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Prescribing patterns of asthma controller therapy for children in UK primary care: a cross-sectional observational study
Asthma management guidelines recommend a stepwise approach to instituting and adjusting anti-inflammatory controller therapy for children with asthma. The objective of this retrospective observational study was to describe prescribing patterns of asthma controller therapies for children in a primary care setting.
Data from the UK General Practice Research Database were examined for children with recorded asthma or recurrent wheezing who, from September 2006 through February 2007, were ≤ 14 years old at the time of a first asthma controller prescription after ≥ 6 months without a controller prescription. We evaluated demographic characteristics, asthma duration, comorbidities, asthma-related health care resource use, and prescribed daily dose of controller medication. In addition, physicians for 635 randomly selected patients completed a survey retrospectively classifying asthma severity at the prescription date and describing therapy and health care utilization for 6 prior months.
We identified 10,004 children, 5942 (59.4%) of them boys, of mean (SD) age of 8.0 (3.8) years. Asthma controller prescriptions were for inhaled corticosteroid (ICS) monotherapy for 9059 (90.6%) children; ICS plus long-acting β2-agonist (LABA) for 698 (7.0%); leukotriene antagonist monotherapy for 91 (0.9%); ICS plus leukotriene antagonist for 55 (0.6%); and other therapy for 101 (1.0%), including 45 (0.45%) children who were prescribed LABA as monotherapy. High doses of ICS (> 400 μg) were prescribed for 44/2140 (2.1%) children < 5 years old and for 420/7452 (5.6%) children ≥ 5 years. Physicians reported asthma severity as intermittent for 346/635 (55%) patients and as mild, moderate, and severe persistent for 159 (25%), 71 (11%), and 11 (2%), respectively (severity data missing for 48 [8%]). The baseline characteristics and controller therapy prescriptions of the survey cohort were similar to those of the full cohort.
Physician classifications of asthma severity did not always correspond to guideline recommendations, as leukotriene receptor antagonists were rarely used and high-dose ICS or add-on LABA was prescribed even in intermittent and mild disease. In UK primary care, monotherapy with ICS is the most common controller therapy at all levels of asthma severity.
Asthma usually begins in the first years of life and is the most common chronic disease of childhood in developed countries
Anti-inflammatory therapy is the cornerstone of pharmacotherapy for persistent asthma to counter the chronic airway inflammation that characterises this condition. International and British asthma management guidelines recommend a stepwise approach to instituting and adjusting daily controller (preventer) anti-inflammatory therapy, beginning with the dose of inhaled corticosteroid (ICS) appropriate to the severity of asthma
The objective of this cross-sectional study was to describe prescribing patterns of asthma controller therapies for children in the UK primary care setting who had not received a controller therapy prescription in the prior 6 months and to explore the clinical and demographic characteristics influencing the choice of medication prescribed, as well as health care utilisation 6 months prior. In addition, we describe these parameters for a sub-cohort of children whose asthma severity at the time of initiating controller therapy was assessed retrospectively. Table
Table 1
Summary of treatment recommendations for childhood asthma according to 2005 Global Initiative for Asthma (GINA) guidelines
2005 GINA Guidelines for adults & children > 5 years old*
2005 BTS Guidelines for children 5-12 years old*
GINA Step 1 Intermittent asthma
No controller medication necessary Short acting β2 agonist as needed
BTS Step 1 Mild intermittent asthma
Short acting β2 agonist as required
GINA Step 2 Mild persistent asthma
Low-dose ICS (
BTS Step 2 Regular preventer therapy
ICS 200-400 μg/d†: 200 μg/d is a reasonable starting dose [for those < 5 y, use LTRA if cannot use ICS]
GINA Step 3 Moderate persistent asthma
Low- to medium-dose ICS
BTS Step 3 Add-on therapy
Add inhaled LABA; if poor response try ICS 400 μg/d; if poor response, add LTRA or SR-theophylline (ICS dose up to 400 μg/d) [for those 2-5 y, trial of LTRA]
GINA Step 4 Severe persistent asthma
High-dose ICS
BTS Step 4 Persistent poor control
Increase ICS dose to 800 μg/d Consider adding the following if needed: LTRA, theophylline, SR-β2 agonist tablets [for those < 5 y, refer to respiratory paediatrician]
BTS Step 5 Continuous or frequent use of oral steroids
Use daily steroid tablet in lowest dose; maintain high-dose ICS; refer to respiratory paediatrician
ICS = inhaled corticosteroid; LABA = long-acting β2-agonist; LTRA = leukotriene receptor antagonist; SR = slow-release
*Guidelines are the same for children ≤ 5 years (GINA) or < 5 years old (SIGN/BTS) unless specified.
† ICS doses are the beclometasone dipropionate equivalent doses.
Data source
Data regarding diagnosis, prescriptions, hospitalisations, co-morbidities, and demographic and clinical characteristics were derived from the General Practice Research Database (GPRD). The GPRD
Approval was given for the use of GPRD data for this study by the UK Medicines and Healthcare products Regulatory Agency (MHRA) Independent Scientific Advisory Committee.
We identified children who, from September 2006 through February 2007, were ≤ 14 years old at the time of a recorded prescription for asthma controller therapy (defined below) and who had no record of asthma controller medication during the 6 months before date of the prescription (index date). As further evidence of asthma recorded in the database, children had to have either a prior medical diagnosis of asthma; ≤ 2 episodes of wheezing at least 28 days apart; or ≥ 2 prescriptions for a short-acting β2 agonist (SABA) or ipratropium bromide at least 28 days apart. We excluded children with a history of bronchopulmonary dysplasia, cystic fibrosis, or any chronic pulmonary disorder other than asthma or wheezing.
In addition, we randomly selected 792 children from the full study cohort for inclusion in a physician-based cross-sectional structured survey to assess asthma severity in relation to controller therapy. (A total of 900 children were originally selected, and 108 of these were ultimately excluded as these children had been prescribed oral corticosteroids, not considered a controller therapy.) Physicians were asked to complete the survey questionnaire (Additional file
Additional file 1
RE-CLIC Survey Physician Questionnaire. physician survey form used in the study.
