tv NBC Bay Area News at 6 NBC April 16, 2013 6:00pm-7:00pm PDT
of those who were unable to see the conclusion of the race here just yesterday. i want to say that boston is beginning to show signs of coming back. we are now one block closer, allowed to be one block closer to where the bombs went off as the investigation area, the crime scene area becomes smaller. live in boston, terry mcsweeney, nbc bay area news. >> okay, terry, thanks for the update. dozens of runners from the bay area flew to boston to participate in this marathon that included a martinez woman whose 11-year-old son was injured in the blast. nbc bay area's jodi hernandez is live in martinez where she spoke with friends of the family. >> we're just trying to get through this. >> reporter: katherine hern is just trying to keep it together as her 11-year-old grandson, aaron, remains in intensive care in boston. aaron was hit by shrapnel monday as he waited for his mother to cross the boston marathon finish line. >> they are just kind of stabilizing him and will go back in tomorrow and finish taking
care of the shrapnel injury. >> reporter: aaron was just six feet away from one of the blasts. his grandmother says he was so close, his hair was singed, and things were so chaotic, the ambulance took him away before his parents could process what had happened. >> after all that 26 miles, katherine ran, they had to walk from hospital to hospital to try to find aaron because they didn't know where he was. >> reporter: tonight aaron's classmates and teachers at martinez junior high school are heart broken and worried. students have started a collection to help the family pay for expenses. >> i'd like aaron to know that we miss him and i hope that he is doing well and we're thinking of him every minute. >> i've known aaron since he was 2. he was the welcome wagon when we moved in, so, you know, it's -- this isn't supposed to happen to people that you know. >> reporter: neighbor nicole is planning a photo shoot fund-raiser on saturday to help the family too.
aaron, his sister and parents are well known in martinez and well loved. >> he has our full love and support and thoughts and prayers. >> reporter: aaron's grandmother has been scrambling to book a flight to boston. she managed to do that today so she'll be flying out on thursday to be by his side. in martinez, i'm jodi hernandez, nbc bay area news. >> and stay with us for continuing coverage of the very latest on the boston bombings. our website, nbcbayarea.com is updated with the very latest information around the clock. right now you'll find a story about some specially trained dogs who are headed to boston to comfort the victims. search comfort dogs. and in 15 minutes, investigators aren't the only ones searching for answers tonight. children are searching for answers today. we're going to take a closer look at the difficult conversations parents are having with their kids about this tragedy. we have some breaking news to share with you. this comes out of the east bay. within the last 45 minutes, oakland police made a major announcement in the shooting death of a santa clara county
paramedic. five people are now under arrest for that crime. nbc bay area's cheryl hurd joins us live from the oakland police headquarte headquarters. i know you were at the news conference. it's the age of the suspects that seems to be catching a lot of people's attention. >> reporter: that's right. police chief howard jordan is very disturbed about that. and it's also ironic that this news of an arrest, five arrests, rather, would come out on the same day that quinn boyer was laid to rest in oakland. but this is what we know so far this afternoon. oakland police gang unit has been conducting surveillance on a group of juveniles they believe shot and killed paramedic quinn boyer. police chief howard jordan said during a news conference today that five suspects are now in custody. their ages range between 14 and 16 years old. boyer was shot and killed while driving his car on keller avenue and handsome drive on april 2nd, you may remember. his car careened into a ravine. sources say the car the suspects used in the shooting was carjacked from a liquor store
hours before the shooting. that car has since been recovered. police chief jordan says teenagers involved in heinous, violent crimes like this is becoming a trend and, he said, it's a trend that needs to stop. >> this is a disturbing trend that we've noticed here in this city. that far too often in the recent past we've noticed that the age of the suspects involved in many violent crimes, including robberies, have now ranged between 13 to 17. >> reporter: now, this case will soon go before the district attorney. now, police say that there were some admissions in this case. now, these juveniles, between the ages of 14 and 16 years old, will be charged with homicide, robbery and carjacking. police say it's too soon to determine if these youth will be charged as adults. in fact the district attorney will make that determination. reporting live from police head
quarter, i'm cheryl hurd, nbc bay area news. new at 6:00 tonight a state senator is asking governor jerry brown to shake up the lordship at the state's public utilities commission. the call comes less than 24 hours after the nbc bay area investigative unit uncovered a confidential internal document raising questions about the puc's commitment to safety. topekay kovaleski broke the story and the senator has called on the governor to hold someone accountable. >> reporter: in fact he's calling for change at the very top. this is clear ly a report the pc wanted to keep from the public. some admitting safety is not a priority at the puc, admitting working in a culture that fos r fosters cozy relationships with the utilities it regulates. >> that's outrageous and goes to the culture that the puc has, it goes to the leadership of the
public utilities commission. >> reporter: state senator jerry hill reacting to the information inside this previously secret, previously confidential report. >> it shows that the culture, that the issue of safety is sdp that has not been a priority. >> oh, my god, that is crazy. >> reporter: since the san bruno explosions in 2010, the puc's role and reputation have been challenged. >> multiple structures on fire and we have a fire ball still coming out. >> reporter: and now questions are coming from the inside. this report included interviews with high-ranking members of the puc and other members of the staff. page two includes this eye-opening quote. if we were enforcing the rules, we would not have to worry about a safety culture. it concludes if we were holding the utilities accountable and doing what we were supposed to be doing, san bruno would never have happened. the confidential document also says insiders identified an overly cozy relationship with regulated utilities, an accusation the executive director denied pack in 2011.
>> this is what i have to say to anyone who has that perception. it's wrong. >> now the puc has declined requests to discuss report on camera. in a written statement it said in part the report is the result of the informal survey. it is not an analysis of our safety culture or conclusions by our consultants, but a reporting back of what some employees said in informal focus groups. >> safety is by far their most important responsibility, and they have neglected that responsibility andclearly indicated by this report and what we saw in san bruno. >> reporter: responding to the details of this report, senator hill says the time has come to force change from sacramento. >> the governor needs to replace the president of the public utilities commission. >> reporter: senator hill says he will ask governor brown to remove puc president michael peevy. remove him from a job he has
held since his apartment in 2002 by governor gray davis. >> are you calling on the governor to make changes? >> if he wants. if we want, and we need the credibility and the integrity of the public utilities commission to be something that we can have confidence that they are protecting our interests, the only way that can happen is to change the top. that means changing the leadership. that means changing the president of the public utilities commission. >> reporter: now, referencing the report, the puc says it plans to use the results to help define what needs to change. we asked for an interview with puc president michael peevy to respond to the senator's call for his job. our request received no response. governor brown's office also declined to comment. now, we do expect comments tomorrow at the capitol. a special hearing into the puc, into that report and woe will be there. >> great work, tony. if you have a tip for our investigative unit just give us a call at 888-996-tips.
unraveling a mystery in the south bay. up ahead the coordinated acts of vandalism that knocked out 911 service in southern santa clara county and prompted a power alert. and i'm kris sanchez in san jose where three teenage suspects go to jouvenile court for crimes that seem very adult. what we know about the hearing today. also a change of plans for thousands of passengers. the glitch that grounded all american airlines flights across the nation for hours today. and we're wrapping up a breezy, cool day around the bay area with snow showers over the sierra and a few lingering showers in northern sonoma county. that cold air dropping our temperatures quick low this evening by 9:00 and, yes, by 11:00 already into the 40s and 30s by tomorrow morning. we'll talk about a winter chill back in the forecast when we come back.
a critical hearing today for three teens accused of sexually assaulting a los gatos girl, an assault her family says led to her death. we know the hearing took place. that may be all we ever know about it. nbc bay area's kris sanchez joins us live from juvenile hall in san jose to explain why. kris. >> reporter: hi there, janelle. there's almost nothing coming out of the juvenile court today except for a very stern warning about the importance of confidentiality in the case of the three young suspects accused of violating a classmate while she was unconscious last labor day. >> i can't confirm or deny that there's any specific juvenile hearings going on. >> reporter: by law none of the parties involved can discuss a detention hearing held this morning for the three teenage suspects accused of sexually assaulting 15-year-old audrie pott, because those suspects are considered minors. we do know that the pott family was present and that everyone was told by the judge that everyone needed to make sure no
details got out. a short time later, the family cancelled a planned interview with nbc news today. yesterday audrie's mother, father and stepmother announced they filed a civil lawsuit against the three teens, saying by sexually assaulting audrie while she was drunk last labor day weekend and showing pictures of the assault at school, they drove the 15-year-old girl to suicide. in addition to the civil suit, the family is pushing hard to have the teen suspects tried as adults. >> these types of crimes are not juvenile. sexual assault is an adult crime. these boys distributed the pictures to humiliate and further bully my daughter. >> reporter: today the family spokesman reiterated the issue of confidentiality. >> everything that happened in there has to stay confidential. that's all i can say, i'm sorry. >> reporter: i reached out to all of the suspects' attorneys. only one returned my call, saying that he believes that juvenile court is the appropriate place for this to be adjudicated. if eventually the court decides
otherwise, then these three teens are tried as adults and then everything will be public. if it remains in the juvenile court, then everything will be sealed, including the possible punishment. in san jose, kris sanchez, nbc bay area news. >> thank you, kris. grief counselors were assigned to a south pay school today after a first grader was killed in an overnight house fire. san jose fire investigators worked to determine what caused the flames to broke out in the city's japan town neighborhood. 7-year-old mariah gomez attended grant elementary. fire officials say the girl's great grandfather rushed in with a fire extinguisher and helped save her 4-year-old sister. the younger girl is hospitalized tonight and she did receive burns. we really don't know her condition. american airlines is blaming a computer glitch for grounding flights nationwide. the problem was with the airline's computerized reservation system. flights delayed and cancelled across the country, including at san francisco international airport. some people decided to get comfortable on the floor and wait out the issue.
