Osteoporosis is a debilitating disease and its risk can be reduced through adequate calcium consumption and physical activity. This protocol paper describes a workplace-based intervention targeting behaviour change in premenopausal women working in sedentary occupations.
A cluster-randomised design was used, comparing the efficacy of a tailored intervention to standard care. Workplaces were the clusters and units of randomisation and intervention. Sample size calculations incorporated the cluster design. Final number of clusters was determined to be 16, based on a cluster size of 20 and calcium intake parameters (effect size 250 mg, ICC 0.5 and standard deviation 290 mg) as it required the highest number of clusters.
Sixteen workplaces were recruited from a pool of 97 workplaces and randomly assigned to intervention and control arms (eight in each). Women meeting specified inclusion criteria were then recruited to participate. Workplaces in the intervention arm received three participatory workshops and organisation wide educational activities. Workplaces in the control/standard care arm received print resources. Intervention workshops were guided by self-efficacy theory and included participatory activities such as goal setting, problem solving, local food sampling, exercise trials, group discussion and behaviour feedback.
Outcomes measures were calcium intake (milligrams/day) and physical activity level (duration: minutes/week), measured at baseline, four weeks and six months post intervention.
This study addresses the current lack of evidence for behaviour change interventions focussing on osteoporosis prevention. It addresses missed opportunities of using workplaces as a platform to target high-risk individuals with sedentary occupations. The intervention was designed to modify behaviour levels to bring about risk reduction. It is the first to address dietary and physical activity components each with unique intervention strategies in the context of osteoporosis prevention. The intervention used locally relevant behavioural strategies previously shown to support good outcomes in other countries. The combination of these elements have not been incorporated in similar studies in the past, supporting the study hypothesis that the intervention will be more efficacious than standard practice in osteoporosis prevention through improvements in calcium intake and physical activity.
Osteoporosis is a disease characterised by bone fragility due to low bone mass and a break down in the skeletal framework. It is a major public health problem affecting millions of people worldwide, with significant physical, psychosocial and financial consequences for the patient and the health care system . Women are at higher risk of getting osteoporosis due to attainment of lower peak bone mass early in life and hormonal changes that occur at the menopause [1, 2].
While osteoporosis is a disease with a strong genetic predisposition, calcium intake and physical activity are well-established modifiable risk factors operating through the maintenance of bone mass and skeletal integrity [1, 2]. Evidence suggests that physical activity and calcium intake can affect not just bone mineral density, but also risk of osteoporotic fractures [3, 4]. Prospective longitudinal studies have estimated that 23% of osteoporosis is attributable to physical inactivity  and that almost 10% of osteoporotic fractures are attributable to low dietary calcium intake . This demonstrates that there are substantial preventable fractions on the order of 10% - 20% for osteoporosis and osteoporotic fractures, and that efforts to develop intervention strategies to achieve this are warranted, thus prompting recommendations for population-based interventions to promote adequate calcium intake and physical activity to prevent osteoporosis.
The majority of health promotion studies addressing osteoporosis prevention suffer from weak intervention designs and lack of methodological rigour. Many intervention strategies did not appear to be guided by behaviour change theory. None appear to have referenced past evidence to determine the level of behaviour change that is required to make an impact on the disease and its consequences [5–8]. Some interventions consisted of one-off information sessions or print resource distribution [5, 9].
None of the studies targeting osteoporosis prevention behaviours have attempted to approach the dietary and physical activity components separately. They adopted the same intervention strategies for both behaviours and did not appear to have incorporated unique strategies for either behaviour into their intervention design. These interventions reported modest or no increases in calcium intake in the short-term [5–7, 10] and generally poor physical activity outcomes [5, 10–12].
Evidence suggests that single health behaviour interventions were more effective at improving the targeted behaviours than multiple behaviour interventions . Interventions that have singularly targeted dietary calcium intake for women have consistently reported positive outcomes [14, 15]. Positive outcomes are also often reported in intervention studies specifically targeting general physical activity [16, 17]. Few physical activity behaviour interventions have been carried out in the context of bone health in adult populations. Prescriptive exercise interventions for adults, which included load bearing activity of moderate to vigorous intensity, have reported strong positive associations with improved bone mass . However, prescriptive exercise interventions only engage participants in regimented exercise and do not address participants' attitudes or barriers towards adopting physical activity. Such interventions consistently suffer high attrition rates and are not suited for implementation at the population level.
A meta-analysis of physical activity interventions suggests that behavioural strategies (such as goal setting, problem solving) are superior to cognitive strategies . Taken together, these studies suggest that an osteoporosis prevention intervention design should place specific emphasis on behavioural strategies targeting calcium intake and physical activity as unique and distinct health behaviours.
Workplaces are valuable settings for the efficient delivery of preventive health intervention programs to healthy adult populations. Women in sedentary occupations are a priority group for osteoporosis prevention, as being both female and sedentary are independent risk factors for low bone mass and osteoporosis. Occupational sitting has been associated with low bone mineral density of the hip . Workplaces with predominantly sedentary employees present great opportunities to address behaviours that can decrease the risk of osteoporosis. There are no published studies to date on workplace-based osteoporosis prevention programs. While most studies targeted women in the community, none of them targeted those with sedentary occupations.
Research resources on osteoporosis prevention in Singapore were predominantly allocated to bio-medical interventions at the time of this Singapore-based study. Relevant health promotion studies in Singapore were limited and predominantly investigated knowledge and attitudes. No local studies had previously investigated the efficacy of behaviour strategies for osteoporosis prevention.
It is the first to address dietary and physical activity components each with unique intervention strategies in the context of osteoporosis prevention.
The intervention design for both behaviours is guided by Bandura's self-efficacy theory. The design focused on behavioural strategies rather than cognitive strategies to increase subjects' self-efficacy to change behaviour.
The utilisation of a workplace platform to address the risk associated with low levels of physical activity at work.
The use of an evidence-based approach when setting the intervention outcomes. Targeted behavioural outcomes were supported by evidence with the potential to affect the burden of osteoporosis.
This study compared a strengthened intervention design to a standard care control, which was current conservative practice. The results would indicate the degree to which the intervention design improves on current practice.
The overall aim of this study was to determine the efficacy of a tailored and self-efficacy focussed workplace-based intervention compared with standard care (print resources) in increasing the calcium intake and physical activity level of women with sedentary occupations.
To test the hypothesis that a tailored workplace based intervention incorporating specific behavioural strategies for calcium intake and physical activity is more efficacious than standard care (simple print resource distribution) in increasing the calcium intake and physical activity levels.
To explore the relationship between self-efficacy scores for calcium intake and physical activity with actual calcium intake and physical activity levels to determine the extent to which self-efficacy mediates intervention-associated changes in calcium intake and physical activity.
This was a prospective two-arm cluster randomised trial. Clusters were workplaces that were randomly assigned to receive either i) tailored workplace-based intervention or ii) print resources (standard care control arm).
In 2004, the Singapore National Nutrition Survey reported the mean daily calcium intake of the female population as 598 milligrams . This level of calcium consumption was below the recommended daily allowance (RDA) of 800 milligrams for 25 to 44 year old women who constituted the main target group for the study. The survey reported that 55.9% of the Singapore female population did not achieve sufficient calcium intake (defined as <70% of RDA) through their diet . Fifty percent of women in the premenopausal age group (30 to 49 years old) had daily intake of 560.5 mg or less (range 258 mg to 565 mg) . We anticipated that the women in our study were similar, and that a deficit of at least 250 mg needs to be corrected. This assumption would be tested through assessment of baseline calcium intake from both intervention groups.
Evidence supports the health significance of this study's proposed effect size for calcium intake. Warensjo et al. (2011) reported on a 19 year follow up on 61,433 Sweden women and found that almost 10% of hip fracture may be attributable to low calcium intake (first quintile) . It is important to note that the first quintile in this study was reported to be less than 759 mg per day . This is high compared to Singapore female population where the mean intake in the first quartile is 411 mg per day . Population attributable risk is potentially higher in the Singaporean female population due to lower calcium intake (e.g. because of lower dairy intake compared to Sweden). According to Warensjo et al. (2011), population attributable risk (%) of hip fracture decreased by 3.34% with every 300 mg increase in calcium intake .
This is further supported by studies in another population with calcium intake comparable to Singapore. Rouzi et al. (2012) studied independent predictors of all osteoporosis-related fractures among 707 healthy Saudi postmenopausal women over 5.5 years. They reported a mean daily calcium intake of 532 milligrams in their study population; very similar to the 598 milligrams reported in Singapore's female population . The study estimated that 26.4% of osteoporotic fractures are independently attributable to low dietary calcium intake (<391 mg/day) . The reported osteoporotic fracture relative risk (RR) is 1.66 for a low dietary calcium intake (<=391 mg/day) when compared to a higher intake (>/=648 mg/day) .
In Hong Kong, Lau et al. (1988) reported hip fracture RR to be 1.9 when comparing calcium intake in the lowest quintile (<75 mg/day) to the highest quintile (>244 mg/day) . Chan et al. (1998) reported the odds of vertebra fracture to double (OR = 2.1) when dietary calcium intake was in the lowest quartile (<249 mg/day) compared to the highest quartile (>382 mg/day) .
Calcium consumption in the Asian population appears to be lower than in Europe [4, 23–25], supporting a particular need for intervention in low calcium intake (e.g., many Asian) populations. Evidence has demonstrated that even a modest increase in calcium intake (in the range of 120-150 mg) can have substantial impact on osteoporotic fracture risk [23–25].
Past interventions have demonstrated that the effect size of 250 mg is achievable. Osteoporosis prevention studies that focused only on dietary interventions and incorporated strong behavioural strategies reported significant increases in calcium intake (200-300 mg) compared to controls [14, 15].
The Singapore National Health Survey in 2004 reported that 54.5% of the female population does not participate in leisure physical activity . Only 18.8% of women in the pre-menopausal age group (30 to 49 years old) reported at least 60 minutes of physical activity per week . The World Health Organisation (WHO) recommends that adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week . This means that majority of Singapore's female physical activity level falls well below the recommended guidelines. We anticipated that the women in our study sample would have a similar physical activity profile.
This study's intervention content was aimed at supporting participants to achieve a 60-minute increase in load-bearing physical activity of moderate to vigorous intensity. Evidence suggests that the risk of hip fracture declines 6% for every increase of 3 MET hr/week, which is equivalent to 60 minutes per week walking at an average pace .
A larger effect size was initially considered. However, participants in this study were anticipated to have very low physical activity at baseline. WHO recommendations state that inactive people should start with small amounts of physical activity and gradually increase duration, frequency and intensity over time . Moreover, this study targets a domain of physical activity that is more site-specific and higher in intensity, hence potentially more challenging to adopt.
Large worksite interventions to increase general physical activity have reported a wide variation in improvements. Reported increases in moderate to vigorous intensity physical activity per week range from 40 to 300 minutes [28, 29]. Differences in intervention design and duration might account for this variability. Notably, none of these workplace based studies were designed for osteoporosis prevention. None of the studies investigating osteoporosis prevention behaviours reported physical activity outcomes in duration or intensity.
In summary, the effect size of 60 minutes of moderate to vigorous intensity load -bearing physical activity is achievable for a workplace-based intervention, and has the potential to meaningfully reduce the risk of osteoporosis.
Sample size calculations took into consideration the cluster randomisation design by incorporating the design effect into the calculation. The design effect was calculated based on a cluster size of 20 and the intracluster correlation coefficient (ICC) using the formula: Design Effect = 1 + (within cluster sample size −1) x ICC. In the absence of ICCs for the outcome measures, available population standard deviations were used to calculate the variances and the ICC using the formula: ICC = variance between cluster/(variance between cluster + variance within cluster). In this study, there were two primary outcome measures, calcium intake and physical activity. Sample size calculations were carried out for both measures. Calculations were based on α = 0.05 and β = 0.1. Table 1 shows the parameters used for calculating the number of clusters and the total number of participants. The study deliberately planned to over recruit within clusters to factor in a 30% attrition rate.
*Calculated using standard deviation from National Nutrition Survey 1998 and based on conservative estimates of inter- and intra-cluster variance .
**Based on estimates from published studies [30, 31].
***Estimate from National Nutrition Survey 1998 .
****Based on estimates from published studies [33, 34].
The number of clusters required was different for each outcome measure, so the study was based on the highest number of clusters required, which was that for calcium intake (14.7). This was rounded up to 16 to ensure equal cluster numbers in both arms of this study.
There was an error in the final step of this study's sample size calculations. The calculation did not double the sample size calculation that yielded the number of required subjects per arm (for this two-arm study). The sample size calculation, however, was very conservative with the ICC estimates and the study was expected to be overpowered despite the omission of this step. This study still has 90% power to detect 355 milligrams increase in calcium intake and 85 minutes increase in moderate to vigorous intensity physical activity with 16 clusters of 20 participants per cluster.
Workplaces in industry that was primarily office-based and sedentary in nature, such as government administration departments, publishing industry, property development and finance industry.
Workplaces that were able to recruit at least 30 female employees engaged in desk-based jobs (sitting for at least 50% of working hours).
Agreement to permit up to 10 hours of paid work time during the course of the study (12 months) for the recruited employees to participate in pre-post data collection and intervention activities.
Clusters were sampled from database of workplaces who were recipients of 2003 Singapore Health Award. These workplaces would have demonstrated commitment to promoting employee health to receive this national award, hence the characterisation of this trial as assessing efficacy rather than effectiveness.
Generic invitation letters were mailed to 97 workplaces to invite them to participate in this study. The letter stated the objectives of the study but did not detail the nature of interventions. It stated that a briefing would be conducted to provide them with the details. A faxed reply from the workplace was requested to confirm participation by a stipulated date.
Thirty-seven faxed replies were received by the stipulated deadline. The workplaces' names were arranged in a data sheet according to the date and time of receipt. Eligibility was on a first-come-first served basis. When sufficient clusters (workplaces) had been recruited, the subsequent workplaces who responded were placed on a reserve list also in order of the date and time of receipt. The workplaces (clusters) that have been recruited were labelled WP1 to WP16 according the date and time of the fax.
When the cluster recruitment process was completed, a statistician generated a set of random numbers for the list of workplaces recruited. The statistician had no access to the faxed replies and was blinded to the identities of the workplaces. The random numbers were generated for the labels WP1 to WP16. When the random number had been assigned to the workplace, the names of the workplaces were re-arranged according to the random numbers assigned in ascending order (smallest number first and biggest number last). The first eight workplaces in this new arrangement were assigned to the intervention group and the subsequent eight workplaces were assigned to the control group. Workplaces recruited were in government administration, property development, finance, publishing and energy provision industries.
Following randomisation, workplace coordinators from the two groups were invited to two different briefings, depending on assignment to the intervention or control group. The briefings provided intervention and control group-specific information to respective workplace coordinators. The briefings also detailed the commitment required of the workplaces, the (within-workplace) recruitment process and the nature of assessments (data collection procedures). The workplaces in both groups were blinded to the type of intervention that the other groups were to receive. It was considered highly unlikely that unblinding would occur, as the workplaces were not geographically close. Figure 1 summarises the recruitment and randomisation process.
Recruitment and randomisation flow chart.
When the workplace (cluster) allocation process was completed, workplace coordinators from both groups were contacted to commence the within-cluster recruitment process. The coordinator was provided with resources (such as posters, e-mailers) to publicise the recruitment. Employees who expressed interest were screened for eligibility before being recruited into the study. Over-recruitment by 30 percent to account for attrition was planned. Workplaces that recruited more than 30 respondents would create a waiting list in the event of withdrawal before commencement. Workplaces with less than 30 respondents would include all eligible respondents in the study.
The study was carried out as part of the Health Promotion Board Osteoporosis Prevention Programme initiative. The study was reviewed and approved by the Health Promotion Board (Singapore) Research and Ethics Committee before commencement.
All recruited employees were provided with a consent form, accompanied by print information about the study. The content of the information sheet and their right to withdraw were explained to the recruits during their individual appointment with the investigator. Signed consent forms had to be returned to the investigator before the employees could formally enrol. The information sheet stated that the right of any subject to cease participation without giving reasons would be respected.
Educational resource distribution was a strategy that was already in place for promoting bone health awareness in many Singaporean workplaces. Resources on osteoporosis prevention were widely distributed through various platforms such as community events, workplaces and health facilities. It would not be appropriate for workplaces in the control arm to receive less than an existing intervention, hence the standard care control.
The purpose of the study was to investigate if a more targeted and structured intervention with organisational support is more efficacious than existing practice. It was important to maintain the existing practices/strategy for the control group for the comparison to be purposeful, and to determine the extent to which current practice can be improved upon. These were the key ethical considerations for the study design.
Data for the two outcome measures, calcium intake and physical activity, were collected at three time points for both study arms. The mediators in this study, self-efficacy scores for calcium intake and physical activity, were also collected at the same time points. Demographic and lifestyle information were collected at baseline.
Data collection for both the intervention and control arms took place during similar periods at every time point. Figure 2 provides an overview of the timeline for data collection.
Data collection and intervention timeline.
Logic model for the intervention group.
Calcium intake was measured using a three-day diet record. This method involved each participant keeping a detailed written record of the foods and beverages consumed over three days. Three day recording was selected as recording periods of more than three or four days were reported to be unreliable due to respondent fatigue . Specific emphasis was put on the correct description of portion sizes so that an accurate estimate of calcium content could be derived.
An appointment was scheduled to meet each participant individually to provide specific instructions for completion of the three-day diet record. The three days would include two representative weekdays and one representative weekend day. Completed dietary records were collected and sent to a qualified nutritionist for analysis to establish the calcium content. The nutritionist was blinded to the treatment arms and the identities of the workplaces and participants.
Physical activity was measured using the EPIC Norfolk Physical Activity Questionnaire 2 (EPAQ-2). The EPAQ-2 was designed to measure the different sub-dimensions of physical activity in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) in 1999 . It is a self-reported questionnaire on disaggregated physical activity enabling the data be re-aggregated to the dimension of physical activity of interest, for example load-bearing activity of relevance to osteoporosis prevention. The EPAQ-2 has been validated against four-day heart rate measurement and was concluded to have the validity and repeatability/reliability to be used in a large-scale epidemiological study . The questionnaire consists of three sections: activity at home, work and recreation. Permission was obtained from Wareham and Jakes to adapt and use the instrument for this study.
The content of the EPAQ-2 was assessed for cultural appropriateness by a panel that included experts from inside and outside the Health Promotion Board (Singapore). Minor modifications were made to the list of recreation activities. Activities that were not relevant to local context, such as "digging, shovelling or chopping wood" were removed, and replaced with common local activities not included in the version developed for use in Europe, such as Tai Chi. Seventeen women at a workplace (not involved in the study) assessed the ease of reading using the Flesch reading ease score. They also provided feedback on the ease of understanding and the ease of completing the modified EPAQ-2. Minor changes were made to the language of instructions on the questionnaires to further increase ease of understanding. Prompts were added in sections where extra information needed to be provided, for example duration of each session recreation activity, to facilitate thorough completion of the questionnaire.
A copy of the EPAQ-2 was sent to each participant through the workplace coordinator. The participants completed the questionnaire independently and submitted it to the investigator at each data collection point. The investigator checked that the EPAQ-2 was completed according to instructions.
Self-efficacy was measured using the osteoporosis self-efficacy scale developed and evaluated by Horan et al. in 1998 . Written permission was sought from the authors to use the instrument.
The content of the questionnaire was assessed for appropriateness to local context by a panel that included experts internal and external to the Health Promotion Board (Singapore). It was also validated for internal consistency and test-retest repeatability through an evaluation process involving 17 women at a workplace (not involved in the study). The original content was found to be relevant to the local context and the questionnaire to have appropriate reliability for use in this study.
Each subject was sent a physical copy of the questionnaire through the workplace coordinator. The completed questionnaires were returned to the workplace coordinator who collated the submissions and dispatched them to the investigator.
Demographic and other health information was collected using questionnaires. At baseline, this included smoking and alcohol habits, family history of osteoporosis, indicators of socio-economic status (such as personal and household income, education level), religious preference (potentially relevant to diet and physical activity), marital status and number of children in the household.
Subjects from workplaces assigned to the intervention group received three intensive workshops targeting behaviour change. The intervention design had a strong focus on behavioural strategies and was participatory in nature. Bandura's Self–Efficacy Model was used to guide the workshop design for the intervention group. Bandura's model states that self-efficacy affects health behaviour and its determinants by influencing goals and aspirations. The stronger the perceived self-efficacy, the higher the goals people set for themselves and the firmer their commitment to them . Bandura also proposed that individuals with high efficacy view impediments as surmountable by improvement of self-management skills, that they persevere and stay the course in the face of difficulties .
Guided by these principles, the workshop design focused on individual goal setting and on building skill sets to attain individual goals. The design avoided presentation style communication and focused on behavioural strategies such as participatory skill building through hands-on activities, goal setting exercises, peer support and problem solving discussions. Attention was placed on helping participants identify individual barriers and build their capacity to overcome them. The intervention also addressed diet and physical activity as different entities that required different behavioural strategies. Though guided by the same principles, the workshops for diet and physically activity were unique in the nature and design of their activities.
Our study reviewed the content of interventions that reported positive outcomes for dietary calcium intake. These studies described strong behavioural strategies using participatory activities such as food preparation and tasting, nutrition label reading exercises, group discussions with exchange of ideas [14, 15, 39]. Their interventions also placed emphasis on using specific examples relevant to the participants' lifestyles and tastes [14, 15, 40], as well incorporating local food sources into activities. Evidence also suggested that the provision of calcium intake feedback might be an effective tool to improve the behaviour . These elements were used to guide the development of intervention content in this study.
In addition, we planned to incorporate quantitative and qualitative dietary information collected at baseline to help tailor intervention strategies. The dietary records would be inspected to identify the common food sources of calcium amongst the study population, as well as their consumption patterns and volumes. This information would also be used to tailor strategies that would be relevant to individual participants.
Common barriers to consuming calcium rich foods, identified in previous research include the perception that these foods are higher in price, are mainly dairy products and are high in fat. Taste aversion, mainly to dairy, has also been highlighted as a barrier. These issues were addressed individually in different components of the workshop. Food tasting was a very effective strategy to expose subjects to a wide range of foods that can provide a substantial calcium boost. The ability to correctly read and interpret nutrition labels was identified as a necessary skill to facilitate selection of calcium rich foods. Practical sessions on reading of food labels were included in the intervention.
Subjects in both the intervention and control group received individual feedback on their average calcium intake based on the diet record they submitted. Although the subjects in the control group received similar information about their calcium consumption, the intervention group had the benefit of using this individualised information during the workshop to develop a strategy to attain their recommended daily allowance whilst the former did not. A logic model of the intervention can be found in Figure 3.
Local media campaigns and community based health promotion activities on osteoporosis prevention have had a stronger focus on diet compared to physical activity in the lead up to the time of the study. Limited local public education sources were dedicated to discussing the impact of physical activity on bone health and more importantly, the types of physical activity that can reduce the risk of osteoporosis.
Physical activity behaviour can have very different psychosocial mediators from dietary behaviour. In this study, physical activity was regarded as a unique behaviour that required a different set of intervention strategies to that for dietary calcium intake.
The types of physical activity that can affect bone mineral density, risk of osteoporosis and risk of fractures are described as load bearing and resistance training exercises [41, 42]. The intensity of activity is also critical. Evidence indicates that only moderate to vigorous level of load-bearing physical activity can affect bone density in important sites such as the hips, a vulnerable site for osteoporotic fractures [43, 44].
Studies about physical activity behaviour in the context of bone health are limited to adolescent populations and were carried out mainly in school settings. Strategies for adolescents cannot be used to guide the content development for this study. There are many studies on prescriptive exercise regimes but the interventions were aimed at studying bone density in response to exercise interventions, not physical activity uptake behaviour. The attrition rates for these studies are very high as behaviour modifications were not a focus.
In the absence of evidence in adult populations, this study evaluated the methodologies from studies that targeted general physical activity in community settings, including workplaces. It is important to note that whilst this study used workplaces as settings or delivery platforms, it did not have sufficient resources to implement changes to workplace environments and policies. This study aimed to improve individuals' self-efficacy to bring about behaviour change. Workplaces provided a platform to support change at the individual level through the provision of infrastructure for communication, peer support and common interest.
Evidence indicates behavioural strategies to be superior to cognitive strategies [19, 45]. Meta-analyses of physical activity interventions emphasise the importance of behavioural interventions, which include goal setting, self-monitoring, physical activity behaviour feedback, consequences, exercise prescription and cues [19, 45]. Our study adhered to these recommendations when designing intervention activities. In addition, emphasis was placed on providing opportunities to sample a variety of the targeted physical activities. These included take home activity samplers in many formats, including DVDs.
The first workshop discussed the relationship between load bearing and resistance training exercises on bone cell formation and bone modelling. This served to communicate the key message that specific types of exercise are needed to protect and promote bone health. The third workshop was focused entirely on helping participants identify their barriers to increasing their physical activity level and to help them overcome the barriers with individually tailored strategies.
The intervention for physical activity was facilitated by a physiotherapist and the investigator. The aims of the intervention were to encourage participants to problem solve and develop strategies to help them increase their moderate to vigorous intensity load-bearing physical activity by 60 minutes per week. Each participant would record their weekday and weekend routine to be shared within a group. In the design of the intervention, peer support was identified as an important mediator for behaviour change and hence the emphasis on group work. This allowed participants to identify common barriers to change, develop strategies together and support one another through problem solving on common issues. Workshop participants shared a common work environment and would be able to develop workplace based strategies based on shared experience. This facilitated discussion as participants shared many ideas that were based on common experience, such as workplace stair access for opportunistic physical activity, discussion of suitable walking routes around the workplaces and sharing of information about exercise facilities near the work premises.
Almost 50% of Singapore adults cited lack of time as a barrier to leisure time physical activity . Unique strategies were developed for this study to facilitate the attainment of the physical activity goal with minimal disruption to the participants' routine. One important strategy was to introduce short bouts of exercise breaks (5–10 minutes) during television viewing time or work time, which many participants would regard as achievable and sustainable. Participants would devise different types of 5–10 minute exercise routines that required minimal room and could be carried out easily at home or at the workstation. Resources, such as an exercise CD and a 10-minute exercise poster with instructions and illustrations would be provided to each participant. The latter was developed specifically for this intervention.
Participants in control/standard care workplaces would receive a resource kit with general print resources on bone health and osteoporosis prevention. They would received a report with their average calcium intake based on their dietary records but would not be provided with recommendations for change.
All analyses will follow intention-to-treat principles when comparing intervention and control arms . Data from the second follow up will be analysed to compare short-term changes after the intervention. Data from the third follow up will be analysed to assess sustainability of any observed changes. The primary dependent variables are calcium intake (milligrams per day), moderate to vigorous intensity load-bearing physical activity level (duration in minutes per week).
The main hypotheses will be tested using cluster-level analyses. This approach adheres to the recommendation of the 2004 Consort Statement for cluster randomised trials to fully account for the clustering effect [46, 47] and is recommended for studies with small number of clusters [47, 48]. Individual-level analysis using multi-level/mixed models was considered, but this study does not have the required cluster numbers for multilevel modelling as recommended by some analysts (minimum recommended is 15 cluster per arm) .
This study will use the two-stage adjusted analysis based on cluster summaries developed by Hayes and Moulten (2009, pp182-184) . In stage one, SPSS linear regression will be run to generate an unstandardised residual for each subject (the difference between the observed value and the fitted value from the model for each individual participant). Baseline calcium value for each subject will be controlled for in the linear regression model. Other variables that were identified as potential confounders will also be included in the model as factors or covariates. This step incorporates repeated measures into the analysis and generates the covariate-adjusted residuals for each individual.
Cluster summaries for the covariate-adjusted residuals are then generated using SPSS descriptive statistics. These summaries are for stage two of the analysis, which is the cluster level analysis. The cluster means of the residuals are then compared in a cluster level analysis using a weighted t-test, with weighting based on cluster size (number of participants per cluster).
Analysis will also test for the mediating effects of self-efficacy (SE) scores on calcium intake and physical activity measures. The relationships between the SE scores and the outcome measures will be examined at baseline and each follow up by exploring if changes in the self-efficacy scores are predictive of changes in the outcome measures in this cohort. The intervention theory and design assumes self-efficacy to be a strong mediator of outcome and this assumption will be tested and discussed.
This study design was developed in response to the need for a well-designed population-based intervention to target osteoporosis prevention behaviours. Although dietary and physical activity behaviour interventions have been extensively researched, limited investigation has been carried out to study the specific domains of these two behaviours relevant to bone health and osteoporosis prevention.
To our knowledge, this was the first population-based osteoporosis prevention intervention that has attempted to intervene with diet and physical activity components as unique health behaviours, and the first that adopts a self-efficacy-based theoretical model to guide behavioural strategies for both health behaviours. The study was also unique in the selection of workplaces as a vehicle for the delivery of the interventions. While worksites have been a popular platform for health behaviour-directed disease prevention, none to date has focused on osteoporosis prevention. Worksites are also ideal setting for identifying higher risk population such as individuals with sedentary occupations.
The participatory components in the study were expected to strengthen the intervention efficacy. The study utilised baseline assessment both to tailor the interventions as well as for evaluation purposes.
The intervention treated calcium intake and physical activity as individual health behaviours. This is vital as the two behaviours have their unique characteristics and barriers and need to be addressed with very different strategies. The study was able to implement separate workshops for calcium intake and physical activity thus facilitating the development of unique strategies for each of the behaviours.
The outcomes measures in this study were all derived from self-reports, which may incur potential bias. Steps were taken in this study to ensure the self-report measurement tools in this study were valid and reliable for the study population. Nevertheless, the osteoporosis preventive potential of the intervention would be more accurately and precisely assessed using objective bone mass density or other biomarker measures. However, resource and feasibility limitations excluded these possibilities. This is an important consideration for future studies in this area.
This study utilised the social structure and existing infrastructure within workplaces to deliver the interventions, but it did not have the capacity to influence workplace policies and practices to address sedentarism at the organisational level. This is a limitation in the study and an important consideration for future research, as intervention strategies to reduce workplace sitting time are rapidly developing.
At the time of the study, published ICC values for the targeted outcome and mediators were either limited or absent. In the absence of published ICCs, we adopted a conservative approach of assuming large ICCs in the calculations. This might have inflated the required number of clusters. However, it is also possible that the study will be underpowered to account for potential confounding. We will publish the observed ICC values for calcium intake, physical activity measures and self-efficacy scores in the reporting of the main results of the study. A retrospective calculation of the number of clusters and power based on the actual observed ICCs will be reported to compare with the original estimates.
High attrition rate is often a problem in population based intervention studies. A higher dropout rate is anticipated in this study because of loss of subjects through work factors such resignation and corporate restructuring. In an attempt to maintain cluster sizes, there was deliberate over-recruitment of within cluster subjects by 30 percent. However, some degree of selection bias may occur if attrition is high.
The intervention was fully funded by Health Promotion Board (Singapore). AD LaMontagne's contributions were supported by Centre-grant funding from the Victorian Health Promotion Foundation (Melbourne, Australia). We acknowledge the statistical advice provided by Siew Pang Chan.
AMT designed the study and the intervention and drafted the manuscript. AD. LM contributed to the drafting and revision of the manuscript. PH contributed to the design of the study and the intervention program, and revised the manuscript. RS contributed to the dietary evaluation component of the study design. All authors read and approved the final version of the manuscript.