Click here for file
Data extraction and analysis
We captured the following asthma controller therapies in the database: ICS, inhaled LABA, ICS and LABA combinations, sustained release β2-agonists, sustained release theophylline, cromones, and antileukotrienes. We also tabulated prescriptions for SABA on the index date, as well as for 6 months before and 12 months after. Database criteria for defining an asthma diagnosis and wheezing are listed in Additional file
Additional file 2
Criteria for identifying a medical diagnosis of asthma or wheezing. Criteria for identifying a medical diagnosis of asthma or wheezing criteria for identifying children with asthma or wheezing in the GPRD.
Click here for file
We tabulated demographic characteristics, smoking history, asthma duration, and the prescribed daily dose of controller medication at the index date for each patient, stratified by controller therapy type and, for the survey cohort, asthma severity. In addition, we collected data on respiratory and allergic comorbidities and on asthma-related health care resource use for up to 24 months before the index date.
Statistical methods
Descriptive statistics were used to characterise the distribution of demographic factors, controller medication prescribing at baseline, SABA prescriptions, comorbidities, and resource use. For categorical variables, the proportion of patients with the variable(s) of interest was calculated and compared using χ2 analysis or Fisher's exact test. For quantitative variables, comparisons were made using Student's
Full cohort and survey cohort-demographic and clinical characteristics at baseline (index date of controller therapy prescribing)
We identified 10,004 children 0-14 years old in the GPRD who were prescribed asthma controller therapy between September 1, 2006, and February 28, 2007, and who had no controller prescription during the prior 6 months. Their mean age was 8 years; 806 (8%) patients were 2 years or younger and the other patients were evenly distributed over the age range of 3-14 years; overall, 30% were 5 years or younger; 59% were boys (Table
Table 2
Characteristics of children new to asthma controller therapy, stratified by full cohort and survey responder cohort
Full cohort (n = 10,004)
Survey responders (n = 635)
p value
Mean age (SD), yr
8.0 (3.8)
8.1 (3.8)
Age 0-2 yr, n (%)
806 (8.1%)
51 (8.0%)
Age 3-5 yr, n (%)
2155 (21.5%)
143 (22.5%)
Age 6-8 yr, n (%)
2307 (23.1%)
126 (19.8%)
Age 9-11 yr, n (%)
2402 (24.0%)
165 (26.0%)
Age 12-14 yr, n (%)
2334 (23.3%)
150 (23.6%)
Male sex, n (%)
5942 (59.4%)
365 (57.5%)
Smoking status
Non smoker
5651 (56.5%)
366 (57.6%)
532 (5.3%)
31 (4.9%)
Ex smoker
77 (0.8%)
6 (0.9%)
Passive smoker
152 (1.5%)
3 (0.5%)
Unknown smoking status
3592 (35.9%)
229 (36.1%)
BMI, n
Mean BMI (SD)
17.3 (5.3)
17.1 (5.0)
Median BMI (range)
16.6 (5.0-49.6)
16.7 (5.2-47.7)
Asthma duration: mean (SD), yr
4.3 (3.6)
4.4 (3.6)
Median (range), yr
3.7 (0.0-15.0)
3.9 (0.0-14.0)
Asthma controller therapy prescription at index date, n (%)
ICS monotherapy
9059 (90.6%)
575 (90.6%)
LABA in fixed dose combination
574 (5.7%)
43 (6.8%)
124 (1.2%)
4 (0.6%)
LTRA monotherapy
91 (0.9%)
6 (0.9%)
55 (0.6%)
1 (0.2%)
101 (1.0%)
6 (0.9%)
BMI = body mass index; ICS = inhaled corticosteroids; LABA = long-acting β2-agonists (in fixed dose combination is with ICS); LTRA = leukotriene receptor antagonists.
During the 6 months before the index date, 396 (4%) children were prescribed an oral corticosteroid, and 525 (5%) received antibiotics for a lower respiratory tract infection. Lung function test results, usually as peak expiratory flow rate, were recorded during the 6 months preceding the index date for 974 (10%) children. On the index date, lung function testing was performed for 1657 (17%) children, recorded as peak expiratory flow rate for 1581 (16%) children.
Of the 792 surveys sent to GPs, 635 (80%) were completed. The baseline characteristics of the surveyed responder cohort were similar to those of the full cohort (see Table
Full cohort and survey cohort-index therapy prescription patterns and doses of ICS monotherapy
Most children (91%) were prescribed ICS monotherapy as asthma controller therapy (Table
For the surveyed responder cohort (those with known asthma severity), monotherapy with ICS was prescribed for all of the patients with severe asthma and approximately 90% of patients in the other severity classifications (Figure
Figure 1
Asthma controller therapy prescription, by asthma severity, for 635 children ≤ 14 years old
Asthma controller therapy prescription, by asthma severity, for 635 children ≤ 14 years old. Children had not been prescribed an asthma controller medication in the prior 6 months. Data were derived from the UK General Practice Research Database. Asthma severity was defined by physicians according to GINA guidelines 2005
Table 3
Prescribed daily dose of controller medication at cohort entry by asthma severity--prescriptions with defined dosage information for survey cohort
Asthma severity classification
Intermittent (n = 346)
Mild (n = 159)
Moderate (n = 71)
Severe (n = 11)
Missing (n = 48)
Total no. prescriptions
7 (2.0%)
5 (3.0%)
3 (5.9%)
Beclometasone, no.
Mean dose (SD)
261 (126)
230 (112)
258 (107)
230 (95)
269 (149)
Budesonide, no.
Mean dose (SD)
218 (101)
364 (229)
350 (100)
300 (141)
400 (346)
Fluticasone, no.
Mean dose (SD)
216 (75)
150 (54)
167 (58)
Montelukast, no.
Mean dose (SD)
5 (0)
5 (1)
5 (1)
Salmeterol, no.
