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The US Food and Drug Administration (FDA) has issued multiple safety communications on the fluoroquinolone class. These statements recommend use of alternative antibiotics for common infections because adverse events associated with the fluoroquinolone class outweigh potential benefits in some situations. 1 FDA safety warnings for the fluoroquinolones include aortic dissection, central nervous system effects, glucose homeostasis disturbances, QT prolongation and disabling side effects involving tendons, muscles, joints, nerves, and the central nervous system. These side effects can occur hours to weeks after exposure to fluoroquinolones and may potentially be permanent. 1–Reference Chou, Wang, Chang, Lee, Shau and Lai7 An FDA advisory panel recommended avoidance of fluoroquinolones unless suitable alternatives were not available for acute bacterial sinusitis, acute chronic obstructive pulmonary disease exacerbations, and uncomplicated urinary tract infections. 8 Despite these FDA warnings, fluoroquinolones continue to be prescribed and remain a high priority for stewardship.
Moreover, fluoroquinolone use has been associated with bacterial resistance and Clostridioides difficile infection (CDI). Reference Low, Neuberger and Hooton9–Reference Deshpande, Pasupuleti and Thota13 The most modifiable risk factor to decrease resistance and CDI is antibiotic use. A meta-analysis found that stewardship interventions directed at reducing the use of fluoroquinolones and cephalosporins had a protective effect against the development of CDI (pooled risk ratio, 0.48; 95% CI, 0.38–0.62). Reference Feazel, Malhotra, Perencevich, Kaboli, Diekema and Schweizer14 Prospective audit with intervention and feedback (PAF) and prior approval are core antibiotic stewardship implementation strategies. These stewardship strategies have been shown to be effective in decreasing antibiotic prescribing and are recommended by the Centers for Disease Control and Prevention (CDC), the Infectious Diseases Society of America (IDSA), and the Society for Healthcare Epidemiology of America (SHEA). Reference Dellit, Owens and McGowan15–Reference Barlam, Cosgrove and Abbo18 Implementation of such policies has been associated with decreased rates of CDI, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and antimicrobial costs without adversely affecting hospital length of stay and survival. Reference Barlam, Cosgrove and Abbo18–Reference Lawes, Lopez-Lozano and Nebot24
Despite these successes, prior approval is not often implemented due to concerns about loss of prescriber autonomy, potential delays in treatment, adverse effects on professional culture, and the consequences of replacing the use of one antibiotic or antibiotic class with another. Reference Barlam, Cosgrove and Abbo18,Reference Davey, Marwick and Scott25,Reference Szymczak, Muller and Shakamuri26 Furthermore, the effectiveness of prior approval depends on the manner of enforcement, expertise of the approver, enforcement policies during evenings and weekends, and permitting providers to self-approve the use of formulary restricted antimicrobials if specified criteria are satisfied (eg, multidrug resistance). Reference Buising, Thursky and Robertson20 These concerns have led many facilities to instead implement prospective audit and feedback (PAF) programs, under which antibiotics can be freely initiated but in which there is a postprescriptive review within 24–72 hours of prescribing. During postprescriptive review, alternative recommendations for antimicrobials are issued; compliance with such recommendations is voluntary. Reference Barlam, Cosgrove and Abbo18 PAF programs have been shown to improve outcomes in general medical-surgical units and intensive care units without adversely affecting patient outcomes. Reference Barlam, Cosgrove and Abbo18 The disadvantages of PAF include the following: (1) implementation is labor intensive, (2) providers may be reluctant to change therapy, (3) specialized technology support may be needed, and (4) success is dependent on the presence of dedicated personnel and the method used to communicate recommendations to prescribers. Reference Barlam, Cosgrove and Abbo18,Reference Cosgrove, Seo and Bolon27
Few studies have explicitly assessed the impact of prior approval and PAF implementation strategies on antibiotic prescribing. In light of the FDA safety warnings and recommendations, evidence is needed for implementation strategies to guide prescribing of fluoroquinolones when suitable alternatives are available. Thus, we evaluated the implementation, perception, and effectiveness of prior approval and PAF to impact fluoroquinolone and total antibiotic prescribing in a Practice-Based Research Network (PBRN) of Veterans’ Affairs (VA) acute-care facilities.
Study design, setting, and study population
A cross-sectional survey was conducted with antimicrobial stewardship champions at 15 acute-care facilities in April 2018. Study data were collected and managed using REDCap electronic data capture tools. The sample included VA medical centers enrolled in a Practice-Based Research Network (PBRN) jointly supported by the CDC and the VA. The sampling strategy included all VA PBRN facilities to ensure that we captured the diversity of perceptions and implemented practices. The antimicrobial stewardship leader was defined as the facility personnel designated to direct antimicrobial stewardship. The survey focused on the local implementation and acceptability of different strategies to improve fluoroquinolone prescribing.
Questions were closed-ended in the form of a survey (Supplementary Table 1 online). Development of the survey was focused on topic areas in the Consolidated Framework for Implementation Research (CFIR) domains: inner setting (organizational context) including current practices and procedures (ie, existing guidelines and/or formularies), characteristics of individuals (ie, knowledge, attitudes, beliefs) and outer setting (ie, awareness of external policies and incentives). The purpose of the survey and accompanying questions were (1) to determine which antimicrobial stewardship strategies were implemented, (2) to assess the perception of the potential effectiveness of antimicrobial stewardship strategies, and (3) to identify the perceived acceptability of antimicrobial stewardship strategies. Questions in the survey were developed based on stakeholder input, current work (AHRQ no. R01HS025175 with primary investigator Samore and NIA no. P30AG022849 with primary investigator Hughes), and the American Society for Health-Systems Pharmacists best practice statement on formulary management. 28–31 Study team members included operational partners, clinicians, and researchers with expertise in the design of surveys to capture provider behavior and strategies to improve prescribing. All study team members reviewed and provided feedback at each stage of questionnaire development. The survey was pilot-tested and feedback was provided by 1 antimicrobial stewardship physician and 1 antimicrobial stewardship pharmacist champion.
Note. SCI, spinal cord injury.
a Based on levels of patient volume and risk, teaching, and research.
Antibiotic prescribing and facility characteristics data collection
Facility characteristics and antibiotic administration data were collected from national VA data sets, including the Veterans’ Health Administration (VHA) Corporate Data Warehouse (CDW) for 2017–2018. These data sets were also used to gather information on mean bed days of care, facility complexity, specialty services available, and antibiotic exposure. Facility complexity is a standardized classification system across the VHA. Complexity is based on patient characteristics, clinical programs, and teaching programs. Facilities with complexity levels of 1a–c were classified as high-complexity facilities and levels 2–3 were classified as low-complexity facilities. Specialty services were categorized into presence of bone-marrow or stem-cell transplant unit, spinal cord injury center, and long-term care facility. Antibiotic exposure was reported overall (all systemic antibacterial classes combined), for fluoroquinolones, and for advanced-generation cephalosporins. Advanced-generation cephalosporins were defined as the third- and fourth-generation cephalosporins. For each facility, antibiotic exposure was reported as mean days of therapy and total days of therapy per 1,000 acute-care days present.
Facilities with audit and feedback (PAF) and/or prior approval were compared with sites without these strategies implemented. PAF was defined as a one-on-one interaction between an antimicrobial steward and a prescriber regarding antibiotic use in a specific case that is conducted within 1 business day after a restricted antibiotic is prescribed. Prior approval was defined as the medication cannot be used without review of the specific patient case and indication (includes instances where first dose is allowed but subsequent doses require approval). Independent t tests and contingency tables were used to determine the differences in continuous and nominal data, respectively. Simple linear regression was applied to test differences in antibiotic prescribing over time. All data and statistical analyses were conducted using SAS version 9.4 software (SAS Institute, Cary, NC). A P value <.05 was considered statistically significant. The VA Greater Los Angeles Healthcare System Institutional Review Board approved this study through expedited review.
All PBRN acute-care facilities (N = 15; 87% antimicrobial stewardship physician; 13% antimicrobial stewardship pharmacist responders) completed the survey for a 100% response rate. Overall, 9 antimicrobial stewardship champions (60%) identified their site as having fluoroquinolone implementation strategies, 2 of 9 (22%) used PAF, 4 of 9 (44%) used prior approval, and 3 of 9 (33%) used both PAF and prior approval. At sites without PAF or prior approval implementation strategies, 20% (N = 3) had criteria for use and 13% (N = 2) had specific prescriber or care area restrictions in place for fluoroquinolones. Most facilities were of high complexity (10 of 15, 67%), and all were urban sites. Most of the facilities were regionally located in the Midwestern (6 of 15, 40%) and Southern (5 of 15, 33%) US geographic regions. Table 1 describes characteristics of facilities with either PAF or prior approval and without these strategies implemented. There was no significant difference in facility characteristics by group, including presence of specialty services and bed days of care.
No differences in total days of therapy at the facility level for 2017 or 2018 were detected for the the presence or absence of implementation strategies. Figure 1 illustrates the total antibiotic (Fig. 1a), fluoroquinolone (Fig. 1b), and advanced-generation cephalosporin (Fig. 1c) prescribing rates for facilities with PAF and/or prior approval implemented for fluoroquinolones compared to facilities without PAF and/or prior approval in place for 2017 and 2018. Even though the total antibiotic rates (Fig. 1a) did not differ by group, fluoroquinolone days of therapy rates (Fig. 1b) were significantly lower in facilities with PAF and/or prior approval. Interestingly, the decrease in fluoroquinolones was achieved in the absence of increased prescribing of advanced-generation cephalosporins (Fig. 1c).
