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Adherence to oral hypoglycemic drugs among type 2 diabetic patients in a resource-poor setting
Israel Abebrese Sefah1, Archibald Okotah2, Daniel Kwame Afriyie3, Seth Kwabena Amponsah4
1 Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
2 Department of Pharmacy, Ho Municipal Hospital, Ghana Health Service, Ho, Accra, Ghana
3 Department of Pharmacy, Ghana Police Hospital, Accra, Ghana
4 Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Accra, Ghana
Date of Decision 02-Oct-2019
Israel Abebrese Sefah
Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta
DOI: 10.4103/ijabmr.IJABMR_270_19
Objective: Diabetes mellitus is a growing public health problem in many countries including Ghana. Adherence to drugs, especially among patients with type 2 diabetes mellitus (T2DM) is often poor is some resource-poor settings. The objective of this study was to assess adherence to oral hypoglycemic drugs and factors that affect adherence among patients with T2DM in the Volta Region of Ghana. Methods: The study was cross-sectional and conducted among 400 patients with T2DM attending diabetic clinics at 4 randomly selected hospitals in the Volta Region of Ghana between January 10 and March 30, 2015. Patients were interviewed using a structured questionnaire and other data collection tools to determine the commonest self-reported reason(s) for nonadherence. Adherence was assessed using the 8-item Morisky Medication Adherence Scale. Multivariate analysis was performed between adherence and statistically significant patient variables. Results: Adherence to oral hypoglycemic drugs among T2DM patients was 47.75%. The odds of adherence with fasting blood glucose between 1 and 6 mmol/L was approximately two-fold (adjusted odd ratio [aOR] =1.92, confidence interval [CI]: 1.11–3.32) versus the odds of having fasting blood glucose of above 10 mmol/L. The odds of adherence among patients with tertiary education was approximately three-fold (aOR = 3.01 CI: 1.44–6.269) versus patients with no formal education. The commonest self-reported reason for nonadherence was forgetfulness. Conclusion: Adherence to oral hypoglycemic drugs among T2DM patients in the current study was sub-optimal. Therefore, in such settings, management of T2DM must include strategies to identify nonadherent patients, and regular patient education and counseling.
Keywords: Adherence, oral hypoglycemic drugs, resource-poor setting, type 2 diabetes mellitus
Sefah IA, Okotah A, Afriyie DK, Amponsah SK. Adherence to oral hypoglycemic drugs among type 2 diabetic patients in a resource-poor setting. Int J App Basic Med Res 2020;10:102-9
Sefah IA, Okotah A, Afriyie DK, Amponsah SK. Adherence to oral hypoglycemic drugs among type 2 diabetic patients in a resource-poor setting. Int J App Basic Med Res [serial online] 2020 [cited 2021 Jan 21];10:102-9. Available from: https://www.ijabmr.org/text.asp?2020/10/2/102/281836
Diabetes mellitus (DM) is a metabolic disorder characterized by impaired insulin-mediated glucose disposal as a result of absence of insulin, or the inability of the human body to respond to insulin.[1] DM is ranked as the seventh leading cause of death worldwide.[2],[3] DM, if left untreated or poorly controlled, is a major cause of morbidity and mortality. This is mostly due to macrovascular and microvascular complications associated with the disease.[4],[5] DM is also known to adversely affect the quality of life of patients.[6],[7] DM is a growing problem in sub-Saharan Africa, as there has been an appreciable change in diet and lifestyle of indigenes, Ghana inclusive.[8],[9],[10] In Ghana, the prevalence of DM according to International Diabetes Federation data as of 2013 was 3.35%.[11] Furthermore, the prevalence of especially type 2 diabetes mellitus (T2DM) in African countries appears to be on the rise.[12]
Management of DM includes pharmacotherapy. Some of the pharmacotherapeutic approaches include the use of oral hypoglycemic (antidiabetic) drugs, exogenous insulins, and lipid lowering drugs.[13] A major challenge to the management of DM is nonadherence to therapy. This is highly prevalent in patients with T2DM, and has been linked with an increase in morbidity, mortality, and healthcare costs.[14],[15],[16] On the average, 50% of new medication users will fail to adhere to at least 80% of prescribed drugs during the first year of therapy.[17],[18] A systematic review of drugs for DM found that patients adherence ranged between 36% and 93%,[14] with some being as low as 23%.[19] Overall, the World Health Organization (WHO) estimates adherence among patients suffering from chronic diseases to be around 50% in developed countries, and much lower in developing or resource-poor countries.[20] Studies have also shown that, there is an association between poor adherence to medications indicated for chronic diseases and health resource utilization.[21]
There have been several studies which have explored adherence to oral hypoglycemic medications among diabetic patients with varying results. Some factors found to be associated with nonadherence to oral hypoglycemic medication include financial difficulties, forgetfulness, level of education of patients, existing diabetes complications, among others.[16],[17],[19] One major impact of nonadherence to antidiabetic medications is increased costs to families especially in most African countries where healthcare costs are borne by patients.[16] In Ghana, there is paucity of data on adherence to diabetic treatment especially in rural areas where the population is generally poor, and with less access to health care. Furthermore, most of adherence to oral hypoglycemic drugs among T2DM patients have been carried out in developed countries, leaving a gap in knowledge about the prevalence and factors that may be associated with adherence to diabetes treatment in resource-poor settings.
This study, therefore, sought to evaluate adherence to oral hypoglycemic agents among T2DM patients in the Volta Region of Ghana, and possible impact on glycemic control. Data from this study would inform policymakers, health managers, and health workers: with a future need of designing interventions that will improve patient adherence.
Study design and setting
This was a cross-sectional study among T2DM patients who reported to 4 district/municipal hospitals in the Volta Region of Ghana between January 10, 2015, and March 30, 2015. The study was conducted in Government Hospitals which operated diabetic clinics. The 4 hospitals were Ho Municipal Hospital and Hohoe Municipal Hospital (representing Northern Volta), and Keta Municipal Hospital and Ketu South District Hospital (representing Southern Volta).
Volta Region of Ghana (as it was called before the creation of new regions in Ghana in February 2019), could be divided into two geographical sectors: Northern and Southern Volta. Volta Region was one of Ghana's ten administrative regions. The region's capital was Ho and had an estimated regional area of 20,570 km2. The population of the Region as of the year 2000 was 1,635,421. In the 2010 population census, a population of 2,118,252 was reported, and this represented 8.6% of the total population of Ghana.
Sampling and sample size calculation
Prevalence of nonadherence to oral anti-diabetic therapy among adults was estimated as 40% based on a similar study conducted in ambulatory patients with T2DM in a healthcare setting in Southwestern Nigeria.[22] The level of significance and margin of error were set as 0.05% and 5% respectively. This gave a minimum sample size of 368. The sample size was increased to 400 to account for 10% nonrespondents.
T2DM patients were included in this study if they were aged 18 years and above after initially giving informed consent. Patients were randomly sampled from Ho Municipal Hospital (n = 200), Keta Municipal Hospital (n = 100), Hohoe Municipal Hospital (n = 50) and Ketu South Municipal Hospital (n = 50). Differences in sample size per hospital were based on respective average total attendance per month per hospital. Patients who did not consent to be part of the study were excluded.
Questionnaires were administered by trained pharmacists and pharmacist technicians in all the 4 study centers. Data collected included social demographics, adherence to oral hypoglycemic agents and clinical parameters (obtained from hospital records). Clinical parameters included comorbidity (whether patients had hypertension, etc.) or complications of T2DM (e.g., neuropathy). The questionnaire used, the 8-item Morisky Medication Adherence Scale (MMAS-8) consisted of 7 dichotomous questions and a 5-point Likert scale questions. Questionnaires were pretested among 10 T2DM patients (at Ho Municipal Hospital).
To ensure privacy, respondents were individually interviewed in counseling rooms at all 4 study sites. Patients were also assured of confidentiality before interview process.
Data generated from the questionnaires were analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, Illinois, USA) version 21 software. Descriptive statistical analysis was used for demographic data. For level of adherence, patients were classified as adherent if the MMAS-8 score obtained was between 6 and 8, and nonadherent if the MMAS-8 score obtained was <6.[23]
Cross-tabulation was subsequently performed to assess relationship between socio-demographic characteristics, as well as clinical characteristics and adherence score of patients. A multivariate analysis was subsequently done to predict adherence in statistically significant independent variables obtained after cross-tabulation. This was done by determining odd ratios at a 95% confidence interval (CI).
The study was approved by Administrations of selected government hospitals under the Ghana Health Service. Written informed consent was obtained from all study participants. Data were kept securely locked at all times and was only accessible to researchers.
Sociodemographic characteristics of patients
Of the 400 patients interviewed, about two-third were females and about 50% middle-aged (41–60 years). More than half of the respondents were married, and most had some form of formal education (with approximately one-third having had a middle school/junior high school education). The majority of interviewed patients were employed: with about 50% being self-employed and about 25% being unemployed. A summary of demographic data of respondents is shown in [Table 1]a. Almost all of the patients (99.3%) were National Health Insurance Scheme holders. About 80% of the patients had no social history of taking neither alcohol nor smoking. Other sociodemographic information are shown in [Table 1]b.
Clinical characteristics of patients
Clinical data showed that about 40% of T2DM patients were on oral hypoglycemic agents for about 3–6. Only about 12% of the patients had been on oral hypoglycemic agents for more than 10 years. Hypertension was the commonest (63.7%) co-morbid condition among patients, whilst the presence of diabetic neuropathy (4.5%) resulted in an increase in the total number of oral drugs to be taken by patients. About seven out of ten patients had their medications prescribed for just 1 month duration after hospital visit. In addition, about half of the patients (n = 209; 52.3%) recorded a MMAS-8 score of <6 and hence were classified as nonadherent to their treatment regimen. A summary of clinical characteristics of respondents is shown in [Table 2]a. Additional clinical characteristics of respondents is shown in [Table 2]b. Furthermore, fasting blood glucose level of patients on day of interview is also shown in [Table 3].
Table 3: Fasting blood glucose level of respondents taken on day of interviews (n=400)
The commonest self-reported reason for nonadherence was forgetfulness (30.87%), followed by a combination of forgetfulness and the side effects of the medication. A summary of reasons for nonadherence is shown in [Figure 1].
Figure 1: Self-reported reasons for nonadherence to oral hypoglycemic agents among respondents (n = 400)
Multivariate analysis between adherence and selected characteristics of respondents
Cross-tabulation of independent variables against adherence gave statistically significant association (P < 0.05) with a number of variables. The variables were: number of years patients had been on their oral hypoglycemic medicines, alcohol/smoking social history status, educational status, fasting blood glucose on the day of interview, and the number of oral hypoglycemic drugs prescribed.
However, multivariate logistic regression controlling for all variables as possible confounders found that alcohol, smoking, and number of years patients were on their oral hypoglycemic agents did not retain their statistical significance [Table 4]. The variables that retained their significance after the multivariate analysis were the fasting blood glucose level recorded on the day of interview, educational status and the number of oral hypoglycemic agents prescribed but unavailable (out of stock) at the pharmacy. The multivariate analysis also revealed that, the odds of adherence was approximately 2-fold in respondents with fasting blood glucose of between 1 and 6 mmol/L as compared to those with fasting blood glucose >10 mmol/L (adjusted odd ratio [aOR] =1.92, CI: 1.11–3.319). The aOR obtained was also statistically significant with P < 0.05 and a narrow CI.
Table 4: Predictors of adherence to oral hypoglycemic agents from logistic regression modela
Furthermore, patients who did not receive all their prescribed medication at their facility had relatively higher odds of adherence [Table 4]. Patients who had at least one drug prescribed but not dispensed had approximately two-fold odds of adherence (odd ratio = 1.99, CI: 1.19–3.33).
The multivariate analysis also showed that educational status had statistically significant association with adherence. From the bivariate analysis, respondents who had middle school/junior high education had approximately two-fold odds of increased adherence compared to those with no formal education, but the ratio reduced after adjusting for confounders. The odds of adherence among tertiary education respondents was approximately three-fold (aOR = 2.888, CI: 1.394–5.982) compared to those with no formal education, and this value was similar to the crude odds ratio indicating the absence of confounding effect.
In this study, we assessed adherence and factors that affect adherence among T2DM patients on oral hypoglycemic agents in the Volta Region of Ghana. Our data showed that adherence to oral hypoglycemic agents among our study population was 47.7%. This percentage is similar to overall adherence rates reported by the WHO for patients with chronic conditions.[20] Adherence to oral hypoglycemic agents in the current study was similar to a 6-month cross-sectional study conducted among 7 primary clinics in Malaysia.[24] However, our finding was marginally lower than the 51.3% observed in a similar study conducted in Ethiopia,[25] but higher than a 40.1% reported in Nigeria.[26] The differences observed could be due to differences in study settings and adherence scales used. It is noteworthy that, self-reported measurement of adherence has the tendency of overestimating adherence. Since interviews were conducted in a healthcare facility, patients may tend to report higher levels of adherence in order to please healthcare provider or to avoid criticism.
In the current study, variables that retained their significance after the multivariate analysis were educational status, fasting blood glucose level recorded on the day of interview and the number of oral hypoglycemic agents prescribed but not dispensed at the pharmacy of visited clinic. Generally, level of adherence to drugs is known to increase with increasing level of education.[24],[25],[26] An important barrier to adherence is the inability of a patient to understand instructions for taking medication. Patients' beliefs are also known to be a strong predictor of adherence. Whilst we did not investigate this in our study, we believe that education has the tendency to positively influence ones beliefs.
In the current study, adherence was higher in patients with fasting blood glucose level between 1 and 6 mmol/L. This is similar to findings from a systematic review which concluded that better adherence to oral hypoglycemic agents tended to be associated with improved glycemic control.[27] Data from the current study showed that only 30% of the respondents had adequate glycemic control (1–6 mmol/L). It is noteworthy that lack of appropriate therapy may be one of the reasons patients fail to reach recommended therapeutic targets, hence, the need for continuous patient follow-up and drug regimen modification, if need be.
Data from current study showed that forgetfulness was the highest self-reported reason for nonadherence to oral hypoglycemic agents. The second highest self-reported reason for non-adherence was a combination of forgetfulness and side-effects of medication. This is consistent with findings in other studies that reported forgetfulness as the main reason for nonadherence to therapy.[28] Whilst lack of oral hypoglycemic agents in stock was reported as a key barrier for adherence to oral hypoglycemic agents,[28] our study showed that patients who had one or two undispensed medication(s) due to unavailability were more adherent than those who received all their medications. Our study, however, did not probe to find out whether these patients obtained drugs elsewhere.
Forgetfulness has been identified as one of the major contributors to nonadherence to antidiabetic medication.[28],[29] To address this short-fall, there is need for regular follow-up visits, counseling sessions involving a family member, and even patient group campaigns. Healthcare workers home visits are likely to significantly improve adherence to antidiabetic medication, improve glycemic control and overall health outcomes. Furthermore, mobile technology for sending reminders have demonstrated improved medication adherence among people with HIV.[30]
We acknowledge that a limitation of our study is the use of self-reported data which has the tendency to overestimate adherence due to recall challenges and patient bias. However, research has suggested that validated self-report questionnaires provide a reasonably accurate estimate of adherence.[23] We are also aware that a preferred indicator for glycemic control is the glycated hemoglobin. However, our study used fasting blood glucose, which is an equally good indicator of glycemic control. In addition, our study sites were diabetic clinics which were government facilities providing free service and medication to National Health Insurance holders, conditions which may not exist in some resource-poor settings. Nevertheless, we believe our findings are relevant and reflect what pertains in a number of resource-poor settings.
Adherence to oral hypoglycemic drugs among respondents with T2DM was found to be 47.75%. The commonest self-reported reason for nonadherence was forgetfulness. Adherence to treatment regimen was significantly associated with fasting blood glucose level, educational status, and availability of prescribed medication at health facility. Therefore, in such settings, management of T2DM must include strategies to identify nonadherent patients, and regular patient education and counseling.
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Tancredi M, Rosengren A, Svensson AM, Kosiborod M, Pivodic A, Gudbjörnsdottir S, et al. Excess Mortality among Persons with Type 2 Diabetes. N Engl J Med 2015;373:1720-32.
Bertoluci MC, Rocha VZ. Cardiovascular risk assessment in patients with diabetes. Diabetol Metab Syndr 2017;9:25.
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Rwegerera GM, Moshomo T, Gaenamong M, Oyewo TA, Gollakota S, Rivera YP, et al. Health-related quality of life and associated factors among patients with diabetes mellitus in Botswana. Alex J Med 2018;54:111-8.
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Rwegerera GM, Moshomo T, Gaenamong M, Oyewo TA, Gollakota S, Mhimbira FA, et al. Antidiabetic medication adherence and associated factors among patients in botswana; implications for the future. Alex J Med 2018;54:103-9.
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Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care 2004;27:1218-24.
Cramer JA, Benedict A, Muszbek N, Keskinaslan A, Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: A review. Int J Clin Pract 2008;62:76-87.
Rwegerera GM. Adherence to anti-diabetic drugs among patients with type 2 diabetes mellitus at Muhimbili National Hospital, Dar es Salaam, Tanzania – A cross-sectional study. Pan Afr Med J 2014;17:252.
Grégoire JP, Sirois C, Blanc G, Poirier P, Moisan J. Persistence patterns with oral antidiabetes drug treatment in newly treated patients – A population-based study. Value Health 2010;13:820-8.
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487-97.
Kalyango JN, Owino E, Nambuya AP. Non-adherence to diabetes treatment at Mulago Hospital in Uganda: Prevalence and associated factors. Afr Health Sci 2008;8:67-73.
World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. 20 Avenue Appia, 1211 Geneva 27, Switzerland: World Health Organization; 2003.
Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care 2005;43:521-30.
Adisa R, Fakeye TO, Fasanmade A. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in southwestern Nigeria. Pharm Pract (Granada) 2011;9:72-81.
Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008;10:348-54.
Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer Adherence 2013;7:525-30.
Wabe NT, Angamo MT, Hussein S. Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. N Am J Med Sci 2011;3:418-23.
Yusuff KB, Obe O, Joseph BY. Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria. Pharm World Sci 2008;30:876-83.
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[Table 1], [Table 2], [Table 3], [Table 4]
resource-poor setting
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redpajama_set_name: RedPajamaCommonCrawl


