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Cognitive-behavioral treatments (CBT) are among the most popular interventions offered for alcohol and other substance use disorders, but it is not clear how they achieve their effects. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. The purpose of this pilot study was to test a treatment in which coping skills were trained in a highly individualized way, allowing us to determine if such training would result in an effective treatment.
Participants were assigned randomly to a comprehensive packaged CBT program (PCBT), or to an Individualized Assessment and Treatment Program (IATP). The IATP program employed experience sampling via cellphone to assess coping skills prior to treatment, and provided therapists a detailed understanding of patients' coping strengths and deficits.
Outpatient treatment.
A total of 110 alcohol dependent men and women.
Participants in both conditions completed experience sampling of situations, drinking and coping efforts prior to, and following, 12 weeks of treatment. Timeline follow-back procedures were also used to record drinking at baseline and posttreatment.
IATP yielded higher proportion days abstinent (PDA) at posttreatment (p < .05) than did PCBT, and equivalent heavy drinking days. IATP also elicited more momentary coping responses, and less drinking, in high risk situations, as recorded by experience sampling at posttreatment. Posttreatment coping response rates were associated with decreases in drinking.
The IATP approach was more successful than PCBT at training adaptive coping responses for use in situations presenting high-risk for drinking. The highly individualized IATP approach may prove to be an effective treatment strategy for alcohol dependent patients.
Cognitive-behavioral treatments (CBT) are among the most popular treatments offered for alcohol and other substance misuse, but it is not clear how they achieve their effects. It has been assumed that the mechanism of action responsible for the success of CBT is the acquisition and performance of coping skills used to manage high-risk for drinking situations, and to enhance the person's confidence in his or her ability to stay sober.(1)
Although greater use of coping skills appears to be related to better outcomes in some studies, it is not clear that coping skills per se are responsible for those outcomes. To make a case for the role of coping in outcome, it would be necessary to show that a treatment designed to increase coping in fact did so, and that increased coping was associated with abstinence or reduction of drinking (2). Data of this sort are hard to come by; few studies actually document acquisition or use of coping skills, or examine whether skills acquisition is associated with treatment outcome. Studies that have evaluated the mechanisms of coping skills treatments have found that either: (a) CBT resulted in greater increases in coping than did a comparison treatment but increased coping was not related to outcome, or (b) coping skills were related to outcome but change in coping could not be attributed to CBT (3, 4). A related development is the finding in several recent studies that CBT was not superior to robust alternative treatments that were not based on development of coping skills(5-7).
There are several possible explanations for the failure to find a mediational role for coping skills in studies of CBT for alcohol dependence. The first is that the measures used to assess coping skills may be inadequate. Generally speaking we have poor methods for measuring coping actions, particularly in actual high-risk situations (8). Another possibility is that coping skills training is not necessary to yield good treatment outcomes. It is possible that other variables, such as motivation or self-efficacy, may be responsible for treatment success, and that simply entering into any treatment may be sufficient to mobilize patients' coping efforts (4).
Finally, another explanation for the lack of superiority for CBT may be that the delivery of treatment is flawed. A potential problem with manualized cognitive-behavioral treatments like those used in research is that individual differences may be overlooked. A typical manual contains a fixed agenda of skills that are deemed necessary for all patients to have (e.g., identifying high-risk situations, managing cravings), on the assumption that a high level of standardization will improve treatment effectiveness and reduce the variance attributable to therapist skill. However, this approach has not always proven to be effective (9).
The purpose of this study was to devise and test a treatment in which coping skills could be assessed in near-real time and, on the basis of that assessment, a highly individualized treatment could be formulated for each patient that would address specific coping deficits and capitalize on existing coping resources. This Individualized Assessment and Treatment Program (IATP) was matched against a more conventional manualized ("packaged") cognitive-behavioral program (PCBT). PCBT, based on the treatment manual used in Project MATCH(10), was chosen because it is widely used, and is a good example of current standardized coping skills treatments employed in the community and in research for both individuals and groups. Both PCBT and IATP were intended to teach coping skills, but in different ways.
Both treatments lasted 12 sessions. Assessments were conducted at intake and at posttreatment, approximately 16 weeks after intake. Initial assessment of coping resources was conducted using experience sampling (ES) methodology. Patients carried cell phones for two weeks prior to beginning treatment, and were called eight times per day to record their thoughts, feelings and behaviors, especially those associated with drinking. In the IATP condition the ES records were abstracted and delivered to the patient's therapist, who used the records to develop an individualized treatment program. In the PCBT condition the records were collected but not used by the therapist. Experience sampling was repeated at posttreatment. This paper reports on the posttreatment drinking rates and coping skills. It was expected that IATP would elicit more use of coping skills, and better drinking outcomes at posttreatment, than would PCBT.
Recruitment occurred from December 2005 through October of 2007. Participants were recruited through newspaper and radio advertisements, and through other research programs at our university medical center. To be eligible individuals had to be at least 18 years old, meet DSM-IV criteria for alcohol abuse or dependence, and be willing to accept random assignment to either of the two treatment conditions. Individuals were excluded from participation if they had acute medical or psychiatric problems requiring inpatient treatment (e.g., acute psychosis, or suicide/homicide risk), current dependence on drugs (except nicotine and marijuana), recent intravenous drug use, reading ability below the fifth grade level, lack of reliable transportation to the treatment site, or excessive commuting distance. Individuals were also excluded if they were already engaged in substance abuse treatment elsewhere, or if they denied any drinking in the previous 60 days.
Of 164 men and women who responded to advertisements and were screened, 144 were eligible according to the criteria described. Most of those excluded had a history of or continuing drug addiction, or were deemed to have treatment needs greater than those that could be provided in this context. Of the 144 eligible, 34 dropped out of the study prior to randomization, primarily due to lack of interest. The remaining 110 participants were assigned to the two treatment conditions, PCBT (n=53) and IATP (n=57), and 93 provided data at posttreatment (45 in PCBT and 48 in IATP). A sample size of 50 per cell was determined to be sufficient to test most hypotheses with a power of .80 and alpha set at .05, based on effect sizes derived from previous studies of coping skills measures and outcomes (7).
Among the participants 58% were male, with a mean age of 48.8 years (SD = 12.3); 86% were White, 9% Black, 3% Hispanic, and 2% other. Their mean years of schooling was 13.9 (SD = 2.1), 56% were employed at least part time outside the home, and 51% were living with a spouse or partner. All met criteria for alcohol dependence (99%) or abuse (1%), drank on a mean of 70% of days in the 3 months prior to intake, and had a mean of 1.2 prior treatments for alcohol dependence (SD = 2.4). Univariate tests revealed no significant differences on any characteristic between the treatment conditions.
The Structured Clinical Interview for DSM-IV Axis I Disorders, Patient edition(SCID-I/P), version 2.0 (11), was used to determine whether subjects met inclusion/exclusion criteria for alcohol abuse or dependence, drug dependence, and psychotic symptoms in the 90 days prior to the interview. A locator form was completed asking the participant about availability of a spouse or close friend who would know the person's whereabouts if he/she moved without notice during the course of the study.
Drinking data were collected using the Form-90 (12), a calendar-based survey of daily drinking for the 90 days prior to intake. It was used again at the posttreatment assessment. The Form-90 has good test-retest reliability, and validity for verifiable events (13).
The Drinker Inventory of Consequences (DrInC)(14), was used to assess problems related to drinking at baseline and posttreatment. The DrInC Total score had an internal reliability alpha = .89.
The Coping Strategies Scale (CSS)(4) was administered at baseline and posttreatment to assess coping skills. Subjects rated the frequency (from 0 = never to 4 = frequently) of utilizing each of 59 strategies to resist drinking in the prior 3 months. The CSS total score was computed by averaging the ratings of the 59 items (range 0 - 4). The internal reliability of the CSS total score exceeded α = .96 at both of the administrations.
Experience Sampling in both treatment groups allowed us to assess use of coping skills while avoiding many of the problems inherent in retrospective recording. ES was conducted through the use of Interactive Voice Response (IVR) technology, in which assessments were made by calling participants on cellular telephones issued to participants upon entry into the study. A research assistant clarified for patients terms such as "urge to drink," (i.e., "intense desire or craving for alcohol") and how much alcohol constituted a single drink. Patients practiced until they respond to the cell phone call and answer the questions without hesitation.
Participants were asked to carry the cellular telephone at all times in Weeks 1 and 2 (before treatment started), and again in Weeks 15 and 16 (at the end of the 12 sessions of treatment), for most patients. Although patients reported no significant difficulties with the experience sampling protocol at pretreatment, some patients did complain that the posttreatment protocol was burdensome. To reduce burden at posttreatment while still retaining a usable sampling of data, the posttreatment experience sampling protocol was changed for the last 47 patients, who were prompted only six times per day, and only for one week instead of two.
To promote protocol compliance at the end of the posttreatment follow-up period (weeks 15 and 16) subjects were paid $5.00 for every day of at least 75% of scheduled recordings completed, and received an extra $15.00 per week for at least 5 such recording days in that week. The possible total incentive was thus $50.00 per week.
The telephone-based Interactive Voice Response system used to place calls, administer assessment questions, and record responses was developed by Telesage (Chapel Hill, NC). The system was programmed to call subjects' cell phones on a quasi-random basis 8 times per day, with one randomly scheduled prompt in each of eight 105-minute time periods from 8:00AM to 10:00PM. This frequency of recording was chosen to enable us to capture as many moments in a patient's day as possible without being disruptive (15). Subjects had the option of delaying responding to a call for 5, 10 or 15 minutes when answering was inconvenient.
Participants responded to recorded questions using the cell phone keypad. Responses were time-and-date-stamped, and entry of out-of-range data was not allowed. If data entry was abandoned in the midst of an assessment, the system called the participant back and resumed the assessment. Assessment data were electronically stored in spreadsheet format on the system server and backed up nightly. Data from each participant engaged in ES monitoring were examined each day for missing responses by a research assistant. If a participant missed two calls in a row, the research assistant contacted the individual by phone. The compliance rates for experience sampling were as follows: at pretreatment (N=108) 70% of calls were completed (range: 2% to 99%; 17 cases responding below 40%); at posttreatment (N=77) 69% of calls were completed (range: 10% to 100%; 12 cases responding below 40%).
Data collected during ES included items related to urges to drink, situations, coping actions, and drinking since the last recording. For every recording the subject was prompted to record perceptions along a 5-point scale ranging from "0=Not at all" to "4=Very much." The first question presented was "Urge to drink." Our laboratory and field studies indicate that this urge rating item has a test-retest reliability of r = .90(15, 16). Situational context was assessed by asking the person to specify where he or she was and what he/she was doing. The participant's voice response was recorded for coding later (e.g., "at work", "in the car", "at home," etc.) by research assistants using a card-sort technique. Participants also indicated if the situation permitted drinking.
