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Part II: The Global Strategy
2. Control: Overcoming Malaria
A. Scale-up for Impact: Achieving Universal Coverage
As illustrated by the limited levels of coverage described in Part I: Malaria Today, it will be a major challenge to achieve universal coverage with even one intervention for all populations at risk. When countries can scale-up a package of preventive and curative interventions together, the resulting benefits will have a dramatic impact on the global malaria burden.[12]Rowe AK and Steketee RW. Predictions of the impact of malaria control efforts on all-cause child mortality in sub-Saharan Africa. American Journal of Tropical Medicine and Hygiene, 2007, 77 (Supplement 6).
Click for source This concept, known as scale-up for impact (SUFI), is one of the biggest opportunities to have a major impact on global mortality and morbidity.
Figure II.4 illustrates the difference in impact of gradual increases in coverage (red lines) and the dramatic impact that results from rapid scale-up (blue lines)
Figure II.4: Intervention coverage scale-up and burden reduction
Source: Based on Steketee R, Lennon A, "Scaling Up for Impact Through Comprehensive Program Improvement", Malaria Control Partnership (MACEPA), June 2007
Rapidly scaling up to universal coverage for populations at risk is critical to achieve the targets of 50% mortality and morbidity reduction by 2010 and a 75% reduction in morbidity and near zero mortality by 2015. The principle of scale-up has been promoted since 2005 by the RBM Partnership. This commitment has been reaffirmed by the UN Secretary-General's call on World Malaria Day in April 2008 to "put a stop to malaria deaths by ensuring universal coverage by the end of 2010" through the use of vector control and case management tools and strengthening of community-level efforts.[13]UN Secretary-General Ban Ki-moon, video message, World Malaria Day April 2008. The Secretary-General reiterated the UN vision
for universal interventions coverage in order to end malaria deaths.
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After expanded coverage of malaria interventions, principally LLINs (distributed through a combination of approaches, reaching over 60% coverage of populations at risk in both countries)[14]Coverage levels have continued to increase in these countries since the completion of the study.
and ACTs in Ethiopia and Rwanda, results are promising: malaria cases in Rwanda decreased by 64% and deaths by 66% between 2005 and 2007 among children under 5 years; in Ethiopia, cases decreased by 60% and deaths by 51% in the same age group[15]Impact of long-lasting insecticidal-treated nets (LLINs) and artemisinin-based combination therapies (ACTs) measured using surveillance data, in four African countries. Geneva, World Health Organization Global Malaria Program, 2008. These results are preliminary and further evidence is needed over time to confirm sustainability of successes due to control efforts. This study is based on results in a limited number of health facilities and therefore not necessarily nationally representative.
in the health facilities selected for the study.
Figure II.5: Impact of increased LLIN and ACT distribution in Ethiopia and Rwanda
a) Numbers calculated assuming three year lifespan of LLINs delivered and one year lifespan for ITNs delivered
b) In-patient malaria cases in children <5 years old, January-October 2003-2007, 7 in-patient facilities, Ethiopia
c) In-patient malaria cases in children <5 years old, January-November 2005-2007, 19 in-patient facilities, Rwanda
Source: Intervention data based on World Malaria Report 2008. Geneva, World Health Organization, 2008; Impact data based on Impact of long-lasting insecticidal-treated nets (LLINs) and artemisinin-based combination therapies (ACTs) measured using surveillance data, in four African countries. Geneva, World Health Organization, Global Malaria Program, 2008
Several other studies demonstrate similar results, including those in Eritrea, Madagascar and Zanzibar. In the latter, high coverage with ACTs and insecticide-treated nets resulted in drastic mortality and morbidity reduction.[16]Bhattarai A et al. Impact of Artemisinin-Based Combination Therapy and Insecticide-Treated Nets on Malaria Burden in Zanzibar, PloS
Medicine, 2007, 4:e309.
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Strengthening health systems lays the groundwork to reach universal coverage. While improving health systems is critical to reaching the universal coverage targets, these efforts will have the biggest impact when they are focused on concrete actions related to malaria control. Therefore, we focus on core elements of health systems needed to enable the scale-up of malaria interventions and not a comprehensive review of all health system strengthening activities.
The sections below describe what is needed from key stakeholders and the components of the health systems to scale-up universal coverage and the support these changes may require from the international community. Many of these activities, while begun during scale-up, will need to be continued once scale-up is complete to sustain control.
Key Stakeholders of the Health System
To strengthen health systems, countries will need strong support from political leaders and coordinated efforts from those who work within the health system at the national, district and local levels. Support required from the international community will be essential.
Strong leadership and governance from political leaders. Success at the country level requires strong, sustained political and budgetary commitment to malaria control. High-level officials (head of state, prime minister, ministries of finance and health) need to support the malaria control programs and their health systems to provide the necessary resources (human and financial), help resolve bottlenecks in countries (remove taxes and tariffs, provide free treatment etc.), accelerate procedures (administrative or regulatory procedures) and affirm governmental leadership in planning and coordinating all partners active in the country to reach rapidly the universal coverage targets. Zambia and Ethiopia, which achieved substantial progress in malaria control, are prime examples of strong political support behind malaria control programs. For instance, the Zambian government has supported the establishment and implementation of the 6-year strategy and has taken the lead on coordinating all partners. The Ethiopian government has demonstrated its commitment by establishing joint steering committees at the national and regional levels to strengthen accountability by removing taxes and tariffs on malaria preventive tools and by promoting demand through communication efforts.
Support required. Advocacy efforts targeted to political leaders to raise malaria on the national agenda of endemic countries are required. Strong emphasis should be placed on the need to create an enabling environment for malaria control by removing bottlenecks to scale-up at the national level. See Part IV - Chapter 1: Advocacy for more detail.
Adequate and well-trained health workforce. Human resource capacity is one of the major concerns in most malaria endemic countries. Scale-up corresponds to a substantial increase in the delivery of malaria interventions and will require bold efforts to match human resources with planned activities. The national malaria control program needs to be structured adequately to match needs, and efforts will be conducted to increase the recruitment, motivation and retention strategies of key personnel (e.g. program managers, logistic or monitoring experts, accountants, entomologists, health workers). Emphasis will be put on developing skills through intensive capacity building and training programs at all levels (national, regional and local). See Part IV - Chapter 4: In-Country Planning.
Support required. Countries need technical assistance to develop comprehensive human resource plans. Increased support for capacity building is needed to increase management skills (program or financial management), technical knowledge (e.g. entomology, monitoring and evaluation, procurement and supply chain management) and knowledge of the delivery of interventions (for community-based health workers and other health care providers).
Components of Health Systems that Enable Scale-up
The key components of the health systems to enable scale-up are presented below. More detail is provided on each of these topics and on the role the RBM Partnership will play in coordinating partner activities around them in Part IV: The Role of the RBM Partnership.
Policy and regulations in line with international guidance. National regulatory bodies register products, ensure quality assurance and enforce mechanisms for quality control of interventions. National policy processes establish treatment and prevention guidelines. National authorities ensure that adopted policies are adopted and implemented throughout the country. Ideally all these national decisions are aligned with international recommendations. The adoption of international regulatory decisions could reduce critical time-delays during the scale-up stage.
Support required. New international recommendations need to be developed (e.g. on RDTs) and current international recommendations (such as WHOPES and prequalification of ACTs) need advocacy in countries to avoid delays in the scale-up stage. Policies that reduce the risk associated with resistance should be strongly encouraged. See Part IV - Chapter 4: Policy and Regulatory for more detail.
Detailed and accurate planning. A clear understanding of local needs will form the basis of accurate planning for each district.[17]For instance the main vector control method chosen depends highly on epidemiological conditions and on logistical in-country capabilities. This is best created through a multi-partner, consensus-based effort, involving the public sector, the private sector, civil society, the main donors, technical and implementation support partners, the research community and neighboring countries. To achieve the ambitious 2010 targets for universal coverage, countries will need detailed, district-by-district planning based on district needs assessments. These should be translated into month-by-month plans of who will do what and where. This will lead to a clear understanding of the major bottlenecks, resource needs and delivery capacities of the country.
Support required. Countries need technical assistance support in developing their health plans and proposal (especially for applications to major donors such as the Global Fund or World Bank). They need to be supported in capacity strengthening to run such processes. The development and dissemination of best-practices of successful scale-up programs will be essential to inform planning. See Part IV - Chapter 5: In-country Planning for more detail.
Timely access to resources. Available resources should be matched to planned activities. Once resource gaps are identified, strong plans should help to build the case for additional funding, and resource mobilization activities should be conducted to fill these gaps. For scale-up, reprogramming of existing grants and accelerating country resources disbursement is a key opportunity: countries and fund recipients need to take advantage of the flexibility offered by major donors,[18]Funding and procurement challenges facing rapid scale-up of LLINs to reach the 2010 targets. World Bank, Presentation at RBM 14th Board Meeting, May 2008.
Click for source such as the Global Fund (frontloading of product purchases, acceleration of phase 2 negotiations and disbursements etc.) or the World Bank (acceleration of commitments for Booster Phase 2, leverage of amendments to previous projects etc.). Mechanisms such as direct payment of grants to procurement agents or manufacturers can be considered to accelerate financing processes.
Support required. An international resource mobilization strategy must be in place to raise funds for all in-country activities and international support required to reach universal coverage. To meet rapidly the scale-up targets, disbursement mechanisms of international donors need to be accelerated. Capacity strengthening at the country level to respond to Technical Review Panels and to resolve disbursement bottlenecks is essential to ensure the availability of resources. Equally important is the political will and accountability within country governments and ministries of finance to ensure the release of funds to malaria control programs. Countries need assistance in completing high-quality procurement and supply management and M&E plans. Besides, innovative financing and procurement mechanisms could be established for ACTs and LLINs. See Part IV - Chapter 6: Financing for more detail.
Effective distribution systems. Expanding distribution to reach universal coverage with interventions requires managing large amounts of products for which adequate forecasting, quality control, procurement and supply chain management systems need to be in place. Strengthening the public health system procurement and supply chain is essential. Quick resolution of implementation bottlenecks and capacity building in procurement and supply chain management are critical to ensure that the short term goals can be achieved while countries manage the long term expansion of these distribution systems.
Support required. Countries need technical assistance to resolve implementation bottlenecks impeding scale-up, especially linked to procurement and supply chain management (PSM) issues. For instance, they need to be supported in using available PSM capabilities of the public sector, the private sector or NGOs and in strengthening mechanisms to improve logistics. To strengthen forecasting capabilities, comprehensive needs assessments are being carried out in sub-Saharan African countries. In the longer term, a process will be established to help identify the best approaches to forecasting for all interventions. Countries may also need to be supported for their tendering systems, contracting out, building and financing supply chains. Updated procurement guidelines will also be prepared. See Part IV - Chapter 7: Procurement and Supply Chain Management for more detail.
Strong communication and behavior change methodologies. Service delivery is not only about delivering products; it is also about ensuring they are used properly. Communication and Behavior Change Methodologies are essential to ensure the appropriate use of interventions. These programs need to be designed with the active participation of both service providers and intervention-users and will aim for improving health-seeking and care-providing behaviors. At the individual level, they will develop strong messages to improve recognition of malaria symptoms and risk groups as well as correct use of interventions (use of LLINs, acceptance of IRS, correct diagnosis to demonstrate parasites before treatment, full compliance with ACTs etc.). They will be designed to create opportunities for people to discuss malaria issues, especially at the community level. Whatever communication channel is chosen, messages need to be tailored to address specific regional and community needs and to involve local leaders (political, religious and traditional) to increase identification and participation of the population.
Support required. To increase utilization rates of interventions, countries need help developing and disseminating consensus-based guidelines and best practices for approaches to Information, Education and Communication / Behavior Change Communication (IEC / BCC) methodologies during the scale-up stage. See Part IV - Chapter 8: Communication and Behavior Change Methodologies for more detail.