Robert Tendy and Sheriff Don Smith review election results. Putnam County will have a new district attorney on January 1st. Putnam Valley Supervisor Robert Tendy defeated two term incumbent Adam Levy on Election Day by 56.8 percent to 42.9 percent o… Please login below or purchase a subscription to the Putnam County Courier to access this content.
One quarter of Putnam's 63,000 eligible voters took the time to ballot on Election Day where races for District Attorney, three seats on the county Legislature and numerous town and village races were decided. District Attorney Adam Levy lost… Please login below or purchase a subscription to the Putnam County Courier to access this content.
Colorful dancing provided by the Eric Moreno troupe entertains the gathering. A gathering at the historic Putnam Courthouse, a march along Gleneida Avenue past the statue of Sybil Ludington and a celebration at the Reed Memorial Library in Carmel Sun… Please login below or purchase a subscription to the Putnam County Courier to access this content.
Kevin and his mom, Kelly, at St. Jude's Children's Hospital in Memphis. Two year old Kevin Blackman, diagnosed with Acute Lymphoblastic Leukemia, continues the fight of his young life. The little boy whose mom, Kelly, and godmother Barbar… Please login below or purchase a subscription to the Putnam County Courier to access this content.
Mahopac FD personnel teach boys and girls about fire safety at the Fulmar Road School. Fire trucks roared up to the Fulmar Road School in Mahopac last week. There was no fire nor any other emergency. Volunteers with the Mahopac Fire Department under … Please login below or purchase a subscription to the Putnam County Courier to access this content.
Autumn in Putnam County is a glorious time of year. At left, downtown Carmel, shot from across Lake Gleneida. Above, the Hudson River looking toward the western shore, from Garrison. … Please login below or purchase a subscription to the Putnam County Courier to access this content.


