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Supporting the CShop Framework
The CShop e-commerce framework is designed, developed and supported by IOCEA. The platform processes over 980,000 transactions a year, worth around £48 million to the businesses delivering their online operations through CShop.
CShop continues to grow rapidly year-on-year and when the team at IOCEA were looking at the renewal of their hosting infrastructure, they searched the market for a secure, scalable and cost-effective solution to support their expansion.
In the video below, CShop technical support expert, Michael Billson, talks about the reasons they selected the Virtual Private Cloud to support CShop, how they found the migration away from their existing provider and why the platform is such a great fit for their application and their business.
Click the header above for the full text transcript of the CShop case study video.
Michael Billson, Technical Support, CShop
CShop has been running now for just over 16 years. It started off by specialising, really, in e-commerce, but since then has grown into other areas such as building applications, digital marketing, SEO, and we're always developing (daily) the CShop framework.
The benefits of using CShop for people who are looking to trade online is really that you can start from anywhere. Bricks and mortar, you've obviously got to pay for that store, you've got to pay for the overheads and you can only open at a certain time. E-commerce is 24/7, 365 days a year. We've taken support calls on Christmas Day before. You've always got to be up, you've always got to be there.
So, we spoke to a load of different hosting providers as you do when you're looking around, but Secura not only gave us a cost-effective platform, they gave us that personal touch of always being in contact – somebody direct to contact that were always pushing us to see what they could do to help us. With the decision to move to Secura, they were by far the best choice.
From start to finish, their support was brilliant. I've emailed people at Secura at 9:00 at night and I've had a response by half past 9:00; they were always there. We were with our previous hosting company for many years but we didn't have as much control over our servers as we do now with Secura. But obviously, we were very concerned because if something did go wrong, it would have taken our servers offline. An hour down for our site could be thousands of pounds for them.
One advantage that Secura gave us was a demo environment which enabled us to set up a server to put a website on it, to load test it, to make sure that it really was going to be as secure, as reliable as they said it was.
One thing that we liked about it was we were in control over every aspect of the resource. We've got customers who are seasonal, so at Christmas with the VPC platform, we can give extra RAM or give extra CPU to the servers to make sure it can handle the load over those times and then take it away again and then we're only paying for what we need when we need it.
Having access to everything means that we can do what we want, we can lockdown who we want, we can block who we want, we can allow who we want. We're as secure as we need to be.
I was very satisfied with the migration. It couldn't have really been handled any better. They would phone us as we were going through the migration to make sure that it was all going as we expected and if there were any questions, they would answer them there and then. Secura were always there, they were always supportive. Whatever questions I had, they answered. There is nothing really that Secura could have done to make it any easier.
In moving to Secura, the key differences really are the cost-effectiveness of the platform, the security of the platform, the control we have of the platform, but most importantly to us, the support of the platform. The whole support team have clearly shown they're knowledgeable in any area and it's been a pleasure working with them.
E-commerce Specialists
The CShop e-commerce framework by IOCEA is designed to make selling online simple and secure.
VPC User
CShop's secure, scalable infrastructure is delivered from the Secura Virtual Private Cloud.
The Secura VPC allowed IOCEA to make significant savings on the infrastructure for the CShop framework and improve platform performance and support.
A smooth migration of revenue generating websites is critical and Secura worked with IOCEA to deliver a well-planned and executed move without disruption to CShop customers.
The team at Secura deliver friendly, helpful and expert support round-the-clock to help IOCEA offer the very best possible service to their customers.


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Boys JV lacrosse's thirst for win against Aragon left unquenched
April 19, 2017
Boys JV lacrosse faced the Aragon Dons in a close match on April 18, resulting in an 8-5 loss for the Scots.
The Scots started the match off strong with a quick offensive upon the Dons' half but resulted in a blocked shot, which was just returned as a goal just as fast, putting Aragon in the lead early on. Following the early score, the Dons were not afraid to get physical, resulting in two of their players being sent off the pitch, and giving the Scots the advantage they needed to maintain possession of the ball. This was not enough, however, as the opposition maintained its defense and managed to score another goal off of a blocked pass.
This surprising turn of events wasn't enough to faze the Scots, as they pushed forward and quickly scored their first goal just minutes later, but this momentum didn't last. Halfway through the second quarter, the game slowed to a halt, with neither team gaining any ground. In spite of this, Carlmont's offense was able to rally together and tie the game at the half with just seconds left on the clock.
At the beginning of the second half, the Dons seemed focused upon beating the Scots' offense, literally, as Parker English, a freshman, was swatted multiple times by the Dons' defense. Shortly after, Brock Lotti, a junior, was also hit in the leg.
As payback, the Scots scored a goal and put themselves in the lead with a score of 3-2. However, revenge went both ways, as the Dons quickly tied the game with a low shot to the home team's goal. With this, the Dons continued to gain ground, pushing the score all the way up to 7-3. Carlmont's goalie, Max Jacobs, a sophomore, seemed to be losing hope on the field as goal after goal slipped by his grasp.
This lack of hope was evident amongst the entire team, as the Scots began to miss consecutive shots and rush their offensive maneuvers.
However, Nathan Durrans, a sophomore, kept his composure and pushed the Scots a little bit closer to a tie with a goal to finish off the third quarter. He was unable to continue to do much on his own, as he lacked the support of a full team behind him.
"A couple of people were absent because they were sick, so that definitely put us a couple of men down. It caused us to be a lot more tired," said sophomore John Griesbach.
At the beginning of the fourth quarter, the Dons seemed committed to maintaining their lead with a goal being scored almost immediately, making the score 8-4. The break in between quarters wasn't one-sided, however, as the Scots found hope in scoring their first goal in nearly ten minutes. The Dons, with their full team advantage over the home team, was able to run down the time of the game, ending in an 8-5 victory for Aragon.
The Dons, with their full team advantage over the home team, was able to run down the time of the game, ending in an 8-5 victory for Aragon.
Spectator Jonathan Deridal, a sophomore, said, "The Scots were able to tie the game, but they lacked endurance, allowing the other team to pull ahead and win."
After this defeat, the Scots will go on to play their rival, Sequoia, on April 20.

subset: commoncrawl


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WHAT: The annual convention is Colorado's premier gathering of school board members, superintendents and other school leaders. The convention provides invaluable opportunity to connect with colleagues and meet new members, share ideas, learn new things and dig into challenges.
WHERE: The Boardmoor Hotel + Resort, Colorado Springs, CO
WHEN: November 30 - December 3, 2017
WHO: Bob Vajgrt, Eric Dufek and Ryan Wallace will be exhibiting at booth 208
WHY: We look forward to learning more about you and your learning environment and community engagement needs. We believe that architecture has the power to unleash true human potential. We understand the impact that can be made by responding to the needs of the teachers, students, administration and community who are touched by the environments we create. Please visit our experts at booth 208 to learn more about EUA and how we can support your district's goals.


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Congratulations! You've decided to get some expert help in your business, either to do something you can't do yourself, or something you don't want to.
Now you just need to decide who to work with. However, if you don't have specialist knowledge in a field yourself, it can be a challenge to know whether someone is really up to the job.
The good news is that you don't need to learn their skills first. Instead, the key is to ask insightful, open, questions that will uncover their ways of working and experience.
Whether you're looking for a web designer, a marketing consultant, a mailing house or someone to edit your podcasts, here are 10 powerful questions to get to the heart of how someone works and whether they're going to be right for you.
1. This is the outcome I want. What problems or challenges might you anticipate in achieving it?
It's important to be very clear about the final result you want from someone. Once you've decided that, asking them about possible challenges will help you see whether they've understood what you want, whether you need to clarify it further, or whether they simply aren't expert enough to understand whether what you want is realistic or not.
2. What are the things most likely to go wrong along the way?
Be wary of anyone who pretends that everything always goes swimmingly. Expect someone to be able to explain the biggest risks, or the best things to do to avoid them. For instance, a mailing company may have experienced that getting a corrupted data file from a client is a common problem, or that a lot of people being involved in making a decision can delay things. You can develop the conversation by asking how to avoid those situations, or what you would both need to do if those things happened. A lack of detail may well indicate a shortage of experience.
3. What would success look like to you?
This is normally a question a good supplier might ask you. But it can be worth turning it round to reveal their motivations and understanding. A web developer saying, 'building you a website that you can update easily, and that doubles your mailing list' would show that they'd listened to you, and be far more convincing than someone answering, 'building you a website that you like'. It also shows what's important to them. If someone highlights quick, effective communication as an element of success, but you're invariably slow at answering messages, you may not be right for each other.
4. What do I need to do to make the process run smoothly?
Any expert needs to have your involvement. A good collaborator will be able to explain how you can help to make things run well. This is invaluable information for you, as the last thing you want is to be responsible for things going wrong because you weren't aware what you needed to do.
5. What time commitment will you need from me to make this work as well as possible?
A mismatch of expectations is a recipe for unhappiness on both sides. A printer might need you to be present (overnight, and at the other end of the country) for the first print run of your new catalogue but just want regular short phone calls after that, while a coach may advise that you need to plan in two hours a week for the next three months for the best results. Getting things clear upfront will help you understand if it's right for you.
6. What should I do if I'm unhappy with the way things are going?
It happens. Things go wrong. You want to work with someone who seems genuinely comfortable with the idea of potentially difficult conversations. If they're comfortable with the question, it's a good sign they'll be comfortable dealing with the situation.
7. What isn't included in your package?
You'll probably ask what is included, but it's always asking what isn't. Will extra phone calls between meetings be charged for? What about travel? Reversing the question can help them remember things they may not have thought to mention.
8. What happens if we need to change my brief?
Projects change and evolve all the time, but if it changes the amount of work, it's likely to change your bill. Agree how many changes, revisions or extras are included in the cost, and what happens if things go beyond the brief. Do they tell you as you go along, or do you only find out when you get the invoice? You'll also get a sense of their approach: will changes be a hassle, or a normal part of the process?
9. How do you think you can make a real difference to my business?
This is a good way of checking whether they understand what your business is, and whether what they want to do is the same as what you want. If they don't get it, it might suggest that you haven't communicated it well enough, or you might have an uphill struggle to work with them. Look for enough specific information in their answer to show that they understand what they need to do, and how they will go about it.
10. What do you look for in a great client?
You'll get the best work from people who really want to work with you. Most people want clients who share their values and approach. See if what they say resonates with you. If their answer sets off alarm bells, it probably means you're not the right fit.
Have some other great questions? Let me know in the comments!


