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as Dead as the next guy by theCHAMBAWatch
©2010-2016 theCHAMBA
I bet it is actually Corey Taylor under the mask!
I bet its actually Corey taylor behind the mask
Reminds me of a Tales Mystic Arte cut-in.
Pretty awesome!
"Why did the nickel jump off the building but the dime didn't?
"The Dime had more cents."
"Why did the nickel jump off the building but the dime didn't?
"The Dime had more cents."
way cool
i f'in love deadpool
this sick
This is definitely a Deadpool I can relate to! Has both a sinister and comical look!! Like the expression bad!
Heheh, I dig the expression on this guy. :`
Great job .
do you smell what the deadpool is cooking??? ^^
Looks awesome!
Teus desenhos são muito bom, e a pintura é fora de sério!!!
cool attitude
This guy is the MAN!!! Sweet job on his facial expression!
i love this guy oO
Wow, I guess Deadpool has exploded in popularity recently. He's still one of my favorite Marvel characters.
LOVE THIS lol and your style simply amazing sir!
oh, he's always been popular...
now he's just mainstream popular!
three cheers for the funniest marvel character ever!
damn well done by the way. love the sinister smirk.
now he's just mainstream popular!
three cheers for the funniest marvel character ever!
damn well done by the way. love the sinister smirk.
Awesome Deadpool art!! Even if he's wearing a mask, the shadows make it so much more alive than flat colours.
now give me your lunch money
i love this. just keep imagining different smartass remarks hes saying!
a little weird perspective, but its a good illustration
Merc with a mouth - hehehe
love the colors
Deadpool awesome as always
Love how you got his personality in there despite the fact he's behind a mask! He looks really cocky and smarmy!!
That's pretty much the coolest
Nice Your Shading is the bomb!
Am I the only one noticing that his face is extremely scrunched? There's barely any space between his mouth, nose, and eyes, yet there is a huge amount of forehead.
you're not the only one, reason is I drew it that way.
How come?
to play with both structure and expression.
he's also looking downwards in the piece.
he's also looking downwards in the piece.
If he's looking down then the nose should be much more protruded. Drawing a face from that angle is very frustrating.
only if whats under the mask is your traditional idea of a face.. which im pretty certain deadpool doesnt have.. hes face is monkey fucked under that mask.. so maybe what jeff drew is spot on.
I take it you haven't read very many Deadpool comics.
he doesn't have a full bridge to his nose (in my characterization anyway).
he's the most beautiful underneath.
hey! i know deadpool!
The background really goes well with this one - and well done for getting so much expression out of a masked face!

subset: commoncrawl


text:
The Chambord is one of the few hotels available for booking through English speaking internet sites in the city of Yeosu. Everyone in the city seems to know it. But unfortunately, it isn't very good. The rooms and the hotel as a whole look extremely dated and most customers seem to be sailors waiting for their ship. Yeosu will be... More
Top-rated Attractions Nearby
Top-rated Restaurants Nearby


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Food & Drink
Top Houston Food & Drink News
Houston's 5 Best Weekend Food Bets: Wine & Dine…
Valentine's Day Dining Friday – Sunday From romantic meals for two to fun holiday brunches, our...Things To Do
Top Houston Food & Drink News
Openings & Closings in Houston: Beer-To-Go…
Growlers, 1005 Waugh, found a buyer, and it's Jon Denman of the Drink of Ages radio show, which...Restaurant News
Top Houston Food & Drink News
Buying Beer, Part 4: Beers Worth Standing in…
Buying Beer: The Series So Far Part 1: Beers For Everyday Drinking Part 2: Readily-Available...Booze
Top Houston Food & Drink News
It's Not Cool to Fake a Food Allergy
Almost 5 percent of the population has a food allergy and it's almost always to one of eight...Random Ephemera
Top Houston Food & Drink News
Here Are 10 Seafood Sandwiches in Houston to…
Hope you pigged out on Fat Tuesday, because the 40-day Lenten season is here. It's often a time...Local Spotlight
Find the best restaurants in Houston:All Restaurants
Latest Houston Food & Drink NewsMore Food & Drink News
Best Food & Drink in Houston
- 10 Best Restaurants for Adult Birthdays in Houston
- 10 Best Budget Restaurants in Houston's Greater Heights
- The 10 Best Dishes in Houston 2015 (UPDATED)
- The 10 Best New Houston Restaurants Of 2015
- 10 Best Restaurants in Montrose
Latest Restaurant Reviews
Best of Houston®: Food and Drink
- Urban Eats
- Down House
- Cleburne Cafeteria
- Bernie's Burger Bus
- Triple A Restaurant
- Prohibition Supperclub + Bar
- Coppa Osteria
- Tacos Tierra Caliente
- Melange Creperie
In Case You Missed It
- Openings & Closings in Houston: Beer-to-Go Improvements
- Here Are 10 Seafood Sandwiches in Houston to Help You Get Through Lent
- Between Review Visits, Brick & Mortar Kitchen Changed Completely, and Not for the Better
- The Only National Food Holidays That Matter
- Openings and Closings in Houston: Beaver's Expands, Piqueo Rebrands
Related Promotions
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Check Out the Gorgeous Winter Dishes at BCN Taste & TraditionWe've been consistently impressed with chef Luis Roger's beautiful and delectable cuisine since we reviewed BCN...4 days ago by Phaedra Cook
Here Are 10 Seafood Sandwiches in Houston to Help You Get Through LentHope you pigged out on Fat Tuesday, because the 40-day Lenten season is here. It's often a time of prayer, atonement...4 days ago by Brooke Viggiano
New Restaurant Owners Think Tequila, Tacos and Cocktails Are the Keys...As reported last week, Cook & Collins has closed. Spare Key, the under-the-radar craft cocktail bar on the...
This Week in Houston Food Blogs: Spicy and Spotted CocktailsThis week's blog round-up includes a hearty vegetarian recipe, a classic Southern meal idea straight from Alabama...5 days ago by Alexandra Doyle
Between Review Visits, Brick & Mortar Kitchen Changed Completely,...Originally, this review was going to praise Brick & Mortar Kitchen's market-fresh ingredients, fine-quality...
Behind The Brick & Mortar Kitchen Review: A Change on Your Part May...As a restaurant critic and food writer, occasionally my world collides with my husband Chuck's, who is a...6 days ago by Phaedra Cook


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K&L's notes - 70% merlot and 30% cabernet sauvignon. Heavy soils at this property, so merlot does well here. Bready nose with some boysenberries. Big wine with good structure and potential. Tannic-close to 2005 quality. * Ralph Sands: Add Clarke to the greatest value wines in Bordeaux today. Big wine. Very dark and serious black cherry and plum fruit with hints of smoke-firm finish. Please note - 2006 Bordeaux futures are not in stock, but will arrive between Jan 2009 and Dec 2009. We will contact you for shipping instructions.
The item you have chosen is not in stock in our retail stores or within our main warehouse.


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Flying Tigers (video game)
From Wikipedia, the free encyclopedia
Flying Tigers was a traditional top-down scrolling shooter game for PC. The game was originally brought out in 1993 and ran on DOS.
Game design was basic, but the weapon system introduced in the game was addictive, since it was associated with the concept of loot. Gamers enjoyed the game mainly because of its capturing music score. Game Soundtrack quality was way ahead of the game itself. There was no story (in spite of the opening scene in the game which consisted of scrolling story). Gamers also enjoyed the different types of algorithms employed in enemy hitpoints, since it forced the games to use strategy in picking and destroying the enemies.
|This scrolling shooter article is a stub. You can help Wikipedia by expanding it.


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From a secluded beach to a backcountry campsite, the Eagles Nest
Outfitters Single Hammock Package is a dream come true for ultralight
backpackers and lazy bums alike. Rugged nylon withstands the rude pokes and prods from jealous branches, and the nylon compresses into a softball-sized sack of sweet goodness when you're on the move. Lightweight aluminum carabiners make "me-time" instantaneous (as long as you have the right trees around) whether you're on the trail or in your backyard. This package comes with the hammock, carabiners, straps, and an attached compression stuff sack.
- 70D high-tenacity nylon taffeta
- Triple-stitched seams
- Aluminum wiregate carabiners
- Attached compression stuff sack
- 400lb capacity
- Included in package: hammock, carabiners, straps, attached stuff sack
- Reviews
What do you think about this product?
Have questions about this product?
- Familiarity:I've put it through the wringer
This hammock has been great for almost 3 years now, and I couldn't be happier with it. It's a breeze to set up, very comfortable, and incredibly lightweight.
It's true that it's small for two people to lay down, but it fits one person brilliantly. I've taken it on backpacking trips, day trips to the crag, afternoons in the park, and everything in between.
sittin' pretty
- Familiarity:I've used it several times
This package is so easy put up, that even your dumbest friend could do it. The straps make setting this up so simple. The hammock is comfy, light, and has been durable so far. However, go with a double if you are trying to get next to someone in your hammock.
great little package
- Familiarity:I've used it several times
I returned a Double Nest last year after I found that there was no way for two people comfortably to use the hammock. This is a nice hammock in an easy to set up package. It includes everything you need.
What's the difference between this hammock...
What's the difference between this hammock and the single nest hammock?
same hammock, only difference is this is a package which includes straps.