Each week, as a part of our Sabbath service at the Vail Interfaith Chapel, I offer a prayer for yet another tragic event that has occurred around the world. Fires, hurricanes, flooding and shootings are occurrences that, sadly, are far too regular in our lives.
The anti-Semitic shooting at The Tree of Life Synagogue in Pittsburgh strikes at the very heart of the Jewish community in Vail. When tragedy impacts any community, we mourn their loss, but when a Jewish community experiences a mass killing in our House of Worship on our Sabbath, we respond with anger and with sadness. We are angry because, once again, Jews are victims of anti-Semitic hatred, and we are sad because of the senseless loss of life.
B'nai Vail Congregation has lived peacefully, side by side with other faiths, in one of the few truly interfaith chapels in America for 40 years. In our valley, we are not immune to what is happening around us, but together with a wonderful relationship with the Vail Police and Eagle County Sheriff's Department, we have made every effort possible to make our place of worship a sanctuary of safety. In light of this latest shooting, we will continue to work with law enforcement to keep our community safe.
When hateful words are spoken within our community, we must be the first to speak up and say "enough." As Americans, this is not who we are. As people of faith, this is not what we believe. As men and women of this valley, we will not tolerate this evil.
When tragedy strikes the Jewish community in Israel, America or Vail, we exclaim the Hebrew phrase: "Am Yisrael chai," the community of Israel lives.
"And all its beauty is like the flowers of the field.
"When the wind of the Lord blows on them.


