text:
What our north shore vets & vet nurses all have in common
We're all a little bit different from each other at Fox Valley Animal Hospital. But there's something all our north shore vets and vet nurses have in common around these parts. That is our absolute adoration of animals.
I recently overheard a conversation between a client and one of Fox Valley Animal Hospital's vet nurses. The client had recently lost her beloved Labrador Retriever to cancer. A wonderful dog we had also known and loved over the past 10 years as a patient in our care. Our vet nurse was listening to the owner talk about the special bond she'd shared with her pet, reminiscing about the cheeky things he'd done. Even recalling a time when he'd helped himself to the contents of her bin.
The owner went on to say "the thing I miss the most is sleeping next to him every night. He used to snore and fidget and take up all the bed. I miss all of that."
It dawned on me that to a non-animal lover what this owner said may sound so foreign. Sharing the bed with her pet dog indeed! However to the vet nurse's listening ear and to me and the north shore vets listening on by the tea room, such an experience is part of the natural bond between human and family pet.
This great love for the family pet is something we as veterinary nurses and doctors share with our clients. It's a huge part of us. And it's why we choose a path in life that involves helping and working with animals on a daily basis.
Here are some of the great love stories between our north shore vets and their family pets
Dr Katie's cat Mr Pickles
Dr Katie owns Mr Pickles. She adopted Mr Pickles 4 years ago.
The heartfelt bond they share is so evident when Katie tells me about the naughty things he gets up to at home. Katie lives out in Dural and is the owner of Puss n Boots cattery.
One of Katie's favourite stories is the time Mr Pickles had been busted causing a bit of bother and trespassing! Mr Pickles had developed a taste for the local Dural social life. He'd been caught red-handed parading in front of the local country club's CCTV camera, setting off the security alarm in the process.. Unfortunately, the club wasn't taking applicants of the four-pawed kind at the time, so Mr Pickles was sent home with a caution.
The unconditional love Dr Katie feels for Mr Pickles is obvious. The connection and friendship between Katie and her rescue pet means as a veterinarian, Katie has great empathy for the complex and extraordinary relationship owners share with the patients we treat.
Heather and Dr Alex's relationship
Heather and Dr Alex have been together since the day he became the owner of Fox Valley Animal Hospital and started classing himself as part of the north shore vets team. You could say Heather was the first hire.
Heather has been Alex's loyal friend and work colleague for more than a decade and a half. She sits in on consults day after day. Heather is a nurse to the sick pets we treat. Her extraordinary sensitivity towards animals patients sees Heather sit by their beds and run to the sound of a whimper, just like a matron in a hospital ward.
With first consults and nervous animals, Heather is there to help. She helps ease a puppy's first visit for vaccinations with her calming nature. And she is a friendly face many of the Fox Valley Animal Hospital pet patients recognise and remember.
To be able to work alongside your furry companion is something most animal lovers dream of. Heather is not only therapy for our sick patients. She is Alex's therapy when we've had a particular hard day. You'll catch her up on Alex's lap, both of them oblivious to their surroundings, enjoying that moment and connection between owner and pet.
Dr Alex knows the healing, quiet support given by a pet through the biggest wins to the toughest of moments. And it's something he deeply respects in the animal and human patient bond he sees at Fox Valley Animal Hospital.
Please share with us your special bond that you have with your pet. What is it that makes them different to the rest? Is it the unconditional love they show you or the way they understand your needs. Is it that naughty but cheeky habit they have? We would love to hear the stories and photos of your pet.

subset: commoncrawl


text:
With all the different types of senior living available today it's difficult to understand the differences between them and even more difficult to choose the right one for you or a loved one. Adding to this confusion is assisted living may mean different services not only at different facilities, but even to two people at the same facility!
The reason for the wide range of services is residents each get the amount of personal care and support that they need while maintaining a certain level of independence.
They are typically a good choice if you need more personal care than you can get at home, but you don't need the constant supervision of a nursing home.
So if you or a loved one find that you're having trouble with everyday tasks but still want to maintain your independence an assisted living facility may be right for you. You can get the support you need while keeping as much of your independence as you'd like.
Many quality facilities will help develop a customized plan that meets all special needs while giving residents the freedom to do what they want to on their own.
Is Assisted Living The Same Thing As A Nursing Home?
No, not exactly. They do offer many of the same services but a nursing home provides 24 hour supervision and medical care for residents. In an assisted living community 24 hour service is available, but privacy and independence is encouraged.
Many offer private and apartment style housing, some even have their own kitchens. Almost all facilities have group dining and areas for social and recreational activities.
Assisted Living And Continuing Care Retirement Community (CCRC)
An assisted living home can be part of a continuing care retirement community (CCRC). These CCRC communities are long term living solutions for seniors, usually in a single location. In the beginning, seniors living at a CCRC enjoy independent retirement living.
As residents get older and begin needing assistance they receive the help they need as they need it. This continues until they need full time supervision and transition into a full nursing home environment providing the resident with all the senior services they'll need for their entire life.
Paying For Assisted Living
Most people pay for their assisted living care with private funds but in some cases exceptions are made. There are some insurance policies that offer long-term care that cover assisted living facilities that are licensed.
Check your insurance policy to see if you are covered. Medicaid assistance is available to help pay for the costs of assisted living for those who qualify.
Is Assisted Living The Right Choice For You Or Loved One?
Deciding to move into an assisted facility and leaving the home that you're familiar with can be difficult. Even if you're anticipating the benefits of assisted living; security, assistance, and social perks that come with it, you have to also consider the impact that it has for your family.


text:
Frontal sinus osteoma
Incidental finding on a pre MRI orbit radiograph.
Patient Data
Age: 65-year-old
From the case: Frontal sinus osteoma
Loading images...
Loading Stack -
0 images remaining
Dedicated images for the orbits show a well-defined and lobulated dense lesion within the floor of the left frontal paranasal sinus. The remainder study is unremarkable.
Case Discussion
Features are consistent with an incidental found paranasal sinus osteoma, a common benign tumor. The diagnosis was achieved only based on the imaging features, a less likely differential to include would be an osteoblastoma.


text:
Login / Register
Login with facebook and Google plus
Don't you have an account? Register Now
B natural pomegranate juice contains no added preservatives that actually contains the enriched pomegranate fruitlets that actually take the world to the next level of the estatic juice
Sorry! No Reviews yet Be the first one to write a review


text:
Sanitized versions of sharia law are common in the West. Take Georgetown University Professor John Esposito's new book, which he wrote with Natana J. Delong-Bas.
In the book, Shariah: What Everyone Needs to Know, Esposito tell us that sharia is a reflection of "the common good (maslahah), human dignity, social justice, and the centrality of the community." Perceiving it as anything less is only due to "myth" and "sensationalism."
The authors make a big point to differentiate between sharia (which is "immutable and infallible" and based on the Quran and the sunna – hence divine in origin) and Islamic law (fiqh), which is fallible and subject to change.
Recently, the world has seen a number of instances of horrific public floggings in Islamic countries. In Iran, a young man was given 80 lashes in a public square for drinking alcohol when he was 14 or 15. The crime was committed over 10 years ago. Witnesses reported the man was tied to a tree and flogged by a masked man while a small crowd watched from a distance. The incident took place in the eastern city of Kashmar last week.
Although details of the whipping were not known, in Iran it is customary to use a one-meter (three-foot-long) whip. Many people faint from the pain after seven or eight strokes.
Drinking alcohol is one of 100 offenses punishable by flogging in Iran.
In Indonesia's sharia-compliant Aceh Province, 15 people were whipped in front a baying crowd of 1,000 on-lookers who shouted, "Flog them harder!" as the cane come down on their backs.
The punished included five women. The offenses ranged from gay sex (87 lashes each) to being drunk (27 lashes) to adultery (26 lashes).
The floggings were carried in front of a mosque after Friday prayers. Children were among the spectators.
John Esposito and his fellow Islamist apologists claim that sharia law is the embodiment of "human dignity" and "social justice." Yet flogging is part of sharia law and finds its source in the Quran and the sunna.
Esposito and company also would have the American public believe that those who oppose sharia are ignorant, at best, or Islamophobic, at worst.
To the contrary. Sharia law opposes the freedoms and values we hold dear in the West. We should not be duped by the professor from Georgetown.
UK Rejects Recognizing Sharia Marriages Under Law
Linda Sarsour Claims Sharia Never Imposed on Anyone. Really …
Majority of Europe's Muslims Favor Sharia Over Democracy


text:
Aimee Mullins. The Story of a Strong Woman
14 Oct, 2011 | category - Celebrities | 23 photos | 6053 visits
Aimee Mullins was born without fibula bones in her legs. When Aimee was just one year old doctors had to amputee her legs below the knees. But the girl never gave up. Aimee Mullins became one of the college's best runners and ran against able bodied runners. She also participated in the 1996 Paralympics in Atlanta. The girl acted in a couple of movies, done modeling and even worked at the Pentagon. She has 12 prosthetic legs for any occasion.
Share with friends
Follow us on Facebook
Leave a comment


