Research shows that obesity prevention has to start early. Targeting interventions towards subgroups of individuals who are predisposed, but yet normal weight, may prove more effective in preventing overweight than interventions towards unselected normal weight subsets. Finally, interventions focused on other factors than diet and activity are lacking. The objectives were to perform a randomized, controlled intervention aiming at preventing overweight in children aged 2–6 years, who are yet normal weight, but have high predisposition for future overweight, and to intervene not only by improving diet and physical activity, but also reduce stress and improve sleep quality and quantity.
Based on information from the Danish National Birth Registry and administrative birth forms, children were selected based on having either a high birth weight, a mother who was overweight prior to pregnancy, or a familial low socioeconomic status. Selected children (n = 5,902) were randomized into three groups; an intervention group, a shadow control group followed in registers exclusively, and a control group examined at the beginning and at the end of the intervention. Approximately 21% agreed to participate. Children who presented as overweight prior to the intervention were excluded from this study (n = 92). In the intervention group, 271 children were included, and in the control group 272 were included. Information obtained from the shadow control group is on-going, but it is estimated that 394 children will be included. The intervention took place over on average 1½ year between 2009 and 2011, and consisted of optional individual guidance in optimizing diet and physical activity habits, reducing chronic stress and stressful events and improving sleep quality and quantity. The intervention also included participation in cooking classes and play arrangements. Information on dietary intake, meal habits, physical activity, sleep habits, and overall stress level was obtained by 4–7 day questionnaire diaries and objective measurements.
If the Healthy Start project is effective in preventing excessive weight gain, it will provide valuable information on new determinants of obesity which should be considered in future interventions, and on new strategies to prevent development of overweight and obesity at an early age.
The prevalence of obesity is increasing, causing a great need for developing effective intervention programs . However, even if multiple controlled primary intervention studies particularly among children and adolescents have been conducted during the past 20–30 years, the majority of the studies have been unable to prevent excessive weight gain. Indeed, a first Cochrane review from 2005 showed that among studies published from 1990 through 2005, less than one in five interventions were efficient in preventing weight gain. The Cochrane review group suggested that a focus on short-term behavior change was unlikely to have a sustained impact on the weight status of children , and that the available evidence suggests that many diet and exercise interventions in children are in fact not effective in preventing excess weight gain, despite being effective in changing diet and exercise behavior. Similarly a recent review of interventions among preschool children aged 2–6 years did not find evidence of effective interventions . Finally, a follow-up review from the Cochrane group from 2011 on intervention studies on children published from 2005 and onwards found that still only 20-30% of the published interventions were producing significant positive results. They found small, but significant intervention-control differences at the meta-level of on average 0.15 kg/m2 units of BMI, or 0.8% weight difference, equivalent to a 0.3 kg difference in weight for a 10 year old child. They concluded in plain language that although many studies were able to improve children's nutrition or physical activity to some extent, only some studies were able to see an effect of the programme on children's levels of fatness, and that combined (meta analyses) suggested that the programmes made a positive difference, but that there was much variation between the study findings which could not be explained .
Normal weight children from socially disadvantaged families (low socioeconomic status based on educational level).
Many of the previous intervention studies did not exclude children already overweight, and have consequently not been primary prevention interventions . Hence, results from such interventions may not be considered as initiatives focused on primary prevention of overweight, but rather as treatment, or a mix of treatment and prevention .
Since a couple of recent reviews, one of which from the Cochrane group, conclude that combined behavioral lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction (1.9-3.3 kg/m2) in overweight in children and adolescents , it is likely that many previous studies that did not restrict their interventions to normal weight subjects may in fact have treated the already overweight and obese, rather than prevented the normal weight from progressing into overweight.
When it comes to primary prevention, targeting predisposed groups or individuals for interventions on preventing development of overweight and obesity, may prove to be more effective than targeting subsets of the entire population of children, because treatment rather than prevention effects are taking place, or because prevention intervention effects among the normal weight may, in reality, may be most effective among high-risk individuals, and hence be diluted and masked by general (low) effects among the non-disposed. Such scenario may provide one of the explanations for the low rate of success in previous interventions. In support of this, a recent review concluded that half of the interventions that targeted high-risk groups were in fact effective as opposed to 1 in 3–4 of the universal interventions .
The purpose of our intervention study "Healthy Start" ["Sund Start"] was threefold: 1) to conduct a randomized controlled intervention to prevent excessive weight gain among normal weight 2–to-6-year old children, 2) to intervene in children who were considered to be at an increased risk of future overweight and obesity, if at least one or more of the risk factors mentioned above was present – e.g. a high birth weight (> 4,000 g), pre-pregnancy obesity of the mother (Body Mass Index (BMI) > 28 kg/m2) or low social class (less than 10 years of education), and 3) to intervene with healthy sleep quality and quantity as well as stress reduction in addition to healthy eating and activity. If the intervention is effective, the results of the study will suggest that a targeted rather than universal, individual effort may be needed to prevent excessive weight gain among normal weight children.
In 2009, data on all births between 01.01.2004 and 31.12.2007 in 11 selected municipalities from the greater Copenhagen area was obtained from the Danish National Birth Registry at the National Board of Health. This register contains information on all births, whether at hospital or home, on factors such as birth weight and length, height and pre-pregnant weight of the mother, parity, and Central Personal Registry number (CPR-number). Data on socioeconomic status (SES) (estimated from maternal educational level) was obtained from the administrative birth forms. This was done manually using the CPR-numbers obtained from the birth register. This showed to require more resources than expected, and it was consequently chosen to select children from low SES families in just one municipality. After selecting the children eligible for participation, the children were allocated to three groups, using computer based randomization stratified on municipality and with simple randomization within strata, and were afterwards identified and invited to participate in the study. All siblings were allocated to the same group.
Participants in this group were invited to see a health consultant trained in dietetics and nutrition. At the first meeting, heights and weights were measured and BMI was calculated. International cut-offs for overweight according to age and gender, developed by Cole et al. were applied . If a child was found to be overweight it was excluded from the intervention study after this first consultation. If a child was normal weight it was included, and had additional anthropometric measurements taken. Each participating family was assigned to the same health consultant, who followed the family throughout the project period, in order to ensure confidence and personal contact. Each child and its family were seen on a regular basis, and it was possible to have up to 10 visits over a 1½-year period, where consultation frequency was based on needs and resources of the individual families. A more thorough description of the intervention and measurements obtained from this group will be presented below.
Children in this group were invited to see a health consultant. At the first meeting their heights and weights were measured and BMI was calculated. The same international cut-offs for overweight according to age and gender as in the intervention group were applied to the control group . If a child was overweight at baseline it was excluded from the control group, and did not participate further. If a child was normal weight it was included, and hadadditional anthropometric measurements taken.
Children from the control group and their families were invited to a follow-up approximately 1½ year after the first visit, but they were not seen between baseline and follow-up.
All families that were invited to see the health consultant prior to intervention (intervention and control group) were told that their child had an increased risk of future obesity. This information may influence future health attitudes and practices, and may be considered an intervention by itself. We therefore applied a design using two control groups rather than only one, because differences in weight development between the intervention group and the control group, and hence development of overweight, could potentially be diluted as a consequence of informing the control participants that the child was predisposed to obesity.
An additional control group (the shadow control group) was therefore chosen, where the families were unaware of whether their child was predisposed or not. Children in this group were not invited to see a health consultant, and were followed exclusively through registers. Information on height and weight was obtained from records of the general practitioners (GPs) who perform regular preventive child health examinations of pre-school children at ages 2, 3, 4, and 5 years. If a child was overweight at time of baseline, it was excluded from the study. Collection of data on height and weight from the GPs is currently on-going. However, as participation in the shadow control group is unaffected by willingness to participate (information for everyone included in this group is obtained via existing registries), differences in weight development between the intervention group and this control group and hence development of overweight, will potentially be inflated since these families do not have to actively show up to become a participant. Thus, it is likely, that the true effects of the intervention may be in the range between the effects of the intervention group compared to the shadow control group, and the intervention group compared to the control group. This use of the study design may, on the other hand, provide an additional result related to whether the simple information given to the families that their child is predisposed to future overweight, may lead to self-selected changes in lifestyle without further help (as described above), and may thus prevent the development of overweight. Hence, differences between the shadow control group and the ordinary control group in excess weight gain will also be examined.
The study is registered with ClinicalTrials.gov, ID NCT01583335.
Based on the information obtained from the Danish National Birth Register and the administrative birth forms, children having either a high birth weight (≥ 4,000 gr.), a mother that was overweight prior to pregnancy (BMI ≥ 28 kg/m2), or a mother with ≤ 10 years of schooling were selected. A BMI ≥ 28 kg/m2 was applied as cut-off for maternal overweight, since BMI ≥ 30 kg/m2 would have led to too few eligible children in the municipalities, and BMI ≥ 25 kg/m2 was considered too low to reflect a real biological pre-disposition to overweight in the child.
After the selection and randomization, each child was checked in the Central Personal Registry, which contains a systematic registration on all Danish citizens regarding names, address, civil status, place of birth registration, and other basic information. Children were excluded from the study if they had moved to another municipality after they were born, if they were protected from being contacted by researchersa, if they did not have a permanent address, lived in a children's home, had died, had emigrated, temporally lived abroad, or had disappearedb. In total 5,902 children were selected. Of these 5,902 children, 2,180 (37%) were excluded from being contacted and potentially enrolled because of one or more of the above mentioned exclusion criteria. During the study's enrolment phase, the aim was to enroll the oldest children first. However, this led to 365 children being excluded from invitation to participate due to other causes than previously described, such as having had an older sibling invited previously.
In total 3,722 children met the inclusion criteria, and were invited to participate in the study.
Figure 1 shows the number of participants selected and invited to participate in the Healthy Start project. When planning the project, it was anticipated that about 40% would accept the invitation to participate. However, as shown in Figure 1, the participation rate for the intervention group and the control group was around 21%. The relatively low participation rate may reflect the focus of primary prevention, since it may be difficult to encourage lifestyle changes to parents of a child who is still normal weight, although at increased risk of developing overweight. Furthermore, it was also estimated that a maximum 10% of the participating children would be overweight, but as much as 15% of the children who turned up for the initial examination were already overweight at baseline (Figure 1). Again, this higher proportion may reflect that parents to the overweight children were more willing to show up, because they were aware that their child was at risk. Table 1 shows the baseline distribution of gender, selection on birth weight, selection on maternal pre-pregnancy overweight and selection on low SES.
Flow diagram of the Healthy Start project. * = n is the expected number of participants from which information on weight development will be obtained from GP's, and is hence not the final number of participants in control group 1.
* = n is the number of participants from which information on weight development is obtained from GP's, and is hence not the final number of participants in control group 1.
From the shadow control group, information on heights and weights was collected from the journals of the GP's (on-going July 2012). As part of the child health examinations and vaccination programs, the GP measures heights and weights at age 2, 3, 4, and 5. The examinations are free of charge, and more than 80% of all Danish children participate at each examination .
Height to the nearest 0.1 cm. was measured using stature meter (Soehnle 5,002 or Charter ch200P). The children were in bare feet or in stockings. Body weight was measured to the nearest 0.1 kg using a mechanical weight or beam-scale type weight (TanitaBWB-800 or SV-SECA 710). The children were measured in underwear only, and were asked to urinate before the weighing. If the child was using diaper, a new diaper was put on before the weighing. Waist circumference was measured to the nearest 0.5 cm midway between the lowest rib and the iliac crest. Hip circumference was measured to the nearest 0.5 cm, at the place where the circumference was the largest, seen from the frontal and medial angles. Both waist and hip circumferences were measured in triplicate and a mean was calculated. Skinfolds were measured at biceps, triceps, subscapular and suprailiac on the left side of the child, using Harpenden Skinfold Caliper or Lange Skinfold Caliper. The caliper was placed perpendicularly to the skinfold right under the fingers of the person taking the measurements. After 1–2 s the caliper was read to the nearest 1 mm. Each measurement was taken in triplicate. Bioelectrical impedance was measured to estimate the child's percentage of body fat at resistance 50 kHz (SEAC Multiple Frequency Bio impedance Meter (model SFB3 and SFB2 version 1.0), RJL or Animeter (BIA-101 and BIA-103)). Prior to the measurements, the child was asked to lie quietly in a supine position with the legs and arms slightly apart. An alcohol wipe was used to remove excess skin oils to secure attachment of the electrodes. Measurements were taken on hand and foot of the child's right side. On the hand, the first electrode was placed right below the joint of the middle finger and the second electrode right midway between the two bones on the dorsal side of the wrist. On the foot, the first electrode was placed below the joint of the 3rd toe and the second electrode right between the two large bones in the ankle on the dorsal side of the foot. Bioelectrical impedance measurements were taken twice and a mean was calculated.
The parents of each participant were asked to fill out a 4-day dietary record of their child. The parents were asked to record the dietary intake from Wednesday to Saturday. These specific days were chosen to obtain information on dietary intake in both week- and weekend days. The dietary record was accompanied by a picture book to help the families estimate portion sizes and a guidance in how to fill out the dietary record. Each dietary record was entered into Dankost 3000, a software program applied to calculate the individual intake of macro- and micronutrients.
A questionnaire completed by the parents provided information on meal habits, physical activity habits, sleep habits, stress in the child, overall well-being of the family, general questions about the family and its structure and relationships, and paternal and maternal basic demographic and social information (height, weight, educational level, occupation, amount of work hours and hours spend outside the home without the child).
The questions on meal habits concerned the child's appetite and way of eating (picky or not), number of times per week the family had breakfast or dinner together, if the family meals were considered to be cozy or conflict-ridden, priorities about serving vegetables or fruit, and who served vegetables on the child's plate.
Information on physical activity was obtained by including the 7-day Children's Physical Activity Questionnaire (C-PAQ) as an integrated part of the parental questionnaire . The C-PAQ questionnaire was modified in order to make the activities match with the possibilities for physical activity for Danish children aged 2–6 years. Questions were also asked on the distance between home and day-care, means of transportation to and from day-care, the number of hours spend outdoor during day-care, the estimated level of physical activity in the child compared to other children of similar age, frequency of which one or both parents were physically active with the child, and if the child enjoyed being physically active.
Parents reported sleep habits in a 7-day sleep diary and also answered questions related to whether or not the child had problems falling asleep in the evening, problems waking up in the morning, if it was difficult putting the child to sleep, sleep onset latency, if the child took naps during the day (and if so, for how long time), routines with the child before bedtime, if the child entered the parents' bed during night (and if so, how often), if the child was afraid when trying to fall asleep, if the child had nightmares, if the child was sleeping calmly, and if the child had difficulties falling asleep again after waking up during the night. Thus, the questions provided information on sleep duration and markers of sleep quality.
