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Portugal and Spain Tour Packages
Portugal and Spain Tour packages are cost effective, pre-planned itineraries tailored to visitors wishing to see the best Portugal has to offer. Portugal tour packages optimize the cost of multiple services such as transfers, transportation, hotels, entry to events and in some cases include meals. Portugal package tours and itineraries are available for those who prefer to join a group tour or for those who would like to explore on their own with pre-booked hotels and rental car.
Azores Islands Getaways
Cooking Tours
Fatima and Santiago
Guided - Mainland Portugal
Guided - Portugal & Spain
Guided - Small Group
Portugal, Spain, Morocco
Private Guided Getaways
Self-Drive Itineraries
Self-Guided Escapes
Portugal Day Tours
Portugal day tours consist of private and regular tours for those looking to forego GPS and maps or wanting to avoid wasting precious hours looking for places and attractions, or worst, getting lost. Choose from the privacy of a chauffeured vehicle or the fun of joining others in motor-coach rides while exploring the greatest corners of Portugal. If you wish to extend your tour a few days,
Amazing Azores
Discover the Culture
Experience Madeira
Lisbon and Central
Discover Algarve
Wild Water Sports
Portugal is located on the west side of the Iberian Peninsula, ideally positioned between Spain and the Atlantic ocean. Its geographic location along the Atlantic coastline is the reason why quickly became an ocean-bound country setting the stage for centuries of sea adventure and discoveries.
All Portugal Information
Budget Friendly Spain, Portugal and Morocco
Getting the best prices for you!
On this Spain, Portugal, and Morocco tour, experience these three glorious countries with rich histories and distinct cultures. You'll overnight in Madrid, Seville, Granada, and the Costa del Sol in Spain; Coimbra and Lisbon in Portugal; and Rabat, Marrakesh, and Fez in Morocco.
Cross the Strait of Gibraltar to Morocco on the African continent by ferry. Step back in time in Rabat, a UNESCO World Heritage Site and Morocco's capital since 1912, where you'll see the Chellah Gardens and Casbah des Oudaias. Fez is still Morocco's cultural and spiritual center, and its centerpiece is the Medina, a UNESCO World Heritage Site founded in the 9th century and whose palaces, madrasas (institutions to study Islamic theology), fondouks (medieval inns used by merchants when they visited Marrakesh), residences, mosques, and fountains date back to the 13th-14th centuries. Also founded in the 9th century, the red city of Marrakesh remains a tapestry of ramparts, mosques, palaces, gardens, vibrant public squares, and souks (markets). You'll see the city's highlights on the included city tour with a local expert. You'll also stop in Casablanca, Morocco's westernmost city.
We also include a guided visit to Granada's legendary Alhambra complex, a lavish palace and fortress built by Moorish kings in 889 AD; a visit to Avila, a UNESCO World Heritage Site with its ancient fortified towers and walls; and the Sanctuary of Fátima, where the Virgin Mary appeared to three local children in 1917. Local experts will show you the main sights in Madrid, Lisbon, Seville and you will have time at leisure to try the local specialties.
These are just some of the many highlights on this comprehensive Spain, Portugal, and Morocco tour. It's a memorable vacation for value-mind travelers.
Day 1 - Arrive in Madrid, Spain
Check into your hotel. The rest of the day is free to start exploring lively Madrid. Tonight, meet your Tour Director and fellow travelers.
Day 2 - Madrid
Spaniards say the Spanish capital, situated 2,180 feet above sea level, is the nearest thing to Heaven. It's certainly worth making the most of today by joining the included guided sightseeing tour: a full panoramic drive by way of the Avenida Mayor, Puerta del Sol, Parliament Square, and a picture stop outside the Royal Palace. The optional trip to Toledo is most rewarding, too. The splendid setting of this old walled city above the Tagus was made famous in El Greco's painting, and even now it's like a great open-air museum of Spanish history and art.
Day 3 - Madrid – Avila – Salamanca – Coimbra, Portugal
Visit ancient fortified Avila with its many towers, a UNESCO World Heritage Site. Continue to Salamanca and make sure you spend some time wandering around Plaza Mayor, the grandest square in Spain. Cross the frontier to Guarda, the highest town in Portugal. From here, descend to the valleys of the Serra da Estrela to Coimbra.
Breakfast and Dinner included.
Day 4 - Coimbra – Fátima – Obidos – Lisbon
Enjoy an orientation tour of Coimbra, celebrated for its beauty and ancient university. Later, travel southwards to visit the Sanctuary of Fátima, one of Europe's most celebrated Marian shrines. Continue to fortified Obidos, one of the most picturesque towns in Portugal, before reaching Lisbon for two overnights.
Day 5 - Lisbon
Henry the Navigator made Lisbon the 15th-century "Mistress of the Seas." On the included guided tour, see his monument, the Belem Tower, the Moorish Citadel, and the impressive Black Horse Square. Spend the afternoon at leisure—maybe in the Alfama's tile-decorated streets, or take an optional excursion to coastal Estoril and Cascais.
Day 6 - Lisbon – Seville, Spain
From the rolling plains of the Alentejo with its woodlands of cork and eucalyptus trees, head southwards all the way to the brilliant light of Andalusia. Admire its neat, white-painted villages and sun-drenched plantations of olives, figs, and almonds while traveling towards magnificent Seville.
Day 7 - Seville
Enjoy an included sightseeing tour of the city's main highlights, such as the cathedral, Alcázar, and Plaza d'España. Afternoon at leisure.
Day 8 - Seville – Ferry to Morocco – Rabat
Drive through Spain's pretty sherry wine region and head south to the coast. Here, you will embark the ferry and cruise across the Strait of Gibraltar to Morocco on the African continent. Travel along what was once the infamous Barbary Coast, then continue the drive south to Rabat, one of Morocco's imperial cities.
Day 9 - Rabat – Casablanca – Marrakesh
Today starts with an included guided city sightseeing tour of the country's lively capital, including a visit to Chellah Gardens and Casbah des Oudaias. Later, reach Morocco's westernmost city: Casablanca. Enjoy an orientation drive in this modern city and see the illustrious Hassan II Mosque—perched dramatically on a platform over the Atlantic Ocean. One of the largest mosques in the world, its minaret soars 689 feet into the sky and part of the mosque's floor is made of glass so worshipers can kneel directly over the ocean's waters. Continue on to the "red" oasis city of Marrakesh. An optional excursion this evening is the perfect end to the day.
Day 10 - Marrakesh
Today's included city sightseeing with a Local Guide will make you feel like you've been whisked back in time. Founded in the 9th century, Marrakesh remains a tapestry of ramparts, mosques, palaces, gardens, and vibrant public squares and souks (markets)—where buying and selling and a fascinating carnival of entertainment occurs daily. Also see the Bahia Palace and Saadin Tombs.
Day 11 - Marrakesh – Fez
Today, travel through the fragrant cedar forests of the Middle Atlas mountains, where a number of peaks soar above 13,000 feet in elevation. This range is home to the endangered Barbary ape, as well as wild boar and polecats. On your way north to Fez, enjoy glimpses of North African village life.