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Report for the Scottish Poverty and Inequality Commission
30 July 2019 by George Bangham and Lindsay Judge
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22 June 2018 by Conor D'Arcy and Torsten Bell
The wealth of Scottish households has grown rapidly in recent years and now exceeds £1 trillion for the first time. But from a living standards perspective, what matters is how that wealth – including property, pensions and savings – is shared. The report explores some of the key inequalities when it comes to wealth in … Continued
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CLASSY MARDI GRAS WEDDING IDEAS - YES IT CAN BE DONE!.
Mardi Gras is one of the most unique celebrations that there is, so if getting married during the Mardi Gras season, it's a great, fun and colourful theme to incorporate in your wedding day. Mardi Gras is extremely popular and celebrated across America from 6th Jan through to Fat Tuesday, which of course changes every year. People love to use this theme for birthdays, dinner parties, and now, increasingly Mardi Gras weddings too. Putting on a classy wedding day with the Mardi Gras theme can be tough though. Mardi Gras parties can be full of cheap feathers and glitter - in fact for Carnival it's usually all about hundreds of cheap feathers, glitter, and zillions of beads. You might (probably infact!) find that really scary for your special day! Add them in gentle proportions though - touches, not swarms, and you can still keep your big day classy.
Pantone Colour of the Year - Ultra Violet. That's Mardi Gras Purple isn't it?
Mardi Gras is exactly the time to embrace Pantones Colour of the Year 2018 - Ultra Violet. Historically, ultra violet has been associated with the spiritual and mystical (think amethyst crystals).
Themed weddings are a great way to inject personality into your wedding day, and for February I truly believe Mardi Gras is a brilliant idea, but even more so than other themes it's vital not to get carried away, turning your wedding day into the carnival parade. You could go find a purple wedding dress - but please don't! Find yourself your dream White or Ivory bridal gown that you would for a non themed wedding day, and stick to Mardi Gras for the decorations, menu, bridesmaids and/or flower girls to successfully blend the Mardi Gras theme with the elegance of a more traditional wedding.
As the bride you could simply add the Purple, Gold or Green into your Bridal Sash, Bouquet, Headpiece, Shoes or Wrist Corsage. For the male members of the wedding party, of course those colors can be incorporated in the cravats, cumber-bands and lapel pins.
Below are some suggestions of where you can inject the Mardi Gras theme. Please don't use them all though. Just select some of them. It's intended as a list of lot's of possibilities, not a shopping list to give your wedding planner. Select a few and you will have a fun filled, bright February wedding, on theme but not over the top. Be sure to do some of the cocktails though.
Flower Girls Dresses - Little girls love dressing up.
Little Girls love dressing up, so the flower girls you can have a little fun with. They'll love you for giving them a Tutu dress to dance around in, and will even be very accepting of oodles of glitter, sequins, and puffy tulle - which perhaps the bridesmaids would not!.
The Flower Girls Dresses below are all available on Etsy, Amazon or other International Online Stores. Click each to go straight to their listings.
For a few years now brides have been opting for the bridal flower crown over traditional veils. I'm not going to recommend for the Bride of a Mardi Gras wedding, but do think you can consider for the Bridesmaids and Flower Girls.
On Etsy, Amazon or Ebay you will find one at every price point depending on quality, fabric and complexity – there's plenty to choose from. Here are a few I've found in the punchy Mardi Gras colors but still subtle, delicate, and affordable price points.
There's no denying that any deep jewel-toned dress looks stunning at a winter or spring wedding. Bridesmaids infinity dresses are super versatile dresses that you can wrap in several (appox 15) different ways. A great option as your Bridesmaids can keep to wear a different way on several later occasions and events.
The Ultra Violet Purple looks stunning on most people, but for contrast you could dress your bridesmaids in a different colour of Mardi Gras each in keeping with the Mardi Gras theme.
If you've chosen Flower Girls dresses in Sequins and Tulle, then of course beautiful gold sequin or beaded dresses would also be perfect for the Bridesmaids of a Mardi Gras Weddings. The Bridesmaids might not want their dresses with quite as much puffy tulle in the skirts - stick with full length beaded or sequin gowns for the bridesmaids.
Don't close down the page yet. When I say Mardi Gras feather accessories, I'm still thinking pretty. Do I suggest you wear the mini top hats with chunks of ostrich feathers fanning out the top and smothered in Craft store glitter? Of course not. Sure they may work for the carnival parade, but this is still your wedding day.
There are still feather accessories that feature the correct colors but with more "sweetness" than the traditional masks and headdresses worn at the carnival. Hair Clips, Fascinators, Bridal Sashes and Shoe Clips are all pretty bridal accessories that can be found in the Mardi Gras colors. Below are some of the best you'll find that won't make your Bridesmaids and Flower Girls feel like showgirls.
A couple of final (but very important - THE BAR!) ideas for you.
If you're throwing a party for Mardi Gras then it's a given that the bar needs be full of Cocktails fitting to the bars of Bourbon Street, but not served in massive plastic tumblers. I'm no foodie or Cocktail expert (you wouldn't want to serve your guests drinks I'd thought up!), so I won't try giving you some of my recipes, but don't forget to have these covered.
So Mardi Gras is about Tossing Beads remember, but the "beads" your toss on your wedding day can be in / on your Bridal Bouquet. This one found on Etsy (click image to view) is made with Jewel Brooches, plus the flowers, and then dripping with beads a little nicer than the faux pearls strings you buy from the fancy dress or dollar stores.
If you're having a Wedding during Mardi Gras, then surely you need to represent it on the cake. I wouldn't want to totally ruin my cake with Jester Hats and Multi Colour Paper Venetian Masks mind, but a Gold Crown on the top would sit well. Click Image above (or here) to find this cheap but effective Cake Topper for Mardi Gras cakes.
Street Lights from Bourbon Street. If you can't get a venue in the French Quarter for your Mardi Gras wedding, (venues might be a little expensive down there at this time of year), then bring Bourbon Street to you. These Bourbon Street Light Place Card Holders are a really sweet nod to the historic place, famous for Mardi Gras and full of old-world charm.
It's A Jungle Out There...Animal Prints.