Mood state was recorded using 8 mood items derived from the circumplex model of mood experience (17). The items were combined to yield four reliable mood composites (alphas exceed .80): Positive-high activation (e.g., happy); positive-low activation (e.g., relaxed); negative-high activation (e.g., angry), and negative-low activation (e.g., bored).
Coping responses were assessed by first asking the subject if he or she had been thinking about drinking, had taken a drink, or been tempted to drink since the last recording. The person was then asked what if anything he or she had done to keep from drinking, and was presented with a list of potential coping responses. The patient was instructed to press "1" for each response he/she used in the face of the drinking stressor. (If the person had not been tempted, all responses were "0"). The coping response items were derived from inventories assessing coping in substance abuse treatment (e.g., the CSS), and from informal surveys of patients in alcohol treatment (15). Sample items include: "Prayed;" "Sought help;" "Called my sponsor;" "Waited until the urge went away;" "Distracted myself;" "Left the situation;" etc. Also included in this list was "Drank," and "Nothing." The final question asked how many drinks were consumed since the last call. The total phone interview required about 2.5 minutes to complete.
Prior to starting treatment, all of these responses were collated by a research assistant and provided to the therapists for use in the IATP condition in the form of a functional analysis (FA) chart. The FA Chart offered a maximum of 112 opportunities (8 entries per day × 14 days) to evaluate patient reactions to various situations. The ES protocol was repeated when treatment was finished.
Prospective subjects were evaluated through an initial telephone screening procedure. Those who were eligible for the research and agreed to be assigned randomly to treatment, reviewed and signed an IRB-approved consent form and completed the intake assessment, consisting of the measures described above. Participants were assigned to treatment using an urn randomization procedure (18) that balanced the two groups for gender, age, baseline readiness to change, self-efficacy and CSS Total score. Participants were reimbursed $40.00 for completion of the intake assessment. The posttreatment assessment was scheduled for the period after treatment was completed, and after the posttreatment experience sampling period. Participants were reimbursed $25.00 for completion of the posttreatment assessment.
Two Master's level therapists with at least two years experience treating alcohol dependence provided both of the study treatments, to minimize therapist effects. Treatment was conducted in 12 weekly 60-minute outpatient sessions, employing detailed therapist manuals. The treatment was provided free of charge. Participants presenting to a treatment session with a breathalyzer reading above .05 were rescheduled. Overall, patients attended an average of 8.4 sessions (SD=4.5), with no differences between treatment conditions. Subjects were neither encouraged nor discouraged from attending Alcoholics Anonymous meetings. For both treatments, patient adherence to treatment assignments was monitored by the therapists.
PCBT in this study was based on cognitive-behavioral principles and designed to remediate deficits in skills for coping with interpersonal (e.g., social pressure, conflict with others) and intrapersonal (e.g., craving, anger) antecedents to drinking. The treatment, based on manuals developed for our previous clinical research and for Project MATCH (10, 19), provided a structured experience using didactic presentations, behavioral rehearsal, and homework practice exercises. Homework was prescribed after every session, and was relevant to the material covered in that session.
The Individualized Assessment and Treatment Program employed a functional analysis of patients' behavior as assessed by the interactive voice response system during the 2-week pretreatment experience-sampling period. The situations that each patient encountered during ES monitoring were reconstructed from the monitoring data, along with accompanying mood states, cognitive appraisals and coping actions taken. A functional analysis chart with this information was prepared by a research assistant and delivered to the therapist prior to the first IATP treatment session. A sample of such a chart appears in Figure 1.
An analysis of situations in which drinking occurred, and of the accompanying thoughts, feelings, and behaviors, was conducted to identify the circumstances that posed the most risk for each individual patient. In those cases in which the ES records did not yield a clear pattern of antecedents to drinking and drinking urges, the therapist asked the patient about possible antecedents to determine what patterns existed. Special attention was paid to situations in which drinking occurred repeatedly (at home, for example, as shown in Figure 1)..
IATP sessions focused on training four basic coping skills sets in each situation: Avoidance, Escape, Environmental Modification, and Personal Coping. Sessions 1 to 3 were devoted to analyzing the high-risk situations shown in the personalized functional analysis chart. Coping skills training initially addressed identification and avoidance of the patient's specific high-risk situations. For situations that could not be avoided, training included skills such as environmental modification (e.g., removing alcohol from the house), drink refusal and assertiveness specifically tailored for dealing with the identified high-risk situations, escape from high-risk situations, and "personal coping" (also known as emotion-focused coping, such as riding out an urge to drink, or relaxation). Homework was individualized, and built on information revealed in the FA Chart, as well as other situations recalled by the patient.
Sessions 4-6 focused on analysis of mood states that tended to predispose the patient to urges and to drinking. The FA Chart was used to explore the role of mood states as antecedents to urges and drinking. Focused skills training might entail mood monitoring, relaxation training, substituting positive thoughts, and other mood-related CB interventions as appropriate.
Sessions 7-9 involved patients' cognitions of self-efficacy, and expectations of the benefits drinking might provide in a situation. The FA Chart indicated when patients felt confident about their ability to stay abstinent and when they did not. Examples from the FA Chart, and experiences during treatment in which the patient did successfully manage high-risk drinking situations, were used to bolster the patient's self-efficacy in those situations, and to encourage generalization to similar situations. Homework entailed using cognitive strategies to boost self-efficacy between sessions (e.g., recording of successful coping efforts and discussing them in treatment).
Sessions 10-12 were concerned with applying the full range of coping skills developed in the prior sessions to the patient's daily life, bringing together skills for managing high-risk situations, mood states, and cognitions. In these final three sessions the therapist and the patient reviewed all the situations that the patient encountered during treatment, and drew upon the full range of coping opportunities to consider which tactics might have been employed in each of them. Homework entailed the monitoring of coping opportunities in the field, and practice of a variety of tactics. The use of problem solving, as well as the four key strategies of avoidance, escape, environmental change, and personal coping, was emphasized in these sessions.
Detailed outlines were provided for each PCBT treatment session, and more general outlines for IATP sessions. Therapists were required to follow the session outline and check off areas covered as sessions proceeded. Each treatment session was audio taped. The Clinical Coordinator listened to all session tapes for the therapist training cases and provided weekly supervision during training. Thereafter, the Clinical Coordinator listened to 33% of session tape recordings to confirm that session outlines were followed, and that elements of treatment were being delivered. Rates of adherence in both treatments were 89% and 93% respectively for the two therapists. After an initial training period, supervision of therapists was provided biweekly and covered both clinical issues and adherence to the treatment protocol.
The primary drinking outcome variables derived from the Form-90 were Proportion of Days Abstinent (PDA), Proportion Heavy Drinking Days (PDH) and Continuous Abstinence (0 or 1) for the 90 day period prior to follow-up (i.e., during treatment). A heavy drinking day was defined as one in which men consumed six or more drinks or women consumed four or more drinks. The PDA and PDH data were arcsine transformed to decrease the inherent skewness of proportion data (20). The DrInC Total score was the primary psychosocial dependent variable.
Changes in PDA, DrInC and CSS Total scores from pre- to posttreatment were analyzed using mixed model regression analyses (Proc MIXED; SAS Institute, 1999). These analyses employed maximum likelihood estimation to calculate parameter estimates, and thus allowed us to take advantage of all data collected. In these analyses Treatment condition was treated as a fixed effect, and Period (pre - post) and intercept as random effects. An unstructured covariance structure was adopted on the basis of accepted fit criteria (-2RLL, AIC) (21). Analysis of continuous abstinence at posttreatment was conducted using chi-square.
Only those records in which the patient indicated that drinking was permissible were included in analyses of coping actions. Two-step logistic regression analyses were conducted to evaluate the probability of a given coping response being reported when tempted to drink. In the first step, the number of records provided, the time of the call nested within recording day, and day nested within recording period, were entered to evaluate the effects of timing on reports of coping. In the second step the terms for assessment Period (pre v. posttreatment), treatment condition, and the interaction of period × condition were entered. A significant interaction of period × condition indicated that that probability of a given type of coping had increased from pre- to posttreatment more in one of the treatments than in the other.
Random effects regression analyses with maximum likelihood estimation were used to evaluate the effects of change in coping responses on posttreatment outcomes. Dependent variables were PDA, PDH, Abstinence status, and DrInC values at posttreatment. The primary covariate was an aggregated coping change score computed by taking the average number of adaptive coping responses (i.e., all responses except "Drank" or "Nothing") per temptation episode for each patient at posttreatment, covaried for the average value at pretreatment. The models included baseline values of the dependent variable and the momentary coping change score.
A logistic regression analysis was conducted to evaluate the influence of momentary coping responses on momentary drinking when tempted. Only those posttreatment records in which some temptation to drink was recorded, and in which it was permissible to drink, were included. With the momentary response of "Drank" (0 - 1) as the binary dependent variable, the model contained the following terms: pretreatment PDA, total records provided per subject, sequential record number during that day, day of recording, record × day of recording, treatment condition, adaptive coping score for that record, and the interaction of coping score × condition.
Figure 2 shows the pre- and posttreatment means on the major outcome variables by treatment condition. Analysis of PDA showed no effect for treatment condition, a large main effect for Period [F (1, 90) = 183.49; p < .001], and a significant interaction effect of Condition × Period [F (1, 90) = 3.78; p < .05; effect size d = .40], such that PDA was higher for IATP patients at posttreatment (Figure 2, panel A). Analysis of PDH yielded a main effect for Time [F (1, 90) = 137.18; p < .001], but no main effect for Condition or for the interaction of Condition × Period (panel B). Analysis of proportion of patients reporting 90 days of abstinence at posttreatment showed a higher rate of abstinence in the IATP condition (30% v. 17%), but this was not significant [χ2(1) = 1.28] (panel C). The effect size of the difference between proportions, however, was moderate, h=.32. Analysis of the DrInC scores showed no effect for treatment condition, a main effect for Period [F (1, 90) = 95.35; p < .001], and a nonsignificant interaction effect of Condition × Period [F (1, 90) = 3.19; p < .07; effect size d = .31] (panel D).
Both conditions resulted in increases in CSS scores from pre- to posttreatment (from approximately 1.3 to 1.8, SD=0.20). Results of the mixed model regression yielded no main effect for treatment Condition, a significant Period effect [F (1, 88) = 42.21; p < .001], and no significant effect for the interaction of Condition × Period.
