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The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): design and methods
Peter T Katzmarzyk1,
Tiago V Barreira1,
Stephanie T Broyles1,
Catherine M Champagne1,
Jean-Philippe Chaput2,
Mikael Fogelholm3,
Gang Hu1,
William D Johnson1,
Rebecca Kuriyan4,
Anura Kurpad4,
Estelle V Lambert5,
Carol Maher6,
José Maia7,
Victor Matsudo8,
Tim Olds6,
Vincent Onywera9,
Olga L Sarmiento10,
Martyn Standage11,
Mark S Tremblay2,
Catrine Tudor-Locke1,
Pei Zhao12 &
Timothy S Church1
139 Altmetric
The primary aim of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was to determine the relationships between lifestyle behaviours and obesity in a multi-national study of children, and to investigate the influence of higher-order characteristics such as behavioural settings, and the physical, social and policy environments, on the observed relationships within and between countries.
The targeted sample included 6000 10-year old children from 12 countries in five major geographic regions of the world (Europe, Africa, the Americas, South-East Asia, and the Western Pacific). The protocol included procedures to collect data at the individual level (lifestyle, diet and physical activity questionnaires, accelerometry), family and neighborhood level (parental questionnaires), and the school environment (school administrator questionnaire and school audit tool). A standard study protocol was developed for implementation in all regions of the world. A rigorous system of training and certification of study personnel was developed and implemented, including web-based training modules and regional in-person training meetings.
The results of this study will provide a robust examination of the correlates of adiposity and obesity in children, focusing on both sides of the energy balance equation. The results will also provide important new information that will inform the development of lifestyle, environmental, and policy interventions to address and prevent childhood obesity that may be culturally adapted for implementation around the world. ISCOLE represents a multi-national collaboration among all world regions, and represents a global effort to increase research understanding, capacity and infrastructure in childhood obesity.
Childhood obesity is the result of a complex interaction of multiple behavioural, biological and environmental factors that adversely impact long term energy balance. The prevalence of childhood obesity remains high, and there are regional differences in both the level of obesity and rates of increase that have occurred over time [1, 2]. Lifestyle behaviours such as physical activity and dietary intake have been associated with childhood obesity in many countries; however, the extent to which differences in lifestyle behaviours predict childhood obesity may not be the same across all regions of the world [3, 4]. These behaviours are complex, and are affected by multiple levels of influence, including individual characteristics and higher-order factors such as local and national policies, the physical or built environment, numerous behavioural settings and domains, and local cultures [5, 6]. The purpose of this paper is to describe the design and methods of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) which will explore these issues.
Key questions about how lifestyle behaviours should be modified to address the problem of childhood obesity on a global stage can be best answered by a multi-national study in which both physical activity and dietary intake are measured in a standardized manner, and key measures of the multiple levels of influence are obtained in several countries. Each country and geographical jurisdiction has its own limited variability in the prevalence of obesity and each of the potentially modifying factors at different levels, yet an international study is able to maximize variability in these factors. The results will be important for adapting lifestyle- and policy-based childhood obesity interventions for implementation in different geographic regions and cultures.
To our knowledge, previous multi-country childhood obesity studies have focused on specific geographic regions (mainly Europe), rather than having a global representation of research sites that included both developing and developed countries. Further, few international studies of children and adolescents have included comprehensive, robust indicators of lifestyle behaviours (e.g. physical activity, food consumption, sedentary behaviour, sleep, etc.) and measures of higher-order characteristics and directly measured body mass or adiposity. However, there are several published and on-going studies that have informed the rationale and design of ISCOLE.
The Health Behaviour in School-Aged Children Study (HBSC) is currently conducted among 11, 13 and 15 year-old children in 43 countries (Europe, USA and Canada) [7]. Results from two previous cycles of the HBSC (2001–2002 and 2005–2006) indicate a consistent relationship between self-reported physical activity and overweight across countries; however, the relationship with dietary variables has been less consistent [3, 4]. The Healthy Lifestyle in Europe by Nutrition in Adolescents (HELENA) study is a multi-country European collaboration that focuses on the health and health behaviour of adolescents [8]. Recent analyses from the HELENA study have examined associations among obesity and several lifestyle behaviours, including physical activity, sedentary behaviour, dietary habits, and sleep duration [9–11]. The European Youth Heart Study (EYHS) was a 4-country examination of cardiovascular risk factors and their related influences in 9 and 15 year-old children [12]. Results from the EYHS indicate a significant association between objectively measured physical activity (using accelerometers) and adiposity (sum of skinfolds), although the variance in adiposity explained by physical activity was <1% [13]. Further analyses incorporating self-reported television viewing habits suggest that physical activity and television viewing may have independent effects on adiposity and cardiovascular risk factors [14].
In addition to purely observational studies of lifestyle behaviours and obesity in children, several initiatives are under way to develop multi-national childhood obesity intervention consortia and studies [15]. For example, the European IDEFICS (identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study was designed as an 8-country cohort study with an embedded intervention [16]. To date, baseline IDEFICS data have been used to explore associations of lifestyle behaviours such as sedentary behaviour [17], dietary preferences [18] and socioeconomic status [19] with obesity.
The existing international studies have demonstrated significant associations between lifestyle behaviours and obesity within the context of developed countries; however, the role of higher-order environmental correlates of lifestyle behaviours on adiposity and obesity are not well understood. The ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) study was designed to explore personal family and school-level environmental correlates of energy balance-related lifestyle behaviours in 7 European countries [20]. However, there is a need to explore these multi-level relationships and obesogenic environments using both objective methods and self-report in a large multi-national sample of children from diverse cultural and socio-economic backgrounds. It is also important to have both high and low-medium income countries in the same study in order to get insight into cultural and socioeconomic aspects of environmental determinants of health behaviours and obesity in children. ISCOLE was established to address these issues, and the purpose of this paper is to present the design and methods of ISCOLE.
The primary aim of ISCOLE is to determine the relationships between lifestyle behaviours and obesity in a multi-national study of children, and to investigate the influence of higher-order characteristics such as behavioural settings, and the physical, social and policy environments, on the observed associations within and between countries. Our over-arching hypothesis is that the relationships between lifestyle behaviours and obesity will differ across countries and across different environmental settings. Much of the information available on the role of lifestyle behaviours and multiple levels of influence on childhood obesity has come from studies conducted in high income, developed countries, but studies from developing countries are limited. Thus, the results of ISCOLE will provide important new information that will inform the development of lifestyle and environmental interventions to address and prevent childhood obesity that can be adapted for implementation around the world.
ISCOLE is a multi-national cross-sectional study conducted in 12 countries (Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, United Kingdom, United States) from five major geographic regions of the world (Europe, Africa, the Americas, South-East Asia and the Western Pacific) (Table 1).
Table 1 International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) field site characteristics
Reflecting the variability in the ISCOLE sample, selected countries differed in several socio-economic indicators. According to World Bank classifications, ISCOLE countries span low income (Kenya), lower-middle income (India), upper-middle income (Brazil, China, Colombia, South Africa) and high-income economies (Australia, Canada, Finland, Portugal, USA, United Kingdom) [21]. Further, the ISCOLE countries also span a continuum of the Human Development Index (HDI), which is a composite score based on life expectancy, gross national income, literacy and school participation [22]. Accordingly, the countries were classified as low (Kenya), medium (China, South Africa and India), high (Brazil and Colombia) and very high HDI (Australia, United States, Canada, Finland, United Kingdom, Portugal) [22]. Additional contextual information can be obtained using the Gini index, which reflects the extent to which the distribution of income or consumption expenditure among individuals or households within an economy deviates from a perfectly equal distribution [23]. A Gini index of 0 represents perfect equality; whereas an index of 100 represents perfect inequality. Among ISCOLE countries, the Gini index ranges from 26.9 (Finland) to 63.1 (South Africa). Table 1 presents a detailed presentation of each of the 12 study sites' rankings, population size, and principal investigators, and Figure 1 presents the geographic locations of the data collection sites. The descriptive socio-economic information provided in Table 1 is assessed at the country level (i.e. HDI, Gini index) and there is further variability within countries. The data collection sites span a range of north and south latitudes and the associated climatic and cultural differences.
Geographic distribution of the International Study of Childhood Obesity, lifestyle and the environment (ISCOLE) sites.
The recruitment goal of ISCOLE was to enroll at least 500 children, gender balanced, with a mean age of 10 years from each of the 12 study sites. Given the anticipated difficulty in obtaining a school-based sample of children who would be exactly 10 years of age, each study site determined the best grade levels to target that would ensure a final sample with minimal variability around a mean age of 10 years. The sample necessarily included children aged 9–11 years of age.
Each study site identified one or more school districts (within reasonably close proximity to the local study center), to provide a sufficient population to draw a sample of 500 students. In an effort to maximize comparisons across ISCOLE sites, the sampling frame included students from urban and suburban areas, but not from rural areas. Rural areas were excluded from the sampling frame due to logistical concerns related to data collection raised by site investigators located in research institutes without access to rural populations. Further, the instruments used for measuring aspects of the neighborhood environment have not been adapted for use in rural areas.
Since within these general parameters, recruitment efforts necessarily differed between ISCOLE sites, Table 2 presents a short description of the sampling strategies employed. The primary sampling unit was schools and the secondary sampling unit was classes in the school that best corresponded to 10-year-old students. The primary sampling frame of schools was typically stratified by indicators of socio-economic status in order to maximize variability within sites. School-specific sampling frames were the lists of all classes corresponding to children on average 10 years of age.
Table 2 Sampling methods employed by International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) sites
Given that the primary sampling strategy was based on schools, ISCOLE data collection was conducted during the school year, which varied across countries. When the school year spanned more than one season, the data collection period was split into phases to ensure that different seasons were covered. Data collection for ISCOLE began in September of 2011, and it is anticipated that it will be fully completed by December 2013. Data collection proceeded in a staggered fashion, such that each site completed their data collection over 12 months, or across one school year.
The ISCOLE protocol includes data collected from several objective and subjective sources, including the students, their parents, school administrators, and direct observations of the school environment by trained ISCOLE staff. Table 3 presents an overview of the measurements obtained in ISCOLE.
Table 3 Summary overview of data collected in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)
Anthropometry and bioelectrical impedance
A battery of anthropometric measurements was taken according to standardized procedures. Stature and sitting height were measured without shoes using a Seca 213 portable stadiometer (Hamburg, Germany), with the participant's head in the Frankfort Plane. Stature was measured with participant fully erect, feet together, and at the end of a deep inhalation, and sitting height was measured while seated on a table with legs hanging freely and arms resting on the thighs [24]. Waist circumference was measured at the end of gentle expiration with a non-elastic tape held midway between the lower rib margin and the iliac crest [25]. Mid-upper-arm circumference was measured on the right arm using a non-elastic tape held midway between the acromion and olecranon processes, with arm hanging loosely at the side of the body [24]. Each measurement was repeated, and the average used for analysis (a third measurement was obtained if the first two measurements were greater than 0.5 cm apart and the average of the two closest measurements was used for analysis).
The participant's body mass, impedance and percentage body fat were measured using a portable Tanita SC-240 Body Composition Analyzer (Arlington Heights, IL) after all outer clothing, heavy pocket items and shoes and socks were removed. Two measurements were obtained, and the average was used in analysis (a third measurement was obtained if the first two measurements were more than 0.5 kg or 2.0% apart, for body mass and percentage fat, respectively, and the closest two were averaged for analysis). In addition, impedance values were recorded for future analyses. Due to harsh field conditions in some sites, a back-up scale was carried by the assessment team to ensure that body weight was obtained.
The Body Mass Index (BMI; body mass (kg)/height (m2)), waist-to-stature ratio, and sitting height-to-stature ratio were calculated.
Demographics and family health history
A demographic and family health history questionnaire was completed by parents (see Additional file 1: ISCOLE Demographic and Family Health Questionnaire). The questionnaire collected information on basic demographics, ethnicity, family health and socioeconomic factors.
Diet and lifestyle information
A diet and lifestyle questionnaire that included questions related to food consumption, physical activity, sedentary behaviour, sleep, health and well-being was administered to all ISCOLE student participants (see Additional file 2: ISCOLE Diet and Lifestyle Questionnaire). This questionnaire is a compilation of validated items obtained from several different sources (described below) as well as new questions designed by ISCOLE investigators where no suitable previous alternatives were found. Technicians were trained to administer the questionnaire in a standardized fashion in order to minimize bias, and provisions were made to administer the questionnaire via an interview for participants with low levels of literacy. Questionnaires were checked for completeness at the time of data collection in order to ensure high quality data.
A food frequency questionnaire (FFQ) that was adapted from the HBSC Study [26] was integrated into the diet and lifestyle questionnaire. The FFQ asks the child about several different types of food consumed in a "usual" week. The FFQ lists 23 food categories and has examples of individual food items, but no portion sizes. The food items included in the FFQ were standardized as much as possible across ISCOLE sites; however, regional variation in food consumption patterns necessitated some cultural and regional adaptations of some of the items and examples provided. In order to better understand the interactions between television viewing and dietary intake, a brief 5-item FFQ was adapted from a published study that asks the children about the consumption of different types of snacks while viewing television [27]. Additional questions related to the consumption of breakfast [26], school lunches [28], and the number of meals prepared or eaten away from home were also included.
Several physical activity and sedentary behaviour questions were obtained from the U.S. Youth Risk Behavior Surveillance System [29]. These questions related to obtaining adequate amounts of physical activity, the amount of time spent watching television or playing video games, and the number of physical education classes attended per week. Questions related to active transport to school were adapted from the Canadian component of the 2009/10 HBSC Study [30]. In order to capture potential windows of opportunity for physical activity, several questions were also developed by the ISCOLE investigators to probe the amount of time the children spent outside before school, after school, and on the weekend.
There is emerging evidence of a link between sleep and the development of obesity [31–33]. Therefore, several questions related to sleep patterns, duration and quality were developed by the ISCOLE investigators for inclusion in the diet and lifestyle questionnaire. The questionnaire also contained sections to measure psychological constructs related to physical activity and dietary behaviour, including adapted scales for motivation for physical activity [34], self-efficacy for physical activity [35], and emotional eating [36]. Finally, questions on health-related quality of life were included, derived from the validated Kidscreen-10 quality of life scale [36].
The Actigraph GT3X + accelerometer (ActiGraph, Pensacola, FL) was used to objectively monitor physical activity, sedentary behaviour and sleep time. The accelerometer was worn at the waist on an elasticized belt, on the right mid-axillary line. Since other studies have reported problems with achieving minimal wearing time with a waking hours protocol (i.e., sanctioning daily instrument removal), ISCOLE children were encouraged to wear the accelerometer 24 hours per day for at least 7 days (plus an initial familiarization day and the morning of the final day), including 2 weekend days. The minimal amount of accelerometer data that was considered acceptable was 4 days with at least 10 hours of wear time per day, including at least one weekend day. Following the final day of data collection, accelerometers were returned to the study site, and the research team verified the data for completeness using the most recent version of the ActiLife software (version 5.6 or higher; ActiGraph, Pensacola, FL) available at the time. Local study sites could ask children to wear the accelerometer for additional days (to a maximum of 14 days) to ensure that the minimal data requirements were met.
Assessment of biological maturity
Although all student participants in ISCOLE were 9–11 years of age, they differed in their stage of biological maturity. Several methods exist to assess biological maturity, including the assessment of secondary sex characteristics, skeletal age, dental maturation, or somatic maturation [37]. All options were considered for use in ISCOLE; however, the method that was deemed most feasible across all countries was to use estimates of somatic maturation. Two methods are employed: 1) percentage of predicted adult stature attained, using the Khamis-Roche method [38] to predict adult stature, and 2) the maturity offset [39].
The rationale for using percentage of adult stature attained is that two children of the same age can be the same stature, but one may be closer to their final adult stature, and hence is more advanced in somatic maturation. Given that the final adult stature of the children was not known, it was predicted using their chronological age, stature, body mass and mid-parent stature (average of father's and mother's stature) [38]. Another important indicator of somatic maturation is age at peak height velocity, which is typically assessed from serial measurements of the child throughout adolescence. Age at peak height velocity is a commonly used indicator of somatic maturity [37]. Given that ISCOLE is a cross-sectional study, the method of Mirwald and colleagues [39] was used to predict years from peak height velocity, or the "maturity offset" from age, sex, sitting height, stature and body mass.
Neighborhood and home environment
A neighborhood and home environment questionnaire was completed by the parents (see Additional file 3: ISCOLE Neighborhood and Home Environment Questionnaire). The questionnaire was adapted from the Neighborhood Impact on Kids (NIK) study survey [40] which drew on questions from other validated instruments [41–43]. The questionnaire includes items related to neighborhood social capital (collective efficacy and the degree to which persons in the neighborhood know each other and engage socially), the home social environment (parental support for and modeling of physical activity), the home and neighborhood food environments (availability of various healthy or unhealthy food and drink choices in the home, and the availability and types of food stores in the neighborhood) and the home and neighborhood physical activity environment and neighborhood built environment (availability of electronics for the child's personal use, access to and use of play equipment in the home environment, access to and use of various places where a child can be physically active, and the suitability of the neighborhood environment for walking and physical activity).
The school environment was assessed using a questionnaire completed by a school administrator (e.g. principal)(see Additional file 4: ISCOLE School Environment Questionnaire), and a direct audit of the school environment, performed by ISCOLE staff. The school administrator questionnaire was adapted from the healthy eating and physical activity modules of the Healthy School Planner [44] used in the Canadian School Health Action, Planning and Evaluation System (SHAPES) [45]. The questionnaire includes items related to school facilities, healthy eating and physical activity policies, extracurricular activities, frequency of physical education and breaks (recess), promotion of active transportation, and the availability of healthy and unhealthy foods in the cafeteria and vending machines. In addition, questions regarding food items sold as part of fundraising efforts were incorporated from the U.S. School Health Policies and Practices Study (SHPPS) [46]. Two additional questions were added by ISCOLE investigators to capture the number of days that students attend school during the academic year and the amount of class time mandated for physical education.
Specially trained ISCOLE study staff completed an environmental audit of each participating school. A single data collector performed each school audit. For at least 5% of the schools within a site, another similarly trained data collector performed a second, independent audit in order to determine item reliability and to monitor consistency in adhering to item definitions. The school audit tool was used to collect directly-observed information pertaining to the school built and food environments. Components of the audit tool addressing the school built environment were taken from the school audit tool used in the SPEEDY (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people) study [47, 48], which has acceptable reliability (agreement between pairs of auditors range from 76% to 99% across components) and good construct validity (components of the tool were able to discriminate physical activity levels of children attending schools in the highest and lowest quintiles) [48]. A question regarding whether fast food restaurants were visible from any of the school entrances was added by ISCOLE investigators in order to better characterize the food environment of the area surrounding the school. Components of the audit tool addressing the à la carte school food environment were modified based on that used in the IDEA (Identifying Determinants of Eating and Activity) study [49]. The wording of choices, including examples of environmental features (e.g. "sidewalk" vs "footpath") and customary food items, were adapted as necessary across ISCOLE sites. A photo dictionary was created to standardize data collection and capture unique features of the different countries.
The overarching ISCOLE protocol was approved by the Pennington Biomedical Research Center Institutional Review Board. Each adapted site-specific protocol was also approved by the ethical review boards at the participating institutions. Informed parent consent/ child assent forms and all questionnaires were translated and back-translated, as necessary, into the local language of each study site following approved procedures of the local institutions.
Governance and study management
A schematic describing the governance and management of ISCOLE is provided in Figure 2. The principal investigators were responsible for overseeing all aspects of the study. The role of the External Advisory Board was to assess the overall progress, rigor and objectivity of the study and to make recommendations to the management team regarding logistical issues, recruitment, safety issues, guidance on overall study direction and future goals. The members of the External Advisory Board were selected to be at arm's-length from both the funder and the investigators in order that they could provide an unbiased assessment of the science and the role of the funder. The ISCOLE Coordinating Center in Baton Rouge, LA was responsible for the overall administration the study. Each of the ISCOLE study sites was overseen by a local site principal investigator, who was responsible for the all aspects of study implementation at the local level. With the exception of requiring that the study be global in nature, the study sponsor had no role in study design, data collection and analysis, decision to publish, or preparation of manuscripts.
Overview of governance and management of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).
Given that the 12 data collection sites for ISCOLE were spread across all regions of the world presented some logistical challenges for data acquisition. To facilitate data collection, entry and management, a secure web-based system was developed by the Coordinating Center and the Research Information Systems group at Wake Forest School of Medicine (Winston-Salem, NC). The web-based data management system facilitated the flow of information and increased the level of communication within ISCOLE. Large volumes of data were entered remotely at each study site using a standard web-browser, and the system allowed both the study site staff and the Coordinating Center to monitor progress and produce missing data reports in real time.
Training of personnel and quality control
Regional training sessions organized for all site-PIs and key staff were conducted by the ISCOLE Coordinating Center (Pennington Biomedical Research Center) in advance of data collection at each study site. All staff members were certified by trained experts as competent to make the required measurements, which involved the completion of on-line training modules, viewing protocol videos and successfully completing on-line exams prior to the hands-on training sessions and one-on-one training by experts.
Quality control and the rigorous standardization of measurement protocols across sites are critical to the success of a multi-center study. Quality control was a shared responsibility of all ISCOLE investigators. Figure 3 provides an overview of the training and quality control program of ISCOLE. The Coordinating Center at the Pennington Biomedical Research Center was responsible for coordinating protocol development and implementation at each site, overseeing the training and certification of study personnel, ensuring regulatory compliance, and monitoring data collection and remote data entry. Site principal investigators were responsible for regulatory compliance, ensuring that the standard protocol was implemented at their site, supervising and ensuring the accuracy of data entry, retraining study personnel as necessary, and maintaining all required regulatory documents in a binder. During data entry, key variables were checked for accuracy with assigned range checks. A review was required for any data entered outside of preset ranges. Through communication with the study sites, the Coordinating Center reconciled any questionable responses within 30 days.
Summary of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) quality assurance, quality control and training program.
Quality control was monitored during data collection through remote source document verification, monitoring data entry errors, and study site visits by Coordinating Center staff using a standard site-monitoring protocol. During site visits, regulatory binders were inspected to ensure regulatory compliance, an independent school audit was conducted by visiting Coordinating Center staff, and local study staff members were observed onsite performing data collection to ensure protocol adherence and proper documentation of measurements. Additional training was provided when necessary to maintain quality control. Data entry error rates, nature of the errors, and any quality control issues found during source data verification were discussed with the site staff and principal investigators. Any deficiencies identified were immediately corrected, with an option to stop enrollment until major deficiencies were corrected.
Statistical analysis approach
Data on participant attributes such as demographic, anthropometric, and lifestyle behaviours will be summarized separately for boys and girls, within and across all study sites, as counts and percentages for categorical variables and means and standard deviations for continuous variables. Given that the primary aim of ISCOLE is to predict obesity as a function of lifestyle behaviours and environmental characteristics, general linear and nonlinear statistical models, including covariate-adjusted models, will be employed to investigate relationships between adiposity and its potential determinants. Multilevel random-effects models that treat schools within site and children within schools as well as schools within countries as random effects will be used for all analyses. Statistical significance will be defined as p < 0.05 with appropriate adjustments for multi-testing.
Sample size calculations
In order to estimate sample size requirements, a regression model was developed to predict BMI from objectively monitored physical activity (accelerometer-determined activity counts/day) and self-reported caloric consumption (kcal/day) among 10-year olds in the 2005/2006 U.S. National Health and Nutrition Examination Survey. Based on estimates gleaned from the regression model, the sample size was determined under the following assumptions: 1) 10-year old students would be sampled in school clusters with an average of 25 students per school, 2) the 5% significance level was desirable, and 3) at least 90% power was required to detect as significant a predictor that explains 3% of the variability in BMI. It was determined that a site-specific minimum of 350 students would achieve a minimum power of 91%. Because the students were to be sampled in clusters by schools, a design effect of 1.3, estimated from Williamson et al. [50], was applied to produce a required sample size of 455. To further allow for students who may fail to provide valid and /or complete data, the enrollment target for each site was set at 500 students, within a target of at least 20 schools. The total sample size of approximately 6000 children across twelve countries should provide excellent power for detecting meaningful significant contributors to the hypothesized multi-level model.
ISCOLE is a multi-national collaborative study of lifestyle behaviours, the environment and obesity in children from around the world. This study extends the results from single-site and regional multi-center studies by incorporating local study research sites and collaborators from a broad spectrum of the world's regions. The standardized protocol and rigorous training and quality control program will ensure accurate and reliable data, and will also lead to the further development of research capacity on energy balance among all participating institutions and countries. Further, the resulting dataset will be a valuable resource for the training and education of students and developing scientists from around the world well into the future, as well as for potential follow-up of participants to determine patterns of weight change.
The strengths and weaknesses of ISCOLE warrant discussion. The major strengths of the study include the recruitment of a large multi-national sample of children from low to high income countries across several regions of the world, the highly standardized measurement protocol, the use of direct measurements whenever possible, the rigorous quality control program, and the consideration of higher-order environmental characteristics. ISCOLE is currently a cross-sectional study with all of the inherent limitations of this design; however, the potential exists to follow the participants longitudinally in several countries. ISCOLE was not designed to provide representative data from each participating country or region; rather, the sampling strategy was designed to maximize variation in socio-economic status at each site. The ISCOLE countries span a wide range of health, social and economic indicators (see Table 1); however, the results of the study may not be directly generalizable to other countries. It should be noted that some of the measures used in ISCOLE are still rather crude, as is usual in epidemiological settings. For instance, a more profound assessment of the children's diets would have been an advantage. However, assessing usual dietary intake in quantitative terms would have required considerably more resources, extensive individual participant burden, and more training for research personnel.
In summary, the results obtained in ISCOLE have the potential to increase our understanding of the correlates of childhood obesity and inform the development of lifestyle and environmental interventions designed to address and prevent childhood obesity that can be culturally adapted for implementation around the world. Diverse international evidence is needed to recommend environment and policy changes related to improving children's lifestyles and reducing the prevalence of obesity. Cross-cultural comparisons may provide unique insight for future interventions.
BMI:
EuropeaN energy balance research to prevent excessive weight gain among youth
EYHS:
European youth heart study
FFQ:
HBSC:
Health behaviours in school-aged children
HDI:
Healthy lifestyle in Europe by nutrition in adolescents
Identifying determinants of eating and activity
IDEFICS:
Identification and prevention of dietary- and lifestyle-induced health effects in children and infants
ISCOLE:
International study of childhood obesity, lifestyle and the environment
NIK:
Neighborhood impact on kids
School health action, planning and evaluation system
SHPPS:
School health policies and practices study
SPEEDY:
Sport, physical activity and eating behaviour: environmental determinants in young people.
Lobstein T, Baur L, Uauy R, the International Obesity Task Force: Obesity in children and young people: a crisis in public health. Obes Rev. 2004, 5 (Suppl 1): 4-85.
Wang Y, Lim H: The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry. 2012, 24 (3): 176-188. 10.3109/09540261.2012.688195.
Janssen I, Katzmarzyk PT, Boyce WF, Vereeken C, Mulvihill C, Roberts C, Currie C, Pickett W: Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev. 2005, 6: 123-132. 10.1111/j.1467-789X.2005.00176.x.
Haug E, Rasmussen M, Samdal O, Iannotti R, Kelly C, Borraccino A, Vereecken C, Melkevik O, Lazzeri G, Giacchi M, et al: Overweight in school-aged children and its relationship with demographic and lifestyle factors: results from the WHO-collaborative health behaviour in school-aged children (HBSC) study. Int J Public Health. 2009, 54 (Suppl 2): 167-179.
Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J: An ecological approach to creating active living communities. Annu Rev Public Health. 2006, 27: 297-322. 10.1146/annurev.publhealth.27.021405.102100.
Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K: Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008, 29: 253-272. 10.1146/annurev.publhealth.29.020907.090926.
Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the 2009/2010 survey. Health Policy for Children and Adolescents. Edited by: Currie C, Zanotti C, Morgan A, Currie D, Looze M de, Roberts C, Samdal O, O.R.F S, V B. 2012, Copenhagen: WHO Regional Office for Europe
Moreno LA, De Henauw S, Gonzalez-Gross M, Kersting M, Molnar D, Gottrand F, Barrios L, Sjostrom M, Manios Y, Gilbert CC, et al: Design and implementation of the healthy lifestyle in Europe by nutrition in adolescence cross-sectional study. Int J Obes (Lond). 2008, 32 (Suppl 5): S4-S11.
Martinez-Gomez D, Ruiz JR, Ortega FB, Veiga OL, Moliner-Urdiales D, Mauro B, Galfo M, Manios Y, Widhalm K, Beghin L, et al: Recommended levels of physical activity to avoid an excess of body fat in European adolescents: the HELENA Study. Am J Prev Med. 2010, 39 (3): 203-211. 10.1016/j.amepre.2010.05.003.
Garaulet M, Ortega FB, Ruiz JR, Rey-Lopez JP, Beghin L, Manios Y, Cuenca-Garcia M, Plada M, Diethelm K, Kafatos A, et al: Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study. Int J Obes. 2011, 35 (10): 1308-1317. 10.1038/ijo.2011.149.
Rey-Lopez JP, Ruiz JR, Vicente-Rodriguez G, Gracia-Marco L, Manios Y, Sjostrom M, De Bourdeaudhuij I, Moreno LA: Physical activity does not attenuate the obesity risk of TV viewing in youth. Pediatr Obes. 2012, 7 (3): 240-250. 10.1111/j.2047-6310.2011.00021.x.
Riddoch C, Edwards D, Page AS, Froberg K, Anderssen SA, Wedderkopp N, Brage S, Cooper AR, Sardinha LB, Harro M, et al: The European youth heart study - cardiovascular disease risk factors in children: rationale, aims, study design, and validation of methods. J Phys Act Health. 2005, 2: 115-129.
Ekelund U, Sardinha LB, Anderssen SA, Harro M, Franks PW, Brage S, Cooper AR, Andersen LB, Riddoch C, Froberg K: Associations between objectively assessed physical activity and indicators of body fatness in 9- to 10-y-old European children: a population-based study from 4 distinct regions in Europe (the European youth heart study). Am J Clin Nutr. 2004, 80 (3): 584-590.
Ekelund U, Brage S, Froberg K, Harro M, Anderssen SA, Sardinha LB, Riddoch C, Andersen LB: TV viewing and physical activity are independently associated with metabolic risk in children: the European youth heart study. PLoS medicine. 2006, 3 (12): e488-10.1371/journal.pmed.0030488.
Borys JM, Le Bodo Y, Jebb SA, Seidell JC, Summerbell C, Richard D, De Henauw S, Moreno LA, Romon M, Visscher TL, et al: EPODE approach for childhood obesity prevention: methods, progress and international development. Obes Rev. 2012, 13 (4): 299-315. 10.1111/j.1467-789X.2011.00950.x.
Ahrens W, Bammann K, Siani A, Buchecker K, De Henauw S, Iacoviello L, Hebestreit A, Krogh V, Lissner L, Marild S, et al: The IDEFICS cohort: design, characteristics and participation in the baseline survey. Int J Obes. 2011, 35 (Suppl 1): S3-S15.
Lissner L, Lanfer A, Gwozdz W, Olafsdottir S, Eiben G, Moreno LA, Santaliestra-Pasias AM, Kovacs E, Barba G, Loit HM, et al: Television habits in relation to overweight, diet and taste preferences in European children: the IDEFICS study. Eur J Epidemiol. 2012, 27 (9): 705-715. 10.1007/s10654-012-9718-2.
Lanfer A, Knof K, Barba G, Veidebaum T, Papoutsou S, de Henauw S, Soos T, Moreno LA, Ahrens W, Lissner L: Taste preferences in association with dietary habits and weight status in European children: results from the IDEFICS study. Int J Obes. 2012, 36 (1): 27-34. 10.1038/ijo.2011.164.
Bammann K, Gwozdz W, Lanfer A, Barba G, De Henauw S, Eiben G, Fernandez-Alvira JM, Kovacs E, Lissner L, Moreno LA, et al: Socioeconomic factors and childhood overweight in Europe: results from the multi-centre IDEFICS study. Pediatr Obes. 2012, 8 (1): 1-12.
van Stralen MM, te Velde SJ, Singh AS, De Bourdeaudhuij I, Martens MK, van der Sluis M, Manios Y, Grammatikaki E, Chinapaw MJ, Maes L, et al: EuropeaN energy balance research to prevent excessive weight gain among youth (ENERGY) project: design and methodology of the ENERGY cross-sectional survey. BMC Public Health. 2011, 11: 65-10.1186/1471-2458-11-65.
World Bank: World Development Indicators 2012. 2012, The World Bank: Washington, DC
United Nations Development Programme: Human Development Report 2011. Sustainability and Equity: A Better Future for All. 2011, New York NY: Palgrave Macmillan
World Bank: World Bank Gini Index. 2012, (http://data.worldbank.org/indicator/SI.POV.GINI/). Accessed on August 20, 2012
Anthropometric Standardization Reference Manual. Edited by: Lohman TG, Roche AF, Martorell R. 1988, Champaign, IL: Human Kinetics
World Health Organization: Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation. Geneva, 8–11 December 2008. 2011, Geneva: World Health Organization
Inequalities in Children's Health: HBSC International Report from the 2005/2006 Survey. Edited by: Currie C, Gabhainn SN, Godeau E, Roberts C, Smith R, Currie D, Pickett W, Richter M, Morgan A, Barnekow V. 2008, Geneva: World Health Organization
Van den Bulck J, Van Mierlo J: Energy intake associated with television viewing in adolescents, a cross sectional study. Appetite. 2004, 43 (2): 181-184. 10.1016/j.appet.2004.04.007.
National Center for Health Statistics: National Health and Nutrition Examination Survey. 2012, Available at: http://www.cdc.gov/nchs/nhanes.htm
U.S. Centers for Disease Control and Prevention: Youth Risk Behavior Surveillance System (YRBSS). 2012, Available at: http://www.cdc.gov/HealthyYouth/yrbs/
Gropp K, Janssen I, Pickett W: Active transportation to school in Canadia youth: should injury be a concern?. Inj Prev. 2013, 19 (1): 64-67. 10.1136/injuryprev-2012-040335.
Chen X, Beydoun MA, Wang Y: Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity (Silver Spring). 2008, 16 (2): 265-274. 10.1038/oby.2007.63.
Patel SR, Hu FB: Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring). 2008, 16 (3): 643-653. 10.1038/oby.2007.118.
Chaput J-P, Tremblay A: Insufficient sleep as a contributor to weight gain: an update. Curr Obes Reports. 2012, 1: 245-256. 10.1007/s13679-012-0026-7.
Mullan E, Markland D, Ingledew DK: A graded conceptualisation of self-determination in the regulation of exercise behaviour: development of a measure using confirmatory factor analytic procedures. Person Indiv Diff. 1997, 23 (5): 745-752. 10.1016/S0191-8869(97)00107-4.
Motl RW, Dishman RK, Trost SG, Saunders RP, Dowda M, Felton G, Ward DS, Pate RR: Factorial validity and invariance of questionnaires measuring social-cognitive determinants of physical activity among adolescent girls. Prev Med. 2000, 31 (5): 584-594. 10.1006/pmed.2000.0735.
Striegel-Moore RH, Morrison JA, Schreiber G, Schumann BC, Crawford PB, Obarzanek E: Emotion-induced eating and sucrose intake in children: the NHLBI growth and health study. Int J Eat Disord. 1999, 25 (4): 389-398. 10.1002/(SICI)1098-108X(199905)25:4<389::AID-EAT3>3.0.CO;2-4.
Malina RM, Bouchard C, Bar-Or O: Growth, Maturation and Physical Activity. 2004, Champaign, IL: Human Kinetics, 2
Khamis HJ, Roche AF: Predicting adult stature without using skeletal age: the Khamis-Roche method. Pediatrics. 1994, 94: 504-507.
Mirwald RL, Baxter-Jones ADG, Bailey DA, Beunen G: An assessment of maturity from anthropometric measurements. Med Sci Sports Exerc. 2002, 34: 689-694. 10.1097/00005768-200204000-00020.
Saelens BE, Sallis JF, Frank LD, Couch SC, Zhou C, Colburn T, Cain KL, Chapman J, Glanz K: Obesogenic neighborhood environments, child and parent obesity: the Neighborhood Impact on Kids study. Am J Prev Med. 2012, 42 (5): e57-e64. 10.1016/j.amepre.2012.02.008.
Rosenberg D, Ding D, Sallis JF, Kerr J, Norman GJ, Durant N, Harris SK, Saelens BE: Neighborhood Environment Walkability Scale for Youth (NEWS-Y): reliability and relationship with physical activity. Prev Med. 2009, 49 (2–3): 213-218.
Sallis JF, Kerr J, Carlson JA, Norman GJ, Saelens BE, Durant N, Ainsworth BE: Evaluating a brief self-report measure of neighborhood environments for physical activity research and surveillance: physical activity neighborhood environment scale (PANES). J Phys Act Health. 2010, 7 (4): 533-540.
Sampson RJ, Raudenbush SW, Earls F: Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997, 277 (5328): 918-924. 10.1126/science.277.5328.918.
Joint Consortium for School Health: Healthy School Planner. 2012, Available at: http://www.healthyschoolplanner.uwaterloo.ca
Cameron R, Manske S, Brown KS, Jolin MA, Murnaghan D, Lovato C: Integrating public health policy, practice, evaluation, surveillance, and research: the school health action planning and evaluation system. Am J Public Health. 2007, 97 (4): 648-654. 10.2105/AJPH.2005.079665.
U.S. Centers for Disease Control and Prevention: School Health Policies and Practices Study (SHPPS). 2012, Available at: http://www.cdc.gov/healthyyouth/shpps/index.htm
van Sluijs EM, Skidmore PM, Mwanza K, Jones AP, Callaghan AM, Ekelund U, Harrison F, Harvey I, Panter J, Wareham NJ, et al: Physical activity and dietary behaviour in a population-based sample of British 10-year old children: the SPEEDY study (sport, physical activity and eating behaviour: environmental determinants in young people). BMC Public Health. 2008, 8: 388-10.1186/1471-2458-8-388.
Jones NR, Jones A, van Sluijs EM, Panter J, Harrison F, Griffin SJ: School environments and physical activity: the development and testing of an audit tool. Health Place. 2010, 16 (5): 776-783. 10.1016/j.healthplace.2010.04.002.
Lytle LA: Examining the etiology of childhood obesity: the IDEA study. Am J Community Psychol. 2009, 44 (3–4): 338-349.
Williamson DA, Champagne CM, Harsha DW, Han H, Martin CK, Newton RL, Sothern MS, Stewart TM, Webber LS, Ryan DH: Effect of an environmental school-based obesity prevention program on changes in body fat and body weight: a randomized trial. Obesity. 2012, 20 (8): 1653-1661. 10.1038/oby.2012.60.
We wish to thank the ISCOLE External Advisory Board and the ISCOLE participants and their families who made this study possible. In addition, we would like to thank the following individuals at each of the participating sites who made substantial contributions to ISCOLE: Coordinating Center, Pennington Biomedical Research Center: Denise Lambert, RN (Project Manager), Ben Butitta, BS, Shannon Cocreham, BS, Kara Dentro, MPH, Katy Drazba, MPH, Deirdre Harrington, PhD, Dione Milauskas, BS, Emily Mire, MS, Allison Tohme, MPH, Ruben Rodarte MS, MBA; Data Management Center, Wake Forest University: Bobby Amoroso, BS, John Luopa, BS, Rebecca Neiberg, MS, Scott Rushing, BS; Australia, University of South Australia: Lucy Lewis, PhD, Katia Ferrar, B Physio (Hon), Effie Georgiadis, BPsych, Rebecca Stanley, BAppSc (OT) Hon; Brazil, Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS): Sandra Matsudo, MD, PhD, Timoteo Araujo, MSc, Luis Carlos de Oliveira, MSc, Leandro Rezende, BSc, Luis Fabiano, BSc, Diogo Bezerra, BSc; Canada, Children's Hospital of Eastern Ontario Research Institute: Priscilla Bélanger, BSc, Mike Borghese, BSc, Charles Boyer, MA, Allana LeBlanc, MSc, Claire Francis, B.Sc.,Geneviève Leduc, PhD; China, Tianjin Women's and Children's Health Center: Chengming Diao, MSc, Wei Li, BSc, Weiqin Li, MPH, Enqing Liu, MD, Gongshu Liu, MD, Hongyan Liu, MPH, Jian Ma, MD, Yijuan Qiao, MSc, Huiguang Tian, PhD, Yue Wang, MD, Tao Zhang, MPH, Fuxia Zhang, MSc; Colombia, Universidad de los Andes: Julio Acosta, Yalta Alvira, BS, Maria Paula Diaz, Rocio Gamez, BS, Maria Paula Garcia, Luis Guillermo Gómez, Lisseth Gonzalez, Silvia Gonzalez, RD, Carlos Grijalba, MD, Leidys Gutierrez, David Leal, Nicolas Lemus, Etelvina Mahecha, BS, Maria Paula Mahecha, Rosalba Mahecha, BS, Andrea Ramirez, MD, Paola Rios, MD, Andres Suarez, Camilo Triana; Finland, University of Helsinki: Elli Hovi, BS, Jemina Kivelä, Sari Räsänen, BS, Sanna Roito, BS, Taru Saloheimo, MS, Leena Valta; India, St. Johns Research Institute: Deepa P. Lokesh, BSc, Michelle Stephanie D'Almeida, BSc, Annie Mattilda R, MSc, Lygia Correa, BSc, Vijay D, BSc; Kenya, Kenyatta University: Joy Lucy Wachira, MEd, Stella Muthuri, MSc; Portugal, University of Porto: Alessandra da Silva Borges, BA, Sofia Oliveira Sá Cachada, Msc, Raquel Nichele de Chaves, MSc, Thayse Natacha Queiroz Ferreira Gomes, MSc, Sara Isabel Sampaio Pereira, BA, Daniel Monteiro de Vilhena e Santos, MSc, Fernanda Karina dos Santos, MSc, Pedro Gil Rodrigues da Silva, BA, Michele Caroline de Souza, MSc; South Africa, University of Cape Town: Matthew April, BSc (Hons), Monika Uys, BSc (Hons), Nirmala Naidoo, MSc, Nandi Synyanya, Madelaine Carstens, BSc(Hons); United Kingdom, University of Bath: Sean Cumming, PhD, Clemens Drenowatz, PhD, Lydia Emm, MSc, Fiona Gillison, PhD, Julia Zakrzewski, PhD; United States, Pennington Biomedical Research Center: Ashley Braud, Sheletta Donatto, MS, LDN, RD, Corbin Lemon, BS, Ana Jackson, BA, Ashunti Pearson, MS, Gina Pennington, BS, LDN, RD, Ryan Roubion, John Schuna, Jr., PhD; Derek Wiltz; External Advisory Board: Alan Batterham, PhD, Teesside University, Sandra G. Hassink, MD, FAAP, A I duPont Hospital for Children, Board Member, American Academy of Pediatrics, Jacqueline Kerr, PhD, University of California, San Diego; Michael Pratt, MD, Centers for Disease Control and Prevention, Angelo Pietrobelli, MD, Verona University Medical School.
ISCOLE is funded by The Coca-Cola Company. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808-4124, USA
Peter T Katzmarzyk, Tiago V Barreira, Stephanie T Broyles, Catherine M Champagne, Gang Hu, William D Johnson, Catrine Tudor-Locke & Timothy S Church
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
Jean-Philippe Chaput & Mark S Tremblay
University of Helsinki, Helsinki, Finland
Mikael Fogelholm
St. Johns Research Institute, Bangalore, India
Rebecca Kuriyan & Anura Kurpad
UCT/MRC Research Unit for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Estelle V Lambert
School of Health Sciences / Sansom Institute, University of South Australia, Adelaide, Australia
Carol Maher & Tim Olds
CIFI2D, Faculdade de Desporto, University of Porto, Porto, Portugal
José Maia
Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS), Sao Paulo, Brazil
Victor Matsudo
Kenyatta University, Nairobi, Kenya
Vincent Onywera
Universidad de los Andes, Bogota, Colombia
Olga L Sarmiento
University of Bath, Bath, UK
Martyn Standage
Tianjin Women's and Children's Health Center, Tianjin, China
Pei Zhao
Peter T Katzmarzyk
Tiago V Barreira
Stephanie T Broyles
Catherine M Champagne
Jean-Philippe Chaput
Gang Hu
William D Johnson
Rebecca Kuriyan
Anura Kurpad
Carol Maher
Tim Olds
Mark S Tremblay
Catrine Tudor-Locke
Timothy S Church
Correspondence to Peter T Katzmarzyk.
PTK researched the literature and drafted the manuscript. All authors contributed to the study design, critically reviewed the manuscript and approved the final version.
Electronic supplementary material
Additional file 1: ISCOLE Demographic and Family Health Questionnaire.(PDF 46 KB)
Additional file 2: ISCOLE Diet and Lifestyle Questionnaire.(PDF 112 KB)
Additional file 3: ISCOLE Neighborhood and Home Environment Questionnaire.(PDF 87 KB)
Additional file 4: ISCOLE School Environment Questionnaire.(PDF 93 KB)
Katzmarzyk, P.T., Barreira, T.V., Broyles, S.T. et al. The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): design and methods. BMC Public Health 13, 900 (2013). https://doi.org/10.1186/1471-2458-13-900
Adiposity


