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The effect of Garcinia Cambogia as coadjuvant in the weight loss process
The World Health Organization (WHO) classifies obesity as an epidemic resulting from the imbalance between intake and energy expenditure, as a consequence of a sedentary lifestyle and poor eating habits1,2,3, as well as the socio demographic conditions4. This disease constitutes a significant global health problem that attacks adults and children and affects a worldwide, growing number of people5.
It is characterized as a chronic disease caused by excessive accumulation of body fat resulting in significant loss of quality of life and longevity. It occurs in developed and developing countries3,6, and it has the involvement of a complex interaction of environmental and genetic factors, besides being associated to morbidity and mortality related to heart attack, high blood pressure, diabetes and even cancer7,8.
Consequently, obesity is a public health problem that requires attention and multisectoral actions to promote a healthy lifestyle and improve the prevention and its control among population4,9.
The Ministry of Health (MoH), through Vigitel (Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases)10, in 2013, revealed overweight in 51% of the Brazilian population; men are the majority. In 2006, this percentage was 43%, a fact that shows that the obesity rate has been growing in the country. In 2012, ABESO (Brazilian Association for the Study of Obesity and Metabolic Syndrome)11 released the report "World Health Statistics 2012" of WHO revealing that obesity is the death cause of 2.8 million of people per year and that 12% of the world population is considered obese, and the American continent has the highest incidence of the disease.
Since obesity is reaching epidemic proportions, its effective management is an important clinical problem. Despite scientific efforts to understand the mechanisms that lead to overconsumption of food and overweight, at the moment, few weight management approaches are effective in a long-term12.
Therapeutic strategies to treat obesity include synthetic drugs and surgery, which can result in high costs and serious complications. Medicinal agents, herbal products, offer an alternative approach to manage weight, in combating obesity and co-morbidities associated resulting in a safer and more efficient treatment without risks to health2,13, due to their fewer side effects compared to synthetic drugs3. Thus, the phytotherapic represent a new potential coadjuvant or alternative therapy for the treatment of obesity14 and have frequently been used to promote weight loss15.
These agents act through five basic mechanisms, including the stimulation of thermogenesis, reduction of lipogenesis, increase of lipolysis, appetite suppression and decrease of lipids absorption13. Currently, the term "thermogenic fat burner" has been used to describe nutritional supplements that promote, somehow, the fat metabolism by increasing energy expenditure, fat burning, weight loss, lipid oxidation during the exercise16.
The probable reasons for obese people prefer herbal products for weight control include healthy weight loss without any side effects; lower demanding in lifestyle changes such as diet and exercise; ease of acquisition, available without a prescription; more easily accepted than a professional consultation with a doctor or a nutritionist; 100% natural with the perception that natural means safe7.
For these reasons, people in all countries have been using herbal medicines for weight control and treatment of obesity1,6,8. But despite these substances promise to improve or prevent the obesity, costs, effectiveness and side effects have to be considered and, for these reasons, they must be studied intensively1,2.
Among the natural supplements, herbals for the treatment of obesity, stands out the natural extract obtained from dried fruit of the tree Garcinia cambogia (GC), which is found in the forests of South India and South Asia, has been studied extensively and used as a supplement for weight loss1,2,6,8,17.
The hydroxyl citric acid or hydroxycitric acid (HCA) is extracted from the rind of the fruit. It is an organic acid considered the main active ingredient, which acts as a potential supplement to the weight control3,17,18,19 by causing the appetite suppression and reducing the body's ability to form adipose tissue3. Besides acting as a phytotherapic coadjuvant for the treatment of obesity, the GC extract and its active component HCA have also been used to reduce cholesterol and triglycerides.
It is also available with addition of calcium, magnesium, potassium and mixtures thereof due to other effects, such as improvement of glucose tolerance and of blood pressure20,21.
Unlike chemical stimulants used for weight loss, it does not act on the central nervous system and does not cause insomnia, nervousness, changes in blood pressure or heart rate and its efficiency does not decrease along the time17,21. This way, the GC extract is quickly becoming a popular ingredient among many supplements for weight loss and has been used routinely for many centuries for not showing toxic effects3.
The evaluation of its toxicity to the weight control is extremely important, as it requires a continuous consumption in the long term in order to maintain its effects8. Currently, the GC is being released by the National Health Surveillance Agency (ANVISA) and has been indicated as a coadjunct of overweight for participating in the regulation of appetite22, but the sale can only be made under a medical prescription.
The Resolution of the Federal Council of Nutritionists (FCN) of Brazil nr.390/200623 regulates the dietary prescription of nutritional supplements by the nutritionist and determines that it can be done based on the nutritional diagnosis in the following cases: I. specific physiological states; II. pathological conditions; III. metabolic changes, and the prescription of nutritional supplements should still be based on the following premises: I. food consumption adequacy; II. definition of the period of supplementation use; III. systematic re-evaluation of the nutritional status and of the dietary plan.
Due to the large supply in the market, marketing and popular use of herbal medicines, such as GC to act as a coadjuvant in treatments for obesity, this study aimed to deepen the scientific evidence on the effects of GC administration as a coadjuvant factor in the treatment of obesity regarding to its effectiveness, form of action, recommended daily dosage, side effects and contraindications, as a way of food and nutritional security for the population.
Literature review study for which there were consulted the LILACS-BIREME, MEDLINE and SciELO databases and selected scientific articles published in English, Portuguese and Spanish, between the period of 2007 and 2014 that conducted studies involving the administration of GC as a way of treatment for obesity. The descriptors used for research articles in the databases were the following: Garcínia Cambogia in Portuguese, and in English the terms used were "Garcinia cambogia", "weight loss and obesity" and "Hydroxycitric Acid (HCA)"; this latter is not an indexed descriptor in the Health Science Descriptors (DeCS), but given the importance of this term for the search, it was adopted as a keyword. Thirty-four articles were identified, but only 21 were related to the objectives of this study. The first analysis of the articles was conducted by the title and then by the summary. In addition, 20 references were included because of their relevance to the study.
Table I shows the main results of non-randomized studies with supplementation of GC/HCA and table II presents the main results of randomized studies with supplementation of GC/HCA.
Due to the dramatic increase of the number of obesity cases in recent years, this disease has become one of the most important problems that public health has faced in several countries around the world, nowadays. In view of this, several methods to assist weight loss have arisen, like miracle diets and dietary supplements, but, often, little is known about the regular use and long-term of certain substances.
According to Kimet et al.24, GC is a popular supplement for weight loss. Studies suggest that the use of GC stimulates the burning of body fat, helps to inhibit appetite by reducing the desire to eat with a consequent reduction in food intake, and promotes satiety, and also acts in weight maintenance.
Being a study that aims the GC administration as a coadjuvant in the treatment of weight reduction, it can provide important information for both scientific uses as for the general population about the effects of its administration as a way to help in the treatment of obesity.
Effectiveness and way of acting
In the analysis of the effectiveness of GC, the study of Kovacs and Westertep-Plantenga28 concluded, in an experimental condition in humans, that the treatment with HCA during overfeeding with CHO can reduce the DNL. In rats, Kim et al.24 verified that the supplementation of this herbal medicine helped to reduce the body fat, but not to decrease weight or appetite.
Although, in humans, Kim et al.15 observed that the GC supplementation did not reduce the percentage of body fat, as it did not act on the decrease of appetite, BW, BMI and waist-hip ratio (WHR). Murer2 concluded that individuals with and without GC supplementation showed reduction of body fat and emphasized that the combination of diet and physical activity still remains the most suitable for positive changes of body composition.
The experiment of Anton et al.14 in humans also did not observe significant effects with the administration of GC dosages on food intake, satiety, weight loss, and oxidative stress levels. They highlighted that further research is needed to explore the promising effects of herbal medicines on food intake and satiety levels. However, they chose the compound derived from GC for their study because they noted in the literature its potential in acting in the reduction of food intake, in BW and in the levels of oxidative stress with safety, affecting the neuroendocrine pathways related to satiety.
Lira-García et al.29, in their review study with among sixteen assessed studies, found only one study that demonstrated significant weight loss between the control group and the experimental group with dosage of 1200 mg/day of GC and concluded that it was not possible to prove the effectiveness of the alternative products for weight loss because there is not enough GC protected against obesity induced [24] by HFD through the modulation of the synthesis of fatty acids and β-oxidation, but induced hepatic fibrosis, inflammation and oxidative stress.
The HFD and HSD groups showed [25] a significant increase in feed intake,
BW, BMI, TG, LDL, oxidative stress and renal disorder, while the groups supplemented with GC showed improvement of the harmful effects of HFD and HSD diets, with consequent reduction of feed intake, increase of the MDA level and decreased oxidative stress in renal tissue.
The supplementation of the GC HFD [26] failed to reduce the rising levels of serum lipids.
High intakes of HCA alone did not [20] lead to signs of inflammation or hepatotoxicity.
EGML and GCE did not promote [15] BW loss neither decreased the TC in overweight individuals consuming
usual diet. EGML increased levels of HDL-C. There were no serious adverse effects reported by the intake of EGML, GCE or placebo (starch).
No significant effects were observed [14] with the administration of the GC dosages or adverse effect level
(NOAEL) in humans at doses of
4000mg/day.
The supplementation of HCA [27] enhances the rate of glycogen synthesis in human skeletal muscle
and improves the postprandial insulin sensitivity.
The combination of diet and physical [2] activity remains the most suitable for positive changes in body composition.
The treatment with HCA during [28] overfeeding with carbohydrates can reduce DNL.
The study of Onakpoya et al.30, also of review, using data from randomized clinical trials (RCTs) in order to examine the effectiveness of GC/HCA extract as weight reducing agent, observed a small significant difference in loss weight, favoring the HCA over the placebo and they concluded that the ECR suggest that the GC/ HCA extracts can cause short term weight loss, confirming the review study of Astell et al.31, who concluded that the results of the RCT showed that the GC extract is effective in reducing body weight by suppressing appetite. The study of Amin, Kamel and Eltawab25, with rats, also concluded that the GC supplementation decreased the feed intake.
The theory behind the GC/HCA is that it works as anti-obesity agent by acting in the neuroendocrine pathways, related to the satiety, producing an anorectic effect, by promoting the inhibition of citrate lyase
enzyme that suppresses the appetite and increases the burning of body fat. Thus, it assists in regulating appetite, with consequent reduction of food intake, caloric restriction and weight loss. By inhibiting this enzyme, the body increases the oxidation of carbohydrates and inhibits the lipogenesis3,14,17,18,32,33. According to the ANVISA34, the register situation of GC in Brazil is classified in the category of appetite modulators and products for special diets, and it is indicated as a coadjuvant of overweight to participate in the regulation of appetite22.
Recently, there was found that the GC supplementation can be used as a metabolic regulator of obesity and lipid abnormalities in the system of mammals.19 Pandya et al.21, Sethi3, and Krishnamoorthy17 claim that GC/HCA reduces the lipid levels in blood, such as triglycerides and cholesterol, besides of increasing the thermogenesis. The HCA inhibits competitively the extramitochondrial citrate lyase enzyme that catalyzes the cleavage of citrate to acetyl-CoA and oxaloacetate, a key step in lipogenesis, necessary for the synthesis of fatty acids and cholesterol35,36.
However, in some studies, such as by Kim et al.24, in rats, there was found that the GC supplementation did not cause significant differences in the levels of TG, TC, HDL-c, phospholipids and free fatty acids. Similarly, the study of Ates et al.26 observed that the GC supplementation coupled with the high fat diet failed to reduce the increased serum levels of lipids in rats. In humans, Kim et al.15 also observed that after the supplementation of GC there were no significant differences in lipid levels (triglycerides and low-density lipoprotein LDL-c), or of adipocytokines (hormones of high adipocytes in obesity). A laboratory study performed by Simon et al.6 also concluded that there were not observed significant effects for the treatment of obesity and of other dyslipidemia with GC.
In contrast, the study of Amin et al.25 in rats, concluded that the GC supplementation improved the harmful effects caused by HFD or HSD, such as hypertriglyceridemia, increase of production of LDL, and of oxidative stress. Santos et al.36 reported in their review study that the administration GC showed inhibition of lipogenesis in the liver of rodents, adipose tissue, and small intestine but without confirmation in humans and claim that the only applicability of the HCA as anti-obesity agent seems to be the reduction of appetite, due to its anorectic effect.
Pandya et al.21 and Krishnamoorthy17 claim that the GC/HCA acts in the suppression of appetite by making glycogen synthesis in the liver and in other body tissues, increasing the energy levels.
The study done by Cheng et al.27 found that the HCA supplementation reinforced the glycogen synthesis rate in human skeletal muscle, improved the postmeal insulin sensitivity, and demanded higher energy expenditure in fat oxidation. Kim et al.2 observed that in rats the GC supplementation caused lower glucose levels, assuming that this could improve glucose tolerance by contributing to the reduction of visceral fat, since it is responsible for insulin resistance even in hyperlipidic diets.
Several in vivo studies have contributed to the understanding of the anti-obesity effects of GC/HCA via the release of serotonin in the brain, which has been considered as the main mechanism to decrease appetite and absorption of glucose and also in the increase of oxidation of fat, reducing DNL29,33. In recent studies in female mouse, there has been observed the effect of HCA on the regulator genes of obesity29. However, studies related to the presence of enzymatic inhibitors in extracts of these plants that participate or are responsible for its anti-obesity properties are scarce in the literature. Since the research conducted to evaluate the effective and safe use of herbal medicines is incipient, the notifications of events help in the generation of new information, promoting its rational use32.
Santos et al.36 still claim that in order to qualify the HCA as an anti-obesity effective metabolic agent it should produce a stimulating effect on the skeletal muscle, on the total fat oxidation or on the calorie consumption, but this has not been proved yet. Studies with this herbal demonstrated its effectiveness in combating obesity; however, there miss further studies on its mechanism of action to generate more security in its therapeutic use.