text:
An article written by
Written By: Maria Anwer:
So many times we hear about individuals attending conferences for effective communication skills, team management, time management and the like as if the change will come from outside in. The reality is that lasting change is an inside out process i.e. building the character. Otherwise, there is a force from the outside demanding change which is unlike the natural laws and, hence robs away personal effectiveness from leadership.
Leaders lead from character and, character is established by having a set of habits which define success on principles rather than based on popular culture.
There are 9 ways in which leadership is shown as strength of character in the book 7 habits of highly effective people by Stephen Covey. He talks in his book's foreword about basic human feelings and, emotions and how do people inspired from the popular culture deal with them. Now we are going to understand each example, explain it with thoroughly through psychology and, then contrast it with the response from Stephen Covey's book:
1.Fear and insecurity3>
It is the feeling which highlights one's weaknesses to deal with the situation and, mars one's view of future with negativity. A part of the fear is good enough to keep one abreast with reality. But, when it gets out of control and shapes up into uncontrollable anxiety, it is then when it becomes a challenge to handle. It is famously said that,' danger is real but, fear is a choice".
But whenever one has fear whether it is the fear of poverty, hunger, loss of job, diminishing finances over time, in all these fears lie a response of the society of independence of individual. However, true sustainability comes from interdependence which Stephen Covey calls in his book as the maturity continuum. It is a principle which is based on teamwork, cooperation and, communication.
The point to mention here would be that in order to conquer fear, one cannot independently make a resolve for a long time. It is from interdependence that one seeks true pleasures of life. It is learnt from nature as a universal principle as nature is also highly interdependent.
Leadership is also fearless once an interdependent structure supports it. Through psychology, it means less of stress and flight conditions as there are many to share the burden or, the cost of any decision.
Popular Culture's Wrong Approach: Mere independence
Principle Centered Approach: Interdependence
2.I want it now – Instant gratification
There is another culture which has propped up with the advent of new financial system, it is of credit card buying or, a behavior of spending more than one's production. This system of instant gratification is a mere loss-loss game in the end. Hence one needs to assess one's resources first with a constant investment in one's skills, health and, priorities to obtain benefit from them later in life. This way, the real mantra of life is sustainability and, growth.
Leadership understands a continuous investment in ones skills to meet the demands of the highly competitive society and, organizational structures.
Popular Culture's Wrong Approach: Credit card societies – get now and pay later
Principled Centered Approach: Invest now and, reap the benefits later
3.Blame and victimization
As human beings, we are very powerful creatures because we have choices to make. The popular culture's approach is to become a product of circumstances. Our minds are wired to blaming that if only my father invested in my education then I would have succeeded. There are so many 'If Only'. We need to rewire our mind to take responsibility of choices which we have instead of sitting back and, complaining. Blames take the responsibility off one's shoulder to that of another but, it also makes one as obsolete because there is no responsibility hence no improvement in self, habits, thinking and, the like.
Leadership recognizes choices and, takes responsibility. It is not passive.
Popular Culture's Wrong Belief: 'If Only' I had ….
Principle Centered Approach: The supreme power of choice
It is the fruit of expectations and, the belief that the society owes us something which is not the reality. It is also the product of the failed mantra that I am crushed under circumstances. It is the human intelligence which understands that everyone will act in their self-interests and, this belief will pacify all souls as it lowers expectations.
Leadership understands the real essence of survival of the fittest ideology which leads everyone to act in their personal interests first. That is the reason to sacrifice for others is Godly and, held in high esteem. But it is when one goes against one's basic nature.
Popular Culture's Wrong Belief: Determinism – A being is a product of its consequences
Principle Centered Approach: Cynicism – Everyone acts in their self interest
5.Lack of life balance
It is not the work which is never ending but, the popular culture which demands in a schedule of walking in early and walking out late as a mark of efficiency.
Leadership marks priorities and, understands focus.
Popular Culture's Wrong Belief: Efficiency is neglecting work-life balance in the name of efficiency
Principle Centered Approach: Priorities and, focus drive real success
6.Whats in it for me?
The new age mantra is to get the deals where one person is which is the self, the beneficiary. Whereas the principle centered approach of interdependence talks about togetherness, it takes a whole group into account for reaping benefits.
Leadership has the character trait of talking on the behalf of many and, not to keep the benefits glued to one self only
Popular Culture's Wrong Belief: "I" – only individual in focus
Principle Centered Appraoch: "We" – togetherness
7.The hunger to be understood
There is habit 5 in the book 7 habits of highly effective people where Stephen Covey advises his readers to become good listeners to get the desired response of outcome from a group or, people in general. He says that to make one completely heard, one needs to genuinely listen.
Leadership is all influence.
Popular Culture's Wrong Belief: Communication skills are enough to influence others
Principle Centered Approach: Real listening is required for real understanding and influence
8.Conflict and, differences
There is a habit 3 in the book by the same author which seeks to strike a middle ground when in decision making. It aims not to put the sole focus on winning the situation but to bringing in cooperation which brings a utility bringing compromise from both parties and, giving a better solution to which both the parties agree.
Leadership understands and, seeks win-win in all conflicts and, differences.
Popular Culture's Wrong Belief: The one who wins all conflicts is more competitive
Principle Centered Approach: Seek a win-win from all parties involved in the conflict.
9.Personal stagnation
It is a point when one feels stuck in life when the author of the above mentioned book shares human nature and, it wiring with us. He says that the human nature is four dimensional. He also shows the difference between popular culture and, principle centered approach. The four dimensions are mentioned as followed in the book:
I.Body – The flesh and, bones
If something wrong happens
Popular Culture's Wrong Belief: Surgery
Principle Centered Approach: Take care of one's health
II.Mind- The thought process
Popular Culture's Wrong Belief: It says watch television, entertain me
Principle Centered Approach: Read broadly and deeply,
Focus on continuous education
III.Heart – The feelings' and emotions' seat
Popular Culture's Wrong Approach: Use relationships for manipulation
Principle Centered Approach: Respect and serve
IV.Spirit – The energy behind actions
Popular Culture Wrong Approach: Teaches secularism
Principle Centered Approach: Find coherence in universal laws for example laws of physics to see from where all positivity and all hope come from.
There is a difference between the popular culture approach and the principle centered approach and there can be many examples for them. But the point of true leadership is to understand the difference and, make a real mark by following the principle centered approaches as they are deeply embedded in the character ethic and, not in the personality ethic. The difference between the two is the difference between organic growth and, inorganic growth of a person. The inorganic cannot last for long whereas, the organic survives. The same goes for leadership.


text:
Beginner In Connect Explore marketing? Try These Pro Tips!
Web marketing can be an exceptionally lucrative Connect Explore if done correctly. Numerous chances exist to release on-line services, though every one of them needs substantial time dedications. Making use of time carefully is incredibly essential. This article will give you time monitoring strategies for your online marketing efforts.
Offers as well as sales could aid increase the position of your website. You could purchase web page rank as well as various other consumer sites will certainly utilize you as an associate. This resembles offering something at a loss so you could do even more service and also obtain more earnings down the line.
Take into consideration the means you intend to promote your site. Free or fairly inexpensive methods to promote your website include hanging posters in neighborhood services, using social networking websites, or posting on blogs. You will find that there are inevitably quite a few methods which to drive web traffic to your company. You simply need to be innovative.
Develop strong ties with consumers using internet marking that generates partnerships above Connect Explore. Send e-mail newsletters concerning your product or services and also avoid all the strong marketing language, choose a more pleasant intonation, and see to it to thank your customers for remaining faithful to your service.
Don't clutter up your content with advertisements. A visitor check outs your internet site with bent on getting the content you have actually published, not being bombarded with several advertisements. See to it you have just sufficient to get your point throughout. Having a lot of will really drive readers far from your site, which is counter-intuitive.
If you utilize photos you need to include a description. Search engine algorithms will factor the relevance of message in the captions in to exactly how relevant your website is to a search phrase being searched. Your web traffic and also search engine position will increase if you make your website keyword abundant, consisting of the picture subtitles and post titles.
To be a wonderful marketing professional on the net, track your stats and also data. Maintaining records of everything you potentially could is incredibly crucial for learning exactly what truly functions. Track what advertising approaches you utilize as well as exactly how they influence individuals. Tape-record specifically just what you sent out or provided or published, when, to which people and in what kind. Track that clicks, that responds, that acquires, and when and also exactly how as well as the number of individuals take each Connect Explore activity in action to your advertising projects. The more you know, the much more you'll see what you should do to enhance your success rate.
For much better success at Web marketing, try a lot of various advertising and marketing methods. Specific individuals are much better at various techniques and also different products are suited much better to specific strategies than to others. There are various methods to market an item on the Internet as well as it could take a while to find the ones that benefit you. Keep in mind the plural, due to the fact that you truly should be utilizing several techniques of advertising to maximize your success, which is another need to try lots of.
To end up being a wonderful marketing expert, learn from the wonderful marketing experts. Take a look at individuals who are doing job similar to the job you want to do and who appear to be successful. Analyze their technique. See what they do much better compared to you do. See exactly what various online marketers do in different ways from each various other with equivalent success. It's not necessarily a great idea to outright duplicate other individuals's techniques, but you could absolutely utilize other people's concepts to inspire concepts that suit your own item as well as personality.
You need to reward the site visitors that have actually offered you aid, by advertising their web links on your homepage. This will assist in 2 ways: It will certainly reveal individuals that aiding is awarded, motivating them to do it extra. And, it reveals that you appreciate all your users.
Make certain your "front door" is a pretty one. Your site is the only means individuals will certainly be familiar with you. Ensure to make a wonderful first impression on your site visitors by developing an open, inviting, as well as descriptive location for them. Understand that your website is your main means of interaction, as well as keep the doors open!
Develop an email account simply for your website and inspect it regularly. Have it connected to your Connect Explore to receive instantaneous updates. Your clients desire you to connect with them, despite the factor they are creating you. Addressing their worries or comments immediately, is a terrific way to enhance public connections.
To earn the best of your Web marketing methods as well as chances, aim to prevent domain names that seem like spam. You wish to give a legitimate service to generate healthy earnings. Include a discussion forum to your site. Add graphics to the online forum as text based discussion forums are not as attractive to customers.
Online marketing is tough, but it doesn't have to occupy every spare second of your life. Be tactical and handle your time wisely, as well as your success will comply with!
See More:
Connect Explore, Connect Explore Review, Connect Explore Bonus, Connect Explore Discount, Connect Explore Software, Connect Explore Review And Bonus, Connect Explore Reviews And Bonuses, Connect Explore Get It Now, Connect Explore Coupon, Connect Explore Buy It Now, Connect Explore Grab It Now.
Powered by GroupSpaces
Privacy Policy
Cookie Use
Create Your Own Group


