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Research Aerosolized measles and measles–rubella vaccines induce better measles antibody booster responses than injected vaccines: randomized trials in Mexican schoolchildren John V. Bennett,1 Jorge Fernandez de Castro,2 Jose Luis Valdespino-Gomez,3 Ma de Lourdes Garcia-Garcia,4 Rocio Islas-Romero,5 Gabriela Echaniz-Aviles,6 Aida Jimenez-Corona,7 & Jaime Sepulveda-Amor8 Objective To compare antibody responses and side-effects of aerosolized and injected measles vaccines after revaccination of children enrolling in elementary schools. Methods Vaccines for measles (Edmonston–Zagreb) or measles–rubella (Edmonston–Zagreb with RA27/3) were given by aerosol or injection to four groups of children. An additional group received Schwarz measles vaccine by injection. These five groups received vaccines in usual standard titre doses. A sixth group received only 1000 plaque-forming units of Edmonston–Zagreb vaccine by aerosol. The groups were randomized by school. Concentrations of neutralizing antibodies were determined in blood specimens taken at baseline and four months after vaccination from randomized subgroups (n = 28–31) of children in each group. Findings After baseline antibody titres were controlled for, the frequencies of fourfold or greater increases in neutralizing antibodies did not differ significantly between the three groups that received vaccine by aerosol (range 52%–64%), but they were significantly higher than those for the three groups that received injected vaccine (range 4%–23%). Mean increases in titres and post-vaccination geometric mean titres paralleled these findings. Fewer side-effects were noted after aerosol than injection administration of vaccine. Conclusion Immunogenicity of measles vaccine when administered by aerosol is superior to that when the vaccine is given by injection. This advantage persists with aerosolized doses less than or equal to one-fifth of usual injected doses. The efficacy and cost- effectiveness of measles vaccination by aerosol should be further evaluated in mass campaigns. Keywords Measles vaccine/administration and dosage; Rubella vaccine/administration and dosage; Immunization, Secondary; Administration, Inhalation; Administration, Cutaneous; Aerosols; Nebulizers and vaporizers; Injections; Enzyme-linked immunosorbent assay; Comparative study; Randomized controlled trials; Mexico (source: MeSH, NLM ). ´ ´ Mots cles Vaccin antimorbilleux/administration et posologie; Vaccin antirubeoleux/administration et posologie; Rappel vaccination; ´ ´ ´ Administration respiratoire; Voie cutanee; Aerosol; Nebulisateur; Injection; ELISA; Etude comparative; Essai clinique randomise; ´ Mexique (source: MeSH, INSERM ). ´ ´ ´ ´ ´ Palabras clave Vacuna antisarampion/administracion y dosificacion; Vacuna contra la rubeola/administracion y dosificacion; ´ ´ ´ ´ ´ ´ Inmunizacion secundaria; Administracion por inhalacion; Administracion cutanea; Aerosoles; Nebulizadores y vaporizadores; Inyecciones; Test de ELISA; Estudio comparativo; Ensayos controlados aleatorios; Mexico (fuente: DeCS, BIREME ). ´ Bulletin of the World Health Organization 2002;80:806-812. ´ ´ ¸ ´ ˜ Voir page 811 le resume en francais. En la pagina 812 figura un resumen en espanol. Introduction vaccination by aerosol involved small numbers of participants, and, in many, no comparison groups received injected vaccine. Studies of measles vaccination by alternative routes were In the largest controlled trial, more than 1000 seronegative recently reviewed comprehensively (1). Routes studied have children without a history of measles were given primary included the aerosol, intranasal, intradermal, intraocular and immunization with aerosolized vaccines (2). All three of the oral routes. Twenty-four studies of measles vaccination by vaccines given by ultrasonic nebulization, including the aerosol were reviewed. The aerosol route seemed to be the Schwarz (SW) vaccine strain, produced results superior to most promising of the nonpercutaneous routes, as judged by those with injected vaccines. seroresponses elicited in seronegative and seropositive A randomized, controlled trial of response to revaccina- children aged 9 months or older. Most of the studies of tion in a large group of South African schoolchildren was 1 Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, GA, USA (email: email@example.com). Correspondence should be addressed to this author. 2 Consultant, National Institute of Public Health, Cuernavaca, Mexico. 3 Academic Dean, National Institute of Public Health, Cuernavaca, Mexico. 4 Senior Researcher, National Institute of Public Health, Cuernavaca, Mexico. 5 Public Health Nurse, National Institute of Public Health, Cuernavaca, Mexico. 6 Head, Department of Epidemiologic Diagnosis, National Institute of Public Health, Cuernavaca, Mexico. 7 Assistant Researcher, National Institute of Public Health, Cuernavaca, Mexico. 8 Senior Researcher and Director, National Institute of Public Health, Cuernavaca, Mexico. Ref. No. 02-0081 806 Bulletin of the World Health Organization 2002, 80 (10) Boosting responses after aerosol measles vaccination published after the review paper (3). The results of this trial showed that previously vaccinated children given aerosolized Edmonston–Zagreb (EZ) vaccine had significantly better booster responses than those given comparable doses of EZ or SW vaccines by injection. Aerosol vaccination for measles was used in mass campaigns in Mexico nearly a decade ago (using methods similar to those in the South African trial), when about 4 million children aged 9 months–15 years were given aerosolized vaccine (4). Revaccination for measles on school entry is required in Mexico, and this provided us with an opportunity to evaluate the reactogenicity and antibody booster responses in school- children, including responses to reduced dosages of vaccine given by aerosol. We carried out studies in the autumn of 1998 in children enrolling in schools of Pachuca and Tulancingo in Hildalgo state. No cases of measles had been reported from these study areas since 1994. We evaluated antibody responses for measles and rubella after children received injected or aerosolized monovalent measles and rubella vaccines or point of use by adding 0.2 ml of a quickly thawed concentrated vaccines containing measles combined with rubella. In this vaccine (105.6 per ml) to vials containing 7.8 ml of cold paper we report only the antibody responses to measles in stabilizer solution. The other two vaccines were supplied in children in the 6 study arms given measles or measles–rubella 5-ml vials containing reconstituted vaccines with concentra- vaccines. tions 10 times higher per ml than the administered doses. Materials and methods Injected vaccine Injected measles vaccine was also given to three groups in Aerosolization method The equipment used to generate the aerosols was devised by customary doses. Each of the injected vaccines was provided in Jorge Fernandez de Castro and has been used in other studies, single-dose vials containing lyophilized powder that was as well as in mass campaigns in Mexico (3–5) (Fig. 1; not to reconstituted with cold diluent just before use. Children in scale). The materials and procedures have been described two groups each received a 103.9 pfu dose of EZ vaccine given subcutaneously in 0.5 ml diluent — one group received elsewhere (5). Briefly, an electrically powered compressor measles vaccine only and the other measles vaccine combined delivered compressed air at 50 lb/in.2 to a nebulizer (IPI with rubella vaccine. Each child in the third group received a Medical Products, Chicago, Illinois) containing reconstituted 103.7 pfu dose of Schwarz measles vaccine (SmithKline measles vaccine in a container filled with crushed ice. A motor Beecham) in 0.5 ml diluent. vehicle battery could be used to power the compressor as well as outlet current. The nebulizer generated small particles (mainly 45 mm in diameter) as a true aerosol (not a spray). Study design and selection of participants We held briefing sessions for parents, school staff and Such aerosols do not ''wet'' surfaces to which they are applied municipal authorities from the study area. A list of all public and efficiently reach the lower respiratory tract. In contrast, elementary schools in the area was prepared, and individual sprays generally have particles >50 mm in diameter, wet schools were randomized to different treatment groups with a surfaces to which they are applied and are generally capable of table of random numbers. Seventy-nine schools were only reaching the upper respiratory tract. randomly assigned to one of the six treatment groups. The vaccine was administered for 30 seconds, during Strategies for randomization and sampling appear in a which time about 0.1 ml of vaccine was nebulized and companion paper (6). delivered into a disposable conical paper cup with its tip At the time of vaccination, the parent or guardian was removed. The cone was held loosely over the nose and mouth asked about the health of the child and about any illnesses in the of the child. Each nebulizer freshly charged with 5 ml of previous two weeks. Each child was physically examined, and his vaccine could be used to vaccinate about 45 children. or her height and weight were recorded. Teachers entered Preliminary simulation experiments showed no detectable loss