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To assess whether reactions to genetic explanations for disparities in lung cancer incidence among family members of African American patients with lung cancer are associated with willingness to participate in clinical genetics research.
Data are reported for 67 self-identified African Americans ages 18 to 55 years who completed a telephone survey assessing reactions to explanations (i.e., genetics, toxin exposure, menthol cigarettes, race-related stress) for lung cancer disparities. Majority was female (70%), current smokers (57%), and patients' biological relatives (70%).
Family members' rated the four explanations similarly, each as believable, fair and not too worrisome. Participants also indicated a high level of willingness to participate in genetics research (M= 4.1 ± 1.0; Scale 1–5). Endorsements of genetics explanations for disparities as believable and fair, and toxin exposure as believable were associated significantly with willingness to participate in genetics research.
These results suggest that strategies to encourage African Americans' participation in genetics research would do well to inform potential participants of how their involvement might be used to better understand important environmental factors that affect health disparities.
Minority participation in genetics research is limited.1,2 Efforts to increase minority participation in genetics research have included targeting high-risk populations through cancer registries, cultural tailoring of study materials, addressing issues of trust in the target population, and incorporating flexible intervention and evaluation methods.3 However, these methods have shown at best to have only modest improvements in minority participation.4,5 While active recruitment methods (e.g., tumor registries) have been shown to be more effective in increasing minority recruitment than passive accrual approaches (e.g., self-referral)6, 7 it is still unclear why minority participation in genetics research remains low.
It has been widely suggested that African Americans may be apprehensive about participating in genetics research due to a legacy of research abuse in the United States (e.g., Tuskegee syphilis study) and fears that this research will be used as a means to label groups as inferior and foster discrimination.1,8–13 Indeed, research has indicated that African Americans who have negative perceptions of genetics research also report less interest in genetics research and testing.14,15 However, these suggestions have not always been substantiated by empirical evidence.
There is evidence suggesting that minority groups may be concerned about participating in research linking genes, race/ethnicity, and health outcomes.8,16,17 For example, African Americans have indicated low levels of belief in messages surrounding medications deemed to be effective specifically for African Americans.18 African Americans also have reported skepticism about race-based medication information,19 fears of a racist conspiracy18 and high levels of suspicion regarding the safety and effectiveness of race-based medications.17,19,20 New discoveries linking genetic variation to racial differences in health outcomes often termed "disparities"21,22 may elicit similar levels of disbelief and skepticism as well as emotional responses such as worry or anger that may in turn exacerbate minority groups' negative responses to and decrease their willingness to participate in clinical genetics research.16,18,19
Indeed, genetic factors are increasingly being examined in an effort to explain racial/ethnic health disparities in common health conditions such a lung cancer.23–27 In the United States there are sizeable disparities in lung cancer incidence and mortality with African Americans disproportionately affected.28,29 While cigarette smoking is the leading preventable cause of lung cancer,30 racial/ethnic disparities in lung cancer incidence can not be explained by differences in smoking behavior alone.31,32 When comparing the smoking patterns of African Americans with whites we find that historically African Americans begin smoking at older ages and smoke fewer cigarettes per day than whites.29 Yet African Americans are more likely to be diagnosed with and die from lung cancer than whites.28
For this report we focus on explanations for disparities in lung cancer incidence where conjectures about different causal factors are well described and relatively straight-forward to convey to lay audiences. 26,27,33 Ongoing epidemiologic research suggests that common polymorphisms in a number of genes may increase genetic susceptibility to the harms of environmental exposures such as cigarette smoking and increase risk for diseases like lung cancer.34,35 For example, results of research conducted by Mechanic and colleagues26 suggest that common genetic variations in TP53 may account for increased risk for lung cancer and worsened lung cancer prognosis among African Americans. Also it has been reported that African Americans may be more likely than whites to carry a less-efficient DNA damage-induced G2-M checkpoint which may be associated with an increased risk of lung cancer among African Americans.27
Other common explanations for disparities in lung cancer incidence include racial differences in menthol cigarette use, exposure to toxins and race-related stress. The majority of African Americans smoke menthol cigarettes (70–80%) as compared with white smokers (20–30%).36 It has been suggested that menthol numbs the lungs allowing for more smoke to be inhaled with each puff.37 Hence, African Americans may smoke fewer cigarettes but take in a greater amount of harmful chemicals.38 Further, a greater proportion of African Americans live in poverty than whites, (25% vs 9%, respectively),39 and may be more likely to live and work near environmental toxins and pollutants than whites.40–42 Race-based discrimination has been linked to increased levels of stress and health conditions such as hypertension among African Americans.43–45 Accordingly, it could be that increased rates of lung cancer among African Americans may also result from increased smoking behavior in response to prolonged exposure to race-related stress.46
The conundrum for clinical genetics research is that adequate minority participation in this research is essential to fully understand the multifactorial influences on lung cancer disparities. Genetic research occurs in a socio-political context23,47,48 that may influence how minority groups' interpret this information and influence their willingness to participate in related research. Moreover, individuals exposed to such information may have preexisting health beliefs and attitudes that lead them to discredit the messages particularly when they do not align with their personal worldviews.