text:
Sant Sarwan Dass Charitable Hospital, Kathar, India.
Sant Sarwan Dass Charitable Hospital, Adda Kathar is well known to the followers of Dera
Sant Sarwan Dass Ji, innumerable people have been cured of their physical and mental ailments
by the Dwa as well as Dua i.e. through medicine and spirituality bestowed upon them by the
Saints of the Dera. This tradition has been continuing in the Dera since the life-time of Sant Sarwan Dass Ji. The successor Saints also followed this practice. To perpetuate the memory of his Guru, Sant Garib Dass Ji thought of starting a hospital. He held consultations with Sh. Beli Ram and Sh. Raj Mal for this purpose who offered to donate land for this purpose. Later Bibi Puro and Bibi Bhajno also donated their share of land. Panchayat of village Koopur also donated land for this noble cause. The foundation stone of this hospital was laid by him at Adda Kathar, Distt. Jalandhar on 20-10-1982. A humble beginning was made by starting a dispensary on 1-1-1984. With the blessings of all Gaddi-Nashin Saints of Dera Sach Khand Ballan this hospital has now assumed gigantic proportions running six specialilties and having 150 indoor beds. The hospital provides patient care by a highly qualified team of doctors in the department of General Surgery, Medicine, Eye, ENT, Pediatrics and Gynaecology. Nearly 200 patients are attended in the OPD daily. The OPD services are supported by modern diagnostic aids. For this purpose the hospital is equipped with state of the art hospital grade ultra-sound machine, a modern laboratory having auto-analysers for blood and urine tests, an X-ray machine and a computerized ECG machine etc. The hospital is known for the general surgery being performed here. Appx 200 surgical operations are performed every month. The hospital has three operation theatres, which are equipped with state of the art machines such as Laparoscope, C-Arm, Boyle's apparatus, fully remote controlled OT tables and pulse oxymeters etc. All the sterilization needs of the OT's and wards are met by the central horizontal autoclave. Very nominal fee is charged for the hospital services to partially meet the hospital expenditure which is approximately 1.5 crores per year. The poor patients are not charges even the nominal fee and their expenditure is met by Maharaj Ji. The management of the hospital is run through a Trust. Shri 108 Sant Niranjan Dass Ji is the Chairman of the Trust and he is assisted by a dedicated team of Trustees who always think of new ways for the improvement of hospital services & introduction of new infrastructure in the hospital.
News published in begumpura shaher
Sant Sarwan Dass Eye Charitable Hospital, Ballan, India.
Sant Sarwan Dass Charitable Eye Hospital, Dera Bal In order to serve the elderly people, an exclusive eye hospital has been established by the Dera adjoining the Dera itself under the aegies of Sant Sarwan Dass Charitable Hospital Trust. Shri Swarn Dass Bangar, Bibi Resham Kaur of Village Bal (U.K.) and their family became the motivating force behind the construction of this hospital. Since mid sixties they had been holding an annual eye camp at the Dera, but due to some restrictions imposed by the Government it became difficult to hold these camps. Therefore they mooted the idea of an exclusive eye hospital at the Dera and took the initiatve by donating the major chunk of the expenditure incurred on establishing this hospital. A donation of rupees one crore one thousand one hundred eleven was given by them for this project. The foundation stone was laid on 10-11-2004 by Shri 108 Sant Niranjan Dass Ji. The construction of the hospital was completed in record time. The hospital was inaugurated on 15th February, 2007 by Shri 108 Sant Niranjan Dass Ji on the auspicious occasion of Birth anniversary of Sant Sarwan Dass Ji. Modern machines such as Yag Laser, Phaco Emulsification machine, Carl-Zeiss Microscope, Carl-Zeiss Slit lamp and A Scan etc. have been installed in the hospital. People from far and wide areas of Punjab avail the facilities of this hospital. Nearly 200 eye operations are performed every month.