information in an illness diary for two weeks after vaccination in potency of EZ measles vaccine in the nebulizer after and reported any absences — the reasons for which were then 20 minutes of nebulization. evaluated through home visits by project staff. The protocol for the trial was approved by the Ethical Vaccines Committee for the Instituto Nacional de Salud Publica (INSP); ´ Aerosolized vaccine the Health Services for Hildalgo state; and the Human Aerosolized EZ measles vaccine was given to three groups at Investigations Committee, Emory University School of Med- different administered doses: 103 pfu (low-dose measles icine. Free and informed consent for children to participate in vaccine group), 103.9 pfu (measles vaccine group) or 104.2 the trial was obtained from the child's parent or guardian. pfu in a vaccine also containing RA27/3 rubella vaccine (measles–rubella vaccine group). The latter two doses were Antibody assays equivalent to the doses normally given by injection. The All sera were tested by enzyme-linked immunosorbent assay vaccine for the low-dose measles group was prepared at the (ELISA) assay using a measles nucleoprotein antigen (7). Bulletin of the World Health Organization 2002, 80 (10) 807 Research Spectrophotometric readings of test sera containing this Results antigen and other reagents (designated ''P'') were compared with readings from test sera that differed only by the exclusion Participants and baseline characteristics of the antigen (designated ''N''); sera were considered to be Data analysis was restricted to participants who met the seropositive if P/N 53.0 and P – N 50.09, seronegative if following requirements: both readings were below these values and indeterminate if one . had documentation that they had received only a single of the two readings was below either threshold. Seroconver- previous dose of a measles-containing vaccine (nearly sion was defined as a change from seronegative to seropositive. always before one year of age) Sera from about 11% of children in each group were . had not been given oral polio vaccine or blood transfusions randomly selected to undergo neutralization tests. Specimens within the two weeks before vaccination taken at baseline and six months after vaccination were tested . were not immunosuppressed and had no allergy to eggs with an enhanced neutralization test to detect measles . had oral temperatures 438.5 oC at vaccination immunoglobulin G (8). Results were reported in mIU/ml . had blood samples taken at both baseline and four months serum, and titres <120 mIU/ml were classified as sero- after vaccination tested for measles antibodies by ELISA negative (9). test . were followed up clinically for two weeks after vaccination. Data management and analysis Information from the data collection forms and laboratory data Selected characteristics of the 1624 children in the six groups were initially provided as Stata files; these were then converted that received measles vaccines and met these criteria are shown into EpiInfo version 6.02 files for analysis and logistic in Table 1. No significant differences were seen between regression with the companion program of Dallal (10). individual groups in the proportion of children aged 6–8 years. Seroconversion by ELISA required a change from seronega- Baseline seronegativity determined by ELISA was comparable tive to seropositive. Neutralizing antibody titres in the different for all groups except the group that received measles–rubella groups were compared after vaccination by using the vaccine subcutaneously, which had a significantly higher proportions of children with at least fourfold increases from frequency of seronegativity. No significant differences in baseline titres (seroconversion), geometric mean titres, average overall age or seronegativity evaluated by ELISA at baseline fold increases in titres from baseline and the proportion of were seen between the two different routes of administration. children who remained seronegative after revaccination. Characteristics of the children in subsamples with We used the w2 or Fisher's tests to compare the neutralizing antibody titres are presented separately in Table 1 proportions of groups that underwent seroconversion or were because this data played the principal role in subsequent seropositive. We used ANOVA (or the Mann-Whitney U-test analyses. No significant differences were seen between groups if non-parametric) to compare differences in antibody titres or between routes of administration in age, seronegativity or between groups. We used multiple logistic regression to baseline geometric mean antibody titres (GMTs). In contrast analyse seroconversions in the different groups by using the with the results from ELISA, the group that received measles– low-dose aerosol group as the reference and controlling for rubella vaccine subcutaneously had the lowest point estimate baseline antibody status. Weight for height, height for age and of seronegativity. The proportion of children identified as weight for age Z-scores were calculated with established norms seronegative by ELISA in each group exceeded the proportion for Mexico (11). identified as seronegative by the neutralization test; this Table 1. Characteristics of children who received measles or measles–rubella vaccines Aerosolized vaccine Injected vaccine Low-dose EZ measles EZ measles– EZ measles Schwartz EZ measles– EZ measles rubella measles rubella General characteristics No. of children 255 248 257 275 281 308 Dose of measles vaccine (pfu) 103.0 103.9 104.2 103.9 103.7 103.9 No. of schools 13 11 12 14 16 13 Pupils per school (range) 4–43 6–83 1–57 3–61 1–49 2–75 Pupils aged 6–8 years (%) 87 81 84 82 81 85 ELISA status Children seronegative for measles (%)a 15 18 18 16 20 28 Children with neutralizing antibody data No. with paired titres 31 31 28 28 30 30 Mean age (years) 6.8 6.5 6.5 6.8 6.5 6.6 Seronegative at baseline (%)b 10 10 14 4 17 3 Geometric mean antibody titres at baseline 609 582 726 556 562 604 (mIU/ml) a P/N <3.0 and P – N <0.09. b <120 mIU neutralizing antibodies/ml of serum. 808 Bulletin of the World Health Organization 2002, 80 (10) Boosting responses after aerosol measles vaccination indicated that the neutralization test had a greater sensitivity for group (Fig. 3), and GMTs four months after vaccination were detecting antibodies. nearly three times higher in the combined aerosol group (Fig. 4). The confidence bounds for both outcomes overlapped within Antibody test results each combined group. Except for slight overlaps of confidence The frequency of seroconversions in baseline specimens bounds for the average fold-increase between the groups that identified as seronegative by ELISA was comparable for all received subcutaneous Schwartz vaccine and low dose groups (n = 231; frequency range 95%–100%) except the group aerosolized measles vaccine, the lower confidence bound of that received measles–rubella vaccine subcutaneously. For each subgroup of the combined aerosol group exceeded the unexplained reasons, seroconversion was significantly less upper bounds of each subgroup of the combined injected group frequent (82%) among the 86 seronegative children in this group. (Fig. 3 and Fig. 4). On logistic regression analysis, the frequency of None of age, sex, illnesses in the two weeks before seroconversion detected by neutralization test criteria — the vaccination (fever, rash, cough, rhinitis, conjunctivitis and ''gold standard'' and more precise quantitative test of response diarrhea) and anthropometric scores contributed significantly — did not differ significantly between the three groups that when added to the logistic model shown in Table 1. received aerosolized vaccine (Table 2). However, the frequency of seroconversion in the group that received low- Post-vaccination reactions dose aerosolized measles vaccine (52%) significantly exceeded We recorded cases of cough, rhinitis, fever, diarrhoea, rash and that for the three groups that received injected vaccines (range conjunctivitis among participants that lasted one or more days 4%–23%). Furthermore, the lower confidence bounds of the in the two weeks after vaccination. The rates were 7.5% for odds ratios for the other two aerosolized groups substantially cough, 3.0% for rhinitis, 2.9% for fever, 1.2% for diarrhoea, exceeded the upper limits of all of the groups that received 1.0% for rash and 0.7% for conjunctivitis. Every symptom injected vaccines; this indicated that these differences were occurred less frequently among the 760 children who received highly statistically significant. Overall, seroconversion was aerosolized vaccine than in the 864 who received vaccine by detected in 57% of the children in the groups that received injection; this difference was significant (P40.002) for all aerosolized vaccine, but only 11% of those in the injected symptoms except rhinitis and diarrhoea. No Koplik's spots groups. were noted. The children that received low-dose aerosolized Importantly, seroconversion was affected by baseline measles vaccine had one or more of the above symptoms neutralization antibody titres — the rate of seroconversion was significantly more often (12.5%; P40.0001) than the children 71% in the 1st quartile of baseline titres (4303 mIU/ml) but in the other aerosol groups (0.8% and 2.7%). The group that only 2% in the 4th quartile (titres >1222 mIU/ml) (Table 2). received