Monitoring and Evaluating (M&E). M&E information systems measure the coverage, utilization and health impacts of interventions, with a view to making informed adjustments in future planning. Every country should have a costed malaria M&E plan addressing national and local need. Increasing staff dedicated to M&E and building capacity are essential to track the indicators that are essential for the scale-up stage, especially levels of coverage and utilization of the interventions (including equity in access), which can be measured through regular surveys (e.g. the Multiple Indicator Cluster Survey, the Demographic and Health Surveys and the Malaria Indicator Survey) and through strengthened routine health information systems. For example, additional information will be needed to monitor new approaches such as the AMFm and the prices of ACTs. Once information is collected and analyzed, countries will share it with all major stakeholders to enable global tracking of progress.
Support required. Countries in the scale-up stage need assistance in developing their national M&E plans. They need support as they increase M&E dedicated staff and roll out frequent population-based surveys. Support is also needed to integrate efforts with wider health sector M&E to enable efficiency. International tracking of progress in malaria control needs to be organized and coordinated internationally. See Part IV - Chapter 9: Monitoring and Evaluation for more detail
.Effective Delivery Strategies Required to Reach Universal Coverage
Most countries are still at low levels of coverage. To reach targets of universal coverage, a substantial amount of interventions need to be funded and delivered globally:
- Globally, an estimated 730 million LLINs are needed to protect populations at risk for whom nets are appropriate. Approximately 50 to 100 million nets already distributed (mostly in sub-Saharan Africa) will remain effective for the next two years. Approximately 315 to 340 million new LLINs are needed annually in 2009 and 2010. For Africa alone, 250 – 300 new LLINs are needed to reach universal coverage by 2010.
- Globally, ~172 million households need to be covered with IRS every year.
- ~25 million pregnant women annually are expected to require IPTp. This estimate is only for high transmission areas in sub-Saharan African countries where IPTp is currently recommended .
- The global annual need for diagnostics (by microscopy or RDTs) based on fever cases is ~1.5 billion.
- Target treatment coverage, assuming diagnosis with microscopy or RDTs, is estimated at ~247 million treatments: 228 million treatments of ACTs and 19 million treatments of chloroquine and primaquine for treatment of P. vivax. Without diagnosis, the number of treatments needed would be much higher due to over treatment of fever cases as malaria.
Figure II.6: Global scale-up in interventions from 2006 to 2010
a) Estimate based on number of nets that should be in use. Because of 3-year lifespan, fewer new nets are needed each year than the number in use
b) Today, actual use is likely not matching confirmed malaria cases
Source: Need based on GMAP costing model; actual based on analysis of World Malaria Report 2008. Geneva, World Health Organization, 2008 and Roll Back Malaria Commodities database
Global production capacities need to be increased substantially to be able to reach global scale-up targets. The production issue needs to be addressed for all interventions and could be even more acute for ACTs due to withdrawal of artemisinin producers from the market in 2007-2008 after the substantial decrease of artemisinin prices. Alternative artemisinin produced through bio-technology from yeast culture will not become available before 2010. Global support and effort is needed to address the issue of adequate supplies.
To achieve universal coverage, countries must go beyond the procurement and financing of interventions to ensure that the products can reach every person at risk. Countries can scale-up interventions to reach the largest populations at risk based on best practices demonstrated by other countries.
Gender and socio-economic status should not determine access to interventions. Against the background of universal coverage for all populations at risk, dedicated strategies will need to be put in place to make sure that the most vulnerable and isolated populations are covered by the interventions, especially those in the poorest economic quintiles, populations living in remote areas and women.
For several interventions, using the skills of the private sector proves to be efficient in scaling up interventions. Commercial networks can be used for the delivery of some products (e.g. LLINs or treatments) provided that adequate information and training are provided, enabling access into even remote areas where health facilities might not be accessible. Private companies or consortia could also be contracted out for conducting programs such as IRS. Private sector competencies to foster demand generation or provide capacity building within countries can enable successful malaria control.
Vector control scale-up. Both long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) can dramatically reduce malaria morbidity and mortality. They both provide community protection at high levels of utilization (>80%).
- LLIN scale-up. In the early years of mosquito net distribution, nets were primarily promoted through social marketing largely through the private sector and subsidized distribution approaches as a personal protection tool for vulnerable groups.[19]Teklehaimanot A et al. Malaria Control needs mass distribution of insecticidal bednets. The Lancet, vol. 369, issue 9580, pp.
2143-2146, 2007.
Click for source Since 2003, a global consensus has been building towards the scaled up distribution of LLINs at no cost to the end-users. WHO endorses this approach and recommends that all targeted populations are 100% covered with LLINs to exploit the community protective effect of insecticide-treated nets (ITNs) that is observed at high coverage levels. For this purpose, distribution to all populations at risk (not only vulnerable groups) with free LLINs is generally considered to be the most rapid and cost effective way to reach universal coverage, and is the approach used successfully in Ethiopia (see Box II.2) and other countries.
Several factors contributed to the success of the Ethiopian LLIN distribution campaign, including the use of a third-party procurement agent, donor flexibility in use of funds which allowed rapid disbursement, and the utilization of multiple delivery methods including enhanced outreach, health facilities and the strong network of 30,000 health extension workers to reach the population.
Using the competencies of the private sector and outsourcing the mass campaigns could also be an effective way to reach the coverage targets, while helping national authorities to focus on their core activities, such as strengthening of routine health services or monitoring and evaluation.
Distribution systems for LLINs should not be viewed as competitive or fighting for "market share", but as complementary approaches to achieving a single goal: a comprehensive LLIN distribution strategy,[20]Lengeler C et al. Program diversity is key to the success of insecticide-treated bednets. The Lancet, 2007.
Click for source including both campaign and routine distribution mechanisms supported by both the public and private sectors, to create a "net culture" in which the use of LLINs becomes a societal norm.[21]Scaling-up Insecticide-treated netting programs in Africa, RBM-WIN and Insecticide-treated mosquito nets: a WHO position statement. Geneva, World Health Organization, 2006.
Click for source Mass campaigns, often integrated with other health interventions such as immunization and vitamin A supplementation are good for initiating high coverage levels rapidly, and routine systems — e.g. distribution during antenatal or infant immunization services — are very efficient for maintaining coverage between campaigns and ensuring that vulnerable populations (such as pregnant women and children under 5) are reached.
Box II.2: Success of LLIN mass distribution in Ethiopia[22]Ministry of Health of Ethiopia, personal communication, 2008; Chambers, Gupta, Ghebreyesus. Responding to the challenge to end malaria deaths in Africa. The Lancet, 2008; Factsheet Malaria in Ethiopia. New York, UNICEF, 2007.
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Between 2005 and 2007, one of the most ambitious LLIN delivery programs ever attempted was implemented in Ethiopia, where nearly 20 million nets were distributed across the country (two nets for each of the 10 million households targeted).
After its worst malaria epidemic in 2003, Ethiopia made a bold proposal to international donors in 2005: to deliver 20 million LLINs in 3 years. Ethiopia made a strong case for the budget required (US$ 160 million, 3 times the previous national malaria budget). Donors responded positively, with over US$ 200 million coming from the Global Fund, World Bank, DFID, the Carter Center and others. Ethiopia took advantage of flexibility built into both the Global Fund and World Bank processes to frontload funding. Rather than disbursing its grants over 5 years, the country drew down on the pledged funds to finance its ambitious distribution program in 1–2 years.
Ethiopia used UNICEF as a third-party procurement agent to increase procurement speed and reduce transaction costs. Funds flowed directly from the Global Fund to UNICEF, avoiding the need to disburse funds from the Global Fund to the government and then on to a procurement agent. At the same time, significant investments were made by the government and partners to build in-country procurement capacity for the post scale-up stage.
A combination of distribution channels were used to achieve a high level of coverage, especially the Enhanced Outreach Program and the network of 30,000 Health Extension Workers in communities (see Box II.6 later in this chapter), as well as distribution from health facilities. UNICEF has also been supporting the development and implementation of a community based social communication program (toolkits, training of health workers and community volunteers) to ensure high utilization rates of the nets delivered. Ethiopia is developing communication programs to improve usage and developing strategies to provide continued access to additional LLINs to maintain 100% coverage, as presented in Figure II.7 below:
Figure II.7: Targeted distribution channels in Ethiopia
Analysis conducted by the WHO-GMP show that the combined delivery of LLINs and ACTs in Ethiopia was very successful: the weighted average percentage decline for children under 5 in in-patient facilities visited in Ethiopia was 60% for cases and 51% for deaths between 2005 and 2007[23]Impact of long-lasting insecticidal-treated nets (LLINs) and artemisinin-based combination therapies (ACTs) measured using surveillance data, in four African countries. Geneva, World Health Organization Global Malaria Program, 2008.
Click for source with coverage of LLINs of approximately 60% at the time of the study. While great successes have been achieved, opportunities still exist to improve utilization. Additionally, monitoring over time will determine the sustainability of the initial gains.
- IRS scale-up. IRS has proved to be an efficient vector control measure for reducing malaria burden, as was the case with the Lubombo Spatial Development Initiative (LSDI) between Swaziland, Mozambique and South Africa, and in countries targeted by the President's Malaria Initiative (10 African countries in 2007-2008 and 15 targeted in 2008 and beyond). In the LSDI initiative, intensive IRS campaigns markedly reduced P. falciparum malaria prevalence and between 1999 and 2005, the number of confirmed malaria cases was reduced by 95% in Swaziland and by 96% and 78% in two adjacent provinces of South Africa.[24]Sharp et al. Seven years of regional malaria control collaboration – Mozambique, South Africa and Swaziland. American Journal of
Tropical Medicine and Hygiene, 76(1), pp. 42–47, 2007.
Click for source IRS is also widely used in Southeast Asia and contributed largely to overall burden reduction during the malaria Eradication campaign from 1950-1970 in countries such as India[25]Incidence reduction from 75 million cases to 100,000. Sharma VP. The Malaria Eradication Experience of the Indian Sub-Continent. Presented at the WHO Informal Consultation on Malaria Control and Elimination, 2008.
or Sri Lanka.[26]Child mortality was reduced by 50% between 1946 and 1956. Newman P. Malaria Eradication and Population Growth, with Special Reference to Ceylon and British Guiana. Bureau of Public Health Economics, University of Michigan, School of Public Health, Research Series No. 10, 1965.
Click for source IRS can be scaled up provided that the logistical structures are in place (equipment, well-trained staff), local epidemiology and transmission patterns are well known, and capacity for regular supervision and quality monitoring exists. Even countries which previously did not have this capacity, such as Mozambique pre-LSDI, can implement programs with the appropriate support and commitment. Generally, IRS programs were clearly separated from other programs in the national control strategy and this autonomy was a success factor. National malaria control programs such as in Botswana, Namibia or South Africa have their own teams of spraying operators composed of government-employed public health workers. In other examples, spraying campaigns were outsourced to private sector consortiums or companies. Success of IRS scale-up campaigns is very much linked to the ability to deploy well-trained spraying teams, to manage the logistics of the insecticides (safe storage, handling etc.) and to be able to monitor and map sprayed structures. - Scale-up of other vector control interventions. Other more targeted vector control interventions, such as larviciding or environmental management, can be used where they are proved to be efficient and cost-effective. One of the key elements of success for these interventions is the participation of local communities, as was the case in India[27]Lindsay et al. Environmental Management for Malaria Control in the East Asia and Pacific (EAP) Region. HNP discussion paper, Washington, D.C., World Bank, 2004.
Click for source or in a regional program in Mexico and Central America[28]Regional Program of Action and Demonstration of Sustainable Alternatives to DDT for Malaria Vector Control in Mexico and Central America (DDT-GEF).
Click for source where local communities worked to reduce breeding sites.
Diagnostics scale-up. In parallel to increasing access to treatments, parasitological diagnosis (with microscopy or, where not possible, with Rapid Diagnostic Tests) should be made available to populations at risk when appropriate[29]Guidelines for the Treatment of Malaria. Geneva, World Health Organization, 2006.
Click for source (see Box II.3). The use of parasitological diagnosis is still limited overall and needs to be expanded to inform treatment choice and make more rational use of anti-malarial treatments. Microscopy and RDTs are both part of laboratory systems. They need their own supervision and quality control. Their use will necessitate strong algorithms to interpret the results and allow appropriate decisions to be made on both malarial and non-malarial febrile illness, and appropriate supply and logistics to support these decisions.
- Microscopy scale-up: increasing the use of quality-assured microscopy requires strengthening capabilities in health facilities. This includes providing microscopes along with strong training programs on microscopy, quality monitoring systems and increasing attendance at equipped facilities. In Indonesia, the use of microscopy has recently expanded to a wide network of local health facilities.
