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QuWeekly is the official weekly newsletter of the Harvard College Office of BGLTQ Student Life. QuWeekly is an extension of the office's programming efforts, serving as a newsletter to feature stories, promote BGLTQ events, and spotlight resources that aim to build community in the houses and on the Yard. Subscribe to QuWeekly by joining our list.
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Sat 9/10/11 1:00 PM
Morgantown, WV
Mountaineer Field
Record: 1-0
Rank: 19/24
Last Game
Marshall W 34-13
Radio: MSN
Web: BlueGoldNews.com
Record: 1-0
Rank: NR
Last Game
Virginia St. W 37-3
Rosters/ Bios
Game Notes
Season Stats
2011 Schedule
Series: First Meeting
First Meeting: NA
Last Meeting: NA
Game Notes
Season Stats
2011 Schedule
After defeating Marshall last week, West Virginia is now 11-0 all-time against the Thundering Herd. The Mountaineers are also 11-0 all-time against FCS opponents (since that division has been created), and look to extend that streak to 12 against Norfolk State. Which winning streak is more likely to end first? You make the call.
Prior to the season, NSU backup quarterback Nicco Flores was expected to play a prominent role in the Spartan offense, perhaps even to the point of splitting time with starter Chris Walley. However, after Wally lit up Virginia State a week ago, how much might Flories be expected to see the field?
The UCF transfer certainly has the ability. In fact, he was on the field for the Spartans first offensive play against Virginia State, and was thus listed as the starter. He finished the game with seven carries for 17 yards, and also completed one pass for five yards in his only attempt. Flores is probably a run-first player, so WVU will be wise to check the normal array of quarterback keepers and zone reads when he comes into the game.
While there has been a good bit of talk about Norfolk State's defense playing the same scheme as West Virginia, there's at least one difference that should be apparent right from the start. NSU plays a 3-4, rather than the 3-3 which WVU employs. That doesn't mean, though, that the two defenses might not share similarities in the tactics they employ.
WVU, in its 3-3, brings often brings the spur down to give its defense a 3-4 look, and can adjust its outside backers and bandit to present multiple front. Likewise, the Spartans might stack one or more of its linebackers directly behind down linemen, thus giving its defensive a similar pre-snap look to some of West Virginia's base defenses.
The upshot of all this? Keep an eye on both defenses, and see how they accomplish the same goals with different initial alignments. It should, if nothing else, point out the fact that schemes, and the labeling of such, might be a bit overrated in terms of what success they bring.
WVU's outstanding 2010 defense crossed the line for stops on a regular basis in 2010. The Mountaineers finished with seven or more tackles for loss in seven contests, including a season-high 10 tackles for loss against both USF and Rutgers.
Last week, WVU continued that pace with seven stops in the Marshall backfield, with eight different players taking part. Will Clarke (The Blue & Gold News defensive player of the game) led the Mountaineers with 1.5 tackles for loss, while Bruce Irvin, Keith Tandy, Tyler Anderson, Jorge Wright, Najee Goode, Pat Miller and Terence Garvin also got in on the action.
Those stops helped WVU hold the Herd to just 72 rushing yards, which also compares quite favorably with last year's squad, which yielded 86.5 yards per outing.
Position changes were in evidence for both teams after their openers a week ago. For WVU, Quinton Spain has been moved from tackle to guard on offense. For Norfolk State, Justin Myler moved from the offensive line to the defensive line, and is expected to see action against the Mountaineers.
Norfolk State's conference, the MEAC, is also in the midst of an expansion process. The league expanded to 13 full-time members, including 11 football-playing institutions, with the additions of North Carolina Central and Savannah State this fall. Each league member will play eight conference games per year.
While this doesn't have any effect on the conference shuffle in the FBS, it does raise some interesting points. Leagues could play with an odd number of teams for a year or two, although that certainly wouldn't be the most desirable train of events.
Norfolk State opened the season in the aptly named Labor Day Classic on Sept. 3 against Virginia State, and faces nearby foe Hampton in the "Battle of the Bay" on Oct. 15. In between, the Spartans face South Carolina State in something called the "Fish Bowl Classic" on Oct. 1. We're offering a free one-month subscription to the first person that can give us details on the origin and history of the Fish Bowl Classic. Email your entry to email@example.com.


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Michael Cimino
The Deer Hunter
In this Oscar-winning epic from director Michael Cimino, a group of working-class friends decides to enlist in the Army during the Vietnam War and finds it to be hellish chaos -- not the noble venture they imagined. Before they left, Steven (John Savage) married his pregnant girlfriend -- and Michael (Robert De Niro) and Nick (Christopher Walken) were in love with the same woman (Meryl Streep). But all three are different men upon their return.


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Guest Blog: Chris Measures, Building your creative business – part 2
Building your creative business – part 2
Last month I talked about how to set up and start your creative business. So, once you've done that and the honeymoon period is over, how do you keep the momentum going? Like anything new the first few months of your own business are incredibly exciting, but when it becomes the norm how do you keep yourself motivated and interested?
Based on my three years running my own company here are five tips for keeping that 'just launched' feeling going:
1. Get out of the house
Most one person creative businesses are based at home. While this is logical and cost-effective too much of your own company can drive anyone mad, so you need to get out and meet other people. Network, travel to relevant events or even have offsite planning sessions to change your surroundings and talk to people face to face. If you know other one person businesses (and they've got the space) why not spend a day week sharing their office to give you someone to bounce ideas off?
2. Find like minded people
I mentioned the importance of mining your contacts for new business when you started up, but don't neglect ex-colleagues who might be doing something similar to yourself. Keep in touch with them and see if you can collaborate on jobs. Not only will it enable you to pitch for bigger pieces of business, but it will help create a virtual agency of your own, where you can share resources, information and ideas. And at the very least it will give you people to ask for advice when the going gets tough.
3. Learn new skills
Such is the rate of change in the creative industries that you need to be continually expanding your knowledge. One of the advantages of working for a big company should be that they have training programmes that help you learn these new skills, but working for yourself doesn't stop you educating yourself. Look around for courses that you can take that will extend your services. These could be run by industry bodies (such as the Chartered Institute of Marketing or Chartered Institute of Public Relations), local business associations or vendors trying to sell their services. Failing to learn new skills will hit you in two ways – you'll get bored doing the same thing day after day and clients will pigeonhole you without room for you to grow your work with them.
4. Take a break
The temptation when you run your own business is to be available 365 days a year 24x7, but this is a recipe for an unhealthy work/life balance, stress, burn out and an upset partner/family. Be clear with clients when you are going to be off work and, if necessary, turn down jobs if they are going to clash. It is better to be up front with people rather than promising what you can't deliver. If you've built up a network of like minded colleagues you can ask them to baby sit clients while you're away, and return the favour when they're on holiday. However you do it, you need to take breaks if you want to return revitalised, fresh and ready to take your business forward.
5. Think about the future
Most creative businesses are selling time, which is a finite resource – so what do you do when you reach the happy stage of being full? Once your business has settled down you need to plan for what you do next. Do you want to grow and employ people, simply work for yourself or bring in freelance support for bigger jobs? Your choices will impact how you operate and evolve the business going forward. Whatever your decision have a plan, with targets to help keep motivation high and prevent things drifting.
When you start your new business there's an inevitable rush of excitement – building momentum beyond this can be tricky, but the key thing is to keep learning and meeting new people so that you develop and don't get bored. Otherwise you may find that working for yourself becomes as unrewarding as the job you left to set up on your own………..
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Northern Maine Medical Center, Fort Kent, Maine
To Martin Taggett and Bobbi Lee Martin of St. Francis, a daughter, Jemma Lynn Taggett, Aug. 21, 2012. Maternal grandparents are Louise Martin and Joe Jackson of St. Francis. Paternal grandparents are Judy and Dale Taggett of St. Francis.
To Dillon Cote and Kelsey Denis of Fort Kent, a son, Dustin John Ouellette, Aug. 21, 2012.


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3D Ultra TrainTown Deluxe
Note: You must enter these codes during a job.
