text:
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Despite the fact that the WHO's "3 by 5" target—ie,
getting 3 million people in low-income and middle-
income countries on antiretroviral therapy by the end of
2005—was not reached, a lot of progress has been
made.1Today it is evident that to scale up the roll out of
antiretrovirals even more, we will need to further
decentralise antiretroviral services, and this will require
new and less expensive ways to monitor the virological
efficacy of treatment.2,3
In developed countries, the decision to change
antiretroviral therapy is based on a rise in viral load, a fall
in CD4+ lymphocyte counts, and the presence of drug
resistance.4Monitoring the efficacy of treatment in
countries with limited resources is more difficult because
of inadequate laboratory facilities, a shortage of trained
staff, unreliable electricity supply, and costly reagents.
Even where such tests can be done, most HIV patients in
developing countries do not have access to them.5
Here, we review existing methods to monitor the
effectiveness of antiretroviral treatment, and propose a
new model that could be used in resource-limited
settings. The purpose of the model is to diagnose
virological treatment failure early enough to allow a
switch to second-line regimens. Changing treatment
early will prevent resistance from developing further,
both in the individual and in the population.
The model is largely a result of the experience of
physicians working at the Infectious Diseases Institute
(IDI) of the Makerere Medical School in Kampala,
Uganda. The institute's clinics in Mulago hospital offer
medical treatment free of charge to more then
12 000 adults and 3000 children with HIV, of whom
about 3000 are being treated with antiretrovirals. The
IDI laboratory can measure CD4+ lymphocyte cell
counts and test viral load, but does not have enough
funding to offer these tests routinely to all patients.
Weekly meetings are held to decide which patients are
failing antiretroviral treatment, and whether a switch to
second-line antiretroviral therapy is justified.
Existing methods for monitoring the efficacy
of antiretroviral therapy
The effectiveness of antiretroviral treatment can be
monitored virologically, immunologically, or clinically.
Virological monitoring
Virological monitoring has been considered the ideal
method for assessing the efficacy of an antiretroviral
regimen. However, HIV RNA viral load testing is costly
($15–150 per test), and needs both adequate laboratory
infrastructure and well-trained personnel. Alternative
technologies are being developed for viral load
testing—eg, heat-denatured quantitative p24 antigen
measurement, the Cavidi real-time reverse tran-
scriptase assay, and real time PCR assays.6-12But these
tests are expensive too (about $3–15 per test). The p24
antigen test might be useful in diagnosing HIV
infection in infants,13but this test and others need
further field validation in resource-poor settings before
they are recommended for monitoring antiretroviral
Ideally, drug resistance should be tested for in any case
of virological treatment failure. Complete genotypic
resistance testing, however, costs about $300 per test. A
way to reduce this cost could be to develop tests that
identify only key genetic mutations such as the Met184Val
mutation, indicating resistance to lamivudine, and the
Lys103Asn and Tyr181Cys/Ile mutation, indicating
resistance to nevirapine or efavirenz.14In developing
countries, the generic fixed drug combination of
lamivudine, stavudine (or zidovudine), and nevirapine is
most widely used.15–17Therefore, knowledge about the
presence or absence of these key mutations could help
decide whether an antiretroviral regimen containing these
drugs should be stopped.
Choosing the best second-line therapy needs
additional information about the presence or absence
of thymidine analogue mutations, since thymidine
analogues—eg, zidovudine or stavudine—are often
used in resource-poor countries.
Lancet Infect Dis2006; 6: 53–59
RC is at the Infectious Disease
Institute, Faculty of Medicine,
Makerere University, Kampala,
Uganda, and the Prince Leopold
Institute of Tropical Medicine
and University of Antwerp,
Antwerp, Belgium; KRM, JL, HMS,
FS, FL, SB-K, and HM-K are at the
Infectious Disease Institute,
Faculty of Medicine, Makerere
University, Kampala; LL is at
University of Antwerp, Antwerp;
LS, SJR, and TCQ are at The
National Institute of Allergy and
Infectious Diseases, National
Institutes of Health, Bethesda,
Maryland and Johns Hopkins
University, Baltimore, USA; and
BV is at the Boston University
School of Medicine, Boston, USA.
Correspondence to:
Dr Robert Colebunders, Prince
Leopold Institute of Tropical
Medicine, 2000 Antwerp,
http://infection.thelancet.com Vol 6 January 200653
Robert Colebunders, Kamya R Moses, John Laurence, Hasan M Shihab, Fred Semitala, Fred Lutwama, Sabrina Bakeera-Kitaka, Lut Lynen,
Lisa Spacek, Steven J Reynolds, Thomas C Quinn, Brant Viner, Harriet Mayanja-Kizza
Monitoring the efficacy of antiretroviral treatment in developing countries is difficult because these countries
have few laboratory facilities to test viral load and drug resistance. Those that exist are faced with a shortage of
trained staff, unreliable electricity supply, and costly reagents. Not only that, but most HIV patients in resource-
poor countries do not have access to such testing. We propose a new model for monitoring antiretroviral
treatment in resource-limited settings that uses patients' clinical and treatment history, adherence to treatment,
and laboratory indices such as haemoglobin level and total lymphocyte count to identify virological treatment
failure, and offers patients future treatment options. We believe that this model can make an accurate diagnosis
of treatment failure in most patients. However, operational research is needed to assess whether this strategy
works in practice.
A new model to monitor the virological efficacy of
antiretroviral treatment in resource-poor countries
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Immunological monitoring
CD4+ lymphocyte counts are useful in detecting
asymptomatic patients or patients with minor symptoms
(WHO stage II disease) who need antiretroviral therapy,
or determining when to start or stop prophylaxis for
opportunistic infections. But it is of less value as an
indirect measure of antiretroviral efficacy. Indeed, in
most instances once a patient has failed immuno-
logically, viral resistance has already evolved.
Moreover, the change in CD4+ count might vary from
one patient to another regardless of the virological
efficacy of a treatment regimen. A patient with only a
slight increase in CD4+ levels (?50 cells/µL after one
year of highly active antiretroviral therapy [HAART]) has
not necessarily failed treatment.18,19Conversely, a patient
on an ineffective regimen, and in whom the HIV strain
is resistant to only one or two drugs in the treatment,
may have a continued rise in CD4+ count.20,21WHO
criteria for immunological treatment failure are a CD4+
count that falls below the baseline level or one that falls
by more than 50% after an initial increase.1
Ideally, CD4+ levels should be measured when the
patient does not have an active opportunistic infection
since intercurrent infections can cause these levels to
fall.22But in resource-poor settings, many opportunistic
infections are difficult to diagnose. Therefore, in a patient
who is not doing well clinically, with a falling CD4+
count, it is often unclear whether this is because of an
intercurrent illness, HIV disease progression, or both.
In Africa, measuring CD4+ levels with flow cytometry
can cost $4–25 per test. Because of this high cost,
alternative tests are under investigation, including
microscopic, bead-based manual methods (Dynabeads,
cytospheres) and more affordable modified flow
cytometry (Guava, Cyflow, PointCARE) and other
methods.23,24But these tests are expensive and can be
Measuring the extent of immune activation could be
another way to provide useful information about the
virological response and immune reconstitution of a
patient taking antiretroviral therapy. In European
cohorts, the proportion of CD8+ T cells expressing the
activation marker CD38+ correlated well with the
virological response.30Although data from the Cote
d'Ivoire suggest that monitoring immune activation
could have a role in assessing treatment failure,31its use
in the presence of endemic parasitic or other co-
infections remains unclear, since such infections may
render these markers non-specific.
In poor countries, few people have access to CD4+
count testing. Therefore, it is worth investigating whether
simple laboratory tests such as total lymphocyte count and
haemoglobin levels might be used to predict
immunological failure during
investigators have shown that once a patient's total
lymphocyte count falls below 1200 cells/µL, the likelihood
that they have a CD4+ count below 200 cells/µL is more
HAART. Several
than 90%.32–38There is, however, no total lymphocyte
count cut-off value that has both a high enough specificity
and sensitivity for detecting patients with a CD4+ count
lower than 200 cells/µL.32–38In the Multi-AIDS Cohort
Study, a rapid fall in total lymphocyte count or
haemoglobin concentration indicated an increased
likelihood that HIV infection would progress to AIDS.39
In another study, within the first 2 years of HAART,
whether or not total lymphocyte count rose or fell
emerged as a strong marker for the direction of
concomitant change in CD4+ (sensitivity 86–94% and
specificity 80–85%, depending on length of interval).40
Despite the fact that studies demonstrate increases in
total lymphocyte count in patients receiving HAART,39,40
whether this assay could be a useful method for
monitoring the efficacy of treatment is unclear.41–43
Haemoglobin response to antiretroviral therapy may
also be monitored inexpensively. Although it might not
be the case in all patients treated with zidovudine,44
studies have shown that haemoglobin levels generally
increase in patients on HAART.45,46In a Belgian study in
patients on HAART,42an increase of haemoglobin level
and total lymphocyte count above baseline values at
week 24 diagnosed virological treatment failure with a
sensitivity of 46·9%, a specificity of 59·8%, a positive
predictive value of 76%, and a negative predictive value
of 29·2%. A fall in haemoglobin level and total
lymphocyte count below baseline was as accurate in
predicting virological treatment failure as was a fall in
CD4+ count below baseline.42
Clinical monitoring
As resource-poor settings get better access to
antiretrovirals, they will need monitoring systems that
are different from those in developed countries. Without
laboratory support, especially in rural settings, there will
be a need to rely more on clinical monitoring, using
symptoms and signs predictive of virological failure.
HAART decreases the incidence of opportunistic
infections, including
infection.47,48Clinical signs suggesting treatment failure,
proposed by WHO are: the appearance of new or
recurrent WHO stage III and IV conditions.1
However, during the first 3–6 months after starting
HAART, clinicians might find it difficult to diagnose
treatment success or failure on the basis of clinical
findings alone. In the months after starting on HAART,
patients can develop symptoms that are not caused by
treatment failure but instead represent the side-effects of
antiretroviral therapy, an immune reactivation inflam-
matory syndrome (IRIS),49opportunistic infections that
continue to appear because the patient is still immuno-
compromised, or an infection or re-infection by a
common endemic pathogen such as tuberculosis or
In South Africa, Grant and co-workers have shown
that individuals on HAART had a major reduction in
http://infection.thelancet.com Vol 6 January 2006
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mortality, although this benefit was only seen after
several months of treatment.50If a patient adheres to a
good HAART regimen and has not previously had
antiretrovirals, very few treatment failures will occur
during the first 6 months.51After 6 months of HAART,
clinical manifestations will be more useful for predicting
treatment success or failure. This will be particularly so
in patients who were symptomatic (WHO stage III and
IV) at the start of antiretroviral therapy, a group that
currently represents most of those who start
antiretroviral therapy in countries with limited
resources. These patients' symptoms will have regressed
or disappeared, and they will have gained weight. In
addition, although they might still have occasional
episodes of oral candidiasis, they should not develop
new severe opportunistic infections.
We therefore propose that in symptomatic patients the
effect of HAART can be seen in HIV-related symptoms
and signs—eg, prurigo, chronic diarrhoea, HIV-related
polyneuritis, and HIV-related cognitive disorders in
adults. In children, growth, neurological, and sexual
development are additional features to follow (panel).
In our experience in Uganda, the disappearance or
reappearance of prurigo seems to be a good indicator of
treatment success or failure. Prurigo occurs in at least
10% of African patients with advanced HIV disease.52
Once prurigo appears, in the absence of antiretroviral
treatment, itching and papular eruptions generally
persist and symptomatic treatment is ineffective.
Occasionally, the number of prurigo lesions might rise
shortly after starting HAART (probably due to IRIS) but
in most patients the prurigo disappears within a few
months after starting antiretroviral therapy and
reappears within weeks after HAART is stopped (RC,
H Byakwaga, personal observation).
Asking what symptoms were present before
antiretroviral therapy was started is important. Often,
these symptoms will have disappeared during therapy.
If some of these symptoms reappear, this, in our
experience, suggests treatment failure. HIV-related
polyneuritis is a much less useful clinical index
because these patients have been exposed to
antiretroviral and other drugs capable of producing
peripheral neuropathy. An unexplained weight loss
after an initial weight gain during antiretroviral treat-
ment is another clinical indicator that might suggest
treatment failure.
Kaposi's sarcoma lesions, particularly if lesions are
very extensive and associated with oedema, may increase
after starting HAART because of an IRIS.53However,
mucocutaneous lesions that reduce in size are a good
indicator that the patient is on an effective antiretroviral
A new model for monitoring antiretroviral
The traditional western model of monitoring patients on
antiretroviral treatment with regular viral load and CD4+
lymphocyte counts is not feasible in poor countries. On
the other hand, monitoring only for clinical and
immunological failure is a risky strategy, both for
patients and for the community as a whole. Waiting for
clinical failure might leave patients susceptible to
serious opportunistic infections and allowing patients to
fail virologically for prolonged periods of time will lead
http://infection.thelancet.com Vol 6 January 200655
Panel:HIV-related symptoms or signs predicting
treatment failure
Unexplained persistent diarrhoea
Unexplained persistent fever
Unexplained weight loss
Unexplained polyneuritis*
Unexplained cognitive impairment
Loss of developmental milestones in children
Growth retardation in children
*Drug-induced polyneuritis should be excluded
Risk factors for virological failurePredictive value
of the criteria
Treatment history
Previous monotherapy or bi-therapy with NRTIs for more than 6 months
Previous exposure to nevirapine for the prevention of mother-to-child transmission of HIV
Infected with HIV by partner with a history of antiretroviral exposure
Current "weak" antiretroviral regimen (eg, 3 NsRTI, or 2 NsRTI and 1 NtRTI)
Long-term use of drugs that could reduce antiretroviral drug levels in the system
Adherence history
Day-to-day adherence score (?95% but ?80%)
Day-to-day adherence score (?80% but ?60%)
History of stopping an NNRTI-containing regimen without continuing NRTIs for at least 5 days
Clinical history
Appearance or worsening of unexplained prurigo
Reappearance of unexplained prurigo and at least one other HIV-related symptom or sign
(not in first 6 months, or not thought to be IRIS)
Reappearance of at least two other HIV-related symptoms or signs (not in first 6 months or
not thought to be IRIS)
Body weight equal or lower than the patient's weight before starting HAART or more than 10% Minor
weight loss from peak values in the absence of signs of lipoatrophy
Development of a new WHO stage IV opportunistic infection (excluding extrapulmonary
tuberculosis and IRIS) or malignancy (not in first 6 months or not thought to be IRIS)
A recurrent WHO stage III opportunistic infection
Tuberculosis and no evidence of tuberculosis IRIS (abscess /cavity formation)
Worsening Kaposi's sarcoma
Worsening after initial improvement of Kaposi's sarcoma
Laboratory history
Unexplained fall of haemoglobin of 10% on two occasions and a reduction in TLC of 50% from
peak values on consecutive testing or haemoglobin and TLC falling below baseline on two
consecutive tests*
A reduction in CD4+ count to 50% from peak values on two consecutive tests or
A CD4+ count below baseline values on two consecutive tests*
*These tests should ideally be done in the absence of an acute intercurrent illness. NRTI=nucleotide reverse trasncriptase
inhibitors, singly phosphorylated (NsRTI) or triply phosphorylated (NtRTI); NNRTI=non nucleoside reverse transcriptase
inhibitors; TLC=total lymphocyte count.
Table: System for assessing the risk of virological failure for a first-line regimen. To be used after at least
6 months of treatment; treatment failure is estimated as probable if at least one major or at least three
minor criteria from different categories are met.
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to drug-resistance mutations in the HIV virus and
facilitate the spread of resistant viral strains.
If this happens on a large scale, the benefits of the