Clinical genetics research generally recruits family members of those affected by cancer.49–51 A loved one's diagnosis with lung cancer may influence how an individual responds to explanations for lung cancer disparities. Smoking status may influence these responses such that smokers may perceive explanations for lung cancer disparities differently than nonsmokers. Thus, it is important to consider these factors in evaluating African American's responses to genetic explanations for lung cancer disparities. In this report we describe an observational study designed to assess reactions to different explanations (i.e., genetics, toxin exposure, menthol cigarettes, race-related stress) for disparities in lung cancer incidence among family members of African American patients with lung cancer. We also examined whether reactions to these explanations were associated with willingness to participate in clinical genetics research.
Data were collected via structured telephone surveys with self-identified African American patients with lung cancer who were receiving care from Washington Cancer Institute at the Washington Hospital Center and their family members aged 18 to 55. Patients and family members who self-identified as African American or Black and were born in the U.S. were eligible for the study. We excluded foreign-born Blacks because previous research has indicated U.S.-born and foreign-born Blacks have different cultural beliefs and health habits, as well as different health outcomes, including cancer.52,53 Family members included both biological and non biological relatives of the patient as well as friends considered as family to the patient. In order to complete the family survey, participants had to meet the criteria for either a current smoker or a never smoker. A current smoker was defined as someone who smoked at least 100 cigarettes in their lifetime, and has smoked at least 7 in the past 7 days. A never smoker was defined as someone who has not smoked at least 100 cigarettes in their lifetime.
Patients were approached by a recruiter during their clinic visits and asked their willingness to be contacted to complete a telephone survey about their general well-being, and to enumerate family members' smoking status. We elected to have only African American/Black recruiters employed by Washington Cancer Institute who already have regular contact with the patient population. Patients who agreed to complete the survey provided written consent to have their personal health information forwarded to the National Human Genome Research Institute.
A trained interviewer contacted patients within one week to complete the survey. For patients who were extremely ill, a proxy completed the survey. Only families of patients who provided current mailing addresses and telephone numbers for at least one current smoker were included in the study. These patients were asked for permission to contact all identified smokers and up to two never smokers. To maximize recruitment reach, family members were eligible regardless of their geographic distance from the patient. This necessitated using telephone interviews for data collection.
Family members were mailed an introductory packet that included a letter describing the study purpose, information on how they were identified, and a toll-free telephone number to call to decline participation. Family members who did not call to decline participation were contacted to determine their willingness and eligibility to complete the survey. Call attempts to family members were conducted within a 21 day window and family members were given options to complete the survey in the evenings and on weekends. Patients and family members who self-identified as current smokers were offered free print smoking cessation materials and all participants who completed the patient or family survey received a $35 gift card. The study procedures were approved by the National Human Genome Research Institute and MedStar Research Institute-Georgetown University Oncology Institutional Review Boards.
The family member survey took 30–40 minutes to complete and was formatted to ask different questions of smokers and never smokers. All family member surveys were audio taped and administered by trained African American/Black telephone interviewers. The primary purpose of the survey was to assess family members' reactions to four common explanations (i.e., genetics, toxin exposure, menthol cigarettes, race-related stress) for racial/ethnic disparities in lung cancer incidence. In order to control for order effects associated with using multiple explanations for disparities, family members were administered one of four versions of the survey which varied based on the order in which the explanations were presented.
Stage of lung cancer diagnosis, age, and gender were obtained from patient medical records. As part of the telephone survey, patients reported race, highest level of education, marital status, current smoking status and exposure to other household smoking.
Family members self-reported their race, age, smoking status, gender, highest level of education, marital status, employment status, exposure to household smoking, and smoking behaviors as part of the telephone survey. Biological relationship to the patient was reported by the patient during the patient survey.
Prior to capturing reactions to the four targeted explanations, interviewers read a short narrative to family members describing lung cancer disparities. Participants were asked to provide their opinions, in an open-ended format, about why lung cancer disparities exist. Responses to the narrative were transcribed and evaluated to identify emerging themes which were used to develop the codebook used for coding participants' responses into close-ended categories. Inter-rater reliability was calculated for 20% of the coded material; all items that contained variability reached acceptable reliability (Kappa ≥0.75). Code frequencies were examined to assess whether other explanations were commonly cited for disparities in lung cancer incidence than the four targeted by the current report.
Interviewers read a short narrative to family members that outlined the four targeted explanations for disparities in lung cancer incidence. A description of each narrative is provided in Table 1. After each narrative, family members were asked to rate the level of believability, fairness and impact of worry for personal lung cancer risk elicited by the explanation. Believability assessed the level of plausibility or credibility of the explanation with participants asked to rate: "On a scale from 1 to 7 where 1 is not at all and 7 is completely believable, how much do you believe the statement that racial differences in lung cancer may be due to blacks having more of the risk versions of some genes than whites?" The fairness item assessed the level of impartiality of the explanation. Participants were asked: "On a scale from 1 to 7 where 1 is not at all and 7 is very fair, how fair is the statement?" Worry was assessed by asking participants: "On a scale from 1 to 7 where 1 is not at all and 7 is very worried, how much does the statement make you worry about your own risk for lung cancer?