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"With changing demographics and a greater focus on funding later life, it is no surprise that the equity release market is undergoing something of a boom."
The London Institute of Banking & Finance says registrations for its Certificate in Equity Release qualification have increased by more than a quarter over the past year.
The increase mirrors the 26% growth reported in the sector by the Equity Release Council over the past year, which saw total annual lending on course to break the £2bn mark for 2016.
CeRER, launched in 2006 when home reversions became regulated by the FCA, allows mortgage advisers to develop extensive knowledge on this growing market and qualify to provide advice on equity release products.
Michael Nicholls, Relationship Director at The London Institute of Banking & Finance, said: "With changing demographics and a greater focus on funding later life, it is no surprise that the equity release market is undergoing something of a boom. As a leading provider of professional qualifications, we are glad to be supporting this growth by providing advisers with the skills and knowledge needed to raise standards and improve outcomes for consumers. As the industry grows still further, we will be working with our stakeholders to ensure professionalism remains at the very heart of the industry."
Daniel Hobbs, Company Director at IFA network New Leaf Distribution, added: "Equity release is really important for a lot of people looking to meet their retirement aspirations, so it's vital that everyone in the business of providing advice is fully compliant and able to offer the very best professional service.
"The Certificate in Equity Release plays a vital role in improving compliance in the industry and at New Leaf, we encourage all of our advisers to take the qualification, in order to raise standards for our clients."


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Sermon outline: This is an abbreviated outline with an expanded outline downloadable at the bottom of the post.
Text: Ephesians 4:3–6
Title: The Unity of Our Vocation
Introduction: What brings us the unity that Ephesians 4:3 tells us we are to endeavor to keep? Verses 4–6 tell us. Our unity does not come because we are all the same (tastes, preferences, etc.) Our unity comes because of a bond of peace.
I. The Unity of Peace—v. 3
A. Through the Fruit of the Spirit
B. Through a Bond in Christ
II. The Unity of a Relationship—v. 4
A. The Church Family
B. The Holy Spirit
1. We are called.
2. We have one hope.
III. The Unity of Doctrine—vv. 5–6
A. One Lord Jesus Christ!
B. One Faith
C. One Baptism
D. One God and Father
1. Above all
2. Through you all
3. In you all


text: I am relocating from London to NYC for two years. I am pursuing a MFA at the New York Academy of Art. I am looking for an apartment to move into. I would ideally like to move in with people my own age. I do not keep Shabbat or Kosher. I am sociable, clean and respectful.


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Photography of dense leaves screen-printed with pink and aqua color
on navy blue T-shirt.
The contrast of vivid pink and dark blue is stylish.
With shorts, the coordination would look cheerful and airy.
Fine look with white or khaki bottoms.
Coordination with high-quality chino would look just for rather formal occasion.
Your Beautiful Days with Power T-shirts !
Make your work and life creative and pleasant.
For the precious time with your family, partner, and friends.
Please see here to know the features of our products.
Fitted style
Neck is tough, but not too thick and this makes the looking sharp and sophisticated.
Cotton 100% Combed Cotton, Jersey Stitch
Comebed Cotton is high-quality cotton which was combed during spinning into thread.
The shirt keeps the shape as the cloth is finely knitted.
At the same time, it is comfortable stretchy.
Also, it does not fluff easily. Silky and comfortable touch.
Care Instructions
Washable with washing machine.
Do not dry clean. Do not tumble dry.
Do not iron as possible and when necessary , please press with a damp cloth.
◇ Order will be processed in $.
◇ Free Shipping for above $150 purchase. Detail >> International Shipping
◇ Payment Method:Credit Card(VISA/Master/JCB/American Express)/ Paypal)
◇ For detail care instructions, please see here.
◇ For gift wrapping, please see here.
◇ For return and refund policy, please see here.
◇ If you have any questions, please free to ask us – firstname.lastname@example.com.


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Enovations Designs shares your vision and are committed to providing the excellent professional design service you deserve. We also deliver expert marketing services that can expand your reach, drive customer development, and retain new customers for life.
We develop your brand while promoting what you do best. Your new site will have superb functionality with outstanding attention to detail. Now you can appeal to the 94% of visitors who judge your business on the look of your site!
Your Business Needs a Great Site!
We create an effective custom strategy for building your site, maintaining content, and driving traffic to meet your goals.
See our comprehensive list of design products below.
Perfect for the new business that needs an effective, attractive site. We design responsive websites that can be viewed on any device. You also get effective copy-writing and quality images. This is the preferred design service for business owners, entrepreneurs, and service businesses.
Is your site looking old? We can refresh your site with eye-catching modern design. These days customers think your outdated site means you're no longer in business. We can remedy that with a modern look and functionality that excites customers and drives sales.
You've got lots of new things happening and they need to be included on your site. No problem. We provide efficient website maintenance that can keep your site frequently updated. Great for customers and Google!
Tried to design your WordPress website yourself? Sometimes it takes a professional designer to make your site shine. We can turn your no-so-great website into a diamond you're proud to show!
No more struggling with complicated WordPress. We are experts at setting up WordPress themes, hosting, child themes and much more. Now you can easily design your site at your own pace.
Capture leads and clients with customer grabbing, professional landing pages. Why look like everybody else when you can have expert custom design. See our portfolio pages for examples.
This half day consultation is structured to capture ideas and develop a plan geared strictly for you and your business or product. We will shape your message, define your market, create a clear outline of your offer plus create a step by step action plan to initialize one marketing strategy or goal.
A newsletter is valuable tool to connect with your customers on a continual basis. Enovations Designs is a big believer in providing relevant, helpful content to your customers and clients. Like walking into your physical place of business and receiving friendly, helpful advice, services and products, a newsletter campaign delivers the same quality assistance.
We develop your message with effective copy-writing and design your ad for promotion in magazines, newspaper, online or for a website web banner.
These are the helpful instructions you need to effectively and affordably market your business. We create a professional strategy plan to expand your business with greater sales and bigger client base.
Connect with your customers/target market with highly efficient and powerful Social Media advertising. We create and set-up your Facebook Fan/Business Page; Twitter; Pinterest; Google+ accounts that are absolutely necessary in today's business world.
Bring more profits and grow your business with a Facebook business page! We will create everything to start you off right! Get your Business on Facebook today! Contact us to learn more.
Your attractive and compelling business card design will share your contact info and assure credibility while promoting your company and brand.
Rack cards for highly affordable and powerful direct marketing.
Explain your business with a professionally designed brochure.
We perfectly capture the style and spirit of your business so people will easily recognize your business brand.
Event banners, A-frame signs for use outside your business or at your upcoming trade show or event. Pull customer in for the sale with a custom made sign.
Banner image for powerful Social Media advertising.
PDF forms to collect client/patient information to eliminate snail mail, save time, and have a digital record. Insert these on your website for ultimate productivity and convenience.
Attractive printed or e-book cover impresses readers and builds sales.
Eye-catching flyers spread the word about your business effectively and at very low cost.
Interest and excite a big audience for your next event!
Promote your business on the fridge or in the car. Now be where customers can see you every day for frequent return purchases.
Install a plugin to your website that provides a sign up form and grabs subscribers for your contact list. We can place a sign up form on your page, use a widget, or create a pop-up. Perfectly integrates with major email service providers like Mailchimp and Constant Contact.
Gives customers access to your own EventBrite page. There you get all the tools you need to make any event a big success. EvenBrite lets customers post, promote, and track any event. Integrates well with your email service provider such as Mailchimp.
These sliders use powerful images for effective visual impact. They are mobile responsive, grab attention, and deliver your most important messages. Build your brand, customer understanding, and sales.
insert your promotional video / video blog or vlog. Videos are one of the most effective sales tools in the online arsenal. We can place videos on your web pages to help you improve sales and educate your visitors.
Set up a professional, fully functional calendar so visitors can see your activities.
No need to struggle with web design. If you've been trying to build your site yourself, we can complete it for you. We provide the professional design you need.
We have had lots of praise for the website that Donna designed for our not-for-profit organization. Through her consultative and collaborative approach she captured the essence of our field and our stakeholders. The website is highly accessible and easy to navigate. All our ideas were incorporated and changes made in a speedy and responsive manner. We love it!
I am absolutely thrilled with my website. The end product perfectly suits my needs as a musician, artist and educator. Equally as important, the process of building the website was invaluable in actually helping me clarify my personal and professional goals and aspirations. I am confident that the beautiful user-friendly appearance of my website is matched by the underlying organizational structure and design that will enable me to make important connections and grow my artistry and my business. If you are considering hiring a website designer, I recommend Enovations Designs without reservation.
We are very happy with the website that Donna had created for our business. It was exactly what we were looking for and something that are business was missing. Donna did an amazing job and I would definitely recommend Donna's services to anyone. Thank you so much
Thanks again Donna. The website turned out great! Nice work.
I had several ideas in my head of how I wanted my business to be marketed but struggled with how to articulate and bring them to life. After completing a workshop with Donna I was able to streamline my ideas to create a more focused message and website. Thank you Donna for your patience and guidance, not only did it help me build a website I love but it helped me find the focus I needed for my business. Katherine Marten, RDH LifeSmiles Dental Hygiene Orono & Whitby Ontario
Enovations Designs created my website for me just over 2 years ago. I loved it then and I love it now. At that time, I found the design work and the planning to be a very satisfying collaborative and creative process. And today, I continue to be very involved with Enovations Designs in the process of growing and building my website to fit my changing needs as an artist and as an educator. In respect to Enovations Designs Marketing Plan and as my business evolves and changes I have received top-notch consultation in the process of helping me to clarify my personal and professional goals and then implement them in effective ways. If you are considering hiring a website designer that offers valuable services after the website is in place, I recommend Enovations Designs without reservation.
Enovations Designs works hard to give you the best possible website and marketing design. We offer real world solutions to build your business and sales quickly and efficiently.
Do you have questions? We have answers. Please complete the short form for a quick reply. We look forward to hearing from you!