antiretroviral scale-up programmes will be short-lived.
To limit the development of resistance, and to keep
monitoring feasible and affordable, we propose a new
model for monitoring the virological success of
antiretroviral treatment.
Steps to assess virological treatment failure
The table and figure show our algorithmic approach for
determining the need to change therapy or seek further
testing. The assessment system (table) uses minor and
major WHO criteria (panel) to predict virological
failure. Criteria not detailed by WHO were scored as
major or minor by doctors at the IDI, and by all co-
authors and reviewers
Acknowledgments). The steps involved in the
assessment system are as follows.
of the paper (see
Obtain an antiretroviral treatment history
Previous use of antiretrovirals either with monotherapy
or bi-therapy, particularly if these drugs are also
included in the new drug regimen, will increase the risk
of treatment failure. One dose of nevirapine during
deliver had initially been shown to cause resistance in
about 20% of women,55,56but more recently researchers
have shown using real-time PCR analysis that an
additional 40% of women with previously undetectable
resistance also had the Lys103Asn mutation.57
Therefore, women should always be asked about the use
of nevirapine during pregnancy.
A related question is whether a non-nucleoside
reverse transcriptase inhibitor regimen has been
interrupted outside efforts
transmission (eg, because of side-effects or inability to
pay for the drugs). Stopping the combination of
stavudine, lamivudine,
continuing the nucleoside reverse transcriptase
inhibitor for at least 7 days may lead to resistance
because of the long half-life of nevirapine.58
to prevent vertical
and nevirapine without
Assess the quality of the HAART regimen and concomitant
A regimen containing three nucleoside analogues may
not be sufficiently effective59–62—eg, one containing
efavirenz, tenofovir, and didanosine is associated with
treatment failure.63,64In addition, the use of concomitant
medication—eg, rifampicin,
phenytoin—might reduce antiretroviral drug levels.65
carbamazepine, or
Assess adherence to treatment
A clear association between extent of adherence and
treatment outcome has been documented in several
studies.66–73Assessing a patient's treatment adherence is
believed to be difficult.69Our experience in Uganda is
that obtaining reliable information about adherence is
possible for most patients, provided that experienced,
non-judgmental counsellors
relationship with the patient. In Uganda, the visual
analogue scale has proven to be a simple and useful
method to evaluate adherence.74
treatment cards, similar to those used for tuberculosis
patients, can be used to improve and assess a patient's
adherence to treatment, and new devices such as
computerised pill boxes, allowing remote monitoring by
wireless technology of adherence by transmitting
information about the time the pill box is opened, could
be useful tools for the future.
Adequately monitoring treatment adherence could
help prevent treatment failure and the development of
drug resistance. A patient who meets one of the
adherence criteria for treatment failure will most
probably have a detectable level of viral load. However,
this does not automatically mean that the patient is
infected with a drug-resistant virus. If there are no other
criteria suggesting treatment failure, improving
adherence with the current treatment regimen should
be tried before considering a change in therapy.
establish a good
Assess clinical symptom development and laboratory tests
Viral load testing should be considered when patients
have mixed indicators that suggest both treatment
http://infection.thelancet.com Vol 6 January 2006
At least three minor
criteria from different
categories, or one major
No criteriaOnly one minor
At least two minor
Assess the patients'
clinical symptoms,
treatment history,
adherence, and
laboratory results
Look for criteria
suggesting treatment
Will knowing viral
load measurement
change disease
Close monitoring
and frequent
Measure viral load
No need for viral
load testing
Treatment failure
very unlikely
Treatment could
have failed or
Treatment failure
Treatment failure
very likely
Figure:Algorithm to monitor the virological efficacy of an antiretroviral regimen when there is no or little
access to viral load testing
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failure and success. However, treatment providers must
always take into account their patients' treatment
options. For many patients in resource-poor settings,
these options are limited. If a patient without access to
second-line antiretroviral therapy has clinical symptoms
or signs suggesting treatment failure, they have only
two options—continue first-line therapy or stop it. If the
patient's decision is made irrespective of the result of a
viral load test, then such a test is a waste of resources.
If treatment failure is suspected, there is little sense in
maintaining the antiretroviral regimen in view of the
high cost of treatment, the public health risk of
transmitting the resistant virus to others, and the risk to
the patient of accumulating genetic mutations that
might make future treatment less likely to work. On the
other hand, even a failing antiretroviral regimen,
particularly one containing nucleoside analogues and a
protease inhibitor, can still have a beneficial effect on a
patient's immune system.75This might be one reason to
continue a failing antiretroviral regimen if no other
treatment option is available. If this option is chosen, at
each visit health-care workers must reinforce the use of
condoms to prevent the transmission of resistant virus.
The model's potential effect
With an optimal non-nucleoside reverse transcriptase
inhibitor first-line regimen and a good strategy to obtain
the best adherence to treatment, we expect that at least
80% of people will have an undetectable viral load at
12 months, similar to the rates in industrialised
and in reports from resource-poor
If we assume that our model could identify 90% of the
80% of patients on a successful treatment and 15% of
the 20% patients on a failing regimen, viral load testing
will be needed to guide therapeutic decisions in only
15% of patients. Thus, only a few samples would need
to be sent to a laboratory. If the medical infrastructure
in poor countries could provide reference laboratories
and new, simple, and inexpensive but reliable ways to
send samples to these laboratories, the application of
our model could greatly reduce the number of
expensive laboratory tests
compromising antiretroviral treatment.
Whether or not our model will achieve its potential
will need to be proven in prospective studies in a variety
of settings and by different categories of health-care
needed, without
Our model aims to improve the sensitivity, specificity,
and positive predictive value of the WHO's criteria for
treatment failure.
Although our model is based mainly on experience
and few published data, we felt it important to publish
our proposal since a growing number of people in poor
countries are on ineffective antiretroviral regimens, and
doctors in these countries find it difficult to diagnose
treatment failure.
The model's effectiveness will rely on health-care
workers having good clinical skills. These workers might
need training to improve clinical skills and the ability to
interpret supporting laboratory results.
Evaluation of adherence has a key role in the model.
antiretroviral programmes must include strategies to
obtain optimal treatment adherence to prevent the
emergence of drug-resistance. It is probably more cost-
effective to fund training programmes for treatment
counsellors and to support a multidisciplinary medical
staff dedicated to following up each patient than to
spend money on expensive laboratory testing.
This model could become a valuable tool during the
scaling-up of antiretroviral treatment in developing
countries, but it needs further study to determine
whether this strategy will be useful in resource-limited
Conflicts of interest
We declare that we have no conflicts of interest.
We thank David Bangsberg, Alain Bouckenooghe, Emanuel Bottieau,
Stevens Callens, Paul De Munter, Meg Doherty, Luc Kestens, Allan
Ronald, Walter Schlech, Patrick Soentjens, Eric Van Wyngaerden, and
Ian Woolley for reviewing the paper before submission. We also thank
the Academic Alliance Foundation for financial support.
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Pathogenesis and Treatment; Paris, France; July 13–16, 2003.
27 Cohen J. Monitoring treatment: at what cost? Science 2004; 304:
28 Kent DM, McGrath D, Ioannidis JP, Bennish ML. Suitable
monitoring approaches to antiretroviral therapy in resource-poor
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29 Diagbouga S, Chazallon C, Kazatchkine MD, et al. Successful
implementation of a low-cost method for enumerating CD4+ T
lymphocytes in resource-limited settings: the ANRS 12-26 study.
30 Tilling R, Kinloch S, Goh LE, et al. Parallel decline of
CD8+/CD38++ T cells and viraemia in response to quadruple
highly active antiretroviral therapy in primary HIV infection.
31 Ondoa P, Koblavi-Deme S, Borget MY, Nolan ML, Nkengasong JN,
Kestens L. Assessment of CD8 T cell immune activation markers to
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patients in Cote d'Ivoire. Clin Exp Immunol 2005; 140: 138–48.
32 Post FA, Wood R, Maartens G. CD4 and total lymphocyte counts as
predictors of HIV disease progression. QJM 1996; 89: 505–08.
33 Blatt SP, Lucey CR, Butzin CA, Hendrix CW, Lucey DR. Total
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34 Beck EJ, Kupek EJ, Gompels MM, Pinching AJ. Correlation
between total and CD4 lymphocyte counts in HIV infection: not
making the good an enemy of the not so perfect. Int J STD AIDS
1996; 7: 422–28.
35 Mekonnen Y, Dukers NH, Sanders E, et al. Simple markers for
initiating antiretroviral therapy among HIV-infected Ethiopians.
36 Jacobson MA, Liu L, Khayam-Bashi H, Deeks SG, Hecht FM,
Kahn J. Absolute or total lymphocyte count as a marker for the
CD4 T lymphocyte criterion for initiating antiretroviral therapy.
37 Kamya MR, Semitala FC, Quinn TC, et al. Total lymphocyte count
of 1200 is not a sensitive predictor of CD4 lymphocyte count
among patients with HIV disease in Kampala, Uganda. Afr Health
Sci 2004; 4: 94–101.
38 Akinola NO, Olasode O, Adediran IA, et al. The search for a
predictor of CD4 cell count continues: total lymphocyte count is
not a substitute for CD4 cell count in the management of HIV-
infected individuals in a resource-limited setting. Clin Infect Dis
2004; 39: 579–81.
39 Lau B, Gange SJ, Phair JP, Riddler SA, Detels R, Margolick JB.
Use of total lymphocyte count and hemoglobin concentration for
monitoring progression of HIV infection. J Acquir Immune Defic
Syndr 2005; 39: 620–25.
40 Mahajan AP, Hogan JW, Snyder B, et al. Changes in total
lymphocyte count as a surrogate for changes in CD4 count
following initiation of HAART: implications for monitoring in
resource-limited settings. J Acquir Immune Defic Syndr 2004; 36:
4141Badri M, Wood R. Usefulness of total lymphocyte count in
monitoring highly active antiretroviral therapy in resource-limited
settings. AIDS 2003; 17: 541–45.
42 Florence E, Schrooten W, Van Esbroek M, et al. The role of non-
viral load surrogate markers in HIV-positive patient monitoring
during antiviral treatment. HAART monitoring without viral load.
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43 Schreibman T, Friedland G. Use of total lymphocyte count for
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38: 257–62.
44 Buskin SE, Sullivan PS. Anemia and its treatment and outcomes in
persons infected with human immunodeficiency virus. Transfusion
2004; 44: 826–32.
45 Semba RD, Shah N, Klein RS, et al. Highly active antiretroviral
therapy associated with improved anemia among HIV-infected
women. AIDS Patient Care STDS 2001; 15: 473–80.
46 Moyle G, Sawyer W, Law M, Amin J, Hill A. Changes in
hematologic parameters and efficacy of thymidine analogue-based,
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47 Badri M, Wilson D, Wood R. Effect of highly active antiretroviral
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48 Hung CC, Chang SC. Impact of highly active antiretroviral therapy
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49 Shelburne SA III, Hamill RJ, Rodriguez-Barradas MC, et al.
Immune reconstitution inflammatory syndrome: emergence of a
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50 Grant A, Fielding K, Charalambous S. Risk factors for early
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and Treatment; Rio de Janeiro, Brazil; July 24–27, 2005. Abstract
51 van Leth F, Phanuphak P, Ruxrungtham K, et al. Comparison of
first-line antiretroviral therapy with regimens including nevirapine,
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52 Colebunders R, Mann JM, Francis H, et al. Generalized papular
pruritic eruption in African patients with human
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53 Leidner R, Aboulafia D. Flare of AIDS-associated Kaposi's sarcoma
(KS) following HAART: a manifestation of immune reconstitution
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AIDS and Other Immunodeficiencies; Bethesda, USA; April 29–30,
54 Gill J, Bourboulia D, Wilkinson J, et al. Prospective study of the
effects of antiretroviral therapy on Kaposi sarcoma—associated
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sarcoma. J Acquir Immune Defic Syndr 2002; 31: 384–90.
55 Eshleman SH, Guay LA, Mwatha A, et al. Comparison of
nevirapine (NVP) resistance in Ugandan women 7 days vs. 6-8
weeks after single-dose nvp prophylaxis: HIVNET 012. AIDS Res
Hum Retroviruses 2004; 20: 595–99.
56 Eshleman SH, Guay LA, Mwatha A, et al. Characterization of
nevirapine resistance mutations in women with subtype A vs. D
HIV-1 6-8 weeks after single-dose nevirapine (HIVNET 012).
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57 Johnson J. Resistance emerges in the majority of women provided
intrapartum single-dose nevirapine. 12th Conference on
Retroviruses and Opportunistic Infections; Boston, MA, USA; Feb
22–25, 2005.
58 Mackie NE, Fidler S, Tamm N, et al. Clinical implications of
stopping nevirapine-based antiretroviral therapy: relative
pharmacokinetics and avoidance of drug resistance. HIV Med
2004; 5: 180–84.
59 Gallant JE, Rodriguez A, Weinberg W, Young B, Berger D,
Lim ML. Early non-response to tenofovir DF + abacavir and
lamivudine in a randomized trial compared to efavirenz + abacavir
and 3TC: ESS30009 unplanned interim analysis. 43rd Interscience
Conference on Antimicrobial Agents and Chemotherapy; Chicago,
IL, USA; Sept 14–17, 2003.
60 Khanlou H, Yeh V, Guyer B, Farthing C. Early virologic failure in a
pilot study evaluating the efficacy of abacavir, lamivudine and
tenofovir in treatment naive HIV-infected patients. AIDS Patient
Care STDS 2005; 3: 135–40
61 Gulick RM, Ribaudo HJ, Shikuma CM, et al. Triple-nucleoside
regimens versus efavirenz-containing regimens for the initial
treatment of HIV-1 infection. N Engl J Med 2004; 350: 1850–61.
62 Ruane PJ, DeJesus E. New nucleoside/nucleotide backbone
options: a review of recent studies. J Acquir Immune Defic Syndr
63 Moyle G, Maitland D, Hand J, Mandalia S, Nelson M, Gazzard B.
Early virological failure in persons with viral loads >100,000 cps/ml
and CD4 counts <200 cells/mm3 receiving ddI/tenofovir/efavirenz
as initial therapy: results from a randomized comparative trial. 44th
Interscience Conference on Antimicrobial Agents and
Chemotherapy; Washington DC, USA; Oct 30–Nov 2, 2004.
Abstract H-566.
64 Podzamczer D, Ferrer E, Gatell JM, Niubo J, Dalmau D, Leon A.
Early virological failure and occurrence of resistance in naïve
patients receiving tenofovir, didanosine and efavirenz. Antivir Ther
65 Back D, Gibbons S, Khoo S. Pharmacokinetic drug interactions
with nevirapine. J Acquir Immune Defic Syndr 2003; 34 (suppl 1):
66 Weiser S, Wolfe W, Bangsberg D, et al. Barriers to antiretroviral
adherence for patients living with HIV infection and AIDS in
Botswana. J Acquir Immune Defic Syndr 2003; 34: 281–88.
67 Weidle PJ, Malamba S, Mwebaze R, et al. Assessment of a pilot
antiretroviral drug therapy programme in Uganda: patients'
response, survival, and drug resistance. Lancet 2002; 360: 34–40.
68 Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to
protease inhibitors, HIV-1 viral load, and development of drug
resistance in an indigent population. AIDS 2000; 14: 357–66.
69 Paterson DL, Potoski B, Capitano B. Measurement of adherence to
antiretroviral medications. J Acquir Immune Defic Syndr 2002; 31
(suppl 3): S103–06.
70 Paterson DL, Swindells S, Mohr J, et al. Adherence to protease
inhibitor therapy and outcomes in patients with HIV infection.
Ann Intern Med 2000; 133: 21–30.
71 Perno CF, Ceccherini-Silberstein F, De Luca A, et al. Virologic
correlates of adherence to antiretroviral medications and
therapeutic failure. J Acquir Immune Defic Syndr 2002; 31 (suppl 3):
72 Press N, Tyndall MW, Wood E, Hogg RS, Montaner JS. Virologic
and immunologic response, clinical progression, and highly active
antiretroviral therapy adherence. J Acquir Immune Defic Syndr 2002;
31 (suppl 3): S112–17.
73 Walsh JC, Mandalia S, Gazzard BG. Responses to a 1 month self-
report on adherence to antiretroviral therapy are consistent with
electronic data and virological treatment outcome. AIDS 2002; 16:
74 Oyugi JH, Byakika-Tusiime J, Charlebois ED, et al. Multiple
validated measures of adherence indicate high levels of adherence
to generic HIV antiretroviral therapy in a resource-limited setting.
J Acquir Immune Defic Syndr 2004; 36: 1100–02.
75 Deeks SG, Hoh R, Neilands TB, et al. Interruption of treatment
with individual therapeutic drug classes in adults with multidrug-
resistant HIV-1 Infection. J Infect Dis 2005; 192: 1537–44.
76 Koenig SP, Leandre F, Farmer PE. Scaling-up HIV treatment
programmes in resource-limited settings: the rural Haiti
experience. AIDS 2004; 18 (suppl 3): S21–25.
http://infection.thelancet.com Vol 6 January 200659