Day 12 - Fez
Ancient Fez is a city of outstanding scenic beauty. Visit the Medina during included sightseeing this morning, and enjoy the maze of narrow streets through the colorful bazaars and exotic atmosphere. The madrasas, fondouks, palaces, residences, mosques, and fountains dating back to the 13th century are now UNESCO World Heritage Sites. In the afternoon, explore further on your own.
Day 13 - Fez – Ferry Crossing to Spain – Mijas
Today, an early departure takes you north for the FERRY back to mainland Spain to the Costa del Sol (Coast of the Sun). Overnight in Mijas.
Day 14 - Mijas – Granada
Travel along the Costa del Sol and head to Granada in the heart of Andalusia. On the agenda: an included guided visit of the Alhambra Complex, a lavish palace and fortress built by Moorish kings. You'll marvel at its architectural Moorish beauty and magnificent gardens, with construction dating back to 889 AD.
Day 15 - Granada – Madrid
Travel through the very heart of Don Quixote's La Mancha, famed for its castle and windmills. Before arriving in Madrid, visit a local wine cellar and taste some of the locally produced wines.
Day 16 - Madrid
Your vacation ends with breakfast this morning.
Hotels. Please click on "Hotels" tab to see hotel descriptions
Buffet breakfasts daily
Headsets throughout the tour
Vacation Highlights
Madrid - guided sightseeing
Ávila & Salamanca - visits
Coimbra - orientation
Fátima - visit the Sanctuary
Obidos - visit
Lisbon - guided sightseeing
Seville - guided sightseeing
Rabat - guided sightseeing
Casablanca - orientation drive
Marrakesh - orientation drive
Fez - guided sightseeing
Granada - guided visit of the Alhambra Complex
La Mancha - Visit a wine cellar
April 20 Departure – Easter
May 4 Departure - Feria in Seville
December 22 Departure – New Year's in Marrakesh including festive dinner
Entrance to the Nasrid Palace is not guaranteed
Rates are per person in US dollars
Rates can change without previous notice
Dates shown are for tour land departure. If you are taking an overnight flight to reach the tour departure city plan to book your flight one day earlier than date shown on table
Rates do not include cost of flight. Please indicate in the reservation process that you want flight and a quote will be submitted for your review.
Single Superior
3/7/2020 $2689 $2089
3/21/2020 $2749 $2149
10/1/2020 $2849 $2249
10/10/2020 $2849 $2249
Request price information for 2021
Single = 1 Person per room
Double = 2 Persons per room
Triple = 3 Persons per room
2020 Departures: the above prices listed for 2020 departure dates are early bird rates. Booking must be made and under deposit before December 2, 2019 to secure these rates. Not applicable to custom tours. Discount will apply to individual members of groups adding a name and non-refundable per person deposit WITHIN the promo window. Not applicable on TBA space. Applies to new 2020 bookings only. Offer reliant on space availability. Full cancellation penalties will apply. Additional restrictions may apply. May be withdrawn any time.
Booking your land only Tour Package
Tour departures, itineraries and prices are subject to change.
A non-refundable deposit of $250 per person is required to reserve and hold space for you.
Final payment is due 45 days before departure
Booking your Tour with Air
For this package Air is only available to passengers traveling from the United States and only available when booked in conjunction with a land tour package.
An additional $300 per person non-refundable air deposit is required for Air booked in conjunction with any land tour package. Air can only be booked by us in conjunction with a land tour package.
If a booking cancellation is received prior to the final payment date of your tour, your non-refundable land deposit and Travel Protection payments will be retained in addition to your Air deposit, Instant Purchase Air payment and service fee, and/or Intra-vacation air deposit. For individual reservations, the following per person cancellation fees apply. Standard Cancellation Fees:
45 days and over - Deposit
Cancellation 45-22 days prior to commencement of services: 20% of total price
Cancellation 21-8 days prior to commencement of services: 30% of total price
7-1 days prior to commencement of services: 50% of total price
On departure day and later: 100% of total price
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If you don't plan to book at this time please click here to contact us with any questions or concerns about your trip or your holiday
A fee of $35 per person, per transaction, will be charged for any revision or alteration made to a reservation after the booking is confirmed.
Provided by state-of-the-art Motorcoach Buses with air conditioning, headsets, individual lightening, and very comfortable seating. Plenty of legroom even for the tall travelers. Reclining seats and foot rests. Up to 45 People.
Note: Hotels shown are for reference only. We reserve the right to change hotels based on availability, group size or other factors. Should alternate hotel be required, it will be of same or better rating .
Granada - Abba Granada
Located just 1,000 feet from the train station, the Abba Grandada features an outdoor pool, a fitness room and a spa with a Turkish bath, hot tubs and saunas.
Abba Granada is next to Fuente Nueva Park and the University of Granada. The historic Albaicin district and Granada Cathedral are around half a mile away.
Each air-conditioned room has modern décor and elegant dark wood furniture. Bathrooms come with toiletries and a hairdryer. Free Wi-Fi is available throughout the hotel.
The staff at the hotel's 24-hour front desk are happy to provide information about the city.
The hotel's Abba Mia restaurant serves Italian and international food. You can try typical tapas in the lively Elvira Street, a 10 minute walk away.
Mijas - Hacienda del Sol
Situated on a quiet hillside between the towns of Mijas and Fuengirola, The Ilunion Hacienda del Sol features outdoor pools, a sauna and a fitness center. Free Wi-Fi is also available throughout the hotel.
The bright and spacious rooms at Ilunion Hacienda del Sol are decorated in neutral tones, and feature wooden floors, air conditioning, a flat-screen TV, and a minibar. The private bathroom comes with a hairdryer and free toiletries.
Family rooms feature a separate seating area with a sofa bed. There are also rooms adapted for guests with reduced mobility.
The restaurant serves a healthy buffet breakfast, while typical local dishes are offered for lunch and dinner. Drinks and snacks are available at the cafeteria and the pool bar.
The Ilunion Hacienda del Sol provides easy access to the AP-7 motorway, and Fuengirola beaches are only 4.3 miles away. Free private parking is available on site.
Coimbra - Hotel D. Louis
Hotel D. Louis is located near the center of Coimbra and and offers breathtaking panoramic views over the city.
The hotel's guest rooms feature seating areas where guests can relax and watch satellite TV. Each is fitted with a mini fridge.
Hotel D. Luís' restaurant offers picturesque views and an extensive range of traditional, regional and international cuisine. After dinner, guests can unwind on the terrace with a drink from the bar.
Portugal dos Pequenitos is less than a 5-minute drive away. A car rental service is provided by Hotel D. Luís and free private parking is available on site. A shuttle service to the city centre is provided for guests of the hotel.
Seville - Hotel Don Paco
