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is Peter Benchley's book a forgotten masterpiece

Estimated sales of 20 million books changed Benchley's life forever, not to mention popular culture as we know it, helped of course by Steven Spielberg's blockbuster movie released a year later in 1975.

Without Jaws there would be no Shark Week,van cleef & arpels knock off alhambra bracelet, no 'Jumping the Shark', and, proving that not all great ideas produce good results, no Jaws 2, 3 D or The Revenge. Commentators from Fidel Castro to Slavoj Zizek have had their say about Benchley's great white. It has been a metaphor for dispassionate nature, international Communism, Watergate, the majesty of the ineffable and Fascism. For Peter Biskind, the shark was a 'greatly enlarged, marauding penis'. For the more literal Kingsley Amis, Jaws was about a bloody great shark that could eat you alive.

While next year's 40 anniversary of Spielberg's film will doubtless be accompanied by anniversary DVDs and documentaries reiterating the rigours of the shoot (mechanical sharks sinking, Robert Shaw drinking), Benchley's prose man eater has entered middle age rather quietly. His UK publishers have not issued a celebratory edition, although a 40 anniversary Jaws has been released in the United States.

Perhaps the nearest thing to a birthday cake is Will Self's new novel, Shark although like a recent Radio 4 documentary, he seems more in love with Spielberg's movie than Benchley's book.

The muted celebrations reflect the idea that Benchley's novel has been swallowed whole by Spielberg's film. Jaws not only broke box office records, it would not look out of place in any top 50 movie list. Benchley's original would struggle to make most literary critics' top 50,000 books. There is little to match Spielberg's marriage of propulsive storytelling with visual innovation: the dolly zoom on Martin Brody after Alex Kintner is attacked on a lilo; the camera placed wave high to enhance the vulnerability of unsuspecting bathers.

Benchley's prose is by turns functional ('lacking the flotation bladder common to other fishit survived only by moving') and melodramatic to occasionally risible degrees: 'He screamed, an ejaculation of hopelessness'. His dialogue too lacks the memorable pith of the film script. Sing farewell and adieu to lines like: "You go in the cage. Cage goes in the water. Shark's in the water," "This was no boating accident," and of course "We're going to need a bigger boat," improvised on set by actor Roy Scheider.

And yet, the hushed celebrations do a disservice to a novel that helped refine the modern bestseller and succeeds in its own right as a compelling, if flawed work of popular fiction. Benchley dreamed up that title. Many are pretentious: A Question of Evil, Anthropophagus, Jaws of Despair, Dark White. Some are baffling: Squam, Letter on Mundus, Pices Redux. Some are simply terrible: Omnivore, The Edge of Gloom and What Have We Done? Jaws plural possesses a latent, biting power that intrigued Stephen Spielberg, although he initially thought was it about a pornographic dentist.

Bite back: happy anniversary Jaws (Universal Archives/ Krause Johansen)

Benchley also invented many of the film's most memorable set pieces: the killing of Alex Kintner, his grieving mother's confrontation with Martin Brody, and the opening, at once mysterious and shocking, primeval and terrifying. Benchley created Amity, a town whose very existence is threatened by the shark's taste for tourists, and the political pressures heaped on Police Chief Martin Brody.

In a sense,van cleef knock off bracelets, Benchley was simply writing what he knew. Born in New York City, he spent his summers sailing and swimming the waters off Nantucket. His father, Nathaniel, was a respected children's novelist. His grandfather, Robert, was the revered Algonquin wit. Eventually Tom Congdon at Doubleday bit, paying $1000 for four chapters, which Benchley wrote funny to Congdon's distaste. The jokes were removed, and the rest was history, eventually.

Jaws was an instant hit, although not a bona fide phenomenon until its paperback release timed to coincide with the movie. The hardback was actually kept from number one by Richard Adams' Watership Down offering the pleasing image of a 20 foot great white being fought off by several cute bunny rabbits.

Read today, the novel's fascination is often inextricable from its weakness. Benchley threw everything at his debut,bracelet fake van cleef, including a vague mafia plot surrounding the town's mayor Larry Vaughan, which owes more to Mario Puzo's The Godfather than Benchley's familiarity with the Cosa Nostra.

There are doses of un Spielbergian sex,van cleef gold fake bracelet, which are dated to the point of offensiveness: Ellen Brody's rape fantasises, for example. Nevertheless, her brief affair with Matt Hooper gives the character depths that are absent in the movie where Mrs Brody is little more than a worried wife and mother. She is this in the novel too, but with a job, a hinterland, desires, regrets and something approaching three dimensions.

Benchley's characters are singularly unlikeable, and all the more interesting for it. Brody remains the focal point, but is edgier, with class and sexual chips on his shoulder. Many are placed there by Matt Hooper, younger, hunkier and WASP ier than Richard Dreyfuss' witty ichthyologist. Quint, however, is essentially Quint, a Captain Ahab for the 1970s: two legged admittedly, but still mad, bad and dangerous to know.

This depiction of human frailty hints at Benchley's main triumph over Spielberg: namely, the portrayal of the shark at the end of the story. In the film, Quint's laconic rage while recalling his survival of the USS Indianapolis transforms Jaws into a revenge tragedy. Relentless, remorseless and even devious, the shark is a smiling villain, more Lee Van Cleef than Moby Dick. The Western subtext breaks the surface in the final showdown between great white and Sheriff Martin Brody. The joyful climax, enhanced by Matt Hooper's resurrection, offers little doubt who we should be rooting for.

The respective conclusions were bones of contention for Benchley and Spielberg. Benchley thought the movie's was absurd. Spielberg countered, not without cause: "If I've got them for two hours, the audience will believe whatever I do in the last three minutes." His high octane finale addressed a problem of his own: that the novel ends on a 'downer'. Benchley's shark simply stops swimming, defeated by days of punishment and literally choking on Quint: 'It seemed to fall away, an apparition evanescing into darkness.' This downbeat conclusion makes a more upscale argument than the film is capable of. Benchley's shark is an amoral force of nature: not bad, just hungry. And what amoral nature has unleashed, so amoral nature reclaims in death. As Brody swims home, the inference lingers that Amity, not the ocean, is home to genuine evil: corruption, selfishness, infidelity, lies, fury and greed.