text:
Sincere Freight Pte Ltd
Company Profile
Our Services
Contact Us
We are an international freight forwarding company
since 1996
Company Profile
We are an international freight forwarding company established since 1996, located in Changi Airfreight Centre.
Our Services
Our businesses include airfreight, ocean freight, customs clearance and door deliveries.
Contact Us
115 Airfreight Cargo Road
#06-18 Building C
Singapore 819466
Copyright ©
Creative eWorld Pte Ltd


text:
Goodbye, David Letterman: An Oral History
Jane Pauley, Reggie Miller, Joyce DeWitt, Rupert Boneham, and other Hoosiers share their best Letterman memories.
An oral history of the funniest guy ever to call Indy home.
The Replay: Paul George, Tamika Catchings, and Bob Knight
The Back-to-Practice Edition
Thirty years ago this week, Bob Knight threw a chair. We remember.
The Replay: Tony Kanaan, Bob Kravitz, and Butler's Big Game
Shirt Off Our Back Edition
There's a lot of hot air left in DeflateGate, plus an Indy 500 champ strips down for Pattern magazine.
The Replay: Deflategate, Colts, and Hoosiers
Slime Balls Edition
The Colts' loss in the AFC Championship game proves that the football world is flat.
Tweets of the Week: Patriots Pummel Deflated Colts
Reactions in the midst of and after New England's rout of Indy 45-7 in the AFC Championship game
Via @bkravitz: "Nobody is suggesting [that balls allegedly deflated by the Patriots are] why the Colts lost obviously. They were manhandled."
My Best of Indy: Julia Moffitt
"Sometimes, I'll just go into T.J. Maxx, find a $20 dress, and wear it on-air," says the WTHR morning anchor. "No one can tell."
Bob Kravitz Knows You Hate Him
Did you read him today? Iconoclast. Idiot. Heretic. Horse's ass. Call him what you will—he doesn't care.
He reads his mail. He takes your calls. He looks at almost every single sarcastic and anonymous comment you leave beneath his stories on the Star's website.
Video: Josh Kaufman Swarmed by Fans at Indy Airport
The budding star arrived to bona fide Hoosier hospitality when touching down in his hometown after a New York City media blitz.
Originally, a grand arrival greeting had been organized for 9:15 p.m. Thursday—but then Voice victor Kaufman's flight was delayed.
Tweets of the Week: Josh Kaufman Edition
Indy's resident "Soul Man" laid claim to the top prize on NBC's vocal competition, and public figures from Indy mayor Greg Ballard to Justin Bieber and Ellen DeGeneres took to Twitter over the news.
Via @PetethePlanner: "Weird day in Indy. The city got 3rd for #SuperBowl2018. The Pacers got 2nd in their playoff game. And @iamjoshkaufman got 1st on The Voice."


text:
Cheap and Easy Crafts
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How to Make Grubby Candles
By: CandleWic
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Grubby candles have a rustic look, as though they are missing a layer of wax in sections. The finish of the grubby candle actually effects the surface of the candle. These candles are very easy to make. Here is how to make grubby candles.
Any size aluminum mold can be used for this candle. The most popular we find is the 3 x 4½. You begin this project by chilling the mold for about 10-15 minutes. You then take the 4045H wax and add about 10% stearic acid to the formulation. Melt your wax to around 150-155 degrees Fahrenheit and pour into the chilled mold as any standard pillar. Top off where needed and remove when the candle has completely hardened. Due to the peeling of the wax the candle may have to be placed in the freezer for removal.
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Willow whips her hair back and forth by spittfireartWatch
©2013-2016 spittfireart
where do you make these at
that's cutie
Headbanging pony is awesome :3
Looks awesome
I can't tell if its my computer or the gif, but is this gif supposed to be slow?
Great drawing btw.
Great drawing btw.
Nah it's pretty quick. Could be your browser :U
And thanks!
And thanks!
Im trying not to remember that damn song.......Cute animation though!!!!!
Pictures that MOVE?! I call witchcraft!
party hard


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Apologies for inconvenience, the video is scheduled to be restored and will be restored between 2 and 8 weeks. Please contact admin @ pkpolitics dot com if you want this video earlier.
Sharmeela Farooqi (PPPP), Rana sanaullah (PML-N), Justice Ret. Saeed-ul-Zaman Sidiqi and Dr. Shahid Masood in Today's episode of Off The Record with Kashif Abbasi.


text:
Redskins Nation - Redskins rookies visit Ronald McDonald House
More Video
About the Show
Join host Larry Michael as he takes you inside Redskins Park every weekday on Redskins Nation.
Watch interviews from Redskins coaches, current and former Redskins players, and other Redskins experts.
Redskins Nation is presented by CroppMetcalfe


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9. Airport and airline food is horrible
8. Packing your stuff to conform to airline regulations sucks.
7. I can bring much more stuff if I rent a car or a minivan.
6. Airline seats suck if you are over 6' tall
5. Truck stop food is yummy! Especially at Flying J's.
4. If you can survive your carmates for several days, you can survive living with them at Burning Man. If you can't, you can ditch them at the truck stop or along the highway some place.
3. Cabela's in Nebraska
2. The trip is beautiful!
1. If your tent collapses, you can live in your car.
More reasons...
Breaded tenderloin sandwiches
Niagra Falls
Driving over the Rockies
The hotels in Winnemucca
Having a lockable/secured thing to store your valuables in, especially during the Burn.
Meeting other Burners on the road
Trying to guess who the other Burners are when you are still east of the Mississippi River
Conversations with truckers at 4am
Feeling like a trucker, conquering traffic in Chicago, Cleveland, Gary.
Writing a book about rest stops along America's Interstates
I'm sure I'm forgetting things here....


text:
Awesome thanks for sharing
Nice piece, glad you found my stock useful.
You have been featured in my latest journal "Happy Halloween" I hope you enjoy it!
Wonderful Halloween work!!
Very beautiful work
This is really good! I have inspiration for a story from this. I'm a writer.
Had to delete the original feature and repost, new link in case you had it
Great Work!
beautiful hun!!
awesome job ^^
This is magical!!!
Its indeed beautiful, so mystical and magical yet again. Totally loving it, great colors and lighting..another great piece of art


text:
With 1.7 million freelancers, we'll match you with the perfect talent.
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Hi Melissa,
What a coincidence that I got your email today. We do have another course that will need to be recorded. See attached. I believe the entire recording would be around 30 minutes. Can you please send us a quote and the date we can expect to receive the files?
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text:
Welcome to Huttons Courtyard Cafe
Huttons Courtyard café is a family run eatery and is located within the Stables Visitor Centre at Hylands Estate. We provide an ideal venue to meet with friends for lunch or stop for a drink when out walking in the park.
Both our outside eating areas are non smoking.
Please note that the café may also be open outside of these times depending on the season, but you should contact us prior to travelling if you plan to visit outside these hours. Given notice, coach parties are very welcome.
Cafe Assistant Required!
We require a new full time Cafe Assistant.
Interested? Call: 01245 346765.
Opening Times
Open 7 days a week
8.30 a.m. - 5 p.m.
Menus & Drinks
Loyalty Card Scheme
Click here to download your card
Dogs Welcome