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Epikko's E-Commerce Platforms
We have concentrated on developing great and unique e-commerce platforms for marketplaces, consumer stores, and B2B stores.
Our first commercially available platform is our Epikko Marketplace platform.
Radically changing the E-Commerce landscape allowing visionaries to start their own Marketplaces
Bring your stores online and in weeks start developing a thriving business ecosystem
With our Epikko Marketplace platform you can easily and quickly setup your marketplace, add new stores and products to sell. Create a great experiences for your shoppers and buyers, in a secure and user friendly environment. Create your marketplace as big, as small, as targetted and as wide as you want it to be ... a place where all your stores can enjoy the benefits of E-Commerce within a few weeks!
The marketplace provides a simple online application process for storeowners interested in having a store in your marketplace. A set of great tools allows new stores start setting up shop easily and independently and existing stores to easily add more products to their catalogs. Our Cloud-based architecture lets, the growth in visitors, customers, and sales to be seamless.
Your marketplace administration team can review both the important business metrics and statistics of the overall marketplace, as well as performance information about each individual store in real-time. Each store's team can see their own performance and manage their online sales, orders, and shipments independently.
The initial setup of your marketplace has the proper language, local currency, and date formats required for your marketplace. Modifying product descriptions, images, prices, inventory, discounts, and more in real-time are just a few of the benefits of working on a platform that provides the flexibility needed in a fast-moving online world!
We will gladly setup an online demonstration of the capabilities of our Epikko Marketplace framework.


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About AWF
We work with some of New Zealand's leading companies and have a huge range of job opportunities daily. Everyday across New Zealand, thousands of people work through AWF.
We are looking for enthusiastic, mature, career minded people to be part of a busy, energetic and fun team. You will be working in a fast paced environment packing and boxing the product to get it ready to go out the door.
There are 3 different shifts and we are looking for people that can work any of the below hours:
- 6:00am - 2:30pm
- 2:30pm - 10:00pm
- 10:00pm - 6:00am
Here is what we are looking for:
- A current CV with 2 work related references that can be contacted - details need to be given on your CV
- Have reliable transport
- Complete a security check confirming you have no past or pending criminal convictions
- Be able to pass a pre-employment drug test
- Be physically fit and able to lift 15 - 25kg
- Be able to follow instructions and work as part of a team
- Reliability to turn up to work on time for each shift
So what's in it for you?
- You have the opportunity to learn new skills
- Keep out of the cold this winter and come and work with us inside
- Our commitment to Health and Safety
Experience is not necessary as all training will be provided.
Please note: This role will start out on a casual basis to cover any shift as required and can lead to an on-going assignment with the potential of getting 40 hours of work per week.
If this sounds like you, apply now


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The Equal Employment Opportunity Commission (EEOC) has released an informal discussion letter suggesting that employers may be obligated to do more than just maintain a separate file for employee medical records, especially when those records are in an electronic format. Both the Americans with Disabilities Act of 1990 (ADA), as amended, and the Genetic Information Non-Discrimination Act of 2008 (GINA) require employers to maintain a confidential medical record, which is separate from the employee's other personnel file(s), for information about the employee's medical conditions, medical history or "genetic information." The statutes do not, however, specify how such records are to be maintained or what level of security must be in place to protect the confidentiality of medical or genetic information.
In its letter, the EEOC makes a distinction between "personal" and "occupational" health information. According to the EEOC, personal health information is "information obtained in the course of diagnosis or treatment," while occupational health information "concern[s] an employee's ability to work."
The EEOC's letter raises two issues for employers in possession of both occupational and personal health information. First, the EEOC's letter suggests that employers need to distinguish between occupational or personal health information. Second, once the employer determines what information is occupational and what information is personal, the employer has to determine whether it has appropriate safeguards in place to prevent unauthorized access to or disclosure of either category of information. For paper files, this might mean maintaining separate folders in separate locations. For electronic medical records, an employer may need to erect an electronic "wall" so that the users of the system only have access to the relevant and appropriate information.
For a copy of the EEOC letter, click here.


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For many people, the narrative of teenage pregnancy seems fairly set: A young girl has sex, misses her period, takes a surreptitious pregnancy test and receives the shocking news.
She then must decide whether to terminate the pregnancy or carry the child to term, both options often devastating to deal with. But there is another scenario that is alive and well, despite decades of access to sex education and contraception: Some teenage girls welcome the news.
"I think one thing that people don't realize is that there's definitely some girls [who]intend to get pregnant," said Sharon Lorber, a social worker who runs the Young Families Program at Toronto's Hospital for Sick Children. Over the past 25 years, the percentage of planned teen pregnancies has stayed steady. Last week, Time magazine reported that 17 girls, none older than 16, are expecting babies at Gloucester High School in a small fishing town outside Boston.
While news of the group focused on contested reports of a "pregnancy pact," in which the girls allegedly planned to get pregnant together, the story offers insight into a group of young women who see pregnancy as a calling, not a mistake.
"They're so excited to finally have someone to love them unconditionally," Amanda Ireland, an 18-year-old who had a baby while attending Gloucester, told the magazine.
In Canada, where the birth rate among teens is 13.6 per 1,000, experts estimate about 20 per cent of teen pregnancies are wanted. In the United States, where teen pregnancies are three times higher and a lack of sex education leads to more unwanted pregnancies, about 12 per cent are planned.
So why do some young people see parenthood as an appealing option, and how can adults dissuade them of the notion?
This week, NBC debuted a reality show called The Baby Borrowers, in partnership with The National Campaign to Prevent Teen and Unplanned Pregnancy.
The show, whose tag line is "It's not TV, it's Birth Control," entrusts five teenaged couples with the care of an infant, a toddler, a teen and, later, a senior citizen.
Modelled after a British show, The Baby Borrowers aims to show teens the reality of being moms and dads, from diaper changes and crying jags to separation anxiety and sullen moods.
Ms. Lorber said counsellors at SickKids try a similar approach with the one in five girls who attend their clinic due to a planned pregnancy.
This group does not respond to counselling that implies they've made a mistake, Ms. Lorber said. Instead, they are presented with the pros and cons of having a baby, the financial implications of parenthood, and the impact it has on housing, school, their family and friends.
But sometimes, teens cannot absorb such abstract adult issues, even when preparing to bring a new life into the world.
"Adolescence, developmentally, is such an egocentric time and it's difficult for them to think about the other," Ms. Lorber said.
But the girls who want to get pregnant share characteristics beyond teenage delusion.
They tend to have a lower socioeconomic status, she said, and have a history of teenage pregnancy in their families.
Many of them yearn for unconditional love absent in their own lives, are dating a boy more than five years older, are doing badly in school and believe that being a mother will give them status they otherwise lack.
"For some girls, no matter what you say or do, they will get pregnant and have the baby," Ms. Lorber said. "So our job is to support them in that and connect them to the community resources that will help them."
The best opportunity to change this mindset comes years earlier, says Debra Hauser, executive director of U.S.-based Advocates for Youth.
Desired pregnancies are "the no man's land of teenage pregnancy prevention," she said, but are generally regarded as an issue of low self-esteem and a perceived lack of options.
"The best contraception is hope," she said. "You need to believe that there's a reason to delay that pregnancy, even if it's just until you get out of high school."
To do this, there are various programs that encourage young girls to get involved in sports and other activities that teach them about their own abilities.
Ms. Hauser said adult role models also play a big role, and partnering a young girl with an older woman who believes in the girl's potential can have tremendous impact.
While most girls who want to get pregnant tend to come from low-income areas, Ms. Hauser said, there are exceptions to the rule.
"There are people who come from upper middle-class communities who have all the opportunities in the world but still feel that hole inside them that says they want a baby, something to love them," she said. "This sense of wanting to reorganize their lives and have something of their own is a very strong desire."
And for some teens, having a baby does truly turn them around, giving them the motivation to continue their education and try to improve their lives, she said.
In one episode of The Baby Borrowers, 18-year-old Sean hopes that his girlfriend, Kelsey, also 18, will change her mind about wanting to get pregnant.
"Doesn't this suck?" he asks her, smiling, as the infant in their care bawls.
"I just needed 24 hours with her," Kelsey says later. "I just know that definitely I'm not ready. I want to wait a little more. A lot more."