Located in the heart of Seville, Hotel Don Paco is just a 10 minute walk from the cathedral and Giralda Tower. It features a rooftop swimming pool and patio with excellent views of the city.
The stylish, air conditioned rooms at the Don Paco have hardwood floors and flat-screen satellite TV. There is a safe and a fridge, and the private bathroom comes with a hairdryer.
Local and international dishes are served in the hotel's buffet restaurant, and there is also a bar.
There is a 24-hour front desk and a free Wi-Fi zone. You can rent a bike or car from the tour desk, and parking is available nearby for an additional charge.
Old Town is a great choice for travelers interested in architecture, tapas and food.
Rabat - Hotel Mercure Shéhérazade Rabat
Located in the heart of the Moroccan capital of Rabat, this Mercure offers quality and comfort in the residential quarter of Hassan. Free Wi-Fi is available throughout the hotel.
The hotel features comfortable and functional accommodations. The air-conditioned guestrooms are stylish, modern and feature satellite TV, a safety deposit box and a mini-bar.
The restaurant, Kangourou Grill, serves international cuisine and, in the summertime, you can enjoy your meals on the terrace. The Aladin bar is also available for a relaxing drink.
Mercure Shéhérazade is just 5 minutes from the main historic area with its monuments and business center. It is also very close to a beautiful golf course and the international airport.
Madrid - Hotel Praga
Hotel Praga is a 10-minute walk from MarquEs de Vadillo Metro Station, around 4 km from central Madrid, and has easy access to the A-42 and M-30 Motorways.
All air-conditioned rooms at the Praga have satellite TV, a pillow menu and minibar. The private bathroom comes with a hairdryer. Free Wi-Fi is also available.
CafE Praga offers a range of cuisine, and also serves set menus for lunch from Monday to Friday. Room service is also available.
Bus 23 stops outside and connects guests to Plaza Mayor and Caja MAgica Sports and Leisure Center in 10 minutes. Vicente CalderOn Stadium is a 15-minute walk away.
MarquEs de Vadillo is just 6 stops from Gran VIa. Atocha Railway Station and the High-Speed AVE Railway can be reached in 5 minutes by car.
Madrid's famous Art Triangle, consisting of the Prado, Reina Sofía and Thyssen-Bornemisza Museums, is just 5 minutes' drive from the hotel. You can hire a car at the tour desk, and private parking is available for an extra charge.
Carabanchel is a great choice for travelers interested in business, ambiance and football.
Lisbon - Hotel Roma
Located in Lisbon's exclusive Alvalade district near many theaters and restaurants, Hotel Roma offers spacious rooms with free Wi-Fi. It features a solarium and an on-site restaurant serving international fare.
All of Hotel Roma's rooms feature satellite TV, work desk and a private bathroom with tub. Some room types also have a private balcony and a separate seating area.
Roma's restaurant offers a varied menu of meals, in addition to a fine selection of Portuguese wines. Room service is also available.
The hotel is just 5 minutes' walking from Roma Metro Station and Lisbon Portela Airport can be reached in 10 minutes by car.
Fez - Menzeh Zalagh
Menzeh Zalagh features sophisticated rooms with private bathrooms just 9 minutes from Saiss airport in central Fez. It offers an outdoor swimming pool, a hammam and a beauty salon.
The air conditioned rooms at Menzeh Zalagh have a flat-screen TV and a private balcony. Each bathroom has a bathtub or a shower.
The oasis-like garden at Menzeh Zalagh provides a large outdoor swimming pool. Guests can relax on lounge chairs or make use of the poolside barbecue facilities and snack bar.
Inside, the hotel has two restaurants serving Morrocan and international cuisine and a pizzeria. There is also a nightclub and a second bar with comfortable armchairs for a quiet drink.
The hotel has a fitness center, a sauna and a hammam on site. A local thermal spa, Moulay Yaakoub, is just 9 miles away.
Menzeh Zalagh is 2.5 miles from the Medina or historic walled town and it can be reached by foot in 15 minutes. Free private parking is available on site.
Madrid - NH Madrid Ventas
The contemporary NH Madrid Ventas is located 1,000 feet from Madrid's bullring and Ventas Metro Station. It offers tennis courts and a seasonal outdoor pool set within gardens.
Modern rooms at the Ventas are air-conditioned and include a private bathroom with a bathrobe and hairdryer, as well as a welcome toiletries kit. They also offer free WiFi, a mini-bar, safe and a flat-screen TV with satellite channels.
A free coffee service is available and guests have free access to the on-site fitness center.
Tendido Siete, the hotel's restaurant, offers a range of healthy breakfast options, as well as meals that guests can enjoy on the terrace. There is also a bar, the Park Avenue, with a wide selection of cocktails and tapas.
Other facilities available include 8 event rooms with capacity for up to 1000 people. There is also an exterior tent for events, available all year round.
The M30 ring road is 1,000 feet away, providing easy access to the city center and surrounding areas. Madrid Barajas Airport is approximately 5 mi away, and you can reach central Madrid in 15 minutes on public transport. You can find a commercial area within 350 feet of the hotel.
Marrakesh - Zalagh Kasbah Hotel & Spa
Situated in southern Marrakesh near the Agdal Gardens, the Zalagh Kasbah offers an outdoor swimming pool, a fitness room, and free shuttle service to Jamaâ El Fna Square.
The air-conditioned guest rooms at this 4-star hotel have modern décor. Each spacious room features a large balcony with views of the Atlas Mountains. All rooms come with a minibar and flat-screen TV.
Zalagh Kasbah Hotel & Spa features a restaurant serving international cuisine and a snack bar. Breakfast is served every morning in the breakfast room.
Additional services include a spa center with a hot tub. Free Wi-Fi access is available in the public areas of the hotel.
With free private parking available on site, the Zalagh Kasbah is just an 11-minute drive from Menara Airport.
16 Night Portugal, Spain and Morocco
From $3323 per Person
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17 Days/ 16 Nights. Combine a visit to North Africa by visiting Morocco along with Portugal and Spain
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12 Nights South Iberian Tour with Morocco
13 Days/12 Nights. A favorite vacation for those wanting to discover the best of Portugal and Spain. A night in Morocco caps this unforgettable great holiday.
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Comfort: May include 3 star tourist class, 3 star superior, and 4 star tourist class hotels
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Q: RTC Jazz Build - Stale workspace I work in a multi-person team with many developers delivering changes to the same stream. Each developer works on their own repository which flows into a main stream. I then have multiple build definitions for each of the environments we need to deploy to. Each build definition also has its own repository which flows to main
The problem we've noticed is that sometimes the build repository/workspace is not picking up the latest changes from each developer.
Can someone suggest a reason why this may be happening? I've checked that everyone is using the correct flow target, the team is distributed (China, Europe, US) but i'm guessing latency is hardly a concern.
Update: I was using the same build work-space across multiple build definitions which is not a recommendation. I changed this and have not had any issues since.