Tucci12 also states that the GC can contribute to the appetite suppression, but it still should be better demonstrated. In his review study, he noted that some phytochemicals show promising effects on weight control, however, more data is needed to define the real magnitude of effects and ideal doses. For Chandrasekaran7, an ideal anti-obesity herbal has to reduce the weight by 10% in relation to the placebo during the period of treatment, showing evidence of improvement of biochemical tests, like in the levels of lipids and glucose, without any side effects.
Daily Recommended Amount
The study of Amin et al.25 observed positive effects, such as decreased appetite and improve of the harmful effects caused by high fat and sucrose diets in rats that received supplementation of 50 mg/day of GC. The study of Cheng et al. 27 highlighted that the HCA supplementation enhanced the rate of glycogen synthesis in human skeletal muscle and improved the post-meal insulin sensitivity in the amount of 500 mg/day combined with a meal high in CHO (80% CHO, 8% LIP, 12% PROT) after 60 minutes of bicycle. Kovacs and Westertep-plantenga28 observed that the treatment with three capsules of 500 mg/day (1500mg/day) of HCA during the overfeeding with carbohydrate can reduce the DNL.
Ates et al.26 observed in rats that the GC supplementation combined with the hyperlipidic diet was not able to reduce the increase of the serum lipid levels in a dose of 2.390 mg/day of GC and suggest that higher dosages of GC extract should be investigated. Kim et al.15, noticed that for humans the intake of 2000 mg/ day of GC did not promote weight loss neither decreased the total cholesterol in overweight individuals consuming their usual diet. Anton et al.14 also did not observe significant effects in individuals with the administration of higher dosages of GC, 2800 mg/day and 5600 mg/day.
Murer2 concluded in his study that the combination of diet and physical activity remain the most suitable for positive changes in body composition by observing the combination of normocaloric diet associated with the intake of two capsules of 500 mg/day of GC (1000 mg/day), since the supplemented group and the unsupplemented group, fed only with normocaloric diet reduced body fat.
Although Onakpoya et al.30, in their review article with ECR have concluded that the dosage of HCA
The effect of Garcinia Cambogia as Nutr Hosp. 2015;32(6):2400-2408 2405 coadjuvant in the weight loss process used among the studies ranged from 1000 mg/day to 2800 mg/day, which resulted in a small weight loss, and they said that the magnitude of the effect is small and the clinical relevance is uncertain; so, future clinical trials should be stricter and better reported and that the ideal dose of HCA is currently unknown.
GC supplements are available in various forms, including pills, capsules and powders. The herbal medicine is usually standardized to contain fixed percentage of HCA, and the usual dosage from 300 mg to 500 mg should be administered three times a day and ingested half an hour before meals with water3.
Side effects and contraindications
About the side effects and contraindications of the GC usage, there was observed in the study of Kim et al.24 that the prolonged use of GC in the administered dose in rats can cause hepatotoxic effects and even develop non-alcoholic hepatic steatosis because of the accumulation of collagen in the liver, independently of being caused by hyperlipidic diet.
Lobb37 claims that there are a growing number of reports of hepatotoxicity caused by supplements containing HCA. In his study, he approached six case reports: two women, of 33 and 40 years old, and four men of 19, 27, 28, and 30 years old; underestimating the incidence of hepatotoxicity associated with weight loss with the HCA. Each report showed similarities; in the screening of hepatic abnormalities and in the symptoms presented by patients, who were healthy and with normal hepatic functions. Among the laboratory findings and symptoms there were reported fatigue, nausea, vomiting, colic, fever, chills, anorexia, abdominal pain, jaundice in a period ranging from three days to three weeks; deregulated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase and bilirubin. Onakpoya et al.30, in their review study, observed, gastrointestinal adverse events twice more common in the HCA group in comparison to the placebo group.
In contrast, Clouatre and Preuss20 claim that the results obtained about the HCA safety and efficacy are different from a variety of studies performed with animals and humans, since they observed in rats that the HCA produced protective effect against the hepatic toxicity associated with ethanol and administration of dexamethasone, and kept levels of SGOT, SGPT, and alkaline phosphatase at almost normal levels. The compound was found to reduce the inflammatory response in the brain, intestine, kidney and serum, and they highlight that high intakes of HCA, by itself, did not lead to signs of inflammation or hepatotoxicity.
Sethi3 also affirms the protection capacity of the GC against external hepatotoxins such as alcohol, and a recent study showed its effect preventing liver cells becoming fibrocytes. Shivashankara et al.38, observed in their review study that pre-clinical studies conducted recently have shown that some herbal medicines, such as GC, protect against ethanol-induced hepatotoxicity, through the mechanism mediated by antioxidant action, elimination of free radicals, anti-inflammatory and antifibrotic, but they emphasized that future studies would be required to establish its applicability in humans.
In humans, Kim et al. 15 did not observe reports of serious adverse effects by the individuals who consumed GC supplements, corroborating the study of Anton et al.14 who also did not observe adverse effect (NOAEL) in humans with doses higher than 4000 mg/ dia. Lira-García et al.29, concluded in their review study that among the eight studies that were evaluated, in none of them were observed adverse effects on the use of GC.
The review studies conducted by Chuah et al.8, and Chuah et al.33, concluded that there was not observed adverse effect (NOAEL) in dosages of GC/HCA of up to 2800 mg/day, suggesting its safety for use. Most of the reports demonstrated the efficacy of GC/HCA, and there wasn't found any toxicity.
Sethi3 concluded in his review study that the herbal medicines are more beneficial in the treatment of obesity due to its fewer side effects and also act on the prevention of diseases such as type 2 diabetes, heart disease, high blood pressure. Until now, there is no case study or report showing the direct adverse effect of HCA8, as well as there is no evidence that demonstrates hepatotoxicity associated with the HCA, and the true agents need to be firmly identified, along with the dose to which the negative effects are induced39.
Pandya et al.21 also claim that there aren't any known side effects for the usage of this herb. However, it is not recommended for people diagnosed with diabetes or people suffering from any kind of dementia or syndrome, including Alzheimer disease as well as pregnant and lactating women and has contraindications regarding the concomitant use of certain drugs.
Egras et al.40 concluded in their review study that many obese people use food supplements for weight loss and that, so far, there is little clinical evidence to support their findings, but it is necessary to determine their efficacy and safety. Health professionals should be aware of the products available for weight loss to help their patients and to determine the risks and benefits of the supplement used to loss of weight. Yuliana et al.41 still claim that despite insufficient data regarding to its safety and efficacy, many herbal medicines are available for sale without a prescription, such as the GC, which reduces the appetite, and that the quality control of these herbal medicines also becomes important.
This review study has several limitations.
Although the research has involved studies in electronic media, there may not have identified all those available involving the use of GC/HCA as a supplement for weight loss. Furthermore, the methodological quality of most studies identified from this study is short. These factors hinder conclusive findings about the effects of GC/HCA on body weight.
Final considerations
Studies suggest positive results concerning the effectiveness of the GC in weight loss process, by reducing the appetite, the percentage of fat, the lipogenesis process, as well as the improvement of biochemical levels, such as triglycerides, cholesterol and glucose, muscle glycogen synthesis, and postmeal insulin sensitivity.
However, the ideal dose has not been well established yet; however the GC supplements are available in 300 mg and 500 mg dosages, with the intake direction of three times a day, with water, half an hour before the meals.
There is little evidence of adverse effects and signs of protective effect against the hepatotoxicity induced by ethanol. Therefore, it is necessary to carry out more randomized, controlled studies, clinical trials to evidence the efficacy of this herbal in the weight loss process, as well as the set of the posology, dosages, indications and contraindications.
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By : Lou Chibbaro Jr. OF THE WASHINGTON BLADE, COURTESY OF THE NATIONAL LGBT MEDIA ASSOCIATION
Tags:American Foundation for AIDS Research, facebook, Gay Men's Health Crisis of New York, Gilead Sciences, GLAAD, Mark Zuckerberg, National Institute of Allergy and Infectious Diseases, Pre-exposure Prophylaxis, PrEP, PrEP4All, the National Minority AIDS Council, The Trevor Project, Truvada, U.S. Centers for Disease Control
More than 50 LGBTQ, AIDS and public health organizations released a joint letter on Monday addressed to Facebook Chairman and CEO Mark Zuckerberg urging him to immediately remove "dangerous and misleading" ads currently running on Facebook and Instagram suggesting the HIV prevention drug PrEP is unsafe.
"As organizations attached to this letter – leaders in lesbian, gay, bisexual, transgender, and queer (LGBTQ) advocacy, public health, and HIV/AIDS prevention – we are urgently reaching out to Facebook and Instagram regarding factually inaccurate advertisements which suggest negative health effects of Truvada PrEP (Pre-Exposure Prophylaxis)," the letter states.
"Using Facebook's and Instagram's targeted advertising programs, various law firms are attempting to recruit gay and bisexual men who use Truvada PrEP as an HIV preventative to join a lawsuit, claiming that the drug has caused harmful side effects in this patient population, specifically bone density and kidney issues," the letter says.
Officials with the LGBTQ advocacy group GLAAD and the HIV prevention advocacy group PrEP4All Collaborative, who organized the joint letter, say the ads in question are lumping together past instances of side effects of Truvada as a treatment for people with HIV who have taken it in combination with other drugs and HIV negative people who are taking Truvada alone as PrEP.
They point out that studies conducted by the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration have found Truvada use in PrEP has had minimal to no side effects and has been deemed safe and effective as an HIV prevention medication. Government studies have shown PrEP to be 99 percent effective in preventing someone from acquiring HIV if taken properly.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which oversees HIV prevention efforts, told a congressional briefing last week that serious side effects of PrEP have been shown in studies to be "very few" and "really not pertinent at all, not at all."
The letter released by the advocacy groups expresses concern that Facebook appears to be ignoring these findings in its refusal so far to remove the ads suggesting PrEP is harmful.
"By allowing these advertisements to persist on their platforms, Facebook and Instagram are convincing at-risk individuals to avoid PrEP, invariably leading to avoidable HIV infections," the joint letter says. "You are harming public health."
The letter says the LGBTQ and HIV prevention groups reached out to Facebook to explain why they believe the advertisements are harmful and for months have urged Facebook to take them down but Facebook has declined to do so.
The Washington Post reported on Monday that Facebook said the ads do not violate its advertising policies.
"We value our work with LGBTQ groups and consistently seek their input," the Post quoted a statement it says Facebook released to the newspaper. "While these ads do not violate our ad policies nor have they been rated false by third-party fact checkers, we're always examining ways to improve and help these key groups better understand how we apply our policies," the Post quoted the statement as saying.
According to the Post, Facebook's archives show that the ads have been viewed millions of times in recent months.
Longtime HIV patient advocate Peter Staley, who is a co-founder of the PrEP4All Collaborative, told the Washington Blade that LGBTQ and AIDS activists have tried unsuccessfully to explain to Facebook and its third-party fact checking officials why they believe the ads are misleading and inaccurate.
Most of the ads in question have been purchased by law firms and personal-injury lawyers representing clients in lawsuits filed against Gilead Sciences, the drug company that manufactures Truvada. The lawsuits charge that some HIV-positive patients who have taken Truvada in combination with multiple other drugs have experienced serious and potentially life-threatening kidney function and bone density problems.
The lawsuits also claim that Gilead withheld releasing a safer version of one of the compounds that make up Truvada for many years until the patent ended on one of the drugs with more harmful side effects.
"All of those drugs together can really attack the kidney and it's really hard to figure out which one is to blame," Staley said.
"But for HIV negative people on PrEP, PrEP is generally the only thing they're taking except maybe Viagra," Staley said while laughing. "So that's why even though it's the same drug – Truvada is the same drug as treatment and as prevention – it has acted very differently in these two patient populations in these two points in history," he said.
"So we tried to explain all this to Facebook and they're just pointing to the label," said Staley. "It's the same drug so it's only got one label. The FDA doesn't issue a separate label for treatment and one for prevention for PrEP. It's all one label," Staley points out.
"And right at the top on the label are these scary warnings that in rare circumstances this can cause kidney problems, this can cause bone density issues," Staley says. "So Facebook points to that and says well it's there, it's right on the label. These law firms running these ads can say this."
"And we're like yeah but you're scaring tens of thousands of people away from a miracle pill that is nearly 100 percent effective and where we haven't seen these toxicities in this patient population at all," Staley said. "And here we are with Facebook just pointing to obscure, undefined advertising policies and third-party fact checkers that know nothing about HIV."
Among the groups that signed on to the joint letter to Facebook, in addition to GLAAD and the PrEP4All Collaboration, are the Human Rights Campaign, AIDS United, the American Academy of HIV Medicine, the American Foundation for AIDS Research, the Gay Men's Health Crisis of New York, the National Minority AIDS Council, and the Trevor Project.
Representatives of the groups that signed the joint letter have pointed out that Facebook recently agreed to ban ads placed by organizations opposing vaccines on grounds that anti-vaccine messages were refuted by virtually all professional medical organizations and public health experts.
The AIDS and LGBTQ representatives are urging Facebook to ban the ads targeting PrEP on similar grounds that medical and scientific evidence refutes any claims that PrEP is harmful for those who take it as an HIV prevention medication.
"As a caregiver I want patients to realize that Truvada is absolutely safe for PrEP," said Dr. Sarah Henn, Chief Medical Officer at D.C's Whitman-Walker Health. "We want to make sure that patients who are at increased risk for HIV acquisition don't get scared away from prevention that could really be important to their long-term health," Henn told the Blade.
Staley said that after months of intransigence by Facebook over the LGBTQ and AIDS groups' requests for dropping the anti-PrEP ads, he was encouraged on Monday afternoon when he and a GLAAD official received an email message from Facebook. The message came after widespread media coverage of the release of the joint letter to Zuckerberg by the over 50 groups.
"You and your partners raise a number of important issues which we have shared with our leadership, and which will receive our full attention," Staley quoted the message as saying from Lindsay Elin, Facebook's director of external affairs.
"And they also say they look forward to continuing the conversation," Staley paraphrased the message as saying. "I think we got their attention."
Lou Chibbaro Jr. OF THE WASHINGTON BLADE, COURTESY OF THE NATIONAL LGBT MEDIA ASSOCIATION
Pasco Pride, advocates show support for LGBTQ youth
Survey finds majority of LGBTQ students in Latin America experience bullying
NIAID Director to Congress: Help us implement plan to end HIV
HIV groups urge states to investigate reduced coverage of AIDS drugs
Texas 'bathroom bill' fades as legislative session wraps up