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Julie Jones | Mar 26, 2015 10:00 AM EDT
'Tazza 2: The Hidden Card' is a stylish, smart and sexy film about the seductive and dangerous world of gambling. For a film that is about a cruel and seedy underworld, the cinematography is surprisingly beautiful.
Ko Ah Sung plays Seo Bom in the drama "Heard It Through The Grapevine." Because Seo Bom comes from a poor family she surprises her wealthy in-laws with her mastery of English.
Lee Young Ae, who has been described as Korea's greatest living actress, will appear in "Saimdang, the Herstory."
Lee Min Ho has spoken about marriage before but now that fans know he is dating singer-actress Suzy Bae, his words may be even more closely examined. And miss A member Suzy Bae has—over the past few years—also made some comments on marriage.
TVXQ's Changmin is up for his first role in a historical drama.
"Fool's Love" made some funny plot twists out of the fact that a lawyer mistakenly thinks he's gay. But then it got serious.
Choi Woo Sik may follow his appearance in the drama "Fool's Love" with a disaster film role.
While Lee Min Ho has expressed interest in another drama role to follow his film debut in "Gangnam Blues," he has also been offered a film role in China.
In "The Queen's Flower" Kim Mi Sook made a fiasco with a suicide attempt and threatened Yoon Park.
In "The Queen's Flower" Yoon Park learned of Lee Sung Kyung's identity and was angered.