- Rapid Diagnostic Test (RDT) scale-up: RDTs can be used in public health facilities that do not have access to microscopy services. They are also well suited for community case management and for private sector distribution. As with microscopy, assurance of quality is essential and concerns have been raised over the quality of many RDTs. An initiative to assess quality assurance of RDTs is being carried out by WHO - Western Pacific Regional Office, WHO - the Special Programme for Research and Training in Tropical Diseases (TDR) and Foundation for Innovative New Diagnostics (FIND) and should inform policies in the near-term future. Proper storage and transport are critical for RDTs and need to be closely monitored since the tests can be damaged by high temperatures and freezing. Therefore, countries that want to scale-up RDTs need to have in place cold chains for transport and storage (i.e. avoiding any exposure to temperatures outside manufacturer's recommendations), quality control testing procedures, and clear treatment algorithms to clarify actions following the results of the test.
Box II.3: Parasite-based Diagnostics for Malaria
Parasite-based diagnosis, based on light microscopy or RDTs, is recommended by WHO for management of all malaria cases, with the exception of children under five in high transmission settings (where evidence of benefit over cost is unclear) and certain specific situations such as epidemics proven to be malaria in low-resource situations. Providing the febrile patient with a correct diagnosis will reduce delays in the correct management of non-malarial febrile illness, and may improve adherence to anti-malarial therapy, thus reducing morbidity and allowing better targeting of resources.
However, the introduction and maintenance of diagnosis through the use of microscopy and RDTs requires considerable investment in training, supervision, logistics and education of health workers and the community. This must be included in program budgets, together with provision for non-malarial febrile illness, as most fevers will not be due to malaria. While this is essential, access to effective anti-malarial medicines must not be delayed, and in some cases may need to be deployed on the basis of clinical diagnosis while capacity for parasite-based diagnosis is rapidly scaled up in such areas.
Anti-malarial treatment scale-up. Universal coverage with anti-malarial treatments (such as ACTs) is a daunting challenge because three-quarters of all anti-malarial treatments are currently obtained outside the public health system,[30]AMFm Technical Design. RBM Resources Working Group, 2007.
Click for source many of the most affected populations live in remote areas with limited access to public facilities, and many cannot afford ACTs at current prices, especially in the private sector. A combination of several strategies can be used to expand treatment coverage:
- Make better use of existing professional resources. Improving the availability and quality of interventions delivered in existing health facilities is the first step to increase effective coverage. This includes improving forecasting and logistical management at all levels, including the local level, to avoid stock outs or expiration of drugs and other supplies, offering training programs for care providers, and using program management to improve the quality of interventions delivered.[31]Scaling Up Home Based Management of Malaria. Geneva, World Health Organization, 2004.
Click for source To avoid overburdening the current health systems, new tasks could be integrated within existing responsibilities, but outsourcing certain activities could also be considered, such as in Bangladesh where the delivery of several interventions was successfully outsourced to NGOs. Every health facility should have adequate drug storage facilities with proper record-keeping procedures. - Expand the reach of the health system into the community. This can be done by providing access to treatment through community providers, supplying medicines and diagnostics to community workers, and implementing community education and communication programs to ensure proper use of drugs. In Ethiopia, malaria control interventions are integrated with the Health Extension Program, which is staffed by more than 30,000 trained, salaried, community-based Health Extension Workers (HEW) and is coordinated by the Ministry of Health. See Box II.6: Health Services Extension Program and Health Extension Workers in Ethiopia. Ghana has put in place a Community-based Health Planning and Services (CHPS) program based on ~3,000 Community Health Officers who are assisted by community volunteers in delivering a broad package of health services, including the provision of insecticide-treated nets, IPTp and case management for uncomplicated malaria.[32]Community Based Health Planning and Services (CHPS), The operational policy. Ghana Health Services, 2005.
This program has been implemented in 104 of the 110 districts in the country.[33]Nyonator et al. The Ghana Community based health planning and services initiative for scaling up service delivery innovation, Health policy and planning, 2005.
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Increase geographical access through the private sector. Ensuring convenient, affordable high-quality anti-malarial treatments in the private sector, and providing information on how to use them are essential steps. Strategies include training and monitoring private sector drug sellers (market sellers and shop-keepers) in parasite-based diagnosis (such as RDTs) and appropriate treatment. Efficient examples of private sector involvement include franchising or accrediting private pharmacies to provide high quality management, contracting out malaria management to private practitioners, and delivering subsidized, affordable ACTs through retail networks are examples that could increase access. Ideally, the public sector will provide overall stewardship to private providers, including training for diagnosis, drug handling, dispensing, advice giving and referral of severe cases, and monitoring of the management of both malarial and non-malarial febrile illness. Careful planning is necessary to ensure that standard management policies are followed, and that providers have appropriate incentives to maintain good targeting of, and adherence to, therapy.
- Increase financial access and pool health risks: Increasing the financial access is important so that all people at risk of malaria can receive appropriate prevention and treatment regardless of their socioeconomic status. There are several ways to increase financial access. One is to reduce the cost of treatments upstream before they enter countries, as is the case with the innovative financing mechanisms currently being considered (such as the Affordable Medicines Facility - malaria which has been endorsed by the RBM Board). Another is to ensure free delivery of treatment and other health services associated with treatment such as consultation and diagnostic tests. Experience in countries such as Mali shows that making health services free for children under five can have substantially higher impact than delivery of free malaria treatment alone.[34]Médecins sans Frontières, personal communication, 2008.
However, this will require sustained financing to cover the costs of providing treatment. See Part IV – Chapter 6: Financing, especially Box IV.2: Affordable Medicines Facility – malaria. The challenge for many malaria endemic countries is to protect individuals from high out-of pocket payments for malaria and other diseases. In addition to decreasing the costs of interventions and services, countries can institute mechanisms to pool health risks and provide financial protection to the population. Four main health insurance mechanisms are used to pool health risks, promote prepayment, raise revenues, and purchase services. These are state-funded systems through ministries of health or national health services, social health insurance, voluntary or private health insurance or community-based health insurance.[35]Health Financing Revisited, A Practioner's Guide. Washington, D.C., World Bank, 2006.
Click for source - Design, implement and evaluate interventions to reach the poorest and underserved populations: Countries need to identify strategies to expand uptake by those who are not currently accessing any malaria treatment. In general the poorer groups are less likely to have treatment and have lower quality treatment than those who are better off. There is insufficient evidence on how best to reach the poorest and underserved groups. The evidence that does exist shows that a variety of approaches can work, depending on how well they are designed and implemented.[36]Reaching the Poor with Health, Nutrition and Population services, What works, what doesn't and why? World Bank, 2005.
Click for source However, there is very little evidence specifically on how best to reach the poorest with malaria treatment as most studies have not looked at who is benefiting from treatment.[37]Second interim report on progress against outstanding AMFm implementation challenges. RBM AMFm Taskforce, August 2008.
Click for source This should be assessed in future studies to see which strategies are most cost effective.
Malaria in Pregnancy (MIP) interventions scale-up[38]A strategic framework for malaria prevention and control during pregnancy in the African region. WHO-AFRO, 2004.
Click for source including IPTp. Since at least 70% of pregnant women in Africa seek antenatal care at least once during pregnancy, antenatal care services provide a platform for the delivery of interventions for the prevention and control of malaria during pregnancy (IPTp, LLINs, effective case management and other interventions for ensuring healthy pregnancy outcomes and maternal and child survival such as iron supplementation against anemia). Malaria in Pregnancy programs work best with strong cooperation between national malaria control programs and reproductive health programs. Distribution channels through antenatal care (ANC) clinics are already in place in many countries; today, several challenges impede scale-up of MIP interventions among which are the availability of MIP interventions in ANC clinics as well as the regular and timely attendance clinics throughout pregnancy.
- Minimize missed opportunities. Despite high ANC utilization, IPTp coverage remains low in countries with stable malaria transmission, reflecting missed opportunities for reaching ANC attendees with effective interventions for malaria control. A significant proportion of pregnant women attend ANC clinics only once in their pregnancy, whereas WHO recommends four visits, three visits after quickening each time with IPTp delivery. Zambia has effectively used antenatal clinics to deliver IPTp, reaching 61% of pregnant women with two doses; in Zambia, 94% of pregnant women attend ANC clinics once and 71% attend them at least 4 times. In several countries of sub-Saharan Africa, IPTp coverage is substantially lower than ANC coverage, clearly demonstrating the extent of missed opportunities in the delivery of IPTp and LLINs through antenatal care services. Scaling up IPTp and other MIP interventions will require concerted efforts to minimize missed opportunities and ensure that all women attending ANC clinics in high transmission settings receive the necessary interventions for malaria prevention and control.
- Challenges to MIP scale-up. Main challenges to MIP interventions include persistent stock-out of drugs for IPTp, inadequately trained personnel, poor supervision and tools for effective monitoring and evaluation of program effectiveness. Success in this regard requires strong collaboration between national malaria control and reproductive health programs and concrete actions to strengthen the health system to support the delivery of these interventions. Specific health systems strengthening aspects include improved availability of drugs, supplies and commodities, joint planning and capacity building of health workers, improved capacity of laboratories with sensitivity for comprehensive care of the pregnant woman and her unborn baby and strong supervision, monitoring and evaluation tools. Of critical importance is the need for communication and behavior change methodologies and support for engaging communities in the prevention and control of malaria during pregnancy. Such engagement ensures that the community develops an appreciation of the need for skilled care during pregnancy and that women receive all the interventions they need in a timely manner with community support.
Scale-up of interventions in humanitarian crises. Some countries that need to scale-up malaria control interventions are experiencing humanitarian crises situations where the appropriate interventions and the delivery strategies need to be adapted. Countries experiencing chronic crises (e.g. Sudan and the Democratic Republic of Congo) require tailored technical support. See Part IV - Chapter 10: Humanitarian Crises.
Rapid and Coordinated Global Support Needed to Reach the 2010 Targets
The Partnership's main objective is to reduce malaria mortality and morbidity by 50% compared to 2000 by the end of 2010. To support countries in successfully achieving these targets, all partners (donors, politicians, local officials, NGOs, etc.) will need to work in coordination and align themselves behind a single strategy, as outlined in the Organization of Economic Cooperation and Development (OECD) Paris Declaration on Aid Effectiveness.[39]Paris Declaration on Aid Effectiveness: Ownership, harmonization, alignment, results and mutual accountability. Paris, OECD, 2005.
Click for source If some countries do not meet the 2010 deadline, they will continue to strive for the achievement of the universal coverage scale-up targets.
In addition to strategies to strengthen health systems and increase coverage of interventions, global support is needed to speed up financing, planning and distribution if the RBM Partnership is to be successful by 2010. In particular, three main steps are needed.
Conduct robust country planning. A roadmap analyzing quarter-by-quarter[40]Quarterly as an example; other time frames could be more appropriate depending on the objective. delivery needs and funding availability will be developed at the country level based on a country Needs Assessments. These plans will be developed with local RBM partners including governments, NGOs, multilateral and bilateral partners, civil society, NGOs, academia and others.
Accelerate and expand financing. An RBM Harmonized Working Group (HWG) analysis of country needs versus donor funding timelines indicates that funding will not be available for earliest distribution windows, even if the major donors (such as the Global Fund and the World Bank) accelerate their disbursements. New national and international funding sources are needed for the near term to cover this gap.[41]Update from the Harmonization Working Group presented at the RBM 14th Board Meeting, May 2008.
Click for source
Speed up procurement and distribution. There are several ways to speed up procurement and distribution of interventions. For instance, the use of third-party procurement agents for LLINs proves to be 2-3 times faster than country-led procurement mechanisms[42]Funding and procurement challenges facing rapid scale-up of Long-lasting insecticidal nets to reach the 2010 targets. World Bank, Presentation at RBM 14th Board Meeting, May 2008.
Click for source and will be a key success factor in achieving the 2010 targets for LLINs. See Figure II.8 for preliminary estimates of delivery needs aggregated for sub-Saharan Africa.[43]A roadmap for reaching the LLIN target as part of a comprehensive package of malaria control interventions, RBM, June 2008.
Figure II.8: Projected LLIN deliveries in sub-Saharan Africa to reach universal coverage
Source: Achieving the Roll Back Malaria Partnership 2010 targets and fulfilling the United Nations SG's Call to Action - A Roadmap for reaching the LLIN target as part of a comprehensive package of malaria control interventions; RBM Harmonization Working Group
As interventions are rolled out, increased focus by countries and partners on communication, behavior change, monitoring and evaluation activities becomes all the more essential to ensure interventions are reaching those who need them and are being used appropriately.