Figures 2a and 2b illustrate fluoroquinolone prescribing rates over time for facilities. The fluoroquinolone days of therapy rates were much lower in facilities with fluoroquinolone PAF and/or prior approval implementation strategies than at sites without fluoroquinolone implementation strategies. However, both groups experienced significant decreases in the fluoroquinolone days of therapy rate over the 2-year period (P = .0001) (Fig. 2a and 2b). Interestingly, in facilities with fluoroquinolone PAF and/or prior approval implementation strategies there was no change in advanced-generation cephalosporin days of therapy rate (P = .10) (Fig. 2a), but we detected a significant increase in cephalosporin rates in the facilities without fluoroquinolone PAF and/or prior approval (P = .001) (Fig. 2b). No temporal decrease in total antibiotic days of therapy rate was detected for either group (P ≥ .20) (Fig. 2a and 2b).
Table 2 illustrates antimicrobial stewardship leaders’ perception of the level of provider acceptance for current fluoroquinolone PAF and/or prior approval strategies implemented at their facility (N = 8). (One additional site with implementation strategies did not complete this section of the survey and was excluded from the acceptability analysis.) Of the sites with either PAF or prior approval implemented, 5 of 8 (62.5%) perceived that PAF and/or prior approval were completely accepted and 3 of 8 (37.5%) were moderately accepted, respectively. Facilities that perceived fluoroquinolone PAF and/or prior approval strategies were “completely” accepted by providers had lower fluoroquinolone days of therapy rates than sites where formulary restrictions were “moderately” accepted (P < .04) (Table 2).
a Days of therapy per 1,000 days present.
b Advanced-generation cephalosporin = third- and fourth-generation cephalosporins combined.
Antimicrobial stewardship leaders at all study sites (N = 15 sites) were asked to rate their perceived effectiveness of potential stewardship strategies. These included mandatory infectious disease (ID) consults for certain conditions, clinical pathways and/or local guidelines, antimicrobial order forms, and prior approval on fluoroquinolone prescribing. With the exception of mandatory ID consults, most stewards perceived that clinical pathways and/or local guidelines, antimicrobial order forms, and prior approval would be effective or had already been implemented to improve fluoroquinolone prescribing (Fig. 3). For prior approval and clinical pathways, only 1 site either did not already have this strategy implemented for fluoroquinolones or did not believe that it would be effective in reducing fluoroquinolone use. Most antimicrobial stewardship leaders (13 of 15, 87%) perceived that implementation of mandatory ID consultations would be difficult.
Implementation strategies to improve fluoroquinolone prescribing varied across the PBRN acute-care sites. Those facilities that implemented fluoroquinolone PAF and/or prior approval implementation strategies had decreased quinolone prescribing over the study period without a corresponding increase in advanced-generation cephalosporin prescribing, a common alternative. Conversely, in facilities without implementation strategies decreased fluoroquinolone use was accompanied by increased use of advanced-generation cephalosporins. Neither group had decreases in total antibiotic prescribing by year or overall. Although stewards are frequently concerned that implementing strategies focused on the fluoroquinolones will lead to increases in other antibiotics with a high risk of CDI (ie, advanced-generation cephalosporins), facilities without fluoroquinolone PAF or prior approval experienced increases in advanced-generation cephalosporin use. The literature on the impact of stewardship strategies to shift use from fluoroquinolones to advanced-generation cephalosporins is scarce. However, many facilities with PAF and/or prior approval implemented for quinolones also had strategies in place for cephalosporins.
PAF and prior approval implementation strategies have been associated with a 50% reduction in acute-care fluoroquinolone prescribing. Reference Feazel, Malhotra, Perencevich, Kaboli, Diekema and Schweizer14 A quasi-experimental, crossover trial found that PAF had a greater effect on decreasing antimicrobial use than prior approval. Reference Tamma, Avdic and Keenan33 In contrast, a 2013 Cochrane review of 52 studies found that although outcomes at 12–24 months were similar, restrictive prior approval had a more rapid, salutary effect on antimicrobial use than did persuasive, PAF programs. Reference Davey, Brown and Charani17 Similarly, a meta-analysis found prior approval to be more effective than persuasive PAF strategies in reducing CDI Reference Feazel, Malhotra, Perencevich, Kaboli, Diekema and Schweizer14 ; this difference was not found in a second analysis that compared a broader range of restrictive and persuasive policies. Reference Davey, Marwick and Scott25 A study in Scotland found that prior approval of amoxicillin/clavulanate, clindamycin, fluoroquinolones, and third-generation cephalosporins was associated with reductions in CDI and methicillin-resistant Staphylococcus aureus (MRSA) infections despite a reciprocal doubling of alternative antibiotic use. Reference Lawes, Lopez-Lozano and Nebot22,Reference Lawes, Lopez-Lozano and Nebot24 A systematic review found that prior approval strategies targeting the fluoroquinolone class were associated with decreases in MRSA, CDI and quinolone-resistant P. aeruginosa, A. baumannii, and E. coli. Reference Pitiriga, Vrioni, Saroglou and Tsakris34 PAF strategies focused on fluoroquinolones similarly observed decreases in MRSA, CDI, extended-spectrum β-lactamase–producing organisms, and quinolone-resistant P. aeruginosa. Reference Pitiriga, Vrioni, Saroglou and Tsakris34
This study has several limitations. The sample of acute-care hospitals participated in a Practice-Based Research Network and, thus, may have been more supportive of evidence-based stewardship practices than other VA or non-VA facilities. Also, whereas 8 of the 9 facilities that implemented PAF and/or prior approval for fluoroquinolones implemented similar strategies for cefepime, ceftazidime, or ceftriaxone/cefotaxime, only 1 of the 5 facilities without such fluroquinolone policies had similar strategies implemented for the use of these cephalosporins. Pharmacist time directly engaged in antimicrobial stewardship may also have influenced our results. At our PBRN sites, pharmacists spent 100% of their time on antimicrobial stewardship activities at 46.7% of facilities, 75% time at 20% of facilities, and 50% time at 33.3% of facilities. The survey was composed of closed-ended questions and allowed for little depth in material obtained. Only 1 person responded per facility to the survey. Thus, the responses may not reflect overall attitudes at their facility and may have introduced ecologic fallacy. The survey was administered in April 2018 and may not reflect current practices or perceptions after the multiple warnings issued on the fluoroquinolone class by the Food and Drug Administration in 2018.
Regardless, our study informs the effectiveness and acceptability of implementation strategies to improve fluoroquinolone prescribing. Furthermore, we demonstrate the feasibility of decreasing fluroquinolone use without increasing the use of other drugs associated with increased rates of C. difficile infection, namely third- and fourth-generation cephalosporins. Facilities are motivated and perceive an opportunity to reduce fluoroquinolone use with a variety of implementation strategies. Although clinical pathways and/or local guidelines, antimicrobial order forms, and prior approval were perceived to be effective in improving fluoroquinolone prescribing, mandatory ID consultations were perceived to be difficult to implement. Therefore, external facilitation should be provided to sites to encourage interventions targeting fluoroquinolones. Although sites may perceive a high workload with the fluoroquinolone class, data on all new acute-care orders should be assessed for appropriateness and potential for alternative treatment. Our work has demonstrated that the volume of new orders is lower than that perceived. Therefore, antimicrobial stewardship programs should be involved in all policies that use persuasive or restrictive strategies on antimicrobials to assess acceptability and feasible implementation. The antimicrobial stewardship program should also determine effectiveness, especially class substitution (a reduction in prescribing of a particular class with a corresponding increase in another class). For the fluoroquinolone class, a common substitution are the advanced-generation cephalosporins. This is concerning due to similar risk of CDI as the fluoroquinolone class. Reference McDonald, Gerding and Johnson35 Our results demonstrate that facilities with PAF and/or prior approval implemented were effective in decreasing fluoroquinolone prescribing without a corresponding increase in advanced-generation cephalosporins. Although we detected a decrease in fluoroquinolone prescribing over time in facilities without PAF and/or prior approval implemented, this was achieved with an increase in advanced-generation cephalosporins.
Additional research should be conducted to provide further insight as to facilitators and barriers to implementing persuasive and restrictive strategies on the use of fluoroquinolones. In addition, appropriate antibiotic substitutes for these agents should be identified based on safety, local sensitivities, and as recommended in treatment guidelines. Finally, factors influencing the decision making regarding antimicrobial selection and feasibility and acceptability of implementation of PAF and prior approval by nonstewards should be assessed.
In conclusion, PAF and prior approval implementation strategies focused on fluoroquinolones were associated with lower fluoroquinolone prescribing rates in acute care. With a trend toward lower total antibiotic use, there was also no evidence of significant class substitution. Fluoroquinolone prescribing rates decreased in the PAF and/or prior approval sites without a corresponding increase in advanced-generation cephalosporins. This finding may indicate increased acceptability of implementation strategies and/or sensitivity to the FDA warnings. The acute-care PBRN sites perceived most formulary restrictions to be effective in improving fluoroquinolone use. Acceptability of antibiotic stewardship strategies which focus on medication restrictions may lower antibiotic prescribing rates and improve implementation.
To view supplementary material for this article, please visit https://doi.org/10.1017/ice.2021.10
The opinions expressed are those of the authors and do not represent those of the Department of Veterans’ Affairs, the Centers for Disease Control or Prevention or the US government.
This material is based upon work supported by Centers for Disease Control and Prevention, Practice-Based Research Network (PBRN).
Conflicts of Interest
All authors report no conflicts of interest relevant to this article.

