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"Chlamydial infections. In: Sexually transmitted diseases treatment guidelines, 2010." has been saved, and will be accessible from the My NGC page.
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Chlamydial infection, including genital infection, ophthalmia neonatorum, and infant pneumonia
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Beginning in 2008, Centers for Disease Control and Prevention (CDC) staff members and public- and private-sector experts knowledgeable in the field of sexually transmitted diseases (STDs) systematically reviewed literature using an evidence-based approach (e.g., published abstracts and peer-reviewed journal articles), focusing on the common STDs and information that had become available since publication of the 2006 Guidelines for Treatment of Sexually Transmitted Diseases. CDC staff members and STD experts developed background papers and tables of evidence that summarized the type of study (e.g., randomized controlled trial or case series), study population and setting, treatments or other interventions, outcome measures assessed, reported findings, and weaknesses and biases in study design and analysis. CDC staff then developed a draft document on the basis of this evidence-based review.
Centers for Disease Control and Prevention (CDC) staff members and invited consultants (including public- and private-sector professionals knowledgeable in the treatment of patients with sexually transmitted diseases [STDs]) assembled in Atlanta, Georgia, in April 2009, for a meeting where all evidence from the literature reviews pertaining to STD management was discussed.
Specifically, participants identified key questions regarding STD treatment that emerged from the literature reviews and discussed the information available to answer those questions. Discussion focused on four principal outcomes of STD therapy for each individual disease: 1) treatment of infection based on microbiologic eradication, 2) alleviation of signs and symptoms 3) prevention of sequelae, and 4) prevention of transmission. Cost-effectiveness and other advantages (e.g., single-dose formulations and directly observed therapy [DOT]) of specific regimens also were discussed. The consultants then assessed whether the questions identified were relevant, ranked them in order of priority, and answered the questions using the available evidence. In addition, the consultants evaluated the quality of evidence supporting the answers on the basis of the number, type, and quality of the studies.
Note from the National Guideline Clearinghouse (NGC) and the Centers for Disease Control and Prevention (CDC): When more than one therapeutic regimen is recommended, the sequence is alphabetized unless the choices for therapy are prioritized based on efficacy, convenience, or cost. For sexually transmitted diseases (STDs) with more than one recommended regimen, almost all regimens have similar efficacy and similar rates of intolerance or toxicity unless otherwise specified.
Chlamydial Infections in Adolescents and Adults
Chlamydial genital infection is the most frequently reported infectious disease in the United States, and the prevalence is highest in persons aged ≤25 years. Several important sequelae can result from Chlamydia trachomatis infection in women, the most serious of which include pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. Some women who have uncomplicated cervical infection already have subclinical upper reproductive tract infection upon diagnosis.
Asymptomatic infection is common among both men and women. To detect chlamydial infections health-care providers frequently rely on screening tests. Annual screening of all sexually active women aged ≤25 years is recommended, as is screening of older women with risk factors (e.g., those who have a new sex partner or multiple sex partners).
Screening programs have been demonstrated to reduce both the prevalence of C. trachomatis infection and rates of PID in women. Although evidence is insufficient to recommend routine screening for C. trachomatis in sexually active young men, based on several factors (including feasibility, efficacy, and cost-effectiveness), the screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, and STD clinics). Among women, the primary focus of chlamydia screening efforts should be to detect chlamydia and prevent complications, whereas targeted chlamydia screening in men should only be considered when resources permit and do not hinder chlamydia screening efforts in women. An appropriate sexual risk assessment should be conducted for all persons and might indicate more frequent screening for some women or certain men.
Diagnostic Considerations
C. trachomatis urogenital infection in women can be diagnosed by testing urine or by collecting swab specimens from the endocervix or vagina. Diagnosis of C. trachomatis urethral infection in men can be made by testing a urethral swab or urine specimen. Rectal C. trachomatis infections in persons that engage in receptive anal intercourse can be diagnosed by testing a rectal swab specimen. Nucleic acid amplification tests (NAATs), cell culture, direct immunofluorescence, enzyme immunoassay (EIA), and nucleic acid hybridization tests are available for the detection of C. trachomatis on endocervical specimens and urethral swab specimens for men. NAATs are the most sensitive tests for these specimens and are U.S Food and Drug Administration (FDA)-cleared for use with urine. Some NAATs are cleared for use with vaginal swab specimens, which can be collected by a provider or self-collected by a patient. Self-collected vaginal swab specimens perform at least as well as with other approved specimens using NAATs, and women find this screening strategy highly acceptable. Rectal and oropharyngeal C. trachomatis infection in persons engaging in receptive anal or oral intercourse can be diagnosed by testing at the anatomic site of exposure. Most tests, including NAAT and nucleic acid hybridization tests, are not FDA-cleared for use with rectal or oropharyngeal swab specimens, and chlamydia culture is not widely available for this purpose. However, NAATs have demonstrated improved sensitivity and specificity compared with culture for the detection of C. trachomatis at rectal sites and at oropharyngeal sites among men. Some laboratories have met Clinical Laboratory Improvement Amendments (CLIA) requirements and have validated NAAT testing on rectal swab specimens for C. trachomatis. Recent evidence suggests that the liquid-based cytology specimens collected for Papanicolaou (Pap) smears might be acceptable specimens for NAAT testing. Persons who undergo testing and are diagnosed with chlamydia should be tested for other STDs.
Treating infected patients prevents sexual transmission of the disease, and treating all sex partners of those testing positive for chlamydia can prevent reinfection of the index patient and infection of other partners. Treating pregnant women usually prevents transmission of C. trachomatis to infants during birth. Chlamydia treatment should be provided promptly for all persons testing positive for infection; delays in receiving chlamydia treatment have been associated with complications (e.g., PID) in a limited proportion of chlamydia-infected subjects.
Coinfection with C. trachomatis frequently occurs among patients who have gonococcal infection; therefore, presumptive treatment of such patients for chlamydia is appropriate (see the NGC summary of the CDC guideline Gonococcal Infection). The following recommended treatment regimens and alternative regimens cure infection and usually relieve symptoms.
Recommended Regimens
Azithromycin 1 g orally in a single dose
Doxycycline 100 mg orally twice a day for 7 days
Alternative Regimens
Erythromycin base 500 mg orally four times a day for 7 days
Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days
Levofloxacin 500 mg orally once daily for 7 days
Ofloxacin 300 mg orally twice a day for 7 days
Recommended Regimens
Alternative Regimens
A meta-analysis of 12 randomized clinical trials of azithromycin versus doxycycline for the treatment of genital chlamydial infection demonstrated that the treatments were equally efficacious, with microbial cure rates of 97% and 98%, respectively. These studies were conducted primarily in populations in which follow-up was encouraged, adherence to a 7-day regimen was effective, and culture or EIA (rather than the more sensitive NAAT) was used for determining microbiological outcome. Azithromycin should always be available to treat patients for whom compliance with multiday dosing is uncertain. The clinical significance and transmissibility of C. trachomatis detected at oropharyngeal sites is unclear, and the efficacy of different antibiotic regimens in resolving oropharyngeal chlamydia remains unknown.
In patients who have erratic health-care-seeking behavior, poor treatment compliance, or unpredictable follow-up, azithromycin might be more cost-effective in treating chlamydia because it enables the provision of single-dose directly observed therapy. Erythromycin might be less efficacious than either azithromycin or doxycycline, mainly because of the frequent occurrence of gastrointestinal side effects that can lead to noncompliance. Levofloxacin and ofloxacin are effective treatment alternatives but are more expensive and offer no advantage in the dosage regimen. Other quinolones either are not reliably effective against chlamydial infection or have not been evaluated adequately.
To maximize compliance with recommended therapies, medications for chlamydial infections should be dispensed on site, and the first dose should be directly observed. To minimize transmission to sex partners, persons treated for chlamydia should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen. To minimize the risk for reinfection, patients also should be instructed to abstain from sexual intercourse until all of their sex partners are treated.
Except in pregnant women, test-of-cure (i.e., repeat testing 3 to 4 weeks after completing therapy) is not advised for persons treated with the recommended or alterative regimens, unless therapeutic compliance is in question, symptoms persist, or reinfection is suspected. Moreover, the validity of chlamydial diagnostic testing at <3 weeks after completion of therapy (to identify patients who did not respond to therapy) has not been established. False-negative results might occur in the presence of persistent infections involving limited numbers of chlamydial organisms. In addition, NAAT conducted at <3 weeks after completion of therapy in persons who were treated successfully could yield false-positive results because of the continued presence of non-viable organisms.
A high prevalence of C. trachomatis infection has been observed in women who were treated for chlamydial infection during the preceding several months. Most of post-treatment infections result from reinfection caused by failure of sex partners to receive treatment or the initiation of sexual activity with a new infected partner. Repeat infections confer an elevated risk of PID and other complications. Unlike the test-of-cure, which is not recommended, repeat C. trachomatis testing of recently infected women or men should be a priority for providers. Chlamydia-infected women and men should be retested approximately 3 months after treatment, regardless of whether they believe that their sex partners were treated. If retesting at 3 months is not possible, clinicians should retest whenever persons next present for medical care in the 12 months following initial treatment.
Management of Sex Partners
Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis. Although the exposure intervals defined for the identification of at-risk sex partners are based on limited evaluation, the most recent sex partner should be evaluated and treated, even if the time of the last sexual contact was >60 days before symptom onset or diagnosis.
Among heterosexual patients, if concerns exist that sex partners will not seek evaluation and treatment (or if other management strategies are impractical or unsuccessful) patient delivery of antibiotic therapy to their partners can be considered (see the NGC summary of the CDC guideline Clinical Prevention Guidance ). Compared with standard partner referral, this approach, which involves delivering a prescription or the medication itself, has been associated with a trend toward a decrease in rates of persistent or recurrent chlamydia. Patients must also inform their partners of their infection and provide them with written materials about the importance of seeking evaluation for any symptoms suggestive of complications (e.g., testicular pain in men and pelvic or abdominal pain in women). Patient-delivered partner therapy is not routinely recommended for men who have sex with men (MSM) because of a high risk for coexisting infections, especially undiagnosed human immunodeficiency virus (HIV) infection, in their partners.
Patients should be instructed to abstain from sexual intercourse until they and their sex partners have completed treatment. Abstinence should be continued until 7 days after a single-dose regimen or after completion of a multiple-dose regimen. Timely treatment of sex partners is essential for decreasing the risk for reinfecting the index patient.
Special Considerations
Doxycycline, ofloxacin, and levofloxacin are contraindicated in pregnant women. However, clinical experience and published studies suggest that azithromycin is safe and effective. Repeat testing to document chlamydial eradication (preferably by NAAT) 3 weeks after completion of therapy with the following regimens is recommended for all pregnant women to ensure therapeutic cure, considering the severe sequelae that might occur in the mother and neonate if the infection persists. Women aged <25 years and those at increased risk for chlamydia (i.e., women who have a new or more than one sex partner) also should be retested during the third trimester to prevent maternal postnatal complications and chlamydial infection in the infant. Pregnant women diagnosed with a chlamydial infection during the first trimester should not only receive a test to document chlamydial eradication, but be retested 3 months after treatment.
Recommended Regimens
Azithromycin 1 g orally in a single dose
Amoxicillin 500 mg orally three times a day for 7 days
Alternative Regimens
Erythromycin base 500 mg orally four times a day for 7 days
Erythromycin base 250 mg orally four times a day for 14 days
Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days
Erythromycin ethylsuccinate 400 mg orally four times a day for 14 days
The frequent gastrointestinal side effects associated with erythromycin can result in noncompliance with the alternative regimens. Although erythromycin estolate is contraindicated during pregnancy because of drug-related hepatotoxicity, the lower dose 14-day erythromycin regimens may be considered if gastrointestinal tolerance is a concern.