text:
Gold was fairly steady overnight, trading either side of unchanged in a narrow range of $1203.20 - $1208. It consolidated its $20 gain from Friday, with activity a bit muted due to the UK on holiday.
Early during Asian hours, gold slipped to its low as it faded some strength in the US dollar - which was buoyed by weakness in emerging market currencies (Turkish lira plunged 3.5% after weeklong holiday), and the euro ($1.1650 - $1.1595).
Later during European time, gold recovered as the DX softened from a bounce in the euro ($1.1622) from a better than expected German IFO Report.
Global equities were firmer and a headwind for gold, still riding the bullishness from Powell's speech on Friday. The NIKKEI was up 0.9%, the SCI gained 1.9%, Eurozone shares were +0.5-0.6% (UK on holiday), and S&P futures were +0.2%. A dip in oil (WTI from $68.64 – $68.33) weighed on stocks.
Just ahead of the NY open, news emerged that the US and Mexico were close to concluding their trade deal. Along with this was a comment from Economist Mohamed El-Erian saying there's a 60 percent chance that Trump's hard line with China and Europe yields "fairer trade".
S&P futures popped higher (+10 to 2888), and the yield on the US 10-year bond climbed from 2.815 – 2.815%. The dollar softened (DX to 95) as the Mexican Peso rallied strongly (18.86 – 18.66), the Chinese yuan strengthened (6.8245 – 6.8155), and the euro continued to climb ($1.1650). Gold rose, but was initially capped in front of the overnight high at $1208.
By late morning, Trump announced that the US and Mexico indeed reached a trade deal, paving the way to replace the much-maligned NAFTA deal, with negotiations with Canada to commence shortly.
US stocks rallied further, with the S&P (+22 to 2899) forging deeper into record territory, led by the materials and financials sectors.
The 10-year yield rose further to 2.851%, while the dollar continued to decline. The DX broke through key support just under 95, and plunged to 94.68 – a 4-week low.
Gold rallied sharply, tripping stops over $1209 (Friday's high) to reach $1212.50 (a two week high), with a decent amount of short covering seen.
In the afternoon, US stocks pared some gains but both the NASDAQ (+72 to 8018) and S&P (+22 to 2897) finished with record high closes.
The US 10-year yield ticked down to 2.844%, while the DX hovered between 94.75- 94.80. Gold pulled back, but was able to hold support at $1209 (Friday's high). Gold was $1210 bid at 4PM with a gain of $4.
Open interest was up 0.1k contracts, showing a small net of new longs outweighing the substantial short covering seen from Friday's rally. Volume surged with 307k contracts trading.
Bulls were pleased with gold's advance today, especially given the strength in equities taking the S&P and NASDAQ to record high closes.
Many bulls feel that gold bottomed at $1160 on 8/16 after a $35 2-day capitulation, and will continue to look to buy on weakness or on some ensuing upside momentum.
They maintain the market has been and remains extremely oversold - having dropped $205 (15.0%) since the 4/11 $1365 high, and $149 (11.4%) since the $1309 high on 6/14. Bulls strongly believe that the dollar's rally was badly overextended, and expect its correction from 8/15's 96.99 high (up 9.90% since its 88.25 low on 2/14) to continue, and drive a significant short covering rally in gold.
Bulls are looking for gold to consolidate recent gains over $1192, and then challenge resistance at $1205-$1205-08 (today's high, and former 9 bottom support – 8/2, 8/3, 8/6, 8/7, 8/8, 8/10 7/7/17, 7/10/17 and 7/11/17 lows), and then $1216-18 (5 tops, 8/6, 8/7, 8/8, 8/9 and 8/10and high).
Some bears have been using gold's recent bounce off of $1160 to rebuild short positions scale up, though some shorts were run out today on the move over $1209 to $1212.50. Bears will look to take profits on an expected retracement toward recent lows.
Other bears, however, are still looking for gold to decline significantly more, as witnessed by Friday's COT Report showing another hefty build in fund gross shorts (+7k contracts to 222k contracts).
They feel fuel from a rising dollar will continue to provide downside pressure on gold, and that the dollar's ability to strengthen against other currency majors (and emerging market currencies) still has legs. They will be gunning for stops below $1200, $1192, $1185 (up trendline from 10/19/08 $682 low), $1175 (options strike), $1171-73 (quadruple bottom – 8/15, 8/17, 1/6/17 and 1/9/17 lows), and then the $1160 low from 8/16 to lead to a test of $1150.
All markets will continue to focus on geopolitical events, developments with the Trump Administration (especially on US-China trade, potential legal issues), oil prices, and will turn to reports Tuesday on the US Trade Balance, Wholesale Inventories, Retail Inventories, Case Shiller Home Price Index, Richmond Fed Manufacturing Index, and Consumer Confidence for near-term direction.
Big bear or buying opportunity? The state of precious metals now
Extreme sentiment on both gold and the US dollar – is it justified?
After a tumultuous week in gold, some think the worst is over
$1216-18 – 5 tops, 8/6, 8/7, 8/8, 8/9 and 8/10and highs

redpajama_set_name: RedPajamaCommonCrawl


broken in the GCL build?
too busy or overloaded with other activities and pass on by.
testing ahead of your news announcement.
I am running 32 bit XPSP2 on AMD 64 bit.
Please let me know if this is the incorrect list.