text:
Technologies and platforms we use in work are as follows:
Web services are a typical example of service oriented architecture of the system (SOA). Our solutions are mainly based on three-layer architecture, where the layer of business logic is on the application server which is accessed via web services. The application of web services in .NET technology provides a very secure and scalable solution to execute business applications.
Windows Mobile platform has become increasingly popular in business environments as users need to be able to access the information relevant to business operations at any moment. We offer to our customers the development of applications for Windows Mobile and connection with any functions within the IS enterprise.
Sharepoint has become increasingly popular in the Serbian market. In accordance with the needs and desires of the market, we specialize in Sharepoint development and we offer different solutions based on Sharepoint:
top of page


text:
Why Veteran Exec David Hill Is Leaving 21st Century Fox After 27 Years
Departs as Murdoch sons arrive
The man who brought the constant score and time graphic to sports telecasts and innovations like hockey's glow puck and football's yellow first-down line, is leaving his longtime home at 21st Century Fox.
David Hill, who has been with News Corp. since 1988, will leave the company just as the next generation of Murdochs takes over.
Hill was the co-founder of the FOX Network, FOX Sports, the Regional Sports Networks and Sky Television. He most recently served as senior executive vp for 21st Century Fox.
"Of all the fun parts, the proudest was running the Fox Network in the late '90s," Hill said in a statement. "When I was given responsibility, it lagged in a pitiful fourth place. Working with Peter Roth, Mike Darnell and a group of fearless television warriors, we took it to No. 2 by 1999."
In 1993, Hill built Fox Sports "from the ground up." It reached new heights when News Corp. CEO Rupert Murdoch and the upstart FOX outbid CBS for the rights to the NFL's National Football Conference games, a relationship that continues today.
Last week, Murdoch named his sons as company successors—James Murdoch becomes CEO next Wednesday, while Lachlan Murdoch takes on the role of executive co-chairman, along with his father.
Hill will launch a new production venture called HILLY, which will be backed by 21st Century Fox and focus on live production and reality shows.
"I believe the future of the broadcast networks lies in big, spectacular live events," Hill said. "As I've spent most of my life producing those, I think I can give some added value. In a funny way, this is like finishing my apprenticeship."
In his new role, Hill will continue working on the final season of American Idol.


text:
HottPerfume Coupons & Free Shipping Codes
HottPerfume specializes in offering fragrances for women and men from top designers. Use free shipping codes and discount coupons to save on perfume and cologne brands like Alfred Dunhill, Burberry, Calvin Klein, Bvlgari, Chloe, Beyonce, Tommy Hilfiger and Sean John.
Get emails when HottPerfume has new coupons.
Free Shipping Coupons & Promo Codes
Free Shipping Code Ends December 31, 2050Free Shipping plus up to 70% Off Perfume at HottPerfume.com.


text: Camaro fans upgrading the second generation model have the perfect blueprint in the Z28 Rally Sport, especially when executed as well as this very attractive 1970 replica. Nicely restored and finished in non-factory but beautiful Black with Red stripes, it benefits from a breathed-on 350 with 450 dyno-proven horsepower and a 5-speed manual gearbox. Bucket seats and console, power windows and locks and a tilt wheel comprise the driver-friendly interior, which also serves up factory air conditioning, power steering and power brakes. This great driver's machine is perfectly finished with front and rear spoilers, Z28-specific five spoke factory wheels and that marvelously styled split bumper front end.


text:
This route starts at The Inn at Grace Winery in Glen Mills, Delaware County, and heads west along the Chester County and Delaware County lines, to Penns Woods, Chaddsford and Galer Estate wineries and Stargazers Vineyard. It's a perfect weekend trip but could be done in a day, with the bookend wineries no more than only a 35-minute ride from each other. For those who have some extra time, take a left on Route 841 and head south to just short of the Maryland line, where Old Stone Cider is located.
The area north and west of Philly is dotted with wineries and a mix of scenic venues and quality product. Several are major spots for weekly entertainment, one is a hub for the arts. Another is among the state's oldest and one of its best-known, all of them close enough to hop-scotch in a day or take a full weekend if you care to linger at each stop. I added the cidery near the Pennsylvania-Maryland border as another product option; it's something I'd like to do more with more cideries and distilleries opening their doors around the region.


text:
November 19, 2018
January 15, 2018
People in the running world making assumptions about my running experience purely on my appearance is one of my biggest bugbears about the sport. It happens all the time. In fact it happens so often that I almost expect it to happen and then I find myself modifying my behaviour in case it does. Like…
August 15, 2017
May 10, 2017
January 4, 2017
February 11, 2016
February 10, 2016
January 26, 2016
So today we are going back to basics and simply reviewing the very best ways to begin your running journey with some suggestions for how to start…none of them are particularly easy, but nothing worth having in life is right? 1. Just start running today – As in put your trainers on this very minute and…
December 23, 2015


text:
Who doesn't love a slushy mixed drink? This strawberry lemonade vodka slush is unadulterated paradise, and particularly with the warmth that California dependably gets each late spring. This is such an invigorating beverage , and very straightforward and with only four fixings.
My preferred spot to be in the late spring, and much progressively immaculate tasting on one of these slushy mixed drinks! The most ideal approach to splash up the late spring beams.
You could utilize solidified strawberries on the off chance that you like, simply curtailed to around some ice rather than three. These vodka slushies are the ideal combo of sweet and tart. Your group will totally cherish them! Obviously you forget the liquor for the kiddos, and they will need everything summer long. Make a major clump as I do and simply toss them in the cooler.
Also try our recipe Pink Lemonade Vodka Slush
This Strawberry Lemonade Vodka Slush cocktail is pure heaven! A super refreshing summer drink with just four ingredients. You'll be craving it all summer long.
- 3 cups fresh strawberries
- 2 cups lemonade
- 2 tablespoon sugar (optional)
- 1 cup vodka
- 3 cups ice
- strawberries and lemons for garnish
- Combine all ingredients into a blender. Blend until smooth.
- Serve immediately store any left overs in the freezer.
Read more our recipe : Strawberry Cheesecake Trifle
Source : https://bit.ly/2Hf7KcW


