Lessons learned from recruiting socioeconomically disadvantaged smokers into a pilot randomized controlled trial to explore the role of Exercise Assisted Reduction then Stop (EARS) smoking
Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth PL6 8BX, UK
University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Walton Street, Jericho, Oxford OX2 6NW, UK
Institute of Population Health Research, St George’s University of London, Cranmer Terrace, London SW17 ORE, UK
Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, Gower Street, London, WC1E 6BT, UK
Research is needed on what influences recruitment to smoking reduction trials, and how to increase their reach. The present study aimed to i) assess the feasibility of recruiting a disadvantaged population, ii) examine the effects of recruitment methods on participant characteristics, iii) identify resource requirements for different recruitment methods, and iv) to qualitatively assess the acceptability of recruitment. This was done as part of a pilot two-arm trial of the effectiveness of a novel behavioral support intervention focused on increasing physical activity and reducing smoking, among disadvantaged smokers not wishing to quit.
Smokers were recruited through mailed invitations from three primary care practices (62 participants) and one National Health Stop Smoking Service (SSS) database (31 participants). Six other participants were recruited via a variety of other community-based approaches. Data were collected through questionnaires, field notes, work sampling, and databases. Chi-squared and t-tests were used to compare baseline characteristics of participants.
We randomized between 5.1 and 11.1% of those invited through primary care and SSS, with associated researcher time to recruit one participant varying from 18 to 157 minutes depending on time and intensity invested.Only six participants were recruited through a wide variety of other community-based approaches, with an associated researcher time of 469 minutes to recruit one participant. Targets for recruiting a disadvantaged population were met, with 91% of the sample in social classes C2 to E (NRS social grades, UK), and 41% indicating mental health problems. Those recruited from SSS were more likely to respond to an initial letter, had used cessation aids before, and had attempted to quit in the past year. Overall, initial responders were more likely to be physically active than those who were recruited via follow-up telephone calls. No other demographics or behaviour characteristics were associated with recruitment approach or intensity of effort. Qualitative feedback indicated that participants had been attracted by the prospect of support that focused on smoking reduction rather than abrupt quitting.
Mailed invitations, and follow-up, from health professionals was an effective method of recruiting disadvantaged smokers into a trial of an exercise intervention to aid smoking reduction. Recruitment via community outreach approaches was largely ineffective.
ISRCTN identifier:
Smokers from disadvantaged groups (such as the unemployed, low-skilled manual workers, and people with mental health problems) attempt to quit at the same rate as others but the success rate in quitting is lower 1 . Smoking has been identified as one of the main contributing factors to health inequalities in industrial countries 2 and, in England and Wales, accounts for nearly half the difference of smoking-attributed mortality (among males) between the highest and lowest socioeconomic groups 3 . Smoking reduction may increase the motivation to quit, which is highly predictive of quit attempts, and reduce smoking dependence, which is related to successful quitting 4 . Also, offering an intervention to support smoking reduction may increase the reach of services to disadvantaged smokers who would not engage in cessation programs 5 6 . Offering support for smoking reduction may attenuate the commonly reported barriers to engagement of ‘fear of failure’ and ‘fear of being judged’ when attempting to abruptly quit 7 .
Evidence for the effectiveness of smoking cessation interventions for disadvantaged groups is limited 1 8 9 10 . The lack of evidence may have resulted from both the inherent difficulties in recruiting and engaging with such groups in clinical trials, and the predominant focus on abrupt quitting rather than smoking reduction. Further research is therefore needed on how best to recruit disadvantaged smokers to increase intervention reach 7 with appropriate behavioral support 7 10 11
More detailed and transparent information on the reach of trials and interventions (such as the proportion of the targeted population that participated) targeting disadvantaged groups is needed to better assess and plan interventions 12 . Various approaches may improve recruitment into studies among disadvantaged groups 13 14 , including the following: engagement with the target population when developing the intervention and preparing participant information about the study and intervention, using a variety of community networks and settings to invite the target population, and use of follow-up telephone calls to explain the study methods and intervention. In a review, the most effective strategies for recruiting smokers into trials 15 suggested that tailored interventions, recruitment methods that are proactive in nature (for example, approaching potential participants directly) 16 , and more intensive recruitment strategies (such as repeated provision of information and contact) may help. But in general there is insufficient knowledge regarding the factors influencing recruitment and the most effective strategies for recruiting into randomized trials 17 18 19 , particularly among disadvantaged groups.
This article reports on the feasibility and acceptability of strategies specifically designed to recruit disadvantaged smokers who wished to reduce their smoking but not quit, into a phase two pragmatic pilot randomized controlled trial: the Exercise Assisted Reduction then Stop (EARS) trial (Health Technology Assessment (HTA) number: 07/78/02, International Standardized Randomized Controlled Trial Number (ISRCTN): 13837944, UK Clinical Research Network (UKCRN) Study ID: 8937. The specific objectives of this study as related to the present paper were: i) to identify the feasibility of recruiting disadvantaged smokers through a variety of settings (through primary care, National Health Service (NHS) Stop Smoking Services (SSS), and through more generalized community approaches) as well as to examine the effect of using varying degrees of recruitment activity intensity (recruitment by invitation letter only compared with an invitation letter plus follow-up reminder telephone calls, and through various levels of community engagement); ii) to examine how recruitment of participants through different locations and different levels of recruitment intensity impact on participant characteristics; iii) to identify the time requirements associated with each recruitment approach; and iv) to qualitatively explore the effectiveness and acceptability of different approaches to recruitment.
Overall, the trial sought to identify uncertainties about the methods and intervention to support smoking reduction with physical activity and behavioral support. The two-arm randomized controlled trial consisted of a weekly one-to-one counselling-based intervention of up to 12 weeks, supporting self-directed changes in smoking and physical activity behaviors, compared with usual care (brief advice on available SSS), among disadvantaged smokers wishing to cut down but not quit. Data collection took place at baseline, eight weeks, and 16 weeks post baseline. The primary outcome was the number of participants achieving confirmed expired air carbon monoxide abstinence at four weeks post-quitting. Other outcomes included the number of quit attempts made, the number achieving at least 50% reduction in smoking at 16 weeks, changes in physical activity, and various other behavioral and process measures. The protocol and main findings of the study have been published 20 .
We set a target to recruit participants of whom at least 75% were unemployed or in social class C2 to E (NRS Social Grades, UK (skilled manual workers, semi-skilled and unskilled manual workers, state pensioners, casual and lowest grade workers, and those unemployed with state benefits only), 30% were single parents, and 20% had indicators of a mental health problem (indicated by answering ‘moderately’ or ‘extremely’ anxious or depressed to item five of the EQ-5D questionnaire). These criteria were based on the high prevalence of smoking among these groups 1 . Recruitment took place in the neighborhoods of Devonport and Stonehouse in Plymouth, United Kingdom, selected for having high deprivation (index of multiple deprivation score of 52 to 59.9, placing them within the 3% ‘most deprived’ areas in England 21 ). Local data indicated that smoking prevalence among adults was over 40%, and the location had generally poor health, with a life expectancy 12.6 years lower than some other areas of the city 22 .
Participants were eligible if they were over 18-years-old, smoked at least 10 cigarettes per day (and had done so for at least two years), did not intend to quit in the next month, were able to engage in moderate intensity physical activity (walking without stopping for at least 15 minutes), were registered with a general practitioner (GP), and did not wish to use nicotine replacement therapy (NRT) to reduce smoking. The study focus was initially on reducing smoking, not quitting, so those who expressed a desire to quit immediately were referred directly to the NHS SSS without entering the study. Those wishing to use NRT were excluded to avoid any confounding of the effects of physical activity on their smoking behaviour. We excluded those with severe mental health problems and ongoing substance misuse due the potential difficulties of engaging them in the intervention, given the large uncertainties and complexities of its delivery, and those who may have put the safety of the research team at risk. Due to the exploratory nature of the study, participants were required to be able to converse in English.
Recruitment was over a 12-month-period between May 2011 and May 2012, with a recruitment target of 120 smokers. Recruitment was split between two distinct approaches: 1) primary care and 2) other community-based approaches.
Initially, one primary care medical practice in each of the two neighborhoods was identified and approached to be included in the research study; a third practice with patients from both areas was approached later in the study in order to expand the scope of recruitment to meet the planned sample size. We planned to recruit 50% (n = 60) of participants through primary care. GP practice lists were searched based on cursory inclusion and exclusion criteria (see Taylor et al., for more details 20 ). A list of potential participants was generated and invitation letters, in batches of 100 per practice, were sent every two weeks from the GP with a postal reminder a week later. To begin with, postal invitations were sent without making any follow-up telephone calls so a response rate to a letter-only invitation could be established. Following on from this, and to increase reach to people with low literacy, telephone calls were made to those who did not respond directly to the invitation letter to check that they had received and understood the invitation, and to explore the effect of follow-up calls on increasing recruitment rates. If there was no answer on the first call a message was left to enquire if the invitation had been received and to leave a contact number for further information. Up to four more calls were made but, to avoid harassment, no further messages were left. Interested participants returned a form indicating interest in the study or telephoned a researcher. They were then screened for eligibility by telephone and provided consent for a researcher to contact their GP to confirm eligibility. Once eligibility was confirmed by their GP, the volunteer was invited to attend a baseline assessment.
The other 50% (n = 60) of the targeted recruitment was categorized as ‘other community approaches’. There were two distinct recruitment methods. The first (for which a target of n = 30 was set) involved the searching of the local NHS SSS database for people who had used the service within the last two years but had failed to quit. The same procedure of mailed invitations and follow-up telephone calls as used for recruitment through GP practices was then adopted, without applying the cursory inclusion and exclusion criteria in the first instance. The second method involved outreach in an attempt to recruit smokers who may not engage with traditional services and may experience higher levels of disadvantage. Potential participants were contacted through: workplaces, educational sites, community sites, and a range of other media (see Table 1). Interested participants contacted the research team directly (in person) and indirectly by telephone or by returning contact details with a request for further information. Following screening, to determine eligibility, a time for attending a baseline session was arranged.
|
Workplace site |
Recruitment activity |
|
Local adult education and training provider |
Flyers and information packs in the reception. Contact at centre informed about study and given packs to distribute. |
|
Post Office Manual Data Entry Centre (MDEC) |
Information cascaded through managers to all employees in team briefings. |
|
Educational site |
|
|
Local primary school |
Article in parent newsletter with study contact details. |
|
Parent and toddler groups; several local children’s centers |
Mother and toddler groups visited. Researchers attended groups and talked with parents. Posters and packs left, or given out during groups. Collected details of interested persons. |
|
Community site or organization |
|
|
Job centre (Devonport) |
Researcher outside the job centre approached smokers explaining the study; 100 packs and reply sheets given out over several periods in a week. Contact details of interested persons collected. |
|
Local community hub cafe |
Local health promotion sessions and food bank sessions attended by researchers; information given out to interested persons. |
|
Local community cooperative organization |
Flyers and posters given out to a local community employer for distribution. |
|
YMCA (community-run gym) |
Posters on display. Fitness Manager promoted study to users of the Stonehouse Gym. |
|
Researchers attended a children’s session; one pack given out. |
|
|
Local gym |
Gym instructors informed about study and provided with information packs and reply sheets to distribute to interested persons. |
|
Local social club |
Central contact informed about study and provided with information packs and reply sheets. |
|
Public health |
Posters and information packs with reply sheets given to the local health club in Devonport. |
|
Three Local Housing Associations |
180 flyers distributed through mailboxes in housing association residences in Plymouth; flyers distributed and attendance at residents’ meetings. Posters, flyers, and packs left at site for visitors. |
|
Neighborhood Managers (City Council) |
Researchers met with managers in Devonport and Stonehouse. Information distributed. |
|
Local community learning centre |
Information and flyers displayed. Researchers attended information sessions. Contact details of interested persons collected. |
|
Other |
|
|
Local library |
Flyers and posters on display. |
|
Heart Radio/Plymouth Sound/Radio; local paper |
Radio chat about the study and news advert in paper. |
|
Word of mouth |
First 60 trial participants asked to invite friends and/or acquaintances to join the study once they had completed the final follow-up assessment. |
|
Individual contacts (for example, church minister, day support facility member, or publican) |
Posters displayed by contacts. |
|
Increasing Access to Psychological Therapies Service, Plymouth |
Met and encouraged Psychological Wellbeing Practitioners to refer to the study opportunistically. Left flyers, information packs, and reply sheets to be distributed. Encouraged by email. |
|
Posters displayed around local shops and businesses |
Trial posters with contact details displayed in up to 50 local shops and businesses, (newsagents, hairdressers, tattoo parlors, and so on). |
Informed consent was obtained from all successfully recruited participants before being randomized into the trial.
Data collection consisted of four elements:
1. Number of invitation letters sent, responses received, telephone calls made, participants declining participation, participants who were ineligible, and participants entering the trial through which recruitment location were all recorded on databases throughout the recruitment period, at the recruitment location and individual level, to allow conversion rates to be produced by recruitment location and by recruitment activity intensity.
2. As part of the main trial, the following data was collected at baseline: demographic information (age, sex, cohabiting status, cohabiting with other smokers, whether they were the parent of a resident child under 16, job status, age at leaving fulltime education, ethnicity, weight, and height), smoking history (age on starting smoking, longest period of cessation in the last year, attempts at cutting down, cessation aids used in past year, use of SSS, and satisfaction with previous use of SSS), number of cigarettes being smoked per day, Fagerström Test for Nicotine Dependence (FTND) 23 24 scores, stage of readiness to use physical activity to control smoking behaviour (scored as either pre-contemplation, contemplation, preparation, action, or maintenance) 25 , expired air carbon monoxide (CO) with cessation or abstinence defined as less than 10 parts per million (PPM) (Bedfont Smokerlyser, Harrietsham, Kent United Kingdom) which is deemed to represent biochemically verified abstinence 26 , and physical activity data (self-reported seven day recall of physical activity and by accelerometer). In the present paper this data was used to compare the characteristics of those recruited through different locations and via different recruitment activity intensity.
3. The time spent by the research team on recruitment activity including: searching GP and SSS databases for potential participants (including screening potential participants for eligibility for GP databases only), preparation and mailing of invitation letters, making follow-up phone calls to non-responders to the mailed invitation, contacting interested participants to screen for eligibility, and arranging baseline appointments were recorded on the trial database. Additional information relating to the time spent recruiting through broader community approaches was recorded via researcher activity logs, diaries, and work sampling procedures.
4. Qualitative data were collected through a combination of field notes, regular documented meetings, audio recorded interviews with the research team, and opportunistic feedback from stakeholders. Semi-structured, audio recorded interviews were also completed with the use of a topic guide on a purposively sampled range of participants after completing the trial to cover a range of demographics and achieved outcomes.
To calculate the conversion rates from invitation to entry into the trial, a percentage was derived from the total number of invites sent out via each location and the resulting number of randomizations from each location. Conversion rates for broader community approaches was not possible to determine due to the open-ended nature of the majority of the methods (it is unknown how many people may have read, for example, a flyer or poster and therefore it is impossible to derive a denominator).
Pearson’s chi-squared and t-tests (independent, two-sample, and two-tailed) were completed for categorical and continuous variables, respectively, to compare characteristics of those recruited through primary care and SSS, and to compare those recruited by initial invitation letter only or by initial invitation letter plus follow-up telephone calls. Statistical analyses were completed using Stata SE (version 12.0, StataCorp LP, College Station, Texas, USA).
To calculate time associated with various recruitment methods, the time associated with samples of invitations sent to groups of potential participants sent via each location which received the same intensity of effort (considered to represent best practice) was totalled and divided by the number of participants successfully recruited. All time associated with broader community approaches was also totalled and divided by the number of participants successfully recruited via these approaches. This resulted in a total amount of time spent by the research team per participant randomized. Reasons for ineligibility were also recorded.
Qualitative data were analyzed using surface-level thematic analyses and case studies in NVivo (version 9 (QSR International Pty Ltd, Doncaster, Victoria, Australia). Ethical approval for the study was granted by the NHS National Research Ethics Service Committee South West, in the United Kingdom (Local Research Ethics Committee number: 10/H0106/59).
Invitations sent from primary care (with no follow-up telephone calls, n = 361) led to 5.1% of those invited being randomized into the study. With attempted contact by follow-up telephone calls to non-responders (n = 485) this proportion increased to 8.8%. Invitations sent from SSS (with no follow-up telephone calls, n = 255) led to 6.8% of those invited being randomized into the study. With follow-up telephone calls to non-responders (n = 137) this proportion increased to 11.1%.
Baseline descriptive data for the recruited sample can be found in Table 2. Those recruited through SSS, compared with primary care, were more likely to be recruited through letter invitation ( X 2 (1, N = 93) = 6.43, P = 0.01), to have used cessation aids before ( X 2 (1, N = 93) = 26.35, P <0.01), and to have made a quit attempt in the past year ( X 2 (1, N = 93) =8.23, P <0.01). No other variables were associated with recruitment from primary care or SSS in univariate analyses.
|
Total sample (N = 99) |
|
|
Female (n, (%)) |
55 (56.1) |
|
Age (mean (SD); median (IQR)) |
46.6 (11.3); 47.5 (38.3 - 55.4) |
|
Ethnicity (n, (%)) |
|
|
White British |
95 (96.0) |
|
Cohabiting (n, (%)) |
50 (50.5) |
|
Children under 16 (n, (%)) |
28 (28.3) |
|
Single parent a (n, (%)) |
6 (6.1) |
|
Employed (n, (%)) |
54 (54.5) |
|
Job status b (n, (%)) |
|
|
A to C1 |
9 (9.0) |
|
C2 to E (excluding unemployed) |
45 (45.5) |
|
Unemployed |
45 (45.5) |
|
Age on leaving education (mean (SD); median (IQR)) |
16.3 (1.9); 16 (15 - 16) |
|
Age on starting smoking (mean (SD); median (IQR)) |
14.7 (3.5); 14 (13 - 16) |
|
Does partner or other cohabitant smoke? (n, (%)) |
|
|
Yes |
31 (31.3) |
|
No |
27 (27.3) |
|
Not applicable |
41 (41.4) |
|
BMI (mean (SD), n; median (IQR)) |
28.1 (6.4), 98; 27.3 (22.4 - 32.4) |
|
Indicated mental health problem c (n, (%)) |
41 (41.4) |
|
Duration of smoking (years, mean (SD); median (IQR)) |
31.9 (12.2); 34.2 (23.3 - 42.2) |
|
Previously used SSS (n, (%)) |
41 (41.4) |
|
Satisfaction with previous use of SSS (if used) (scale 1 to 11); mean (SD), n |
8.3 (2.8), 40 |
|
Participant made a quit attempt lasting 24 hours or more in the past year (n, (%)) |
37 (37.4) |
|
Did the participant cut down before previous cessation? d (n, (%)) |
|
|
Yes |
5 (13.5) |
|
No |
32 (86.5) |
|
Total, n |
37 |
|
Used cessation aids as part of a quit attempt in previous 12 months e (n, (%)) |
|
|
Yes |
29 (78.4) |
|
No |
8 (21.6) |
|
Total, n |
37 |
|
Used cessation aids not as part of a quit attempt in previous 12 months (n, (%)) |
|
|
Yes |
21 (33.9) |
|
No |
41 (66.1) |
|
Total, n |
62 |
|
Self-reported cigarettes smoked per day (mean (SD); median (IQR)) |
21.6 (14.3), 19.1 (14.4 - 24.4) |
|
Expired air CO (ppm), mean (SD) |
18.0 (8.0) |
|
FTND (mean (SD); median (IQR)) |
5.6 (2.0); 6 (4 - 7) |
|
Readiness to use physical activity as a way of controlling smoking, action and maintenance stage (n, (%)) |
9 (9.1) |
|
Self-reported minutes of moderate and vigorous physical activity over previous 7 days (median (IQR)) |
315 (120 - 540) |
|
Accelerometer data |
n = 66 |
|
Minutes spent in moderate/vigorous/very vigorous activity per day (mean (SD), n; median (IQR)) |
31.9 (24.5); 28.37 (13.2 - 44.8) |
|
Step counts (mean (SD), n; median (IQR)) |
7701.7 (3536.2); 7343.5 (4909 - 9853) |
Those recruited via initial invitation letter, compared with those recruited via a follow-up telephone call, were more likely to have used SSS in the past ( X 2 (1, N = 93) = 4.45, P =0.035) and to self-report completing at least 30 minutes of moderate and vigorous physical activity per day at baseline ( X 2 (1, N = 92) = 4.45, P =0.035), but other variables were not associated with the recruitment method.
Based on the figures above and data collected on researcher time dedicated to each recruitment method, to recruit 100 participants (with a 5.1% conversion rate) through primary care (via letter invitation only, without follow-up) would require 1,961 invitations to be sent and 1,800 minutes (30 hours) of researcher time. To recruit 100 participants via letter invitation and follow-up telephone reminders (8.8% conversion rate) would require 1,336 invitations to be sent and would require 7,134 minutes (118.9 hours) of researcher time.
To recruit 100 participants (with a 6.8% conversion rate) through SSS (via letter invitation only, without follow-up) would require 1,471 invitations to be sent and 2,400 minutes (40 hours) of researcher time. To recruit 100 participants via letter invitation and follow-up telephone reminders (11.1% conversion rate) would require 901 invitations to be sent and 7,547 minutes (125.8 hours) of researcher time. Further details can be found in Tables 3 and 4.
|
Denominator |
To recruit 100 (letter only - 6.8% response) |
To recruit 100 (letter plus follow-up telephone calls - 11.1% response) |
||||
|
Activity |
Number |
Time (minutes) |
Number |
Time (minutes) |
Number |
Time (minutes) |
|
Database searching |
Per practice/location |
60 |
Per practice |
60 |
Per practice |
60 |
|
Initial screening |
To produce 200 eligible |
60 |
1,471 |
441 |
901 |
270 |
|
Mailing invitations |
200 |
240 |
1,471 |
1,765 |
901 |
1,081 |
|
GP screening of responses |
1 |
2 |
100 |
200 |
100 |
200 |
|
Associated researcher time |
1 |
24* |
100 |
2,400 |
100 |
7,547 |
|
157** |
|
Denominator |
To recruit 100 (letter only - 5.1% response) |
To recruit 100 (letter plus follow-up telephone calls - 8.8% response) |
||||
|
Activity |
Number |
Time (minutes) |
Number |
Time (minutes) |
Number |
Time (minutes) |
|
Database searching |
Per practice/location |
60 |
Per practice |
60 |
Per practice |
60 |
|
Initial screening |
To produce 200 eligible |
60 |
1,961 |
588 |
1,336 |
401 |
|
Mailing invitations |
200 |
240 |
1,961 |
2,353 |
1,336 |
1,603 |
|
GP screening of responses |
1 |
2 |
100 |
200 |
100 |
200 |
|
Associated researcher time |
1 |
18* |
100 |
1,800 |
100 |
7,134 |
|
145** |
The reasons for ineligibility were similar across recruitment methods (Table 5). The main reason for ineligibility (for more than 50% of those ineligible) was due to the individual having already quit smoking. A summary of recruitment via different locations is shown in Table 6, and the flow of participants through each recruitment method up to randomization is shown in Figure
|
Reasons for ineligibility |
Primary care |
SSS |
|
Health/physical (%) |
15.8 |
20.5 |
|
Already quit (%) |
57.9 |
53.8 |
|
Smokes <10 cigarettes per day (%) |
10.5 |
10.4 |
|
Close friend or relative of somebody already in the trial (%) |
0.0 |
5.1 |
|
Currently using NRT (%) |
5.3 |
5.1 |
|
Under 18 years (%) |
0.0 |
5.1 |
|
Wants to quit immediately (%) |
10.5 |
0.0 |
|
Recruitment method |
N = 99, n (%) |
% of target |
|
Primary care |
62 (62.6) |
62/60 (103.3%) |
|
Letter only |
31 (31.3) |
|
|
Letter plus reminder telephone calls |
31 (31.3) |
|
|
Stop Smoking Services |
31 (31.3) |
31/30 (103.3%) |
|
Letter only |
24 (24.2) |
|
|
Letter plus reminder telephone calls |
7 (7.1) |
|
|
Community (without invitation letter) |
6 (6.1) |
