikes hard, and sometimes you have to choose where your heart is truly at home.
I'd rather not mull over what's going on right now.
The guys and I've been on a seven-day trip—five days in Munich working with a Brazilian Jiu Jitsu guru—and now I was just going to mosey on back home. Until this girl appeared out of nowhere, a wild dream in a flurry of white fluff and lace, breezing through security.
Disheveled and beautiful. Fairytale features and yellow hair flowing thick down her back. But what got me were the shoes in her hand. Until I bent and realized her feet were black with crap from the airport floor. She was mad and anxious and flustered. Oh hell, I couldn't walk away.
Now we're at another airport, and I still can't walk away. On the flight here, I prodded more about her life than I've done with any girl before. It's a risk to prod—the more you know, the more interesting they can get.
I guess I am mulling over what's going on after all. Am I taking these chances because Maiko didn't come along? Since her angina episode, she's been avoiding abrupt ambience changes, which in my mother's mind equals risks.
"The flight has been delayed overnight." Keyon's face is dark with annoyance.
"All right, I'm getting a hotel," I mutter.
"The plane leaves at six in the morning."
"Well, transit hotel then. I can't stay in a pub for eight hours."
Helena trails after me with her giant purse full of jewelry. She's a freaking vision. "So there's a hotel in the airport?"
"Yep. With the delays though, chances are everyone else will want a room. Better hurry." I squint at her. "Are you doing it too?"
She huffs. "What, you think I want to loiter in the transit hall all night? Get drunk with the guys? Oh wait, Zeke will take good care of me. That's right."
I chuckle at that.
I was right. The lobby of the only hotel in the transit hall is packed with travelers. I'm sure I'm out of luck once it's my turn, but the receptionist copies my documents and hands me a keycard. "Here you go, Mister. Enjoy your stay."
I thank her and exchange a relieved look with Helena. "I'm in three-oh-seven if you want to grab a bite to eat."
She's got a pretty mouth. It widens now, in a smile. I grab my backpack, hike it up on a shoulder, and lumber toward the elevator.
"I'm sorry, Ma'am. We have full occupancy tonight," the same receptionist I spoke with tells Helena.
"No way?" Helena says. "Please, I'll take anything. I'm not picky."
The receptionist shakes her head, repeating that she's sorry.
"Okay," I break in. "We're changing this up. She'll have my room."
Helena's grip on the countertop loosens as she turns to me. "Oh no, you don't." She returns to the receptionist again, shaking her head. "I don't want his room." She tucks her hair behind an ear and bends to her oversized purse on the floor.
I eliminate the distance between us. "Helena. Wait."
She does, eyes round.
"How many beds are there in three-oh-seven?" I ask the receptionist.
The girl tells me there's only one but that it's big. Clearly, she's onto my idea.
"Can we have some extra sheets and pillows sent up, maybe a few extra towels?" I ask.
"Victor, no…" From Helena's tone she's more surprised than against my idea.
"Why not? We'll watch films. Maybe we'll find Cinderella," I say, which makes her laugh.
Praise for the Book
"This book plastered a smile on my face from page one and it remained there long after 'The End'. It took me to a place of princesses and ball gowns and fairy tales and castles, and the girly-girl in me was absolutely in love." ~ Deedles
"OMG, what a fantastic story and I could not put it down. This was my first book by this amazing author and it will not be my last. [...] This story will hit all your emotion buttons and keep you wanting more. This is a must read, so do yourself a favor and download this book." ~ Rhonda
"I would read Sunniva Dee's summary of a takeout menu. The woman can write, so when I had the opportunity to check out this latest gem, of course I couldn't wait to dive in. I immediately lost my heart to this modern fairytale that had all the heat, realism, and passion of her other works." ~ Alyson Santos
"I actually held my breath at one point in Dee's story. I was so worried about the outcome. But of course, the worry was for naught. How this story ends is more than wonderful. It really is a modern day fairy tale. The Fighter and the Baroness will have readers believing in the power of love and justice." ~ Amazon Customer
"This book is PHENOMENAL. Absolutely my favorite Sunniva book so far. The writing is simply amazing! A beautiful fairytale in a contemporary-romance setting." ~ Lauren (Romance Novel Giveaways)
About the Author
Between studies, teaching, and advising, Sunniva has spent her entire adult life in a college environment. Most of her novels are new adult romance geared toward smart, passionate readers with a love for eclectic language and engaging their brain as well as their heart while reading.
Born in the Land of the Midnight Sun, the author spent her early twenties making the world her playground: Southern Europe (Spain, Italy, Greece), Argentina (Buenos Aires, in particular). The United States finally kept her interest, and after half a decade in Los Angeles, she now lounges in the beautiful city of Savannah.
Sometimes, Sunniva writes with a paranormal twist (Shattering Halos, Stargazer, and Cat Love). At other times, it's contemporary (Pandora Wild Child, Leon's Way, Adrenaline Crush, Walking Heartbreak, Dodging Trains, and In the Absence of You).