text:
Hi everyone! I've decided to try and put together a fandub of a memorable moment from Dragon Ball Z but rather than trying to stick closely with the Japanese version (as many other fandubs already do) I've decided to take some creative liberty with the project and dub it in a way that I haven't seen done before. Basically I want to try and cast a small group of actors who can best fit the original Canadian cast performances seen in the first "Ocean dub" of the show. Along with these performances the scenes will also have additional sound effects to increase dramatic effect (a common practice of the Ocean dub) and feature alternative, yet fitting music placement (not Bruce Faulconer or the original Japanese music).
For those unaware, the original English dub of Dragon Ball Z featured actors from Vancouver Canada and is often referred to by fans as the "Ocean dub" due to being produced by Ocean productions. This particular cast and crew only managed to originally dub the first 53 episodes of the show (technically 67 edited down to 53) and were later brought back after a hiatus to continue dubbing the rest of the series for TV in parts of Europe and Canada. Because they had to keep up with the American version of the show they skipped over a significant amount of episodes, most notably the post Ginyu Force episodes as well as the famous Super Saiyan transformation.
For this project we will be starting off light by only dubbing one important scene from the Freeza/Frieza saga. The scene will be split into two parts and dubbed one at a time. The first part will essentially be a test to see how well this goes and if we should continue into part 2.
Scene we will be dubbing: The aftermath of the Spirit Bomb on Namek/Freeza's return (Part 1) & Krillin's death/Goku's transformation (Part 2)
My role will be directing the actors, editing the footage/music/sound and providing the script. I will also make sure to provide chosen actors with the appropriate video clips necessary to dub. I am considering acting in this project as I can do a decent impersonation of two of the characters however I am waiting to hear other actor's auditions/impersonations before making a decision.
Things to consider:
-The original voices are merely a reference for what to sound like. If your impersonation isn't perfect I am still open to an audition from you if you feel you can nail the performance.
-Despite the original Ocean version of Freeza having a female voice actress I am open to female AND male auditions for this character (Keep in mind Freeza only has a speaking role in part 2 of this scene which will be dubbed later).
-A narrator will only be needed for part 2
-Piccolo will only be needed for part 1
-For pronunciations I will be sticking to the standard well known English dub pronunciations unless stated otherwise (i.e Na-mek, Say-en, Krillin etc).
A hobbyist voice-over fan equipped with a microphone and the editing skills to make my vision a reality. Often eager to collaborate with talented people of any kind.
When I'm not impersonating my favourite voices or coming up with my own I enjoy creating personal passion projects and love the process of editing performances together and directing other voice actors.
Feel free to add me on Discord, I love to collaborate.
-Originally voiced by Ian Corlett (example 2) and replaced by Peter Kelamis (example 2)
-A Peter Kelamis impression is preferred for this project but Ian Corlett styled auditions are also considered.
-Being able to scream will be needed for part 2. Along with McNeil, Kelamis also had unique screams and a crazy kiai that would make the character sound more like a stereotypical martial artist.
-When not fighting or in situations of danger the character should sound naive and somewhat goofy.
-A commanding tone of voice with lots of energy is preferred.
So how's about we head home? [pause] I'd say my ship can get us back to Earth in... [thinking] five days, give or take. (Happy/upbeat)
Don't scare me like that Krillin, for a second I thought you saw Freeza again! (Worried)
Snap out of it Gohan! (Shouting)
-Originally voiced by Terry Klassen.Example 1 & example 2
Looking for something that sounds close to Klassen's performance OR Samuel Vincent's Edd (From Ed, Edd n Eddy). Basically more of a high pitched, cartoony or innocent take on the character is preferred here.
-The character is short in stature but is not a child.
-Being able to give a good comedic delivery (even when lines are not particularly intended to sound funny) would be preferred over a more serious performance.
-Being able to sound believably scared is also needed.
I completely forgot about... Bulma… [sigh] (Worried/anxious)
With her temper the way it is I fear that the real battle has only just begun (Annoyed/disappointed)
-Originally voiced by Scott McNeil. Examples here & here
-Looking for a deep to medium ranged male voice. If your voice isn't very deep try to avoid forcing it as it usually just results in the character sounding brutish and unintelligent.
-I am looking for more of a Clint Eastwood type of voice that can convey the feeling of a character that's calm, wise and badass.
-Some distressed growling and anguish filled yells will be required for part 1 so keep this in mind. McNeil's performance would often feature demonic sounding yells similar to a metal vocalist. This is not required but but is preferred over a plain/generic death yell as the character has demonic origins (as well as being an alien).
Planet Namek has endured one hell of a battle this day...
I only hope this will allow the Grand Elder, and all others who have died, to rest in peace.
-Originally voiced by Pauline Newstone (But I don't mind this one being different).
-Character is a powerful humanoid alien and is the villain of this scene.
-The voice should sound pompous, sadistic and sophisticated yet constantly on edge like his tempter would erupt at any moment. Ideally it should have a somewhat frightening quality (Think Mark Hamill Joker but more serious).
-Voice should ideally be in the higher pitched range although medium ranges will also be considered.
Do you actually think I would let any of you escape?
Because I'm afraid to say that none of you will be leaving here alive!
Simply need a deep voiced narrator preferably with an old, wise sounding voice. Something similar to a Peter Cullen Optimus Prime should do fine.
(Will only be needed for the conclusion of part 2)
Will this unsettling transformation be enough for our hero
to put a permanent end to Freeza?
Only time will tell…
Stay tuned....


text:
What is European Walled Towns
The European Walled Towns (EWT) is the international association for sustainable development of walled towns, walled cities and fortified historic towns in Europe.
EWT aims to promote the many mutual interests shared by walled towns; EWT wishes to maintain and strengthen the historic walled towns for future generations by applying for European funding and partaking in European project.
Latest News
Please reload


text:
NoahI am currently earning two bachelor's degrees at the University of Illinois, one in Spanish and one in finance. My entire junior year of college was spent as a Spanish tutor. I have also been a yoga instructor, so I have plenty of experience teaching people. I am a very hands-on and outgoing teacher and tutor. I am looking forward to meeting and working with students in the Buffalo Grove area. I enjoy tutoring Spanish of all levels, including conversational Spanish and Spanish 1-3. I tutored as a senior in high school, where I worked with foreign exchange students. In my spare time, I like cooking, drawing, listening to music, and traveling.
University of Illinois at Urbana-Champaign - Current Undergrad, Spanish and Finance
Spanish 2
Spanish 3
Conversational Spanish
+2 subjects
NiranjanI can be described as a passionate and energetic physics and math tutor with a fresh and creative approach to teaching. I have a bachelor's degree in electrical engineering from the University of Illinois at Urbana-Champaign. I am available to help with many subjects such as trigonometry, test prep, pre-algebra, music theory, algebra, and others. I encourage creative learning in STEM subjects. My tutoring style includes creating a productive and safe learning environment for my students to learn in. I am looking forward to helping my students reach and exceed their physics and math goals. I like playing basketball, playing board games, and music composition in my spare time.
University of Illinois at Urbana-Champaign - Bachelor of Science, Electrical Engineering
AP Physics C: Electricity and Magnetism
AP Calculus AB
+40 subjects
DanielI am currently earning my bachelor's degree in economics with a statistics minor from the University of California-Los Angeles. I love working with students of all ages, but I specialize in elementary through high school instruction. In the future, I want to either work in finance, audit, or data science relating to ACT prep. I spent a lot of time preparing for the ACT, so I know many tips and techniques to teach the material. In addition to test prep, I can help with writing, English, math, and geometry. I enjoy completing do-it-yourself projects around the house, watching eSports, and playing basketball in my spare time. I look forward to meeting you.
University of California-Los Angeles - Bachelor in Arts, Economics
ACT Reading
AP Microeconomics
High School English
+21 subjects


text:
R-Studio Crack 8.5 Build 170237 Network Edition Free
R-Studio Crack 8.5 Build 170237 can be an advanced level and incredibly information which is easy-to-use software that which allows you retrieve deleted data, lost, formatted, as well as other reasons for simplicity. This system is running on a information that is comprehensive technology, allowing one to recover information from the selection of file systems produced by Windows, Linux, and Macintosh including FAT 12/16/32, NTFS, NTFS5, exFAT, HFS / HFS +, UFS1 / UFS2, and Ext2 3 / 4FS. R-Studio is made not just to be easy-to-use for newbies, but in addition, made for higher level users. R-Studio Crack 8.5 Build 170237 gives tools which are advanced forensic, as well as other things. You're permitted by this program to recuperate information from both neighborhood and community drives.
The R-Studio Crack 8.5 Build 170237 compressed with new technology file system and resolve the situation of each computer that is individual. That is especially employed for undone files and destroy the herpes virus or every other form of threats on your desktop. It really works in LAN and makes our work really easy like screen installation partition. It's got really supply that is dependable magnificent settings. R-Studio 8 create is minimized the proper time frame and framework for your restrictions. In addition to that is unpredictable and settings which can be marvelous inside it.
R-Studio Crack 8.5 Build 170237
Another R-Studio 8.5 Build 170237 software that actually works better in terms of the data recovery rate than comparable computer software, plus the power to recover disk that is harmful aside from its competitors. Using this planned system, it is possible to recover files which have been erased wrongly and destroyed because of the virus. This pc software uses a program that is easy use any user at any degree of computer information from the environment. The house web page with this software includes two components, one for viewing a record of drives, therefore, the other for viewing detailed information regarding them and their content.
R-Studio Crack 8.5 Build 170237 is pc software ended up being initially developed to be used by information data recovery specialists, system administrators, IT specialists, and experienced and advanced level computer users. A number of R-Studio's features had been also created solely for computer forensic professionals, and a lot of R-Studio users don't require every function that is solitary of pc software.
R-Studio Crack 8.5 Build 170237
It additionally provides you with a shelter that is complete conservation of one's individual files. R-Studio Crack 8.5 Build 170237 makes it is possible to save your valuable information to virtually any drive maintaining really mode that is safe. It offers extraordinary outcomes though it is operating just like a device.
R-Studio also established the piece that is fantastic for manufacturers. R-Studio recuperate software genuinely organized for any deleted and lacking or formatted information. A while in error we push the delete key and erase our important information than R-Studio 8.5 Build 170237 Crack will help us in times that are hard. We overcome our dilemmas to use that computer software. After that, we eradicate others low priced and computer software that is worthless would not just work at the full time of need.
Key Features:
- The user interface very standardized.
- Supporting for all kinds of windows.
- Using the recovery files in the network mode.
- To scan the files having little bit virus in it.
- Keep safe from major damaged of files.
- Easily e recognized y the users.
- Automatically assembling each segment.
- Identify all the parameters
- Having a substitute feature of processing.
- Transfer and managed the files in s single click.
- To review the apps in every second.
- Monitoring and integration system is comprehensive.
What,s New :
- The device NVEM supported by the software.
- Better results for MP3 and MP4 files.
- FLV files JPG files easily e converted.
- It also presents the masks for the files.
- Processing the files in the very short period of time.
- Fixing the bugs automatically.
Minimum Requirements:
- Windows 2000/ XP/ Vista/ 7/ 8/ 8.1/ 10 or Server 2003/ 2008/ 2012/ 2016 (32-bit or 64-bit – all editions)
- 32 MB RAM (Memory)
- 200 MB disk space
- 800 x 600 display
How to install/activate:
- Disconnect from internet (most recommended)
- Unpack and install the program (run Setup)
- Copy Cracked files from Crack to install dir#
- #Default is here!: %ProgramFiles%\R-Studio
- Or just extract and run R-Studio Portable
- Now run R-Studio and register with key
- Never let the program to apply any updates
- Always block the program in your firewall!