Mean dose (SD)
88 (25)
FDC Budesonide
Mean dose (SD)
267 (116)
333 (116)
Mean dose (SD)
16 (7)
20 (7)
Mean dose (SD)
400 (173)
180 (42)
240 (152)
294 (232)
Mean dose (SD)
100 (0)
90 (21)
90 (22)
94 (25)
FDC = fixed-dose combination
Doses are actual doses as prescribed (μg/d).
Prescriptions for SABA were written for 31% of all patients during the 6 months before their index controller prescription; for 75% on the index date; and for 72% during the 12 months after the index date. Similar overall proportions of patients in the survey cohort as in the full study cohort received SABA prescriptions, as shown in Table
Table 4
Short-acting β-agonist prescriptions
6 months prior
On index date
12 months after
No. prescriptions, median (range)
1 (1-13)
1 (1-3)
2 (1-26)
Patients with prescriptions, by controller therapy, n (%)
ICS monotherapy (n = 9059)
2805 (31.0)*
6876 (75.9)*
6515 (71.9)*
ICS + LABA (n = 698)
174 (24.9)
497 (71.2)
519 (74.4)
ICS + LTRA (n = 55)
13 (23.6)
44 (80.0)
49 (89.1)
LTRA monotherapy (n = 91)
38 (41.8)
30 (33.0)
69 (75.8)
Other (n = 101)
31 (30.7)
62 (61.4)
82 (81.2)
Total (n = 10,004)
3061 (30.6)
7509 (75.1)
7234 (72.3)
Survey cohort: patients with prescriptions, by asthma severity, n (%)
Intermittent (n = 346)
87 (25.1)*
274 (79.2)
241 (69.7)*
Mild persistent (n = 159)
57 (35.9)
118 (74.2)
129 (81.1)
Moderate persistent (n = 71)
30 (42.3)
52 (73.2)
62 (87.3)
Severe persistent (n = 11)
6 (54.6)
9 (81.8)
9 (81.8)
Missing classification (n = 48)
13 (27.1)
31 (64.6)
36 (75.0)
Total (n = 635)
193 (30.4)
484 (76.2)
477 (75.1)
*P < 0.01 for comparisons among controller therapy groups or asthma severity groups.
Full cohort-characteristics according to asthma controller therapy
Additional file
Additional file 3
Table S5 for the manuscript Table S5: Characteristics of 10,004 children new to asthma controller therapy, stratified by treatment group (column percentages). original table S5.
Click here for file
We found that the most common asthma controller therapy recorded from September 2006 through February 2007 in the UK GPRD for children aged 14 years and younger with no controller prescription during the prior 6 months was monotherapy with ICS, prescribed for over 90% of children. This is in line with UK guidelines
Results of this observational study indicate that prescribing practices did not always correspond to recommendations of asthma management guidelines. Both international and British asthma guidelines recommend stepwise introduction of controller therapy, typically beginning with low-dose ICS, defined in British guidelines as 200 μg/day of CFC-beclometasone dipropionate or equivalent for children 12 years and younger and 400 μg/day for older children
The pattern of prescribing of combination therapy with ICS and LABA, which asthma guidelines recommend for patients with moderate or severe persistent asthma, was further evidence that recalled asthma severity and therapy were not consistent. Combination ICS-LABA therapy was prescribed for 7% of patients, most of whom were classified as having intermittent or mild persistent asthma; these children tended to be older and to have a longer duration of asthma. Similarly, in a recent study of insurance claims in the US
Recent studies have suggested that LABA use is increasing in children, particularly as a first-line combination inhaler
Over 50% of patients in the survey cohort were classified as having intermittent asthma and thus, assuming the classifications were correct, may not have asthma of sufficient severity to warrant controller therapy. Both the 2005 GINA guidelines and the British asthma management guidelines in effect at the time
Of the children with severe asthma, none were prescribed additional therapy as add-on to ICS, although almost half received oral corticosteroids on the index date; these patients were too few in number (n = 11) to enable us to draw conclusions from the findings. Leukotriene antagonists were not commonly prescribed. Finally, objective measures of airway obstruction (spirometry or peak flow measurement) were recorded for fewer than one fifth of children.
Our findings point to sub-optimal clinical practice but are not unusual. Clinical guidelines, including asthma management guidelines, are often not followed in general practice
Guidelines are formulated to present busy clinicians with a summary of up-to-date evidence of the effectiveness of different treatment options, and so to aid therapeutic decisions. The British asthma guidelines are distributed to all clinicians treating asthma in the UK, where this study occurred, and are accepted as the standard for asthma treatment. These guidelines recommend that "...departures from the national guideline....should be fully documented in the patient's case notes..." and justified
Our findings describe prescribing practices specific to the UK. Turner and coworkers
The GPRD is a large, well-validated database that records real-life prescribing practices and is relevant and accepted for studying childhood asthma in the UK, as most of these children are managed in primary care
An important study limitation is the possibility of missing data; for the survey sub-study we were unable to link data on 51 prescriptions to asthma severity. Moreover, it cannot be assumed that drugs as prescribed in the database were also dispensed or consumed. In addition, our findings could reflect seasonal trends, as we gathered data for 6 months and not a full year. When available, we gathered information on comorbid conditions for the prior 24 months; however, some children did not have data going back 24 months, e.g., those under 12 months old, thus the patient percentages for these data may not be comprehensive. Finally, asthma severity, based on 2005 GINA guidelines
This cross-sectional study has enabled us to describe UK primary care prescribing practices in late 2006 and early 2007 for asthma controller therapy for children with recorded asthma or recurrent wheezing and no controller therapy in the prior 6 months. We found that physician classifications of asthma severity did not always correspond to guideline recommendations for prescribing controller therapy. Children classified as having intermittent asthma were prescribed controller therapy with ICS, sometimes at high doses, and those with intermittent and mild asthma received combination therapy with ICS and LABA. High doses of ICS were prescribed without a prior low-dose ICS prescription for some children, and combination therapy with ICS and LTRA was rarely prescribed. In UK primary care, despite endorsement in local guidelines, children with asthma are seldom treated with LTRA, and monotherapy with ICS is the most common controller therapy at all levels of severity.