This author is the happiest when her characters let their emotions run off with them, shaping her stories in ways she never foresaw. She loves bad-boys and good-boys run amok, and like in real life, her goal is to keep the reader on her toes until the end of each story.
Enter the blitz-wide giveaway for a chance to win a $25 Amazon gift card.
"The Jakkattu Vector" by P. K. Tyler
Posted: 29 Nov 2016 02:02 PM PST
REVIEW and GIVEAWAY
The Jakkattu Vector
(Jakkattu Book 1)
by P. K. Tyler
P. K. Tyler has just released The Jakkattu Vector, the first full-length novel in the Jakkattu series of sci-fi thrillers! Also available for only $0.99 each: Avendui 5ive (read my blog post) and Twin Helix (ready blog post).
The Jakkattu Vector is currently on tour with Novel Publicity. The tour stops here today for my review, an excerpt, a short interview with the author, and a giveaway. Please make sure to visit the other tour stops as well.
More books and stories by this author: White Chalk (read my blog post), Dead Girl (read my blog post), Heaven's Vault (read my blog post), Alt. History 101 (read my blog post), UnCommon Bodies (read my blog post), Mosaics Volume 2 (read my blog post), CLONES: The Anthology (read my blog post), UnCommon Origins (read my blog post), and Book of Lilith (read my blog post).
They came as saviors to a deteriorating Earth.
Julip Thorne questions whether there is more to life beyond the barren dirt, acidic seas, and toxstorms her people work and die in. Living in poverty on the withering Greenland Human Reservation, she wonders if the alien Mezna goddesses are truly as holy as the temple preaches. Julip begins to dig deeper into the history of the planet and her leaders' rise to power. But nothing can prepare her for the atrocities she uncovers.
Meanwhile, Jakkattu prisoner Sabaal suffers constant torture and heinous medical experiments as her Mezna-priest captors seek to unlock the key to her genetic makeup. Escaping from captivity, she finds herself suddenly alone on the hostile alien planet of Earth. To survive, she's forced to work with the same Mezna-human hybrids she's loathed her entire life, but the more they work together, the more they realize that their enemy is the same.
When humans and Mezna collide, will Sabaal turn out to be the genetic vector the Mezna have been searching for all along, or will she spark the flame that sets a revolution ablaze?
The Feral
It started to rain as they walked, but Norwood kept an impossible pace. Julip slipped and fell more than once, but he just kept going. She guessed he was right to hurry; they had to get back before nightfall so they didn't get caught. Ma would be furious as it was, what with them gone missing for so much of the day.
The sky darkened despite it still being midday, and clouds rolled in behind them. Back home it would be a mess. Rain put everyone in a sour mood. The sea was too volatile to risk going out when it stormed, and while the rainwater was clean and safe, the ocean steeped in chemicals that could peel a person's skin before too long. Their father had burning water scars up and down his arms and speckled across his face from working as a jellyfisher for so long. By comparison to other men who worked the sea, he had remained pretty intact.
The Cotillion was probably having a great time. Rain meant clean air and fresh water, for a little while at least. Sometimes if the rain came at the same time as a toxstorm, it would bring the fumes down to Earth, keeping everyone inside for days, sometimes weeks. The last time that happened, Julip had been nine and was forced to stay in her parents' dwell with no one but her brother for nineteen straight days. The damage the fumes caused still marred the walls of the bedroom they shared.
The siblings had complained, begged to be allowed outside, but nothing they said or did would convince the adults to let them go. Only her father ventured out to pick up a daily ration of food and water from the Center-of-It-All. He would bundle up, covered from head to toe in fabric and plastic. Even his head was wrapped in one of her mother's scarves, and his eyes hid behind goggles he'd made out of extra window plastic.
Thirteen people died during that storm, and two more were blinded. For months after, there was a rash of stillbirths on the reservation. The Daughters all agreed that the fumes had come down and poisoned the babes. It'd been five years since the last bad toxstorm whipped through Greenland, so one was due to come soon. Julip loved the cool rain as it soaked through her scarf. She uncovered her head and felt the water trickle down her face and saturate her hair. Parents would take the littlest kids on the rez outside, strip them, and scrub them red. Clean rain meant a real washing, not a quick, timed wipe-down with the gray water from the sinks.
Norwood pulled a canteen from his trouser pocket and caught drips of water from the oversized leaves surrounding them. The trees weren't much taller than him, but the forest canopy closed in as they walked. Soon they walked on dry earth, and the only remaining evidence of the rain was the heaviness of her hair and the sound of water dripping on leaves high above.
"I've never been deep in the Wilds," she said.
"Ya've never been shallow in the Wilds."
"True, but there ain't even words for this back home. It smells different, dirty, but my nose ain't pained by it."