subset: commoncrawl


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Get To Know "Gary Pepper Girl" Nicole Warne, the First Blogger To Sign With IMG Talent
Model? Stylist? Entrepreneur? Check, check and check. Sydney, Australia-based Nicole Warne of the fashion blog Gary Pepper Girl is a fashion triple threat. And while all bloggers dream of beingREAD MORE
Americans Taste Filipino Street Food and Are Pleasantly Surprised
Last month we all rolled our eyes at Americans overreacting to Asian food where, as you can guess from the title, a few taste testers made it seem like Asian food was the most horrible thingREAD MORE
Karl Lagerfeld Courts Asian Celebs at Chanel Haute Couture Fall/Winter 2014-15 Show
Want more proof that Asia's influence is rising in the fashion world? Check out the front row at Chanel Haute Couture show on July 8. Yup, that's K-pop star CL just aREAD MORE
Step Into Mind-bending Paintings at Hong Kong's First 3D Museum
Hong Kong, though it be little in contrast to other major cities in Asia, has never shied away from adding fun, creative attractions for its tourists and locals. In fact, the city of 7.5 millioREAD MORE
How To Style a Structured Handbag, Courtesy of Ready Two Wear Blogger Mallory
Think a structured handbag is too stuffy for summer? Think again. Check out fashion blogger Mallory's vintage Louis Vuitton bag. One of two bloggers on the fashion blog Ready Two Wear, MREAD MORE
Bottom's Up! Drink (Fake) Blood at a Vampire-Themed Cafe in China
Remember when you fell in love with Edward Cullen in the vampire series, Twilight? Said no one above the age of 12, ever. Well, maybe not no one — looks like the vampire craze isn't juREAD MORE
Get Ready! 3.1 Phillip Lim's New Nail Lacquer Collection For Nars Debuts Tomorrow
Back during the fall/winter 2014 runway shows in February, cool-girl cosmetic brand NARS announced their next collaboration with 3.1 Phillip Lim. And while not all of us can afford Lim&READ MORE
Watch These Chinese Dancing Grannies Get Their Groove On
It seems like this year, people in China are breaking a sweat everywhere, dancing the summer days away. Last week, we brought you a video of a Chinese boy dancing his way into a pair of pants wREAD MORE
Chinese Malls, Now Adding The Weirdest Activities To Your Shopping Experience
Personally for me, going shopping in a mall in itself — especially one in the United States — is somewhat of an experience. Between all the shameless people-watching (admit it, you do itREAD MORE
Choi Siwon Rescues A Puppy and Makes Us Fall in Love With Him… Even More
Just when we thought we couldn't love Super Junior's Choi Siwon any more than we already do, he goes and does some heroic act like this. Siwon has been in Taiwan filming a new movie, To ThREAD MORE