ADESA Chicago. Photo courtesy of ADESA.
After a $40 million investment from parent company KAR Auction Services, ADESA is officially opening its Chicago auction.
Among the amenities at the new auction are mobile iOS applications that allow dealers to pay for cars, request post-sale inspections and get gate passes emailed to their phone.
Also available at ADESA Chicago is technology that can enable streamlined checkout through an iOS app. The app scans the driver's license, gate pass and vehicle bar code for checkout. Additionally, employees are stationed at mobile printers so dealers can print bid badges from their phones prior to sale.
"More than 200,000 vehicles were sold at auction last year in Illinois. We are committed to expanding our market share and facilitating the exchange of many of these vehicles. We are filling an unmet need in the market with our end-to-end remarketing services and unmatched technology," St-Hilaire added.
With the Insurance Auto Auctions and Automotive Finance Corp. locations also in the area, KAR Auction Services now has seven locations within 40 miles of Chicago.
The auction is now hiring for 100 jobs, as well.
The facility is 167,000 square feet and is on 65 acres.


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How Do You Get a Copy of a Police Report in Albuquerque, N.M?
Credit: Jordan M/CC-BY-SA 2.0
Online Police Record Search - Enter Name- No Records, No Fee
www.police.us.org/Police-Records/Official
Look up Detailed Police Records. Enter a Name, Choose a State, and Begin Your Search Now! Easy Online Access to Official City Records. Get a Copy of a Police Report in Minutes.
rating for us.org
Police reports in the city of Albuquerque, N.M., may be obtained in person by stopping by any of the police substations between the hours of 8 a.m. and 5 p.m., Monday through Friday. The six substations include the Foothills (12800 Lomas NE), Northeast (8201 Osuna NE), Northwest (10401 Cibola Loop NW), Southeast (800 Louisiana SE), Southwest (6404 Los Volcanes NW) and Valley (5408 2nd St. NW) area commands.
If the police report involved a traffic accident, the report may be purchased online through LexisNexis for a fee. Consumers must first create an account and can locate the report by entering a report number, their first and last name and the date of the incident or their first and last name and the street where the incident occurred. Traffic accident reports are also available by stopping by the Law Enforcement Center at 400 Roma NW.
Each of the six substations is headed by a commander and staffed with police department employees that provide general information to walk-in visitors and respond to telephone inquiries. Residents may also stop by any command to file a new report, notify the department of abandoned and disabled vehicles, comment on the department's service or report any non-emergency situations.
What Are the Jo-Ann Fabrics Store Hours?
How Do You File a Complaint With the Ford Motor Company?
What Is the Customer Service Number for Groupon?
What Is the Telephone Number for Pearson Vue?


