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Journal of Obesity
Volume 2014, Article ID 271532, 7 pages
Joint Effects of Physical Activity and BMI on Risk of Hypertension in Women: A Longitudinal Study
1Centre for Longitudinal and Life Course Research, School of Population Health, University of Queensland, Herston Road, Brisbane, QLD 4006, Australia
2School of Human Movement Studies, University of Queensland, Blair Drive, St. Lucia, Brisbane, QLD 4072, Australia
Received 8 October 2013; Revised 19 November 2013; Accepted 28 November 2013; Published 23 January 2014
Academic Editor: Yuichiro Yano
Copyright © 2014 Caroline Jackson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction. There is debate as to whether physical activity counteracts the adverse effect of weight on health outcomes. We investigated how physical activity modifies the effect of body mass index (BMI) on hypertension risk. Methods. BMI, physical activity, and hypertension were measured at baseline and at three-year interval for 14 years (from 1996 to 2010), in 10,339 participants in the Australian Longitudinal Study on Women's Health. Generalised estimating equation models for binary repeated measures were performed to determine the individual and joint effects of BMI and physical activity on incident hypertension. Results. At baseline (mean age SD), 57% were healthy weight, 28% overweight, and 14% obese. Increasing BMI and decreasing physical activity were associated with increased risk of hypertension. Physical activity attenuated the positive association between weight and risk of hypertension, especially for obese women. Compared to healthy weight high active women, risk of hypertension in obese high active women was 3.4 times greater (OR 3.43, 95% CI 2.68, 4.39) and in obese inactive women 4.9 times greater (OR 4.91, 95% CI 3.92, 6.13). Conclusions. Both physical activity and maintenance of a healthy body weight are associated with lower risk of hypertension. Physical activity reduced but did not remove the effect of obesity on hypertension risk.
1. Introduction
There is persuasive evidence that obesity increases [1], whilst regular physical activity reduces the risk of cardiovascular disease [2]. However, contradictory findings from previous studies has led to debate about the relative importance of weight and physical activity with respect to risk of future adverse health outcomes [3–5]. Two studies have shown that the risk of all-cause mortality among overweight but fit men was similar to [6] or less than [7] the risk among healthy weight unfit men, leading to the hypothesis that cardiovascular fitness may offset the health risks of being overweight.
In contrast, physical activity, rather than cardiovascular fitness, has not been found to negate the excess mortality or cardiovascular risk resulting from being overweight or obese [8–12]. In keeping with this, there is evidence that physical activity also does not completely counteract the risk of diabetes among overweight or obese individuals [3]. However, little is known about the effect of physical activity on the association between weight and hypertension [5]. To our knowledge, only one previous prospective population-based study has addressed this issue [13]. In it, Hu et al. found that among women, physical activity attenuated the increased risk of hypertension associated with higher weight, but there was little difference in risk between overweight physically active women and normal weight physically inactive women. However, BMI and physical activity were measured at one time point only, and the authors did not distinguish between overweight and obese participants. As both physical activity and BMI are likely to change over time, and the effects of physical activity may be different for overweight and obese women, we aimed to investigate relationships between both physical activity and BMI and risk of hypertension and the extent, if any, to which physical activity moderates the effect of BMI on risk of incident hypertension among mid-aged participants in the Australian Longitudinal Study on Women's Health.
2. Methods
2.1. Study Setting
We included participants from the Australian Longitudinal Study on Women's Health (ALSWH), a national population-based study of women born in 1921–26, 1946–51, and 1973–78. Women were randomly selected from the Medicare database, which covers all citizens and permanent residents of Australia, including refugees and immigrants. Women born in 1946–51, and thus aged 45–50 at baseline, were first surveyed, using self-completed questionnaires, in 1996 (survey 1, S1) and again in 1998 (survey 2, S2), 2001 (survey 3, S3), 2004 (survey 4, S4), 2007 (survey 5, S5), and 2010 (survey 6, S6). Full details of the recruitment and response rates are reported elsewhere [14].
2.2. Study Population
For this study we included women from the 1946–51 cohort who reported no history of hypertension at baseline and were not underweight at baseline or at followup. We included those who responded to at least two sequential surveys and who had complete data on all exposures and hypertension at the appropriate time points.
2.3. Exposures and Outcome
At each survey, BMI was computed as self-reported weight (kg)/height (m2) and categorized as healthy weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), or obese (≥30 kg/m2). At S1, physical activity scores were derived from reported frequency and intensity of activity. The weekly frequency of exercise (never = 0; once a week = 1; 2 or 3 times per week = 2.5; 4–6 times per week = 5; every day = 7; and more than once a day = 10) was multiplied by the intensity of activity (vigorous = 5 (e.g., aerobics, jogging) and less vigorous = 3 (e.g., walking and swimming)). The resulting physical activity scores ranged from 0 to 50 and were categorized as none (<5), low (5 to <15), moderate (15 to <25), or high (≥25). At S2 to S6, physical activity was assessed using modified (self-report) version of the Active Australia questionnaire [15]. The women were asked to report frequency and total duration of walking, moderate, and vigorous intensity leisure time physical activity during the last week. A physical activity score in metabolic equivalent (MET) minutes per week was derived using the following formula: MET·min/week = (walking minutes 3.5 METs) + (moderate minutes 4.0 METs) + (vigorous minutes 7.5 METs). Physical activity was categorized as sedentary (0–39 metabolic equivalent (MET) min/wk), low (40–599 MET min/wk), moderate (600–1199 MET min/wk), and high (≥1200 MET min/wk), based on international guidelines [16]. We created a composite variable of BMI and physical activity, thereby creating 12 categories of each possible BMI/physical activity combination at each survey. Smoking at each survey was categorised as never, ex-smoker, or current smoker. Alcohol intake was categorized as non/rarely drinker (less than once per month); low risk (up to 14 drinks per week); or risky drinkers (15 or more drinks per week) [17]. Education, ascertained at S1, was categorised as no formal qualifications; school certificate; trade/apprenticeship; or higher education. At S1 women were asked if they had ever been diagnosed with or treated for diabetes mellitus, heart disease, stroke, or hypertension. At subsequent surveys they were asked if they had been diagnosed with these conditions in the three-year period since the previous survey. Women were classified as having diabetes if they reported having been diagnosed with or treated for diabetes by a doctor. A history of cardiovascular disease was defined as present if women reported having been diagnosed with or treated for heart disease or stroke by a doctor. New cases of hypertension were identified through self-report at S2 to S6.
2.4. Statistical Analyses
To account for multiple observations for each participant, we used generalised estimating equation regression models for binary outcome data (using an unstructured correlation structure and a logit link function). We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for the association between each of BMI and physical activity (included as time-varying covariates) and incident hypertension. Women who reported hypertension at any survey did not contribute to the analyses of time periods thereafter. We calculated crude ORs before adjusting for age and education at baseline and history of cardiovascular disease, diabetes, smoking, and alcohol, as time-varying covariates. Once women reported cardiovascular disease or diabetes, they were considered to have that condition at subsequent surveys. We examined the joint association between BMI and physical activity by comparing the odds of hypertension in each combined BMI/physical activity category with the odds in the reference category of healthy weight and high physical activity. We also performed a sensitivity analysis, where we repeated the primary analysis but excluded the women with a history of diabetes or CVD at baseline.
This paper was prepared in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement [18].
3. Results
Of 13,715 women recruited at baseline, 3001 had a previous history of hypertension and 375 were underweight at one or more time points. Of the remaining women, 72 did not respond to the question on hypertension at baseline and 1050 did not have complete data on all exposures and the outcome for at least two consecutive surveys. Therefore, data from 9217 (89%) women were included in the analyses (Figure 1). In general, women who were excluded due to nonreturn of surveys or incomplete data were less healthy and had a lower education level than those who were included in the analyses (Table 1). There was no difference between included and excluded women in terms of BMI at baseline, but a greater proportion of excluded women were sedentary.
At baseline, the mean age of included women was 47.6 (±1.5) years and 5097 (56.5%) were of healthy weight. A further 2596 (28.8%) were overweight and 1325 (14.7%) obese. Almost a fifth of all women were highly physically active, a quarter were moderately active, a third reported low physical activity, and a quarter were classified as participating in no physical activity. As shown in Table 2, we compared baseline characteristics of women in the three weight categories at baseline.
3.1. Individual Effects of BMI and Physical Activity on Hypertension Risk
During followup, 2260 incident hypertension cases were identified, giving a hypertension prevalence of 24.5% in 2010. The odds of developing hypertension were almost double (adjusted OR 1.92, 95% CI 1.72, 2.15) in overweight women and more than three times higher (adjusted OR 3.52, 95% CI 3.12, 3.97) in obese women than in healthy weight women ( for trend <0.001; Table 3).
The effect of physical activity on hypertension risk was less marked, but still evident. Compared with high active women, odds of hypertension were not significantly higher in those who reported moderate activity, but 26% higher in those who reported low physical activity (adjusted OR 1.26, 95% CI 1.11, 1.43) and 28% higher in those who reported no physical activity (adjusted OR 1.28, 95% CI 1.11, 1.47, for trend <0.001; Table 3).
3.2. Joint Effects of BMI and Physical Activity on Hypertension Risk
A formal test for interaction between BMI and physical activity revealed a significant interaction ( value < 0.0001). The odds of hypertension were 37% higher in healthy weight inactive women than in healthy weight high active women (adjusted OR 1.37, 95% CI 1.05, 1.78; Table 4). Compared with healthy weight women, overweight and obese women also had increased odds of hypertension, irrespective of activity level (Table 4; Figure 2). However, physical activity reduced the effect of BMI on hypertension, and this was more apparent for obese than for overweight women. The odds of hypertension were 3.4 times higher in obese high active women (adjusted OR 3.43, 95% CI 2.68, 4.39) and 4.9 times higher in obese inactive women (adjusted OR 4.91, 95% CI 3.92, 6.13) than in healthy weight high active women (Table 4). Physical activity therefore reduced but did not remove the effect of obesity on hypertension risk (Figure 2). We found similar results in a sensitivity analysis where we excluded women with a history of diabetes or CVD at baseline (data not shown).
4. Discussion
In this population of mid-aged women, both high BMI and low physical activity were individually associated with an increased risk of hypertension, but the effects were more marked for BMI than for physical activity. When the joint associations of BMI and physical activity with hypertension were studied, we found that being active attenuated but did not eliminate the excess risk of hypertension associated with being overweight or obese. Odds of hypertension were almost twice as high in women who were obese but physically active as in healthy weight inactive women.
4.1. Comparisons with Other Studies
Our results are consistent with previous findings on the joint association of obesity and physical activity with diabetes [3], cardiovascular morbidity, and mortality [8–12]. All these studies found that BMI and physical activity independently predicted incidence of diabetes and CHD, but that physical activity did not completely counteract the risk among overweight or obese individuals. Similarly, one study found that multiple low-risk lifestyle factors were significantly associated with lower risk of hypertension among normal weight and overweight women, but not among obese women [19].
Until now, only one prospective study had examined the joint associations of BMI and physical activity with incidence of hypertension [13]. Similar to our findings, this study showed that physical activity attenuated the increased risk of hypertension associated with weight. However, this study showed little difference in risk between overweight active women and normal weight inactive women. In contrast, we found that the risk of hypertension was higher in obese active women than in healthy weight inactive women. Our findings therefore suggest that even high levels of physical activity cannot completely negate the increased risk of hypertension associated with overweight and obesity. Differences in findings may be explained in part by the diversity of hypertension, physical activity, and BMI measures. We used a self-reported measure of hypertension, whereas the previous study defined hypertension on the basis of national data for hypertension treatment. Furthermore, physical activity in the previous study included occupational, commuting, and leisure time physical activity, whereas our measure did not include occupational activity. However, unlike our study, the previous study collected data on exposures at baseline only and any changes in exposure during followup were therefore not accounted for. This is important because BMI typically increases with age, especially during mid-age. Also, in our cohort activity levels increased when women retired from paid work [20]. Effect estimates from the previous study are therefore likely to be residually confounded. Furthermore, obese individuals were not differentiated from overweight individuals. This is important because the risk of hypertension was much higher and the effects of activity more marked in the obese women in our study. It has been suggested that moderate to high levels of cardiovascular fitness, in contrast to physical activity, completely eliminate the increased mortality or cardiovascular risk associated with obesity [6, 7]. In the present study we did not assess physical fitness. However, a recent study of the association between hypertension and cardiorespiratory fitness found that the adverse contribution of baseline BMI to the risk of hypertension was substantially attenuated, but not eliminated, after controlling for cardiorespiratory fitness [21]. However, this study was small and the findings need to be replicated in larger prospective studies.
4.2. Limitations
There are a few limitations to our study. First, exposures and incident hypertension are limited by self-report. However, self-reported height and weight have been shown to be valid for calculating BMI in this cohort [22]. The physical activity questionnaire in this study has also been found to have measurement properties which compare favourably with those of other commonly used physical activity measures [23]. Moreover, studies that compared self-reported hypertension against medical records, indicated good validity of self-reported hypertension [24, 25]. A validation study found that 86% of self-reported hypertension cases were verified by medical records [25]. In addition, the prevalence of self-reported hypertension is also in line with the worldwide hypertension prevalence in women [26]. It is also likely that any misclassification will have occurred at random, which may have attenuated the observed findings toward the null, leading to an underestimate of effect estimates. We also relied on self-report of previous history of cardiovascular disease. Concordance between self-report of cardiovascular disease with health records has been found to be substantial [25]. Some misclassification may have occurred, but again this is more likely to have occurred at random. Second, although we adjusted for a range of major lifestyle, biological and psychosocial risk factors for hypertension, residual confounding due to unmeasured factors, such as diet (including salt intake) and presence of prehypertension, cannot be excluded. Third, our study population included mid-aged women and thus we cannot necessarily extrapolate our results to women outside this age group or to men. Further study is therefore warranted in more diverse populations. Finally, we assessed adiposity through BMI measurement. Although BMI is correlated with percentage body fat [27], other clinical measures of adiposity, such as waist circumference or waist hip ratio, may be a better predictor of hypertension and should be examined in future studies.
4.3. Strengths
Our study has a number of strengths. To our knowledge, this study is one of the first to examine the combined effects of BMI and physical activity on incidence of hypertension. Our study population was large and community-based which allows us to extrapolate our findings to other middle-aged women. A further strength is the long duration of followup and subsequent large number of accrued hypertension cases, leading to sufficient power for assessing the joint effects of physical activity and BMI. The longitudinal approach of the ALSWH, with repeated measures of exposures and confounders, enabled us to model BMI and physical activity more accurately over time and to take into account changes in exposure variables during followup. Furthermore, the large study sample allowed us to differentiate between obese and overweight women.
4.4. Conclusions