Willingness to participate in genetics research was assessed with one item. Participants were asked: "If you were invited to participate in a clinical research study, in which you had to provide a blood sample, to identify genetic risk factors for lung cancer, how likely is it that you would participate?" Response categories were: 1 = Definitely Not; 2 = Probably Not; 3 = Possibly; 4 = Probably; and 5 = Definitely Would.
We generated descriptive statistics stratified by smoking status to characterize the family members' demographics. Partial correlations were used to evaluate relationships among the reactions to explanations and the main outcome (i.e., willingness to participate in clinical genetics research) while adjusting for smoking status and level of education. The intraclass correlations for the reactions to explanations and willingness to participate in clinical genetics research approximated zero, indicating that family members' responses were essentially independent. Thus, analyses did not control for family clustering. Also, we tested whether the means for reactions to each explanation was different across the four survey versions and the results indicated no order effects on these variables. Effect sizes were calculated using Cohen's r statistic (small = 0.14, medium = 0.36, large = 0.51).54 All statistical analyses were conducted using SAS (Version 9.2; SAS Institute, Cary, NC). A p-value of 0.05 was established as a level of significance.
A total of 147 patients were approached for the study of which 93 self-identified AA patients provided written consent to be contacted for the patient survey. A total of 70 patients completed the telephone survey. The majority was female (64 %) and had been diagnosed with early-stage lung cancer (64%). The mean age was 62 ± 11 years, 29% were married, 54% had a high school education or less and 11% reported being current smokers at the time of the screening survey. Only 4% of patient surveys were completed by a proxy on behalf of the patient. The majority of patients who completed the survey identified at least one family member who smoked (64%), 59% were eligible to have all identified family members contacted about the study and 41% had at least one family member who completed the study.
Patients collectively identified 158 family members. They gave permission to contact 147 of these family members and 139 family members were successfully referred that is, the patient was able to provide complete contact information for the family member. Figure 1 shows the cascade of family referral.
A total of 33 referred family members were ineligible to complete the family survey due to age (n= 25) and smoking status (n = 8). There were 106 family members deemed eligible to participate and 67 family members completed the family survey (63%). The 67 survey completers were from 29 families from which a range of 1–6 and a median of 2 family members completed the survey. There were no significant differences in gender, smoking status, or biological relationship between eligible family members who completed the survey and those who did not complete the survey. A description of eligible family who completed the survey and family who did not complete the survey is provided in Table 2.
The majority of survey completers was female (70%), 57% were current cigarette smokers, and 70% were biologically related to the patient. The mean age was 43 ± 9.3 years, 46% were married and about a third of family members reported exposure to other household smokers. On average, smokers reported smoking 9.2 ± 5.4 cigarettes in a typical day. The majority smoked their first cigarette within 30 minutes of waking (74%) and reported smoking menthol cigarettes (89%). There was a significant association of smoking status with employment status and education level. Smokers were less likely to be employed full-time for pay and reported lower levels of education than never smokers. The sample characteristics of family members by smoking status are shown in Table 3.
A total of 60 interviews were included in the analysis of the open-ended data. There were seven recordings excluded due to recording errors. Evaluation of the open-ended data indicated the four targeted explanations were the most frequently mentioned explanations for disparities. The proportion of family members citing one of these explanations ranged from 32% to 15%. There were other less frequently mentioned explanations for disparities. For example, 12% of participants cited racial/ethnic differences in attention to self-care and 8% indicated differences in lifestyle factors as explanations for lung cancer disparities.
Overall, family members endorsed explanations of racial differences in genetic risk, toxin exposure, menthol cigarette use and race-related stress as believable and fair but not particularly worrisome (See Table 4). While toxin exposure was endorsed as the most believable explanation for lung cancer disparities (mean = 5.6 ± 1.6; Scale: 1 = not at all and 7 = completely believable), reactions to genetics as an explanation were relatively favorable such that the mean scores for believability and fairness were 5.2 ± 1.5 and 5.3 ± 1.6, respectively. Race-related stress was endorsed as the least believable, fair and worrisome explanation (means = 5.1 ± 1.9; 5.0 ± 2.1; 3.7 ± 2.2, respectively). Nonetheless, there were no significant differences in evaluations across the four explanations.
Family members indicated a high level of willingness to participate in clinical genetics research (mean = 4.1 ± 1.0; Scale: 1 = definitely not and 5 = definitely would). Partial correlations between willingness to participate in clinical genetics research and reactions to the four explanations while controlling for smoking status and education level are presented in Table 3. Endorsements of genetics as a believable and fair explanation were positively associated with willingness to participate in genetics research. Also endorsements of toxin exposure as a believable explanation were positively associated with willingness to participate. Worry about menthol use as an explanation tended to be positively associated with willingness to participate; however this association was not statistically significant. None of the reactions to race-related stress as an explanation for racial differences in lung cancer was significantly associated with willingness to participate.