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This month, filmmaker John Landis makes his second appearance as a TCM Guest Programmer, having first appeared in that capacity with Robert Osborne hosting in 2009. Now Landis returns, sitting with Ben Mankiewicz to talk about his programming choices ranging from the obscure to the celebrated, from the comic to the dead serious.
Born in Chicago, Landis moved to Los Angeles as a child, and as a teen he began his career in the film industry as a mailboy at 20th Century Fox studios. He made his feature debut as a director in 1973 with Schlock, a tribute to monster movies. In addition to directing dozens of movies and television productions, Landis has often served on his films as producer, director and actor. Recent directorial credits have included the feature Burke and Hare (2010) and an episode of TV's Franklin & Bash (2012).
Among the classic film comedies directed by Landis are National Lampoon's Animal House (1978), The Blues Brothers (1980), An American Werewolf in London (1981), Trading Places (1983) and Beverly Hills Cop III (1994). He also directed Michael Jackson's music videos "Thriller" and "Black or White."
As his first film choice for the night, Landis chooses a little-known B movie from Paramount Pictures, The Monster and the Girl (1941, TCM premiere). He says he first saw this one on TV when he was around 11. It has remained a favorite because it is "such an unusual melange of genres: film noir, courtroom drama, white slavery, gangster, mad scientist, gorilla picture and a boy-and-his-dog movie!"
Stuart Heisler directed the movie in which George Zucco plays a scientist who salvages the brain of a gangster (Phillip Terry) and transplants it into the head of a gorilla. The cast also includes Ellen Drew, Robert Paige, Paul Lukas and Charles Gemora, the actor in the gorilla suit. Landis notes his fascination with such effects, which dates to his days on Schlock with special-effects artist Rick Baker.
As a great fan of Stan Laurel and Oliver Hardy, Landis chooses two of their MGM comedy shorts from the sound era, Helpmates and Towed in a Hole (both 1932). The first deals with the disastrous results when Stan tries to help Ollie clean up from a party while Ollie's wife is gone; the second, with the boys' attempts to become fishermen despite a malfunctioning boat.
"I genuinely love Stan and Ollie," says Landis. "I think they're angels. They're so professionally brilliant as performers, and these characters they created are so universal."