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Home / Health and Physical Education final year complete project topics & materials / SUICIDAL IDEATION AMONG SECONDARY STUDENTS
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Category: Health and Physical Education final year complete project topics & materials. Tags: health education project, project topics for community health students, project topics for masters in health education, project topics on health education pdf, project topics with materials on physical and health education, research topics in health education, research topics in physical education, seminar topics in physical and health education.
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Background to the Study
Every society is dynamic and has its peculiar problems. However, when these problems, overwhelm the young ones who have no coping ability, they may start thinking of risky behaviour of suicide or attempt suicide. Suicide among teens and young adults is a complex and distressing problem (Tellioglu, 2006). To contemplate suicide at any age is awful. When it involves a teenager who has a life full of potentials ahead of him, it is almost too awful (Behning, 2006).
In recent years the rate of suicide among adolescents has risen to alarming proportions (Goldman, 1988). Worldwide, suicide is among the top five causes of mortality in the 15 to 19 years age group in many countries, suicide ranks first as a cause of death among both boys and girls in this age group (World Health Organization (WHO), 2000). In persons between the ages of 15-34years, it is the third leading cause of death (Vijayokumar, Nagaraji, & John, 2004). However, incidence and pattern of suicide varies from country to country depending on social, cultural, and religious values (Saeed, Bashir, Khan, Igbal, Rajo, & Rehman, 2002). It is considered a sin or immoral act in many religions and a crime to help someone commit suicide in some countries. On the other hand, some culture have view it as an honorable way to exit certain shameful or hopelessness situations (Columbia University Press, 2003).
Suicide is the act of taking one's life voluntarily and intentionally (Saeed, Bashir, Khan, Igbal, Rajo, and Rehman, 2002). Suicide is a self-execution, an act in which one deliberately and intentionally kills himself, is gradually seen as extreme and complex behaviour, involving all aspects of human experience, the biological, psychological, social, and environmental aspect of life (Moscicki, 1994). It is the act of deliberately taking one's life. Suicidal behaviour is any action with potentially life threatening consequences, such as taking a drug overdose (Taylor, 2003).
Suicide attempts or completed suicide have bearing in suicidal thoughts or ideas. When a person has ideas or thoughts about suicide, it is called suicide ideation. Ideation is the collective representation of thoughts and ideas, recalled from memory, or projected into the future, singly or combined (Segen, 2002). Ideation is also viewed as knowledge or understanding of something without being certain about it, belief or opinion, a purpose or reason for doing something (Procter, 1995). According to Wordnet (2007), ideation is the process of forming and relating ideas. When these ideas are related to suicide, it is termed suicide ideation.
A host of life events, personal and social variables must be involved when people have thoughts about suicide and when they actually make attempts. Such an extreme and unusual occurrence reflects the combined effect of these variables, which are difficult to study because of their complexity (Reich, Newsom, & Zautra, 1996). However suicidal ideation is maladaptive and realistic precursor in many cases of suicide attempt (Hawton, 1986).
Suicide ideation is the capacity for or the act of forming or entertaining ideas that are suicidal in nature (Wikipedia, 2007). According to National Centre for Health Statistics (2007), suicidal ideation is having thoughts of suicide or thinking of taking action to end one's life. Suicidal ideation includes all thoughts of suicides, both when thoughts include a plan to commit suicide and when they do not include a plan. This means that suicidal ideation will include the wish or the plan to commit suicide.
Suicidal ideation, given its specificity to cognitions, is consistent with a cognitive behavioral focus (Kendal & Hollon, 1981), and may be viewed as a domain of self-statements. It extends from vague wishes that do not exist (extremely mild ideation) to thoughts quite specific to the act of suicide such as thinking about how and when one will kill himself or herself.
Suicidal ideation is a common medical term for the mere thoughts about and of plans of committing suicide, not the actual following through or act itself. People who undergo suicide ideation do not commit suicide. The range of suicidal ideation varies greatly from fleeting, detailed planning, role-playing, and half-hearted attempt. Fleeting as applied to suicide ideation refers to someone having an idea about intention to commit suicide, but this idea soon fades away and starts again. Planning refers to the process of outlining the activities to be carried out in a purposive manner including the methods to be used in committing suicide. Role-playing is attempting or acting out the activities outlined under planning to explore the possibility of how it will work. Finally, half-hearted attempt is concerned with field testing or trying the plan of committing suicide but not with the actual intention to commit the action (suicide) (Wikipedia, 2007).
Suicide ideation can be active and this involves a current desire and plan to die. Suicidal ideation can be passive, involving a desire to die but without a plan to bring about one's death (Shields & Barton, 2005). Suicidal ideation is often the precursor of later and more serious, suicide related behaviour (Konick & Gutierrez, 2005). Wikipedia, (2007) indicated that, regardless of what percentage of people with suicidal ideation that commit suicide, it is still risk factor for suicide. Andrews and Lewinsohn, (1992), Dubow, Kausch, Blum, Reed, and Bush (1989), explained that many adolescent suicide attempters express high levels of suicide ideation, however, many suicide ideations never attempt suicide. Rohde, Seeley, and Mace (1997), further indicated more importantly that adolescents who make one suicide attempt have an elevated risk for future attempts and completed suicide.
Suicidal ideation, which includes thinking about the reasons for and ways of killing oneself, and suicide attempts are related to variety of life events in childhood and adolescence. For instance, confusion and frustration in coming to terms with gender identity, gender role, as well as sexual orientation may lead to a feeling of depression and suicidal ideation (Frisch & Frisch, 1998). This view is also supported by (Allan, Kashani, Dahlmeier, Taghizadeh, & Reid, 1997), that there appears to be a dramatic rise in suicidal behaviour as children make the critical transition from childhood to adolescence and young adult. Suicidal thoughts become abnormal in children and adolescents when the realization of those thoughts seems to be the only way out of their difficulties. There is then a serious risk of attempted suicide or suicide (WHO, 2000).
Many adolescents who are suicidal are also depressed or in a state of extreme demoralization as in the case with adults (Beck, Kovacs, & Weissman, 1975; Beck, Steer, Kovacs, & Garrison, 1985). Suicidal adolescents often feel an overwhelming sense of hopelessness (Garfinkel, Froese, & Hood, 1982; Robbins & Alessi, 1985). However, hopelessness appears to be experienced by many adolescents, not just those who think about or attempt suicide (Spirito, Slark, Fristad, Hart, & Owens-Stively, in press). Adolescents frequently find themselves under tremendous stress. Problems most often occur when stressors at home, school, and with peers occur within a context of minimal social and emotional support. These problems are further exacerbated when there is lack of coping strategies or when behavioral deficit or dysfunction exists.
For the purpose of this study, suicidal ideation refers to an individual who has thoughts to die, which involves the process of fantasizing, planning and motivation to commit suicide.
Research has shown that adolescents are at greatest risk when they are experiencing a major negative life event, having a lot of "hassles" and having little social support (Reynolds & Waltz, 1986). Other investigators have also noted the relationship between high life stress and suicidal ideation and behavior in young adults (Schotte &Clum, 1982) and adolescents (Smith & Crawford, 1986).
Apart from the home, school, and peers contributing to suicide behaviours, suicidal behaviour tends to differ on the basis of gender, age, and grade or class and location. Factors of gender have been suspected to be associated with suicide ideation, and Frisch & Frisch (1998), maintained that there are significant gender differences in rates of adolescents suicide, while more females admit having suicidal ideation and more attempts at suicide; more males actually succeed in completing suicide. These differences have been found to be related to gender feelings of loneliness and experiences of substance abuse in males than female adolescents.
Many adolescents including secondary school students are involved in chronic drug use, which leads to drug abuse and addiction. For example, marijuana is a drug commonly used in Nigeria since after the civil war. This substance has been linked with acute psycho toxic reactions, withdrawal symptoms like restlessness, anxiety, sweating, and hyperactivity. Adolescents who are found under these conditions may think of committing suicide. The high incidence of armed robbery, assassinations and other crimes are often as a result of drug abuse. When some of these adolescents commit some of these crimes, some of their accomplices are caught, those who escape may think of committing suicide while, others commit suicide. The society frowns at adolescents' misbehavior, rebellion, riots and other crimes. When they are napped in these vices, there is a tendency for them to think of taking their lives to escape from the shame.
Mohr (2003) stated that it is often hard for parents and teachers to detect the warning signs of suicidal behaviour. He documented the signs of suicide to include statements such as "I won't be around for you to yell at" or "you won't have to worry about me much longer" (p.673). Lack of emotional responsiveness, social withdrawal, inability to enjoy previously enjoyed activities, drug or alcohol abuse, threat making, and giving away of possessions and certain cheerfulness after being depressed, may not be common to adolescents but some may be present, for example, lack of emotional responsiveness, social withdrawal and drug misuse or abuse.
Attempted or completed suicide may to a large extent be preceded by suicidal ideation. These situations may not always be uncommon with adolescents as those in the present study. Situations which may give rise to suicidal thoughts in Nigeria abound. According to WHO (2007), lack of reliable information at local/regional/national levels significantly undermines the problem of suicidal ideation or attempted suicide. In the case of suicides, considerable under reporting and misclassification occurs in data gathering. Hospital information systems do not include suicides and these are often listed under "injuries and accidents" or occasionally under "mental health problems". Adolescents' suicidal ideation or behaviour is widely deemed to be under reported, because many deaths of this type are inaccurately classified as unintentional or accidental (WHO, 2000).
WHO (2000) indicated that in some countries there is an alarming increase in suicide among children aged less than 15, as well as in the 15-19 year age group. Therefore, the identification of adolescents' severity of suicide ideation serves as a variable proactive approach for the identification of youth at risk of suicide. This explains why this study is pertinent especially in Taraba State.
Investigations have continued to focus on suicidal ideation as an important aspect of suicidal behaviour in adolescents and young adults. Schotte and Clum (1982) noted the importance of research on suicidal ideation "especially since there is demonstrated relationship between the frequency of suicidal ideation and the likelihood of suicide attempting" (p.690). Furthermore, they asserted that "with adult attempters, suicidal ideation and depression explained the greatest proportion of the variance in adolescent suicide behaviour; the more serious the suicidal ideation, the more likely was the adolescent to have attempted suicide" (p.491).
In Taraba State, for instance, four cases of adult suicide were recorded in the last 4 years (Taraba State Police Command, 2007). No record of adolescent case of suicide was reported following investigation with the Federal Medical Centre (FMC) of the State, the State Police Command and the State Social Welfare Office. In addition, to the knowledge of the researcher, no study has been carried out to identify adolescents with suicidal ideation who may be at risk of suicide attempts or complete suicide, in Jalingo Local Government Area of Taraba State. This reason makes the study necessary.