Benchley, who died in 2006, would repent his depiction of the great white shark, which now exists on the endangered species list. The great whites killed by accident and design are just a fraction of the 100 million sharks killed each year, largely for their fins. Warnings about the real villains of this tragedy human beings are present in Peter Benchley's Jaws, not Steven Spielberg's. One day we might even read it and weep.

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Jun 23 · 0 comments
Fremantle draftee Alex Silvagni is elevated off the rookie list,van cleef fake bracelets

The famous Silvagni name will be back in the AFL this weekend after draftee Alex was elevated off the rookie list in time for the opening round clash with this weekend.

After coach Mark Harvey had tipped Dream Team managers to include Silvagni in their line ups for this season, those who took note were not disappointed when the club confirmed the 22 year old was being upgraded from rookie status.

Silvagni, the second cousin of Carlton legend Stephen, enjoyed an impressive pre season, playing on some of the best forwards in the game including St Kilda's Justin Koschitzke and Melbourne's Brad Miller.

Jay van Berlo, who played four senior games last season, was given a similar reward for his efforts in the pre season and is in line for a fifth,van cleef knock off gold bracelet, with Harvey saying earlier this month he would only elevate rookies he intended to play.

With first round draft pick Anthony Morabito also poised to make his first AFL appearance, and Michael Barlow already elevated off the rookie list, that means three debutants for the Dockers in week one.

"There's a couple in the mix there. Maybe one or two of those guys we might look at from a selection point of view that we might have to elevate them.

"[Morabito] is in line for selection,van cleef and arpels perlee replica bracelet. The squad comes out today and he'll be in the squad. We're still juggling a bit with the balance of our team."

,van cleef alhambra knock off bracelet, meanwhile, have named a relatively familiar side for the trip to Perth, with rookies Will Young and Tony Armstrong named in a squad of 25.
Jun 23 · 0 comments
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Jun 23 · 0 comments
Iyanla Vanzant To A Father Of 34 Children

Jay Williams is a successful video producer in Atlanta who has worked with some of the music industry's top talents. He has certainly excelled professionally,van cleef and arpels knock off clover bracelet, but his personal life is a different story.

In a revealing letter written to spiritual and relationship expert Iyanla Vanzant, Williams said he has fathered 34 biological children with 17 different women. His oldest daughter is 26 and his youngest is 3; Williams says his relationships with his children range from excellent to non existent. To help him fulfill his role as a father and begin to put the pieces of his personal life back together, Iyanla travels to Atlanta for a no holds barred conversation on "Iyanla: Fix My Life."

The first thing Iyanla does is confront Williams with a physical representation of his responsibility by bringing him 34 dolls. She asks Williams to hold as many dolls as he can, to feel the weight of what he's created. He can only hold 14.

"Let me ask you this question,bracelet alhambra replica van cleef, Jay. Thirty four children. At any point, did it dawn on you [that] this is too much?" Iyanla asks.

"No," Williams answers evenly.

When Iyanla asks Williams about using protection during sex, he insists that he did. "I probably would have 200 kids if I didn't use condoms," he says.

Williams says he never considered getting a vasectomy, either. "I don't want one," he explains,van cleef and arpels knock off alhambra bracelet, still holding the 14 dolls. "I don't have a problem with what I created."

As Iyanla continues to question him about his choices, Williams appears frustrated and decides to place each one on the dolls on the chair next to him. "I'm tired of holding the dolls," he tells Iyanla.

One by one, she hands each doll right back to him.

"I'm sorry,van cleef & arpels alhambra knock off bracelet, as a mom, I don't get not to take care of my children, no matter what I'm thinking or feeling," Iyanla says to Williams. "I didn't get to just put them down because it was inconvenient."
Jun 23 · 0 comments
Highly sensitive MRD tests for ALL based on the IKZF1 Delta3

Highly sensitive MRD tests for ALL based on the IKZF1 microdeletionN C Venn1, V H J van der Velden2, M de Bie2, E Waanders3,van cleef and arpels knock off alhambra bracelet, J E Giles1, T Law1, R P Kuiper3, V de Haas4, C G Mullighan5, M Haber1, G M Marshall1,6, Norris MD1, J J M van Dongen2 and R Sutton1Current clinical trials for patients with acute lymphoblastic leukemia (ALL) depend upon the measurement of minimal residual disease (MRD) at early stages of therapy to determine the risk of relapse for each patient who is being used for treatment stratification.1 PCR based MRD tests are usually designed to detect the specific rearrangements of immunoglobulin and T cell receptor (Ig genes found in the leukemic clone. We now present evidence supporting the hypothesis that the most common deletion in the IKZF1 gene in ALL also provides the basis for highly sensitive MRD tests that give MRD results in close agreement with Ig MRD markers.

Mullighan et al.2 reported that DNA copy number alterations (CNAs) in the IKZF1 gene, which codes for the lymphoid transcription factor IKAROS, were very common in leukemic DNA from Philadelphia chromosome (Ph) positive ALL patients (83 CNAs were not detected in the IKZF1 gene at diagnosis in 23 patients with chronic myeloid leukemia but IKZF1 CNAs were found after blast crisis (that is, conversion to acute form of leukemia) in 4 out of 15 patients including 3 out of 4 patients with lymphoid blast crisis.2 A subsequent study showed CNAs in IKZF1 in 29 of high risk, Ph negative ALLs.3 One quarter to one third of patients with IKZF1 alterations had a deletion of exons 4 corresponding to loss of coding exons 3 and resulting in the expression of a dominant negative IKAROS isoform, IK6.2 The deletion breakpoints for these IKZF1 alterations are usually located within a few nucleotides, and have characteristic N regions comparable to Ig gene rearrangements.