a ma rock maraga couple said th going home and will try again tomorrow. >> until they get their systems back they can't start planning where they put people. so they stopped taking flights into their hubs, so they're not even allowing flights out of here to go to their destinations. >> american flies about 275,000 passengers a day. the carrier said in a statement that it saw no evidence the technical outage was in any way related to the deadly bombing in boston. the stones are rolling into town next week and today it was announced that sir paul himself will be making a visit. the lineup for the sixth annual outside lands music and arts festival at golden gate park in san francisco released today. headlined by former beatle palm mccartney, other bands include the red hot chili peppers and nine inch nails. some 200,000 people are expected to attend the festival which is
scheduled for august 9th. if you're interested, tickets go on sale at noon this thursday. >> too bad it's not this weekend because we've got some great weather on the way. let's check in with meteorologist rob mayeda. >> we're going to get a little summer preview of our weather by the time we reach this weekend but this evening it is cool and breezy once again. 58 degrees in san francisco. still mid-60s inland around fairfield, concord. almost everybody is seeing the same temperature right now, 65 degrees. but based on where you are you're seeing different winds coming into the north. there's cooler drier air which will settle into the inland valley setting us up for a cold night in the north bay. but a west wind in san francisco bringing marine layer air over towards oakland. gusty at the airport, west at 28 miles an hour. that will ensure that the inner bay will see temperatures in the 40s to near 50. inland, a different story. we've been watching those showers in the sierra which has been dropping a few snow showers
at times around lake tahoe. notice how things are calming down as the sun sets. the atmosphere begins to stabilize. these showers will begin to decrease, including the few we've been watching around lake county this afternoon. so mainly cloud-free tonight. even along the coast some patches of low clouds. as we head along tomorrow morning, these clear skies will lead to temperatures mainly in the 40s and some 30s as you head further inland. 40s around the inner bay but look at the 30s showing up around live more and up towards santa rosa, down towards morgan hill. some of the cooler spots tomorrow morning so you definitely need the jacket for the morning. now we're getting closer to t-shirt weather by the afternoon. 70s foinally coming back to the bay area. and by thursday and friday, these numbers you see behind me may jump by 10 degrees. 80s coming back in your seven-day forecast. we'll have a look at that coming up in our next half hour. back to you. >> thanks, rob. some finished, but some could not. still ahead, why boston
the youngest victim of the boston bombings was a third grader who lived in the city. he had just gotten an ice cream and was near the finish line watching for friends to run by. martin richard was only 8 years old. his mom and his 6-year-old sister are still hospitalized. neighbors say the sister had one of her legs amputated. outside the family home, someone had written the words peace and shock and set a candle on their front step. the boy's father released a statement saying, quote, my dear son, martin, has died from injuries sustained in the attack on boston. we thank our family and friends,
those we know and those we have never met for their thoughts and prayers. the bombing in boston has left people of all ages with questions, especially the young ones. many parents are struggling to explain to their kids how an innocent sporting event could turn to tragedy. joe rosato jr. has more from one expert. >> reporter: the imannuges of t blasts striking tragedy at the boston marathon play over and over. pictures of the injured and the aftermath have shaken people across the u.s. and beyond. christey's 9-year-old twin boys haven't yet seen those images, still they know something is wrong. >> i think they overheard something yesterday and they were like there was a bombing? yeah, there was a bombing in boston. >> the bombing took sara back to the day of the newtown shootings when she grappled with how to explain to her sons what had happened. like yesterday, cherry picking information they would hear. >> we really try to focus on the positive from it. look at what good is being done
from that and people that are going to help the situation. the people that are stepping up now after the situation is over. >> i think you let children know that people do get hurt in the world and people can help one another heal. >> reporter: parenting expert and author patty whipler says following a tragedy like the one in boston, it's important to give children a sense of security. she says many kids will feel anxious and fearful. it's important to answer their questions. >> i think what we want to say to our children is when you're scared, come here. come tell me. i'll help you. >> reporter: she says parents should first sort out their own feelings before talking to their children. >> it doesn't mean we can change the conditions. it means we can change what's going on inside our children, so they can use what power they have to encounter the scary things. >> reporter: sara doesn't think parents need to share everything about a tragedy with their kids, though some things can't be
ignored. >> i think we can't put them in this situation or make them think that it's a fairy tale world, because it's not. >> marathon runners who weren't allowed to finish yesterday's race returned today to claim their medals. race organizers honored all runners with the coveted memento after yesterday's explosions prevented hundreds from the chance to earn it at the finish line. to many, this medal means a lot more than just completing a 26-mile race. >> it's a badge of courage for sure. our coverage of the terror in boston continues after the break with a live report from our own terry mcsweeney. also coming up, investigators are calling them acts of vandalism. we'll show you how the attacks put public safety in jeopardy in the south bay. and the new store that's giving downtown san jose an economic boost.
the search for answers tens in boston tonight. >> federal agents say the range of suspects and the motives remain wide open in tuesday's bombing. more than 170 people were wounded, many of them still hospitalized tonight. three people died, including that 8-year-old boy we told you about just a short time ago. a second victim of the bombing has been identified as 29-year-old krystle campbell from massachusetts. her mother spoke to the media today. >> we're heart broken about our krystle marie. she was a wonderful person. everybody that knew her loved her.
>> that poor woman's pain is so palpable. many bay area families have also been affected by this horrific tragedy. for more on that we head to terry mcsweeney who joins us live from boston tonight. terry. >> reporter: yeah, the people here in boston trying to figure out a way to deal with their grief after yesterday's attack, which hit many of these people very personally. and right now on the street where the bombs went off, we have this memorial with flags and signs and candles. it's not just the people of boston, it's people across the country, including some people from northern california who came out here for the boston marathon. we're talking about the cortains of chico. >> when he handed me the bottled water, that's when the explosion went off. my fellow runners turned around and saw the smoke and thought what was that?
>> reporter: her husband was at the finish line waiting for his marathoner mate. >> i was probably about 100 yards away when the first bomb went off and about 50 yards away from the second bomb. and at that point kind of the first thing that clicked in was cindy is somewhere near the finish line, i didn't know where. i started running, you know, towards the bombs, towards the finish line. and going in and out because a lot of areas were cordoned off so you couldn't get through there. that's when i came upon a lot of people hurt. got to where i thought she would be and we couldn't find anybody. there was a real kind of lack of communication at that point. about a half an hour later she was finally able to get to her cell phone and she texted me and said i'm okay. >> reporter: is this going to change anything that you do? >> how i look at life. will it change my running or anything? i'm already talking, i'm planning on coming back next year. can't let them win. >> reporter: you're looking at a
live picture of the people who have come out to this memorial on boylston street. again, the very street where the bombs went off just yesterday. as we look down boylston street, we are getting closer and closer as they move these barricades further and further towards the scene. that bright light down there, those lights are shining right on the area where the bombs went off. the investigation goes on. the crime scene is still huge. not as big as it was even this morning during the 11:00 a.m. news this morning, we were a block that way and there was also a barricade down that way, so things are beginning, beginning to return to some kind of normalcy for the people here in boston. live in boston, terry mcsweeney, nbc bay area news. >> terry, you talk about normalcy and you see that memorial, but are people still walking around stunned, dazed or do people still feel frightened? >> reporter: it is a -- i would say it's a very obvious sign, the look on people's faces. there's also still a lot of
people here who ran in the marathon. you can tell because they have these blue jackets that you could buy if you were registered for the marathon. you see them around. we just had a couple come over here, put down a sign in memory of those who died and they were hugging each other and flat out sobbing. i went over to see if they wanted to share their story, talk about the person or persons they were grieving for and they just shook their head and walked away, arms tightly around each other. >> such an emotional day there. our hearts go out to all the victims. terry live in boston, thanks so much. >> so many raw emotions there. well, around the nation, police are still on high alert, but secretary of homeland security janet napolitano said there's no evidence that the bombings in boston are connected to any type of broader terrorist plot. steve handelsman is in the nation's capital where an annual event like the boston marathon that's coming up was not coming up. >> reporter: right, jess, thanks, good evening. i think a lot of people here in the nation's capital and a lot
visit here like a lot visited in boston this week had the attitude of that young runner from chico, california. can't let them win. and so there were people on the streets here. now boston has dominated in a way what lawmakers are talking about on capitol hill, but lawmakers and ordinary life here in the nation's capital has gone on. in washington, the annual emancipation day parade went off safely. lots of cops everywhere. >> good to see a good police presence. >> reporter: trash cans were tipped over and secured. >> i feel pretty safe. i do. >> reporter: big issues like gun control are out of the spotlight. gabby giffords understands. the horrifying attack dominates the nation's attention, but pulls americans together. this was the chicago tribune, solidarity from one sports mad city to another that's in pain. citing how bostonians rushed in to help the injured.