Most families in Jalingo, Taraba state are observed to be large families, with high rate of unemployment, and with schools under equipped and under staff, and with HIV/AIDS affecting many families, which have resulted to several children, with attended family poverty, low parental and school monitoring of the children. Consequently, in the course of adolescent development, they are likely to encounter emotional disturbance, frustration, anxiety, depression and hopelessness. In this situation, the adolescents who are in the study area may get involved in antisocial vices like substance use, robbery, prostitution, and other antisocial crimes. These aforementioned personality problems will subject the adolescent student to suicidal ideation.
The study therefore is intended to find out whether suicidal ideation tendencies exist amongst secondary school students in Jalingo Local Government Area of Taraba State. The study will help in planning intervention and prevention programme for secondary school students identified with suicidal ideation. Certain factors such as parent's occupation, gender, location, religious affiliation, tribe, and class grade have been implicated to suicide behaviours including suicidal ideation. Nouins, Beals, Roberts, and Manson (1999), conducted a study on factors associated with suicidal ideation, the study however, showed that three tribes (South West, North Plains, and Pueblo Youths) of American Indians did not differ in terms of age and gender.
In the course of development, the adolescence is volatile and characterized by role change. Communication is problematic; they often feel very isolated (Behning, 2006). James (2005) had indicated that some 7-14 per cent adolescents will self-harm themselves at some time in their life and 20-45 per cent of older adolescents are reported having had suicidal thoughts at some time.
Adolescence is the period of psychological, social, and physical transition between childhood and adulthood. Adolescence is the stage of psychological breakthrough in a person's life when the cognitive development is rapid and the thoughts, ideas, and concepts developed at this period of life greatly influence the individual's life in future and play a major role in character formation. In the course of character formation, adolescents could develop problems such as emotional distress, frustration, anxiety, depression, and hopelessness. As Warren, Smith, and Tyler (1983), puts it, adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities. Such feelings can overwhelm young people thus leading them to think or consider possible solutions, including suicidal thoughts or suicide.
The groups under study are secondary school adolescents in Jalingo Local Government Area who are also undergoing developmental and social changes. In the course of these changes, any unsatisfactory change will cause some of them to experience such things as stress, confusion, and depression, which can predispose them into antisocial vices like drug abuse or addiction, prostitution, and crimes like robbery. Consequently, some of them may start thinking of suicide or even attempting suicide. This lends support to (Frisch & Frisch, 1998), who indicated that suicidal ideation, and suicide attempts are related to variety of life events in childhood and adolescence. For instance, confusion and frustration in coming to terms with gender identity, gender role, and sexual orientation may lead to feelings of depression and suicidal ideation. Those experiencing suicidal ideation or thoughts about fatally harming one's self, may struggle to be heard or understood and a person feeling suicidal may also wish to avoid being seen as making suicide threats. This may lead to a situation where a person attempts or commits suicide without telling friends or family members of how they felt (Columbia University Press, 2003). This situation may not be different among secondary school students in Jalingo Local Government Area of Taraba State.
Though, Taraba State has no official record or any research study identifying adolescents with suicidal ideation, this problem should not be ignored, because some of these adolescents may be faced with factors that precipitate suicidal ideation. What will then be the outcome of such adolescents, who will in the future be leaders of tomorrow? This study is therefore necessary to identify such school adolescents who may be experiencing suicidal ideation and thus provide a way of preventing these thoughts, and subsequently preventing suicide attempts (self-harm) or suicide among these young generation.
The purpose of the study is to determine the suicidal ideation among secondary school students in Jalingo Local Government Area (LGA) of Taraba State. Specifically, the study is find out the;
extent of students' intention or wish to commit suicide;
extent of students'' suicide plans;
extent of students' use of suicide as retribution to others;
extents of students' use of suicide as way of making others realize their worth;
extent of students' use of suicide because they think no one cared if he or she lived or died;
extent of students' use of suicide as a way of solving problems;
difference in the suicidal ideation among various classes; (SS1, SS2, SS3)
difference in the suicidal ideation of male and female students;
difference in the suicidal ideation of urban and rural students.
difference in suicidal ideation according to age.
difference in the suicidal ideation according to religious affiliation
relationship between students' life situation/ events and the various demographic
factors; and
relationship between the various dimensions of suicidal ideation and the various
demographic factors
What is the extent of students' intention or wish to commit suicide?
What is the extent of students' suicidal ideation plans?
What is the extent of students' use of suicide as retribution to others?
What is the extent of students' use of suicide as a way of making others realize their worth?
What is the students' extent of thought that no one cared if he or she lived or died?
What is the extent of students' use of suicide as a way of solving problem?
What is the difference in the extent of suicidal ideation among SS 1, SS 2, and SS 3?
What is the difference in the extent of suicidal ideation of male and female students?
What is the difference in the extent of suicidal ideation between urban and rural students?
What is the difference in the extent of suicidal ideation according to age?
What is the difference on the extent of suicidal ideation according to religious affiliation?
What is the relationship between life situation/ events and the various demographic factors?
What is the relationship between the various dimensions of suicidal ideation and the various demographic factors?
The following hypotheses were postulated and to be tested at .05 level of significance;
There is no significant difference in the extent of suicidal ideation of male and female students.
There is no significant difference in the extent of suicidal ideation of urban and rural students.
There is no significant difference in the extent of suicidal ideation among students in senior secondary one (SS1), senior secondary two (SS2), and senior secondary three (SS3).
There is no significant difference in the suicidal ideation of students according to religious affiliations.
There is no significant difference in the extent of suicidal ideation of students according to age.
The results of student's suicidal intention or wish to commit suicide will reveal students who may have the intention to commit suicide. The results of the study may be useful to health educators, counsellors, health administrators, school administrators, and parents in planning strategies/intervention programme for the students to curb their wishes. It will help counsellors and parents in guiding or advising the students on how to direct the energies of students in more rewarding activities instead of taking risk behaviors. The data that is generated on suicide plan by students will assist them to redirect students' activities into those ones that help them realize their fullest potentials in academic, social, and physical endeavours instead of thinking of negative ways of ending their lives.
The results of the study regarding the extent to which students plan to using suicide as a way of making others realize their worth will help health educators, school administrators, counsellors, and parents to advise students to know that there are other positive ways of making others realize their worth. Such means include excelling in academics, sports, music, and arts. Furthermore students will be made to realize that these are positive and better ways of making people realize their importance rather than thinking suicidal. Addition data generated from this study, will help the school personnel to mount activities aimed at enlightening the students that using suicide as a punishment to others is morally and religiously wrong and should be advised emphasizing that it is better to discuss matters over with school personnel and parents instead of contemplating taking life. Another finding that will be generated on the extent of students' thoughts that no one cared if they lived or died, will be useful and helpful to school personnel and parents to realize that they should pay particular attention to the students' interests and concerns about their life events, because ignoring or showing no interest on them would push them into actions capable of causing themselves self-harm which could turn out to cause shame to the school and family.
The finding that generated regarding the students use of suicide as a means of solving problems was to a very low extent. This finding will help health educators, school administrators, and parents to continue to satisfy student's physical, social, emotional needs and strive to ensure that the various environments and the climate under which they study and handle their problems is not only justified but adequate. This will positively reinforce and motivate them to adopt healthy lifestyles.
The study generated data on suicidal ideation of female and male students was very low extent. Counselors encourage students not to think of negative ways of living their lives. Seminars and workshops should be organized to give the students correct information on life events in order to encourage them to prevent these negative life events.
The results that were generated concerning suicidal ideation of rural and urban students showed that suicidal ideation of students was very low extent. The health educators and school administrators will be better armed to use this result to continue to encourage both urban and rural students to always take life events in a purposeful and constructive manner. The finding generated regarding suicidal ideation according to age will be useful to health educators and school administrators too. The health educators will be better armed to conduct discussions with the age bracket that demonstrate a higher extent of suicidal ideation in order to reduce the incidence and prevalence of suicidal ideation among students.
Scope of the Study
The study will be delimited to public and private secondary schools students in Jalingo Local Government Area of Taraba State. Suicidal ideation will include morbid ideas, suicide plans, suicide as retribution, suicide as a means of recognition, suicide thoughts that no one cares if one lived or dies and suicide as a way of solving problems. The study examined such variables as location, gender, and age o
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GLENDALE, Calif. - Avery Dennison Corporation (NYSE:AVY) today announced preliminary, unaudited results for its third quarter ended September 27, 2014. All non-GAAP financial measures referenced in this document are reconciled to GAAP in the attached tables. Unless otherwise indicated, the discussion of the company's results is focused on its continuing operations, and comparisons are to the same period in the prior year.
"Third quarter EPS was in line with our expectations, despite a modest decline in sales in Retail Branding and Information Solutions, and higher-than-expected transition costs associated with the consolidation of Pressure-sensitive Materials operations in Europe," said Dean A. Scarborough, Avery Dennison chairman, president and CEO.
For more details on the company's results, see the summary table accompanying this news release, as well as the supplemental presentation materials, "Third Quarter 2014 Financial Review and Analysis," posted on the company's website at www.investors.averydennison.com, and furnished to the SEC on Form 8-K.
All references to sales reflect comparisons on an organic basis, which exclude the estimated impact of currency translation, product line exits, acquisitions and divestitures, and, where applicable, the extra week in the fiscal year. Adjusted operating margin refers to income before interest expense and taxes, excluding restructuring costs and other items, as a percentage of sales.
PSM segment sales increased approximately 5 percent. Within the segment, Label and Packaging Materials sales increased mid-single digits. Combined sales for Graphics, Reflective, and Performance Tapes also increased mid-single digits.
Operating margin declined 10 basis points to 10.1 percent as the net impact of raw material input costs and pricing, transition costs in Europe, and country and product mix roughly offset the benefit of higher volume and productivity. Wage inflation was largely offset by lower incentive compensation. Adjusted operating margin declined 20 basis points.
RBIS segment sales were down approximately 2 percent, reflecting softer demand from U.S.-based apparel retailers and brands.
Operating margin improved 220 basis points to 5.4 percent as the benefit of productivity, lower restructuring costs, and lower incentive compensation more than offset the impact of wage inflation and lower volume. Adjusted operating margin improved 80 basis points.