These findings suggested the feasibility of designing MRD assays based on real time quantitative (RQ) PCR in the same way as Ig MRD tests. One possibility was the use of two primers and a probe, with one primer specific for the unique N regions at the breakpoint fusion site. Another possibility was the use of a generic IKZF1 RQ PCR assay based on one probe and two primers that all bind to germline sequences and create a PCR product that bridges the breakpoint. Given the assumption that these IKZF1 rearrangements are absent or rare in normal lymphocytes, such a germline assay might be specific for leukemia. These approaches were assessed by comparison with standard Ig MRD tests.

Patients carrying the IKZF1 deletion were identified by two alternate methods. PCR analysis of diagnosis leukemic samples with published IKZF1 primers2 was used to identify 28 patients (6 in a set of 458 patients enrolled on the Australian and New Zealand Children's Haematology Oncology Group (ANZCHOG) Study 8 clinical trial. For patients enrolled on the Dutch Clinical Oncology Group (DCOG) ALL9 trial, an IKZF1 focused multiplex ligation dependent probe amplification test was used and revealed a range of CNAs involving the IKZF1 gene in 15 (44 of relapse cases and 18 (14 of unselected patients.4, 5 Some of the patients with the IKZF1 deletion were used in this study. This research was approved by the institutional bioethics committees at University of New South Wales and Erasmus Medical Centre with informed consent from parents of children for the use of the samples for research.

The subsequent RQ PCR analyses for MRD were performed using different sets of primers and probes to detect the IKZF1 deletion, which are shown in Figure 1. MRD was measured by RQ PCR in triplicate using standards made by serial dilution (10 10 10 5 10 10 5 10 10 of the patients diagnosis DNA diluted in normal mononuclear cell DNA in 25 volumes in 96 well plates. The RQ PCR of ANZCHOG patients was performed using set A or set B on 500 ng DNA with KAPA Biosystems (Boston, MA, USA) mastermix using a touchdown program (with extension temperature dropping by 1 for 10 cycles from 71 to 61 and then a further 45 cycles) on the Biorad (Hercules,sweet fake alhambra bracelet, CA, USA) IQ5 or CFX96 platform. The RQ PCR of DCOG patients was performed using set C on 600 DNA with Universal mastermix (Roche, Indianapolis, IN, USA) on an Applied Biosystems (ABI, Foster City, CA, USA) StepOne plus cycler. MRD tests using set A primers and probe were performed on 61 follow up bone marrow samples from eight patients, set B on 57 samples from seven patients (four in common with set A) and set C on 44 samples from seven patients. All MRD data were assessed according to EuroMRD guidelines.6

Figure 1.

Primers and probes used for RQ PCR analysis of IKZF deletions. The gene coding for Ikaros has eight exons (gray boxes 0 of which 1 are coding. The sequence between the two breakpoint arrows is deleted in IKZF1 and this gene alteration can be detected by RQ PCR using primer sets A, B or C (horizontal arrows, and F IKZF1 and R IKZF1 sequences) and probes (open boxes and T IKZF1 sequences). For both sets A and C, the 5 primer and probe match sequences before the breakpoint in intron 2 and the 3 primer binds after the breakpoint in intron 6. Set B used the same probe and 5 primer as set A in combination with a different allele specific primer for each patient which bridged the unique breakpoint sequence. Both probes were synthesized by Applied Biosystems, but with different chemical structures: T IKZF1 A has a minor groove binding capacity,bracelet knock off van cleef and arpels, and T IKZF1 C is a TAMRA Taqman probe. The location of primer and probe sequences shown in brackets are according to NT_033968.6.

Full figure and legend (53K)

The set A primers and probe were designed to detect all 28 IKZF1 rearrangements in ANZCHOG Study 8 patients allowing for the most truncated intron 2 and intron 6 sequences, and has a forward primer and a minor groove binding probe both binding to intron 2 upstream of the breakpoint and a reverse primer downstream in intron 6. Set B has the same probe and forward primer as set A, but was used in combination with an allele specific reverse primer (positioned over the breakpoint fusion). Set C was used in the Dutch cohort and has primers and a Taqman probe in similar positions as set A but all closer to the breakpoint giving a shorter product. The random deletions and insertions of bases at the breakpoint fusion cause variations in the size of the PCR products between the patients, but the size for the RQ PCR product with no insertion or deletion is 171 base pairs for set A and 109 base pairs for set C. Set C was therefore potentially a more efficient RQ PCR assay than A, but it would not be suitable for about 25 of patients with IKZF1 rearrangements.

An overall comparison of MRD results obtained with the IKZF1 marker tested on the same samples as earlier MRD analyses using Ig markers is shown in Figure 2a. The close concordance of results was confirmed by the Spearman's coefficient of rank correlation (rho) of 0.985 (0.979 95 confidence interval; P This scattergram also illustrates the limits to MRD testing with less reliable results obtained for MRD levels (1 in 10 cells). The results are highly correlated with a slope of the linear regression of the log10 MRD values approximating 1 (0.98 The IKZF1 results were as close to the Ig results as an earlier study in which we examined reproducibility by repeating MRD tests for samples using Ig markers.7

Figure 2.

Measurement of MRD using markers based on IKZF1 deletions compared with Ig rearrangements. The RQ PCR MRD data were interpreted using EuroMRD guidelines6 and the analyses use the log10MRD of the dilution of diagnosis sample giving the same amplification as each sample. (a) Scatterplot comparing overall MRD results on 164 bone marrow samples from 16 patients tested using both methods. (b Bland analysis for the three different IKZF1 MRD tests displayed as the difference in results for the IKZF1 and Ig markers against the Ig gold standard.7 All negative MRD results were coded as log10 MRD of and non quantitative results as as standardized by the EuroMRD. Figure 2b shows data for IKZF1 set B obtained with patient assays each designed so that one primer binds to the specific breakpoint sequence, Figure 2c shows data for Set A germline primer combination (with same probe as Set B) and Figure 2d shows Set C data for a different germline primer set.