6/30 (20.0%) |
Figure 1
CONSORT diagram showing recruitment approaches and participant flow up to randomization.
CONSORT diagram showing recruitment approaches and participant flow up to randomization.
A qualitative summary of the variety of other community approaches to recruitment are presented in Table 7. The various approaches resulted in only six participants entering the study and had a directly associated researcher time of 469 minutes to recruit one participant. To recruit 100 participants via other community approaches would require 46,900 minutes (781.7 hours) of researcher time.
|
Workplace site |
Relative success and qualitative observations |
|
Local adult education and training provider |
Total recruited = 0. Despite being followed-up on after initial provision of information, nobody came forward expressing an interest in the study. Location was identified as an attempt to target the unemployed and low skilled. A general feeling that the information became lost amongst lots of other available information. |
|
Post Office Manual Data Entry Centre (MDEC) |
Total recruited = 0. After initial meeting and briefing with the personnel manager, information was distributed at team meetings to all employees (n = 500. Despite following up with the personnel manager, nobody came forward expressing an interest. No confirmation of the quality of information that was cascaded to all employees; uncertainty over how well or enthusiastically the information was distributed. Likely to have been a low priority among the managers and a potential burden on their time. |
|
Educational site |
|
|
Local primary school |
Total recruited = 0. A small article about the study published and distributed to parents within the newsletter failed to attract any interest. Potentially intended to target single parents, but likely to be too broad an approach which people took little notice of as the information became lost amongst other more relevant information in the newsletter. Potentially out of place in the school letter context. |
|
Mother and toddler groups; several local children’s centers |
Total recruited = 0. Intended to target single parents as much as possible, the mother and toddler groups consisted of relatively low numbers, not all of whom were smokers. Small amounts of interest were shown, but researchers reported that the mothers’ focus was on their children and they were generally not very receptive to the information being offered. Researcher potentially viewed as an ‘outsider’. |
|
Community site/organization |
|
|
Job centre (Devonport) |
Total recruited = 1. Intended to target the unemployed, one person was recruited into the trial from approximately 100 information packs being distributed. Researcher found it to be quite an ‘intrusive’ activity on people smoking outside the job centre and met with some degree of hostility. Reported a sense that people would take the information just to get them to ‘go away’. A feeling that people were not very receptive to the information as they were there for other reasons with other pressing concerns. Potentially being viewed as ‘an outsider’. |
|
Local community hub cafe |
Total recruited = 0. Intended to target the unemployed and low skilled. Researchers reported a feeling that the people attending this location had multiple other serious issues (housing, drug addiction, and so on) which made them unreceptive to the information on offer. For most, smoking behaviour was not a high priority. |
|
Local community cooperative organization |
Total recruited = 0. Reports that once the information had been handed over and staff briefed about the study, it would quickly become a low priority among staff given information for distribution. |
|
YMCA (community-run gym) |
Total recruited = 0. No idea on the number of smokers actually using the service. Potential again for the enthusiasm for promoting the study to be lost once the information is left with those outside the study team, despite follow-up attempts. |
|
Local gym |
Total recruited = 0. Impression that promoting the study was a very low priority for the gym instructors, with no interest being generated. |
|
Local social club |
Total recruited = 2. The contact at the small local social club was very proactive and involved with the study. They had their own motivation to promote healthy initiatives to the local community and as such generated interest. The comparative success of this location was reported to be solely due to the individual’s motivation for promoting the study and encouraging their service users to take part. |
|
Public health |
Total recruited = 0. Similar reports to other groups where information was left for groups attended by potential participants - not all attending were smokers, and with relatively low numbers attending, no interest was generated. |
|
Three Local Housing Associations |
Total recruited = 0. Potential for information to be dropped to houses which had already received an invitation via their GP. This type of invitation possibly lacked the ‘authority’ of the invitation coming directly from their GP. |
|
Neighborhood Managers (City Council) |
Total recruited = 0. It was again reported that whilst enthusiasm was high amongst the neighborhood managers when meeting with the research team, the study took a very low priority for what is a very busy work force. |
|
Local community learning centre |
Total recruited = 0. Intended to target the unemployed and low skilled, it was unpredictable how many people would attend the sessions at which the researchers provided information and again not all attendees would be smokers. Potentially seen as ‘an outsider’. |
|
Other |
|
|
Local library |
Total recruited = 0. No way of knowing how many people read or saw the information on display. Potential for information to become lost amongst swathes of other information. |
|
Heart Radio/Plymouth Sound/Radio Devon/Newspaper |
Total recruited = 0. Broad awareness of the study was generated and interest attracted from people too far outside the study areas to be offered inclusion. The approach was not targeted enough at the disadvantaged groups intended. |
|
Word of mouth |
Total recruited = 0. Proved to be ineffective, attracting no interest. Potentially due to lack of motivation on an individual level in promoting the study; potentially could be improved by incentivizing referral. |
|
Individual contacts (such as minister of religion, local day support facility member, and publican) |
Total recruited = 1. One person recruited opportunistically through a researcher’s local contact. Relatively small reach via this approach and again reliant on individual promotion of study by people outside the study team. |
|
Increasing Access to Psychological Therapies Service (IAPT), Plymouth |
Total recruited = 0. Intended to target those with mental health problems. Systems for recruiting and referring individuals were problematic and at times convoluted (due to data protection). Communication between the research team and IAPT was difficult as there was a sense that the study was a low priority for the practitioners who had other issues to deal with. |
|
Posters displayed around local shops and businesses |
Total recruited = 0. Generally reported to be wholly ineffectual, assumed to be due to individuals’ lack of motivation to take the initiative and contact the research team directly. |
One participant was recruited opportunistically after enquiring at the health centre where the study was based about support services for smokers; another participant was recruited through a friend who had been approached via SSS. A summary of the characteristics of the participants interviewed at the end of the study can be found in Table 8.
|
Control (N = 10) (20% of sample) |
Intervention (N = 15) (30% of initial sample) |
|
|
Demographics |
||
|
Age (years); mean, (SD) ) |
46 (11) |
52 (11) |
|
Gender (m :f) |
5:5 |
8:7 |
|
Job status a ; n (%) |
||
|
A1 to C1 |
0 (0) |
0 (0) |
|
C2 to E (excluding unemployed) |
5 (50) |
9 (60) |
|
Unemployed |
5 (50) |
6 (40) |
|
Single parenthood; n (%) |
1 (10) |
0 (0) |
|
Baseline data |
||
|
Smoking characteristics |
||
|
Tobacco (grams/day); mean (SD) |
17.4 (8.7) |
18.4 (12.5) |
|
FTND; mean (SD) |
5.3 (1.9) |
4.9 (1.7) |
|
Self-reported MVPA (minutes/week); mean (SD) |
595 (757) |
401 (644) |
|
Self-reported MVPA (minutes/week); Range; n (%) |
||
|
0 |
2 (20) |
4 (27) |
|
1 - 499 |
4 (40) |
9 (60) |
|
500 - 1999 |
3 (30) |
1 (7) |
|
2000+ |
1 (10) |
1 (7) |
|
Quit attempt in past year; n (%) |
5 (50) |
5 (33) |
|
Outcomes |
||
|
Quit attempt made; n (%) |
0 (0) |
5 (33) |
|
Four-week CO confirmed abstinence; n (%) |
n/a |
4 (80) |
|
>50% reduction in smoking; n (%) |
2 (20) |
4 (>33)* |
|
No change in smoking; n (%) |
8 (80) |
4 (>26)* |
|
Recruitment |
||
|
Avenue (GP:SSS:community); n (%) |
5:5:0 (50:50:0) |
7:6:2 (47:40:13) |
|
Type (letter:telephone:other); n (%) |
7:3:0 (70:30:0) |
6:7:2 (40:47:13) |
The novel approach of actively promoting support for reduction in smoking was well received by the majority of the sample. Many emphasized the appeal of reduction against the alternative of stopping abruptly. The appeal of reducing smoking appeared to stem from an underlying desire to change behaviour, but due to a lack of confidence or desire to stop abruptly, reduction seemed a much more manageable objective:
‘I think that was probably it, the reduction thinking.  For some, it was clear that a pervading message of the need to stop smoking would have completely alienated them from engaging in the study:
‘[The researcher] was saying “We can help you to cut down. We may in time be able to stop you smoking” and I said “Well, that’s a very sensible attitude to take” because someone telling me “I’m going to stop you smoking” I’d tell them to… go away! So that’s what made me do it initially, because they weren’t threatening me that they could stop me smoking. But even at this time, there is no-one that can tell me “I can stop you smoking” you know what I mean?’ (Male, 55 to 60 years, unemployed, heavy smoker, intervention)
The invitation was designed, as was the intervention, to be supportive and client-centered and a step away from traditional services, and the supportive and unpressurised nature of the invitation was well received:
‘You know, I say, when [the researcher] gave me the leaflet I thought “Yeah, alright, I’ve heard all this before” and I thought “Well, here we go with the hard sell”. But [they were] totally different. [They were] so relaxed, so friendly, and that’s what pushed me towards it. If [they] had tried to come across with the hard sell I would most probably have just ignored [them] and said cheerio. But I think just approaching people in a friendly manner…I mean, sometimes it helps.’ (Male, 55 to 60 years, employed full time, heavy smoker, intervention)
Negative experiences of using NRT and other medicinal therapies emerged as a strong theme linked to motivation for taking part. The intervention was envisaged as a novel alternative to NRT, and people’s description of past experiences seemed to confirm this particular aspect of the intervention:
‘Oh I’ve tried a couple of times to cut out smoking totally ‘cause I’ve tried the smoking aids and all the things you know, the puffer and the patches and that hasn’t worked, so I thought “Oh well, I’ll give this a try then try and cut down,” yeah.’ (Male, 40 to 45 years, employed part-time, very heavy smoker, intervention)
The appeal of the invitation to reduce smoking, as opposed to quit, was supported by the Health Trainers when interviewed, who identified a desire to reduce smoking as the primary factor when asked ‘What attracted participants to the study?’:
‘They’re only coming in because we’ve said reducing smoking, rather than quitting and I think that’s what is getting them into the surgery…’ (Health Trainer three)
‘Um, a different approach maybe, slightly different to what they’ve actually done before, and I think it wasn’t about quitting, it’s about trying to reduce rather than them quitting…’ (Health Trainer two)
Overall, there was a clear indication that the invitation appealed to, and reached, people who would not have been interested in support to quit.
This unique study provides much needed data on the engagement of disadvantaged populations with a focus on harm reduction as opposed to abrupt quitting, and provides a systematic attempt to assess the effects of increasing intensity of recruitment activity (via follow-up telephone calls) and recruitment methods on accessing disadvantaged groups.
Recruitment targets were met for the operational definition of a disadvantaged group of 91% in social class C2 to E (target 75%), 41% with an indicated mental health problem (target 20%), but failed to reach the proposed target of 30% for single parents (17% of sample). This was a particularly difficult group to target, partly due to this information not being available from GP and SSS databases, and also due to the difficulty in targeting single parents within the community. From the attempts that were made to target this sample within the community (parent and toddler groups and school settings) no single parents were recruited. More robust and effective methods are needed to understand the best way to engage with single parents who smoke. Since conducting the study we have become aware of several smoking and harm reduction studies (for example, studies cited in the National Institute for Health and Care Excellence (NICE) guidelines on harm reduction, 2013, and these may provide further ideas on how best to recruit single parents. Future ideas for recruitment of single parents may include the use of midwifery records which record the smoking status of antenatal women.
The greatest reason (>50%) for ineligibility was an individual having already quit smoking, although it is possible that potential participants used this as an excuse for not participating. Records of smoking status, held by both GP practices and SSS, were obviously dated in terms of the last contact at which they were recorded as smoking, thereby increasing the resources needed for inviting and screening.
The sample consisted overall of relatively heavy smokers (with a mean of 20 self-reported cigarettes per day, compared with a national average of 12.7 cigarettes per day) 27 , indicating that the invitation to support reduction can recruit heavier smokers, building on previous survey data 28 . The sample self-reported high levels of daily physical activity, averaging more than the recommended 30 minutes of moderate andvigorous activity per day, although objectively measured physical activity suggested that individuals were overestimating their levels of activity. There is evidence to suggest that this is fairly typical of a disadvantaged population due to higher levels of activity associated with work and active transport 29 30 31 . The higher levels of activity may also reflect self-selection bias; the trial invitation referred to an intervention which included physical activity and lifestyle support which may have attracted a more active sample. Of those recruited, the gender balance was relatively even and similar to levels of engagement within the NHS SSS 32 . Overall, approximately 44% and 56% of all mailed invitations went to males and females respectively, indicating very similar recruitment rates for males (7.7%) and females (7.4%), suggesting the approach to recruitment and appeal of the invitation is equally effective at recruiting both males and females.
Whilst the use of follow-up telephone calls was effective at increasing recruitment rates, this increased researcher time (and costs) about five to seven-fold per participant recruited. The findings suggest that those recruited via follow-up telephone calls represented a harder-to-reach population, being both less likely to have used SSS in the past and less physically active. The use of follow-up telephone calls therefore may offer added value in reaching the more service-resistant smokers. It is possible that the reach of the intervention was higher than indicated in the recruitment rates presented; potentially anywhere between 10 and 66% of smokers invited into the study were not interested or were ineligible due to having a desire to quit 33 . For example, if 1,000 invites were sent, but potentially 66% of those invited were not part of the targeted population, the conversion rates of 5.1 to 11.1% presented here may in fact represent 11.6 to 25.2%, allowing for those who were no part of the intended targeted population for recruitment.
Differences were observed in those recruited through primary care and SSS predominantly in terms of smoking history. Those recruited through SSS were more likely to have used cessation aids in the past and more likely to have made a quit attempt in the previous 12 months. Another significant difference was that those invited through SSS were more likely to respond directly to the letter invitation than to the follow-up telephone call. These differences probably reflected a much more motivated group coming through SSS, as they had already engaged with a service to help address their smoking behaviour and were likely to have contemplated changing smoking behaviour. Of those recruited through primary care nearly three quarters (72.6%) had never previously engaged with SSS. When considered alongside differences in previous cessation aid use and previous quit attempts, this finding suggests that those recruited via primary care represented a much harder-to-reach group of smokers than those who had attended SSS.
The use of an invitation to receive support to cut down, sent out via primary care, could therefore be a valid way of increasing the reach of traditional smoking services. The nature of the invitation itself (not being branded as part of the SSS and offering support to cut down as opposed to quit) may also have played a large part in increasing the interest in participation in the study among those harder-to-reach smokers, and qualitative data supported this premise. There appears to be value in the invitation as a successful ‘smoking cessation induction approach for those who would not otherwise engage with traditional services.
Other community approaches were generally very unsuccessful, only recruiting six out of a targeted 30 participants. Data collected suggested this was due to three main reasons. First, when information was given to third parties for distribution the effectiveness relied on the individual’s motivation and priority for promoting the study, which was frequently low. Second, when the researchers took an active role in promoting the study in community-based locations they felt they were viewed as an ‘outsider’ and treated with some degree of skepticism (as has been shown elsewhere 13 ) and, on occasion, hostility. Third, the recruitment approach of distributing information in the form of flyers, posters, and public advertisements, all of which relied on the smoker’s motivation to directly contact the research team, was shown to be completely ineffective. An additional element restricting the effectiveness of the community-based recruitment approaches was concern over the researchers’ personal safety, which restricted the kinds of activity that were deemed appropriate. Our experiences mirrored those of public health outreach workers trying to recruit smokers into SSS to attempt abrupt quitting in the same location a year before the present trial.
Overall, more research is needed about community-based recruitment approaches, although the indications from the present study suggest they are likely to be ineffective. Additional time spent with, and incentives for, community groups could be explored along with enrolling community ‘gatekeepers’ into the study as part of the research team and promoting partnership working. There is little evidence to suggest that the distribution of information via posters and other community media is effective; the possibility remains that doing so may raise the profile and increase the legitimacy of the research, making recruitment via other avenues more likely 34 , although this cannot be quantified from the current research.
It is a limitation that the present study did not seek to recruit homeless and other disadvantaged smokers who were not registered with a GP, as well as excluding those with serious mental illness (groups demonstrating high levels of smoking), but within the scope of the study this was necessary to ensure adequate screening during recruitment and safety of the research team. Smoking reduction trials may have particular appeal amongst such groups and future research in this area would be appropriate.
Overall, assessing the reach of the current study (in line with the RE-AIM framework, used for assessing an intervention’s Reach, Effectiveness, Adoption, Implementation, and Maintenance 35 ) is problematic due to lack of any denominator figure for the eligible population from which the sample was derived. Ethical approval was not obtained for profiling those who were invited into the study but did not respond and were not successfully contacted by the research team. A future study should carefully consider ways to address this in order to more firmly establish the reach of the study in terms of accessing the most disadvantaged groups within society.
This study has demonstrated that using General Practice lists is a powerful way of recruiting patients to health interventions in an area of deprivation, and much more effective than community approaches. More than 98% of people in the United Kingdom in all areas are registered with a GP and on average visit 5.3 times per year 36 . People trust information provided via their GP more than other sources 37 , and this almost certainly was the reason for the much higher response rate. It provides important and pragmatic information for the future recruitment of disadvantaged populations into research trials.
BMI: Body mass index; CO: Carbon monoxide; EARS: Exercise assisted reduction then stop; FTND: Fagerström test for nicotine dependence; GP: General practitioner; HTA: Health technology assessment; IQR: Interquartile range; ISRCTN: International Standardized Randomized Controlled Trial Number; LREC: Local Research Ethics Committee; NHS: National Health Service; NICE: National institute for health and care excellence; NRT: Nicotine replacement therapy; PA: Physical activity; PC: Primary care; SD: Standard deviation; SSS: Stop smoking services.
PA has been a consultant and done research for manufacturers of smoking cessation products. RW has undertaken research and consultancy for companies that develop and manufacture smoking cessation medications. He is Co-Director of the National Centre for Smoking Cessation and Training and a trustee of the stop smoking charity, QUIT. He has a share of a patent on a novel nicotine delivery device. All other authors have declared no competing interests.
RW has undertaken research and consultancy for companies that develop and manufacture smoking cessation medications. He is co-Director of the National Centre for Smoking Cessation and Training and a trustee of the stop-smoking charity, QUIT. He has a share of a patent on a novel nicotine delivery device. All other authors have declared no competing interests.
TT was responsible for the day-to-day operationalization and management of the study, the initial drafting of the text, and the completion of the statistical analyses. AHT (as Principal Investigator) had overall responsibility for the study and initial drafting of the text, and completing the statistical analyses in the text. FW was involved in completing the statistical analyses. RA and RB advised and supported the development of recruitment methods. PA and CG participated in the design of the intervention and its methods. RT supported with the trial design and statistical analysis plan. JC, MU, SM and RW participated in the overall design and methods of the study. All authors were involved in all stages of the work: the design, development of methods, analysis, commenting upon and drafting the manuscript. All authors read and approved the final manuscript.
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Health Technology Assessment Research Programme (grant reference number: 07/78/02). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
The team would like to acknowledge and thank the three researchers working as Health Trainers on the project (Julie Lloyd, Maggie Kelly, and Mel Fairbairn) for their insights and tireless efforts in recruiting for the trial, Naomi Southern for her diligent administrative support throughout, Russ Moody and his team at the Stop Smoking Services in Plymouth for their support, all the staff at the various GP practices involved with recruitment, and all the broader community contacts who supported recruitment.
Socioeconomic status and smoking: a review
Socio-demographic predictors of quitting smoking: how important are household factors?
Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America
Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review
Evaluating initial reach and robustness of a practical randomized trial of smoking reduction
Do behavioral smoking reduction approaches reach more or different smokers? two studies; similar answers
Improving access to smoking cessation services for disadvantaged groups: a systematic review
A systematic review and meta-analysis of the effectiveness of behavioral smoking cessation interventions in selected disadvantaged groups
Systematic review: smoking cessation intervention strategies for adults and adults in special populations
Low-income groups and behaviour change interventions: a review of intervention content, effectiveness and theoretical frameworks
Evaluating the public health impact of health promotion interventions: the RE-AIM framework
Accessing the community: gaining insider perspectives from the outside
“Reaching the hard to reach” – lessons learned from the VCS (voluntary and community sector). A qualitative study
Interventions for recruiting smokers into cessation programmes
Proactive recruitment predicts participant retention to end of treatment in a secondhand smoke reduction trial with low-income maternal smokers
Methods to improve recruitment to randomized controlled trials: Cochrane systematic review and meta-analysis
What influences recruitment to randomized controlled trials? a review of trials funded by two UK funding agencies
Recruitment to clinical trials: a meta-ethnographic synthesis of studies of reasons for participation
A pilot randomized trial to assess the methods and procedures for evaluating the clinical effectiveness and cost-effectiveness of Exercise Assisted Reduction then Stop (EARS) among disadvantaged smokers
English Indices of Deprivation 2010
Life expectancy in Plymouth - produced as part of Plymouth’s joint strategic needs assessment
The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom tolerance questionnaire
Determinants of tobacco use and renaming the FTND to the Fagerstrom Test for Cigarette Dependence
Readiness to use physical activity as a smoking cessation aid: a multiple behaviour change application of the transtheoretical model among quitters attending stop smoking clinics
Outcome criteria in smoking cessation trials: proposal for a common standard
Statistics on smoking: England, 2013
Relapse prevention in UK stop smoking services: current practice, systematic reviews of effectiveness and cost-effectiveness analysis
How socio-economic status contributes to participation in leisure-time physical activity
Explaining socio-economic status differences in walking for transport: an ecological analysis of individual, social and environmental factors
Can the built environment reduce health inequalities? A study of neighborhood socioeconomic disadvantage and walking for transport
Performance of English stop smoking services in first 10 years: analysis of service monitoring data
Smoking and Smoking Cessation in England 2011. London: Smoking in England; 2012
Gaining access to underresearched populations in women’s health research
The RE-AIM framework: a systematic review of use over time
Trends in consultation rates in general practice 1995/1996 to 2008/2009: analysis of the QResearch database
92% patients have trust in their GP despite diminishing resources - RCGP response to GP patient survey results out today