low-dose aerosolized measles vaccine was signifi- When evaluated by route of administration and quartile of cantly less frequently (P = 0.0007) affected with such baseline titre (Fig. 2), seroconversion was significantly symptoms, however, than those who received measles–rubella (P<0.0005) more frequent when vaccine was administered vaccine subcutaneously (23.7%). The frequency of such by aerosol in every quartile except the 4th quartile, where there symptoms in the group that received low-dose aerosolized was little response to either administration route. No child in vaccine did not differ significantly from that for the groups that any group was seronegative four months after vaccination. received EZ vaccine (16.0%) or SW vaccine (8.5%) sub- The above findings were supported by both average fold cutaneously. The groups that received standard dose aero- increases in titres and GMTs of neutralizing antibodies. solized measles and measles–rubella vaccines had symptoms Antibodies increased on average nearly 12-fold in the combined significantly less frequently than any group that received aerosolized group versus only twofold in the combined injected injected vaccines (P40.004). Table 2. Percentage of children with fourfold or greater increases in neutralizing antibody levels four months after receiving a booster dose of measles vaccinea Group No. (%) of children Adjusted odds ratio (95% CI) Adjusted P b Vaccine group Aerosol administration Low-dose EZ measles 16/31 (52)c 1.0 (reference) EZ measles 20/31 (65) 2.1 (0.5–9.8) 0.34 EZ measles–rubella 15/28 (54) 2.6 (0.5–13.6) 0.24 Subcutaneous administration EZ measles 1/28 (4) 0.003 (<0.001–0.06) <0.0001 Schwartz measles 7/30 (23) 0.034 (0.003–0.35) 0.0003 EZ measles–rubella 2/30 (7) 0.004 (<0.001–0.07) <0.0001 Baseline quartile of neutralization titre (mIU/ml) First (4303) 32/45 (71) 1.0 (reference) Second (304–637) 17/44 (39) 0.041 (0.005–0.38) 0.0002 Third (638–1222) 11/45 (24) 0.006 (<0.001–0.07) <0.0001 Fourth (51223) 1/44 (2) <0.001(<0.001–0.007) <0.07001 a Determined by multivariate analysis using low-dose aerosol as the reference group and controlling for baseline antibody titres. b Likelihood ratio statistic. c Figures in parentheses are percentages of children responding over total. Bulletin of the World Health Organization 2002, 80 (10) 809 Research of this potency simply by extending the time of administration from 30 seconds to about 45 seconds. This means that no specially prepared vaccine is needed for aerosol vaccination campaigns, which could vaccinate several times as many children as injection campaigns with the same amount of vaccine as needed for injection and with the expectation of significantly better antibody responses. The public health implications of better antibody responses from aerosolized vaccines include an increased duration of protection from measles and less viral replication upon exposure to wild measles virus in those receiving aerosolized vaccines and longer protection in the infants of mothers so vaccinated (13). Thirty seconds of exposure to aerosolized vaccine is a time short enough to provide efficient vaccination but long enough to accommodate variations in breathing patterns. Some children breathe slowly and deeply (as instructed), others seem to take only tidal breaths and a few even stop inhaling briefly on initial exposure to aerosol. Such differences doubtlessly produce widely varying retained doses, which may be only approximately one quarter of the inhaled dose (14). The superior antibody responses observed after aerosol vaccination show that these and other variables that adversely Discussion affect aerosol performance are not enough to offset its This randomized, controlled trial strongly confirms previous advantages over subcutaneous injection. results that showed a superior boosting response for aerosol The superior boosting effect of low-dose aerosolized vaccination compared with vaccination by injection. Substan- vaccines compared with injected vaccines was convincingly tially better boosting responses were obtained with aerosol documented with highly significant differences, despite rela- doses of only 1000 pfu than with vaccines given in their usual tively small numbers of neutralizing antibody tests. The doses by injection. equivalence of responses within the aerosol and injected groups, The standard titre vaccines — that is, doses <104.7 pfu however, was less confidently established. In this regard, the — provided for injection in this study each had 5000 or more increased point estimate of response to injected SW vaccine pfu per dose. Such vaccines, when reconstituted and nebulized compared with other injected vaccines in our trial contrasts with in a 0.1ml volume, deliver doses of vaccine containing the significantly better responses with injected EZ compared 51000 pfu. The minimum acceptable dose of measles with injected SW vaccine seen in the South African trials (3). vaccines for injection is 1000 times the tissue culture infectious Studies in progress will further evaluate the reasons for dose 50 (TCID50), but most vaccines used in the Expanded the observed lack of stability of SW vaccine under field Programme on Immunization contain 55000 TCID50 per conditions of nebulization (3). It is clear from Terskikh's 0.5ml dose in order to meet stability test requirements. The experience that aerosolized SW can perform well when lyophilized vaccine powder must lose <1 log in titre after 7 days delivered by a different type of nebulizer (2). Until these at 37 oC and still contain a minimally acceptable dose (Julie issues are clarified, it seems prudent to use only vaccines shown Milstien, personal communication, 24 July 2000). A to be stable under simulated aerosol field conditions. 5000 TCID50 dose is equivalent to 3500 pfu (12). Aerosol The use of a single nebulizer for aerosol immunization of doses of 1000 pfu or more can thus be achieved with vaccines multiple children was extensively employed in Mexico nearly a 810 Bulletin of the World Health Organization 2002, 80 (10) Boosting responses after aerosol measles vaccination decade ago with the same equipment and procedures used in repeatedly exposed to wild measles virus itself while caring our trial, and it was noted to be well tolerated and without for sick children, but that such exposures have never been serious side-effects (4). Furthermore, in both this and the recognized as a source of harm for immune people. South African trial (3), the frequencies of respiratory illnesses The aerosol route for measles vaccination is painless, after vaccination were higher in those given injected vaccines simple, quick, well tolerated, more immunogenic in lower than in those receiving aerosolized vaccines. Although aerosol doses than injected vaccine and avoids the risk of unsafe vaccination may be less reactogenic than vaccination by injections. Currently available vaccines and equipment are injection, differing rates of background illnesses at the times suitable for mass campaigns, and subsequent studies may show when vaccines were given to different groups could have aerosolized vaccines to be an inexpensive alternative to mass played a role in both studies. Such a mechanism may underlie injections, as envisioned by the late Albert Sabin many years the different frequencies of symptoms within the three groups ago (16). Aerosols could be a critically useful complement to that received aerosolized vaccines in our trial. In addition, the injected vaccines in the ultimate global elimination and actual dose the child receives from an aerosol is substantially eradication of measles. n less than the nebulized dose administered over 30 seconds because the vaccine is only taken into the lungs during Acknowledgements inspirations that occur during those 30 seconds and only about The generous donation of vaccines by the Swiss Serum and one quarter of the inspired vaccine is retained (14). Vaccine Institute is gratefully acknowledged, as is the The US Pharmacopeia permits low levels of microbial constructive advice and assistance extended to us by Drs contaminants in substances delivered by aerosols (15). Such Reinhard Gluck and Mateo Schaffhauser. We are also grateful standards are consistent with the lack of sterility of inhaled air for the assistance of Mr Heriberto Lara Boy (SmithKline and the natural defences of the respiratory tract. All vaccines Beecham, Mexico) for donating the Schwarz vaccine used in were chilled when placed in the nebulizer and then kept cold on this study. The assistance of health services staff in Hildalgo crushed ice, thus providing inhospitable conditions for state was essential to the success of these studies, and the outgrowth of any contaminants over the time needed to collaboration of Dr Irma Eugenia Gutierrez is especially deliver 40 doses. The prospect for retrograde contamination of acknowledged. We are also grateful to Dr Paul Rota of the vaccine in the nebulizer is greatly reduced by the loose fit of the Centers for Disease Control and Prevention, who assayed viral disposable paper mask over the nose and mouth of the child titres in pretrial aerosol simulations with measles vaccine, and and the high pressure inside the nebulizer. to Dr William Bellini and Irene Williams of CDC, who assisted Concerns about the safety of aerosol vaccination for in antibody assays. those receiving the vaccine, as well as for