Coping responses were recorded in response to "temptation episodes," situations in which participants felt the urge to drink. Temptation episodes in both conditions averaged 1.60 (SD = 0.45) per day at pretreatment, but dropped to 0.79 (SD = 0.35) per day for PCBT patients and 0.14 (SD = 0.28) per day for IATP patients at posttreatment. Mixed model regression was used to evaluate the number of temptation episodes per day. No main effect for Condition emerged, but a main effect was seen for Period [F (1, 74) = 32.23; p < .001], and for the interaction of Condition × Period [F (1, 74) = 7.10; p < .01], indicating that IATP patients reported significantly fewer temptation episodes at posttreatment than did the PCBT patients.
Results of logistic regression analyses on occurrence of coping responses to drinking temptations are summarized in Table 1. Condition was effect coded (-.5 = PCBT; .5 = IATP), and period was coded 1 (pretreatment) and 2 (posttreatment). A Bonferroni-Holm step-down procedure (22) was used to correct for the multiple tests. Shown in the table are results only from Step 2 of each of the analyses. (Step 1 results are not shown; for the most part there were no effects on any momentary coping response variables attributable to time of day, or day of the monitoring period).
As seen in the table, IATP patients were significantly less likely than PCBT patients to have reported drinking at posttreatment in response to temptation episodes. Numerous main effects for treatment condition emerged, mostly to the effect that the IATP condition was associated with greater probabilities of producing momentary coping responses overall than was the PCBT condition. The significant Condition × Period effect for "Drank" indicated that, at posttreatment, those in the PCBT condition were significantly more likely to take a drink in response to a drinking situation than were those in the IATP condition. Conversely, the other significant interaction effects shown in the table suggest that those in the IATP condition were significantly more likely than PCBT patients to respond to a drinking situation by avoiding situations, distracting oneself, refusing a drink, going elsewhere when tempted, or waiting out the urge to drink. As an illustration of the magnitude of the between treatment differences, Figure 3 shows the mean pre-post changes in proportions of coping responses reported in response to temptation, by treatment condition.
To get an overall estimate of coping change, an analysis of variance was conducted on the aggregated coping change scores by treatment condition. At pretreatment, participants in both treatment conditions reported using an average of 2.3 adaptive responses per temptation episode (SD = 2.2). At posttreatment IATP patients reported using 5.8 adaptive responses per temptation episode versus 4.2 responses for PCBT patients [SD=3.2; F(1,76)=4.01, p < .05; effect size d=.50].
The analysis of Posttreatment PDA showed a significant effect for pretreatment PDA [F (1, 74) = 23.10; p < .001], and a significant effect for the coping response change score [F (1, 74) = 3.92; p < .05], such that increases in coping at posttreatment were associated with greater PDA. However, posttreatment PDH, DrInC scores, and continuous 90-days abstinence rates were not predicted by coping response change score.
Logistic regression analysis of momentary drinking at posttreatment yielded no effects for pretreatment PDA, record number (roughly equivalent to time of day), day of recording, or the interaction of record × day. The analysis did yield a significant effect for treatment condition (B= -1.4, se = 0.54; Wald χ2 = 6.25, p < .01; OR=0.79, 95%CI=0.43 to 0.95), a significant effect for coping score (B= -0.35, se = 0.06; Wald χ2 = 37.73, p < .001; OR=0.71, 95%CI=0. 63 to 0.79), and a non-significant interaction of treatment × coping score.
In order to determine if observed increases in adaptive coping in the IATP condition were accounting for the effects of treatment on PDA outcomes, a series of mixed model analyses was conducted in which: 1. posttreatment PDA was evaluated as a function of Treatment (with pretreatment PDA covaried); 2. posttreatment adaptive coping was evaluated as a function of Treatment (with pretreatment coping covaried); and 3. posttreatment PDA was evaluated as a function of adaptive coping (with both pretreatment coping and pretreatment PDA covaried). Regression estimates from these three equations were submitted to a product of coefficients analysis (23). The indirect effect of treatment condition on outcome, with coping as a mediator, was β' = 1.52 (se = 0.99); z= 1.56; p < .07; 95% CI= -0.42 to 3.46.
The IATP pilot study was intended to explore whether a treatment could be devised that would train adaptive coping skills to alcoholic patients more effectively than current manual-based coping skills treatments. It was hypothesized that IATP, with its highly idiographic approach to skills assessment and training, would yield more use of coping skills and better posttreatment outcomes than would a well-constructed, but less individualized, approach. To an important extent these hypotheses were borne out. PDA outcome was significantly (if modestly) better at posttreatment in IATP than in PCBT, although IATP yielded equivalent PDH and DrInC scores. IATP yielded nearly twice the abstinence rate as PCBT. If the follow-up had continued it is possible that the discrepancy between PCBT and IATP in abstinence might have increased over time, as has been demonstrated in other clinical trials (24).
The use of experience sampling allowed us to carefully assess not only drinking episodes, but also the coping responses employed (or not) in response to high risk situations. As hoped, IATP yielded significantly greater increases in the use of a variety of coping skills than did PCBT. Additionally, the increased coping was significantly associated with both posttreatment PDA, and with posttreatment drinking recorded on a momentary basis.
As indicated by the logistic regression analysis, participants who used an adaptive coping response when they were tempted were much less likely to drink at those moments. Indeed, each coping response reported resulted in a 30% reduction in the risk of drinking at that moment. Likewise, those who were in the IATP condition were less likely to drink. The interaction of treatment × coping was not significant in that analysis, but this was not surprising. We would not expect coping to be more effective just because a person is assigned to IATP. The function of IATP was to enhance coping, which in turn should reduce drinking.
One aspect of the coping response results is interesting. The IATP treatment appeared most successful at eliciting greater use of behavioral coping, or problem-focused strategies. Thus IATP patients responded with significantly greater increases in the use of avoidance, distraction and drink refusal than did the PCBT patients. The one cognitive or emotion-focused strategy that emerged for IATP was "waiting out the urge." Both "waiting out the urge" and the use of behavioral coping were specifically covered in IATP as responses to the pretreatment ES assessments. Although these skills were also covered in the PCBT protocol, the nature of IATP, with its focus on addressing individualized strengths and deficits, allowed for greater time spent on tailoring the training of specific skills that would be most useful to the patient in his or her own environment.
The PCBT condition used here is an example of the kind of structured relapse prevention treatment used in many community and research settings. The highly individualized structure of the IATP program made it much different from PCBT. It is not clear, therefore, whether differences in coping and outcome variables were a function of differences in therapy structure, content, or both.
There are some limitations to this study. Because of the pre-post design, the drinking recorded at posttreatment occurred during the treatment period. It is not known how these two treatments would have compared at more distant follow-up periods. Also, the failure to blind research assistants to treatment assignment must be considered a weakness, as is the fact that therapist adherence ratings were made by the therapy supervisor. Another issue is possible reactivity to the ES protocol; the idea that frequent prompts to answer questions about alcohol-related urges and behavior might have altered these urges and behavior. Reactive effects, if they occurred, do not threaten internal validity because all subjects participated in the same ES protocol. The greater threat is to the external validity of the study. However, there is evidence in the literature that experience sampling does not affect the relapse rate of treated alcoholics (25, 26), or prevent substance use or other behaviors, such as overeating in dieters (27).
Another problem with any treatment based on analyzing high risk situations, is the difficulty many people have recognizing cravings or urges to drink. Our own research (15) has indicated that treated alcoholics are frequently unwilling to acknowledge, or unable to identify, cravings for alcohol. Therefore the results presented regarding temptation situations must be viewed with some caution. The IATP treatment in the present study, however, was based not only on drinking urges, but also recurring situations that were associated with drinking during the pretreatment period.
Because of limitations in the technology employed when the study started, open-ended coping questions were not used. Instead, subjects responded to a checklist that may have restricted or directed participants' recall of how they reacted to a potential high-risk situation. Two aspects of the data suggest that the restriction-of-choice problem may not have been severe. First, the data are distributed in a way that is consistent with how we believe patients respond in real life. For example, there was relatively resort to "pleasant thoughts." Likewise, the rate of endorsing "refused a drink" was low; there are relatively few instances in most participants' days in which they are actually offered a drink. Second, participants did record their drinking episodes, and, more important, recorded when they did "nothing" to avoid drinking. The present dataset, then, is at least valid on its face. Our upcoming work will allow free responses to characterize coping efforts.
A final limitation is that the IATP condition was only superior to PCBT in one of four outcomes. This is not a very serious limitation, however. The control condition used here was, intentionally, extremely strong. The intent of the present study was to determine if a treatment such as IATP could be implemented and if it would work as planned.
Despite the limitations of this study, we find the results to be quite encouraging. IATP did work as planned. IATP resulted in fewer temptation episodes at posttreatment than did PCBT, and when temptations were recorded IATP patients were less likely to drink and more likely to employ adaptive coping efforts to deal with them. Additional work will be undertaken to improve delivery of IATP and in-vivo assessment of coping.
Consistent with the hypotheses, IATP resulted in increased coping and reduced days of drinking at posttreatment. Additionally, a test of meditational effects of coping on PDA outcome approached significance. Nevertheless, the results of this study must be interpreted with caution. It is not clear whether reduced drinking at posttreatment reflected coping changes that occurred as a function of treatment (as hypothesized), or whether coping responses were enhanced due to changes in drinking. It will require another study with additional follow-ups and interim coping assessments to establish a causal chain. It is possible, even likely, that coping and drinking influence each other over time, in a dynamic relationship. We are optimistic that the methodology employed here, for training coping skills and evaluating their effects on drinking, lead to a better understanding of the dynamics of coping and recovery.
Support for this project was provided by grants R21-AA014202 from the National Institute on Alcohol Abuse and Alcoholism, and in part by General Clinical Research Center grant M01-RR06192 from the National Institutes of Health. The authors would like to acknowledge Eileen Porter, William Blakey, Kara Dion, Abigail Sama, Aimee Markward, and Christine Calusine for their work in the conduct of 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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Babies Sleeping On Stomach
Study Confirms SIDS Risk for Babies Sleeping on Stomach
By HospiMedica staff writers
Posted on 21 Oct 2002
The most definitive study of its kind has shown that putting a baby to sleep on the stomach more than doubles the risk of sudden infant death syndrome (SIDS). The study was published in the October 2002 issue of Pediatrics.
Researchers examined the records of 260 infants from the age of birth to one year who had died of SIDS in Chicago (IL, USA) between November 1993 and April 1996. Information on each infant was compared with information about a control infant from the same racial or ethnic group and with a similar birth weight. In the cases of SIDS, all had been reviewed by the medical examiner and autopsies had been conducted to rule out other causes of death. The study found that African American infants, who accounted for 75% of those with SIDS, have about twice the risk of SIDS as other infants, due to the fact that 58% are put to sleep on their stomach, compared to only 12% for other groups.
In prior studies, the SIDS cases had sometimes been evaluated under a number of different standards. In the current study, researchers used standard criteria for evaluating all potential SIDS deaths. In 1992, the American Academy of Pediatrics recommended that infants not be placed to sleep on their stomachs, based on studies of infants in New Zealand, Australia, and the United Kingdom.