Both elevated BMI and reduced physical activity appear to play an important role in the development of hypertension. The lowest odds of hypertension were in healthy women who reported moderate or high levels of physical activity, thus reinforcing the importance of maintaining a healthy weight and being physically active to reduce the risk of hypertension in mid-aged women, who often find weight reduction difficult. Risk of hypertension associated with overweight and obesity was however reduced considerably by increased physical activity levels. Overweight and obese women should therefore be encouraged to be more physically active. Further large prospective studies in both men and women, with more objective measures of BMI, physical activity, and hypertension, along with measurement of cardiorespiratory fitness, are needed to confirm our findings.
Conflict of Interests
The authors declare that there is no conflict of interests regarding the publication of this paper.
Authors' Contribution
Caroline Jackson and Gerrie-Cor Herber-Gast contributed equally to this work.
The Australian Longitudinal Study on Women's Health was conceived and developed by groups of interdisciplinary researchers at the Universities of Newcastle and Queensland and is funded by the Australian Government Department of Health and Ageing. Caroline Jackson and Gerrie-Cor Herber-Gast are supported by an Australian National Health and Medical Research Council Centre of Research Excellence Grant (APP1000986).
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Archive for November, 2010
5 Paragraph Essay Narration
The most memorable time in my life is when I first learned to ride a bike, without training wheels of course. I remember the day like it was yesterday even though it was fifteen years ago. This is one of the proudest moments in any childs life. It's a lesson that they remember forever. Usually it becomes a stepping stone for most, it signifies a new chapter. Learning to ride my bike for the first time meant a lot to me.
I had just turned five years old and my dad had been trying to teach me for a while had to ride my bike. For the most part I mastered the art of riding with training wheels, but the more challenging part was riding without them. Now I had never attempted it before because my dad wanted to make sure that I was ready for the big step. Everyday I would ride and ride, without any problems or hesitations. I would go around and around the block time and time again. It was something that I was definitely scared to do. What if I fell? What if I couldn't even start to pedal? There were so many things that could go wrong with my bike that I almost didn't even want to do it.
As a stood outside with my dad, I looked down the long narrow street. It seemed longer than usual. I know my dad wouldn't steer me wrong when he said I was ready to take my training wheels off. I thought he was crazy. I would be ok with leaving them on for a few more years, even if all the other kids were moving ahead of me. As a prepared for take off I safely secured my helmet, my kneepads, and my elbow pads. If I was going to fall I wanted to be prepared with all safety precautions. As I took a deep breath, my dad began to unscrew the bolts to remove the training wheels. One by one he took them off. It looked like a whole new bike. It was no longer a little kids bike, it was a big kids bike now.
As I lifted my leg over the seat my heart began to beat faster and faster. I closed my eyes envisioning myself riding down the street smoothly. As my dad balanced me on the bike I took off. I didn't stop. I was actually riding my bike, as I can hear my dad cheering me on in the back. I was proud and I knew he was too. The wind was blowing in my hair and it felt like I was flying. I couldn't believe that I was riding so perfectly. The only problem was that I didn't learn how to turn around. Big mistake. I had no choice but to keep riding around the block. I rode until I reached my dad again. As we both smiled and laughed I couldn't help but think how perfect this day was.
Learning to ride my bike without training wheels was a huge step for me. Not only did I learn something new, it was the first time that I knew I could do something without the help of anyone else. It was something I did on my own. It was definitely one of the proudest times of my childhood.
5 Paragraph Essay Compare and Contrast
There are several similarities that cats and dogs share, but at the same time they are very different. These two animals are two of the most popular pets today. Some people prefer the company of a cat, while others are considered dog lovers. Through the various aspects of each animal, we will look at the similarities and differences each one holds, and we can get a good insight as to why these animals are so loved.
First, we shall discuss the similarities that these two creatures share. One of the most obvious similarities between these two animals is that they both have hair. They are also domesticated animals kept as pets. They require love and affection from their owner, and can show love and affection If you show it towards them. Another thing is that when you pet them, not only does it relieve stress, it gets dog or cat hair everywhere. They both give birth to multiple offspring at one time, which must be very hard on the mother. Both animals are easy to love, and with the right affection they become like children to most.
Aside from the similarities, there are also various differences between the two animals. To begin with cats, who belong to the family of felines.Cats are loners, meaning they can spend a lot of time alone without getting lonely. They like spending time away from people. The sounds they make also differ from a dog. Typically you will hear a "meow" or a "purr" from a cat. Cat's do not have ranks that determine their social status. All cats are basically equal, one doesn't dominate over another. Another difference is the signals cats give off. When a cat holds its tail up in the it shows a sign of happiness. Another difference is that cats are nocturnal, meaning they go out at night. They also have retractable claws, unlike dogs. Cats seem to be very well-balanced and a lot more flexible than dogs. Most would say that cats have a higher intelligence than dogs do.
Dogs, on the other hand, are canines. They are a pack of animals, which means you should spend lots of time with your dog so that it doesn't get lonely. A dog goes woof, bark, growl, or howl, complete opposite of a cat. The canine group also has a particular social status, and how they determine their ranks.The determining factor in dogs is the tail. In dogs, how high they hold their tail is how they determine ranks. If one dog meets another dog, and one holds it's tail up, it is the one of the higher social class. Dogs, however, are day animals. Another very obvious difference between dogs and cats is that dogs are usually bigger than cats. Dogs are also somewhat smarter than cats in the area of verbal command. For example, you can call your dog by name and usually it will come to you, unlike a cat. Also, you can train dogs to do tricks when commanded. Some of the most commonly seen tricks in dogs are role over, fetch, shake hands, sit down, lay down, and play dead.
As one can tell there are various similarities and differences that dogs and cats hold to each other. This compare and contrast between the two animals can be perceived in different ways. Some may think more highly of cats due to their intelligence, while others will choose a dog any day because of their companionship. It primarily relies on the personality of the person.
5 Paragraph Essay Description
One of the scariest moments in any childs life is their first visit to the dentist. They are told horrifying stories about their first visit. They people they see, the sounds they'll hear, the work that will be done on their mouth will have them scared out of their minds. It's an experience that most kids don't forget, and even as adults they still fear going to the dentist. My first time was full of mixed emotions and the visual image of that day still lies in my head.
As I walk into the dungeon of doom, I push the large, wooden door open. The bell tinkled, with a soft but shrill ring. It's almost as if the door is speaking to me telling me to leave while I still have the chance. A wave of rubber gloves and disinfectant masked with cheap air freshener washes over me. It has a distinct smell to it. Nothing that I had ever smelled before. Chairs are cluttered in the waiting room of the dentists. Clusters of magazines lie on the scratched wood of the coffee tables, shiny bright plastic screaming out logos and slogans. A little way forward from where I stand is a desk. A smiling receptionist sits there. She seems to have been expecting me somehow, as she indicates to the couches and chairs. The chairs have an old pattern to them, like if the place has been here for decades.
A few nervous patients are already there. They try to avert their eyes from the closed, threatening doors leading to the dental surgery rooms, where an ominous high-pitched whirring sound is coming from. Occasionally, I hear a muffled thud, or yell. One by one, the receptionist calls out the patients name. Plastered on the walls are dramatic "Before/After" photos. They show yellow teeth, set crookedly in red raw gums becoming brilliantly white and straight. The walls are painted a stark, clinical white, however photographs of people with toothy grins beam down at me, from newspaper clippings over the years. It must be my imagination, but already I can taste the slightly stale, bubblegum flavoured gloves, the cool hard metal of the examining probe, and the chink clink it makes when it sometimes collides with my teeth. I can feel the vinyl of the reclining chairs, which are covered in plastic, and also which clammy legs have a habit to stick to.
The overall feeling is unexplainable. The atmosphere gave a chilling vibe, while the receptionist called out my name. As I walked the dark halls seem to get longer and longer. Filled with frightening sounds and shrieking victims, I can't help but think something is going to happen to me. The dentist is a slightly tall woman, short hair, with perfect white teeth, just as I had suspected. She smiles down at me with a soft grin that gives me the chills. She tells me to relax and lay back. As I close my eyes I can hear the machinery going off. It's loud and gets even louder as it approaches my mouth. I clinch my eyes as she begins to drill. Her gloves in my mouth taste like rubber, very disgusting. Before I know it the procedure is over.
Going to the dentist was a memory that is burned in the back of my brain and every time I go I always reflect on that first time I went. Although it was a scary moment, it actually goes by faster than most people think. The atmosphere and the scary effects just add more suspense to it.
5 Paragraph Essay Cause and Effect
One of the major problems in society is alcoholism. The effects of this disease are very dangerous and serious. It can cause many problems in a person's life without the person even knowing. We will discuss the physical, psychological, and emotional effects of alcoholism and what causes it to happen.
The first effects of alcoholism are physical. These are the most important because these can cause your death. For example, alcoholism causes cancer in the stomach, kidneys, and liver. Besides, alcohol alters the digestion of nutrients that the body needs to stay healthy. Alcoholism also causes severe damage in the neurons, so it causes alterations in the body movements, loss of appetite, and depression. There are other effects in the body like gastritis and cirrhosis of the liver. All these physical consequences could cause your death if you drink alcohol in mass quantities. Losing your life or poisoning it is not worth the joy of drinking. Take care of your body because it's the only one you have.
The second effects caused by alcoholism are psychological. At the beginning, alcohol makes you feel relaxed, but if you drink it in excess, it increases anxiety and causes depression. It also causes family and legal problems, violence, changes of behavior, suicide among others. Alcohol is very powerful and alters all your normal behaviors. Many people believe that they can handle their drinking and that it won't affect them at all. For some this may be true, but for others it is a cover up for what can really happen. Since alcohol alters the perception of most people, they make decisions that could change the rest of their lives. One of the most common ones is drinking and driving. Each year numerous amounts of people are killed in drunk driving incidents. This means jail time, fines, suspensions, and even worse, death. The chance that you could take your own life, or someone else's life on account that you wanted to have a good time is very serious. So always think before you drink and drive.
The third effects of alcoholism are emotionally. Alcoholism affects families all over America, and some families are even divided because of it. Alcoholism can definitely take a toll and someone when it causes them to lose their family, their job, and even their sense of well-being. It can lead to depression and a down fall of someone's life. Why risk everything you have for a drink? It becomes a habit, taking over your life that one day you won't be able to control. Some might get help, while others lose faith and it drives them to the end. It isn't worth losing everything you love.
In conclusion, the effects of alcoholism which are physical, psychological, and mentally. It can cause many problems that affect your life in all aspects. Alcohol alters your brain, muscles, digestion process, and other disorders that affect your health. It also can cause you depression or changes in your behavior that result in problems with your family, friends, and with yourself. So before you drink ask yourself is it really worth losing it all?
Thank You M'am by Langston Hughes
Character Analysis: Roger (the boy)
In the short story Roger is portrayed as a young boy, maybe fourteen or fifteen, that is roaming the streets late at night up to no good. His mission is steal a pocketbook in order to buy some blue suede shoes. At first Roger seems incompetent when snatching the purse. He is described as little compared to the woman. Throughout the story we see a change in Roger and how the woman has affected his life in such a short period of time. He is quiet and doesn't say much except for when asked a question. One can conclude that the boy comes from a seperated household when he explains that he hasn't eaten because nobody was home.
Also, when the woman notices the dirt upon the boy's face, she points it out making him wash his face. At no point in time did the boy run out of the house knowing that he had several opportunities to do so. He wanted the woman to trust him even when she paid no mind to him. It's almost as if he wanted to show her that he wasn't a trouble maker just a troubled kid. He was worried about the fact that she could've taken him to jail but didn't. After enjoying a meal together, the woman gave the boy ten dollars and sent him off. Just before walking off he had a thought in his mind to say something other than "thank you m'am," but no words came out. He couldn't show his appreciation but he definitely felt it.
How does the story relate to contemporary times?
It seems as though this story takes place in a different time period like the old days. They're language sense is more old fashion, but the story behind it is something that is still experienced today. In contemporary times people still steal and a portion of the youth is corrupted, but there's always that one instance when someone reaches out to change someone in need. In the story the woman reaches out to the boy instead of turning him in or cutting him down. She teaches him a valuable lesson that he will remember for the rest of his life, she might've even changed him. Now and days, people still take that initial step to teach others a lesson.
It's all about second chances. In today's society things are different, but values aren't. Some poeple still believe in taking a chance on others no matter their past actions. They see the good in someone rather than judge. It happens everywhere it could be done by anyone no matter the age, race, sex, anyone is capable of making a change. Till this day the youth is still trying to be preserved and if just one person, such as the woman in the story can reach out and not give up, they can make a bigger difference than they think. People who are strong in spirit often influence those around them.
Pg. 244 Act 1
Claim: Medical marijuana should be legalized
1. Marijuana is harmless – there have been zero known deaths related to the use of marijuana compared to alcohol and tobacco.
2. Marijuana has proven to increase metabolism for cancer patients causing them to eat more
3. Marijuana relieves patients of nausea and pain after chemotherapy
4. Helps sooth patients and ease their mind about their sickness
5. Would be easier for patients to access, not only at the doctors request, but nationally.
Warrant: Legalizing medical marijuana would make the lives of sick patients much easier, and it would give them easier access to the supplies they need to boost their metabolism.
Ch. 3 (DA) 5 Paragraph Essay
Paradox: Happy yet sad
Throughout life many people have experiences where they have a positive yet negative effect on their lives. When people experience this, they are experiencing a paradox. Whether it be at school, work, or just in life, paradoxes are all around us and come in different times in our lives.
The workplace is a good example where one might experience a paradox. For example, if you've worked for a company for years and years and you find a new job, the feeling of starting a new job can be exciting, yet sad at the same time. You will have to say bye to people who you've worked with for a very long time. You will be leaving a place that has become very familiar to you. At the same time the thrill and excitement of meeting new people and being in a different atmosphere will come upon you.
Another great example of a paradox is leaving for college. Going off to school is a big deal for most teenagers. They will be away from their parents, away from their homes, and away from the one place they knew so well. They will be leaving behind the only friends they knew and meeting new ones. It can definitely be a time of sadness having to say good-bye to their parents. At the same time, they are embarking on a new journey that starts the rest of their lives. It's sad to leave, but they're happy to go.
At last, one of the biggest, and perhaps most important, paradoxes one can face is the feeling of death. When someone close to you dies it's an automatic feeling of sorrow and sadness, but at the same time if they were sick and struggling to live you're happy they are in a better place. A place where they won't have to hurt anymore, a place where they can be at peace with themselves. The fact that you'll never see them again can be very devastating, but knowing that they won't have to go through anymore pain is relieving.
As one can tell, there are many ways someone can experience a paradox. Whether it's through a new job, a new school, or the loss of someone special, there are always mixed feelings when it comes to these things. So feeling happy yet sad is a normal way that many can express their emotions.