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Ensure barcode and printed text quality with machine vision
Sponsored by: Microscan
Focused on:
- Quality
- Legibility
- Reliability
Date: 15 October
Time: 3PM London/10AM New York
Appearances can be deceiving
The barcode on your packaging may look fine, but is it readable? Barcodes, expiration dates and other marked or printed information on packaging should always be legible. Unreadable barcodes, poorly printed date and lot codes, or otherwise faulty packaging, can all result in returned shipments, fines, or even a product recall. Achieving consistent print quality can be a challenge, especially on packaging lines due to substrate quality, motion, and low mark contrast. Also, a wrong lid can be placed, or a wrong film entered, into the packaging machine due to human error.
In this webinar, we'll discuss how machine vision can help you prevent errors, monitor barcode quality, verify codes, and detect printer issues before problems arise with inline barcode verification and inspection solutions using Microscan's AutoVISIONâ"¢ product suite.
Human errors can be avoided by matching a barcode or OCR text to a barcode with barcode readers or smart cameras. An inline machine vision inspection solution is a cost effective and reliable way to ensure consistent print quality and legibility with greater reliability than random sampling. Even if you catch just one error before the product is shipped, the investment will pay for itself.
Join our webinar and learn how you can address print quality issues before they become serious problems.
Presented by
Jonathan Ludlow,
Machine Vision Promoter
Jonathan Ludlow is Machine Vision Promoter at Microscan's Technology Center in Nashua, NH. He has been active in machine vision product development for many years, has authored papers on the application of machine vision in semiconductor packaging and electronic assembly, holds several patents relating to inspection systems and is a regular speaker at machine vision symposia.
Sadie Zeller,
Product Manager
Sadie Zeller is a Product Manager at Microscan's headquarters in Seattle, WA. She is responsible for a range of products including barcode verification solutions, as well as all laser barcode scanners, Nerlites®, and I-PAK®, Microscan's Package Inspection System. Her main goal is to make sure Microscan is providing products that solve the process and traceability issues our customers are facing.
Key Learning Objectives
- Understand how barcode quality and legibility affect product traceability
- Learn how OCR can be used to avoid human errors, and to ensure packaging quality and product safety
- See how you can implement inline machine vision verification and inspection on your packaging line
- Hear how food companies use machine vision to improve quality and traceability
- Quality Engineer
- Quality Manager
- Production Engineer
- Plant Manager
- Packaging Engineer
- Project Manager
- Traceability Specialist
- Regulatory Compliance Officer
- VP/Director of Manufacturing
- VP/Director/Manager of Supply Chain
- VP/Director of Procurement


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What is a Napoleon?
A Napoleon is a pastry which is made with puff pastry dough and layers of pastry cream. Other fillings including jam, custard, and almond paste can be used, and there are also savory versions of the Napoleon; the defining feature of this food is the puff pastry. Napoleons are also known as custard slices, mille-feuilles, and mille foglie. This food is widely made through Europe, and it also appears in North America and other former British colonies.
Puff pastry is a special type of pastry which has been repeatedly folded and rolled out, creating a multitude of very thin layers of pastry. When the pastry is baked, these layers puff up, creating flaky layers of delicate pastry which are made rich and buttery by the high amount of butter in the puff pastry dough. One of the most well known uses of puff pastry is in the croissant, a classic French pastry, and numerous other sweet and savory pastries call for puff pastry.
It is believed that puff pastry may be Hungarian in origin, although the French have also laid claim to the credit for this unique pastry dough. It is certainly heavily used in French and Italian cuisine, with a myriad of fillings and toppings to create a wide assortment of dishes. The Napoleon is a very popular puff pastry dessert in many regions, thanks to the pairing of sweet, flaky pastry, tender pastry cream, and the flavored icings which are commonly drizzled on top.
Most Napoleons are made in big baking sheets, meaning that they are cut into slices like cakes. They are commonly decoratively iced, with many bakers creating icing patterns to make their Napoleons more decorative. Flavors can include vanilla, orange, almond, strawberry, or chocolate, among others. It is also possible to find versions with cheese, spinach, mushrooms, and other savory ingredients.
If you want to make a Napoleon at home, you can try your hand at making your own puff pastry, or you can cheat and get some at the store. In either case, roll out the puff pastry dough, cut it into equal segments, and toast it in the oven until it is golden brown. You should end up with three to four sections, ideally. Use one segment as the base for the Napoleon, spreading custard cream or jam onto it before applying another layer and repeating the process. When you reach the top layer, add icing, decorating if you like, and then chill the Napoleon before serving.
Readers Also Love
Discussion Comments
The possibilities for the filling in a Napoleon recipe are endless. One of my favorites is a Lemon Cream Napoleon. The cream filling is made one day and then stored in the fridge overnight.
Lemon zest and lemon juice in the cream filling are the low calorie ingredients. But listen to this - you need to add 8 whole eggs, two egg yolks, three cups of sugar and three sticks of butter!
Most people buy the fillo pastry. Prepare according to package directions. It's much easier than preparing your own.
When preparing the layers - use four layers of pastry and three of the filling. Prepare some blackberries and crush them - add berries and sprinkle some powdered sugar on top. This makes about eight servings. That amounts to quite a bit of sugar and butter per person - oh well!
It takes some time and patience to make this delicate dessert, but well worth it!


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Realtime Access Map
Applications of graph coloring
MetadataShow full item record
A graph G is a mathematical structure consisting of two sets V(G) (vertices of G) and E(G) (edges of G). Proper coloring of a graph is an assignment of colors either to the vertices of the graphs, or to the edges, in such a way that adjacent vertices / edges are colored differently. This paper discusses coloring and operations on graphs with Mathematica and webMathematica. We consider many classes of graphs to color with applications. We draw any graph and also try to show whether it has an Eulerian and Hamiltonian cycles by using our package ColorG