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Exhaust too loud? We have this universal exhaust baffles that is easy way to take the bark out of your drag pipes without losing all the sound and power you wanted from them to start with. Simply drill a small hole in backside of your pipe out of view, and slip in and hold in place with a small bolt. This is a Level 2 installation. Please see below for more details and installation instructions.
Made Specifically for the Softail El Jefe exhaust.


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Q: Defining and including local tileLayer in Leaflet I have a problem with including path of the local tileLayer (generated in OpenStreetMap) in Leaflet.
Here is the code in which I define path to the map.png
var map = L.map('map', {
    zoom: 8,
    layers: L.tileLayer('/tiles/{z}/{x}/{y}.png')
});

Errors in my console:
GET http://192.168.1.1:3000/tiles/8/139/92.png 404 (Not Found)   92.png:1
GET http://192.168.1.1:3000/tiles/8/139/93.png 404 (Not Found)   93.png:1
GET http://192.168.1.1:3000/tiles/8/140/92.png 404 (Not Found)   92.png:1
GET http://192.168.1.1:3000/tiles/8/139/91.png 404 (Not Found)   91.png:1
GET http://192.168.1.1:3000/tiles/8/138/92.png 404 (Not Found)   92.png:1
GET http://192.168.1.1:3000/tiles/8/138/91.png 404 (Not Found)   91.png:1
GET http://192.168.1.1:3000/tiles/8/138/93.png 404 (Not Found)   93.png:1
.......