posts tagged with "open science"
Pointing to an article by Lydia Pyne in Ars Technica that focuses on the process of science in our South African project.
My reflections on a panel at the American Anthropological Association meeting that raised a troubling question.
Is there a trade-off between publication impact and open approaches?
An essay by two biomedical researchers raises a question about the citation race and opening up data.
An essay by Pete Etchells calls for scientists to bow out of reviewing when no data are provided to the public.
New scientific publication models have introduced more open peer review models, but it remains hard to quantify the value of the review process.
Sabine Hossenfelder describes her experience with a recent case of open peer review, leading me to consider the situation from an anthopology perspective.
A link to a perspective piece by Philippe Desjardins-Proulx and colleagues, with some comments.
What to do, as experimental psychologists are finding they can't replicate high-profile findings.
Looking for early career scientists to participate in the analysis of more than 1000 hominin fossil specimens.
"We find it hard to see what publication would achieve at this stage"
A White House request for comment on access to journal articles brings an unexpected comment.
Can Watson navigate the medical literature?


got my mederma today. i will be posting before and after pics if results r good.
i didnt' mention it but just keep using it B2001..If u dont see the results in 6 weeks..u can refund it but remember to keep ya receipt. I'ts bettter to give Mederma a try, it works for me.


yes folks. its true. ap collective is here.
I know its been quite the wait, but hopefully you'll find it well worth it. I know I sure think it is..and I'm still hard at work to bring you more! i actually have more that I need to upload, but thought we just needed to hit the road with what we have.
I plan to update the shop as often as possible, but know that with diving full force into our busy photo season, a ton of my creative energy [and time!] will be poured into that. But with that said, I do hope for frequent, smaller sized updates.
We are SO close. so so so close to opening up our online boutique.
I can't even express how crazy excited I am! allllll day yesterday was in prep for it -- Jon was my photog extraordinaire [props to him for catching this in-between-takes shot yesterday...I guess that IS what we do...]! We ran out of daylight yesterday and had a crazy busy day today, so hopefully we'll be able to squeeze in a few more photos in the next two days to bring the store LIVE super soon. SUPER. SOON.
and this I've realized.. I've had to let a few things go. I wanted to have EVERYTHING, each and every idea, that I wanted to make ready for the initial launch. but I just had to realize it wasn't possible. I have enough projects twirling and dancing in my head to fill up an entire year or so of work. for real. So if you don't see something that you're looking for or were hoping for, please be patient with us. We plan to update the store as frequently as possible [these fingers can only take so much hand stitching...and there is one other thing..oh right. the photo gig].
PLEASE, totally feel free to drop any and all suggestions of product you'd LOVE to see in the comment section below.
for now, I just want to remember this. this moment. how super stoked I am that this long time dream of mine [a boutique full of my handmade lovelies -- online counts, right? right?!?!] is just about to come true.
a photography business AND an online boutique of beautiful, handmade loveliness?!?
oops. how'd that little sneak peek get in there?!?!
...i can taste it. and its delicious.
stay tuned faithful friends and followers!
..with Jon's arms draped over me, the rise and fall of our breathing in sync, the pitter patter of rain on the window, and the lightening illuminating the shadows of our 12x14 bedroom. it was lovely..and i am thankful..
oh goodness. WHY do these bursts of inspiration hit me at 10pm?!?!? Actually. I've felt inspired most of the day. Of all things, a mall day with some of my most favorite ladies (and their cute kiddos) did it. As we chatted, ate lunch, laughed, watched the kids play, secretly wanted to trip the sprinting boys that we FAR too big to be the play place anyway (not to mention the kid who apparently thought it was totally fine to choke/strangle (!) pour Jackson), and walked in and out of stores, I found myself busting at the seams with anticipation to get home and create.
You see, I find that I can't simply be creative in only one avenue..so while the photo gig lets me pursue my emotional creativity -- the desire to pause and capture something that you can NEVER get back -- I also find myself NEEDING to pour my creativity into making things. [*side-note* i've always had a serious desire to paint -- and used to as a little girl. My BFF and I would play "art galleria" and paint to our hearts content. honing in on tips from Bob Ross and begging my mom to take us to Michaels because we simply COULD NOT paint without a fan brush, we'd create little bits of beauty [Debbie, I still have that waterfall painting. :) but its something that I never really pursued into adulthood -- with the small exception of painting a little diptych canvas set for our first little apartment..and a wooden painting in Xander's room. I think its on the cusp of making a return to my life...but not quite yet.]..
but to continue with my rush of creativity..I've felt so crazy inspired to create things this week. Yet found myself SO INCREDIBLY frustrated because I haven't had the time to devote to it. Don't get me wrong, our evening was lovely -- breakfast for dinner (a family fav), cleaning TOGETHER, a little rough housing with the boy [which incidentally went bad as heI busted his lip while flipping him over on the bed..he's good now..], chatting with our girls, laughing at the crazy little quips that dance out of their mouths, even simply talking over folding laundry with Jon [yes ladies. I know. he does laundry. hands off -- he's spoken for.]..I wouldn't trade ANY of that for time alone in our studio..its just hard to know that I'm brimming with creativity and can't really put much of it to work. And then when I find the time, that inspiration has dwindled. Or its 10:45 and I know that in 8ish hours, those kids are going to be leaping in my room asking for some breakfast (I STILL don't understand the need to eat the MINUTE one wakes up. coffee on the other hand....), so then I choose. Do I stay up late and create, listening to the beautiful monsoon roll in, or go to bed and hope that that same inspiration (and that monsoon!) is still hard at work in my brain and in my heart ready to pour out of my hands into something beautiful. Its a pickle I tell ya.
and I still haven't made up my mind..
this one. its this one that makes me laugh right out loud..
hahahahahahaha!!! is Evie flashing gang signs? and WHAT is with her EYES?!?!
ETA: that beautiful monsoon? its a doozy. my sliding glass door is actually SHAKING from the wind gusts..and that lighting is CLOSE. I think I might need to turn in so that Jon can hold me close as I'm feeling a wee bit anxious all of a sudden..


text:
In this Jan. 7, 2020, photo, Husson University swimming coach Butch Babin fist-bumps with a student while coaching during a practice at Webber Pool in Bangor, Maine. After multiple medical procedures and amputation of part of his right leg, Babin, 57, returned to coaching on a part-time basis in October and then resumed as the head coach full time after Thanksgiving. (Natalie Williams/The Bangor Daily News via AP)
Maine swim coach on pool deck despite medical setbacks
BANGOR, Maine (AP) — A college swimming coach has endured a quadruple bypass after a heart attack, removal of cancerous tumors from his colon and wrists, and the amputation of part of his leg. But Husson University's Butch Babin is still on the pool deck. Babin, 57, returned to coaching at the...
FILE - In this Oct. 16, 1968 file photo, U.S. athletes Tommie Smith, center, and John Carlos raise their gloved fists after Smith received the gold and Carlos the bronze for the 200 meter run at the Summer Olympic Games in Mexico City. The International Olympic Committee published guidelines Thursday, Jan. 9, 2020 specifying which types of athlete protests will not be allowed at the 2020 Tokyo Games. Athletes are prohibited by the Olympic Charter's Rule 50 from taking a political stand in the field of play — like the raised fists by American sprinters Tommie Smith and John Carlos at the 1968 Mexico City Games. (AP Photo, file)
IOC details rules on political protests at Olympics
LAUSANNE, Switzerland (AP) — No taking a knee at the Olympics. No hand gestures with political meaning. No disrespect at medal ceremonies. The International Olympic Committee published guidelines Thursday specifying which types of athlete protests will not be allowed at the 2020 Tokyo Games...
Agnes Keleti, former Olympic gold medal winning gymnast, poses for a photo with two of her Olympic medals at her apartment in Budapest, Hungary Wednesday Jan. 8, 2020. Although she turned 99 on Thursday, even a 9-year-old would have a hard time keeping up with Agnes Keleti's irrepressible energy and enthusiasm. Keleti is the oldest living Olympic champion and a Holocaust survivor. She won 10 medals in gymnastics — including five golds — at the 1952 Helsinki Games and at the 1956 Melbourne Games. (AP Photo/Laszlo Balogh)
Agnes Keleti, the oldest living Olympic champion, turns 99
BUDAPEST, Hungary (AP) — Although she turned 99 on Thursday, even a 9-year-old would have a hard time keeping up with Agnes Keleti's irrepressible energy and enthusiasm. Keleti is the oldest living Olympic champion and a Holocaust survivor. She won 10 medals in gymnastics — including five golds —...
Los Angeles Lakers' LeBron James, right, dunks against the Dallas Mavericks during the second half of an NBA basketball game Sunday, Dec. 1, 2019, in Los Angeles. (AP Photo/Marcio Jose Sanchez)
The King reigns: LeBron James is AP's male athlete of decade
He left Cleveland for Miami, finally became a champion, went back to his beloved northeast Ohio, delivered on another title promise, then left for the Los Angeles Lakers and the next challenge. He played in eight straight finals. No NBA player won more games or more MVP awards over the last 10...
Daiya Seto celebrates after his swim in the the men's 400-meter individual medley during an International Swimming League event Friday, Dec. 20, 2019, in Las Vegas. (AP Photo/John Locher)
Swimming reinvents itself with glitz and cash of pro league
LAS VEGAS (AP) — In a darkened arena on the Las Vegas Strip, swimming is being reinvented. Some of the sport's biggest names are competing in the grand finale of the International Swimming League, with flashing lights, pulsating music spun by an on-deck DJ and action-packed racing in a concept the...
FILE - In this Aug. 11, 2019, file photo, athletes compete in a marathon swimming test event at Odaiba Marine Park, a venue for marathon swimming and triathlon at the Tokyo 2020 Olympics, in Tokyo. The IOC moved next year's Tokyo Olympic marathons and race walks out of the Japanese capital to avoid the stifling heat and humidity. Some swimmers and an 11,000-member coaching body want similar treatment: find an alternative to the distance-swimming venue in Tokyo Bay known as the "Odaiba Marine Park."(AP Photo/Jae C. Hong, File)
Troubled waters: Open water swimming faces do-over of 2016
ATLANTA (AP) — Haley Anderson has been through this before. In the lead-up to the Rio Olympics, all the talk about open water swimming focused on the conditions rather than the competition. Now, it's happening again with the Tokyo Games less than a year away. This time, there is concern about the...
FILE - In this Aug. 10, 2015 file photo, Peter Farrelly, left, and Bobby Farrelly attend The Project Greenlight Season 4 premiere of "The Leisure Class" at The Theatre At The Ace Hotel in Los Angeles. The Boston-based Ruderman Family Foundation said Wednesday, Dec. 4, 2019, that the brothers are recipients of its sixth annual Morton E. Ruderman Award in Inclusion for pressing Hollywood to do a better job of casting and portraying people with disabilities. (Photo by Paul A. Hebert/Invision/AP, File)
'Green Book' director Farrelly, brother get disability award
BOSTON (AP) — In Peter Farrelly's 2018 Oscar-winning film, "Green Book," chauffeur Tony Lip quips: "The world's full of lonely people afraid to make the first move." Neither Farrelly nor his brother, Bobby Farrelly, the director of 1998's "There's Something About Mary," fits that description. Both...
FILE - In this Aug. 15, 2019, file photo, athletes dive into the water at the start line during a women's triathlon test event at Odaiba Marine Park, a venue for marathon swimming and triathlon at the Tokyo 2020 Olympics, in Tokyo. The IOC moved next year's Tokyo Olympic marathons and race walks out of the Japanese capital to avoid the stifling heat and humidity. Some swimmers and an 11,000-member coaching body want similar treatment: find an alternative to the distance-swimming venue in Tokyo Bay known as the "Odaiba Marine Park."(AP Photo/Jae C. Hong, File)
Hot Water: Pressure to move Tokyo Olympics open-water venue
TOKYO (AP) — The IOC moved next year's Tokyo Olympic marathons and race walks out of the Japanese capital to avoid the stifling heat and humidity. Now some swimmers and an 11,000-member coaching body are asking that something similar should be done with the distance-swimming venue in Tokyo Bay...
LA Current makes first of first world swim league
WASHINGTON (AP) — LA Current overhauled the Cali Condors and MVP Caeleb Dressel as the teams booked their passage to the first International Swimming League grand final in Las Vegas next month in a pulsating American derby in College Park, Maryland. The Condors were 21.5pts ahead with four events...