On Wednesday, August 31, Alliance San Diego hosted a successful fundraiser at the Lafayette Hotel entitled "Cocktails for a Cause." This event brought together a diverse group of 70+ social justice warriors to raise money for Alliance San Diego and call attention to the importance of the upcoming November election.
Thank you to our donors for joining your voices with ours and mobilizing with us to create a San Diego where all people can achieve their full potential. To see pictures of the fundraiser, click here.


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Giselle. The Australian Ballet (2018)
30 & 31 August 2018, State Theatre, Victorian Arts Centre, Melbourne
Maina Gielgud's Giselle, brought back once more by the Australian Ballet for a Melbourne only season, began beautifully—so beautifully that it gave me goose bumps. Small groups of villagers moved across the stage, interacting with each other, laughing and joking, while Orchestra Victoria, masterfully led by Simon Hewett, put us in the mood for what was to follow. It all seemed beautifully real rather than staged and distant. Much of this kind of interaction continued throughout with only a few moments where everyone stood around in a semi-circle of inactivity.
The opening night cast of Ako Kondo as Giselle and Ty King-Wall as Albrecht left me a little cold, although Kondo, who always dances superbly, was charmingly shy, perhaps even naive about what was happening to her. She needed a stronger Albrecht to give extra meaning to her portrayal. It takes two for the nature of any relationship to be seen and understood by an audience.
Andrew Killian did a sterling job as Hilarion and Lisa Bolte played Berthe as a motherly figure consumed by domesticity. I have, however, always imagined Berthe as a somewhat more feisty character, who is respectful towards the Duke (Steven Heathcote), Bathilde (Alice Topp) and their entourage, but who doesn't behave obsequiously towards them. Perhaps the Duke was Giselle's father? (This was an interpretation in the mind of Laurel Martyn and others and influences how Berthe encounters and interacts with the Duke and his party).
But the real stars of Act I on opening night were Brett Chynoweth and Jade Wood who danced the Peasant pas de deux. Chynoweth in particular danced spectacularly well with beautiful control and great placement at the end of those airborne tours. It was wonderful to watch him, too, when Wood was dancing her variations. There he was going from friend to friend telling them all how wonderful she was.
Brett Chynoweth and Jade Wood in the Peasant pas de deux, Giselle Act I. The Australian Ballet, 2018. Photo: © Jeff Busby
The mad scene was adequate, but that's about it.
Act II on opening night also began beautifully with visions of Wilis appearing in the mist as Hilarion ran through the forest in search of Giselle's grave. But I didn't feel moved as events unfolded, due perhaps to an ongoing lack of strength in the relationship between Giselle and Albrecht. Valerie Tereshchenko as Myrtha had a fierce look on her face but her gestures and the way she attacked the choreography didn't quite match the facial expression, which also lessened the emotional impact one expects from Act II.
Ty King-Wall, Ako Kondo and Valerie Tereshcheko, Giselle Act II. The Australian Ballet, 2018. Photo: © Jeff Busby
I was lucky, however, to be at the second performance in which Leanne Stojmenov as Giselle danced with David Hallberg as Albrecht. Act II this time was the stronger of the two acts, although it was interesting to see Stojmenov's reading of Giselle in Act I as a somewhat less naive character, a little coy at times but certainly in it (to start with anyway) for the ride. This of course made her collapse, when she realised she had been betrayed, much stronger.
Hallberg and Stojmenov gave a moving performance in Act II. She had the right ethereal, supernatural touch, he could plead for mercy from Myrtha and make us feel for him. Their central pas de deux unfolded slowly and exquisitely before our eyes. Hallberg's solo of entrechats six was spectacular from a technical point of view and yet he managed not to look like he was dancing in an eisteddfod. At last I felt emotionally involved, even from a distance since I was sitting in the gallery (aka the gods of former times). Amy Harris as Myrtha in this cast was forceful in her gestures and body language as a whole, and so she drove the action along nicely.
I often wonder to what extent the dancers of the Australian Ballet think about the nature of the characters they are portraying in ballets like Giselle. Do they wonder what goes on inside the minds of those characters? Do they wonder what kind of existence the characters might have beyond the immediate story? And so on. And do they then consider how to encapsulate that character in movement?
But there was a lot beyond interpretation of characters to admire about this production. The corps de ballet in Act I, for example, appeared to have had someone working with them on the use of head, arms and upper body. Fluidity of movement was thus more noticeable than usual. I also admired Hewett's leadership of Orchestra Victoria. I felt I was listening not to a concert performance of the Adolphe Adam score, but to music to accompany the story as it was unfolding onstage. It was also an experience to sit high up in the auditorium. Apart from the fact that Stojmenov and Hallberg were able to project emotion the way they did right up into the gods, I have never been so aware before of the spatial patterns of the choreography for the corps de ballet.
To finish, there were two interesting happenings with regard to curtain calls. On opening night, minor principals who only appear in Act I joined the cast of Act II for a curtain call—not a usual occurrence. Then, following the second night's performance, as Stojmenov and Hallberg moved downstage to take another bow together, the cast of Wilis behind them broke into applause—now that's an accolade.
Featured mage: Ako Kondo and Ty King-Wall in Giselle Act I. The Australian Ballet, 2018. Photo: © Jeff Busby
Ako Kondo Alice Topp Amy Harris Brett Chynoweth David Hallberg GISELLE Laurel Martyn Leanne Stojmenov Lisa Bolte Maina Gielgud Steven Heathcote The Australian Ballet Ty King-Wall Valerie Tereshchenko
← Previous post Dance diary. August 2018
Next postab [intra]. Sydney Dance Company →
5 thoughts on "Giselle. The Australian Ballet (2018)"
Anna Campbell says:
Oh hi fellow Hallberg/Stojmenov audience member! He was such a generous partner (his feet are so beautiful, no wonder he didn't wear the boots in Act I) and she was so great, especially on début (was pregnant for 2015 Sydney season). I felt Amy Harris (much-delayed début as Myrtha, due to IIRC glandular in 2008 and also pregnancy in 2015) more involved in her character than some other TAB Myrthas I could name – Michela Kirkaldie still my TAB benchmark though. Amanda McGuigan on Saturday night was a really believable Myrtha.
It's a bit annoying that the company doesn't mark role débuts in the cast sheets any more, audience members have no way of knowing unless they actually know, if you know what I mean!
"It was also an experience to sit high up in the auditorium. Apart from the fact the Stojmenov and Hallberg were able to project emotion the way they did right up into the gods, I have never been so aware before of the spatial patterns of the choreography for the corps de ballet."
This. Michelle, you need to see Stephen Baynes' Swan Lake from high up, too. The white acts' patterns are gorgeous.
I know a large number of them do, or so they tell me. I remember when they were just starting work on the Murphy R&J several of the potential leads (who'd never danced any version of R&J) did quite a lot of reading and thinking. Also, as I understand it, Maina Gielgud's coaching encourages that kind of thinking.
You mention Brett Chynoweth on opening night, what did you think of Benedicte Bemet and Shaun Andrews in the peasant pas? Having seen both Friday and Saturday nights, one from row P of the stalls, the other row H, Andrews was the only dancer of whom I can say "all his landings were soundless" (and Friday was his first, too). No super elevation, but nice clean lightly bouncy jumps – as seen by Chynoweth on previous occasions – think I'd like to see him in some Bournonville…
Fun fact from Saturday night – Adam Bull claims to have "old knees" incompatible with successful entrechats, so we were treated to the alternative – brisés volés – which I'd never actually seen live. In fact it does make Albrecht go all over the place and be legit exhausted.
Now looking forward to a sneaky matinée for Dimity Azoury and Callum Linnane. Hoping to see some alternative Lead Wilis, as I got the same pair on both Friday and Saturday.
Hi Anna, always good to hear your comments. Yes, it is annoying that debut performances aren't noted. I didn't know that Stojmenov and Harris were making their debut as Giselle and Myrtha resepectively. Given that, I am even more impressed. As for Myrtha, I did see Amanda McGuigan in 2015 and looking back I said she was 'cold and haughty.' Appropriate! I have always enjoyed her performances.
When I was just a young ballet student (a long time ago) I used almost always to sit in the gods – it was affordable. I bought a ticket for the Friday night show (as opposed to having a house seat on opening night) and all that was available that wasn't on the side was the front row of the gallery (balcony).so that's what I bought. Apart from the spatial patterns, it was also interesting to see how the peasants' skirts swirled out making circular patterns themselves. It's good sometimes to move around the theatre.
Re Bemet and Andrews in the Peasant pas, I quite enjoyed their performance but it didn't grab me the way that of Chynoweth and Wood did. But I agree that Andrews would be interesting to watch in a Bournonville piece.
I simply can't imagine Albrecht executing brisés volés instead of entrechats! But I saw Jones and Bull in Canberra in 2015. They made a terrific partnership I thought and Bull's knees must have been younger then. As far as I remember he did the entrechats.
I would love to see Dimity Azoury and Callum Linnane. Maina asked me if I was going to be in Melbourne still on Wednesday (I'm not), so I get the impression that the Wednesday show could be something to watch.
Thank you Michelle. Wish I'd known you were there Friday night, I would have looked out and we might have met up … except I was with my brother (our joint subscription), and we met up with a friend of mine and her mother … and there were photos of my brother's recent I Got Engaged In Paris sojourn in Europe to marvel over (he took A LOT of photos, way more than me last year!).
Ahhahaha Maina's spruiking them! She chose them and put them together, so … I have enjoyed watching Azoury over the last few years: she seemed to gain enormous confidence from her ballet dancer award win, and as for Linnane … he has so much potential and it seems to be being carefully fostered … we will be lucky as an audience to have him for more than a couple of years, he could go anywhere, what with Neumeier, Wheeldon, and Gielgud's positive opinions.
Oh, and Bemet and Andrews were also on debut as a partnership, he hasn't danced with her before at all, and it was his first PPDD – she had done it in 2015.
All I said to Maina was, very heartfelt, "Madame, thank you for the corps!" and she laughed.
The brisés volés, the only time I've seen them otherwise is in the Baryshnikov/Makarova ABT 1977 film, also Baryshnikov in The Turning Point, and I've read that Angel Corella used to do them.
Seeing the spatial patterns from the balcony used to be one of my favourite things, but now that all the circle except the very sides is either Premium or A Reserve, and even the balcony front row is A Reserve, and B Reserve is around $175 …
Linnane was a heedless young man who grew up in about two seconds flat, and Azoury will be able to use the role as a ticket to guesting anywhere she wants (sad it's such a short season and she only gets two goes at it). He's a partner in the tradition of Hallberg and Curran – generous and classy.
Mason Lovegrove danced peasant PDD with Dana Stephenson and I had such fun watching him – he kept blowing her kisses, and was so obviously showing off how happy and lucky he felt to be with her to all the other villagers, it was delightful.
TAB's Giselle: Youngest Village In Mittel-Europe. Even Jake Mangakahia's Hilarion is as young as the rest of them. It's really weird having Berthe as the only adult around. Would it kill them to add a few supernumerary adults and children?
I am envious!
But your comment about having older people in Act I is interesting. I still have such fond memories of Sylvie Guillem's Giselle, which she did for the Finns some time ago and which I was lucky enough to see. I can't remember now whether she had older people in her cast but the population of that village was a motley lot and it made a lot of sense. I will check out the review I wrote and see what I mentioned. It didn't get great reviews from people like Clement Crisp but I loved it.