president obama sent a message of solidarity and defiance. >> you want to know who we are, what america is, how we respond to evil? that's it. selflessly, compassionately, not afraid. >> reporter: the president's national security team told him today there's no evidence of a broader plot beyond yesterday's attack that he's calling terrorism. >> any time bombs are used to target innocent civilians, it is an act of terror. >> reporter: u.s. intelligence did not detect the terror planning, says a lawmaker. he got an intel briefing last week. >> and there was no evidence of this at all. no intelligence that seemed to be out there. >> reporter: the top senate republican was critical. >> i think it's safe to say that for many, the complacency that prevailed prior to september 11th has actually returned. >> reporter: today, nervousness returns. false alarms at la guardia, boston and cleveland's airports.
suspicious packages. reassurance from new york's mayor. >> we won't let the attack in boston keep us from our normal, daily routines. >> reporter: and most americans, seem to agree. >> reporter: two quick things. you heard that criticism from the top senate republican, mitch mcconnell, who complained of complacency. seen here by some democrats as a finger point at the obama administration. it was answered by california senator dianne feinstein who said in effect, wait a minute, there have been lots and lots and lots of terror plots since 9/11 thwarted by federal officials. this is not the rule, whatever happened at boston. point two, gun control suddenly will lurch to the forefront here in washington, pushing boston at least in this town off of front runner. the big vote on the post newtown gun control measure due, and this is a surprise, tomorrow. from the capital, i'm steve handelsman, nbc bay area news.
>> we'll be watching that closely as well, thank you, steve. today we learned more about the makeup of the bombs used in the attacks in botch. they're called pressurer cooker bombs. explosive material that's packed inside a pressure cooker and then set off. inside the bombs were nails, bb bullets, ball bearings and shards of metal that were spewed into the crowds when they exploded. this type of bomb is seen in afghanistan, india and pakistan. an al qaeda magazine recently published instructions on how to make one. investigators say the bombs were hidden in black duffel bags. in the wake of the bombings in boston, the police department says it is taking the precautionary measures. they are increasing security at san jose sharks games this week. a canine unit will do a bomb sweep of the arena prior to all games. officers at the san jose airport have been placed on high alert and provide uniformed presence. our coverage of the terror in boston continues throughout this newscast and online at nbcbayarea.com.
it is updated around the clock. two disturbing acts of vandalism are under investigation in south san jose tonight. one of them involves gunshots that then led to a massive oil spill at a pg&e transformer. the other knocked out 911 service. tens of thousands of phones in gilroy and other parts of the county. it now appears that the two attacks may be linked and that has sheriff deputies asking some very troubling questions. arturo santiago spoke with the santa clara county sheriff and he joins us live in south san jose. what did you learn? >> reporter: well, we did speak with santa clara county sheriff lori smith less than two hours ago. her investigators now believe that these two acts of vandalism are related. here's how it played out. just after 1:00 this morning, the 911 system in gilroy and others in south santa clara county communities stopped working. a short time later gilroy's residential phone systems stopped working. at&t found the problem at around 7:00 a.m. several manhole covers had been
broken into and critical fiber optic wires had been cut, but they couldn't do anything to fix it. that's because just after 3:00 a.m., pg&e reported someone had broken through a fence and vandalized a utility substation in the same area. specifically someone used a high-powered rifle to shoot several holes in a pg&e transformer, starting a massive oil leak. >> we believe that the perpetrator or perpetrators were familiar with systems. they knew where to go for the fiber optic. they knew where to cut. they also were able to take out some very, very critical parts of the pg&e substation. >> reporter: now, the cut phone lines and the pg&e substation are within half a mile of each other. it took at&t crews more than nine hours to reroute 911 land line service and they say full phone service may not be completely restored until tomorrow morning. let's bring you back now to a live picture and one more note.
monterey road was shut down here at metcalf for the investigation. it caused a pretty big backup. then just a few minutes ago, they opened one lane of monterey road and that relieved all the traffic that had been building up. still, drivers are being asked to avoid the area. we're live in south san jose. i'm arturo santiago, nbc bay area news. well, he was the first enduring image from the boston bombings. coming up you'll hear from the runner that millions saw collapse as the world got its first look at images of the actual blast. >> reporter: i'm scott budman with a big and rare retail presence in silicon valley. coming up, the japanese giant drawing big crowds in san jose. and we watched a pretty nice day around the bay area, a little on the windy side. temperatures in the upper 60s and a few low 70s outside today, but ahead, we do have some warming changes ahead as high pressure starts to build in. temperatures getting close to 80 in your seven-day forecast. a look at that when we come right back.
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one of the most enduring images from monday's bombing is the runner this falls when the explosion depose off. watch the runner in orange on the right side of the screen. he collapses as the blast goes off. he is 78-year-old bill iffrig and he was only 100 yards from finishing his third boston marathon. >> this tremendous explosion, sounded like a bomb went off right next to me. the shock waves just hit my whole body. >> despite that dramatic fall, bill says he scraped his knee but that he got back up and he
was able to cross the finish line. >> so many brave people out there. let's get a check of our forecast. a little windy today. >> before warming we have to go through a little winter chill. we've got the breezes out of the north. you can see it moving the flag there. clear skies tonight setting us up for chilly temperatures, but 80s in your seven-day forecast. we'll have a look at that when we come right back. look at them kids. [ sigh ]
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a retail success story in the south bay after a long dry spell without much success. >> our scott budman did a little shopping today at the opening of san jose's newest big store. >> hey, how's it going? >> reporter: as soon as the door opened, it was clear silicon valley has a new hit on its hands. the register was busy all day at the newest muji store, a
japanese import planted in downtown san jose that has local shoppers buying in. >> well, i definitely save a lot of time, you know, driving up to sf is pretty far, you know. so yes, it's convenient for me and my friends. >> so when i heard muji was coming to downtown san jose, i just live over there in one of the high rises. i thought this is so cool. when i first moved to san jose in '82, it's kind of a dump. now it's great. this is really cool. >> reporter: with its inexpensive mix of clothes and products for your home, muji fits in well with the college and young tech crowd. this is only the third muji store in the u.s., and a lot of thought went into putting it here. >> we offer everything from stationary, clothing, housewares, and they're all simple designs that can fit into any kind of lifestyle for any age range. >> reporter: which makes san jose city leaders, who have struggled with downtown retail
in the past, very happy. >> this is fabulous because muji appeals to modern, urban people who want to buy housewares and clothing and stationary, things we need in our regular lives. >> reporter: a new shot in the arm for an area that could use it. and it's worth mentioning that in addition to new shoppers, muji expects to bring in new jobs for the downtown san jose. the owner of the store told me earlier today that if the success continues, he expands -- plans to expand even more here in the bay area. reporting live in downtown san jose, scott budman, nbc bay area news. >> thank you very much, scott. let's turn things over to rob mayeda. i hope some of the people at the muji store bought some shorts. >> yeah, shorts weather coming our way by the end of the workweek. outside right now mostly 60s except closer to the inner bay in san francisco where you've got that stronger sea breeze, 58 degrees. mid-60s from oakland over towards livermore. notice the wind direction, in
off the ocean across san francisco, but a cooler, drier wind out of the north reaching into fairfield and the north bay valleys. those locations as the air dries out and enclosure skies overnight, that will allow our temperatures to dip maybe into the 30s tonight. 40s elsewhere for inland valleys. a little warmer for tomorrow. as we get towards thursday and friday, that's when you'll see the temperatures start to climb on up as the winds start to back off. today snow in the sierra. still ongoing around interstate 80 and lake tahoe. that should subside as the sun sets. as high pressure builds in, it will give us clear skies at times but thanks to northerly breezes, we shouldn't see much in the way of low clouds tomorrow morning, which means by the way we'll see clear skies into tomorrow afternoon but set us up for a chilly start for the day tomorrow. we're looking at 30s in our inland valleys, a little colder than we saw this morning. san jose close to 40 degrees. down towards gilroy, livermore and up to the north bay around santa rosa shall those will be
some of the coldest spots tomorrow morning. the afternoon looking a bit boerm warmer than the -- 75 degrees in pleasanton and low to mid-70s out towards fairfield. over to san francisco, not much warming just yet. we're still in the mid-60s here but even the peninsula and over to oakland, you're going to get those numbers climbing into the 70s by the end of the week. north bay should see those numbers in the mid-70s by tomorrow. so just a slight warmup. cold start to the morning. the morning temperatures will be a bit more mind as we wrap up the workweek and temperatures continue to climb as we approach the upcoming weekend. it does look like the warmest days will arrive just in time for those weekend plans. if you're going to head out to the beach, this is the weekend to do it. we'll see the numbers into the 70s and maybe even mid-80s on monday. so you said shorts weather. beach weather too. >> hope muji carries swimsuits too. thanks, rob. let's get to sports.