To our knowledge, this is the first empirical report to assess African Americans' responses to genetic explanations for racial/ethnic health disparities. Our sample of African American relatives of patients with lung cancer did not respond negatively to explanations conjuring racial/ethnic differences in genetic variation to explain lung cancer disparities. Reactions to genetic explanations were similar to reactions to the other common explanations. Additionally, favorable endorsements of genetic explanations as a believable and fair explanation were significantly associated with willingness to participate in genetics research.
Previous research has indicated that minorities have negative perceptions about the use of race-based medicine.8,16–20 However, our results suggest that genetics as a basis for racial/ethnic health disparities need not limit minority participation in genetics research. The ever increasing media coverage describing anticipated health benefits of genetic discovery may be increasing African American's receptivity to messages linking genes, race and health.55,56 However, it is important to note that the genetics explanation we used focused on racial/ethnic differences in susceptibility to the harmful effects of smoking. It may be the case that messages that consider the role of gene-environment interactions in health disparities instead of genetics-only messages may be more acceptable to minority populations and may buffer against skepticism about the use of genetics research to foster discrimination.
While none of the explanations for lung cancer disparities elicited a particularly strong emotional reaction in terms of high worry about personal lung cancer risk, participants rated genetic explanations as having the highest impact on lung cancer worry. This is not surprising as 70% of family members who completed the survey were biologically related to the patient. Previous research has shown African American women with a family history of breast or ovarian cancer to be less likely to participate in BRCA1/2 genetic services compared to similar white women.57 However, here level of worry generated by genetics as an explanation for disparities did not significantly inhibit willingness to participate in genetics research. This suggests that reactions to genetic explanations and willingness to participate in genetic research may differ for different health conditions.
Limitations of the study must be considered in interpreting these results. The data reported are cross-sectional and thus no causative inferences can be made. There was a relatively small sample. Sixty three percent of eligible family members completed the survey. This response rate is somewhat lower than other studies involving survey only methodology.15,58 Yet minority participation in research requiring more commitment such as genetic testing and participation in cancer genetics registry has been much lower.2,6,59 In the current report, willingness to participate in research was based on a hypothetical scenario and may not accurately reflect how participants would respond to an actual invitation to research. Indeed, previous research has indicated that minorities express high levels of willingness to participate in genetics research but actual participation remains limited among minorities when invited to participate.2,6,59,60
Further, these families were dealing with the diagnosis of lung cancer; therefore, results may not be generalizeable to African Americans without personal experiences of lung cancer, suggesting the need for replication in larger and more diverse samples of African Americans and in non-clinical settings. Our small sample did not enable us to control analyses for patient characteristics (e.g., stage of lung cancer, age, smoking history) in examining associations of reactions to explanations with willingness to participate in genetics research. Future studies with larger samples are needed to examine the role of such factors in family members' beliefs about lung cancer. Also we had limited demographic information (i.e., gender, smoking status, relationship to patient) on family members who did not complete the survey. Factors such as education level are commonly found to be negatively associated with research participation.5
As part of this research we addressed four common explanations for disparities in lung cancer incidence. The narratives and questions used to assess reactions were developed as part of the study protocol. The investigators aimed to provide scientific evidence for each explanation while at the same time not biasing respondents by presenting either explanation as more plausible than the others. However, variability in certainty associated with each explanation may have influenced family members' responses. These items need to be evaluated for reliability and validity for future use. Further, while results of our open-ended survey indicated our four targeted explanations as the most commonly cited, there may be additional explanations and reactions that African Americans consider important in understanding lung cancer disparities, which might be associated with willingness to participate in genetics research. These might have been elicited had we used focus groups or face-to-face interviews rather than telephone surveys.
In the future it is important to examine the influences of other factors such as smoking status, causal attributions for lung cancer, and experiences with discrimination on beliefs about the role of these factors in disparities and willingness to participate in genetics research. Also additional work is needed to examine cognitive and emotional reactions to genetic explanations for disparities in health outcomes that do not have a well-established and highly stigmatizing behavioral risk factor such as cigarette smoking but for which disparities are increasingly being attributed to genetics (e.g., breast cancer, asthma).
The current research is a first step in gaining information about how African American smokers and never smokers personally affected by lung cancer might respond to clinical genetic research related to health disparities in lung cancer. In order to fully understand the role of genetics and other environmental factors in lung cancer disparities more minority participation is needed. The results of this report suggest that developing messages that inform participants how their involvement in genetics research might be used to better understand the impact of other environmental factors on lung cancer disparities may generate more willingness to participate in genetics research.
This research was supported by the Intramural Research Program of the National Human Genome Research Institute, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHGRI, or the NIH. We thank Lorraine Denis-Cooper, Studly Auguste, Shea Lott and ShaDonna Jackson for their assistance with recruitment and data collection. We are very grateful to all of the patients and their family who participated in this study.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.

