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Virtual Piano 3.2
You dream of owning a piano but can't afford one? Then Virtual Piano is just for you. You can play the piano, and compose original music. It's fun to be creative! To play you need to click on the keyboard or the mouse. Play on and feel the melody!
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PaintCOST Estimator for Excel 15.1
Make paint cost estimating productive and fun with this easy-to-use software! Designed for painting contractors, decorators, builders, remodelers, and do-it-yourselfers. Contains user modifiable cost data and intelligent takeoff area calculator. Saves time and improves accuracy. Estimates by space/room breakdown. Incorporates wall, ceiling, floor, baseboards, trims, doors, windows, coats, extra items. Automatically creates price quotation.
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Virtual Piano Play Melody 2.0
Use this app to learn to play piano with realistic sounds.With Virtual Piano - Play Melody, you just pick a cool song and learn how to play it in 1 minute. It has four beautiful keyboard themes.
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Aml Maple 4.14
Aml Maple has a new kind of view on keyboard layout indicators: simple, modern, flexible. Aml Maple indicates the active layout being currently used (the language you are typing at this particular moment). It is always in front of you, exactly at the place you are typing!
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Bank2PDF 184.108.40.206
Bank2PDF is an useful utility to convert your OFX, QFX, QIF, QBO, OFC files to PDF. Simply browse for your file, review transactions, save it or copy to clipboard.
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NOV Gauge for .NET 2015.1
Gauge controls can be very useful when you need to create user interfaces for dashboards, KPIs, dials, stopwatches, clocks, thermometers, LEDs and simple indicators. Some of the major benefits of the NOV Gauge control are: Radial and Linear Gauges, LED Displays and State Indicators; Multiple Gauge areas and Gauge combinations; Advanced Gauge Axis Model and Scales Configuration; Unmatched Visual Styling; Import Gauges into NOV text documents.
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VISCOM DVD Player playback ActiveX SDK 4.01
DVD player, playback SDK ActiveX For vb, vb.net, c#, delphi, vfp, c++, access, labview. Playback DVD movie, include CSS-protected DVD or DVD image from hard disk. Play, pause, stop, fast forward and backward, step forward. Menu selection for Title, Root, Sub-picture, Audio Language selection. High performance de-interleave technology. Programmatically select specific menu button and activate it. Fully Control Sound Volume. Support Full Screen mode.Allow define specific keyboard key or mouse button to clear the full screen. Fully Control different DVD events, e.g. Playing, Displaying Title, Displaying Title Menu, Title Change events Include VB.NET 2005, VB, VC++ Sample source code. Royalty free distribution of the OCX file. Compatible with any programming language that supports ActiveX (Access, Visual C++ , Visual Basic , Visual Foxpro, Delphi, .Net, etc.) added OpenDVDPath method that allow open the DVD image on specific folder. added EnableSpanMultiMonitor property that allow playback the ...
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VISCOM Video BroadCast ActiveX SDK 3.62
Streaming FLV, F4V, VOB, MPEG2, MOV, H.264, MP4, 3GP, MPEG1, DIVX, AVI, WMV, ASF video files in real time to client computers. It include Video Broadcast Encoder ActiveX and Video Broadcast Player. Built-in mov, FLV, F4V, MPEG2,VOB, 3gp, mp4 decoder, it support broadcasting FLV, F4V, VOB, MPEG2, AVI, divx, mpeg1, mov, 3gp, mp4 video files over lan and internet. Support add on any directshow compatible decoder. Create high quality video and audio for realtime streaming , Allow to adjust Video Bitrate, Audio Bitrate, frame rate, Width, Height, Time out values before broadcasting. Support broadcasting from playback list with different video format. Return current broadcasting position, total duration of video files. It have client connected , disconnected event , include the client IP address information. Video Broadcast Player support aspect ratio control and allow resize the video screen in design time or runtime. Video Broadcast Player support full screen mode, adjust sound volume. Compatible with a ...
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VISCOM Video Capture ActiveX SDK 7.6
Capture Video/VCR/TV Program to AVI or Streaming file format (WMV file). Add Picture in Picture effect , Video Capture mixing image file or mixing two Video Capture devices, adjust alpha channel and position of each video capture device or image. Capture Video From web cam, capture card, TV Tuner to AVI or Streaming file format (WMV file). Capture Video stream From Axis, Panasonic, D-Link, Eltis, FlexWatch, Gadspot, GRANDTEC, Hawking, HikVision, Hun OsBRiDGE, Panasonic, PiXORD, Planet, RF Link, Samsung Techwin, SOHO, Sony, Sparklan, Stardot, Swann, Sweex, Toshiba, TRENDnet, Trust, VCenter, Vivotek, Xannet, Y-Cam IP Camerea. Frame grabber to memory or clipboard. Refresh audio pin when audio device changed. Detecting insert or remove USB device. Support TV, FM Radio, AM Radio, Digital Satellite Service TV Tuner. Adjustment display area, e.g. full screen or user define size. Support Custom WMV Profile. You can configure streams to use Window Media Video 9 Codec, VBR and CBR bitrates, uncompresse ...
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VISCOM Media Player Gold ActiveX 3.86
Powerful media player, video player sdk activex ocx. Support Audio effects,including ParamEq, WavesReverb, Gargle, Compressor, Distortion, Echo, I3DL2. Support dual display feature, the video will display full screen in monitor 2. Support AVCHD, F4V, FLV, VOB, AMR,Mov, M4a, Mp4, 3gp, Avi, Wmv , asf, RM (need rm decoder), MPEG-1, MPEG-2 , ASF, WAV, MP3, MID File formats. Bulit in mov,mp4,3gp decoder (Do not need download third party codec pack, some third party codec pack is illegal) . Video Color Adjustment, contrast, brightness, invert color, saturate, hue, lightness. WMV, ASF, WMA support change playback rate. Custom View, Full Screen, Double Size. Allow define specific keyboard key or mousebutton clear full screen. Overlay text and bitmap on video in same time. added support playback streaming MP4, MOV video from URL, get the buffered percentage, file size, available data. Allow display secondary video window. Multi-Line Scrolling text on video. Video Mixing, you can mixing multiple vid ...
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VISCOM Video Player Pro ActiveX 9.52
Powerful media player, video player sdk activex ocx. Support AVCHD, F4V, FLV, VOB, AMR,Mov, M4a, Mp4, 3gp, Avi, Wmv , asf, RM (need rm decoder), MPEG-1, MPEG-2 , ASF, WAV, MP3, MID File formats. Bulit in mov,mp4,3gp decoder (Do not need download third party codec pack, some third party codec pack is illegal) . Video Color Adjustment, contrast, brightness, invert color, saturate, hue, lightness. WMV, ASF, WMA support change playback rate. Custom View, Full Screen, Double Size. Allow define specific keyboard key or mousebutton clear full screen. Allow display secondary video window. Multi-Line Scrolling text on video. Video Mixing, you can mixing multiple video and playback in same time. User define alpha channel, the area of video layer. Allow change the audio pitch to male, female, child voices. Useful for karaoke software. Allow change the audio tempo to speed up or slow down the song. Overlay text on video. User define scrolling type, alpha value, font size, font name, text color, backg ...
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VISCOM Video Media Player ActiveX SDK 5.19
For Professional Windows Developers who need to provide video/audio playback function within their business application. Support Mov, Avi, Wmv (window media video), RM (need rm decoder), MPEG-1, ASF, WAV, MP3, MID File formats. Video Color Adjustment, contrast, brightness, invert color, saturate, hue, lightness. WMV, ASF, WMA support change playback rate. Including mov decoder.(Do not need download third party codec pack, some third party codec pack is illegal) . Allow change the audio pitch to male, female, child voices. Allow change the audio tempo to speed up or slow down the song. Change the audio tempo , it can speed up or slow down the wmv or asf playback rate. Fast Snapshot to BMP,JPG,GIF,TIF,PNG from movie files. User Define Display area, you can resize the control to any size. Custom Playback rate. normal playback speed, half speed, twice speed, etc. Audio channel selection.( both, left, right channel). Allow switch to Full Screen mode and using specific keyboard key or mouse ...
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VISCOM Picture Viewer ActiveX 9.03
Image viewer CP is a simple and easy ActiveX OCX control to creates,crop, displays, edits, flips, resizes and rotates image, photo and graphic. It supports BMP, GIF, ICO, JPEG, JPEG 2000, PCX, PNG, PSD, TIFF, WMF, WBMP, TGA, PGX, RAS, PNM, and others and can convert between them. Images can be printed to printer. Moreover, it provides some helpful source code sample includes Access, Delphi, VB, VB.net, VFP and Web Page. With Image viewer CP, you can convert the images between several popular formats, output the images in greyscale, retrieve and set images to clipboard and picture box, save and restore the specified location of the images, provide a value-added function called "Map System helper" which help you to develop an application that involved with electronic map creation or map-related function, support keyboard or mouse wheel scrolling images. It is compatible with any programming language that supports ActiveX (ASP, Access, Delphi, Visual Basic, Visual C++, Visual Foxpro, .Net,Powe ...
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VISCOM 3D Carousel SDK ActiveX 2.42
For Windows Developers who need to 3D Carousel user interface in c++ , c#, vb.net , vb, delphi, vfp, access. Support BMP, GIF, ICO, JPEG, J2K, JP2, JPC, J2C, PCX, PNG, PSD, TIF, WMF, WBMP, TGA, PGX, RAS, PNM image format Support raw image format, including CR2, NEF, CRW, MRW, RAF, ERF, 3FR, DCR, RAW,DNG, PEF, X3F, ARW, SR2, MEF, ORF image format. Support change the background color of carousel. Support change the thumbnail size. Support use mouse or keyboard to control the thumbnail direction. Support programmatically adjust the direction or speed of thumbnail. Support resize the control in runtime. Support click, double click, right click mouse button event for each thumbnail. Provide Royalty free distribution of the OCX file. Include vb.net 2010, C# 2010, Visual Basic ,Visual C++ Sample Code. Compatible with any programming language that supports ActiveX (Access, Visual C , Visual Basic , Visual Foxpro, Delphi, .Net, etc.) added allow change the thumbnail size. added allow use keyboard control ...
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Turbonika 3.7
Turbonika offers dynamic and fun arcade racing. The main feature of the game is speed. Speed, and the ability to shred opponents left and right, using a gun or a mill, which literally breaks the enemy vehicles apart. 15 runs, each of which will serve you up new kinds of obstacles, enemies and traps. Take part in races driving at breakneck speed, jump on the springboard and introduce the enemy vehicles to unbridled firepower.
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Word Killer 2.9
Wordkiller is an unusual combo of a keyboard trainer with an arcade game, in which entertainment stimulates the user to learn type faster and with more accuracy. The player must defend from enemies coming from three lines by killing them with blades. To start the blade, you must type the words that are shown separately for each of the projectiles and it is ready to use. It is worth noting that the game has 10 missions with different playing tasks
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Collect Fruit 1.8
Your goal is to get the fruit in the box, using items such as a board, conveyor, tree stump, trampoline, fan, etc. Upon passage of each level, a certain number of items are earned, and time is allotted accordingly. Items can also be bought in the store (purchases are made for the stars). Earn more stars as you pass through each level.
Download now
Turtles Battles 2.6
Game for one or two persons. Control by keyboard: A W D + arrows. You need to throw bombs to others half of field in 20 seconds to win. Very easy and fun!
Download now
Kill Them All 5.8
Fight nasty pirates! Recently, Gloomy Jack betrayed his crew, so they staged a mutiny and threw his ass overboard! How dare they? But he survived. The traitors have landed on the island to celebrate, but little do they know, Gloomy Jack has followed them! The main goal of the game is to figure out how to kill the enemy. There are several methods to carry this out.
Download now
Virtual Piano Keyboard 1.2
Virtual Piano Keyboard is a high-quality Delphi component that allows developers of music and multimedia software for implementing functions of keyboard instruments like pianos and synthesizers. Virtual Piano Keyboard will become the core part of your programs, contributing to their success and popularity. You can easily and seamlessly integrate Virtual Piano Keyboard into a variety of teaching, gaming, professional, music and multimedia project.
Download now
Falco Lines 6.6
The game starts with a 9x9 board with three colored balls selected from seven possible colors. The player may move one ball per turn, and only to a particular space on the board if there is a path (linked set of vertical or horizontal empty cells) between the current position of the ball and the desired space. The goal is to remove the balls by forming lines (horizontal, vertical or diagonal) of at least five balls of the same color.
Download now
Cut The Apple 2.0
Do you like fruit salads? So does the hero of this game, and so today you will whip one up. But the method of cutting it is somewhat different from what we are used to. Instead of a knife, the hero of this game uses a sharp sword, and instead of cutting on a board, throws fruit in the air. Your task is to help him cut up all the fruit into small pieces. But please, be careful and beware of bombs which can break the sword. Good luck!
Download now
Virtual Drum And Piano 3.2
Behold out new Virtual Drum And Piano simulator. You don't have the instruments or means to buy them? Then Virtual Drum And Piano is just for you. You can produce REAL MUSIC on the drums, songs played with real rhythm and inspiration. Add in some piano to brighten the mood. Controls are simple using the keyboard and mouse. Feel good about what you are playing with this software and maybe even produce a hit song!
Download now
Sokoman 2 1.7
Sokoman 2 - is a puzzle game in which you have to move the blocks on the marked spots. The complexity of the game lies in the fact that the seats on the board a little and to do the job, you need to move the boxes in a certain order.
Download now
Air Fighter 4.0
Arcade scroller featuring military aircraft. At the beginning of the game you can choose any one of 12 aircraft to carry out the mission and shoot enemies. In addition to fighting the enemies, you must also collect coins to earn points. A nice feature of this game is the ability to play together with a friend on a single keyboard. Each player is given the opportunity to choose a plane and compete against each other in a dogfight.
Download now
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Get prepared. Download the MSN Weather app.
MSN Weather
The MSN Weather app gives you the most up-to-date and accurate weather information for you to plan your day — no matter where you are in the world. You can view current conditions, daily and weekly summaries at-a-glance, and receive breaking weather alerts in your area. You will also find rich, interactive, 10-day forecasts, radar maps, and historical records that make it easy to plan for the days ahead.
Note: Weather currently available on Windows, Amazon and Google Play. Coming to the Apple App Store in the next few months.
- Other MSN apps:
MSN News
MSN Sports
MSN Money
MSN Health & Fitness
MSN Food & Drink