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|Note how the jacket bunches up at the back due to my short waist and sway back.
|Note the big gap between the last and the 2nd last button because I had cut off the original at waist button hole.
|Note that the back doesn't bunch up anymore! Yay!
The only thing I am not sure is the big gap between the last and 2nd last button. I'm not sure if I should add something there to balance it out. But if I put something there then perhaps it would draw attention to the gap. What do you think? Should I do something to hide the gap or should I just leave it alone?
You can see my entire journey for this project on my Blog.


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Markedly high rates of remission were seen among patients with very early peripheral spondyloarthritis (SpA) treated with golimumab (Simponi), a single-center, double-blind trial found.
On the study's primary endpoint, clinical remission at week 24, a total of 75% of patients randomized to receive subcutaneous golimumab at 50 mg every 4 weeks had achieved clinical remission compared with only 20% of those on placebo (P<0.001), according to Filip Van den Bosch, MD, and colleagues from Ghent University Hospital in Belgium.
And already by week 12, the clinical remission rates were 70% versus 15% for the golimumab and placebo groups, respectively (P<0.001), the researchers reported online in Annals of the Rheumatic Diseases.
"The spondyloarthritis concept is split depending on the predominant clinical manifestation into axial and peripheral disease, the latter including psoriatic arthritis and non-psoriatic peripheral SpA."
The researchers noted that the natural history of peripheral SpA is not well chronicled, with some reports suggesting the possibility of spontaneous remission, and it is also not known if an early window of opportunity exists (as there is in rheumatoid arthritis and axial SpA) during which intensive treatment with tumor necrosis factor (TNF) inhibition can influence the course of disease.
To explore this, Van den Bosch and colleagues enrolled 60 patients newly diagnosed with active peripheral SpA from 2012 to 2015. Patients had arthritis, enthesitis, or dactylitis plus other features of SpA such as HLA-B27 positivity, sacroiliitis on radiographs, or psoriasis. All patients underwent magnetic resonance imaging of the sacroiliac joints at screening.
During the 24-week study, patients were allowed to continue on stable doses of nonsteroidal anti-inflammatory drugs (NSAIDs). Clinical remission was defined as complete resolution of enthesitis, dactylitis, and peripheral arthritis.
Two-thirds of the patients were men, whose mean age was 40 and whose symptom duration was about 5 weeks. More than half were HLA-B27 positive, and the majority were taking NSAIDs. Almost all had peripheral arthritis, and almost half had enthesitis and dactylitis. Bone marrow edema of the sacroiliac joints was detected on MRI in 35%.
The study included a variety of secondary endpoints, including joint and enthesis counts, patient-reported outcomes, erythrocyte sedimentation rate, and C reactive protein. From week 12, non-responders were allowed to receive rescue medication with golimumab, and adverse events were recorded.
The composite peripheral SpA remission criteria (pSpARC) and the percentages of patients in the golimumab group achieving a 40%, 50%, and 70% improvement at week 12 were 57.5%, 55%, and 50% compared with 20%, 20%, and 15% of the placebo group.
At week 24, the percentages of patients having SpARC 40%, 50%, and 70% responses in the golimumab group were 50%, 55%, and 40%, compared with 15% for all three responses in the placebo group.
Significant differences also were seen for the individual components of the pSpARC. At week 24, the median number of tender and swollen joints was zero for both in the golimumab group compared with five and one for the placebo group (P<0.001 for both).
And at that same time point, the percentages of patients with enthesitis and dactylitis were both 17.5% for the golimumab group compared with 80% and 60% for the placebo group, respectively (P<0.001 and P=0.003). For the patient global assessment of pain on a 10-point scale, the golimumab score was 2 compared with 6 for the placebo group (P<0.001). C-reactive protein levels were 1 mg/L for the golimumab group and 6 mg/L for the placebo group (P=0.003).
Significant improvements in swollen and tender joint counts and patient global assessments were already apparent after only 4 weeks of treatment in the golimumab group, and use of NSAIDs had decreased significantly, the authors noted.
On the Assessment of Spondyloarthritis International Society response criteria, 20% and 40% improvements were seen in 67.5% and 65% in the golimumab group compared with 30% and 15% in the placebo group (P<0.05).
Physical function and quality-of-life measures also showed significant improvements with the active treatment.
The most common adverse events in both groups were nasopharyngitis and upper respiratory tract infections. Four serious adverse events occurred in the golimumab group, none of which were considered treatment-related. Half of the patients in the placebo group began rescue treatment after week 12, compared with 10% of those in the active treatment group.
The findings have important implications for management of patients with peripheral SpA, the authors stated. These include the observation that early initiation of anti-TNF treatment had substantially greater benefits than has been seen in patients with longstanding disease. In addition, the lack of improvement in the placebo group does not support the hypothesis that many patients with peripheral SpA experience spontaneous remission, Van den Bosch and colleagues stated.
"The data of our proof-of-concept study will need to be confirmed in larger multicenter studies. In any case, the data reiterate the importance of early recognition and referral strategies from primary care to rheumatologists, in order to install adequate treatment and consequently achieve better outcomes."
The study was supported by Janssen Pharmaceutica NV.
The authors reported having no financial conflicts.
- Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
last updated
Primary Source
Annals of the Rheumatic DiseasesSource Reference: Carron P, et al "Anti-TNF-induced remission in very early peripheral spondyloarthritis: the CRESPA study" Ann Rheum Dis 2017; doi:10.1136/annrheumdis-2016-210775.