Code Effect NoFuel Allow Trains to run forever without using any fuel. NOTE: You need the 1.1 patch. Lionel Complete a job Gimme Control all cars Andrew Give 30 second bonus Chris Give 300 second bonus Movelt Give the all trains a speed increase Load Load the selected car Neal Refuel the selected car CominThru Remove things in your way JCarey Repair broken switches FixAll Repair track problems JobBoss Trigger a special job cheat Kelle Turn off speed limits Paul Unload the selected car Brian Unlock jobs in job bin
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text: Dark Streets - less pno verb by Mike Gorman published on 2013-05-02T13:13:43Z Examples of music I have written for various briefs/jobs in the TV and Library music field. Some tracks have already been used, some are available for use. I can also write fresh tracks based on the style/content of any of these. Contact me for details. Genre Tv music


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(2/5 stars) I don't finish very many lousy books; I'm selective about what I read in the first place, and if I don't like a book, I'll put it down. The 4-Hour Workweek was an exception. Despite having serious issues with the book, I hung on because I hear about it on nearly a daily basis, and because there were occasional jewels. It is those jewels that get the book a second star, but make no mistake: this book is mostly a fraud.
With a title like "The 4-Hour Work Week", you know Ferriss is selling snake oil. Just picking the book up off the shelf requires saying to yourself, "I know I'm about to be defrauded, but what the hell." We want so badly to believe what the author is promising, we pick it up anyway. If the problem was just a punchy title, the book might be tolerable, but there are hundreds of these moments throughout. You'll be part of the "New Rich"; with a couple weeks of setup, you'll have a business that turns high profits with zero work; you'll quickly and easily outsource your entire life to a virtual private assistant in India; you'll improve your productivity X% by following this one simple tip; you'll keep a good job and live like a king, while never needing to attend another meeting or talk to another human being again. If you're a reasonably intelligent person, an inner voice should be telling you "it can't be that easy", but you have to squelch that voice in order to keep reading.
Although Ferriss goes to great lengths to insist he is ethical, his is a strange brand of ethics and values. He advocates all manner of deception to shirk work. He advocates advertising and selling products that don't actually exist yet, to test a market. That's great for the reader–sitting on a lawn chair on a beach in Rio de Janeiro, saving himself time–but not so great for deceived customers who waste their own precious time placing product orders that the company will, regrettably, be unable to fulfill. Ferriss tells his readers how to become recognized "experts" on anything in a few weeks, by reading one or two books on a given subject and then gathering worthless but impressive-sounding credentials and landing mutually reinforcing interviews as a subject-matter expert. But don't worry–he explains how this is not actually deceptive. As for the products Ferriss sells and advocates, they reflect a similar concern for quality. Ferriss made his first fortune on an unscientific sports supplement he called a "neural accelerator, marketed infomercial-style by experts… probably of the same pedigree just discussed. Oh, and if you dig around on the net, you'll find plenty of discussion suggesting that Tim is outright lying to his readers about the business' profitability. And if you're still not convinced that the promise of a "four hour work week" is snake oil, check out the bitter reviews written by people who carefully followed his formula to get a "four hour body."
Ferriss also seems to have a deep disdain for most people, and his entire model is built around minimizing or eliminating human contact in the workplace. If you actually like the people you work with, or feel that taking genuine interest in your coworkers' lives is a human responsibility and virtue, this book isn't for you.
What makes all this so unfortunate is that Ferriss really does have something to offer: passion and vision for living a wonderful and unconventional life. Most of us are capable of achieving far more than we dream of, and Tim is an excellent coach for pursuing dreams and overcoming fears. These sections of the book were excellent. He's also really onto something, when laying out the math of how affordable foreign travel can be. Finally, the book has some genuinely good suggestions for increased productivity.
It's too bad that to find these jewels, the reader has to slog through hundreds of pages of oversold promises about easy riches. I won't tell you not to read this book, but before you fall under Ferriss' spell, go pick up an issue of "Entrepreneur" magazine and a couple biographies of business leaders. You'll find inspiring stories about people who took control of their lives, but you'll also find sweat, tears, and a hell of a lot of work.


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Intex has extended its Aqua series with a new smartphone dubbed as Intex Aqua Strong 5.1. The smartphone is now listed on company's website at Rs. 5,590 and will be offered in White, Blue, and Champagne color variants.
The Intex Aqua Strong 5.1 features a 5-inch FWVGA (854 X 480 pixels) display with Corning Gorilla Glass 2 protection. It is powered by a 1.0GHz quad-core MediaTek MT6735 processor, coupled with Mali [...]
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The man accused of sexually assaulting and bashing to death Sydney teenager Mahmoud Hrouk will remain behind bars, while the results of a post-mortem examination on the 16-year-old will not be known for at least three months.
Topics: law-crime-and-justice, courts-and-trials, murder-and-manslaughter, fairfield-2165, campbelltown-2560
A man clashed with a reporter outside Fairfield Local Court on July 17, 2015, after a hearing for the man accused of the murder of teenager Mahmoud Hrouk.
Topics: courts-and-trials, murder-and-manslaughter, fairfield-2165
Posted| Updated
Supporters of a 22-year-old charged with the murder and aggravated sexual assault of 16-year-old Mahmoud Hrouk clash with the media outside a Sydney court after the man is refused bail.
Topics: courts-and-trials, law-crime-and-justice, murder-and-manslaughter, nsw, fairfield-2165
Posted| Updated
A Sydney mayor details his brush with an extortion attempt via networking website LinkedIn, warning users to be wary of "sexploitation".
Topics: police, government-and-politics, fairfield-2165, nsw, sydney-2000
Posted| Updated
The parents of a missing teenage boy discover a brutally bashed body, believed to be that of their son, in a vacant house in Sydney's south-west.
Topics: murder-and-manslaughter, police, fairfield-2165, villawood-2163
Posted| Updated
A 23-year-old man is found shot dead in his house in Horsley Park, police say. The man's housemate told officer he thought the victim had answered a knock at the door before being shot.
Topics: police, death, horsley-2530, fairfield-2165
A woman and a 10-year-old boy are taken to hospital after their car crashed into a shop in Sydney's west.
Topics: accidents, fairfield-2165
Posted| Updated
This weekend's Tet Festival is expected to draw 60,000 people as Sydney's Vietnamese community celebrates the Lunar New Year.
Topics: community-and-society, fairfield-2165
Posted| Updated
More than 100 young migrants and refugees take part in a soccer tournament at Fairfield in Sydney's west to send a message of unity in the wake of the Sydney siege.
Topics: community-and-society, immigration, refugees, terrorism, fairfield-2165, sydney-2000
Posted| Updated
A criminal lawyer who has represented a string of clients charged with terrorism offences says comments the Prime Minister made in Parliament this week could poison a jury against two men accused of planning an attack.
Topics: law-crime-and-justice, government-and-politics, courts-and-trials, terrorism, unrest-conflict-and-war, abbott-tony, parliament, federal-parliament, australia, nsw, sydney-2000, fairfield-2165
Topics: terrorism, fairfield-2165
Police have briefed the media over the arrest of two men on terrorism related charges yesterday afternoon.
Topics: fairfield-2165
Posted| Updated
One of two men at the centre of an alleged Sydney terrorist plot recorded a video in front of an Islamic State flag just 20 minutes before heavily armed officers stormed the pair's makeshift home, police say.
Topics: police, sydney-2000, fairfield-2165
Posted| Updated
Whether you are a beginner looking for a cheap bicycle, or looking for a child's Christmas gift and cannot afford a new bike, these volunteers have the bicycle for you.
Topics: cycling, charities-and-community-organisations, charities, volunteers, fairfield-2165
Posted| Updated
The ABC spends a night with Sydney police to find out what it is like for officers dealing with the sad and violent reality of domestic abuse.
Topics: crime, crime-prevention, domestic-violence, fairfield-2165
Posted| Updated
Police set up a strike force as they search for four men who threatened a pregnant bank employee during a series of armed robberies and attempted car-jackings in south-western Sydney.
Topics: sydney-2000, chester-hill-2162, auburn-2144, fairfield-2165
Posted| Updated
Dr Sharobeem survived a violent arranged marriage to lead the way for women's rights.