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List of sitting yoga poses
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text: Snapshot: Lincoln Day Dinner held at Ritz Charles brings Pence, GOP leaders by Current in Carmel · April 14, 2016 On April 13, the Hamilton Co. GOP Republican Party held a Lincoln Day Dinner at the Ritz Charles in Carmel to provide a meet-and-greet with local candidates. Gov. Mike Pence was also in attendance. From left: Judge Brian Poindexter, Westfield City Councilor Jim Ake and State Representative Jerry Torr gather at the event. (Photos by Anna Skinner) Assistant Attorney General Abby Kuzma, left, is running for the attorney general spot. John Schaibley was in attendance to support State Representative Luke Kenley and his wife, Donna Schaibley. From left: Kathy Laesch, a Republican from Hamilton Co., Attorney Gary Miller, Event Planner Jennifer Trattner and Tammy Meyer, lawyer attend the event. "We are here to support the Hamilton Co. GOP and get information about the upcoming election and support the candidates who are coming," Laesch said. Lt. Gov. Eric Holcomb, left, speaks with Laura Campbell, a Carmel City Council member and the new chairman of the county's Republican party. "We have record breaking crowds and attendance for the reception and dinner tonight," Campbell said. "Funds being raised stay in Hamilton Co. for the Hamilton Co. Republicans." Denise Moe, of the Hamilton Co. Republican Party, left, pauses with Steve Carter, an attorney general candidate. Ersal Orzdemir, left, owner of Indy Eleven, attends the event with Brian Bosma, speaker of the house. Laura Campbell, chairman of the party, welcomes the attendees to the Lincoln Day Dinner. Gov. Mike Pence pauses with his wife, Karen. The Pences were special guests at the Lincoln Day Dinner. Share


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I was once again drawn in at the local secondhand bookstore by an interesting-looking book with a British connection. In Mustn't Grumble by Joe Bennett, the author (a British born ex-pat living in New Zealand) decides to travel around Britain following the same path H.V. Morton took years earlier and documented in his book In Search of England.
Of course, I would be interested in any book about travel in Britain, but I was especially seduced (and you'd think by now I would have learned my lesson) by all the glowing blurbs on the cover. Among them: "Extremely funny," "A very funny book," A brilliant wit," and "A funny and poignant portrait of Bennett's homeland."
{sigh} I don't know, after seeing all that emphasis on humor, wouldn't you open the book with the expectation that there might be the odd chuckle to be had among the pages??? Maybe the likes of Bill Bryson and J. Maarten Troost have unreasonably raised my expectations in regard to humorous travel books. Suffice it to say, there was nary a giggle to be found in this dreary travel tome.
The author has acquaintances scattered around Britain that he visits throughout his trip, which I'm sure was all very nice for him, but his narratives of the encounters don't exactly make for exciting reading for the uninvolved observer. He's also inordinately fond of recounting his drunken exploits -- both old and new. Why he thinks anyone would care is a question that's never answered.
Perhaps if I had been familiar with the Morton book I would have enjoyed this one more, as the author is continually comparing Morton's descriptions of towns with what he encounters some 80 years later. As it was, I found Bennett's descriptions of his day to day travels exceedingly dull. His main observations seem to be that no one will pick up hitch-hikers in Britain anymore, and that the British are extremely fearful of apparently widespread and random, out-of-control violence that plagues everyone who dares to step outside their homes.
So I'm not sure if all the authors of the raving blurbs on the cover of the book read a different one than I did, or if maybe they needed some wildly inaccurate blurbs for their own book covers. At any rate, I found nothing humorous and very little of interest in this book. I really MUST grumble about being misled yet again!
Final Verdict for Mustn't Grumble: One Gherkin, for some descriptions of unfamiliar areas of Britain, but overall a gloomy and unamusing read
About Me
- Lisanne624
- I'm a librarian who is interested in all things British. I try to visit London as often as possible, and am always planning my next trip. I lived in Sweden for a few years with my Swedish husband, so the occasional Swedish reference may occur . . .
The Gherkin Scale
Good, innit?
Fair to middlin'
Has some good points
Oi! Wot you playin' at?
Don't be givin' me evils!
I'm waiting! My library holds
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Friday, July 9, 2010
But sometimes a grumble is necessary!
I was once again drawn in at the local secondhand bookstore by an interesting-looking book with a British connection. In Mustn't Grumble by Joe Bennett, the author (a British born ex-pat living in New Zealand) decides to travel around Britain following the same path H.V. Morton took years earlier and documented in his book In Search of England.
Posted by Lisanne624 at 10:08 AM
Labels: Joe Bennett, Mustn't Grumble
2 comments:
- Gail said...
There's nothing more disappointing than being beguiled by the kudos and comments and then finding a book is really dull.
- July 10, 2010 at 12:36 PM
- Lisanne624 said...
Oh I know, Gail, and they get me every time! :) When will I ever learn???
- July 20, 2010 at 1:25 PM
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This post begins:
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Hydration & Exercise
While thirst may be a reliable indicator for some people to maintain the right level of hydration, the more active you are, the less reliable it becomes. Incredibly, a mere 2% drop in hydration can lead to an 8-10% decrease in your performance. [2] If you wait until you "feel thirsty", you've waited too long. Studies show that by the time you feel thirsty, you're already dehydrated. [3] If maintaining high productivity or achieving a new personal best is your primary goal then it's crucial to ensure you are getting sufficient water to meet your training demands.