domain: literature


As a contract manufacturer focusing on machine cladding and containers, you have to be able to cover a wide range of sheet thicknesses when bending. The sometimes large and heavy components with their flat character are predestined for swivel bending. There are also a variety of challenges to be overcome in terms of bending geometries. These include folds, radii, inside bends, sheets with sensitive surfaces, and the full spectrum from very thin to very thick materials. With the RAS GIGAbend swivel bending machine, this balancing act succeeds perfectly, confirms Mareen Kaupp, who should know.
Just a glance at the machinery of Kaupp Blechbearbeitung GmbH &Co.KG illustrates the range of tasks. It all starts with a well-stocked sheet metal warehouse. In cutting, you will find a guillotine shear, a punch-laser combination machine and a plasma system. For bending, three press brakes of different lengths and tonnages are added. The GIGAbend swivel bending machine with 6 mm bending capacity on 3200 mm length completes the technology mix.
Managing Director Mareen Kaupp has been leading the company in the fourth generation since the sudden death of her father. Mother Karola Kaupp is responsible for the commercial tasks. With this female power, the company from Alpirsbach mainly manufactures machine cladding, trays and oil tanks for hardening furnaces, veneer presses and panel saws.
Mareen Kaupp is not only the managing director and workshop manager, but also actively works in production. She maintains a holistic and self-reliant work style with the workshop staff. This means that each specialist is responsible for a part from A to Z and can therefore perform all activities.
This starts with analyzing the received step files of the sheet metal components on the 3D CAD system. The process continues with the creation of the blanks by cutting, punching, lasering or plasma cutting. In bending, swivel bending complements the three press brakes.
Deputy workshop manager Immanuel Digel tells us, “For the large and heavy tubs, the swivel bending technology has enormous advantages because the bent part lies on the stop and does not have to be guided up.” Kaupp has chosen a machine configuration with a closed rectangular fence with a depth of 3 meters for this purpose. With the help of a vacuum lift, even large unwinds of 3000 x 2000 mm can be loaded, bent and unloaded by one person alone.
Mareen Kaupp emphasizes, “For us, accuracy is important right from the first bent part. With the large cladding sheets, parts for running in would cause very high costs.” Therefore, the leg dimensions, angle and straightness of the bends must be correct right away. The stop fingers position the bent parts very precisely and simply slide the parts during subsequent bends. The upper beam then clamps the sheet with 120 tons of clamping force to prevent slippage in the bending process.
The swivel movement of the bending beam causes the bending to the desired angle. In a press, the angle is generated by a linear downward movement of the punch. Swivel bending is different. Here, the bending beam moves directly to the desired angle by means of a swiveling movement. The material tables stored in the software take into account the springback for different materials, sheet thicknesses and bending lengths. The swivel angle of the bending beam is therefore the nominal angle plus an automatically added correction value.
“As an artisanal company, we make many decisions in the workshop,” explains Mareen Kaupp. For such cases it is helpful that the GIGAbend outputs an unwinding of the bending profile as the stretched length of the material. The software also calculates the bending sequence of profiles and displays the result of such a simulation in a graphic for each bending step.
An intelligent crowning system integrated into the bending beam is responsible for the straightness of the bend. This system uses sensors to measure the deflection of the cheek during bending and automatically sets a crown for each bend.
Mareen Kaupp is still amazed every day at how straight the bends are. “Of course, before we purchased it, we watched the GIGAbend videos showing the angular accuracy along the bend and thought ‘good marketing’. Today, we know that the machine actually does that.”
Many customers get by with one set of tools for the upper collet and the bending collet. This is not the case with Kaupp due to the extreme part spectrum. Here you can find pointing tools, which are used for profile-like parts with maximum sheet thickness. The 200 mm high tools have a large clearance area behind the tool and can be used for parts up to 4 mm sheet steel. The 300 mm high tools with large front clearance are still approved up to 2 mm.
And another advantage should not remain unmentioned: If you have equipped the machine with pointing tools and then want to bend a box, you do not have to disassemble the entire machine. Instead, only some sections of the pointing tool are removed and higher tool segments are built there. Immanuel Digel confirms, “Since we sometimes rebuild 5 to 6 times a day, this reduces the setup effort considerably.”
Kaupp also enters the race well sorted in the field of bending beam tools. In addition to 36 mm wide tool segments for full bending performance, 18 mm wide bending beam tools are also available for narrow Z-bends. As a special feature, chamfered leading tool segments can also be used to produce internal window bends. The split bending beam tools not only simplify setup, but gaps can be built in the bending beam to create the space for vertically protruding tabs during bending.
On some bent parts, envelopes can be found in the edge area. On the one hand, such folds serve to reinforce the edge zones. On the other hand, they serve as a protective edge so that no one can injure themselves on a sharp sheet edge during assembly.
Sometimes profiles with open envelopes are also used as connectors of, for example, two tubs. The pressing of envelopes is done with the same tools that are used for bending. The upper cheek presses a leg that is bent as far forward as possible downward with its closing force. This is where the 120 tons of clamping force of the upper beam come into play again. However, to ensure that the covers are also pressed down evenly in the center of the machine, the stiffness of the voluminous top beam is crucial.
In terms of materials, too, Alpirsbach’s sheet metal production facility has almost everything the market has to offer. Besides normal steel sheet, you can find bent parts made of galvanized material. In addition, bent parts are made of steel or aluminum checker plate. Using the swivel bending technique, Kaupp was even able to win an order for luminaire reflectors made of high-gloss 0.5 mm thin aluminum sheets, where the impression-free bending of the individual facets is crucial. Thus, the GIGAbend exploits the entire spectrum of very thin, up to 6 mm thick sheets.
“We have never decided so quickly on a machine purchase. With the GIGAbend, we have found an absolutely professional machine that offers us the variety of applications required in the trade,” concludes Mareen Kaupp.


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All you need to find out about mortgage loans in one single spot. Make use of our “frequently asked questions" area to learn everything about mortgages, refinancing, house equity personal lines of credit and much more.
Having very poor credit isn’t only inconvenient, it may be a roadblock that is huge big acquisitions like a property. Considering that the harm from a couple of errors or an regrettable accident make a difference you for decades, many individuals decide to look for a loan provider which will make use of their credit, as opposed to hold back until they could purchase more house or apartment with the exact same cash using an even more conventional real estate loan.
The nice thing about it is your bad credit may remain sufficient. Numerous programs have actually paid down their minimal fico scores or allow handbook underwriting when thereвЂ™s an extenuating scenario behind the credit hit.
More Forgiving Loan Tools
Although you nevertheless could get rejected, there are many conventional loan programs which will help you can get a significantly better loan utilizing the credit youвЂ™ve got at this time. Your file may need underwriting that is manual nevertheless, and never all banking institutions are able to try this. Ask before you apply, if they inform you they never do a manual underwrite, move ahead to another man. Listed here are three good places to begin mortgage-hunting:
Usa Department of Agriculture. You may qualify for one of the USDAвЂ™s loan programs if you live in a rural area. The website states they now need a credit history of 640 to streamline the application, however they do enable manual underwriting that may result in the loan during the lenderвЂ™s discernment. This is when youвЂ™d plead your instance and show your credit dilemmas are caused by some situation which has passed away.
Usa Department of Veterans Affairs. Veterans and presently serving people in the military are able to find a friendly harbor for their woeful credit into the VAвЂ™s mortgage system. Probably the most essential certification for these loans will be your solution, perhaps maybe perhaps perhaps not your credit or your revenue. They positively simply take your power to spend into account, but are more forgiving than you may imagine. You should be certain to enable sufficient time for approval, considering that the VA can go gradually.
Federal Housing Management. FHA is definitely the mortgage that is first for house purchasers who’re engaging in the marketplace. It really is a simpler company to do business with than Fannie Mae or Freddie Mac and providers are often more ready to manually underwrite loans for borrowers which are promising. The bottom rating to be eligible for an FHA loan is 500, however with a caveat. YouвЂ™ll need a big down payment for that be effective. 580 could be the true number if youвЂ™re looking to benefit from FHAвЂ™s 3.5 % downpayment choice.
ThereвЂ™s one more asterisk about this: Lenders can add on their own needs on the loans they generate. These rules that are extra called lender overlays, will make it difficult for you really to qualify at one bank and easier at another. TheyвЂ™re nevertheless offering the exact same system, but working together with two various sets of interior guidelines. As an example, Bank the may perhaps perhaps maybe not compose an FHA loan on credit ratings under 620 in just about any situation, where Bank B could be prepared to compose at 580, offered you do have a solid work history and good current repayment history.
Your option that is last for home loan with Bad Credit
Peddlers of non-qualified mortgages could possibly offer you an exotic-type home loan that will ignore your credit dilemmas, if not connect you up by having an investor who’s to locate a good return to their investment via high rate of interest mortgages. ThereвЂ™s a lot to dissect right right here, nevertheless the quick version is going this path is fraught with danger.
YouвЂ™re no further in realm of regulated lending, youвЂ™re in the open West. Such a thing goes, so that you have actually to read through every kind, do every calculation, and just simply simply just take every precaution to safeguard yourself from shady practitioners. ThatвЂ™s not to imply that there arenвЂ™t ethical NQ mortgage providers, exactly that you will find surely some that arenвЂ™t. Plus it just takes anyone to simply take your credit from bad to dumpster fire right away.
Whenever you speak to an NQ mortgage provider, ask a complete lot of concerns. Enquire about the home loan features, and just why they believe this home loan is a better fit than another. Ask whoвЂ™s funding the home loan. The greater you ask, the higher of a feel youвЂ™ll have for the financial institution in front side of you. When they make an effort to go you through quickly and wonвЂ™t respond to the questions you ask, youвЂ™d be better to show your self away.
Items to view with an NQ mortgage consist of, but arenвЂ™t restricted to:
Interest levels. YouвЂ™re almost always going to be paying considerably more in interest if youвЂ™re dealing with an NQ mortgage. Just make sure you realize exactly how much interest youвЂ™re actually spending, particularly if youвЂ™re making use of numerous loans with aвЂќ rate that isвЂњblended.
Prepayment penalty. Don’t ever get home financing by having a prepayment penalty. This penalty means which you canвЂ™t spend your loan down before a group duration, even though you offer the home, without a substantial monetary penalty. You canвЂ™t also make a more impressive re re payment as compared to minimum or submit your taxation come back to eat along the principal a bit. Prepayment charges arenвЂ™t advantageous to the buyer under any circumstances.
Shutting costs. Dealing with an NQ mortgage company usually ensures that youвЂ™ll do have more choices from more banking institutions and investors than you’d using the bank that handles your account that is checking instance. But therefore many choices also have a many more charges. The closing expenses using this form of loan provider could be often times more than from the bank that is traditional make certain you understand how much youвЂ™re have to for closing from the get-go.
Exotic loan features. If for example the loan includes a balloon, negative amortization or an interest-only period, donвЂ™t sign the documents until you certainly determine what this implies while having a strategy to have a much better item ASAP. These features only establish you for catastrophe later on.
No matter what kind of home loan you decide on, constantly browse the documents very very carefully and have about what you donвЂ™t realize. Mortgages are complicated, and youвЂ™re not expected to understand every thing. It is that loan youвЂ™ll be associated with for a long time and another that bad credit oregon will destroy your economic life if you become defaulting.