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Much awaits in the world of SEO and digital marketing this year. We've already experienced the Penguin and Pigeon updates from Google at the end of 2014. What will the search engine giant who "won't be evil" decide to focus on improving this year?…
Posts Tagged 'Social media'
Thursday January 15, 2015 Tags: content, Social media
Category: Company News
We would like to think the Internet is a utopia of fairness and opportunity but the reality is, some members of society miss out more than others.
A surprising statistic has been revealed recently – there are 200 million fewer women online globally.…
Thursday June 5, 2014 Tags: internet, marketing, Social media
Category: Online Marketing, Social, Web & Technology
The true value of what mobile technology has offered consumers and marketers has perhaps not been recognised until recently. For the first time ever, there are more than one billion smartphones currently on the market. Don't underestimate what this figure means – the rise of mobile technology has doubled our time spent online in the last few years.…
Wednesday May 7, 2014 Tags: branding, marketing, mobile, online branding, Social media
Category: Online Marketing, Web & Technology
Digital inequalities such as digital divides are a big issue in the information society, potentially influencing engagement in political, social, and educational life. They create marginalized, excluded groups who do not have access to the Internet, to information, or maybe to the necessary skills for using these devices and social applications.…
Monday November 11, 2013 Tags: digital divide, mobile technology, Social media
Category: Web & Technology
Why Use Social Media?
Businesses can take advantage of social media to :
– gain customers
– maintain customer loyalty
– promote products
– advertise their services
Best Reasons to Engage Consumers Through Social Media & Benefits
This method is highly effective because it can target specific customers and can invite consumers to interact with the advertisement, as opposed to simply watching it on television or listening to it on the radio.…
Thursday March 22, 2012 Tags: advertising, Social media
Category: Web & Technology


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Please also see: Speech by His Highness the Aga Khan and Photographs
Ottawa, Canada, 6 December 2008 - His Highness the Aga Khan and the Right Honourable Stephen Harper, Prime Minister of Canada, today inaugurated the Delegation of the Ismaili Imamat in Ottawa, Canada.
The Delegation will serve a representational role for the Imamat and the AKDN's nine non-denominational, philanthropic, development agencies.
In his Speech, His Highness the Aga Khan underscored the importance of the milestone event and what it represented for Canada. "What we celebrate today can be seen as a new creative link between the spiritual dimensions of Islam and the cultures of the West," he said. "Even more particularly, it represents another new bridge between the peoples of Islam and the peoples of Canada."
Quick links
What's new
11 March 2015
Aga Khan Rural Support Programme Awarded 2015 Times of India Social Impact Award for Safe Drinking Water and Improved Sanitation
09 March 2015
The Aga Khan: Creating a Brighter Future for Africa
02 March 2015
Aga Khan University Addresses the Challenge of Educating a New Generation of Leaders in Africa
24 February 2015
Aga Khan University Graduates to Have a "Multiplier Effect" in Civil Society
23 February 2015
The Aga Khan University's New Charter Sets the Stage for Major Expansion in the Region
© 2007 The Aga Khan Development Network. This is the only authorised Website of the Aga Khan Development Network.


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Spring 2015 SCHEDULE
Thu, Apr 9, 07:05:00 PM
Crosstown Showdown - Lansing Lugnuts vs MSU Spartans
Location: Cooley Law School Stadium
EY representatives will be joining us at the game. This is a great chance to make connections and ask questions.Also, enjoy a great game of baseball and cheer on you . Details
- more events
The Accounting Student Association is organized by students for the purpose of providing those with an interest in accounting the opportunity to learn more about the profession.
Our goal is to provide information about the field of accounting and the many alternative career paths within it. We do this through professional, academic, and social activities.
There are several functions each semester including:
- Speakers to introduce you to the many careers that accounting majors can follow such as those in industry, academia, or with public accounting firms.
- Seminars on career development.
- Social events to provide opportunities for you to meet with fellow students who have similar interests.


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rain , out.
Reviewed By Frank A (SugarLoaf, PA) Reviewed for a 2005 Chrysler 300 —2/28/2015 7:35 PM
these are a great fit, great for the money. not a cheap plastic not off window visor!
Reviewed By MICHAEL T (Brown Deer, WI) Reviewed for a 2011 Chrysler 200 —2/13/2015 12:12 PM
It makes the appearance looks more elegant and stylish. .love them I waited for a long time for them not knowing about the outcome only to just visualizing it..and glad that I did buy it ..not to mention in Chrome. ..They look AWESOME. ..


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|Flea & Tick
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Cosequin For Cats
*Not recognized as an essential nutrient by the AAFCO Cat Food Nutrient Profiles.
Cosequin For Cats 81 83
Learned by mistakes I just bought this from my cats Vet and paid $40.50 for it. I thought it was quite expensive, but needed it right away. Came home and looked up PetMeds and was dumbfounded at the difference in the cost. In the future, I will definitely buy it from PetMeds. 04/07/2011
Surprising UTI Treatment Like the reviewer below, our vet also recommended Cosequin for bladder infections. I found our poor cat in a bush on a rainy day when he was about 4 weeks old. After bottle feeding him and then weaning him, the food we weaned him on caused a kidney disorder called Fanconi Syndrome (have to watch out for foods that contain products made in China!). It is usually fatal in cats but we were lucky enough to catch it. Long story and chain of events but with the involvement of some amazing professionals, he is still with us. Now, due to the kidney disorder, he gets chronic UTI's. Our vet, who is one of those amazing professionals, recommended Cosequin for his UTI's. Since giving him this supplement daily, he hasn't had a UTI since! With everything else this poor cat has been through and the daily treatment regime he has to undergo for his disease, it is really nice that he doesn't have to suffer with chronic UTI's on top of it! 04/07/2011
Really awesome product My 15yr old (16lb) cat Codi is feeling so much better, She has arthritis in her back. She was limping, couldn't jump well, had a hard time jumping down from our bed, hard time going up and down the stairs. Her main problem was constipation. The Dr. said she wouldn't push hard to use the bathroom, because it hurt her back too much. I have to tell you our Vet prescribed this for her last month. And within a week or so she was more spry and frisky than she has been in years. Her eyes seem brighter and she seems so much happier. I would recommend this product to anyone! Hope this helps. 03/29/2011
Blonde is moving much better with Cosequin, he's p Blonde is 16 and moves around much better on Cosequin. He's playful and goes up the stairs like a kitten. No side effects at all. Now find me a pill LOL 03/25/2015
This product is amazing! Miss Puff was having great difficulty walking. I made a ramp for her to get up on the bed but it didn't really help much. Using her litter box also became a challenge. After 2 weeks on the Cosequin I began to see some difference in her mobility. She is using the ramp and litter box with a lot more ease. She comes out of her room more often and just seems a lot more comfortable. For being nearly 18 years young she is doing so much better, big thank you to the cosequin! 02/27/2015
51 Questions · 70 Answers
Ask & Answer.
Talk to other pet lovers about this product.
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I've saved a bottle of just the capsules to refill with the power to save money.
Answer:Thank you for your question. We only sell this medication in the capsule form.
1 answer
Dasuquin vs Cosequin for cats
My cat (13yrs) has been taking Dasuquin for 5-6 mo's & it has improved her pain alot.. The one differing ingredient is Avacado/Soy with Dasquin & Cosequin has Maganese 1 mg
What makes one better than the other??
Should I try the other one?
Answer:Thank you for your question. They are both made by the same manufacturer; Nutramax. Dasuquin has more milligrams of Glucosamine and Chondroitin than Cosequin.
Ever since I adapted her since she was 2 months old. She seems in a little over weight though I feed her raw feed diets and try to cut down her food. Anyway, she seems to prone to her joint pain or tissue pains on her limps ( 2 rear legs ) I brought her to see her doctor the results were fine ( no bone informities -- Osteochondrodysplasia, which caused by the cartilage defect that causes their ears to fold ) so the doctor said he would assume that she might playing too hard, which she normally does. This situation was happen to her left rear limp then, now it happens to her right rear limp again. So, my questions are : Is this product good for a young 1 year old kitty? Is this product good for healing tissue raptures and ligaments?
Answer:Thank you for your question. This will help with the ease of moving joints and effective joint pain relief. No, this does not heal tissue rips and ligaments.
1 answer
Is there an arthritis medicine for cats with no fish products (fish oil, tuna, shrimp, etc) in it?
My cat is allergic to fish products, the slightest amount of even fish oil and she has an allergic reaction.
Answer:Thank you for your question. We have the Super Joint Enhancer Soft Chews which does not have any of those ingredients. Product number 11019.
1 answer
Flavorless Pt.2
Thank you for your answer..but did you mean it does come flavorless or does not?
Answer:Thank you for your question. Unfortunately, the product only comes in a tuna and chicken flavor.
Note: Any trademarks are the property of their respective companies.
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Around the Diabetes Blogosphere — January 2012 Edition
Welcome again to 2012! Last year, we launched a monthly recap of the best blog posts we've seen around the blogosphere, and now we're back with even more awesome posts that can't be missed. As always, we love reader participation, so please feel free to send us your recommendations for the next round-up.
It's often difficult to explain to others what it's really like to live with diabetes. Patricia Brownell, a type 1 PWD and…Read more »


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It stays all day and it has the creamiest, smoothest application. It is JET black which is what I want out of a good black eyeliner. I loved this sample so much that I purchased a full-size liner... and I will be purchasing it again as I'm almost out again.5