text:
|Game Title
Windows (2003), PlayStation 2 (2005) and Dreamcast (2004)
Baldr Force EXE is an enhanced release of Baldr Force. It adds a new weapon (gravity field), a "very easy"...
Windows (1999)
In the future, technological excesses lead to never-ending conflicts between religious groups, newly-formed nobility and people of different social classes....
Windows (2009)
During the course of the 21st century, nanomachines became more and more prevalent in daily life. Many humans chose to...
Windows (2009)
RECORDARE is the second episode of Baldr Sky, directly continuing the story that was not concluded in the previous entry....
In an adaptation certainly not endorsed by PBS, this game puts the player in the shoes of a sociopathic Beavis...
Windows (2009)
Remember Prick's chief in Barn Runner 1: The Armageddon Eclair, called Holly, and Dr. Noriko from Barn Runner 2: The...
The founder of a prestigious girls' high school comes back after 20 years of absence, in order to begin a...
Battle Queen is all about fights between beautiful young women. In the beginning of the game the player is given...
Windows (2002)
Battle Raper is another hentai fighting game, only this time with the added bonus of in-game groping and molestation.That's right....
Windows (2005)
Battle Raper II is an adult hentai fighting game. There are two main modes in the game, the story mode...
Atari 2600 (1982)
This is a double-ended cartridge that contains a re-release of Mystique's Beat 'Em & Eat 'Em on one side and...
Beer Trivia tries something that very few games (only Rockstar and BarneySplat come to mind) attempt: to simulate inebriation in...
iPhone (2011)
A choose-your-own-adventure for horny frat boys, this automated conversion of the author's novel (also available as a PDF for e-readers)...
PC-98 (1993), FM Towns (1993) and Sharp X68000 (1993)
Bell's Avenue is a collection of three very short games, all of which play like minimalist Japanese-style adventures and have...
Monstrous aliens are attacking a skyscraper area in a modern city on the Earth. A special battleship, navigated by captain...
Windows (2006)
Everything is not as it seems in the school grounds, rumors run amok about students practicing black magic, and a...
Browser (2007)
This game is in the same vein as Coconut Bounce where once again the player takes control of a well...
Windows (1999)
In Biing! 2 you take over the part of a hotel manager at a holiday resort called "Lollibay Inn".You'll have...
Windows (2002)
Bikini Karate Babes combines the basics of a fighting game with realistic real-life video. Players can choose from various (all-female)...
Windows (1999)
Biko can be described as a "stalking simulation". You play as Akira, a guy who stalks pretty girls. When you...
Windows (2000)
Biko 2 is a Japanese 3D stalking simulation. You play as Inagaki Tetsuya, a guy who stalks pretty girls. The...
Windows (2004)
The third game in Biko series is once again a 3D "stalking simulator". You control Takumi, an ordinary Japanese guy...
The content of the game can be easily deduced from its title ("Kinbaku Jinmon Densetsu" means the legend of bondage...
Critic Score
Top games by as rated by the press:
- 95 The Witcher 3: Wild Hunt
- 94 The Witcher 3: Wild Hunt
- 94 Grand Theft Auto: San Andreas
- 94 God of War III
- 93 The Witcher 3: Wild Hunt
- 93 Grand Theft Auto: San Andreas
- 93 God of War II
- 93 God of War
- 92 Grand Theft Auto: San Andreas
- 91 The Witcher 2: Assassins of Kings - Enhanced Edition
Games must have at least a Critic Score of 80 to be considered.
Top games by as rated by our users:
- 5.00 Chaos Angels (1989)
- 5.00 Chaos Angels (1989)
- 3.67 D.P.S: Dream Program System (1990)
- 4.05 Dragon Knight 4 (1994)
- 4.05 Dragon Knight 4 (1994)
- 5.00 Dragon Pink: The Zero Castle (1992)
- 3.61 Duke Nukem Forever (Balls of Steel Edition) (2011)
- 5.00 Filsnown: Hikari to Toki (1995)
Games must have at least 1 votes and a User Score of 4.0 to be considered.
Adult is part of Themes. This group of genres contain:
- Anime / Manga
- Arcade
- BattleMech
- Board / Party Game
- Cards / Tiles
- Casino
- Chess
- Comics
- Cyberpunk / Dark Sci-Fi
- Detective / Mystery
- Fantasy
- Fighting
- Flight
- Game Show
- Helicopter
- Historical Battle (specific/exact)
- Horror
- Interactive Fiction
- Interactive Fiction with Graphics
- Interactive Movie
- Managerial
- Martial Arts
- Meditative / Zen
- Mental training
- Naval
- Paddle / Pong
- Persistent Universe
- Pinball
- Post-Apocalyptic
- Puzzle-Solving
- Real-Time
- Rhythm / Music
- Sci-Fi / Futuristic
- Shooter
- Spy / Espionage
- Stealth
- Survival Horror
- Tank
- Train
- Turn-based
- Video Backdrop
- Visual Novel


text:
David Delannoy's contacts (94)
See who has added David Delannoy as a contact »
João Espinho
João Espinho has been a member since Jul 2007 and goes by nikonman2007.
daniele castellucchio
I am italian... my photos.... good or bad that they may be, are what I had the...
Rebecca Danieli
Photography is my hobby. I love to compose my images and always search for new...
Marcus Hammerschmitt
I'm a writer, journalist and photographer located in southern Germany.
Susan B. Griffith
Started out photographing people and events to illustrate my newspaper articles....
Fred Martin
I am a photography lover living in France.
Aaron Morgan
Please, if you think like a histogram, keep it to yourself.
Michael Yagoda
I am a retired teacher who LOVES TO TAKE PICTURES!
Jeff Johannsen
There are moments in our lives that are precious, views that are breathtaking,...
Giampaolo Lolli
I am looking for the beauty in things, only my sense of beauty that i find in the...
rashmi a
I love to take photos.
Pedro Teixeira
Hi, first of all I want you to to know it is a pleasure to be here on JPG...
Andrew Bloomquest
I am still breathing, I am still reaching, I am still falling, I am still trying,...
Tom Harvey
I regularly update old works with new ideas (there is no rhyme or reason to my...
elfriede fulda
I am a person who sees a photo opportunity in everything. Embracing nature as I...
JPGirlrazzzi has been a member since Aug 2008 and goes by martin80.
Betty Maxey
I love photography, and love sharing my photos, and viewing yours........ thanks...
jan-louise haller
I had my first camera at 8 years old. Photography gives me the greatest thrill....
Ariel Arias
I am Cuban Photographer based in Paris ,France ,born 1966
jen bellefleur
my work is an attempt to create something outside of myself that will serve as a...


text:
He thinks it possible that Shiva and Chicxulub were created by portions of different asteroids that fragmented when they hit the atmosphere. The energy from the fragment that produced Chicxulub is estimated to have been equivalent to the explosion of 100 trillion tons of TNT -- 10,000 times the explosive potential of the world's arsenal of nuclear weapons. The much bigger fragment that created Shiva may have shoved India north. India was then an island moving three to five centimeters a year. Then came what has been a mystery to students of plate tectonics -- the surge of the Indian plate to the astonishing rate of 15 to 20 centimeters a year.
Dinosaurs, who were thriving in India, had lived a thousand times longer than humans have yet lived. Then they and more than 75 percent of Earth's plant and animal species died. Perhaps the two collisions, combined with a lot of volcanic activity in that era, some of it perhaps caused by the collisions, tossed up enough dust to block sunlight, creating perpetual night, and acid rain, impeding photosynthesis and causing the starvation of many creatures. Or perhaps by screening sunlight, the dust caused a glacial episode.
Or perhaps dust and water vapor had a "greenhouse effect," holding in heat and cooking much life out of Earth. The discovery, two decades ago, of a bed of dinosaur fossils on Alaska's North Slope suggests that temperatures may have been warmer long ago, before there were human beings to blame for that.
Before Darwin, many people believed that no species could become extinct because this would mean there had been an imperfection in God's original handiwork. Yet 104 years before publication of "On the Origin of Species," the Lisbon earthquake of 1755 had caused some people to doubt that God has ordained a benevolently ordered universe. Nevertheless, in 1787 other people -- Americans call them the Founding Fathers -- who were influenced by Newtonian physics and the deist idea of God as cosmic clockmaker, devised a constitutional system of separated powers, checking and balancing one another, mimicking what they considered our solar system's clocklike mechanics.
Today, we know there is a lot of play in the joints of the Constitution, and that every 40 million years or so asteroids of more than half a mile in diameter strike Earth. Yet the Constitution still constitutes, and the fact that flora and fauna have survived Earth's episodes of extreme violence testifies to the extraordinary imperative of life.
Bush mocks Rubio and his fans: Stop whining that it's "unfair" that you're being attacked by another candidate's Super PAC | Allahpundit


text:
CloTi' wallpaper by KatalunaEternityWatch
©2011-2016 KatalunaEternity
Another version of my Cloud and Tifa photmanip.
Tifa render:
CloTi photo manip:
Tifa render:
CloTi photo manip:
love it so much
LULZ! Pffft Ahahaha! Really? Man you just made my day. Can't stop laughing. XDDDD
aww, how cuuuuuuuuuute!!!!
hahaha I luv it! looks like cloud is defending tifa and tifa is glad XD u should write a fanfic based on this XD
Haha, thank you. XDD Too happy?
Huh? XD
Huh? XD
LOL i meant that it looks sweet and cloud is holding his love. That is why you should write a fanfic based on this
I love this couple so much *_*!
|3 Me too. It's just frustrating cuz they're both shy.
One Question. Why is he mad?
He's not mad, that's his HAPPY face. Maybe Tifa ate all his cookies?
His job is to protect his friends and his family at the cost of himself. Cloud is my hero and my idol.
Mine too.