text:
34 Ratings
Parducci Sustainable Red Blend
Wine Details
Wine Description
(2012 Vintage) Honoring the complex nature of the Pinot Noir grape, we select individually-vinified small lots of premium varietal Pinot Noir grapes to blend a wine of sensual character and nuanced flavors. Our Pinot Noir offers aromas of juicy, ripe raspberries and strawberries. Its berry flavors are full and rich on the palate, picking up a hint of cedar in the finish. Enjoy this medium bodied red wine with grilled salmon, pork tenderloin, and fine cuts of red meat.
Nice red blended table wine on a par with Menage but a little dryer. $8.99 on sale. Great little red house wine
not too dry. flavorful and smooth


text:
I got up early to read "The Shift Index," but then, for no reason, decided to take a "break" by going to Taylor Davidson's Twitter stream (@tdvaidson) and saw his tweet about this post.
I make it a point to never mix my Big Shift and my Singularity because the same thing always happens: boom! – my head explodes. Although, I must say, it explodes with possibility, that we just might make it through the next thirty years with something quite remarkable on the other side.
And, if not, it's going to be extremely interesting and [something] trying. Big thanks for giving such a compelling account of your experience at SU, loved it.


text:
The maintenance person may be the most important person in a child's life. The kitchen worker is rebuilding his or her brain as he works beside her in a work-study job.
Support staff include the receptionist, the administrative support, the kitchen workers, the maintenance folk, people in the business office. Their interaction with clients can be frequent or rare, short or intensive. In trauma-informed care, every person is a treater. Each person has the opportunity to change a child or adult's ideas about what other humans are like.
Everyone has something to offer a child. Each person has gifts, skills, a smile, a connection. Each person shapes the client's impression of what sort of place this treatment program is: is it warm, welcoming, flexible, respectful? Or more harsh, judgmental, and patronizing?
We demonstrate that there are many good ways to be a man or a woman, many talents, many places in the world. Therefore it is essential that support staff be trained in trama-informed care, and be clear on exactly how they, within their role, can offer healing to a client.
It is also important that staff understand that before they succumb to the temptation to offer the client anything outside their role that they talk it over with the treatment team. Our good hearts lead us to wish we could spend extra time with the child, take the client out to lunch, give them a present, offer to be their foster parent. Sometimes these impulses may be just what the client needs. Other times they may be actually harmful. That is why discussing the ideas BEFORE mentioning them to the client is so important.
The client has learned that people hurt them. Support staff can help them learn that some people don't hurt them. Some people are kind, trustworthy and like them.
Support staff are vital to our role in offering healing to our clients.
Click here to join our community and receive a guide for support staff in supporting trauma-informed care. This guide will be useful to you in training your support staff.
Click Here to Join our Community
Share this on:


text:
Opponent of democracy
The battle for democracy did not end with the fall of the absolute monarchy and the Constitution passed in 1848. It took more that half a century for freedom of assembly and freedom of speech, the right to join a union and not least the parliamentary ground rules to be…
Images from Esplanaden
Det var her ved dette hus at attentatet mod Estrup skete
År: 2010 PHOTO:Kjeld Borch Vesth
- Recommend Log in or create profile to recommend
- Send
- Share
- Share in facebook
- Upload image
Contribute to Esplanaden
Contribute with a story about this place?
Contribute with one or more pictures
Contribute with videos
Contribute with links
Stories (1)
Political assassination attempt
Estrup was hated by many Liberals and Socialists. A farm worker remembers a song being sung in the …


text:
from the Past
May, 2001
NEWS FLASH !!! Well, nearly . . .
AICF releasing results of 2001 Masters' National Championships
. . . . eventually.
we go again - it's late evening, Monday, May 28th. The Australian
Masters Championships finished Saturday 26th May. . . and
the official results (on the Australian Indoor Cricket Federation's
website) still only show results up until (but not including)
last Thursday !!! The grand finals have been played, the Australian
sides have been chosen and announced . . . and most of the players
have left Townsville and arrived home - but according to the AICF
results page, there are still three days of competition to go.
If we'd known there were no electronic communications on the east
coast, we'd have arranged to publish results as they happened,
like we did for the South African World Cup - but hey, we thought
it a forgone conclusion that the promotional arm of the AICF would
have done the right thing by the rest of Australia and done so
themselves. You'd think we'd have learned by now . . .
Yet again the promotion of the game is treated with alarming indifference,
and the players and supporters around the country are treated
with contempt.
There have been rumours for some time that some in the upper echelons
of the AICF don't whole-heartedly support the continuation of
the Lords Taverners competition - perhaps the AICF no longer
sees the Masters Championships as important either. We know
they say they do . . . .
Or maybe it's the players and supporters around the country who
aren't important to the AICF. We can't really answer these questions
of course - if you'd like them answered, we simply suggest you
ask the AICF itself. You could try emailing them at firstname.lastname@example.com
, but after their efforts in electronic communications this week,
perhap snail-mail may be more appropriate:
PO Box 79
Roma Street
Queensland 4003
Good luck . . . .
marked or clearly identified as otherwise, all images and photographs
are the original work of the author, who retains copyright and
ownership. For enquiries on the use and/or purchase of photographs,
please contact us. Textual content is also the original work of
the author (unless marked or identified as otherwise) and subject
to copyright and the author's ownership. Please Contact Us for
information on use of any content of these pages.
� 2000, 2001, 2002, 2003, 2004 Indoor Cricket World (formerly
the Australian Indoor Cricket Page)
© Indoor Cricket World


text:
THE Shawshank Redemption has been voted the greatest movie of all time.
The 1994 classic, starring Tim Robbins and Morgan Freeman, beat Star Wars film The Empire Strikes Back into second place.
Lord of the Rings favourite The Fellowship Of The Ring came third.
Star Wars came fourth and The Godfather fifth in the poll of 20,000 readers of Empire movie magazine.
Pulp fiction is sixth, followed by Lord of the Rings: The Return of the King, Fight Club, Goodfellas and The Matrix.
The Shawshank Redemption was not a huge box office hit on its release.
But the heart-rending tale of a wrongly imprisoned man notched up seven Oscar nominations and its popularity spread through word of mouth.
De Niro
Harrison Ford and Robert De Niro are the most popular actors in the list of the 201 most greatest films, each appeared five times.
Steven Spielberg maintains his position as the biggest-name director with five mentions for Jaws (11), Raiders Of The Lost Ark (15), Jurassic Park (34), E.T (35) and Schindler's List (46).
Top actress is Cate Blanchett who has three mentions for each part of the Lord Of The Rings trilogy.
Lord of the Rings and Pirates of the Caribbean star Orlando Bloom is the biggest British name with four films in the top 50.
Sir Alec Guinness is the highest ranked British actor for The Empire Strikes Back in second place.
Helena Bonham Carter is the top British actress for Fight Club in eighth place.
Toy Story is the favourite animated film, making the list at number 45.
Shawshank Redemption star Robbins told Empire: "It feels great to be top of the pile.
"The reason why it's had a profound impact on people has a lot to do with its spirit and the hope within it - the idea that over a long period of time someone's ambitions can come true, that resilience and persistence pay off."
Colin Kennedy, Editor of Empire, said: "The triumph of Frank Darabont's prison drama in what we like to think of as the definitive poll of UK film lovers completes the rehabilitation of a film that was ignored upon release in 1994 and seals its reputation as a modern classic.
"In a tightly contested top 20 it certainly helped Shawshank's cause that unlike the Star Wars saga, the Lord Of The Rings trilogy and the Godfather movies there was nothing to split the vote.
"But there is little doubt that 12 years after it was made Darabont's movie has earned a permanent place in the hearts of all discerning film fans."
The full list of the top 201 films is published in Empire's 201st issue.
Top 100:
1. The Shawshank Redemption
2. The Empire Strikes Back
3. The Fellowship of the Ring
4. Star Wars
5. The Godfather
6. Pulp Fiction
7. The Return of the King
8. Fight Club
9. Goodfellas
10. The Matrix
11. Jaws
12. The Usual Suspects
13. The Godfather Part 2
14. Alien
15. Raiders of the Lost Ark
16. Gladiator
17. Aliens
18. The Lord of the Rings: The Two Towers
19. Casablanca
20. Back to the Future
21. Se7en
22. Heat
23. L.A. Confidential
24. Apocalypse Now
25. The Big Lebowski
26. Citizen Kane
27. Reservoir Dogs
28. Die Hard
29. Raging Bull
30. Some Like it Hot
31. Lawrence of Arabia
32. Blade Runner
33. 2001: A Space Odyssey
34. Jurassic Park
35. E.T. The Extra Terrestrial
36. Batman Begins
37. Terminator 2: Judgment Day
38. Lost in Translation
39. The Silence of the Lambs
40. Revenge of the Sith
41. Donnie Darko
42. Amelie
43. Taxi Driver
44. Magnolia
45. Toy Story
46. Schindler's List
47. Pirates of the Caribbean
48. Return of the Jedi
49. Memento
50. Almost Famous
51. American Beauty
52. Chinatown
53. Rear Window
54. True Romance
55. The Shining
56. Ghostbusters
57. The Exorcist
58. Titanic
59. Dr. Strangelove
60. Grosse Pointe Blank
61. Moulin Rouge!
62. City of God
63. Vertigo
64. The Princess Bride
65. Scarface
66. Sin City
67. Once Upon a Time in the West
68. Gone with the Wind
69. Annie Hall
70. Seven Samurai
71. Saving Private Ryan
72. Rocky
73. The Wizard of Oz
74. Withnail & I
75. The Third Man
76. A Clockwork Orange
77. Cool Hand Luke
78. Toy Story 2
79. Kill Bill Vol. 1
80. Braveheart
81. It's a Wonderful Life
82. Stand by Me
83. Eternal Sunshine of the Spotless Mind
84. Evil Dead 2
85. Monty Python's Life of Brian
86. Psycho
87. Garden State
88. Serenity
89. Double Indemnity
90. Clerks
91. Shaun of the Dead
92. This is Spinal Tap
93. The Searchers
94. Jerry Maguire
95. Edward Scissorhands
96. Leon
97. The Lion King
98. Superman
99. The Thing
100.The Terminator.
What do you think? Let us know your thoughts.