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Catamaran Cruise to Saona Island from Punta Cana
Read what other Viator.com travelers think about the Catamaran Cruise to Saona Island from Punta Cana. What they loved, what they liked and what they think could be improved, it's all here to help you make the most of your next trip.
Click here for tour details, schedule and pricing
Excellent! My family and I had a wonderful time. I would recommend this tour to individuals looking to enjoy crystal clear water. The food was delicious, and the company very friendly and fun.
Lot s of fun. If you are at Punta cana you have to do this tour. Best tour ever.
Paula M
The trip and and the staff were great. The bus ride is a bit long but it is clean, comfortable and air conditioned . We all enjoyed the lunch we were served on the island. We had a great day.
Kelly V
Our cruise was actually cancelled for until Wednesday April 21, no one called us so we were glad we checked the day before! This was a very enjoyable day! Our guide gave us a very good review of Dominican culture and made as many stops as was allowed for our "comfort". Our catamaran for the sail back to the mainland was beautiful. The support staff was alot of fun too. The papparazzi as they were called took a video of the day which we purchased! A great souvenir indeed! It was the highlight of our trip for sure!
Lise B
It was a lot of fun and very beautiful. Bring water and lots of sunscreen. I would recommend. Swimming in crystal blue water with star fish below, feeding the fish bread and then the island swimming and exploring. It was a beautiful day and guide was great.
Jeff I
We all had a great time. The staff was just wonderful and made sure that you were having fun. Very well organized and well worth it. Thank you.
This was like a trip of a lifetime, we had a great time, the crew was great the facilities were more than adequate. For those of you who are thinking about this trip, do yourself a favor, bring extra cash for things like headbands and tips for the boat crews. When you return from Saona Island, you may have the opportunity to purchase a bottle of rum with your photo on it. The bus we had stopped at a local store that was much better than the local markets at the hotels.
Sandra M
Amazing day! From pickup to drop off, we were thoroughly entertained. Beautiful waters, countryside and island. We will do it again!
Best experience and fun time!
Lev G
A lot of fun, I would recommend it!
The one down side was trying to get confirmation of a pick-up time from the hotel and even after a time was given they were 50 minutes late.
Once on the bus (which was extremely comfortable) the rest of the tour was really good. Weather was rubbish but unfortunately you can't control that. Barbecue on the beach was excellent.
Dan R
Good value, well organized and lots of fun.
This excursion was a good respite from the drudgery of sun and food at the resort. It was a beautiful day. The day starts with an early morning bus ride of about 1 1/2 hours, stopping at other hotels to pick up guests. Once at the fishing village where the day really starts, we were assaulted by numerous vendors selling hats, booze, towels, and anything else you could want. They are PERSISTENT! Our guide seemed friendly for the most part, however he was obviously tired (napping while on the catamaran). The staff managing the boat were great, interacting with the tourists, dancing, and having fun. After the catamaran ride to the island, you get lunch (reasonably good - lobster for an extra $35 - $45 USD), and hang around on the beach. Then, into the speedboats to a lagoon where we saw starfish. In all cases, there are LARGE GROUPS of people, all going to the same place, starting at the same time, etc. The ride back was long after a day in the sun. Everyone seemed a bit pissed that the bus stopped at a tourist center for "potty break" with only 10 minutes left to get back to our resort and relax. The guide explained that he was required by the tour company to do this. We were NOT happy about the stop.
All-in-all, a good day.
I think we just timed this trip badly. Cancelled twice on the third attempt the water was very choppy going out that was on the catamaran, I was a bit disappointed with the island as well but the food was good. Coming back on the speed boat was much better and stopping for the starfish was great time
Enjoyed everything about this excursion...BUT....way too much time sitting around after lunch waiting to go to last part of the excursion. Other than that, I'm glad we went.
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Congressional Leaders Reach Bipartisan Budget Agreement
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NCAA power conferences couldn't be stopped
The train was coming.
The diehards in the NCAA's Division I could have prostrated themselves on the railroad tracks in defiance, I suppose, but the outcome only would have been worse.
The train was coming.
Once the five so-called power conferences of the NCAA began to openly campaign for their autonomy, there was no stopping them, as Thursday's vote showed.
The Division I board of directors voted 16-2 to allow the 65 schools of the Power Five conferences, plus Notre Dame, to begin drafting many of their own rules.
Formal approval still has to come from a vote of all 351 Division I colleges and universities, but as they said in a Star Trek movie, resistance is futile. If the Southeastern, Big Ten, Pac-12, Big 12 and Atlantic Coast conferences aren't allowed to write their own rules, they likely would simply separate and start their own association, with their own TV deals and big-bucks tournaments.
The train was coming.
And frankly, I was too naïve to gauge the mighty momentum of it three years ago, when I wondered in print if TCU was doing the right thing. The Horned Frogs were about to abandon their plans to join the football-friendly Big East, and I conjectured whether it was worth giving up those 10 or 11 annual gridiron victories, just for a few easy road trips to Lubbock and Waco.
The Frogs, lucky for them, grabbed ahold of the Big 12 caboose, and there's no need for them to look back, except to occasionally polish the Rose Bowl trophy.
They're in with the big boys — with Texas, with the Big Ten schools and with Notre Dame. It's full speed ahead.
Based upon reports, that means that student-athletes in the Power Five will soon be receiving cost-of-attendance stipends — i.e., spending money. Scholarships will cover all four years. Coaching staff sizes may increase. Recruiting rules may get modernized. Common sense may be added to the NCAA governing equation.
But unionized players? Weekly athlete paychecks? Free Escalades for the quarterbacks? That's not what the autonomy vote was all about.
As Big 12 commissioner Bob Bowlsby said, the new Power Five rules will reflect a "new covenant, reflective of 21st century realities."
And in so doing, maybe the NCAA, as a whole, will be able to withstand the max-blitz of legal assaults it could be facing — union certifications, increased congressional scrutiny and a continuing wave of player lawsuits. The O'Bannon case is just the beginning.
I have no idea how much full-cost-of-attendance payments to athletes would add to, say, TCU's and Baylor's budgets. Estimates have ranged from $2,000 to $5,000 per athlete. (Schools know the figure because it calculates into how much aid each regular student can receive.)
For the non-Power Five leagues, the divide will only become larger.
Texas athletic director Steve Patterson made that point starkly last week, when he said, "We're the ones making the money and carrying the liability ... The others don't make any money. Nobody wants to watch them on TV."
But not every university in the Power Five has its own TV network, and not all are able to fill a 100,000-seat football stadium each week. The Power Five's new rules are going to come with a price tag.
That money is going to have to come from somewhere. Rutgers, which jumped from the Big East to the Big Ten just in time, eliminated eight sports in the 2006-07 school year. Maryland cut seven sports, including swimming, tennis and indoor track, just three years ago.
Bowlsby, a former college wrestler, knows the intrinsic value of the NCAA's nonrevenue sports as well as anyone. But he's also wondered aloud lately whether it's the colleges' mission to support the "Olympic movement."
If I were an NCAA swimming, tennis or rowing coach, I'd be listening for the next train.
About Gil LeBreton
@gilebreton Follow @gilebreton
Gil LeBreton has been entertaining and informing Star-Telegram readers for more than 34 years. He worked for newspapers in his hometown of New Orleans, Baton Rouge, Kansas City and Baltimore before finding his true home in Texas. Over the years he's covered 25 Super Bowls, 16 Olympic Games (9 summer, 7 winter), soccer's World Cup, the Masters, the Tour de France, saw Muhammad Ali box, Paul Newman drive a race car and Prince Albert try to steer a bobsled.
A Vietnam veteran, Gil and his wife Gail have two children -- J.P., a computer game designer in San Francisco, and Elise, an actress living in New York. Gil also once briefly held the WBC Junior Welterweight title belt -- he had to, because the guy he was interviewing, champ Bruce Curry, had to suddenly step into the men's room.Email Gil at firstname.lastname@example.com
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Deer Valley Closing Remarks
What will you miss most about Deer Valley? (And look forward to next year?)
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Here are some quick tips for a prepared family when spring skiing, and a 7yr old's take on @thecanyons terrain park: http://t.co/NWLyBWCcmZ
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From backcountry to side country and even inbounds riding, Powder Project is the next gene… http://t.co/0zP4hmmX4j http://t.co/K8RIUB0wXu
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Nov 6 2008
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I live for winter, from skiing to snowboarding to bobsledding to aprés skiing, it's all good. I live in Utah because it always snows here.
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I have a main form that has an inline-form. Is it possible to access the main form's cleaned_data from the inline-form's clean function?
Here is why I am asking.
The main form has a field to define if a property is for-sale or to lease. The inline form then displays either a sale price field or fields for the lease amount and deposit. I am trying to validate that if the property is for sale, then the lease and deposit fields should be empty.
I can do this in a view for the frontend interface, but is it possible to be done in forms.py for both the frontend and the admin?