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sludge treatment plants Companies in Burundi
Business type: Technology ×
Keyword: sludge treatment plants ×
Location: Africa ×
Location: Burundi ×
EEC European Division
based in Cambridge UK, UNITED KINGDOM
Environmemtal Services including Water Treatment RO plants,Wastewater Treatment,MBBR process Wastewater Treatment MBBR-MBR process,Mini STP`s Solid Waste Treatment,DCR plants for Hazardous Waste,Plant Suppliers,Technical & Financial Proposals,sludge management, Ultra Filtration, Operator Training,Operation Manuals.
Aquaflow Ltd. - a Veolia Water Company
based in Savonlinna, FINLAND
Water, effluent and sludge dewatering equipment, plants and services for the pulp and paper industry. Aquaflow is specializing in water, effluent and sludge treatment in the pulp and paper industry. Whether you are a producer of chemical or mechanical pulp or a user of recycled fiber or producer of different paper grades, you can rely on our wide experience to create ...
AAT Abwasser- und Abfalltechnik GmbH
based in Wolfurt, AUSTRIA
AAT offers plant design, process engineering and equipment supply for sorting and anaerobic treatment of organic residue and highly polluted organic waste water including biogas handling and utilization. AAT core business is pre-treatment and anaerobic digestion of sewage sludge, sorted organic waste, agricultural residues and energy crops.
The Definitive Deodorant Company
based in North Kansas City, MISSOURI (USA)
For industrial wastewater treatment FORMULA 105 effectively and safely controls industrial wastewater odor in sludge and sewage, lift stations, air scrubbers and wastewater lagoons without masking agents or VOC emissions. Customers report reduction of suspended solids (saving on sewage up-charges), and accelerated flocculation of metal sludge.
DRAUSY GmbH
based in Schweigen-Rechtenbach, GERMANY
Achievements of linear/widespread treatment Sludge Decrease in Water-Sites by aeration: organic sludge is mineralized by linear, fine-bubble aeration on the bottom of the water-sites. Anaerobic milieu is transformed into aerobic conditions. Linear Treatment in Sewer-Networks: Air, enriched air, oxygen or liquid agents can be dispersed homogeneously over kilometres. So ...
Anaergia Inc.
based in Burlington, ONTARIO (CANADA)
Anaergia, headquartered in Burlington, Ontario, Canada, is a global pioneer in the generation of renewable energy through anaerobic digestion of organic waste streams such as municipal solid waste, source separated organics, wastewater treatment plant sludge, food waste, industrial waste streams, manure and energy crops. Operating out of 14 offices globally, Anaergia has ...
Combined Environmental Technologies Ltd (Ireland)
based in Skerries, IRELAND
Combined Environmental Technologies is a wastewater treatment technologies company providing Compact & Modular wastewater treatment solutions to the Municipal, Industrial, Chemical, Pharmaceutical, Petrochemical and Landfill industry. Combined has developed an innovative new process called "Pro-Bio Advanced Treatment" for the treatment of Landfill Leachate and other ...
Dr. Baer Verfahrenstechnik GmbH
based in Frankfurt/Main, GERMANY
Engineering firm for research, design of processes and for delivering of complete plants for the treatment of industrial waste water on a turnkey basis.Founded more than 30 years ago, the company started out with the introduction of Electroflotation, an effective and unique process for treatment of industrial waste water containing a variety of pollutants. The ...
Keppel Seghers
based in Willebroek, BELGIUM
Keppel Seghers is a leading provider of comprehensive environmental solutions ranging from consultancy, design and engineering, technology and construction to operations and maintenance of facilities. Our advanced technology solutions address a wide spectrum of environmental issues such as solid waste, wastewater, drinking & process water, biosolids & sludge.
Aqua Services & Engineering (Pty) Ltd. (ASE)
based in Windhoek, NAMIBIA
Aqua Services & Engineering (Pty) Ltd. (ASE) as a company to support the local water treatment industry. This mainly includes the supply of turnkey water and wastewater treatment installations, water treatment equipment (components), chemicals and a fully-fledged instrumentation section. It is our mission to be able to implement the latest water treatment technologies by ...
Related Terms for sludge treatment plants
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Enel Group
Contact us
The history of the last hundred years shows us that electricity is the driving force behind industrial growth. And as the world goes through an economic recession, an efficient energy market can help wealthier nations recover and developing nations grow, by allowing the poor access to goods and services that they previously couldn't have.
Enel is supporting the United Nations International Year of Sustainable Energy for All with its programme Enabling Electricity, which focuses on three types of project:
As of today more than two million people worldwide already benefit from the Group's energy access projects, and with Enabling Electricity