Full figure and legend (112K)

To assess the three different primer IKZF1 sets used to measure MRD, Bland analyses8 were performed for each set, comparing the difference in MRD level for the IKZF1 marker and Ig markers, regarded as the current gold standard (Figures 2b On the basis of this analysis, all three IKZF1 MRD sets of reagents provided highly suitable MRD tests, generating MRD results in close concordance with Ig MRD results tested on the same samples. In each set, the average difference and regression lines were not significantly different from zero and there was no real difference in standard deviations. Samples from four of the patients were tested using both Set A and Set B, and the concordance of results was also high (data not shown).

The three IKZF1 MRD sets all showed high specificity with no or very low levels of background amplification observed for control mononuclear cell samples from individuals without leukemia, which were included in every patient assay. Established EuroMRD (ESG MRD ALL) guidelines were used to assess all MRD data6 and the assay slopes, quantitative ranges and sensitivities are shown in the Supplementary Information for the paper. The slopes for set A amplification curves (3.40 mean were not higher than set C MRD tests (3.55 suggesting that the longer RQ PCR product did not reduce the efficiency of the assay. With a single exception, (quantitative range of 5 10 for one set B assay), all the IKZF1 MRD assays would meet current clinical trial requirements with quantitative ranges and sensitivities between 10 and 10 corresponding to the detection of a single leukemic cell in 10 to 100 normal cells.

Given the relatively small number of patients and the high level of concordance of MRD results, it is not possible to identify one of the methods as superior. All three IKZF1 sets have given highly acceptable MRD results in comparison to regular Ig MRD tests. Set A is applicable to more patients with the IKZF1 deletion including those with slightly longer truncations, and the germline sets (A and C) have the advantage of not requiring DNA sequencing or specific custom made primers.

Two DNA MRD markers with high sensitivity (at least 10 are generally required in MRD intervention clinical trials,1, 9 and in a large cohort of 2854 pediatric precursor B ALL patients,van cleef and arpels perlee fake bracelet, 20 of patients had only one sensitive marker and 8 had none.9 Four of the 16 cases evaluated in this study had only one sensitive Ig marker so that availability of IKZF1 based MRD testing would have been useful for their risk stratification. Using routine PCR, IKZF1 rearrangements were identified in 6 of ALL patients in the ANZCHOG cohort in this study, so inclusion of this marker in standard screening for MRD targets would be an easy way to provide more patients with two sensitive markers.

The concept of using disease related markers for MRD testing has been already established for fusion transcripts such as BCR ABL and for gene rearrangements such as for SIL TAL1 in T ALL and for MLL rearrangements in infant ALLs.10 Kuiper et al.4 in an analysis of paired diagnosis and relapse samples from 34 patients found IKZF1 deletions and nonsense mutations in 14 (41 patients at diagnosis and showed that all were conserved at relapse, in contrast to other recurrent genetic lesions found at diagnosis such as PAX5, CDKN2A and EBF1. It is therefore likely that this IKZF1 marker will be at least as stable as Ig rearrangements, although this will need to be confirmed in more extensive studies.

In summary, we have assessed three ways to measure MRD levels by RQ PCR for the most common deletion of the IKZF1 gene found in ALL and demonstrated that all three methods provided robust and sensitive MRD assays for patients with this arrangement. The two primer and probe sets based on germline sequences could be used within a few days of diagnosis to provide quantitative measures of very early responses to therapy. We expect that IKZF1 gene deletions (IKZF1 and probably others) will provide a useful addition to the repertoire of MRD markers currently available for monitoring MRD in ALL.

Top of pageReferencesTop of pageAcknowledgementsWe acknowledge the NH and the Cancer Council NSW for their financial support of the Australian MRD studies, and clinicians participating in the ANZCHOG Study 8 trial particularly Dr L Dalla Pozza. Standardization and quality control for MRD testing is supported by the EuroMRD (previously ESG MRD ALL) group. Children's Cancer Institute Australia for Medical Research is affiliated with both the University of New South Wales and Sydney Children's Hospital.
Jun 23 · 0 comments
In A Daydream

The Calgary band Women dove headfirst into the ambiguous wormhole that is "hiatus" last year, so a new album from its producer Chad VanGaalen acts as a welcome antidote to the group's disappointing implosion. Mentioning Women here is only relevant insofar as Diaper Island, VanGaalen's latest record, has moments that feel uncannily close to what he helped craft on Women and Public Strain or at least much closer than any of his other albums. The affected balladry and brilliant vocal lines are still a big part of the sound,van cleef arpels clover necklace replica, but so is the distinctive guitar tone and off kilter riffs that make Women's work such a treat.

"Peace on the Rise" is a great example of the new mix. "Slip into the same old dream every night," VanGaalen sings during the chorus, adding, "Welcome all the things that could've been." That line wouldn't have felt out of place on an earlier record like Infiniheart, but its context is warped here: The vocals and guitar line interlock in a weird swing of the melody that progresses unexpectedly,replica van cleef and arpels four leaf clover necklace, yet completely works.

Between the slinky guitar parts,van cleef necklaces replica, VanGaalen's pacific vibe and the swampy, droning bridge, the song as a whole supports the daydreamy tone that's so effectively encapsulated in the chorus; it definitely has VanGaalen's distinctive touch. In terms of Women's sway,replica van cleef four leaf clover necklace, it's hard to know where the influences begin here as is the case with many band producer relationships but it's exciting to hear that the aesthetic VanGaalen helped create lives on for now, even if Women chooses to sit out the next few rounds.
Jun 23 · 0 comments
Dick Van Dyke poses with wife Arlene Silver during his 90th birthday celebration,replica van cleef inspired necklace

'He gets so many people around him I didn't want to be intrusive, so I would just say I'll come over after work and we'll have dinner, and it turns out he was looking forward to it the whole day.'

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'When we were working together on a movie, there was one time when we were doing a night shoot and he was laughing like he always does, but it was the way he was lit or something he had on a sweater and I thought, "Wait a minute!" I just felt a little different.'

Before Arlene Dick was wed to Margie Willett from 1948 to 1984,van cleef and arpels alhambra necklace replica.

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Jun 23 · 0 comments
infant relationship and infant attachment in socioeconomically deprived community in South Africa

Interventions The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team.