A: Latency shouldn't matter because the deliver operation is atomic, and your build monitors a stream.
So you need to check if the build definition is similar to one described in "Continuous Integration with Rational Team Concert and Microsoft Visual Studio" (based on RTC4.x though), with, for instance, a periodic schedule:

redpajama_set_name: RedPajamaStackExchange


Membership is unrestricted and opened to those who are interested in the field of microscopy and characterization. The society also welcomes instrument manufacturers and vendors as it can provide an opportunity for advertising latest equipment to a keenly interested audience and to obtain customer reaction directly. The society believes in facilitating the bridging of knowledge in research and industries among the members.
Registration can be done with the downloaded application form.


Hassle-free application form takes just a few minutes to complete - no paperwork!
Once approved, expect the money to arrive to your bank account - easy as that!
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Background: Compared to women's health providers, primary care physicians are less likely to provide contraceptive counseling and are more likely to provide preventive counseling. We evaluated clinical visits with both preventive and contraceptive counseling, to identify the potential of integrated health services.
Methods: Procedure and diagnosis codes were used to identify annual or family planning visits of women aged 13-49. Five managed care plans identified providers with at least fifteen of these visits in 2013. We abstracted 1,054 visits and performed a multilevel logistic regression analysis, with clinic site as the level-2 random effect, controlling for age, visit reason, clinic specialty, and non-contraceptive service.
Results: In 134 visits, both contraceptive and preventive counseling occurred. Women were more likely to receive both types of counseling when they had family planning (OR=5.9, 95% CI=2.7-12.7) or reproductive health (OR=3.1, 95% CI=1.6-6.0) visit reasons; received non-contraceptive services (OR=2.6, 95% CI=1.3-5.3) or visited multispecialty clinics (OR=38, 95% CI=4.9-273.9) and less likely if women were referred for primary care services (OR=0.1, 95% CI=0.1-0.9).
Conclusion: Combined counseling occurs mainly in family planning visits and when preventive health is included in the visit rather than referred out. Clinicians at multispecialty sites are more likely to integrate contraceptive and preventive counseling than those at family planning or primary care clinics. Annual visits represent a valuable opportunity to provide both types of counseling.
The 2010 Affordable Care Act (ACA) elevated disease prevention as a national priority, requiring that health plans cover a variety of preventive screening and counseling services without co-payment [1,2]. According to ACA guidelines, preventive services comprise screening and counseling for obesity, substance use, sexually transmitted infections (STIs), and cervical cancer. Contraceptive counseling and service provision are also included under the umbrella of "preventive services" . Yet, provision of preventive health and contraceptive counseling tend to occur in separate contexts.
Primary care physicians, including family medicine, internal medicine, and adolescent medicine clinicians, represent the first point of contact for persons with a wide range of health concerns, providing health promotion, disease prevention, and counseling services in a variety of settings. They often collaborate with other health professionals and obtain appropriate consultations or referrals [1,4]. Despite this broad definition, only a low percentage of primary care providers administer contraceptive counseling during clinical visits. Numerous barriers may result in this gap in care, including competing preventive and acute health needs in the primary care setting [5-7]. Providers have inadequate time to address patients' numerous family planning needs, they may be unprepared for detailed conversations regarding contraceptive methods, or they may believe that these responsibilities belong to specialists [8-10].
For women of reproductive age, well-woman visits or annual check-ups may represent appropriate occasions to provide counseling on contraceptive options in conjunction with other preventive health behaviors. Furthermore, visits that address treatment of chronic diseases should include conversations about contraception as part of preconception care, because hormonal contraceptive methods may interact with drugs used to treat certain chronic conditions, and because taking teratogenic medications may require avoidance of pregnancy .
Clinical guidelines for family planning providers recommend incorporating preventive health care topics into preconception care . During family planning visits, physicians should address aspects of general well-being, including management of mental health, weight, and chronic illnesses. Preconception health services include counseling on topics such as domestic violence, STI prevention, and effective usage of contraceptive methods [12,13]. A 2013 survey of publicly funded clinics found differences in the self-reported delivery of preconception care services by clinic type .
By integratingffairsion Disease Control and Preventionttingian/gynecologists are more likely to provide these ing impairments, older adults0or preventive and contraceptive services, providers can promote comprehensive, coordinated care and facilitate the improvement of maternal and infant health outcomes, focusing on individuals who have difficulty accessing care outside of family planning visits . Women with medical conditions may not go to a family planning provider in addition to their specialist. However, the extent and context in which this integration occurs is not known.
As part of a larger medical record review assessing the quality of family planning services in primary care clinics, we identified characteristics of Medi-Cal (California's Medicaid program) managed care visits that provided both contraceptive and preventive health counseling during the same encounter. Specifically, we wanted to determine whether visits offering both contraceptive and preventive health counseling differ by provider specialty or by the reason for the visit.
Our research questions were designed in response to community members'  concerns that women who enrolled in Medicaid due to the Affordable Care Act implementation receive sufficient family planning services and counseling when they interact with their primary care providers.
Five Medi-Cal Managed Care plans participated in the study using sampling procedures designed to identify reproductive health visits in primary care clinics. With the plans' medical directors, we identified outpatient primary care and OB/GYN clinics that were not enrolled in California's Family Planning, Access, Care, and Treatment (Family PACT) program, as the quality of Family PACT providers had been assessed in the 2011 UCSF Family PACT evaluation [7,15].
The study cohort consisted of all providers affiliated with one of the five plans and who served at least 15 female clients ages of 13 and 49 with a family planning service or annual/well-woman visit at outpatient office visits in 2013. Visits were identified using a list of CPT codes, ICD-9-CM diagnosis codes, and ICD-9-CM procedure codes.
Medical directors from each plan sent letters introducing the study to eligible providers. Upon agreement to participate, providers were interviewed by telephone about main clinic characteristics and received client lists with visit dates of the first consecutive eligible women seen in 2013 for the abstraction.
Trained nurse abstractors collected data using iPads preloaded with survey questions that aimed to assess characteristics of clients and clinical visits. The custom iPad application used for the 2011 Family PACT MRR  was updated for the iPad 10.0 version. Completed surveys were transmitted to the UCSF Research Electronic Data Capture (RedCap) server. All data analyses were performed with SAS 9.4.
The main outcome variable included visits where both contraceptive and prevention counseling were documented. Topics covered during contraceptive counseling included counseling on any reversible or permanent contraceptive methods, including natural family planning and emergency contraception. Prevention counseling topics included preconception care, folic acid use, STI and HIV prevention, cervical cytology, mammograms weight management, intimate partner violence, alcohol, tobacco, or substance use, and chronic disease management. A binary variable was created to highlight visits during which both prevention and contraceptive counseling were provided.
Visits were categorized based on four primary reasons for the visit: family planning, reproductive health, annual well-woman visits, and primary care. Reasons for the visit were grouped according to the chief complaint of the patient and the clinician's documented reason for the visit. If there was more than one reason, each visit reason was counted separately. Visit reasons were not strongly correlated with each other, with correlation coefficients ranging from -0.32 to 0.03. We also assessed whether women had more than one reason of visit.
Clinic-reported provider specialties were assigned to three mutually exclusive categories: Primary care (i.e. family medicine, internal medicine, adolescent medicine), OB/GYN/women's health, and multispecialty (two or more specialties at the clinic).
Patient age was categorized into women under 20 years, 20-29 years, and women 30 years and older. A binary variable was created to describe whether a non-contraceptive medical service was provided at the visit. Non-contraceptive medical services included the provision of immunizations and non-contraceptive drugs; treatment of an injury or acute or chronic illness; or pregnancy.
Referrals for preventive or reproductive health services included mammography, domestic violence services, substance abuse management or smoking cessation services, and other gynecological services.
SAS 9.4 Proc GLIMMIX was used for a multi-level logistic regression analysis with clinic site as the level-2 random effect. The study was approved by the University of California, San Francisco (UCSF) Institutional Review Board, the California Health and Human Services Agency (CHHS) Committee for the Protection of Human Subjects, and the California Department of Health Care Services (DHCS) Data Research Committee (DRC).
Overall, 1,244 charts from 63 clinics were abstracted, representing 18 counties in California. After excluding ineligible charts (women who had previously received a sterilization procedure or hysterectomy, or were in the sample due to coding errors), we kept 1,054 charts for the analysis.
The majority (75%) of clinics described themselves as having a primary care specialty, whereas only 15% had multiple specialties, and 10% identified as having an OB/GYN or women's health specialty. Women were on average 28 years old, with the largest proportion (42%) in the 20-29 age range. A fifth (21%) were adolescents and 37% were between 30-49 years.
Three plans could not provide information on race/ethnicity, which is kept in enrollment files that are not easily linked to the medical records. Of the 516 charts with race/ethnicity available, 42% were Hispanic. Parity was documented in only 522 of the charts. Where documented, most women had at least one child, and a third (34%) had three or more children (Table 1).
Table 1. Reported clinic specialties and documented patient demographics.