domain: economics


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Thomas Gregory Associates Insurance has an in-depth understanding of our Nationwide home insurance products and other personal liability policies. Find us in Wakefield at 201 Edgewater Dr. Our agents are highly trained and are capable of answering all of your questions about home insurance policies. Call Thomas Gregory Associates Insurance at (781) 435-6080 to explore your insurance options.
At Thomas Gregory Associates Insurance, we want to make customers aware of how easy and affordable life insurance is. We know many people in Wakefield think they cannot afford to have a good policy that protects their financial interests. That is why we work with Nationwide to provide customers with the diverse coverage options they need to sleep peacefully at night.
Affordability is a major concern for most. In addition to choosing coverage based on what you can afford, you need to think about how you or your loved ones may need to use your policy proceeds. Maybe you’ll need to replace lost income or pay for long-term care expenses and your kids’ college education. These issues may not completely encompass your current concerns. However, keeping them in mind will help you discern the proper coverage level for your situation.
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By speaking with a life insurance agent who works with Nationwide, you can gain a better understanding of options that are ideal for your situation. The amount of coverage you need can help you meet your current and future financial goals.
To better understand coverage options, we encourage you to contact Thomas Gregory Associates Insurance at (781) 435-6080 to arrange a time to meet in office at 201 Edgewater Dr,Wakefield,MA,01880 to discuss your needs. For additional convenience, our agents are ready to help you go over coverage options over the phone.
Whether your Wakefield company is looking for liability, property, or more specialized commercial insurance, the Thomas Gregory Associates Insurance can help better manage your company's risk. We have insurance expertise in major industries like retail and construction, as well as more niche industries like golf courses and beauty salons.
We also offer several types of employee insurance, including many that go above and beyond state-required coverage like workers compensation. What if someone blows out a knee at the company softball game, for example? Let one of the experts at Thomas Gregory Associates Insurance explain to you the advantages of Nationwide's GrouProtector℠ coverage. Meanwhile, the On Your Side® Review is a great way to keep your company up-to-date with the latest changes to state laws and local markets.
With a business owner's policy and flexible billing options, we can readily develop an insurance solution that's customized for your Wakefield business. For a policy that leaves no coverage gaps and a payment schedule that makes sense for your business' day-to-day, don't hesitate to contact us. Thomas Gregory Associates Insurance or one of our other knowledgeable agents can help protect your business from coverable losses. Give us a call at (781) 435-6080. You can also schedule an appointment with our 201 Edgewater Dr office.
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domain: finance


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A/N: Next update is the last update. =[ -cries-
#31 - Book
"I think you'll like this," she said, and held out for him a leather-bound tome.
#32 - Eye
"OW," Rachel cried, "How the hell do women manage put this stuff on their eyes EVERY DAY?"
#33 – Never
"Have you ever considered cutting your—" Rachel shut her mouth as Escad fixed her with a withering glare, and she swore that his blonde head began shining prettier than usual for emphasis.
#34 - Sing
"Lips, red as the berries in June; Red the rose, red the rose…Skin, pale as the light of the moon, gently as she goes…"
#35 - Sudden
"And so I took my sword and bore it down upon—why are you staring at me like that?" he asked suddenly, and with a start Rachel cast her eyes away, red-faced as she fumbled for an excuse.
#36 – Stop
"STOP," Rachel snapped loudly; Escad froze, wondering dimly if he should be fearing for his life.
#37 - Time
"Heh," Rachel croaked brokenly, and Escad swore that he heard something inside of him break with it; "I guess I have all of eternity to figure it out, right?"
#38 – Wash
Escad offered a kind of sheepish, somewhat apologetic shrug as he watched Rachel hold up his soiled shirt with a curled lip; "Ugh," she said.
#39 - Torn
"I don't know," he told her—her hard eyes, her trembling lips, her tear-streaked cheeks; "I don't know what I want."
#40 - History
"Come on," she whispered, cupping his dirty cheek; "Let's make history."


Ford Econoline Wheel Parts
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great coilover suspension for the price i paid. car rides better than my old tokico set up.
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Received the hood after 7 days from the order date. thanks for the quick shipping! I have already putted on the hood and my accord looks really slick now. Thanks ilovebodykits
my car sounds aggressive with this exhaust n i felt the acceleration is smoother n more power when the vtec kicks
Christopher R. - (Mesa. AZ)
43 reviews 4.5 out of 5 stars


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This black dog collar by Rogz from the series "Trendy" offers good nylon dog collars, dog leashes and dog harnesses of excellent quality in modern prints.
The dog collar is made of sturdy nylon and has a engraved Rogz snap closure.
Reflective yarn is woven into the webbing for night time visibility.
Available in the following sizes:
|XS||14 - 21 cm||8 mm|
|S||19 - 30 cm||12 mm|
|M||28 - 46 cm||16 mm|
Koper heeft geen omschrijving achtergelaten.
Beoordeling Petsonline: 9.1 / 10 (2212 beoordelingen) op Kiyoh.nl

domain: pet


text:
Unlike any other cell type, immune cells traverse blood, lymph, and tissues, and so, they are uniquely exposed to all of the different oxygen levels in the body (physioxia).
Ischemic injury and tumors can produce oxygen levels that are particularly low (hypoxia). None of these in vivo environments compare to room air oxygen, which is where most immunological assays are performed. That is an essential disconnect between in vitro and in vivo Immunology, contributing to problems with Reproducibility and Translatability of findings.
Evidence is accumulating that oxygen and Reactive Oxygen Species (ROS) affect immune cell function in profound ways. Below are some ways our hypoxia & modular incubator chambers are used in immunology research:
- Oxygen affects T cell differentiation – subtypes and function
- Oxygen affects B cell migration
- NK , macrophage, and dendritic cells use ROS functionally
- Oxygen is a critical part of hematopoietic bone marrow niche physiology as well as germinal center physiology
- Oxygen affects immunomodulation by MSC
- Immunometabolism is a rapidly expanding field where the role of oxygen is being understood.
It is possible to control in vitro environments to the proper oxygen level for culturing cells as well as handling cells.
OxyCycler C42 & C-Chamber
Cell Research – physioxia/hypoxia workstation, combined oxygen incubator and hood system, in vitro oxygen/hypoxia glove box, with independently programmable control of O2, CO2, and Temp in one (or more) modular incubator chamber and/or hood chambers – Xvivo System
Immunology Research at Royal College of Surgeons Ireland
Immunology Research at University of California, San Francisco