text: Clinical ScienceHighly Sensitive C-Reactive Protein, Body Mass Index, and Serum Lipids in HIV-Infected Persons Receiving Antiretroviral Therapy: A Longitudinal StudyBoger, Michael S MD, PharmD*; Shintani, Ayumi PhD, MPH†; Redhage, Leigh Anne MD*; Mitchell, Valerie*; Haas, David W MD*; Morrow, Jason D MD‡; Hulgan, Todd MD, MPH*Author Information From the *Department of Medicine, Division of Infectious Diseases; †Department of Biostatistics; and ‡Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN. Received for publication January 13, 2009; accepted June 17, 2009. Supported by funding from National Institutes of Health/NCCAM Career Development Award K23 AT002508 (T.H.) and Vanderbilt CTSA grant 1 UL 1 RR024975 from NCRR/National Institutes of Health. This work was facilitated by the infrastructure and resources provided by the Vanderbilt-Meharry Center for AIDS Research, a National Institutes of Health-funded program (P30 AI 54999); the Vanderbilt University School of Medicine Emphasis Program; and National Institutes of Health Molecular Basis of Infectious Diseases Training Program T32 AI07474-13. A portion of these data were presented at the XVII International AIDS Conference, August 7, 2008, Mexico City, Mexico. All authors have no conflict of interest disclosure. J.D.M., MD, deceased July 8, 2008. Correspondence to: Michael S. Boger, MD, PharmD, A-2200 Medical Center North, 1161 21st Avenue South, Nashville, TN 37235. (e-mail: firstname.lastname@example.com). JAIDS Journal of Acquired Immune Deficiency Syndromes: December 2009 - Volume 52 - Issue 4 - p 480-487 doi: 10.1097/QAI.0b013e3181b939e5 Free Metrics Abstract Background: Antiretroviral therapy (ART) affects cardiovascular disease (CVD) risk. In the general population, highly sensitive c-reactive protein (hsCRP) is an established predictor of future coronary events. Little is known about its utility in chronic inflammatory conditions such as HIV infection. We assessed relationships between hsCRP and metabolic parameters over time in HIV-infected patients on ART. Methods: Data are from a prospective cohort of HIV-infected adults enrolled June 2005 to July 2007. Participants were receiving ART, had HIV-1 RNA <10,000 copies per milliliter, and no diabetes or CVD. Nonlinear mixed-effect regression models assessed relationships between body mass index (BMI), lipids, and hsCRP over time adjusting for covariates. Results: Ninety-four individuals had data from ≥1 study visit. Median age was 44 years, 27% were female, 57% white, and 54% were on protease inhibitors. Median CD4+ T cells, HIV-1 RNA, and hsCRP were 502 cells per cubic millimeter, 50 copies per milliliter, and 2.94 mg/dL, respectively. Median Framingham score was 3. Multivariate analysis identified associations between increased hsCRP and greater BMI (P = 0.001), higher non-high-density lipoprotein cholesterol (P = 0.013) and triglycerides (P = 0.017), and lower high-density lipoprotein cholesterol (P = 0.015). Conclusions: Among HIV-infected adults with low estimated CVD risk and virologic suppression on ART, hsCRP was elevated and independently associated with BMI and lipid changes. Future studies should assess associations between hsCRP and clinical outcomes. INTRODUCTION Antiretroviral therapy (ART) for HIV infection has resulted in dramatic improvements in morbidity and mortality.1 However, metabolic complications due to ART may increase cardiovascular disease (CVD) risk. Metabolic complications of ART resemble many features of the metabolic syndrome, including abdominal obesity in the setting of lipodystrophy, insulin resistance, and dyslipidemia. Thus, it is not surprising that ART may contribute, at least indirectly, to increased long-term CVD risk.2 The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study demonstrated an increased risk of myocardial infarction with each year of combination ART exposure. A follow-up analysis showed that this risk was associated with protease inhibitor (PI) therapy, which has long been known to cause metabolic complications, particularly dyslipidemias.3,4 Interestingly, the association between PI exposure and myocardial infarction in the DAD study persisted after adjusting for serum lipid profiles, suggesting that any increased CVD risk associated with PIs may, at least in part, be independent of effects on lipids.4 The critical role of inflammation in CVD among the general population is well recognized5-7 and is also evidenced by the increased risk of CVD in chronic inflammatory diseases.8-10 Chronic infection with HIV induces inflammation,11,12 and the role of this inflammation in CVD has been highlighted by recent data demonstrating an increased risk of CVD events among individuals who interrupt ART despite previously well-suppressed HIV-1 RNA.13,14 The potential for dual effects of inflammation resulting from both ART toxicity and HIV replication makes this area of research particularly complex and interesting and highlights the need to study both traditional and novel markers of inflammation and CVD risk among HIV-infected individuals. Traditional CVD risk factors, such as those included in the Framingham risk score, may underestimate coronary risk in HIV-infected patients on ART.15 This suggests the potential need for other surrogate markers of coronary risk. Highly sensitive c-reactive protein (hsCRP) correlates with risk of an acute coronary event (rather than taking into account other CVD risk factors such as those included in the Framingham score) and outcome in the general population,16 and evaluation of hsCRP in HIV-infected populations has been limited to cross-sectional studies.17,18 The implications of elevated hsCRP and its clinical utility in this population are not fully elucidated. Our study is the first to assess longitudinal relationships between hsCRP, body mass index (BMI), and serum lipids over time in individuals with HIV infection and virologic suppression on ART. METHODS Study Design Data are from a prospective clinical cohort study of adults from middle Tennessee with chronic HIV infection enrolled and followed between June 2005 and July 2007. The cohort was established to assess the contribution of oxidant stress, which involves the generation of highly reactive free radicals in vivo that cause direct tissue damage,19 to the pathogenesis of ART-related toxicities, including metabolic and neurologic complications. Study Population Participants were eligible if they were at least 18 years of age, diagnosed with HIV infection at least 12 months before enrollment, currently receiving ART including at least 2 nucleoside reverse transcriptase inhibitors (NRTIs) for at least 24 consecutive weeks, and had plasma HIV-1 RNA <10,000 copies per milliliter within 180 days of enrollment. Participants were classified into 2 study groups: (1) persons with clinical evidence of peripheral neuropathy and/or lipoatrophy, and (2) those with neither symptoms nor clinical evidence of peripheral neuropathy or lipoatrophy. Peripheral neuropathy was defined as vibratory sensation (using a 128 Hz tuning fork applied to the distal interphalangeal joint of the great toe) reduced to less than 5 seconds at the first interphalangeal joint of the great toes, diminished ankle reflexes, and subjective symptoms of numbness, tingling, or pain.20 Lipoatrophy was defined as subcutaneous fat loss as perceived by both the study participant and study personnel.21 Lipoatrophy was graded by study personnel using the HIV Outpatient Study Severity Scale: none (score of 0), mild (noticeable on close inspection, score of 1), moderate (readily noticeable by patient or physician, score of 2), and severe (readily noticeable to a casual observer, score of 3).22 Exclusion criteria included active opportunistic infection diagnosed within 30 days of enrollment and/or on current induction phase of opportunistic infection therapy, documented lactic acidosis within 12 months of enrollment, diabetes mellitus that was not diet controlled, documented or reported history of myocardial infarction, active neoplasm, or systemic antineoplastic chemotherapy within 12 months of enrollment. The study protocol was approved by the Institutional Review Board at Vanderbilt University School of Medicine, and all participants provided written informed consent. Data Collection At enrollment and subsequent follow-up study visits, current ART, BMI, smoking status, and use of lipid-lowering and antiinflammatory medications were assessed using standardized questionnaires. Serum was obtained at each visit for assays including serum lipids [total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides], lactic acid, and hsCRP. The most recent HIV-1 RNA and CD4+ T-cell count within 3 months of the corresponding study visit were obtained from the medical record. Fasting state was assessed and defined as at least an 8-hour fast. Heavy smoking was defined as greater than or equal to 20 cigarettes per day. Statistical Analyses Baseline characteristics were presented using median and interquartile range (IQR) for continuous variables and frequency and proportions for categorical variables. Spearman correlation coefficients and Mann-Whitney U tests were used to assess unadjusted effects of demographic and clinical factors on hsCRP at baseline. Adjusted effects of BMI and serum lipids were assessed using data at all 4 time points via multivariable general linear models with bootstrap covariance accounting for correlated measures within a patient, with outcome being natural log-transformed hsCRP to achieve normality in regression residuals. Demographic factors (sex, race, and age) were included as fixed covariates; other covariates were included as time-dependent factors, including BMI, smoking status (current smoker of any amount, current heavy smoker, and current nonsmoker), fasting state, CD4+ T cells, HIV-1 RNA, and the current use of PIs and lipid-lowering medications. For computing the adjusted effects of BMI and other nonlipid-related factors on hsCRP, serum lipid variables (LDL cholesterol, non-HDL cholesterol, HDL cholesterol, total cholesterol, and triglycerides) were combined into 2 lipid components using Factor analysis.23 The 2 lipid components were included in the multivariable regression analysis to prevent multicolinearity. Assessment of serum lipid factors on hsCRP was performed separately in a similar multivariable regression where the 2 lipid components were replaced with each lipid variable. The effect of LDL cholesterol and non-HDL cholesterol were further adjusted for HDL cholesterol as it was of a priori determined clinical relevance. Graphical displays of the relationship of lipid parameters and BMI with reverse log-transformed hsCRP were created based on multivariable regression models using nonlinear cubic spines to allow visualization of nonlinear association. Data analyses were performed using Stata IC version 10.0 (Stata Corporation, College Station, TX) and R version 18.104.22.168,25 RESULTS Clinical characteristics of study subjects at baseline and each follow-up visit are shown in Table 1. Ninety-four subjects had data available from at least 1 (baseline) study visit. The median CD4+ T cells and HIV-1 RNA at baseline were 502 (IQR 334-738) cells per cubic millimeter and 50 (range 50-9285) copies per milliliter, respectively, indicating virologic suppression to below the level of assay quantitation in most subjects. Median nadir CD4+ T cells were 190 (90-254) cells per cubic millimeter. Median duration of ART was 790 (395-1610) days. Median baseline BMI was 25.6 (IQR 23.3-28.2) kg/m2, and median (IQR) lipid values in mg/dL were as follows: total cholesterol 194 (161-222), LDL cholesterol 98 (77-126), non-HDL cholesterol 139 (116-176), HDL cholesterol 48 (41-53), and triglycerides 173 (117-307). This population had a low baseline CVD risk as assessed by traditional risk factors, with a baseline median Framingham risk score of 3 (IQR 1-6) in both males and females, reflecting a 10-year CVD risk of 5% and 3%, respectively.16 Seventy-four percent of individuals had low (<10%) 10-year CVD risk by Framingham score, 23% intermediate (10%-20%), and 3% high (>20%) risk. However, the median (IQR) hsCRP was 2.94 mg/dL (0.83-5.53), corresponding to high CVD risk (10%-20% 10-year risk) by cutoffs based on non-HIV-infected populations.26 Thirty-two persons (34%) had lipoatrophy.TABLE 1: Characteristics of Study Subjects*At baseline, all subjects were receiving at least 2 NRTIs. Thirty-five percent were on tenofovir, 33% on zidovudine, 22% on abacavir, 9% on didanosine, and 7% on stavudine. Fifty-four percent were on a PI, 33% were on a nonnucleoside reverse transcriptase inhibitor (NNRTI), and 2% were on the fusion inhibitor, enfuvirtide. hsCRP did not differ according to the use of individual antiretroviral agents (data not shown). Details of PI use are in the footnote of Table 1. Similar proportions of study subjects were on agents from each ART class at each visit (data not shown). One study subject underwent a class change in ART, from an NNRTI-based to a PI-based regimen between study visits 2 and 3. Two other subjects had within-class (NRTI) changes between study visits 2 and 3. The ART regimen of all other study subjects was unchanged during follow-up. Sixty-five subjects had data from 2 follow-up visits, 41 from 3, and 19 from 4 or more visits. Median overall follow-up was 230 (113-362) days. There were a median (IQR) of 122 (99-197) days between enrollment and follow-up visit 2; 122 (112-172) days between follow-up visits 2 and 3; and 119 (111-159) days between follow-up visits 3 and 4. Because this is a clinical cohort, patients were not followed up at standardized time points. Differences in follow-up time were accounted for by repeated measures analysis. As demonstrated in Table 1, parameters were stable over time. There was not a correlation between changes in Framingham risk score and hsCRP over time. In univariate analyses (Table 2), hsCRP levels correlated with BMI (r = 0.33, P = 0.021) and were weakly correlated with increasing age (r = 0.1, P = 0.054) but not with lipids, CD4+ T cells, or HIV-1 RNA. They also did not differ according to race, smoking status, fasting state, PI use, NNRTI use, use of lipid-lowering therapy, or the presence of lipoatrophy. Women had a higher median hsCRP compared with men (4.32 and 2.35 mg/L, respectively), although this difference was not statistically significant.TABLE 2: Univariate and Multivariate Analysis of Factors Potentially Associated With HsCRPIn multivariate analyses (Table 2), there was a significant association between increased hsCRP and greater BMI (regression coefficient = 1.44, P = 0.001) after adjusting for PI use, CD4+ T cells, HIV-1 RNA, age, race, sex, smoking status, fasting state, use of lipid-lowering therapy, and time. Given the significant association of BMI with hsCRP, multivariate analysis of the association of lipid parameters and hsCRP was performed with adjustment for BMI in addition to the above covariates. There were associations between increased hsCRP and higher non-HDL cholesterol (regression coefficient = 1.47, P = 0.018) and triglycerides (regression coefficient = 1.31, P = 0.019) and lower HDL cholesterol (regression coefficient = 0.81, P = 0.050) in these models, as shown in Table 3. The effect of HDL cholesterol was adjusted for non-HDL cholesterol, and the effect of both LDL and non-HDL cholesterol were adjusted for HDL, respectively.TABLE 3: Multivariate Analysis of the Association of Lipid Parameters and HsCRP, Including BMI in the ModelThere was a trend toward higher median triglyceride levels at nonfasting visits (170 vs. 136 mg/dL, P = 0.31), but there were no statistically significant differences between lipids or hsCRP at nonfasting as compared with fasting visits. We therefore analyzed all lipid data together, adjusting for fasting state in the multivariable model including hsCRP and BMI as covariates. We did not examine the effect of individual lipid-lowering agents or individual PIs due to the small numbers of subjects in each subgroup. Figures 1A-E illustrates the associations of lipid parameters and BMI with hsCRP. These figures are based on data used in the model for Table 3, adjusted for median values of covariates indicated in the footnote of Table 3. We examined whether the effect of BMI or lipids differed according to the presence or absence of ART-related toxicity (either lipoatrophy or neuropathy) by interaction analysis. There was no evidence of effect modification, as all P values for interaction were >0.3. Therefore, pooled data of individuals with and without ART-related toxicity are presented.FIGURE 1: Association of (A) LDL cholesterol, (B) Non-HDL cholesterol, (C) HDL cholesterol, (D) triglycerides, and (E) BMI with hsCRP. Data are reverse log-transformed from multivariable repeated measures analysis adjusting for sex, race, age, smoking status, fasting state, CD4+ T cells, HIV-1 RNA, and use of PIs and lipid-lowering therapy. R, regression coefficient.DISCUSSION The most important finding of our study is that hsCRP was elevated in individuals with low Framingham risk score and correlated with changes in serum lipids and BMI over time. Forty-nine percent of the individuals in our study had an hsCRP >3 mg/dL, consistent with a high risk of future acute coronary events, despite a low overall CVD risk by Framingham risk score. Changes in hsCRP were not associated with changes in Framingham risk score. These data highlight the potential disparity in traditional CVD risk factors and risk of future acute coronary syndrome in HIV-infected patients on ART. To our knowledge, these associations have not been described in a longitudinal cohort of HIV-infected persons. A joint statement from the Centers for Disease Control and American Heart Association26 recommends categorizing patients according to break points for hsCRP <1, 1-3, and >3 mg/dL to define low risk, average risk, and high-risk, respectively, of future acute coronary events. Measuring hsCRP in individuals judged at intermediate risk by global risk assessment for primary prevention of coronary disease was a Class IIa recommendation. hsCRP is a promising marker that may provide prognostic information not possible from serum lipids alone. In patients with acute coronary syndrome, a significant difference in the risk of recurrent myocardial infarction after statin therapy was observed among those with hsCRP less than vs. greater than 2 mg/L. This effect was present at all levels of LDL cholesterol achieved, suggesting that attenuating inflammation in addition to addressing LDL cholesterol27,28 may be important.29 It should be noted that this study involved individuals at high risk of CVD because they already had a prior acute coronary event, unlike our study which involves individuals of overall low CVD risk by traditional risk assessment. In the DAD study, the rate of myocardial infarction increased with duration of combination ART.4 However, the Strategies for Management of Antiretroviral Therapy (SMART) study demonstrated that ART interruption increased CVD risk compared with continuous therapy.14 In addition, recently presented data from a prospective cohort demonstrated a trend toward decreased CVD risk in those remaining on ART more than 95% of the time over an 8-year period and no apparent association between particular ART and CVD risk.30 Such conflicting reports suggest that chronic ART exposure, uncontrolled HIV replication, or both, likely contribute to CVD in HIV-infected patients. hsCRP is a minimally invasive method for assessing risk of future acute coronary events in an HIV-negative population with intermediate risk as determined by traditional risk assessment. Ultimately, its use in HIV may allow practitioners to tailor ART and primary prevention strategies in at-risk individuals. In the SMART study,31 hsCRP was higher in those on abacavir compared with other NRTIs, suggesting that this agent may have proinflammatory properties. This was a pertinent finding after the DAD study found an increased risk of myocardial infarction in those receiving or having recently received abacavir.32 However, the HIV Study with Epzicom and Truvada (HEAT) study found a longitudinal reduction in hsCRP with an abacavir-containing regimen, similar to that with tenofovir.33 There was an increased risk of myocardial infarction with didanosine in the DAD study, although no significant change in hsCRP was seen with its use in the SMART study. Although the number of individuals in our study on abacavir [20 (21%)] and didanosine [9 (9%)] was small, there was no difference in hsCRP according to the use of either agent. A cross-sectional study17 of 245 subjects on and off ART found that hsCRP positively correlated with LDL cholesterol and triglycerides and negatively with HDL cholesterol. No correlation was seen with HIV-1 RNA or CD4+ T cells. When adjusting for smoking, LDL cholesterol, and HDL cholesterol, ART use was associated with higher hsCRP, suggesting an enhanced cardiovascular risk on these medications. Those on PI-based regimens or a concomitant PI and NNRTI had a nonsignificant trend toward a higher hsCRP. However, we did not find a difference in hsCRP in subjects on PI vs. non-PI-based ART. This suggests, at least in our small study population, that this inflammatory marker does not seem to underlie the effect of PIs on cardiovascular risk. A potential limitation of our study is that subjects were recruited based on the presence of other ART-related toxicities that may influence hsCRP-lipoatrophy and peripheral neuropathy. Lipodystrophy is associated with features of metabolic syndrome, and elevated hsCRP has been reported in that setting.34,35 hsCRP was associated with greater visceral and subcutaneous adipose tissue in a cross-sectional study of HIV-positive and HIV-negative individuals.35 There is no evidence that peripheral neuropathy is associated with hsCRP, nor did we find an association; thus, we did not adjust for peripheral neuropathy in multivariable models. We did not have an HIV-negative control population. Because our study was designed to follow individuals with and without ART-associated toxicities, selection bias could affect generalizability of results. Interaction analysis did not reveal evidence of effect modification of ART-related toxicities. However, our study may have limited statistical power to detect an interaction, and further study with a larger sample size may be warranted. Finally, a small proportion of our study population had an intermediate 10-year CVD risk by Framingham score, where hsCRP may be most useful. We did not utilize other indirect measures of CVD risk, such as carotid intima-media thickness or flow-mediated dilation. Previously presented data demonstrated that subjects with HIV infection had higher hsCRP and carotid intima-media thickness than uninfected persons, although these were not correlated.18 We excluded persons receiving therapy for diabetes mellitus but did not assess insulin resistance, a factor that may influence inflammation and CVD risk. Statins may have important antiinflammatory in addition to lipid-lowering effects, reducing hsCRP compared with placebo in HIV-negative individuals.36,37 We did not find a significant effect of lipid-lowering therapy on hsCRP. However, only 16% of subjects in our study were on lipid-lowering therapy, with 11% on a statin. Lipid-lowering therapy was included as a covariate in our multivariate model; it did not affect the independent relationships between hsCRP and BMI or lipids. LDL cholesterol was missing for some of the study subjects. Thus, non-HDL cholesterol was used in the primary analyses. Data suggest that non-HDL cholesterol may be a reasonable measure of CVD risk.38 We found that higher BMI was strongly correlated with elevated hsCRP. Due to changes in body habitus resulting from ART, it would not be surprising if BMI were less predictive of CVD risk in HIV-infected persons. Data regarding the prognostic use of BMI in HIV-infected patients are limited. However, our results suggest that BMI may be quite useful in this population at predicting CVD risk. Visceral fat accumulation in lipodystrophy likely plays a key role, and visceral abdominal fat by computed tomography scan was a significant predictor of elevated hsCRP in HIV-infected women.39 A limitation of our study is that lipoatrophy assessments were subjective. Studies using single-slice computed tomography scan or other objective measures for visceral adiposity are needed to extend our observations. A potential confounding issue regarding the use of hsCRP in persons with HIV infection at assessing risk of an acute coronary event is the effect of chronic infection such as HIV on hsCRP. Individuals with AIDS or nonsuppressed HIV RNA had much higher hsCRP than those with virologic suppression.40 Therefore, uncontrolled viral replication may confound interpretation of hsCRP at assessing coronary risk. High hsCRP in patients with HIV infection predicts HIV-related mortality and disease progression.40,41 Although there was a trend toward higher hsCRP with higher viral load in our well-suppressed population, this association did not reach statistical significance and did not substantially affect the relationship between hsCRP and BMI and serum lipids. In summary, our study is the first to show in HIV-infected subjects with well-suppressed HIV-1 RNA on ART and low CVD risk by Framingham score that hsCRP is longitudinally correlated with BMI and serum lipid changes. These data are important because they suggest that inflammation is relevant to the pathophysiology of metabolic disturbances in chronically HIV-infected persons on treatment with minimal plasma HIV-1 replication, confirm that CVD risk by traditional risk factors and risk of acute coronary syndrome by hsCRP are often discordant in HIV-infected persons, and that noninvasive inflammatory markers may be of utility. hsCRP is a particularly useful marker because it allows risk stratification and provides prognostic information. Larger studies are needed to assess the associations between hsCRP and clinical outcomes in this population. ACKNOWLEDGMENTS The authors wish to thank the many study volunteers, participants, and staff of the Comprehensive Care Center and the Vanderbilt AIDS Clinical Trials Center, who made this study possible. The authors would like to posthumously acknowledge J.D.M., MD, who served as a coauthor and mentor and was a pioneer in oxidant stress pharmacology until his untimely death on July 8, 2008. Dr. J.D.M. was instrumental in the design and development of this study.REFERENCES 1. Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338:853-860. Cited Here 2. Waters L, Nelson M. Long-term complications of antiretroviral therapy: lipoatrophy. Int J Clin Pract. 2007;61:999-1014. Cited Here 3. Friis-Moller N, Sabin CA, Weber R, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349:1993-2003. Cited Here 4. Friis-Moller N, Reiss P, Sabin CA, et al. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356:1723-1735. Cited Here 5. Vaccarino V, Johnson BD, Sheps DS, et al. Depression, inflammation, and incident cardiovascular disease in women with suspected coronary ischemia: the National Heart, Lung, and Blood Institute-sponsored WISE study. J Am Coll Cardiol. 2007;50:2044-2050. Cited Here 6. Kinlay S, Schwartz GG, Olsson AG, et al. Inflammation, statin therapy, and risk of stroke after an acute coronary syndrome in the MIRACL study. Arterioscler Thromb Vasc Biol. 2008;28:142-147. Cited Here 7. Wang TJ, Nam BH, Wilson PW, et al. Association of C-reactive protein with carotid atherosclerosis in men and women: the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2002;22:1662-1667. Cited Here 8. Urowitz MB, Gladman D, Ibanez D, et al. Accumulation of coronary artery disease risk factors over three years: data from an international inception cohort. Arthritis Rheum. 2008;59:176-180. Cited Here 9. Hahn BH, Grossman J, Chen W, et al. The pathogenesis of atherosclerosis in autoimmune rheumatic diseases: roles of inflammation and dyslipidemia. J Autoimmun. 2007;28:69-75. Cited Here 10. Dessein PH, Joffe BI, Veller MG, et al. Traditional and nontraditional cardiovascular risk factors are associated with atherosclerosis in rheumatoid arthritis. J Rheumatol. 2005;32:435-442. Cited Here 11. Appay V, Sauce D. Immune activation and inflammation in HIV-1 infection: causes and consequences. J Pathol. 2008;214:231-241. Cited Here 12. Coll B, Parra S, Alonso-Villaverde C, et al. The role of immunity and inflammation in the progression of atherosclerosis in patients with HIV infection. Stroke. 2007;38:2477-2484. Cited Here | PubMed 13. Tebas P, Henry WK, Matining R, et al. Metabolic and immune activation effects of treatment interruption in chronic HIV-1 infection: implications for cardiovascular risk. PLoS ONE. 2008;3:e2021. Cited Here 14. El-Sadr WM, Lundgren JD, Neaton JD, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355:2283-2296. Cited Here | PubMed 15. Law MG, Friis-Moller N, El-Sadr WM, et al. The use of the Framingham equation to predict myocardial infarctions in HIV-infected patients: comparison with observed events in the D:A:D Study. HIV Med. 2006;7:218-230. Cited Here 16. Sabatine MS, Morrow DA, Jablonski KA, et al. Prognostic significance of the Centers for Disease Control/American Heart Association high-sensitivity C-reactive protein cut points for cardiovascular and other outcomes in patients with stable coronary artery disease. Circulation. 2007;115:1528-1536. Cited Here 17. Masia M, Bernal E, Padilla S, et al. The role of C-reactive protein as a marker for cardiovascular risk associated with antiretroviral therapy in HIV-infected patients. Atherosclerosis. 2007;195:167-171. Cited Here 18. Huse P, Lo J, Franklin A, et al. C-reactive protein levels in patients with HIV: a marker of cardiovascular risk of chronic infection? Abstract 864, Presented at: The Conference on Retroviruses and Opportunistic Infections; February 6, 2008; Boston, MA. Cited Here 19. Yin H, Havrilla CM, Gao L, et al. Mechanisms for the formation of isoprostane endoperoxides from arachidonic acid. "Dioxetane" intermediate versus beta-fragmentation of peroxyl radicals. J Biol Chem. 2003;278:16720-16725. Cited Here 20. McArthur JC, Brew BJ, Nath A. Neurological complications of HIV infection. Lancet Neurol. 2005;4:543-555. Cited Here 21. Nolan D, Mallal S. The role of nucleoside reverse transcriptase inhibitors in the fat redistribution syndrome. J HIV Ther. 2004;9:34-40. Cited Here 22. Carr A, Emery S, Law M, et al. An objective case definition of lipodystrophy in HIV-infected adults: a case-control study. Lancet. 2003;361:726-735. Cited Here 23. Asanuma Y, Chung CP, Oeser A, et al. Serum osteoprotegerin is increased and independently associated with coronary-artery atherosclerosis in patients with rheumatoid arthritis. Atherosclerosis. 2007;195:e135-e141. Cited Here 24. StatCorp. Stata Statistical Software: Release 10. College Station TX: StatCorp; 2007. Cited Here 25. Hornik K. The R Project for Statistical Computing. The R Manuals. Available at: www.r-project.org. Accessed April 1, 2009. Cited Here 26. Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499-511. Cited Here 27. Giraldez RR, Giugliano RP, Mohanavelu S, et al. Baseline low-density lipoprotein cholesterol is an important predictor of the benefit of intensive lipid-lowering therapy: a PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) analysis. J Am Coll Cardiol. 2008;52:914-920. Cited Here 28. Wenger NK, Lewis SJ, Welty FK, et al. Beneficial effects of aggressive low-density lipoprotein cholesterol lowering in women with stable coronary heart disease in the Treating to New Targets (TNT) study. Heart. 2008;94:434-439. Cited Here 29. Ridker PM, Morrow DA, Rose LM, et al. Relative efficacy of atorvastatin 80 mg and pravastatin 40 mg in achieving the dual goals of low-density lipoprotein cholesterol <70 mg/dl and C-reactive protein <2 mg/l: an analysis of the PROVE-IT TIMI-22 trial. J Am Coll Cardiol. 2005;45:1644-1648. Cited Here 30. Lichtenstein KA, Armon C, Buchacz K, et al. Analysis of cardiovascular risk factors in the HIV outpatient study cohort. Abstract 735, Presented at: Conference on Retroviruses and Opportunistic Infections; February 5, 2008; Boston, MA. Cited Here 31. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients. AIDS. 2008;22:F17-F24. Cited Here 32. Sabin CA, Worm SW, Weber R, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet. 2008;371:1417-1426. Cited Here 33. McComsey GA, Smith K, Patel P, et al. Similar reductions in markers of inflammation and endothelial activation after initiation of abacavir/lamivudine (ABC/3TC) or tenofovir/emtricitabine (TDF/FTC) in the HEAT study [Poster 732]. Presented at: 16th Conference on Retroviruses and Opportunistic Infections; February 10, 2009; Montreal, Canada. Cited Here 34. Samaras K, Wand H, Law M, et al. Prevalence of metabolic syndrome in HIV-infected patients receiving highly active antiretroviral therapy using International Diabetes Foundation and Adult Treatment Panel III criteria: associations with insulin resistance, disturbed body fat compartmentalization, elevated C-reactive protein, and [corrected] hypoadiponectinemia. Diabetes Care. 2007;30:113-119. Cited Here 35. Reingold J, Wanke C, Kotler D, et al. Association of HIV infection and HIV/HCV coinfection with C-reactive protein levels: the fat redistribution and metabolic change in HIV infection (FRAM) study. J Acquir Immune Defic Syndr. 2008;48:142-148. Cited Here 36. van der Harst P, Asselbergs FW, Hillege HL, et al. Effect of withdrawal of pravastatin therapy on C-reactive protein and low-density lipoprotein cholesterol. Am J Cardiol. 2007;100:1548-1551. Cited Here 37. Liang YJ, Shyu KG, Wang BW, et al. Simvastatin inhibits C-reactive protein-induced pro-inflammatory changes in endothelial cells by decreasing mevalonate pathway products. Cardiology. 2007;110:182-190. Cited Here 38. Pischon T, Girman CJ, Sacks FM, et al. Non-high-density lipoprotein cholesterol and apolipoprotein B in the prediction of coronary heart disease in men. Circulation. 2005;112:3375-3383. Cited Here 39. Dolan SE, Hadigan C, Killilea KM, et al. Increased cardiovascular disease risk indices in HIV-infected women. J Acquir Immune Defic Syndr. 2005;39:44-54. Cited Here 40. Lau B, Sharrett AR, Kingsley LA, et al. C-reactive protein is a marker for human immunodeficiency virus disease progression. Arch Intern Med. 2006;166:64-70. Cited Here 41. Drain PK, Kupka R, Msamanga GI, et al. C-reactive protein independently predicts HIV-related outcomes among women and children in a resource-poor setting. AIDS. 2007;21:2067-2075. Cited Here Keywords:body mass index; HIV; hsCRP; lipids; metabolic complications © 2009 Lippincott Williams & Wilkins, Inc.View full article text