HIV Infection
Patients who have chlamydial infection and also are infected with HIV should receive the same treatment regimen as those who are HIV negative.
Chlamydial Infections Among Infants
Prenatal screening and treatment of pregnant women can prevent chlamydial infection among neonates. Pregnant women aged <25 years are at high risk for infection.
C. trachomatis infection of neonates results from perinatal exposure to the mother's infected cervix. Although neonatal ocular prophylaxis with silver nitrate solution or antibiotic ointments does not prevent perinatal transmission of C. trachomatis from mother to infant, ocular prophylaxis with these agents does prevent gonococcal ophthalmia and, therefore, should be administered (see the NGC summary of the CDC guideline Gonococcal Infections).
Initial C. trachomatis perinatal infection involves the mucous membranes of the eye, oropharynx, urogenital tract, and rectum, although infection might be asymptomatic in these locations. Instead, C. trachomatis infection in neonates is most frequently recognized by conjunctivitis that develops 5 to 12 days after birth. C. trachomatis also can cause a subacute, afebrile pneumonia with onset at ages 1 to 3 months. Although C. trachomatis has been the most frequent identifiable infectious cause of ophthalmia neonatorum, perinatal chlamydial infections (including ophthalmia and pneumonia) have occurred less frequently because of the institution of widespread prenatal screening and treatment of pregnant women.
Ophthalmia Neonatorum Caused by C. trachomatis
A chlamydial etiology should be considered for all infants aged ≤30 days who have conjunctivitis, especially if the mother has a history of untreated chlamydia infection.
Sensitive and specific methods used to diagnose chlamydial ophthalmia in the neonate include both tissue culture and nonculture tests (e.g., direct fluorescent antibody [DFA] tests, EIA, and NAAT). Most nonculture tests are not FDA-cleared for the detection of chlamydia from conjunctival swabs, and clinical laboratories must verify the procedure according to CLIA regulations. Specimens for culture isolation and nonculture tests should be obtained from the everted eyelid using a dacron-tipped swab or the swab specified by the manufacturer's test kit, and they must contain conjunctival cells, not exudate alone. A specific diagnosis of C. trachomatis infection confirms the need for treatment not only for the neonate but also for the mother and her sex partner(s). Ocular specimens from infants being evaluated for chlamydial conjunctivitis also should be tested for N. gonorrhoeae.
Recommended Regimen
Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 days (Note: An association between oral erythromycin and infantile hypertrophic pyloric stenosis (IHIS) has been reported in infants aged <6 weeks who were treated with this drug. Infants treated with erythromycin should be followed for signs and symptoms of idiopathic hypertrophic pyloric stenosis (IHPS). Data on use of other macrolides (e.g., azithromycin and clarithromycin) for the treatment of neonatal chlamydia infection are limited. The results of one study involving a limited number of patients suggest that a short course of azithromycin, 20 mg/kg/day orally, 1 dose daily for 3 days, might be effective.)
Recommended Regimen
Topical antibiotic therapy alone is inadequate for treatment of chlamydial infection and is unnecessary when systemic treatment is administered.
Because the efficacy of erythromycin treatment is only approximately 80%, a second course of therapy might be required. Therefore, follow-up of infants is recommended to determine whether initial treatment was effective. The possibility of concomitant chlamydial pneumonia should be considered.
Management of Mothers and Their Sex Partners
The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated (see the section on Chlamydial Infection in Adolescents and Adults, above).
Infant Pneumonia Caused by C. trachomatis
Characteristic signs of chlamydial pneumonia in infants include 1) a repetitive staccato cough with tachypnea and 2) hyperinflation and bilateral diffuse infiltrates on a chest radiograph. In addition, peripheral eosinophilia (≥400 cells/mm3) occurs frequently. Wheezing is rare, and infants are typically afebrile. Because clinical presentations differ, initial treatment and diagnostic tests should include C. trachomatis for all infants aged 1-3 months who are suspected of having pneumonia (especially those whose mothers have untreated chlamydial infection).
Specimens for chlamydial testing should be collected from the nasopharynx. Tissue culture is the definitive standard for chlamydial pneumonia. Nonculture tests (e.g., EIA, DFA, and NAAT) can be used, although nonculture tests of nasopharyngeal specimens have a lower sensitivity and specificity than nonculture tests of ocular specimens. DFA is the only FDA-cleared test for the detection of C. trachomatis from nasopharyngeal specimens. Tracheal aspirates and lung biopsy specimens, if collected, should be tested for C. trachomatis.
Because test results for chlamydia often are not available in a timely manner, the decision to provide treatment for C. trachomatis pneumonia must frequently be based on clinical and radiologic findings. The results of tests for chlamydial infection assist in the management of an infant's illness and can help determine the need for treating the mother and her sex partner(s).
Recommended Regimen
Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 days
The effectiveness of erythromycin in treating pneumonia caused by C. trachomatis is approximately 80%; a second course of therapy might be required. Follow-up of infants is recommended to determine whether the pneumonia has resolved, although some infants with chlamydial pneumonia continue to have abnormal pulmonary function tests later in childhood.
Mothers of infants who have chlamydia pneumonia and the sex partners of these women should be evaluated and treated according to the recommended treatment of adults for chlamydial infections (see Chlamydial Infection in Adolescents and Adults, above).
Infants Born to Mothers Who Have Chlamydial Infection
Infants born to mothers who have untreated chlamydia are at high risk for infection; however, prophylactic antibiotic treatment is not indicated, and the efficacy of such treatment is unknown. Infants should be monitored to ensure appropriate treatment if symptoms develop.
Chlamydial Infections Among Children
Sexual abuse must be considered a cause of chlamydial infection in preadolescent children, although perinatally transmitted C. trachomatis infection of the nasopharynx, urogenital tract, and rectum might persist for >1 year (see the NGC summary of the CDC guideline Sexual Assault and STDs).
Nonculture, nonamplified probe tests for chlamydia (EIA, DFA) should not be used because of the possibility of false-positive test results. With respiratory tract specimens, false-positive results can occur because of cross-reaction of test reagents with C. pneumoniae; with genital and anal specimens, false-positive results might occur because of cross-reaction with fecal flora.
Recommended Regimen for Children Who Weigh <45 kg
Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 days
Recommended Regimen for Children Who Weigh ≥45 kg but Who Are Aged <8 Years
Azithromycin 1 g orally in a single dose
Recommended Regimens for Children Aged ≥8 Years
Azithromycin 1 g orally in a single dose
Doxycycline 100 mg orally twice a day for 7 days
Recommended Regimen for Children Who Weigh <45 kg
Recommended Regimen for Children Who Weigh ≥45 kg but Who Are Aged <8 Years
Recommended Regimens for Children Aged ≥8 Years
Other Management Considerations
See the NGC summary of the CDC guideline Sexual Assault and STDs .
Follow-up cultures are necessary to ensure that treatment has been effective.
None provided
The type of supporting evidence is not specifically stated for each recommendation.
Throughout this guideline document, the evidence used as the basis for specific recommendations is discussed briefly. More comprehensive, annotated discussions of such evidence will appear in background papers that will be published in a supplement issue of the journal Clinical Infectious Diseases.
These recommendations should be regarded as a source of clinical guidance and not prescriptive standards; health-care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. The recommendations are applicable to various patient-care settings, including family planning clinics, private physicians' offices, managed care organizations, and other primary-care facilities. These guidelines focus on the treatment and counseling of individual patients and do not address other community services and interventions that are essential in sexually transmitted disease (STD)/human immunodeficiency virus (HIV) prevention efforts.
An implementation strategy was not provided.
Not applicable: The guideline was not adapted from another source.
United States Government
Chairperson: Kimberly A. Workowski, MD, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC and Emory University, Atlanta, Georgia
Presenters: Heidi Bauer, MD, California Sexually Transmitted Disease Control Branch, Oakland, California; Laura Bachman, MD, Wake Forest University; Gale Burstein, MD, MPH, Erie County Department of Health; Linda Eckert, MD, University of Washington; William M. Geisler, MD, University of Alabama, Birmingham, Alabama; Khalil Ghanem, MD, Johns Hopkins University; Matt Golden, MD, MPH, University of Washington; Linda Gorgos, MD, New Mexico Department of Health; Margaret Hammerschlag, MD, State University of New York, Downstate Medical Center, Brooklyn, New York; Lisa Hollier, MD, University of Texas at Houston; Peter Leone, MD, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Jeanne Marrazzo, MD, University of Washington, Seattle, Washington; Kenneth Hugh Mayer, MD, Brown University Medical School, Providence, Rhode Island; Paul Nyirjesy, MD, Drexel University College of Medicine, Philadelphia, Pennsylvania; Anne Rompalo, MD, Johns Hopkins School of Medicine, Baltimore, Maryland; Pablo Sanchez, MD, University of Texas Southwestern Medical Center, Dallas, Texas; Bradley Stoner, MD, PhD, Washington University, St. Louis, Missouri; Anna Wald, MD, University of Washington, Seattle, Washington; George Wendel, MD, University of Texas Southwestern Medical School, Dallas, Texas; Harold C. Wiesenfeld, MD, University of Pittsburgh, Pittsburgh, Pennsylvania
Moderators: Willard Cates, Jr., MD, MPH, Family Health International, Durham, North Carolina; King K. Holmes, MD, PhD, University of Washington, Seattle, Washington; David Martin, MD, Louisiana State University Medical Center, New Orleans, Louisiana
Rapporteurs: Hunter Handsfield, MD, University of Washington, Seattle, Washington; William McCormack, MD, State University of New York Health Science Center, Brooklyn, New York; William M. Geisler, MD, University of Alabama, Birmingham, Alabama
Consultants: N. Franklin Adkinson, MD, Johns Hopkins University; William Andrews, MD, PhD, University of Alabama, Birmingham; Michael Augenbraun, MD, State University of New York Health Science Center, Brooklyn, New York; Bryon Batteiger, MD, University of Indiana; Gail Bolan, MD, California Department of Health, Oakland, California; Bruce Coles, DO, New York Department of Health; Carolyn Deal, PhD, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; J. Dennis Fortenberry, MD, Indiana University School of Medicine, Indianapolis, Indiana; Edward Hook, III, MD, University of Alabama, Birmingham, Alabama; Jane R. Schwebke, MD, University of Alabama, Birmingham, Alabama; Joann Schulte, DO, National Institutes of Health, Bethesda, Maryland; David Soper, MD, Medical University of South Carolina, Charleston, South Carolina; Lawrence Stanberry, MD, PhD, University of Texas Medical Branch, Galveston, Texas; Bruce Trigg, MD, New Mexico Department of Health; Yolanda Wimberly, MD, Morehouse School of Medicine; Jonathan M. Zenilman, MD, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Liaison Participants: Kaytura Aaron, MD, HRSA; Laura Bachman, MD, HIV Association of America; Lynn Barclay, MD, American Social Health Association; Margaret J. Blythe, MD, American Academy of Pediatrics; Carolyn D. Deal, PhD, National Institutes of Health; Jordon Dimitrakov, MD, PhD, American Urological Association; Mark FitzGerald, MD, British Association for Sexual Health and HIV, Southampton, United Kingdom; Dennis Fortenberry, MD, Society of Adolescent Medicine; Edward W. Hook, III, MD, Infectious Disease Society of America; Noreen Jack, MD, Pan American Health Association; Peter Kerndt, MD, National Coalition of STD Directors; Jeanne Marrazzo, MD, American Sexually Transmitted Diseases Association; Francis J. Ndowa, MD, World Health Organization, Geneva, Switzerland; Michael Parkinson, MD, American College of Preventative Medicine; Jeffrey Piepert, MD, American College of Obstetrics and Gynecology; Patricia Reams, MD, National Commission on Correctional Health Care; Bisan Salhi, MD, American College of Emergency Physicians; Karen Shea, MSN, Planned Parenthood Federation of America; David Soper, MD, Infectious Diseases Society for Obstetrics and Gynecology; Bradley Stoner, MD, PhD, CDC STD Prevention Training Centers; Amy Swann, Association of Reproductive Health Professionals; Litjen Tan, PhD, American Medical Association; Tom Wong, MD, Public Health Agency of Canada, Ottawa, Ontario, Canada
CDC, Division of Sexually Transmitted Disease Prevention Treatment Guidelines 2010 Project Coordinator: Kimberly A. Workowski, MD, NCHHSTP, CDC and Emory University, Atlanta, GA
Project Manager: Richard Voigt, NCHHSTP, CDC, Atlanta, Georgia
NCHHSTP/CDC Presenters: Deblina Datta, MD; Eileen Dunne, MD; Matthew Hogben, PhD; Scott Holmberg, MD; Emily Koumans, MD; Lori Newman, MD
CDC Consultants: Sevgi O. Aral, PhD; Ronald Ballard, PhD; Bernard Branson, MD; John Brooks, MD, MPH; John Douglas, MD; Alison Friedman; Dale Hu, MD; Peter Kilmarx, MD; John Papp, PhD; Phil Spradling, MD
Support Staff: Brenda Kelley, Valerie Barner, and Deborah McElroy, NCHHSTP, CDC, Atlanta, Georgia
Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site .
Print copies: Available from the Centers for Disease Control and Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402-9325; (202) 783-3238.
The following are available:
None available
This NGC summary was completed by ECRI Institute on September 13, 2011. This summary was updated by ECRI Institute on October 25, 2013 following the U.S. Food and Drug Administration advisory on Fluoroquinolone Antibacterial Drugs.
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text:
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subset: commoncrawl