Main outcome measures Primary outcomes: quality of mother infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months.

Results The intervention was associated with significant benefit to the mother infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, Pd=0.24; 12 months: mean difference=0.42 (0.18), t=2.04 , Pd=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, Pd=0.26; 12 months: mean difference=1.76 (0.86), t=2.28 , Pd=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P

Conclusions The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother infant relationship and on security of infant attachment, factors known to predict favourable child development. In early and middle childhood, the benefits of a secure attachment are principally shown in good peer relationships and socio emotional adjustment6 7; in adulthood, associations are consistently found with lower rates of mental health problems.1 Notably, emerging evidence also indicates benefits of secure attachments for physical health, including lowered rates of failure to thrive in infancy and early childhood, fewer chronic and recurrent health problems, and better health and lifestyle practices in adulthood (for example, in relation to smoking, drug use, and sexual behaviour), and these benefits are reliably associated with lower health costs.8

The capacity of parents to provide the kind of care that promotes security of attachment in infancy and good developmental outcome in childhood can be severely compromised in adverse conditions such as poverty, particularly when mothers have depression.9 10 11 This is of particular concern in populations in the developing world, where rates of poverty and of maternal depression after childbirth are high.12 Research in Khayelitsha, a peri urban settlement in South Africa, where a high prevalence of maternal depression was found, also showed, for example, marked impairments in mother infant interactions compared with those seen in populations in the developed world.13 A recent extension to this work showed that these early parenting difficulties were associated with longer term insecurity in the mother infant attachment relationship.14 Interventions in the developed world have been successful in bringing about improvements in mother infant relationships and infant attachment when they are focused on difficulties in parenting behaviours,15 and an urgent need exists to develop such interventions for developing world contexts. Moreover, given the marked limitation in healthcare resources, interventions in the developing world that capitalise on locally available resources are a particular priority.

A small case series in Khayelitsha, in which local mothers from the community were trained to give support to mothers of young infants, produced promising evidence of an improvement in mothers' capacity to interact sensitively with their infants.16 The study reported here was a randomised controlled trial of this intervention, which aimed to determine not only whether short term improvements could be brought about in mother infant interactions but also whether a reduction could be achieved in rates of insecure attachment later in infancy. We had the secondary objective of determining whether the intervention would confer benefits in terms of maternal mood. With regard to mother infant interactions, as well as the general characteristic of sensitive responsiveness, we also sought to reduce rates of highly intrusive parenting. We had found that this type of parenting difficulty, in which parents impose their own agenda and cut across, or interfere with,replica van cleef necklace clover, the infant's behaviour, is particularly common and extreme in Khayelitsha; moreover, extensive research has shown that intrusive parenting is a major risk factor for those poor childhood outcomes that are of particular concern in such communities, such as conduct disorder and gang violence.17 18 These same childhood behavioural problems are also associated with particular kinds of attachment insecurity namely, those in which the infant fails to treat the parent as a source of comfort and trust and instead either avoids contact with them when distressed (the avoidant insecure pattern) or else responds in a confused and dysregulated fashion (the disorganised attachment pattern).19 When considering attachment outcome, therefore, we were particularly concerned to reduce rates of these two forms of insecurity.

MethodProtocol, design, and objectivesThe study was a randomised controlled trial, in which we randomly assigned pregnant women to an intervention group or a no treatment control group. We made independent assessments, blind to treatment groups, before treatment,replica van cleef and arpels alhambra diamond necklace, at the end of treatment, and at 12 months and 18 months postpartum.

The study took place in two adjoining areas of Khayelitsha (SST and Town II), a peri urban settlement of between 500000 and 750000 people on the outskirts of Cape Town, South Africa. SST is an informal settlement of shacks characterised by particularly high levels of unemployment and poverty; most shacks are without running water, and considerable overcrowding exists. Many of the inhabitants are recent migrants from rural parts of South Africa. Town II, into which SST merges, is characterised by a somewhat better standard of living. Dwellings are supplied with electricity, most have an indoor water supply, and increasing numbers are served by an indoor waterborne sewage system. Since the election of the ANC government in 1994, a concerted nationwide effort has been made to improve housing conditions; during the study period, much of SST was razed and the inhabitants were accommodated in better housing nearby, similar to that in Town II.

Sample sizeOur own epidemiological work in Khayelitsha showed that most (58%) of the mothers were rated as being insensitive to their infant during play interactions (compared with a rate of 25% in a British sample of non depressed mothers20).13 If the intervention was to effect an improvement by six months in the quality of the mother infant relationship of at least one third (the same order of improvement as effected by interventions in developed countries1), this improvement could be detected (=0.05, 80% power) with two samples of 145 each. A similar degree of improvement in intrusiveness would also be detectable with such samples. (This estimate is conservative, because we intended to analyse the mother child interaction variables as continuous variables and this would probably mean increased power).

ParticipantsOver a period of 22 months, we made efforts to identify and recruit unselected women living in SST and Town II who were in the last trimester of their pregnancy (on the basis of the accounts of their gestation that women had received from the antenatal clinic). Throughout the recruitment period, over three week cycles, a research assistant visited all the homes in both areas to inquire whether anyone had become pregnant or a pregnant woman had moved into the area and to invite identified women to participate in the study.

We anticipated a substantial loss to follow up, particularly after women had delivered their infants, because many women from rural areas come to the city to use the obstetric services and then return to their rural homes. We identified a consecutive series of 452 women as pregnant within the study area and invited them to take part in the study. Of these, only three refused. After the women had given written informed consent, we made an antenatal assessment to obtain demographic details (such as age and marital status) and information on wider circumstances (such as obstetric factors and housing conditions); we also assessed mental state (see below). We then assigned the 449 women to the intervention or control group by using minimisation,21 balancing for antenatal depression, whether or not the pregnancy was planned (that is,replica van cleef zipper necklace, factors known to be associated with adverse outcome14), and whether the mother was living in SST or Town II. We did not pay the women for their participation in the research, but at each assessment we provided a small gift for the infant (an item of clothing). Seven pairs of twins were born, of whom we included only the first born child in the study.