Do I need to rename map.png file?

A: If you have a single image to display, you would not use a Tile Layer, but an Image Overlay instead.

Used to load and display a single image over specific bounds of the map

Make sure you retrieve the bounds coordinates of the image you downloaded (on OSM website, open the "Export" tab; it should show the view port bounds coordinates).
For information, a "Tile Layer" is used when you have a map made up of different zoom levels (usually 1 folder per zoom level, referred to as {z}), and for each of these zoom levels, the map is split in thousands of "tiles" (small sub-images, usually square), usually arranged by their column number (1 folder per column, referred to as {x}) and which file name corresponds to their row number (referred to as {y}.png). Hence the usual URL template "/{z}/{x}/{y}.png".
On OSM map, do a right click and select "View image" to see an individual tile and its exact URL in the browser location bar.
For more explanations, please refer to Wikipedia and OSM wiki:

*

*https://en.wikipedia.org/wiki/Tiled_web_map

*http://wiki.openstreetmap.org/wiki/Tiles

redpajama_set_name: RedPajamaStackExchange


Click on the stars on the top of our website for the reviews we have received since we started asking our clients for their views via the independent review site, FEEFO. We ask for both reviews of our service and the villas.
Below are a handful of the superb comments we have received for our villas and service in 2017.
We pride ourselves on our service and attention to detail in selecting villas at a great quality for all party sizes and party tastes and are delighted with the 2017 reviews which we will add to year on year via client feedback.
We found a perfect house through Quality Villas, and the team were consistently kind and helpful. We were in very good hands! The property itself was absolutely stunning - the nicest house we've ever rented.
The customer service was excellent and prompt throughout, the information given was clear and concise, the villa was as described and the photos an accurate depiction.
A very comfortable and well equipped villa. Beautifully presented and located. The swimming pool was fantastic. We received excellent service from Quality Villas both through the booking procedure and from the local contact while we were on holiday.