text:
TPIR: Stephen Charlamoore is first today to play Plinko. He gets by all the small prizes to get all five chips. First chip lands in nada. Second chip lands in the left $1,000 slot. Third chip lands in the $100 slot at the right end of the board. The last two chips each land in $1,000, meaning this man has $3,100 in addition to all of those prizes.
Christine Lazenbean then plays Clock Game for $1,000, a gas grill and a fireplace. She doesn't waste much time in winning it all- she gets the $779 grill in 13 seconds and then gets the $999 fireplace with just six seconds left!
Katrice Powell, a lieutenant from the U.S. Air Force, then plays Let Em' Roll for a Chevy Aveo.
She has no problem with the groceries, so she has three rolls to win. First roll gives her three cars and $2,500. Second roll yields another car and $1,000. Last roll....she ends up doing the worst anyone can do in this game, $500.
BTW, everyone who got on stage in the first half won a bit of cash. I think that has never happened before on this show.
The Clock Game player gets into the Showcase after a spinoff with the Plinko man.
Fourth is Keith Rodeneber, who plays Most Expensive for a daybed, a popcorn cart and a treadmill. This man agrees with me that the popcorn cart is the most expensive. But I'm not as sure now, because the other day I saw a daybed that cost almost $3,000. The treadmill is $1,299, the daybed is $2,262....and the popcorn cart is $3,038, so he wins!
Billy Hider, from Jacksonville, Florida, then hits the picnic equipment ARP of $500 on the nose in the fifth IUFB, winning a $500 bonus! He then plays Coming or Going for a trip.....to Ft. Lauderdale! That's a bit close to his home, isn't it? Anyway, if he comes, the guess is $8,817, and if he goes, the guess is $7,188. Eight grand plus sounds too much for Florida to me. Hider agrees to go to $7,188 and he wins!
Teressa Lee, who is NOT the one who won the $100,000 Tournmanent on "Street Smarts" in its last season (the big winner there had one less S in her first name), is last to play Any Number for some dinnerware or a Ford Mustang (Std., Airbags, WLocks). First number of the Mustang price is 2. When this show was taped, this was Lee's birthday. Hopefully she'll make it a very nice one. First pick is 9, and the dinnerware is worth at least $900. Second pick is the other 2, and that's the fourth number of the car ($ 2 _, _ 2 _). Third pick is 1, and that's the middle number of the dinnerware ($ 9 1 _ ). Fourth pick is 4, and that's the middle number of the car ($ 2 _, 4 2 _ ). Fifth selection is 3, and that's the middle number of the piggy
bank ($ _. 3 _). The sixth pick is 6, and that's the last number of the piggy bank ($ _. 3 6).
Lee picks 0 next, and that's a wise pick, because first of all, the piggy bank can't be just thirty-six cents, and number two, that's the second number of the car ($ 2 0, 4 2 _). It comes down to this last pick.....
...she picks 5 and wins a Mustang ($ 2 0, 4 2 5) as her big birthday gift! The dinnerware was $917 and the piggy bank was worth $8.36.
SSD2: The first man this half spins a quarter....and goes over. The Florida man spins 20....and a nickel for a total of a quarter. Lee wins by spinning 80 cents and will go to the Showcase, where she will have a chance to win a boat to go along with that Mustang!
First Showcase features a fake superhero called The Untangler. First, she can live up to her name by untangling the cords from a new computer system. Second, she snags a lady's hair after it had been ruined by a new spa. Now, for that boat I was referring to. She has to help out a ship anchor untie the anchor rope off the propeller of this boat- a Reinell 18" 185 Ski Boat!
Lee bids here and after originally considering $28,000 and $35,000 as her bids, she bids 25 grand. I'm not so sure about that bid. The Clock Game champ has a living room, a security system and a trip to Athens to go for, and she bids $19,500, and I think she's won.
Lee's ARP: $25,974, a difference of $974! But did the Clock Game woman do even better? Her ARP: $15,927, meaning she's over and Lee adds the boat Showcase to her huge birthday haul, for a grand total of $48,364! The other lady leaves with $3,548 in cash and prizes.
Family Feud: The show tries again to crown undefeated family #10. The Hannas try to take that honor and possibly be the last entrants in the Winner Take All Tournament coming up very shortly, if there is one. But first, they must beat the Adevas. The Adevas strike first with 66 on daytime divas (one of which was Meredith Viera!). After winning that round, two members of the family do a similar bumping pose that people saw by a team on "Lingo" not too long ago!
The champs take the lead with 87 on public places that usually has at least one crying baby inside, and I HATE crying babies with a passion.
Double: Things you get hit by at the beach. Starting with:
#1- Beachballs (60, Tom)
The champs take control. Tandi says frisbees...#2 (12)! Israel, whom Marci says is the star of the team, says surfboard....strike. Marci says waves, and that's #3 (9)! Becki says sand shovels...sorry. Tom says sand....#4 (7)! Back to Tandi, who says umbrellas....three strikes.
For the challenger steal, JoJo (sorry, not the popular lady singer) says the sun's rays....NO, so the champs go to 263! #5 was bird/droppings (5) and #6 was boats (2).
Triple: An excuse a friend gives for not helping you move. Sarah of the challengers says work....NUMBER ONE (51), so they'll play! Marie says having kids....sorry. JoJo says being out of town....bottom answer (7)! Sunnary says being sick...#3 (10)! If they get #2, we've been robbed again of our tenth undefeated family. Joseph says a bad back is #2....it is, so they win the championship at 360! The Hannas leave with $41,135.
Fast Money: Tom and Sunnary play this one out.
1. A food people are allowed to eat following dental surgery.
2. An appliance that makes a loud noise.
3. A pet you could carry in your pocket.
4. A musical instrument that's difficult to play.
5. Name something someone goes to the hospital to have removed.
Tom says soup, blender (#1), hamster, piano and teeth (bad, because he misunderstood the question) for 73. Sunnary says water (bad), drill (really bad), mouse (#1), violin (#1) and appendix (#1) for 160 total and $800.
WOF: One of these three players will have the chance to help us make history. They are:
Tracy Olsen (in the blue), Jay Pelano (who wears a WOF tie!) and Jean Hein. Round 1 category is Before and After. After Hind calls the I's, we have...
Now I know. She calls the C's for the Free Spin, and solves SACRIFICAL LAMB CHOPS to score her first $1,000.
Jackpot/Prize Puzzle Round category is People. After the winner of the last round calls the A's, we have...
...and she calls three I's. She calls the L for $300, and after calling the R's for $1,200, we have...
...and she solves ITALIAN OPERA SINGERS for more money and a trip to Venice, for a new total of $9,618.
$10,000 Mystery Round category is Event, and it's a fairly big puzzle. Olsen spins a Mystery Wedge off the bat and calls two N's. She flips....$10,000! After Hein calls the P's later, we have...
I don't know the last word. She calls five O's, and two O's follow the second R in the last word of the puzzle. Now I know. She calls two D's for $1,100, and solves DEVELOPING A PHOTOGRAPH IN THE DARKROOM to go to $14,518, and she still has that Free Spin.
The man has CLOSE TO HOME on the $3,000 Toss Up to go to $5,000. Next category is Thing. After losing the Free Spin, Hein calls two N's for $10,000! After calling the G, we have...
It's something MARKETING. After calling two D's, she says INDOOR-OUTDOOR CARPETING....I've been duped, and she wins $12,650 more, and she now has $27,168!
Speed-Up Round category is In the Kitchen, and consonants are worth $1,350 each.
After she calls the R, we have...
..and she solves BUTTER KNIFE to win the match with $31,218! The man has $5,000 and Olsen has $1,000.
Now, for the moment of truth. Should Hein win this bonus round, it will be just the third time in five years that we have had a perfect bonus round week. She spins the N in BONUS, and the all-important category is Phrase. Starting with:
_ ' _
I know this. She calls B, D, Y and I and gets...
...does she know I'M HUNGRY????.....
...YES!!!!!!!! PERFECT BONUS ROUND WEEK!!!!!!! And she wins $40,000 for a total of $71,218! What a way to go out as the show will head to San Diego next week!!
WWTBAM: We may be going from extreme happiness to extreme sadness, as this show is in danger of a WIPEOUT for the first time all season long. The player who has the best chance of doing so on this episode is Ryan Dickerson. For $4,000:
Gruyere cheese takes its name from a region in what European country?
A: Germany
B: Switzerland
C: Belgium
D: The Netherlands
Dickerson asks the audience. 66% said Switzerland and 24% said Belgium. He agrees with Switzerland and is right. Next, for $8,000:
At the State of the Union Address, who usually sits with the Vice President right behind the President?
A: Speaker of the House
B: Chief Justice
C: Secretary of State
D: Senate majority leader
Dickerson uses his 50:50, leaving the top two choices. He wanted to go with my choice of A originally, but he agrees now and is right. For $25,000 and to avert the WIPEOUT:
Meryl Streep has won two Oscars, one for "Sophie's Choice" and the other for what movie?
A: "Silkwood"
B: "Kramer vs. Kramer"
C: "The Bridges of Madison County"
D: "Out of Africa"
While he works in movie theaters, he's not that familiar with movies. So, he calls his movie buff, Eric, who came with Dickerson to the show's tryouts. With only about five seconds left, he says "Kramer vs. Kramer", and Dickerson agrees to kill the WIPEOUT threat and get to $25,000!
For $50,000:
Theoretically the lowest temperature possible, absolute zero has roughly what value on the Fahrenheit scale?
A: -260 degrees
B: -360 degrees
C: -460 degrees
D: -560 degrees
Having a memory of hearing about this from a previous source, he says -360 degrees....IT WAS A BAD SOURCE. It's actually -460 degrees. But he still saved the week from being a total disaster, and he is going home with $25,000!
Next is Wareen Deluty. He is on a roll, heading into this $25,000 question. This is for a chance to come back the next time to go for at least $50,000:
As a symbol of friendship between the two lands, the state flag of Hawaii features the flag of what nation in its upper-left corner?
A: Canada
B: Japan
C: Great Britain
D: The Philippines
He uses the 50:50, leaving Canada and Great Britain. His original though prior to the 50:50 is not there anymore. He then asks the audience, and 75% said Great Britain, while 25% said Canada. Knowing that the audience tends to be wrong on questions valued of at least $25,000, he calls his cousin, Mariam. She knows it's Great Britain, and when the player agrees, he'll be returning the next time!
Jeopardy!: Andrew Rostan, who won 31 big ones on the last show, defends for the first time against Juli Hinds and Brian Marshall. Whoever emerges as the champion after this show will take a rest for two weeks while the $100,000 College Tournament begins this Monday, which will eminate from USC.
In the meantime, we have this game. For Round 1, The New York Times section featured this show is The Arts. Rostan almost sweeps The Civil War, but Marshall gets the $1,000 clue.
The match gets fairly tighter afterwards up to the first break, and when we get there, Rostan leads with $3,200. The lady has $2,200, and Marshall has $2,000. Marshall starts to tip the scales in his favor after the two challengers each screw up on a few clues, having $5,000 at one point while the challengers have only about $1,000 each. He tries to sweep In the Middle of the State, where each of the clues there will have a few letters that are part of the state's name, and the players must come up with the right state. When he tries for the sweep on the $1,000 clue, he finds the Daily Double with $8,000, and he bets half ($4,000):
"Ask" me about these two states (I love them).
"What are Alaska and Arkansas?" UH, NO. "Ask" is nowhere to be found in Arkansas. The other state was Nebraska. Down to $4,000 he goes. After he gets the final $1,000 clue in It's a Scientific Fact, he ends the round still in the lead with $5,000. Marshall has $2,800 and the lady has $2,200.
One of the categories in Double Jeopardy! is "This Old House: The Green Project". Marshall gets back to the roll he was on late in the first round after getting the $2,000 clue in They Played Wyatt Earp, and he now has $11,400. Marshall, after getting the $1,200 clue in Fictional Ships, finds the first Daily Double under the $1,600 clue. He has $4,800 to the champ's $11,400, and he bets $2,000:
Lieutenant Steve Maryk takes command of this destroyer-minesweeper from an unstable captain.
"What is....The King?"....right, and he now has $6,800! But Rostan adds to his lead by getting the $2,000 clue there. After getting a few clues in "T" Time, he is over the $15,000 mark. But the lady finds the other Daily Double in You Can Czech In Any Time You Like, and she has $4,800 at this point. Marshall has $7,200, and the champ has $15,400. The lady bets $3,600:
It's what we're experiencing outside in the Czech capital, or the name of Czechlslovakia's moment of reform in 1968.
"What is.....The Fresh Air?" LOL!!!!! The event was The Proad Spring, and she sinks to $600.
The "This Old House" category featured video clips from the show as Alex read the clues.
After the round ends, the champ has $17,800. But it's not over yet, as Marshall has $9,600 and the lady has $7,800.
FJ! category: U.S. Transportation.
Writing in the 1820s, Lafayette's secretary called it a "great channel of communication, executed in eight years".
I'm thinking of something like The Panama Canal. The lady writes down "What is the Erie Canal?"....right! She adds everything but a buck, and goes to $15,599. Marshall has that and doubles up to $19,200. Rostan has that....and bets $1,500 to retain and have a two-day total of $50,300! We'll see him again after the collegians have their fun.
Identity: This could very well be the last show of the series. They get off to a bad start when Jennifer Anderson busted out when going for $50,000.
The show tried to end with some money being won when Melissa Sandvig took the podium.
IDs for this game:
Jazz pianist
Beer tester
Co-hosted "The View"
NBA team owner
Ghost hunter
Porcupine trainer
Invented TiVo
Hostage negotiator
Ice skating teacher
Her first guess is #3 being the supermodel, and that's right for $1,000.
She then says the lady at lucky #7 was a co-host of "The View"....and she was, Debbie Matenopoulos to multiply the bank by five.
Sandvig then says the man at #9 is the Trekkie....yes, and she doubles to 10 grand.
She makes her first error by saying the man at #8 is the ghost hunter.
Then, she uses the Tri-dentity on the ice skating teacher, leaving the man at #8, the man at #4 and the woman at #5. Instead of asking the experts, she guesses #5 is the teacher....and that's another $5,000 for her.
Sandvig knows that the man at #6, Joe Maloof, is an NBA team owner (Sacramento Kings, to be exact) to go to $25,000.
Sandvig has trouble talking it out with her family members about IDing the mime, so the experts are asked. Mark says it's #4 because he believes that man held the position for a long time, just on the man's refusal to budge. All of the experts say #4. Sandvig agrees and doubles to $50,000! I suggest she stop now.....
...and she does! Not too bad of a way to go out. She would have guessed the man at #11 was the hostage trainer, but he's actually the TiVo inventor. The man at #1 was the porcupine trainer, the lady at #2 was the ghost hunter, #8 was the jazz pianist, the lady at #10 was the hostage trainer and the lady at #12 was the beer taster.
Friday, April 27, 2007
4/27/2007- WOF goes for PERFECTO; Identity's last stand?
Posted by Robert McBride at 2:44 PM
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tabs in JSP and passing values between tabs
Mark Henryson
Ranch Hand
Joined: Jul 11, 2005
Posts: 200
Mar 04, 2006 07:58:00
I am doing one project with
and Oracle DB. First I want to design a tab in JSP, not using Swing or AWT. I had searched in gogle, and got some idea. Now I am coming to my problem.
I will be having 5 tabs and each tab will have 12 to 15 text boxs. The user can fill the fields in the each tab some may be optional , when he filled all the fields in the tab and on clicking the submit button, all the values from the 5 tabs should enter into the Oracle DB.
How to achieve it without any performance hit. PLease give me some idea on it. if any of you come across soln for this with sample codings in the net, it will be useful.
I am still searching in net and reading some documents related to this.
The reason I'm posting in this forum is, this forum has many active members who can solve/given some ideas in it before.
[Bear edit: what's with the all caps?]
[ March 04, 2006: Message edited by: Bear Bibeault ]
Bear Bibeault
Author and ninkuma
Joined: Jan 10, 2002
Posts: 63874
I like...
Mar 04, 2006 09:31:00
Arranging the various layers into tabs is a simple matter of HTML and CSS and has no JSP dimension to it. As such, this has been moved tothe HTML forum.
Asking smart questions
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About Bear
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Mark Henryson
Ranch Hand
Joined: Jul 11, 2005
Posts: 200
Mar 04, 2006 21:54:00
I had searched in gogle, and got some idea. Now I am coming to my problem.
My problem is not with how to design tab. I already mentioned that I had got some tips for the tabs. But what my problem is, how to get the value from each tab and while submit, all the values from all the tabs should be stored in the DB.
In a normal sceneario, we can get the value from the form by using getParameter to the servlet and then store it ti the DB. But here I am having 5 tabs and each tab will have several text fields.
Supposing I am having three tabs namely, T1,T2,T3
T1 - T1 is a tab and it has a form with some text fields. I am filling the fields and after that I am going to tab T2.
T2 - T2 is an another tab with some text fields and i am filling that to & same for tab T3.
Now I am at Tab T3 with the values from the Tab T3, how can I get the values from the tabs T1 and T2. SInce I want to store is DB with all the values from tabs T1, T2 and T3. Whether we can store the values from T1 and T2 in the page scope or request scope or session scope. We don't know in which order the user is going to fill the fields in the tabs.
When the user fills the text fields in one of the tab T1 and store all the values in the session and similarly to T2 and T3 and finally submitting we can get it from the session and store it in the DB.
Bear Bibeault
Author and ninkuma
Joined: Jan 10, 2002
Posts: 63874
I like...
Mar 04, 2006 23:26:00
There is no reason that all of the fields on all of the tabs cannot be part of a single form that is submitted to the server when the form is submitted.
Unless there's something you're not telling us. Is there any reason that a server hit needs to be made when "switching" between tabs?
Alex Kravets
Ranch Hand
Joined: Jan 24, 2001
Posts: 476
Mar 07, 2006 09:01:00
Check this out:
This is a good implementation of tab panes in dhtml and it has good JavaScript API.
All right brain, you don't like me and I don't like you, but let's just do this one thing so I can get back to killing you with beer.