Competing interests
Neither Mike Thomas nor any member of his close family has any shares in pharmaceutical companies. In the last 3 years he has received fees for acting as a consultant for MSD, Schering, and GSK and has received speaker's honoraria for speaking at sponsored meetings from the following companies marketing respiratory and allergy products: Astra Zeneca, Boehringer Ingleheim, GSK, MSD, Schering-Plough, Teva. He has received honoraria for attending advisory panels with Altana, Astra Zeneca, BI, GSK, MSD, Merck Respiratory, Schering-Plough, Teva. He has received sponsorship to attend international scientific meetings from GSK, MSD, Astra Zeneca. He has received funding for research projects from GSK, MSD, Astra Zeneca. He holds a research fellowship from Asthma UK.
Tao Fan and Stephanie Taylor are employees of Merck & Co., Inc.
Tarita Murray-Thomas and Tim Williams are GPRD members of staff and have no competing interests to declare.
Authors' contributions
MT participated in the study design, data analysis, results interpretations, and manuscript development. T M-T participated in the study design, data analysis, results interpretations, and manuscript development. TF participated in the study design, data analysis, results interpretations, and manuscript development. TW participated in the study design, data analysis, results interpretations, and manuscript development.
ST participated in the study design, data analysis, results interpretations, and manuscript development. All authors read and approved the final manuscript.
Writing assistance was provided by Elizabeth V Hillyer with the financial support of Merck & Co., Inc.
This study was funded by Merck & Co., Inc., Whitehouse Station, NJ, US.
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Pre-publication history
The pre-publication history for this paper can be accessed here:


text:
Looking for uplifting inspiration? Temporarily opt out of the busy world around you and do something fun. It works wonders! How do I know? I just got back from Kauai, Hawaii.
My Hawaii adventure was awesome! A group of blogging friends and I met to discuss business. Getting away together was a great decision—pure enjoyment even if it was a working vacation.
Although we had a lot on our agenda, we definitely enjoyed spirited conversations around the most excellent meals. Of course we had lots of laughs and spontaneous fun, too!
And then those palm trees. And beaches. And sunsets (satisfied sigh).
Now that I'm back home, I've wanted to re-create that fabulous food journey for my family. The fresh pineapple and coconut was amazing. There were several tastes that I would like to make and haven't conquered yet, but one of the meals we particularly enjoyed in Hawaii was a twist on a southern classic.
We had THE BEST mashed/whipped potatoes ever! They were regular mashed potatoes but they had goat cheese on top. It's hard to believe the upgrade in the taste. It was served in personal-sized, cast iron pans with fried chicken.
It's not a difficult meal to make and it was the perfect accompaniment while sharing photos and stories with my family about the trip.
No palm trees were served with dinner, but Lipton Peach flavor iced tea goes perfectly with this most delish comfort food.
As I continued my stories after dinner, we were still setting around the table, drinking our iced tea and my son proposed a "toast": "To Mom, I'm glad you had a good time…but I'm glad you're home."
And with that, I realized that even though I had a great time on my Hawaii business trip, sharing it with my family made it even more meaningful.
Good food. Good friends. FAMILY…and that's what it's all about.
- 40 ounces golden potatoes
- 4 cloves of garlic
- 4 tablespoons butter
- 4 ounces goat cheese
- 1 cup of milk
- 2 tablespoons salt
- 1 tablespoon pepper
- Wash and quarter potatoes. Add all the potatoes to a pot of cold water at once.
- Crush and peel garlic and add to the potatoes along with a tablespoon of salt.
- Turn the burner on high and bring to a boil. Cook potatoes for 10-15 minutes, until fork tender.
- Drain potatoes and transfer into a mixing bowl. Add half the milk, half the butter and half of the goat cheese. Using a potato masher or whisk, gently mash the potatoes. Add the rest of the ingredients and continue mashing until all ingredients have melted into the potatoes.
- Mix the potatoes with a hand mixer on the lowest setting until smooth. Do not over mix.
- Serve along-side rotisserie or fried chicken and vegetables.
This is a sponsored conversation written by me on behalf of Lipton. The opinions and text are all mine.

subset: commoncrawl


text:
I rinsed my face, the refreshing water wakes me up fully. I have survived half way through the hallway. Almost everyone glared at me as I walked through the hallway, but luckily, the restroom was feet away. I dried my hands and made my way back out. Here goes nothing...
The bell rang, I was the first one to come early to class... I was a bit nervous, especially since Angelo was still my partner for this period. My joy for writing class has vanished... thanks to that butthead. The class started filling up... and finally, the devil himself walked in. Once he sat down I scooted away dramatically making sure that he noticed. He gave me a scowl. The class proceeded with Ms.Gwen teaching us the meanings of poems. 'Poems can mean many different things to an individual... what something means to you, can mean something different to someone else', Ms.Gwen explained. 'I want you guys to write a poem, whether short or long, but it has to have a deep meaning to it.' We scribbled away, some were taking advantage of the 'no maximum or minimum stanzas', writing only about ten words in their paper. After about half an hour, most of the class had finished. 'Well now that most of you guys are done, you and your partner must decide on who will be reading their poem.', Ms.Gwen instructed. I avoided any type of contact with Angelo. I suddenly felt my chair being pulled closer. I looked down to find none other than the homophobe with his hand on my chairs leg. 'If we aren't going to speak to eachother personally, then so be it. But this affects my grade, and I can't afford a low grade.', he told me. 'I don't have any interest in talking to you. Not personally, not academically, not any way.', I told him avoiding eye contact with him. 'Well, that's too bad because I'm in the mood to spill my guts to you.', he said smiling. Ugh that jerk! How does he have the audacity to smile after what happened last night!?!... 'You ready?', he asked. I remained silent as I said I would. 'I'll take that as a yes.', he said clearing his throat, and then begun reading:
' I saw an angel... An angel that floated above the stars.'