domain: medical


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By Tswelopele Makoe
THIS past Wednesday, October 4, residents of District Six were in an uproar after blocked drains and burst pipes left their homes damaged.
Sewage, raw faeces, and dirt streamed into their homes, leaving many of the residents displaced. In fact, many of the residents had to stay in hotels and alternative accommodation.
This incident is not only affecting the lives of innumerable citizens, but also exacerbating the housing crisis and socio-economic strain that people are already undergoing.
It is truly devastating that, as the year draws to a close, and the joyful holiday season ensues, masses of people will still be contending with the resultant damage of this event.
Lack of service delivery is not unique to Cape Town – it is rampant across the country.
By definition, service delivery refers to the provision of basic services. These include, among others, electricity, clean water supply, functioning roads, street lights, health services, refuse collection, traffic controls, sewage disposal and maintenance.
Local government through municipal infrastructure is responsible for ensuring the provision of these services. Without the consistent provision of these fundamental services, the quality of life in our communities and our living conditions would rapidly decline.
This would further lead to the decline of resources, and dwindling job opportunities. Additionally, this would affect access to shelter, food, and health care, leading to widespread malnutrition, as well as poor physical and mental health.
In our highly unequal post-apartheid context, underprivileged South African communities bear the brunt of poor basic service delivery, particularly where water, sanitation and electricity are concerned.
Over the past decade, South Africa has experienced a proliferation of service delivery protests aimed at local municipalities for their perceived lack of provision of basic services.
People are angry, and people are frustrated. As time goes by, these protests magnify, not only increasing in participation and occurrence, but also in intensity.
As a result, they become more violent, dangerous, and destructive. In 2022 alone, the SAPS was present at about 2 455 protests.
There were 122 service delivery protests in the first half of 2023 alone. The first 32 protests, recorded in January, were a direct response to the rolling blackouts as a result of Eskom’s power cuts as well as water outages caused by load shedding.
The rampant power outages have not only resulted in the disruption of business operations and productivity, but they have also impacted schools, workplaces, the banking industry as well as vital household routines that require electricity.
This has left countless people scrambling for alternative sources of power, many of which are unaffordable and inaccessible.
Another challenge to contend with during load shedding is the amplification of criminal behaviour. In the dark, criminals tend to roam and enact crimes more easily, particularly because of a lack of light and working security systems.
Furthermore, communities are unable to take evening walks and travel freely, and as such the quality of life is highly compromised in many communities. Ultimately, the deterioration of basic services leads to the escalation of various societal challenges and compounds our societal problems.
In South Africa, a nation deeply riddled with economic disparities and socio-economic inequalities, the failure of public services has had a rampant effect.
With a poverty rate of over 60%, the stratified cost of living, coupled with poor service delivery, and compounded by crime and corruption, has left the nation highly discontented.
These challenges amplify the daily struggles of South African citizens, further impeding their access to employment, and to agricultural resources, as well as vital services and other resources.
This year marks 29 years since the advent of democracy, yet millions of citizens of all ages are still struggling to access proper infrastructure, proper sewerage and refuse disposal, clean water, proper toilets, homes, and electricity, among others.
Due to the high unemployment and poverty rate, scores of citizens remain dependent on the government for these services and provisions. In fact, the government refuses to recognise and acknowledge the need for these services in many rural areas and informal settlements.
Countless citizens are disempowered and remain unheard, and as such, the rise in service delivery protests is unsurprising and inevitable.
As South African socialist and scholar-activist Dr Trevor Ngwane reflected: “For the grass to burn, it must be dry.” People are disheartened, and the needs of the society have completely overburdened the fibre of the nation.
Kevin Allan, the managing director of Municipal IQ, referred to service delivery protests as a “regularly occurring and firmly entrenched social phenomenon”.
We need to ensure that we are tackling this issue not only at a governmental level, but also at an institutional and social level.
We should not minimise the power of protests as a tool for change. Echoing Ngwane’s sentiments in an SABC News interview: “The failures of the present government have turned poor South Africans into communities of protesters… the lack of service delivery has forced ordinary poor citizens to go to the streets in order to be heard, because no one hears them otherwise.”
Perhaps this is why South Africa is dubbed by some as the “protest capital of the world”. This not only speaks volumes about the state of our society, but the anguish that is embedded in our society as a result of a defunct system.
Service delivery is not only about the provisions that are pertinent to the survival of a society. It is about the crucial role of the local municipality in supporting household empowerment and promoting a stable society.
The role of service delivery is a crucial one that promotes social equity, drives economic development, and maintains political stability, environmental sustainability, fostering public trust, and enhancing accountability and transparency.
It seems that service delivery is only made a national focus during election times, where it is partnered with elaborate empty promises. We need to start addressing service delivery with the seriousness that it deserves, understanding its direct impact on the empowerment of the individuals in our society, and its power to construct a formidable society overall.
As former UK prime minister Gordon Brown once tactfully said: “The vision of personalised public services – meeting the individual needs of all our citizens – requires continuing reform in the way services are delivered.”
* Tswelopele Makoe is a gender activist. She is also an Andrew W Mellon scholar, pursuing an MA Ethics at UWC, and affiliated with the Desmond Tutu Centre for Religion and Social Justice. The views expressed are her own.


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We [M21, F22] have been together for almost a year now and have always just clicked in a way where we almost know exactly when something might be wrong.
I've always been a very private guy when it comes to my emotions and feelings. When she goes through hardships and bad times, I am always there to show my support and cheer her up. This is anything from flowers, to supportive texts. She has always been open about her feelings, but this being my first relationship, I find it quite difficult to do. She feels that I am always there for her, but she is never there for me when I need it.
Recently, things in my personal life have taken a turn. When I was grieving, I told her what would help me cope and she tried her best despite being busy herself. A part of me is always hesitant to come out or text her how I'm feeling during the week, because she is usually very stressed with work and I don't want to be a burden to her with my issues.
She told me that she feels that I am not open enough with my feelings to her and this has led her to not wanting to share her own with me. She thinks that I do not want to confide in her during my time of need. When I told her that I find it hard to communicate about my feelings past the usual "I'm good" and "I'm feeling meh", and that I need help being more open about it, she told me that it's as if we are not serious and that she feels reluctant sharing her feelings with me because of it. Even when I really am feeling "fine" and I tell her, she suspects that there is more I'm feeling.
At times, I just don't really feel in touch with my feelings myself and despite loving her, it's hard for me to communicate it with her. This is ruining my relationship.
TL;DR: I find it difficult to express my feelings openly in my relationship. This has made my girlfriend think that I do not want to confide in her and has led her to feel reluctant about sharing her feelings with me.
Whenever things are going smoothly and calmly in the relationship, we have these small petty arguments about things that's often caused by miscommunication. Despite having very open and honest communication, these things still happen sometimes. I've always been a very private guy when it comes to my emotions and feelings

domain: sociology


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Mesnevi Farm Aged Kashkaval Cheese (Eski Kasar)
Mesnevi Farm Aged Kashkaval Cheese, also known as Eski Kasar in Turkish, is a finely aged cheese with roots deeply embedded in Turkish culinary tradition. Made from high-quality cow's milk, this cheese undergoes an extended aging process to develop its nuanced flavours and a firm yet crumbly texture.
Mesnevi Farm Aged Kashkaval Cheese boasts a rich and nutty flavour profile, with hints of caramelized notes that intensify during the aging process. The cheese has a firm texture that crumbles delicately, offering a satisfying mouthfeel that adds depth to your culinary creations.
Country Of Origin

domain: food


Knee Scooter Secrets in Fairchild Air Force Base WA 99011
Get where you left off? You’ve been signed out because of inactivity, but it’s easy to choose up in which you still left off on Walgreens.com.
Functions twin loop hand brakes and sturdy eight inch wheels. The Northrup Knee Walker – Supports around four hundred kilos. Options Device free peak adjustments and easy folding for journey. Reclaim your Way of life in the course of the healing course of action by leasing considered one of our easy mobility scooters today!
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Fairchild Air Force Base WA - BingNews Search results
Black Hawks staged at Fairchild Air Force Base to help with firefight
The National Park Service says a 60-year-old man died after falling while climbing a mountain peak in northwest Washington state. The Seattle Times reports the Skagit County Coroner's Office identifie...
Ex-NFL star Herschel Walker speaks about mental illness at Fairchild Air Force Base
Walker, who had just given an hour-long talk at Fairchild Air Force Base about mental health, engaged the couple of hundred airmen and airwomen, taking pictures and signing memorabilia. Hatcher grew u...
Col. Derek Salmi to Assume Command of Fairchild Air Force Base
On Friday, hundreds of airmen at Fairchild Air Force Base gathered to welcome their new commander ... STEVENS COUNTY, Wash. - Washington State Patrols responded to a fatal crash in Stevens County Frid...
3M : Neighbors of Fairchild Air Force Base sue makers of toxic fire retardant, including 3M Co.
April 11--Nearly 100 people who live near Fairchild Air Force Base have filed a federal class-action lawsuit against manufacturers of a firefighting foam that has contaminated the area's water supply. ...
Neighbors of Fairchild Air Force Base sue makers of toxic fire retardant, including 3M Co.
Nearly 100 people who live near Fairchild Air Force Base have filed a federal class-action lawsuit ... The case involving Fairchild was filed last week in the U.S. District Court for Eastern Washingto...