text:
Published: January 2013
Human immunodeficiency virus (HIV) is a retrovirus that infects primarily CD4+ T helper cells. Depletion of these cells causes progressive immunologic decline. When CD4+ T cell counts fall below 200 cells/mm3 or opportunistic infections occur, an infected patient is described as having the acquired immunodeficiency syndrome (AIDS).
At the end of 2009, an estimated 780,000 people in the United States were living with HIV. The largest percentage was in those aged 45 to 49 years (20%), according to surveillance data published at the end of 2009, which were obtained from the 46 states that use name-based reporting. However, from 2007-2009, the largest percentage increases were seen among people aged 60 to 64 years. Among HIV-infected men in all age groups, 68% identified their risk behavior as men having sex with men (MSM), 13% reported a history of injection drug use (IDU), 8% reported both MSM and IDU, and 11% reported heterosexual contact as their route of HIV exposure. Of HIV-infected women, 71% identified heterosexual sex as their HIV exposure, and 27% had IDU as a risk factor.1
The magnitude of the global HIV/AIDS epidemic vastly exceeds what is seen in the U.S. As of the end of 2011, 34 million people were estimated to be living with HIV/AIDS worldwide. Approximately 69% of those with the disease are in sub-Saharan Africa, where access to antiretroviral therapy is limited.2
HIV infection was first described in 1981 when an epidemic of Pneumocystis jiroveci (formerly identified as Pneumocystis carinii) pneumonia (PCP) was noted in homosexual men.3 In 1984, HIV was identified as the causative agent of AIDS. Subsequently, 2 genetic types of HIV were identified. The predominant type worldwide is HIV type 1 (HIV-1). HIV-1 is further subdivided into subtypes (also called clades), designated A through K (collectively referred to as group M), N, and O. More than 98% of HIV-1 infections in the United States are caused by subtype B. HIV type 2 (HIV-2) is found in West Africa, particularly Guinea-Bissau, Gambia, and Senegal, as well as in France, Portugal, Angola, and Mozambique. Disease caused by HIV-2 appears to be less readily transmissible and to result in slower disease progression than that caused by HIV-1.4
The human immunodeficiency viruses belong to the lentivirus subfamily of the RNA retroviruses. Like most retroviruses, the HIV genome consists of 3 structural genes, gag, pol, and env. The gag gene codes for viral capsid proteins, env for viral envelope proteins, and pol for proteins responsible for viral replication, including the RNA-dependent DNA polymerase known as reverse transcriptase. In addition, several other regulatory genes are present, including nef, rev, and tat.
Most commonly, transmission of the virus occurs after a breach in the integument or mucous membranes. HIV infection occurs when the envelope subunit gp120 binds the human CD4+ T cell receptor found primarily on lymphocytes and monocyte-derived macrophages. In addition, binding also requires the presence on the host cell of the chemokine receptor CCR5 or CXCR4. The viral envelope then fuses with the host cell, allowing release of the viral core into the host cell. Viral DNA is synthesized by reverse transcriptase and incorporated into the host genome by the protein integrase. Once the viral gene products are transcribed and assembled, the HIV protease mediates packaging of new virions for release into serum to propagate the infection.5
Over time, infected persons have a progressive loss of CD4+ lymphocytes, although in the early stages of infection, this is not associated with increased immunosuppression. The rate of CD4+ cell loss is variable and depends on viral and host factors. On average, infected persons lose 40 to 80 CD4+ cells/mm3/year.6 A subset of patients progress rapidly; however, 5% of infected persons, known as long-term nonprogressors, will have little or no progression of clinical disease or decline in CD4+ counts over 10 years, even without antiretroviral therapy.7
Transmission of the virus occurs through exposure to infected body fluids, including blood, semen, and vaginal fluid. The most common modes of transmission are sexual contact (male-male or heterosexual sex), parenteral exposure to blood and blood products, and vertical transmission during pregnancy. The magnitude of risk depends on the exposure and degree of viremia of the source. For example, the risk of HIV transmission from a known HIV-positive source from receptive anal intercourse is 0.1% to 0.3%, whereas receptive vaginal intercourse carries a risk per episode of 0.08% to 0.2%. A percutaneous exposure from a needlestick injury or IDU results in transmission 0.3% or 0.67% of the time, respectively.8 The risk of vertical transmission from mother to fetus without any preventive therapy is approximately 25%.9 The efficiency of transmission increases with greater degrees of viremia in the source patient and the presence of concurrent sexually transmitted diseases.
In an estimated 40% to 90% of individuals, HIV seroconversion is associated with a clinical syndrome known as acute or primary HIV infection, or the acute retroviral syndrome. In a prospective study, among those with symptoms at the time of seroconversion, 95% sought medical care. Nevertheless, acute HIV infection is rarely diagnosed, partly because the symptoms are protean. The onset of illness is between 2 and 6 weeks after viral transmission and is believed to correlate with peak viremia, often in excess of 1 million viral copies/mL. Fever (mean, 38.9° C), rash, lymphadenopathy, and nonexudative pharyngitis are each present in at least 70% of individuals (Table 1). Most often, the rash is reminiscent of a viral exanthem with erythematous maculopapular lesions on the face and trunk, although many types of lesions have been described. Headache with or without cerebrospinal fluid pleocytosis, myalgia, and gastrointestinal symptoms are also common. Although present in only 5% to 20% of patients, oral or genital ulcers can be an important diagnostic clue. Laboratory abnormalities, specifically leukopenia, thrombocytopenia, and elevated transaminase levels, are not uncommon. Opportunistic infections such as mucocutaneous candidiasis and PCP may manifest during acute HIV infection as a result of transient but dramatic CD4+ cell count depletion caused by the high level of viremia.
|Sign or Symptom
|Frequency (%)
|Nausea and vomiting
|Weight loss
|Myalgia or arthralgia
|Neurologic symptoms
|Oral or genital ulcers
Adapted from Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents, March 27, 2012. Available at www.aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf.
The symptoms of acute HIV infection are self limited and most likely correlate with viremia. After reaching high levels, the viral load declines to a steady state or set point, and the CD4+ count recovers. HIV-1–specific cytotoxic T lymphocytes are present in high titer and appear to play an important role in controlling viral replication. The magnitude of the viral set point and the severity of initial symptoms predict disease progression. Recognition of this syndrome has obvious implications for public health. Whether early antiretroviral treatment changes an individual's disease course remains unclear.10 Diagnosis is discussed below.
Various historical details, findings on physical examination, and laboratory abnormalities should prompt testing to identify persons with established HIV infection. As expected, these findings are more prominent in patients with more advanced disease. Often, the initial diagnosis of HIV infection is made when the patient develops an AIDS indicator condition (Table 2).11 However, the astute clinician can often detect signs and symptoms of HIV infection earlier in the course of disease, allowing access to appropriate therapy and prophylaxis before significant illness develops.
|Indicator Conditions
|Candidiasis of the esophagus, bronchi, trachea, or lungs
|Cervical cancer, invasive
|Coccidioidomycosis, extrapulmonary
|Cryptococcosis, extrapulmonary
|Cryptosporidiosis, chronic intestinal (>1-month duration)
|Cytomegalovirus disease of any organ other than the liver, spleen, nodes
|Encephalopathy, HIV-related
|Herpes simplex with mucocutaneous ulcer >1-month duration, or bronchitis, pneumonitis, or esophagitis
|Histoplasmosis, extrapulmonary
|Isosporiasis, chronic intestinal (>1 month duration)
|Kaposi sarcoma
|Lymphoma, Burkitt's, immunoblastic, or primary CNS involvement
|Mycobacterium avium complex or M. kansasii, extrapulmonary
|M. tuberculosis, any site
|Pneumocystis jiroveci pneumonia
|Pneumonia, recurrent bacterial (≥2 episodes in 1 year)
|Progressive multifocal leukoencephalopathy
|Salmonella septicemia, recurrent
|Toxoplasmosis, CNS
|Wasting syndrome caused by HIV
AIDS, acquired immunodeficiency deficiency syndrome; CNS, central nervous system; HIV, human immunodeficiency virus.
A history of certain illnesses can also be suggestive of HIV infection. Infections such as active tuberculosis, recurrent community-acquired pneumonia, esophageal candidiasis, and either multidermatomal herpes zoster or zoster in younger adults should lead to HIV testing. Neoplastic diseases such as B-cell lymphoma, severe anal or cervical dysplasia, or invasive carcinoma and Kaposi sarcoma are indications for HIV testing, as is idiopathic dilated cardiomyopathy. The evaluation of fever of unknown origin or unexplained weight loss should always include an HIV test, even in older patients without identified risk factors.
Various findings on physical examination may suggest coexisting HIV infection. Examination of the skin can be particularly revealing. Seborrheic dermatitis or molluscum contagiosum are common in early disease, as is psoriasis. Oral candidiasis and oral hairy leukoplakia can be seen, typically with CD4+ counts <500 cells/mm3. Generalized lymphadenopathy is common. Recurrent or severe lesions of herpes simplex virus may be indicative of underlying HIV infection. Neurologic findings such as unexplained peripheral neuropathy or dementia are suggestive.
On laboratory evaluation, idiopathic thrombocytopenia, unexplained anemia, neutropenia, and/or leukopenia are frequent early clues to underlying HIV infection. An elevated total protein level or globulin fraction is also suggestive.
Since the recognition that HIV is the agent causing AIDS, many tests have been developed to aid in establishing the diagnosis of HIV infection and evaluating the stage of infection. However, only a few have application today for routine use.
The principal tests for the diagnosis of HIV-1 infection are the HIV enzyme-linked immunosorbent assay (ELISA) and the confirmatory Western blot test. Both detect host antibodies to HIV. ELISA is the initial screening test and has sensitivity and specificity >99%. A false-negative ELISA result occurs most commonly when the test is performed in a newly infected patient before an antibody response has developed (the window period). Most patients have a positive ELISA finding 10 to 14 days after infection, although seroconversion may be delayed in some. False-negative results occur rarely in patients with late-stage disease and in those with subtype N or O HIV-1 infection. False-positive results occur in various settings, including in patients with autoimmune diseases, multiparity, and liver disease, as well as recipients of multiple transfusions, hemodialysis, and vaccinations.12 An isolated positive ELISA finding should never be considered evidence of HIV infection, and clinicians should counsel patients accordingly.
The confirmatory study for a persistently positive ELISA finding is the Western blot test, which detects antibodies to specific HIV proteins. A positive study is defined as one in which bands are present in 2 of the following 3 proteins: the envelope proteins gp41 and gp120/160 and the viral capsid protein p24. A negative Western blot test result has no positive bands, but a study with any positive bands that do not meet the above criteria is considered indeterminate. Of patients with persistently positive ELISA results, 4% to 20% have indeterminate Western blot test findings. Indeterminate findings may occur during the window period between infection and seroconversion. Alternatively, other conditions such as autoimmune disease can lead to an indeterminate study. Western blot tests have a reported specificity of 97.8%; therefore, false-positive results can occur. Patients with both false-positive ELISA and false-positive Western blot test results are rare (6 to 7 in 1,000,000 tests).12
New fourth-generation assays that detect both HIV antibodies and the p24 antigen are now available in some labs. These tests would be beneficial during the window period of acute HIV infection. Additional diagnostic tests are available for use in specific circumstances. The diagnosis of HIV-2 infection requires an ELISA finding that will detect HIV-2 antibodies, followed by an HIV-2–specific Western blot test. Many currently available HIV ELISAs will detect antibodies to HIV-1 or HIV-2, and HIV-2–specific ELISAs are available. It is important to understand the test characteristics and a patient's risk of HIV-2 infection─highest among immigrants from West Africa and in people with exposure to an individual at risk─before drawing conclusions based on test results.
Rapid testing systems allow the HIV assays to be run in 5 to 20 minutes. Negative rapid test assays can be considered negative unless there concern of acute HIV infection; however, all positive rapid assays must be confirmed by standard ELISA and Western Blot assays. Currently available U.S. Food and Drug Administration (FDA)-approved kits are available for blood, plasma, serum, and saliva specimens. These tests are particularly beneficial in the delivery room, emergency room, and after occupational exposures. Additionally, the availability of Clinical Laboratories Improvement Act-waived testing allows these assays to be run in the community, expanding access to testing. Home tests are available that allow patients to collect a blood sample after a finger stick, which is then sent anonymously for testing and a recently FDA approved Over-the-counter, in-home test kits can detect HIV-1 and HIV-2 infection, some can distinguish between the 2 viruses, and others can detect only samples positive for HIV-1 antibodies.
As with all diagnostic tests, the positive predictive value depends on the rate of disease in the population being screened. In low-prevalence populations, the likelihood that a positive ELISA result represents a false-positive result may exceed the likelihood of the test's indicating true HIV infection.
Quantitative plasma HIV RNA (viral load) testing is most commonly used to measure response to antiviral therapy or to predict disease progression. Several methods of measuring viral load are commercially available, including viral RNA quantification by the polymerase chain reaction (PCR), branched-chain DNA assays, and nucleic acid sequence–based amplification. At present, the RNA PCR assay is most commonly used, but it should not be used for the diagnosis of HIV infection unless acute infection is a consideration. HIV-infected individuals can have undetectable viral loads in the absence of antiviral therapy, and the false-positive rate approaches 3%. When the clinician is concerned about acute HIV infection with a symptomatic patient and ELISA and Western blot test findings are negative or indeterminate, viral load testing can be helpful. With initial viremia, before the development of an immunologic response to the virus, the viral load is extremely high, often >100,000 copies/mL. Low viral loads (<15,000 copies/mL) with negative serologic studies may represent a false-positive RNA PCR result and the test should be repeated.12 Qualitative measurements of proviral DNA can also be useful for the detection of viremia before seroconversion.
Measurement of p24 antigenemia has also been used to detect HIV infection before seroconversion. On average, however, HIV DNA or RNA can be detected 2 to 3 days earlier than the p24 antigen. As a result, viral load testing has become the preferred method for the diagnosis of acute HIV infection. Studies of p24 antigen can be useful to help clarify confusing serologic or quantitative viral load results.