AssignmentThe relevant information from the initial assessment was communicated by telephone to the trial manager (MT), who ran the minimisation programme and communicated group assignment. The figure shows the progress of participants through the study. By the final assessment at 18 months postpartum, 107 of the 449 women were lost to follow up, leaving 342 women (76% of the original sample); most of the losses occurred, as anticipated, in the six month period after delivery. This is consistent with the known high mobility within this community and equivalent to the proportion lost to follow up in our previous study in the same two areas.13 14 The women lost to follow up did not differ from those retained in terms of demographic characteristics (parity, marital status), apart from age; those lost were somewhat younger than those retained (mean 24.9 (SD 4.4) years versus 26.1 (5.8); t=2.07, df=447, P

Flow of participants through study

InterventionWe based the intervention on an adaptation of a preventive intervention programme by health visitors devised for implementation in Britain, which itself closely follows the principles contained in The Social Baby.22 We adapted this programme for the Khayelitsha project by incorporating the key principles of the World Health Organization's document Improving the Psychosocial Development of Children.23 The content and conduct of the intervention was specified in a manual, which was used to train the therapists. The aim of the intervention was to encourage the mother in sensitive, responsive interactions with her infant. A major aspect was the use of particular items from the neonatal behavioural assessment schedule,24 to sensitise the mother to her infant's individual capacities and needs. The intervention was delivered by four women, resident in Khayelitsha, who had been selected with help from the local community council. The women had no formal specialist qualifications, although all were mothers. Two had completed schooling. They received training over a four month period in basic parenting and counselling skills, as well as in the specific mother infant intervention. An experienced community clinical psychologist (ML) provided them with group supervision throughout the study, on a weekly basis, offering session by session supervision. The intervention was delivered in participants' homes in hour long sessions. The women in the intervention group were visited,alhambra van cleef necklace replica, ideally, twice antenatally, weekly for the first eight weeks postpartum, fortnightly for a further two months, and then monthly for two months (that is, 16 sessions in total, ending at five months postpartum). Women in the control group received the normal service provided by the local infant clinic (as did the intervention group). This involved fortnightly visits by a community health worker, who assessed the physical and medical progress of mothers and infants, and encouragement of mothers to take their infant to the local clinic to be weighed, have their physical health assessed, and be immunised.

OutcomesThe primary outcomes at six and 12 months were those aspects of the mother infant relationship previously found to be associated with both socioeconomic adversity and maternal depression (that is, maternal sensitivity and intrusiveness); at 18 months the primary outcome was infant attachment. The secondary outcome was maternal depression (a dichotomous variable for depressive disorder and a continuous variable for depressive symptoms) assessed at six and 12 months.

Assessments took place in a custom made prefabricated research unit adjoining a local well baby clinic and women's health project, to which the research team brought mothers and infants. The building included a playroom with a one way mirror and an adjoining observation room. Mothers and infants were assessed at six and 12 months postpartum, when mother infant interactions were observed, and at 18 months postpartum when infant attachment was formally assessed (see below). At six and 12 months postpartum their mental state (see below) was assessed. Mothers and infants in the intervention and controls groups visited the research unit on an equal number of occasions and for equivalent lengths of time, and their experience of the assessment procedures, including the video recording, was similarly equivalent.

Mother child interactionsWe used age appropriate measures to assess the quality of mother child interactions at six months and 12 months, by scoring with established, reliable scales. At six months the mothers and infants were filmed in a 10 minute free play interaction, in which we asked mothers to interact with their infants as they would if they were at home. We rated episodes with the parent/caregiver involvement scale, which measures the responses of the mother to her infant's needs and initiations.25 In view of the literature and our own earlier findings in Khayelitsha,14 21 our focus was on whether the intervention significantly improved the sensitivity of maternal interactive behaviour and reduced maternal intrusiveness. Accordingly, a trained rater, blind to both treatment group and maternal mental state, scored the videotapes on the five dimensions of "physical involvement," "verbal involvement," "responsiveness," "positive statements," and "control over child's activities," each rated on a five point scale for the "quality" and "appropriateness" of maternal behaviour. We calculated sensitivity as the sum of ratings for the first four dimensions and intrusiveness as the sum of ratings for the last dimension (with codes reversed). We assessed inter rater reliability on 20 tapes and found it to be uniformly good (=0.81 for sensitivity and =0.85 for intrusiveness).

At 12 months the mother and child were observed in a structured play situation.26 27 This comprised two three minute episodes, in each of which the mother was asked to play with the infant by using novel toys a set of stacking rings and a form board. Each typically requires infants of this age to be given support by an adult, so they provided an opportunity to observe how well the mother was able to facilitate the child's play. A trained rater, who was blind to treatment group, maternal mental state, and the interactions at six months, scored maternal behaviour from the videotapes on measures of sensitivity and intrusive coercive control. We used an established measure to rate sensitivity on a five point scale26 27; scores were summed across the two tasks. We established intrusive coercive control by counts of the defined behaviour.27 A second trained rater, also blind to group and maternal mental state, scored 20 of the videotapes to establish inter rater reliability: weighted =0.91 for sensitivity, and Pearson r=0.83 for intrusiveness. A collective decision was made about each of the relevant symptoms, on which the decision about the presence or absence of a DSM IV major depressive disorder was based.30 We also obtained a continuous measure of depressive symptoms by incorporating the 10 items from the Edinburgh postnatal depression scale, each scored 0 3, into the structured clinical interview for DSM IV.

Infant attachmentAt 18 months, we used the strange situation procedure developed by Ainsworth and colleagues to assess infant attachment.31 This is a structured, standard procedure, used extensively in research in both the developed and developing world. The assessment has good reliability and predictive validity.32 The infant was filmed through a one way mirror, in an unfamiliar playroom over a 21 minute period, during episodes of separation and reunion with the mother and in the presence of a stranger. MT, who had been trained for reliability and was blind to all other information about the infants and their mothers, rated the videotapes. He used the ABCD system31 33; that is, infants were rated as securely attached or insecurely attached, the second of these being specified as avoidant, anxious resistant, or disorganised. We confirmed reliability by assessing agreement between MT and a second trained rater on 16 tapes (=0.96).