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9 wounded in Isabela bus accident
More News from Jamie Marie Elona
More News from INQUIRER.net
MANILA, Philippines — Nine people were wounded when a bus figured in an accident with a trailer truck in Isabela province before dawn Friday, police said.
Chief Inspector Alejandrino Ganmadan said a Florida bus was on its way to Cagayan when it tried to avoid a motorcycle that suddenly blocked its way along Quirino, causing it to ram a trailer truck parked at the other side of the road around 3 a.m.
He said nine people, all of which were from the Florida bus, sustained injuries, including its driver identified in radio reports as Pablo Antonio Valderas.
Ganmadan said the feet of the bus driver were stuck and nearly amputated due to the impact of the collision.
He, however, said authorities have yet to identify the names of the other injured victims.
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A pro-Russia woman speaks to pro-Ukrainian supporters holding Ukrainian flags during a rally in the center of the eastern city of Donetsk on April 22, 2014. (AFP PHOTO/ ANATOLII STEPANOV)
KIEV: A Ukrainian military surveillance plane was hit and damaged by small arms fire as it was on a reconnaissance flight over the rebel-held eastern town of Slavyansk, the defence ministry told AFP on Tuesday.
The plane, a propellor-driven Antonov An-30, safely made an emergency landing, the ministry said. None of its crew members was hurt.
Airbus holds first A400M test flight since Spain crash
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Airbus holds first A400M test flight since Spain crash
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Saudi-led coalition strikes against Iran-backed Shiite rebels in Yemen's second city Aden on Thursday and ground...


text:
The Reformation Study Bible (2015) notes are now available on Bible Gateway! Click to learn more.
(n point or thorn.)
+ A town in the mountain district of Judah. (Joshua 15:48) only. It probably lay some eight or ten miles south of Hebron.
+ A place in Mount Ephraim, the residence and burial-place of Tola the judge. (Judges 10:1,2) Perhaps Samur, half-way between Samaria and Jenin .
+ A Kohathite, son of Micah or Michal, the first-born of Uzziel. (1 Chronicles 24:24)


text:
CHICAGO, Oct. 22, 2007 The Journal of the American Dental Association (JADA) joins 234 other international scientific journals today in publishing a global theme issue on poverty and human development, an unprecedented collaborative effort among the worlds biomedical publications.
The Council of Science Editors (CSE) organized the theme issue, which involves simultaneous publication by science journals throughout the world of articles on povertys devastating effect on health. As part of this effort, JADA today is publishing online four articles by researchers internationally respected for their work in the area of increasing disadvantaged populations access to health care. Several of the authors also are members of JADAs domestic and international editorial boards.
The articles, which also will appear in JADAs November print edition, are
The articles are available free of charge online at www.ada.org/goto/jadathemeissue.
JADA Editor Glick said that The Journal is proud to be one of the participating publications, especially as the global theme issue underscores the important role oral health plays in general well-being.
It is undisputed that oral health is part of overall health, Dr. Glick writes in his editorial. However, attention to oral health from a public health pers
|Contact: Fred Peterson
American Dental Association


text:
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Sir Thomas Tyrwhitt (circa 1762-1839), Gentleman Usher of the Black Rod
Sitter in 1 portrait
Thomas Tyrwhitt entered Parliament as MP for Okehampton, on the edge of Dartmoor in Devon, in 1796. He spent the next twenty years working to cultivate and populate the wasteland of Dartmoor. Tyrwhitt built several roads across the moor and created a hamlet which he named Prince's Town, in honour of the Prince of Wales. He persuaded the government to erect a prison at Prince's Town to house prisoners-of-war captured during the Napoleonic Wars. Dartmoor Prison was completed in 1809. He was also responsible for the railway line that opened in 1823, running from Prince's Town to Plymouth. In 1812 Tyrwhitt was appointed Gentleman Usher of the Black Rod and received a knighthood.


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GRAPHIC CONTENT) A model poses during a bondage demonstration at the... News PhotoArts Culture and Entertainment,Berlin,Bondage,Business,Celebrities,Fashion Model,Germany,Horizontal,Messe Berlin,Pornography,Portrait,SensualityPhotographer Adam BerryCollection: Getty Images Entertainment 2012 Getty ImagesBERLIN, GERMANY - OCTOBER 18: (EDITOR'S NOTE: GRAPHIC CONTENT) A model poses during a bondage demonstration at the 2012 Venus Erotic Fair at Messe Berlin on October 18, 2012 in Berlin, Germany. The trade fair for the adult entertainment industry will be open from October 18 through 21. (Photo by Adam Berry/Getty Images)


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May 29, 2015
314 Clifton Drive
May 30, 2015
412 Ferry Way
June 6, 2015
110 Clifton Drive
June 13, 2015
414 West Hanagita Street
June 14, 2015
212 Fairbanks
View all calendars is the default. Choose Select a Calendar to view a specific calendar.
2014-3-9T4:00 PMMarch 9, 4:00 PM - 6:10 PM
@ Civic Center Cinema
2014-3-9T8:00 PMMarch 9, 8:00 PM - 10:10 PM
@ Civic Center Cinema
2014-3-9T3:00 PMMarch 9, 3:00 PM - 4:30 PM
@ Valdez High School
A great way to get some indoor exercise, play games or shoot some hoops. Open to all ages. Children 8 years old and under must be accompanied by an adult.
2014-3-9T4:30 PMMarch 9, 4:30 PM - 6:00 PM
@ Valdez High School
Open air space to fly your remote controlled planes and helicopters around in the indoor environment. Children 8 years and under must be accompanied by an adult.
2014-3-9T6:00 PMMarch 9, 6:00 PM - 9:00 PM
@ Valdez High School
Gym time dedicated to basketball. For anyone age 16 and up.
2014-3-9T6:00 PMMarch 9, 6:00 PM - 9:00 PM
@ Hermon Hutchens Elementary School & Playground
Come have some fun with a pick up game of volleyball. All ages welcome, children 8 years and under must be accompanied by an adult.
2014-3-9T11:00 AMMarch 9, 11:00 AM - 4:00 PM
@ Salmonberry Ski Hill
The Ski Hill Rope Tow will be running and is open for all skiing and snowboarding activities. Children under the age of 10 years must have a parent or guardian accompany them.
2014-3-9T1:30 PMMarch 9, 1:30 PM - 2:30 PM
@ Valdez Swimming Pool
Fun for all ages! Both pools are open, diving board is open. Deep-end is roped-off from the shallow end, making "lap swimming" difficult. Must be 8 years old or accompanied by an adult.
2014-3-9T4:30 PMMarch 9, 4:30 PM - 5:30 PM
@ Valdez Swimming Pool
Get some exercise swimming laps! Lanes lines are used to separate swimmers and reduce their waves. If under 14 years old, must be accompanied by an adult and be proficient enough to swim laps.
2014-3-9T4:30 PMMarch 9, 4:30 PM - 5:30 PM
@ Wading Pool
A time for parents and their young children to interact and play in the water! The small pool is open for parents and children age 6 or younger. We bring out some of our favorite water toys just for these tots! Parents must be in the water with their children.
2014-3-9T5:30 PMMarch 9, 5:30 PM - 7:00 PM
@ Valdez Swimming Pool
Local USA Synchro Swim Club, the Valdez Synchro Seals, hones their skill and increases their strength and endurance under the direction of Coach Gail Renardson. For more information about joining the club, please contact Gail Renardson at 834-1664.
2014-3-9T7:00 PMMarch 9, 7:00 PM - 9:00 PM
@ Lap Pool
Bring in your own boat and practice your skills before going out in the open water this summer! All boats must be hosed off prior to being put into the pool.


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Monthly Archives: August 2014
Red Ribbon Run Oct. 11
The Bearskin Healthcare & Wellness Center will host the Red Ribbon Run Oct. 11. For more information, check out the flier. Click here.
Retail/QSR District Manager – WTOK-WNR – Contact = email@example.com
Position Title: Retail/QSR District Manager Location: Wyandotte, OK Summary: The District Manager is a multi-unit manager who oversees multiple convenience store/truck stop/quick service food restaurants in the northeastern Oklahoma/Southwest Missouri district. This position is responsible for the oversight … Continue reading
Touch Therapy coming to Wyandotte
Wyandotte Nation Tribal Member Tina Allen will be hosting Touch Therapy for Children in Wyandotte Sept. 4 (Infant Massage session) and Sept. 8 (Children's Massage session) at Bearskin Fitness Center from 6:30 to 9 p.m. Registration for the first session … Continue reading
WNTPD Police Chief elected president of law enforcement association
Wyandotte Nation Tribal Police Department (WNTPD) Police Chief Ken Murphy was recently elected as President of the Oklahoma Association of Chiefs of Police (OACP). Murphy has served on the Board for four years and his recent election is a two-year … Continue reading


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Resolution: standard / high
Figure 8.
An illustration of the protein cores derived from the CATH phylogenetic tree. Protein cores extracted from the tree in Figure 6 by cutting the tree at various levels. The domains shown are: (a) 1w4e and 1w4i (b) those domains shown in (a) and 2 eq9 and 1w85 (c) those domains shown in (b) and 1w4h, 1zwv, and 1zy8 (d) those domains shown in (c) and 1nvm and 2fna. Groups (a) through (c) are from class 4.10.320.10, while the domains included in (d) are from domain 220.127.116.11.
Shealy and Valafar BMC Bioinformatics 2012 13:105 doi:10.1186/1471-2105-13-105