In summary, serologic testing is the gold standard for diagnosing HIV infection and should be performed on all patients in whom HIV infection is suspected. Viral load testing has no role in the diagnosis of established HIV infection. When suspicion of acute HIV infection is present, viral load testing can be performed, in addition to serologic studies. Negative serologic studies in the setting of a strongly positive viral load (>15,000 copies/mL) suggest acute HIV infection. These patients should be urgently referred to an HIV specialist; however, seroconversion must also be documented in the ensuing weeks to months. Indeterminate Western blot findings can present challenging management issues. At a minimum, the study should be repeated 6 months after the initial result to clarify whether the indeterminate findings were the result of ongoing seroconversion.
Appropriate treatment of the HIV-infected patient requires much more than consideration of antiretroviral therapy. The initial evaluation of such a patient should include a careful medical and social history, a medication history, including alternative and herbal supplements, and a thorough physical examination. The clinician should explore the patient's knowledge of HIV, understanding of the course of disease, emotional well-being, and presence or absence of support systems. A discussion of safer sex practices and contraception is vital. Notification of sex partners should be discussed. Identification of a durable power of attorney and discussion of advanced directives are valuable early in the course of the disease.
Several baseline laboratory studies aid in establishing a treatment plan for the patient, choosing agents for antiretroviral therapy, and guiding prophylaxis (Table 3). HIV infection should be staged with a CD4+ count and HIV viral load measurement. Current guidelines suggest performing HIV resistance testing (HIV genotype) in all newly diagnosed patients, because acquisition of resistant virus is becoming more commonplace (6% to 16%).13 Recommended studies also include a complete blood cell count with differential and platelet counts, determination of electrolyte, blood urea nitrogen (BUN), creatinine, transaminase, and alkaline phosphatase levels, urinalysis, and serologies for hepatitis A, B, and C.13 Additional testing includes rapid plasma reagin or Venereal Disease Research Laboratory (VDRL) testing to assess for syphilis, Toxoplasma gondii IgG serology to assess past exposure, and determination of the glucose-6-phosphate dehydrogenase (G6PD) level.14 A purified protein derivative (PPD) test must be performed if not done within the past year, and exposure to any individuals with active tuberculosis must be assessed. An anergy panel is not necessary. Women should have a Pap smear performed every 6 months until 2 consecutive smears are negative, and then annually. Women with abnormal Pap smears should be referred for colposcopy. Annual ophthalmologic and dental visits are recommended. Consultation with a nutritionist experienced in HIV care and a social worker are beneficial.14
|Laboratory Evaluation
|Complete blood count, including differential and platelets
|Determination of levels of electrolytes, blood urea nitrogen, creatinine, transaminases, alkaline phosphate, glucose-6-phosphate dehydrogenase
|Rapid plasma reagin (RPR) or VDRL testing
|Toxoplasma gondii IgG determination
|Hepatitis B and C serologies
|CD4+ count
|Quantitative HIV RNA level
|HIV genotype
|Purified protein derivative (PPD) test
|Consider determination of cytomegalovirus IgG, hepatitis A IgG levels, baseline chest x-ray
HIV, human immunodeficiency virus; IgG, immunoglobulin G; PPD, purified protein derivative; RNA, ribonucleic acid; VDRL, venereal disease research laboratory.
Preventive care is essential to treating the HIV-infected patient. Some infections can be minimized by avoiding uncooked and undercooked foods such as seafood, eggs, and meats, abstaining from drinking lake and river water, avoiding contact with cat litter boxes and animals with diarrhea, and institution of careful hand washing. The patient's vaccination history should be carefully reviewed. All patients should receive the pneumococcal vaccine, updated every 3 to 6 years. The influenza vaccine is recommended, as is hepatitis B vaccination if the patient is seronegative. Although hepatitis A vaccination is indicated if the patient has existing hepatitis B or C, most clinicians favor vaccinating all seronegative individuals. Tetanus boosters are indicated every 10 years. At present, live vaccines are not recommended for patients with advanced disease. The safety of these vaccines (eg, varicella, measles-mumps-rubella, and yellow fever) early in the disease is unknown and should be considered on an individual basis. The inactivated vaccines for typhoid (Typhim Vi capsular polysaccharide vaccine, ViCPS) and polio should be administered when required rather than live vaccines.14
Patients with advanced HIV disease require prophylaxis to prevent opportunistic infections. With a CD4+ count <200 cells/mm3 (or CD4+ percentage <14), prophylaxis against PCP should be initiated promptly, because the incidence of disease approaches 20% per year in these patients in the absence of prophylaxis. The first-line agent is trimethoprim-sulfamethoxazole (TMP-SMX), 1 double-strength tablet daily. Dapsone, 100 mg/day, is recommended for patients who are TMP-SMX–intolerant and not G6PD-deficient. When the CD4+ count is <100 cells/mm3, patients with positive T. gondii IgG serologies require prophylaxis to prevent reactivation. Daily TMP-SMX is again the drug of choice. Patients receiving dapsone require the addition of pyrimethamine. Although Mycobacterium avium complex (MAC) prophylaxis is recommended at CD4+ counts <50 cells/mm3, initiation is never emergent, and active MAC disease should be ruled out before starting prophylaxis if the patient has any suggestive symptoms. The most common regimen is azithromycin, 1200 mg/week. More detailed information can be obtained from the U.S. Public Health Service and Infectious Disease Society of America guidelines for the prevention of opportunistic infections.14
In the past decade, selection of highly active antiretroviral therapy (HAART) has become increasingly complex. Furthermore, textbook chapters often become obsolete almost as soon as they are printed as new classes and agents become available and recommendations for use change. Appropriate individualized selection of HAART should be left to an HIV specialist.
HAART therapy is now recommended for all HIV-infected individuals.13 Recent Department of Health and Human Services (DHHS) guidelines detail that the strength of the recommendation to initiate vary by the patient's CD4+ cell count. However, there is no CD4+ cell count at which HAART is contraindicated. Initialization of HAART is strongly recommended in the setting of pregnancy, history of AIDS-defining illness, HIV-associated neuropathy, and HIV/ hepatitis B co-infection, regardless of CD4+ cell counts.
Current therapy should almost always include a minimum of 3 agents and often more, selected from among presently licensed drug classes: nucleoside nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), entry inhibitors, chemokine receptor antagonists, and integrase inhibitors. Recommended first-line regimens consist of: efavirenz (EFV)/ tenofovir (TDF)/emtricitabine (FTC), ritonavir-boosted atazanavir + TDF/ FTC, ritonavir-boosted darunavir + TDF/ FTC, raltegravir + TDF/ FTC.13 PIs are recommended to be prescribed in a boosted formulation, which means that low-dose ritonavir is added to an active PI, not for antiviral activity but as an inhibitor of the hepatic metabolism of the active agent. This increases the levels of the active drug, improving its potency and often allowing longer dosing intervals. Several alternative regimens are also available; in some instances, these regimens may be preferred when taking into consideration additional factors including comorbidities, other prescribed or over-the-counter medications, lifestyle, and family history.13
Once HAART is initiated, the goals of HAART are to reduce HIV-associated morbidity and prolong survival, restore immune function, suppress HIV viral load, and prevent HIV transmission. The suppression of HIV-1 RNA to below the limits of assay detections usually occurs within the first 12-24 weeks of therapy.13 The most critical and modifiable factor affecting success is patient adherence. Only 45% of patients taking 90% to 95% of the prescribed doses of antiretroviral medications will achieve viral suppression (<400 copies/mL) compared with 78% in those taking >95% of doses.15 Incomplete viral suppression leads to the development of drug resistance. Adherence to the antiviral regimen should be addressed at every visit with every physician in a detailed fashion, and the importance of careful adherence should be stressed. Once-daily dosing of many treatment regimens is now possible and changes in pill formulations have allowed more potent regimens to be prescribed with fewer total pills. Both pill burden and dosing frequency have been shown to correlate with adherence.
Side effects of the currently available antiretroviral agents are considerable, and the general practitioner should be aware of them (Table 4). Those that are the most common and potentially serious include cytopenia with zidovudine; pancreatitis with didanosine; peripheral neuropathy with didanosine and stavudine; hypersensitivity, including rash, fever, and risk of death with abacavir; Fanconi syndrome with tenofovir; rash with all NNRTIs; hepatitis with nevirapine; nephrolithiasis with indinavir; unconjugated hyperbilirubinemia with indinavir or atazanavir; and gastrointestinal toxicity, including diarrhea and nausea, with all protease inhibitors.
|Adverse Events Unique to Agent
|Adverse Events Common Across Class
|Nucleoside and Nucleotide Reverse Transcriptase Inhibitors
|Lactic acidosis with hepatic steatosis (higher incidence with d4T), lipodystrophy*
|Zidovudine (AZT, ZDV)
|Anemia, neutropenia, myopathy
|Didanosine (ddI)
|Peripheral neuropathy, pancreatitis
|Zalcitabine (ddC)
|Peripheral neuropathy
|Stavudine (d4T)
|Peripheral neuropathy
|Lamivudine (3TC)
|Hypersensitivity syndrome
|Fanconi syndrome
|Non-nucleoside Reverse Transcriptase Inhibitors
|CNS symptoms
Protease Inhibitors
|Fat misdistribution,* GI intolerance, hyperglycemia, lipid abnormalities
|Nephrolithiasis, unconjugated hyperbilirubinemia
|Unconjugated hyperbilirubinemia
|Entry Inhibitor
|Injection site reactions
CNS, central nervous system; GI, gastrointestinal.
*The role of various antiretroviral agents in the development of lipodystrophy is not fully understood.
More recently appreciated are the metabolic abnormalities that can occur in patients taking HAART. Hyperglycemia, hypercholesterolemia, and hypertriglyceridemia should be carefully monitored and treated (with attention to interactions between the protease inhibitors and many 3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitors). Additionally, studies have suggested an association between antiretroviral therapy use and increased relative risk of cardiovascular end points, such as myocardial infarction.16
In addition, significant drug interactions can occur between antiretroviral agents and commonly prescribed drugs that can lead to drug toxicities or reduction in levels of the drug or the antiretroviral agent, rendering them ineffective. For a complete listing of adverse effects, toxicities, and medication interactions, refer to the DHHS Antiretroviral Guidelines.13
The advent of HAART has improved mortality for HIV-infected patients who have access to these medications. In the U.S., deaths caused by AIDS declined sharply in 1996 and 1997, when protease inhibitors were first introduced. Among a cohort of adults with advanced HIV infection, death rates decreased from 29.4 per 100 person-years in 1995 to 8.8 per 100 person-years by 1997.17 Morbidity has declined as well, as measured by the incidence of opportunistic infection.17 Between 1994 and 1997, the incidence of PCP, MAC disease, and cytomegalovirus retinitis combined decreased by 83% (21.9 to 3.7 per 100 person-years). A study using a computer simulation of HIV disease has estimated that a total of 2,100,000 years of life were saved by prophylactic therapy and antiretroviral therapy between 1989 and 2003. The per-person survival gain attributed to HAART for HIV infection is estimated to be 180 months, or 9 times that of coronary artery bypass surgery.18 Current efforts are focused on improving ease of use and decreasing toxicity of HAART in hopes of enhancing the quality of life in those infected with HIV.
Physicians must conduct a thorough, nonjudgmental assessment of risk factors for HIV infection. Persons at increased risk for HIV infection include those with a history of IDU, sexually transmitted diseases, including human papillomavirus, hemophilia, and receipt of blood products between 1977 and 1985. Men who have had sex with men, sex workers, and heterosexual persons with more than one partner since their last HIV test are also considered to be at high risk, as are the sexual partners of high-risk or HIV-infected persons. Mental illness and incarceration may serve as markers for high-risk behavior, as does a history of hepatitis B or C infection. Persons who consider themselves at risk should receive testing, even if risk behaviors are not disclosed. Past efforts have focused on testing individuals perceived to be at increased risk for HIV infection. The Centers for Disease Control and Prevention (CDC) has now recommended that all persons aged 13 to 64 be screened for HIV infection at least once, and that this should be done unless the patient declines testing (opt-out testing).19 Individuals at high risk should be screened more regularly and all pregnant women should be screened for HIV unless they choose to opt out of testing. Pre-exposure prophylaxis (PreP) has recently been approved by FDA for HIV-negative individuals in whom sexual transmission is poses a risk of HIV infection.20 Co-formulated HAART tenofovir/emtricitabine daily has been shown to reduce risk of HIV transmission in this population.
Treatment of pregnant women poses special considerations. Antiretroviral therapy in pregnancy has been shown to dramatically decrease the risk of transmission to the child. Therapy with zidovudine in the third trimester, followed by IV infusion of zidovudine in labor and administration to the infant for the first 4 weeks of life, have been shown to lead to a 66% reduction in the risk of transmission of HIV to the infant.9 Currently, combination antiretroviral therapy during pregnancy is recommended. Delivery by cesarean section further reduces that risk, from approximately 8% to 2%. However, when the maternal viral load is reduced to <1000 copies/mL with HAART therapy, the likelihood of transmission to the fetus is <1%, regardless of vaginal or cesarean section delivery. Although counseling regarding the risks of antiretroviral medications to the fetus is necessary, the transmission benefits of antiretroviral therapy generally outweigh the risks of teratogenicity. Efavirenz is a pregnancy category D agent and should be avoided.21
Health care workers are at risk for contracting HIV infection through exposure to infectious body substances. Blood, cerebrospinal fluid, semen, and vaginal, peritoneal, synovial, pleural, and amniotic fluids, as well as tissue samples, can all transmit HIV, although nonbloody urine, saliva, tears, sweat, and vomitus cannot. Percutaneous exposures (needle sticks) carry a risk of transmission of 0.3%, whereas mucus membrane exposures (eg, a splash) transmit less virus and are less likely to lead to seroconversion (0.01% of the time). The risk of a percutaneous exposure is increased when blood is visible on the device causing the injury, when the device was in the source patient's artery or vein, when the injury is deep, or when the source patient died within 60 days of the event. Retrospective data, animal data, and mother-to-child transmission data all suggest that immediate antiretroviral therapy after an exposure reduces the risk of HIV seroconversion in the exposed individual. Currently, administration of a 3-drug antiretroviral regimen is typically used.22 The postexposure regimen should be continued for 4 weeks if no toxicities occur and the first dose should be administered as soon as possible. Follow-up testing is recommended at 6 weeks, 3 months, and 6 months.8