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text:
All the concerts from Cannibal Corpse
Follow this artist and we'll let you know when they have concerts.
Cannibal Corpse is a death metal band from Buffalo, New York. Core members Chris Barnes, Alex Webster and Jack Owen founded the group. Since forming in 1988, the band has released an impressive catalog of 12 full-length studio albums. What drove Cannibal Corpse through the years were their devoted fans, which gave the group a unique cult following. Their 2nd and 3rd albums sold over 1 million copies respectively. However, controversy around the group has banned them from performing live as well as having their albums sold in certain territories around the world. Their debut album called Eaten Back To Life was released in 1990. This album was banned in Germany for its abusive and offensive language. The most recent full-length offering from Cannibal Corpse was the 2012 release Torture. Erik Rutan at Sonic Ranch Studios in Austin, Texas, produced the album. Torture sold almost 50,000 copies and landed the band on the Top 40. Despite their violent language and imagery, the band has developed an ever-growing fan base around the world. In addition, the fact that the band's albums are not universally distributed has not prevented their fans from collecting their records. It has been said that part of the enigma around the band is their controversial material. Even though the band is banned from performing at certain locations around the world, their music has always maintained a strong belief in the First Amendment. In other words, although Cannibal Corpse have been criticized for their language, the band has never compromised their voice.
12 Concerts
09 Oct 2021 · Madrid
The European Siege: Arch Enemy + Benemoth
02 Jun 2021 · Viveiro
01 Jul 2021 · Santa Coloma de Gramenet
16 Apr 2021 · El Paso
Rotting Christ concert in El Paso
11 Mar 2021 · El Paso
28 Sep 2021 · San Jose
Dark Tranquillity concert in San Jose
02 Jun 2021 · Barcelona
Concerts in Madrid
Concerts in Barcelona
Concerts in Seville
Concerts in Valencia
Concerts in Bilbao
Concerts in Granada
Concerts in Zaragoza
Concerts in Murcia
Flamenco festivals
Songwriter festivals
Latin festivals
Metal festivals