text:
Increasing speed in today's Western society has a big influence on our lives, and the way how our surroundings and the landscape look like. Through automation processes, use of robots and the world of multimedia.
What impact has increasing speed on our observation. Can our brains perceive the growing amount of fast pictures. And what are the consequences? Do we make the right decisions in our hurried lives?
As an artist, Pauline wants to investigate 'The price of increasing speed'. She creates images where speed is shown. From a moving car she photographs the highway landscape and city architecture. The result will be different depending on the speed of the car and the specific light on that moment.The faster the car drives, the more abstract the images get. The distortions in the picture give a different, new truth.


text:
RP indicates Responsive Parenting.
aPotential participants may have had multiple exclusions.
Responsive parenting group infants had lower conditional weight gain scores reflecting slower, less rapid weight gain. Conditional weight gain scores from birth to 28 weeks greater than 0 indicates faster weight gain.
Infants in the responsive parenting group have lower weight-for-length percentiles at age 1 year compared with control group infants (ANOVA P = .04). Among responsive parenting group infants, 5.5% were overweight at age 1 year compared with 12.7% of control group infants.
Trial Protocol.
Customize your JAMA Network experience by selecting one or more topics from the list below.
Savage JS, Birch LL, Marini M, Anzman-Frasca S, Paul IM. Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year: A Randomized Clinical Trial. JAMA Pediatr. 2016;170(8):742–749. doi:10.1001/jamapediatrics.2016.0445
© 2020
Can rapid weight gain and overweight status at 1 year be prevented by a responsive parenting intervention that is delivered by nurse home visitors?
In this randomized clinical trial that included 279 mother-infant dyads, the responsive parenting intervention was associated with reduced rapid weight gain, and fewer than 6% of infants in the responsive parenting group were overweight at age 1 year compared with 13% of control group infants, a significant difference.
A multicomponent intervention that promotes responsive parenting behaviors is associated with healthy growth trajectories in infancy.
Rapid infant weight gain is associated with later obesity, but interventions to prevent rapid infant growth and reduce risk for overweight status in infancy are lacking.
To examine the effect of a responsive parenting (RP) intervention on infant weight gain between birth and 28 weeks and overweight status at age 1 year.
Design, Setting, and Participants
The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing randomized clinical trial comparing an RP intervention designed to prevent childhood obesity with a safety control. The study includes primiparous mother-newborn dyads (n = 291) and was conducted at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, in addition to home visits. Enrollment was initiated in January 2012, and evaluable population analyses for this study were conducted between April 2015 and November 2015.
At 2 weeks post partum, initial intervention materials appropriate to the assigned treatment group were mailed to the participant's home. Research nurses conducted home visits at 3 weeks, 16 weeks, 28 weeks, and 40 weeks, and a research center visit occurred at 1 year. The Intervention Nurses Start Infants Growing on Healthy Trajectories curriculum included messages about infant feeding, sleep hygiene, active social play, emotion regulation, and growth record education. The control group received a developmentally appropriate home safety intervention also delivered by nurse home visitors.
Main Outcomes and Measures
Conditional weight gain from birth to 28 weeks was calculated. General linear models examined intervention effect on conditional weight gain. The intervention's effect on infant weight-for-length percentiles was tested using analysis of variance. Logistic regression compared the odds of overweight status (weight for length ≥95th percentile) at 1 year as a function of conditional weight gain.
Of the mothers included in the study, 246 were white (88%), 260 were non-Hispanic (93%), 210 were married (75%), and 201 were working full time (72%) at time of enrollment. The mean conditional weight gain score was lower among infants in the RP group compared with the control group (−0.18; 95% CI, −0.36 to −0.001), reflecting that the RP infants gained weight more slowly than control group infants (0.18; 95% CI, 0.02-0.34); this effect did not differ by feeding mode (predominantly fed breast milk or not). Infants in the RP group also had lower mean weight-for-length percentiles at 1 year than infants in the control group (57.5%; 95% CI, 52.56%-62.37% vs 64.4%; 95% CI, 59.94%-69.26%; P = .04) and were less likely to be overweight at age 1 year (5.5% vs 12.7%; P = .05).
Conclusions and Relevance
An RP intervention is associated with reduced rapid weight gain during the first 6 months after birth and overweight status at age 1 year.
Trial Registration
clinicaltrials.gov Identifier: NCT01167270.
Overweight status and rapid weight gain during infancy are associated with increased fat mass, later risk of being overweight,1-4 and numerous comorbidities.5-7 Infancy is a critical period of developmental plasticity with long-lasting metabolic and behavioral consequences,8,9 and interventions developed for delivery during this period may alter long-term risk for obesity and associated comorbidities. Although modifiable factors that promote overweight status and rapid growth during infancy have been identified,10-12 few preventive interventions addressing these factors have been tested.13
Based on our previous pilot randomized clinical trial demonstrating that an early responsive parenting (RP) intervention focused on infant soothing, sleeping, and feeding was associated with a significant decrease in infant weight gain and affected weight for length at age 1 year,14 we developed the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT), a randomized clinical trial, to evaluate an RP intervention designed for the primary prevention of obesity.15 Mothers received guidance on RP, which is defined as developmentally appropriate, prompt, and contingent on their infant's needs.16 The curriculum for INSIGHT includes messages about infant feeding, sleep hygiene, active social play, emotion regulation, and growth record education; these areas were selected based on the overarching RP framework, their potential to be modified, and evidence linking them to obesity risk.15 Additionally, RP promotes a range of adaptive outcomes in children including secure attachment, emotion regulation, cognitive and language development, and aspects of self-regulation including inhibitory control and executive function.17-20
The aim of this study was to examine the effect of the RP intervention on infant weight gain and overweight status at 1 year compared with infants in the control condition, who received equal attention in a home safety intervention.15 Based on prior research,21-23 the interval between birth and age 6 months was chosen to evaluate infant weight gain, and we hypothesized that infants in the RP intervention would have slower weight gain than infants randomized to the control group, resulting in reduced overweight at age 1 year. Because formula feeding is a risk factor for excessive weight gain in infancy,24 a second objective was to assess whether the effects of our intervention differed between breastfed and formula-fed infants.25
Primiparous mothers and their newborns were recruited in person by research staff shortly after delivery from 1 maternity ward (Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania) into the INSIGHT study (Figure 1). Participants were told that the purpose of the study was "to see if nurse visits to your home during your baby's infancy can improve your ability to either respond to your child's cues related to feeding and fussiness or improve your ability to provide safe environment for your child and prevent injuries." Enrollment was initiated in January 2012, and analyses for this study were conducted between April 2015 and November 2015. Quiz Ref IDBriefly, major eligibility criteria included full-term (≥37 weeks' gestation), singleton newborns delivered to English-speaking, primiparous mothers at least 20 years of age residing within 80.5 km of the medical center. Infants born at less than 2500 g were excluded. More details have been published elsewhere.15 Randomization was completed by the research nurse(s) during a telephone call 10 to 14 days post partum. The randomization scheme used permuted blocks (block size: 6) and stratified on birth weight for gestational age (<50th percentile or ≥50th percentile) and intended feeding mode (breastfeeding or formula feeding). Of 316 mother-newborn dyads who provided written consent to participate, 291 were randomized 2 weeks after birth, and 279 completed the first home visit at 3 to 4 weeks after birth. This study was approved by the Human Subjects Protection Office of the Penn State College of Medicine and was registered at http://www.clinicaltrials.gov prior to first participants' enrollment. The formal trial protocols can be found in the Supplement.
Quiz Ref IDThe Intervention Nurses Start Infants Growing on Healthy Trajectories RP intervention addressed 4 infant behavioral states: drowsy, sleeping, fussy, and alert (eg, active social play and feeding) as previously described.15 At each visit, intervention components were mapped to the 4 states. For example, age-appropriate sleep hygiene instructions promoted longer sleep duration and avoidance of feeding to sleep. The emotion regulation component encouraged parents to use alternative strategies besides feeding to calm a fussy infant. Parents were provided with a video, The Happiest Baby on the Block,26 and received hands-on demonstrations of these strategies by visiting nurses. The feeding component taught parents to recognize hunger, satiety cues, and age-appropriate portion sizes and to use food for hunger only and not as a reward, punishment, or to soothe a distressed but not hungry child. Guidance included use of repeated exposure to promote acceptance of foods and beverages and the importance of modeling healthy eating behaviors, shared feeding responsibility, and establishing routines and limits. The active social play component focused on developmentally appropriate physical activities to engage infants, ranging from "tummy time" to outdoor play. Limit setting specific to screen time was also discussed. Last, growth chart education included instructing parents on typical patterns of infant growth and weight gain using color-coded growth charts that allowed nurses to provide feedback based on the individual child's anthropometrics. The control group received a developmentally appropriate home safety intervention also delivered by nurse home visitors.15 The safety control intervention was dose-matched to ensure equivalent time and intensity.
Several efforts were made to maintain the integrity of these behavioral interventions including the use of scripted manuals for training and fidelity monitoring. Specifically, INSIGHT RP and the safety control intervention included detailed manuals of intervention content, standardized training procedures, evaluation of the research nurse's delivery of the curriculum materials, and regular monitoring in the field. Random audio recordings of scheduled visits were reviewed, and feedback was provided to minimize drift in the research nurses' skills and ability to implement the curriculum as intended. Last, following each study visit, the nurse home visitors and study participants completed a checklist to monitor cross-contamination of the intervention groups.
Following randomization, a prestudy survey was administered to mothers electronically, and initial intervention materials appropriate to the assigned treatment group were mailed to the participant's home. Study data were collected and managed using Research Electronic Data Capture27 tools hosted at the Penn State College of Medicine. If the mother lacked reliable internet access, the online survey was mailed with the intervention materials (n = 20). Research nurses were trained in both RP and safety interventions, and generally, an individual nurse completed all study visits for each family. Home visits were conducted at infant ages 3 to 4 weeks, 16 weeks, 28 weeks, and 40 weeks, and a research center visit occurred at 1 year.
Family demographic information was collected at enrollment. Data extracted from medical records included maternal age, gestational weight gain, infant gestational age, birth weight, and length.
A modified version of the Infant Feeding Practices Study 2 food frequency questionnaire from the US Centers for Disease Control and Prevention28 was administered at 2 weeks, 16 weeks, and 28 weeks. Following the Infant Feeding Practices Study 2 study definition,28 feeding mode at 16 and 28 weeks was defined as predominantly breastfed if 80% or more of milk feedings were breastmilk, either at the breast or by bottle; otherwise feeding mode was identified as not predominantly breastfed.29
Maternal prepregnancy weight (kilograms) was extracted from medical records. Maternal height was measured in duplicate to the nearest 0.1 cm (n = 256) using a portable stadiometer (Shorr Productions) or obtained from medical records (n = 23). Maternal prepregnancy body mass index (BMI) was calculated as prepregnancy weight in kilograms divided by height in meters squared.
Infant birth weight and length were extracted from medical records. At each study visit, infant weight and recumbent length were measured by trained research nurses. Prior to age 1 year, these assessments were conducted by the research nurse completing the home visits for both groups. At the 1-year visit, anthropometrics were measured by research nurses blinded to study group. Weight was measured in duplicate to the nearest 0.1 kg using an electronic scale (Seca 354). Recumbent length was measured in duplicate to the nearest 1 cm using a portable stadiometer (Shorr Productions). A third measurement was taken when weight and height differed by more than 0.05 kg and 1 cm, respectively. Multiple measures were averaged. Infant weight for age, length for age, and weight for length at birth, 28 weeks, and 1 year were converted to percentiles and z scores using World Health Organization data.30