jim is in the newsroom and we are going to talk about baseball first. hi, jim. >> reporter: hey, ladies. that's the way to start it. let's do it with the world champion giants because they began the day tied for first in the nl west with colorado. after the giants took three of four on their current road trip. after a day off, they're back at it tonight in milwaukee, which is actually pronounced milwaukee, which means the good land. for the highlights. giants/brewers. bruce bochy celebrating his 58th birthday. both teams wearing the number 42 on this day in honor of the jackie robinson day monday. pablo sandoval doubles into the gap. pagan and scutaro come on around the bottom of the third, tied at three. a single up the middle. two brewers score. they lead 5-3. in this game right now,
switching gears a green and gold bit of news. scott size more underwent successful acl revision surgery on his left knee this morning in pensacola, florida. sizemore, who injured his knee on april 9th dpeagainst the ang not expected to play again during the 2013 season. major league soccer has suspended earthquakes forward allen gordon for three games. he was also fined for using unacceptable language against an opponent last sunday against the portland timbers. the commissioner saying that he also has mandated that gordon attend adversity and sensitivity training. a familiar name will once again grace the 49ers practice field. nate montana, son of hall of fame joe montana, scheduled to be aiming to be the draft eligible -- let's get through this players working out for the 49ers koechcoaches and scouts o
wednesday. good luck to him. we move it story. espn reporting that former cal receiver keenan allen was red flagged for a drug test at the nfl combine in indianapolis. one source said allen had high levels of water in his system. however, allen's agent said the story flat-out wrong. allen, one of the top if not the top wide receiver in this year's draft. to the fight games. robert "the ghost" guerrero held a media day today. the gilroy native who once postponed his boxing career to help his wife, casey, battle leukemia, spoke about the numerous channel engz floyd and mayweather present inside the ring. >> people say you need an a, b, c game plan. with floyd you need an a to z game plan. i'm ready to go, man. i'm excited. worked hard for this. worked hard to be in this
position. god blessed me with a lot and i'm ready. i had the right fight to be here, built up the right way so i'm ready to go. i'm excited for this. >> and a lot coming up tonight at 11:00. sharks hosting the kings down in san jose, highlights. a's and astros coliseum highlights. giants highlights and more. that's all tonight at 11:00. guys, back to you. >> jim is going to be very busy this evening. >> yes. >> for a full half hour of bay area sports coverage, watch comcast sportsnet at 10:30.
believe that homosexuality is a condition that can be fixed. california has just become the first state in the nation to pass a law banning so-called gay conversion therapy. now, that law will be challenged in federal court tomorrow. tonight, though, we speak with people who have undergone the procedure. some say they were converted. others say it made them want to commit suicide. >> yeah, i was suicidal by the end of the time that i spent doing this. >> i felt freer too when i finally got rid of my shame of having homosexual feelings. >> tonight we're going to show you what impogoes on in convers therapy sessions. that's at 11:00 tonight. rob is here to talk about the warmup coming this week. >> in the meantime we've got a little cooling tonight. you'll notice it tomorrow morning as the showers shut down over the sierra, this will open the door for high pressure, which will lead to warming ahead. that should start to kick in a little bit tomorrow. you'll see those numbers climbing into the low 70s inland on wednesday, but really it's the thursday through monday part of the seven-day forecast you
really see the warming kicking in. mid-80s in some of our warmest spots by the beginning of next week. a little chilly in the meantime but it looks really nice to head out to the coast this weekend. >> thanks, rob. that's going to do it for us. we'll see you tonight at 11:00. >> good night. bye-bye.
>> i am maria menounos in boston right now on "extra." >> terror at the marathon. the angelic 8-year-old killed trying to hug his father at the finish line. the runner that was knocked to the ground but determined to finish the race. the hero in the cowboy hat that rushed in to save lives. "extra" on the ground with the incredible survivor story.
>> he got my wife and kids to safety. >> then the manhunt for the mastermind behind the attack. >> we will find whoever harmed our citizens. >> "extra" with matt lauer reporting from the scene today. >> the chaos was very disturbing. >> the man who captured the first blast on camera. >> this is not an accident. this is something that's gone horribly wrong. >> i was here in boston near the finish line when i heard the explosion. i will tell you what it was like in the middle of all of that chaos. >> everyone from conan to ben affleck to mark wahlberg. > tom bergeron in tears, his wife and daughter in boston when the bombs went off. now from boston here is maria menounos. >> i am back in my hometown where a massive search is
underway for the terrorist behind the attack. people are in total shock today. >> i can't get this video out of my mind, the moment the bomb went off. today we will talk to the man that shot it. first we have to talk about the im. ing herois >> so many more could have lost their live it is without the elpers and e.m.t. workers. >> the face of heart drth break. the face of determination. the president vow to hunt down the killers. >> we will take time to follow every lead, but we will find out. >> "extra" in boston with the story behind the faces, their triumph and tragedy. 8-year-old martin richard frozen in time in photographs, being remembered as a boy that loved to run and climb. he had just gotten ice cream and was cheering


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Only Ever You by Rebecca Drake
A mother loses her child for 45 minutes...only for her to be taken again three months later. Soon, the parents become the prime suspects. The whole book was suspenseful with many twists and turns. Every time I thought I had the story figured out, it surprised me. If you love psychological thrillers, this is a great read.
The Girl Before by J.P. Delaney
I only read this book a few weeks ago, but it has stayed with me. I've mentioned before I think the best kind of thrillers are the kinds that you can't say much about without spoiling it. This thriller is GOOD. It's insanely twisted and just when you think you know what's going on the author says HAHA and throws another plot twist. It alternates from the girl before (Emma) who was killed in the house the current girl (Jane) is renting. There were a few uncomfortable moments, but the ending really sealed the deal for me. If you love thrillers, you have to get your hands on this one!
Honorable Mention: Find Her by Lisa Gardner (review here)
Swear on This Life by Renee Carlino
It's been a long time since I've felt this emotional while reading a book. I knew Renee Carlino could write after reading Before We Were Strangers, but this book is a million times better. The story captivated me from the first page. Emiline, a creative writing professor living in San Diego and struggling with her own writing, is recommended a debut novel from J.Colby. From the first page, Emiline realizes the novel is written about her by the boy who was everything to her growing up...who she hasn't seen in 12 years. The past and present is intertwined perfectly with a book within a book format. As you read the book with Emiline, you get to see Emiline and Jase's love develop, and you truly feel all the pain Emiline experienced growing up. The book absolutely consumed me-I could think of nothing else until I finished. It's not perfect. There were several things that bothered me, and the ending felt a bit rushed, but it's five stars for me based on how emotionally invested I got and how much I want to tell everyone I know about it.
It Ends with Us by Colleen Hoover
I have always wanted to read a Colleen Hoover book. In fact, I have several of her books that have been hanging out on my Kindle for years waiting to be read. After reading It Ends with Us, I think I need to move them up higher on my list. I went into this book not knowing much about it. I thought it was just a love story. It's not just a love story. It's beautiful, heartbreaking, raw, and truly eye-opening. Even before I got to the Author's Note, I could tell the author had experience with the topic from the way it was written. I started this book blindly, and I don't want to give anything away because I think that's the best way to read it. You go into it not knowing anything and come out shaken by this powerful read.
The Royal We by Heather Cocks and Jessica Morgan
This book was such a guilty pleasure! I like the royal family, though I didn't know much about Kate and William's love story (I knew they met at St. Andrews, and it took him a while to propose). Of course, I had to look up more of their story while I read The Royal We, and this novel does loosely follow the same timeline. I really thought this book was fun. As much as I liked Bex and Prince Nick, I thought the supporting characters really made this story. It was longer than I expected, but I didn't really mind. I was in the mood for this kind of novel, and I'm glad I read it.
Honorable Mention: The One You Really Want by Jill Mansel (review here) and One True Loves by Taylor Jenkins Reid (review here)
Best World War II Historical Fiction
I usually read a lot of World War II historical fiction, but this year I only read five books. Thankfully, they were all good!
Karolina’s Twins by Ronald H. Balson
I love Ronald H. Balson's writing. Last year, Saving Sophie was one of my favorite reads of the year, and I liked Karolina's Twins just as much. Lena's story of her life during World War II and her current search for the twins was beautiful and heartbreaking. I guessed the big "twist" early on in the book, but that didn't detract from the novel. If you're a fan of World War II historical fiction, this one is a must read!
Lilac Girls by Martha Hall Kelly
Even though I've read a lot of World War II historical fiction (and non-fiction), I feel like every time I pick up a WWII book, I learn something new. I had never heard of Caroline Ferriday and barely knew anything about the Ravensbrück "Rabbits." The thing that stands out to me about this book is a decent chunk of the story occurs after the war is over. It was interesting (and heartbreaking) to read a book that truly how difficult it was to glue a life back together after such unimaginable trauma. If you are a fan of WWII historical fiction, I think Lilac Girls is worth a read.