'Tis the season to be soulful: This Friday, September 29, Craft Recordings and Stax Records will celebrate the holidays with the CD, LP, and digital release of A Stax Christmas. This festive 12-track compilation features songs by the label's most beloved artists including two previously unreleased tracks from Carla Thomas and Otis Redding. The venerable Memphis label has had a long association with the music of Christmas. House band Booker T. and The MG's 1966 album In the Christmas Spirit
One of the greatest music festivals of the '70s is getting celebrated with an exhaustive array of reissues in 2023: Wattstax, the multi-dimensional Los Angeles celebration of soul, funk, blues and gospel courtesy of Stax Records. A half-century after the premiere of a Golden Globe-nominated documentary on the star-studded 1972 event, Craft Recordings, custodian of the Stax catalogue, will release the most definitive looks at Wattstax, most recently addressed in a 3CD box set in 2003 that took
Producer-compiler Bob Stanley's last couple of compilations for Ace have placed him squarely within the 1970s. Earlier this year, Saint Etienne Present Songs for the Fountain Coffee Room (compiled by Stanley, Sarah Cracknell, and Pete Wiggs) conjured "the soundtrack for a bar in mid-'70s Los Angeles," or a St. Etienne-style spin on "yacht rock" with Stephen Bishop, Ned Doheny, Boz Scaggs, and Seals and Crofts among those featured. Stanley has followed Fountain Coffee Room up with a trip to a
Today, we're looking at another trio of recent releases from the team at Ace Records! If you missed Part One of our Ace Round-Up, click here! While The Beatles are no doubt Liverpool's most famous musical export, Merseyside - spanning 249 square miles (or 645 square kilometers) bordering Lancashire to the northeast, Greater Manchester to the east, Cheshire to the south and southeast, and The Irish Sea to the west - yielded an abundance of groups like The Cryin' Shames, Gerry and The
SoulMusic Records has recently brought together the five Columbia/ARC albums of the beloved R&B trio The Emotions on one 3-CD set with a selection of eight bonus tracks. Don't Ask My Neighbors: The Columbia/ARC Recordings (1976-1981) has Flowers (1976), Rejoice (1977), Sunbeam (1978), Come Into Our World (1979), and New Affair (1981) in one clamshell case. Sisters Sheila, Wanda and Jeanette Hutchinson first recorded on the small Brainstorm and Twin Stacks labels before receiving national
Welcome to this week's Release Round-Up! Here's what arriving today, August 23. Elvis Presley, American Sound 1969 (RCA/Legacy) (Amazon U.S.) The Elvis 1969 celebration continues! In January of that year, Presley and his band began sessions with producer Chips Moman at American Sound Studios in Memphis, which resulted in his acclaimed From Elvis In Memphis album and its lead single "In the Ghetto." He also laid down such iconic songs as "Suspicious Minds," "Kentucky Rain,"
Rarely has a group's name been as befitting as that of The Emotions. Sisters Sheila, Wanda and Jeanette Hutchinson couldn't help but touch a wide spectrum of emotions with their spirited, soulful recordings. Blessed: The Emotions Anthology 1969-1985, released earlier this year on Cherry Red Group's Big Break Records imprint, is a deliciously comprehensive, 2-CD, 40-track collection drawing on the vaults of Stax/Volt, Columbia/ARC, Red Label and Motown to paint the fullest portrait of The
We have plenty of news coming your way from Big Break Records as the Cherry Red soul specialists have closed out 2013 and already announced plans for 2014 in a big way. Before we dive into recent releases from Joe Bataan, The Salsoul Orchestra, Chris Jasper and Herbie Mann, we wouldn’t want you to miss two recent disco-flavored releases from The Emotions and Foxy! The BBR label welcomes The Emotions, appropriately enough, with the R&B girl group’s 1979 album entitled Come Into Our World.
A new compilation of music from Stax Records is coming courtesy of a most interesting source: rapper/producer/actor/director RZA of The Wu-Tang Clan. The man born Robert Fitzgerald Diggs has rarely slowed down in the 20 years since Enter The Wu-Tang (36 Chambers) was released in the winter of 1993. Besides producing most of his group's early records and solo projects (including ODB's Return to the 36 Chambers, GZA's Liquid Swords, Method Man's Tical and Raekwon's Only Built 4 Cuban Linx...),


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We’ve teamed up with the guys from banger bros to bring you some exclusive tasty treats. It starts with our sausages.
We take an authentic bockwurst, made to a classic german recipe, top with fried shallots, specially sourced relishes and served on a lightly toasted brioche bun.
Choose from our range of damn fine bangers chargrilled to perfection and match with your choice of mash – from classic buttery to mustard favoured then add a gravy to top off a classic dish.
AND BURGERS TOO
We take an all-butter brioche bun, lightly toast then add a 100% beef burger and top with all sorts of good stuff from classic cheddar cheese and crispy bacon to bbq pulled pork or tangy blue cheese. No feeling beefy? There’s chicken and veggie options too.
A note on our free range eggs-
Due to instruction from the Department for Environment, Food and Rural Affairs (DEFRA) we have been advised that our Free Range eggs have been laid by hens temporarily housed in barns for their welfare. Our supplier wish to support these farmers and the welfare of their flocks and therefore our Free Range eggs will shortly carry this advice until the risk to hens has been reduced.


A Solar Powered Bike Sharing System
Copenhagen gets a sustainable bicycle network in a concept design by Stefano Marchetto.
Already one of the most bike-friendly cities in the world, Copenhagen is used as the setting for an interesting conceptual bike sharing system. Termed “Bicyclus” by Italian designer Stefano Marchetto, the new eco-friendly plan would reuse some 8,000 bikes that are abandoned every year and further facilitate easier commutes for residents through the city.
The Bicyclus idea intends to upgrade the city’s current world-famous bike system run by Bycykelservice. Since 1995, the city has systematically expanded the number and accessibility of bicycle lanes and routes, making bicycle travel more efficient than using cars or buses.


By Josh Farmer, IndyCar Reporter
AVONDALE, Ariz. – Yellow flags and equally fast teammates kept Helio Castroneves out of Victory Circle in last night’s Desert Diamond West Valley Phoenix Grand Prix at Phoenix Raceway.
The driver of the No. 3 REV Chevrolet sat on pole for Saturday night’s race and led the opening 73 of 250 laps. Team Penske teammate Will Power inherited the lead by staying out a few laps longer before pitting than Castroneves.
Following the stop, the 41-year-old Brazilian settled into second place until a yellow on lap 136 for Takuma Sato’s accident in Turn 4 trapped he and Power a lap down as Simon Pagenaud had not pitted yet. The field was waived around, putting Castroneves in third place for the restart.
Once the race restarted, the three-time winner of the Indianapolis 500 then found himself in a battle with teammate Josef Newgarden and Ed Carpenter Racing’s JR Hildebrand, as well as a number of drivers that were off the lead lap.
While mired in traffic, Castroneves stayed in close quarters with Newgarden and Hildebrand until Newgarden was eliminated from the fight following contact with Ryan Hunter-Reay.
Hildebrand zoomed past as Castroneves faded back and nearly lost the car towards the end of the race on his way to finishing in fourth. He noted that once Hildebrand was by, he felt his race end at that point.
“Hildebrand got the advantage, so that’s the race,” he told Motorsports Tribune. “At the end, we had a front wing. Unfortunately I was too greedy, I got too loose and it spooked me out.”
Castroneves noted that the Team Penske cars were so equal being out in clean air was the key to the race and if he would have stayed out in front, he would have had the same luck as Pagenaud – the eventual race winner.
“All four cars were close to each other,” he said. “You can see that everyone was putting up the same lap times.
“I would have been pretty much the same. Whoever would have gotten that lucky break from us, he would be sitting in Victory Circle.”
Although he was looking for more, he is happy with Team Penske and Chevrolet’s overall pace throughout the weekend and thinks it will build momentum heading into the Month of May.
“It was a great team effort, great work for the entire group,” Castroneves added.
“Unfortunately, when we have three other great drivers, that’s what happens. Somebody’s day is going to be short and someone’s day is going to be good.”


text:
This specific ISBN edition is currently not available.View all copies of this ISBN edition:
Proceedings of the conference, Sexuality and Edo Culture, 1750-1850, held at Indiana University on August 17-20, 1995. More than 130 illustrations. Sexuality in Edo culture has long been a taboo subject in literary histories and critical studies in spite of the fact that, as with other major cities, Edo urban culture materialized in narratives grounded in sexual fantasies. In Imaging/Reading Eros, scholars from many disciplines explore the connection between the awareness of the body and the self-consciousness of the city's culture in an effort to find a place for sexuality in teaching and research on Japan, while establishing a place for Edo popular culture in the canons of world art and literature.
"synopsis" may belong to another edition of this title.
Book Description East Asian Studies Center, 1996. Paperback. Condition: Fine. Like New Condition. 161 pages, illustrations. Text is clean and bright, binding is tight, covers are in excellent condition, tiny smudge on back cover, separate letter signed by editor. 100% Money Back Guarantee! Ships within 1 business day, includes tracking. Carefully packed. Serving satisfied customers since 1987. Seller Inventory # mon0000010721

domain: library


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Village Birth is a place to meet new parents, connect with your transition into parenting, and find support in community. Our gatherings are an opportunity to feel less alone in your postpartum time and feel safe enough to ask for help as you grow further into parenthood. Our Postpartum Support Group and Village Prenatal (Pregnancy Circles) are the core of our community gatherings, but our other offerings allow for you to grow and stay in touch with the Village Birth Community.
Some of our events are casual, while others are more structured, led by a specialist and call in reverence for this beautiful rite of passage. Most take place in our space in Pasadena, some at a residence, and others at parks and gardens throughout Northeast LA.