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An all metal sprinkler that will gently water an area up to 32 feet by 32 feet; covers square up to 32 feet; all metal construction. Durable, rustproof polymer construction. Operates at low or high water pressures. Five different watering patterns: circle up to 35' diameter; large square up to 30' x 30'; small square up to 18' x 18'; rectangle up to 20' x 40'; long strip up to 10' x 50'. Metal screen filter prevents clogging. Constructed of heavy-duty non-corrosive zinc and brass. Pulsating sprinkler head adjusts from partial to full circle.
High impact, rust resistant poly and stainless steel construction on impulse head. Provides full or partial coverage. Durable, rust resistant poly spike base. Patented impulse arm saves water by eliminating back and side splash. Diffuser screw allows for easy fingertip adjustment of water stream for even coverage. Water coverage up to 86' diameter at 30 PSI; 112' diameter at 60 PSI. Two spike with brass 3/4" female swivel and plastic cap end. Brass and zinc alloy head. Plated finish and durable construction. Coverage area: 45' diameter. Adjustable head. From partial to full circle. Constructed of heavy duty non-corrosive zinc and brass. Provides full uniform coverage up to 60' in diameter.
Plastic base/case. Water coverage up to 1566 sq feet. Aluminum tube with 18 solid brass jets. With jet clean needle. Brass swivel coupling. Durable, rust resistant poly sled base. High impact, rust resistant poly and stainless steel construction on impulse head. Fingertip diffuser adjustment screw. Provides full or partial coverage. Patented impulse arm saves water by eliminating back and side splash. Water coverage up to 86' diameter at 30 PSI; 112' diameter at 60 PSI. Ideal solution for watering lawns. The quiet operations and gentle sprinkling action provides soaking moisture to small to mid-sized yards.