- Homer Simpson
I agree. Here's the link:
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November 30, 2015
Associated Press News Release
ST. PETERSBURG, Fla. (AP) -- The Tampa Tribune (http://bit.ly/1sgrkrQ ) reports a 61-year-old front desk clerk has been fired after mistaking the body of a tenant for a mannequin and then throwing it in a trash bin.
Ronald Benjamin told police he saw the body in the parking lot of the 16-story St. Petersburg apartment building early Wednesday and assumed someone put a mannequin there as part of an April Fool's Day prank.
A co-worker arrived and told him a body was in the parking lot but he insisted it was a mannequin. He got a newspaper carrier and her son to help him toss the body in the garbage. A maintenance worker saw the body and called authorities.
Police say a 96-year-old woman committed suicide by jumping from her apartment balcony.
CBS News Copy
ST. PETERSBURG, Fla. -- Authorities say a clerk who thought the dead body of a woman was a mannequin placed outside an apartment complex as an April Fools' Day prank enlisted the help of two others to throw the body into a dumpster.
St. Petersburg police reported in a news release that the Peterborough Apartments clerk first spotted the 96-year-old woman's body during a smoke break around 4:30 a.m. Wednesday. Thinking it was a joke, he returned to work without notifying anyone. Two hours later, another employee told the clerk about the body, but he insisted it was a prank. The clerk and a couple delivering newspapers then moved the body to a nearby dumpster.
According to CBS affiliate WTSP, detectives believe the clerk and another man who assisted in moving the victim possibly mistook the victim for a mannequin because rigor mortis had set in.
Finally around 8 p.m., a maintenance worker saw the body in the dumpster and realized it wasn't a mannequin.
Police found a suicide note in the woman's apartment. It appeared she used a stool to jump from the 16th-floor window.
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Gordon-Levitt's 'Don Jon' gets streamlined title
Joseph Gordon-Levitt arrives at a screening of "Don Jon's Addiction at the SXSW Film Festival, on Monday, March 11, 2013 in Austin, Texas. (Photo by Jack Plunkett/Invision/AP Images)
AUSTIN, Texas (AP) — First, he agreed to cut some of the graphic sex scenes. Now, Joseph Gordon-Levitt is trimming the title of his directorial debut.
His racy comedy, originally called "Don Jon's Addiction," has been streamlined to just "Don Jon."
Outside its screening at the South by Southwest film festival Monday night, Gordon-Levitt said he altered the name because some people mistakenly believed the film is about sex or porn addiction.
"I called it 'Don Jon's Addiction' because there's this central symbol in the movie of this rut and this habit that Jon is in," said Gordon-Levitt, who also stars in the film. "It's about a guy getting out of this rut, learning to be present and have more engaged and realistic relationships."
It's the story of a modern-day Don Juan, a New Jersey lady's man who prefers porn to actual sex — even though he's having no shortage of the real thing.
Gordon-Levitt first announced the title change via Facebook, posting that the comedy is actually about "how men and women treat each other, and how the media we consume can create unrealistic expectations that we put on one another."
Still, Gordon-Levitt, who previously starred in "Inception," ''50/50" and "(500) Days of Summer," had already said he was going to remove some of the sex in "Don Jon" to ensure it maintained an "R'' rating.
Joseph Gordon-Levitt arrives at a screening of "Don Jon's Addiction at the SXSW Film Festival, on Monday, March 11, 2013 in Austin, Texas. (Photo by Jack Plunkett/Invision/AP Images)
"That was always the premise," he said Monday. "In my original script, there's a note that says, 'This is how we're going to do this, we're going to license real pornography clips and alter them such that they fit into an R-rated movie.'
"I never wanted to make something that was overly provocative, I never wanted to shock people," Gordon-Levitt said. "I wanted this to be a pop movie, a mainstream movie."
The version that played in Austin was edited from its January debut at the Sundance festival but is still a work in progress, Gordon-Levitt said.
Brie Larson, of "21 Jump Street" fame, plays Gordon-Levitt's sister.
"Those are always my favorite films, the ones that leave people divided at the end because they're raising questions, not giving you some sort of opinion," she said.
The movie also features Tony Danza, who joined Gordon-Levitt and Larson on the red carpet, and Scarlett Johansson and Julianne Moore who did not. Danza noted that he first acted with an adolescent Gordon-Levitt about 20 years ago in the film "Angels in the Outfield."