"'Cause it's real. This dirt is from the Earth, not the toxes."
"Why do we have so much tox on the rez if this is right here?"
"I dunno, but I reckon it's 'cause we're human. People made the toxes. In some way, I guess it's only right we live in 'em."
[Want more? Click below to read a longer excerpt.]
Praise for the Book
"Descriptions are lush and easily visualized, backed with characters that, despite their differences are accessible to everyone, even as you wonder what could happen next. Wholly new and different – there is a sense of this could (did and may be already) happen should we lose the ability to see the similarities in our differences." ~ Gaele
"This is genre-busting at it's very finest. There's a little bit of everything in here and it's done with such skill and flair I'm practically speechless. The Jakkattu Vector is like nothing I've ever encountered before. [...] On the surface it's dystopian science fiction. But this cleverly hides a political thriller with hints of horror and romance thrown in to round out the flavor. In the hate-mongering climate we live in today, this is a timely reminder to us all to believe nothing at face value and question everything we're told." ~ Kristen Lewendon
"As with any series, the first has the daunting task of not only creating the world for the reader, but keeping them there, and The Jakkattu Vector does so very well. Taylor's world building is complex, but well-planned and written so that the reader can very quickly become immersed in the story, providing just enough back story where needed, and always keeping the plot steaming forward at a good pace. It's definitely a bleak tale, with some shocking moments, but manages to keep its head above water long enough to keep the reader absorbed, and although there is an underlying tinge of hope that runs through the narrative, it remains to be seen whether the characters will harness it, or fall foul of their baser instincts. The Jakkattu Vector is a well-crafted, compelling read, often provocative and thought-provoking without being overly preachy, and benefits from putting the story first, while still addressing many important issues in today's society. More importantly, it's also great sci-fi, and I look forward to reading more in this series." ~ Eamon
My Review
By Lynda Dickson
The Mezna are hailed as saviors when they come to a toxic Earth to save the human race. But what are they really after? In a world of interminable dust, toxstorms, and acid oceans, the Mezna build their hygienic terraformed cities which house the Miscegenate blue-eyed Mezna-human hybrids and the half-robot teks. Outside their cities are the Human Reservations, where the people live in poverty and squalor. And, in the Wilds in between, live the Undone, humans born with severe birth deformities and considered monsters. The Jakkattu Vector interweaves the stories of Sabaal, a native of the planet Jakkatta who escapes from a Mezna breeding facility, and Julip, a fifteen-year-old girl from the Greenland Human Reservation. Insignificant as they might seem, their meeting might just spark a revolution.
The author continues to build the world we encountered in Avendui 5ive and Twin Helix. Here we are introduced to a matriarchal society where Jesus's mother is the supreme deity - Mother God - and where the men are uneducated and only considered good for labor and for breeding. We meet interesting characters from all parts of this new world, and we follow a number of different storylines until they come together in a thrilling climax. Even though the book is science fiction, its message is applicable to today's world. It is a timely warning to all humans about the consequences of continuing to treat the Earth the way we do. We are also given a heartbreaking look at how ignorance can turn people against each other, how people who are basically the same can turn on each other for being slightly different, how discrimination if often based on lies and unfounded beliefs, and how religion can be used to brainwash its followers.
This is story-telling at its finest. While this story is complete, I can't wait to read the next installment of this enthralling new series, The Jakkatu Insurrection.
Guest Post by the Author
Hi Pav. You're the head of marketing for Novel Publicity, a business woman, and an award winning author. What does a typical day work day look like for you?
A lot like this:
How do you find balance between working life, your family and everything else?
Have a forgiving spouse? I don't do everything, I can't. It's just not possible. Thank god for a man who loves to cook and clean! My kids are getting older now so they need less of my focus and more of my driving skills, so I do a lot of reading in the car waiting for them. I don't know how to organize it, I kind of just do it. I'm really walking talking chaos so I'm the wrong person to give advice on this.
Do you have any tips for those of us that work from home?
I'd say the most important thing is to accept that you can't do it all and not only is that okay, it's normal and good.
About the Author
P. K. Tyler is the author of Speculative Fiction and other Genre Bending novels. She's also published works as Pavarti K. Tyler and had projects appear on the USA Today Bestseller's List.
Pav attended Smith College and graduated with a degree in Theatre. She lived in New York, where she worked as a Dramaturge, Assistant Director and Production Manager on productions both on and off-Broadway. Later, Pavarti went to work in the finance industry for several international law firms.
Now located in Baltimore, Maryland, she lives with her husband, two daughters and two terrible dogs. When not penning science fiction books and other speculative fiction novels, she twists her mind by writing horror and erotica.
Enter the tour-wide giveaway for a chance to win a Kindle Fire, a signed paperback copy of The Jakkattu Vector by P. K. Tyler, P. K. Tyler's entire paperback collection, or a special Jakkattu bookmark.
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