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Mar 21, 2012 - Four best practices for retailers and online stores to increase marketing exposure. Comments
Jan 11, 2012 - How to strengthen the existing media buying models over the next few years to assure that better targeting takes place automatically. Comments
Dec 14, 2011 - Looking at the potential that audience targeting brings to digital marketers and how it allows marketers to start meaningful conversations with prospects. Comments
Nov 16, 2011 - One company is making inroads against poor marketing practices that seem to care little about message or relevance. Comments
Oct 19, 2011 - Does your offer make things easier for your consumer and not just for you? Comments
Sep 21, 2011 - It's important to make sure you have a solid understanding of what happens after you get a consumer to join the conversation. Comments
Aug 24, 2011 - Is there anything wrong with marketers using information about a consumer to help that consumer find what they're looking for? Comments
Jul 27, 2011 - New ways to reach the right person with the right message at the right time for the right price. Comments
Jun 29, 2011 - Three factors to consider when making a decision to put your brand in front of an audience. Comments
Jun 1, 2011 - Best practices that will help you gain a better understanding of the targeting landscape. Comments
May 4, 2011 - While ad retargeting is often defined as a single approach, it's typically divided into these distinct methodologies. Comments
Apr 6, 2011 - Most traditional mass-market approaches are hugely inefficient and wasteful, like direct mail. Witness Chase bank. Comments
Mar 9, 2011 - The differences between declared data and observed data and how they can effectively be used to reach target audiences. Comments
Feb 9, 2011 - The ups and downs of using digital video to drive brand awareness and traffic. Comments
Jan 12, 2011 - Don't fall into these marketing traps. Comments
Dec 15, 2010 - Six ways to ensure your RFP attracts the best sites, networks, and target audiences. Comments
Nov 17, 2010 - Don't reach the right audience with the wrong message, or vice versa. Comments
Oct 20, 2010 - Effective branding brings with it the need to step away from one's brand in order to see it with fresh eyes. Comments
Sep 22, 2010 - How a candidate for Congress went over the top with misdirected online display advertising. Comments
Aug 25, 2010 - A close look at the evolution of automated bidding systems that place the right ads on the right pages for the best price. Last in a three-part series. Comments
Jul 28, 2010 - The effect of ad networks on media buyers and the rise of the ad exchange. Second in a three-part series. Comments
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I'm currently working on an audio project with XAudio2 and I've been using MSVC++ Express 2010. I wrote some basic functionalities, and I thought I'd try making a UI with Qt, so I followed the steps to be able to use Qt in my version of MSVC:
- Download the Qt source code
- Compile everything in MSVC with the cmd prompt
- Create a Makefile project that uses qmake & nmake
- Add the directories for the libs, includes, dlls in my project
And everything works fine.
Now, I would love to go the other way around and import my project into Qt Creator to use the Qt designer easily, and also because I would simply like to play with it and see if I like it.
So, I imported a simple console application I made using XAudio2, and I added the XAudio include path in the .pro:
INCLUDEPATH += "C:/Program Files/Microsoft DirectX SDK (June 2010)/Include"
The problem I get at compilation is:
main.obj:-1: error : LNK2019: unresolved external symbol __imp__CoInitializeEx@8 referenced in function _main
File not found: main.obj
The file is right there though, the compilation creates it:
and I have no idea why Creator can't find it... Any ideas? Is it a libraby I need to include that would be automatically included when I worked in MSVC?


text:
One year ago I casually encouraged a real estate client of mine to test for radon in the house they were buying in Crowley Lake and the test came back with high levels of radon. I did not know much about radon at the time, but had heard there may be elevated levels in Crowley. The more I looked into radon, the more I felt that I needed to share what I learned and encourage my real estate colleagues and my friends to test homes for radon.
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Build a complete mobile app from scratch with C#/XAML using the Windows Phone SDK and Windows Store SDK, in this project-based course.
Lays the groundwork for coding and distributing your very first app for Windows 8.
Shows developers how to write their first Windows Store app with HTML5, JavaScript, and CSS.
"I am really enjoying Java Essential Training. In the past, I looked at Java as some kind of hieroglyphic language. It is so enlightening to have the blinders removed, and see the individual parts explained and how they relate to each other." —Daniel J.
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Comfort Suites
4714 N.E. 94th Ave.
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Phone: (360) 253-3100
Fax: (360) 253-7998
Alberta Street
Alberta Street is an epicenter of diversity, art and culture. Trendy little art galleries, novelty stores and unique restaurants line the street. Portlanders of all kinds come to Alberta Street for their annual fair: a lively celebration complete with live music and dancing, food, kids' stuff and a free trolley that rolls right through the middle of everything. Come and see why Northeast Portland is quickly becoming the capital for culture in this town.
Northeast Alberta Street
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Earn valuable points toward free nights.


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Why ambulance service is a tough business
Tracey Samuelson
Aug 27, 2014 The business of ambulances is a tough balancing game.
Obama campaign operative's surprising move to Uber
Krissy Clark
Aug 20, 2014 David Plouffe's new role at the ride-sharing tech company raises some eyebrows.
Your Wallet: Has the Affordable Care Act changed your life?
Raghu Manavalan
Aug 16, 2014 Stories of how health care is changing our experiences.
Will the cash from the VA healthcare overhaul help?
Dan Gorenstein
Aug 7, 2014 Will the $16.3 billion dollar bill fix the beleaguered VA healthcare system?
We have a tag for "Sharknado" stories
Mark Garrison
Jul 30, 2014 Our coverage of business and health insurance through the lens of "Sharknado"
Who gets a healthcare rebate? 4 questions answered
Dan Gorenstein
Jul 25, 2014 Insurers will be issuing $330 million in refunds, but few people will get checks.
Data opens doors in healthcare, but then what?
Dan Gorenstein
Jun 13, 2014 A test for the healthcare system is how well providers respond to data.
Data: The secret ingredient in hospital cooperation
Dan Gorenstein
Jun 13, 2014 Sharing patient information could save billions a year, but it doesn't happen.
Turns out, shame and fear don't fight cancer
Lauren Silverman
May 21, 2014 What we can learn from one clinic's experiment with mammogram "marketing".
The triple tax break of a Health Savings Account
David Lazarus
Interview by
May 9, 2014 HSAs make that high-deductible insurance plan go down a little smoother.


text: Hi, My name is Barbara, I'm a Brazilian and live in São Paulo. I work with Technology and studied Photography and Computer at University (may seem completely different things but what can we say about photographs by phone) . I really like to travel and know different cities, specially to walk around and photograph, and of course to know different people.


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Report Women's 'Lasara' Regular Suede Boots (Size 6)
Achieve casual-chic with the Report Lasara boots. Features a suede and faux-leather upper with a slouchy shaft and strap-and-tie detail. Breathable leather lining and a padded footbed ensure a comfortable stride all day long
- Details
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ITEM#: 15049428Achieve casual-chic with the Report Lasara boots. Features a suede and faux-leather upper with a slouchy shaft and strap-and-tie detail. Breathable leather lining and a padded footbed ensure a comfortable stride all day long. A chunky stacked heel gives a boost while maintaining support. The man-made outsole delivers sure traction and reliable wear.
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- Gender: Women
- Measurement taken from size: 6
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Measurement Guide
Women's Shoe Sizing Guide
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- Model : Lasara
All measurements are approximate and were taken using a size 6. Please note measurements may vary slightly by size.
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text:
This is a split board - You can return to the Split List for other boards.
So Valve is trying to redefine PC gaming as... console gaming?
pc gaming = finished
time to move to superior nipponrpg :3... ^_^;;
Valve is trying to introduce console peasant appeasing features.
JaspaI_Il posted...
We've got another codetalker.
http://i.imgur.com/J0lvB6S.jpg | http://i.imgur.com/DoHj9yA.jpg | http://youtu.be/YXkx-PSwbG4
Only thing Valve will do is probably go out of business due to all the resources they're putting into this project just so it will fail, and it will fail. Then Microsoft buys it.
Best Windows ever, Windows 8!
Xeeh_Bitz posted...
Only thing Valve will do is probably go out of business due to all the resources they're putting into this project just so it will fail, and it will fail. Then Microsoft buys it.
This was one of my initial reactions that it was just a terrible idea, but I would rather wait to see what else they have in store.
http://i.imgur.com/J0lvB6S.jpg | http://i.imgur.com/DoHj9yA.jpg | http://youtu.be/YXkx-PSwbG4
TheFeshPince posted...
JaspaI_Il posted...
That's copyright infringement, and I intend to take legal action.
i5-3570K | HD 7850 | Z77-D3H | 700W | Intel 550 180GB | Seagate Barracuda 1T
over dramatic tc is over dramatic
im on my mobile phone so excuse the cruddy spelling
it sounds like to me they trying to make a console, to me pc gaming is sitting in my office chair with my monitor, keyboard etc on desk in front of me, not lying down on a sofa in living room.
Whats particurly important is my pc is multi purpose, its for work, tv/movies and for games. If I play a console I route the sound through my pc also and my console monitor is next to my pc monitor, I dont do any gaming on a sofa in a living room.
MaxCHEATER64 posted...
Callmege posted...screens too small
Most PC gamers are using what? 17-21 inch screens these days? Does the valve hardware survey collect that data? Regardless, console gamers these days are gaming on 32+ inch screens and I've not seen many PC gamers with screens that big. The only time I ever use a screen that size is when I hook the laptop up to the TV to watch a movie or play a racing game (because how the **** you play one with a keyboard is beyond me. It was fine in the Destruction Derby days but only having the option of full lock on a modern racing game? No thanks I'll slob in the chair with a controller for that one).
God save our gracious Queen, Long live our noble Queen, God save the Queen!
not changing this sig until we have a King - started: 30/8/2008
Callmege posted...
MaxCHEATER64 posted...Callmege posted...screens too small
Then they stick to their TV screen?
WTF is this ****? Screen is smaller because you're closer to it. TV works and they can just set it up there but ... I don't even want to ******* know what idiocy makes anyone say PC screens are too small.