subset: commoncrawl


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Here is a very interesting discussion on the situation and treatment of Minorities in Pakistan, and specifically the Hindus. One of the guests Munir Saami has an incisive take on mess in Pakistan. He gives reference of the Persian rulers – the Mughals – who also treated Hindus extremely badly. He cites a popular Poet of that time, which underscores his point.
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**Get the Hot-List of Available Long Beach Homes!
One of the most desired areas in all of Long Beach is the area known as Naples. This small island community has a history that dates back to 1903 when Strong and Dickinson and Robert March & Co subdivided and started development of the Alamitos Bay Peninsula with approximately 500 lots. With it's name being Naples it embraces Italianate features in the names of its streets and you can even enjoy a Gondola trip through the canals.
This wonderful area composed of three separate islands has a limited number of homes that are on the canals. If you are lucky enough to have a home that is on the canal you get to enjoy the annual boat parade in December which is a wonderful event where people from all over bring their boats decorated for the season through the canals.
Long Beach real estate here is limited in number so you need to keep your eye out for the luxury property that is right for you.
Long Beach real estate here is limited in number which means you will you will need to keep your eye out for the luxury property that is right for you.
Here you will find homes of all shapes and sizes. Homes that reckon back to early development of the 1940's and those that have been reconstructed to take full advantage of one of the finest water locations in southern California. As many of the homes were built in the 1940's you will still find some small homes of 800-900 sq ft on beach sized lots of 2,300 sq ft.
Some of the largest homes line the canals and Alamitos Bay, where you will find multi-story homes that can range from 1,700 sq ft to well over 4,000 sq ft. You will find a wide variety of architecture from modern homes to wonderful Mediterranean properties. One common theme that you will find, nearly regardless of the era of development, is that the homes embrace their water location. Large windows abound to help you enjoy stunning views and front patios are common to allow you to embrace the cool breeze or just have a coffee during the annual boat parade.
Although the island is composed mainly of homes, there are a small number of condos. Condo developments such as those on the Toledo and Bay Shore, offer great opportunities to live on the island.
One of the most popular aspects of Naples is 2nd St. 2nd St provides ample restaurants and shops where you can stroll on the many beautiful days we have here in Long Beach. Here you will find wonderful restaurants like BJ's Pizza & Grill, Café La Strada and Naples Rib Co. With two Starbucks coffee shops along this strip it is great to get a some coffee and walk through the canals to see some of the wonderful real estate and gaze at Alamitos Bay.
With duplexes, homes, and condos on Naples Island you will want to focus your search for the type of Long Beach real estate that best meets your goals. Use our free Long Beach MLS so you can see the currently available inventory of what is available on the island. If you want a FREE updated website of the homes, condos, or multi-units on Naples Island, then please request our HOT List so you can see the real estate that is right for you. Our professional team of Long Beach realtors would be happy to take the time to learn more about what you are looking for or planning to sell if you call directly at 562-989-7111.


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Dear Arte: Can I call you Arte? I just finished reading this long screed by Gustavo Arellano on the pages of OC Weekly suggesting you pack up and move the Angels away. Let me be the first to suggest, when it comes to baseball, Gustavo doesn't have a clue. The guy needs Google to explain…
Tag Archive for DPOC
DPOC Hosts BBQ at New Office Grand Opening
by Joel Smith •
The DPOC headquarters had been in the city of Santa Ana for almost two decades, but this last week they made the big move over to the city of Orange to what they call "a larger, brighter, newer, more visible location."
DPOC Announces Honorees for 19th Annual Truman Award Dinner
by Chris Prevatt •
The Democratic Party of Orange County announced yesterday the honorees for the 19th Annual Truman Award Dinner scheduled for October 19, 2013. Harry S Truman Award Honoree: Assembly Speaker, John A. Perez
Costa Mesa Democratic Club Kick Off Tonight
by Dan Chmielewski •
The Democratic Party of Orange County is taking another step in the right direction through city-by-city Democratic clubs to better organize, register voters and get out the vote to weaken the grip Republicans have on local city governments. Costa Mesa was less than a sneeze away from taking control of the City Council last November…
Rep Joaquin Castro to headline Annual DPOC Truman Award Dinner
by Chris Prevatt •
Democratic Party of Orange County Chairman Henry Vandermeir announced on Monday that Texas Congressional Representative Joaquin Castro will be the keynote speaker at our 19th Annual Harry S Truman Awards Dinner on October 19th.
DPOC Revamps Democrats of Greater Irvine Club
by Joel Smith •
The Democrats of Greater Irvine held a meeting Sunday afternoon at the Rancho Senior Center with the goal of revamping their club and electing new officers. New DPOC Chair Henry Vandermeir organized a meeting for what turned out to be around 75 eager Irvine residents…
Irvine Democratic Club Starts Up on Sunday
by Dan Chmielewski •
The Democratic Party of Orange County is helping to organize a new Irvine Democratic Club to organize and get an early start on building a strong base of new voters, recruit new candidates and mobilize to start the Tea Party Republicans who control our City Council majority from dismantling the quality of life and progressive…