vaccinators, have Financial support for these trials was obtained from been addressed elsewhere (1). One of the most frequently INSP and Mexico's National Council for Research (Grant # expressed concerns has been the safety of repeated exposures M0009-M). of vaccinators to aerosolized vaccine. In this regard, it should be re-emphasized that health care workers have been Conflicts of interest: none declared. ´ Resume ´ ´ ´ ´ Les vaccins antirougeoleux et antirougeoleux-antirubeoleux en aerosol induisent une meilleure reponse ´ ´ de rappel en anticorps antirougeoleux que les vaccins administres par injection : essais randomises chez ´ des ecoliers mexicains ´ Objectif Comparer les reponses en anticorps et les effets ´ ` ´ ´ Resultats Apres correction des titres d'anticorps de reference, la ´ ´ secondaires de vaccins antirougeoleux administres par aerosol et ´ frequence des quadruplements, ou davantage, des titres d'anti- ` ` ´ par injection apres revaccination d'enfants entrant a l'ecole ¸ corps neutralisants ne variait pas de facon significative entre les primaire. ¸ ´ trois groupes ayant recu le vaccin par aerosol (intervalle : 52 %- ´ Methodes Les vaccins antirougeoleux (Edmonston-Zagreb) ou ´ ´ ` 64 %), mais etait significativement superieure a celle des trois ´ antirougeoleux-antirubeoleux (Edmonston-Zagreb avec RA27/3) ¸ groupes ayant recu le vaccin par injection (intervalle : 4 %-23 %). ´ ´ ´ ´ ont ete administres par aerosol ou par injection a 4 groupes ` ´ ´ ´ ´ L'elevation moyenne des titres et le titre moyen geometrique apres ` ` ¸ d'enfants. Un cinquieme groupe a recu le vaccin antirougeoleux ˆ ´ vaccination suivaient le meme schema. Les effets secondaires ¸ Schwarz par injection. Ces cinq groupes ont recu les vaccins aux ´ ` ´ etaient moins nombreux apres administration du vaccin par aerosol ` ¸ doses habituelles. Un sixieme groupe n'a recu que 1000 unites ´ ` qu'apres injection. ´ formatrices de plages de vaccin Edmonston-Zagreb, par aerosol. ´ ´ Conclusion Administre par aerosol, le vaccin antirougeoleux est ´ ´ ´ ´ Les groupes ont ete randomises par ecole. Les titres d'anticorps ` ´ plus immunogene que lorsqu'il est administre par injection. Cet ´ ´ ´ ´ ´ neutralisants ont ete determines dans des echantillons de sang avantage persiste avec des doses d'aerosol inferieures ou egales a ´ ´ ´ ` ´ ´ ´ ´ preleves au debut de l'etude (valeurs de reference) et 4 mois apres ´ ´ ` ´ 1/5 des doses habituellement administrees par injection. L'efficacite´ la vaccination dans des sous-groupes d'enfants (n = 28-31) ˆ ´ et le rapport cout-efficacite de la vaccination antirougeoleuse par choisis par tirage au sort dans chaque groupe. ´ ˆ ´ ´ aerosol devront etre evalues plus avant lors de campagnes de masse. Bulletin of the World Health Organization 2002, 80 (10) 811 Research Resumen ´ ´ ´ Las vacunas aerosolizadas contra el sarampion y el sarampion–rubeola inducen mejores respuestas de refuerzo de los anticuerpos antisarampionosos que las vacunas inyectadas: ensayos aleatorizados en escolares mexicanos ´ Objetivo Comparar las respuestas de produccion de anticuerpos y ´ ´ Resultados Despues de ajustar segun los tı´tulos de anticuerpos los efectos secundarios de las vacunas antisarampionosas aero- ´ basales, la frecuencia de incrementos de cuatro o mas veces de los ´ ´ solizadas e inyectadas despues de la revacunacion de ninos ˜ ´ anticuerpos neutralizantes no difirio significativamente entre los matriculados en escuelas primarias. tres grupos que habı´an recibido la vacuna mediante aerosol ´ ˜ Metodos Cuatro grupos de ninos recibieron vacunas contra el ´ (intervalo: 52%–64%), pero fue significativamente mas alta que la ´ ´ sarampion (Edmonston–Zagreb) o contra el sarampion–rubeola ´ de los tres grupos a los que se habı´a inyectado la vacuna (intervalo: (Edmonston–Zagreb con RA27/3) mediante aerosol o por 4%–23%). Los aumentos medios de los tı´tulos y sus medias ´ ´ inyeccion. Un quinto grupo recibio la vacuna antisarampionosa ´ ´ geometricas posvacunacion corroboraron esos resultados. Se ´ Schwarz mediante inyeccion. Estos cinco grupos recibieron las observaron menos efectos secundarios con el aerosol que con las vacunas a las dosis habituales. Un sexto grupo recibio solo´ ´ inyecciones. 1000 unidades formadoras de placas de la vacuna Edmonston– ´ Conclusion La inmunogenicidad de la vacuna antisarampionosa Zagreb mediante aerosol. Los grupos fueron aleatorizados por aerosolizada es superior a la de la vacuna inyectada. Esta ventaja se escuelas. Las concentraciones de los anticuerpos neutralizantes se mantiene en las dosis aerosolizadas equivalentes a un quinto o determinaron en muestras sanguı´neas obtenidas en condiciones menos de las dosis inyectadas habituales. La eficacia y la relacion ´ ´ ´ basales y cuatro meses despues de la vacunacion a partir de ´ costo-eficacia de la vacunacion antisarampionosa mediante ˜ subgrupos aleatorizados (n = 28–31) de ninos de cada grupo. ˜ aerosol se deben seguir evaluando en campanas ması´vas. References 1. Cutts F, Clements J, Bennett J. Alternative routes of measles immunization: 8. Albrecht P, Hermann K, Burns G. Role of virus strain in conventional and a review. Biologicals 1997;25:323-38. enhanced measles plaque reduction neutralization test. Journal of Virological 2. Terskikh A, Danilov AI, Shchelchkov GI, Fadeeva LL, Khaletskaia EV. Theoretical Methods 1981;3:251-60. substantiation and effectiveness of immunization with aerosols of liquid 9. Chen RT, Markowitz LE, Albrecht P, Stewart JA, Mofenson LM, Preblud SR, et measles vaccine. Vestik Akademii Meditsinskikh Nauk SSSR 1971;26:84-90. al. Measles antibody: reevaluation of protective titers. Journal of Infectious In Russian. Diseases 1990;162:1036-62. 3. Dilraj A, Cutts FT, de Castro JF, Wheeler JG, Brown D, Roth C, et al. Response 10. Dallal G. Logistic: a logistic regression program for the IBM PC. American to different measles vaccine strains given by aerosol and subcutaneous routes Statistician 1988;42:272. to schoolchildren: a randomized trial. Lancet 2000;355:798-803. 11. Anonimo: Norma oficial mexicana para el control de la nutricion, crecimiento 4. Fernandez de Castro J, Kumate-Rodriguez J, Sepulveda J, Ramirez-Isunza JM, y desarrollo del nino y del adolescente [ Anonymous: Mexican guidelines about Valdespino-Gomez JL. La vacunacion antisarampionosa en Mexico por el child nutrition] Diario Oficial de la Federacion 1994, Mexico, 13 de Abril. metodo de aerosol [Measles vaccination by the aerosol method in Mexico]. In Spanish. Salud Publica de Mexico 1997;39:53-60. In Spanish. 12. Dulbecco R, Ginsberg HS. The nature of viruses. In: Dulbecco R, Ginsberg HS, 5. Fernandez de Castro J, Kumate J. La vacunacion contra el sarampion. Situacion editors. Virology. Philadelphia: Harper and Row; 1980. en Mexico y America. Avances en el metodo de immunizacion por aerosol 13. Dilraj A, Cutts FT, Bennett JV, Fernandez de Castro J, Cohen B, Coovadia HM. [Vaccination against measles. The situation in Mexico and America. Advances Persistence of measles antibody two years after revaccination by aerosol or ´ in the method of aerosol immunization]. Boletı´n Medico del Hospital Infantil subcutaneous routes. Pediatric Infectious Diseases Journal 2000;19:1211-3. ´ de Mexico 1990;47:449-61. In Spanish. 14. Sabin AB, Flores Arechiga A, Fernandez de Castro J, Sever JL, Madden DL, 6. Sepulveda J, Valdespino J, Garcia L, Bennett J, Romero R, Echaniz G, et al. A Shekarchi I, et al. Successful immunization of children with and without randomized trial demonstrating successful boosting responses following maternal antibody by aerosolized measles vaccine. JAMA 1983;249:2651-62. simultaneous aerosols of measles and rubella (MR) vaccines in school age 15. Microbiological attributes of pharmacopeial articles. Pharmacopeial Forum children. Vaccine 2002;20:2790-5. 1996;22:3099-302. 7. Hummel KB, Erdman DD, Heath J, Bellini WJ. Baculovirus expression of the 16. Sabin A. My last will and testament on rapid elimination and ultimate global nucleoprotein gene of measles virus and utility of the recombinant protein eradication of poliomyelitis and measles. Pediatrics 1992;90:162-9. in diagnostic enzyme immunoassays. Journal of Clinical Microbiology 1992;30:2874-80. 812 Bulletin of the World Health Organization 2002, 80 (10)
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On radar | casey research, Another central bank hits the panic button. the ecb hits the panic button; hedge funds are in bed with central bankers; and the black swans that could ignite a bull. We road traveled, A lifestyle & travel blog devoted to sharing adventure, military life, and everything in-between!. Bike lanes casey neistat - youtube, Rating is available when the video has been rented. follow me on snapchat - caseyneistat check out my second channel - https://www.youtube.com/snapstories.
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The Style Gallery is a great new way for you to view, love, and share outfit photos. It's meant to showcase
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A Latte to Love Dress in Mint
Much like your favorite peppermint beverage, this striped dress boasts delectable details that are sure to make your heart melt! Available exclusively from ModCloth, this flowing frock features a plunging V-neck, angular black stripes, and elegant folding along its waist sash accent, for a sweet ensemble youll want to enjoy ...