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December 1, 2015
An Amber Alert was issued around five o'clock Tuesday morning for a five-month-old baby authorities say was taken by her biological father by knife point out of Alamosa.
The suspect is described as a 28-year-old black male about 165 pounds.
People are asked to be on the lookout for a Silver Saturn with Colorado license plate 175 RSW.
The baby girl was reportedly taken from her house in Alamosa. The baby girl is wearing a pink jumper and has dark brown hair.
If you have information about this infant you're asked to call 719–589–5807.
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text: Carers, family and friends This section is for everyone affected by mental illness, carers, families and friends. Much of the information is designed for people who know someone who has a mental illness. Our Diagnosis & Treatment section and Living with mental illness sections are more designed for people directly affected. Although some information is written with a particular reader in mind, all of it is open to everyone. In this section you can also find information and advice from our Siblings Network, a unique project for brothers and sisters of people with mental health issues. What you need to knowThe big questions for anyone affected by mental illness, including carers, family and friends. Worried about someones mental healthGetting help in a crisisResponding to unusual behaviourSuicidal thoughts - how to support someoneSupporting someone with a mental illnessRespite careCarers Assessment and Support PlanningDealing with someone elses financesConfidentiality with family & friendsNearest Relative rights informationDoes mental illness run in familiesWills And TrustsYour relative's future care and supportInquestsSuicide - coping with lossHospital for carersSiblings Network for brothers and sistersAbout being a siblingGet info and adviceYouth siblings areaEvents and workshopsYour storiesTalk to other siblingsInformation for parentsInformation for professionalsSibling research projectsEvaluating the Siblings Network