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China has adamantly denied any involvement in the Renault case. "We have noticed the relevant reports," Foreign Ministry spokesman Hong Lei told a regular news briefing on Jan. 11. "We think that some people saying China is behind this case is totally baseless and irresponsible. China cannot accept it." Chinese media suggest that some in the west are simply struggling to accept the rise of Beijing's international economic and political clout. "China's growth not a result of espionage," ...
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CHENNAI, India, July 22, 2013 /PRNewswire/ --
- Ford, with two plants in Chennai, India, is first automaker to sign on to voluntary greenhouse gas reporting program for all industries established by India-based organizations
- Ford already voluntarily reports greenhouse gas emissions in the United States, China, Canada, Mexico, Brazil and Argentina
- Reporting CO 2 emissions is part of one facet of Ford's broad approach to cutting greenhouse gases, which includes reducing emissions at global facilities 30 percent per vehicle by 2025
Ford Motor Company (NYSE: F) is taking another major step toward helping stabilize carbon dioxide emissions globally, today becoming the first automaker to join a voluntary greenhouse gas reporting program recently established in India.
Participation in the India program builds on Ford's leadership in greenhouse gas reporting – the company already participates in similar programs in the United States, China, Canada, Mexico, Brazil and Argentina.Voluntary reporting provides overall transparency regarding the company's CO 2 emissions and underscores the importance of the issue to Ford, which has a goal of reducing CO 2 emissions at its global facilities, including two in Chennai, India, by 30 percent per vehicle by 2025. "Ford is pleased to be the first automaker to participate in the voluntary India greenhouse gas reporting program," said Andy Hobbs, director of the company's environmental quality office. "We look forward to sharing our knowledge and helping to establish greenhouse gas reporting in India." India's program is a joint effort between the World Resources Institute, The Energy and Resources Institute and the Confederation of Indian Industry. As the first automaker to participate in the program, Ford's role will be to assist in the establishment of credible and verifiable greenhouse gas inventories. "Ford India is committed to bringing fuel-efficient and safe vehicles to India that our customers want and value. And we are growing our manufacturing capabilities in India in an environmentally responsible way as part of our One Ford plan," said Joginder Singh, president and managing director, Ford India. "Ford is proud to be the first automotive company to join the voluntary greenhouse gas reporting program in India, and this is a reflection of our ongoing commitment to sustainability of manufacturing operations globally." Ford operates a manufacturing plant that produces the Ford Figo, Ford Fiesta, Ford Classic, Ford Endeavour and Ford EcoSport, and an engine plant that produces 17 variants of gasoline and diesel engines. A vehicle assembly and engine plant complex are under construction in Sanand, Gujarat.


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Davidoff discussed the need to understand dynamic knowledge, or knowledge in action. This is the knowledge that people harness in doing their jobs, but it is generally not articulated well. Gueron responded that dynamic knowledge comes from a different conceptual base for innovation and leadership than static knowledge.
The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
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Reviewed By John M (Glenville, NY) Reviewed for a 2008 Pontiac G8 —5/15/2015 3:38 PM
Excellent fitting cover. It fit perfectly.
Reviewed By tim G (HIAWASSEE, GA) Reviewed for a 1996 BMW Z3 —5/20/2015 2:04 PM
I have a 1996 BMW Z3 that I must store outdoors due to the purchase of a new car that will be in the garage. This cover is very soft in the inside and durable of the outside. It fits like a glove. I like the elastic all around to secure the cover. It has been out in the rain and cold, wind and rain, and sunshine. Dries very easily after a rain. I will have to wait until next winter to see how it holds up under snowing conditions. But up until now, I would purchase this cover again.


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"The most amazing paper quality and beautiful design!! I was beyond amazed by these!! I will never get invitations anywhere else!!!"
"This invitation was extremely easy and fun to design, with lots of font options and useful tools on the Tiny Prints website. The upgraded paper options are superb! I ordered samples before purchasing my full order and was so impressed that I knew my future orders would be coming from Tiny Prints as well! Once I placed my personalized invitation order, I was given an expected delivery date; however, my order arrived in just a couple of days, well in advance of the estimated arrival date. Everyone has been blown away by the beautiful design and high quality of the paper, and the upgrade to the metallic silver envelopes was the icing on the cake!"
"I purchased these cards and added the extra review on them. I was a little worried it would take too long in order to receive them, but they were reviewed and shipped within 24 hours. I am 100% pleased with how they turned out. Beautiful!"
"Loved the design of this invitation. Easy to incorporate the baby carriage theme for the shower as well. Used the modified rectangular envelopes and ordered the solid color back."
"I wanted a baby shower invitation to celebrate the royal event of the arrival of my grandson. He is not really going to be a prince except in my eyes. Therefore, this was the perfect combination of sophistication, elegance and panache. The design was simple, striking, different, and the focus was on the word "Baby." Everyone loved them!"


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Pesticides, herbicides
ACTION: Herbicide. USE: A selective, soil-active herbicide applied preplant or preemergence. Shallow, mechanical soil incorporation may be necessary to imp More detailed
Chlorpyrifos (IUPAC name: O,O-diethyl O-3,5,6-trichloropyridin-2-yl phosphorothioate) is a crystalline organophosphateinsecticide that inhibits acetylcholin More detailed
Crawling Insect Killer Insecticide Aerosol
Crawling Insect Killer (CIK) is a totally unique solvent based (Oil or Alcohol) formulation, which utilizes powerful p More detailed
We offer our customers a wide range of off-patent generic products. Our product range include More detailed
Household Herbicide
STH retails a wide range of garden supplies such as garden & farm tools, fertilizer and garden grade plant protection (insecticide, fungicide and herbicide). Specially formulated and repackag More detailed
Aerosol Insecticide
1) Active Ingredient:Tetramethrine, Beta-cypermethrin2) Features: Deadly to insectswith no affect on human and livestock. More detailed
Common Name Active Ingredient (g/L or g/Kg) More detailed
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2,4-D Acid 95 More detailed
Herbicides are used for preventing, destroy and suppress weeds or other unwanted vegetation. More detailed
Vaporiser Liquid
Family Vaporiser Liquid formulated with 30 days, 45 days, 60 days and 90 days packing sizes repeis ans knocks mosquitoes effectively. The Liquid release pleasant smell while functioning and is safe an More detailed
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- Pesticides, herbicides in Kuala Lumpur 12
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- Pesticides, herbicides in Subang Jaya 4
- Pesticides, herbicides in Kulai 2
- Pesticides, herbicides in Ipoh 2


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You're reading the news with potential spoilers, make them spoiler free, dismiss
Gyeongju DVD (En Sub)
A Muse 2DVD + OST (Normal Edition) (En Sub)
The Heaven is Only Open to the Single ! DVD (No En Sub) (En Sub)
A Muse 2DVDs + OST (First Press Limited Edition) (En Sub)
A Muse DVD 2-Disc (First Press Limited Edition) (En Sub)
The Day He Arrives DVD (En Sub)
Second Half DVD (En Sub)
Les Formidables DVD (En Sub)
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설마 그럴리가 없어
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Second Half
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Star Parties
The SFAA offers two opportunities each month for the general public to join the club members for viewing. On Mt. Tam we collaborate with the Friends of Mt. Tam for a full evening of astronomy each month from April through October. In San Francisco we host a monthly City Star Party at Point Lobos near Lands End [or another location in the City – sometimes at the Exploratorium, sometimes in the Presidio]. And if you join the SFAA, we have the Members Only Night on Mt. Tam as well. Select a venue for details.
Mt Tamalpais (usually above the fog!) City Star Parties – San Francisco
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Hot French Onion Soup
|Beef soup bones
|3 Pound
|4 Quart
|Garlic buds
|3 , sliced (Fresh Ones)
|Yellow onion
|1 Large, cut in half
|Freshly cracked black pepper
|1 Teaspoon
|Parsley sprigs
|Beef bouillon cubes
|Yellow onions
|3 Large, sliced paper thin and separated into rings
|4 Tablespoon (Enough To Wet Rings)
Place all ingredients in Group A in large pot, bring to boil, then simmer for 3 days (72 hours).
Do add boiling water from time to time as needed, but not last 12 hours.
On the 4th day, remove from heat, strain, and let stand at room temperature till cool enough to put in refrigerator.
When stock is cold all fat will come to top.
Remove all fat from stock.
This stock may be made and placed in the freezer then one always has some on hand.
It is excellent for gravies too.
In a large pot, place butter and melt, add sliced onion rings.
Using wooden spoon (this helps to keep rings from breaking), stir till all rings are "wet", then saute, till onions are brown.
Add 1 T.
Worcestershire sauce and stock (1 C. per person) and simmer for 20 minutes.
Remove from heat, place sliced mozzarella cheese in soup for about 3 minutes or till cheese melts and comes stringy.
Serve immediately.
This soup may be made hours before serving but once the cheese is added it must be served immediately.
This recipe is a favorite with MEN.
I usually serve French bread with it.
A good red wine is also appreciated.


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Dwyer Pages (100+)
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Dwyer Mentions
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Robert M. Dwyer passed away on March 19, 2011, after a gallantly fought battle with pancreatic cancer, with his loved ones gathered by his side. He will always be remembered and deeply missed. Relatives and friends are invited to attend a memorial service to celebrate his life on Saturday, April 2, at Somerset Hills Hotel, 200 Liberty Corner Road, Warren, N.J., from 2 p.m. to 5 p.m. Arrangements are by the Paul Ippolito Summit Memorial, 7 Summit Ave., Summit, N.J. To send condolences, please visit
. Robert was born on Dec. 9, 1955, and raised in Montclair, N.J. He leaves behind a wife, Lorene Connolly, and sons, Michael K. Dwyer, Mark E. Dwyer and A. Graham Connolly. He also leaves behind sisters, Leslie Weeks, Sharon Nickerson, Linda Eveleth, Rachel Dwyer and his brother, Steven Dwyer. He was predeceased by his parents, Robert Dwyer and Mariam Coffman Dwyer. Robert graduated from Lowel Institute, now part of University of Masachusetts and worked in the pharmaceutical industry, first as an analytical chemist and later as an information technology and database specialist, throughout his career. Robert developed many interests and hobbies outside of work. A favorite was participating in gaming. He was a member of the New Jersey Association of Games, of which the members became some of his closest friends. Robert and Lorene regularly enjoyed ballroom dancing with friends and studied under several teachers and studios through the years. More recently, with Lorene, Robert kept a small kennel of borzoi that they enjoyed both as companion dogs and competed with in the conformation ring. They were members of several local area borzoi breed clubs and The Borzoi Club of America. Their borzoi became their passion as a way to cope with the "empty nest syndrome." Robert will be deeply missed by all who knew and loved him for his special way of being calm in a crisis and creating the sense that all was well. In lieu of flowers, donations in his name would be greatly appreciated to the American Kennel Club Canine Health Foundation, Borzoi Challenge Donor Fund,
or to the Overlook Hospital Foundation. See
and click on "how to help."
Published in Star-Ledger on Mar. 31, 2011
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Fox Delta Games is a small, global, indie game development studio founded to create exceptional games that promote challenge, re-playability, and of course, fun. Fox Delta Games seeks to breathe new life into a stagnant industry, and provide the world with games that entice the player with engaging gameplay, rather than gimmicks
No engines, games or mods appear to be published or in development by Fox Delta Games. We suggest you add engines, games and mods you are developing here (or update existing engines, games and mods on the site which should be linked with this Developer & Publisher).
If this profile is not used to publish or develop engines, games and mods we recommend you contact us and we will move it to the groups section and this page will display a blog instead.