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updated 09/24/2009 AT 4:00 PM ET
•originally published 09/25/2009 AT 6:00 AM ET
Amanda Bynes enjoyed a night out at new West Hollywood nightspot Mi-6, sitting at a table filled with guys. Despite the crowded table, though, the actress seemed content to just dance to the music in her seat, shaking her shoulders and smiling. Bynes also was busy people-watching. And there were lots of stars to see, including Emile Hirsch, who sipped drinks on the dancefloor, Jesse McCartney, who was surrounded by guy friends, and Frankie Delgado, who loved being the center of attention as he worked the room.
In Atlanta to shoot her movie Life as We Know It, Katherine Heigl took new daughter Naleigh to the high-end Lenox Square Mall in Buckhead for a walk. Says a source: "She looked happy."
Amy Poehler dined out at Vento in New York with former Saturday Night Live castmate Rachel Dratch. Since the Parks and Recreation star is a regular there, her server brought over a bottle of her favorite wine – the Ex Libre Cabernet Sauvignon – on the house. The ladies also ate pasta and chocolate fudge cake and gelato for dessert. They were also joined for after-dinner drinks by Seth Meyers and friends.
Looks like they're still hanging out! Derek Hough and Shannon Elizabeth were "super friendly" while spending a night out together at Playhouse Hollywood recently. Also there that night: Leonardo DiCaprio, who hung out upstairs in a VIP room and drank vodka.
Following his show at San Diego's House of Blues last week, John Legend and his brother popped into new San Diego nightspot Side Bar, where the R&B singer's brother sang along to DJ Scooter's remixes.
By JENNIFER GARCIA, LINDA MARX and LESLEY MESSER