Topics: womens-health, women-religious, australia-day, fairfield-2165
Posted| Updated
As hundreds of thousands of Iraqi Christians and Yazidi refugees flee Islamic State militants, family members living in Australia are hoping to secure special humanitarian visas for their loved ones.
But groups representing the communities say the 4,000 places freed up by the Government are far too few.
Topics: refugees, immigration, community-and-society, unrest-conflict-and-war, terrorism, foreign-affairs, fairfield-2165, sydney-2000, nsw, australia, iraq
A man is dead after being stabbed in the neck at Greenfield Park in Sydney's west.
Topics: crime, greenfield-park-2176, fairfield-2165
Posted| Updated
Iraqis in Sydney have met to discuss measures to prevent the crisis in their homeland from fuelling violence locally.
Forum organiser Husam Shkara from the Australian Iraqi Forum said there were concerns the extremist insurgency in Iraq could spark tensions in the local community.
"We haven't experienced any problems so far but we've been proactive in this area." he said.
"We are in dialogue with our local area [police] commanders in different areas such as Fairfield and Bankstown to stop culprits spreading poisonous messages.
"We need to target our community leaders and organisations and spread the word of peace and harmony."
Topics: unrest-conflict-and-war, terrorism, community-and-society, islam, sydney-2000, iraq, bankstown-2200, fairfield-2165, mount-pritchard-2170
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Psychologist Eman Sharobeem has not heard from one of her regular clients for three days and she is worried.
Topics: domestic-violence, law-crime-and-justice, religion-and-beliefs, marriage, immigration, women, womens-health, fairfield-2165, australia
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Police say they have broken up a Middle Eastern crime gang that was once linked to the 1997 murder of police officer David Carty.
Topics: crime, police, prairiewood-2176, fairfield-2165, green-valley-2168
Posted| Updated
Residents of the Sydney suburb of Fairfield are struggling to understand how two teenagers could be gang-raped in a public park in broad daylight.
Topics: sexual-offences, fairfield-2165
Posted| Updated
Police are seeking information on three men wanted over the sexual assault of two schoolgirls in Fairfield Park in Sydney's south-west.
Topics: sexual-offences, assault, fairfield-2165
Posted| Updated
A man has been charged after he allegedly assaulted a man in a wheelchair at a train station in Sydney's west.
Topics: assault, police, disabilities, fairfield-2165, liverpool-2170


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First Daughter (2004)
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Samantha MacKenzie, the daughter of the president of the United States, arrives at college with a group of Secret Service agents. Samantha, however, resents their presence and decides she wants to attend school just like a normal student. Her father agrees to recall the agents but secretly assigns James, an undercover agent, to pose as a student. They fall in love, but their romance is jeopardized when Samantha learns James' true identity.Starring: Katie Holmes, Marc Blucas, Michael Keaton, Margaret Colin, Lela Rochon, Ameriie
Links: Posters, IMDb
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|Message view
|« Date » · « Thread »
|« Date » · « Thread »
|Pierre-Arnaud Marcelot ...@marcelot.net>
|Re: [ApacheDS] adding a global trust manager
|Tue, 23 Oct 2012 08:14:01 GMT
Hi Kiran, On 23 oct. 2012, at 08:09, Kiran Ayyagari <firstname.lastname@example.com> wrote: > Hi All, > > I am currently implementing an X509 trust manager that is used for > checking client certificates while using TLS for replication. > > This trust manager can work in any one of the two modes > 1. trust all (default mode) > 2. trust only the specified certificates Sounds cool. :) > In the 2 mode trust manager loads a set of certificates stored in > DiT under ou=certificates,ou=system (a new branch) [1] Sorry to hijack a little the original topic here, but I think its related. I really think we should get rid of the system partition, it has no use and the only interesting thing it still holds is the default/admin user. Everything that is configurable (including the default/admin user) has its place in the configuration partition. That includes the certificates you're talking about. ATM, the default password is not included in the configuration and it makes it uncomfortable having to first launch the server to be able to edit this value. It would be the same thing for those certificates. I think the configuration partition should really be the place where we store everything that can be configured. Once that's done, the system partition has no reason to exist anymore WDYT? > and checks against this list. The certificate that is not present > in this list but is signed by a known CA will be trusted > automatically. > > The initial idea is to use this trust manager only for replication > connections, but I would like to know your thoughts about using it > in StartTLS and LDAPS connections by default? Sounds like a good idea to me. There's a related issue on the API as well (with some kind of a patch proposal). https://issues.apache.org/jira/browse/DIRAPI-72 Regards, Pierre-Arnaud > [1] am thinking of replacing the unused > prefNodeName=sysPrefRoot,ou=system branch with > ou=certificates,ou=system, please raise any > objections you may have w.r.t this change. > > > -- > Kiran Ayyagari > http://keydap.com
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|Kaspar Brand <httpd-dev.2...@velox.ch>
|Re: [Result] Re: [Vote] Add commentary system to httpd docs
|Mon, 21 May 2012 06:07:42 GMT
On 20.05.2012 14:47, Daniel Gruno wrote: > This will effectively make for two (or three) new votes for adopting > each piece: > > - Adopt a privacy policy for the docs and refer to the various tracking > methods used as they get implemented - see the draft at > http://wiki.apache.org/httpd/PrivacyPolicy Thanks for preparing this draft. As previously stated, I consider such a policy a mandatory requirement before integrating any tool into httpd.apache.org which systematically processes user data [1]. The section "Additional tracking by third parties" of the draft currently says: "The Apache HTTP Server project makes use of additional third party tools, such as the Disqus commentary system, which itself may apply visitor tracking for internal purposes." In the interest of an early declaration, let me say that I'm (rather strongly) opposed to running the project's site in a way that requires us to have such a generic disclaimer in the privacy policy, for several reasons. First, my expectation would be that an ASF project, and in particular ours, is able to run the infrastructure of those features it considers essential for its operations on its own. It's true that some other projects are using Google Analytics, but this doesn't mean that others should follow this practice, IMO. Second, I see several technical issues when integrating third-party tools which basically rely on JS code being injected into the HTML on httpd.apache.org: "surreptitious" tracking is one of them, but it's also problematic from a security point of view: by pulling in JS from remote URLs we expose our visitors to the risk of running untrusted code in the context of our site. (As an aside: having to turn off JS for httpd.apache.org as a whole, as - rightfully - suggested in the draft privacy policy for effectively turning off GA, would have the collateral damage of disabling the newly-added syntax highlighting as well, which seems quite unfortunate.) Third, *iff* we really decide to do user tracking on httpd.apache.org, it should at least be opt-in, not opt-out, in my view (i.e., we should e.g. make sure to honor "DNT: 1" headers before pulling in JS tracking code, and ensure that visitors agree to being tracked before we do so). > - Implement the Disqus commentary system for the docs - see the proposal > at http://wiki.apache.org/httpd/DocsCommentSystem In the meantime I skimmed over its Terms Of Service [2], and it took me only a short time to identify several elements which made me quite worried: a) User Content: Disqus is granted a "a royalty-free, sublicensable, transferable, perpetual, irrevocable, non-exclusive, worldwide license to use, reproduce, modify, publish, list information regarding, edit, translate, distribute, syndicate, publicly perform, publicly display, and make derivative works of all such User Content" etc. b) Changes to the service: "We may, without prior notice, change the Service; stop providing the Service or features of the Service, to you or to users generally; or create usage limits for the Service." c) Advertisements: "You agree that Disqus may include advertisements and/or content provided by Disqus and/or a third party (collectively "Ads") as part of the implementation of the Service." This just a small sample of rules I consider highly problematic, and to be honest, they pretty much rule out the option of using Disqus on httpd.apache.org, I think. PHP's system, on the other hand, uses an approach [3] I'm completely comfortable with: no dependencies on third-party sites, comments are covered by a Creative Commons license, and do not rely on any remote JS code or so. > - Implement visitor tracking for the docs so we can improve on them - > see proposal at http://wiki.apache.org/httpd/DocsAnalyticsProposal I would highly prefer Piwik over the others (or more generally: a tool we run ourselves, not a third-party service). Kaspar [1] see also http://firstname.lastname@example.com%3E and other messages in that thread, e.g. [2] http://docs.disqus.com/help/29/ [3] http://www.php.net/manual/add-note.php
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text:
Give 10 Year Old Colin a LIKE for his birthday!