Best Other Historical Fiction
A Fine Imitation by Amber Brock
(c/o Blogging for Books)
I was surprised by how much I liked this book. Alternating between Vera's senior year at university in the 1910s and her socialite life in the 1920s, A Fine Imitation really portrays why there is more to life than money. Even though she has everything she could possibly want, Vera is terribly lonely until she meets Emil Hallan, the artist invited to paint a mural in the pool room of her building. As they begin to get to know each other, Vera begins to question whether her life of privilege is worth being miserable. It's written well, and both timelines were woven together beautifully at the end.
Honorable Mention: The Winemakers by Jan Moran (review here)
Best Books That Don’t Fit a Category
Dark Matter by Blake Crouch
I think it's almost impossible to review this book without spoilers, so I'm going to be super generic. Jason Dessen is kidnapped one day heading home from the bar and wakes up in a totally different life. This book sucked me in. It's intense and overwhelming at times (the physics parts weren't my cup of tea). I thought the twist was unique, and the ending was interesting.
Valley of the Moon by Melanie Gideon
This is the best time travel book I've ever read. It's a love story, but it's so much more than that. It's a coming of age story. A story about second chances, of feeling stuck and fighting to get out of it. It's slow at first but gets so much better. I loved all the characters. I don't usually tear up while reading, but this book got me. It's truly beautiful.
No Ordinary Life was a fascinating account of how sudden child stardom affects the child and the rest of her family. Molly is discovered after a viral YouTube video, and her mother Faye becomes her manager while still being a mother to her two other children and dealing with a broken marriage. I loved the behind the scenes look of making a television show, and Faye and Molly were both great characters. No Ordinary Life hooked me in from the first page, and I couldn't put it down!

domain: library


I could have easily made this a 30 or 40 or 50 Greatest Fictional Weapons of all time list but I didn’t. While I may double up on a couple of them making it more than the 25 it’s more for parallel comparison than adding to the number. Above is the Lancer from Gears of War. This chainsaw adorned assault rifle is a beast in its games and gets honorary mention here. This isn’t a list ranking weapons though. This is an accounting of just a few I picked from movies, comics and video games. So in no particular order I give to you part 1 of Fizmarble’s, 25 of the Greatest Fictional Weapons Ever.
Not to be confused with the Sword in the Stone, Excalibur is the blade given to King Arthur by the Lady of the Lake. It was given to the king to be his weapon against those who would do great evil against him and his people. Where as the Sword in the Stone was a symbol showing who the true ruler of Britain would be, Excalibur was the blade of legend that would enforce that title.
While much of Batman’s arsenal could be included in this list it’s his Batarangs that are the most notable. Working as ninja stars, knives and boomerangs these razor sharp ranged weapons can be used to incapacitate, remove weapons from the hands of criminals or stop them in their tracks via expertly placed throws in their escape paths. Batman doesn’t use guns but he has found a worthy alternative.
Star Trek Phaser
The go to weapon of choice for Star Fleet personel this handheld pistola of sorts can stun you or cook you depending on its setting. They can even be set to overload for a last ditch explosive effort. They build up a force-chamber explosion by continuously generating energy without releasing it; the resulting blast can destroy most natural objects within a 50 meter radius. seeing as how the ship phasers can blast through asteroids these mini-versions are nothing to scoff at.
The Hammer of Dawn
While the Lancer is a standout Gears of War weapon my vote goes to The Hammer of Dawn. If I had a chance to use it I most likely would. That little gun above may not seem like much but it is used to paint your enemy. Point, shoot and keep on your target and the oribital satellite on high will let loose with an Imulsion energized laser leaving nothing but a hole in the ground. A really, really big hole in the ground.
The 1835 Colt Paterson revolver, usually referred to as “the Colt”, was made by Samuel Colt for a paranormal hunter. According to legend, anything shot by this gun, using one of its thirteen original bullets, will die, including creatures normally immune to any and all weapons. On Supernatural Sam & Dean Winchester have used this weapon to kill many an aspect of evil but it was lost after a trip to the past. That whole past thing though…it has a way of finding you.
Before he was a tank in the movies and games, Megatron would transform into a gun far smaller than one would expect. Usually fired by Soundwave he would let loose with highly destructive blasts of concentrated energy that one can only assume used a combination of Energon and Megatron’s own anger as ammunition.
The Proton Pack
The Proton Pack, designed by Dr. Egon Spengler, is a backpack-portable particle accelerator system that is used to create a charged particle beam – composed of protons – that is fired by the proton gun or neutrino wand. Described in the first Ghostbusters movie as a “positron collider”, it presumably functions by colliding high-energy positrons to generate its proton beam.
It was believed that Wolverine’s claws were additions made to him during his time in the Weapon X program. It later came to light that they were a part of his initial mutation and all Weapon X did was make them more dangerous. These 6 blades (3 for each hand) are coated in unbreakable Adamantium as is the rest of Wolverine’s skeleton. By using certain muscles of his forearms he is able to “pop” these claws much like a cat does and once they lock in place they will not budge until he retracts them. These claws are synonymous with Wolverine and have done more than their fair share of damage over the years.
The Point of View Gun
Created for the Hitchiker’s Guide to the Galaxy film by Douglas Adams himself, The Point of View Gun was commissioned by the Intergalactic Consortium of Angry Housewives, who were tired of not getting through to their husbands during arguements. One blast from this weapon and all gripes and grievances are dealt with leaving you more time to ponder the answer to life, the universe and everything.
The Noisy Cricket
This little guy hails from the Men in Black series. It fires a powerful orb of destructive energy but has one hell of a kick. Noisy Crickets are deliberately given to rookies, and bets are taken on how far the rookie will fly as a result of the gun’s recoil (a practice discouraged under MIB’s ‘No Hazing’ policy).
The BFG & The Redeemer
These two I place here in tandem due to their similiarity and destructive properties. The BFG 9000 known more commonly as the Big F@#$ing Gun or Bio Force Gun in the Doom movie shoots antimatter resulting in an instant kill if a direct hit is made. The Redeemer from the Unreal games is a portable thermonuclear warhead launcher. The Redeemer’s missile causes a gigantic explosion, the shockwave of which vaporizes players instantly. The secondary fire launches a guided nuke which the user can pilot remotely, via an onboard camera. While guiding the missile, the user can see only the missile’s point-of-view and is thus unable to see what happens to his/her player. M-m-m-m-monster kill.
A Green Lantern Ring
Quite possibly the most powerful weapon in the DC Universe the rings of The Green Lanterns form whatever the wearer can conceptualize from their imaginations into green energy constructs. Fueled by the great central battery and directed by sheer willpower these rings are both limited (in overall energy expenditure) and limitless (the potential in what is able to be created and the capability of its creator). On the hand of someone like Hal Jordon it is a tool for great good. On someone like Sinestro it could be used for something far darker.


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Most people who have an ‘acceptable’ looking set of teeth that need to be replaced usually like the replacement dental implants to be put in on the same day they have been taken out.
It’s perfectly understandable to want your teeth replaced on the same day. Missing teeth is a common source of lowered self-esteem and can make people feel self-conscious.
One way you can have your teeth replaced on the same day is through a process called an immediate denture. An impression will be taken two weeks before the planned tooth extractions. The dental technician will then estimate the position of your gum after your teeth have been taken out.
In this type of procedure, the bone and gum can significantly change shape and shrinks for the first three months after extraction, therefore that type of denture never really fits perfectly and you usually end up needing a new one after a few months
The other, more advanced method is referred to as ‘All-on-4’ or ‘All-on-6’. This is a dental implant treatment where we restore all, if not most of the teeth. Implants are placed with the help of a digitally-planned surgical guide. The technician adjusts a denture-like restoration that has already been prepared in just a couple of hours and is then permanently attached.
Since it is fixed, you don’t have to remove it. You walk out of surgery with great looking teeth as well as having your confidence restored!
Unsure about your dental health? Call your nearest Synergy Dental Clinic and we’ll be happy to help.

domain: medical


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Michaeal Jackson - No more
Description: It may be very hard to belive that pop icon MJ or Micheal jackson is no more. Entire world seems to be moaning on this man who has rags to riches story to be told for any person to be successful. Even our own Bollywood stars like Mithun chakravarthy,Prabhudeva, Hrithik roshan seems to have inspired from him and who can forget bappi lahiri copying his tunes and acheving his status in bollywood. So all movie lovers please express this gratitude by your favorite MJ songs and why.

domain: artistic


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Welcome to our July Blog Hop featuring Summer Themed projects. To purchase any of the items seen in our blog hop today, contact your local consultant to place an order.
We hope that you will take the time to leave comments on our posts, as we love to get feedback from our viewers....whether it was something that you really liked or some new technique that was used that you would like to learn how to do....by leaving us comments, we get to hear what you like, and what you want to see. Thank you… now on to our hop!
If you have just hopped onto my blog, you can start here as this is a circular hop,and I'm the first stop. If you came from Corinna's Blog then you are in the right place.