(IG)and how it is often confused with other similar industry terms, such as information technology (IT) governance and data governance. The definitions put forth at times have compounded the confusion by offering a convoluted definition of IG, or sometimes offering a definition of IG that is just plain incorrect, often confusing it with simple data governance. Let's clear this up once and for all.
Whew! Maybe that's all true but no one can remember it.
That means that information is kept as long as required by regulations and laws, or internal business needs and risk assessments, then it is discarded according to an established retention and disposition schedule, (unless it is subject to a legal hold). The information that remains has business value and can be leveraged to create new insights that feed into management decisions.
The IG Initiative defines IG as "… the activities and technologies that organizations employ to maximize the value of their information while minimizing associated risks and costs." This definition emphasizes finding and exploiting value in information, while keeping costs and risks as low as possible. It is a broad definition but it is sharper than Gartner's.
Corporate governance is the highest level of governance of an organization and includes the articles of incorporation, bylaws, shareholder agreements, policies and procedures used to manage the relationship of the organization with its stakeholders. A key aspect of corporate governance is IG. IG processes are higher level than the details of IT governance and much higher than data governance, but both data and IT governance can be (and should be) a part of an overall IG program. The IG approach to governance focuses not on detailed IT or data capture and quality processes but rather on controlling the information that is generated by IT and office systems, or their output.
An overall IG program should include IT governance. IT governance is the primary way that stakeholders can ensure that investments in IT create business valueand contribute toward meeting business objectives. This strategic alignment of IT with the business is challenging yet essential. IT governance programs go further and aim to elevate IT performance and deliver optimum business value, while meeting regulatory compliance demands.
Although the CIO typically has line responsibility for implementing IT governance, the CEO and board of directors must receive reports and updates to discharge their responsibilities for IT governance and to see that the program is functioning well and providing business benefits.
The focus is on the actual software development and maintenance activities of the IT department or function, and IT governance efforts focus on making IT efficient and effective. That means minimizing costs by following proven software development methodologies and best practices, principles of data governance and information quality, and project management best practices while aligning IT efforts with the business objectives of the organization.
Several IT governance frameworks can be used as a guide to implementing an IT governance program. Although frameworks and guidance like CobiT®, ITIL, ValIT®, andISO 38500 have been widely adopted, there is no absolute standard IT governance framework; the combination that works best for an organization depends on business factors, corporate culture, IT maturity, and staffing capability. The level of implementation of these frameworks will also vary by organization.
A data governance program should be a part of an IT governance program and an overall IG program. Data governance involves processes and controls to ensure that information at the data level—raw alphanumeric characters that the organization is gathering and inputting—is true and accurate, and unique (not redundant). It involves data cleansing ( or data scrubbing) to strip out corrupted, inaccurate, or extraneous data and de-duplication, to eliminate redundant occurrences of data.
Organizations may use master data management (MDM) tools and techniques to clean their data and leverage business rules that can prevent inaccurate data from being entered into the database. MDM seeks to standardize the data, and ensure there is one "single version of the truth." MDM is a quality-control tool and set of processes used to ensure control and consistency of data over time.
Data governance focuses on information quality from the ground up at the lowest or root level, so that subsequent reports, analyses, and conclusions are based on clean, reliable, trusted data (or records) in database tables. Data governance is the most rudimentary level at which to implement information governance. Data governance efforts seek to ensure that formal management controls—systems, processes, and accountable employees who are stewards and custodians of the data—are implemented to govern critical data assets to improve data quality and to avoid negative downstream effects of poor data. The biggest negative consequence of poor or inaccurate data is poorly and inaccurately based decisions.
Data governance is a newer, hybrid quality control discipline that includes elements of data quality, data management, IG policy development, business process improvement, and compliance and risk management.
IG consists of the overarching polices and processes to optimize and leverage information while keeping it secure and meeting legal and privacy obligations in alignment with stated organizational business objectives. IT governance consists of following established frameworks and best practices to gain the most leverage and benefit out of IT investments and support accomplishment of business objectives.
Data governance consists of the processes, methods, tools, and techniques to ensure that data is of high quality, reliable, and unique (not duplicated), so that downstream uses in reports and databases are more trusted and accurate. Master data management (MDM) tools can assist in this effort.
Once the definitions of these three information-related governance disciplines are clear, their differences become more distinct.