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Science has determined that every sperm represents half the genetic make-up of a human being. That means that each and every sperm is a potential human being.
Therefore, the destruction of sperm is the destruction of human life.
God, in His Infinite Wisdom, has designed the male body to expel thousands of sperm with every ejaculation. Since we lack a method to save all these lost potential souls, we can only do as God has ordained, and limit the loss of life.
Therefore, in order to honor and protect life, henceforth the following actions are illegal for any man to do:
- Masturbate (alone or with a partner);
- Anal sex;
- Oral sex;
- Premature Ejaculation;
- "Nocturnal Emission" (whether at night, while sleeping, or not).
The evidence on presence of sperm in "pre-cum" for stimulated males is pending.
Only the following methods of sperm release shall be permitted to men:
- Vaginal orgasm with a consenting, adult, female, to whom you are lawfully wed.
Only the following method of "birth control" is acceptable, since all others require the murder of human life, either the slaughter of sperm, or the death of a fetus:
- "The Pill";
(Note that use of "the pill" might be morally objectionable under the "promotes being a slut" provisions, even when used by a lawfully married woman, prepared to provide documentation she is having sex only with her husband, and prepared to sign a pledge saying she will not become a slut, harlot, or loose woman.)
(Note also that we have given this a lot of thought. If you fancy you can think of a method of "birth control" that we haven't, then you're wrong and should seek medical attention - from a licensed doctor, or aggressive religious leader, whichever - for your deviancy.)
- First time sperm murdering men will be sent to self-control education classes;
- Second time sperm murdering men will be put on medications to control their unnatural, psychotic, murdering urges;
- Third time offenders will be shot by a robot-controlled gun, on a random timer, because every life is sacred, and guns don't kill people, people kill people, and the random timer means that God ordains the moment of death for the sick, murderous sinner.