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Social Media Marketing Intern
Bookmark This
Southern California Fine Music Center
4912 W Slauson Ave.,
Los Angeles, CA
At Southern California Fine Music Center, parent company of the Ladera Music Academy, we believe that making music should be a fun, stimulating, stress-reliving, and self-expressive endeavor. After two years in the after-school enrichment field, we have expanded to open a location to further serve the community. We are looking for team members who will bring their passion to our hard-working team. The Social Media Marketing Intern will assist in developing & fostering our online presence. The intern may complete some work home but will be requested to come in at least once weekly. The internship is on-going. There is an opportunity for permanent, part-time placement.Responsibilities
• Monitor and engage on Twitter, Facebook and LinkedIn through HootSuite• Put together regular newsletters in ConstantContact
• Internet research to find relevant blogs for guest blogging
• Follow and list appropriate people on Twitter
• Communicate exciting news
• Update website, as needed
• Work on SEO, including keyword research, on-page website optimization, link building, other off-page optimization, and more.
• Reputation Management through monitoring the web for comments about the company and its products or services. Individuals should try to resolve negative comments while highlighting positive comments and strengthening relationships
• Maintaining & building email list
• Design & draft emails
• Familiar with Twitter and Facebook• Passionate about Social Media
• Friendly and conversational
• College GPA at least 3.0
• Must be detail oriented, team player and technologically savvy
• Must be comfortable with Microsoft Excel
• Fast Learner