However, the reality is that the optimal intake of water varies significantly from one individual to the next. Depending on your age, sex, body type, level of health and activity, your ideal water intake will vary. The standard general guideline is to consume 8 glasses of water daily, divided throughout the day. While this is a good tip for most people, a Paleo diet is rich in fruits and vegetables which provide you with added hydration, so you may not need the full 8 cups.
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Are Sports Drinks the Best Option for Refueling During Exercise?
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Daisy Lea & Tegan Ashley Are Topless And Other News
Leonardo DiCaprio is talking about babies now. Babies. [Lainey Gossip]
I suck at finding man candy. Michael K does not. [Dlisted]
Mark Cuban basically says Khloe is full of shit. [TMZ]
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Your morning links. … More »


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John Grose Latest News
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Ford GT Heritage Edition to honour 1967 Le Mans win!
The Ford GT is to be made available in a limited-edition Heritage theme honouring the GT40 Mark IV race car driven to victory by Dan Gurney and A.J. Foyt at Le Mans in 1967. The supercar will feature unique interior and exterior colour themes, and an exclusive wheel finish. "In creating a…
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New DS 7 Exclusive Preview at Oaksmere Hotel
We held an exclusive viewing of the new DS 7 Crossback at the Oaksmere Hotel on Saturday 12th August 2017. Our lucky guests enjoyed bubbles, canapés and an exclusive viewing of the pre-production model. For one day only, we were host to the only DS 7 Crossback showcar in the country,…
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Meet the pinnacle of the exclusive DS brand: The new DS 7 Crossback is an SUV like no other. Unveiled in the heart of Paris in February 2017, the new DS 7 Crossback is the height of luxurious French motoring. Available to order online this autumn, the first few lucky drivers of the high-fashion…
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Fast Ford Event - Sunday 13th August 2017
To celebrate the fantastic range of Ford Performance vehicles now available, including the Focus RS & ST, Mustang GT and the New ST-Line range, we were joined by many of you at the Fast Ford Event at our FordStore Ipswich dealership on Ransomes Europark on Sunday 13th August. We were…
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Cyclists in East Anglia were again treated to a taste of the pro cycling experience on our second Tour de Ford ride, in association with Team Sky, hosted by our FordStore Ipswich team on Sunday 14th May. The day began with registration and refreshments in the showroom on Ransomes Europark, followed…
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Akari Amou is the famous prism star in Pretty Rhythm Fairytale Dream. Akari is the daughter of famous star June Amou. Akari in the series shows up in episode 9, showing that she is doing a prism show in the beginning of the show and how she is very confident with her jumps and her song. Akari and Asuka become friends when they both challenge Miyuki Fujimoto and Sophie Suzuki to a contest.
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Discussion in 'Miscellaneous' started by Jetfire, May 30, 2010.
A couple of chewy chocolate chip cookies.
Subway BMT
Sharp cheddar on crackers and a black coffee.
Veggie lasagna with ground beef added
Some diet cola. Haven't made nor eaten lunch yet.
I made a very nice white wine pork with Bicentennial Rub (Penzey's blend). It was yummy, if I do say so myself. Too bad hubby can't manage to make it home to eat it while it's still hot.
cinnamon toast
Diet cola.
A very tiny piece of birthday cake and a black coffee.
Some cheddar cheese snack crackers and chasing them down with a little diet cola.
Bierwurst and hot mustard on dark rye bread and a green tea with lemon.
chili with cheddar cheese on top
Red wine and a home made brownie with walnuts.
Im drinking Iced Tea
Nacho chips.
Dry cereal and a black coffee.
Separate names with a comma.


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Charity and Sponsorship
We firmly believe that business reputation of a modern company is based, among other things, on adherence to high ethical standards.
Social and charitable activities in relation to the most vulnerable groups of the population, as well as support for cultural development, education, medicine, sports and other society-focused programs across the world form an important part of Gazprom Export's activities.
Alongside this year's Tribeca Film Festival, Gazprom had the privilege of sponsoring a private screening of the documentary film "The Russian Winter" for business contacts and film buffs at the Tribeca Film Center in New York City.
On April 21 a hockey match between Russia and Slovakia was held in the Moscow Sokolniki Sports Palace as part of the All-Russia charity event "In the Name of Kindness!".
Children from the orphanages "Together We Create, Together We Grow" and "I Learn from You" became participants of master classes within the framework of a charitable program. Master classes which lasted from 23d to 25th of March in the Moscow Region were conducted under the auspices of Gazprom Export and the German company Wintershall Holding AG.
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Russian chamber ensemble - Soloists of Moscow- under the baton of conductor and violist Yuri Bashmet held a concert at the Berlin Philharmonic on February 22 as part of the world tour anniversary dedicated to the 20th anniversary of the orchestra.
On January 9, 2012, the University of Warsaw officially launched the second recruitment for post-graduate students scholarship at the University of Warsaw, specializing in Russian-Polish relations, global energy subjects and related issues. The program is designed for 5 years and is being sponsored by Gazprom Export and EuRoPol Gas since 2011.