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Well, before that, earlier in the week, I had gotten an invitation to the 1st birthday party of my good friend, Catie's, youngest - to be held on Sunday afternoon, after church. I had thought about making him a hat, too, but talked myself out of it because I didn't really know what size to make and I wasn't sure I'd have time. The yarns for our grandson's hat were two Red Heart acrylic yarns because I wanted Mom to be able to throw it in the washer and dryer. The contrast color in the hat would be black so it didn't
As I began knitting with all that color, I kept thinking about how Catie often says that she loves COLOR, all colors. I finally convinced myself that I'd have time to do her little one a hat like the one I'd started for grandson, if I hustled. But I had already started. aarrgghh About noon on Friday I got the "brilliant" idea (we'll see how brilliant) to use my yarn winder and wind up a ball of each color, starting with the opposite end of yarn that I had started the first hat with, which I did, rather painlessly. I still needed to decide what size needles, how many stitches to cast on, etc. for the second hat. Both boys have "good sized heads," one being 3 and one being 1. I wasn't even certain I had grandson's figured correctly.
And using them began to hurt my old hands. And the more I knitted on that little hat, the more I thought it was too small. I kept hoping that it would be bigger when it was off those tiny needles.
So by Friday around 1:00, I had about 2 inches of hat #2 done. BUT then Catie and I began texting about when she might be able to come over and give our dog a much-needed grooming. And, wouldn't ya know, the best time we came up with was Friday evening. Soooo I had to bathe the dog and blow dry her to get her ready. Hubby & I got supper out while we did some errands in town.
In preparation for Catie coming, I had to hide both hats and all 4 balls of yarn without tangling them. I put them under a blanket on a chair and put a throw pillow on top of that. When Catie finished grooming the dog and because her children were all in bed with her husband "minding their homestead," she stayed and visited for a long while. We have been aching to have some time to visit but this evening I had knitting for her son in the back of my mind. :)
After she left, I decided to pull an all-nighter. Well, not like the all-nighters I pulled in college to cram for exams. More like an old woman's all-nighter, which was until about 12:30. I just had to finish that hat by Saturday night so it would be blocked for Sunday afternoon. And, you know, after I crawled into bed, I think I dreamed all
However, very soon into my all-nighter, I realized that the first hat, the one for grandson, was going to be a better size for the little 1 year old than the second hat I'd started. So that's what I focused on late Friday night. When I got up Saturday morning, I had the primary, large design section finished. That got me only a few rows from the decrease rows.
Well, I guess, if I ever finish that smaller hat for a tiny baby, I'll just have a couple more ends to weave in. But on the other hand, what mother of a new born would ever put those colors on her new bundle!! In fact, I had begun to second guess my color selection for Catie's little one. Oh well, if she loves colors, ALL colors, that's what she's gettin'!
I finished the hat Saturday afternoon, in time to get up and prepare dinner. And got it blocking after the dishes were washed.
So everything was in order for the party, the little books I got him, the singing card, and the hat, originally meant for grandson. I do know now that I need to make grandson's bigger. AND the hat for my friend's son did fit him. And she said she likes the colors! But I'm not sure she would have said anything else. We'll see if I ever see him in it.
|Finished hat, photo taken Sunday
morning before church
|And just look at those colors
on the tippy-top
|3 year old grandson
with our golden doodle
|1 year old son of friend Catie
|"Enjoying" his birthday cake
|One year old modeling hat originally
meant for grandson.


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GCD/Grafix Blog Party
GCD Studios and Grafix have teamed up for a Blog Party. There will be a main post on GCD Studios blog everyday this week. There will be a link in that post to each of designers blogs. We incorporated Grafix products into our creations. Sadly, I can only show you one of them today but Thursday I can reveal the rest of them.
There will be a winner chosen on Friday to receive a $100.00 worth of free product.
Now here's a card I created using the Grafix clear acetate.......
I stamped the yellow flourish on the acetate using yellow stazon. Then added the red flower accent using cherry red stazon. I layered the acetate panel over GCD Sudios patterned paper. The chipboard is also fron GCD Studios. The ribbon is by Wright's Company.
TSM fr stopping by!! Have a super day!