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blu mar ten - the beginning (joe syntax remix) / blue skies (unquote remix)
the beginning (joe syntax remix) / blue skies (unquote remix)
catalog number:
9.70 €
out of stock
bought together
This July Blu Mar Ten releases the second in a three-part series of remixes from their album 'Love is the Devil'. The Beginning (Joe Syntax remix) - Rising star of Med School Music, Joe Syntax, channels the spirit of 90s Bristol and transforms 'The Beginning' from its original esoteric moodiness into a militant bassline stepper that recalls the high points of V Recordings and Full Cycle. Metronomic pulses and vocal samples lead up to an almighty analogue bassline guaranteed to do the required damage to any club. Truly, 'High Tech Soul'. Blue Skies (Unquote remix) - Joe Syntax's Med School brother-in-arms, Unquote, tackles the frenetic percussion and dense sound design of the original 'Blue Skies' head-on, stripping it down and folding it back in to itself in a bleak, rain-filled dub workout. Fragments of the original can be heard in the far distance, pitched down, chopped up and smothered in static while a river of deeper-than-deep basslines carry lo-fi vocal chops, dubbed out instrumentation and rusty drums in its current. BMT008 will be available as a strictly limited 12" pressing together with mp3s. This will be a single-run only with no repressings. Full sleeve artwork by resident designer ithinkitsnice. Blu Mar Ten receives regular DJ support from: Marky, London Elektricity, SPY, Teebee, Instra: mental, D Bridge, Hype, Logistics, Ed Rush, Marcus Intalex, Utah Jazz, Makoto, Spectrasoul, Kasra, Ulterior Motive, Apex, Craggz, DKay, Seba, Loxy, Ink, Lynx, Jaydan, Annie Nightingale, Crissy Criss, Tom Middleton, ASC, State of Mind, Lomax, Alleycat, Big Bud and many more.
a01. the beginning (joe syntax remix)
b01. blue skies (unquote remix)
b01. blue skies (unquote remix)
© 2007-2015 deep music kft. All rights reserved. | r2306+r2311+r2312 | | FAQ | made by su


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Good morning to all our lovely Doll Fans and Collectors out there, this is a well over due little up date to what has been happening at My Doll Boutique this year so far, we have welcomed Isabelle American girl of the Year who has been so popular, one of the quickest selling dolls as to her being an inspired dancer and having an amazing mix and match dance accessories collection which we have available.
Isabelle has amazing hazel eyes, long blonde hair and comes with a pink highlight attachment for her hair.
We currently have a waiting list for Isabelle due to high demand if you wish to be added please contact us at firstname.lastname@example.com
- The collection of accessories for Isabelle is huge this year, here are some of the dolls in our dance studio here at My Doll Boutique wearing some of the dance collection that we now stock ……… Our newest collection of dolls that we found at the London Toy Fair this year is Our Generation collection. We have had a great interest in this for many years as I have purchased many accessories from this collection over the years for my daughter but nothing was available in the UK due to CE testing. So when we found this at the Toy Fair we were so excited to see the collection finally starting here in the UK. The collection has started with a small but beautiful range of dolls and horses.
The range includes Ayla, Holly, Daisy, Holiday Hailey, and Lily Anna our poseable horse rider.
We have been using Ayla and daisy for most photo shoots as they have the most amazing coloured hair and piercing blue eyes these dolls are a fantastic starting point for children and doll collectors.
The hair is perfect for children to style and learn new hair techniques on these dolls the hair is very soft and manageable, they come beautiful dressed for a perfect gift.
The packaging is outstanding on this collection to as you can simply fold over the boxes like a gift box. They have certainly thought about everything on this collection.
One of the most popular demands we have from our customers is requests for accessories and horses and Our Generation have added two horses to this collection which have been very popular so far. Our Generation posable horse has been a huge hit due to all the extras that come with it saddle, bridle with fabric reins, saddle pad, feed bag, canteen, sponge, bucket, brush, spray bottle, wrist watch, completion certificate, trail map.
My Doll Boutique daily update there facebook page with our new clothing ranges and accessories too, we have deliveries every month and are looking forward to our new Gotz delivery and of course Lydia from A Girl For All Time who is due late summer.
So things change everyday here and we love to hear and see all your collections and photos so keep us posted!!!


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Delays, Delays, and More Delays
I want to apoligies for delays in just about everything to do with ArchForge. I can ensure you that we still have features we most definitely want to roll out so that you guys can enjoy the server more. Now I know some of you know some of the features, but here is a quick list of what is too come (or should of already been added and tweaked fully).
- Upgrade to better system of earning money.
- Server shop where members can buy items. Items will not, however, be sold in these shops. Instead, I would like members to focus on making their own shops to sell items. You guys already have the ability to do so using chest shops.
- Add showcase plugin for members to have more premium looking shops?
- Add ways to earn "premium" items/perms by allowing players to buy them in-game or by other means.
- Create and setup a PvP arena for members who like to fight other players without breaking the server rules.
- Other Mini-Games.
I plan to hopefully get to the PvP arena, and money earning system by the end of the week, along with any additional things I can get too. Unfortunitly due to my new position at work, plus school and other things in my personal life, I normally don't have alot of time to do things. On the plus side, this weekend plus Monday is looking like I will have ALOT of free time to do things. So hopefully expect new features between now and than.
With that said, I am still looking for new staff for the server. If interested, please apply! Also, I may look for some help from someone who has a bit of experience with balancing and working with a servers economy system. Working with the economy system is not one of my strongest things, so help will be welcomed. PM me if interested and I will let you know if there is anything I need help with or done.


text:
166394536742048Square Full Magnet
Looking for color ideas?Visit the Color Boutique to explore, create, and share color palettes.
See and use your colors as you shop!
Don't lose your colors!
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Sample any 3 for free—in your colors!
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Floating across a vibrant blue sky, hot air balloons of all shapes and sizes bring color to this simple Calendar Magnet design. The plain white background makes the calendar months and your contact information easy to read for your clients. For quantities of 3,000 or more, please request a quote.
For quantities of 3,000 or more, please request a quote.


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Last post Jul 29, 2009 12:15 PM by Dilip Kumbhar
Jul 29, 2009 08:37 AM|rsrraju|LINK
Good Day!
In my ASP.NET MVC application, I have 2 dropdown lists.
First one with 2 items namely A.P. & U.P(states).
When I select an item in the dropdown list, second dropdown list should be populated with corresponding cities in that state. Cities names should be retrived from a table in SQL Server 2005 database.
Your help will be very much appreciated.
Thank you,
4496 Points
Jul 29, 2009 11:50 AM|Augi|LINK
This is problem of cascading dropdown lists. Look at these articles:
http://stephenwalther.com/blog/archive/2008/09/07/asp-net-mvc-tip-41-creating-cascading-dropdown-lists-with-ajax.aspx (IMHO the best one)
21 Points
Jul 29, 2009 12:15 PM|Dilip Kumbhar|LINK
On the selectedIndexchanged event of the first dropdown call a function that loads the cities.In the function pass the value of the first dropdown as parameter to the sql query and fetch the city names.


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Editor Profile
Angelica Selim, MD
Associate Editor
About the NEJM Journal Watch Dermatology Board
Angelica Selim, MD, is Associate Professor of Pathology and Dermatology at Duke University Medical Center in Durham, North Carolina. She joined the Duke faculty in 1999, upon completion of a fellowship in Dermatopathology at Harvard Medical School. She serves on the Editorial Board of the Journal of Cutaneous Pathology. Her research interests include melanoma and mycosis fungoides, and she is a member of the International Society for Cutaneous Lymphomas and the Cancer and Leukemia Group B. However, her true passion is teaching. She is the director of the dermatopathology fellowship at DUMC and has coordinated and directed courses and seminars for medical students, residents, and practicing pathologists. Dr. Selim joined the NEJM Journal Watch Dermatology board in 2003.
National Institutes of Health/National Cancer Institute; The Plastic Surgery Foundation
Summaries by Angelica Selim
- May 14, 2015
When Lymphomas Are Spindly
- Angelica Selim, MD
When a skin tumor displays spindle morphology, lymphomas need to be included in the differential diagnosis.
- March 12, 2015
Lichen Sclerosus Sine Sclerosis: A Challenge to Detect
- Angelica Maria Selim, MD
Histologic clues aid diagnosis of LS with the appearance of a psoriasiform lichenoid dermatitis.
- January 27, 2015
Primary Cutaneous Perivascular Epithelioid Cell Tumor: Not the Same as the Noncutaneous Tumor
- Angelica Maria Selim, MD
No local recurrences or metastases occurred in a series of eight tumors.
- January 23, 2015
Adult T-Cell Leukemia/Lymphoma: Skin Manifestations Predict Course
- Angelica Maria Selim, MD
ATLL severity and outcomes range from aggressive acute disease with short survival to chronic and smoldering subtypes with protracted courses.
- November 6, 2014
Differentiated Vulvar Intraepithelial Neoplasia: Still Searching for a Good Biomarker
- Angelica Selim, MD
What is the diagnostic value of p53 staining for this precursor lesion?
- November 6, 2014
Chronic Graft-Versus-Host Disease with Eruptive Angiomas
- Angelica Selim, MD
Researchers suggest the name GVHD-associated angiomatosis for what they consider a distinct entity.