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Do you think an Elder Scrolls MMO makes too much sense? So does everyone else. And now everyone else includes Bethesda, because they’ve officially announced The Elder Scrolls Online.
Everything rumored before seems to be true. Three factions fighting for the control of the Emperor’s throne, a millennium before the events of Skyrim. Something newly revealed is the main antagonizing force behind it all. Daedric prince of domination, Molag Bal, is working behind the scenes to drag Tamriel into his plane of Oblivion. Any more details like its solo quests and sprawling dungeons will be revealed in Game Informer’s June issue.
The cover is also obviously an Ouroboros, the self-destructive beast which consumes itself and represents an eternal cycle of life and death. It’ll be interesting to see how the symbol factors into the MMO.

domain: game


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Gun control persuasive essay questions introduction examples statistics expert authority facts conclusion - what events led to the idea of the gun control law in the us - what are the pros and the cons of gun. View essay - persuasive essay- gun rights docx from english ap at pacific high school persuasive essay gun rights saxon hagemann adv english iii rogan 3rd hour 11/18/16 hagemann 1 in the most. Persuasive speech outline title: gun control (con) reviewed as a means to open your eyes to the thought of a country that actually granted us our rights . Argumentative essay on gun control 2014 mr bultman gun regulations and rights of american citizens for centuries guns have always been a part of america’s way .
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This is a sample essay on the gun control issue you can use this structure and format to compose your own persuasive essay of such a kind if you have no time or . View essay - pro-gun-persuasive-speech from english 97 at university of pittsburgh body ithe foundation of our country is based in english bill of rights and . Free essays available online are good but they will not follow the guidelines of your particular writing assignment if you need a custom term paper on gun control: persuasive speech for gun ownership, you can hire a professional writer here to write you a high quality authentic essay.
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Persuasive essay on gun control constitution needs to be updated another argument, americans have the rights to defend themselves and their homes against criminals.

domain: law


Alright, we'd say you've earned your stripes. Go ahead and take these babies home. Semi-stretchy distressed denim skinny jeans feature an allover camouflage print, an elasticized waistband with an adjustable drawstring, frayed slits on the knees, and sporty striped panels down the sides of the pant legs. Pants are finished with a classic five-pocket design, a faux zip fly, and no additional closures. Pattern placement and distressing may vary slightly.
Model is wearing a small All measurements are for a small Length: 37.5" Inseam: 27" Waist: 24" 97% Cotton, 3% Spandex Machine wash cold inside out gentle with like colors, hang dry. Do not bleach Made in China


Where are you on the continuum of ‘free’ or ‘subscription’? I have personally being paying to Spotify for around 4 years now – as I think it is the only way the music industry has a future.The ‘free’ model for me is akin to asking me to play a gig for free – not only is it not sustainable, but it also sends the wrong message – Music Should Not Be a Free Commodity!
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Merthyr Music Project


By Hans M. Kristensen
The cost of securing U.S. non-strategic nuclear weapons deployed in Europe is expected to nearly double to meet increased U.S. security standards, according to the Pentagon’s FY2015 budget request.
According to the Department of Defense NATO Security Investment Program , NATO has invested over $80 Million since 2000 to secure nuclear weapons storage sites in Belgium, Germany, Italy, the Netherlands, and Turkey.
But according to the Department of Defense budget request, new U.S. security standards will require another $154 million to further beef up security at six bases in the five countries. Continue Reading →


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Once upon a time there was a king by the name of Wu, who ruled China. The kingdom was prosperous and everyone was happy. At the same time in the endless palace gardens, there was a nightingale too which was keeping people happy in her own way. The nightingale would sing and the guards would be happy and cheerful listening to it. But Wu never came to know about this lovely nightingale that resided in own gardens.
One day, a messenger came running into the court, bearing a message about the Japanese emperor’s visit to their kingdom. Wu at once ordered that the Japanese emperor should receive the best treatment and that he should be taken care of well until he returns back to Japan. And so the Japanese emperor came and he received the best hospitality.
One day, as the Japanese emperor was walking through the palace gardens, he heard the nightingale sing and owing to her soothing voice, he drifted off to another world. Then eventually, the Japanese emperor returned to his kingdom and he sent Wu a letter, thanking him for his hospitality. In the letter, there was a specific mention about the nightingale and her sweet voice. Wu then wanted to know about the whereabouts of this nightingale and so he ordered his guards to bring her to him.
The guards took the nightingale from the gardens and brought her in front of Wu. The nightingale then began to sing as was her habit and Wu was deeply impressed by her voice. From then on, Wu raised the nightingale in his room and they both became very close friends.
One day in order to thank Wu, the Japanese emperor sent a gift to him. It was a wooden toy of the nightingale he had seen. But that was not all. It had a key to it and when the key was twisted enough, the toy would sing, just as if a real nightingale would sing. Wu fell in love with this present and he ordered that it be taken to his room. From that day on, Wu only played with the toy and listened to its voice and he never called upon his best friend, the nightingale to sing for him. The nightingale saw all this and grew distressed. She then left the palace with a vow to never return again.
Wu never realised the absence of his best friend until the toy broke one fine day. He asked his guards to enquire around the world for anyone who could repair it. After many days, the guards returned with bad news and said that there was nobody who could fix it. They said that even the original toymaker had died and hence there was no hope. Wu, who had now grown attached to listening to the sweet songs of the nightingale, fell sick and became bedridden. The doctors, after conducting numerous tests and analysing his situation, said that only the nightingale’s voice could heal him.
Wu remained bedridden with no cure in sight and he was on the verge of death. The guards tried to look for the nightingale but they could not find her anywhere and had completely given up. One fine day, a flutter of wings was heard by the windowsill and a lovely song filled the air in the room where the king was lying. Wu woke up thinking it was a dream, only to see his long lost friend sitting on the windowsill, right there in front of him. He went running up to her and apologised for his mistake. The nightingale continued to sing happily and Wu recovered fully. The nightingale and Wu lived happily ever after.
Moral - Always make sure to keep your best friends close and take care of them.

domain: artistic


This two-person, Off-Broadway musical by Andrew Lippa and Tom Greenwald is about challenging family relationships, and spans decades in its intimate and emotional storytelling. This collection features a dozen vocal selections from the musical along with a show synopsis, composer bios, and an essay by Lippa about composing the musical. Songs include: Bye Room • Every Goodbye Is Hello • Hold Down the Fort • It Took Me a While • Just like You • Old Clothes • Out of My Sight • The Road Ends Here • Smile of Your Dreams • That Was My Way • Trouble with Men • Welcome to the World.
$19.99 (US) Inventory #HL 00251079 ISBN: 9781540012098 UPC: 888680715175 Width: 9.0" Length: 12.0" 92 pages
Prices and availability subject to change without notice.
Series: Vocal Selections


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” ‘Zero Theorem‘ was more a reaction to the connected world,” director Terry Gilliam told us at the Marrakech Film Festival in December. “We all exist as part of the connection, we are a neuron in this bigger thing, can we disconnect? Can solitude be more interesting? I don’t know if people know who they are unless they spend time alone…they only know reactions, tweets etc, not actual existences. So that’s what interested me in the script, and we just started working. The film is much different than the film we started with. I like this film!” But will we like it? The first official trailer is here to make the case.
Starring Christoph Waltz, David Thewlis, Melanie Thierry, Ben Whishaw, Tilda Swinton and Matt Damon, the effort is one of the 21 Best Films Of 2014 We’ve Already Seen, telling the story of Qohen, who is tasked with solving the Zero Theorem, an equation that proves that existence is meaningless. Of course, this sends the man down the futuristic rabbit hole as he fights bureaucracy and gets lost in a world that blends reality and fantasy — basically, it’s all right in Giliam’s wheelhouse, in a picture called “an admirably ambitious and thoughtful sci-fi mindbender.”
Still no exact word on a U.S. release date (or distributor) but this trailer is a start. Watch below.

domain: entertainment


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Overview of Lab Reports
Students undertaking scientific courses such as Physics, Biology, and Engineering carry out lab experiments that prompts them to write lab reports.
But how should they write the lab reports? This is a question that most students would love to be answered
In this post, we provide the tips of writing an internationally accepted lab report
First, the lab reports provides the students with the opportunity to showcase that they properly understood the experiment they carried out in the labs. It acts as a very detailed diary of the lab experience.
Structure of lab report
The basic structure of lab report consists of (in that order);
- Title of the report
- Materials and Methods
Abstract: The abstract of the lab report is simply the summary of the report, the data, the results, and the major conclusions. In other words, it represents the synopsis of the experiment. It enables the reader to know whether the lab report would serve his or her propose to read the entire report.
Introduction: Here, the student should discuss the basic problem under the study and the theory that relates to the problem. The introduction should provide a background of the experiment and the reasons for conducting the experiment. Besides, the introduction should contain the goal of the experiment. The goal can be one sentence that explains what the experiment hopes to achieve. Therefore, the introduction should define the subject of the report and give a scientific purpose/objective of the report. The introduction of a lab report may answer the following three questions;
- Why was the experiment performed?
- What knowledge already exists on the topic?
- What is the specific purpose of the study?
Materials and Methods: This section should provide the actual materials and methods as they were used in the lab. This section should be written in a concise manner without overwhelming the reader. The procedures should be exactly as they are explained in the lab manual. Properly written materials and methods section should attempt to answer the following questions;
- What materials were used?
- How were the materials used?
- What methods were used?
Results: This section should basically summarize the data from the experiment without discussing their implications. The data presented at the results section can be organized into tables, figures, graphs, charts among others. All these should be presented in such way that they should have descriptive enough and have proper titles.
The figures and the diagrams also need to be numbered (such as Fig. 1….). Also, the figures, charts, and tables should be self-explanatory. This section of your report should concentrate on general trends and differences and not on trivial details. Many authors organize and write the results section before the rest of the report.
Discussion: This section should interpret the results and relate them to theory and established academic knowledge. This section should be written in such a way that it allows for the acceptance and the rejection of the original hypothesis. The section can also suggest ways of improvement concerning the topic in question.
Note that longer lab results can also have the “conclusion” section as a separate heading.
Also, the “appendix” section can be included after the references to show the information that is too detailed and could not be part of the original report. If the appendix is “formal,” it should contain a beginning, middle, and ending. For example, if the appendix contains tables of test data, the appendix should not only contain the tabular data, but also formally introduce those tables, discuss why they have been included, and explain the unusual aspects that might confuse the reader.
References: This section lists all the sources cited in the lab report. The sources should come from trusted academic sources such as books and academic journals. The references should be properly written in the correct format such as APA, HARVARD, MLA among others. Besides, the references should be listed in alphabetical order. All the references listed in the bibliography must appear in the body of the report as in-text citation.
Karin Knisely. A Student Handbook for Writing in Biology. W. H. Freeman, 2009