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Ronald Tillery of The Commercial-Appeal: Grizzlies forward Zach Randolph didn't need to bulldoze defenders and bully his way toward this basket. The lane opened up because of matador defense played by the Sacramento Kings. So Randolph, normally a ground-and-pound punisher, made the middle of the paint his runway, took flight and threw down a two-hand dunk. The Griz haven't had many highlights over the past week, but they had several Monday night, with the best one the final score: a 97-83 victory in FedExForum. Memphis snapped a three-game losing streak that included convincing losses to San Antonio, Golden State and Cleveland. "We were desperate for a win," Randolph said. "We came out and did what we had to do. We came out with the same approach we had against San Antonio. We wanted to play 48 minutes and that's what we did. It was a team win." A dry erase board displaying the Western Conference standings at the entrance of the Grizzlies' locker room illustrated where coach Dave Joerger and his team want to be headed, too. One day after losing their hold on the Southwest Division and No. 2 playoff seed, the Griz moved a half-game back in front of the Houston Rockets for both spots.
Jay King of MassLive.com: A famous NBA gambler considers Boston Celtics head coach Brad Stevens the league's best in-game coach. Haralabos "Bob" Voulgaris might watch -- and critically analyze -- as much basketball as anybody. In 2013, an ESPN profile labeled him "the world's top NBA gambler." He makes a living by watching a ton of basketball, parsing through a heap of data, and determining which bets to take. His claims are backed by evidence and highly respected in the NBA world. And he believes Stevens -- not Gregg Popovich, Rick Carlisle, Erik Spoelstra, Mike Budenholzer, Steve Kerr or anyone else -- tops everyone with his game management skills. ... ESPN recently ranked Stevens the NBA's ninth-best coach -- one spot behind Doc Rivers -- and he might actually be better than that. Last summer, the Celtics hired one heck of a coach.
Michael Grange of Sportsnet.ca: James Harden may well be the NBA's leading MVP candidate. At the very least, he's on anyone's shortlist as one of the best in the sport. But if DeMar DeRozan had his way, Harden wasn't going to build his résumé Monday night. Not in his house, not against the
Toronto Raptors. It took a career night from DeRozan to do it, but he got it done as a career-best 42 points held off the Rockets in a 99-96 win for the Raptors despite 31 points from Harden. The win, Toronto's second in a row, improved the Raptors to 44-30 on the season as they head out on a brief, two-game road trip. With eight games remaining, the Raptors have a fighting chance to break the franchise record of 48 wins set last season. As an added bonus, with the win DeRozan earned some bragging rights over his longtime friend and rival. Harden and DeRozan came into the NBA together — taken No. 3 and No. 9 respectively in the 2009 draft — and battled each other on the Los Angeles high school and AAU scene well before that. They were teammates on USA Basketball's world championship team this past summer. So Monday night was personal, as battles with friends can be.
Mike Bresnahan of the Los Angeles Times: This has become a March Madness all its own, the Lakers sitting perfectly healthy players not because they're preparing for a playoff run but because, um, let's just say it's complicated. The Lakers would never admit it publicly, but their 113-111 overtime victory Monday over the 76ers probably cost them something on lottery night. They moved three games ahead of Philadelphia in the overall standings and are practically locked in as the NBA's fourth-worst team. There is a 16% chance two teams could pass them in the May 19 draft lottery, at which point they would forfeit their first-round pick because of the Steve Nash trade. Had the Lakers fallen below the 76ers in the standings between now and April 15, there would be only a 3% chance of three teams passing them on lottery night. One more stat for lottery gluttons: The team with the third-worst record has a 15.6% chance at winning the No. 1 pick, the fourth-worst team only a 10.4% chance. The present-day Lakers don't care. The victory felt great. Their lottery-laden fans might say otherwise. Coach Byron Scott would gladly debate them. "I don't care about all that stuff," he said. "It's all about us trying to get better as a basketball team and trying to win games. Whatever happens after that happens. We can't control that."
Matt Winkeljohn of The Atlanta Journal-Constitution: Kyle Korver finally fell in love with his mask, which is saying something because he has hated that thing, but the best part of his shift Monday night against the Milwaukee Bucks did not come upon the occasions where he said, "it saved me [and his broken nose]." No, the best part of his work came when he pretended like "it" wasn't there. As he blitzed the Bucks with 11 consecutive points in a span of 65 seconds in the third quarter for his only scores, the Hawks' shooting guard looked like the pre-All-Star game sniper who put up remarkable shooting numbers. Korver missed his first five shots in the game, and then – with Milwaukee having whittled Atlanta's lead to five points – he hit a 30-footer with 5:49 left in the period, a 21-footer at the 5:27 mark, and two more long balls at 5:05 and 4:44. ... Korver doesn't want his nose separated from its moorings again. So, he'll keep wearing that mask. "I really don't want to talk about it. I shouldn't have brought it up," he said. "I'm grateful for it."
Kerry Eggers of The Portland Tribune: A wag had the best line of the night after the Trail Blazers' 109-86 dismantling of the Phoenix Suns Monday night at the Moda Center. "I knew it was a bad idea to serve wine (in the Suns' locker room) at halftime," the member of the Fourth Estate observed dryly. No, the Suns weren't smashed, but their hopes for victory certainly were during a third quarter in which they were outscored 37-16. The result was a Portland victory that seemed as easy as a Maui sunset, clinching a Western Conference playoff berth for the Blazers (48-25) with still nine regular-season games yet to play. "It was a good way to clinch a playoff spot," Portland coach Terry Stotts said. "We played well for most of the night. A win like that is always nice to have." But there was no celebration in the Blazer locker room afterward. "Our goals are beyond just making the playoffs," Stotts said. "With our magic number at one, it was inevitable. It's nice to clinch a spot, but we still have a few games to go that are important to us." None more so than Wednesday night when the Los Angeles Clippers come to town. The Clippers (49-25) are riding a seven-game win streak and are a half-game ahead of Portland in the battle for the fourth-best record in the West. When the Blazers clinch the Northwest Division championship -- their magic number is two (Portland wins or Oklahoma City defeats) -- it guarantees them at least the No. 4 seed in the conference. But if the first-round playoff opponent owns a better regular-season record, it will get homecourt advantage.
Aaron Falk of The Salt Lake Tribune: Flip Saunders was fired up after his team's win over the Jazz last week in Salt Lake City — and not just because of his short-handed squad's play in an overtime victory. Jazz broadcasters Craig Bolerjack and Matt Harpring had discussed the "tanking" in the NBA and mention was made of the Timberwolves dressing only seven healthy players against the Jazz. The Timberwolves, meanwhile, did not broadcast the game that night, so Minnesota fans who tuned in did so via the Utah feed. And after the game, Saunders said he had received some 25 text messages informing him of the conversation. "That's totally irresponsible, we're not tanking games," Saunders said to the Minneapolis Star Tribune and other reporters gathered. "If that's so, then [Utah] got beat by a team who was tanking. … We're playing to win. Our guys are out there: We won two games ago at New York, we lost in the fourth quarter against Charlotte last night. We're not tanking games. It is irresponsible for them to go on TV saying that. If you work at ESPN, you get fired for saying stuff like that." Bolerjack, however, apparently disagreed that the conversation went too far. And during Saunders' pregame interview Monday night, the Jazz play-by-play man asked the coach if his feelings had changed. "Still feel like the announcers need to be fired, including myself?" Bolerjack asked. "I didn't say you," Saunders replied. "I just said that at ESPN, you do things like that. … You know, we have these [interviews] beforehand, people come and ask us, you know, who we have, who's playing, who's not. So that's why we have this here." "But did you hear the broadcast?" Boljerack asked. "Yeah. I heard the thing. I heard the broadcast. I didn't go back and hear it again," Saunders said. The situation ended amicably.
First Cup: Tuesday
Ronald Tillery of The Commercial-Appeal: Grizzlies forward Zach Randolph didn't need to bulldoze defenders and bully his way toward this basket.


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Bears beat Vikings in OT
Eagles now can earn 2nd seed, bye with win at Dallas
The Vikings lost again last night, beaten by the Bears, 36-30, when Jay Cutler tossed a 39-yard strike to Devin Aromashodu. Minnesota fell for the third time in four games, and the defeat gave the New Orleans Saints homefield advantage throughout the NFC playoffs.
Playing for the first time since the dustup between Favre and coach Brad Childress became public, the Vikings' late rally wasn't enough. Despite Favre's stunning, fourth-down, game-tying touchdown pass to Sidney Rice with 16 seconds left in regulation, Cutler threw the game-winner just over 9 minutes left in overtime.
The Vikings' loss means the Eagles will get the No. 2 seed and a bye in the NFC playoffs with a win at Dallas Sunday.
Chicago's Robbie Gould had a chance to win it on the first possession of the overtime but missed a 45-yard field goal wide right.
The Bears (5-10) took advantage a few minutes later, though, when Hunter Hillenmeyer knocked the ball away from Peterson and Nick Roach recovered. Cutler found an open Aromashodu, who had beaten Antoine Winfield, and the Bears won for just the third time in 11 games.
"D.A., he's been coming along," Cutler said. "He had some injuries early on . . . I'm happy for him."
Favre has never led a team to a win after trailing by 17 or more points, falling to 0-43 in such situations. The Bears were up 23-6 in the third quarter and the Vikings were able to tie it twice.
The Vikings started 10-1 behind a resurgent Favre, but have tailed off since. Favre had a good game after three mediocre performances, completing 26 of 40 passes for 321 yards and two touchdowns. Peterson ran for 94 yards and two scores, but the Vikings simply couldn't pull this one out.
Cutler looked more like the player the Bears thought they were getting than the one who's been racking up interceptions at an alarming rate. He was 20 of 35 for 273 yards, although he did throw his league-leading 26th interception.
"It's fun," Cutler said of outdueling Favre. "He got me in Denver. I got him when he was in New York . . . It was a good game."
Aromashodu had seven catches for 150 yards, and Danieal Manning set up two touchdowns with kickoff returns of 57 and 59 yards.