Pablo Amaringo, the seventh of thirteen children, was born in 1943 in Puerto Libertad, a small settlement near the town of Tamanco in Peru. He had completed only two years of schooling when his father abandoned the family, forcing the loss of their farm and subsequent move to Pucallpa, Peru, where 15-year-old Pablo found work on the docks. After falling critically ill, and with his family in extreme poverty, he began to draw and found that he could create bank notes using brushes and Chinese ink. Arrested for counterfeiting, he escaped from jail and fled to Brazil, where he worked for almost two years. He then returned to the Peruvian jungle, where he was cured of his heart trouble by an ayahuasquero, or vegetalist shaman. Arrested again for his past crime, he spent several months in jail and was released in 1969.
Soon after, Amaringo was taught the mysteries of healing by a forest woman who appeared to him in dreams. He practiced vegetalismo from 1970 to 1976, traveling throughout the Peruvian Amazon. Plunging deeper and deeper into the power of ayahuasca, or yajé, an herbal concoction widely used in a shamanic context among the Indian and mestizo populations of the upper Amazon, he became tortured by the spirit world. After fighting with and being injured by sorcerers and spirits, he decided to abandon shamanic practices and forsake ayahuasca. He began to paint, interpreting the other worlds of his experience in his art, and working for preservation of Amazonian environment and culture.
In 1988, Amaringo founded the Usko-Ayar school, where he teaches students to visualize internally what they are going to paint, in the same way that he does himself. As Amaringo notes, "The school's purpose is well defined: it is a tool for the conservation of the Amazonian environment and culture. By observing and depicting nature, people � especially young children � become more aware of its beauty and richness, and they learn to respect it. In addition, the students hope that their paintings will inspire other people to share similar attitudes of appreciation and reverence." Amaringo feels that he has a mission, which is to show glimpses of other dimensions through his paintings. Language, he says, is an imperfect means of communication. The spirits do not talk, but express themselves through images.
In 1992, Amaringo received the prestigious Global 500 Peace Prize from the United Nations Environmental Program, joining Jacques Cousteau, Chico Mendez, and Jimmy Carter, among others, as a true hero of the environmental movement.
Complete descriptions of many of the visions represented in Amaringo's paintings can be found in Ayahuasca Visions: The Religious Iconography of a Peruvian Shaman (North Atlantic Books, 1991) by Luis Eduardo Luna and Pablo Amaringo.


It would be fantastic if our life coaching services were able to reach those all around the lower mainland who could use our help. Unfortunately, this is not a realistic outlook, and our services are quite limited in terms of who can see us and how often. We can offer our guidance to those living in areas such as Burnaby, Coquitlam, Surrey, and other portions of BC's lower mainland. Because we already have such a high number of clients working in Vancouver BC, we are forced to have many (if not most) of our offices in the city centre.
How far can we go in terms of helping?
Most would agree that our services are quite helpful. There are a number of reasons why one might see a life coach in Vancouver. The main reasons are for relationships, financial/career, and for yourself (identity). Some even credit us for changing their lives entirely. Do we take credit for these kinds of results? Absolutely not – we aren't the ones doing the hard work, that would be you. Life coaching Vancouver is here to support you in every way to become the best person you can be, but we cannot change you. It all starts from within yourself.
It will vary from person to person. Some of our clients leave feeling happy and fulfilled after a week while others may spend years with us before they get to the point they really want to get to. Most clients spend a few months with us before they feel they're ready to accomplish whatever it is that they want to accomplish. Patience is a virtue and it is important that you do not give up too easily if you don't see the results you expected right away. If you feel that you cannot wait for results or that you need to solve your problems A.S.A.P. then our services may not be for you. Life coaching Vancouver is committed to helping you on a long-term scale; We do not offer a service which will benefit you for the next 3 years – our services are meant to help you for your entire lifetime.
If you have the right mindset going into this, it does not matter where you are in life right now. Regardless of how low you think you may be, it will not matter in the long-run. A famous quote is "attitude over aptitude". We live by this motto at Life Coaching Vancouver because of how true it is; as long as you have the right attitude coming into our program, you will be able to achieve unimaginable heights.


Lucerne, 16 April 2019 – At the start of 2018, Emmi gave its employees the motto "We are proactive and not afraid of hard work – together". No fewer than 20 projects – including seven from abroad – were submitted to the jury. On 12 April 2019, the best approaches to achieving a great deal together under time and work pressure received awards. First place went to an anti-food waste project.
Emmi has been holding an annual Sustainability Competition since 2012. It is launched at the beginning of the year with a motto. Employees can then voluntarily develop projects in line with this motto. If such a project is implemented successfully, it is eligible for the Emmi Sustainability Award at the end of the year. A jury comprising internal and external experts – headed by WWF Switzerland for the last two years – evaluates the projects submitted. The awards ceremony is then held in the spring.
The interpretations of the 2018 motto "We are proactive and not afraid of hard work – together" were many and varied. The most convincing idea was to use an internal online platform to place surplus products within Emmi, thereby reducing food waste.
While the Emmi Sustainability Competition was initially a purely Swiss affair, in recent years, employees abroad have also been encouraged to develop their own voluntary sustainability projects. Seven of the 20 entries assessed by the jury this year came from abroad, which is extremely pleasing. And the quality of the entries is also increasing. An impressive water-saving project with a big impact by Vitalait (Tunisia) and a packaging project by Redwood Hill (USA) also secured places on the winners' podium. The jury also decided to present a special Lifetime Award this year. Over the last decade, Switzerland's largest production site in Ostermundigen has achieved impressive improvements in all key environmental indicators. Long-standing site manager Isidor Lauber and his team from Ostermundigen therefore received a special award for this.
No one knows a company better than its employees. Emmi has used this fact for many years to boost its efficiency and cut its costs, as Emmi Operational Excellence (EOE) is fundamentally nothing more than an extensive employee suggestion scheme.
Emmi firmly believes that the knowledge of its employees is also needed to make the company more sustainable, because in addition to the four priorities that are managed top-down, the foundations for many aspects of sustainability in the company's daily operations are set by the 6,150 people who work at Emmi.
To ensure that these foundations are laid properly, a broad understanding of sustainability must be created among employees. Besides continuous communication on smaller and larger sustainability projects along the value chain, we also use an annual sustainability motto to achieve this awareness.
Emmi is a major Swiss milk processor. The company dates back to 1907, when it was founded by 62 dairy farming cooperatives around Lucerne. Over the past 20 years, Emmi has grown into an international, listed group. It has for many years pursued a successful strategy based on three pillars: strengthening its Swiss domestic market, growth abroad and cost management. Throughout its corporate history, Emmi's keen awareness of its responsibility to society, animal welfare and the environment has been fundamental to its mission.
In Switzerland, Emmi manufactures a comprehensive range of dairy products for its own brands and private label products for customers, including leading exports such as Emmi Caffè Latte and Kaltbach. In other countries, its products – mainly speciality products – are manufactured locally. Alongside cow's milk, it also processes goat's and sheep's milk.
In Switzerland, the Emmi Group has 25 production sites. Abroad, Emmi and its subsidiaries have a presence in 14 countries, seven of which have production facilities. Emmi exports products from Switzerland to around 60 countries. Its business activities focus on the Swiss domestic market as well as western Europe and the American continent. Half of its CHF 3.5 billion in sales – over 10 % of which stems from organic products – is generated in Switzerland, the other half abroad. It has over 6,000 employees who are also spread equally between Switzerland and other countries.