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FISH River Sun was buzzing with karateka who came from all over the Eastern Cape as well as further afield for last weekend's SASKA East Coast Karate Open (Secko) Championships.
A highlight on the Ndlambe sporting calendar, the 11th edition of the Secko Championships saw about 350 karateka compete representing 18 dojos across South Africa.
For many Eastern Cape karate athletes and spectators the hotel has become somewhat of an institution for hosting the popular championship over the past decade.
The karateka competed in the championship in categories ranging from novice to elite. Karate styles represented at the championship included Shotokan-Ryu, Goju-Ryu and Shorin-Ryu.
About 18 dojos contested this year's championship. Locally based East Cape Shotokan-Ryu (Grahamstown and Port Alfred) shared overall top honours with King Karate Club (King William's Town), while the always competitive Joza Karate Club achieved third position overall.
At 17 years old, Brent Smith of East Cape Shotokan-Ryu made Secko Championship history by becoming the youngest ever winner of the Men's Open Black Belt Kata (forms) category.
Isa Ayob of Titan Karate Club (Port Elizabeth) placed a close second. Lutho Singata of clinched victory against strong opposition in the Men's Open Black Belt Kumite (fighting) category.
Yanga Jongile of Joza Karate Club (Grahamstown) put up a spirited fight to take the runner-up position.
Secko organiser and ECSR head instructor Gary Grapentin was exceptionally proud of Men's Open Winners' Smith and Sinagta, both of whom he coaches.
Kayleigh Chamberlain of Western Suburbs Karate Club (Port Elizabeth) successfully defended her 2016 Secko Kumite title by winning the Senior Ladies' Black Belt Kumite category for the second year in succession.
In second place was Tanya de Villiers (also of Port Elizabeth). De Villiers trains at both PE North Karate Club and Kase Ha Karate Club.
Ilze van der Merwe of Helderberg Dojo in Somerset West won both the Veteran and Ladies' Open Black Belt Kata Categories with Chamberlain claiming the silver medal. Van der Merwe had made the trip to the Secko Karate Championships as part of her preparation for the WUKF World Championships which will take place in Scotland next year.
According to Grapentin, the categories were extremely competitive with a number of exceptional athletes in the elite categories. The large number of athletes in the novice and intermediate children's categories was also indicative of karate's growing popularity in the province.
"The categories were extremely competitive and the standard in the elite categories was of an exceptionally high standard," he said.
For karate in Grahamstown, Kenton-on-Sea or Port Alfred, Grapentin may be contacted at firstname.lastname@example.com.
Local (ECSR Port Alfred and Kenton-on-Sea) results:
Lizelle Pienaar: Silver (kata)
Thembile Ngangqu: Gold (kata)
Jason Herrington: Bronze (kata)
Azukile Hendele: Bronze (kata)
Hlehle Mali: Bronze (kata and kumite)
Ethan Roetz: Gold (kata) and Silver (kumite)
Brett Williams: Silver (kata)
Kirwan Scott: Silver (kumite)
Jaco Slabbert: Gold (kumite)
Imo Isaac: Bronze (kumite)
Fagan Van Heerden: Gold (kata) and Silver (kumite)
Josh De Vos: Bronze (kata) and Gold (kumite)
Xola Mali: Silver (kumite)
Janay Williams: Silver (kata)
Tainn Neethling Bronze (kata and kumite)


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Fieldsheer High Temp Mesh Jacket
- Ultra-breathable and abrasion resistant Polytitanium mesh with 500 Denier Maxtena-Pro in the impact areas
- Anatomically fitted for the riding position
- Removable CE approved armor in the shoulders, elbows, and back.
- Unique FS Matrix two-stage waterproof and breathable liner with Nanomax and Rainguard barrier technology plus an insulated liner to suit the rider's needs
- Phoslite reflective piping for nighttime visibility
- Micro fleece padded mandarin collar
- Four-step adjustable upper and lower sleeve volume control
- Adjustable Velcro waist strap with elasticized panels at hips for added comfort
- Gusseted adjustable Velcro wrist cuffs
- Pockets included: two zipped front hand warmer, one zipped map, one inside Velcro, and one mobile phone pocket
- 8" waist zipper and universal snap belt connector to attach to pants
Check out these similar products:
Sizing Information
We put a size Medium on Huey and a size XL on Dewey for our Fit Check review and those are the sizes they normally wear. The jackets look great for the pictures, but in practice would probably be a bit snug. In checking Fieldsheer's size chart for 2014 (see below), you'll see that the chest sizes listed for each alpha size are a couple inches smaller than you would expect to see (at least in the smaller size ranges), and this confirms our observations.
My advice then would be to measure your chest and choose a size based upon the chart below, which for those in the Small to XL range will be one size larger (alpha size) than you normally wear. If you are between sizes, just choose the larger (don't go 1-1/2 sizes bigger).
If you have a bit of a belly, you'll want to make sure you won't have a fit issue. To check, just measure and make sure the chest size of the jacket you choose is at least 4" bigger than your max belly. For example, if your belly is 40", then choose a minimum size XL which has a max chest of about 44".
|Jacket Size
|Max Chest
|Regular Sleeve Length
|Tall Sleeve Length
Tall sizes are available in this style. If you normally have to buy tall sizes in men's clothing then buy one of the "tall" jackets to get more length in the sleeves and body. The tall sizes have the same chest and belly as the regular jackets, but they are 2" longer in the sleeves and torso. Sleeve lengths in the chart are measured from the shoulder seam to the cuff.
Product Video
Our Two Cents
This is a special, limited time sale. The Fieldsheer products in our closeout department right now were all part of a new line of gear introduced in 2014. We really like the products (as you can see from my original review below). But about a year ago, these products were discontinued and sold by the Fieldsheer distributor for mass liquidation through limited channels (which didn't include us). But through unlikely circumstances, some of the inventory has become available again and we are offering it at VERY GOOD prices. When this inventory is sold through, there won't be any more, so make a choice while you can! :: Paul, 1-30-17
About this jacket: The High Temp Mesh jacket is a part-mesh/part-textile jacket that includes a full featured waterproof/windproof and separate thermal removable liner. I'll tell you more about the liner system in a moment, but generally speaking, I'd recommend this design for those that live in warmer climates and want a jacket that will work for them most of the year. The overall style is waist-length sport and will appeal to just about any type rider. We've taken a whole series of photos for you to show all the features such as the storage, armor, etc, so be sure and click the "View Larger Images" link above to see those. The liner system included with this jacket will be the key to making this a multi-season design for you. Being part mesh, the outer shell will allow air to flow through to your skin quite readily, so without either of the two liners in use, you'll get lots of cooling air that will be comfortable in even the hottest weather. For moderate or cooler temps or if it turns wet, you can use one or both of the removable liners. The Nanomax waterproof liner is made to work with the removable thermal liner so that you can "mix and match" to suit the conditions. For wet conditions, or for cooler temps, the waterproof liner can be used to keep you dry and/or to provide a wind block. If you're interested, here's a brief video that gives you some info about Nanomax. And if you need a bit of insulation, you can also add the thermal liner. So, for all but the coldest weather, you should be able to find a combination of liners that keeps you comfortable and dry. As for protection, CE approved armor is supplied for the shoulders and elbows. This armor is about like all other quality of armor you'll find. And the back armor they supply is well above others in terms of overall sturdiness (just my humble opinion… not based on testing). Overall, this is a very nice style for warm weather, and one that will adjust for seasons and varying weather conditions. The dual liner system is the thing that will set this one apart from the many full mesh jackets out there. :: Paul, 12-11-13
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Today makes it the 5th Saturday, the COOL CRITICS tackle the world and it's issues. If we can enlighten you, THIS IS WHAT ITS ALL ABOUT! Join Cecelia Davis (First Class/Top Choice), Anna Redding, Aaron Anderson, Mark "Tony" Dixon and me, Lynn Tol - 3pm pacific - 5pm central & 6pm eastern. 347-205-9366. ALL RIGHTS RESERVED 2011 - Any rebroadcast must be approved in writing. The Jay King Network
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Supporters of municipal market reforms are worried that the Securities and Exchange Commission appears to be backtracking from earlier calls for widespread legislative and regulatory changes to disclosure and accounting standards, instead favoring a much more modest set of draft regulatory reforms which it will consider at a meeting tomorrow.
But SEC officials insist that the commission is not backing down and say that the meeting to consider reforms is merely a first step in a longer process.
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Contact Info / Websites
Entry #5
Hey all its been awhile. I just recently got back into animating again as games and other things have been getting in the way for the past 8 or so months. For all you people who want Diversion of Destruction 2 I am currently not working on that. I have started animating an old flash I started a year ago which is a dbz flash. I will be working on both a dbz part 2, and Diversion of Destruction 2 depending on my mood.
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2011-06-16 00:48:31
Download here: http://cashload.org/5fcdf00e
She starts crying at the end.


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- Trending Now: More Trending:
- righteous Kafkaesque mike moron terrorism
Examples of recent in a Sentence
Recent events have brought attention to the problem.
I usually watch that show every week, but I missed the most recent episode.
Medical science has made amazing progress in recent decades.
That was the biggest earthquake in recent history .
Recent Examples of recent from the Web
If Auburn hadn't agreed to a recent contract extension with Clint Myers, which several news outlets reported earlier this summer with Myers himself as the source, why did Auburn wait till now to correct that mistake?
Recent questions have included: ▪ CEOs look for good attitude, clean clean résumés when interviewing job applicants ▪ CEOs say students who improve certain skills are better prepared for future jobs ▪
Tinley Park officials will consider installing more surveillance cameras at key intersections in the wake of a recent home invasion in the village.
Even more recent are the so- called workers under totalitarian control starving and lacking medical help.
Now, after a stretch of modest evolution, the recent building surge downtown and the Crossroads has seeped southward.
One recent Wednesday, David is waiting at the door.
The retailer began using predictive technology in 2004, according to the New York Times, mining trillions of bytes' worth of sales data from recent hurricanes, to determine what customers most want to purchase leading up to a storm.
Your recent servile pandering to one end of your base has the potential to throw a lot of that human potential—upon which our nation depends—away.
These example sentences are selected automatically from various online news sources to reflect current usage of the word 'recent.' Views expressed in the examples do not represent the opinion of Merriam-Webster or its editors. Send us feedback.
Origin and Etymology of recent
First Known Use: 15th centurySee Words from the same year
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The post mortem result for a female passenger found dead on arrival from American Samoa to Samoa last week showed she died from heart failure.
The woman, a Phillipino was in her sixties and lived in American Samoa.
Samoa's assistant police commissioner, Leaupepe Fatu Pula, says negotiations are underway between Samoa and the Embassy of the Philippines in New Zealand for the woman's body to be flown to her home country for burial.