To assess behavioral difficulties and stress in the child, the Danish version of the Strengths and Difficulties Questionnaire (SDQ) was included as an integrated part of the parental questionnaire. SDQ is a behavioral screening questionnaire that consists of 25 items on prosocial behavior and emotional and behavior problems. Scores on 5 scales are derived from these 25 items: emotional symptoms (5 items), conduct problems (5 items), hyperactivity/inattention (5 items), peer relationship problems (5 items) and pro-social behavior (5 items) . The SDQ has been translated into the different Nordic languages, and has so far been completed for nearly 100,000 children in the Nordic countries during the past years .
Table 2 shows the pre-intervention distribution of age, height, weight, BMI, waist circumference, hip circumference, sum of 4 skinfolds, percentage body fat, energy intake, carbohydrate intake, protein intake, fat intake, sugar intake, sleep latency, SDQ-score, and household income by group. T-test analyses showed a statistically significant difference in total SDQ-score between the intervention group and the control group (Table 2). No other significant differences in baseline characteristics between the intervention group and the control group were found (Table 2).
The Parental Stress Index (PSI) is a self-reported inventory designed to measure parental experiences of stress in relation to the parent–child interaction. It has six child subscales and seven parent subscales. In the Healthy Start project, a modified Swedish version  was included, as an elaboration of the parental part of the questionnaire. The questions included information on perceived changes in life since the child was born with regard to factors such as sleep, work, stress, life satisfaction, conflicts with spouse, and worries. Moreover, one question asked if the parent thought he/she had enough time together with the child.
This section of the parental questionnaire included information on paternal, maternal, and child ethnicity, whether the parents were living together, number of siblings, household income, chronic physical diseases in the child, mental diseases in the child, and estimated general physical health of the child.
Both the mother and father were asked if he or she was the biological parent of the child, and about their heights and weights, their highest completed educational level, occupation, average number of work hours per week, average number of hours per week spend outside the home without the child per week, as well as their level of physical activity per week.
During the last or second to last visits we sampled hair and saliva from children and their parents in the intervention- and the control group.
Hair was sampled from each child and both parents to obtain an objective measure of chronic stress. Long-term cortisol can be used as an indicator of both sub-acute and chronic stress, as analysis of cortisol in hair potentially gives a non-invasive measurement of long-term activity in the HPA-axis . It has previously been found that hair from human individuals may be used as an integral measure of cortisol production in the past 3–6 months . As hair grows approximately 1 cm per month, it is estimated that the first cm of hair (from the scalp) contains cortisol from the previous month, whereas the next one cm of hair contains cortisol from two months back and so on . Information on frequency of hair washes and whether the hair was currently colored was also obtained, in order to adjust for potential dilution of the cortisol level. Compared to subjective measurements of stress derived from inventories, the hair analyses may provide a more accurate measure of chronic stress level, by estimating cortisol over the previous 1–6 months. The measure may hence be used to study how chronic stress may affect the body , and in particular the risk of developing overweight and obesity. Cortisol will be extracted from hair using the Elisa method . The biochemical extraction of cortisol is still on-going, but is expected to be ready fall of 2012.
Saliva samples for each child and both parents were also collected, using Oragene OG-500 and OG-575. OG-500 was used for the parents and children who were able to spit on their own. They were asked to spit 2 ml in a tube, which was afterwards closed and shaken for 5s.
OG-575 was used for children who were not able to spit on their own. A swab was placed and moved in cheek pouch along the gums and inner cheeks to absorb as much saliva as possible. The swab was then placed in a v-notch of funnel, and saliva was wringed out of v-notch into the tube. The tube was then closed and mixed for 5 s. DNA is currently being extracted from the samples and specific SNP analyses or GWAS will be performed later in relation to candidate genes related to obesity and weight gain, food dependency, appetite, hunger and satiety, physical activity and sedentariness, stress coping or sleep quality (melatonin and clock genes).
As a means of validating the questionnaire information, objective information on daily activity as well as sleep duration and sleep quality was obtained on a subgroup of the intervention children over 5 days/nights (n = 79) half way through the intervention period, using Actigraph GT3X. Actigraph catches a person's movements triaxial through an accelerometer on one single axis or multiple axes. The device catches movements between 0.25 Hz – 2.3 Hz, as previous studies have found that voluntary movements take place within this range . Specifically, information on sleep efficiency (sleep/number of hours spend in bed), time the child went to bed, time the child got out of bed, time asleep, awakenings, sleep onset, minutes awake, average duration of awakening and sleep latency, was obtained. The child was asked to wear the Actigraph for 5 successive days, and the parents were instructed that if the child did not want to wear the device all the time, the most important time to wear it was during the night. Moreover, parents were asked to complete a sleep diary for the same days that the Actigraph was worn. The device was placed on the left wrist (right wrist if the child was left-handed) using an elastic band. If the elastic was too big for the wrist, it was placed on the upper arm or the ankle (left ankle if the child was right-handed and vice versa). Actigraph GT3X was also used for obtaining objective information on physical activity over five consecutive days (n = 79). The device was set to an epoch length of 60 s with normal filter level.
Finally, from all included children (intervention- and both control groups), information and measures of various factors during the child's first years of life is available from a clinical database which visiting nurses from 12 municipalities from the Copenhagen area have established. This clinical database includes standardized records with information on breast-feeding, exposure to passive smoking, maternal health, decreased ability to care for the child because of alcohol or other substance abuse, network in the family, remarks about the child's signals and reactions (sleep, anxiety, crying), and growth during the child's first years of life. Information from this database will be obtained by linkage with the CPR-numbers.
With a power of 90%, alpha of 0.05 and 275 individuals in each group, it will be possible to detect a difference between the intervention- and control groups of 0.28 SD in BMI. For a 7-year old boy with a height of 1.25 m (equivalent to the mean height for 7-year old children in 1980–1983), a 0.28 SD BMI corresponds to a difference in BMI = 0.45 kg/m2, or 0.70 kg body weight between the intervention and control groups. With 80% power and a significance level of 5%, we will be able to demonstrate differences of 0.5 BMI units between the intervention and control group children. We greatly oversampled in relation to the main outcome (BMI) to secure sufficient numbers post-intervention and in relation to more specific outcomes such as body fat and fat free mass.
The intervention consisted of four main areas: optimizing dietary intake and physical activity quantity and quality, improving sleep duration and quality, and reducing chronic stress of the child and the family by improving interaction between child and parents. The intervention was planned and organized according to each participating family's individual needs and resources. Thus, the intervention was not administered as a standardized package that was more or less identical for all participants. Based on primarily the dietary record and the parental questionnaire, the consultants evaluated the specific needs of each family, and subsequent consultations were planned to include one or more of the four themes (ex. intake of sugar, intake of vegetables, physical activity outside day-care, bed time routines etc.). This evaluation was also based on the themes each family was motivated to work with, using the "stages of change" motivational models. Translational assistance was not provided by the project, and consequently non-Danish speaking individuals were not able to participate.
The main focus of the intervention was on the family as a whole and not only on the child. Stages of change principles and motivational interviewing were used as the framework for the counseling process , and the main concept was to improve the family's knowledge and action. Motivational interviewing (MI) is a psychotherapeutic method that is evidence-based and is applicable across a wide variety of problem areas including health behavior change . MI uses a guiding style to engage with people, clarify their strengths and aspirations, evoke their own motivations for change, and promote autonomy of decision making , and was applied to enhance personal motivation for change. In the stages of change model, change is a process involving progress through a series of stages. MI was used to help families to proceed through these stages .
Each consultation started with asking the family if they had any themes they wanted to discuss, and how problems or agreements had progressed since the previous consultation. In addition to the consultations, families in the intervention group were invited to participate in bi-monthly cooking classes and monthly play (activity) classes. The idea behind these classes was to inspire the participants to convert the theory from the consultations into practice, to motivate the family to spend more time together and to network with other families. The cooking classes had various themes, such as using fish in the meals, healthy fast food, healthy desserts etc.
Keywords for each of the four main intervention areas were prepared to support the health consultants in their planning of the consultations. For these keywords, tools to change behavior in a given direction were created, and together with the consultant each family then decided which tools they wanted to work with until next consultation. Examples of tools are presented in Table 3.
· Supply the lunch · package with small tomatoes, carrot sticks etc.
· Restrict intake of sweets, but when provided, use for instance fruit sorbet as an alternative to ice cream, fruit as an alternative to sweets etc.
As it emerges from Table 3, the various parts of the intervention were often integrated – i.e. focusing on the area of physical activity may additionally benefit sleep quality and reduce the stress level of the child.
The daily project team consisted of a research director, a project leader and three health consultants. Trainees and student workers were connected to the project continuously. Moreover, the project had supervision from statisticians, psychologists and dieticians on designing and carrying out the study.
Data was entered into the Epidata system and subsequently cleaned.
Baseline data was cleaned first by going through all questionnaires, dietary records, measurements and notes from the consultations, and comparing information from the paper forms with information in the database. This comparison was conducted for six variables, which were selected based on a high proportion of missing information. Then, information from questionnaires, dietary records and measurements from 5% of the participants was re-entered, and it was decided to accept an error rate of 2%. The same procedures will be performed with follow-up data.
The Danish Data Protection Agency approved of the study (journal number: 2007-41-0530). The Scientific Ethical Committee of the Capital Region in Denmark decided that according to Danish law, the project should not be submitted to the committee (journal number H-A-2007-0019). Informed consent to use the collected data for research purpose was obtained from all participant's parents.
Future weight development will be followed for participating children in the intervention and both control groups by first linking the CPR-numbers to the school-health records (heights and weightsare measured at enrolment (age 6–8 years), midway (age 10–12 years), and at termination (age 14–16 years)), then to draft board records for the males (draft board examinations are mandatory in Denmark, and includes, among others measurement of heightsand weights) and to the Danish National Birth Registrywhere information on weights and heights can be obtained, because pre-pregnancy weights and heights is recorded during the first 6–10 weeks of all pregnancies. Thus, the project has important potential for evaluating the long-term effects of the intervention.
This primary intervention study described in this paper aims to prevent development of overweight among those children aged 2–6 years, who are still normal weight but also are at high risk of future overweight, because of either a high birth weight, having a mother who was overweight prior to pregnancy, or having a mother with low educational level. The study is considered to be the first to perform an intervention focusing on young high-risk children. Additionally, it is also among the first studies to intervene not only by improving diet and physical activity habits, but also by optimizing sleep quality and quantity, and reducing stress levels. Finally, few prior studies considered normal weight children only, but included both normal and overweight children in their interventions.
Our study will be able to assess not only the short-, but also the long-term effects of an early intervention, due to the possibility to link the participants' CPR-numbers to relevant Danish registers, with information on weight development during school years and way into adolescence and adulthood.
The limitations of the study include attrition bias, since it is likely that the most resourceful families will remain in study. This will be explored by describing attrition according to maternal BMI and SES, and the child's birth weight which are known for both participants and non-participants. Randomization should eliminate the problem with a lower than expected participation rate. However, it may inflate observed differences between intervention and control group since the participating families may be those who already focus on healthy lifestyles, and who are the most resourceful.
The present study focused on the overweight mothers, and did not consider overweight among fathers. Generally, predisposition to obesity in a child is dependent of whether the mother or the father is overweight or obese, but unfortunately no Danish registers contain information on paternal heights and weights around the time the child was conceived or born, which could have been used for selection of the children predisposed to future overweight in the present study. If the result of the intervention is found to be effective in future, information on familial obesity may be obtained from the public health nurses who have contact with almost all families from birth through 1 year of the child, or through GP's who generally have contact to families on a regular basis including during the child's first years of life. Also, the mandatory draft board examinations may be used to identify those fathers who were overweight already at age 19 on average. Finally, school health registries can be used to identify children with overweight siblings.
An important strength of the study is the randomized design and the use of two control groups, which increases the possibility to estimate a true effect of the intervention. This design also makes it possible to evaluate if the simple information to parents that their child is at a high risk of future overweight, is an easy and inexpensive way of preventing some later overweight in the child. Another important strength is the use of hair samples to measure long term stress exposure via cortisol level from around 350 children and 650 parents, which is considered to be one of the largest sample of hair cortisol collected till date.
Indeed, if the intervention proves to be effective, it may easily be integrated into the already established and very efficient Danish visiting nurses system, where families are offered home visits from a nurse and counseling on ex. the child's well-being, lactation, and development during the child's first two years of life. It may also be an independent program in municipalities who wish to draw special attention to pre-school children and/or primary prevention of overweight and obesity.
The Danish Board of Technology recently published a report that focused on action on targeted prevention of obesity. It was concluded that "in order to curb the obesity epidemic, effective ….. prevention in yet normal weight is needed". It was summarized that there is a need for improving the effect of obesity prevention in those groups who are at the highest future risk of developing overweight and obesity , and that future efforts therefore should target high risk groups to a higher extent . It is considered that the Healthy Start project is in line with this conclusion, and thus may provide the first important information on the effectiveness of such programs, and if effective, in addition contribute with evidence on how to curb the obesity curve.
In conclusion, the Healthy Start project aims at preventing overweight among pre-school children who are still normal weight, but at risk of future overweight. If the study is effective, it may provide valuable information on new determinants of overweight and obesity and a new strategy to prevent development of overweight and obesity at an early age.
aProtection from being contacted by researchers provides protection from participation in statistical and scientific surveys, based on data delivered from the Danish Central Person Registry, From 2000 to 2007 protection from being contacted by researchers was linked to moving, as it was obtained by ticking off a box when filling out moving certificates. Since 2007 it was removed from the moving certificates, and replaced by a separate certificate that needs to be filled out.
bA person is considered to be disappeared if an individual has been searched for as being disappeared or if its life status is unknown.
The Healthy Start project was funded by grants from TrygFonden, Danish Medical Research Council and The Health Insurance Foundation.
The authors would like to acknowledge all participating children and parents from the Healthy Start project. Moreover, we would like to acknowledge Naghmeh Rahmanfahd, Lauren Lissner, Gabriella Eiben, Kenneth Christiansen, Lone Viggers, Ellis Tauber-Lassen, Helle Grønbæk, Åshild Skogerbø and Hanne-Lise Falgreen Eriksen for their help and suggestions during the planning and conductance of the intervention.
NJO conceived the study, was responsible for its design and coordination, participated in the data collection and drafted the manuscript. TBA carried out the data collection and helped to draft the manuscript. MNH participated in the data collection and helped to draft the manuscript. LMØ carried out the data collection and helped to draft the manuscript. JP participated in the data collection and helped to draft the manuscript. CS carried out the data collection and helped to draft the manuscript. MS participated in the data collection and helped to draft the manuscript. MT carried out the data collection and helped to draft the manuscript. KL helped to draft the manuscript. ELM participated in the design of the study and helped to draft the manuscript. CH was responsible for the randomization and statistical support and helped to draft the manuscript. BLH conceived the study, was responsible for its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.