text:
Lost Echo Review
- Beautiful environments.
- Intriguing plot.
- Pace is far too slow.
- Dialogue isn't very engaging.
- Movement controls aren't reliable
A handsome adventure game with an enticing air of mystery let down by poor pacing and weak dialogue.
- Full Review
- App Store Info
Imagine if you will that an encounter with your partner at an ice cream shop could lead you to question the very fabric of reality. Sound unlikely? Well, that's what happens to Greg, the protagonist of Lost Echo. A casual meeting and a flash of white light later, and suddenly he is the only person who can remember his girlfriend.
That's just the start of the mystery, of course. We'll refrain from discussing further as the plot is one of the main things the game has going for it. The ideas are intriguing enough, and the futuristic world setting is a marvel to behold.
But even for an adventure game, Lost Echo is painfully slow paced. The dialogue scenes seem to last forever without imparting much entertaining or useful information. This dirth of excitement is exacerbated by the slow speed at which you amble around the environments. You can run by double-tapping, but command this isn't as reliable as you would like.
Lost Echo is a pretty streamlined experience. If you pick casual mode, you can press two fingers on the screen to uncover hotspots, which is useful if you don't want to spend your time hunting for interactive pixels. Sometimes games of this nature can become confusing, but here, your next step is generally spelled out fairly clearly. This gives you relatively stress-free experience, but the lacadaisical pace at which the stroy unravels does undercut the interest factor.
And it's a shame, because the environments give you a great snapshot into a beautiful world. The lighting and clean-cut look of the architecture evokes memories of Mirror's Edge, where a shiny exterior is hiding a darker reality under the surface. If you can stomach the slow pace, advneture game fans should feel right at home here - especially if you like a good mystery. We'd need some snappier pacing and better characterisation if we were going to recommend it to anyone else, though.
DescriptionFeatured by Apple in:
-Epic Adventures
-15 Greatest Storylines
-Amazing Adventure Games
-Spectacular Stories
-Best New Games
"A richly defined, innovative experience, Lost Echo is exactly what an iOS adventure should be, capturing the spirit of traditional adventure gaming with all the potential the platform has to offer." -AdventureGamers.com
"I can't help but be completely and utterly impressed." -IndieGames.com
"This is a must-buy for anybody who loves sci-fi, mystery, or just adventure games in general." -148apps
"A good looking game with a challenging mystery waiting to be solved: you won't be able to put it away!" -Touch Tap Play
In the near future Greg's girlfriend Chloe mysteriously disappears in front of him. He starts a desperate search for her. What happened? Why does no-one else remember her?
Solve puzzles, explore fully 3d environments, interact with numerous characters and solve the mystery!
Lost Echo is a modern, story driven, visually ambitious, intuitive, sci-fi mystery adventure game.
* Detailed and realistic graphics, rarely found on mobile devices. And they work on devices as old as a 3GS!
* A soundtrack written specifically for the game. Drawing from multiple genres so it creates the proper atmosphere for each area.
* An engrossing mystery with a satisfying conclusion. Meet and interact numerous characters, find clues and slowly reveal the truth. But is the truth really enough?
* Point and click is one of those genres where touch devices just make sense. We made sure we took advantage of that.
* Two modes: normal and "old school", so you can play regardless of experience with the genre!
Find out more info and media on:
What's New in Version 1.7.18+Small dialogue changes.
+Slight adjustments to the dialogue sound (again!).
+Fixed chip minigame camera movement in old-school mode.
+Shortened camera fadeout time in card minigame.
+Fixed small issue with the splash screen.
+Added Unity logo to the credits!
I thought it was quite good although replay value was lacking. It would have been great if there were alternate endings and scenarios. The ending was kind of ambiguous though...