He's a curious monkey, a mad king and a nursery rhyme, plus we're all carrying him around in our wallets. But how does this choice wear on a real child?
Today's name is in honor of a local birthday boy: George.
Georgia is fashionable these days. George meets most of the requirements for a pleasing throwback choice, too, but he's lagged far behind other regal appellations like Henry and William.
It's a bit of a mystery, but we submit that George would fare better if we reclaimed his old nickname – Geordie. Maybe George feels too formal for a small child, but we can easily imagine Geordie running across the playground with Charlie and Theo.
Odds are strong that you'll find a George on your family tree. The name was a Top Ten staple in the US through 1937; remained in the Top 50 until 1974 and even today ranks #147. It's almost George's worst ranking ever, but it still keeps him about even with Oliver (#140) and Edward (#145). The difference is that Ollie and Eddie are climbing, while George seems likely to slide even further.
Saint George, a Roman soldier. He was probably real; his dragon-slaying activities, not so much.
Kings of England, Greece and, naturally, Georgia, have worn the name. King George III – known for his less than stable mental condition – was on the throne with the American colonists staged a revolution.
George Washington eventually became the first president of the new country, post-revolt. Plenty of politicians and officials have worn the name since, including Presidents George Bush and George W. Bush.
There's also George Marshall – general, Secretary of State and Nobel Peace Prize winner for his work rebuilding Europe following World War II.
Inventor George Eastman is partly responsible for those snapshots of our adorable children.
Comedians include George Carlin and George Burns.
Pianist and composer George Gershwin is one of several musical bearers of the name. There's also country music's George Jones and George Harrison of The Beatles.
George was the pen name of choice for George Orwell – born Eric Arthur Blair, George Eliot – born Mary Ann Evans and George Sand – born Amandine Aurore Lucile Dupin.
Besides the monkey, fictional Georges include Seinfeld's George Costanza and Harry Potter's George Weasley.
Georgie Porgie kissed the girls and made them cry in the traditional nursery rhyme.
This list could not be complete without Hollywood leading man George Clooney.
It's a classic name that defies type-casting. Choose your passion, and there's a George that has distinguished himself in that field.
If we follow the English, as we so often do with baby naming trends, George is due for a comeback. He currently ranks #14 in the UK. Even without that boost, we've noticed plenty of parents reviving George – perhaps enough to propel him back in the Top 100.
George is our favorite for a boy – before we had our daughter, Imogen, we were leaning heavily toward George (if it turned out to be a boy). We'd tried for 8 years to have a baby and George had remained tops for us all those years (we were less consistent with girl names)… Still, when push came to shove, (we had moved from England back to my home country of the USA and it was '07 and not '99 anymore) we were definitely thinking twice about George… of course because of W! We wondered how many friends and strangers would think it was a tribute to W (after all, there are still a good many conservative souls who think he is a fine example of leadership – we don't, but some people do\)… In any case, we looked for a good alternative, but leaned on George heavily anyway… We considered William (too mundane for us), Henry/Harry (couldn't quite get ourselves to like it), Archer, Jarvis (oddly the runner up for us in the end), and many others (we really love Charles, but that's my dad's name and neither of us are big on naming our kids after relatives, which is also what was standing in the way of Eleanor for a girl… that and my husband's dislike for the name). In the end our boy-name preference was moot, but maybe one day it won't be… and if that ever turns out to be the case, I'm sure George and it's pudgy loveliness will definitely be a top contender for us… I just love it! And thanks for the suggestion of 'Dodge' as a nickname – that is really fun and very cool!
Since I have a celeb chef crush on Gordon Ramsay, that's one I'm happy to do! He's NotD on 12/30.
I'd say Jordy, too, and I'm fairly confident that's correct. But Allison, I suspect many people would see Geordie and read it with a hard G, so that's certainly a consideration.
Because Gordon? I think that's a name not quite ready for revival!
I've always said Jordy for Geordie. Anyone care to tell me if I'm right or not? I always figured if Geordi LaForge was "Jordy" in sound…. Now I'm second guessing myself, help!
I just realized, reading Emmy Jo's post, when I see "Geordie," I read it as (hard "g") Gordy, not George-y with j-sounds. Anyone else?
George is my black kitten! I've realized the name's sound doesn't appeal to me much, especially when I find myself calling it over and over (I think it's the two "j" sounds in one syllable), but I certainly like the classic feel. Geordie's a darling nickname, and it does get around those two "j" sounds.
I'm so glad George gets a warm reaction from the crowd! It's the name of an uncle of mine – actually, my dad's cousin. He's a great guy, and has always made me think of the name favorably.
As for the current president, I do wonder if that's why more parents aren't choosing it right now. It's not enough of a reason to sour me on the name forever, but it did give me pause.
Lola, glad you're back on the grid. And I didn't even THINK of Jetson – d'oh!
Lyndsay, Dodge as a nickname for George – that's really interesting. As a given name, Dodge seems a bit much (or it just because of the current auto chaos all over the news?) but it makes a very cool nickname.
Bek, I think I agree that George works *every* well in the middle spot.
A few years back, I was flying solo with Alexei when I ended up in the security line with a woman flying solo with THREE boys under five – William, Henry and George. It's always stuck in my head – not just for the classic names, but for her total courage in squiring a trio of small children through the airport!
I thoroughly like George. I have trouble working him in first place but he works beautifully in the middle for me. Makes me think of my late Pop, St. George was his patron Saint. I also theink "George Jetson" but that doesn't bother me any (especially since my top name comes from that show too!). Funny how Dubya doesn't come to mind until I read someone else's post about him. I think it's as simple as there have been so many famous George's that he blends almost out of the picture for me. George Harrison was the only Beatle I ever liked and count me weird, George Weasley (Oliver Phelps) is awesome! I think George is simply fabulous. And I agree, Geordie needs a comeback.
It's a fine name, but it falls flat for me. I have a hard time getting on board with one-syllable names, I like more nickname options. I do like them as middle names, and I think George could be a standout choice there. For now, my distaste for the (mercifully soon to be) former president is too strong an association. It's certainly easier to embrace a historical name with an unfortunate association; this one is too topical for my comfort level.
I love George. Seems silly to dismiss a name on a president, I mean, there have been plenty of lousy presidents, kings and other forebearers, with lots of names, but we don't always dismiss them. I know some think he's too Constanza, as in Seinfeld's chubby, bumbling friend, but since I've never seen an episode in my life, I look past that one too 😉 George just has a warm, happy feeling for me, probably because so many great men have worn the name so well (including a grandfather for both my husband and me, and a great-grandfather on my side.) I'd love to use it as a middle name someday.
I don't really care for George at all. I can't get past the George Bush association (worst president in the universe. His father is bad too.), and although I love George Clooney and George from Seinfeld, I could never name my child George. I know or have met a couple of great George's though. One of my cousins has a good friend named George (He's 16) and my Grampa's father's name was George too.
Someone on another blog recently suggested Jory for a nickname for George. Feels a little feminine to me, but I could get on board with it.
My cousin's name and he makes a good George (whatever that is!). He was named after his uncle. Not too stuffy to use. But I don't like Georgie for a nickname.
When Georgia was NotD I hoped you would eventually do George, too, I'm glad to see it so soon! George is thoroughly wonderful, isn't he? So distinguished, but wears well on any type of person. My mom just told me recently that she regrets not naming my brother (Jeffrey) George, I certainly wish she had, he'd have been a great George. It was her uncle's name, and he was apparantly an amazing man. I would LOVE to name a baby George (and I'd nickname him Dodge), but my husband absolutely hates it… so disappointing. The closest I'll ever get is probably Georgiana in the middle spot.
George is a very stout name, isn't he? I really like his sound but happen to like Georgia more. I think part of the lag on a comeback might be due to George W; it seems like no one wants anything to do with him these days. I could see myself using George at some point, and the history is fascinating!
[…] to say that names failing to make this list aren't classics.
[…] George R.R. Martin's A Song of Ice and Fire series is better known an HBO original series A Game of Thrones.
[…] – Name your son John, Paul, or George doesn't scream Fab Four.
[…] know, for example, that youngest Llewelyn-Davies brother Nicholas answered to Nico.
[…] George Gershwin, his brother Ira, and husband-and-wife team DuBose and Dorothy Heyward get credit for the enduring Porgy & Bess.
[…] Clarice Maud, Alma Sebastopol, Oliver Archibald, Ira and Adonis, Ruby Violanthe, Flora Amanda, George Ocatvius – absolutely fascinating lists!
[…] Unless, of course, you go with something completely unexpected, like one of these Celtic Cool names from British Baby Names – Jory, Lorcan, Macsen, Treeve; Aderyn, Eleri, Emblyn, Kerensa, Tressa, Ysella.
[…] Byron to Donatella Versace.
[…] ever so slightly French, but sounds at home with Mid-Century modern picks like Nancy, Sally, George, and Ralph, too.
[…] of notables have answered to the surname over the years, including a military family.
[…] up: the short-lived Showtime series Dead Like Me.
[…] if you haven't seen a Kurosawa film, you've almost certainly seen his influence.
[…] Eighty-Four's main character was records clerk Winston Smith.
[…] Sequoia was a man before he was a tree.