Festive raw bites, perfect for sharing with loved ones over some soy nog or a cuppa!
Makes 20 – 24 puds.
Last for up to two weeks in the fridge.
• Put all of the ingredients in a deep mixing bowl and press together with clean hands until all are mixed together well, with the dates fully pressed forming a strong paste and the other ingredients evenly distributed.
• Roll into evenly sized balls.
• Refrigerate for at least 30 minutes, then enjoy!


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Home Our Work Campaigns Other campaigns
Other campaigns
In addition to the major campaigns run in the framework of our 7 Most Endangered Programme, Europa Nostra supports other campaigns to rehabilitate and protect heritage gems that are in serious danger of being lost forever, such as:
Historic town of Bougival, near Paris
Europa Nostra's delegation visit at Bougival, 19 June 2016. Photo: Europa Nostra
The small town of Bougival, located 18km south of Paris, preserves the memory of an impressive number of 19th century European artists, ranging from Impressionist painters to the French composer Georges Bizet, the Spanish-born mezzo-soprano Pauline Viardot-Garcia and the Russian writer Ivan Tourgeniev.
Europa Nostra's President Maestro Plácido Domingo has given his strong support to the preservation and revival of this exceptional site of European heritage, in particular in a letter sent to the French authorities in July 2016, following a special visit to Bougival.
Related news: Bougival
Serres d'Auteuil Botanical Gardens in Paris
The Botanical Gardens of the Serres d'Auteuil, located to the west of Paris, were designed by the great landscape architect Jean-Camille Formigé. This Parisian masterpiece contains circa 10,000 tropical and sub-tropical plants in its warm greenhouses.
Photo: Lise Bloch-Morhange
Following the granting of the permit to enlarge the Roland Garros sport complex with the construction of a new tennis stadium of about 5,000 seats, partly located on the site of the Serres d' Auteuil, Europa Nostra has added its voice to support the civil society campaign to save Garden complex. In a statement released on 18 December 2015, the Executive President of Europa Nostra Denis de Kergorlay urges the authorities to seriously examine the merits and the feasibility of the alternative project proposed by French heritage organisations.
Related news: Serres d' Auteuil
Museum of Textiles and Decorative Arts in Lyon
Photo: Sylvain Pretto
The Museum of Textiles and Decorative Arts in Lyon, which has been active for more than a century, brings together the exceptional textile heritage of France, Europe and the rest of the world. Its remarkable collections of almost 2.5 million artefacts cover over 4,000 years of history.
Europa Nostra's President Maestro Plácido Domingo has lent his voice to the large campaign to save the Museum. In a letter sent to the French Minister for Culture and Communication in March 2016, the President of Europa Nostra advocates a long-lasting solution which will ensure that the museum continues to operate and has a sustainable future.
Related news: Textile Museum of Lyon
No to the closure of the Textile Museum of Lyon


As you may, or may not know, it snowed all week here in the UK!* So that means it's been freezing and all i've wanted to do is curl up in bed with books… hence, the bibliophile sweater tag.
* As I look out of my window the snow has melted and it is raining… hurrah for British weather, aye?
Previous so, it's been a while.
1984 is one of my favorite classics!! And Six of Crows is defintely one of my favorite books of all time!


Like a local apartment is ideally situated at 8a Korotka Street in Lviv only in 1.9 km from the centre. The apartment is conveniently close to The Ivan Franko National University of Lviv, The Palace of Counts Pototskikh, Lviv State Academic Opera and Ballet Theater and only in 4.4 km from the Lviv International Airport.
Tourists can take advantage of a huge range of services: car park, accommodation with pets is possible, internet services, special non-smoking rooms. You can pay for the accommodation and amenities only in cash.
For your comfortable accommodation is offered only one room type - apartment. For guests are provided facilities such as clothes rack, desk, refrigerator, extra long beds (> 2 metres), electric kettle, washing machine, free toiletries.
Friendly owner, clean, comfortable, location, kitchen ..
Wonderful apartment just in 10 minutes walking from the railway station. Volodymyr, the host, was very kind, despite of the late check-in of mine.


Whether the air conditioner is being used to heat or cool a place, the internal system produces a large amount of water due to condensation. All the air-conditioners on the market resolve this excess water by draining or evaporating it into the air.
A LED light located behind the frontrale window both indirectly illuminates the grass and creates mood lighting for dark spaces.


Gemini Mortgage and Real Estat Corp is located at 25422 TRABUCO RD # 105E, El Toro, CA. This business specializes in Real Estate Financing.
Gemini Mortgage and Real Estate Corporation can be found at Trabuco Rd 25422. The following is offered: Real Estate Financing. The entry is present with us since Sep 10, 2010 and was last updated on Nov 14, 2013. In Mission Viejo there are 67 other Real Estate Financing. An overview can be found here.