As the saying goes: when you play the game of the yourunion.com ticket checkout, you win or you die. For those of us who won, at 5pm, Tuesday the 5th of February, it seemed winter was coming as we joined the queue reaching from the doors of Younger Hall to the gates of St Salvator's Quad on a cold, wet and dark North Street.
The students huddling under umbrellas and hurriedly calling friends to give location updates were waiting to attend a talk given by Maisie Williams, one of the young stars of Game of Thrones. Organised as part of Career Week, this talk brought Arya to our humble Bubble to give an insight into her explosive career in the creative industry, and to promote her latest venture, an app called Daisie that functions as a social media tool to unite young creatives, allowing them to collaborate and showcase their work through the site.
The wait wasn't long. The queue soon zipped through the doors: those with silver wristbands were ushered to the stairs, those with gold ones continued into the downstairs section. Cameramen hung around the sides of the room as we were directed to seats, upon which lay questionnaires, which were presumably to do with Miss Williams' app, although it didn't say.
A lectern stood ominously in the centre of the stage, surrounded by not one, but four University of St Andrews banners. This was a surprise – I was expecting two seats for a discussion between Miss Williams and a host. I suddenly had a vision of Arya delivering an academic lecture on some complicated culture theory: having just come from two such lectures, I had an irrational desire to leave. Running.
Yet, I stayed. My fears disappeared as the star strolled onstage, pink ponytail swinging and a friendly smile on her face. Beginning with a thanks for her invitation, Miss Williams immediately seemed sincere, humble and enthusiastic. Aged 21 and wearing a sweater and high-top boots, she could easily have been taken for a student herself. She launched in with a run-down of her career so far: from humble beginnings, to her Billy Elliot-esque dreams of being a dancer, then her audition process for Game of Thrones. This was followed by an explanation of how Daisie came about and the motivations behind it. She lost her place during a rousing ending, and anyone who has ever done a presentation felt her struggle as she flicked through pages muttering, "I mean, it's really not that complicated". #relatable.
Her initial talk lasted about 20 minutes, which was worrying given the two hours runtime advertised. She asked for questions, somewhat apprehensively. The first hand went up. After that question, some more were raised. And then more and more and more. Most questions were illuminating, asking about both working in the arts and her app (and one about her dinner plans). Her answers were genuine, thoughtful and showed clear passion for what she was talking about.
This may sound far-fetched, but I had had a hunch that not all attendees were necessarily pursuing a creative career. This was confirmed by my hard-won source (the friend I attended with, who studies medicine), as she covertly identified intruding scientists hidden amongst us humanities students. But if they were expecting a discussion about Game of Thrones in all its bawdy glory, they were mistaken.
By the end, her fame didn't matter. Her sly wit and down-to-earth sense of humour, wise-beyond-her-years advice and insight into one of the world's most elusive industries made an event that could have been merely a spectacle informative, motivating and fantastic opportunity for students pursuing a career in the arts, and for that Maisie Williams should be highly commended. My medic friend equally enjoyed it, and if people weren't taking photos, they were downloading Daisie, making it a successful night all-round.
The bar has been set: I don't envy the speaker set to follow during Careers' Week 2020.