text:
module RailsAgnosticModels
  module ArelTranslator
    class Order
      attr_accessor :order

      def initialize(order)
        @order = order
      end

      def translate!
        "order(\"#{self.order}\")"
      end
    end
  end
end

redpajama_set_name: RedPajamaGithub


text:
Het mineraal quetzalcoatliet is een zink-koper-telluride met de chemische formule Zn8Cu4(TeO3)3(OH)18.

Eigenschappen
Het blauw tot blauwgroene quetzalcoatliet heeft een duidelijke splijting volgens kristalvlak [1010]. De gemiddelde dichtheid is 6,05 en de hardheid is 3. Het kristalstelsel is hexagonaal en het mineraal is noch radioactief, noch magnetisch.

Naamgeving
Het mineraal quetzalcoatliet is genoemd naar de Tolteekse god Quetzalcoatl, vanwege de zeegroene kleur van het mineraal.

Voorkomen
Quetzalcoatliet is een secundair mineraal in geoxideerde telluurhoudende gesteenten. De typelocatie is de Ambollita mijn in de Sierra La Huerta, Moctezuma, Sonora, Mexico.

Zie ook
Lijst van mineralen

Externe links
 Quetzalcoatliet op Webmineral.com

Zinkhoudend mineraal
Koperhoudend mineraal
Telluride (mineraal)
Hydroxide (mineraal)

redpajama_set_name: RedPajamaWikipedia


Dr Rosell is also Chief Medical Officer and President of the Dr Rosell Oncology Institute, University Hospitals Dexeus, Teknon, General de Catalunya & Sagrat Cor, Quirónsalud Group. Additionally, he is Director of the Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Germans Trias & Pujol Hospital (Barcelona), and Founder & Chief Scientific Officer of Pangaea Oncology SA. He is furthermore Professor of Medicine at the Autonomous University of Barcelona.
Dr Rosell is a member of the ETOP Foundation Council, serves on the ESMO Annual Congress Scientifc Sub-Committee (non-small-cell lung cancer) and Editorial Board member of several medical journals. He is the Founder and Director of International Relations and Projects, Spanish Lung Cancer Group, and served as President from its inception in 1991 until 2014. He is a driving force behind current Spanish medical oncology research. He has over 600 articles published in peer-reviewed journals and has given hundreds of invited lectures at international medical conferences. In 2013, he was recognized as one of the highest authorities in lung cancer in Europe by The Lancet.


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I only had 2 emails with the owner, and both were answered within minutes. The same day we booked, and my only regret was not booking more of the furniture. it really did the job, and we are forever grateful.
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The bar was a hit, and the bar tables kept people around the dance floor. We had the circle cubed package for our dance floor side area, so people were still really close to the floor when drinking/talking.
Awesome Shelley! So glad to hear our furniture set the tone for your wedding. Photos were amazing, and you guys were fabulous clients!
Richard at Alberta cubed was the easiest vendor to deal with. Always responded same day and helped make our wedding lounge amazing. The colours of the equipment were matched to our theme of baby blue and white. This really worked well by the dance floor.
The light up bar had people gathering around it as it was like a centre piece. Bar tables were perfect addition with our cube sofa package. Thank you so much!
We had an incredible ultra lounge for our guests. It was one of the most unique parties I have ever thrown, and the guests all loved it. Booking was easy and emails were fast to respond. Thanks again!


When buying a home, "inspection" is one of the most common conditions included in the Agreement of Purchase and Sale. For the vast majority of homebuyers, the completion of their real estate purchase is contingent on a home inspection being performed.
The home inspection is a non-invasive, visual inspection of a property, carried out by a qualified professional. Home inspectors are trained in the evaluation of major household systems, including plumbing, electrical, HVAC, foundation & roof. Your inspector will provide a written report outlining the condition and functionality of each of these systems.
Depending on the size of the home, an inspection will take 3 to 4 hours and can add approximately $350-$800 to your costs. No drilling or digging is performed. The home will be in the same condition following the inspection as it was before it began.
A home inspection has two major functions. First, it clearly identifies any significant defects that can affect your buying decision. Second, it points out components in need of near-term repairs, or those reaching the end of their functional life.
As a buyer, an inspection can help you to decide whether or not a home is worth buying. Both older and newer homes will generally turn up a list of repairs, or "deficiencies". Some issues are immediate, while others may not cause problems for a number of years, if ever. Reviewing your inspection report with an experienced Realtor can help you decide if any of these repairs are serious enough to sway your buying decision.
Knowledge is power, and a home inspection will help you learn all you can about your prospective purchase. You'll have the opportunity to ask questions and learn the locations of major systems and components throughout the home. You'll also be able to assess whether you want to invest in any upgrades or repairs that might be needed.