Following the methods of Griffiths et al,31 conditional weight gain (CWG) scores were calculated as standardized residuals from the linear regression of weight for age at 28 weeks on weight for age at birth, with length for age at birth and 28 weeks and infant age at the 28-week assessment entered as covariates. The CWG score represents the variation in child weight gain not explained by child age, birth length, or birth weight. A CWG score of zero represents the population mean.31 Positive CWG scores (above the estimated regression) indicate more rapid or faster than average weight gain, while negative scores (below the estimated regression) indicate slower weight gain.
The study was powered to detect a 0.67 difference in BMI z score at 3 years at 90% power, 5% type I error rate, with an anticipated attrition rate of 30%. Two hundred seventy-six participants were required for the study cohort a priori, defined as those completing the 3- to 4-week visit. The final cohort size of 279 resulted from additional participants who were in the "run-in" phase of the trial when the sample size goal was met and subsequently completed the 3- to 4-week visit.
Analysis of variance was used to examine the effect of the RP intervention on rapid weight gain. First, we examined the effect of study group on CWG scores from birth to 28 weeks (model 1). Next, feeding mode was included as a moderator to examine whether intervention effects differed for infants who were either predominantly breastfed at 16 weeks or not (model 2). These models were also tested after adjusting for covariates including marital status, maternal age at enrollment, maternal prepregnancy BMI, and estimated annual household income. Last, a Kolmogorov-Smirnov 2-sample test was used to determine whether there was a significant difference in the distribution of the CWG scores by intervention group. Weight for length at or higher than the 95th percentile at 1 year on the WHO growth charts30 was defined as overweight per American Academy of Pediatrics guidelines.32 Means and their 95% CIs were calculated in the general linear models program in SAS (SAS Institute). Logistic regression was used to compare intervention effects on the dichotomous outcome of overweight at age 1 year.
At 28 weeks and 52 weeks, 269 (96.4%) and 253 (90.7%) dyads remained in the study, respectively. Multiple imputation was used to account for the 10% of missing data at the 1-year weight outcome. To generate the multiple imputations, the following variables were included: infant weight at 3 weeks, maternal prepregnancy BMI, infant race/ethnicity (white vs other), gestational age, infant sex, marital status (married or not), mother age at recruitment, intent to breastfeed at 2 weeks, and study group. A Markov chain Monte Carlo imputation was used (Proc MI; SAS Institute). Parameter estimates from imputation were virtually identical to full-data case analysis (Proc MIANALYZE; SAS Institute), and therefore, results are included for the full-data case analysis only. Data were analyzed using the SAS software, version 9.4 (SAS Institute).
There were no differences between RP and control groups on demographic characteristics (Table 1) or attrition. Two hundred forty-six mothers were white (88%), 260 were non-Hispanic (93%), 210 were married (75%), and 201 were working full time (72%) at time of enrollment. Mothers were also predominately well educated and privately insured. Compared with those completing the 1-year visit, mothers of infants who elected to withdraw from the study (n = 26) were significantly younger, more likely to be single, had lower education levels, and reported lower annual household incomes (data not shown).
During the first 6 months after birth, mean CWG score was negative for RP infants (mean, −0.18; 95% CI, −0.36 to 0), reflecting a slower than average pattern of weight gain. In contrast, mean CWG score was positive for control infants (mean, 0.18, 95% CI, 0.02-0.34) , reflecting faster weight gain (model 1) as shown in Table 2 (P = .004). Figure 2 shows that the distribution of CWG scores for the control infants was shifted to the right relative to infants in the RP group, reflecting more rapid weight gain among control infants (Kolmogorov-Smirnov asymptotic test, 1.6; P = .01). Quiz Ref IDThe effect of the RP intervention on CWG from birth to 28 weeks did not vary by feeding mode (predominantly breastfed or not) at 16 weeks (Table 2, model 2). Results were similar when examining feeding mode at 28 weeks and when missing data were imputed (data not shown).
At age 1 year, 7 infants in the RP group (5.5%) were overweight (weight for length ≥95th percentile) compared with 16 infants (12.7%) in the control group (χ2 = 4; P = .05; Figure 3). Children in the control group had greater mean weight-for-length percentile values at 1 year (mean, 64.4%; 95% CI, 59.8%-69.0%) compared with children in the RP group (mean, 57.5%; 95% CI, 52.6-62.4) (F1,251 = 4.13; P = .04). Similar results emerged when missing data were imputed (data not shown).
Quiz Ref IDInfants in the INSIGHT RP intervention grew less rapidly (ie, lower CWG scores) during the first 6 months after birth, had a lower mean weight for length percentile at 1 year, and had lower prevalence of overweight status at 1 year than control infants. The effects of the intervention on growth and weight gain did not differ between breastfed and formula-fed infants. Although long-term data on the effects of the INSIGHT RP intervention are not yet available, results are promising: infants in the RP treatment had lower weight for length at 1 year, with 5.5% of RP group infants being overweight at 1 year compared with 12.7% of control group infants.
In addition to INSIGHT, 3 other trials focused on preventing obesity in infancy have reported beneficial effects on infant growth or weight status: Sleeping and Intake Methods Taught to Infants and Mothers,14 which informed the design of INSIGHT, the Healthy Beginnings Trial,33 and NOURISH-RCT.34 Similarities and differences among these completed trials provide information on common features distinguishing the trials with positive effects on early growth from those multicomponent behavioral interventions reporting null findings for weight status.35 One common feature of these trials is that only primiparous mothers and their full-term newborns were eligible to participate. Second, except for NOURISH, these interventions were delivered by nurses during home visits, allowing for somewhat tailored guidance. Third, the intervention dose was higher in the successful trials than most of those showing null effects.35 Fourth, all provided guidance on aspects of RP, and 3 of the 4 interventions were implemented during early infancy.
Unique to INSIGHT, instead of explicitly focusing on nutrition, feeding, and obesity prevention in discussion with parents, INSIGHT used a "stealth" approach to preventing childhood obesity by promoting RP behaviors across infant behavioral domains (drowsy, sleeping, fussy, and alert). The focus on variables such as these is of more immediate interest to most parents of infants than obesity prevention. We hypothesized that by promoting feeding, sleeping, and soothing within a RP framework, we could affect early growth and obesity risk. Self-regulatory skills begin to develop in late infancy, and infants need responsive caregiving to help them regulate distress. Teaching RP and effective soothing strategies and allowing infants opportunities to learn how to regulate their own distress, for example, by self-soothing during night waking, can scaffold children's developing self-regulation abilities.36 Parenting interventions that increase child self-regulation may also positively affect the development of empathy, cognitive and social competence, ability to delay gratification, compliance, and academic achievement.18,19,37
Given that development in infancy is rapid, the timing of intervention initiation and duration is likely to be critical. In INSIGHT, initial intervention materials were provided at 10 to 14 days post partum, with the first home visit occurring approximately 3 weeks after birth. For SLIMTIME, the first home visit occurred 2 to 3 weeks after birth. Healthy Beginnings started even earlier, beginning at 30 to 36 weeks' gestation. Interventions reporting null results on weight outcomes35 began later, waiting until 2 to 4 months after childbirth to intervene. Although rapid growth in infancy has been measured at different times and defined multiple ways, a meta-analysis across 10 cohort studies38 showed that rapid weight gain during the first year of life is positively associated with subsequent obesity. Further, birth weight and weight during the first weeks after birth explain substantial variance in later growth outcomes, another reason for focusing on early development.38
Quiz Ref IDThere are limitations to this study. First, the INSIGHT sample was fairly homogeneous, with limited minority participation. The study population was recruited from a single hospital with English-speaking mothers who, as a group, were well educated, and findings cannot be generalized to other populations. However, INSIGHT extends our previous work14 by including women intending to formula feed and women intending to breastfeed. Second, because only first-time mothers were recruited, it is unclear how effective the INSIGHT RP intervention would be for multiparous mothers. However, first-born infants are at increased risk of developing obesity39 and symptoms of metabolic syndrome40 compared with their younger siblings.
The results of this study suggest that a multicomponent intervention promoting responsive parenting behaviors can be efficacious, promoting healthy growth trajectories in infancy that can reduce obesity risk. These findings, in combination with those of other trials,14,33,34 reveal that interventions beginning early in infancy can have effects on growth and weight status, preventing rapid infant weight gain by providing RP guidance for first-time mothers. Future analyses will examine whether the INSIGHT RP intervention results in differences in parenting behaviors and in infant sleep, feeding, and emotion regulation, which may mediate effects on weight outcomes. We will continue to follow these infants longitudinally to examine the longer-term effects of the INSIGHT RP intervention on BMI at age 3 years and older.
Corresponding Author: Jennifer Savage, PhD, Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA 16802 (firstname.lastname@example.com).
Accepted for Publication: February 11, 2016.
Correction: There were errors in the Discussion section, the Conclusions section, and in the legend of Figure 3. In the first sentence of the second paragraph of the Discussion section, "Nourishing Our Understanding of Role-modeling to Increase Support and Health" should be replaced with "NOURISH-RCT." In the third sentence of the fourth paragraph of the Discussion section, "with the exception of NOURISH34" should be deleted. In the second sentence of the Conclusions section, reference 34 should be added following references 14 and 33. Finally, the legend of Figure 3 should be replaced with the following: "Infants in the responsive parenting group have lower weight-for-length percentiles at age 1 year compared with control group infants (ANOVA P = .04). Among responsive parenting group infants, 5.5% were overweight at age 1 year compared with 12.7% of control group infants." This article was corrected on October 10, 2016.
Published Online: June 6, 2016. doi:10.1001/jamapediatrics.2016.0445
Author Contributions: Dr Savage had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: Savage, Birch, Marini, Paul.
Drafting of the manuscript: Savage, Marini, Paul.
Critical revision of the manuscript for important intellectual content: Savage, Birch, Anzman-Frasca, Paul.
Statistical analysis: Savage, Marini, Paul.
Obtained funding: Savage, Birch, Paul.
Administrative, technical, or material support: Marini, Anzman-Frasca, Paul.
Study supervision: Birch, Marini, Paul.
Conflict of Interest Disclosures: None reported.
Funding/Support: This research was supported by grant R01DK088244 from the National Institute of Diabetes and Digestive and Kidney Diseases. Additional support was received from the Children's Miracle Network at Penn State Children's Hospital. US Department of Agriculture grant 2011-67001-30117 supported graduate students. Research Electronic Data Capture support was received from The Penn State Clinical and Translational Research Institute, Pennsylvania State University Clinical and Translational Science Award, and National Institutes of Health/National Center for Advancing Translational Sciences grant number UL1 TR000127.
Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We acknowledge Jodi Mindell, PhD, for contributing to the sleep curriculum development (Saint Joseph's University, Philadelphia, Pennsylvania), Jessica Beiler, MPH, Jennifer Stokes, RN, Patricia Carper, RN, Amy Shelly, LPN, Gabrielle Murray, RN, Heather Stokes, and Nicole Verdiglione for their assistance in recruiting and retaining participants, intervention delivery, and data collection (Pennsylvania State College of Health and Human Development), Susan Rzucidlo, MSN, RN, for contributing to the safety control curriculum development (Pennsylvania State College of Health and Human Development), Lindsey Hess, MS, Emily Hohman, PhD, Chelsea Rose, PhD, Katherine Balantekin, PhD, RD, and Julia Bleser, MS, for assisting with data collection and data management (The Center for Childhood Obesity Research, Pennsylvania State University), and Eric Loken, PhD, for statistical advising (Pennsylvania State University). Drs Birch and Paul are principal investigators on the National Institutes of Health grant R01DK088244 that supported the study.
Create a personal account or sign in to:


text:
For as long a I can remember, people warn against having tunnel vision. They tell you to "gain a broader perspective", "open your mind", or "take in your surroundings". In general, yes, those are very good things. I'll always be the first one to take in the scenery and the last one to make a decision if I haven't considered all the options. But I'll tell you one thing I learned last weekend: sometimes tunnel vision isn't such a bad thing. It can save your life when what's going on around you is too much. I'm alive to prove it.
Category: Uncategorized
What is it about water? I was asked recently where my favorite vacation spot would be. The more I thought about it, harder it seemed to provide an answer. I love to travel and can be happy in pretty much any environment. I love mountains, beaches, cities and wilderness. But then it struck me. If I truly want to relax, I need to be near water. Being around water cleanses my spirit. It lets me exhale and release every ounce of anxiety and stress. Jesus talked about sending rain on the just and the unjust in Matthew 5:45. As it did then, water means crops, prosperity, and life.


text:
Checklist787 wrote:Correct me if im wrong
The strategy change is to use smaller aircrafts to operate routes currently operated by 77W (Minimum ~350 seats) and A380. Another words, a reduction of capacity on some routes. It is no longer wise to assume 777X alone will replace 77W and A380. Consequently the requirement for 777X in a future EK fleet is probably less than originally envisioned when the order was first placed. How much less will depend on the world economy and how EK likes 787/A330neo/A350 class aircrafts and the possible -neo version of 787/A350/NMA/Whatever Airbus develops to counter. This also opens the door for A350-1000 (and -ULR/Sunrise Project variant), which is now a substantially different aircraft compared to when EK first rejected it, in competition for 777-8.


text: Moderators hazelnut 3 Posted March 16, 2010 Moderators Share Posted March 16, 2010 Just in case you fancy a play with some of the little demos. I tried out the speed demos... you want to try out the download preview? Let us know how it goes! http://ie.microsoft.com/testdrive/ Link to post Share on other sites


text:
As a young girl, Annette Cameron, MD, would accompany her Spanish-speaking grandmother to medical appointments and serve as translator.
"I wondered why there weren't any doctors who spoke Spanish," says Dr. Cameron, now a pediatrician. "So around 7, I knew I wanted to be a doctor, and my specialty came naturally because I always gravitated to other children."
Now a mother of four herself, Dr. Cameron sees patients at Chapel Street Pediatrics in Hamden and at the Yale New Haven Hospital Primary Care Center in New Haven. "I enjoy the variety of patients I see, as well as the continuity of care I have with many families. I take care of entire families and some kids I once took care of have now had their own children," she says.
No matter the age, Dr. Cameron says her first priority is to make a child comfortable. "Most of the time, for younger kids, I try to approach them in their parents' lap and might even do the entire exam there," she says. "Or if they bring a stuffed animal or doll, I'll do an exam on them first."
She also strives to make connections with her patients. "I see a lot of kids with asthma, which I have myself, so I am familiar with the symptoms and how to manage it," she says. "I also love teenagers. I tend to get a lot of complicated teens, but they trust me and tell me things. It's hard, but rewarding."
Plus, her language skills continue to pay off. "It's always nice when I walk in the room and see the relief on parents' faces when I can speak to them in their own language," she says. "A lot is lost in translation."


text:
We've never been content to stay on land. We wanted to fly, so we built planes. We wanted to walk on water, so boats. And the human and boat have been surpassed in partnership only by the human and horse. Even then, given the dependence of the human on the boat when the boat is in the water, perhaps there really is no relationship quite like it.
Images can be ordered in a variety of sizes from very large to small, matted or framed. Contact me for details.
(Note: Sometimes, on some screens, the previews may appear a little grainy. Click the preview to load a clear and enlarged view of the image.)