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History, wine, tranquil beauty, dramatic people and spectacular views an Italy cruise has everything! You can visit the main sites of Italy on a European cruise or a Mediterranean cruise, but to really experience Italy – to really taste it – you need to immerse
yourself in everything that Italy needs to provide by taking an Italy cruise.
Italy cruises depart from numerous ports around the country. Lots of depart from Civitavecchia – the gateway port to Rome. Nevertheless, to obtain the full Italy experience it is advised that an Italy cruise be embarked upon from the ports of Savona or Genoa on the Ligurian Peninsula and taken all the way round to Venice, or vice-versa. In this manner, you will find that there is a lot more to Italy than a cruise departing from Civitavecchia would have the ability to show you!
So, what thrills await in this classical land? The Ligurian Peninsula is a real paradise. Mostly undiscovered by mass tourist, enchanting Italian towns line the shoreline in this amazing part of Italy. Gorgeous sandy beaches alternate with rocky headlands, and spectacular coastal villages shine like beacons on the shore.
In Genoa you can find the birth place of Christopher Columbus and admire the citys sensational Gothic architecture. A little additional to the south Livorno is a port of call worth investing a little time at. Here, you will have the ability to organize shore expeditions to see the famous leaning tower of Pisa, in addition to go to the grand Renaissance city of Florence – home to Dante, Michaelangelo and the Medicis.
The Colosseum at Rome, Mount Vesuvius and the ancient city that it buried – Pompeii – are essential destinations to go to when on an Italy cruise, as is Rimini on the Adriatic Sea. From Rimini you can take a shore adventure to visit the enclave of San Marino, which is less than an hours drive from Rimini port.
Finally, tempting Venice waits for as the last stop at the end of your cruise. Venice is a real waterworld, consisting of more than 120 islands through which a network of waterways can be
checked out by gondola. Renaissance-style architecture is all over in this city, and you will be able to take a coast adventure that takes in the popular Rialto Bridge and the Bridge of Sighs.
Whether you want to discover exactly what it felt like to be a gladiator in Romes Colosseum, peer into the big crater of Mt Vesuvius or navigate your method around Venices canal system, an Italy cruise is a special adventure that you will never forget.


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|Stevens-Johnson Syndrome Lawyers - http://sjs-lawyers.com/
Stevens-Johnson Syndrome Lawyers - Toxic Epidermal Necroylsis - Los Angeles Children's Motrin Attorneys Aggressive Stevens-Johnson Syndrome Lawyers and Children's Motrin Attorneys. »» [ Link Details for Stevens-Johnson Syndrome Lawyers ]
|Chiropractors in Amarillo Texas - http://www.mustardwellness.com/
Mustard Wellness Center is a Regional Natural Healthcare Clinic established in 2004. The clinic offers 5-Star Natural Health Doctor Consultations and Evaluations focused on non-medical alternative solutions. The clinic is the "go to" clinic in the Panhandle for alternative and non-medical treatments for serious conditions like Arthritis, Fibromyalgia, Chronic Pain, Migraine Headaches, and Disc Conditions. If you have any questions or concerns about your experience, please let us know. Dr. Jack Mustard, BSDC, PA (806) 351-2708. »» [ Link Details for Chiropractors in Amarillo Texas ]


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Gloucester Patrolman Heath S. …
Posted on Tuesday, 2nd May 2017 | Gloucester
Gloucester Patrolman Heath S. Moseley, 41, husband of Melissa E. (Greeke) Moseley, of Rockport, passed away at his home on Thursday, April 27, 2017. Heath was born in Landstuhl, Germany, on December 21, 1975. He grew up in the South and graduated from Cumberland County High School in Crossville, Tenn., with the goal of becoming a police officer. In 1994, he enlisted in the United States Marine Corps, where he served honorably for six years as a military police officer and artilleryman, stationed at Camp Lejeune, North Carolina, and Twentynine Palms, California. When his parents, Patricia and Jackson Pope, moved to Cape Ann, Heath joined them. He soon met Melissa who was waitressing at the Blackburn Tavern where Heath became a bouncer. Heath also worked at Gorton's as a security guard before graduating from the MBTA Transit Police Academy and joining the Gloucester Police Department. Heath was well-known for his kindness to all he encountered and his willingness to help others in need. Having grown up partly in foster care and under the loving care of extended family, Heath always wanted to make others feel loved and secure. Said his brother, Eric Moseley, "His heart was so big he could take everyone's problems in and help them." He brought empathy, compassion, and sensitivity to his police work and Melissa said, "He would throw caution and protocol to the wind in order to save anyone." He jumped into the water at St. Peter's Town Landing in winter to rescue a fisherman who was suffering from hypothermia, and while off-duty he revived an unconscious man. Heath was also known for his hugs and his ability to make any person, man or woman, feel beautiful, special, and important. He taught his mother-in-law how to hug, and saying "I love you" to his male buddies came naturally to him. Heath's greatest joy was raising his four children. He loved to snuggle, laugh, and run around with them. He coached his son's flag football team; his daughter's softball team, the Rockport Bandits; and his wife's Dog Bar softball team. He became an avid Patriots and Red Sox fan and enjoyed fishing trips in Kill Devil Hills in North Carolina with his cousin Bryan and his buddies. Nicknamed "Big Country" by the police department for his southern roots, he enjoyed the music of Tim McGraw, Garth Brooks, Johnny Cash, Willie Nelson, and Sam Hunt. His karaoke rendition of Sir Mix-a-lot's "Baby Got Back" got the whole room singing and dancing along. He loved movies in all genres, but especially Marvel superhero films such as Captain America, Ironman, and The Hulk. In addition to his wife, Melissa, he is survived by his children, Hayden Moseley of Mansfield, Texas, and Madison, Travis, and Ryan Moseley of Rockport; his parents, Patricia and Jackson Pope of Colorado; siblings, Eric Moseley and wife, Valerie of Rockport, David Pope and his wife of Colorado, Jennifer Pope of Florida, and Marcus Moseley and wife, Lori of Tennessee; father- and mother-in-law Peter and Billie Anne Greeke of Gloucester; best friend, Tim Sullivan of Medford; 14 nieces and nephews, many cousins, and countless friends he considered to be family. Visiting hours in the Greely Funeral Home, 212 Washington Street, Gloucester, will be held TODAY, Tuesday, May 2, from 4 to 7 p.m. A graveside service will be held in Beech Grove Cemetery, Rockport, on Thursday, May 4, at 1 p.m. Relatives and friends are cordially invited to attend. Please omit flowers. Contributions may be made to W.E.L.L. (Wellness Education for Lifelong Learning) at RPS, c/o Rockport Elementary School, 34 Jerden's Lane, Rockport MA 01966. For online condolences, please visit www.greelyfuneralhome.com.
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James Bond TM 007 and related James Bond Trademarks © 1962-2010 Danjaq LLC and United Artists Corporation. All Rights Reserved. This website is a fan site and is in no way related to the official production companies.
Saturday, September 4, 2010
Moonraker Cream Turtleneck
Land's End Men's Regular 100% Cotton Turtleneck $19.50 landsend.com
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Terramar Silk Interlock Turtleneck with EC2 - Long Sleeve (For Men) $28.95 sierratradingpost.com
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A Wethersfield resident has admitted to one count of wire fraud stemming from an investment scheme that defrauded individuals and couples of more than $874,000.
According to court documents and statements made in court, from 2001-2012, Anthony G. Sciarra operated AGS Financial, through which he offered insurance, securities and other financial products. He solicited investments from various victim-investors with promises of high annual investment returns ranging from 4 percent to 12 percent or more. Instead of investing any of the invested money as promised, Sciarra diverted funds for his personal use, including personal bills, shopping and gambling.
In addition to telling victim-investors that their funds had been invested as represented, Sciarra sought to prevent the discovery of the scheme by issuing partial payments to the victim-investors as a partial return of the principal and monies that were then due. Eventually, these payments stopped and the scheme was discovered.
The Connecticut Department of Insurance revoked Sciarra's insurance license in May 2012 after he defrauded at least 12 victim-investors of approximately $874,000.
Sentencing is scheduled for April 26, at which time Sciarra faces a maximum term of imprisonment of 20 years. He is released on a $100,000 bond pending sentencing.