Statistical analysesWe used SPSS 12.0 for Windows for descriptive and analytical statistical analyses. We investigated continuous variables for departure from normality by using Shapiro Wilk's test and compared the treatment groups by means of two sample t tests or Mann Whitney U tests, as appropriate. For dichotomous outcomes we used 2 tests to compare groups. We also expressed the differences between the intervention and control groups for the mother infant interaction variables in terms of effect size by using Cohen's d.34 As mothers from Town II and SST did not differ on any of the outcomes for either the intervention or the control group, we ignored this variable in the analyses reported below.

ResultsThree quarters of the women in the intervention group received the full 16 sessions, and less than 15% received fewer than 10 sessions (mean number of sessions=14.1, SD 3.92). Table 1 shows the characteristics of the sample. The randomisation process resulted in closely equivalent groups in terms of demographic variables.
Jun 23 · 0 comments
'I don't want to do any more explaining to white people about the horrors they're not seeing'

The first time I saw Jamila Johnson Small perform she was on the floor wrestling with a huge sheet of peach coloured latex, elbows and knees stretching the fabric like a foal struggling in its amniotic sac.

The second time I saw her she was wearing a wig and shades, carrying a toy tiger around the room and gyrating to a dancehall number, then asking members of the audience to daub her near naked body in black paint. "Well!" said someone in the audience next to me, raised eyebrows expressing something between an exclamation mark and a question mark.

Amid the pop culture meets feminist theory provocation Johnson Small is a compelling dancer, a beautiful mover of long limbed style although she thinks she's more like "a giant wiggly spider" but I'm hesitant to tell her that, when we meet in a Shoreditch caf, because her work carries an implicit criticism of how we watch, judge and label women's bodies, especially women of colour.

Both of the performances I saw were with Project O, a collaboration with fellow dancer Alexandrina Hemsley, and the pair aren't shy in addressing issues of race, gender and sexuality.

As well as Project O, Johnson Small is involved in another duo, Immigrants and Animals, who seek to make "dances of resistance" (resistance to the "bullshit conventions of contemporary dance" among other things), and she makes solo work under the guise Last Yearz Interesting Negro. She also writes blogs, runs a discussion series, Hotline, and a radio show called Bitches Minute.

What's the common ground between all her projects? "They're all like, f you with your bullshit boxes!" she says. "How can we break open binaries? How can we break open our eyes? How can we break open our bodies and find new movement?"

It's quite a mission statement, and Johnson Small is part of a wave of young dance artists who embody an anti establishment DIY spirit and are constantly questioning the norms of dance and the wider world.

But they're starting to attract the attention of some major producers. Recent performances took place at Somerset House and the Festival Hall, she's got work lined up at the Tate, and now she's been commissioned to make a new solo performance for the opening weekend of the annual Dance Umbrella festival.

The fact that the title of the new show is I Ride in Colour and Soft Focus, No Longer Anywhere suggests that Johnson Small hasn't given in to snappy crowd pleasing,arpels van cleef necklace replica, but still this success is problematic for the 29 year old Londoner, who speaks between thoughtful silences. "I guess I still have my fantasies about not selling out," she laughs.

She's uncomfortable getting into bed with institutions that might reinforce the social structures she's railing against, or tie her to people whose work or opinions she doesn't agree with. And she doesn't want to be used for anyone's "diversity" agenda. "I'm aware that my body and me, they're a currency, and it's a currency that I can't cash in on," she says. "But other people can. They get to tick lots of boxes by having me there."

Johnson Small imagines a utopia where she's not seen primarily as a black woman. Has she experienced racism as a black dancer? "Of course," she says. "I think you encounter it every day. Racism is in the structure of how we are living here, so I don't know how it's possible not to encounter it."

She's less inclined to be specific. "I don't feel comfortable talking about really personal things," she says. "When I started working with Alexandrina we wanted to make visible the awkward and racist and horrible experiences we'd had," she adds but at this point she tires of talking about it. "I don't want to do any more explaining to any white people about the horrors they're not seeing," she says. "I'm not here to hold white tears in my hand."

The kind of protest Johnson Small makes isn't the dance equivalent of holding a placard. "I've been thinking a lot about the conventions of visibility around black and queer at the moment," she says. "And I don't want to have to be the biggest and shout the loudest. I just want to have respectful attention."

She isn't a natural show off. "I don't really like being looked at," she admits. "There's something that sits uncomfortably for me, having a job as a performer. Being in this position where there's a potential desperation: I need the audience to like me. I find it icky but I do love dancing," she adds, and that's why she's still doing it, despite never planning a career as a performer.

Johnson Small grew up in Stoke Newington and went to secondary school in Waltham Forest. "I hated school," she says. "I was one of maybe seven black people in a school of 1,000 kids. In the first term I was there I didn't talk."

The other black students were divided into the hip hop gang and the churchgoing gang but she hung out with the grungers and punks. "People would come to me and say, 'Why do you listen to the music of the devil?' I felt really ostracised from everyone."

Her teacher mother and publisher father had "a black power agenda" but at the time Johnson Small didn't really want to engage with the realities of race in the UK. "It's only now that I can really think about this kind of internalised hatred I had of myself as a teenager, which is very much in relation to being the brown one, the one with the weird hair."

Picasso Portraits,alhambra necklace van cleef replica, National Portrait Gallery

We don't necessarily remember Picasso for his portraits, but they prove what a varied and skilled artist he really was. The National Portrait Gallery is staging a major exhibition of them, featuring realist work alongside his better known cubist and surrealist painting. Included are portrayals of family, friends and lovers, with many works being shown for the first time in the UK.