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Advanced Bat To Exe Converter
Advanced BAT to EXE Converter is a powerful tool that is designed for creating .EXE files from the .BAT format. The application's interface is a standard...
|Brandon Dargo
Windows 2000, Windows 2012, Windows 10, Windows XP, Windows 8, Windows 7, Windows 2003, Windows 2008, Windows Vista, Windows 98
Advanced BAT to EXE Converter is a powerful tool that is designed for creating .EXE files from the .BAT format. The application's interface is a standard window featuring an uncomplicated layout. You can load a Batch file by using either the file browser or 'drag and drop' method.
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As a Jersey girl, I've heard all the obsessive talk comparing our car culture to that of L.A. Our traffic jams are longer! Our vehicles are bigger! You call those potholes?
After seeing five vignettes at Moving Arts' "The Car Plays" at REDCAT, though, it occurred to me that this environmental piece devised by Paul Stein should pack its trunk and motor on over to the Garden State. Jersey's a conducive setting for staging a work where drivers also do some of their best acting, especially gestural.
Hey, I'm talkin' here!
Bring your kick-ass "Car Plays" to New Jersey, Mr. Stein. We've got the parking lots — plenty are abandoned — and you wouldn't even need professional actors; the locals are colorful enough. Isn't The Situation's contract up?
Here are a few tweaks to consider when making your production more palatable for Jersey sensibilities:
— Subpoena the audience.
— Assigning team names like "Route," "Avenue" and "Blvd" to groups of spectators should be revised to "Construction Ahead," "This Lane Closed" and "Whassup."
— Play-goers can jaywalk with abandon on their way to the site.
— One of the playlets, "Shampooed," has a bobblehead Steelers player on the dash. Very wrong. Opt for a CD hanging from the rearview. Mall hair required for the actresses.
— In L.A., a show sponsor, FlowerPower, distributes nifty vehicle vases to participants. Solicit Little Trees fresheners or EZPass for Jersey swag.
— More bumper stickers are needed on vehicles: "Honk for Hoboken," "I Brake for Diners," "What Would Bruce Do?"
— Tolls are collected from show-goers before they enter each car. Deal with it. The "car hops" have to subsidize that rental down the shore.
— Plays in the middle lane will move slower than the others because the car in front is from New York or Pennsylvania. Spectators are also permitted to hassle anyone in that car.
— Blacktop, not red carpet, for opening night.