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TV Show Spoilers
'Prison Break' Season 5 Latest News: Cast, Plot, Photos & What We Know So Far
"Prison Break" season 5 is already filming various scenes in Vancouver. Here are the things that we know so far about its plot and what we should expect from the Fox television serial drama.
Towards the end of last week, Dominic Purcell took to Instagram to let the show's fans have a look of Wentworth Miller in character as Michael Scofield, Movie News Guide shared.
"@wentworthmilleractorwriter ….It's a joy working with my friend on something that connects to all parts of the world," Purcell, who plays Miller's older brother Lincoln Burrow captioned a snap of their scene together for "Prison Break" season 5. "We both thank you for your continued support. Much gratitude Dom and Went."
Meanwhile, it can be observed that so much has changed on how Rockmond Dunbar looks now considering the seven years that the show has been off air.
Based on the photo he shared on Instagram, the actor, who portrays the role of C-Note, had his beard grow in full and sported an "Islamic look."
Apart from filming in Vancouver, a report by Morrocan Times, as shared by Movie News Guide, hinted that "Prison Break" season 5 is set to shoot some scenes in other parts of the country as well, while another speculation claimed that its main stars would fly to Middle East to plan for their biggest escape yet.
In the meantime, International Business Times dished in its spoilers that Scofield is alive and only imprisoned in Yemen.
With his situation, his brother, along with Sucre (Amaury Nolasco), Sara Tancredi (Sarah Wayne Callies) and possibly his son Michael Jr., would be doing their best to save him from incarceration.
Accordingly, this particular scenario would set the tone for their biggest escape as they were rumored to shoot a number of scenes in Morrocan locations "to portray the Middle East."
"Prison Break" season 5 is expected to arrive in September, after more than seven years of hiatus.
Read Also: 'Prison Break' Revival Cast Updates: Paul Adelstein Returns As Paul Kellerman
Related Article: 'Prison Break' 2016 Spoilers: New Major Character Revealed!


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The Communications Bureau is a comprehensive communications consultancy with branding and digital expertise. The Los Angeles- based collective helps brands understand and navigate the quickly changing media landscape through considered relationships, zeitgeist-led research and results driven campaigns.
The non-traditional consultancy offers its clients a global and strategic point of view through an extensive network in Los Angeles, New York and London. The Communications Bureau has a partnership with global branding agency Redefined, whose clients include Apple, Spotify, and SXSW. The strategic alignment allows the consultancy to deliver creative, content and communications campaigns to its partners.
In this new and exciting role you will work closely with the The Communications Bureau's leadership on executing its client's strategies. The Public Relations Manager will be the daily point of contact for media and should have established relationships with journalists across multiple mediums to include national broadcast, print and online. The ideal candidate is proactive, entrepreneurial and results-driven.
- Secure meaningful and considered press coverage for clients based on agreed strategy and target audiences.
- Write press releases to support client's launches, initiatives and campaigns.
- Create and maintain media contact lists and editorial calendars.
- Track and monitor press coverage and compile monthly reports for clients.
- Deliver creative, forward-thinking ideas to clients
- Planning and implementing of special projects from conception to execution, including seasonal previews, client launches and brand experiential activations.
- Relationships with print, broadcast and online outlets
- 3-4 years of of experience in public relations (agency or in-house)
- Digitally savvy and entrepreneurial.
- Excellent written, verbal and interpersonal communication skills.
- Excellent presentation skills and a critical thinker.
- Self motivated and hard working.
- Interests in fashion, interior design, beauty and tech.
CONTACT: email@example.com


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Pictures on 4x4 section. 3 door Pajero or a 3 door Prado + cash
Pajero: 1990 Model. 2.5 liter turbo intercooler. Diesel. Prado: 1994 Model. 3 Liter. Turbo. Diesel.
2009 / 2010 Toyota Corolla 2009 Belta or Japaneese Corolla1996 Onwards Mercedes E or C Class
post some pics plzz ,
Do you hve anything interesting for exchange?
Mention price of both jeeps
using this way you can get nothing from this thread. Post pics and more details. this might get interest of some one. otherwise say bump, bump, bump
pls check the dates of my posts..both car sold longggggggg time agoo....


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Upon further reflection on my recent stupid injuries, I realized that the real cause was that I'm still too young, rather than too old. First of all, if I was a bit older (either mentally or physically), I probably won't be playing those silly games with the girls. Secondly, although I no longer want to win everything at any cost, I still want to win a lot of things. When I was explaining to the girls that I was hurt so bad because I fell when running really fast, Vivian asked me a question that hit the key point: "Daddy, why do you want to run really fast?" And finally, I still can run really fast. According to the formula E = (m * v^2)/2, tripping over some unknown objects can have serious consequences when one is running at a fast speed.
Anyway, my knee is good enough to carry me back to office today. As expected, everyone (except Jessie) asked me if I had a bike-related accident. I told everyone that the real story was far more embarrassing than that, and people with kids seem to be able to understand. Jessie asked me if I injured myself while having fun or just doing something silly, and my answer to that was "I was doing something silly to have fun at that time".


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17-31 Park Avenue
East Avenue, Rochester, 14607
Commute to Downtown Rochester
Most errands can be accomplished on foot.
Many nearby public transportation options.
Flat as a pancake, minimal bike lanes.
About your score
17-31 Park Avenue has a Walk Score of 89 out of 100. This location is Very Walkable so most errands can be accomplished on foot.
This location is in the East Avenue neighborhood in Rochester. Nearby parks include Pearl-Megis-Monroe Area # 4 Park - Broadway And Marshall St., Pearl-Megis-Monroe Area # 3 Pet Friendly Park and Playground.
Explore how far you can travel by car, bus, bike and foot from 17-31 Park Avenue.
17-31 Park Avenue has good transit which means many nearby public transportation options. Car sharing is available from Zipcar.
Bus lines:
45X/51X/1X South/Clinton/Lake
0.0 mi
47X/31X/48X Park/Monroe/University
0.0 mi
31 Park
0.0 mi
74 Tiger East End Express
0.0 mi
N3 Nazareth East End Express
0.0 mi
4X/38X Genesee/East Main
0.1 mi
81 East Rochester - Fairport
0.2 mi
Geneseo/Rochester Geneseo/Rochester - Geneseo
0.2 mi
57 East Ave
0.2 mi
47 Monroe
0.3 mi
Car shares:
View all East Avenue apartments on a map.
Search for homes in Rochester or find a Rochester real estate agent who knows walkable neighborhoods. Links will open on our partner site Redfin.com.
17-31 Park Avenue is in the East Avenue neighborhood. East Avenue is the 8th most walkable neighborhood in Rochester with a neighborhood Walk Score of 78.


text: EAST NAPLES A clerk at a landmark East Naples corner store shot and killed a man Tuesday as he attempted to rob the family-run shop and flee with her 1-year-old daughter. http://www.naplesnews.com/news/2011/oct/18/deputies-responding-possible-shooting-dels-24-hour/ Do you think she will be charged? What circumstances are the law looking for to make this decision? What kind of facts will they home in? Can they pick at the kind of gun or caliber she was using, and whether or not it was "overkill" for the purpose?


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Polished Concrete: Realistic Expectations & Clarifications
Polished Concrete is a durable and easy-maintenance floor. But its presentation may be inconsistent and can offer a variety of appearances that need to be considered by the site's owner. Read the through the foloowing clarifications to understand the all the steps involved in the Polished Concrete process.
The current condition of the concrete slab will influnce the appearance of the finished product. Any Polished Concrete samples or presentations that you have seen can only offer a general idea of how your finished floor may appear. Stains, cracks, irregular aggregate patterns, floor patches, joints, various shades, and corrosion in the existing concrete will affect the appearance and may affect the finish of the Polished Concrete.
When grinding to achieve exposed aggregate, it is impossible to know the pattern, color and volume of aggregate imbedded beneath the surface of the concrete. The exposed aggregate may be irregular in color, shape and volume, and the final design and pattern is out of the control of PennCoat's installation team.
Dust Control
Excessive dust is an unavoidable by product of polishing concrete. Prior to polishing concrete, we will assess and suggest dust mitigation methods that will help contain and control dust from breaching into unwelcomed areas. Our dust mitigation methods will be limited to what is defined in the scope of work. The owner is responsible for any containment or mitigation that extends beyond the scope of work.
Concrete Repair
Penncoat, Inc. will repair damaged, cracked, pitted concrete and joints to fulfill a flush and level floor. We will make every attempt to match and blend the patches with the surrounding floor. These repairs can be polished with the floor, and offer the same sheen and luster. But they will be inconsistent in color and will appear as distinctive repair markings in the floor.
The polished concrete equipment has access limitations and is unable to serve areas less than 3' wide and 4' tall. Special requests made by the owner to polish areas beyond what is accessible will incur additional charges.
Any future cracking of the polished floor system due to movement of concrete slabs is out of the control of PennCoat, Inc. and therefore PennCoat, Inc. accepts no responsiblity for repairing cracks. Should the Owner/Contractor request PennCoat, Inc. to repair joints; all work will be completed at an additional charge.
Do not use Acidic cleaners. Use Lithium Silicate cleaners.
|Daily Suggestions -
|Dusts mop the floor with a microfiber pad to remove any dirt or debris that is resting on the surface.
|Weekly Suggestions -
|Wet mop with a clean mop using clean water and a lithium silicate* cleaner. Allow the cleaner enough time to suspend the dust and dirt from the floor. Do not let the cleaning solution dry on the surface. If using an autoscrubber, use clean water and a lithium silicate* cleaner. be sure to equip the autoscrubber with nonabrasive polishing pads.
|Every 3-6 Months Suggestions -
|Apply a surface-penetrating lithium silicate stain resistor with a pump spray, and spread with a microfiber mop. Burnish the floor with a high-speed propane Burnisher, equipped with a Diamond-Impregnated 3000 grit burnishing pad.