This mom started a facebook page for her 10 year old son who was diagnosed with disorder similar to autism. She asked her son about throwing him a birthday party and he said he didn't have any friends.
She set up this facebook account to show him how many people cared about him. https://www.facebook.com/Coliniseleven
She also set up a P.O. Box where people can send cards: PO box 756 Richland, MI 49083-0756
Give him a like!


text:
by Trish Jones
(Chicago, Illinois)
Getting through my anniversary was really tough. Joe always gave me the most awesome cards. He would stand by the Hallmark rack for an hour until he found just the right one. He would then underline key words and sentences, write ~ I love you more than I did last year, sign his name and the date. I missed not getting a card this year but I have all 37 from the previous years.
Yesterday was a really tough day. I received an invitation to my old neighbor's daughter's 50th birthday party. Their daughter was in my sister's bridal party when she married 28 years ago as was I. We had no idea we had purchased a home next door to my sister's best friend's parents. We were very pleased. We had the most wonderful neighbors ever.
Joe and I were forced to sell our home last fall. The University of Chicago informed us that our portion of Joe's heart transplant would be approximately $500,000.00. Sure...do you take Visa? As home owners we didn't qualify for any assistance. We had no choice but to sell our home at no profit. The little bit of money we got went directly to medical bills. You do everything you're supposed to do, keep your credit in stellar condition and get penalized for it. Within a two month period I left my job and the security that went with it, had to put down our beloved pet of 18 years, moved from our home to an apartment and lost my husband. Joe died three weeks after we moved. I hadn't even finished hanging the pictures on the walls.
As I got out of the car every glance indicated that a new family was now living in "my" home. I think my knees buckled a little. I was so happy to see all of our old friends and neighbors. I had 10 people come to me and tell me what a fabulous husband I had. They all told me they miss him too.
I woke up this morning with a depressed feeling like I've never experienced. Bad. Really bad. Then....me cell phone rang. It was my daughter's fiance reminding me I had promised to go the jeweler's with him. I am giving my daughter the 2 carat diamond from my wedding ring. It was with total joy in my heart that I handed my ring to the jeweler. When I saw the look of love on my future son-in-law's face my depression lifted immediately. They will have a yours, mine and ours situation. She has a son from a previous relationship, he has a son and daughter from his first marriage. He is so much like Joe...I love it.
The diamond belonged to my mother-in-law. I got it in a new setting for my 25th anniversary (I guess she thought after 25 years I could be trusted). Passing it on to my daughter is the right thing to do. When my husband first passed the thought of giving up my ring actually nauseated me. Nine months later I know it's the right thing......and.....life goes on.
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text:
Credit Card Sized Flashlight Fits Right in Your Wallet
If you think that you may get into situations where illumination is needed in dark places when you least expect it, there ways you can avoid it by carrying a torch around wherever you go. Of course, a full-sized torch will be very impractical and silly to be carrying around all the time. Here's one mini torch that that is not only slim in size but will fit right into the credit-card slot in wallets.
The Ian Sinclair EON-C Classic is a slim credit-card sized torch flashlight that can be used for illuminating dark places such as during emergencies or for finding things in darkness. It comes in a sleek-looking steel brushed outer shell which not only protects it but gives it a very classy look.
With an inbuilt lithium battery powering the LED bulbs, the battery is able to power them for 168 hours, meaning if it's used occasionally for emergency situations the torch will be able to last for years before running out of battery power.
A handy gadget that comes in a size that fits right in the wallet.
The Ian Sinclair EON-C classic ultra slim credit card sized torch retails for $9.99 from Amazon.


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|The Sackboy Affair
Episode Info Edit
The Sackboy Affair is the third episode of the second season in Scooby-Doo's Ghost Gallery.
The gang is on a snowy mountain when they meet Sackboy! Sackboy built the mountain with Materials and checkpoints. But a yeti is haunting the mountain! Meanwhile the gang has to deal with an ogre Sackboy has in his castle he built.
"Is that Sackboy's Castle?" a man asks a woman as they reach the top of a snowy mountain. A castle is there.
"Well, the climb was worth it," the woman says.
The man rushes inside the castle.
"I'll get you back for not waiting for me!" the woman yells. The man laughs and shuts the castle doors.
A yeti appears behind the woman, grabs her, and vanishes.
Meanwhile, the man is inside the heated castle.
"This is what I call a hotel," he says. He walks onto the balcony.
Suddenly, an ogre appears behind him and pushes the man off the balcony.
The man grabs on to a pole sticking out of the side of the mountain. He looks up at the ogre. It's gone!
The next day, the Mystery Machine is driving along a road. There is grass all around the road with white fencing along the road too.
It's a sunny afternoon outside.
"La-la-la," Fred says.
"Ra-ra-ra!" exclaims Scooby.
"Hey, where are we?" Shaggy asks. "Like, one second we were there, now I see a snowy mountain up ahead."
"What did you say?" exclaims Velma.
"Shaggy, it's a hot summer day," Daphne says. "But you are right; I do see a snowy mountain. Wait a snowy mountain!"
"Rikes!" cries Scooby.
"Yeah, rikes, last time we were on a snowy mountain there was a white Bigfoot, wait that was a few times ago... wasn't last time with a yeti?" Shaggy asks.
As the Mystery Machine starts driving up the mountain the yeti spies on them, it takes off the yeti costume to reveal the ogre.
Meanwhile, the van is driving up the snowy mountain.
"Like, look at that castle!" Shaggy says, pointing very far up.
Suddenly, the Mystery Machine gets stuck in a pile of snow. The more Fred tries to get out of it, the deeper it goes in.
"It's hopeless," Fred says.
Suddenly, as if magic, the pile of snow starts to vanish. Soon it has completely vanished. Fred sees a blue thing on the Mystery Machine. The van glows blue and it hovers over where the pile was and puts it past it. The blue thing vanishes and the van stops glowing.
"What was that all about?" Fred asks.
The van continues driving towards the castle at the top.
Soon, it stops at the very top. The gang enters the castle. The yeti is on the roof. If jumps down towards the Mystery Machine.
Meanwhile, the gang is inside the castle.
"Like, look!" exclaims Shaggy. "The doors are labeled: Shaggy and Scooby, Velma and Daphne, and last Fred."
The gang all goes into the rooms with their names on them.
Inside Scooby and Shaggy's room, an ogre keeps tapping at the window. The cowards are too busy sleeping. The ogre chuckles and vanishes from sight.
Meanwhile, Fred is in his room. The yeti is tapping at his window. Fred continues sleeping. The yeti chuckles and vanishes from sight.
Meanwhile, Daphne and Velma are sleeping. The ogre keeps tapping at the window. The two continue sleeping. The ogre chuckles and vanishes from sight.
The next day, the gang heads to the room labeled Breakfast.
Inside, they sit down at a table.
"Roast!" exclaims Scooby.
"All who want toast raise your hand," Fred says.
Everybody raises their hand. Toast floats onto the table.
"Who's doing all these magic tricks?" Daphne asks.
"They aren't magic tricks," a voice says. "It's my Popit."
Sackboy appears in sight.
"Sackboy!" exclaims Velma.
"Like, that's funny, you're as tall as me, in the game you're a lot smaller," Fred says.
"Well, I'm on vacation," explains Sackboy. "I built this mountain and castle using my Popit and Materials. But, I'm having quite a bit of trouble, a yeti and ogre haunts this place!"
Soon, Scooby, Shaggy, and Sackboy are searching for clues on the snowy mountain.
"Row rabout re ro rack rand rall rit ra ray Raggy?" Scooby asks.
"Like, I'm with you Scoob, you Sackboy?" Shaggy asks.
"Yeah, I agree, let's call_" he begins, but the yeti appears.
"This isn't your mountain!" he bellows. The yeti grabs invisible rope and swings into non-existence.
Meanwhile, Fred, Daphne, and Velma are searching for clues inside the castle.
"We'll never find anything!" Fred says.
"I am the Castle Ogre!" a voice yells. The ogre appears!