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Jason Clark
MSDN Magazine July 2003
View Complete Post
In the July 2003 installment of the . NET column I covered the basics of Win32î interoperation with the Microsoftî . NET Framework (P/Invoke). Based on reader feedback, this topic is worthy of further coverage, so I have decided to revisit P/Invoke in this column.
MSDN Magazine October 2004
I am trying to send parameters to a C++ api and came across one problem.
One of the Parameters passes: this->GetSafeHwnd() normally in win32.
I understand I can use
HwndSource source = (PresentationSource.FromVisual(this) as HwndSource);
However this is a WPF handle that I would be sending to a win32 so really I need to use "HwndHost" as a parameter.
How can I go about passing this value. Can I get the presentation window as a HwndHost?
is there a way to make the first column of a report use the an alternating background color?
I have the background color set for the entire row however it does not work for the first column if the color is set to an expression. If I just set it to a color i.e. red it works just fine. If I insert a dummy column to the left it works just fine (but the dummy column does not work, presumably because it is first??).
In the file below only the textbox for part number does not show an alternating background. All others work correctly.
<TableRows> <TableRow> <TableCells> <TableCell> <ReportItems> <Textbox Name="PartNumber"> <rd:DefaultName>PartNumber</rd:DefaultName>
Hola, I have a gridview which is bound to a sds which returns 7 columns and I added two columns from the GUI. What I want is to fill up the 9th column with DDLs and these DDLS will get their data from a different sds which is using a stored procedure with a single parameter. I created the 9th row, used template field, made the sds for 9th row, the stored_procedure, threw a DDL in Item template and all I need now is to pass a parameter in the first column to the sds in the 9th column. I can code this but i'm getting tired of aspx.cs :) and would like to do it from the GUI.
Hi, I have a requirement to hide a field called details on a gridview
and show it in a jQuery modal dialog when users click on the Customer
ID hyperlink. This grid is created programmatically. I will be hiding
the details column via the CSS display:none property. Does some one know
how can I pass the grid's selected hidden column value to the modal?
Here is some of the code I started: GridView mygrid = new GridView(); //.....................................More columns code for the grid
//Here is where I need to pass the Details column value associated with
the customer ID field selected to the Modal and open the Modal
dialog. HyperLinkField linkField = new HyperLinkField(); string[] dataNavigateUrlFields = { "CustomerID" }; linkField.DataTextField = "CustomerID"; linkFi
Scenario: If you create a table with a column of type nvarchar, populate it with some content and try to modify it using the WebMatrix editor, from nvarchar to ntext, it does not display any error message or warning that this is not possible. It silently saves and reverts the change, back to nvarchar. Wasted some hours on this issue as I thought my column was ntext, but in fact was still nvarchar.
Expected behavior: It should change to ntext, or if SQL CE doesn't support that, it should notify the user that no change was applied.
I'am using dnamic entity with EF4. On a list page of a table, I would like to display a column containing information from a child table of the current element. Sample :
Order List :
Order Data | Required Date | Shipped Date | etc... | ... | Customer Name (foreign key with tostring() method override) | Customer Postal Code (Column that I want to add) |
I don't known how to do that. Is it possible ? Maybe I have to to create my own Metadata proxy that will add dynamicly a column on the MetaColumn list of the table.
Does someone have an easier or better idea ?
Thank you for any help.
I am having trouble finding out where and how to HTML Encode a cell's data on the Dynamic Data (v4.0) gridview of List.aspx. As a simple case, suppose I have formatted cell data that is A<br/>B in the DB. Obviously, I want A stacked on B in the cell.
It seems gridView1.HtmlEncode = true has gone away.
So maybe I'll try to catch it on the RowDataBound event:
protected void GridView1_RowDataBound(Object sender, GridViewRowEventArgs e) { if (e.Row.RowType == DataControlRowType.DataRow) { // Html Encode the cells } }
but this event never fires?
Has anyone figured out how to properly render HTML tags data in the List.aspx's GridView1?
If I figure this out, then I can add a MetaAttribute called something like [EncodeAsHtml(true)] and be on my way. Thanks!
After looking for a driver to open legacy dbf drivers to connect, the next level trouble a have is this one:
first, i can retrieve the data but when trying to filter by a parameter (somesc columns) i get an error.
The error says about the database can't determine some blah blah!
The error is a columm tha is formated ( 1234 ) about 8 space, fixed. The values in the query appears like that. I resolve this by Trimming Ltrim(ColumnName) and i get this (1234).
Now in SqlExpress, how can i filter by the new Trimmed Expression? (This is a primary key that the DBF use)
SELECT column1, column2, column3TABLE FoxProDB
SELECT Ltrim(column1) as NewExp, column2, column3TABLE FoxProDBWhere NewExpre = @NewExpres -Error-
Hi Everyone!
I know this is probably a very basic question but how do I keep a column's text values unique in SQL server (ie for a unique username)? The column is not an integer it's varchar(50), and it's not the primary key but I could make it the primary key if recommended.
The front end could handle it; where the user would enter text, it's validated, then a query is done to see if that username is available. If so, then user can decide to choose it and an insert is done, if not they pick a new username and process repeats. With this approach, the responsibility of keeping the value unique solely rests on the front end, nothing on the database side.
Is this the correct way to handle this?
Thank you!
I follow the tutorial and create DAL with Dataset. I created a Table Adapter with many column, but when i Call a simple Get for 2 column only. The system display 2 column and the rest column with empty data.
My question is that will this affect the performance? because i only need 2 column.
example: Table with 40 column define in Dataset in DAL. I have GetMember from Dataset with 40 column, some request only 1 column (with 39 empty), some request 22 column (with 18 empty column). Will this affact the performance?
Should i create a seperate DatasetAllColumn, Dataset1Column, Dataset22Column ?? so system only return exact column i need. and hofully the performance is optimized to it best.
I have a sample web service and aspx file. I deployed them to an existing website that contains classic asp files.
using System;
using System.Collections.Generic;
using System.Linq;
using System.Web;
using System.Web.Services;
[WebService(Namespace = "http://localhost/MyWebServices/")]
public class MembershipRegisWebService : System.Web.Services.WebService {
public MembershipRegisWebService () {
//Uncomment the following line if using designed components
public string HelloWorld() {
return "Hello World.";
aspx.cs file:
using System;
using System.Collections.Generic;
using System.Web;
using System.Web.UI;
using System.Web.UI.WebControls;
using System.Web.Services;
public partial class CallWebService : System.Web.UI.Page
protected void Page_Load(object sender, EventArgs e)
MembershipRegisWebService mrWs = new MembershipRegisWebService();
Response.Write("Calling web service:" + mrWs.HelloWorld());
It runs locally, but it shows an error when running it from the server:
Server Error in '/' Application.
Compilation Error
Description: An error occurred during the compilation of a resource required to service this request. Please review the follow
I need to develop 3 pages.
On the first page user defines atmost 7 column names to be displayed on the report. I'm saving these names in a Sql DB table 'Columns' with Column_Nm and Column_ID as Table columns.
On the second page I'm retrieving column_Nm from the table and displaying them on the page so that the user enters the data. This data is saved in another table 'Summary' with the Columns column1 through column7.
on the 3rd page I need to show a report of 'Summary' table.
How do I dynamically replace column1 through column7 names with that of 'Column_Nm' on the report?
Any help/suggestions would be appreciated.
This month John Papa fields some of his favorite questions regarding data manipulation with ADO.NET.
John Papa
MSDN Magazine January 2007
This month Paul DiLascia teaches readers the right way to create dynamic dialogs, explains satellite DLLs and discusses language resource DLLs.
Paul DiLascia
MSDN Magazine September 2006
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Running an auction preview site can aid the success of your fundraising event in numerous ways. An auction preview site is one of the most effective methods of promoting and generating excitement around a live auction event. They both create early competition and publicity around a fundraising event, and give people the opportunity to pledge their support for the charity.
Auction theory suggests the more information you provide people the more likely they will be to want to bid on an item. The information available on a preview site motivates people into taking an interest in the auction and increases competition for lots before a fundraising event has even begun.
The interactive nature of a preview auction allows more scope than a printed brochure. Perhaps most importantly potential bidders can be sure that information about the lots is fully detailed and updated, therefore increasing confidence. This encourages stronger bidding for the items as bidders are comfortable with what is for sale and become more motivated to win the item.
Auction preview sites make it much easier for people to pass on details of lots and the auction itself to other people via email, social networking and blogging. Thus the auction event and the items for auction can be promoted on a wide scale and at a minimal cost. The preview site has the potential of coming to the attention of people who would not otherwise have been aware of the event. Even if it is not possible for these people to attend the event, proxy bidding arrangements could be made so these too can take part in the auction.
Collective intelligence can be used to discover data about what most interests visitors to the site, and how they found out about the site. This information can help you market the auction in a more targeted and efficient way. The lots that attract the most interest can be promoted more heavily, and the data can be used as a helpful guide as to what might be most successful in future fundraising auctions.
You can read more about the services we can provide to charitable organisations here.


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"The Good news is going to keep coming." So shouted the Prime Minister at Miliband in that cockpit that is Prime Minister's question time in the House of Commons. And if hyperbole was an Olympic sport the two would be competing for that elusive gold.
As it is the Olympics delivered not an extra medal for Cameron but something much more valuable, growth.
This has just been confirmed by the Office of National Statisitics(ONS). Their first look at the figures show that the economy grew by 1% in the three months of the third quarter of the year. This follows a 0.45% contraction in the GDP in the previous three months.
So the ticket sales for the Olympics and the Para Olympics helped the country move out of the longest double dip recession since the Second World War. The quarter gave the country the strongest growth figures for five years.
Although economy expanded larger than expected, all the signs are that it is unlikely to be repeated.
Looking closely at the figures construction, which is a recognised barometer of how well an economy is doing, suffered a 2.5% decline in the quarter. But the Olympics would surely have contributed to the increase of 1.8% in distribution, hotels and restaurants and also to the 0.8% increase in the transport sector.
But just as quick as a ferret down a hole, the chancellor was hailing it as evidence that his policies had put Britain "on the right track."
He went on to say "There is still a long way to go, but these figures show we are on the right track. This is another sign that the economy is healing and we have the right approach."
But that's politician speak. The reality is that further lapses are likely. There are plenty of potential iceberg's that could puncture his optimism. The first being his continuing austerity programme. Add to that tight credit conditions against the backdrop of a world economy that is sluggish and the still unresolved serious problems in the eurozone. All in all a very toxic mix. And all factors that are likely to burst the growth bubble.
The danger is that the Chancellor believes his own spin and thinks that we're out of the woods.
The cost of the Olympics was £9 billion. Now that produced growth. Classic Keynes.
Now there's a lesson there for our dear Chancellor. If he wants growth to continue, his austerity policy needs ditching. He needs to upgrade more than his travel arrangements.


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Larry Janiszewski, 65, of Hot Springs Village, passed away June 27, 2013. He was born May 7, 1948 in Chicago, Ill., to Clarence and Wanda Janiszewski.
Larry was a U.S. Army veteran and was in the Navy Reserves.
He retired from the Chicago Police Department after 30 years of service. Larry enjoyed the outdoors and was an avid golfer.
Larry is survived by son, Matthew Janiszewski of Chicago, Ill.; daughter, Mary Janiszewski and husband Robert Levi of Denver, Colo.; grandchildren, Caitlin and Julia Janiszewski and Samantha Levi; and brother, David Janiszewski of Orlando, Fla.
Arrangements are under the care of Caruth Village Funeral Home; guests may register at www.caruth-hale.com.