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Poker Chip Cufflinks
Cufflinks are a perfect and thoughtful gift for any guy!
Cufflinks for the high roller!
Thick sterling silver replica casino chips are the perfect good luck charm for the gambler. Sterling silver with square bullet back closure.
Dimensions: Approximately 3/4" in diameter
Total Pair Weight: 25.2 g (.89 oz.)
Poker Chip Cufflinks
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text:
Still reeling from his break up with Rita Ora, broken hearted Rob Kardashian has been finding comfort at the bottom of a bottle and in the company of a call girl, according to a bombshell new report in Star magazine.
PHOTOS: No Weigh! Kim Kardashian Denies Claims She's Piled On 65 Pregnancy lbs — Says She's Only Gained 20!
The sexy blonde escort shared her story — and texts between her and Kardashian — exclusively with Star, giving a full critique of Rob's bedroom skills along with her account of his heavy boozing and partying.
Not surprisingly, the Kardashian family is said to be concerned about the 26-year-old's carousing, which is reportedly spiraling out of control.
VIDEO: Scott Disick Orders Sobbing Kourtney Kardashian To Lose Baby Weight Faster, 'You're My Piece Of Machinery'
"Rob is a complete mess. He drinks like a fish, starting in the afternoon and going all night long," a source tells Star. "Even worse, he's hooking up with paid escorts, and his business is tanking."
Mom Kris Jenner and sister Khloe Kardashian have tried to talk sense into Rob since his recent boozy birthday night with Lamar Odom at Hollywood's Greystone Manor, but their pleas have fallen on deaf ears, according to Star.
VIDEO: Kim Kardashian Gets 'Vampire Facial' … Using Her Own Blood?!?
The reality star got his heart broken late last year after learning that Ora had cheated on him, although she claimed she never thought of them as being in a relationship or as "boyfriend, girlfriend."
The romantic rebuttal reportedly sent Rob over the edge, sparking a cycle of drinking and sexcapades, as well as a 40 pound weight gain which he is now desperately trying to lose by joining rapper The Game in his '60 Days of Fitness' exercise plan.
For the full explosive story pick up the the new issue of Star magazine — on newsstands Thursday.