I've been asked to create some summery themed cards to sell at a local stationary store for the tourists, and these are 2 cards that I've completed for them. Unfortunately, I had to use these cards which are using retired stamps and paper, as my order did not arrive in time for me to complete my layout that I've been working on.
Your next stop on the Cross Canada Hop is Nicky.
If you get lost along the way, you can come back her, I've got the list here for you.
Thanks for hopping along with us - we hope we were able to inspire you to get creative using some of the designs, products and techniques seen along the way. We hope you will join us again next month when we will be featuring projects full products from the new Annual Catalog. So mark August 15th on your calendars and hop along with us.


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Background Specialist Lifestyle Management (SLiM) is a structured patient education and self-management group weight management programme. Each session is run monthly over a 6-month period providing a less intensive long-term approach. The groups are patient-centred incorporating educational, motivational, behavioural and cognitive elements. The theoretical background, programme structure and preliminary results of SLiM are presented.
Subjects/methods The study was a pragmatic service evaluation of obese patients with a body mass index (BMI) ≥35 kg/m2 with comorbidity or ≥40 kg/m2 without comorbidity referred to a specialist weight management service in the West Midlands, UK. 828 patients were enrolled within SLiM over a 48-month period. Trained facilitators delivered the programme. Preliminary anonymised data were analysed using the intention-to-treat principle. The primary outcome measure was weight loss at 3 and 6 months with comparisons between completers and non-completers performed. The last observation carried forward was used for missing data.
Results Of the 828 enrolled within SLiM, 464 completed the programme (56%). The mean baseline weight was 135 kg (BMI=49.1 kg/m2) with 87.2% of patients having a BMI≥40 kg/m2 and 12.4% with BMI≥60 kg/m2. The mean weight change of all patients enrolled was −4.1 kg (95% CI −3.6 to −4.6 kg, p=0.0001) at the end of SLiM, with completers (n=464) achieving −5.5 kg (95% CI −4.2 to −6.2 kg, p=0.0001) and non-completers achieving −2.3 kg (p=0.0001). The majority (78.6%) who attended the 6-month programme achieved weight loss with 32.3% achieving a ≥5% weight loss.
Conclusions The SLiM programme is an effective group intervention for the management of severe and complex obesity.
- NUTRITION & DIETETICS
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Strengths and limitations of this study
A large comprehensive service evaluation of a programme for patients with severe and complex obesity within the UK National Health Service setting.
Reduced contact and simplicity producing clinically significant weight loss outcomes.
No comparison group (non-randomised study).
Only initial data reported, therefore lack of long-term data up to 12 months.
Future evaluation needed for educational and self-management elements of the Specialist Lifestyle Management programme.
Obesity is a major challenge for health services worldwide. In particular, the percentage of patients with extreme and complex obesity is increasing with greater recourse to bariatric surgery.1 Clinical obesity management guidelines recommend a multidisciplinary approach that includes behavioural intervention.2 ,3 While intense behavioural interventions have been delivered successfully by several clinical trials,4 ,5 these interventions have not translated into usual care due to a variety of reasons including lack of suitable expertise and insufficient resources. Instead, structured educational programmes have been developed to improve self-management of chronic disorders such as diabetes mellitus, employing a group approach to improve patient knowledge and aid disease management.6 ,7
In the UK, recent commissioning policy8 for referral to bariatric surgery services states that patients are required referral from a specialist medical obesity service. These services also cater for a proportion of patients with extreme and complex obesity who prefer a medical solution. The effectiveness of specialist medical obesity services is, however, unknown. In the face of limited resources and in response to greater demands for specialist weight management services in the West Midlands, UK, the Specialist Lifestyle Management (SLiM) programme was developed. The theoretical background, structure and preliminary results from the SLiM programme are presented here to inform future service development and implementation.
The regional specialist weight management service at the Heart of England National Health Service (NHS) Foundation Trust, Birmingham, received patients with extreme and complex obesity from primary care based on the following referral criteria: a body mass index (BMI) of 40 kg/m2 or above, or a BMI of 35 kg/m2 with a comorbidity, such as type 2 diabetes mellitus.2 Patients were referred to the service by their general practitioner or hospital doctor having often exhausted all other avenues for weight loss, including commercial, primary care and community interventions. Prior to implementation of the SLiM programme, patients were initially reviewed by a physician with specialist interest in obesity and a care plan was agreed which included the SLiM programme. Only a minority of patients (<10%) with specialist requirements were referred for individual dietetic aftercare, for example, those with end-stage renal failure and preparation for renal transplant, previous bariatric surgery and liver disease, and those who wished to be seen individually, which allowed them to ‘opt-out’. Within this model, physicians, dieticians and dietetic assistants carried out all further follow-up, usually between 3 and 6 months after the initial visit which included arrangement and follow-up of relevant investigations (eg, sleep studies to exclude obstructive sleep apnoea), medication adjustment and, if required, individual psychological support. Any adjustments to medications were carried out by physicians within the clinic in collaboration with primary care. Following their initial clinical assessment (supported by the use of the Hospital Anxiety and Depression Scale questionnaire), any patient identified clinically to have underlying psychiatric or psychological issues requiring mental health support was discussed by the multidisciplinary team and referred to local mental health services or a psychologist within the clinic, respectively.
Frequent follow-up is an important factor in the success of weight loss programmes and weight maintenance.9 A review of the clinic referral numbers, capacity of current clinical resources and waiting times for new and review appointments highlighted that frequent individual support by bariatric physicians and dieticians was not feasible. Thus, there was a need to reformat the service to effectively cater for greater patient volume. This resulted in the design and implementation of the SLiM programme based on available evidence and recommendations.
Aims of SLiM
The aims of SLiM were:
To achieve at least a 5% weight loss;
To educate patients regarding obesity;
To encourage self-management of obesity.
General structure of SLiM
Multicomponent interventions combining diet, physical activity and behavioural modification have been highlighted as essential for weight loss and goal achievement,2 with a comprehensive behavioural approach producing a 10.7 kg (11%) weight loss while significantly reducing attrition.10 The SLiM programme aims to empower patients to make lifestyle and behavioural changes while providing them with weight maintenance strategies. Within SLiM, key behavioural theories and techniques are used to encourage lifestyle change and help participants gain control of eating behaviour and enable weight maintenance. The use of groups in weight management has been incorporated into a range of commercial and non-commercial programmes.11 ,12 Evidence suggests that group interventions may produce better weight loss outcomes than individual therapy;10 ,13 ,14 even in patients who initially indicated a preference for individual care.15 Thus, a group approach was adopted in SLiM. SLiM is a monthly programme running for 6 months and designed to be delivered by a trained facilitator.
To aid the cost-effectiveness of the SLiM programme, dietetic assistants were selected as ideal programme facilitators. A variety of training methods for facilitators were used including direct observation of senior dieticians delivering the sessions, joint sessions, and session observation with feedback and follow-up work to aid learning. In addition, a structured approach to session delivery was used to ensure programme fidelity, with core topics to be covered within each session and standardised presentations. Sessions are provided on a weekly rolling basis to allow patients to attend any missed session; this is a unique format as usual group programmes run for between 6 and 12 weeks. SLiM sessions lasted between 60 and 90 min and had between 2 and 10 patients within each session.
Components of SLiM
Table 1 describes the behavioural modification strategies utilised in SLiM. The key components, including their theoretical background and evidence, are described in detail below. Table 2 lists the contents of each SLiM session.
Goal setting techniques have been extensively used to encourage adoption of healthy behaviours,15 ,16 while allowing participants to assess progress. In SLiM, participants are encouraged to set weight loss and personal goals and these are subsequently subdivided into monthly goals for stepwise progress. Goal setting is focused around the principles of SMART (Specific, Measurable, Achievable, Relevant and Time-Bound). This is achieved initially using a theoretical example and reinforced with a specific example from the group.
Setting a realistic weight loss between 0.5 and 1 kg/week is recommended,16 with overall weight loss targets based on a clinically significant weight loss of 5–10% from initial weight.17 ,18 This is calculated and written down for each patient; however, this is often significantly less than patients’ expectations.19 There is evidence to suggest that unrealistic weight loss goals could affect overall weight loss.20 In contrast, Linde et al19 found that more ‘unrealistic’ weight loss expectations were associated with greater long-term weight loss success. A recent meta-analysis21 has shown that the evidence is not favourable for the setting of realistic goals to improve weight loss outcome, suggesting that setting realistic weight loss goals might not be beneficial. It has, however, been shown that counselling patients on goal setting does help set more realistic weight losses in line with clinical guidelines,22 with the patient's satisfaction of that weight loss possibly being more important than matching their ‘dream’ weight.23
The amount of weight loss selected by the individual participant in SLiM is typically not shared with the group and patients are weighed at the end of the SLiM session instead of the beginning. The timing of the ‘weigh in’ has been found to be important, as during the initial pilot sessions it was observed that patients’ interactions and emotional state became overly negative if they gained or even maintained weight and were weighed at the start of the session.