The academic instinct for words and ideas has remained strong in her work, along with that teenage sense of rebellion. She's not interested in making things easy,replica mini van cleef necklace, because life's not like that. "In some ways I think allowing myself to be my complex self is an act of resistance," she says. "Trying to hold on to the multiple and confusing parts of my identity and make situations more complex rather than making them more simple. Allowing myself to bring the trouble."

In the Dance Umbrella piece, which is set to new soundtracks commissioned from the likes of artist Phoebe Collings James (an old friend of Johnson Small's), producer Nkisi and DJ Shelley Parker, the aim is to create an experience for the audience "that somehow has the atmosphere of my internal world. It relays a certain vibe, between an apocalyptic, crushing chaos, a state of being totally overwhelmed,replica van cleef & arpels necklace alhambra, and this thing of riding the flow, quite meditative and chilled."

That's definitely a complex self. She's setting up the structure of the piece and developing movement but much of the choreography will come together at the last moment and won't be set in advance. "I'm too disobedient for set movement," she smiles. You can believe it.
Jun 23 · 0 comments
Het syndroom van Jekyll and Hyde

Sommige als niet alle mensen vrezen deze bepaalde fase van iemands leven genoemd mannelijke menopauze. Voor velen is deze crisis het begin van de helft sterven en halve levende natuur,van cleef & arpels necklace replica.

Maar wat over mannelijke menopauze is echt eng?

Wanneer een man de leeftijd van 40 bereikt, hij begint te worden prikkelbaar, gemakkelijk benadrukt en begint te verliezen zijn passie en doel in het leven. Dit keerpunt van de weg naar andropauze achtervolgd mannen in unidirectioneel of een andere mannelijke menopauze syndroom.

Er zijn drie oorzaken gekoppeld aan mannelijke menopauze syndroom. Ten eerste is de schommelingen van de mannelijke hormonen. Dit is een normaal verschijnsel naarmate we ouder worden. Maar ook, kan dit worden geopenbaard vanwege gebrek aan voedingsstoffen en oefening. De volgende factor is de verandering in de biochemie van de hersenen. De daling in de levering van neurotransmitters verhoogt vijandigheid, woede en ongeduld. De derde en de omgezet oorzaak is de toename van stressniveau. Het zou als gevolg van te veel consumptie van alcohol of als gevolg van psychologische benadrukt. Hoe je omgaat met omstandigheden kunnen een grote factor in dit gebied worden. Vermeden kunnen worden als slechts u zou proberen. Deze factoren werd een deel van de mid life strijd die uitdaging mannen te overwinnen.

Vele vrouwen had hun verhalen te vertellen over hun partners met wijzigen van tekens, echtgenoten die beurt van Jekyll wordt naar Hyde, uit mededogen te betekenen. Het syndroom van de mannelijke menopauze patroon aan het boek van Robert Louis Stevenson getiteld "Dr. Jekyll en Mr. Hyde" had zoveel met elkaar gemeen.

Het verhaal gaat over Dr. Jekyll die had dit streven van het scheiden van de goede en de slechte aard van de mens. In zijn zoektocht ontmoet hij afwijzingen van collega's en oversten. Voor dat hij moest werken alleen voor zijn project. Vervolgens, Dr. Jekyll moest doen het experiment met zichzelf. Die gescheiden zijn kwade aard die bleek te zijn van Mr. Hyde. In in strijd met de goede persona van Dr. Jekyll,alhambra style necklace replica, had Mr. Hyde zijn vermoorden de Raad van gouverneurs die de oorzaak van Dr Jekyll afgewezen. Alle door het verhaal, had Dr Jekyll tevergeefs jarenlang nastreeft om te controleren zijn kwaad helft.

De dezelfde uitoefening gebeurt er met mannen die aan het syndroom van mannelijke menopauze lijden. Worden de verantwoordelijk en liefdevolle Jekyll, hadden ze de neiging om te zetten om de slechtgezinde Hyde. Mannen op deze leeftijd leek te veranderen 's nachts.

Maar deze tendensen zijn vaak veroorzaakt door verlies van een vriend of familielid. De dood van een nauwe persoon leek te leiden tot de gedachten van hen wordt volgende in lijn,replica van cleef black necklace. En de realisatie van hun sterfelijk wezen is zo opvallend dat hij heeft ingewikkelde gedachten.

De verwarring die hij voelt is vaak goed aan zijn verantwoordelijkheden en aan de mensen rondom hem,replica van cleef lucky alhambra necklace. Vervolgens hij beschrijft dit gevoel zoals wordt gevangen en vervolgens verliest zijn gevoel van het zijn.

Met deze crisis moeten mannen worden begrepen. Het is een cruciale periode wanneer een man willen zou om vrij te zijn en te vernietigen de volgorde van de oude manieren. Het is de periode waarin ze nodig hebben om te voelen nodig, en die zij belangrijk zijn. Er zou een heleboel rechtsmiddelen in de winkel proberen te verlichten de symptomen van mannelijke menopauze. Ze kunnen leiden tot bijwerkingen, echter. De beste remedie is om hen voldoende ondersteuning en begeleiding om deze crisis te overwinnen.

Verwante artikelen in mannen kwesties

Mensen die genteresseerd zijn in het bovenstaande artikel zijn ook genteresseerd in de aanverwante artikelen hieronder:

Net als van kinderjaren, adolescentie, volwassenheid is ouderdom ook een fase van het leven. Met verloop van tijd is verouderen van het lichaam onvermijdelijk. Mensen ouder worden anders, en de periode doorlopen op een andere manier op basis van levensstijl, attitudes, en vooral erfelijkheid. Shilajit ES capsules zijn de meest effectieve remedies van de Ayurvedische te vertragen veroudering in mannen. Veel jongere mannetjes ook last van dit probleem. Er zijn verschillende oorzaken voor de uitbreiding van de prostaat. Zodra de ziekte zich heeft voorgedaan, zal de persoon die lijdt aan deze aandoening ernstige pijn hebben in het gebied. Prostocure capsule is de beste Ayurvedische behandeling voor prostaat uitbreiding. Het zal ook helpen bij de vermindering van ontsteking als gevolg van BPH.
Jun 23 · 0 comments
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