text:
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Search Tags: Stop Loss Pay
Stop Loss deadline extended
If you still haven't claimed your stop loss special pay, the deadline has been extended to October 21st.
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Stop Loss deadline set for March 4th
People whose military service was involuntarily extended or whose retirement was suspended between Sept. 11, 2001, and Sept. 30, 2009, have until March 4 to file for retroactive payments of $500 for each month of their extended service under the "Stop Loss" policy.
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35k troops still owed 'stop loss' bonuses
The Army is struggling to find about 35,000 soldiers, most of them veterans now, who are owed bonuses because they were forced to remain in the military beyond their normal enlistment.
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Stop loss pay application deadline extended
The deadline for servicemembers and veterans seeking stop loss pay from September 11th, 2001 and September 30th, 2009 now have until March 4, 2011.
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DoD stop loss pay deadline extended
March 4, 2011, is the new deadline to apply for Retroactive Stop Loss Pay.
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Intrauterine contraceptive devices and risk of pelvic inflammatory disease: standard of care in high STI prevalence settings.
Keywords: intrauterine contraceptive device, pelvic inflammatory disease, sexually transmitted infection, gonorrhoea, chlamydia, infertility, ectopic pregnancy, standard of care
THE intrauterine contraceptive device (IUD) is a highly effective method of contraception. It is also one of the most cost-effective methods available, providing long-term protection at a public sector cost as low as US$5 per woman/year of contraception in developing countries. (1) Use of the IUD is limited in some regions (Figure 1), however, due to concerns about increased risk of pelvic inflammatory disease (PID)--estimated to range from two to nine times (2)--and subsequent complications such as infertility and ectopic pregnancy. A recent review concluded that the overall risk of PID with modern IUDs is lower than suggested by earlier studies, is concentrated in the weeks to months following insertion and is related to prevalence of sexually transmitted infections (STIs). (3) In other words, the IUD appears to be very safe under conditions where women can be determined to be free of infection at the time of insertion.
Others have argued that evidence of safety from regions with low prevalence of STI may not apply in settings where gonorrhoea and chlamydial infection are prevalent, and where it is not possible to rule out infection prior to insertion. (4) In fact, the technical difficulty of ruling out cervical infection due to these organisms in low-resource, high-prevalence areas is a broader problem of women's sexual health that has resisted easy solution. (5) This constraint, together with the challenges of ensuring aseptic conditions for IUD insertion, raises questions about appropriate standards of care for safe IUD use in low-resource settings.
These issues assume greater relevance in the light of a recent report from a USAID-supported inter-agency workshop that advocates wider use of the IUD even in countries with high STI prevalence. (6) Other materials designed to promote the IUD among health care providers in such countries are also beginning to appear. (7)
WHO classifies the IUD as Category 3 (use of method not usually recommended unless other more appropriate methods are not available or not acceptable) when there is a very high individual likelihood of exposure to gonorrhoea or chlamydial infection. In the presence of current purulent cervicitis or chlamydial infection or gonorrhoea, it is classified as Category 4 (method not to be used) for initiation of use and Category 2 (generally use the method) for continuation of use (8) (Peterson H. Personal communication, 2004).
Against this background, we reviewed the literature addressing two issues: 1) the question of safety, specifically the risk of PID following IUD insertion in low-resource settings where gonorrhoea and chlamydia are prevalent, and 2) the value of antibiotic prophylaxis prior to IUD insertion in settings when it is not possible to rule out existing infection.
The risk of PID following IUD insertion
Reported PID incidence ranges from one per 1000 measured in a US-based study (10) to two per 100 in the month following insertion in several African studies. (11-13) Within this approximately 20-fold range should lie some explanation for why the IUD is a significantly lower-risk method of contraception in some settings than in others. At least two factors--the background prevalence of STI and the conditions under which the procedure is performed--influence the risk of PID following IUD insertion.
PID can be caused either by sexually transmitted infections (STIs) or introduction into the uterus of bacteria from the vagina or outside contamination. Among common pathogens, gonorrhoea is more likely than chlamydial infection to cause acute symptomatic PID and to come to the attention of clinicians. Because of its more insidious progression and lack of symptoms, chlamydial PID may be a more important cause of complications such as tubal infertility. (14) In a Nairobi study, however, only one-third of clinically diagnosed PID episodes were in women with proven gonococcal or chlamydial infection. (11) The contribution of non-sexually transmitted contaminants to PID following IUD insertion under poor aseptic conditions has been given little attention, but is well documented for puerperal and post- abortion infections. (15) The role of bacterial vaginosis in IUD-related complications is also under investigation. (16)
There is little debate about how IUD insertion increases risk of PID in the period immediately following the procedure. (3,17) Disruption of the cervical mucus barrier by a foreign object that deposits bacteria directly into the uterine cavity is a well-established mechanism for infection following transcervical procedures. Intrauterine microbial contamination has been found to be highest in the month following IUD insertion and to decrease with time. (18)
Since organisms cannot be pushed into the upper genital tract if they are not present in the first place, the risk of PID following IUD insertion is related to both local STI prevalence and to the capacity of health care services to identify pre-existing cervical infection and ensure aseptic conditions for insertion. In other words, both a source of infection and a transport mechanism are important. In epidemiological terms, there is a strong interaction (as opposed to confounding) between IUD insertion and the prevalence of pathogens capable of causing PID.
How often does this happen? The true risk of insertion in low-resource settings with moderate-to-high STI prevalence cannot be accurately estimated from studies conducted in low STI prevalence settings, or where screening reduces the likelihood of STI at the time of insertion and hygienic conditions are optimal. Unfortunately, data from higher-prevalence, low-resource settings are few, and estimates of PID risk following IUD insertion are often generalised from inappropriate settings.
Moreover, even where data are available, commonly used case definitions and outcome measures for PID underestimate the extent of the problem and introduce classification bias. (14,19,20) Because PID symptoms are often mild or absent, a clinical diagnosis only picks up about a third of all PID cases compared to laparoscopy. (14) A few studies have used broader case definitions in an attempt to increase sensitivity. (10,12) While still imprecise, such definitions yield higher rates that may be closer estimates of true PID incidence. The importance of accurate measurements is highlighted by one meta-analysis which found stronger associations between IUD use and asymptomatic PID compared to symptomatic PID. (21)
Taking these issues into account, we take another look at estimates of relative and absolute risk of PID following IUD insertion from high-prevalence, low-resource settings, and factor in a correction for low diagnostic sensitivity of methods used in those studies.
Relative risk
A strong association between the time of IUD insertion and the development of PID has been documented in several studies. (22,23) An extensive WHO multi-centre review (22) estimated the overall risk of PID to be concentrated in the first 20 days after insertion when the risk was six-fold higher than at later times. Such evidence is a direct measure of risk related to insertion that avoids a number of biases in choice of comparison group in case-control and prospective studies. Notably, most of the IUD insertions in the study took place in low STI prevalence settings; one-fifth were from China in the 1980s when gonorrhoea and chlamydia were rare. (24) In fact, no cases of PID were reported from Chinese IUD users, a finding in line with evidence that IUD-related PID risk correlates highly with STI prevalence. (3,23)
Absolute risk
Studies from Africa report PID rates (Table 1) that are significantly higher than those found in developed countries. (10-13) In these series, specific but insensitive PID case definitions requiring three signs of tenderness (abdominal, cervical motion and adnexal) plus evidence of lower genital tract inflammation or fever were used. The studies were conducted under research conditions in university teaching hospitals with better-than-average hygienic conditions and careful selection of IUD candidates. These factors all work to underestimate the risk of PID in typical service delivery settings. One study reported considerably higher rates (>5%) using more sensitive criteria for "infection-related complications" (women with IUD removals for infection or pain and women with signs of pelvic, cervical motion or adnexal tenderness during physical examination). (12) Adjustment of the measured PID rates for asymptomatic or minimally symptomatic cases (assuming 30-50% sensitivity of study methods) would also yield incidence estimates in the range of 3-6% during the post-insertion period for most African samples. This is far higher than can be attributed to observed gonorrhoea/chlamydia prevalence alone, and greatly exceeds infection rates measured in a US study. (10)
Preventing infection with IUD insertion
Data from China (22) and high-resource countries (3,23) suggest that PID risk following IUD insertion can be minimised if 1) gonorrhoea and chlamydia prevalence is low or infection is ruled out prior to insertion, and 2) insertion is performed under aseptic conditions. Unfortunately, these conditions do not exist in many low-resource settings. (5,15) A number of studies report on attempts to identify women with cervical infection by means of clinical examination or demographic and behavioural risk assessments, but these have proven disappointing, especially when used for screening in family planning populations. (5,25)
What are the options? First, IUD use can be restricted in areas of high STI prevalence or where safe insertion under aseptic conditions cannot be assured. This approach would certainly prevent iatrogenic infections but at the cost of limiting choice of effective and affordable contraception. An alternative strategy would be to assume that infection is present if it cannot be reliably ruled out, and to provide antibiotic coverage effective against organisms known to cause PID.
Antibiotic prophylaxis versus presumptive treatment
A number of studies have looked at the value of antibiotic coverage at the time of IUD insertion to reduce the risk of PID. (26) The available evidence is difficult to interpret, however, for several reasons. One trial showing no benefit of prophylaxis was conducted in a developed country setting with low STI prevalence among women who were screened for infection prior to IUD insertion. (10) In the absence of STI at insertion, the value of antibiotics to prevent development of PID is difficult to evaluate. In Kenya, with higher gonorrhoea and chlamydia prevalence and no prior laboratory screening, prophylaxis reduced both PID and unplanned IUD-related clinic visits by one-third, although the PID reduction was not significant (p = 0.17). (11)
A fundamental limitation of the controlled trials on antibiotic prophylaxis conducted to date is the choice of the antibiotic regimens (doxycycline 200 mg or azithromycin 500 mg) evaluated. There is no evidence to support the therapeutic effectiveness of these single-dose regimens against organisms commonly associated with PID. While a single dose of doxycycline 200 mg has been shown to be effective in reducing infectious complications of elective abortion in low prevalence settings, (26) it is insufficient for treatment of cervical infections due to gonorthoea or chlamydia. (20,27) A seven-day course of doxycycline (100 mg twice a day) is standard for chlamydial cervicitis. Gonorrhoea has been shown to be highly resistant to the tetracyclines (including doxycycline) in all regions. One study used azithromycin 500 mg as prophylaxis based on standard loading dose recommendations. (10) Current recommendations for treatment of gonorrhoea and chlamydia with azithromycin advise at least one gram; two grams are recommended for gonorrhoea in some guidelines. (20)
The existing direct evidence thus considers the value of a sub-curative dose in reducing the progression of infection to the upper genital tract. There are no trials evaluating the protective effect of a full curative dose of antibiotics (presumptive treatment) effective against either N. gonorrhoeae or C. trachomatis. Such treatment would be expected to reduce the risk of PID associated with IUD insertion and other transcervical procedures for several reasons. First, treatment of potential pathogens in the endocervix removes an important source of upper genital tract infection. Second, cure rates above 95% for gonorrhoea and chlamydia can be achieved; several single-dose regimens are recommended as treatment for cervical infection and provide coverage for other pathogens implicated in PID. Finally, the fact that these same regimens are also recommended for treatment of these organisms in established PID argues that coverage at the time of the procedure would prevent iatrogenic spread of infection. (20,27)
Cost-benefit considerations
The risk of complications following PID is high, especially in low-resource settings. The risk of infertility following a single episode of PID has been estimated to be 50-60% in settings with limited access to treatment (two to three times higher than in developed countries). Ectopic pregnancy risk increases 7-10 times following PID and the mortality rate associated with this event is especially high in low-resource settings where emergency surgical services are uncommon. (28)