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BRISTOL — In its continuing effort to update the town plan, the Bristol Planning Commission on Tuesday dove into the "Resource Extraction" section of the proposed town plan and tore out a wide range of definitions from ensuing sections of the 120-page draft.
The plan has been a focus of attention as townspeople have debated the merits of a particular gravel pit proposal and sand and gravel extraction in general over the past several years. An application for gravel extraction by the Lathrop family has been the subject of litigation.


text: Edmunds.com Sues Website Over Bogus Reviews Site says one source posted 60 reviews By Matt Cantor, Newser User Posted Jul 24, 2013 2:03 AM CDT STORY COMMENTS (0) (Newser) – Car website Edmunds.com is taking a stand against bogus online reviews. The company is suing a firm it says created 60 fake reviews of about two dozen car dealerships, the Los Angeles Times reports. Humankind, which runs GlowingReviews.co, was behind some 2,000 Edmunds member accounts, according to the suit. The reviews "are just glowing," says a lawyer for Edmunds. The head of GlowingReviews says his comments came from handwritten cards and he was passing the information on to Edmunds. On its website, GlowingReviews offers to post reviews for businesses on up to 15 websites, including Google+, Yelp, and Cars.com, for $25 a month. With its lawsuit, Edmunds says, "There's a real opportunity to purify consumer reviews." Edmunds wants the court to award damages as well as put a halt to Humankind's reviews. In this Wednesday, March 20, 2013 photo, a row of Ford Fusion sedans sit in a lot at a Ford dealership. (AP Photo/Steven Senne) ADVERTISEMENT(Click Prev or Next to continue viewing images.) « Prev« Prev | Next »Next » Slideshow Los Angeles Times (Source Grid ») Crime & Courts • Technology online review • car dealers • Edmunds.com CLICK BELOW TO VOTE 5% 2% 0% 89% 2% 3% RETURN TO THE STORY To report an error on this story, notify our editors.


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Monthly Archives: December 2005
Remembering John Lennon
I was eight years old when, 25 years ago, John Lennon was killed. I don't remember hearing about it, and I don't think I would have known his name if I did. My mind was on treehouses, rope swings, and … Continue reading
Chord Chart Update
A veritable cornucopia of carefully crafted chord chart compositions! Crooked Teeth – Death Cab For Cutie – I dig the guitar riff—the clean telecaster tone, even rhythm, and chromatic movement makes it sound like it should play during the credits … Continue reading
Snow in Seattle
It's snowing in the city! Snow always makes this place feel magical. In addition to checking the window every thirty seconds, the weather has inspired me to post Ordeal by Eggnog again. It's the story of my buddy Chris and … Continue reading


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Sale Price @ $149 This usually never happens! Once they are gone, they're gone!
***As seen on The Living Room!***
Didn't think you had space for an edible garden, think again, the all new Wall Garden is here!
Simple DIY
Building a vertical garden has never been easier. The modular design makes Wall Garden incredibly versatile. Rearrange each module independently and build your garden as long or as tall as you want, you can continue to add at any stage.
Natural Growth
Plants grow upwards, just like they would in a garden bed. It means Wall Garden suits more plant varieties and grow larger and for longer.
Each pack contains 10 modules. Each module is 600mm wide, 200mm deep and 200mm hide.
Coverage - 6 modules @ 20mm spacing equals 1 square metre.
Manufactured in Australia from UV stabilised recycled polypropylene.
Combine with our wall mounting kit which is available to make set up really quick and easy.
Posted by Fiona Guy on 20th Aug 2012
Recently purchased your vertical wall garden to use for
Not many instructions but got is installed and now planted
so will wait for the results. One side (left) of the groove is a different size to the other so a normal plaing had to be pushed in hard to get it to fit.