Continuing from the successful series of previous IMA Conferences on Flood Risk, the IMA is planning its 4th International Conference on this topic in 2019 to bring together engineers, mathematicians and statisticians working in the field. The conference intends to be used as a forum for participants to meet and exchange their views on important technical issues, new and emerging methods and technologies in assessing flood risks in a world that is being altered by the climate change and moving towards an uncertain future. The emphasis will be on new developments in mathematical modelling methods, statistical techniques in assessing flood risks, especially on quantification of flood risks with a nonstationary climate and modelling uncertainty. Methods and application of assimilating new data from cutting-edge new type of observations will be among the topics for discussion.
The conference will be of interest to flood defence practitioners; flood defence managers; statisticians, mathematicians, civil engineers.
We look forward to contributions drawing upon diverse conceptual bases, including reliability theory, statistical analysis, mathematical modelling of flood flows, forecasting systems and assimilation techniques, modelling of flood risk communication and decision making, and of course mathematics. Papers will be organised under four principal themes: • Climate change, hydro-climatic extremes and non-stationarity • Computational methods in flood flow modelling and the emerging AI techniques • Emerging observation technology and data assimilation method for flood modelling • Mathematical methods for evaluating flood risk perception, communication and human reaction Contributions that span these while addressing the overall conference theme are most welcome. Contributed papers will be accepted on the basis on an abstract (300-500 words) which should be submitted via https://my.ima.org.uk/ by 3 May 2019. If you are an IMA Member or you have previously registered for an IMA conference, then you are already on our database. Please "request a new password" using the email address previously used, to log in.