Two thirds (65%) of the visits had one visit reason and 35% two or more reasons. Visit reasons were mainly family planning (46%), annual/new visits (44%) and primary care visit reasons (41%). A smaller percentage (15%) of visits had a reproductive health visit reason. Having more than one reason of visit was highly correlated with annual visit reason (r=.78). Women presented often with more than one reason of visit. While clinicians working at clinics with primary care specialty had mainly primary care and annual/new visit reasons (47% each), they also had a large proportion of visits (37%) with family planning reasons. Correspondingly, visits to clinics with OB/GYN or women's health specialties primarily had family planning as the reason of visit (65%), but also included annual/new visits (25%), and primary care (17%) visit reasons. The distribution of visit reasons at multi-specialty clinics included family planning as the reason of visit (75%), annual/new visits (43%), reproductive health (29%), and primary care (25%) (Table 2).
Table 2. Reason for patient visit stratified by reported clinic specialty and number of visit reasons (n=1,054).
Contraceptive counseling, method provision, and referrals tended to occur more often in visits that had a family planning visit reason. For instance, 43% of charts with a family planning visit reason included documentation of contraceptive counseling, compared to 5% in visits with an annual health visit or primary care visit reason. In contrast, charts that had a primary care visit reason or annual health visit reason had higher percentages of referrals for follow-up primary care visits, provision of non-contraceptive medical services, and preventive health counseling (Figure 1).
Figure 1. Provision of preventive and contraceptive counseling by visit reason (n = 1054).
*Not included in multivariable model due to a high correlation with annual visit reason.
Overall, 134 visits (13%) included both contraception and preventive health counseling during the same session. Provision of contraceptive and preventive counseling were not correlated (Phi = 0.14). Women who presented with more than one reason of visit were slightly more likely to receive contraceptive and preventive counseling (19%) than women with only one reason of visit (9%).
A multilevel logistic regression model was constructed to assess the characteristics of client visits in which both preventive and contraceptive counseling occurred (Table 3).
Table 3. Associations between service, provider, and client characteristicsa and provision of both contraceptive and preventive counseling (n = 1054).
aIndependent variables: visit reason, referral for care, age, provider specialty.
In the multivariable analysis, women with a family planning visit reason had 5.9 times the odds of receiving both preventive and contraceptive counseling compared to those who did not have this visit reason, when controlling for age, clinic specialty, non-family planning service and referral (OR = 5.9, 95% CI = 2.7-12.7). Similarly, women with a reproductive health visit reason were about 3 times as likely to receive both counseling types compared to women with all other types of visit reasons. Yet, having a primary care or new/annual visit reason did not appear to significantly affect the likelihood of receiving both types of counseling. There were no differences by age in the odds of having integrated counseling.
Women who received a non-contraceptive medical service during their clinical visits had about three times the odds of receiving preventive and contraceptive counseling (OR = 2.6, 95% CI = 1.3-5.3). However, women who received primary care referrals were significantly less likely to receive both preventive and contraceptive care (0.3, 95% CI=0.1-0.9).
Women who were seen by a clinician at a multi-specialty clinic were significantly more likely than those seen at family planning specialty clinics to receive combined preventive and contraceptive counseling (OR = 36, 95% CI = 4.9-273.9). There was no significant difference in the likelihood of receiving both types of counseling between those seen at primary care and family planning specialty clinics.
Clinical practice guidelines encourage coordinated care across specialties and the integration of preventive and family planning topics in primary and women's health care [3,16]. Comprehensive counseling reduces the need for multiple medical visits and prevents fragmented health messages. The Affordable Care Act included access to contraception into the list of women's preventive health services . Preconception care topics that should be discussed with reproductive age women include preventive health topics such as weight management, smoking cessation, and management of chronic diseases . In our medical record review, a third of the women presented to their managed care visits with more than one visit reason. Yet, only one in eight women (13%) received preventive health and contraceptive counseling at the same visit. This percentage was only slightly higher (19%) for women presenting with more than one visit reason.
Women with a family planning or reproductive health visit reason were more likely to also receive counseling on primary care topics, consistent with clinical practice standards for family planning visits . Yet, visits with primary care visit reasons rarely combined contraceptive and preventive counseling topics. There were missed opportunities to address women's contraceptive needs during annual well-woman visits where the discussion of preventive health behaviors is likely to occur and where women are likely to present with more than one visit reason. In addition, when prescribing medications with interactions or teratogenic side effects, clinicians need to address the effects of contraceptives, including potential drug interactions, on women's fertility and chronic disease management. This is often not the case, and subspecialists may initiate medications important for women at risk of pregnancy (e.g. insulin, anti-infectives, or drugs that are teratogenic or affect fertility) without assessing contraceptive usage or providing contraceptive counseling [8,11,19].
The work setting may play a role in the provision of counseling. Clinicians tend to provide contraceptive counseling if they work alongside colleagues who have training in women's health . In this chart review, contraceptive and preventive counseling topics were more likely to be provided in an integrated form by clinicians at multi-specialty clinics than by those working at clinics with family planning or primary care specialties. Clinicians who can consult with colleagues of other specialties in the medical office may feel more comfortable discussing cross-specialty topics. As healthcare delivery moves toward coordinated care models such as the patient-centered medical home , it may become easier to address several topics during a clinic visit.
This analysis is limited to variables that can be retrieved from the abstracted medical records and may underestimate referral or counseling services if they were not recorded. Additionally, we could not include race/ethnicity or parity in the multivariable model due to high percentages of missing values. Furthermore, a chart review does not assess client preferences or concerns and whether these have been appropriately addressed in the patient-provider interaction. Chart review information on counseling needs to be complemented with patient feedback to determine counseling quality.
As managed care providers serve more women in need of reproductive health services, primary care visits provide the opportunity to counsel on contraception and preconception care in addition to preventive health counseling. Annual and well-woman visit, in particular, represent an underused opportunity to provide comprehensive client-centered counseling services and to facilitate prevention of unintended pregnancies and promotion of optimal women's health.
Regardless of specialty, clinicians should address preventive and preconception counseling topics in women's health visits and family planning counseling during annual well-woman and primary care visits.
We would like to thank Larry Suarez, software developer at 11Health Inc., for helping us modify the abstraction tool for the new iPad version.
This study was prepared by the University of California, San Francisco, Bixby Center for Global Reproductive Health and was supported by funding from an anonymous foundation. Additional support was provided by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR001872. The publication's contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. All analyses, interpretations, or conclusions are those of UCSF.
Sonfield A (2012) Beyond contraception: The overlooked reproductive health benefits of health reforms preventive services requirement. Guttmacher Policy Rev 15: 18-24.
US Department of Health and Human Services. Preventive services covered under the Affordable Care Act, 2014. http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/preventive-services-covered-under-aca (accessed 11 December 2016).
Gavin L, Moskosky S, Carter M, Curtis K, Glass E, et al. (2014) Providing quality family planning services. MMWR Morbidity & Mortality Weekly Report 63:1-54.
AAFP Policies Website, Primary Care. http://www.aafp.org.ucsf.idm.oclc.org/about/policies/all/primary-care.html (accessed 11 December 2016).
Robinson R, Reiter J (2007) Behavioral consultation and primary care. Springer Science + Business Media, LLC.
Thiel de Bocanegra H, Watts L, Menz M, Rao S, Darney P (2013) The 2011 Family PACT Medical Record Review: Assessing the Quality of Service. Sacramento, CA: Bixby Center for Global Reproductive Health. University of California, San Francisco, CA.
Essential Access Health Women and Health Care Reform Coalition. Pathways to Coverage and Care: Fufilling the Promise of Health Care Reform for Women. Los Angeles, 2016. http://www.essentialaccess.org/sites/default/files/Essential-Health-WHCR-Focus-Group-Report-20160822.pdf Accessed: June 5, 2017.
California Department of Health Care Services. Family PACT, 2016. http://www.familypact.org/Home/home-page (accessed 12 February 2016).
March of Dimes, Implicit Interconception Care Toolkit, 2017. https://prematurityprevention.org/Toolkits-Reports/IMPLICIT-interconception-care-toolkit (accessed 15 April 2017).
Centers for Disease Control and Prevention, Preconception Health and Health Care, Content of Care for Women: Every Woman, Every Time, 2014. https://www.cdc.gov/preconception/careforwomen/index.html (accessed 15 April 2017).
Nielsen M, Olayiwola JN, Grundy P, Grumbach K, Shaljian M (2014) The Patient-Centered Medical Home's Impact on Cost & Quality: An Annual Update of the Evidence, 2012-2013. Patient-Centered Primary Care Collaborative.
©2017 Thiel de Bocanegra H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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48. The Beach (I) (2000)
R | 119 min | Adventure, Drama, Romance
Vicenarian Richard travels to Thailand and finds himself in possession of a strange map. Rumours state that it leads to a solitary beach paradise, a tropical bliss. Excited and intrigued, he sets out to find it.
Director: Danny Boyle | Stars: Leonardo DiCaprio, Daniel York, Patcharawan Patarakijjanon, Virginie Ledoyen
49. The Magnificent Seven (1960)
Approved | 128 min | Action, Adventure, Western
Seven gunfighters are hired by Mexican peasants to liberate their village from oppressive bandits.
Director: John Sturges | Stars: Yul Brynner, Steve McQueen, Charles Bronson, Eli Wallach
50. The Jungle Book (1994)
PG | 111 min | Adventure, Family, Romance
Rudyard Kipling's classic tale of Mowgli, the orphaned jungle boy raised by wolves, and how he becomes king of the jungle.
Director: Stephen Sommers | Stars: Jason Scott Lee, Cary Elwes, Lena Headey, Sam Neill