The use of self-monitoring helps patients change their eating behaviours. Patients who monitor eating, activity and weight on a regular basis have significantly greater weight loss and maintenance.24 Throughout SLiM, patients are encouraged to maintain a daily diary of all food and drink consumed, when they consume it, where, with whom, their hunger throughout eating and finally their mood. Unlike some programmes which encourage patients to follow a daily calorie and even fat intake,5 ,12 SLiM focuses more on the patient's eating patterns, identification of triggers and enabling them to be more conscious eaters. One key element is emphasising that the diary is only for personal use and the facilitator will not see it unless the patient wishes them to. This allows for more open, realistic diaries to minimise under-reporting, which is the main disadvantage of food diaries.25 Hunger is an important factor within weight control;26 therefore, providing techniques to help control hunger, identify satiety and the sense of deprivation often highlighted during ‘dieting’ behaviour could potentially be associated with better outcomes.11 Therefore, the use of a hunger scale and helping patients identify a sense of satisfaction, while moving away from using external cues of fullness (ie, plate being empty), allows patients to reduce their portion sizes themselves, giving them a sense of autonomy over how much they eat.
A key message within SLiM is regular meal intake. This is encouraged as studies have suggested that individuals who eat breakfast weigh less than those who typically skip this meal,27 although the exact mechanisms are unclear.28 Development of a regular structured meal pattern is the first step in dealing with erratic eating.29 Unlike other programmes which give patients a prescribed eating plan of 500–600 calories deficit per day,5 ,12 by calculating estimated resting metabolic rate (RMR) using predictive equations, patients are provided with behavioural techniques to reduce portions and identify internal triggers of satiation. Patients are also educated regarding portions and serving control, providing a less prescriptive approach. Furthermore, there is significant evidence to show that the use of predictive equations for RMR within the obese is unreliable30 ,31 and rarely valid within the obese population.32 This could provide hypercalorific or hypocalorific energy intakes, which may in part explain this technique's lack of long-term success in the treatment of obesity.
The nutritional recommendations within SLiM are initially based on guidance for healthy eating produced by the UK Department of Health,33 using the eatwell plate. These healthy diet principles are based on starchy foods (carbohydrate based), having five servings of fruit and vegetables daily, reducing the total fat intake within the diet, particularly from sources such as sweets, crisps and animal fats and replacing them with unsaturated sources, and having high-quality sources of protein and dairy foods. This information is discussed within a group environment to enable patients to gauge the discrepancy between their current intake and the recommendations.
Often, obese individuals’ eating behaviour, characterised by maladaptive34 and uncontrolled eating, combined with dysfunctional or distorted body-related beliefs,35 affect their ability to lose weight. Strategies from cognitive therapy enable patients to begin to identify and modify dysfunctional thought patterns and consequences of negative mood states. Examining how magnifying negative thoughts about themselves or situations, or failing to identify positives, can affect their ability to make lifestyle changes. How to challenge and change these to be positive36 is an essential component. Other skills used to aid behavioural change are helping to identify the locus of control. Enabling a patient to understand their locus of control allows them to appreciate their responses, recognise their ability to change their lifestyle and achieve their goals.11 ,37 Furthermore, the use of definitive words such as ‘must’, ‘always’, ‘never’ and ‘can't’ are highlighted to make the patient aware of negative words and how these might prevent success. These are then rephrased by using positive language such as ‘I will aim to’, ‘I will aim not to’ and ‘I can’ to help support change.
The ability to cope with life stresses and not turn towards food as a coping mechanism is an important factor to address. This has been defined as managing external and internal triggers that are seen as taxing or exceeding the resources of the person, by using cognitive and behavioural techniques and skills.38 Helping patients cope more easily with cravings and using coping techniques to help in relapse situations have been shown to help with weight loss and maintenance.39 ,40 Furthermore, problem-solving techniques are taught to allow effective coping with triggers and stresses. This uses multistep problem-solving techniques to help during stressful times.36 ,41 These are supported by stimulus control principles, which enable patients to gain control and change their environment (eg, home and/or workplace) to allow for successful behaviour and lifestyle change. By facilitating an environment that reduces exposure to high-calorie foods, this should reduce consumption of these foods. Also, SLiM encourages increasing exposure to healthy foods and snacks and promotes physical activity by, for example, having walking/running shoes by the front door.
Weight loss maintenance
Throughout the programme, weight loss maintenance skills are taught. This upskilling equips the patient to anticipate and cope with circumstances that could bring about lapses and relapses.42 Several skills are highlighted throughout SLiM to help with this process (table 1). Some of the key aspects include recognising and identifying situations that have the potential of high-relapse risk and develop problem-solving techniques to cope with them.43 Ongoing vigilance and eating and physical activity self-monitoring are pre-requisites to achieving weight loss maintenance.42 ,44
The US National Weight Control Registry45 highlights three main factors that play a distinct role within SLiM, with these factors being consistently emphasised to facilitate continuing behavioural change. These are: (A) eating a diet low in fat, (B) frequent self-monitoring and (C) regular physical activity. Additionally, social support and positive reinforcement are considered to be important for continued weight loss maintenance;38 therefore, patients are encouraged to mobilise their support network including family and friends.46 There are suggestions, however, that interference from life partners could affect weight loss maintenance.38 To address this, SLiM highlights areas where this could occur and appropriate tactics are discussed. Finally, the importance of self-esteem is also addressed, as it has been suggested to be an important relapse trigger.47
Physical activity has a positive effect on weight loss maintenance and cardiovascular health.48 ,49 For the majority of SLiM patients with extreme and complex obesity, physical activity is difficult due to issues of extreme obesity and conditions such as arthritis. SLiM primarily aims to encourage a reduction in sedentary behaviours,50 although for those able to do physical activity, they are advised to follow recommendations for health by engaging in physical activity for at least 30 min/day, 5 days/week.2 ,51 For individuals already achieving this, higher physical activity levels are encouraged for optimal weight loss and maintenance but also aim to ensure that patients keep within their maintainable limits and seek medical advice.52 Potential benefits of using a variety of physical activities are highlighted.
Patient educational material and homework
Patient educational materials are integral in SLiM to support and reinforce the topics covered. Diet sheets follow NHS guidelines including using an easy to read font and size.53 The materials have additional homework elements to consolidate the learning points from each session and prepare the patient for the next session's topics such as the supermarket tour. These also incorporate visual and written elements to aid learning and information retention.
Over time, evaluation and patient feedback is key to help inform and improve clinical practice and has been used to help the SLiM programme to become more patient focused. Regular feedback was used to gain information about content, length of session, whether the sessions met expectations and areas where improvements could be made.
Preliminary anonymised data from the SLiM programme were analysed using the intention-to-treat principle. The primary outcome measure examined was weight loss. Descriptive statistical methods were used to present change in weight at 3 and 6 months for all patients, completers and non-completers. Values are presented as means (SDs) or medians (IQR) for continuous variables and as frequencies (percentages) for categorical variables. Normally distributed data and skewed data were analysed using appropriate tests (t tests, repeated measure analysis of variance, Mann-Whitney U test and Wilcoxon signed-rank test) to compare weight loss and BMI from referral to the end of SLiM and the differences between completers and non-completers. Patients were considered to be completers of the SLiM programme if they had attended all six sessions within the SLiM programme, with total patients enrolled within the programme being defined as the patients who attended at least one session. Percentages between different categorical weight losses at the end of SLiM were compared using χ2 tests. We present weight change as absolute weight change, percentage weight change, median weight change, BMI change and also percentages achieving at different categorical weight losses. If there were missing data, the last observation carried forward (LOCF) was used. Statistical significance was be set at p value ≤0.05. All analyses were conducted with IBM SPSS Statistics V.20 (SPSS Inc, Chicago, Illinois, USA).
Of 828 patients enrolled within the SLiM programme, 464 completed the programme between August 2009 and June 2013. The characteristics are shown in table 3 comparing completers and non-completers. The majority of the patients were women (73.7%), representing a similar distribution to other studies.55 ,56 The mean age was 48.2 years, and 80% were white European. The mean weight on referral was 135 kg with a mean BMI of 49.1 kg/m2. Diabetes was present in 32.1% of patients. The session attendance for non-completers showed that the majority (57.7%) only attended the first two sessions (36 and 21.7 for sessions 1 and 2 respectively). Non-attendance then reduced to between 12% and 17% for the subsequent sessions, with all 364 non-completers attending between one and five sessions.
By comparing the completers and non-completers, it was found that the completers were significantly older (49.2 compared with 46.9 years, p=0.005), had a greater prevalence of obstructive sleep apnoea (p=0.0001) and had a greater referral BMI (p=0.02). There were no significant differences in the other measures (table 3). Table 3 shows that SLiM produced a significant difference between referral weight and BMI and the end of SLiM within all subgroups.
The change in body weight for all the patients enrolled in SLiM ranged from 58.4 kg loss to a gain of 14.8 kg, with a mean BMI change of −1.48 kg/m2 (95% CI −1.3 to −1.7 kg/m2) and a mean weight loss of −4.1±7.3 kg (95% CI −3.1 to −4.0 kg, p=0.0001), equal to 2.9±4.9% weight loss at the end of SLiM (table 4). Of the patients started SLiM, 68.4% lost weight while 20.9% gained weight. The percentage achieving ≥5% weight loss was 24.9% at the end of SLiM, with 7.7% of patients achieving ≥10% weight loss (figure 1).