This house satisfies our dear clients' wish to have a new house very similar to the one they were living in at the time we first met with them. The existing house was too low, it needed new electrical and plumbing, new windows and doors, all new bathrooms and kitchen and new Family Room addition and Garage. So we, in fact, gave them a new house with the same traditional Cape Cod look and the same red door but with added dormers and higher ceilings inside. The floor plan was similar as well except for the family addition and garage apartment.
The owners are collectors of artifacts gathered on their travels and they desired to organize these treasures and show them off properly in their new home. We lined many of the hallways with display cases and placed them in the Family Room and Stair Hall as well. The Family Room has an African theme because these owners have visited Africa 18 times and have acquired many objets d'art from various countries there. The cabinetry is painted except for in the Library and Kitchen where the woodwork is stained mahogany. The exterior was given a weathered shingled look and the back porch off the Family Room is ideal for visiting with friends and enjoying their garden. Many other exterior vintage items are displayed outside as well. They certainly feel as if they are in an updated version of their old house but with everything new that they wanted.


you a while if you want and chat a while." We can only agree with the adage: "If you get a friend in Brazil you will get a friend for life. "What can you do in a small fishing village, you might wonder? Well, there is always the ocean for a swim, and because we are close to the equator it provides excellent opportunities for children and even adults to swim in the natural pits which will be available when the sea retreats for a while. Imagine bathing in warm salt water aquarium, with little fishes in their beautiful lively colors swimming around you. Would you like to swim in the sea, however, the village has many long sandy beaches, and when you tired of that we recommend to try a body board or a surfboard. Or why not try what people worldwide go to Taiba for: Kitesurfing. You will find courses and a bit north of the village there is a lagoon where many train before they try kitesurfing in the ocean. When you're tired of the sea you can visit the small shops, get something to eat in one of the restaurants or just sit and take something to drink – that possibility is almost on every corner, especially around the fish market. A fishing trip is to recommend otherwise, it is quite a experience to go out an early morning with a couple of fishermen. On evenings we recommend to the main square, where there are often things happening. Ask those who live in the village, they have many tips.


WRITING IN A NUTSHELL: Before the beginning, there was.... uh, what?
Okay, so my story begins when my characters are ages 15 and 17. They have a history, but no one knows it. The characters don't even know it. It will be revealed to all as the series progresses.
The thing is - I don't quite know it yet either, and I want to. I want to know that back story. I want to know their history.
Unfortunately, since it hasn't been written yet, I'm as much in the dark right now as readers will be later. But the author should know, right?
So I have two little side projects along with writing my main MS -- I'm going to write that back story. It will really just be for my own edification, and probably no one will ever read it, but I will have it, and I think it will help with writing the novels.
Because as they say--you don't really know where you're going unless you understand where you came from.
They will be short, maybe about 30k - 40k each, 2 novellas which chronicle the beginning.
Do you ever experience this when you're writing? Or do you usually already know the history of your characters and your story when you start?
I normally have some vague notion of who they are, but most of the details come from revision and other time.
Oh yes, sometimes their back story doesn't come out until the middle of the book! Then I have to go back and integrate it. But that's okay with me.
I'll have a shadow of an idea of where I want to go. Once I begin writing my shadow disappears and I go in a totally different direction.
I generally have an idea of their history. Sometimes to help build that history, I'll look at certain traits or behaviors they have, and wonder back, about what prompted those traits.
I usually have a general idea of it, but never find out until much later in the story.
Of course, sometimes my characters decide to be annoying and spill their life story when they are specifically told not to, but they're learning.
Or, I'm learning ways to get them to shut up.
I agree with Aubrie - sometimes my characters' stories just jump out at me when I'm in the middle! Other times, I might have a vague idea but nothing concrete. They really come into their own when I'm writing.
I do character synopsises for each person, no matter how minor. It's usually just an outline of everything about that person, including a timeline of major events from birth to present. More important characters get more in depth than minor, but I know about everyone. My synopsises (synopsi?) are for my eyes only, and are more note-like than a story.
I usually do some form of character outline when it comes to appearance, mannerisms, etc., just to make things clearer for me, but as far as plot and character development, nada.
I definitely learn as I go along. I didn't know back story for some characters till I was 3/4 of the way through. Amazingly it still worked. As though the book knew or something. But yeah, it definitely is important to know. Good luck!
I knew hardly anything about my character's history and where the story would end up when I started writing TAT, but it's been fun discovering them as I go along. That said, I'll probably do a little more character biography-ing for my next one because it will help set me on the right path so I won't have to do as many revisions.
Erinn - Thanks for sharing!
Joanne - That's a great exercise too!
Rebel - Ahhh, it's so true! You never know who's really in control.
Jemi - That's a good idea too. I find things change so often, it's hard to get a firm grasp on them until you actually start writing.
Talli - It's amazing how strong stories can form out of that ambiguity!
Mesmerix - That's something I need to try - I've only done that for my MC's so far.
Terri - You're right :D. I think that's why I'm so anxious to know my MC's backstories as well.
The side stories are a good idea. That's usually how I figure things out - by forcing the characters to show me. Good luck!


Island Automated Gate is based on the belief that our customers' needs are of the utmost importance. Our entire team is committed to meeting those needs. As a result, a high percentage of our business is from repeat customers and referrals.
We offer a wide range of services from new construction installation to troubleshooting and repairing systems or gates that have been installed many years ago.


The request will be persisted to a data store.
An algorithm will find a doctor that matches the incoming request based on availability and proximity.
Push Notifications will be sent to update the physician and patient.


When Speed Cleaning co-owner Debbie Sardone heard how Houston-area cleaning businesses were struggling in the aftermath of Hurricane Harvey, she turned to her husband Steve —the other Speed Cleaning owner— and said that she needed to figure out a way to help. Debbie coaches maid services around the world about how to become highly successful, many of whom are attending the January 2018 Speed Cleaning for the Pros conference.
As the rain dripped down their Dallas-Fort Worth area windows, Debbie leapt into action and put a call out to maid service owners. She would offer her most popular Cleaning Business Fundamentals training course at half price and donate all of the proceeds from the first six sold to Houston cleaning businesses to help them get back on their feet. The response was tremendous, and within a day she had raised $10,000. The money goes directly to Houston-based maid services to help with the cost of cleaning up their locations, buying replacements for damaged supplies, and keeping their business open while they recover from the disaster.
Debbie was excited about the response of business owners to help. "They loved being able to both help Houston colleagues and have a program that will transform their business," she said.
Business owners from across the U.S. and Canada were thrilled to have this win-win opportunity to donate to hurricane victims while gaining invaluable consulting expertise from Debbie. "I am passionate about helping people improve their businesses, so it was a natural fit to find a way to help owners recover from the storm," she said.


Based on a Jack Moore flute scale, supplied by Albert Cooper in 1978, and since revised.
It is for an Open Hole model (French Cups) and for either C or B foot.
* NB: the cup rise should be 3.5mm above the saddles at the front and more, perhaps 4mm, for the foot. It is part of the design of the scale for good intonation.
* We would prefer larger right hand saddles, up to 14.4mm diameter. This slightly improves the 'response' of the RH notes.
Similarly, we suggest that G# benefits in the 3rd octave by a smaller saddle, perhaps between 12.5 and 12.8mm, the same as C.
* There are tests taking place at the moment to determine exactly what the closed hole/open hole displacement will be. We suspect it will 1.5mm but are trying to establish if the right and left hand open holes are different.


Lewis Lacey was born in Montreal on February 17, 1887. In 1915 Lacey won the Argentine open in polo and became Argentina's second 10-goal polo player. He then served for England during World War I before returning to Argentina to pursue his polo career.
In 1920, Lacey opened a sports shop in Buenos Aires, and continued to play polo, for both English and Argentinian teams until he retired in 1937. The short sleeved jersey shirts worn in the 1923 season by the Hurlingham Polo Team of Buenos Aires were created by Lacey and featured an emblem of a mounted polo player on the left breast.
In a similar manner, French Tennis star Rene Lacoste, known as 'le Crocodile' for his snappy style, began producing a polo shirt with a crocodile logo on the left breast in 1933. The shirts were marketed by Izod in the United States beginning in 1951.
In 1967, Ralph Lauren adopted the brand line 'Polo' for his men's collection and first used a polo player motif in advertising in 1972, adding the emblem to all his polo shirts in 1978. However, Alberto Vannucci was selling shirts in Buenos Aires with a similar polo player motif. Lauren sued Vannucci, who proved his version predated Lauren's because it was created in 1923 for Lewis Lacey. The polo line frequently ends up in court with the United States Polo Association over the right to use a polo player motif in the production of clothing and accessories.
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Brian Panichelle was born and raised in Southwestern Pennsylvania. He is the oldest of two children. He is the husband of Heather. He and his wife Heather met at Geneva College, where they both obtained Bachelor Degrees in Business administration. Brian is a Ruling Elder in the Reformed Presbyterian Church of North America.
The LORD has blessed he and Heather with six healthy children. Brian is a successful author, coach, businessman, and has been self employed most of his adult life. He aids Heather in homeschooling their children. Brian has taught several business and computer classes at the County Community College and has successfully completed and trained the Referral Institutes Certified Networker Program. Brian also enjoys speaking to young people. He has led seminars for 4-H and spoke at multiple youth events. Brian is a member of several Chambers of Commerce and has helped deliver Chamber education programs in his local Jr./ Sr. High Schools.
As a Ruling Elder Brian serves in teaching and governing his local church and also serves in various capacities in Presbytery and Synod. Brian and his family enjoy volunteering their time together for the Food Bank and the Salvation Army as well as helping neighbors, friends, family and going on mission trips.
Contact Brian at brian@panichelle.com for books or speaking engagements.