all garments are designed, drafted, graded, cut, sewn and hand dyed by fia herself.
lilla by fia is a small sunshine coast label that aims to use as little resources and materials as possible. with the environment in mind, fia creates awareness and educates people on the impacts the fashion industry has on the environment. this is her sole purpose.
fia strives to be eco friendly in her approach to business and continues to make changes where she can.


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Community Courses
Meal Prep/Planning
Mindset Mondays
Saturday Strategy
Wanna Join Our Movement? Here's How!
POSTED ON September 28, 2016 BY Drew Canole
Holy juice, Batman!
One of our favorite things about what we do here at Fitlife and Organifi is providing solid information to help YOU live an incredibly abundant life. That means, empowering you to take control of your life and create the experience of your dreams simply by showing you the tools to make it all possible!
There are so many ways to get involved in our growing community. If you're someone who is passionate about health and wellness and believes in the power of positive mindset… you're already halfway there!
We're always in search of other game changers looking to join our movement and share it with their own communities.
What does that look like?
Well, we have a certified writers course for those who want to contribute weekly content to our blog. We have a coaching and certification program for those that want to lead others on their path towards optimal health. We also have a membership to connect with other like-minded people! And we have our TRIBE!
All of these avenues are absolutely amazing ways to connect with people JUST LIKE YOU who want nothing but to see others succeed in all areas of their life.
But today, we're going to focus on what it takes to become an Organifi Tribe Member because we truly believe in the RIPPLE EFFECT and doing our part to share our knowledge and passion with the world. How does that sound?
Pretty cool, right?!
Are you active on Facebook and Instagram? Do you want to help us CHANGE THE WORLD? Do you have a burning desire to be part of an incredibly powerful movement with others on a mission to transform lives and improve health around the world?
Now is your chance to do just that!!!
Ahhhhhhhh…. EXCITING isn't it?!
Go ahead and fill out this brief application and a member of our Tribe Program will contact you with specifics.
Curious what some of our other Tribe Members are up to? Check out one of our absolutely amazing partners, Jenna Phillips Ballard. She is inspiring people all over the place – something YOU can do too!
1. What is your full name and where are you from?
Jenna Phillips Ballard. I'm from a little tiny ski village in Northern California called Bear Valley. 150 people live there!
2. What do you like most about being in the Organifi Tribe?
I love being part of a vision that is bigger than me. The whole Organifi tribe is a bunch of amazing human beings. Everyone is on a mission to make the world a better place.
3. How did you first hear about Organifi?
Mae and Drew introduced it to me, and they asked me to be an ambassador! It was love at first taste! I felt like it was a magic potion I'd been missing my whole life!
4. What advice would you give to fellow Organifi Tribe member on how to be successful in the tribe?
Always share from your heart. Use your own unique flare to spice up your posts, and be the radiant being that only YOU can be! Also: remember to ask for support! There is a whole team of people who are happily available to support you!
5. What are you passionate about?
I'm passionate about standing for people to be their most authentic selves. We all have a special gift that no one else has. I want everyone to fall in love with all that they are!
6. What is your favorite quote?
"I owe all my success to having no PLAN B. No other plan of survival. Failure is not an option." – Busta Rhymes
It's true: we've got a long ways to go, but we're committed. And guess what? We can't – and we don't want to – do it alone! We are looking for people in our community to join us and prove that consistent action, alignment with others on the same path and sharing our passion with the world CAN make a difference.
Are you with us? I hope so. Check out the app here and we'll be in touch.
Remember, we're in this together.
Drew Canole
CEO at Fitlife.tv
Drew Canole is a rockstar in the world of fitness, nutrition and mindset, with a huge heart for others and doing his part to transform the world, one person at a time.
As the founder and CEO of Fitlife.TV, he is committed to sharing educational, inspirational and entertaining videos and articles about health, fitness, healing and longevity. He is also a best selling author and the founder of Organifi, an organic, incredibly delicious greens powder, chock-full of superfoods to make juicing easy no matter your busy schedule.
Latest posts by Drew Canole (see all)
Putting All The Pieces Of The Puzzle Together - November 13, 2018
How To Create Community & Connection Daily - November 7, 2018
Simple And Amazing Full Body HITT Workout - October 24, 2018
Sunrise to Sunset Power Box
Wake up with Green Juice!
What Our Clients Say*
Glenn was in an accident with a hockey puck that made it so his mouth had to be wired shut! While he was going through recovery he found that Organifi Protein sustained him in a healthy way where he was able to maintain his muscle mass while still be able to loose weight.
-Tragedy Turns to Opportunity, Weightloss and Holistic Health
*Results may vary by individual
Heal the WorldCustomer SupportHealth & Nutrition
Our mission is to create a movement positively impacting communities around the world through education, inspiration, and empowerment.
We are committed to transforming over a billion lives…and we won't stop there!
20 Drinks to Start Your Day the Right Way November 15, 2019
Immunity Diet: Nutrients to Incorporate Into Your Meal Plan November 8, 2019
15 Reasons to Care About Joint Health October 9, 2019
© Copyright Fit Life All Rights Reserved