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CHICAGO—Brek Shea sure knows how to make an entrance.
Just 42 seconds after coming into the game as a substitute Sunday, Shea pounced after Landon Donovan whiffed a shot and poked the ball into the net. His goal in the 69th minute gave the United States a 1-0 victory over Panama and the CONCACAF Gold Cup title. It is the fifth Gold Cup title for the Americans, but their first since 2007.
It also is the first international title as a coach for Jurgen Klinsmann, who won the 1990 World Cup and 1996 European Championship with Germany.
"It doesn't matter who scored," Shea said. "We won."
The U.S. is doing a lot of that lately.
This was the 11th straight victory for the Americans, four more than their previous record, and they likely will leapfrog Mexico as the best team from the North and Central America and Caribbean region when the next FIFA rankings come out Aug. 8.
When the final whistle sounded, the Americans on the field began celebrating while the rest of the team raced off the bench. Several players jumped up and down, and hugs and high-fives were exchanged. Klinsmann, who watched the game from a luxury box after being suspended for his tirade over the officiating in the semifinal, quickly made his way down to the field, pumping his fists in the air.
"They wanted to send out a signal that they are the best group in CONCACAF, and they are," Klinsmann said. "For today."
But their performance in this tournament is likely to stay with the Americans for a while. At least until the next round of World Cup qualifying in September. Not only did they outscore opponents 20-4 in the tournament — no other team had more than 11 goals — but they showed they are deeper than they've ever been, with one young player after another stepping up.
And one veteran, too.
Despite his big whiff, Donovan was selected the tournament MVP. He finished with five goals and seven assists, a particularly impressive performance considering it followed a four-month sabbatical over the winter that cost him his place on the national team.
"In terms of just having fun, it's up there," Donovan said. "I'm just enjoying being part of it, I really am."
Though Klinsmann picks his roster based on form, not reputation, he acknowledged it would be almost impossible to leave Donovan off the roster for the next round of qualifying.
"He deserves every compliment for this tournament," Klinsmann said.
The only disappointment for the Americans was the loss of Stuart Holden with another right knee injury. Holden sprained his knee early in the first half, and while he will have further tests, Klinsmann said after the game that "it's not looking good."
"We are very, very sad for him," Klinsmann said. "We are very concerned about Stuey's situation. It looks like a very serious knee injury."
While most expected a Mexico-US final, Panama had other ideas, upsetting El Tri twice on the strength of its stingy defence. Panama was just as dogged against the Americans early, crowding Donovan and Eddie Johnson and not giving the U.S. any space.
But rather than taking wild shots or trying to force things, the Americans stayed patient.
"At times it may have been a little slow or been going back and forth, but we stuck to the game plan," Besler said.
And as the game went on, the Americans began to break Panama down. They finished with three shots on goal and another eight that were off target — six in the second half alone.