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From Alaska to the Andes, there is no question that the world is getting hotter –FAST. Globally, the temperature is up 1 degree Fahrenheit over the past century, but some of the coldest, more remote spots have warmed much more. The results are harrowing. In a three-part documentary report, the cover story for the September issue of National Geographic magazine focuses on the biggest issue facing the environment today: global warming and its effects. Four years in the making, this astounding story traverses the globe, pinpointing the physical and ecological signs of climate change (both stunning and subtle) and revealing what abrupt climate changes in the past are telling us about our own future.
Warnings about climate change can sound like an environmentalist scare tactic, meant to force us out of our cars and cramp our lifestyles, but National Geographic reveals the cold hard facts on the ground, and the Earth has disturbing news. Global warming is happening. Things that normally happen in geologic time are happening during the span of a human lifetime.
Doubters say that climate is notoriously fickle, that recent anemic snowfalls and five-year-long droughts are part of a passing phase. Leading scientists counter, "Don't bet on it." The level of carbon dioxide today is higher than it has been for hundreds of thousands of years. That we are changing the climate is undeniable. What's worse, even if we stopped our CO2 emissions this instant, we are already committed to a warmer world. And experts fear that the warming may not be gradual, but could accelerate into a devastating climate lurch, giving us little or no time to adapt.
Scientists long ago predicted that the most visible impacts from a globally warmer world would occur first at high latitudes: rising air and sea temperatures, earlier snowmelt, later ice freezes, reductions in sea ice, thawing permafrost, more erosion, increases in storm intensity. Now all those impacts have been documented in Alaska, a canary in the coal mine of climate change. The drastic changes observed there by scientists and reported and photographed by National Geographic provide an early-warning system for the planet.
Dividing the report into three parts –GeoSigns, EcoSigns and TimeSigns –National Geographic magazine presents an unprecedented view of global warming.
GeoSigns: Data from the last 100-150 years show just how drastic the climate changes are.
-Winters are shorter now: Freshwater ice breakup in the Northern Hemisphere now occurs nine days earlier.
-Global average sea level has risen between 4 and 8 inches worldwide –over the past 100 years, the average rate of sea level rise has been around a tenth of an inch a year. This continually increasing sea level has great potential for reshaping coastlines and displacing more than
100 million people worldwide. (Every inch of sea level rise could cause shorelines to move inland by 8 feet.)
-Ocean temperatures are rising in all ocean basins and at much deeper depths than previously thought, according to NOAA scientists.
-Many rivers are getting less water than a century ago due to earlier snowmelt in the spring and less snow falling overall. In California, the reduced water input is as much as 12 percent.
-The people of Wisconsin are losing winter as they know it. Lakes in the state are now frozen
up to 25 percent less time.
-In Alaska, the breakup of sea ice off the coast happens weeks earlier than it once did. Since 1978, the area of perennial Arctic sea ice has declined 9 percent per decade.
EcoSigns: Animals and plants are coping with the heat –or they're not. As the planet warms, plants are flowering sooner and trees are shedding their leaves earlier. Habitats are changing, causing migration schedules, births, and food cycles of animals and plants to shift out of sync.
-The Adelie penguin colony on the Antarctic Peninsula has dropped by five-sixths from 1900 to 2004 due to a 9 degree increase in temperature over the past 50 years and severe retreating of sea ice. Just since the 1960s, the number of breeding pairs has dropped by two-thirds. Of the Antarctic ecosystem, scientists state, "It has gone to hell."
-Tree swallows in North America migrate north in the spring 12 days earlier than 25 years ago.
-Scientists have long known that hot weather during the incubation phase causes turtles' eggs to yield more females. What's surprising is that they have now detected a gender imbalance in sea turtles in favor of females worldwide.
-Researchers have seen 15 percent body mass declines in polar bears in the Hudson Bay region. The bears are not getting as much food as they used to because of the loss of sea ice from which they hunt seals and fish. If ice loss trends continue, polar bears will either move to the high Arctic or have to learn to hunt caribou.
-Caribou herd numbers have dropped from 178,000 in 1989 to 123,000 in 2001. Scientists believe that global warming may be the cause, as the necessary plants they eat at calving time are growing earlier and dieing back before the caribou can eat enough to gain body fat to survive the winter.
TimeSigns: Today, scientists are working to understand what has caused –and what will cause again –the sudden climate changes that Earth periodically undergoes. Not the 100,000-year fluctuations, but the more rapid shifts that scientists have recently identified when the Earth switches like a light from frozen Ice Age to picnic-warm and back again. How often and how quickly have such dramatic changes happened? What do these reversals tell us about the direction of Earth's climate today and in the future? Only by understanding past linkages among the ocean, atmosphere and biosphere, and determining which the really big players were in past sudden change, can we better deal with future surprises.
Presenting the hard truth about global warming as scientists see it, National Geographic magazine lays a firm foundation upon which the growing debate over fossil fuels and the environment takes place.


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Flowers & Such is an independent florist in the centre of Copthorne village.
Fresh, seasonal flowers are delivered daily to our shop, so that we can create stunning bouquets and arrangements for collection or delivery to Copthorne, Crawley, Crawley Down, Maidenbower, Horley, Felbridge, East Grinstead and surrounding areas in Surrey and Sussex, including Gatwick Airport.
Our team of qualified, talented Florists have a wealth of experience and can arrange beautiful classic, contemporary and country bouquets for any occasion. We specialise in Wedding Floristry, in particular Country and Modern Styling (see our Wedding Page for inspirtation). If you have an Event coming up and need ideas and prices, please contact us to discuss.


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Read this tip to make your life smarter, better, faster and wiser. LifeTips is the place to go when you need to know about Business to Business Research and other Business Research topics.
What's a Business Wiki? It's a collaborative web site in which anyone can help to write and edit a business profile, which is then made available to the public. That's right, anyone can write and edit the copy. It's an interesting wrinkle in the ever-changing web world. And you'd likely be surprised at how much information you can find in a Business wiki. Of course, you have to take the information for what it is -- unverified. But if you're doing business-to-business research, a business Wiki might offer up some interesting facts that you can confirm through other research.
|Guru Spotlight
|PJ Campbell


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PSM Executive EditorRandy Nelson knows that love can bloom on a battlefield. Randy Nelson gives his life not for honor, but for you. Randy Nelson knows that the foibles of politics and the march of time can turn friends into enemies just as easily as the wind changes.Randy Nelson feels asleep.
Think you're tough, punk? We say you don't know what tough is. Not until you've clicked on the Movies tab above and seen Randy Nelson sing.
July 28, 2006


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Tel: 07717190609
Karosa Jewellery works hard to ensure all our materials are ethically sourced……ethical by design
Welcome to Karosa Jewellery
Based in the beautiful Forest of Dean, Karin Whittaker of Karosa Jewellery offers exclusively designed jewellery with the individual in mind. Each unique item is hand-crafted with love and care; and many pieces reflect the stunning beauty of the natural landscape.
Reclaimed and Fairtrade metals are used in the making of every piece of Karosa Jewellery.
If you are looking for a totally unique gift, your idea can be made into reality using silver or gold. Either email your design ideas or visit for a consultation, which is free of charge and without any obligation to place an order.
You may have a beautiful stone which would look stunning in a complimentary setting, or an old piece of Jewellery in need of remodelling. Old broken gold rings can be melted down and cast into a completely new shape, such as an acorn.
When you have a special event to commemorate; when you are looking for that extraordinary gift with a personal edge to it, come for a consultation at the Karosa Jewellery studio. There is no obligation to order, and the whole process is free of charge. Usually a sketch is made for you within 48 hours, and any further work will then be charged for. Please don't hesitate to have a consultation - it might work out a lot less costly than you think!
Previous commission include pendants made with reference in the design to the local Forest of Dean, to incorporate leaves and acorns, a beautiful tree pendant, a logo for a local company, a bangle with meaningful words laser-engraved, sparkly earrings to compliment a wedding dress, a pair of studs inspired by a TV program to name only a few.
"Much of my inspiration comes from the surrounding forest as well as from ferns which seem to love my garden! Natural shapes and surfaces provide a never ending source of ideas for creating new pieces, which I develop using a variety of techniques to give different textures and finishes." Karin
"Adornment is never anything except a reflection of the heart." Gabrielle 'Coco' Chanel.


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Wrangler Men's Slim Fit Cool Vantage Cowboy Cut Jeans
Item # 013949
- Wrangler Men's Slim Fit Cool Vantage Cowboy Cut Jeans
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$49.99 Online Price
Additional Information
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Your favorite Wrangler jeans just got better! These Cool Vantage Cowboy but jeans are a step above with Cool vantage technology providing lasting and comfortable wear. The Cool Vantage Technology wicks away moisture 5x times faster keeping your body cool. The sweat control technology keeps your jeans dry in hot conditions while working and riding, and the cotton polyester fabric allow for ease of movement for the cowboys on the go!. Whether you are working riding or just relaxing these jeans will keep your cool and comfortable.
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The once-pristine Dirk Hartog Island off Western Australia is set to be restored with one of the most extensive feral animal eradications ever attempted worldwide.
WA Environment Minister Bill Marmion said the ambitious plan would involve the removal of introduced plants and animals, the rebuilding of populations of locally extinct wildlife, and the implementation of strict biosecurity measures to protect the island.
The first stage of the project could take 20 years or longer to complete.
Situated in the Shark Bay World Heritage area off the Gascoyne coast, Dirk Hartog Island was the site of the first European landing in WA in 1616 and became a national park in 2009.
Mr Marmion said it was one of the world's most important islands for mammal conservation.
"Almost 400 years ago the island was pristine and there were at least 13 ground-dwelling native mammal species," he said.
"In the past 150 years, the island has been used by pastoralists, recreational fishers and campers, and by the late 20th century, weeds, sheep, goats and feral cats were well established, leaving just three small mouse-sized native mammal species on the island."
Mr Marmion said the first phase of the project will include the removal of weeds, sheep, goats and feral cats.
"This will be followed by the introduction of at least 10 species of mammal that are locally extinct on the island, including the boodie, woylie, western barred bandicoot, chuditch, brush-tailed mulgara, dibbler, greater stick-nest rat and three mice species, as well as the banded hare-wallaby and the mala or rufous-hare wallaby," he said.
"The successful establishment of these animals will be a huge achievement for DEC (Department of Environment and Conservation) and further elevate World Heritage-listed Shark Bay on the international conservation stage."