redpajama_set_name: RedPajamaCommonCrawl


The Customs Service this month awarded Motorola Inc. a contract to supply radios for voice communications as well as ones that the agency can use to transmit data, such as digital photographs and reports.
The contract, worth an estimated $165 million over five years, will help Customs replace radios that do not work under the new wireless communications standard that federal agencies must adopt. The contract will be open to other federal agencies.
As Customs adopts the new standard and as advances in radio technology make it easier to send data, the Motorola radios should allow Customs officers to share documents and images. Customs agents in the field will be able to receive information more quickly.
"We would think at some point in time we would be able to send fingerprints, photographs and pictures," said George King, chief of very high-frequency engineering at Customs.
"Migrate Up to the Next Level"
King said that although Motorola's new digital land mobile radios (LMRs) will be used primarily for voice communication, the contract can provide in the future products that are more specialized for transmitting data. "They have started on a road...that will allow them to migrate up to the next level," said Jim Vest, the Motorola manager working on the Customs contract.
Customs and other law enforcement agencies, such as the FBI, are using contracts similar to the Motorola pact to migrate current networks of land-based mobile radios to a new portion of the spectrum that will provide more channels. In 1993 the National Telecommunications and Information Administration determined that the part of the radio spectrum that agencies use to communicate— at 25 KHz— was becoming too crowded and required agencies to shift to 12.5 KHz by January 2005.
The shift will make it easier for more law enforcement agents— from local police officers to federal agents— to talk to one another and to share information in digital form.
Warren Suss, a telecommunications consultant based in Jenkintown, Pa., said the migration to the 12.5 KHz range will offer more radio channels than the 25 KHz portion of the spectrum, but each channel will have less bandwidth. Technological advances, such as being able to send a data file over more than one channel, should allow law enforcement officials to overcome the bandwidth obstacle, he said.
The Customs contract also indicates a lack of competition, Suss said. It is the second major law enforcement wireless contract that will help agencies move to the new 12.5 KHz standard, and Motorola is involved in both. The FBI awarded a contract in April to Harris Corp. for an estimated $105 million. But under that contract, Motorola's radios will be coupled with Harris' wireless security products.
"Motorola has pretty well had the market locked up," Suss said.


Notifications will need to be enabled per your preferences, by editing your profile.
Click the user name of the intended recipient and choose send me a message. Type in a title and message and click send. You have the option to use a post editor.
You will see a bell icon for conversations that you will be notified of updates to, and a bell with a red slash for conversations that you will not receive notifications for.
You should then type a message subject and the message body, just like you would for a new topic in the forums. When you are done, you can press Send Message or Save (Send Later) to save the message for later.
To reply to any conversation, press the "Add Reply" button when viewing it or press the "Reply" button underneath any existing message to quote it. Then type your message just like you would a post and press Send Message. You can also use the Fast Reply box at the bottom of each conversation to quickly reply to the conversation.
If you wish to report to a moderator a message that someone has sent to you, you can press the "Report" button underneath the message.
To add a new folder press the "Add" button beneath the list of folders.
To rename empty or delete a folder press the "Edit" button beneath the list of folders.
To rename a folder type the new name in the textbox currently containing the folder name, and then press the ">" button. You cannot rename default folders.
To empty a folder press the trash can icon beside the folder name.
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As per blackberry "messaging", are the messaging coversations on this site subpoenable?
Interesting question, what exactly are you planning on discussing in your conversations?
I'm willing to bet that anything you put in print out there into cyberspace can be used against you at anytime by someone.
If you're serious, I'll ask the Invison folks.
Likely one of the weirder question's I've ever heard. If you type it and hit send, your accountable for it.
Very interesting topic, I have a tiny drop of knowledge in this area.
If you want the long version, read this.
The initial header was "private conversations/PMs", which sure sounds simple enough. Then there was 1/2 page of stuff on how to actual perform a conversation.
From a legal point of view, yes anything posted here, including your IP address, email address, pm conversations, ect can be turned over to law enforcement. This would only happen in an extreme case. If you told someone that they sucked and started swearing at them then that won't be subpoenaed. If you threatened to kill someone here and then started stalking them, then perhaps you might have to worry.
Also for this to happen, the Canes legal team (meaning their lawyers) would have to receive official notification from a court about a court order for information. Just because someone emails them and says that they have a subpoena won't get them the information.
The other way your information could be used is if you are sending inappropriate messages via pm to other members. They can choose to send copies of your messages to staff here and as a group we would decide what if any action is required. This would generally be no more serious then being banned.


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Who is the richest football manager?
phill brown
is not the richest because the new Manchester city one is the richest
1 card
When was Kimia Aqqala F.C. created
Q: Who is the richest football manager?
What is the richest club in football manager 2012?
What is the richest football club in the world on Football Manager handheld 2009?
Manchester City - £211 Million
Which club on football manager 2012 has the richest transfer budget?
What Scottish football club is the richest?
The Celtic is the richest Scottish football club.
Richest club in football manager 2009?
Manchester City, Real Madrid, Chelsea, Manchester United, and Inter Milan.
What is the fourth richest football club?
The fourth richest football club is bayern Munich.
Who is the richest man from football?
The richest man from football is David Beckham who plays for England and A.C. Milan.
Is Chelsea football club among richest football clubs in the world?
Yes Chelsea football club is the top ten richest clubs.
Who are the richest football in international?
The richest footballer in the world is David Beckham.
Who are the current richest football players in Africa?
kudakwashe tutisani is the richest
The richest football club as at 2010?
The richest football club was Real madrid. Followed by Barcelona and then Manchester United.
Who is the richest football?
The richest football player?
What sport is the richest in the world?
Who is the richest in golf and football?
The richest golfer is tiger Woods of U.s.A, the richest footballer is David Beckham.
Is Queens Park Rangers Football Club the richest football club in the world?
The worlds richest club is Manchester City
Richest African football player?
Yaya Toure is the richest African football player $13.5 million annual salary
Richest football player in the world?
Which is the richest football team in Africa?
Kaiser Chiefs is the richest team in Africa.
Who is the richest football player in Nigeria?
Kanu Nnwankwo is the richest player in nigeria.
Who is the manager of Reliance?
India's richest man ambani
Who are the richest football coaches?
The richest football coaches are Sir Alex Ferguson , Jose Mourinho, Arsene Wenger and Pep Gaurdiola.
Who is Spain's football manager?
The football manager of Spain is vincente Del Bosquet.
When was Football Manager created?
Football Manager was created on 2005-10-21.
When did Football Manager Live happen?
Football Manager Live happened in 2008.


A primary goal of Scalypso is to support a wide range of terrestrial 3D laser scanning devices. Thus, as our customer, you can choose the optimal device for each project and still use the same software workflow.
As a first step of each Scalypso project, the Scalypso Converter translates the scan data from a vendor specific into a uniform Scalypso point cloud file format, which is usable by all of our software applications.
The number of supported formats and devices is continuously increasing, so this list is constantly being updated. If you are missing a specific format or device, do not hesitate to contact us.


After an inauspicious start to the 2016/17 Fantasy Premier League season, we were left with no alternative but to play the wildcard. Sometimes drastic measures are called for and the inclusion of Christian Benteke is an indication of how bad things are.
Hopefully the big man will come good and we've also put our faith in Arsenal and Everton players, in an attempt to propel our squad up that leaderboard.
Olivier Giroud has had a good rest and we're expecting the big Frenchman to fire some life into Arsenal's stuttering title challenge, with the ammunition being provided by Mesut Özil and Alexis Sánchez.
Ronald Koeman has transformed Everton in a matter of weeks, injecting some much-needed pace into the side, while shoring up a leaky defence at the same time. The Toffees have a nice set of fixtures coming up and now looks the perfect time for Romelu Lukaku to hit the goal trail.
We're hoping that Burnley and Southampton can pick up a number of clean sheets in the next few rounds and we'll be rotating our goalkeepers according to fixture severity.
We're gone for a 3-4-3 formation in Gameweek 4 and are hoping that our stacks can connect, with Özil a confident choice for the arm-band.
Let us know what you think of our wildcard selections.