There are precedents for treating cervical infections presumptively under certain situations where background prevalence is high. (27) Current WHO STI treatment guidelines recommend presumptive treatment to partners of patients with STI, and to women with genital complaints and a high likelihood of infection. Cost-benefit analyses of syndromic algorithms that include presumptive antibiotic treatment of cervical infection for women with symptomatic vaginal discharge have been conducted (Ndowa F. Personal communication, 2003). Above a breakpoint of 5-10% gonorrhoea/chlamydia prevalence, the cost of treating women for cervical infection is balanced by averted cost of care for PID and its complications, even in low-resource settings where the cost of such care is low. It should be noted that vaginal discharge is a poor predictor of cervical infection or PID. (5) Women undergoing IUD insertion, on the other hand, have a greater risk of developing PID in the month following insertion. Factoring in a relative risk of six (22) would reduce the cost-benefit breakpoint to much lower levels (1-2%) of gonorrhoea/chlamydia prevalence.
Programmatic implications
Would presumptive treatment to reduce risk of post-insertion PID constitute a medical barrier to contraception? We think not. Even with an additional US$1-2 to cover the cost of effective single-dose treatment for each insertion, the IUD would remain one of the most cost-effective methods of contraception available. While supplier (UNFPA, USAID) prices for copper IUDs range from US$0.35 to $1.72 per unit, the programme cost of the IUD is in the order of US$5 per year. The incremental cost of providing full antibiotic coverage at the time of insertion to prevent PID would add approximately 2-10% to the programme costs of IUD provision, assuming an average of five years of use per woman. With longer IUD use, the incremental cost would be even less.
A related concern sees IUD access tied to the ability of poorly resourced health care systems to obtain and manage sufficient quantities of effective antibiotics. Ensuring adequate supplies of commodities is a sine qua non of family planning programmes, however, and essential commodities include supplies related to safe provision of services. The alternative-to promote IUD insertions where access to antibiotics is compromised-would spell disaster for women who do develop PID, and ultimately for the reputation of the family planning programme. In fact, availability of essential antibiotics should be seen as a basic requirement of health care services that cannot be ignored by any programme working in the health sector.
Research gaps, safer procedures and reproductive health
Over 90% of global expenditure on medical research focuses on diseases causing 10% of the global burden of disease. (29) This "90/10 research gap" means that health problems confined to poorer regions receive inadequate attention, and that evidence increasingly reflects conditions (of prevalence or access to technology) that do not exist in poorer settings. This research gap also applies to important areas of reproductive health. (30)
The safety of IUD use under the right conditions is not in question. In the US, where litigious fallout from the Dalkon Shield has kept IUD use at low levels, "rehabilitation" efforts to reassure potential users and their health care providers are justified. Even where STI rates are relatively low, however, including in the US, authors stress a standard of care-careful client selection and prior screening for STI--that is simply not attainable in low-resource settings.
A programme of research to support safer IUD use in low-resource settings should address outstanding issues of service provision and outcome measurement. Priorities include evaluation of safety under typical service delivery conditions, development of affordable and accurate diagnostic and screening tools for cervical infections, and more sensitive methods for measuring PID outcomes. Operational research to improve safety of health care procedures is already a priority to reduce parenteral transmission of HIV and hepatitis B and C, and should be expanded to include transcervical procedures, including IUD insertion. This should include better methods for identifying STI as well as ways to reduce contamination with other organisms during procedures. For settings where cervical infection cannot be reliably ruled out, the effectiveness of treatment with a full curative course of antibiotics at insertion could be evaluated by randomised, placebo-controlled trial.
Attention to several ethical and standard of care issues should be more overt in the research and service provision agendas. To what extent does effective contraception, taking into account the considerable health benefit of preventing unwanted pregnancy, balance risks associated with its provision? Arguably, family planning programmes--especially those financed by developed countries--are ethically obligated to ensure a standard of care (comparable to donor country standards) that minimises those risks. The alternative, promotion of dual standards of care for low-resource and high-resource countries, would be hard to justify. >From an ethical standpoint the principle of justice calls for "treating like persons alike". How is a young woman seeking family planning in Africa different from a young woman in Europe or North America in terms of her contraceptive needs? Although she has the same desire to control and preserve her fertility, her risk of complications related to IUD use is actually much higher. To deny these risks and promote a method under sub-standard conditions pits fertility control against health concerns, a position which goes squarely against the paradigm shift initiated at ICPD.
Furthermore, even with safe insertion, IUD promotion in areas of high STI/HIV prevalence must address women's needs for dual protection from infection and unwanted pregnancy. The commitment to women's reproductive health, reiterated at ICPD+5, states: "All primary health care and family planning facilities should offer the widest achievable range of safe and effective family planning methods, essential obstetric care, prevention and management of reproductive tract infections, including sexually transmitted diseases, and barrier methods to prevent infection." As solutions are sought to achieve these goals, efforts to prevent iatrogenic infections should be seen as an integral part of the process.
Table 1. STI prevalence and estimated PID incidence following IUD insertion one US and three African studies Study site Background STI PID per 100 insertions prevalence (specific criteria) Gonorrhoea Chlamydia Kenya (a) [11] 3.2-4.0% 12.0-12.9% 1.3-1.9 Kenya (b) [12] 4.8-7.8% 0.2-1.4 Nigeria (c) [13] 1.1-1.3% 6.7-6.8% 1.3-1.7 USA (d) [10] Not reported 0.1 All women were screened for gonorrhoea and chlamydia prior to or at the time of insertion Study site Possible infection-related outcomes per 100 insertions Kenya (a) [11] 8.9-13.0 had unplanned IUD-related visits (two-thirds of these had PID-related symptoms) Kenya (b) [12] 5.7-6.9 had IUD removed for infection or pain Nigeria (c) [13] Not reported USA (d) [10] 0.7-1.3% were treated with antibiotics because of adnexal or uterine tenderness 3.4-3.8% had IUD removed for reasons other than partial expulsion Note: PID outcomes measured post-inseertion at: a) 1 month; b) 1 and 4 months; c) 30 and 90 days; and d) 90 days.
(1.) An extremely low-cost option: IUCD Method Brief No. 3. Nairobi: Kenya Ministry of Health, 2003.
(2.) Washington AE, Aral SO, Wolner-Hanssen P. Assessing risk for pelvic inflammatory disease and its sequelae. JAMA 1991 ;266:2581-86.
(3.) Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet 2000;356 (9234):1013-19.
(4.) Coggins C, Sloan NL. Prophylactic antibiotics before insertion of intrauterine devices [Comment]. Lancet 1998;351 (9120):1962-63.
(5.) Dallabetta GA, Gerbase AC, Holmes KK. Problems, solutions, and challenges in syndromic management of sexually transmitted diseases. Sexually Transmitted Infections 1998;74(Suppl.1):S1-S11.
(6.) Increasing Access to the IUD: An Inter-Agency Workshop organized by Family Health International's Research to Practice Initiative in collaboration with USAID's Service Delivery Improvement Division. Chapel Hill NC: FHI, 2003.
(7.) Expanding Women's Contraceptive Choices: IUCD Method Brief No. 1. Nairobi: Kenya Ministry of Health, 2003.
(8.) Improving Access to Quality Care in Family Planning. Medical Eligibility Criteria for Contraceptive Use. 2nd ed. WHO/RHR/00.02. Geneva: World Health Organization, 2000. At: < http://www.who.int/ reproductive_health/ publications/RHR_002_medical eligibility criteria_second_ edition>.
(9.) World Contraceptive Use. New York: UN Population Division, Department of Economic and Social Affairs, 2001.
(10.) Walsh TL, Grimes DA, Frezieres R, et al. Randomized controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group. Lancet 1998;351:1005-08.
(11.) Sinei SK, Schulz KF, Lamptey PR, et al. Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion. British Journal of Obstetrics @ Gynaecology 1990;97(5): 412-19.
(12.) Sinei SK, Morrison CS, Sekadde-Kigondu C, et al. Complications of use of intrauterine devices among HIV-1-infected women. Lancet 1998;351:1238-41.
(13). Ladipo OA, Farr G, Otolorin E, et al. Prevention of IUD-related pelvic infection: the efficacy of prophylactic doxycycline at IUD insertion. Advances in Contraception 1991;7(1):43-54.
(14.) Westrom L, Eschenbach D. Pelvic inflammatory disease. In: Holmes KK, Spading PF, Mardh P-A, et al, editors. Sexually Transmitted Diseases. New York: McGraw-Hill, 1999. p.783-809.
(15.) AbouZahr C, ,Ahman E, Guidotti R. Puerperal sepsis and other puerperal infections. In: Murray CJL, Lopez AD, editors. Health Dimensions of Sex and Reproduction. Boston: Harvard School of Public Health, 1998.
(16.) Ferraz do Lago R, Simoes JA, Bahamondes L, et al. Follow-up of users of intrauterine devices with and without bacterial vaginosis and other cervicovaginal infections. Contraception 2003;68: 105-09.
(17.) Shelton JD. Risk of clinical pelvic inflammatory disease attributable to an intrauterine device. Lancet 2001 ;357 (9254):443.
(18.) Lu R, Wang N, Zhao J. Investigation of intrauterine microbes after intrauterine operation [in Chinese]. Chung-Hua Fu Chan Ko Tsa Chih (Chinese Journal of Obstetrics @ Gynecology) 1998;33(3): 168-69.
(19.) Paavonen J. Pelvic inflammatory disease. From diagnosis to prevention. Dermatologic Clinics 1998; 16(4):747-56.
(20.) Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. MMWR--Morbidity & Mortality Weekly Report 2002;51 (No. RR-6).
(21.) Gareen IF, Greenland S, Morgenstern H. Intrauterine devices and pelvic inflammatory disease: meta-analyses of published studies, 1974-1990. Epidemiology. 2000;11 (5):589-97.
(22.) Farley TM, Rosenberg M J, Rowe P J, et al. Intrauterine devices and pelvic inflammatory disease: an international perspective [Comment]. Lancet 1992;339(8796):785-88.
(23.) Wright FA, Aisien AO. Pelvic inflammatory disease and the intrauterine contraceptive device. International Journal of Gynecology @ Obstetrics 1989;28(2):133-36.
(24.) Cohen MS, Henderson GE, Aiello P, et al Successful eradication of sexually transmitted diseases in the People's Republic of China: implications for the 21st century. Journal of Infectious Diseases 1996;174(Suppl.2): $223-29.
(25.) Morrison CS, Sekadde-Kigondu C, Miller WC, et al. Use of sexually transmitted disease risk assessment algorithms for selection of intrauterine device candidates. Contraception 1999;59:97-106.
(26.) Grimes DA, Schulz KF. Antibiotic prophylaxis for intrauterine contraceptive device insertion. Cochrane Database of Systematic Reviews 2001(1).
(27.) World Health Organization. Guidelines for the Management of Sexually Transmitted Infections. WHO/HIV_AIDS/ 2001.01, WHO/RHR/01.10. Geneva: WHO, 2001.
(28.) Meheus A. Women's health: importance of reproductive tract infections, pelvic inflammatory disease and cervical cancer. In: Piot P, Holmes KK, Pitt P, et al. Reproductive Tract Infections: Global Impact and Priorities for Women's Reproductive Health. New York: Plenum Press, 1992.
(29.) World Health Organization. Investing in Health Research and Development: Report of the Ad Hoc Committee on Health Research Relating to Future Intervention Options. Geneva: WHO, 1996.
(30.) Villar 3, Carroll G, Gulmezoglu AM. The gap between evidence and practice in maternal healthcare. International Journal of Gynecology and Obstetrics 2001;75:S47-S54.
Le sterilet est tres efficace et rentable. Pourtant, il est peu utilise clans certaines regions par crainte d'un risque accru de maladies inflammatoires pelviennes (MIP) et de sequelles comme la sterilite et la grossesse ectopique. De recentes etudes indiquent que le risque global de MIP avec les sterilets modernes est inferieur aux provisions, au moins dans les regions presentant une faible prevalence de MST. Le risque de MIP peut s'accroitre dans des regions ou la blennorragie et la chlamydiase sont prevalentes, ou le depistage des MST est limite et ou il est difficile de garantir des conditions d'asepsie pour l'insertion. Plusieurs travaux, notamment une erude de l'OMS dans plusieurs centres, ont etabli que le risque de MIP est liee aux procedures d'insertion du sterilet. Les etudes sur l'efficacite de la prophylaxie antibiotique pour prevenir les complications infectieuses sont peu concluantes, en partie du fair de l'utilisation de doses soustherapeutiques pour des pathogenes frequemment impliques dans les MIP. Le sterilet peut etre stir et efficace s'il est insere dans des conditions aseptiques chez des femmes ne presentant pas d'infections gynecologiques. De nouvelles eudes devront definir des normes appropriees pour l'insertion d'un sterilet quand la provalence des MST est e1evee et la capacite a eliminer le risque infectieux est limitee. Meme avec une insertion sore, clans les regions a forte prevalence de MST/VIH, la promotion du sterilet doit tenir compte du besoin qu'ont les femmes d'une protection double, contre l'infection et les grossesses non desirees.
E1 dispositivo intrauterino (DIU) es muy eficaz y rentable. No obstante, en algunas regiones, su uso es limitado debido a un riesgo mas elevado de enfermedad inflamatoria pelvica (EIP) y subsiguientes complicaciones como la infecundidad y el embarazo ectopico. Los ultimos estudios sugieren que el riesgo general de EIP con el DIU modemo es mas bajo que lo previsto, en regiones con un bajo indice de infecciones de transmision sexual (ITS). Puede que el riesgo de EIP sea mils alto en lugares con un alto indice de gonorrea y clamidia, donde es dificil garantizar condiciones asdpticas para la insercion del DIU. En un estudio realizado por la Organizacion Mundial de la Salud en multiples centros y en otros estudios se confirmaron las diferencias regionales en el indice de ITS, y el estudio de la OMS establecio que el riesgo de EIP esta relacionado temporalmente con la insercion del DIU. Los estudios sobre la eficacia de la profilaxis antibiotica para la prevenci6n de complicaciones infecciosas son inconclusos debido, en parte, al uso de regimenes subterapeuticos para patogenos comtinmente implicados en la EIP. El DIU es seguro y eficaz si es insertado bajo condiciones asepticas en mujeres sin infeccion cervical. Es necesario realizar mas estudios para definir las normas apropiadas de atencion para la insercion del DIU cuando existe un alto indice de ITS y la capacidad de descartar la infeccion es limitada. Aun cuando la insercion es segura, la promocion del DIU en areas con alto indice de ITS/VIH debe abordar las necesidades de las mujeres de doble proteccion contra infeccion y embarazo no deseado.
Richard Steen, Katharine Shapiro
Clinical and public health advisors in STI control and reproductive health, Geneva, Switzerland. E-mail: email@example.com
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