These last years have seen an interesting growth of the nautical sector. A lively sector in constant bustle, where investment in new techniques and approaches always rewards entrepreneurs. Here is our innovative way to present boats to end customers: the new 3D configurator for the nautical sector.
In these days recreational boating and sea life enthusiasts will gather in Genoa for the 58th Salone Nautico, the famous Italian boat show.
From the 20th to 25th September Genoa will be the right destination to discover all about the latest trends in the nautical sector. You will find more than 1000 boats, i.e. sailboats, outboard engines and inflatable boats, powerboats and motor yachts, displayed along the docks in Genoa and could participate to various events.
And this will also be the right occasion for boat producers to discover DERWID's new 3d configurator for the nautical sector.
Configure your boat: try our demo!
DERWID's 3D configurator for the nautical sector offers boat producers a new approach to customers.
Ever dreamed of configuring your boats at the moment, presenting them with a real time high definition 3D image?
With DERWID's 3D full web and cross-platform configurator, you could show your yachts or inflatable boats to end-users avoiding the long time needed by the classical rendering. It's modular, extensible and customizable: handling the variety of your boats couldn't be easier, both for sales and production.
Do you need more information about the 3D configurator for the nautical sector? Contact us, we will be pleased to answer all your questions.


An interesting glimpse into other cultures.
A ritual for leaving the house other than hitting the garage door closer would be nice.
I brought a video home that has captured the Youngest's imagination about a little girl who builds a house for the fairies and all the creatures who come to use it. He keeps drawing the tree, the fairy house and the animals. I think we need to go outside and build one. We will have to choose an auspicious location.
A few years back, O sold the building that housed his bookstore to a young Thai gentleman who had plans to start a gourmet restaurant. He was backed by his family's money, and when his dad discovered the closing date, he demanded that it be moved to the next day -- a more auspicious day.
The paperwork was already done, and it would have cost a small fortune to change the closing, so O refused. The sale went through, the bookstore became a restaurant; a restaurant that became the scene of a near-tragedy and failed miserably.
Now, this kid made a LOT of BAD mistakes along the way, so I don't blame the non-auspicious day. But O wonders if the family blames HIM for the failure.
I want to build a spirit house.
A common Hindu prayer at shrines begins "You are everywhere, but I worship You here / You have no form, but I worship You in this form / You need no prayers, but I offer You these prayers."
I have a little shrine in my bedroom where I burn incense, and where I sit when I chant my rounds. I think it's important to have a sacred space.
Very well said liked how you put it. One ritual that came to mind is on weekends, if I leave the home and *A* is at home too, she will drop a crystal of suge in to my mouth.
I think it goes back to "go out and face the day and the world.. for that you need energy so here is something".
I used to work for a Chinese business man who had to have things happen on auspicious dates, the addresses of the home he bought for his daughter had to have auspicious numbers in it. This blew me away, as if a number could hold you back in the land of the free, home of the brave? (snicker - I was quite young).
I have a string of tiny bells on a red cord that I jingle everytime I walk in or out the door. Scares the bad spirits away...seriously!
This is what I need! A spiritual place. We need more spiritual (not religious) rituals in our country...at least it would help me.
Oh, I really like and appreciate this post! This is one of the key things that has been so enriching, having adopted another way of life. All of it makes me feel more connected to the cycles of life itself. Mundane things become embued with meaning.
We put more effort into housing SUVs, than our spirits. It's a shame.
I have a mirror box at home that serves as a miniature alter. On it are tiny statues of female deities from all cultures, and gifts in all elements (shell-air, stone-earth, fire-candle, feather-wind). I'm not religious or superstitious, it just feels right.
Lucia, I agree that we have too few moments of awareness. Most Westerners have NONE. Too busy living in the past or in the future. No sense of NOW.
I once read a book (I don't remember which) that said you should have a sacred space somewhere just for yourself that you could meditate and fill yourself. A way to really be alone I guess. I always liked that thought.
oh, i love this. when in southeast asia i had the fortune to learn about spirit houses and the roles they play..and you are right the mindfulness. and the lack of.


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text:
Goodbye Tampon Tax
By Michaela Helean / New Mexico News Port
New Mexicans will no longer have to pay state gross receipts tax on products such as pads and tampons starting in July, when the bipartisan "Tampon Tax" cut goes into effect.
The tax cut was part of a package of economic relief measures passed by the state Legislature earlier this year.
"New Mexico is leading the way with innovative tax policies that support our working families," House Majority Leader Javier Martínez said in a press release.
Gov. Michelle Lujan Grisham's office said she expects the tax cuts together will save consumers around $5 million per year, but did not specify estimated savings on period products. Sales tax, technically a gross receipts tax, in New Mexico varies by location from 5.1% to 9.4%.
About 20 states now exempt period products from taxes. A study of a similar program in New Jersey found that "repealing tampon taxes removes an unequal tax burden and could make menstrual hygiene products more accessible for low-income consumers."
In 2021 many states still taxed period products. New Mexico is no longer on that list.
Some women in Albuquerque say they are grateful for this change.
Self-described feminist Ashley Long says the change makes sense. It makes her glad the New Mexico governor is a woman.
"Groceries are not taxed, so it makes sense to cut something so necessary just like groceries," Long said.
Long appreciates that the governor is looking out for women. "I don't think a man would have had this as a priority," she said.
Ashley Long is an advocate for women in the New Mexico Labor Union
Still, Long says there's more work to be done for what she calls "menstrual equity."
Menstrual equity means "ending the stigma around periods that has prevented not only decision-makers, but also healthcare providers, educators and individuals from ensuring that menstrual health is a priority," according to Women's Voices, an activist organization working related to women, health and the environment.
The cost of period products can be significant. For example, a box of 34 Tampax Pearl tampons costs $7.49 at Target and would last an average user about two months.
But there is a huge range of experience and some people need to use more of them or use a combination of products.
College student Moriah Marshall says she buys generic pads at Walmart to save money.
"I also have to use thicker pads which are more expensive than normal sizes. I just want to be comfortable and these cheap products are the opposite of that."
It's not possible to simply use fewer tampons or pads for a longer time because of the risk of Toxic Shock Syndrome, a rare but potentially life-threatening disease.
Long says she hopes all women will be able to choose which brand they use. She believes the tax cut is a positive move.
However, she thinks more can be done to make women's lives more equitable, such as addressing the "Pink Tax," problem of companies charging more for all kinds of products, from razors to shampoo, that are marketed to women.
"If women do better our economy does better," Long said.
Michaela Helean is a reporter for New Mexico News Port and can be reached at nmnewsport@gmail.com.
Published April 26, 2022 By NM News-Port
Categorized as Healthy New Mexico, New Mexico Voices, Top story
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Although one or more of these may figure in depression, depression is much more than any one of them alone. In this section, we are going to look at the psychological component of depression - the way you think, and how the study of this has led to some of the most effective treatment for depression.
Depression, to be ongoing, has to be maintained. Otherwise, depression will simply evaporate over time. This maintenance is performed by thinking styles that encourage any introspection to be emotionally arousing.
It's natural to feel sad for a while when something sad happens. When this happens, we may find our energy levels drop and we become more insular to allow us to adjust to our changed life. This is what grief is for.
The chemical imbalance often cited as the cause of depression is just as often present in someone who is grieving.
The person not suffering from depression can "see beyond" the sadness. Even if they haven't formed the thought, unconsciously they know that the sadness will lift. Depression often makes the sufferer think that 'things will always be this way'.
The sadness, or depression, will only affect specific things, even if it is "always there" for some time. Although the mood may be constant, it doesn't "color" everything.
So it's the event itself that is sad, not life in general. And even if this thought or feeling arises, it is only temporary.
As we explain these thinking styles you will see how each helps to maintain depression, by altering how we perceive reality.
It's these thinking styles that make it so hard to see an end to the depression, as they limit our possibilities of thought. Once these patterns take hold, the emotional arousal they cause begins to affect us physically.
If you are thinking now "Yeah, but you don't know my life" - remember: there is nothing so awful that you can imagine that someone somewhere hasn't survived without becoming depressed.
It is not your fault if you are depressed, but there are concrete, effective things you can do about it.
51. Peterson, C. and Seligman, M. E. P. (1984) Causal explanations as a factor for depression: theory and evidence. Psychological Review, 91, 341-74.


Food and Drug Administration (FDA) delays in implementing the 2011 Food Safety Modernization Act have put Missouri lives at risk and cost the country $22 million in economic costs, according to a new report by MoPIRG Foundation.
This report offers a snapshot look, from October 2012 to October 2013, at multistate foodborne illness outbreaks identified by the Center for Disease Control and Prevention (CDC). Failures in the rules and processes that protect our food supply have led to numerous serious outbreaks over the past year that left many Americans sickened and at least 2 dead. The economic cost of just the multistate outbreaks caused by food products recalled over the past 12 months comes to more than $22 million.