Road to Rhode Island Dress
Providence awaits, so hit the highway with bountiful brio in this petal pink dress! Touting a crocheted neckline and bib applique, this jersey knit dress looks adorable in the front seat. Meanwhile, its ultra-soft fabric and loose cap sleeves are totally comfortable for the duration of your scenic drive!
White Haute Cocoa Dress in Vanilla
At your dinner party, you astound by stepping out of the kitchen in this lacy dress, a tray covered in mugs of velvety white-chocolate cocoa at the ready. The V-neckline and graceful keyhole back of this dress appear as delicate as lace cookies you serve up, while the cream skirt ...
Confectioner's Dream Dress in Sky
As you embark on a tour of your favorite candy factory, youre feeling lovely as can be in this powder-blue dress from Bea Dot - a ModCloth exclusive! Tiered pleats, a lacy collar, and nonpareil-inspired buttons adorn the belted silhouette of this stylish treat. So sweet!
Is That All You Dot? Dress in Sage
Give stylish pals an ensemble to look up to with this polka-dotted dress! The sage-and-white color scheme of this jersey-knit frock raises the bar on cute and casual style, while its sheer, crocheted back inspires others to kick their glamour game up a notch.
Jolly Good Mellow Dress
Celebrate a leisurely morning stroll through the neighborhood, clad in this hazy floral frock. Illustrated in muted hues of blue, ivory, and eggplant-purple, this silky, lightweight sheath blooms with effortless beauty.
Charming Darling Dress
Delight everyone in sight each time you style this feminine floral dress. Sheer, ivory crocheted panels kiss the shoulders and sides of this date-ready frock, which flaunts muted hues of pink, green, amber, and black. Its an oh-so sweet look to behold!
Ruffled and Radiant Dress
Beam with carefree beauty in this breezy, turquoise-hued frock. Boasting fluttery ruffles, gathered shoulders, and a relaxed silhouette, this buoyant shift dress hits all the bright notes!
Turn Up the Basic Dress
This charcoal dress is the perfect comfy-chic base for your next look! Maybe youll clasp a colorful bib necklace above this short-sleeved frock's V-shaped neckline, or perhaps youll strut a pair of pastel pumps beneath the swingy, subtly-striped skirt. No matter how you wear it, this jersey-knit number is ideal ...
All in a Day's Quirk Dress
Brighten your day at the office by arriving ready to be creative in this colorblocked shirt dress! Gingham and diamond-shaped patterns bring captivating charm to this collared frock, while a button closure and an orange, sapphire, and charcoal color scheme embolden your wonderful work ethic!
Come What Paisley Dress
Whatever the day brings, you stay cool and stylishly collected in this captivating maxi dress. Boasting a rosy-pink, wrap-style top and a flowing, richly hued paisley skirt, this bohemian twofer lends breezy elegance to any occasion!
My Fair Ladylike Dress
Inspire awe with your dazzling elegance in this pale-blue frock by Nataya. Boasting a bejeweled neckline, this icy-grey-lined dress features layers of delicate mesh and sparkly white netting for decadent ethereal charm! Nataya's eponymous brand unlocks the glow of every woman by creating wearable art with ethereal silhouettes and romantic ...
Flora Borealis Dress
When you float by in this fabulously boho-inspired dress, onlookers are struck with a sense of awe. Dashed with a blend of tie-dye and floral patterns in white, peach, blue, and grey, and enhanced with a cinched panel to create an empire waist effect, this batwing-sleeved frock is the look ...
Breathtaking Belle Dress in Ivory
Jaws drop and delight overtakes the faces of your party guests as you enter the room in this ivory A-line dress, found exclusively at ModCloth. You blush demurely as compliments for everything from the dreamy, tulle overlay to the layer of sequined, black lace gracing the bodice and cap sleeves ...
For the Love of Monet Dress
Paying homage to your favorite artist, you don this ivory A-line, which beams with a watercolor-inspired print of lilac, emerald, and sky-blue flowers. This chiffon frock is sure to leave an impression with its graceful flutter sleeves, surplice neckline, and gathered, flexible waistline.
Promise to Impress Dress
You cant go wrong with this floral shift dress! Touting a gold-accented cutout at the neckline and an abstract motif of blue-and-brown bouquets, this pale-blush frock guarantees a look of pure panache.
You Spring Me Joy Dress
Deliver cheer to everyone you meet in this sweet, vintage-inspired dress. Featuring vibrant blossoms, softly gathered shoulders, and a charming Peter Pan collar, this delightful white A-line adds sunshine to any day!
Record Time Dress in Sage
As your new record starts to spin, so does the pleated A-line skirt of this sage green dress. With its white Peter Pan collar, cool hue, short sleeves, and exposed zipper, this simple, sweet frock is the perfect dance partner.
Owl-Time Favorite Dress
And the winner for most-beloved bird print goes to this sweet black owl dress! You cant get enough of this 100% cotton A-line, which boasts playful repeating rows of tessellated owlets in blue, white, and brown along with a scoop neck, short sleeves, and casual hip pockets.
Form of Fluttery Dress
Inspire awe with your carefree elegance in this whimsical, smoky-blue dress. Blooming with rich hues of rust, bitter orange, blush, and fern-green, this gauzy A-line boasts a layered, keyhole-adorned bodice and fluttery sleeves for admirably charming style!
Mew Should be a Model Dress
Make the sidewalk your own personal runway as you sashay in this vintage-inspired, mint-green frock. Featuring a charming array of kitties and starbursts, this breezy, pleated A-line compliments your close-up-ready style!
Coherent Collage Dress
Craft a mixed, matched, and marvelous look around this colorblocked shirt dress! Checkered panels, diamond motifs, and lacy appliques unite on this cotton frock, which showcases added whimsy in its creative combination of sky-blue, orange, and ivory hues!
Connecting the Dots Dress
Is it just you, or does the sun seem to shine a little brighter each time you sport this charming green and ivory frock? Featuring playful, alternating pleats of dainty dots and stripes, this A-line always leads to a stylishly cheerful day!
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King of all Schmoes
Join Date: Dec 2004
Posts: 15,608
Favorite Movie: GoodFellas
I'm not what you would call the biggest Bond fan. I haven't seen many of them, and the recent output other than Casino Royale haven't been very good (and I had some problems with Casino Royale). Big budget movies like this have a tendency to make their plots overly complicated. When you bring a guy like Sam Mendes in, he strips it down and keeps the plot simple, giving characters that generally haven't had a lot of meat on their bones a surprisingly amount of depth. So instead of having a bunch of unnecessary exposition between the incredible action sequences, Mendes gives us great character moments. Many villains in films like these have little motivation. They are just bad and their actions just show us how bad they are. Here, Mendes keeps the villain closely tied to the main characters (specifically M), instead of it being some random foreign crazy person that just happened to pop up on the radar. By doing this, it makes the film much tighter. And while the character is most certainly a "bad guy", I empathized with him, which is partly due to how the character is written and partly due to Bardem's excellent performance. He chews the scenery, sure, but that scene in the middle when he is talking to M took my breath away. No Bond film that I have seen has ever made me so interested in the characters.
This is what big budget entertainment should be. It doesn't take itself so seriously that it forgets what it ultimately is, but also gives its characters enough depth that we actually give a shit about them. I also give them props for having the balls to go with the climax that they did. Very contained, almost like what would happen if Kevin McCallister grew up to be a spy and people were trying to kill him. At first I thought it was a bit silly, but as it went on it really worked. The way that sequence is shot and how it progressively gets darker and darker was spectacular. That cut from Craig first hearing music to Bardem and his crew flying in on the chopper with that great Animals rendition of "Boom Boom" was a great moment.
So yeah, thumbs up from this guy. Highly recommended.
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George Pelham (bishop)
From Wikipedia, the free encyclopedia
For the American architect, see George F. Pelham.
George Pelham (13 October 1766- 7 February 1827) was a Church of England bishop, serving in the sees of Bristol (1802–1807), Exeter (1807–1820) and Lincoln (1820–1827). He began his career as Vicar of Hellingly in Sussex in 1800.
George Pelham was the third son of Thomas Pelham, 1st Earl of Chichester and was educated at Westminster and Clare College, Cambridge, graduating in 1787.[1] He also served from 1815 to 1827 as Clerk of the Closet.[2]
- ^ "Pelham, Hon. George (PLHN784G)". A Cambridge Alumni Database. University of Cambridge.