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Our leadership and partners are responsible for setting the firm's strategy and overseeing its implementation.
KPMG in Romania and Moldova delivered sound revenues of Euro 39.2 million for the financial year ended 30 September 2014, a 8% increase as compared to the previous financial year.
Through Innovation, a High Performance Culture, Integrity and a mission of "Cutting Through Complexity", KPMG in Romania is ready for what we face in today's and tomorrow's world.
Infrastructure is a story of evolution. It drives social and economic development. It enables us to renew our public services and physical surroundings.
The Romanian IFRS Institute is a resource dedicated to the implementation process of IFRS, providing useful information about the global financial reporting framework for CFOs, members of the Board, leaders and shareholders of companies.
21 november 2012, Bucharest - Global partnership expands to better respond to client needs on current market conditions
KPMG, a leading advisory firm in Romania and Moldova, and Tagetik, a global provider of enterprise software solutions for Performance Management, Disclosure Management, Financial Governance and Business Intelligence, today announced an exclusive partnership agreement to provide Performance Management services in Romania and Moldova.
"This agreement confirms our strong commitment to innovation and investments in leading-edge solutions for our clients. The combination of Tagetik and KPMG's functional know-how, finance expertise, business and industry focus will enable us to better support our clients in the strategic steering of their business operations," explains Serban Toader, Senior Partner KPMG in Romania and Moldova.
"Tagetik places strong emphasis on collaborative relationships with professional services firms, which allow us to better understand market dynamics and respond with more valuable product offerings," adds Bani Brandolini – President International at Tagetik (www.tagetik.com/about/management/bani-brandolini). "We are very pleased to extend KPMG and Tagetik's global partnership to Romania and Moldova, where the combination of our product knowledge and KPMG's extensive industry expertise will allow us to provide competitive, high value solutions to clients."
The agreement will allow companies in Romania and Moldova easy access to Tagetik solutions as well as to benefit from KPMG's consulting experience and knowledge of the local market. The Tagetik 4 Performance Management software (www.tagetik.com/software) is an automated, unified solution, which incorporates budgeting, planning and forecasting, consolidation, financial close, profitability analysis and disclosure reporting into a single application to give CFOs better operational insights into their business — while still meeting complex financial and regulatory demands.
"We are very excited to offer our clients end-to-end solutions. Until now we have supported them in designing metrics, improving processes and developing methodologies needed to monitor and manage the business performance of any enterprise. We now have the software to address all of these needs. Our aim is to simplify the work of the CFO and strengthen the role of Finance within any organization," concludes Aurelia Costache, Partner, Management Consulting, KPMG in Romania.
About KPMGKPMG is a global network of professional firms providing Audit, Tax and Advisory services. We operate in 152 countries and have 145,000 people working in member firms around the world. The independent member firms of the KPMG network are affiliated with KPMG International Cooperative ("KPMG International"), a Swiss entity. Each KPMG firm is a legally distinct and separate entity and describes itself as such.
KPMG in Romania and Moldova operates from six offices located in Bucharest, Cluj-Napoca, Constanta, Iasi, Timisoara and Chişinău. We currently employ more than 650 partners and staff; Romanians and Moldovans as well as expatriates.To learn more: www.kpmg.com/ro
About Tagetik Tagetik is 100% dedicated to simplifying and streamlining business processes for the Office of Finance to accelerate informed decisions that achieve strategic goals. Our award-winning Tagetik 4 Performance Management software is the ideal solution for global companies that seek a clearly superior level of financial expertise in a single unified solution for planning, forecasting, consolidation, close, reporting, profitability management, disclosure, financial governance, and analysis.
Tagetik is a rapidly growing global company with operations in more than 20 countries and 500 customers yet provides an exceptional experience by focusing solely on the needs of finance and doing it better than anyone else. To learn more: www.tagetik.com
Maria Stancu
Marketing Director
© 2015
KPMG Romania S.R.L., a Romanian limited liability company and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ("KPMG International"), a Swiss entity. All rights reserved.KPMG International Cooperative ("KPMG International") is a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm.


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Latest podcast is here for your consumption, folks.
Dan Wolken most definitely knows his hoops. He was at the Memphis Commercial Appeal, serving as the beat writer for the Memphis Tigers before ascending to the role of columnist last August.
In December, he was hired at The Daily, an iPad-driven news application. Dan and I discuss Tim Floyd's antics, whether Bruce Pearl should be fired now and how he is prepping for writing hoops in a way he never has before -- with a national scope. We also discuss ways Dan is similar to George Clooney. (Despite me bringing this up in the podcast, it was all his idea.)
Remember, you can subscribe to the podcast in iTunes, or if you have a Zune, we've got you covered there as well. And for the XML-savvy, here's a permalink.
Podcast: Talkin' with Dan Wolken


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Melbourne BreakFree Bell City
Instalaciones Mapa Streetview Críticas
205 Bell St Preston VIC
Nota: Es responsabilidad de la cadena hotelera o de la propiedad individual garantizar la precisión de las fotos que se muestran. Travellerspoint no es responsable de las imprecisiones de las fotografías.
Perfect for the budget conscious traveller, Melbourne's BreakFree Bell City rooms provide a quality product at a competitive price.
BreakFree Bell City – a hotel complex like no other.
Our accommodation options range from the luxurious and sleek open-plan studio apartments to extremely affordable and comfortable budget rooms with access to extensive resort-style facilities. No matter what your budget, Bell City has you covered.
With multiple bars and restaurants on site, Bell City has dining and entertainment options for every occasion.
Budget1 Hotel offers comfortable and affordable 2.5-star rooms to provide you with a quality overnight stay at a very competitive price. At Sleep & Go Budget you have all of the facilities you would associate with an international hotel at a fraction of the price.
Compact and well appointed studios are available in single or double configuration, private bathrooms, LCD TV, internet access (charges apply), microwave, air-conditioning/heating and tea & coffee making facilities. Communal kitchens are available for all guests for self-cooking. Utensil packs are available through reception (refundable deposit).
• fully equipped gymnasium
• outdoor swimming pool
• CHILL Restaurant & Bar
• JD's Diner & Bar
• Pantry café & convenience store
• fully equipped business centre
• courtesy weekday CBD shuttle
• 24 hour reception
• barbeque facilities
• Australia Post, beauty salon & hairdresser
• lounge & recreational room
• Undercover & off-street parking ($7)
• guest laundry facilities and dry cleaning services on site
Please note:
Parking charges are $7 effective 12/03/2013
Budget Single:
Contains 1 Single bed, LCD TV, bar fridge, microwave, air-conditioning/heating, telephone, writing desk with broadband internet, chair, and own bathroom.
Sleep and Go Queen / Twin room:
Featuring floor to ceiling glass, these rooms consist of 1 Queen bed and offer work station with high speed internet, foxtel, tea & coffee making facilities, en suite and self controlled air conditioning.
BreakFree Bell City Suite:
Featuring floor to ceiling glass with great views of the city skyline or Dandenong Ranges. These rooms offer 1 King bed with en suite including shower & bath with spa jets, work station with high speed internet, LCD TV, foxtel, tea & coffee making facilities and self controlled air conditioning.
Exit onto the Tullamarine Freeway from the airport heading towards the city. Take the Bell Street exit on the Tullamarine Freeway and drive approximately 10 minutes along Bell Street. BreakFree Bell City is located just past the corner of Hotham and Bell Streets on the right hand side of the road. Turn right at the traffic lights to enter the above-ground carpark.
If you're coming via public transport, the nearest stops are Bell Station (on the Epping train line) and Bell Street / Plenty Road (on the 86 tram).
Car Parking:
BreakFree Bell City has over 600 complimentary off-street car parks ¬– both outdoor and underground parks are available. Access to the underground carpark is via Gate 3 on Hotham Street (off Bell Street).
¿Te has alojado aquí? Escribe una crítica
Nota: Es responsabilidad de la cadena hotelera o de la propiedad individual garantizar la precisión de las fotos que se muestran. Travellerspoint no es responsable de las imprecisiones de las fotografías.


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Clairton ballot appeal headed to higher court
A court fight over Clairton's mayoral race isn't over yet.
On Wednesday, Mayor Richard Lattanzi's attorney Glenn Smith filed an appeal with the state Supreme Court Western District in Pittsburgh in a final bid to erase Councilman Richard Ford III's name from the May 21 Democratic primary ballot for Lattanzi's job.
"I'm looking for someone to say, 'We need justice here, this isn't right,'" Lattanzi said. He again insisted that Ford "was trying to hide his debt from the taxpayers."
Smith contended before Allegheny County Common Pleas Judge Joseph M. James and Commonwealth Court that Ford owes money to the city of Clairton, Clairton City School District, Clairton Reinvestment Corp. and the Internal Revenue Service.
The debts are in excess of $6,500, Smith said in papers filed with courts in Pittsburgh and Harrisburg. The IRS lien alone is for $7,423.50.
James told Ford to amend his statement of financial interest. He did so, listing all those creditors but listing the federal tax lien and the obligation to CRC as "under protest," adding that the statute of limitations had expired on the CRC claim.
Smith argued before James and later wrote in his filing to Commonwealth Court that no such protest existed. James ruled in Ford's favor and Commonwealth Court Judge Renee Cohn Jubelirer affirmed that ruling.
Ford's attorney, Burrell A. Brown, said he would file a reply only if the high court agrees to review it.
"I see nothing of constitutional significance with regard to this case that would encourage the court to take another look at this matter," Brown said. "I would be surprised if the Supreme Court agrees to even entertain the appeal filed. It seems to me that Mr. Lattanzi would rather fight Mr. Ford in the courts as opposed to the ballot box."
Lattanzi said his decision was not affected by the Monday Clairton Democratic Committee vote endorsing Ford for mayor over Lattanzi, the city committee chairman, as well as Councilman Terry Lee Julian and former council candidate Kenneth Barna.
"I don't know how the people on my committee could endorse something like that," Lattanzi said, referring to Ford's reputed obligations.
"Given that Mr. Lattanzi was unable as chairman of the Democratic committee to get the endorsement of his own city committee, I can understand his fear of facing Mr. Ford at the ballot box," Brown said.
The committee also disregarded Lattanzi by endorsing Julian for another council term in Ward 3 and Ford for re-election to council in Ward 2.
Lattanzi's focus was on Ford, but Julian's candidacy for mayor and council had been challenged for similar reasons by legal secretary Lee Lasich, who is running against Julian in the Ward 3 primary.
Lasich claimed Julian owes $34,000 in back taxes to the city and school district. James ruled in Julian's favor because Lasich did not file her challenge in a timely manner.
Julian said he may take legal action, because documents attached to Lasich's petition gave incorrect information about what he still owes from a venture that went out of business in 1996. He also questioned how Lasich obtained those documents.
Patrick Cloonan is a staff writer for Trib Total Media.
He can be reached at 412-664-9161, ext. 1967, or email@example.com.
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Save a bunch of cash.
$150 off Philips 47-inch 1080p LCD HDTV -new
Posted: 2616 days, 10 hours ago
SecondAct.com's deal of the day for 9/30/08 features the Philips 47-inch 1080p LCD HDTV -new (model no. 47PFL5603D) for $999.99, that's $150 less than their regular price of $1149.99 and even with the front door delivery fee of $175 this is still the lowest price we have seen on this HDTV by $373. Sales tax applies for residents of Minnesota.
Detailed Product Information
The Philips 47-inch flat panel LCD HDTV has a dynamic contrast ratio of 29000:1, 1920 x 1080p panel resolution, and 5ms response time. Features include ATSC/NTSC/QAM tuner, pixel plus 3HD, 3D combfilter, active control + light sensor, dynamic contrast enhancement, progressive scan, HD natural motion and thee HDMI inputs. It is backed by a one year in home warranty from Philips. Dimensions: (W) 45.79" x (H) 30.94" x (D) 12.8" ; weight 77.16lbs.