Sackboy, Scooby, and Shaggy run in. Sackboy uses Materials to build a cage around the ogre.
"Time to unmask the ogre," Fred says. He tugs off the mask.
"It's the yeti!" Fred says.
The yeti roars and breaks the cage open. It runs off, roaring.
"Well, better luck next time," Fred says.
"Let's all search the castle for the yeti," Fred says.
Soon, Sackboy is searching the castle with Shaggy.
"Like, hey Sack, do you know where we could get a snack?" Shaggy asks.
Sackboy makes a bag of chips and hands it to Shaggy.
"There you go," he says.
"Like, thanks Sackboy!" Shaggy says.
"No problem," Sackboy says.
Suddenly, the yeti appears.
"Problem!" yells Sackboy.
The two run away from the yeti.
A Scooby-Dooby-Doors chase scene begins, it shows the castle hallway. One door opens and Shaggy and Sackboy run out of it and into another door. The door across the hall from Sackboy's and Shaggy's opens at the same time as Sackboy's and Shaggy's. Sackboy pokes his head out at the same time as the yeti. They both are shocked and slam the doors.
The chase scene ends.
Shaggy and Sackboy are in a closet. The door opens. Fred and Scooby are there.
"Are you guys okay? You're shaking with fear," Fred says.
"Like, we just saw the yeti, he's right behind you Scoob!" Shaggy says.
Scooby turns around. There is the yeti.
"Rikes!" yells Scooby. He falls on the yeti. The yeti falls of the fencing a floor down.
"C'mon!" says Fred.
Fred and Sackboy follow Shaggy to rescue Scooby.
They run down and wake him up.
"Raggy!" cheers Scooby. He licks Shaggy.
Th yeti remains knocked out on the floor.
Velma and Daphne walk over.
"I know who the culprit is," Velma says.
Fred tugs off the yeti's mask to reveal a green colored Sackboy.
"Do you recognize him Sackboy?" Velma asks Sackboy.
"Yes, he's my rival, Joe!" says Sackboy. "I'll make sure he's locked up."
Sackboy creates a police car and a police.
"And I would have gotten away with it if it hadn't been for you all!" yells Joe as he is taken away.
The next afternoon, the Mystery Machine is all packed up to go home.
"Goodbye!" Sackboy says.
"Scooby-Dooby-Doo!" cheers Scooby.
Writer's NoteEdit
I'm Decca03, the writer of this episode and all the others. I'm really bad at getting the guest stars in early, and this is the latest I've ever put one in, 603 words through out of 1,098 words total! Thanks for reading!
Cast and charactersEdit
|Frank Welker
Fred Jones
|Matthew Lillard
|Shaggy Rogers
|Mindy Cohn
|Velma Dinkley
|Grey DeLisle
|Daphne Blake
|Dee Bradley Baker
|Sam Vincent
- Ogre
- Yeti
|Joe as Ogre as Yeti
|He wanted to get more people coming to his creations.
- Sackboy's Snowy Mountain
- Sackboy's Castle
- This episode is also called Sackboy's All Affair.
- "Raggy!"
- Scooby-Doo
- "Goodbye!"
- Sackboy
Home MediaEdit
- Sadly, the rights to release this episode with Sackboy on DVD were not obtained. Therefore this episode was not released on The Best of Scooby-Doo's Ghost Gallery.


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Effectiveness guidance document (EGD) for acupuncture research - a consensus document for conducting trials
Basic research
There is a need for more Comparative Effectiveness Research (CER) to strengthen the evidence base for clinical and policy decision-making. Effectiveness Guidance Documents (EGD) are targeted to clinical researchers. The aim of this EGD is to provide specific recommendations for the design of prospective acupuncture studies to support optimal use of resources for generating evidence that will inform stakeholder decision-making.
Document development based on multiple systematic consensus procedures (written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders including patients, clinicians and payers were involved.
Recommendations focused mainly on randomized studies and were developed for the following areas: overall research strategy, treatment protocol, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication.
The present EGD, based on an international consensus developed with multiple stakeholder involvement, provides the first systematic methodological guidance for future CER on acupuncture.
Effectiveness guidance documents (EGDs) provide specific recommendations about the design of prospective studies that will inform decisions by patients, clinicians and payers
Comparative Effectiveness Research (CER) is the generation and synthesis of evidence that compares the benefits and harms of different treatment options to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels
There is a strong need for additional CER for disorders that are common and costly to society and that have a great degree of variation in their treatment.
"Effectiveness" is a measure of the extent to which an intervention, when deployed in the field in routine circumstances, does what it is intended to do for a specific population
Traditional medical systems such as Chinese medicine frequently use multiple interventions, many of which are individually complex, e.g. an herbal formula or an acupuncture point combination. Such complex interventions, whose components may act additively or synergistically, are difficult to evaluate. Yet, the aspect of CER that addresses effectiveness in a more everyday practice setting suggests that studies can be designed to compare real-world whole systems of health care. The Medical Research Council guidance in the UK provides the following advice for developing and evaluating complex interventions
A good theoretical understanding is necessary to understand how the intervention causes change, so that weak links in the causal chain can be identified and strengthened.
Lack of effect may reflect implementation failure rather than genuine ineffectiveness; a thorough process evaluation is needed to identify implementation problems.
Variability in individual level outcomes may reflect higher level processes; sample sizes may need to be larger to take account of the extra variability. Cluster randomized designs may also be considered.
A single primary outcome may not make best use of the data; a range of measures will be needed and unintended consequences accounted for where possible.
Ensuring strict standardization may be inappropriate; if a specified degree of adaptation to local settings is allowed for in the protocol, the intervention may work better.
The aim of the present EGD is to provide comprehensive, consensus-based guidance for future acupuncture studies by taking existing guidelines into account. This document should be seen as part of a larger research framework that would include translational research strategies to enhance the likelihood that mechanistic studies, clinical studies and clinical practice will each inform and be informed by one another.
The development of the EGD followed a clear predefined process and included an initial written Delphi round on the methodological remarks and overall structure of the document, followed by a one-day consensus development workshop (July 24, 2011 Santa Fe, USA) and two written post-workshop Delphi rounds to finalize the document. Participants of the workshop had following background (2 acupuncture patients, 1 health insurance representative, 4 medical doctors (one of them providing acupuncture), 2 acupuncture practitioners with Asian background living in the US, 1 nurse, 7 methodologist with background in statistics or epidemiology or neuroscience). Half of them had long-term experience in acupuncture research. In the consensus meeting an adapted the "World Café" methodology was used. The World Café method as developed by Brown and Isaac is a simple, effective, and flexible format for hosting large group dialogue
In addition, an international review by acupuncture research experts was employed at several stages of the EGD development process. After the pre-workshop Delphi round (before the consensus meeting) and after the two written post-workshop Delphi rounds the document was sent to an external international review board including eight experts from four countries (US, Germany, UK, Italy), who did not participate in the consensus development workshop.
The consensus process was finalized after all workshop participants and the external review experts consented.
To allow a comprehensive summary of the recommendations as well as to provide relevant methodological background information, the results of the consensus were structured into two parts 1) methodological remarks and 2) recommendations.
This EGD refers also to the following documents:
CONSORT for parallel group randomized trials
CONSORT extension for pragmatic trials
CONSORT for non-pharmacological trials
CONSORT extension for cluster randomized trials
STRICTA as a CONSORT extension for acupuncture studies
SAR Board of Directors White Paper
Methodological remarks
This EGD for acupuncture is the first such document in the field of Complementary, Alternative and Integrative Medicine (CAIM) and may serve as a model for other CAIM interventions. Here we will describe the methodological issues that impact CER in acupuncture research.
Acupuncture as a complex intervention
Acupuncture is a component of Chinese medicine, which comprises a "whole medical system" using unique diagnostic and therapeutic approaches.
Needling components (i.e., needle size, retaining time, depth, stimulation, location, frequeny)
Specific (acupuncture theory-related) non-needling components that are traditionally considered to have therapeutic value, for example, in Chinese Medicine the physical components such as palpation.
Generic, nonspecific non-needling components that are not unique to acupuncture treatments, such as belief and expectations of the practitioner and patient, therapeutic setting, time and attention.