- ^ This article incorporates text from a publication now in the public domain: Courtney, William Prideaux (1895). "Pelham, George". In Lee, Sidney. Dictionary of National Biography 44. London: Smith, Elder & Co. p. 243-244.
|Church of England titles
|Preceded by
FHW Cornewall
|Bishop of Bristol
|Succeeded by
John Luxmore
|Preceded by
John Fisher
|Bishop of Exeter
|Succeeded by
William Carey
|Preceded by
George Pretyman
|Bishop of Lincoln
|Succeeded by
John Kaye
|Court offices
|Preceded by
Robert James Carr
|Clerk of the Closet
|Succeeded by
William Jackson
|This article about a Church of England bishop is a stub. You can help Wikipedia by expanding it.


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Atrophic Vaginitis
DefinitionAtrophic vaginitis is characterized by redness, itching, and dryness of the vagina. Over time, there may be narrowing and shrinkage of the vaginal opening and the vagina itself.
|Copyright © Nucleus Medical Media, Inc.
CausesA woman's ovaries make estrogen until menopause, which happens at about 52 years of age. Before menopause, estrogen in a woman's bloodstream helps keep the skin of the vagina healthy and stimulates vaginal secretions. After menopause, when the ovaries stop making estrogen, or after ovarian failure or removal, the walls of the vagina become thin, and vaginal secretions are lessened. Similar changes can happen to some women after childbirth, but in this case these changes are temporary and less severe.
Risk FactorsFactors that may increase your chance of more severe symptoms of atrophic vaginitis include:
- Smoking
- History of having childbirth by cesarean section
- Never having been pregnant
- Anti-estrogen medications
SymptomsSymptoms of atrophic vaginitis can range from minor to severe. They include:
- Vaginal dryness
- Vaginal itching or burning
- Vaginal pain
- Problems with sexual intimacy because of painful intercourse
DiagnosisYou will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a doctor specializing in women's reproductive health. Your vaginal fluids may be tested. This can be done with:
- A test of the acid-base balance (pH balance) of the vagina
- A swabbing of a small part of the vaginal wall
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A systematic review found that participants given chewing gum after abdominal surgery may have a faster return to normal for their digestive system. Unfortunately, the quality of trials is low and more research will need to be done before this simple solution is confirmed.
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Nicole Richie
Nicole Richie in Genetic Denim Shya in Gaze
Nicole Richie was spotted doing some shopping in West Hollywood, California. The designer wore a pair of Genetic Denim Shya in Gaze with some ankle boots and a sweater under a jacket. She then topped the look off with a Chanel fanny pack.
I think this is a great way to wear gray denim, but I might be a bit bias since I have been wearing a similar look lately with mine. I think the layering is great and the color scheme is down right perfect. How have you guys been wearing your gray denim? You can click here to purchase Genetic Denim from their website.
Nicole Richie in Ksubi Spray On Skinny Jeans in Black Night
Nicole Richie was spotted at LAX Airport to catch a flight out to Miami to attend Art Basel. The designer wore a pair of the Ksubi Spray On Jeans in Black Night with some Lanvin boots. Then always the eclectic, she mixed a striped turtleneck with a rose printed Givenchy wool biker jacket.
This has to be Nicole's favorite jacket. I have seen her wear it more than a few occasions now. Even with the all over print, I find that it is a versatile piece that can be worn with a lot. Which is an amazing skill that Riccardo Tisci has. You can click here to purchase these jeans from the Ksubi website.
Nicole Richie in a Balmain Denim Dress
Nicole Richie was snapped while heading out of her hotel in New York City. She was heading to the Style Awards which kicked off Fashion Week. I wonder if we'll see Nicole attending any shows?
Nicole wore a Balmain denim dress with matching Balmain boots. This dress has a very 90s Versace feel to it with the oversize gold buttons, but I think the seaming detail gives it a nice update and makes it more streamlined. I like that Nicole chose to style it with booties instead of heels, which I think gives it a nice edge.
images from Pacificcoastnews.com
Nicole Richie in American Eagle Washed Black Denim Shorts
Nicole Richie was pictured looking very cheerful while having some lunch with some friends in West Hollywood in Los Angeles, California.
Nicole wore a pair of American Eagle washed black denim shorts with a striped tank top and black boots. She really loves her cut off denim shorts, especially the ones that have that vintage look to them. She really does wear them well though, don't you think?
Images courtesy of Ryan/WENN.com.


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In just 20 minutes, you can serve a hearty chicken chili with three different varieties of beans.
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Posted by Darren Cottingham
on September 1st, 2008
Purporting to be smart cars with a body kit, these sports car ripoffs surely aren't real! We can't find any evidence of them being legit and anything other than an elaborate Photoshop exercise, so we present them here with tongue firmly in cheek.
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Due to go on sale in January 2009 in the UK the new Avensis features engines that are both more...


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23 years old. Works in a bookstore. Very meek and a bit flighty. Her life is soon to be profoundly changed.
Comics: 192Recent Appearance: Chapter 14 - Demon Queen - Page 20First Appearance: Page 1
The first shinobi queen. She united the 4 clans. She was also known as the demon queen.
Comics: 28Recent Appearance: Chapter 14 - Demon Queen - Page 20First Appearance: Page 2
A ninja doctor. No clan affiliation. independent from the royalty and the clans. A beautiful woman but a bit of a pervert.
Comics: 49Recent Appearance: Chapter 14 - Demon Queen - Page 20First Appearance: Shinobi Queen: Chapter 7: Schools in Session – Page 15
Remember Me
I was trying here to get across them communicating through pictures. I'm not exactly happy with the way the page turned out. So perhaps it doesn't work to move the story along as I thought it would. In any case it is what it is.
Ah the joy of possesing slaves I mean servants meaning underlings no wait retainers? Maybe Vassals? Queen's smile sure is supicious.
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I got some donations recently and I want to say thanks. You don't know how much I apreciate it. Every penny will be spent for making comics. So thanks again.
great for you. thanks to this person.
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It seems like we are all in agreement that Pocono is going to come down to some sort of strategy play. There is a driver that I think will not only have a fast car, but I think can play any strategy that is needed to get the win.
88 to win 8/1
22 to win 11/1 - Another guy that should be quick, and he seems to have learned from BK how to do that "hyper-miling."
78 top 3 5/1 - Just not sure these guys actually have what it takes to close the deal.
14 top 3 25/1 - Got this one early in the week. His odds to win the race dropped from 90/1 to 45/1.
16 top 3 30/1 - This guy is picking up speed and playing the fuel mileage game of late.
Trucks - Most likely I am late to the party, but I am taking Reddick at 5/1, and I'll go Crafton at 3/1. This should most likely be the week that Erik Jones closes the deal since I have been on him over and over with no love.
Looks like the Gibbs teams have found that "extra bit of speed" that they said they were lacking.
Hamlin - My book left the odds up during practice yesterday, and I am not one to pass on a book's generosity. Got the 10/1, but just not the 20/1 like a few of you got.
Johnson - Doesn't look like he has the speed, or the long run ability of Hamlin, but it is still Dover. 4/1
Bowyer top 3 - The truck and Infinity races came down to a long fuel run at the end, and I could see drivers like the 19, 15 and 88, and even the 14 doing something out of the ordinary to get to the front. 30/1
McMurray top 3 - This guy always seems to be lurking at the short tracks. He is another one where a strategy play may get him to the front. Don't think he has anything for the Gibbs boys, but a top 3 is not out of the question. 12/1.
28-34 +$405
Parlays 3-7 +$607
Cubs -1.5 +125 - Looks like we could have a shootout with the total set at 10.5. I will take the better offense and arguably the better pitcher.
Padres -1.5 + 115 - I am assuming Tulo will sit since it is Sunday, and that is what he does. Kendrick will be lucky to get out of the 4th, like usual, and then in comes the Rockies bullpen, which has been overused on this trip. I'll also play the -2.5 when I get it. Might also play Padres to win by 4 or more when that comes out as well.
I love this race because of the huge odds and the opportunity to bet a few more drivers than normal.
43 - 55/1 $20.00
13 - 70/1 $10.00
1 - 25/1 $30.00
16- 25/1 $30.00
17 - 40/1 $20.00
22 - 12/1 $35.00
Let the chaos begin!
I really don't see how this doesn't go the full 12, but I am on the following:
Mayweather wins in Round 1-6 +22/1 ($35.00)
Mayweather wins in Round 7-10 16/1 ($60.00)
Mayweather wins in Round 10-12 22/1 ($55.00)
24-28 +$429
Parlays: 3-6 +$657
Nats -1.5 +140 -
Angels -1.5 +140
Rockies - 1.5 +155 - Don't think they get this game in today with the rain.
Astros + 136
I will continue to preach that this guy is the real deal until proven otherwise. Other than Prince Fielder, I do not think there is a player on the Rangers that can turn on Archie's fastball. Add in the fact that the Rangers have never seen him, and I think we have enough to get the W on the runline.