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Canoe Kayak Canada
National Sport Organizations
Canoe Kayak Canada is the national body for competitive paddling in Canada. We are a volunteer lead and staff driven organization made up of a community of paddling enthusiasts – athletes, coaches, officials, volunteers, staff and supporters – from coast to coast.
Canoe Kayak Canada is a member-based organization which includes an intricate network of clubs as well as provincial and divisional paddling associations for the disciplines of sprint, whitewater and marathon. Elite National Teams proudly represent Canoe Kayak Canada at various competitions around the globe – most notably the Olympic Games, Pan American Games, ICF World Cups as well as Junior, Under 23 and Senior World Championships.
Canoe Kayak Canada is recognized by its partners at the International Canoe Federation, the Canadian Olympic Committee, the Canadian Paralympic Committee and Sport Canada as the designated authority for the sport in Canada.
Canoe Kayak Workshops Open in a new tabWebsite


Spiritual Bangalore > News > Ayurveda the Answer to Healthcare Challenges?
Ayurveda the Answer to Healthcare Challenges?
BANGALORE, INDIA, March 17, 2011: Taking healthcare to the masses will be India's biggest challenge in the next two decades, and the ancient medicinal system of ayurveda is the only reliable way of doing so, Sam Pitroda, adviser to the PM, said. 'We can't adopt the western model to deliver that to the masses,' he said at the inauguration of the Institute of Ayurveda and Integrative Medicine (I-AIM) on Thursday.
Tata Group chairman Ratan Tata inaugurated the 100-bed healthcare center that aims to integrate traditional medicine with modern health science. The center is wholly supported by Tata Trusts (Mumbai), the group's philanthropic arm.
Pitroda, who is also the co-founder and chairman of the Center's precursor Foundation for Revitalization of Local Health Traditions, said the integration of modern medicine and traditional health sciences was the best way to deal with challenges that lie ahead.


Where's the coffee table when you need one to place your drink!
Short on space but need a functional coffee table at the same time? The Tuc-Away Tables KTC2143-WH Kensington Edition Table is a great addition for any small apartments on the lookout for smart and functional furniture. Just Flip it up to use. Or Fold it down to open up floor space!
Pros: No Assembly Required. Great space saving feature for a coffee table. Does the job. Has 3 color options.
Cons: Set up is not intuitive, you'll need to take a look at the instructional video to have a easier time with it. Easy wear and tear. Not suitable for placing heavy objects.
Available in 3 colors: White, Grey and Black.


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Peter James: "Nobody with a drink problem is going to last 24 hours in the modern police force" (The Big Issue)
Interviews | Thomas Quinn | Jul 5, 2012
The crime novelist on overnight success, acting as a Sussex police researcher and solving puzzles
If you want to know how to write a bestselling crime novel, ask the expert. The author currently on top of the bloody heap in Britain, arguably, is Peter James. He bagged the number one slots in both hardback and paperback charts earlier this month with Not Dead Yet and Perfect People.
A keen amateur racing driver, scion of a Royal glove maker, former film producer and author of a series of "not very good" spy thrillers, Brighton-based James turned his writing fortunes around by inventing DI Roy Grace. He's now shifted 11 million copies and is, as James puts it, "an overnight success, 25 years in the making".
But DI Grace isn't necessarily what you might expect. Unlike many a fictional 'tec, he doesn't drink. Nor does he have a problem with authority. And as far as his love life goes, he's actually pretty sorted, thanks very much.
"I felt there was a stereotype," James said. "The reality is that nobody with a drink problem is going to last 24 hours in the modern police force. It just would not happen."
James' approach was to reflect current police methods and structures as honestly as possible. He feels it is this realism his readers respond to.
Early in his writing career a burglary at his house led to him meeting and becoming friends with a Sussex police detective. James soon knew several officers and detectives. Now he acts as a Sussex police researcher, representing the force at international homicide conferences.
"Those are great," he says. "You get to take part in three to five-hour workshops by homicide detectives. They show you all the details of major crimes. What homicide detectives do more than anything else is solve puzzles.
"Every major crime is a huge puzzle with hundreds, if not thousands, of pieces that need to be fitted together.
"But so many detective novels and crime series on TV fall apart because it is just not how it happens. Morse is a classic example. Two detectives solving a major homicide? It would be a team of 30 or 40 people. Often you see on television the scene of crime guys there in the white suits and then the senior detective comes in and tramples all over it in his brogues.
"The reality is that the first person at a crime scene is a uniformed policeman and his priority is to seal it off. He is entitled to not let anyone through, not even the chief constable. And if you get those kinds of details right the reader feels instinctively that they are in safe hands."
James also believes that you have to find some way to make the reader immediately like the hero and care about what happens to him.
"A friend of mine wrote the original questions for Who Wants to be a Millionaire," he recalls. "He used to say it wasn't a quiz show at all – but a drama. Because you had to care about the person in the chair and whether or not they won."
The last element James highlights is pace. The Grace novels, in common with books by the likes of Lee Child, Jeffery Deaver and James Patterson, rattle along like steam trains, the narrative packaged up into brief chapters finishing on cliff-hangers.
"Writing moves with the times. Two hundred years ago you could write long chapters and let people get slowly absorbed," he says.
"Now you have to grab people in a few lines. And if you think about it, most people read in bed, at night, tired. If they think, I'll read one more chapter, then see it's 43 pages, they'll say, 'Forget it'. But if it is only a couple of pages they'll read it – and then the next one, and the next."


After eluting the generator, the radioactivity concentration of the eluate should be measured using an isotope calibrator and recorded.
At this point it is also necessary to ensure that the radionuclide is of acceptable purity, again using the isotope calibrator. For more information on radionuclidic purity, please see the Quality Control Module.
Watch a video of this process from related videos.