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@Target(value=TYPE) @Retention(value=RUNTIME) public @interface RequiredClass
RequiredClasses
and its aim is to
provide more options on how to handle required classes.
This annotation is used to indicate the following information:
| Modifier and Type | Required Element and Description |
|---|---|
String |
value
The required class
|
| Modifier and Type | Optional Element and Description |
|---|---|
String[] |
alternatives
The other classes that are alternative or aliases of the primary class
provided by attribute
value() . |
String[] |
excludes
If one of the classes provided by this attribute is in the classpath,
then the implementation can't be used.
|
public abstract String value
public abstract String[] excludes
This attribute can be used in conjunction with value()
.
For example:
@RequiredClass(value="com.sendgrid.SendGrid", except="com.cloudhopper.smpp.SmppSession")Means that the class
com.sendgrid.SendGrid
must be present.
If the classpath also contains
com.cloudhopper.smpp.SmppSession
then it indicates that the
implementation can't be used.
If both value()
and excludes()
are provided, then the
implementation can be used only if all the classes provided in
value()
are available in the classpath and none of the classes
provided in excludes()
is in the classpath.
public abstract String[] alternatives
value()
.
Attribute {excludes()
is common for every alternative.
For Example:
@RequiredClass(value="com.sendgrid.SendGrid1", alternatives="com.sendgrid.SendGrid2")Means that the implementation can be used either if the class
com.sendgrid.SendGrid1
is present or if the class
com.sendgrid.SendGrid2
is present.Copyright © 2020. All rights reserved.