Research strategy
For the field of complementary medicine, several authors have highlighted the importance of comparing different treatment options that reflect usual care
In order to provide a realistic assessment of treatment options in a usual care context, CER trials often include multiple comparison groups, more heterogeneous patients and longer-term outcomes. CER trials will also require additional time to engage stakeholders in study planning and to engage and train participating practitioners working in usual care. Cluster-randomized trials on acupuncture were recommended as one of the priorities for CER by the IOM
A Bayesian (adaptive) statistical approach might be an interesting option for real-world CER where it is "noisier" than in "efficacy" studies. Standard statistical (frequentist) techniques to determining study size require increased sample sizes in effectiveness studies, because of greater variability and the fact that when comparing several active treatments relatively small differences are expected
Research question and the efficacy-effectiveness continuum
When planning a study, it is important to determine the location on the efficacy-effectiveness continuum. In other words, should the study be designed primarily to exclude bias and increase the chance of detecting a specific effect or to reflect usual care?
Efficacy studies aim to produce results with high internal validity by reducing both bias (e.g. using blinding) and variation (e.g. narrow eligibility criteria and a standardized treatment protocol) to increase the likelihood of detecting the hypothesized difference. These studies aim to assess a treatment outcome under "ideal" conditions with highly selected patients. At the other end of the continuum, results from effectiveness studies aim to inform decision makers about the potential benefits of an intervention in a usual care setting, making the results of the study generalizable and relevant to routine care by studying patients within the context (methods and practitioners) in which the acupuncture treatment is usually deployed.
The place along the continuum is multi-dimensional and is influenced by the research question
Possible research questions are
Specific effect
Does acupuncture needling have acupuncture point specificity (i.e. is needling at real acupuncture points superior to a penetrating sham procedure at non-acupuncture points)?
Does acupuncture needling have a specific effect (i.e. is needling at real acupuncture points superior to a non-penetrating sham procedure at acupuncture points or non-acupuncture points)?
Does depth of needling, type of stimulation or other needling parameters have an effect on the outcome?
Acupuncture effect
Is acupuncture treatment superior or non-inferior to conventional standard treatment?
Is acupuncture treatment in addition to usual care or standard care superior to usual care or standard care alone?
What dose (number of treatments) of acupuncture is needed to see an effect?
Safety and costs
What are the types and frequency of acupuncture side effects?
Is acupuncture treatment cost-effective compared to another intervention?
Studies that aim only to determine the specific effect of acupuncture are not part of CER, because sham acupuncture is not considered an "active" comparison group or as a real treatment option. Only trials that compare a minimum of two treatment options are considered to represent CER
A helpful tool for planning randomized trials is the PRECIS (pragmatic–explanatory continuum indicator summary)
Starting from these PRECIS dimensions
The following paragraphs will introduce the methodological background for some designs aspects that are highly relevant for CER on acupuncture.
Developing the acupuncture and comparison group interventions
The treatment protocols for the intervention and the comparison group are central aspects of the study. The STRICTA guidelines for reporting acupuncture trials should be taken into account when planning intervention and comparison group treatment protocols
Acupuncture treatment protocol
The acupuncture intervention in CER could be a new intervention (e.g. new acupuncture style or microsystem) or an intervention that is already available (e.g. Chinese style needle acupuncture). When evaluating a new intervention, its characteristics (e.g. dosage, frequency, setting) should reflect the context in which it will be deployed in the future in a usual care context. When evaluating acupuncture as an existing intervention that is widely available for the external validity of the results, it is important that the treatment protocol of the acupuncture group reflects common practice to the extent possible. However, this could be difficult because of the large heterogeneity in acupuncture styles and expertise of the practitioners. Registries (see below) or prospective observational studies are helpful sources to inform researchers about practice in usual care. If this information is not available, cross-sectional surveys or consensus procedures with acupuncture experts are the next best option. However, when selecting the experts participating in the consensus, their expertise should reflect the heterogeneity of the acupuncture practised in usual care. If consensus is lacking before large randomized comparative effectiveness studies are performed, pilot studies comparing different treatments should be considered
Comparison group treatment protocol
The comparison group treatment protocol should be planned and developed with the same rigor and attention to detail as the acupuncture intervention. When standard treatment or usual care is used as the comparison group, the treatment components should be described in the study protocol and detailed usage during the study should be documented and reported.
In CER, co-interventions (e.g. pain medications in pain trials) are often more heterogeneous than in efficacy trials, and for understanding the context of the study, it is relevant to document and report them.
The Agency for Health Care Research and Quality (AHRQ) in the US has defined patient registries as an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves a predetermined scientific, clinical, or policy purpose(s)
Another approach is to use existing data, usually from the electronic medical records of a well-defined health care delivery system, for comparative effectiveness research
An important reason for extending acupuncture CER research into these domains is the opportunity to evaluate this complex intervention as it is actually practiced, in the types of patients who are willing to use it, and in the settings where it is generally used.
Allocation methods
Although CER promotes registries and observational studies in addition to randomized trials, randomized studies are still considered the most robust method for generating comparative effectiveness evidence, as they are more likely to control for bias and confounding. The randomized trial will undoubtedly remain an important component of an advanced CER framework
Dynamic allocation procedures could be an alternative to randomization procedures. Depending on the study design, they could balance treatment arms across baseline prognostic factors for clinical trials more effectively than randomization
Response-adaptive allocation algorithms use both previous patients' baseline characteristics and outcomes. There is a lack of successful studies, especially in acupuncture research, using these response-adaptive allocation approaches.
Although methodologically important, allocation methods create an artificial context that may influence the outcome, e.g. they could have a direct impact on the selection of participants. Treatment preferences that are influenced by patient expectations are considered a relevant determinant of the placebo effect
Randomization methods including both simple and stratified randomization could be used to allocate patients to the treatment groups. Stratified randomization is a useful approach to control for relevant factors for imbalances in treatment groups. In settings where randomization at the patient level is not feasible, cluster randomization might be an option. Cluster trials randomize social units, such as households, primary care practices, hospital wards, classrooms, neighborhoods and entire communities, to different intervention arms. Compared with randomized trials at a patient level, cluster trials have less statistical power while using the same number of patients
Blinding and expectation
Blinding reduces bias by minimizing the possibility that the results can be affected by expectations of patients and practitioners. It is commonly accepted that practitioners cannot be blinded to the acupuncture intervention. In contrast, the intent to blind patients is common practice in efficacy trials that compare acupuncture with sham acupuncture, even though data from sham-controlled acupuncture trials suggest that patients' expectations might influence the treatment outcome
Health economic evaluations
Over the last few years, health economic data has become increasingly relevant for decision makers faced with the challenge of reconciling the growing demand for healthcare services with the funds available
Recommendations for acupuncture comparative effectiveness research
These recommendations aim to support optimal use of resources for generating evidence that will inform stakeholder decision-making as fully as possible. They are based on the assumption that it is a conscious decision of the relevant stakeholders to reduce internal validity in order to increase generalizability, relevance, feasibility and timeliness of research results. Multiple stakeholders were involved in the consensus process for this EGD to balance aspects of internal and external validity in the recommendations.
Recommendations developed for the following fields are summarized in (see also Table
Designing CER studies
Treatment protocol, expertise and setting
Study design and statistical analyses
Economic evaluation
Designing CER studies
1) Stakeholder engagement
a) Involvement of all relevant stakeholders (e.g. practitioners, clinicians, patients, payers, researchers) is highly relevant for CER.
b) Identifying relevant topics, planning and design, and interpreting study results should involve all relevant stakeholders.
2) Study question and the efficacy-effectiveness continuum
a) The study question should be clearly phrased, and include all relevant information about study participants, interventions, comparison groups and outcome parameters. In particular, it should clarify whether the acupuncture treatment is to be assessed as an "alternative" in direct comparison, for superiority or non-inferiority, to or as an adjunctive to a usual or standard care treatment.
b) During the trial planning phase, time should be given to discuss and determine the trial's position in the efficacy-effectiveness continuum for the following aspects: participant selection/eligibility criteria, treatment protocol, practitioner expertise, outcomes, study setting. Using the more detailed PRECIS tool to support this process is recommended
Study population
3) Eligibility criteria
a) In the context of available resources, eligibility criteria should be as broad as possible. The criteria should reflect the evidence of the pattern of usage and disease burden, and the study population should reflect all well-known relevant disease characteristics that may interact with the treatment.
b) Patients with co-morbidities should not be explicitly excluded from the study enrollment, with the exception of relevant safety aspects. Both acupuncture naïve and non-naïve patients should be enrolled as well.
c) The study disease/condition should be defined as clearly as possible.