'An angel unlike any other angel I have seen.'
'I saw an angel... An angel that looks at me with little hope.'
'An angel that makes my heart beat ten times faster than the usual.'
'But this Angel... this angel that has captured my heart... is guarded by its most strongest weapon... its confidence.'
'I saw an angel... the angel that has me floating in the clouds.'
He looked at me with a 'what do you think?' Face. I tried making small talk. 'It was...good', I said simply. 'Oh my god, he can talk', he joked. I ignored his dumb joke. 'One question though', I told him. He turned to look at me. 'And that is?', he asked. 'How many of these angels did you say there were?', I asked. 'I think the 'an' pretty much explains it.', he said. 'Are you sure its just one Angel? Because maybe its just me... but if im not mistaken. You have two angels under your wing.', I told him. Angelo stopped playing with his pencil. 'What are you on about Carter?', 'nothing, I should get back to work', I said grinning. 'Spill it! Or i'll slice you like a potato!', he mumbled agressively low enough so only I could hear. 'Well, do you remember the time when you went to the supplies store with your girlfriend, and, to be specific... the one with blonde hair?', I asked. He put his head down in shame knowing where I was going. 'Yeah.', he said in a whispering voice. 'Do I really need to continue for you to know where this is going?', I told him. He banged his fists on his desk. 'You don't know what you are talking about.', he said with killer eyes, I couldn't help but get turned on by that look. 'Maybe not, but even I, a 'faggot', knows better than to play with two girls.', If it weren't for the bell ringing, I could have sworn he would have punched me right there.
'So did he try anything?', Randy asked. 'Nope', I responded in the happiest mood that I have been since months. 'Woah, did you win the lottery or something? You seem a bit too happy.', Randy asked curiously. 'Better, I found Angelos weakness', I told Randy. 'Really? What is it?', he asked me curiously. 'I'll tell you sometime', I told him. 'Oh come on! Why not today?!', he asked. I laughed. 'Bye Randy', I told him. He gave me a short hug. 'What was that for?'... 'Well... it's a new way to say bye to friends', he said stuttering. 'Well bye...I guess', I told him. I went inside my house to find my grandma cooking. 'Is that you Artie?', she called out. 'Yeap, it's me grandma.', she came out of the kitchen. 'Guess what i'm making today', grandma said giving me a peck on the forehead. 'I give up, what?', I asked curious. 'Your favorite, chicken alfredo.', she said. 'Aww thanks grandma', I told her. I followed her to the kitchen. I took in the scent of the pasta, a delicious scent. 'Grandma, is it just me, or did you make more than usual?', I asked. 'Nope, I made more than usual', she answered. 'Did you see my stomach getting bigger?', I laughed. 'Haha no, but we are having a guest over.', she said. 'Guest?', I wondered. 'Well it was a day when you weren't here, a young man came by asking for work, so I took advantage of the opportunity, and well he's gonna do housework from now on... since I got a job as a cashier in Mrs.Clarks bakery shop.', 'Wow, where have I been all this time.', the door bell rang. 'That must be him.', my grandma said, rushing up with the food. 'I'll get it..', I swung the door open and couldn't believe what stood before me... my worst nightmare...
'Carter?!', Angelo looked just as shocked as I was. 'What are you doing here?!', he said. 'I live here, what are YOU doing here?', I asked. 'I was here for a job... but... I guess the lady moved to another home?'... 'that lady is my grandmother you fool, and shes been expecting you.'... 'well, do I wait out here or come on in?', Angelo asked. 'I never thought I would say this EVER to you but, come on in Angelo.' He came in just in time, my grandmother had set up the table. 'Sit.', I told him with hate in my voice. 'Okay.. don't get any happier about seeing me.', he said sarcastically. 'Why hello Angelo, how nice to see you again!', my grandmother greeted him nicely. I hated it. 'Mrs.Stein a pleasure to see you... and your grandson.', Angelo said shaking her hand. What a lie. We sat down and began eating. 'Grandma, did you know that Angelo goes to my school?', I told her. 'Oh really?, How is my grandson at school?', she asked Angelo. He looked at me, 'Charming... Very Charming.', he told her. 'Why if I had 5 thousand bucks for everytime he was nice, I would be a millionaire!', apparently my grandma didnt realize that he had just called me a jerk. We talked more over dinner. Finally it was time for Angelo to leave... 'Can you start working tomorrow?', grandma asked him. 'Sure', Angelo responded. 'Well se ya later Mrs.Stein...', he said while waving to my grandmother. 'Later Carter...', he said grinning. Oh how I HATED him!!


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We have got a week off from school and I'm really bored I want to go to the shopping centre but there's nothing on at the movies in the shopping centre that I want to see and we don't live near any fun places I need some ideas of things to do so I'm not bored, I might go insane if I don't get something to do.
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In these situations, Netflix is love, Netflix is life.00|00|0
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Java network security
Prentice Hall PTR, 1998 - Computers - 232 pages
This book gives managers and administrators the tools they need to build highly-secure, easy-to-administer Java applications and applets. Learn about Java's built-in security capabilities and how you can make the most of them. Discover how to evaluate the security risks associated with using Java in various environments; understand the known loopholes in Java security; and discover techniques and fixes to avoid those security risks. Learn how to establish standards for systems management in Java applications, and how to instrument a Java-based application for control and performance measurement. This is essential reading for all IS managers, administrators, system analysts and consultants who want to build secure, manageable Java applications.