Since a read of a Fortran NAMELIST scans a file for a match you can use this feature very easily to maintain a single configuration file for several programs. For example, if you have an input file that looks like:
This is file "config.nml" which contains setup information for programs that launch xclock(1) and the xterm(1) program. &xclock background='black' foreground='yellow' geometry='64x64-0+0' / ! setup for xterm program &xterm background='green' foreground='black' number=3 /
This contrived sample shows a single file ("config.nml") holding multiple NAMELIST input sets ("xterm" and "xclock") and a small program that reads the first "xterm" set (ignoring other content in the file) and builds and executes system commands using the information.
program config character(len=30) :: background='black' character(len=30) :: foreground='white' integer :: number=1 namelist /xterm/ background, foreground, number ! before reading config file call mysystem('xterm -bg '//background//' -fg '//foreground//'&') open(10,file='config.nml',delim='apostrophe') read(10,nml=xterm,iostat=ios) ! notice how the READ skipped down to the xterm NAMELIST group!! ! after reading config file do i10=1,number call mysystem('xterm -bg '//background//' -fg '//foreground//'&') enddo contains subroutine mysystem(string) character(len=*) :: string write(*,*)'COMMAND:'//string call execute_command(string) end subroutine mysystem end program config
COMMAND:xterm -bg black -fg white & COMMAND:xterm -bg green -fg black &