subset: commoncrawl


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Photos: Verbolten coaster at Busch Gardens Williamsburg
The Verbolten coaster opening in 2012 at Busch Gardens Williamsburg will take riders on a German-autobahn-themed ride in a sports-car-styled train.
Image 1 of 13
Lightning bolt
The Verbolten name is a play on verboten, German for forbidden. A bolt of lightning figures prominently in the stylized V logo for the ride.
Featured Stories
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I am studying the history of both, The Dexter Family and The Washburn Family. |
Journey Through Time - Dexter Geneology
Updated September 21, 2000 |
Daniel George Dexter email@example.com |
Edit Your Page |
Family Tree Maker Reports and Trees |
The content shown on this page has been submitted by a Genealogy.com customer, and is not subject to verification by Genealogy.com. Neither Genealogy.com nor its affiliates are responsible for the accuracy of any information contained on this page. The opinions expressed on this page are the author's alone and not the opinions of Genealogy.com.
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claire - 03/03/2001
Try this dance you'll love it coz you can dance it to loads of tunes and its a nice dance for improovers
Bob The Builder
Catherine - 02/03/2001
I think this is a great dance because it's fast and fun to dance.
This Will Be
Gillian - 01/03/2001
Absolutely fantastic dance - phrased beautifully to the wonderful music. Never seena reaction like it to a dance before!! Cheering after the kick section because it just goes so well. Don't let length of dance put you off, steps are fairly easy, it's just getting used to the order. Congratulations Max - a surefire 'hit' in my opinion, and hopefully a dance we'll be doing for a long time to come.
Rhythm Of The Night
sue denning - 01/03/2001
excellent, first class dance, very well received by everyone in our class, a real joy to dance to, well done phil
7 Digits
Allan Beauchamp - 01/03/2001
I'd give 10 hats if possible this dance is so much fun to do,we do need more dnaces like this
Down On The Corner
margaret - 28/02/2001
This dance is fun. It gets hilarious when people are facing different directions and seem to get "lost" in the dancing.
Nicola Glenc - 28/02/2001
I think this dance is 'The bomb' i totally love it, it fits so well to the music. Don't let the # of counts put you off, it's not hard - It's a fab intermediate dance. Well done Rachael!!
Mack The Knife
John Dowling - 28/02/2001
What a fantastic dance. A great up-beat version of the song gives you no option but to get up and give it some. I remember Brian Setzer from hi Stray Cats days and he's lost none of his style. A case of where a line dance and non-country music fit perfectly. Rachael has written a winner!
Keith Zammit - 28/02/2001
Nice simple little dance. I quite like when we do it do "Cannibals" by Mark Knopfler (its on the No.1 Line Dancing Album, they have it in Chelmsford Library)
Put Your Feet To The Beat
Joanne Brady - 28/02/2001
I learned this at the Crystal Boot Awards and brought it home to my weekly class. It went over extremely well! It can truly be done to any well phrased 32 count upbeat music. Thanks Peter!
7 Digits
Tom B. - 28/02/2001
Finally something other than country to dance to, it really is a "club" song and dance.
Just A Memory
Klair Price - 27/02/2001
This is a brilliant, fun dance. As an instructor I found it very easy to break down and teach. My class members think it is great and we believe it has 'staying power'!!! Fantastic.
Liz Bone - 27/02/2001
What a shambles! If you've ever seen a herd of frightened sheep being chased around a field, this is what our class looked like when we first started learning this. Once we'd got ourselves sorted out though, it was fun. Even the most experienced dancers had a bit of trouble, and it's confusing when we changed to the left foot and only did 1/2 the dance before beginning again. It will probably take a little while to get used to it.


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Classic® Veranda Stackable Chairs Cover
Item # WX2-123977
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This item is shipped directly from the factory. To see the expected shipping date, please add to your Shopping Cart. Sorry, no express shipping available. We are unable to ship factory direct items to Alaska, Hawaii, Puerto Rico or APO or FPO addresses.
- Details & Specs
Classic® Veranda Stackable Chairs Cover.
These Covers sure do stack up well! I can tell you that I got real tired of toting our stack of six chairs from the deck down to the basement when it rained, and lugging them back when the sun came out again!
You can cross that chore off your list permanently. One of these handy-dandy Stackable Chairs Covers will let you keep your chairs on the deck no matter what the weatherman has in store for your neck of the woods any time of the year!
Plus features that add up big:- Gardelle¿ protective fabric system
- Won't crack in cold weather
- Click-close straps close over the legs to secure the cover on windy days
- Handles for easy fitting and removal
- Air vent reduces condensation and lessens ballooning in wind
- Adjustable elastic hem cord for a tight and custom fit
- Covers a stack of up to six patio chairs
- 3-year limited warranty.
State Color, as available in the Shopping Cart.
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Motocross Socks designed specifically for offroad riders from Fox, Thor, MSR, A.R.C. plus many more at the best selection and price.
Garrett in WY
love the thick socks!
Read All ReviewsMARK in OR
Amazing comfort and quality for the money
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Best MX socks I've ever owned look great and not too thick.
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4 Responses to "Tom Spencer and Geyata Ajilvsgi Butterfly Gardening for Texas"
By Linda Jo Conn on Oct 12, 2013
I am a member of the El Camino Real Texas Master Naturalists (Milam Co) and our group would like to contact Geyata Ajilvsgi for a possible speaking engagement for our organization. Is it possible to share contact information for her? We have completed a successful project: "Bring Back the Monarchs" at the Milano Junction Memorial Garden in Milano TX and want to continue our education about butterflies and wildflowers.
Our chapter web site is: http://txmn.org/elcamino/
Thanks for any help you can give us…ljc -
By L. A. Garcia on May 5, 2014
Would like to have Geyata sign my copy of, "Wildflowers of Texas".
Need address to send book for her to sign; return postage will be included.
Thank you.


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Transmission Dipstick, Locking, Steel, Gold Iridited, Chrysler, Torqueflite 727, Each
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Date: March 17, 2014
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Trains / Videos
Steamtrain ride Le Crotoy & Classic cars
07:50Authentic steamtraintrip on a railway in the north of France, Picardie, Bay of the Somme. Departure from the village Le Crotoy to Noyelles-sur-Mer and Saint-Valery-sur-Somme and back. At the start…
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Austin Steam Train Association, 501(c)(3)
03:5013.7K Plays / 1 Likes / 0 Comments
www.DoggettBros.com Dir. Daniel Doggett Stewart Doggett Music Will Thomson Special Thanks To: Doc Schoen Ben Sargent Paul Phalen Holly Doggett Cody Eastman Zena Vaughn Gregg…
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Rocky Mountain Express Trailer
01:2622.9K Plays / 14 Likes / 0 Comments
Rocky Mountain Express takes audiences on a steam train journey through the breathtaking vistas of the Canadian Rockies as it tells the epic story of building the nation's first transcontinental…
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Steam Powered by Waste Vegetable Oil
11:5769.7K Plays / 84 Likes / 5 Comments
Grand Canyon Railway is powering its classic steam engine with waste vegetable oil, collected from the restaurants at the South Rim of the Grand Canyon and from Williams. The run occurs September…
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635K Plays / 86 Likes / 4 Comments
The moment you step onboard one of Grand Canyon Railway's restored vintage train cars, you are transported to a seemingly different era where the romance of train travel surrounds you. The ground-shaking…
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Dubai hotels |
About Expat Holidays
Expat Tourism LLC are part of the Expat Group which was set up in Dubai by a group of expats from the UK. The three directors have managed a very successful online travel company in the UK for over 20 years. Their philosophy is simple Offer the same levels of service and expertise to the UAE market that they provided to the UK market, using experienced and qualified staff trained to the highest standards. Provide a user friendly dynamic website that enables all bookings to be made online in 5 simple steps using the latest technology.
Expat Tourism LLC are committed to offering exceptional value for money, choice and independent advice, whilst providing detailed descriptions of each resort and every accommodation to help you choose your perfect holiday. In addition we also offer our clients complete peace of mind as all credit card payments are processed through Barclays secure server and credit card numbers are encrypted, providing you with the best security online. We offer an amazing breadth of choice. Our search system checks every flight departing from the UAE at the touch of a button. Our accommodation is sourced through the most reputable suppliers who offer local knowledge and expertise along with excellent value. To help assist you at any stage through your booking process and to provide you with after sales assistance, we have set up a dedicated helpline - +971 4 435 6612. Our Aim To provide our clients with a fast and efficient booking system, that will help you to find the perfect holiday for the best possible price and is supported by a friendly and dedicated customer service team. We will continually try to improve our service and any feedback you can offer to help us achieve this is greatly appreciated. What Expat Tourism LLC offer Dedication Customer satisfaction is our No1 priority Expat Tourism LLC are dedicated to our customers, we believe in the value of a customer not the value of a transaction. Immediate online reservations Expat Tourism LLC is the first website in the UAE to book all available flights, accommodation and transfers immediately online. No need to wait 24 hours to know if your reservation has been made. Efficiency All our support team are English speaking and trained in the UK with at least 10 years experience in the travel industry. We promise to provide a level of service that Expats cant find anywhere else in the UAE. Security Credit card transactions are processed by Barclays secure online payment system and all data is encrypted by Thawte, ensuring total security. Value We will not be beaten on price. Expat Tourism LLC has a team dedicated to contracting preferential rates with hotels worldwide to ensure that you get the best value possible and benefit from our superior buying power. |