Using the finest materials from all over the world and the most technologically advanced equipment available, we are experts in new construction, commercial, and remodeling. With 1000's of satisfied customers, Gold Coast Granite Custom Countertops has the knowledge and experience to help you achieve your dream kitchen, bath, fireplace, or other custom project. If you can envision it, we can do it! Gold Coast Granite, quality that you can be proud of!
and mroe text example 1 text anything you want me to put here example 1 text anything you want me to put here!!
We service the following cities: Antioch 60002, Barrington 60010-60011, Deerfield 60015, Fox Lake 60020, Grayslake 60030, Third Lake 60030, Gurnee 60031, Highland Park 60035, Fort Sheridan 60037, Highwood 60040, Ingleside 60041, Island Lake 60042, Lake Bluff 60044, Lake Forest 60045, Lake Villa 60046, Lake Zurich 60047, Libertyville 60048, Long Grove 60049, Mundelein 60060, Vernon Hills 60061, North Chicago 60064, Lincolnshire 60069, Round Lake 60073, Round Lake 60073, Russell 60075, Waukegan 60079, Wadsworth 60083, Wauconda 60084, Waukegan 60085, North Chicago 60086, Waukegan 60087, Great Lakes 60088, Buffalo Grove 60089, Libertyville 60092, Winthrop Harbor 60096, Zion 60099, Algonquin 60102-60156, Barrington Hills 60021-60102, Cary 60013, Crystal Lake 60012-60014-60039, Fox River Grove 60021, Holiday Hills 60050-60051, Johnsburg 60050-60051, Lake in the Hills 60102-60156, Lakemoor 60050-60051-60056, McCullom Lake 60050, McHenry 60050-60051, Oakwood Hills 60013, Prairie Grove 60012-60050, Richmond 60071, Ringwood 60072, Spring Grove 60081, Sunnyside 60050, Trout Valley 60013, Village of Lakewood 60014, Volo 60051, Wonder Lake 60091 and Woodstock 60098 Illinois.


TSS is the recognized leader in the controlled environment compliance industry. This is because we've made it our aim to do more than simply test and certify your cleanrooms. TSS is deeply involved in the professional organizations and regulatory bodies that shape the biotech and pharmaceutical industries. From the TSS representatives currently sitting on the executive boards of associations such as the IEST, to our longstanding support of organizations like ABSA and the ISPE, we believe that affiliating ourselves with an organization means more than just dropping names.
* The name and Corporate Member Logo of ABSA International are the sole property of the American Biological Safety Association, Inc., and ABSA International does not endorse any activities, materials, or products marketed by this company or organization.


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The Football Blog
Gillingham 1-1 Swindon Town
"We were always in control of the game." These were the words of the very disappointed Gillingham manager Mark Stimson, as his side conceded a late equaliser to give Swindon Town a share of the spoils at the KRBS Priestfield Stadium.
It was a crucial match for the Gills, as they needed to avoid defeat and hope Cheltenham Town lost to give them any hope of staying up. And the Gills got off to the perfect start when Garry Richards scored in the 2nd minute. But after leading for 86 minutes, the Gills surrendered their 1-0 advantage when Hasney Aljofree equalised for the Robins in the 88th minute.
This was the fourth time in a row the Gills had taken the lead then lost it, and manager Mark Stimson believes his side should be more clinical in front of goal, saying: "Sometimes it is good goalkeeping and sometimes it could be forwards slashing at opportunities when they are not relaxed as they haven't scored for a few weeks; they might be an eager beaver to score. I don't think we created too much at Millwall but since then, we've created better chances. It tells everyone a stat that we need to bring a striker into the club that is a regular 15 to 20 goal a season man. They don't fall off trees and are hard to get. If we can get a big one to go alongside a couple of the smaller guys we've got, then it will be a positive move by the football club. That is something we will look to do whatever division we are in."
Today's result at Priestfield means the Gills still have a chance of staying up, as Cheltenham lost 2-1 away to Oldham Athletic. The Gills players paraded the pitch at the end of the game, and manager Mark Stimson was amazed by the support he received from the club's fans: "It amazed me walking around the pitch that so many people stayed behind and clapped. That makes me even more eager to turn this into something good. I got a massive buzz out of that."
Gillingham: 22 Derek Stillie, 37 Garry Richards (scored 2 mins), 4 Danny Cullip, 5 Simon King, 35 John Nutter, 11 Nicky Southall, 7 Andrew Crofts, 27 Kevin Maher, 39 Stuart Lewis (replaced by Georges Ba 91 mins), 9 Gary Mulligan (replaced by Dennis Oli 67 mins), 20 Simeon Jackson
Gillingham Subs: 30 Leroy Griffiths, 28 Dennis Oli (replaced Gary Mulligan 67 mins), 24 Georges Ba (replaced Stuart Lewis 91 mins), 8 Mark Bentley, 13 Chris Kiely
Swindon Town: 12 Peter Brezovan, 2 Jack Smith (replaced by Ben Joyce 86 mins), 5 Jerel Ifil (replaced by Sean Morrison 34mins), 16 Hasney Aljofree (scored 88 mins), 3 Jamie Vincent, 18 Michael Timlin, 10 Jon-Paul McGovern, 8 Craig Easton, 27 Anthony McNamee (replaced by Billy Paynter 68 mins), 31 Simon Cox, 4 Lee Peacock
Swindon Town Subs: 35 Ben Joyce (replaced Jack Smith 86 mins), 25 Sean Morrison (replaced Jerel Ifil 34 mins), 20 Billy Paynter (replaced Anthony McNamee 68 mins), 24 Chris Allen, 1 Phil Smith
Result: 1-1Â Â Â Attendance: 6,334
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2012 stanley cup playoffs May 5, 2012
The Capitals Even the Series at Two
The Capitals celebrate the go-ahead goal in the third period of Game 4.
The Rangers won the first game of their series with the Capitals, lost the second, and won the third before falling in this afternoon's Game 4. Sound familiar? It should: It's how their opening-round series against Ottawa had played out through four games. And in today's Game 4, the Capitals scored a third-period power-play goal to break a tie score, then protected their one-goal lead in the final minutes to secure the 3-2 victory. That might sound familiar as well; it's how they've won both their games in this series.
The Rangers fell behind by a goal three times in this one, but only answered back to tie the score twice: Once early in the second period on Artem Anisimov's goal, and again late in the period on Marian Gaborik's tally off an Anisimov pass from behind the net that called to mind the triple-overtime winner from early Thursday morning.
The positive takeaways from this game for the Rangers: They bounced back from a rough first period (in which they were out-shot 14-3) with a strong second. Their forecheck — such an important aspect of their game — looked good at times. And Gaborik, the team's best goal-scorer during the regular season, lit the lamp for the second straight game.
If not for some spectacular saves by Henrik Lundqvist, though, the Caps could have had more than three goals. Still, those three goals were enough this afternoon. (It must be noted that for all the things Chris Kreider has done right in his first weeks in the NHL, it was his awful turnover that led to the first Caps goal. He deserves a damn assist for setting up Alex Ovechkin for such a perfect one-timer.) The defensive-minded Caps shut down the Rangers during their last-gasp attempts late in the third, and as they've been doing all series, gave the Rangers a taste of their own medicine when Brooks Laich blocked a Dan Girardi shot as the clock wound down. (The Capitals blocked 27 shots in this game, compared to seven for the Rangers.)
Some of the refereeing will be scrutinized after this one. Carl Hagelin was (correctly) whistled for slashing in the third period — Mike Green would score the game-winner on the ensuing power play — but an Ovechkin slash on Brian Boyle earlier on went uncalled. Shortly after Green's goal, replays showed that Mike Knuble batted the puck over the boards and out of play with his hand, but the referees didn't call a delay of game penalty. Meanwhile, Alex Ovechkin's charge of Dan Girardi might get a look from Brendan Shanahan, though we wouldn't expect much to come of it. (Ovie has been suspended in the past, but there was body contact, and, perhaps most importantly in a system in which such things are considered, Girardi wasn't knocked out of game. Ovechkin was given a two-minute minor on the play.)
Like they did in the first round against Ottawa, the Rangers had a chance to put their foot an opponent's throat with a Game 4 victory and couldn't. In fact, the Rangers have yet to win a game in this playoffs when leading in the series. (In the first round, they won games when tied at 0-0 in the series, when tied at 1-1, when down 3-2, and when tied at 3-3. In the second round, they won Game 1, and then won Game 3 when the series was even at one.)
Today's Caps win sets up a critical Game 5 at the Garden on Monday night. It's not necessarily a must-win — the Rangers lost Game 5 at home against Ottawa then came back to win the final two games of the series — but surely the Rangers won't want to return to Washington in Game 6 facing elimination. Like the Senators before them, the Capitals are giving the top-seeded Rangers a fight. The conference semifinals are now a best-of-three.


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Buy Basketball Tickets
Players With Birthdate August 1, 1994
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Alexander Bork Kuhnel F 6-4 194 - Aug 1, 1994 Denmark - -
Valentin Bouquety SG 6-0 175 Rouen Aug 1, 1994 France - -
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Anthony Chisley G 6-3 - - Aug 1, 1994 United States - -
Akil Douglas C 6-10 190 San Jose, CA Aug 1, 1994 United States Clark Atlanta -
Austin Karazsia F 6-8 220 Linton, IN Aug 1, 1994 United States South Alabama -
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Walker Swenson FC 6-8 215 St. George, UT Aug 1, 1994 United States Dixie State -
Brandon Taylor PF 6-6 225 Tabernacle, NJ Aug 1, 1994 United States Penn State Rethymno
Andree Vela PG 5-10 - North Miami, FL Aug 1, 1994 United States Florida National U -