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Getting Syntax Error for update query in mysql Error:
> #1064 - You have an error in your SQL syntax; check the manual that corresponds to your MariaDB server version for the right syntax to use
> near 'where `membership_num`='1'' at line 1

Query:
   UPDATE `MEMBERSHIP`
    SET `member_id`= 2,
        `sales_id`=1,
        `duration`='3 شهور',
        `start_date`='2016-10-16',
        `end_date`='2016-10-16',
        `membership_cost_before`=500,
        `discount`=0,
        `member_ship_cost` =500,
        `membership_type` ='Silver',
        `amout_done` =500,
        `amount_reminder` = 0,
        `trainer_id` =
     WHERE `membership_num`=1

A: trainer_id = where membership_num=1

You have to specify what trainer_id is. Right now you just have an = sign with nothing after so that is the syntax error.

A: You forget to put value for trainer_id= so Put any value for trainer_id before where condition, Here I'm putting Null value  trainer_id=Null
Try this Query
UPDATE `MEMBERSHIP`
    SET `member_id`= 2,
        `sales_id`=1,
        `duration`='3 شهور',
        `start_date`='2016-10-16',
        `end_date`='2016-10-16',
        `membership_cost_before`=500,
        `discount`=0,
        `member_ship_cost` =500,
        `membership_type` ='Silver',
        `amout_done` =500,
        `amount_reminder` = 0,
        `trainer_id` =NULL
     WHERE `membership_num`=1

Note: Make sure trainer_id column should be set not null false in database structure if you want to update null value for that.


text:
Pankaj Bhargava, M.D.
Executive Partner / Entrepreneur
Executive Partners
Dr. Pankaj Bhargava is an Entrepreneur at MPM and BioImpact Capital, an affiliate manager of MPM. He is currently the CEO of a newly formed, stealth portfolio company. Pankaj is active in supporting MPM's investment collaboration with Dana-Farber Cancer Institute (DFCI), after having previously served as an Attending Physician at DFCI for over a decade. In addition, Pankaj supports MPM's relationships with its key strategic pharmaceutical partner. He is also interim Chief Medical Officer (CMO) at Aktis Oncology and serves on the board of Tizona Therapeutics, both portfolio companies.
Prior to joining MPM and BioImpact Capital, Pankaj served as Vice President and Head of the Oncology Therapeutic Area at Gilead Sciences where he was responsible for driving oncology strategy and execution across programs spanning preclinical development to post-marketing commitments. In this role, Pankaj was instrumental in building the Gilead oncology portfolio with key partnerships and transactions including the acquisition of Forty Seven, Inc. and immuno-oncology partnerships with Arcus Biosciences, Agenus, Tizona and Pionyr Therapeutics.
Pankaj has been involved in drug development over two decades, during which he oversaw several functions, including clinical research, clinical operations, pharmacovigilance, regulatory affairs and medical affairs. He previously served as Chief Medical Officer at Dicerna Pharmaceuticals where he focused on RNA therapeutics in oncology, rare diseases and liver diseases, and held roles with increasing responsibilities at Tioma Therapeutics (now ARCH oncology), Sanofi Oncology and AVEO Pharmaceuticals. Pankaj has filed multiple INDs and led global registration programs and regulatory filings leading to drug approvals in US, EU and other regions.
Pankaj earned his M.D. from the University of Delhi and completed his training in medical oncology and developmental therapeutics at Georgetown University and Lombardi Cancer Center. He also completed a post-doctoral fellowship in clinical pharmacology at Georgetown University and NIH, during which he was a visiting fellow at FDA. Pankaj previously served as an Assistant Professor at Harvard Medical School and Dana-Farber Cancer Institute (2004-2017), and currently serves as a Clinical Assistant Professor at University of California, San Francisco.