As long as he continues to locate with his pitches, he will continue to roll. Don't expect the ERA to edge above 2.00 tonight, which should get us to the W.
19-22 +$351
Parlays: 3-5 + $697
Cincy +102 - I'll continue to fade the Brewers until they make me pay, or they switch the manager out.
Minnesota +138 - Kyle Gibson's ERA against the Royals is absurd. Twins shouldn't need more than 3 tonight, but that is asking a lot nonetheless.
Parlay Rockies and Over: 40 to win 93
18-19 +$376.00
Parlay: 3-5 + $697.00
Nice to be three games under in the record column, but over a $1,000.00 where it counts most. Two of the losses were games where a five run lead evaporated.
Mets -1.5 +115 - Harvey actually looks like he is capable of giving up hits, but I don't think this Marlins team will take advantage. Hopefully the Mets bullpen can get it together today.
Pirates - 1.5 +125 - I think things don't get right for the Brewers until a manager change. Won't be shocked if the Brewers score two runs again at the most. This team looks completely lost and uninterested.
16-18 +$171
Parlays 2-5 +$180
Parlay: over Philly/Pitt/Colorado $100 to win $517
Mets runline +150
Yanks runline +150
Pirates runline +155
Better enjoy these fat numbers on Archie, because they will continue to drop as the world catches on that he is legit.
Big number against an anemic offense, don't mind if I do.
9-11 -$9
Parlays 2-2 +$300
Took a beating with the Rockies finally losing yesterday.
Mets +104
Rockies/Cubs over 10 Even
Milwaukee -1.5 +170
Parlay - Mets ML/Rox over 10/Brewer run line - $40 to win 400
Parlay Mets ML/Rox over 10/Chisox over 7.5 +105/Brewer Run line $40 to win $820
7-9 +$131.00
Parlays 2-1 +$340
Colorado Rockies Run Line - +170 - Back to facing a right handed pitcher, and having Hundley behind the plate should equal a comfortable win for the Rockies. This team has paid me well so far this year, and looking to go 5-0 with them.
Colorado Rockies -2.5 +230
Parlay: Under Cincy/SD/Tex and Colorado -1.5 35 to win 623.
Cubs -1.5 +190 - I could see the magical story of the Cubs starting off well tonight. I don't buy them as a legit contender, but I do thing Lester can keep the Cardinals in check. Lean to the over if it goes back to + money.
ChiSox +105 - I think the team in Chicago that will surprise and turn heads isn't the Cubs, but the ChiSox. I'll take the plus money in this matchup and wait for Ventura to have a middle inning meltdown.
Cincinnati -1.5 - +175 - Cincy is a team that I see making a huge turnaround barring injury. Cueto, plus this offense, make a solid statement tomorrow.
Colorado +140 - I think I am one of the very few who thinks the Rox will actually be respectable. This offense will be a monster with the key pieces healthy. Once Tulo gets hurt, it'll be all down hill.
Good luck on the season to all. Especially to those that don't take favorites.
Harvick - 4/1
Larson 7/1
Not a fan of going against the 22, but Harvick owns this place and Larson is primed to win a bunch this year.
Solid start to the season with a Duel win and an Xfinity win yesterday. Not happy with my numbers for today's race, but that is what happens when you wait.
88 - 6/1 - Horrible number, but I think he wins handily today.
48- 9/1 - Possible overreaction to the Duels, but it looks like he has a bad fast car. Hard to tell since the majority of the fast cars were in the other Duel.
4 - 12/1 - This will depend on whether or not he drops to the back to just ride around. I think he needs to stay near the front, even in the early stages of the race.
16 top 3 - 10/1 - Ever notice this guy is always lurking at the 500? Don't think he has the team to get him to the front, but I think he can linger around the top spots long enough to maybe pull off a top 3 finish.
42 top 3 10/1 - I think he wins multiple races this season, but not today. He will be in the mix just about every weekend in my opinion. Kyle Busch being out is going to open the door for this kid in both series.
Might look at one or two more top 3's, but I am set on the 88 winning today.
Plus money after the Duels, now looking to make a huge splash. Big names in this race means big numbers on other drivers.
Brian Scott 20/1
Regan Smith 10/1 - I don't get why his numbers are always high in these plate races.
Field - 12/1 - Relying on Mike Wallace to bring this one home.
Good luck on the season boys!
Duel I - I was surprised to see the 88 at 6/1. Starting in the back means nothing in a race like this when there is plenty of room to move. I'll take the 88 and 20 at 6/1 in the first race. I get the two strongest cars and the two best plate racers.
Duel II - 78 and 11 - Don't quite get the low odds for Carl, but it helps me get a better number. Carl is playing the "better teammate" card, and it wouldn't surprise me to see him push the 11 to the win. Truex looked strong in the Unlimited, and I think he has a good chance tomorrow. 78 at 10/1 and 11 at 5/1 look solid.
With the new year, the time for hitting conference moneyline dogs has come. Todays card is ugly.
Seton Hall +290
Air Force +110
St Louis +240
St Joes +180
Another solid week last week to bring the total to 27-10-1 for the year. Two more underdogs on the money line with Rutgers and Iowa coming through. This week I am way behind on the line moves, so my absolute must play of Boston College will move to no action. Plenty of good money to be made this week though.
New Mexico moneyline +175 – Defense will be optional, I'll take the home conference dog.
Penn State -10 – Still not understanding why these Penn State lines are so low. They have a stout defense, and Hackenberg is a solid game manager. Not to worry though, I will keep collecting on the Lions. I really think this team has a solid chance to be undefeated heading into the MSU game.
Cal -14 – Colorado has to be one of the worst road teams in the nation. Jared Goff should be able to pick apart the Colorado defense, and I don't see CU being able to keep up on the offensive end.
Washington +7.5 – The last couple of years, this game has been a slugfest. This year should be no different. Wanted to take the moneyline, but not certain the Huskies can close the deal.
UTSA -6 – UTSA will control the game with their defense, and their offense should be able to march up and down against the Owls.
Notre Dame – 10 – Too much talent for the Irish in this one. 31-10 Irish.
Nebraska /Illinois... [More]
22-8 YTD and had another solid week last week with the Iowa State money line coming in. Underdogs have been solid so far, but there are a couple of favorites that I like this week.
Penn State -26.5 – Don't see UMass scoring more than a field goal in this one.
Michigan -3.5 – Not getting all the love for Utah. Clobbering Fresno will end up meaning nothing this year since everyone will be doing it.
Colorado -9 – Altitude and warm weather will wear down Hawaii. Think the Buffs pull away in the 2nd half. Also like the over in this game as the Buffs will be pushing the pace. Line is down to 60, and I am hoping to get a better number closer to kickoff
East Carolina -2.5 - I'll continue to ride the Pirates gravy train. Solid offense that NC will not be able to stop.
Rutgers moneyline +200 - I like this Rutgers team. I think Ralph Friedgen will continue to get the offense going in the right direction, and this defense should be good enough to hold up.
Iowa moneyline +230 – Just a hunch, but I think the Hawks will keep this one tight.
16-5 through the first two weeks, with a 5-2 week 2, and another nice moneyline hit on Northern Illinois. I saw a ton of games that I liked, but I narrowed it down to the following:
Iowa State +12 – I don't think the Iowa model of offense is going to work. Two QB's and running backs rotating, won't allow an offense to flow. No consistency, and lack of speed at any position on offense, will be the downfall of the Hawkeyes. Might be time to replace the coach as well.
The Cyclones stunned me with the effort that they put in versus KSU. At times, they actually looked like they had some talent. I think the speed on offense should be enough to keep them in the game. If the Cyclones limit the mistakes, I think they take this one.
Iowa State money line +330
East Carolina +10 – Looking for a bit of a letdown from Va. Tech. I think facing an uptempo, spread offense when you are in a possible letdown spot is a recipe for disaster.
Central Michigan Money line +170
South Carolina +7 – Wanted to take the moneyline, but I'll take the home dog with the points. I think Texas A & M and East Carolina are bad matchups for most of the country, so I am not sold on SC being as bad as they look. Georgia would be best off playing uptempo, but I think this game turns into a grinder in the trenches. Won't be shocked if SC pulls ou... [More]
Solid Week 1 with an 11-3 record, and a couple of nice underdog moneyline wins with Temple, Rutgers and Colorado State getting it done. Week 2 is the toughest weekend to cap in my opinion because it is easy to label a team based off of the one week of action. There are teams that are not as good as they looked, and there are teams that are not as bad as they looked. I think for this week, I have found the team that is as bad as it looked, and the team that is as good as it looked.