domain: biology


Everton transfers: Toffees chief confirms Leroy Fer deal is off
Everton transfers: Toffees chief executive Robert Elstone confirms the club have pulled out of a deal for FC Twente's Leroy Fer
Everton have pulled out of a deal to sign FC Twente midfielder Leroy Fer, the Toffees chief executive Robert Elstone has confirmed.
The Merseyside outfit had agreed a £8.6m deal with the Eredivisie outfit for the Netherlands international, but issues arose surrounding a long-standing knee problem during Fer’s medical.
Everton were reported to have gone back to Steve McClaren’s Twente in a bid to renegotiate the deal, but Elstone revealed the club have now called off the transfer.
“We were very excited about the prospect of a young international Dutch player coming to Goodison, and the combination of a lot of hard work we thought we had the player,” said Elstone.
“But the transfer did not go smoothly and there were some issues and, as our fans would expect, we have to put the club first, and as our track record proves, we thought long and hard about it but it did not work out.
“We have to be very careful about how we spend our money.”
Elstone insisted Everton would still look at other possible deals to complete before Thursday’s transfer deadline.
“We are still looking and there are other options for us and I refer back to our track record, and as any club we do have other options and it will not be for the lack of trying,” he added.


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|Georgia Alaskan Malamute Rescue
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1,849 Alaskan Malamute Dogs have been adopted on Rescue Me!
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|Rescue Me ID: 18-05-23-00037Clue (male)|
Clue is an Alaskan Malamute 4yrs 90 lbs He is a very friendly and outgoing fella, who is excited and has high energy. He is great with kids and other pets, but does not want to be bullied by another dog. Clue loves walks and car rides, but pulls EXTREMELY hard on a leash due to the fact he spent the previous 4 yrs of his life on a chain. Clue needs some leash work and a special collar to walk him with safely. He also needs daily exercise and mental stimulation. Clue is housetrained and cage trained as well. He is neutered and fully vetted. Clue was heartworm positive. He received full heartworm treatment 5/7/18 and will be ready for a new home 5/30/18. Wouldn't it be great if he had a wonderful family waiting for him? ADOPTION FEE $300 To set up a time to meet him or if interested in adopting please visit our website to submit an adoption application www.pregnantdogrescue.org or call 404-997-2831 or email firstname.lastname@example.org (Less)
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|Rescue Me ID: 18-05-02-00521 (female)|
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|Rescue Me ID: 18-04-26-00182Yogi Bear (male)|
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4627 Highway 17
Glynn County Brunswick, GA 31525 MAP IT!
|Rescue Me ID: 18-03-07-00170Cloud (male)|
Cloud is a majestic looking Malamute, about 2 years old who was impounded as a stray at Dekalb Animal Control. He is a very verbal fella and loves to make him self heard. He has the typical Malamute voice and Stubborn Personality. He is a but tense when you touch him on certain areas on his body but seemingly he is just not used to being loved on. Cloud gets along with female dogs medium to bigger size best. We woul dnot suggest a small dog and absolutely NO CATS! Unfortunately his beautiful coat was so matted and he had to be completely shaved down. His hair will grown back!!!! If you would like to meet Cloud, please send us a message in order to receive an application. We are only meeting with pre approved applicants since we do not have a shelter available to the public. DO NOT FILL OUT AN APPLICATION ANYWHERE ONLINE!!! Only via e mail can you receive the proper forms. Other applications can not be accepted. His adoption fee is $ 350 which includes all vaccines, heartworm test, neuter and micro chip. Adoption fees are not negotiable! (Less)
Paws and Stars Animal Rescue
Gwinnett County Lawrenceville, GA 30046 MAP IT!
|Rescue Me ID: 16-05-23-00584SUGAREE (female)|
SHE IS A SWEET DOG almost 2 she needs a big yard.
Forsyth County CUMMING, GA 30040 MAP IT!
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|PIease Read Before Adopting an Alaskan Malamute in Georgia|
Alaskan Malamute Dogs can make good pets in Georgia if they match your IifestyIe. The Alaskan Malamute is an extremely friendly, large breed. Alaskan Malamutes are wonderful with older children. Alaskan Malamutes like to roam outside and need a large yard or acreage. Fences should be high with a buried base, since Alaskan Malamutes like to dig and can get out easily. The Alaskan Malamute is rowdy as a puppy but calms down as an adult dog. Human companionship is important as Alaskan Malamutes can get into trouble and ruin property if not given enough attention. Alaskan Malamutes need to be socialized with children and other dogs at an early age. Alaskan Malamutes, especially males, can be very dominant and may fight with other dogs if not exposed to them when young.
Rescue Me! - HeIpingAnimaIs in Need.
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Dr. Colleen Dell
- Substance use and abuse
- Aboriginal women's health
- Solvent abuse
- Treatment and healing
- Women's programming
- Equine therapy
- Program Evaluation
- Dr. Dell’s research is grounded in a community-based participatory approach, and through which the findings are naturally translated into action. Her currently funded research projects focus on the relationship between identity and healing from drug addiction, substance abuse programming, self-harm, equine therapy, program evaluation and the connection between youth resiliency and inhalant abuse. Her research areas are specific to First Nations, Inuit and Métis peoples, drug using populations, and criminalized women.
- PUBH 847 – Studies in Addictions
Recent Grants and Awards
- 2010, May, YWCA Women of Distinction Award, Research, Science and Technology category, with S. Acoose.
- 2010, April, Saskatchewan Health Research Foundation, Phase II Team Grant - Saskatchewan Team for Research and Evaluation of Addictions Treatment and Mental Health Services, Co-Principal Investigator.
- 2010, June, Alberta Centre for Child, Family and Community Research - Horse as Healer: Treating Volatile Solvent Abuse through Equine Assisted Learning, Co-Principal Investigator.
- 2010, September, CIHR - Network Environments for Aboriginal Health Research, Co-Investigator.
- 2008 March, SSHRC, International Opportunities Fund – Treating Volatile Solvent Abuse Among Indigenous Youth, Principal Investigator
- 2008 March, Canadian Institutes of Health Research, New Emerging Team Grant HIV/AIDS CBR Program-Operating Grants (Aboriginal) – The Impacts of HIV and Stigma among Aboriginal Peoples Seeking Alcohol Abuse Treatment in Canada, Co-Principal Investigator
- C. Dell, D. Chalmers, N. Bresette, S. Swain, D. Rankin, C. Hopkins (2011). “Creating Healing Spaces: The Experiences of First Nations and Inuit Youth with Equine-Assisted Learning”. Child and Youth Care Forum. On-line: DOI 10.1007/s10566-011-9140-z
- C. Dell, M. Seguin, C. Hopkins, R. Tempier, R. Duncan, D. Dell, L. Mehl-Madrona, K. Mosier (2011). “From Benzos to Berries: How Treatment Offered at an Aboriginal Youth Solvent Abuse Treatment Centre Highlights the Important Role of Culture”. In Review Series. Canadian Journal of Psychiatry. 56(2), pp. 75-83.
- C. Dell, T. Lyons, K. Cayer (2010). “The Role of ‘Kijigabandan’ and ‘Manadjitowin’ in Understanding Harm Reduction Policies and Programs for Aboriginal Peoples”. Native Social Work Journal. 7, pp. 109-138.
- V. Desjarlais, C. Dell, J. Kilty (2010). “This is Who I Am: Aboriginal Women’s Healing from Criminalization and Problematic Drug Use”. Journal of Prisoners on Prison. 20(1), pp. 58-71.
- C. Dell, J. Kilty, C. Fillmore, S. Grantham, T. Lyons, S. Clarke, C. Hopkins (2010). “Turtle Finding Fact Sheet: The Role of the Treatment Provider in Aboriginal Women’s Healing from Illicit Drug Abuse”. On-line: CES4Health.info.
- B. Eshrati, R. Taghizadeh Asl, C. Dell, P. Afshar, P. Millson, M. Kamali, J. Weekes. 2008. “Preventing HIV Transmission Among Iranian Prisoners: Support for Providing Education on the Benefits of Harm Reduction Practices”. Harm Reduction Journal. 5:21. On-line