text:
Inside Cooper
CooperHealth.org
Cooper Blogs
New Physicians
Cooper Donates $10,000 to Ronald McDonald House Charities
The Children's Regional Hospital at Cooper participated in the annual CBS3 "Change the Luck of a Child" fundraiser to benefit the Ronald McDonald House Charities by making a $10,000 donation and answering pledge calls. These efforts helped to raise $1.2 million for the organization, which serves as a home away from home for families with a child in the hospital.
Joanne Fox, Autum Shingler-Nace, and Brittany Spaeth from Children's Regional Hospital at Cooper taking calls for "Change the Luck of a Child" at CBS 3 Studio to raise funds for Ronald McDonald House Charities.
Michael Goodman, MD, Chief of Pediatrics at the Children's Regional Hospital at Cooper, is joined by (left to right) past Ronald McDonald House visitors Lorelei and Chelle McIntyre-Brewer; Robyn Harvey, RN, BSN, MBA, Executive Director of The Women's and Children's Institute and The Children's Regional Hospital at Cooper; CBS3 Reporter Nicole Brewer; and Teddy Thomas, President, Ronald McDonald House of Southern New Jersey.
"Ronald McDonald House Offers Sanctuary for Parents of Hospitalized Children" via SNJ Today.
"Ronald McDonald House of Southern New Jersey" information from the Cooper website.
"Child Life Services" information about our dedicated team of specialists helping families and children experiencing challenging illnesses or accidents requiring hospitalizations.
Posted in: Announcements, Events	Tagged: Child Life, Children's Regional Hospital at Cooper, Cooper Children's Regional Hospital, Ronald McDonald House Charities, The Ronald McDonald House of Southern New Jersey
Cooper University Health Care First Hospital in South Jersey to Offer New Treatment for GERD
Cooper Foundation to Kick-Off Free Summer in the City Music Festival in the Park Tuesday, July 23, 2019
Surgeon Joins Cooper University Health Care's Bariatric and Metabolic Surgery Center
Cooper & US Special Operations Combat Medics Teach "Stop The Bleed" to NJ State Police Cadets
GME Opportunities for Residents/Fellows Displaced From Hahnemann University Hospital Closure
Copyright © 2019 Inside Cooper.


Peelwood Creative is Jo Bertini and Thomas Studer. Jo is a painter, teacher, camel-wrangler, adventurer, dreamer and full-time resident of the deserts of the world. Thomas is a songwriter, photographer, film-maker, lighting designer, renovator of historic bathrooms and expert in guiding boats in a backwards direction. Together they explore the world, near and far, and document it's marvels of beauty and sobering reality through paint, music and video.
Jo Bertini is a master teacher of painting technique and, more importantly, a master teacher of artistic intent and concept. Her painting workshops leave participants refreshed with inspiration, renewed vitality and motivation like they've never experienced before. Master-level professional students walk away in awe of Jo's generosity as a teacher- she shares all the insights and techniques that she has accumulated over her 30 year career.


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Linda Ronstadt: The Sound of My Voice (2019)
With one of the most memorably stunning voices that has ever hit the airwaves, Linda Ronstadt burst onto the 1960s folk rock music scene in her early twenties.
Best Biographical Documentaries
A collection of the highest rated and most popular documentaries covering the lives of truly extraordinary people, coupled with brilliant film making.
Country Music Documentaries
These documentaries trace the history of country and western music through the careers of some if its greatest artists including Glen Campbell and Johnny Cash.
Female Rocker Documentaries
From Janis Joplin to Pussy Riot, these documentaries explore the lives of women who rock.
Shows like Miss Americana: Female Pop Star Documentaries
Documentaries for anyone who wants to go behind the scenes with Taylor Swift, Britney, Christina Aguilera, Beyonce, Katy Perry, Adele, or Miley Cyrus--these


Bettors are pounding the UNDER for Thursday night's game between the Los Angeles Rams and the San Francisco 49ers. Jason Lake takes a closer look at the numbers.
Remember how the new NFL is supposed to be all about offense? That's so 2013. Through two weeks of the new regular season, teams are scoring an average of 20.1 points per game. If that rate continues, this will be the lowest-scoring season since 1993, the year before the NFL adopted the 2-point conversion. And go figure, the UNDER is 19-12 heading into Week 3.
We can explain this away easily enough. There are the new PAT rules adopted in 2015, making the kicks longer and giving teams the option of skipping "unnecessary" attempts at the end of games. There are several teams with major injuries on the offensive line. It's early in the season, and offenses take more time to get game-ready than defenses. And lastly, 31 games is a small sample size. Dumb luck plays a larger role in football than people realize or care to admit.
Having said all that, the San Francisco 49ers are doing a great job of keeping points off the scoreboard. Their first two games both went UNDER, and all 12 of their points thus far have been scored by PK Robbie Gould. No wonder early bettors have been hammering the UNDER for Thursday's game (8:25 p.m. ET, NFLN) against the visiting Los Angles Rams, driving the total down from 41 points at the open to 40 points at press time. Is there still some value here for our Week 3 NFL picks? Let's do the math and see.
Right off the bat, we have to raise the red flag now that the total has dropped from 41. You may be familiar with magic numbers (3, 7, 10, et al.) when it comes to the point spread, but there are certain totals that contain their own magic, and the most important numbers, in this case, are 41 and 37. Those are the most common combined final scores in the NFL; moving a half-point off these magic totals is worth 10.6 cents, according to Wizard of Odds. That's the same value as moving from +10 to +10.5 on the point spread.
That next step from 40.5 to 40 points isn't small potatoes either at 8.0 cents. That adds up to… let's see, carry the one… 18.6 cents in value between UNDER 41 and UNDER 40. Hedge fund managers are strangling each other trying to get that kind of value per annum out of their investments. We'd better have a darned good reason to stick with the UNDER at this lower total.
Which brings us back to the Niners. In yesterday's look at NFL teasers, we called the new stadium in Santa Clara an "abomination," and that term wasn't used loosely. The turf has been an absolute disaster since they opened this barn in 2014. And it's still terrible; in July, they hosted the Gold Cup soccer final between Jamaica and Team USA, and it was a joke. Divots, divots everywhere.
And let's not forget Super Bowl 50. The Denver Broncos beat the Carolina Panthers 24-10, going UNDER the posted total of 43. At halftime, both teams were looking for longer cleats to wear. It's tempting to auto-bet the UNDER for Thursday's game just out of spite. The Niners defense may be mediocre, but it looks a lot better than it did last year when they split the totals down the middle. And their offense is a glorious mess. The weather forecast isn't giving us any rain to grease the wheels, but we'll recommend a suitably small wager on the UNDER here, especially with the deals on vigorish available on the NFL odds board at press time.


High-quality personalised table cloth give the best foundation for your fondest picture memories. Personalised tablecloths bring color and personality to big spaces and are certain to be a hot topic with your party guests!
These resilient non-crease cloths make sure that anything design and style you have chosen is reflected to perfection. Build yours to match the precise theme of your occasion, add beautiful photos, energetic designs or perhaps emotional slogans for a special table top touch. You may also upload photos directly from your notebook, mobile phone device or even straight through social media sites. Using a broad variety of colors such as White, Black, Emerald, Navy, Red and also Royale, you'll certainly be spoilt for choice in beautifying your table.
Perfect for wedding ceremonies, big birthdays, graduation or even backyard parties, these types of personalised table cloth can be a unique occasion for your recipient to keep. With personalised wedding table cloth so great, you'll be looking for any special occasion to seize a table and also dress up to impress!


The Procurement Manager is responsible for procurement planning, costing, negotiation, warranties, specifications and related supply chain and logistics management functions for several projects, primarily in the Nigerian Oil and Gas sector.
The individual will ensure cost-effective procurement of supplies, equipment and services for all installations and maintenance contracts of the company.
Development of procurement strategies for preparation and presentation to directors.
Manage the procurement operations in the Procurement and Logistics Department of the organization.
Meticulously manage all aspects of procurement from negotiation to delivery.
Promote safety and awareness among Supply Chain and Vendor staff aimed at zero accident/incident rate.
Experience in Project & Construction Management.
Master's degree in Supply Chain Management and Procurement (desirable).
Certified Purchasing Manager (C.P.M) and HSE qualification is an added advantage.
10 years' experience in Procurement within the Oil and Gas sector.
Good knowledge of ORACLE ERP System.
Have very strong connections and contacts in the Oil and Gas sector.
Currently working in a similar role.
Be ready to reside in Port Harcourt.
Strategic Procurement skills acquired within the oil and gas sector.
Ability to exploit opportunities to gain best value in procurement and supplier management.
Possess in-depth knowledge and experience of diverse range of markets and commodities in the oil and gas sector.
Proficient in design, implementation and management of inventory control systems.
Have a high level of commercial acumen.
Interested and qualified candidates should send their CV's to: jobs@michaelstevens-consulting.com with the job title as subject.