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ATTEMPTS by the SDLP to reach out to Crumlin Star in the wake of a row over a pitch in South Belfast have failed with the club chairman telling the North Belfast News nothing has been resolved.
Eamonn Hawkins confirmed that Balmoral Councillor Donal Lyons had been in contact with him but added that he is "still disgusted by his attitude" after talks.
The row broke out after Councillor Lyons sent a letter to residents living close to Strangford Avenue playing fields saying he would oppose Crumlin Star's bid to use the facility close to the King's Hall for home games. The team currently have to travel to Larne for 'home' fixtures because of a lack of pitch provision in Belfast.
Among the claims made in the letter were that upwards of £50k would need to be spent by the Council installing turnstiles and making upgrades to facilitate Star's move – something Eamonn says is simply untrue.
But it was Cllr Lyons' description of the club in the letter as being situated "at the Ardoyne Roundabout" that most angered the club – Eamonn said he believed the reference would link the club to the Camp Twaddell saga in the minds of residents of the leafy suburb. In fact, the Crumlin Star premises are in Balholm Drive.
The row has proved awkward for the SDLP in Belfast as North Belfast reps Nichola Mallon MLA and Councillor Paul McCusker have built up warm and friendly relations with the club down through the years.
The North Belfast news met Cllr Lyons and asked if he regretted the Ardoyne Roundabout reference. He said it was "never my intention" to make the link and confirmed he had been talking to the club to get the matter resolved.
Cllr Lyons' wife, South Belfast SDLP MLA Claire Hanna, became embroiled in the spat when she rejected claims on social media that opposition to the Crumlin Star move was down to snobbery or sectarianism. She said it was a lack of consultation that had caused difficulties. However, Eamonn Hawkins says nothing has been resolved and he blames Cllr Lyons for ending the club's dream of a home pitch in Belfast.
"I'm still disgusted by his attitude," he said. "His letter has scuppered the whole deal. He responded to my email but I think the fact is he just doesn't want us there. I asked him how many letters he put out and he said over 100. He told me he had around 20 responses but now there's not chance of getting a deal done and it looks like we'll have to travel to Larne again next season."
The matter was raised at last month's Belfast City Council meeting where UUP Councillor Jeff Dudgeon threw his weight behind opposition to the Crumlin Star move and said he hoped the SDLP would continue their opposition to the plan. Councillor McCusker called for a report to be compiled and told the chamber he wanted the Council to "treat Crumlin Star fairly".