--- title: "Work day with turtles" date: 2018-05-07 tags: [portugal] ---
This was a work day, so little travel to report. Emma is joining me in trying the “write for 30 mins to start the day” strategy, since she’s in the process of trying to crank out three papers. At lunch, I took off for a nice break at a local park where I sat near the turtles, at the local standard (bread, ham, and cheese), read my book, and people-watched. Sam and I met up in the evening to run at the only local track we know of.


Recipe: Stokes Purple Sweet Potato Pie with Maple Whipped Cream
by CBS NewsStokes Purple sweet potato pie is a modern twist on the classic sweet potato pie, from the vibrant purple color to the maple whipped topping.
Stokes Purple Sweet Potato Pie with Maple Whipped Cream
From Frieda's Specialty Produce
Ingredients:
1 9-inch frozen, pre-made pie crust, thawed
Filling:
2 large, baked* Stokes Purple® sweet potatoes (5-6 inches long), peeled and roughly chopped
3/4 cup coconut milk (from 15-ounce can full-fat coconut milk)
4 tablespoons butter
1 egg
1 teaspoon cinnamon
1/4 teaspoon allspice
1 teaspoon sea salt
1/2 cup plus 1 tablespoon sugar
Seeds from 3-inch piece vanilla bean (or 1 1/2 teaspoons vanilla extract)
Topping:
1 cup heavy whipping cream
2 tablespoons maple syrup
Seeds from 1-inch piece vanilla bean (or 1/2 teaspoon vanilla extract)
1/8 teaspoon sea salt
Pecans, whole or crushed
Preparation:
- Preheat oven to 350 degrees. Bake pie crust 15 minutes. Meanwhile, in blender container or food processor, blend sweet potatoes, coconut milk, butter, egg, cinnamon, allspice, sea salt, sugar, and vanilla until smooth. If too thick to blend, add 1-2 teaspoons coconut milk.
- When crust is done, increase oven temperature to 425 degrees. Transfer pie crust to wire rack; carefully pour in filling. Smooth out top with spatula. Put pie back in oven and bake 15 minutes. Then, decrease oven temperature to 350 degrees and bake additional 15 minutes. When done, crust should be barely golden and filling should look set. Remove pie and allow to cool to room temperature on wire rack. Cover and place in refrigerator to cool overnight.
- Chill whisk and bowl from stand mixer (or regular bowl and whisk) in freezer at least 10 minutes. Pour heavy whipping cream, maple syrup, vanilla, and salt into chilled bowl and whip on high until peaks form, about a minute. It's better to under-whip than over-whip! Store whipped cream in refrigerator up to 4 hours.
- Before serving, allow pie to come to room temperature. Just before serving, whip topping by hand to make it extra fluffy. Top pie with maple whipped cream and pecans. Slice and serve.
- *Note: For extra-creamy sweet potatoes, wrap in foil and bake the night before making pie. Store in refrigerator, still wrapped in foil, and use in recipe as directed.
For more info:


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The System.Windows module provides interface to Windows API and contains support for Windows GUI applications. This library is linked with programs and libraries that have target=winguiapp , target=winapp or target=winlib in a .cmp file.
The target declaration is discussed here.
The System Windows Library document presents the structure and usage of the System.Windows library and discusses the creation of Windows GUI applications using Cmajor.
| System | ||
| Windows | ||
| API | ||
| IO |
| public void | WindowsAssertionFailureFunction(const char* assertion, const char* function, const char* sourceFilePath, int lineNumber) |


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The Protagonist
function Player(args) {
let {x = canvas.width / 2} = args;
let assoc = AssocMixin(Player, args);
let merge = MergeMixin(Player, args);
let that = Object.freeze({
x,
y: canvas.height - 50,
w: 25,
h: 25,
color: 'green',
assoc,
merge,
update: () => that
});
return that;
}
The Enemy
function Enemy(args) {
let {x, y} = args;
let assoc = AssocMixin(Enemy, args);
let merge = MergeMixin(Enemy, args);
let that = Object.freeze({
x,
y,
w: 25,
h: 25,
color: 'white',
assoc,
merge,
update: velX => assoc("x", x + velX)
});
return that;
}
Getting Armed
function Bullet(args) {
let {x, y, d, color} = args;
let assoc = AssocMixin(Bullet, args);
let merge = MergeMixin(Bullet, args);
let that = Object.freeze({
x,
y,
w: 5,
h: 5,
d,
color,
assoc,
merge,
update: () => assoc("y", y + d)
});
return that;
}
function PlayerBullet(args) {
let {x, y} = args;
return Bullet({
x, y, d: -1, color: 'white'
});
}
function EnemyBullet(args) {
let {x, y} = args;
return Bullet({
x, y, d: 1, color: '#FF9900'
});
}
The Game State
When there is no change in gamestate return the old gamestate
let that = Object.freeze({
x,
y,
gameRunning,
enemyBullets,
playerBullets,
enemies,
playerFinalBulletNframeCount,
playerBulletNframeCounter,
player,
updateIfGameIsRunning,
bulletCollision,
enemyCollisionWithBorder,
enemyShootsAI,
updateBodies,
playerShoots,
updateGameLoop,
assoc,
merge,
});


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Chile expresses concern over interruption of Bolivia electoral process
SANTIAGO (Reuters) - Chile said it was concerned over the interruption of Bolivia’s electoral process, and called for a prompt and peaceful solution in a statement from its foreign ministry on Sunday.
Bolivian President Evo Morales resigned on Sunday amid weeks of heavy protests over his disputed election victory on Oct. 20.