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Perspective: 'All life is waiting'
DAMASCUS - Only her eyelashes can be seen in profile, fluttering obsessively like the wings of a butterfly. She is like her own striking, svelte Kaaba, surrounded by an ocean of pilgrims - full black elegantly draped chador over jeans and a discreet mauve pair of pointy shoes, full hijab, only the heavily kohl-rimmed eyelashes trying to decode the torn-down messages in Arabic script, and then the official's request for a pile of abstruse documents. Inevitably she has to sit down, like everyone else, in the antechamber of purgatory - the cramped, dingy room of the consular section at the Iraqi Embassy.
Her first words, when she breaks her silence, are "Waiting ... All life is waiting." Then her story shapes around familiar contours...
In a less harsh universe she would have been the female lead in a Hollywood tear-jerker - those kohl-rimmed eyelashes under the black-veiled face filling the screen, and the audience, with awe. In unforgiving real life she is just one more Iraqi refugee - one more whose story will never make it to the front pages of US corporate newspapers or be carefully re-enacted by glamorous Diane Sawyer lookalikes.
Read the rest at Asia Times


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As governmental attorneys, we often deal with cases involving death. Whether we are defending a Wrongful Death lawsuit against law enforcement officials or prosecuting a felony murder charge, we frequently come into contact with Coroners and Medical Examiners.1 Many of us may have spoken with a Coroner about autopsy results without analyzing whether such a conversation may breach the doctor-patient privilege. Surprisingly, there is no case law directly on this point in Illinois.
A hypothetical will help illustrate this issue: Bob is a hard-working and grossly under-paid governmental lawyer defending a civil lawsuit. Sue is opposing counsel. A Coroner is subpoenaed to testify at a deposition. Bob appears for the deposition, but Sue does not. After a reasonable amount of time, the court reporter is released, and Bob discusses the particulars of the autopsy with the Coroner while in the elevator. The Coroner mentions that the cause of death was arterial blockage secondary to diabetes. Bob grins. This directly contradicts the Plaintiff's theory of proximate cause. He now has his issue for summary judgment. When Sue discovers the "elevator conversation," she seeks sanctions against Bob for violating the doctor-patient privilege.
The analysis of this issue begins with the Privileged Communications-Physician and Patient Act (Privilege Act).2 The Privilege Act states that "[n]o physician or surgeon shall be permitted to disclose any information he or she may have acquired in attending any patient in a professional character, necessary to enable him or her professionally to serve the patient."3 The Act states several exceptions to this general rule, including: (1) homicide cases; (2) medical malpractice actions against the plaintiff's physician; (3) with the express consent of the patient; and (4) actions brought by the patient which put her medical condition at issue.4 The fourth exception applies to "all actions," encompassing both criminal and civil actions,5 though this exception can be overridden by confidentiality provisions in other statutes.6 For example, statements made to a psychiatrist during the course of an examination to determine fitness for a criminal trial can remain confidential.7 The Privilege Act extends to healthcare professionals other than physicians and surgeons.8
The exceptions enumerated in the Privilege Act are not unlimited; they must be read in concert with the Petrillo doctrine. This doctrine is named after Petrillo v. Syntex Laboratories, Inc.9 The doctrine states that ex parte communications between defense counsel and a plaintiff's treating physician are prohibited because such communications are contrary to the doctor-patient privilege.10 The doctrine can apply even when no confidential information is disclosed.11 Like the Privilege Act, the Petrillo doctrine applies to health care professionals other than physicians and surgeons.12 The doctrine limits the exceptions listed in the Privilege Act by requiring that the doctor-patient privilege can be breached only through the normal discovery methods authorized by the Supreme Court Rules.13 Ex parte communications are prohibited.14
The courts have explained that the public policy behind the Privilege Act and the Petrillo doctrine stems from two areas: the code of ethics which governs the conduct of medical professionals, and the fiduciary relationship between a patient and his physician.15 The physicians' code of ethics includes three prongs: the Hippocratic Oath; the American Medical Association's (AMA) Principles of Medical Ethics; and the Current Opinions of the Judicial Council of the AMA.16 The Petrillo Court observed that under these ethical considerations, the relationship between a doctor and patient remains viable only for so long as a patient can trust that his consent is required before the doctor will disclose medical information.17 For the second indicia of public policy, the Court cited cases from Illinois and other jurisdictions emphasizing that at the heart of a fiduciary relationship is trust, loyalty, and faith in the discretion of the fiduciary.18 In other words, the major public policy behind the sanctity of the doctor-patient privilege is to encourage full disclosure between a patient and her doctor.19
Obviously, the privilege (and the underlying public policy) is implicated only when there is a physician-patient relationship established between a patient and a treating physician.20 A physician becomes a "treating physician" when a patient seeks his assistance in the treatment or curing of a physical or mental illness or symptom.21 In at least one instance, the appellate court has held that a doctor-patient relationship is not established when a patient merely has a future appointment with a doctor that is not kept because of the patient's death, and the doctor has never examined the patient or reviewed any medical records.22
Our hypothetical scenario where a Coroner speaks to a governmental attorney about information gained during an autopsy has not yet been presented to the Illinois courts. However, the Michigan Supreme Court has ruled that there is no doctor-patient privilege involved in the performance of an autopsy.23 The Michigan Court relied upon their state statute setting forth the physician-patient privilege which is substantially similar to the one in Illinois.24 The Court stated that the purpose of the privilege is to protect the doctor-patient relationship and to insure that communications are confidential.25 The Court went on to find that applying the privilege to an autopsy would not further the purpose of the act because there is no communication between a doctor and a patient during an autopsy.26
The Michigan and Illinois laws and public policy are substantially similar on this topic. It seems logical that Illinois courts would rule similarly to the Michigan Supreme Court. As in Michigan, there are no communications between a doctor and a patient during an autopsy in Illinois. Therefore, it does not appear that upholding the privilege during an autopsy in Illinois would serve any public purpose.
Furthermore, a Coroner's status during an autopsy does not fit within the definition of a treating physician. The Coroner is not attempting to actually treat the decedent. Thus, this scenario does not involve an actual physician-patient relationship because there is no treatment involved. There is no public policy reason that the physician-patient privilege should attach to information garnered from an autopsy. For the same reason, the Petrillo doctrine should not be applicable.
Applying this analysis to our hypothetical situation, Sue does not have a basis to ask for sanctions against Bob. He did not violate the doctor-patient privilege or the Petrillo doctrine by speaking with the Coroner privately.27 The elevator conversation was appropriate, and it gave Bob an excellent chance to defeat the lawsuit on a motion for summary judgment.
As government attorneys, we should examine the public policy behind the rules that govern our unique practice of law. The doctor-patient privilege, read with Petrillo, identifies the importance of patients' candor with their treating physicians, but the privilege is not meant to protect post-mortem examinations. As with Bob, we should have the ability to speak with a Coroner to gather all the information necessary to properly defend or prosecute on behalf of the People. ■


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Viking Times
Löddeköpinge, Kävlinge (Skåne county), SWEDEN
Vikinga Tider ("Viking Times") is an archaeological open-air museum under construction in Löddeköpinge, Skåne county, in southern Sweden, and aimed to provide a faithful reconstruction of a Viking landscape with houses, farms, animals and everyday life as it could have been like a thousand years ago. The Löddeköpinge region is strategically located close to both Malmö and Copenhagen, in the middle of the attractive Öresund Region, one of Europe's most innovative and multi-cultural environments and rich in finds from especially the Viking Age.
The Vikinga Tider will be an interactive open-air museum as well as a working archaeology laboratory. The final project, once completed, will consist of two parts, the modern main building, "Fortress of Culture", and the 24 hectares reconstructed Viking Age landscape with a park featuring not only farms and houses, but the daily life of the whole community with pastures, meadows, animals, agriculture, handicrafts, trade and religion. Besides, also a stave church (a medieval wooden church with a post and beam construction related to timber framing) is being planned as a faithful reconstruction of one the two 12th century excavated stave churches on the site.
Today the Vikinga Tider has at its disposal a simple base camp with an information hall, office, gift shop, storage space and workshops. In connection with the temporary "base-camp" a small Viking Age farm is built with a longhouse, which is a reconstruction of a Viking farm from the 10th century in Skåne. The goal of the park is to tell the true story of the Vikings and to bring history to life by offering a first-hand live-in experience. The site hosts several cultural events, craft weekends, including the Archaeology Days and the annual Viking Market, the "Fröja Thing" (to find out more about the event please visit our dedicated page, click here).
Guided tours, day-trip programs, summer camps, historical crafts displays take place throughout the season. The site is also available for customized private and corporate events. Every year larger events are arranged, like Walpurgis Night and a Viking weekend. Lectures and school programmes are also a part of the current activities. Vikinga Tider can produce and package different experiences and products for visitors and supply learning activities that both stimulate and develop.
Info & Contact
Address: Ådalsvägen 18 - 246 36 Löddeköpinge, Kävlinge Municipality, Skåne County, Sweden
Tel.: +46 046706210 | Fax: +46 046712810
E-mail: email@example.com
Web: http://www.vikingatider.se
Facebook: https://www.facebook.com/VikingaTider
Image: VikingaTider
Text sources: VikingaTider
Löddeköpinge on Google Maps:
Experiencing the Archaeology Day at the VikingaTider in Löddeköpinge
Reconstructing a Stave Church