I love my house. I love it's location, I love the view of Lake Michigan and I love how calm and serene it is here. What I don't love are our carpets. We rent this farmhouse and can't really do much about the carpet. Having two dogs and two toddlers (and a husband who insists on wearing his shoes in the house) can be frustrating and damaging to carpet.
Recently I was approached about reviewing Stanley Steemer's carpet cleaning service. I had expectations that this would be a good experience. I never thought I would LOVE my carpet so much afterward. My husband and I literally looked at each other at least five times throughout the night and said "wow, I can't believe how different this house feels now!" My husband even said "I think that now that we have clean carpets and have rearranged a little bit that the feng sui is much more positive in here." Who has a husband that says things like that? Not this girl.
I called Stanley Steemer to set up our appointment early last week and the receptionist was friendly and helped me get the day that worked best for me. I asked her to have the cleaners call me ahead of time to ensure I had time to get all of the living room/dining room furniture out of the house. She assured me that they would. She also asked what room(s) I wanted cleaned and I told her. She gave me a quote based on the room, not the square footage. This surprised me because my living/dining room combo is quite small.
Forward to Saturday, about 8:30am...we get a call that the cleaners will be here in about half an hour. My husband and I FREAKED!! We needed to finish up with breakfast and get the furniture OUT! When the two Stanley Steemer workers got here they asked if they could help move the furniture out but we were on our last item. One of them said "this is part of what we do." That upset me since the secretary didn't mention that at all when we set up our appointment even after my comment.
It took the two men about an hour to set up and clean our carpets. It was already about 80 degrees outside and I was excited that the carpets would dry quickly (which they did!) I am astonished with the results of the carpet cleaning. See side-by-side pictures below to see for yourself how amazing Stanley Steemer is!
Are you ready for some cuteness overload?
Oliver, Oliver. All of 18 months and WAY too cute for his own good. He deserves a post of his own!
Wanna win a $100 Stanley Steemer Gift Certificate for your own Spring Cleaning needs? Fill out the Rafflecopter form below!
We have four kids and we used to have a big dog...our carpets get lots of traffic and need a good cleaning.
We have a toddler and two messy dogs, so this would be great for carpet cleaning in our home! Thanks for the chance to win!
We have 3 kids so our carpet has a lot of foot traffic. Also, all 3 kids have allergies so with Spring in full swing, they could use a pollen free carpet.
I'm buying a new house this summer and could definitely use the help while moving in/out.
My daughter's carpet is only 2 years old but it's really horrible and smells..I'm afraid to try to clean it myself.
I have a baby who will be crawling soon and I want a clean floor for him.
We have mint colored carpet and the stains and dirt is horrible! We are in desperate need of a carpet cleaning!
my 5 month old is on th emove now and it would be awesome to have really clean carpets!!!
i need it because my carpets are way dirty from years and years of trudging along! Thanks for a super giveaway!
Sounds awesome Maggie! I would love to win!
We need our carpets to be cleaned desperately. For some reason, I chose an off-white carpet when we built our house. We've been here almost 5 years and it's needed a good cleaning for about 4 of those 5 years!! Would love to win this!


How Should We Read Genesis 1?
On this coming Thursday, February 8, at 8:00 pm, I'll be giving a talk in Buffalo, NY on how best to read Genesis 1 in a contested cultural context.
Many Christians today try to make this ancient text, which describes God's creation of the cosmos, fit with modern assumptions. The main assumption that modern people bring to Genesis 1, which distorts what it is actually saying, is that this creation account must be coordinated with what we think science teaches us about the world.
For some, this means rejecting any aspects of modern science that don't seem to match the text (the typical view of young earth creationists). For others, it means rejecting Genesis 1 because it clearly doesn't match modern science (the view of many skeptics).
The trouble is that Genesis 1 is an ancient text that has no interest in addressing modern science at all. It has an entirely different focus.
In my talk, I will be taking participants on a journey of understanding, to see what this ancient text was saying to its original audience, and how its amazing message can impact us today (even in a modern scientific world).
The talk is being held as part of the Nickel City Forum, sponsored by Anglicans of Western New York. which hosts various events, including a series of talks typically given in pubs and open to the public.
This talk will be held at The Place, on 229 Lexington Ave, Buffalo, New York 14222. For more information about the event, including how to register and get tickets, click here.
I'm about to head off to a four-day conference (June 8-11, 2016) that will address the topic of "Reading Genesis in an Age of Science." This is the kick-off conference of a three-year "Creation Project," sponsored by the Henry Center for Theological Understanding at Trinity Evangelical Divinity School, in Deerfield, IL.
The conference is known as the Dabar Conference (this is the Hebrew term for "word," pronounced davar). The name evokes Scripture as God's Word and the biblical theme that God creates by the word (Genesis 1; Psalm 33:6-9; Psalm 119:89-91; John 1:1-3).
The Creation Project's topics for the next two years are "Affirming the Doctrine of Creation in an Age of Science" (2017) and "Reclaiming Theological Anthropology in an Age of Science" (2018).
Although it is not stated explicitly, evolution (of the cosmos and of humanity) is an important aspect of the science that will be addressed.
You can see the full 2016 Dabar Conference schedule here.
The Dabar Conference is billed as a "working" conference, where position papers are presented, followed by respondents (of which I am one), and then open discussion.
I was invited to participate likely because of my work in Old Testament (especially Genesis) and also because of my connection to BioLogos.
I've been asked to bring my philosophical and biblical studies backgrounds to bear as a respondent to C. John ("Jack") Collins's paper, entitled "Reading Genesis 1-11 in Biblical and Social Context." Although I'm mostly on board with his reading, I'll be exploring some of the implications of Collins's framing of matters, wondering out loud about how we might better articulate some of his points in light of important issues in contemporary science.
There is no guarantee that everyone at the conference will agree (in fact, we are likely to disagree), but we are coming together as Christian sisters and brothers to explore the questions in an atmosphere of critical and charitable inquiry.
I'm particularly glad for this stated intent since, paradoxically, my own work on postmodernity and biblical faith back in the mid-nineties was summarily dismissed by none other than Carl F. H. Henry (after whom the Henry Center is named).
Carl Henry heard a paper that Brian Walsh and I delivered at the Wheaton Theology Conference back in 1994 (based on our book, Truth Is Stranger than It Used to Be, which was published by IVP the following year). He wrote a single-page scathing critique (in World magazine) of the conference and of our book, which he had not actually read. Instead, he based his critique on lines he quoted from a phone interview that IVP did with us about the book .
While there were undoubtedly legitimate differences of opinion between Henry's point of view and our own position, the tragedy is that his critique (in the article) was based primarily on out-of-context quotations from the phone interview, which omitted important clarifications of what we meant.
For example, Henry quoted me as saying: "Even the truth of the gospel . . . is a human construction." And he took this to mean that I denied the reality of revelation from God (something no-one who knows me would ever think).
Here it is important to note that something crucial was left out of the quote (signified by the ellipsis dots).
Brian had just commented about truth as both given from God (revelation) and our responsibility to formulate it in human language in order to communicate it.
I first read Carl Henry's works when I was an undergraduate theology student in Jamaica and found that he was someone I could respect. So I was quite disappointed by this dismissive misreading.
Even though Carl Henry is no longer alive (he passed away in 2003), perhaps my participation in this conference (sponsored by the Henry Center) will serve to bring a certain reconciliation.
Although there are divergences of opinion on details (since the science is always being refined), most paleo-anthropologists date the first hominin remains (the australopithecines) to some five million years ago and think that the first examples of the genus Homo appeared about two million years ago (Homo habilis). The most likely hypothesis for the evolution of anatomically modern Homo sapiens places their origin some 200,000 years ago, with an original population of perhaps 10,000.
Many religious skeptics and committed Christians alike have judged this scientific account incompatible with the biblical version of the origin of the humanity recounted in the early chapters of Genesis.
From the skeptical side, the Bible has often been dismissed because its mythical or prescientific account of origins (both cosmic and human) is thought to contradict what we know from modern science. This skeptical approach is most evident in the "warfare" model of science and religion made famous by John W. Draper and Andrew Dickson White in the nineteenth century, and perpetuated by the new atheists like Christopher Hitchens and Richard Dawkins in the twentieth and twenty-first centuries.
Many Christians (especially evangelicals and fundamentalists in North America) have bought into the warfare model, with the difference that they assume the "literal" truth of the biblical account—taking "literal" in the sense of necessitating a one-to-one correspondence between details of this account and events and actualities in the empirical world. This approach, which often goes by the name "scientific creationism" or "creation science" (or, more recently, "origin science") assumes that the Bible intends to teach a true scientific account of cosmic origins—including a young earth and the discontinuity of species (particularly the discontinuity of humans from other primates).
Since this way of reading biblical creation accounts clearly contradicts the understanding of origins provided by modern science (both in cosmology and in evolutionary biology), proponents of "creation science" typically dismiss the putative claims of modern science (at least in the case of cosmic and biological origins) as ideologically tainted. The result is a concordist attempt to force science to fit what the Bible (on a superficial reading) is thought to say about these topics.
A more recent, equally problematic, concordist approach works in the opposite direction, attempting to harmonize the Bible with the conclusions of modern science. This approach, spearheaded by Hugh Ross and the organization called "Reasons to Believe," attempts to make the Bible agree with major scientific findings, at least at the level of cosmology. Thus, the Bible's cosmological and cosmogonic statements (about the nature and origin of creation) are not understood in their ancient conceptual context, but interpreted so as to make them harmonize (anachronistically) with modern scientific claims (including a universe of galaxies billions of years old).
Yet at one point this alternative concordist project agrees with that of "creation science"—biological evolution (especially human evolution) is beyond the pale.
Despite what many Christians think, there isn't at present any genuine scientific debate about the reality of evolution, including the descent of humans from previous life forms. The only debate is about certain details (as is to be expected in any empirical discipline). I myself have become convinced (by both genetics and paleontology) that biological evolution is the best scientific account of the development of life on earth—human evolution included. I have come to believe that the evolutionary process is simply the menchanism through which God has been creating life over the eons.
Nevertheless, simple honesty requires me to admit that there are ongoing problems concerning how we are to relate human evolutionary history with the biblical teaching concerning origins.
One of the most problematic dimensions of affirming both biblical origins and biological evolution is the doctrine of the "Fall," since the Bible seems to teach (in Genesis 3) a punctiliar, one-time event in which an original couple transgressed God's commandment after an initial paradisiacal period.
I don't believe that the classical, Augustinian doctrine of "original sin" is required (in all its specificity) for creedal orthodoxy. Nevertheless, the Bible itself certainly seems (at first blush) to tie the origin of evil to an understanding of human beginnings that is quite different from what we find in evolutionary biology.
Given the putative contradiction between biblical-theological claims and evolutionary science, what's an honest Christian to do?
In my next post, I'll examine some alternatives to the warfare model (and the resulting Christian attempt to make science harmonize with the Bible).