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- Filed Under
Drivers on Interstate 71 between Delaware and Morrow counties will see 25 miles of orange barrels this spring.
The Ohio Department of Transportation plans three projects to widen and repair the highway.
Project One adds a lane in each direction between Ohio 95 and the Morrow County-Richland County line. That work is under way. ...


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Roxanne Drake goes through a stack of petitions 30 minutes after Wednesday's filing deadline at the Board of Elections on Liberty Drive in Lancaster.
- Filed Under
Berne Township voters are being asked for a $1.2 million bond issue to build a new firehouse.
The bond issue was one of four filed before Wednesday's filing deadline to appear on the May 7 primary ballot. Walnut Township schools and Lithopolis are pursuing income taxes, and Lancaster is seeking a property tax to fund street repairs.
The only political races are for the Lancaster City Council, where there will be several Republican and Democratic primaries. Three wards will be contested in November, along with the at-large seats and the council presidency.Taxes on the ballot ...


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- Filed Under
A Haldane teacher charged with sending threatening text messages to a Yorktown man who once coached her son in youth sports appeared in Town Court last week and had her case continued to November.
Town police on Aug. 28 charged Christine E. Comerford, 43, whose son played on a youth football team Richard Giannasca coached, with second-degree harassment, a misdemeanor, for allegedly sending the threatening texts. Comerford, a Haldane teacher who lives in Yorktown, was accused of sending the harassing messages between Aug. 5 and 12 to Giannasca's cellphone.
Giannasca and his wife, Athena, ...


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text:
James Bryant, 69, retired from Detroit Public Library in 2000. He said he's leaning toward voting yes on the plan because he sees some kind of hope for retirees now that the Legislature agreed to chip in money to help Detroit move ahead in its Chapter 9 bankruptcy. / Susan Tompor/Detroit Free Press
Leland C. Blaim Jr., 58, who worked in emergency medical services, said he thinks cutting pensions at all is wrong. He plans to vote no.
As City of Detroit retirees and some active workers contemplate casting ballots for the proposed bankruptcy plan, angst over lost money from city savings accounts could prove a wild card in the voting.
Thousands remain upset by the citys complex move to claw back some interest paid into city savings plan from July 1, 2003, to June 31, 2013. The clawback fancy words for take back applies to about 9,900 retirees and active workers savings plans.
Regardless of frustration, many retirees facing the loss must understand that it cant be avoided, even if they vote no on the plan of adjustment, Detroit emergency manager Kevyn Orr said. But voting yes and having the plan approved by pensioners would cap how much money can be taken, he said.
The clawback, plus regular pension cuts under the citys proposed bankruptcy plan would be capped at 20% of a pension check, if pensioners vote to approve the plan. Active city workers would see lump sums disappear from their savings accounts, which work like annuities after retirement.
To be counted, pensioners must cast ballots and have them arrive in the mail by July 11. Theyve already received ballot packets, which lists how much each individual pensioner, active worker or former employee is losing if they participated in the citys savings plan. Orr said the city paid excessive interest and bonuses into the plan, even in really poor economic times. He said that was unfair and is taking back some of it to help pensioners, in general.
Its really vexing for some retirees and active workers because they thought a savings plan would be a safe pot of money. Who wouldnt be upset?
On top of any losses from the clawback, pensioners also face cuts to their monthly pension check as part of the bankruptcy. If Orrs plan is approved, general retirees would lose all future cost-of-living adjustments plus 4.5% of their monthly pension checks. Police and fire wouldnt see any cuts to pension checks and their annual cost of living adjustment would decrease to 1% from a little more than 2%.
Getting majority yes votes and approval from the two groups of pensioners general retirees and police and fire could speed Detroits move out of bankruptcy, with a potential resolution to the whole thing as early as fall.
But if one or both retiree classes rejects the plan, then the ultimate level of cuts to benefits would be up to Orr to propose and for the bankruptcy judge to approve.
But Orr stresses that the cuts would for sure be a lot deeper than currently proposed because $816 million would disappear from the equation. That money has been pledged by state lawmakers, national and local foundations and the Detroit Institute of Arts to lessen cuts to pensioners and at the same time protect DIA masterpieces from being sold to pay off city creditors.
The pledges are valid only if everyone agrees to the plan and also agrees not to sue later. The deal negotiated by bankruptcy mediator U.S. District Judge Gerald Rosen has been dubbed the grand bargain.
Even so, the numbers are shocking for some retirees who have pensions and the annuity savings plans.
For retirees with a pension reduction as a result of an annuity clawback, pension checks could be cut by up to 20% each month the maximum 15.5% annuity cut plus the 4.5% across the board cut if both classes of pension claims approve the plan of adjustment. But if retirees reject the plan, the risk is that the clawback goes much, much higher, according to the emergency managers team.
Susie Nicholson, 67, who retired in 2006 and lives in Farmington Hills, hates the clawback and plans to vote no on the plan of adjustment. She worked in wastewater treatment on Jefferson Avenue.
She said the clawback would eliminate $350 a month from her pension check, plus about $100 lost each month from the 4.5% cut. Her total cuts are nearly 20% a month.
Its an unfair situation, she said. Why should we have to take such a deep cut?
James Bryant, 69, said hes leaning toward voting yes. He worked 35½ years for the city and retired in 2000 after working in the public library.
We love our city, and we want to see it coming back, he said. And its coming back.
Bryant does not face any clawback. And he doesnt like voting to see a 4.5% across-the-board cut to his pension. But its better than the 27% or possibly more Orr predicted if the plan is rejected and the grand bargain money goes away. Bryant said he doesnt think people should let their anger cloud their judgment.
Just staying angry, he said, wont help a thing.
Others are less forgiving. One upset woman shouted Grand Theft! as a legal team explained the options at a meeting two weeks ago at Fellowship Chapel in Detroit for retirees covered under the General Retirement System of Detroit.
Each persons exact clawback amount was revealed on his or her ballots on the third page under the line Estimated Annuity Savings Funds Recoupment amount.
Retirees are angry that the clawback is annuitized and would continue as long as they live and as long as their spouses live, if after death a surviving spouse is covered by the pension, too.
And then there was the clawback screw-up.
The city initially mailed about 20,200 ballots to holders of Class 11 pension claims and about half supposedly facing a clawback, according to a bankruptcy filing.
But about 3,200 ballots used the wrong time frame and gave wrong figures.
New ballots have been sent, and as a result 1,300 fewer are facing any clawback and 1,900 face a smaller cut. Pink replacement ballots were sent to replace the earlier blue ballots.
Leland C. Blaim Jr., 58, who worked in emergency medical services, said he received his new pink ballot and no longer faces a $4,000 clawback. He retired in January 2003, outside of the clawback time frame.
Yet he still plans to vote no, even though a rejection vote would lead to deeper cuts than the $150 or so a month cut he would face if the plan is approved. He said he thinks cutting pensions at all is wrong.
Its a gamble and one most retirees, as well as the city, cannot afford to take.
More information on retiree voting
More information on retiree voting
■ Ballots are due by 5 p.m. July 11 in California.
■ Once I read the paperwork, can I just drop off my ballot at City Hall? No. It must be sent to the balloting agent in California and arrive by July 11 to qualify as a vote. That means you will need to send the ballot several days before July 11.
■ What if the information sent to me is just plain wrong? What if I did not get a ballot yet? Contact the citys hotline at 877-298-6236 weekdays during regular business hours.
■ Pensioners are voting on pension cuts in two classes. Class 10 represents police and fire, and Class 11 represents general retirees. Each class must approve the plan for it to pass. Two calculations come into play. First, a majority of the pensioners who cast ballots must approve the citys pension cut plan in order for the smaller cuts to take effect.
But its not enough for a simple majority to vote yes in a bankruptcy. For the plan of adjustment to go through, the yes votes must represent at least two-thirds of the amount of pension claims the full value of pensions of those who cast ballots.
So in Detroit, the votes cast by police and fire, who are covered by one pension plan, matter to the general city retirees, who are covered by another plan, too.
Detroit pensioner voting guide
■ What Detroit retirees need to know about the bankruptcy vote
■ What cuts to the annuity savings plan would look like
■ Loss of COLA saps pension checks
■ Health care trusts to take over; why some get 2 ballots
■ Some will feel more pain than others
■ Retirees face complex ballot as they mull voting on Detroit's bankruptcy plan
Contact Susan Tompor: 313-222-8876 or firstname.lastname@example.com