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Available on the Google Play
@iMarwanKhoury -
2014 | 16 tracks
2014 | 1 track
2013 | 1 track
2012 | 1 track
2011 | 1 track
2010 | 10 tracks
2010 | 1 track
2008 | 1 track
2008 | 12 tracks
2007 | 1 track
2006 | 10 tracks
2004 | 9 tracks
2002 | 6 tracks
Marwan Khoury
Marwan Khoury is a Lebanese composer famous singer, born in 1968. His name sounds in Arabic books of musicology and the compilation of songs by stars in the Middle East.
Very young, he studied musicology in his native country, specifically the piano and music history at the University of the Holy Spirit - Kaslik in 1986. Studious student, he won the first prize in composition, as Lebanese President Amin Gemayel at the time gave him in person. He began his career writing lyrics and melodies for other artists such as Asalah Nasri, Najwa Karam, Majida El Roumi and Nawal Al Zoghbi for whom he composed the two songs "Tia" and "Dalaouna". Parallel to this, he played for the other celebrities Lebanese concerts as a pianist.
"Kasak Habibi" was his first single, however, mark a turning point in his artistic career. The success of this first title will get him to compose and produce two consecutive albums: "Khayal El Omr" (2003), which includes 7 tracks, and "Kel El Qasayed" (2004). For the first album, Marwan received a Golden Murex for Best Composer for the song "Ya Shoq" whose video clip was directed by his brother Claude Khoury, artistic director.
"Asr El Shoe" is the name of his third album. It contains 9 songs all signed by him. Some consider that this is certainly the most accomplished work of Lebanese artist because of his romantic touch and innovation in the Arabic song. The output of this third album, "Asr El Shoe"(2006) has definitively confirmed the role of Marwan in the Lebanese pop industry.
During his career, Marwan Khoury has written songs for many artists such as: Fadel Shaker, Shireen Abdul Wahab, Saber Rebai, Carole Samaha, Najwa Karam, Myriam Fares, Nawal Al Zoghbi, Asalah Nasri, Cheb Mami, Elissa and Majida El Roumi.
In 2008, he released his album "Ana We Leil" with Rotana. He collaborated for the first time with Dany Khoury in the organization of the whole album, especially after the success of "Ya Rab". The album made huge sales figures and was number one in the charts for several weeks.
In 2010, Marwan Khoury collaborates with Rotana for the release of his album "Rajain." It was not until the year 2012 for the launch of a single "Kena Etafakna." The song received a quick success and was filmed as a video clip by the director Claude Khoury.
In 2013, he released two singles: "Albak Ala Albi" and the song "Al Aad Al Aaksi" of the TV series "Loaabat El Mawt."
Marwan Khoury has participated in many concerts and festivals in Lebanon and the Arab world, including the Carthage Festival, Mawazine and the Opera House in Egypt...
In November 2013, Marwan launched his single "Mich Aam Bitrouhi Min Bali" during an episode of the ninth edition of "Star Academy".


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Physician Assistant Program Alumni
Welcome back to Penn State College of Medicine! We're glad you're visiting the PA program website.
If you're a Penn State PA graduate from the 1974-1986 program, you've come to the right spot.
Would you like to attend an upcoming event, become involved with our program, or simply update your information? Use the tabs listed below to assist you.
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If you are interested in becoming involved with the Program, either as a potential student mentor, clinical preceptor or otherwise, please email Program Director, Christine Bruce, at firstname.lastname@example.com
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Update Your Information online through the Penn State Alumni Association or email Alumni Relations at email@example.com to update Penn State and the College of Medicine with any new information.


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Your participation will advance liberty. Join us as an Independent Institute member. The Independent Institute100 Swan Way Oakland, CA 94621-1428 510-632-1366 Phone 510-568-6040 Fax Send us email Interested in working with us? Click here for more information.
Iraq, Afghanistan, War, and Money: A Look at Two Presidencies By Anthony Gregory | Posted: Mon. March 7, 2011


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Williams FW 28 - turning vanes 09 June 2006
The area immediately in front of the sidepods is a crucial one in terms of a car's overall efficiency. At Silverstone Williams have reintroduced a solution seen on last year's car - a narrower and more pointed turning vane, profiled like a wing, replacing the squared flat one used more recently. In addition, the small barge board in front of the main one has been removed to reduce turbulence. These changes improve the aerodynamic balance of the car at high speed, the compromise being a slight loss of stability in slower corners.


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Australian industrial laws not so bad, says Computershare
PUBLISHED: 28 May 2013 11:57:00 | UPDATED: 29 May 2013 00:33:14PUBLISHED: 28 May 2013 PRINT EDITION: 29 May 2013Computershare CEO Stuart Crosby says, "the employment law problems we have are not in Australia, they are in other markets." Photo: Louie Douvis
Labour market
Shaun Drummond
Computershare chief executive Stuart Crosby said labour market flexibility has more to do with culture than regulation and aspects of Australia's industrial relations laws were better than in Canada or Europe.
The share registry company has sacked a third of its staff in each of the company's four biggest markets – the US, Britain, Australia and Canada – since 2008.
Mr Crosby said the layoffs were much more expensive to do in Canada although it hasn't been "dramatically easy or difficult" in the other jurisdictions.
"I think I may be about to be a bit of a heretic, and it may not make me popular with my peers, but honestly the employment law problems we have are not in Australia, they are in other markets," he told The Australian Financial Review at the Group of 100 annual conference in Sydney on Tuesday.
In Canada, for instance, he said termination benefits were "horrendous". He also said there is no mandatory retirement age, "so people will just hang on and you end up having to pay them two or three years' salary".
Continental Europe – particularly Germany, Italy and France – were also "horrendous in terms of managing a flexible workforce".
But he said the flexibility of the US workforce, so feted by business, has more to do with culture than regulation. "We have just laid off hundreds of people in Pittsburgh, but they all get up and move to Denver, to wherever the job is," Mr Crosby said.
However, in Germany, where Computershare has offices in Munich and Frankfurt, he said workers were much less willing to move to where the jobs are.
"If someone in Munich loses their job, they will not look at anything more than half an hour's tram ride from where they live."
The Australian Financial Review
Read more
Companies | Computershare Ltd |
People | William Crosby |
Topics | Employment & Industrial Relations, Financial Services Industry, Technology /Online Services |
Management, Economy |


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The Near-Term Shift in Risk Sentiment
The U.S. equities market has stole the spotlight and there's no doubt that the market is on a good bit of "hope-ium" as the risk seems to be coming back on the table. But is it really? As a forex trader there are markets we look at to confirm that the risk is truly on the table. So far, there are more signs of confusion ahead than clarity.
Examining a number of interrelated charts is the key to understanding the global view on risk, not just the U.S. The fundamentals have not shifted in any significant way. Just a glance at the headlines show that there's still plenty of pessimism to go around surrounding China's slowdown, the European debt crisis, low commodities prices, and a strong U.S. dollar.
And yet, the U.S. equities market seems to be shrugging off this fear and worry as the Dow and S&P are rallying
Past performance is not indicative of future results
The Dow Jones Industrial Average has broken the downtrend. "Risk off" has been the dominant trend for over a month and today's rally and move to the 50 period SMA close is the confirmation that while there may be exhaustion in the market off the near-term ceiling, the downtrend is no longer the dominant trend.
Past performance is not indicative of future results
Crude oil is not rallying at all despite the Dow's gap up this morning; in fact the trend is still convincingly down. This lack of participation from the "king of commodities" must be a concern for equities bulls. Without participation from commodities, it will be difficult to convince a longer-term crowd to buy into the rally.
The U.S. Dollar Index's strength notwithstanding the risk off (risk aversion) outlook is still holding on to many markets like the AUD/JPY and EUR/USD. The AUD/JPY has shifted sideways enough to put the downtrend in jeopardy and strengthen the argument for a pair that is not entering a potentially choppy sideways market.
Past performance is not indicative of future results
The daily AUD/JPY is not showing the strong RISK OFF attitude that was seen in the steeper part of the downtrend. The Japanese yen has begun to weaken with equities strength and the Australian dollar is more stable. The recent rally (a bounce) has done enough to transition the daily AUD/JPY out of the downtrend. But do not assume that a broken downtrend is automatically an uptrend. Look for sideways chop as transition invites volatility.
Past performance is not indicative of future results
The daily EUR/USD (aka the "fiber") had gapped higher into the resistance of the 34EMA Wave before losing footing and slipping lower. This is in fact not only a gap close to 1.2500 but also the follow-through for a swing short. It will be difficult to convince longer-term traders and investors to get prematurely optimistic while the fiber still is hammered on rallies.
As an active forex trader and Chief Currency Analyst for InterbankFX.com I do write for a number of sites all over the web and I am happy to say that I will be posting updates at www.IBFXconnect.com. My Activity Board will feature the trades from my trading account as well as intraday commentary.
Start the discussion! Questions? Comments. Leave it here at the Daily Forex Trading Edge for Raghee to personally answer. Using the icons at the top of the article to forward this update to a friend via email, post it on Google or Facebook or simply print it out for reading later.
Forex trading is one of the riskiest forms of investment available in the financial markets and suitable for sophisticated individuals and institutions. The possibility exists that you could sustain a substantial loss of funds and therefore you should not invest money that you cannot afford to lose.