Fish broth, salmon, liver, wheat gluten, meat by-products, corn starch-modified, chicken, artificial and natural flavors, soy flour, salt, added color, tricalcium phosphate, MINERALS [potassium chloride, magnesium sulfate, zinc sulfate, ferrous sulfate, copper sulfate, manganese sulfate, potassium iodide], natural seared salmon flavor, Red 3, taurine, mono and dicalcium phosphate, choline chloride, VITAMINS [thiamine mononitrate (Vitamin B-1), Vitamin E supplement, niacin (Vitamin B-3), calcium pantothenate (Vitamin B-5), Vitamin A supplement, menadione sodium bisulfite complex (Vitamin K), pyridoxine hydrochloride (Vitamin B-6), riboflavin supplement (Vitamin B-2), Vitamin B-12 supplement, biotin (Vitamin B-7), folic acid (Vitamin B-9), Vitamin D-3 supplement].
Feed an average size adult cat 1 can per 2 ½ pounds of body weight daily. Feed up to twice this amount to kittens. Refrigerate unused portion. An ideal pairing with Fancy Feast Gourmet Dry Cat Food.
Fancy Feast Gravy Lovers Salmon Feast In Seared Salmon Flavor Gravy is formulated to meet the nutritional levels established by the AAFCO Cat Food Nutrient Profiles for growth of kittens and maintenance of adult cats.
The only canned food she will eat, like up all the gravy.
My cats really enjoy the seafood gravy Fancy Feast flavors. Can even hide my 1 cats medicine in it.
My Two Cats Loved It!
I have one picky cat and the other is not so picky. Both cats loved the texture and smell. Both devoured the food on each plate that they had. I would like to purchase more for my cats since they both enjoyed eating it. However, I can only purchase them when they go on sale or become a free item because of a coupon.
Purrfect meal for the 5 of us!
My dynamic 5 (Kayla, Ebony, Mango, Cricket & Willow) just love their Fancy Feast Gravy Lovers Salmon. It quickly disappears from their dishes & they're ready for another can. It definitely is their favorite meal.
This is one of many that all my cats eat and they just love it when we set out a buffet for them.
My cat, Bitta, LOVES Gravy Lovers Salmon Feast. She is a very fussy eater, so when I found the Gravy Lovers line, I started trying them and she absolutely adores the Salmon Flavor! It is all she will eat!
My Three LOVE all gravy lovers, except beef not crazy about that one for some reason, They are ALL very picky eaters but with Gravy Lovers I cannot go wrong! Only wish I could find coupons! as it gets quite costly with three cats!!For Zannie, Buddy and Kallie it is the ONLY way to go! If you just give it a try I am sure your Kitty will Love it too!
My kitten loves this... Attacks it like she will never get it again.
My cat, Pumpkin never leaves without licking her bowl clean!
We also feed ferrules. They too lick the bowl clean!
My cats love this flavor the best. Always fresh and their bowls are licked clean!!
Made with real tuna and mackerel, cooked to perfection.


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Casino panels' diagonal louvers form a pattern throughout the system that are certain to get noticed. Panels can be placed in a pleasing, mirrored pattern or parallel to each other. You could even mix the 2 styles to add some extra flair. Placement and pattern are completely up to you and your preference. The infill can consist of PalmSHIELD's traditional slanted louvers. These louvers don't allow any light, but still maintain an attractive contemporary design. If you would just like to break things up and allow a little light to come through, you may want to consider their smaller diagonal slats.
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