text: NickW 321 Report post Posted March 1, 2008 So I'm working on this software renderer and I've got it all SSE optimized the most part, but there are a few problems. First of all, it's not very fast. With my Pentium Core2 Duo, I'm getting about 90-100 fps (just rendering a simple teapot, which is about 6300 polys). I was expecting the SSE optimizations to give a lot better performance than that. Second, there are some weird artifacts in the output. Thin one-pixel lines that are either darker or lighter than the surrounding pixels. They seem to be near edges of the polys, but I can't figure out why they're so dark. To rasterize the polys, I'm basically splitting the poly in half and drawing the top half and botton half independently (it makes it easier to intersect the scanline with the triangle if you only have to worry about 2 of the 3 lines). It seems like a decent algorithm, but if there is a more efficient way to do it, I would be very interested. If anyone's interested, the code can be downloaded here: http://nick.weihs.googlepages.com/rasterizer.zip 0 Share this post Link to post Share on other sites


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What restaurants does The Huntley Hotel have?
Answers from Our Experts (1)
With crystal-clear, wall-to-wall windows, a romantic all-white interior scheme and sweeping views of the Malibu Mountains, the Pacific Ocean and Santa Monica's umbrella-lined shores, The Penthouse restaurant and lounge at The Huntley Hotel is one of the area's most fashionable eateries for good reason. The airy space emanates beach glam. Sleek furnishings strategically arranged in intimate vignettes make the space good for dining, lounging and taking in the scenery. At the beautiful bar in the center of the room, bartenders craft delicious, beachy cocktails like the serrano-chili-infused Spicy Hot Margarita and the refreshing Mello Mojito, made with fresh watermelon and cucumber.
Dishing up a farm-to-table menu created by buzz-worthy executive chef Seth Greenberg, the hotel's one and only restaurant is a standout. Greenberg prefers to keep the menu diverse, with seasonal ingredients from the local farmers markets. He takes delight in creating custom menus for guests.
Surrounded by windows, the hotel has an outside-in vibe that makes it a hip, eclectic scene. In the morning, eat breakfast in serene environs. The afternoon brings on the power lunch, as the dining room becomes a hot spot for locals and business travelers. After a brilliant sunset, the lights are dimmed and The Penthouse becomes an intimate, candlelit experience. During the weekend, the lounge often features DJs or live music; it's a fun place for cocktails. The main attraction, however, is the Santa Monica restaurant's renowned weekend brunch, which makes The Penthouse a classic dining destination for such dishes as the black truffle omelet stuffed with truffle cream, wild mushrooms, ricotta and black truffles.


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Finally home after a few days at the Yasuragi spa at Hasseludden in Stockholm. We attended the 24 hour business camp that was held there for the third year in a row.Read More
Sweden Social Web Camp
After an awesome weekend at SSWC we are back to our cave for some programming. All conversations, meetings and sessions sparked a lot of new ideas, but currently they will have to wait until we have some more time on our hands.Read More
An iPhone app for Siljan Tourism
A couple of weeks ago, Popdevelop hired a cabin in the woods outside of Båstad to get some serious apping done. For six days we designed and implemented an iPhone app for Siljan Turism and the sweet baby can be downloaded from the AppStore.Read More
We are giving away protective iPhone skins for SSWC
We just released sswcskins.se, which gives everyone going to Sweden Social Web Camp this weekend the oppurtunity to have their own protective iPhone skin with the SSWC logo printed on it. Oskar Dahlbom made a custom design in 6 different color themes and they all look stunning!Read More
Hacknight.se <3
For the third year in a row we're attending hacknight.se, a hacker conference here in Malmö organized by the hackerspace Forskningsavdelningen. It's a mix of workshops and talks focused on creative use of open software/hardware. The lineup this year is better then ever and I hope to learn new things and meet some nice people.Read More
Popdevelop <3 SingTel
A few weeks ago we attended the Öresund Mobile Meetup conference here in Malmö, Sweden. A conference with everything from good speakers, companies like SingTel, RIM, Venture Beat, Golden Gekko and a few VC firms. To be honest we only attended about half of the sessions to get some hours of coding in during that […]Read More
Interior Decorating 101
Twenty minutes before the stores closed this friday, we decided to buy some furniture for our new office. We took our bikes for a ride in the sunset and bought a Muji Sacco sack. Check out the video below music by @jimtegel, video recording and editing by @brissmyr.Read More


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Gallo hits HRs 40, 41 to lift Rangers over A's 8-4
ARLINGTON, Texas (AP) - Joey Gallo hit his 40th and 41st home runs, Andrew Cashner pitched six solid innings and the Texas Rangers beat the Oakland Athletics 8-4 on Saturday night.
Gallo had a two-run homer in the second inning and a solo shot in the third, becoming the sixth Ranger to hit 40 homers in a season and the first since Josh Hamilton had 43 in 2010. Gallo ranks fifth in the majors in home runs. He also walked twice and scored on a single by Rougned Odor in the seventh.
Cashner (11-11) limited Oakland to five hits and two runs in six innings. He finished his season with a 3.40 ERA, good for ninth in the AL.
Gallo gave Cashner an early lead when he homered on a 1-1 pitch from Daniel Gossett (4-11) that hit the batter's eye in straightaway center.


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Casinos & Learn About European RouletteRoulette wheel to American, as well as European roulette wheel on roulette wheel American roulette, richness gaming.
European Roulette owns 37 bags devised bags are one - 36 as well as Zero red and colors of black are appointed, while the zero is a green bag. European Roulette is as well a stated zero roulette.
European Roulette has 36 amounts as well as one null bag (37 in whole).
In American roulette, distinctive colored chips are given to each player to mark their bets on the table.
To exchange the playing odds in roulette, players should follow special strategies of roulette and tips to grow their abilities of gaining. Routes that a player can expand their possibilities of gaining is to simply play Roulette plays, have a budget for their cash, stay with the desk tiny, watch out placing in bets as well as usual, don t seek alike wagering patterns every time. Furthermore, beware of five number bets in Roulette from America as it is the wager with the highest advantage for the home at 7. 89%. Generic, roulette wheel is a by chance game and can change one's lot over night. A gambler must have discipline exceptionally if they are on a winning strip. With roulette fortunes can convert to misfortunes rapidly and easily.
The chances for hitting a precisely gambling bet are 2. Not to be mixed up with Roulette of Europe, French roulette wheel as well owns a low house edge as well as high antes. Its house edge is fewer than that of the European roulette.
The European Roulette wheel is spun and the ball is fallen onto a wheel containing 37 quantities from Zero - 36.
The edge of house for a European Roulette desk is 2. 7% as well as 5. 26% for its countertype from over the pond. It is this edge of house that possesses caused most gamblers to believe the European Roulette wheel came top, and was then promptly succeeded by the United states version, once the house accepted this needed to pull more money from the sacks of its purchasers.
The American kind of roulette possesses an additional numbered slot of Century. Zero European roulette wheel which is the roulette game of alternative for a number of gamblers has the indentical plan as American roulette, take manner the 00. This presents European roulette wheel gamblers much better possibilities.
Euro Roulette is the regular title of online roulette games called classic roulette, scientists support roulette wheel initiated in Europe, hence the classic variety is reputed at present like European Roulette.
European Roulette Gold is the luxe variant of what is before now one of the most known classes of Roulette from Microgaming.
The Microgaming Internet casino: Aztec Riches owns a good reward for their players.
The casinos in the Internet tender another types of roulette wheel ranging from American Roulette and European Roulette at multiple levels.
2013 plastic cards online has.
Undoubtedly, European Roulette is still the most opted game of roulette in most states through Europe as well as even all along the world.
European Roulette Gold is part of Microgaming's Gold sequences of desk games, which as well involve Baccarat as well as Blackjack.
The game of roulette wheel obtains its name from French People word for "little wheel".
Roulette from America started cluster later and possesses minor distinctions compared to its roulette wheel cousin.
The Euro roulette is more extensively certified as the 'single zero roulette".
Euro Roulette should keep the roulette moving.
Euro roulette regularly loses a double zero.
Yet it is crucial to conceive that casinos do not suggest players a payment that is established on the true odds of the wager.
European roulette wheel gaming houses rely on a person's recollection like all the chips are the equate colour.
French roulette is evidently barely European roulette wheel, but generally means the "French bets" (which confer gamers some shorthand methods to stake on giant portions of the wheel without delay), including the en jail code, which furnishes the player the possibility to 'save" even money gambling wagers when the end of the turn is a null.
Roulette of Europe, French and American roulette, pontoon, European, joker poker.
European Roulette - The Roulette Player's version.
Outside antes are those placed in the teams outside of the grid.
Seat at the classic casino European roulette.
The en prison control orders simply to European Roulette. This methodology is one which will below the house edge, (ordinarily 2. 63% for European Roulette) to 1. 35% for even money bets.
Highfield are below staking Australia roulette online selections for Roulette of Europe.
Bowling alleys, roulette of Europe is not simply the tuxedo - wearing cousin of the Roulette of America.
The top on-line roulette wheel is Roulette of Europe as this only has uniquely one null.


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Partner with your favorite team to support St. Jude
CHEERSPORT is kicking off the weekend with CHEERSPORT Friday Night Live!
The Worlds exhibition will include select teams from Level 5 divisions. The team that raises the most donations for St. Jude Children's Research Hospital and receives the most popular vote via social media will be the winner of Friday night's events.
Thank you to all of the athletes, coaches and fans participating to support our lifesaving mission: Finding cures. Saving children.®
With your help, families never receive a bill from St. Jude for anything, because all they should worry about is helping their child live.
Donate Now
Find your team below and support St. Jude today!
Kat Daddies
Cheer Express
Miss Silver
Cheer Extreme
Coed Elite
Senior Elite
Cheer Extreme - Raleigh
Cheer Savannah
Lady Lace
Crimson Heat
5 Alarm