Meet F-cubed, a Fantastic Friends Feast of fabulousness. This new idea of dinner conversation is all about gathering people together to enjoy learning and discussion all while engaging in meals cooks by top chefs, indulging in fine wines that keep flowing, and partaking in sumptuous desserts. And it's coming to Glamifornia Style Lounge on July 21 at 6 p.m. It's a perfect fit.
The GSL is Malibu's premiere health, wellness, beauty and fitness salon. In fact, the mantra is always come for the style, stay for the lounge. We cater to art and fashion, beauty and wellness. Under the tutelage of Terah Tidy, passion is always on the menu!
This will be F-cubed's first official Malibu dinner, and will feature Mike "The Zipper" Sable, former Mr. America, Mr. USA and Mr. Universe. He'll speak about how to create success on a spiritual, mental, emotional, and physical label.
This dinner experience is all about conviviality. It promises to be a casual, close-knit dining experience. And it's just $72 per person. Check it out at f-cubed.org.


text:
Sunday Suggestions
September 17, 2007 December 9, 2012 Dr Bob
This week's links:
Global warming slapdown: There's plenty of heat and very little light in the global warming hysteria. Here's a breath of fresh air: Challenge to Scientific Consensus on Global Warming:
A new analysis of peer-reviewed literature reveals that more than 500 scientists have published evidence refuting at least one element of current man-made global warming scares. More than 300 of the scientists found evidence that 1) a natural moderate 1,500-year climate cycle has produced more than a dozen global warmings similar to ours since the last Ice Age and/or that 2) our Modern Warming is linked strongly to variations in the sun's irradiance. "This data and the list of scientists make a mockery of recent claims that a scientific consensus blames humans as the primary cause of global temperature increases since 1850," said Hudson Institute Senior Fellow Dennis Avery….
"We have had a Greenhouse Theory with no evidence to support it-except a moderate warming turned into a scare by computer models whose results have never been verified with real-world events," said co-author Singer. "On the other hand, we have compelling evidence of a real-world climate cycle averaging 1470 years (plus or minus 500) running through the last million years of history. The climate cycle has above all been moderate, and the trees, bears, birds, and humans have quietly adapted."
"Two thousand years of published human histories say that the warm periods were good for people," says Avery. "It was the harsh, unstable Dark Ages and Little Ice Age that brought bigger storms, untimely frost, widespread famine and plagues of disease."
The Dems & Gen. Petraeus: Some great cartoons over at Flopping Aces:
(HT: Maggies Farm)
It's Knot What You Think: This could help my surgical skills — or knot: Animated Knots (HT: Neatorama)
San Fran Health Plan: San Francisco tries covering everyone — in San Francisco. Interesting, in some ways; the devil's in the details, especially how much it will cost and who pays (usually businesses, who will likely migrate outside the city if the burden is too onerous): San Francisco to Offer Care for Uninsured Adults
Catholic & Protestant: Happy Catholic gets it exactly right: Back of the Bus" Christians? No Way.
The truth about indulgences: Bad rep, indulgences: selling salvation, seriously PO'd Martin Luther and fomented the Protestant Reformation. Like the Crusades, much misunderstood, however, and the truth is far different from the conventioal wisdom (isn't it always?). Here's the scoop in all its glorious detail: Indulgences
That's all for now. God bless, have a great week.
Wednesday Links
The Problem of Miracles
One thought on "Sunday Suggestions"
Julie D. says:
Thanks for the link! :-)


The Stag's Head Is An Independently Run Pub And Restaurant In The Village Of Great Doddington, Northants. We Are Very Easy To Find, Situated Just Off The A45, A Ten Minute Journey From Northampton And A Few Minute Journey From Wellingborough. We Also Have A Very Large Car Park Therefore Parking Is Not A Problem.
We Pride Ourselves On Our Extensive Menu Of Home Cooked Food, Our Friendly & Helpful Customer Service & Wonderful Warm Welcome.
The Recently Refurbished Stag's Head Was Established In 1693. It Now Has A Modern Vintage Twist & Consists Of A 48 Seater Traditional Beamed Restaurant, A 26 Seater Cosy Cellar Restaurant, A Large Open Lounge Bar, A Separate Garden Bar And A Beautiful Secret Garden.
The Stags Head Is Dog Friendly & Allow Your Four Legged Friends To Join You ...In The Garden Bar Or Secret Garden. The Stag's Head Can Cater For Any Occasion, Party, Event Or Celebration, So Please Feel Free To Send An Enquiry For Details.


Karimia Institute is proud to start a new FREE 'Quranic Arabic and Basic Islamic Studies course' (for Revert sisters). The course will start on Sunday 1st July 2018 at 5:00pm – 6:30pm and will take place every Sunday. The course will be held at: Fig Tree Primary School, which is located on: 30 Bentinck Road, Hyson Green Nottingham, NG7 4AF.


I'm a clinical psychologist working in the Linksfield, Edenvale areas as well as in Parkwood - close to the zoo. I offer supportive psychotherapy for depression, anxiety, mood and bipolar disorders, and many other problems that individuals, adults, couples and children struggle with. I offer treatment for relationship problems, bereavement, post-natal depression, eating disorders etc. I have many years experience working with clients and supervising colleagues. I have worked in community organization's, the corporate world, and in children's homes. I've run Staff Support and supervision groups for trainees and colleagues. I am an editor and co-author of 'Elements of Counselling', a manual for lay counsellors, now going into its third edition.
Specialising in: Chronic medical conditions, fertility related issues, play therapy, neuropsychiatric disorders, schizophrenia, addiction, anxiety disorder, bipolar disorder, depression, developmental disorders, eating disorders, family difficulties, learning difficulties, life changes, loss/grief, personality disorders, relationships, self development, sexuality and gender, and trauma.


text:
Ending the Debt Ceiling Drama for Good
iStockphoto/The Fiscal Times
President Trump said Thursday that there are "a lot of good reasons" to get rid of the debt ceiling, and he's far from being alone in thinking that.
"Why don't we just do away with it?" House Minority leader Nancy Pelosi told reporters Thursday. "We're not going to let the government default."
The Washington Post's editorial board wrote Friday that "Such a long-term fix is well worth pursuing. The all-too-frequent need for Congress to authorize fresh debt has become a destructive game of chicken for both parties. Without relinquishing its constitutional prerogatives, Congress should join the president in looking for a mechanism that is less likely to produce grandstanding — and threats to the nation's financial stability."
But while members of Congress generally dislike having to vote to raise the debt limit, they are divided about eliminating the ceiling altogether. Conservatives in particular worry about losing the leverage the debt ceiling may provide to force spending cuts.
Ultimately, the "gentlemen's agreement" the president struck with Senate Minority leader Chuck Schumer this week to pursue an end to debt ceiling drama may not involve doing away with the borrowing limit completely. In an interview with Fox News on Friday, OMB Director Mick Mulvaney described a conversation he had with the president about the debt ceiling Thursday night: "We did talk about this: How do we depoliticize it? How do we make it so that it's not sort of this precipice, this cliff, every couple of months or years? How do you make it to where it's more of an ordinary course of business and is not yet just another divergent sort of leverage point in the process of Washington, D.C.?"
Republicans Defy Trump as House Passes Two-Year Budget Deal
The House on Thursday afternoon passed a two-year budget deal that would raise spending, suspend the debt ceiling...
Deficit Don? Now Trump Has to Sell His Budget Deal
They've clinched a deal. Now they have to sell it. The Trump administration and congressional leaders set out Tuesday...
Trump and Pelosi Strike a Big Budget Deal
President Trump announced Monday afternoon that he had reached a deal with House Speaker Nancy Pelosi and other...


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Verimatrix appoints CTO
8th March 2010 @ 23:00
Conditional access specialist Verimatrix has appointed Petr Perteka as chief technology officer.
Prior to joining Verimatrix, Peterka was a member of the technical staff in the CTO's office at Motorola's Home and Networks Mobility team. He will succeed Bob Kulakowski, a founder of Verimatrix, who remains a shareholder and an adviser to the company.


July 30, 2013 — Guerbet has announced that Cincinnati Children's Hospital Medical Center (Cincinnati Children's) last week performed the first U.S. injection of Dotarem (gadoterate meglumine), the only macrocyclic and ionic gadolinium-based contrast agent (GBCA) approved by the U.S. Food and Drug Administration (FDA). The procedure was performed in a school age child.
Dotarem is indicated for intravenous use with magnetic resonance imaging (MRI) in brain (intracranial), spine and associated tissues in adult and pediatric patients (2 years of age and older) to detect and visualize areas with disruption of the blood brain barrier (BBB) and/or abnormal vascularity.
Dotarem was approved by the FDA in March 2013 and was released for the U.S. market in early July. Cincinnati Children's was the first hospital to order the product in the United States. In the past year, Cincinnati Children's performed 18,000 total MRIs, with more than 6,600 performed as contrast-enhanced MRIs.
Dotarem — which has been commercialized widely outside the United States since 1989 and more than 37 million doses administered (according to data on file as of Jan. 1, 2013) — is the only macrocyclic and ionic GBCA. The recommended dose is 0.2 mL/kg (0.1 mmol/kg) body weight (BW). Dotarem Injection 0.5 mmol/mL contains 376.9 mg/mL of gadoterate meglumine and is available in vials and pre?filled syringes.