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Seasonal Music Round-Up — Winter / Spring 2021
Apr 1, 2021·10 min read
For those who have been long-time followers of the blog, you may have been wondering where my monthly round-up articles have ran off to. Due to my aim to invest my time more thoughtfully this year, my answer to that comes in the form of my decision to create "seasonal" round-ups instead.
When I say "seasonal" in this case, it essentially means that I will be compiling a round-up for every quarter of 2021, with the first edition of these highlighting everything we've received so far this year, spanning from the very first day of January, to the final day of March.
This time of year is an important one for artists to establish either themselves or the newest of their great projects early on in the year, giving them much more of an advantage when it comes to building up sentimentality gradually over the course of the year. That being said, these picks of mine are special cases of ones to watch.
I will be compiling this round-up similarly to how I would've done for the monthly round-ups last year, with some minor adjustments, tweaks and conveniences along the way.
So with all of that out of the way, let's jump right into the round-up, starting with my first category; my favourite albums of the season.
Top 10 Favourite Records of the Season
[in no particular order]
R.A.P Ferreira & Scallops Hotel — Bob's Son
Released at the very start of the year, Rory Allen Phillip Ferreira brought two of his musical projects together into one piece. Successfully combining the more raw qualities of R.A.P Ferreira, with the trippy and artistic production that feels more synonymous with Scallops Hotel, Bob's Son stood out as a very unique project, even amongst the artist's numerous catalogues.
In The Pines — Slow Blink
Another album which arrived in the earliest part of the year, Slow Blink instantly gave off that warm and feel-good rock vibe; one that's only become more enjoyable with the warmer days of spring rolling in. This project is absolutely brimming with bright and upbeat energy, and with a jazzy twist to boost, Slow Blink makes for a pretty wicked project.
Madlib — Sound Ancestors
I remember going into Madlib's Sound Ancestors not really knowing what to expect, given that my only real exposure to the producer up to that point was his 2019 collaboration with Freddie Gibbs Bandana. But with the sheer versatility and technical skill that Sound Ancestors has to offer, this album ultimately became one that sticks out as a fantastic project.
Kid Kapichi — This Time Next Year
It was definitely fair to say that This Time Next Year was amongst one of my most anticipated releases of 2021, with Kid Kapichi releasing a generous helping of hard-hitting and highly engaging teaser tracks. The full album, upon its release, most certainly didn't disappoint. Giving listeners even more modern punk bangers to enjoy, it ended up being everything I'd hoped for.
slowthai — TYRON
Another highly anticipated 2021 project was of course the sophomore effort from slowthai. Following on from his phenomenal debut, TYRON offers a more introspective side to the artist, splitting this album into halves, with hard-hitters followed by more mellow tunes, it was easy to see that there was a lot of thought, effort, and passion that went into TYRON.
Tash Sultana — Terra Firma
Following her awesome 2018 album Flow State, Tash Sultana brings us yet another album whose amazingly colourful sound shines vibrantly through. There is so much life and passion that this album carries, that it felt way to easy for me to sink deeply in to its atmosphere. I imagine with the more hazy summer days on the way, Terra Firma will grow on me even more.
Architects — For Those That Wish To Exist
While For Those That Wish To Exist was another 2021 album I had highly anticipated, I still wasn't expecting it to stands as my favourite album the band had put out since Lost Forever // Lost Together, but it easily managed to stand as such a record. A rally cry for listeners who are desperate to find a better life for themselves in a world like this, this project's engagement is truly unreal.
Genesis Owusu — Smiling with No Teeth
The debut album from Genesis Owusu absolutely blew me away, for just how many different moods and atmospheres the artist managed to champion so effortlessly. The sense of ambition that Smiling with No Teeth holds is totally awe-inspiring. It's the kind of album that I could only dream of creating myself if I was an artist, as it is a true treat for the eclectic listener.
Black Honey — Written & Directed
The sophomore project from Brighton band Black Honey, I was utterly impressed with how far the aesthetic of the band has seemingly grow with this project. Not only do they stray further away from being your "typical indie band", but they do so in a way that feels greatly unique to them. On top of this, the bright and warm feel this album has me pumped for the summer.
serpentwithfeet — DEACON
The latest album to make it to my top 10, DEACON had no trouble at all when it came to giving me the sense that it was a special album. With its bright, heavenly, and very affectionate presence, this album feels like a guaranteed way to feel good through music. By injecting his signature artistry into a more accessible framework, serpentwithfeet creates a lasting appeal with DEACON.
Top 30 Tracks of the Season
Bakar — Having a Good Time, Sometimes
Bakar has a brilliant knack for creating wholesome-feeling tracks, and what better way to start the year off, than with this atmospheric and uplifting tune?
R.A.P Ferreira & Scallops Hotel — yamships, flaxseed
One of Bob's Son's finest examples of Rory Ferreira's talent when it comes to switching things up, and creating a real artistic sense.
Gary Numan — Intruder
Bewitchingly dark and foreboding, and incredibly engaging too, "Intruder" had my hope skyrocketing in regards to Gary Numan's upcoming album.
Years & Years — It's A Sin
After this track ultimately persuaded me to watch the Channel 4 series of the same name, this minimal rendition of it's theme song felt truly connective.
Arlo Parks — Portra 400
It felt apparent from her new album, and especially this track, that Arlo Parks was highly talented when it comes to creating sentimentality through music.
Brent Faiyaz, DJ Dahi & Tyler, The Creator — Gravity
A colourful and surreal musical experience with a highly catchy edge, I loved how Brent Faiyaz was introduced to me through this awesome tune.
Madlib — Road Of The Lonely Ones
"Road Of The Lonely Ones" was where I felt the strongest sense of effective sampling and minimalism on Madlib's Sound Ancestors project.
Kid Kapichi — Don't Kiss Me (I'm Infected)
Ultimately becoming one of my favourite tunes that arrived with the full album, this track is gritty, and insanely engaging.
Foo Fighters — Making A Fire
I have to admit, Foo Fighters really managed to add a unique twist to their beloved energy on "Making A Fire"
Zella Day & Weyes Blood — Holocene
Incredibly beautiful, serene, and warm, Zella Day and Weyes Blood come together beautifully on this track.
Black Country , New Road — Track X
I absolutely loved just how well this track flowed, and how it really showed off the chemistry behind Black Country, New Road.
Rebecca Black, 30H!3, Big Freedia & Dorian Electra — Friday (Remix)
Almost a full decade after the original song's release, and I was clearly able to see how far Rebecca Black has come independently.
slowthai — focus
The beauty of this track is truly in its subtlety, and "focus" ultimately became my favourite track within a very strong album.
JPEGMAFIA — PANIC ROOM!
While EP2! wasn't as beloved by me as its predecessor, "PANIC ROOM!" still stood as a track that brought that unique JPEGMAFIA energy.
Alfie Templeman — Everybody's Gonna Love Somebody
Alfie Templeman takes one giant step forward in developing his style, as shown by this warm and vibrant summer-made anthem.
Bob Vylan — CSGB
The closing track to Bob Vylan's incredibly hard-hitting and unapologetic new EP, "CSGB" is awesomely gritty and menacing in tone.
Architects & Winston McCall — Impermanence
To see Architects come together with Parkway Drive's Winston McCall was a real treat to behold, and I'm glad this awesome song did them both justice.
Greentea Peng — Nah It Ain't The Same
Even as far as Greentea Peng's tracks go, "Nah It Ain't The Same" is brilliantly warm and hazy in its atmosphere, and carries an engaging premise.
JID — Skegee
It was hard to pick amongst the four incredible tunes that JID released in February, but 'Skegee', with its historical reference, spoke to me the most.
Freddie Gibbs — Winter In America
An awesome cover of Gil Scott-Heron's 'Winter In America, that was recontextualised to keep awareness raised for Black Lives today.
Genesis Owusu — Bye Bye
Out of all of the track I could've chosen off of Genesis Owusu's amazing debut album, I feel that the impactful closer feels most apt.
Gengahr — Under the Skin
Gengahr inject their captivating indie sound into something that feels phenomenally layered, and even epic to an extent, with this new track.
KSI, YUNGBLUD & Polo G — Patience
KSI really threw a creative curveball towards fans with his latest single, which defies my expectations in all of the best ways.
Nubiyan Twist — Keeper
I felt that from Nubiyan Twist's latest record, Freedom Fables, it was "Keeper" that truly felt like the fullest and most passionate musical experience.
IDK — Just Like Martin
Much like IDK's 2020 single "King Alfred", this new track does another brilliant job of showing the artist's unwavering attitude.
Black Honey — Fire
When it came to my opinion that Black Honey's sophomore album really captures that warm spring vibe, it was "Fire" that was at the front of my mind.
serpentwithfeet — Hyacinth
A beautifully radiant and highly soothing start to the amazing new album by serpentwithfeet. "Hyacinth" really set the stage for the rest of the album.
BROCKHAMPTON & Danny Brown — BUZZCUT
Awesomely psychedelic, well-crafted, and frankly like nothing the BROCKHAMPTON group have ever done before.
Gojira — Amazonia
A brilliantly awe-inspiring hard-hitter that carried a powerful environmental message, "Amazonia" has me highly excited for Gojira's next album.
Lil Nas X —MONTERO (Call Me By Your Name)
It was easy to see how more refined the sound of this new track is compared with Lil Nas X's 2019 EP, but it still remains as adventurous as ever.
Listen to the full playlist of all of my favourite tracks of January, February, and March below.
My Favourite EP of the Season
Bob Vylan — We Live Here
How could it honestly not have been this EP? Not only does We Live Here carry such a hard-hitting and fiery energy throughout, but it does an incredible job of addressing racism in the UK, from the perspective of the artist themselves. Not to mention, it's great to see one of my favourite tracks of last year become the title track for its very own EP. You need to give this one a listen!
Music Video of the Season
Lil Nas X — MONTERO (Call Me By Your Name)
It's still hard for me to believe that we exist in a reality where we get to see Lil Nas X pole-dancing to hell to give the devil himself a lap-dance; we are honestly not worthy! But what really made this music video so great was how it intentionally rocked the homophobic boat, attracting negative criticism from insecure straight people, just as Lil Nas X had planned all along.
Album Cover of the Season
I'm glad that Architects have been breaking further away from re-hashing the letter A with each recent release, and the cover art for their newest venture is easily the most eye-catching in my opinion. Seeing a person in a space suit standing inside a church is uncanny enough, but the use of light and the subtle symbolism is also ingenious.
And that conclude the first of four seasonal round-ups, as well as the first quarter of 2021. Keep your eyes peeled for the next round-up, arriving at the end of June.
Craftsmanship: My three favorite rap songs of all time.
Daniel Goodwin
Album Review: SZA — 'Ctrl'
William Widnell
but you will have to modify the context by adding =I'll do=
Hamadouche Yani
Be The Artist You Have Become
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grandson — Death Of An Optimist — Album Review
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The 16 Year Old Who Changed the Music Industry Forever
Baqsam Behbehani in History of Yesterday
An Exploration of Evermore by Taylor Swift
Eliza Wright in ILLUMINATION


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