4) Patient recruitment
a) The type of comparator group chosen should take into account its possible effect on recruitment success.
b) As far as possible, recruitment strategies should be similar for all treatment arms and recruitment should be carried out in places where the respective treatments are usually employed (e.g., both CAM and conventional clinics and practitioners).
c) Sampling of study participants should be as systematic as possible, for example, by using registries or health insurance records and inviting a random sample or systematic sample of patients seeking treatment (e.g. every 50th patient) from the health insurance record list.
d) Patients' treatment preferences should be determined and efforts should be made to recruit both those who express strong treatment preferences and those who do not.
Treatment protocol, expertise and setting
5) Acupuncture intervention
a) The acupuncture treatment protocol should to some extent reflect real-world clinical care. If acupuncture points are predefined, the point selection should be based on broad systematic consensus (e.g., expert opinion survey, consensus meetings and/or textbook survey).
b) Different acupuncture treatment protocols (standardized, semi-standardized, fully individualized) should be compared in a design with multiple treatment arms.
c) Standardized acupuncture may take Chinese pattern diagnoses into account by:(1) including only those patients who have the most frequent pattern differentiation for the condition of interest, with treatment protocol tailored to this pattern, or (2) having different pre-established standardized treatment protocols for different Chinese pattern differentiations
6) Comparison groups
a) The treatment protocol for the comparison group should be based on broad systematic consensus (e.g., expert opinion survey, consensus meetings and/or textbook survey).
b) If the terms "usual care", "standard care" or "best practice" are used to describe comparison group treatment, a detailed description must be provided, stating how these terms are defined within the trial. In addition, relevant references should be provided.
7) Treatment documentation
a) All treatments (interventions, co-interventions, over-the-counter self-medication) carried out in all groups should be documented. A variety of documentation methods and sources may contribute details (including medical records, case report forms, etc.).
8) Measures
a) If no standard outcome measures for the respective disease/condition exist, or are not suitable for CER and no pilot data is available, pilot studies should be carried out to explore the value of a broad range of outcomes that may be sensitive to the condition treated and the interventions. Qualitative and quantitative research methods could be combined to identify all relevant associated outcomes.
b) The main outcome measures should focus on patient-centered outcomes and, if appropriate, include relevant biological measures for the respective disease/condition. Diagnosis-specific validated standards for outcome measures published by professional associations (e.g., the International Headache Society on headache measures
c) Multiple primary outcomes addressing distinct dimensions may be used, if appropriate. This should be addressed in the sample size calculation and statistical analysis plan.
d) There is great value in reporting the percentage of patients with clinically meaningful response for the main outcome measures, because this information is easily interpreted by non-scientists.
e) Secondary outcome measures should capture relevant patient-centered dimensions of the respective disease/condition (both self-reported and biological) and might, if appropriate, include measures of collateral effects (i.e., positive and negative consequences of the treatment experience, often seemingly unrelated to the main outcomes).
9) Timing
a) In chronic diseases long-term observations (at least 1 year) are highly recommended.
b) The use of periodic intervals to document and compare the trajectory and persistence of treatment effects is recommended. However, the frequency of assessment should be balanced, so that relevant information is gained without major disruptions of treatment implementations or practice setting.
Study design and statistical analysis
10) Registries
a) The clinical trajectory of individual patients, which can be tracked by registries, could inform future acupuncture studies (e.g., as to intervention details, outcomes, safety, or characteristics of a usual care population that receives acupuncture treatment outside of a study situation).
b) When collecting registry data, information should be obtained from all types of providers who offer the services of interest.
c) Registries may be useful in identifying frequency of important potential covariates, including spirituality and beliefs, prior CAIM use, nutrition, exercise, etc., but this information is often not included.
d) Registries could serve as a recruitment platform for comparative studies.
e) If experience with registries in acupuncture research is lacking, the development and use of pilot registries may prove helpful.
11) Allocation methods
a) Use of appropriate allocation methods is strongly recommended. Randomization at the level of individual patients is still the method most frequently used, but dynamic allocation procedures (e.g. rank minimization
b) Stratified randomization or adaptive allocation techniques may be used to prevent imbalances for relevant covariates and potential confounders in study arms.
c) Partially randomized patient preference designs have an advantage in that they provide additional exploratory information, whether the results observed for randomized patients are different from those not randomized because of strong treatment preferences. These designs, while adding potentially important outcomes data to a clinical trial, are often not feasible because of the need for much larger sample sizes.
d) Cluster randomization is recommended by the Institute of Medicine especially for acupuncture studies and may be used if feasible
e) Standard procedures ensuring allocation concealment (e.g., central randomization or secure databases) should be employed. Recommendations for stratification will be given under point 15.
12) Blinding
a) Blinded outcome measurement (e.g., a blinded rater) is recommended in order to reduce bias, especially for outcomes that are assessed by the practitioner (e.g. range of motion as a physical assessment). Methods to minimize the risk of unblinding (e.g., allocation concealment, rater training, standardized assessment protocol) should be employed.
b) Patient-reported trial outcomes data (e.g., migraine days, quality of life) should be kept inaccessible to the practitioner (e.g., by using sealed envelopes or preferably by sending questionnaires directly to a study office independent of the intervention site or using a blinded interviewer). This should not influence the symptoms usually reported by the patients to the practitioner for treatment follow up.
13) Patient preferences and expectation
a) Patient preferences should, if appropriate, be acknowledged in the study design, e.g., by using a partially randomized patient preference design. If such a design is not feasible, then it is important to document both the patients' preferences regarding the treatment options available in the trial as well as the degree of their knowledge about these treatment options.
b) Patient and practitioner preferences and expectations should be assessed before the intervention begins (in randomized trials before randomization).
14) Sample size
a) Sample size depends mainly on the outcome(s) of main interest and the minimum clinically important difference (MCID) for the respective outcome(s).
b) Sample size should account for greater heterogeneity in CER study populations; because of this researchers should specifically avoid conducting small trials (< 50 patients per arm) in CER, unless there is a specific reason to do such studies (e.g., pilot studies to test feasibility and recruitment).
15) Subgroups
a) Relevant subgroups for the disease/condition under study should be identified based on existing data and the literature. Subgroup analysis should be done at least for gender, because there is preliminary evidence that acupuncture might be more effective in women than men
b) The main subgroup analyses should be pre-specified in the analysis plan and included in sample size planning for confirmatory testing. Further subgroup analyses could be done on an exploratory level, but should be stated as an objective in the study protocol.
16) Statistical analysis
a) Primary analysis for trials on superiority of acupuncture should be intention-to-treat. In order to assess real-world effectiveness of treatments, benefits and harms should be judged and compared according to the treatment to which patients were assigned.
b) Analyses should adjust for relevant potential confounders (e.g., baseline value of the outcome measure, stratification variables, expectation).
c) Especially in non-randomized studies (e.g. observational data from registries), procedures to compensate for baseline differences must be used (e.g., matching and/or adjusted analysis).
Economic evaluations
17) Relevance
a) Comparing the effectiveness of treatment options should be the primary aim of CER, but economic evaluations should be included whenever possible as a secondary aim.
b) To allow realistic cost estimates, the setting(s) of the study should reflect as closely as possible the real-world clinical practice setting for each intervention. If a study includes a standardized and a non-standardized acupuncture arm, it would be useful to compare their cost-effectiveness.