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MPPT treatment of wounds and pressure ulcers in spinal cord injured patients
Post category:Amicapsil / Amicapsil-SCI / Clinical studies / Health-economics / Pressure ulcers / Safety / Spinal cord injury
New data indicate that the global annual prevalence of pressure ulcers in SCI-persons is 32.4% (Shiferaw et al. 2020).
When a pressure ulcer is severe and not treated aggressively it can lead to further disability (e.g., reduced mobility, dependence, surgical intervention, amputation, fatal infection; Krause 1998). It has been estimated that 7-8% of those who develop pressure ulcers will die from related complications (Richards et al. 2004).
It has been estimated that pressure ulcers account for approximately one-fourth of the cost of care for individuals with SCI. In the United States alone, it has been estimated that the cost of care for pressure ulcers is about 1.2 to 1.3 billion dollars annually while prevention could cost about one-tenth of this amount (Bogie et al. 2000; Byrne et al. 1996). Because of the costs associated with treating pressure ulcers, Krause et al. (2001) state, "they [pressure ulcers] have received more attention among rehabilitation and public health professionals than any other type of secondary condition associated with SCI" (p107). Despite the attention given to prevention strategies, pressure ulcers are common among individuals with SCI (Krause et al. 2001). The most recent econometric analysis of pressure ulcer resource utilization for community dwelling people with SCI identified that 62% of the cost of pressure ulcer treatment was attributable to hospital admission costs. The average monthly costs of treating SCI-patients with pressure ulcers in community care were £2,739 in 2010 values (Chan et al. 2013). Nursing costs accounted for the greatest cost amongst non-physician health care providers (Chan et al. 2013).
(Source: summary of data from Hsieh et al. 2014)
This was an open, single-arm prospective study of the effects of MPPT (Amicapsil, Amicapsil-SCI) on wounds and pressure ulcers in persons with spinal cord injury (SCI). Spinal cord injury disrupts communication between nervous and immune systems. As a consequence, SCI-persons are immune deficient and have low ability to fight wound infections. The study includes 43 wounds (20 acute and 23 chronic) and found that MPPT consistently treated wound infections. This led to reductions in odour and exudate, and to tissue regeneration, which again led to reductions in wound size and, if osteomyelitis was not present, to closure. The reduction in tissue infection removed or reduced the frequency and severity of autonomic dysreflexia and, by combining the use of MPPT with an air supply, patients could escape constant bedrest and resume an active life. MPPT was safe, including following long-term use directly on muscle and bone, and did not cause any allergic reactions. Ease-of-use of MPPT meant that patients could be responsible for treatment, thus providing maximum opportunity for self-care and independence.
Generally in wounds, once infection has reached bone and osteomyelitis developed, the clinical picture changes completely as the bone now becomes a source of infectious debris, continuously draining into the adjacent soft tissue. This causes a diffuse and disseminated soft tissue breakdown which results in an uncontrollable wound. As osteomyelitis requires surgical removal, the aim of using MPPT changes from wound closure to improving the outcome of surgery for the patient. MPPT was able to regenerate lost tissue and to facilitate the formation of a structured and controlled fistula between the bone and the wound through which the infectious debris from the bone could drain. This substantially reduced the level of soft tissue infection and thereby the risk of septicaemia and sepsis. It also reduced the frequency and intensity of autonomic dysreflexia. Both issues are common causes of mortality. Additionally, by implementing the use of an air-providing pump, it was possible to avoid extended bedrest, allowing the patient to resume an active life while awaiting surgery, thus avoiding the detrimental effects of extended bedrest (Dittmer 1993; Teasell 1993). Finally, by minimizing the extent of soft tissue infection, less tissue will need to be removed during bone surgery. As the tissue acts as cushioning, its removal increases the risk of renewed pressure ulcers caused by protruding bones. Limiting the amount of tissue removed, will improve the long-term rehabilitation prospects for the patient.
In terms of costs, the study found:
Acute grade 1 or 2 wounds (10 wounds): all healed and required less than 1 bottle of 750mg to heal. They usually required minimal support.
Acute grade 3 or 4 wounds (10 wounds): Average costs of Amicapsil-SCI were £251.66. Patients were responsible for the daily dressing changes, but if daily nurse visits from start to full closure are included into the calculations at £33 per visit (NHS data), average cost per wound to closure were £56.
Chronic grade 3 and 4 ulcers (10 ulcers 3 months to 12 years of age) without osteomyelitis: Average costs of Amicapsil-SCI to closure were £1,059.59, ranging from £359,52 to £3,954.72 with costs being affected by wound grade, age, size and individual response. For all wounds, it was the patient, family or carers, who performed the dressing changes. Study protocol required daily monitoring of the wound but once patients had become familiar with Amicapsil-SCI daily help was not needed, but could easily be reduced to every three days or less frequent. For cost calculations, daily monitoring for the first 30 days were included to teach the patient how to use Amicapsil-SCI, followed by visits every third day until closure. Using this regime, the total average cost per wound were £3,234.75.
Chronic grade 4 wounds with osteomyelitis: Once osteomyelitis develops, the treatment goal is no longer wound closure, but to minimise risks associated with the wound until surgery. The use of Amicapsil reduces risk of sepsis, frequency and severity of autonomic dysreflexia, both of which are associated with high mortality, and improves rehabilitation outcome following surgery.
Chan et al. (2013) estimated the average annual costs of treating SCI-patients with pressure ulcers in community care were £32,868 in 2010 values and Guest et al. (2018), using the NHS THIN database, found for non-SCI persons the average costs of a grade 3 or 4 pressure ulcer for the first 12 months after presentation to the GP to be £12,845. In this study 100% of the Amicapsil-treated acute wounds closed, whereas in the findings by Guest et al. (2018) only approx. 15% healed within the first 12 months, meaning that their costs continued the following years. As these costs have not been included, the actual savings will be considerably higher. Comparing the acute grade 3 and 4 ulcers to the findings of Guest et al. (2018) the savings are 86.1% for the first 12 months only. For the chronic wounds without osteomyelitis, comparing the costs of reaching a closed wound to the costs of Chan et al. (2013) for one year, the savings are 90.2%. All of these saving-calculations only include the costs of one year, which is unrealistic as the wounds continue to deteriorate and become more and more expensive to treat.
Wounds without osteomyelitis: Amicapsil-SCI healed all wounds.
Wounds with osteomyelitis: Amicapsil-SCI removed soft tissue infection and regenerated new tissue, reducing the wound to a draining fistula; this reduced the amount of tissue that needed to be removed during surgery for the osteomyelitis, which improved prospects of rehabilitation.
Amicapsil-SCI is suitable for teletreatment, providing freedom and independence as individuals can decide themselves when and where to perform dressing changes.
No requirement for extended or continuous bedrest, which has detrimental health consequences. All other approaches require immediate and full bedrest.
Reduced frequency and severity of autonomic dysreflexia.
Reduced risk of septicaemia and sepsis.
High prevalence of pressure ulcers immediately following injury severely impact long-term rehabilitation outcomes. Access to effective treatment that ensures rapid resolution, allows timely enrolment in rehab maximising future independence.
Effects of Amicapsil-SCI (MPPT) treatment on the risks caused by wound. Risks can be septicaemia, development of osteomyelitis and further spread of infection. For grade 1-3 wounds, not having penetrated the adipose layer (tela subcutanea), data indicate that the risk does not increase beyond a certain level. For grade 4 wounds, risk increases as infection can spread unhindered in the tissue and this will at some point lead to the development of osteomyelitis. Once osteomyelitis is present, surgery is required to resolve the condition. Without osteomyelitis, MPPT can achieve wound closure, but time to reach wound closure increases with wound age. With osteomyelitis, MPPT can control soft tissue infection and the body will form exit tracts for debris from the infected bone. However, as MPPT cannot affect osteomyelitis inside the bone, the osteomyelitis will gradually worsen and at some point MPPT will no longer be able to control the amount of debris coming from the bone, including preventing spread to other structures.
See cases: https://willingsford.com/blog/category/wounds/sci-and-wounds/
Tags: Acute, autonomic dysreflexia, Chronic, osteomyelitis, sepsis, spasms
Previous PostMPPT induces tissue regeneration, whereas PHMB causes degeneration, in patient
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Is MPPT safe?
Why is impaired wound healing common to diabetes, spinal cord injury and multiple sclerosis?
3.5 year old sacrum pressure ulcer
Amicapsil for wounds in humans
SertaSil for wounds in animals
Aprobaxil for dermatological wounds in humans
Adinasil for dermatological wounds in animals
Adinasil
After MPPT
Amicapsil
Amicapsil-SCI
Aprobaxil
Case reports – clinical
Case reports – veterinary
Diabetic foot ulcers – DFU
Dog tail
Health-economics
Mode-of-Action
SertaSil
Veterinary studies
Willingsford


Unite, the UK's largest union, has accused the government of washing its hands of thousands of workers who are experiencing the misery of being paid via an umbrella company.
In the majority of cases workers are initially engaged via an employment agency but are then told that they will be paid via an umbrella company.
Under an umbrella company the worker has to pay both the employer's and employee's national insurance contributions in addition to income tax, which amounts to 46 per cent of a worker's eligible earnings. The worker is also charged an additional sum - often up to £25 a week - for the 'privilege' of being paid in this manner.
In 2015 the Treasury estimated that 260,000 workers were employed by umbrella companies but this figure was considered an underestimate and the tentacles of umbrella companies have spread further since then.
Unite assistant general secretary Gail Cartmail said: "The government has clearly washed its hands of workers who are subjected to the misery of being paid via umbrella companies.


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Renaissance est le premier album du groupe de rock progressif britannique Renaissance, sorti en 1969. Il est formé des ex-Yardbirds, Keith Relf au chant, à la guitare et à l'harmonica et Jim McCarty à la batterie, John Hawken au piano et au clavecin, Louis Cennamo à la basse et Jane Relf la sœur de Keith au chant et aux chœurs.

Titres

Toutes les chansons sont de Keith Relf, Jim McCarty, John Hawken et Louis Cennamo, sauf mention contraire.

Face 1

 Kings and Queens – 10:56
 Innocence – 7:07

Face 2

  Island – 5:58
 Wanderer (Hawken, McCarty) – 4:02
 Bullet – 11:21

Musiciens

 Keith Relf : chant (1, 2, 5), guitare, harmonica
 Jane Relf : chant (3, 4, 6, 7), percussions
 John Hawken : piano, clavecin
 Louis Cennamo : basse
 Jim McCarty : batterie, percussions, chant sur (2)

Album de Renaissance
Album musical sorti en 1969
Album publié par Island Records
Album publié par Elektra Records

redpajama_set_name: RedPajamaWikipedia