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An Overview of Java Security
Attack and Defense
The Java Virtual Machine
11 other sections not shown
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algorithm allow applet class loader application architecture attack authentication browser bytecode verifier bytes Chapter class file verifier class loader ClassLoader client compiler configuration connection constant pool contains create Cryptography Cryptolope object decompiler Destination port digital signatures environment example executable content Figure firewall function gateway header implementation installed instruction interface JAR files Java applet Java bytecode Java class file Java code Java security Java virtual machine JavaSoft key database key pair language lnternet lP address machine code Microsoft Netscape operating system package packet perform PointlessButton primordial class loader protocol proxy server public key certificate public void request runtime sandbox restrictions script security manager SecurityManager signed applets signed JAR signer SOCKS server specific stack String TCP/lP trusted classes value of type Web browser web of trust Web server


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How to update the form after submission with another personAsked by KELLIE RAINBOW on March 02, 2016 at 11:44 PM
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Bushy Run Picnic at the Battlefield
- Aug 28, 2016
From: 12:00PM to 5:00PM
- 1253 Bushy Run Road
- Jeannette, PA 15644
Bring your own lunch and relax for an old-fashioned picnic on the battlefield grounds. Concessions will be available. Stop by the *Visitor Center for a guided golf-cart tour of the battlefield.
*Regular admission costs for visiting the museum still apply.


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Data from: Genetic structure of fragmented southern populations of African Cape buffalo (Syncerus caffer caffer)
Date Published: December 10, 2014
DOI: http://dx.doi.org/10.5061/dryad.8f409
Content in the Dryad Digital Repository is offered "as is." By downloading files, you agree to the Dryad Terms of Service. To the extent possible under law, the authors have waived all copyright and related or neighboring rights to this data.
|59 times
|The African buffalo microsatellite database is presented as an excel file with two sheets. The first sheet displays the allelic composition of the 14 autosomal microsatellites used within the present study, which is concentrated on southern African sampling localities. The first four lines of this first sheet refer to the title attributed to the present database sheet, the number of clusters identified with the STRUCTURE software, the number of loci studied, as well as the total number of individuals studied, respectively. The table below covers the following information for each specimen involved in the present study: species name, country of origin, sampling locality (protected area), gender, sample ID, cluster affiliation (result from the STRUCTURE analysis), followed by the allele composition for each 14 loci (diploid species). The second sheet displays the allelic composition of the 3 Y-chromosomal microsatellites used within the present study. The first three lines refer to the title attributed to the present database sheet, the number of loci studied, as well as the number of male individuals studied within the present study, respectively. The table below cover the following information for each male specimen genotyped in the present study: sample ID, alleles composition for each three Y-chromosomal microsatellites, haplotype designation for each three Y-chromosomal microsatellites, and final haplogroup determination. The haplotype designation is a number attributed to designate the combination of alleles for each of the three loci because they can appear as multicopies on the Y-chromosome. The haplogroup is thus defined as the combination of the haplotypes, written as {n UMN1113 haplotype, n UMN0304 haplotype, n INRA189 haplotype}, where n UMN1113 haplotype = 1,...,15, n UMN0304 haplotype = 1,...,9, and n INRA189 haplotype = 1,...,12. For further information, please see the main manuscript.
|DRYAD-SYNCERUS.xlsx (59.75 Kb)
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Additionally, please cite the Dryad data package:
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text:
Julie's Cuban Restaurant Map
202 Dovercourt Rd. (Dundas St. W.)
416-532-7397 | Make Restaurant Reservations
Find Julie's Cuban Restaurant with this handy map to the restaurant. If you don't see a pop-up, click on the map's green arrow to get driving directions to and from Julie's Cuban Restaurant.
Find out which restaurants and chefs top the list of GAYOT's 2016 Annual Restaurant Awards.


text:
Meteorologist is a free weather program for OS X. It allows users total control over their weather viewing, including simultaneous interlaced weather reports from multiple weather servers, multiple weather locations, weather alerts and much more.
Other Useful Business Software
User Ratings
User Reviews
LOVE Meteo! BUT...after updating to 3.0.4, I only get "Loading" in the Menubar. This fixed itself after 10 minutes so my review is back to FIVE stars. Great product!
Excellent program with responsive assistance and support. Use it constantly.
I downloaded the version 3.0.1 of Meteorologist and still have the same problem as with version 3.0.0, which is, the temperature shows as: 9999ºF/% and i get a message that says: Lag/Long:Invalid API key. I'm running OX 10.12.3, Sierra.
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Had another temp monitor in menubar app that no longer functions... wanted the functionality back so I went looking and found this gem. Am VERY glad it offers a source other than Yahoo for getting data, made me realize the "other" app is failing because it also depends on Yahoo, and something changed there so apps can no longer draw on it for the data.


text: This gallery features a small selection of my animal images taken from various locations around Scotland; all from small insects to large mammals. All of my photography work is available to buy via my online stores, listed below; they are available in canvas prints, framed prints and cards. Thank you for looking through my portfolio.


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By: Han Bowen(Author)
Huayu Nature Book Trade Co.Ltd
Language: Bilingual in English and Chinese
Paleontological Fossils of Gansu Province provides an overview of fossils from different eras in the Gansu Province in the northwest of China.
1. Foreword
2. An Introduction to the Permanent Exhiitions in Gansu Provincial Museum
3. Preface
4. Paleozoic Era-Eruption of Invertebrates
(1) Cambrian Period
(2) Ordovician Period
(3) Silurian Period
(4) Devonian Period
(5) Carboniferous Period
(6) Permian Period
5. Mesozoic Era-Thriving and Prosperous Time of Reptile
(1) Triassic Period
(2) Jurassic Period
(3) Cretaceous Period
6. Cenozoic Era-Happy Time of Mammal
(1) Paleogene Period
(2) Neogene Period
(3) Pleistocene and Holocene
7. Epilogue
8. Postscript
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Copyright : telugumirchi
Link : http://www.telugumirchi.com/en/technology/ringo-launches-cheapest-calling-service.html


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The Best Tricks To Keep Your Kids Entertained Thes...
School holidays are almost upon us, which means there are thousands of busy parent's looking for ways...20
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Children are continually learning and evolving, so being constant in your positive parenting techniques will help in...699
"Rain, rain, go away," I hear my kids humming, but unfortunately to no effect. Rain or not,...18
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Teaching mindfulness to kids has a lot to do with staying out of nature's way. Children have...17
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When you have young children, toys somehow make it in your home whether you like it or...46
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Candidates receive the recommendation of the MNEA-PAC by demonstrating a commitment to public education and upon the recommendation of local educators. For more information about the Missouri NEA Recommendation process please visit www.mnea.org/Missouri/PoliticalAction/21.aspx
How you vote is a personal decision; however, Missouri NEA leaders hope that, as you review the issues and positions of candidates, you will consider the recommendation of your fellow educators in the following elections:
Missouri NEA local affiliates made recommendations for school board candidates and bond issue elections in April.See below for the outcomes of those elections.