18) Methodological approach
a) Standard methods for economic evaluations should be employed, and effectiveness measures that include both benefits and harms (e.g., utility measures based on SF-36, SF-12 or EQ-5D) should be used
b) Sensitivity analysis should include, whenever possible, different stakeholder perspectives (e.g., society, payer and patient). Because acupuncture is often paid out-of-pocket, the patient's perspective is highly relevant.
c) Subgroup analysis should mainly follow the subgroups defined a priori for the effectiveness study. A subgroup analysis for gender is recommended, because there is preliminary evidence that gender may influence the cost-effectiveness of acupuncture treatment
d) Exploratory analyses of factors that predict a better treatment response are suggested to develop future hypotheses.
19) Observation time
a) In chronic diseases long-term observations (at least 1 year) with intermediate measurement time points are highly recommended, in order to evaluate cost-effectiveness as developed over time.
20) Existing guidelines
To ensure that CER on acupuncture will fulfill reporting standards, the relevant CONSORT guidelines should be consulted and followed:
CONSORT for parallel group randomized trials
CONSORT extension for cluster randomized trials
CONSORT extension for pragmatic trials
CONSORT for non-pharmacological trials
STRICTA as CONSORT extension for acupuncture studies
21) Content
a) Publication of a detailed study protocol (design publication) should take place whenever possible prior to publication of study results.
b) The study should be registered in an international accessible trial database with as many details as possible provided.
c) Publication of the completed study should describe why and how it qualifies as CER and make clear the phase of the study.
d) The setting of the study should be described, including information about the typical usual care setting in the country where the study was performed (and if relevant in other countries). The procedure for selection of practitioners for each treatment group should be described, with an account of whether and how those included in the study differ from the average practitioner (e.g. training, experience).
e) Wording of treatment group descriptions in the informed consent should be provided.
f) If a usual-care or standard-care comparison group is used, a detailed description with citations should be included in the intervention section.
g) Detailed results of all treatments, adherence, and co-interventions in the different groups should be provided.
h) The most relevant subgroup analyses and analyses of patient characteristics that predict a better outcome should be published together with primary results. Detailed subgroup analysis and/or de-identified patient level data could be provided as online files.
This is the first EGD in the field of Complementary, Alternative and Integrative Medicine and it offers many potential benefits. During the development process, a broader understanding of the unique methodological aspects of CER emerged in the stakeholder group. CER studies are intended to improve the external validity of clinical research to enable decision makers to make informed decisions. Also, EGDs can contribute to a more strategic use of limited research resources and more consistency in trial design.
While other documents provide guidance for publishing studies (e.g. CONSORT statement) EGDs provide recommendations for the design of future studies.
This acupuncture EGD derived from a systematic development process, and the active involvement of different stakeholders who have experience with acupuncture (clinicians, patients, payers and researchers). Furthermore, an additional international expert review with eight acupuncture research experts from four countries enhanced the content and quality of the present EGD.
That stakeholders living in Asian countries were not involved in the development of this EGD might be seen as a limitation, but to date, CER has had its main focus in the United States, and is mainly known in Western countries. In addition, a consensus procedure using a web-based survey method might have allowed even broader and more heterogeneous contributions from stakeholders in Eastern as well as Western countries. That this EGD focuses on acupuncture and covers CER for acupuncture independent of condition treated has the shortcoming that the recommendations on outcomes are not at the disease level. However, the aim of this EGD is to provide a single comprehensive guideline for future acupuncture research on the seven fundamental methodological areas: (1) CER study design, (2) treatment protocol, (3) expertise and setting, (4) outcomes, (5) study design and statistical analyses, (6) economic evaluation, and (7) publication. The feasibility of the EGD to design studies was tested in February and April 2012 in two CER research methodology courses with 20–25 participants each, one with US master students and the other with an international audience of researchers.
For the first time, the present EGD provides systematic methodological guidance for future CER on acupuncture. This is the first EGD in the field of Integrative medicine and further EGDs are planned and many aspects of this EGD might be transferrable to other non-pharmacological interventions in the field of complementary and integrative medicine.
Competing interests
The work shop was funded by The Institute for Integrative Health a non for profit organization, Brian Berman is the president of the Institute for Integrative Health and Claudia Witt received a travel grant for the submitted work; there was no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; there are no other relationships or activities that could appear to have influenced the submitted work.
Authors' contributions
Wrote the first draft of the paper: CMW. Contributed to the results, the writing of the paper and the Delphi rounds and agreed to the final version: all authors. Reviewed the paper and gave useful comments and agreed on the final version: all collaborators. CMW and BB are guarantors for the paper and accept full responsibility for the work and controlled the decision to publish.
The development of this EGD was initiated by The Institute for Integrative Health (Baltimore, US) and the Center for Integrative Medicine, University of Maryland School of Medicine (Baltimore, US) in cooperation with the Center of Medical Technology Policy (Baltimore, US). Further cooperative partners were the International Society for Complementary Medicine Research (ISCMR) and the Institute for Social Medicine, Epidemiology and Health Economics, Charité University Hospital Berlin (Berlin, Germany). Funding of the stakeholder meeting was provided by The Institute for Integrative Health.
The document was reviewed by the following experts who did not participate in the workshop: Benno Brinkhaus, MD, Charité University Medicine Berlin, Germany; Francesco Cardini, MD, Health and Social Agency of Emilia Romagna Region, Bologna, Italy; George Lewith, MD, University of Southampton, UK; Klaus Linde, MD, Technical University Munich, Germany; Richard Nahin, PhD., MPH., National Center for Complementary and Alternative Medicine, National Institutes of Health, USA (Disclaimer: The findings and conclusions of this report are those of the authors and collaborators and do not necessarily represent the views of the National Institutes of Health, National Center for Complementary and Alternative Medicine); Hugh MacPherson, PhD, University of York, UK; Rosa Schnyer, DAOM, Lac, University of Texas, USA; Charles Turkelson, PhD, Center for Medical Technology Policy, USA.
Collaborators: Benno Brinkhaus, Francesco Cardini, George Lewith, Klaus Linde, Hugh MacPherson, Richard L Nahin, Rosa Schnyer, Charles Turkelson
What is Comparative Effectiveness Research?
Characterics of CER
Complementary and alternative medicine use among adults: United States
Clinical research on acupuncture - Concepts and guidance on efficacy and effectiveness research
Improving the reporting of pragmatic trials: an extension of the CONSORT statement
Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy
A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers
Developing and evaluating complex interventions: the new Medical Research Council guidance
CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials
Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration
CONSORT statement: extension to cluster randomised trials
Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement
Paradoxes in acupuncture research: strategies for moving forward
A pilot whole systems clinical trial of traditional Chinese medicine and naturopathic medicine for the treatment of temporomandibular disorders
Pragmatic clinical trials
Clinical research in traditional medicine: priorities and methods
Researching complementary and alternative treatments–the gatekeepers are not at home
Rethinking randomized clinical trials for comparative effectiveness research: the need for transformational change
Bayesian clinical trials
How well do randomized trials inform decision making: systematic review using comparative effectiveness research measures on acupuncture for back pain
Which Research Is Needed to Support Clinical Decision-Making on Integrative Medicine? Can Comparative Effectiveness Research Close the Gap?
Challenges and recommendations for placebo controls in randomized trials in physical and rehabilitation medicine: a report of the international placebo symposium working group
Defining an adequate dose of acupuncture using a neurophysiological approach
Comparative effectiveness research and CAM
A Simulation Study of the Validity and Efficiency of Design-Adaptive Allocation to Two Groups in the Regression Situation
Statistical issues in the use of dynamic allocation methods for balancing baseline covariates
The use of minimization in clinical trials
Rank-Minimization with a two-step analysis should replace randomization in clinical trials
The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review
Pragmatic randomized trial of effectiveness and cost-effectiveness of acupuncture for chronic low back pain
Acupuncture in Patients with Osteoarthritis of the Knee and the Hip
Acupuncture for patients with chronic neck pain
Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care
Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial
The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain
Priority setting in public and private health care. A guide through the ideological jungle
Health economic studies on complementary and integrative medicine
Assessing clinical efficacy of acupuncture: considerations for designing future acupuncture trials
Ethical issues posed by cluster randomized trials in health research
Patient Characteristics and Variation in Treatment Outcomes: Which Patients Benefit Most From Acupuncture for Chronic Pain?
Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care
Pre-publication history
The pre-publication history for this paper can be accessed here:


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