[gecode-users] compilation problem on windows + mingw32
Alexandre Fayolle
alexandre.fayolle at logilab.fr
Tue Sep 8 14:47:01 CEST 2009
Hi everyone,
(appologies if this is the wrong mailing list)
I'm having some compilation problems. I want to compile a python extension
module which uses gecode 3.1. Python2.5 extensions require VisualStudio 2003
and gecode needs VS2008 (stop me if I'm wrong). So I'm currently giving a try
at mingw32.
Unless I'm mistaken, the windows installer for gecode is meant to be used with
Visual Studio, so I'm attempting to recompile gecode with mingw32 from source.
configure went fine (eventually), but make fails with the following message:
g++ -mno-cygwin -I. -DNDEBUG -Wextra -Wall -pipe -ggdb -O3 -fno-strict-aliasing
-ffast-math -mthreads -DGECODE_BUILD_SEARCH -c -o gecode/search/stop.o gecode/search/stop.cpp
In file included from ./gecode/search.hh:44,
from gecode/search/stop.cpp:38:
./gecode/support/timer.hh: In member function 'double Gecode::Support::Timer::stop()':
./gecode/support/timer.hh:83: erreur: 'timersub' was not declared in this scope
A quick google search didn't provide useful results.
Editing gecode/support/config.hpp seems to solve this. Am I missing something obvious such as a mingw package?
(By the way : is there a pre-built package with mingw32 available for downloading somewhere? This could be a great time-saver...)
--
Alexandre Fayolle LOGILAB, Paris (France)
Formations Python, Zope, Plone, Debian: http://www.logilab.fr/formations
Développement logiciel sur mesure: http://www.logilab.fr/services
Informatique scientifique: http://www.logilab.fr/science
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August 15, 2003
Congolese children becoming cannibal killers
Mirror | Submitted by: Buzz Beer
"First there were the mothers, after he'd raped them. Then their babies. Four of them. The eldest aged three. He speaks softly, with great precision, about what he did. ...  Six of us raped them. Then we stabbed them to death with machetes. It was cheaper than bullets. They begged us to spare them, but we laughed. We had orders. We cut out their hearts to take to the commander. Their babies were aged three months, a boy; a one-year-old girl; another boy, two; and the last aged three. We killed them and used their bodies to make medicine. I boiled their feet and arms to grind and put in bottles. The potion has the power to stop bullets.'"
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Read article...
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Perp prays for divine retribution at sentencing hearing
Fresno Bee | Submitted by: vitosurf
"Moments before he was sentenced Thursday to a half-century in prison, a Fresno street gang member invoked a death curse upon his accusers. And his accusers' children. And his accusers' children's children. ... The judge stopped Cha within minutes because the family of a girl and her great-grandmother injured during the shooting said Cha was threatening them with death. 'He asked God to eliminate, to punish us, to kill us generation after generation,' said the young girl's father, Nusoua Vang. Cha offered the court an explanation. He said the curse wasn't a threat against the victim's family, but aimed at those who wrongfully accused him."
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Read article...
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Man kills pregnant woman, coats her in peanut butter, kills self
WCAU-TV 10 Philadelphia | Submitted by: Tim Howard
"A pregnant woman whose peanut butter-covered body was found in a city lot was killed in a drug-related dispute by a man who later became distraught and committed suicide by jumping into the Schuylkill River, police said. The naked body of Susan Brennan, 32, was found strangled, her hands and feet bound by electrical wire and a rope around her neck, in an isolated lot in southwest Philadelphia on Monday. ... Authorities believe Burley may have covered the body with peanut butter in order to attract rodents, so as to get the body to decompose more quickly."
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Read article...
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Sniper on the loose in West Virginia
WKMG-TV 6 Orlando | Submitted by: Tim Howard
"There have been three fatal shootings outside convenience stores in Kanawha County, W.Va, within four days. ... Kanawha County sheriff's spokesman Lt. J.S. Bailes said the shootings appear to be random. Sunday night, 34-year-old George Carrier of South Charleston, W.Va., was shot in the head and killed while using a pay telephone outside a Charleston Go-Mart. ... Police are not confirming that the shootings are connected, but they are an eerie reminder of Washington, D.C., sniper shootings last year."
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Read article...
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Pay-per-view photos of Williams' decapitation
AZ Central | Submitted by: Tim Howard
"A former executive of the Scottsdale cryonics company where baseball great Ted Williams' body is frozen has launched a pay-per-view Web site with gruesome decapitation photos to raise money for his legal defense. Larry Johnson, former chief operating officer of Alcor Life Extension Foundation, ... said he observed 'horrific' activities relating to the handling of Williams' remains and other disturbing Alcor practices. ... The site asks for donations of as little as a dollar to help support his battle to 'free Ted' from Alcor. Initially, viewers were offered the chance to pay a $20 'donation' to see 20 photographs 'documenting the fate of Ted Williams.' The photos, which were removed from the site Wednesday afternoon, appear to show someone using a hammer and chisel to decapitate a head."
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Man plots to use mobsters to collect from Steven Seagal
cbs2chicago.com | Submitted by: Reid Fleming
"A former business partner of Steven Seagal's admitted Wednesday that he plotted to have the mob shake down the action-film star. ... [Julius] Nasso, 50, told a federal magistrate that he had an 'understanding' that a reputed capo in the Gambino crime family, Anthony 'Sonny' Ciccone, would confront Seagal about a debt in a way 'that would be perceived to be a threat.' Ciccone was convicted along with Peter Gotti, brother of late mob boss John Gotti, in a racketeering case and is awaiting sentencing. ... Nasso also claimed Seagal still owes him $2.5 million, and he said he would sue him to get it back."
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Dead tourists returning home without vital organs
BBC | Submitted by: Tim Howard
"The bodies of British citizens who die in Spain are being returned by the Spanish authorities minus internal organs ... the organs are retained for research or simply incinerated following post mortems. But a Nottinghamshire coroner who highlighted the practice said families found it distressing."
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FBI fucks up missile sting, blames the press
Sun | Submitted by: Tim Howard
"US anti-terror chiefs yesterday accused the BBC of blowing a chance to penetrate Osama Bin Laden's arms network. Agents planned to secretly recruit British weapons dealer Hemant Lakhani and use him to lead them to bigger fish. ... Agents intended to spare him from prosecution then let him lead them to senior al-Qa'ida operatives seeking sophisticated weapons."
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Falun Gong stole Chinese satellite
Newsday | Submitted by: Reid Fleming
"Practitioners of the outlawed Falun Gong spiritual movement commandeered China's main television satellite twice this week, the Chinese government said Friday. Sino Satellite, known commonly as SinoSat, was 'taken over by illegal TV signals' transmitted by Falun Gong at 9:05 p.m. Tuesday and at 8:23 p.m. Wednesday, the Ministry of Information Industry said. ... '(Falun Gong) practitioners in China have discovered a nonviolent means -- one that harms neither people nor equipment -- to break through the information blockade and let the people see programs that openly show the human rights violations happening in their own country,' Falun Gong spokesman Erping Zhang said last week in a release posted on the group's Web site. The Chinese government banned Falun Gong in 1999 as a threat to public safety and calls it an 'evil cult.'"
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Lawyer suspects Burger King lawsuit was a con job
oaoa.com | Submitted by: Reid Fleming
"Ramirez, who was 20 at the time, was ordered by Wimberly into the women's rest room of the restaurant and directed to remove her clothes so she could be searched for a missing coin purse. ... Wimberly claimed someone called the restaurant saying he was an Odessa police officer and directed Wimberly to conduct the search. ... [His lawyer] said he believes the call to Wimberly was a hoax, and that itís been done before. He said he believes the man on the telephone and Ramirez set up the scene for the express purpose of suing Burger King. ... 'It sounds to me like Burger King got set up for a nice little lawsuit, and it worked.'"
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Microsoft promises no back door for Feds
The Age | Submitted by: Reid Fleming
"Microsoft has scoffed at suggestions its software contains back doors for use by United States intelligence services as the Australian government signed on for access to the source code behind Windows. Creating back doors for the CIA would be a 'stupid decision' as the feature would certainly be discovered, says Microsoft's chief security strategist Scott Charney. ... 'If it was discovered, what do you think our long-term business survivability would be? I think it would be zero.'"
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Paintball prank backfires
ABC TV affiliates | Submitted by: Tim Howard
"Two teens who drove around Pittsburgh shooting passers-by with paintball guns were shot with real bullets for apparently targeting the wrong group, police said. ... When the teens turned around to tell the group on the street they were only shooting paintballs, someone returned fire with a gun, peppering the driver's side of the car with more than a dozen bullets, Dacey said. Smedley was shot in the left arm, while the 17-year-old was hit in the buttocks."  The Ohio agriculture department has ordered Jenkins to stop distributing the water, which he says has healing properties. The state says tests have shown the water to contain coliform bacteria, which comes from human and animal waste and can cause serious illness. ... Jenkins has been in a running battle with the Ohio agriculture department over his water and its safety. He was fined $200 last year because he didn't have a license to sell the water. Rather than getting a license, he agreed to stop selling the water. Later, the department used undercover agents to purchase the water from Jenkins. Again, it contained coliform, the department said."
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Jews for Jesus launching worldwide offensive
Cleveland Jewish News | Submitted by: Reid Fleming
"Armed with a budget of $28 million, the missionary organization Jews for Jesus is launching an aggressive campaign beginning this week to convert Jews in Cleveland to Christianity. Cleveland is one of three 'red letter' U.S. cities targeted for 2003 in what the group's Web site notes 'might be the largest Jewish evangelistic effort since (the) first century.' In a campaign slated to continue until 2005, the group plans to 'launch an outreach in every city worldwide that has a Jewish population of 25,000 or more.' That would entail 60 different cities around the world, half of which are in the United States."
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Read article...
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Michael Jackson goes shopping
Evening Standard | Submitted by: Reid Fleming
"Michael Jackson is so desperate to be 'normal' he hired a supermarket and got friends and family to pretend to be shoppers as he wandered the aisles filling his trolley. The singer's bizarre attempt to experience 'reality' included getting his cousins to dress up as bag boys to load his groceries. The surreal shopping experience was filmed for the entertainer's private collection of home movies."
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SARS Jr. simmering in Canada
canada.com | Submitted by: Gorg
"Federal and B.C. health authorities are looking into the deaths of at least three people and the infection of dozens of others at a B.C. nursing home hit by a mysterious, 'SARS-like' respiratory virus. While stressing this was not another outbreak of SARS, which killed more than 40 people in the Toronto area this year, officials said they were treating it like the deadly form of pneumonia until they learn more about it. ... 'There have been seven deaths, although only three of them have been directly associated with a respiratory illness,' Peck told a news briefing."
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Read article...
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Legal problems for talking dick cable access show
ABC TV affiliates | Submitted by: Reid Fleming
"Tim Huffman was convicted of indecent exposure because of a skit on his cable-access TV show in Grand Rapids, Michigan.  The talking organ told jokes, but one woman in the audience wasn't laughing. She complained to a friend in the county prosecutor's office."
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Read article...
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Dutch tourists arrested making porn in Vietnam
South Africa Sunday Times | Submitted by: Reid Fleming
"Two Dutch nationals were arrested in Vietnam's southern metropolis of Ho Chi Minh City after being caught taking part in an orgy with six prostitutes, police and consular officials said today. ... The two men and the six women, aged 16 to 25, were arrested. Police also confiscated a box of what they believed was Viagra, 17 pornographic VCDs, one laptop, the video camera and 16 pornographic pictures. While checking the contents of the laptop they discovered hardcore pictures of European couples engaged in sexual activity, as well as video clips of the two men involved in previously-recorded naked romps with the same prostitutes."
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Newly-discovered microbe thrives in boiling water
Guardian | Submitted by: Tim Howard
"Scientists have discovered the world's toughest life form. The single-celled microbe, called 'strain 121' for the moment, can survive at a scorching 130C -- higher than the boiling point of water and nearly 20 degrees higher than the previous record holder. It raises the possibility that life began on earth earlier than currently thought."
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Inspector Adler:
Ah, we meet again! Apparently the chaos caused by Pailaka has still not been resolved. If you are willing, I can send you to Pailaka again. What would you like to do?
Enter Pailaka.