One of the most scenic New England destinations, Coastal Maine features tranquil beaches, delicious cuisine, fascinating museums, and world-class state parks. Whether you want an action-packed vacation full of sightseeing and outdoor adventures or a relaxing trip with plenty of time to unwind, there are plenty of unforgettable ways to spend your time in the area. Below, we've provided a guide on the top Maine Coast attractions and things to do on your vacation.
For the most comprehensive list of Maine Coast attractions, take a look at our free Travel Guide. In addition to our recommendations below, we've included details on the best beaches, outdoor attractions, museums, restaurants, wineries, and a few of Maine's hidden gems.
Any visit to Georgetown should certainly include a trip to the beach. Our stunning, rugged coastline is best reached through one of the fabulous state parks with beaches. One of our favorites, Reid State Park is just minutes from Grey Haven Inn and offers one-and-a-half miles of wide, sandy shores. This coastal park is a great place for hiking, swimming, and surfing. In fact, it's considered the number one place for surfing in Maine!
New England is rich in history and our region is no different. Although there is a range of fabulous historical sites near Georgetown worth exploring, a few of the most popular include the Maine Maritime Museum, the Farnsworth Art Museum, and the Hendricks Hill Museum. Learn about our area's seafaring past, see exquisite art, and find out about the interesting lives of one of Maine's oldest families.
You haven't fully experienced Maine until you've had a taste of New England's quintessential cuisine. At Grey Havens Inn, you'll find one of Coastal Maine's best restaurants, Blue, which features freshly caught seafood, outstanding wine, and waterfront views. Another one of our favorite Georgetown restaurants with some of the best Maine lobster in the state is Five Islands Lobster Company.
After a delicious meal, head one of the local breweries or wineries near Georgetown. You'll find the perfect cozy spot to relax with a glass of wine or a refreshing beverage. Visit Bath Brewing Company for a selection of craft beers in a welcoming atmosphere or Sweetgrass Winery & Distillery for some of the region's best spirits and local wine.
If you're looking for the best place to stay near the Maine Coast attractions mentioned above, look no further than Grey Havens Inn. Our historic waterfront hotel features a selection of charming guest rooms that overlook the North Atlantic coast and nearby islands. Enjoy luxurious linens, fine bath amenities, stunning views, and a few thoughtful touches to make your stay extra special. Grey Havens Inn is the escape you've dreamed about.
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Japan, UK, Italy to develop next-generation fighter jet
The new 'Global Combat Air Programme' is slated to produce its first jets by 2035, merging the three nations' costly existing research into new aerial war technology, from stealth capacity to high-tech sensors.
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Britain, Italy and Japan said Friday they will jointly develop a future fighter jet in a project that UK Prime Minister Rishi Sunak said would guarantee national security and safeguard thousands of jobs.
The three nations held out the prospect of cooperation with European and US allies, which are developing their own "sixth-generation" planes, vowing to maintain "interoperability" among all the allies against threats from the likes of China and Russia.
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"We're one of the few countries in the world that has the capability to build technologically advanced fighter aircraft," Sunak told reporters on a visit to a Royal Air Force base in eastern England.
"That's important because it means we can keep the country safe from the new threats that we face," he said.
"It also adds billions to our economy and supports tens of thousands of jobs across the country. But it's also good for our international reputation."
The announcement was accompanied by a set of images showing an artist's impression of the sleek new jets flying past Mount Fuji and over London and Rome.
In a joint statement, the three countries said the project would "accelerate our advanced military capability and technological advantage" at a time when "threats and aggression are increasing" worldwide.
The objective is to develop by 2035 a twin-engine stealth aircraft that could be operated with or without a crew, that would be impervious to radar and boast features such as laser-directed weapons and a virtual cockpit.
For the current "fifth generation" of fighters, the three nations are relying on US-made F-35s.
But officials in Tokyo stressed that Japan was not turning its back on its close military alliance with Washington.
In a separate joint statement with Japan's defence ministry, the US Department of Defense said it supported the project.
"We have begun important collaboration through a series of discussions on autonomous systems capabilities, which could complement Japan's next fighter programme among other platforms," the US-Japan statement said.
For Britain and Italy, the new jet codenamed Tempest would replace the Eurofighter Typhoon developed with other European allies including Germany and Spain.
For the next generation, Germany and Spain have joined France in their own project, while the United States has separate plans in development, as do China and Russia.
Pressure from China
Japan's prior project to build a next-generation fighter plane, named F-X, was reportedly expected to cost more than five trillion yen (around $40 billion).
Friday's announcement comes with Tokyo poised to make the largest overhaul to its security strategy in decades.
The government plans to ramp up defence spending -- a controversial move in a nation whose constitution limits military capacity to ostensibly self-protective measures.
But the war in Ukraine, repeated missile launches from North Korea and growing pressure from China have helped build support for a bigger budget.
Japan's Nikkei business daily said that companies Mitsubishi Heavy Industries, BAE Systems and Leonardo would oversee the new project, which is Tokyo's second joint development after its SM-3 missile made with Washington.
Other companies expected to be in the mix are British jet maker Rolls-Royce, Italy's Avio Aero and IHI Corp. of Japan.
The Global Combat Air Programme is the latest high-profile example of allied countries collaborating on an ad-hoc basis to develop defence equipment.
Such moves proved controversial last year when the United States snatched a lucrative contract to supply Australia with submarines from France and launched a new US-UK-Australia alliance in the Pacific, dubbed AUKUS.
After a meeting between US and Australian ministers this week in Washington, the two countries said they would welcome Japanese troops into three-way rotations, vowing a united front in the face of China's rapid military advances.
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Sometimes I walk away from a wedding, thinking, "I could totally be friends with those people!!!" Ok. Well, maybe it happens more often than not. But with Nick and Kristina, I was really saying it on my drive home that night!
These two love each other — they're the best of friends. They're honest and down to earth and incredibly fun. I loved my time with Kristina's sweet bridesmaids, who doted on her and helped her look and feel her best throughout the day. Nick's groomsmen were a hoot. When we're all laughing, even an hour in to photos, you know it's going to be a good day.
My favorite part of the day was reading my vows to Nick. It was all my emotions on one page. My other favorite part was dancing with my friends. I always laugh so hard when I am with them and since they are from my hometown, I hardly get to see them anymore. One of my favorite things in life is when we are all together in one place. I'm never worrying about the next day or work struggles or finances. I'm just me, with them, and I felt whole. Lastly, getting ready in the morning with my girls :) Kathryn and Abby nailed it. Everything was so fun and everyone looked amazing.
Now, before I show you this beautiful wedding day, I have to add another favorite part of the story.


Anegada from 12 miles away, photographed from the top of the ferry with a long telephoto lens. Sailboats in the anchorage are "hull down", with only the tops of their masts visible above the horizon. The buildings ashore are below the horizon.


Germany's first nationwide state lottery Gemeinsame Klassenlotterie (GKL) has been formed following the agreement between two state lottery vendors NKL German Lottery Northwest (NKL) and the South German Class Lottery (SKL) ensuring that sixteen German Lander have comprehensive offerings.
From now on, NKL and SKL will be operated as a joint institution of public law and their merge has been described as a primarily corrective measure introduced by the Prime Minister as an amendment to the State Treaty on Gambling.
The new national lottery products will remain unchanged for players, with head offices of both state vendors to remain situated in Hamburg and Munich, yet new additions to the existing lottery offerings are promised by 2013.
As per the joint advisory of Dr. Gerhard Rombach, former Director of SKL, and the present NKL CEO Günther Schneider, the main intention of the German Government is provision of an attractive alternative to private gambling sites under a Government-guaranteed, controlled system of lotteries and related gaming activity.