Iowa State once again appears to be a bad team, and this upcoming matchup with Kansas State is a really bad one for the Cyclones. It appears that the weakness of the Clones is their run defense. Now they have KSU coming in, fresh off of 51 rush attempts in their last game. What also intrigues me about Kansas State is the fact that they actually put up a ton of pass attempts last week. This is almost becoming a balanced offense. I think with this newfound "balance," KSU will get their standard four and five yard rushes, but they will break this game wide open with their passing attack. Tyler Lockett was too quiet last week. I think this week he gets behind the ISU secondary a couple of times with the play action attack.
Once KSU gets into the lead, I see no way that ISU can get back into this one. Sam Richardson just can't move the ball down the field consistently. If you subtract the 48 yard pass to Lazard, Richardson had 19 compl... [More]
One of my favorite scenarios on display with the Rams and Buffaloes in week 1. CSU got the extra practice time after the season with their bowl appearance in December. Not only that, but they pulled off a miracle which only boosts the confidence. CU on the other hand, had yet another dismal season, and the move to the Pac-12 is looking worse and worse by the season. Although the Rams are losing a ton on the O-Line, I think they bring in enough talent on that line to offset some of the losses. The return of Garrett Grayson, Kivon Cartwright, and Rashard Higgins should help the offense through the air, and the addition of Dee Hart at Running Back is huge for CSU. He brings a big, nasty presence to the Rams running game, and I think it will help CSU keep control of the ball. He isn't technically the starter, but I think he ends up as the number 1 when all is said and done.
Even though the Rams are losing talent up front on defense also, they are not losing the leadership of Max Morgan. He keys the defense, and if healthy, he will help the Rams D keep some of these lower octane offenses from running up big numbers. The linebackers and the secondary are experienced, and they should be much improved from last year.
On the CU side of things, the one threat that always scared me to death in these CU/CSU games is now gone. Paul Richardson absolutely torched the Rams with his speed, and it didn't hurt that the ... [More]
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Gallery: Aveda is Saving Oceans & Marine Life One Plastic Cap at a Time
Wondering how to turn all of those plastic bottle caps running rampant in your household into a green, planet saving endeavor? Well, lucky for you, and for marine life everywhere, Aveda has come up with an alternative solution for all of the un-recyclable rigid plastic caps that invade your medicine cabinets, refrigerators and kitchen drawers. The very same ubiquitous bottle-toppers pose a dangerous threat to oceans, birds and marine life when they are improperly disposed of and wind up in landfills or sent down storm drains. Aveda's Caps Recycling Program will re-purpose these toxic plastics as a base for new packaging, in an effort to eliminate them from our oceans before it's too late.
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Carol Hasvold July 9, 2010 at 8:01 pm
I have containers for frozen raspberries with the symbol 5 inside a triangle, would you accept these also? I understood that it was caps with symbol 5 that you are recycling – –
Carol Hasvold
Decorah, Iowa
jplanet July 30, 2009 at 8:39 pm
I teach kids how to create all kinds of percussion instruments using recycled, reused, & repurposed plastic & metal bottle caps… along with all kinds of other upcycled materials.
Good work Aveda! Keep 'em out of the ocean!
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Superman (casting, rumors, pix till release)
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October 14 2011, 04:59 AM
Nerys Myk
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Location: A boat on a river
Re: Superman (casting, rumors, pix till release)
Twilight Sparkle wrote:
I love what someone said in the comments on that page...
When did Superman turn into Wolverine?
When they hired a tall, good looking actor with a well toned body to play Wolverine.
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Rain stops play at charity party (From Oxford Mail)
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Rain stops play at charity party
ORGANISERS of the NSPCC's Party in the Park were left disappointed after the rain stopped them reaching their cash target.
But despite the bad weather, the event at Wilton Park, Beaconsfield, on Saturday, is likely to have raised £10,000 for charity.
Peter Cullimore, the chairman of the organisers, said: "Our target, had the weather been fine, was to raise £20,000 but we can say that because of the weather it has been halved.
"Unfortunately you cannot count on the vagaries of the British weather. And Henman completing his match at Wimbledon."
Many people still made the journey to Wilton Park, the home of the Defence School of Languages, to watch human table football, It's A Knockout, dodgems and to try to score against Wycombe Wanderers football club.
It was the first time Wilton Park had been open to the public for more than 20 years.
Mr Cullimore said: "We have had a steady stream of people coming through all morning.
"As we had the use of Wilton Park we thought that it was important that we had a number of other charities involved as well.
"We have tried to involve other local groups. We have the Friends of Beaconsfield here, and four of the theatre groups in Beaconsfield are in the theatre.
"There are a few people around but we could do with a lot more."
Alex Dunlop, the vice-chairman of Beaconsfield Round Table, said: "It is a great site here.
"We were asked if we could run the beer tent and we are always happy to do things like this. It is just a shame the weather could not have been better."
"It is the first time this event has been held.
"News of events like this spreads by word of mouth. Next year will be better and hopefully it won't rain."
Helen Regan, from Berkshire, said: "We came just to look around really and the children have been on the dodgems but it is just a shame about the rain."


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University/College Questions Part III (incl. protest discussion)
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Ayatollah Chowmeini
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Join Date: May 2010
Location: MTL/MKE
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Originally Posted by
Seems like trivial reasons, but:
I want an english school because while it would be cool, I can't see myself learning a third language to the point that I'd be okay speaking it on a day to day basis. That leaves German, Australian and British schools. I speak fluent french, but something about France turns me off. Germany would be cool, but I'm not sure if I'm willing to spend a lot of money of a German school. I'm preferably looking for a place with good climate, culture, which matches or surpasses that of Montreal (or else it would be pointless, no?). I would love to study in Australia, but I keep hearing horror stories about spiders, and I'm a huge arachnophobe, so I don't think I'd be able to survive six months if I woke up next to a huge spider one night
So that leaves the US, since I'm guessing rent in the UK is through the roof (isn't London the only city more expensive than NYC in terms of sq. ft?).
There are a few Californian schools that look interesting, but they're state colleges. Don't know if I'd want to go to a State school, considering I've heard bad things about them.
But I wouldn't rule out the opportunity. The one that interested me the most is DePaul in Chicago. Heard great things about that city, and the school. Plus, apparently you get a $5 000 grant if you get accepted to the program, which could pay a serious chunk of rent.
EDIT: Ireland also looks fun as well.
Whoever told you that state schools in the US are bad doesn't really know what they are talking about. The Cal system and a number of Land-grant universities in the Midwest (think OSU, Michigan, Wisconsin, Minnesota) are top-notch research institutions with enormous budgets and fantastic faculties. I can't attest to econ specifically, but I'd be shocked if certain Cal schools (probably UCLA, UC-Berkeley, maybe Santa Barbara or San Diego) didn't have very, very well-regarded programs.
If you want to go to Chicago for economics, you should go to University of Chicago. Probably the most dominant economics faculty in world history.
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Originally written on DraftAce | Last updated 2/5/13
1. Quarterback It's time for the New York Jets to move on. Mark Sanchez has been given plenty of opportunities to prove himself and he's failed time and time again. While he will probably be on the roster in 2013, the Jets will likely bring in someone to compete for a starting job. In the second round, Tyler Wilson and Mike Glennon could be options. 2. Outside Linebacker Rex Ryan's defense has gotten progressively worse during his tenure in New York. And the primary reason for the struggles has been the lack of a pass rusher. This could be the Jets target in the first round. Barkevious Mingo and Dion Jordan both have the potential to offer an immediate threat, even if only in a specialist role. 3. Wide Receiver Stephen Hill will be expected to take the next step in 2013, but the Jets clearly need another weapon. Since they need immediate help and are unlikely to address this need in the first round, the Jets may push to solve this issue in free agency.
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I have an app where users have a membership that expires.
I'm working on setting up a
before_filter in my
applications.rb file to check that they're membership is active prior to letting them in the site.
In my application.rb file:
before_filter :check_account
def check_account
if user_signed_in?
if current_user.account.expired
flash[:error] = "Your account is expired. Please contact Navanti for renewal."
redirect_to destroy_user_session_path
I keep getting a redirect loop error. I'm guessing that it's because of the logout page that's being called is also doing the
before_filter, but if I put an
except => [:users => :sign_out] it still throws the loop error.
Thanks for the help.
Requested Devise Method:
# DELETE /resource/sign_out
def destroy
redirect_path = after_sign_out_path_for(resource_name)
signed_out = (Devise.sign_out_all_scopes ? sign_out : sign_out(resource_name))
set_flash_message :notice, :signed_out if signed_out && is_navigational_format?
# We actually need to hardcode this as Rails default responder doesn't
# support returning empty response on GET request
respond_to do |format|
format.any(*navigational_formats) { redirect_to redirect_path }
format.all do
head :no_content