Missouri National Education Association


text:
The Brabus 850 6.0 biturbo WIDESTAR has been unveiled ahead of the Frankfurt Motor SHow that is scheduled to take place shortly.
It has been based on the Mercedes G63 AMG, which receives wider fender flares, the front spoiler and the ram air hood. It also gets tinted xenon headlights and 23-inch alloy wheels.
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18 Aug 2017
Support Center
Troubleshooting HDR - not all frames are taken
Troubleshooting HDR - not all frames are taken
When doing HDRs with Promote Control, you may find that only the first few frames are being taken, and then Promote Control may show an error, or silently complete the sequence a few frames short. This happens because some cameras, especially entry level ones, may not respond fast enough to Promote Control shutter release commands. You can make Promote Control go slower, so that your camera will catch up.
We recommend you update Promote Control firmware first to make sure you will have access to all the setup features. To do that, please visit the
Promote Control Firmware Update Knowledge Base section
to download the latest firmware update files as well as the firmware update application. Please consult Promote Control User Manual for details on how to update your Promote Control firmware.
To ensure your Promote Control is working as fast as your camera can, use the following Promote Control setup settings:
1. If you are not using shutter cable, and only use USB, use "USB shutter release frame delay" setting. Increase the value of that setting until all frames are being taken successfully.
2. If you are using shutter cable, use "Adapt shutter cable to small cam buffer" setting. Increase the value of that setting until all frames are being taken successfully.
3. If you use Live View mode while taking HDR images, refer to the following KB article:
Canon 5D Mk II and Live View/MLU - one Mirror Up per sequence
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Keshi Pearl & Peridot Bracelet
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Price: $62.00
Smoothly polished peridot beads stand out as they are intermingled with luminous White Keshi pearls to add a splash of Spring Green. Available in your choice of metal color and clasps. *Please note that bracelet length will not be adjustable with a toggle clasp.
E-mail to a friend | Add To Wish List
About Freshwater Keshi Pearls:
Pearls are the official birthstone for the month of June. Cultured freshwater pearls have been highly prized and are considered to offer the power of love, money, protection and luck. They are thought to give wisdom and cement engagements and love relationships.
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About Peridot:
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text:
We're huge fans of Giulia here at Female First, with the singer herself sometimes writing exclusive guest blogs for the website on a variety of different and unique topics!
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text:
safte-monitor reads disk enclosure status information from SAF-TE capable enclosures (SCSI Accessible Fault Tolerant Enclosures), which is common on many intelligent SCSI disk enclosures and some rackmount servers with SCSI hotswap drive bays. It can monitor multiple devices and will probe for and detect them. The information retrieved includes power and fan status, temperature, audible alarm, drive faults, array critical/failed/rebuilding state, and door lock status. safte-monitor logs information to syslog and can execute a program with details of component failures. It also has a web status display.
|Hardware Monitoring
|Operating Systems
|POSIX Linux
Release Notes: This first production release candidate fixes reading of the Celsius flag in the high bit of the "number of thermostats" field, fixes an offset bug in reading doorlock and speaker fields, adds a safte-monitor manpage, makes the install directories FHS compliant, and adds pre-built RPM and deb packages.
Release Notes: A problem where an IOCTL buffer overflow occurred with 2.6 kernels was fixed. Compilation issues with newer GCC versions were corrected. A Debian package was created, and changes were made to the RPM. The install location for the daemon was changed from /usr/bin to /usr/sbin.
Release Notes: Renamed to safte-monitor
Release Notes: Added internal HTTPD and Web status display, and an RPM spec file and RPM target to Makefile.
A Fluent OpenStack client API for Java.
A TWiki appliance that is easy to use and lightweight.


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|<< Previous book
Uncle Janice(2015)
A novel by Matt Burgess
On any given day, Janice Itwaru might be found trolling the streets of Queens for drugs. Janice is an "uncle" - an undercover narcotics officer - trying to meet the impossibly high quota of drug busts needed to make detective, or be sent back down to uniformed patrol. So Janice is out there in her secondhand hoochie skirt, trying to get potential drug dealers - criminals, addicts, dumb kids, whomever - to commit a felony on her behalf. Other days are spent in the "Rumpus Room" at the precinct, trying to keep up with the bantering lies and inventively cruel pranks of her fellow uncles while coping with the insane demands of the big bosses. With an ailing mother at home, her cover nearly blown, four more buys to get her gold shield and rumors circulating that Internal Affairs has her unit under surveillance, Janice is running very short on luck as her quota deadline approaches. Now she has to decide which evil to confront: the faceless bureaucrats at One Police Plaza, or the violent drug dealers who may already be onto her identity. Bursting with the glorious chaos of the streets of New York, Uncle Janice is an uproariously funny portrait of how undercover cops really talk and act, and a compelling story of their crazy, dangerous and often nonsensical lives.
Similar Books by other authors...