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Lawrence "Larry" Perez spots a white BMW 750Li blowing through a stop sign at the intersection of West Flagler Street and SW 62nd Avenue. It's about 20 minutes past 10 p.m. The husky, bald Hialeah Gardens police detective flips on the blue-and-red lights inside his unmarked silver Ford Fusion and pulls the Beemer over.
He asks the driver, Wilfredo Gonzalez, and the passenger, Danny Zequiera, for their IDs and then sniffs the air. "I smell something strange," Perez announces. "Open up the trunk."
Inside is a duffel bag packed with ten pounds of marijuana belonging to Zequiera. Perez arrests Gonzalez on the spot but lets Zequiera go. A few minutes later, a white tow truck with the words "Good Fellows" stamped on the door whisks the BMW away.
It might sound like an ordinary pot bust, but the car was never sent to an impound lot. Gonzalez was never booked into jail, and the ten pounds of pot — worth $33,000 on the street — never ended up in an evidence room.
Zequiera didn't know it, but he'd been victimized in a plot hatched by Carlos Teran, a rival drug dealer nicknamed "El Negro"; Gonzalez, a pot middleman; and Perez, a dirty cop way out of his jurisdiction.
Perez's story — outlined in interviews and hundreds of pages of court documents — opens a window onto what has become an increasingly common tale in Miami-Dade: cops turned by greed or desperation into working for the drug dealers they're supposed to be busting. In the past two years, federal prosecutors have charged four Dade-area cops, including Perez, for helping dealers. The others are:
• Miami Police Officer Roberto Asanza, arrested last June after the FBI found ten bags of cocaine and two bags of marijuana from a drug bust in his truck. A yearlong investigation revealed Asanza had swiped the drugs and given them to an informant. Asanza pleaded guilty to a misdemeanor charge in exchange for helping in another case.
• Opa-locka Police Capt. Arthur Balom, charged last November with eight counts of trafficking Ecstasy, cocaine, and oxycodone. Federal prosecutors say Balom also protected a violent drug gang by tipping members off to police raids. Balom's trial is pending.
• Miami-Dade Police Officer Daniel Mack, indicted April 11 for helping a Miami Beach code inspector transport what they thought were more than a dozen kilos of cocaine in exchange for $25,000. He was charged with four counts of cocaine possession with intent to distribute. His trial is pending.
It's not clear whether increased numbers of cops have been helping drug dealers or if the feds are just upping their efforts on the problem. Some experts, though, say there might be a link between plunging budgets and greater temptation.
"Cops have to pay bills too, and we know the economy has been bad," says Bob Jarvis, a Nova Southeastern University law professor who co-authored Out of the Muck, a book about corruption in the Broward Sheriff's Office. "When that happens, you have more of a chance to flip a police officer into committing a crime. Certainly a cop in Nebraska doesn't have the same opportunity to protect drug dealers like a cop in Miami does."
Jarvis's theory seems to fit the bill for Perez, a cop whose life at first seemed like an American success story.
Born in Newark, New Jersey, on May 22, 1967, Perez had a rough childhood. His biological father abandoned him and his Ecuadorian mom, Linez Alvarez, when he was 1 year old. He and his mom soon moved to Miami, and she remarried. In court, Perez said he had wanted to be a cop since he was a kid: "It was my dream to help people and do what I saw police officers do."
But after finishing 11th grade, Perez dropped out of Miami Senior High because his stepdad had died of respiratory failure. "I had to help my mom by working," he said. He found jobs as a busboy and a waiter and later as a school bus driver and, by the late '80s, a county bus driver. In 1989, he married his girlfriend, Adela Rodriguez. Seven years later, the couple purchased a three-bedroom house in Allapattah for $107,500.
One of his neighbors, a Cuban-American electrician named Luis Agular, recalls fixing the wiring in their house for free as a way to welcome the young couple to the neighborhood. "We became fast friends," Agular says. "Every weekend, I'd have him and his wife over for breakfast. He's my daughter's godfather."
Agular, who cannot read English, says Perez would help him write bid proposals for electrical work on county projects. "He was always willing to help," Agular remembers. "He's a tremendous person."
In late 1996, Agular taught Perez how to ride a motorcycle. Perez soon bought a used Harley-Davidson and joined his neighbor's motorcycle club. That's where he met Teran, a 53-year-old originally from Matanzas, Cuba.
The two bonded instantly. During later testimony, Teran said he'd regularly go on double dates with his new pal and their spouses: "We'd go to restaurants and motorcycle shows. We would ride down to the Keys together."
Perez never gave up on his dream of becoming a cop. In 2004, at age 36 — two years after Adela gave birth to their daughter, Lauren — he passed his GED test and enrolled in the police academy at the Miami Dade College North Campus. For nine months, he drove a Metrobus from 5 a.m. to 2 p.m. and then attended class from 4 to 11 p.m.
"who cannot read English" It amazes me how more than half the Cubans who come to an English speaking country don't learn English. Every other immigrant who came to America in history learned English and became Americanized, not most Cubans. My best friend is Cuban and his family moved North because they are ashamed how people act in Miami.
so now he is in jail and lost everything including his wife and will never be a cop again.
However she may justify it, JliciousB is still a whore for cheating on her boyfriend. What the hell does she have on her lip ???
they told me that you are a desk rider,and great as a parking meter maid,but i like you
You know I was speaking to someone the other day about the Russian Mob. They're all over Fisher Island. I feel like there are no good cops left in South Florida... I think even the FBI is aware and prolly some of them (FBI) are as crooked as these bum cops.
majority of local police in miami dade county are criminals,majority of fbi agents in south florida have no idea what is happening here,and yes when was the last time when they got anyone from russian mafia.


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Alumnae Faculty Leadership Award
For Outstanding Faculty Leadership resulting in added benefits to students. This award is presented annually to a full-time or part-time faculty member of Saint Mary-of-the-Woods College. The National Alumnae Association believes that by recognizing outstanding faculty leadership, it will, in turn, aid in the strong future of Woods Alumnae.


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Marty Ernesto Flores, 44 of Carson City, passed away on Jan. 18, 2013. Autumn Funerals & Cremations is trusted with the arrangements. 888-6800.
- Assemblyman Richard Carrillo arrested on suspicion of DUI
- Cutting through histrionics of immigration decision
- Will the real Kaepernick please stand up
- Boys and Girls Clubs of Western Nevada youth of year named for her resilience, determination
- Two Carson City businesses cited for selling alcohol to minors


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For me, this man is the embodiment of a manner of acting not just in journalism but in politics, a manner that has undeniably gained widespread acceptance and that, over time, has turned into one of the country's ways of life. In the beginning, Clinton; then the gossip about Gore's mental health; then the scurrilous rumors making Tom Daschle an agent of Saddam Hussein; then, more recently, the ads by the so-called Swift Boat Veterans for Truth, the 527 group aiming to sully Kerry's military past. I won't go into all that, obviously; I'll also pass over the cases—for there were several—in which the Democrats, through their own 527s, tried their hands at this base game. But in the end, the example is there: each time, it's the same combination, expertly applied, of insinuation, gross lies, and media hype; each time, it's personal attacks and manhunts instead of the exchange or clash of ideas. Step by step, it's a degrading of public debate, of which I know no equivalent in any other democracy, and which, all in all, is profoundly worrisome.
A modest suggestion, then, from a reader of Tocqueville who cannot forget and doesn't want to forget that this is the same America that invented modern democracy. A humble proposition to the newspapers I see involved in the formidable task of self-criticism: I'd like to be able to convince them that David Brock deserves treatment at least as severe as that meted out to Jayson Blair, Stephen Glass, and Mike Barnicle (the falsifiers from, respectively, The New York Times, The New Republic, and The Boston Globe).
Of course, these publications aren't the only ones at fault in the degradation of public life. We should not leave it to them, in place of politicians, to perform a postmortem on the corpse of calumnies; and certainly we should not leave it to them to try to rehabilitate the public arena, without which a democracy wastes away.
But still …
Imagine the leading media reaching a decision on some kind of minimal ethical charter. Imagine them agreeing on the absolute necessity of respecting the private lives of political leaders. Imagine them proclaiming the inalienable character of this new human right: not, as Baudelaire proposed, the right to contradict yourself and the right to leave, but the right to privacy.
Envision a solemn declaration by which the papers, radios, and networks would enjoin one another from ever acting as the echo (whatever the form of this echo, whether underhand, or mock-hypothetical, or warning-like, or seemingly disinterested) of any ad hominem attack that hasn't passed the test of those famous fact-checking techniques at which they're self-professed experts.
Picture a journalist who has publicly confessed that he made up information with the sole aim of hitting a president "between the eyes," or launched, without verification, the appalling accusation against a presidential candidate of having invented, exaggerated, or simulated his war wounds. Imagine this journalist, this rabble-rouser, being banned from his profession with the same vigor as a plagiarist or a fabricator of interviews in this country.
A different paradigm might be created. Junk politics in its entirety might turn out to be less profitable. And for American democracy it would be the most resounding way of reviving the legacy of Thoreau, Emerson, and, of course, Tocqueville.
This is a personal anecdote, but one that says so much about the security-related neurosis that reigns in this country that I can't resist the temptation to record it here.
I get a phone call informing me that my daughter has just given birth. Naturally, I decide to travel back to Paris to see mother and child.
The problem is that with a final meeting in Washington that same night, and a dinner the next day in Baltimore that's difficult to cancel, I see I have exactly enough time to make the round trip in its literal sense: takeoff from Dulles Airport on the last plane, at 11:00 P.M.; landing at Charles de Gaulle at noon the next day; a motorcycle that will take me to the clinic, wait for me, and return me just in time, two hours later (having so to speak fit myself into the regulation period for cleaning, inspecting, and refueling the aircraft), to take the same plane back and be in Washington for dinner.
It's tight, but doable. Somewhat ridiculous, but important all the same.
So here I am on that night, at the appointed hour, in the middle of a long line of passengers waiting to check in for the flight to Paris.
In front of me a couple of young people are arguing in low voices about the nature of their affair: Are they "dating" or are they in a relationship? If they are just dating, how serious is it? And isn't the fact that the boy didn't invite the girl to Thanksgiving dinner at his parents' house an obvious obstacle to its being a full-fledged relationship? It's simply a mystery to me, since this most American notion of "dating" has no equivalent in French … This very un-French way of turning the date itself, and later the relationship as such, into a separate entity, living its own life alongside the two lovers … The oddity, too, of the mania these lovers have for verbalizing, evaluating, codifying, and, when it comes down to it, ritualizing anything that might happen within the framework of their relationship … For the sake of a series of social gestures, which suddenly become nothing but gestures, that sense of the unexpected, the romantic, is lost, which in Europe even the most trifling love affairs preserve … I observe all this with infinite curiosity.
Behind me, a woman who read my first articles in The Atlantic starts asking me questions—gently, though, with that extreme politeness that always makes me wonder whether this tone is feigned or sincere, and which in any case is the exact opposite of the outright screaming match I'd have been treated to under similar circumstances in Paris. A reader, smiling, benevolent, who reproaches me for the attitude I adopted in my analysis of the megachurch phenomenon, especially in Willow Creek: Why do I mock these new churches? Why not pay attention to the good they might bestow on the men and women of today? What about the community ties they establish? The generosity they exhibit? The fact that Bono, for instance, appealed to them when he launched his campaign for awareness of AIDS in Africa?