ImageParticle QML Type
For visualizing logical particles using an image More...
| Import Statement: | import QtQuick.Particles 2.0 |
| Inherits: |
Properties
- alpha : real
- alphaVariation : real
- autoRotation : bool
- blueVariation : real
- color : color
- colorTable : url
- colorVariation : real
- entryEffect : EntryEffect
- greenVariation : real
- opacityTable : url
- redVariation : real
- rotation : real
- rotationVariation : real
- rotationVelocity : real
- rotationVelocityVariation : real
- sizeTable : url
- source : url
- sprites : list<Sprite>
- spritesInterpolate : bool
- status : Status
- xVector : StochasticDirection
- yVector : StochasticDirection
Detailed Description
This element renders a logical particle as an image. The image can be
- colorized
- rotated
- deformed
- a sprite-based animation
ImageParticles implictly share data on particles if multiple ImageParticles are painting the same logical particle group. This is broken down along the four capabilities listed above. So if one ImageParticle defines data for rendering the particles in one of those capabilities, and the other does not, then both will draw the particles the same in that aspect automatically. This is primarily useful when there is some random variation on the particle which is supposed to stay with it when switching painters. If both ImageParticles define how they should appear for that aspect, they diverge and each appears as it is defined.
This sharing of data happens behind the scenes based off of whether properties were implicitly or explicitly set. One drawback of the current implementation is that it is only possible to reset the capabilities as a whole. So if you explicitly set an attribute affecting color, such as redVariation, and then reset it (by setting redVariation to undefined), all color data will be reset and it will begin to have an implicit value of any shared color from other ImageParticles.
Note: The maximum number of image particles is limited to 16383.
Property Documentation
An alpha to be applied to the image. This value is multiplied by the value in the image, and the value in the color property.
Particles have additive blending, so lower alpha on single particles leads to stronger effects when multiple particles overlap.
Alpha is measured from 0.0 to 1.0.
Default is 1.0
The variation in the alpha channel between particles.
Alpha is measured from 0.0 to 1.0.
Default is 0.0
If set to true then a rotation will be applied on top of the particles rotation, so that it faces the direction of travel. So to face away from the direction of travel, set autoRotation to true and rotation to 180.
Default is false
The variation in the blue color channel between particles.
Color is measured, per channel, from 0.0 to 1.0.
Default is 0.0
If a color is specified, the provided image will be colorized with it.
Default is white (no change).
colorTable : url |
An image whose color will be used as a 1D texture to determine color over life. E.g. when the particle is halfway through its lifetime, it will have the color specified halfway across the image.
This color is blended with the color property and the color of the source image.
This number represents the color variation applied to individual particles. Setting colorVariation is the same as setting redVariation, greenVariation, and blueVariation to the same number.
Each channel can vary between particle by up to colorVariation from its usual color.
Color is measured, per channel, from 0.0 to 1.0.
Default is 0.0
This property provides basic and cheap entrance and exit effects for the particles. For fine-grained control, see sizeTable and opacityTable.
Acceptable values are
- ImageParticle.None: Particles just appear and disappear.
- ImageParticle.Fade: Particles fade in from 0 opacity at the start of their life, and fade out to 0 at the end.
- ImageParticle.Scale: Particles scale in from 0 size at the start of their life, and scale back to 0 at the end.
Default value is Fade.
The variation in the green color channel between particles.
Color is measured, per channel, from 0.0 to 1.0.
Default is 0.0
opacityTable : url |
An image whose opacity will be used as a 1D texture to determine size over life.
This property is expected to be removed shortly, in favor of custom easing curves to determine opacity over life.
The variation in the red color channel between particles.
Color is measured, per channel, from 0.0 to 1.0.
Default is 0.0
If set the image will be rotated by this many degrees before it is drawn.
The particle coordinates are not transformed.
If set the rotation of individual particles will vary by up to this much between particles.
If set the rotationVelocity of individual particles will vary by up to this much between particles.
sizeTable : url |
An image whose opacity will be used as a 1D texture to determine size over life.
This property is expected to be removed shortly, in favor of custom easing curves to determine size over life.
source : url |
The source image to be used.
If the image is a sprite animation, use the sprite property instead.

Note that the sprite image will be scaled to a square based on the size of the particle being rendered.
For full details, see the Sprite Animations overview.
If set to true, sprite particles will interpolate between sprite frames each rendered frame, making the sprites look smoother.
Default is true.
Allows you to deform the particle image when drawn. The rectangular image will be deformed so that the horizontal sides are in the shape of this vector instead of (1,0).
Allows you to deform the particle image when drawn. The rectangular image will be deformed so that the vertical sides are in the shape of this vector instead of (0,1).


url = "/" layout = "default" title = "Basecamp" description = "Welcome to Voilaah Basecamp!" hidden = 0 ==
View Account
View Basecamp


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Image Attribution: marsupium photography
Pre-registration & thresholds; Dynamic internal links;
Continuous integration; Embedded assertions
In this paper we simply ask whether paleoecology was the best, but why, exactly, it is the best. We used a survey of the lead and only author to examine this central question.
if (codeblock.pval>0.05) {Our study found that excitement related to attending and participating in #GSA2017 was strongly correlated to how many talks on Quaternary paleoecology our participants attended (p == `
lock.version()
return.warning()
add.marginalcomment('Recent changes have rendered this statement non-significant.')
}
pval
`).Pre-registration & thresholds; Dynamic internal links;
Continuous integration; Embedded assertions


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As well as videos of all the goals, you can watch match highlights, check out the latest scores and results and stay bang-up-to-date with the big football stories from The Guardian publication.
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User-friendly Interface
The in-game goal clips from every Premier League match are available to Guardian TV customers with a Guardian subscription.
So, if you’re not a subscriber, now’s the time to make that savvy call. If that’s a step too far for you, you can still watch loads of firecracker Premier League action as long as you sign in with a free Guardian iD.
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--- layout: default title: Typography permalink: /typography/ ---
The examples below demonstrate Odin's default styling of various HTML elements. It is not recommended that you change styling in the odin.css
file itself. Rather, it is recommended you do so in a stylesheet that loads after odin.css
. This way, you can upgrade to future releases of Odin without worrying about losing custom styling.
Odin uses a base font size of 18px
and a sans-serif
font stack. The default text color is almost black (#111
). This applies to paragraphs, list items, table data, and pretty much everything else other than headings.
All 6 heading levels are available. Here is an example of the default styling for each.
Heading 1 |
Very dark gray, semibold, 4.0rem (72px) |
Heading 2 |
Very dark gray, semibold, 2.666rem (48px) |
Heading 3 |
Very dark gray, semibold, 2.0rem (36px) |
Heading 4 |
Very dark gray, semibold, 1.5rem (28px) |
Heading 5 |
Very dark gray, semibold, 1.333rem (24px) |
Heading 6 |
Very dark gray, semibold, 1.0rem (20px) |

Heading 1

Heading 2

Heading 3

Heading 4

Heading 5

Heading 6

Blockquotes are indented and given a very light gray border on the left side. The font size is also slightly larger than the base font size.
Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

Lorem ipsum...

Citations can be added to blockquotes by wrapping citations in the
tag after the quotation.
Don't believe everything you read on the Internet.
Abraham Lincoln

Don't believe everything you read on the Internet.

Abraham Lincoln

The only styling applied to lists are minor adjustments to margins and padding to keep consistent spacing with other Odin elements.

List item

List item

List item

List item

List item

List item

The list-unstyled
class can be used on both orderered and unordered lists to remove numbering/bullets as well as indentation.

List item

List item

List item

Make text stand out with
or
elements. Add emphasis with
or
elements. You may want to draw attention to text by highlighting it with the
element.
Make text stand out or add emphasis.
You may want to highlight text.
De-emphasize text by using the light
class.

This text is lighter.


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Aguero will miss Manchester derby after limping off in win over Chelsea
Man City boss Pep Guardiola says they will be without their top striker for the visit of United on 7 December.
by The42 TeamSERGIO AGUERO WILL sit out the Manchester derby at Etihad Stadium on 7 December though injury, Pep Guardiola has confirmed today.
The Argentina international limped off the pitch during City’s 2-1 home win over Chelsea on Saturday with a suspected muscular injury.
Aguero is City’s leading scorer in the Premier League this season, with nine to his name from 12 outings to date.
It has been feared that the 31-year-old could now face an extended spell on the sidelines, as City approach a hectic festive period which could have a huge bearing on this season’s title race.
When asked if Aguero will miss a crucial clash with United next month, Guardiola responded: “Yes.”
He added on how long the Argentine is likely to be sidelined: “A few games. I don’t know exactly.
He has a tendon problem and will be a few games out. We will miss Sergio.
“We have had some problems with injuries but we will wait for him and meantime we have Gabriel [Jesus] and [Raheem] Sterling who can play in that position.
“We have no other injuries. David Silva had cramp but he’s okay.”