The Martini Shot
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(Hap Collins and Leonard Pine, book 11)
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Used availability for Matt Burgess's Uncle Janice
See all available used copies of this book at Abebooks UK or Abebooks US
Hardback Editions
April 2015 : USA Hardback
|Title: Uncle Janice (Thorndike Press Large Print Core Series)
Author(s): Matt Burgess
ISBN: 1-4104-7819-X / 978-1-4104-7819-1 (USA edition)
Publisher: Thorndike Press
Availability: Amazon Amazon UK Amazon CA
January 2015 : USA Hardback
|Title: Uncle Janice: A Novel
Author(s): Matt Burgess
ISBN: 0-385-53680-1 / 978-0-385-53680-6 (USA edition)
Publisher: Doubleday
Availability: Amazon Amazon UK Amazon CA
Paperback Editions
November 2015 : USA Paperback
|Title: Uncle Janice
Author(s): Matt Burgess
ISBN: 0-345-80344-2 / 978-0-345-80344-3 (USA edition)
Publisher: Anchor
Availability: Amazon Amazon UK Amazon CA
Audio Editions
January 2015 : USA Audio CD
|Title: Uncle Janice
Author(s): Matt Burgess
ISBN: 1-62231-608-8 / 978-1-62231-608-3 (USA edition)
Publisher: HighBridge Audio
Availability: Amazon Amazon UK Amazon CA
January 2015 : USA Audio edition
|Title: Uncle Janice
Author(s): Matt Burgess
Publisher: HighBridge, a division of Recorded Books
Availability: Amazon
Kindle Editions
January 2015 : USA, Canada Kindle edition
|Title: Uncle Janice: A Novel
Author(s): Matt Burgess
Publisher: Anchor
Availability: Amazon Amazon CA
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Fluent dpm (unsteady) problem! Urgent!
When I save .cas & .dat files (unsteady case with unsteady combusting particles)i close fluent (6.4.11) and reopen it fuel's inventory makes an unreasonable peak (increases). Have you got any idea? I suspect that fluent makes all particles raw (as they are when they enter the field).
Please help!
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Welcome to My Favorite Travel Agent!
Stephanie Cavelli at My Favorite Travel Agent has been sending clients on memorable vacations independently for many years. In fact, My Favorite Travel Agent was created, in large part, to continuous requests for assistance in creating perfect vacations for Stephanie's friends and family. Our agency has made it our goal to stand out from other agencies- both local and online- by offering unparalleled service. We listen closely to our clients needs and wants to find the best vacation for their personalities, budgets, and dreams.
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The greatest asset any business can have is loyal clientele and we are constantly growing our clientbase. We consider ourselves very fortunate many of our clients refer our agency to people looking for an honest, knowledgeable, and customer service oriented travel agency. If you'd like to hear a little more about what some of our clients are saying about us, check out our 'Testimonials' page. Thanks for visiting our site and we look forward to speaking with you!


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Technical Support information
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A broker is an intermediary, middleman if you will, that arranges or otherwise organizes a transaction. Basically, it is someone with connections that helps buyers or sellers complete transactions that they would otherwise have a hard time doing.
Brokers can be found in most types of businesses. Typically, they work on a commission type basis. They will usually take a percentage of the selling price as their fee for making the arrangements.
Let's take a look at some of the more common types of brokers and what they specialize in.
Customs Brokers
A customs broker works with importers and exporters to help them move goods in and out of the country. In the United States a customs broker most often operates on behalf of importers. They facilitate the clearance of goods arriving in the country through U.S. Customs as well as other government agencies such as FDA, EPA, Fish and Wildlife, and many others.
Customs brokers act as a liaison between importers and the government helping make the process much smoother and quicker. More often than not the importer rarely ever needs to deal directly with Customs as the broker handles all of the particulars.
Often freight forwarders also employ customs brokers, but brokers can also work on their own. A customs broker must have a license and permit to operate. To obtain their license they must pass a rigorous test, meet all of the basic requirements as laid out by Customs and Border Protection, and pass a background check. Of course there are fees that must be paid to obtain the license and permits as well.
If you are interested in becoming a licensed customs broker you may want to take a course such as this one by Customs Broker Geek.
Freight Brokers
A freight broker is someone that is licensed by the FMCSA to arrange the transport of goods. They do not have their own trucks and equipment, but rather connect the parties that do with those who need to transport freight. There are all different sizes of freight brokers. You can find everything from the one-man operation all the way up to a multi-billion dollar company.
The freight broker is responsible for hiring motor carriers that meet the FMCSA guidelines with regards to insurance, safety standards, and other operating guidelines. Margins are typically low and it is a highly competitive industry, but it is large in that in the United States millions of tons of cargo is transported across the country every day.
Insurance Brokers
Insurance brokers specialize in different types of insurance ranging from health, home, auto, and life insurance. The requirements of this industry have changed drastically over the last 50 years. Fraught with fraud and misrepresentation the government has made legislation changes to protect consumers.
Today, most insurance brokers are regulated by the state governments. Most states require a license to operate. To obtain this license the broker must take a pre-licensing course and then pass an exam. An application fee must be paid and a background check is also completed. After one obtains their license there will typically be continuing education courses and seminars that they must keep up with to maintain their license.
Insurance brokers play a large role in helping small businesses find the appropriate insurance coverage for their facilities as well as find affordable health insurance coverage for the owners and employees.
Mortgage Brokers
Most people that have purchased a house have worked with mortgage brokers. They work as an intermediary for home buyers to find lenders that will allow them to purchase a home. A mortgage broker must be licensed through the NMLS to operate. Surprisingly 68% of all mortgages are financed through a mortgage broker. It is big business in the U.S. with more than 400,000 employees nationwide working at more than 50,000 businesses.
The rest of the loans are purchased direct through the lenders. However, as can be seen by these statistics banks would prefer to arrange their loans through the use of brokers. It helps them expand their reach and it doesn't cost them anything. This is because the mortgage broker takes a percentage of the sale for their fee.
Stock Brokers
Perhaps the most well-known of all brokers is the Stock Broker. If someone just says they are a broker most people assume that they are a stock broker. Stock brokers buy and sell various types of securities on behalf of individuals and businesses. To become a stock broker typically the individual will attend college for a degree in finance or accounting. To operate they must pass the Series 7 exam and often the Series 63, or 66.
The industry is heavily regulated by the SEC which outlines rules that businesses and traders must follow. The likely reason that this type of broker is so well known is due to highly popular movies such as "Wall Street", "Wolf of Wall Street", "Boiler Room", and many more. Our economies are highly tied to the stock market with shares of publicly traded industries being traded through the stock exchange. It is a tough industry but highly essential to our modern day economy.