The annual international winter festival of music and fine art "December Nights of Sviatoslav Richter" held from 2 to 29 December at the Pushkin Museum of Fine Arts with the support of Gazprom export. Yuri Bashmet was the artistic director of the festival.
The main hall of the Hofburg palace in Vienna on December 15 hosted more than 800 children, aged 5 to 12, from European social institutions, charitable, religious, social and other organizations, who gathered for the children's Christmas party "Energy for life".
Since the beginning of December, pupils from the sponsored orphanages of our company are preparing and waiting for the most important and magical holiday - the New Year. Christmas trees are being erected and decorated everywhere, a sweet anticipation reigns, while the children are rehearsing their musical presentations for the New Year concert with enthusiasm.


text: Plus, there will be a home brewers contest judged by an expert panel! Relax and drink a cold one at our luxury resort in a cool, air-conditioned environment. 5:00pm – 8:00pm PGA National Conference Center, 400 Avenue of the Champions, Palm Beach Gardens – http://www.pgaresort.com/events for info and tickets. #LetsBeFrank #JupiterFL #CraftBeer #FloridaLife #Events


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Place of Creation:
Genetically Re-engineered Corporate manufactured Bio-Mechanical Weapon System
Trans-Organic Macro-Bacterial Bio-Weapon
HYDRA or Human Y-class Defense Reproductive Active unit is a Trans-Organic Bio-Mechanical Internal Ultra Ships Defense System primarily used on all Vekxul-class and Aslan-class Heavy Defense Warships.
System BasicsEdit
Basic Genetic Sub-StructureEdit
A basic HYDRA Bio-Queen genetically consists of a primary Human Genetically enhanced Quintuple Helix. Within these 5 bio-chemical strands are interlinked Sub-Quantum strands of Macro-Bacterial genetic material with every other chemical signature laced with a protective Sub-electron matrix (this is to increase the effectiveness of the units Chakra/Internal Bio-Power abilities/systems) and bound all this is a Growth Hormone/Stem Cell based Ultra Adaptive Chemical super-chain. This Chain is the systems Central Control Circulatory System which without none of the systems to control Self replication, Absorption, Assimilation, and Bio-Energy systems
Main Weapons SystemsEdit
Bio-Energy Field GenerationEdit
All HYDRA Bio-Units are equipped with a specialized form of Bio-Energy generation called a "Chakra" Field by VekXul Genetic Designers. Similar to the Chakra within Hindu philosophy the field system consists of a interconnected energy distribution grid throughout the entire units cellular structure.
Chakra Field StructureEdit
The field itself is centrally controlled by 7 central areas within the units body these are.
- Muladhara (Sanskrit: मूलाधार, Mūlādhāra) Base or Root Chakra (located at base of spinal cord which not bone but instead is a massive Central nerve base)
- Swadhisthana (Sanskrit: स्वाधिष्ठान, Svādhiṣṭhāna) Sacral Chakra (ovaries/prostate)
- Manipura (Sanskrit: मणिपूर, Maṇipūra) Solar Plexus Chakra (navel area)
- Anahata (Sanskrit: अनाहत, Anāhata) Heart Chakra (heart area)
- Vishuddha (Sanskrit: विशुद्ध, Viśuddha) Throat Chakra (throat and neck area)
- Ajna (Sanskrit: आज्ञा, Ājñā) Brow or Third Eye Chakra (pineal gland or third eye)
- Sahasrara (Sanskrit: सहस्रार, Sahasrāra) Crown Chakra (Top of the head; 'Soft spot' of a newborn)
Chakras in the head from lowest to highest are: golata, talu/talana/lalana, ajna, talata/lalata, manas, soma, sahasrara (and sri inside it.)
Each of these energy centers are whorls of constantly rotating vortices of Subtle matter which consist of a controlled massively interlinked Neutron, Electron, Photon Sub-Quantum structure that surrounds all of the units Genetic structures and Sub-Structures.
Fundamentals of Energy DistributionEdit
The Bio-Units ability to Distribute and convert energy into various weapons forms by 1st channeling of focusing the basic Sub-Quantum matter into the appropriate body points as the matter is accelerated into its new forms to be expelled this stage is called Quantum Microcosmic Orbit. As the energies further speed and collide in order to convert into various forms of weapons fire/conversion the moment that the energy is finally expended from the units body is known by many Bio-Mechanical physicists as Quantum Macrocosmic Orbit in which the internal energy is primarily expelled through either the main limbs (arms) or the back extending tentacles which are used as energy cannons/point defense weapons.
Main Offensive WeaponsEdit
Most of the HYDRA's central weapons systems were created and named by Dr. Keiko O' Brian who is considered the mother of modern Bio-Mechanics. Most of these systems were named after various Japanese Ninjutsu techniques. These are:
Primary Energy ManipulationEdit
The most basic form of the Bio-Units ability of energy manipulation is the acceleration/deceleration of various forms of light, air, and basic heat outside (and at times inside) of the body. Somewhat similar to Illarian and Ocompan psychic or telekinetic techniques the HYDRA Bio-Unit has the ability to at will utilize its energy distribution grid to either rapidly speed or slow down basic air and electromagnetic molecules that come into contact with the units skin. By using this basic macrocosmic acceleration process, it is capable of creating fire, water, ice or frost, the generation of high impact speed wind and various forms of EM based radiating energy blasts. The unit is also able through this process of creating primary forms of light and naturally occurring bio illumination. and also while capable of generating basic electricity internally can in an emergency generate it externally as well.