Table 3 summarises the weight loss achieved by the completers and non-completers over the SLiM programme. Of the patients who completed the SLiM programme, the mean weight loss was −5.5 kg (95% CI −4.9 to −6.2 kg, p=0.0001), with a mean BMI change of 2.0 kg/m2 (95% CI −1.7 to −2.2 kg/m2, p=0.0001), with a percentage weight loss of 3.9±5% and 32.3% achieving a ≥5% weight loss compared with 15.4% of non-completers. By comparing this with the non-completers, it was found that there was a clinically and statistically significant difference in weight loss and percentage weight loss achieved (5.5 kg vs 2.3 kg, and 3.9% vs 1.7% respectively, both p=0.0001). A significantly greater percentage of completers compared with non-completers achieved weight loss at all the weight loss categories (p=0.05; figure 1). Significantly more non-completers than completers (28.3% vs 15.1%) gained weight from referral to completion of SLiM (p=0.0001).
Data from a subset analysis of 142 patients with diabetes who completed the SLiM programme showed that the mean age of patients with diabetes was slightly greater at 52.5±11 years, and a smaller percentage were women (64.8%), with a comparable BMI and weight of 50 kg/m2 and 137 kg, respectively, compared with patients without diabetes. At baseline, the mean glycated hemoglobin (HbA1c) was 64±18.2 mmol/mol (8±3.8%). At the end of SLiM, there was a clinically and statistically significant reduction in mean HbA1c levels from baseline, with the mean HbA1c falling to 60.1±15.5 mmol/mol (7.6±3.6%), a mean reduction of 3.96±14.8 mmol/mol (p<0.05). Patients lost a clinically and statistically significant mean body weight ranging from a 29.8 kg loss to a gain of 8.8 kg. The mean weight loss was 5.71±6.89 kg (p=0.001), which was similar to that of the overall population, with 30% of patients achieving ≥5% and 11% achieving a ≥10% weight loss with a mean weight loss of 4±4.57% being achieved in the weight loss group (p=0.0001).
The SLiM programme is an innovative group intervention to help treat obese patients within a specialist weight management service. From the results presented, using the SLiM model has helped patients achieve a clinically significant weight loss and improvement in diabetes control. The programme is unique as it provides care to patients within a specialist service while giving support over a 24-week period instead of the typical 6–12 week programmes commonly implemented.7 ,53
The weight and BMI reduction observed with SLiM are comparable to those within more intensive weight loss trials, in addition to commercial and primary care lifestyle interventions.4 ,5 ,11 ,54–56 For example, the Counterweight programme achieved a 4.24 kg weight loss and a BMI reduction of 1.55 kg/m2 for the attendees compared with the 5.5 kg weight loss and a reduction of 2 kg/m2 for more complex cases within the SLiM programme.
With much of the current literature being based within a primary care or commercial group settings,53 ,54 direct comparison of SLiM with other programmes is difficult given the greater burden and complexity of obesity for SLiM participants. The most similar service evaluation to that of the present study is that of the Glasgow and Clyde Weight Management Service (GCWMS).55 ,56 The phase 1 group programme comprised of nine fortnightly sessions of diet, exercise and behavioural intervention over a 16-week period is the first of three phases. The mean weight loss for all patients (LOCF) attending these phase 1 groups at the end of the 16 weeks was −3.06 kg compared with a similar 4.1 kg for all SLiM patients. 36% of phase 1 completers (n=1322) lost ≥5 kg compared to 44.4% of SLiM completers (n=464). When comparing identical time-point data at 6 months (including phases 1 and 2), the results were again very similar with 50% losing ≥5 kg.56 Although similar results were achieved within both specialist services, the SLiM programme had significantly reduced clinical contact and was facilitated by a dietetic assistant, which could be more cost-effective.
Of the patients who completed SLiM, 32.3% achieved a clinically significant weight loss ≥5% initial body weight, which again is comparable to other UK-based lifestyle interventions.4 ,54 ,57 ,58 Importantly, 78.6% of the patients who completed the SLiM programme lost weight with an additional 6.3% maintaining their weight, giving a total of 84.9% who lost or maintained their weight during the study period.
A recent randomised control Lighten Up trial53 examined the effectiveness of local non-specialist weight management services within the West Midlands. They compared the three main commercial weight loss programmes with local healthcare professional options including dietetic-led or pharmacy-led programmes and general practice one-to-one counselling. The study reported statistically significant weight loss for all programmes ranging from 1.37 to 4.43 kg (p=0.001) at 12 weeks. However, patients attending the commercial group session, Weight Watchers, Slimming World and Rosemary Connelly, lost on average 2.3 kg (95% CI 1.3 to 3.4, p=0.004) more than the primary care programmes. The percentage of patients achieving 5% weight loss or more ranged from 16% to 46%, with Weight Watchers (46%) and Rosemary Conley (42%) performing the best. One aspect of this high percentage could have been related to the lower referral weights and the relative weight loss to achieve this target. A key part of these commercial groups in helping patients lose weight has been suggested to be the peer support, supporting patterns of behaviour, preventing relapse and promoting weight maintenance.11 As these elements are also incorporated in SLiM, this might be an explanation in part to the success of SLiM, which enables reinforcement of essential messages and possibly encourages changing behaviour.
The SLiM programme produced a significant weight loss and improvement in glycaemic control in patients with diabetes. Over the initial 4-month period, the diabetes education programme, X-Pert,7 showed a mean reduction of HbA1c of 0.4% (CI 0.1% to 0.7%), which is similar to the mean reduction found in SLiM. Even small reductions of HbA1c have been shown to have significant reductions in diabetes complications.59 However, one significant difference between SLiM and X-Pert was the amount of weight lost over the period of the programmes, with the subset of diabetic SLiM completers achieving a 5.5 kg weight loss compared to 0.3 kg within the X-Pert group. Focusing on weight loss and not glycaemic control might be an important way of improving diabetes complications while producing clinically significant weight loss, although more controlled investigations are needed to confirm these findings.
Consistent with other interventions,5 ,54 the most favourable results were seen in the completers compared with the non-completers, suggesting that patient cooperation, optimisation of attendance and retention of patients are important aspects for improved weight loss outcome. In the present evaluation, 56% of participants who started SLiM programme completed all the sessions. Pragmatic solutions to reduce non-completion included did not attend letters and reinforcing attendance within physician follow-up. With high dropout rates often being found within obesity treatments, further investigation is warranted to aid greater understanding of predictors and reasons for attrition.
The strengths of this study are that this is one of the first evaluations of an effective specialist service for complex and severe obesity within the UK NHS setting including a large number of patients in a UK region with significant levels of obesity. The programme was developed based on current available evidence and extensive clinical experience. The evaluation also examined the impact on diabetes, a common and devastating comorbidity. There are a number of limitations to this study. This study was a non-randomised pragmatic service evaluation. In addition, long-term data are not available at this time, which would have been useful to demonstrate maintenance of weight loss following the initial 6 months. In addition, a more formal evaluation of the programme’s aim regarding education and patient self-management is required. Further evidence is required from a randomised control study to assess the short-term and long-term clinical and cost-effectiveness of SLiM programme. Another consideration is that a significant proportion of patients did not attend all the sessions, although the majority of non-completers attended the first two sessions. Future work should explore and identify the complex patient and intervention-related factors that determine programme completion.
In conclusion, we have shown that SLiM can achieve a clinically significant weight loss, which is comparable to more intensive programmes. However, there is a need for further long-term data analysis and assessment of predictors of attrition to allow this study to have greater generalisability. With the dearth of research into the treatment of severe and complex obesity within the specialist weight management service within the UK, the SLiM programme provides an innovative, practical model to help cater for the increasing number of patients with extreme obesity who require specialist obesity management.
The authors would like to acknowledge the patients and clinic staff of the specialist weight management service.
Contributors AB developed the concept of SLiM with support from ST. AB was the lead dietician and ST the lead physician within the specialist service supporting SLiM. AB with the help of AF and WT wrote the content of the sessions. ST, JS, SB, MA and RJ were physicians within the specialist service. AG provided dietetic support to SLiM. AB, AG and AJ contributed to data collection and preparation. AB, ST and GNT developed the service evaluation and data analysis plan. AB carried out the data analysis with support from TA. AB wrote the first draft. AB, GNT and ST prepared subsequent drafts. All authors reviewed the final draft prior to submission.
Funding Professor Shahrad Taheri and Dr Teresa Arora are funded by the Biomedical Research Program at Weill Cornell Medical College supported by Qatar Foundation.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Extra data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi:10.5061/dryad.g2q42.

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Update accomplished! And This is the last page of the print book!
Sadly, It has to go on hiatus again for a little while. I’ve got to concentrate on commissions to make sure we can pay bills and eat and hubby can get to work. 😀 The next chapter has six pages already penciled, two inked and ready for shading – so when I can, I will jump on it immediately.