text: Comparing SQL Server 2008, MySQL and PostgreSQL/PostGIS July 21, 2008 by James Regina Obe has developed a table to compare the new SQL Server 2008 with PostgreSQL/PostGIS (with MySQL thrown in there to boot).? The table does a wonderful job showing the comparative strengths and weaknesses of all three relational databases. Share this:EmailTwitterFacebookGoogleLinkedInPocket


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What can we learn from Glasto???
There is something unique about Glastonbury; it has an aura and reputation unlike any of the other festivals on offer over the summer period. Whilst music fans scramble to get tickets, bands are also busy trying to make sure they are on the lineup for Britain's most famous live music event.
And when a group of the guys here made the trek to Glasto this year it made me think – are the comparisons between a band getting on the lineup & a candidate getting an interview for a new gig (pardon the pun). Here's what I've come up with:
Bands Getting on the line up | Candidates getting an interview |
Must first decide whether Glastonbury is the right Festival for them, i.e. given the festival genre, their experience and their fans will it be a good fit. | Must first decide whether a Company is the right one for them, i.e. given the company culture, their experience and their career goals will it be a good fit. |
Must fight for the attention of the promoters. | Must vie for the attention of employers'. |
Realise that getting booked is just the start of the hard work! | Realise that getting an interview is just the start of the hard work! |
Need to prepare – before stepping on stage Bands need to prepare an entertaining set, select the right songs to play, and practice, practice, practice to make sure they're ready to perform. | Need to prepare – before stepping into the interview Candidates need to prepare their career story, think about the questions they have, and practice, practice, practice to make sure they're ready to answer the tough questions. |
Should understand that playing at a festival they're effectively competing for audience with the other bands that are also playing. Delivering a polished performance on stage is therefore the bare minimum. | Should understand that when interviewing they're effectively competing with other candidates that are also being interviewed. Delivering a polished performance in the interview is therefore the bare minimum. |
Festivals provide bands with the perfect opportunity to promote their music, get noticed and kick start their careers. | Interviews provide candidates with the perfect opportunity to promote their skills/ experience, get noticed and kick start their careers. |
So, who knew being in a band and the job hunt were so similar?
I guess there's just enough space left for the blatant plug – if you're looking for a way to stand out from the crowd and drive your career forward, log on to Zookel. Think of it as the Glastonbury of job sites – the best place to get noticed!
Zoe & Team Zookel


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Su Socio de Negocios DesayunoSu Socio de NegociosWednesday, February 27, 2013 from 7:00 AM to 9:00 AM (PST) |
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When & Where
El Clasificado Headquarters
11205 Imperial Hwy
Wednesday, February 27, 2013 from 7:00 AM to 9:00 AM (PST)
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Humanist groups gathering anywhere will have a model and a stimulus for growth according to best practices.
The Humanist movement will have a network of high-functioning local organizations that will generate new members, advocates, and supporters for national organizations such as the American Humanist Association, Secular Coalition for America, Foundation Beyond Belief, and Secular Student Alliance.
Around the world Humanism will be represented by thriving communities, bringing together people of like minds to share views and serve others. These communities will help religious and nonreligious people alike to understand that Humanism is an ancient, evolving tradition with importance equal to that of the world's major worldview traditions.
Where you live: There will be a community center where you can come to meet new friends, learn about Humanism, build a better world, raise a Humanist family, and be a better person.
At Harvard: Secular students at Harvard and beyond will develop as ethical, compassionate, fulfilled individuals, inspired by Humanist values and by connection with a community and movement of Humanist peers.


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Four of our contests are closing tonight. Have you entered yet? Well, here's your last chance. Follow the links below for more information and to sign up.
Click here to enter the Anthony Logistics For Men contest.
Enter to win free nail polish, sponsored by Boys In The Bottle.
Are you a girl with curls? Then don't let The Curl Cloth contest pass you by.
Three lucky winners will receive the cutest Felix Rey cosmetic case you've ever seen!


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About Us
Everyone's been told that getting there is half the fun. But what about the other half? The being there half? The promise of landing smack-dab in the middle of fun (or adventure or excitement or just something new) is why we put ourselves in motion. It's why we go to such lengths and hassle to temporarily uproot ourselves from the places we call home. We travel to immerse ourselves into experiences that are enriching, invigorating, and are fantastic for their unfamiliarity.
But instead, travelers often find themselves settling for very un-special places. They're there because they just couldn't find anything better. Or because they couldn't resist the siren call of reward points…those amazing little numbers with the magical ability to transform a year of have-to business trips into a can't-wait, life-changing getaway.
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Become a Stash Partner Hotel to build loyalty and attract new business.


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Rob returned to Los Angeles on July 23 and got a whole lot closer to his ex Kristen Stewart in the process. So to get his mind off of it, the 'Twilight' star headed out for a fun night with friends on July 24. Read on.
Robert Pattinson had himself a nice homecoming on July 24 after returning to Los Angeles from filming Maps to the Stars in Toronto, Canada.
Robert Pattinson Parties With Michelle Rodriguez & More Friends
The 27-year-old actor went out with an artsy-cool group of friends that included Fast & Furious actress Michelle Rodriguez, actor Simon Pegg, and artist/photographer Tasya van Ree. The tight-knit group of friends hit up the Chateau Marmont, one of Rob's favorite spots in Hollywood, where they were spotted by a few fans.
"To all Robert Pattinson fandom yes it was at Chateau & yes he was dining w/ friends & Michelle eventually joined them," Twitter user Brianna Morelli tweeted.
Rob and Michelle at one point took a few minutes off from the party to go for an intimate smoke break, according to Brianna. Brianna also couldn't help but state how good Rob was looking: "Oh michelle rodriguez and robert pattinson are here sup buddies but damn let me tell u that piece of white chocolate can rock a beanie." We agree, Brianna.
In a photo posted by Tasya, the group of friends clearly look like they're having a blast, as she and Michelle goofing around while Rob chats up another friend in the background. "Gallivanting," Tasya captioned the photo.
Robert Pattinson: Still 'Sad' After Kristen Stewart Breakup
A fun night out is exactly what Rob needed after returning to Los Angeles, where he's likely constantly reminded of the pain from his breakup with Kristen Stewart. Even though it's been a couple months since they split, he's still feeling the effects, a source tells HollywoodLife.com exclusively.
"Does he get sad about Kristen? Of course — they went through a ton together."
But the source also stated that he gets his mind off of K-Stew by working and by hanging out with his close friends, so we're happy to see him enjoy a night out with Michelle and company.
What do you think, HollywoodLifers? Let us know!
WATCH: Robert Pattinson Spotted Kissing Mystery Girl
– Andrew Gruttadaro
More Robert Pattinson News:
- Robert Pattinson Hasn't Ruled Out Reuniting With Kristen Stewart
- Robert Pattinson's Night Out In Los Angeles: Avoiding Kristen Stewart?
- Robert Pattinson Cuddles Up To Kyle Richards' Daughter In New Pic
View Comment
Posted at 11:00 AM on August 1, 2013
Posted at 11:14 AM on July 31, 2013
Hollywood is not going to stop with their lies until they suck as much money out of our Twilight obsessions as they can.
With Katy Perry's recently confirming that Kristen & Robert's romantic relationship WAS REAL – I've got a BELIEVABLE explanation about those cheating photos that MOST COINCIDES with Kristen's public apology. I know we've been debating whether or not that apology was real – but ANY publicist would have advised her to come clean as soon as the situation happened. The source for that apology COULD have been someone in Kristen's camp.
Kristen did NOT cheat on Robert with Rupert (this is the reason they reunited so soon) – she got caught fending off a predatory boss, and the photos were manipulated to either make things look WORSE to drive us all as crazy as possible, OR they were manipulated to 'tone them down' so Twilight Fans would be more easy to manipulate through all this.
The MAJORITY of Hollywood's stories at the time ALL the way up until now have been outright LIES because they are TRYING to get Kris or Rob to 'say something' – because if they can get them to correct what's being said about them, that's more REAL fodder for them to twist around for us, which equals even MORE money for them.
I even thoroughly DEBUNK the 'staged stunt' and 'fake photo' theories. It's FASCINATING – you have to read between the lines, Ladies. Come check it out and SIGN the PETITIONS to set them and us FREE from these Hollywood LIES.
Search: explaintwilightbreakingdawnending on blogspot – just like that. I just got done putting up a condensed SUMMARY about all of this right up at the top so you don't have to search around for it.
It would be really cool if we Twihards could UNITE and SHOCK THE WORLD with this big TwiBomb as an Anniversary Present to our beloved Hollywood's Gossip Tabloids and Paparazzi who care SO DAMN MUCH for Freedom of Speech!