Phase Blast GenerationEdit
The Bio-Unit is capable of Phased Energy Rectification through focused energy distribution by thousands of micro energy bio-sacs located throughout the units body. The sacs contain small amounts of amino acids and other complex bio-chemicals in which are housed pockets of micro Electro-Plasma which the chemicals keep active. When activated the micro-plasma is channeled through the Chakra distribution grid in which the plasma is compressed and accelerated guided by the active Electrons and Protons as the energy is accelerated it automatically converts into its final Macrocosmic Orbital Form.


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This hotel is very close to the train station. I would recommend if you're only staying for one night for travel connection. The inside of the hotel is okay; clean, that's all. I stayed here few weeks ago, there were scattered groups of what looks like homeless folks who hang out in the park adjacent ...
Nice hotel, some staff could have been more helpful than they were. It was further out than we expected but we found a metro close to the hotel which we used to get us around just under 5 euros for a day pass.
Nice room , had spa bath, couldn't make a cup of tea, no bottle water available, the filter water was not great. Have money available bell boy expected a tip. Steak meal was highlight. Could do with a hotel sign visible from station across road.
Easy access to place of interest. Nice bedroom, helpful staff, nice breakfast
Huge room, comfortable bed and good air con. Very quiet. Wide choice at breakfast buffet. Loads of parking. Train station adjoins hotel and it costs 4.5 euros return to centre of Milan. 4 stops and only 17 minute journey. Would highly recommend.
The hotel is a short walk from Milan Central train station. Quiet neighborhood. The give you a yellow rubber duck and free non-alcoholic holiday beverages from the mini-fridge. The staff shows they care about guests.
Hotel reasonable, though needs some updating. Desk staff very helpful, others a little curt, breakfast as expected, nothing to get excited about.
Great location, close to the centeral , excellent breakfast! I would satay again in this hotel
This hotel has a very convenient location if you are flying in or out of Linate Airport, otherwise it does not make sense to stay in it. It is only 5 minutes by hotel shuttle from airport. This must have been a 4 star hotel back in the 60s and 70s but time has not passed in this place and everything ...
The staff were exceptionally helpful and accomodating. The room was clean, well lit, and very comfortable. Room service was efficient and the food was very good. Lastly, the location could not have been better. Loved this hotel and everything about it!
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Happy Camper Basic Round Button Key Ring
per keychain
About This Product
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Style: Basic Button Key Ring
Set your keys apart with a custom key ring. Create your own or choose from thousands of cute and cool designs. The sturdy clasp keeps your keys together securely and holds up well through daily wear-and-tear.
- Dimensions:
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- Depth: 0.5 cm
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Will be made by
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San Jose, CA
About This Design
Happy Camper Basic Round Button Key Ring
This camping trailer design is perfect to add to towels for the camper.
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Cisco Interface Module - Expansion module - Gigabit Ethernet x 8 + 10 Gigabit SFP+ x 1 - for ASR 903Item#: 13830679 | Model#: A900-IMA8T1Z=
- Price:
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Additional Resources
Cisco Interface Module - expansion module Product Details
Cisco ASR 900 Series Ethernet interface modules are designed to give customers a high degree of flexibility and value. All Ethernet interface modules share a common core that supports time stamping on the module for Y.1731 operations, administration, and maintenance (OAM) delay measurement functions to achieve precise results for one-way and two-way delay measurement. The modules also provide time-stamping functions for the IEEE 1588-2008 protocol. These time stamps help ensure that the Cisco ASR 900 Series Aggregation Services Routers achieve outstanding results when deploying IEEE 1588-2008 protocols for frequency and phase synchronization. Not all customers will deploy IEEE 1588-2008 for synchronization; therefore, the Ethernet interface modules also support input and output frequency synchronization using synchronous Ethernet (SyncE).
Device Type: Expansion module
Form Factor: Plug-in module
Ports: Gigabit Ethernet x 8 + 10 Gigabit SFP+ x 1
Connectivity Technology: Wired
Cabling Type: Ethernet 10Base-T, Ethernet 100Base-TX, Ethernet 1000Base-T, Ethernet 10GBase-X
Data Link Protocol: 10Mb LAN, 100Mb LAN, GigE, 10 GigE
Expansion / Connectivity
Interfaces: 8 x 1000Base-T - RJ-45 ¦ 1 x 10GBase-X - SFP+
Manufacturer Warranty
Service & Support: Limited warranty - advance hardware replacement - 90 days
Compatibility Information
Designed For: Cisco ASR 903
Additional Resources: Product Manuals
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Manufactured by: Cisco
Warranty provided by: Cisco
UPC No: 0882658538216
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