text:
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own. The social worker is available to you when you need him/her
to speak with in person or call in between visits at (323)


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Step back and have a great time in this cozy two bedroom Sawmill Creek condo. Located just one block from historic Main Street and 20 yards from the bottom of the Four O'clock run, you are surrounded by everything. This unit has a welcoming stone gas fireplace, as well as a washer and dryer, free Wi-Fi, and a fully equipped kitchen. Take a dip in the two indoor hot tubs, enjoy the shared grills and a covered parking space. Just outside the complex is the nearest bus to take you to your next skiing destination.
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Internet: Free WirelessLaundry: Private Washer/DryerLiving Room Bedding: Queen Sleeper SofaLiving Room TV: Flat Screen TVMaster Bedroom TV: Flat Screen - MasterParking: Covered ParkingRating: Gold - A Rated UnitsSki Hill - Park AveSkiing: Ski-in / Shuttle-outSleeps: 10Town Access: 1 BlockView from Deck: Parking Lot Viewnon smoking only: Yespets not allowed: Yes
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Workplace Safety and Health:
Safety in the Meat and Poultry Industry, While Improving, Could Be Further Strengthened
GAO-05-96: Published: Jan 12, 2005. Publicly Released: Jan 28, 2005.
Additional Materials:
- Highlights Page:
- Full Report:
- Accessible Text:
(202) 512-9889
Office of Public Affairs
(202) 512-4800
Because meatpacking is one of the most dangerous industries in the United States, we were asked to provide the Congress with information on the characteristics of workers in the meat and poultry industry and the conditions in which they work, the types of injuries and illnesses these workers incur, how injury and illness rates have changed over the past decade, and factors that may have affected these rates. We were also asked to determine what is known about the effectiveness of the Occupational Safety and Health Administration's (OSHA) efforts to improve safety and health in the meat and poultry industries.
The largest proportions of workers in the meat and poultry industry, according to the Bureau of Labor Statistics (BLS), are young, male, and/or Hispanic. Although the majority of workers are citizens, an estimated 26 percent of them are foreign-born noncitizens. They work in hazardous conditions involving loud noise, sharp tools, and dangerous machinery. Many workers must stand for long periods of time wielding knives and hooks to slaughter or process meat on a production line that moves very quickly. Workers responsible for cleaning the plant must use strong chemicals and hot pressurized water. While, according to BLS, injuries and illnesses have declined over the past decade, the meat and poultry industry still has one of the highest rates of injury and illness of any industry. The most common injuries are cuts, strains, cumulative trauma, and injuries sustained from falls, but more serious injuries, such as fractures and amputation, also occur. According to BLS, the injury and illness rate for the industry has declined from an estimated 29.5 injuries and illnesses per 100 full-time workers in 1992 to 14.7 in 2001. Injury and illness rates can be affected by many factors, such as the amount and quality of training, employee turnover rates, increased mechanization, and the speed of the production line. Some evidence suggests that OSHA's efforts have had a positive impact on the injury and illness rates of workers in meat and poultry plants. However, while the criteria OSHA uses to select plants for inspection--which focus on plants with relatively high injury and illness rates--are reasonable, OSHA could improve its selection process by also considering trends in plants' injury and illness rates over time. In addition, it is difficult to assess the effectiveness of OSHA's efforts because the agency does not assign a unique identifier to each plant, making it hard to compare the data it collects on specific plants' injury and illness rates with the information the agency collects on the results of its plant inspections and other programs.
Recommendations for Executive Action
Status: Closed - Implemented
Comments: In its official response to our recommendation, OSHA stated that it has added 400 employers with low rates in high-hazard industries to its fiscal year (FY) 2006 Site-Specific Targeting (SST) program. OSHA also stated that it will look to expand the SST in future years based on the results of the FY 2006 program. In addition, OSHA has solicited public comments on its SST program and is currently reviewing comments from industry associations, employers, and safety and health professionals. As it completes this review, it will consider GAO's suggestion to expand the criteria for SST inspections in this industry.
Recommendation: In order to strengthen the agency's efforts to improve safety and health of workers at meat and poultry plants, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health to consider adjusting OSHA's criteria for selecting worksites for site specific targeting inspections and for record-keeping audits to consider worksites that have had large reductions in their injury and illness rates over time.
Agency Affected: Department of Labor
Status: Closed - Not Implemented
Comments: According to officials at OSHA, the agency already has the ability to analyze trends in rates for specific establishments. Establishments that report high rates of injuries and illnesses (i.e., a Days Away, Restricted, or Transferred (DART) rate of 7.0 or greater) are included in the data collection in consecutive years. OSHA has stated that it can therefore trend rates for that establishment on an annual basis. Collection of multiple years of data during one collection would be redundant and contrary to the requirements of the Paperwork Reduction Act (PRA). According to OSHA, establishments that do not report high DART rates are included in the OSHA Data Initiative (ODI) collection on a rotating basis, generally every second or third year. While this precludes OSHA from having a complete data set, it does not limit the agency's ability to trend data over time. If the establishment continues to operate, OSHA will have multiple years of data for that establishment. Given its current ability to trend and analyze multiple years of establishment level data, OSHA does not see the need to modify its data collection procedures as recommended by GAO. With regard to the collection of data on injuries and illnesses to workers that work at meat packing facilities but are employed by other companies, OSHA believes this recommendation would be contrary to the record developed in the 2001 revision of the injury and illness recordkeeping requirements (29 CFR Part 1904). While the concept may be feasible, OSHA made the decision not to adopt it based on the record developed through the rulemaking process. The January 19, 2001 Federal Register (pp. 5921-5923) discusses the "site log" concept and outline the agency's reasons for not adopting that proposed provision. OSHA stands by the rulemaking. Its 2003-2008 Strategic Management Plan directs OSHA to allocate its resources to specific industries with high injury, illness, and fatality rates or special population needs. According to OSHA, the meat packing industry is not identified in the agency's current Plan and, therefore, is not targeted for enforcement, outreach, or cooperative program emphasis. The agency continues to maintain the ability to analyze trends at specific establishments and also asserts that collection of injury and illness data of contract employees not under the day-to-day supervision of meat and poultry plant employers is contrary to the record developed in its last recordkeeping rulemaking. Requiring data from contractors would necessitate rulemaking which is not prioritized on OSHA's regulatory agenda at this time. It should be noted, however, that the new Administration is reviewing and re-examining OSHA's regulatory agenda, and the possibility of reconsidering site logs has not been entirely eliminated.
Recommendation: In order to strengthen the agency's efforts to improve safety and health of workers at meat and poultry plants, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health to consider requiring worksites that are surveyed by OSHA to obtain worksite-specific data on injuries and illnesses to include (1) multiple years of data, so that trends in their rates may be analyzed and (2) data on injuries and illnesses to workers employed by cleaning and sanitation companies that provide workers to the plant under contract so that these data can be included in the rates OSHA uses to select plants for inspection.
Agency Affected: Department of Labor
Status: Closed - Implemented
Comments: OSHA is implementing a new comprehensive information system (i.e., the OSHA Information System (OIS)) that houses its multiple data program systems. OSHA last reported that the OIS would include identification and matching features. The capability these features will provide are referred to as "robust trending." According to OSHA, all business lines (e.g., VPP, enforcement, consultation, alliances, partnerships, whistleblower/11c program) will enter information into OIS in the same way. Its "business object software" will allow "establishment processing," that is, investigators anywhere in the country will be able to see all OSHA activity for an establishment, regardless of business line. OSHA completed a limited pilot of the OIS in November of 2008. OIS deployment remains on schedule for 9/30/10 absent funding challenges or agency reprioritization. The OIS includes uniform establishment processing.
Recommendation: In order to strengthen the agency's efforts to improve safety and health of workers at meat and poultry plants, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health to consider requiring that a common identifier for each plant be used in all of its enforcement and cooperative program databases so that these different data sets can be more easily compared in an effort to measure the agency's impact on worker safety and health.
Agency Affected: Department of Labor
Status: Closed - Not Implemented
Comments: According to OSHA officials, cooperative program participation is voluntary - typically resulting from private and public sector interest to partner with the agency. OSHA cannot require a specific group or industry to participate in cooperative programs; typically, organizations or companies approach OSHA to partner. Based on the link to the Strategic Management Plan, potential for impact on reducing fatalities, injuries or illnesses, and available resources, OSHA makes a decision whether to form a cooperative relationship with the interested party. In the past decade, OSHA has entered into cooperative relationships with the meat packing industry due to the employers' and employees' belief in the value of implementing effective safety and health management systems and promoting a safety and health culture. A total of 22 meatpacking industry sites have attained VPP status. In addition, OSHA has formed three partnerships in the meatpacking industry. The most recent partnership is the Nebraska Animal Slaughtering and Processing Industry (NASPI) partnership, which started in June 2006, and was noted in our report. OSHA has no plan to expand the partnership to other parts of the country.
Recommendation: In order to strengthen the agency's efforts to improve safety and health of workers at meat and poultry plants, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health to consider expanding successful partnerships, such as the Omaha Area Office's partnership with meatpacking plants in Nebraska to other area offices with high concentrations of meat and poultry plants.
Agency Affected: Department of Labor
Status: Closed - Implemented
Comments: Although USDA and DOL have not updated their MOU, USDA issued Food Safety and Inspection Service (FSIS) Directive 4791.12, Reporting and Correcting Occupational Hazards, which instructs FSIS inspection program personnel about how and when to refer concerns about hazards appropriately within FSIS and to OSHA. It includes a section instructing FSIS personnel on how to report safety and health hazards verbally or in writing within FSIS, and how to file safety or health hazard complaints with OSHA. In addition, the FSIS Center for Learning has developed a training course, "Identifying and Reporting Workplace Safety and Health Hazards," an e-learning project that all FSIS employees can access electronically. In addition, the center has updated its training modules covering OSHA safety and health requirements.
Recommendation: The Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health and the Secretary of Agriculture should direct the Acting Administrator of the Food Safety and Inspection Service to revisit and update their memorandum of understanding to ensure that USDA inspectors receive training in recognizing and referring workplace hazards and that the agreement remains current.
Agency Affected: Department of Agriculture
Status: Closed - Implemented
Comments: In FY 2006, OSHA stated that it planned to cooperate with the Department of Agriculture (USDA) to encourage the revitalization of the USDA-inspector training. OSHA also stated that it was in the process of updating and reviewing existing memorandums of understanding (MOUs) based on their relevance and obsolescence but did not indicate when these actions would be completed. In November 2007, OSHA stated that it provided an initial training session to members of the Food Safety and Inspection Service(FSIS) joint team, focusing on making them aware of OSHA's purpose, educating them about what constitutes serious workplace safety and fire safety hazards, and making referrals to OSHA. OSHA was also to provide training materials for the initial session and additional master copies so they could conduct subsequent field training. In addition, according to OSHA, both agencies coordinated standards development programs to minimize possible inconsistencies, exchange information and reports on general enforcement matters on common issues of concern, etc. The OSHA training institute also developed a train-the-trainer course for FSIS.
Recommendation: The Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health and the Secretary of Agriculture should direct the Acting Administrator of the Food Safety and Inspection Service to revisit and update their memorandum of understanding to ensure that USDA inspectors receive training in recognizing and referring workplace hazards and that the agreement remains current.
Agency Affected: Department of Labor
Status: Closed - Not Implemented
Comments: As of August 2007, the National Institute of Occupational Safety and Health (NIOSH) reported that it is exploring opportunities with the American Meat Institute to develop a collaborative research effort focused on reducing injuries in the meat industry, which could include a review of the speed of the production line. It is NIOSH's position, however, that the issue of line speed is not an independent factor directly contributing to injuries but is confounded by a multitude of other factors and cannot be examined in isolation in research focusing on prevention of injury outcomes. NIOSH noted that successful injury prevention research in the meat industry would require cooperative worksite access and industry participation, which is difficult to obtain.
Recommendation: In addition, the Secretary of Health and Human Services should direct the Director of the Centers for Disease Control and Prevention to have the National Institute of Occupational Safety and Health conduct a study of the effect of the speed of the production line on workers in the meat and poultry industry, a study that would also include other job-specific features that interact with line speed to increase the risk of injuries and illnesses to these workers.
Agency Affected: Department of Health and Human Services
Explore the full database of GAO's Open Recommendations »
Feb 11, 2016
Veterans' Health Care:Preliminary Observations on VHA's Claims Processing Delays and Efforts to Improve the Timeliness of Payments to Community ProvidersGAO-16-380T: Published: Feb 11, 2016. Publicly Released: Feb 11, 2016.
Feb 10, 2016
Medicaid:Changes to Funding Formula Could Improve Allocation of Funds to StatesGAO-16-377T: Published: Feb 10, 2016. Publicly Released: Feb 10, 2016.
Jan 19, 2016
Medicare and Medicaid:Additional Oversight Needed of CMS's Demonstration to Coordinate the Care of Dual-Eligible BeneficiariesGAO-16-31: Published: Dec 18, 2015. Publicly Released: Jan 19, 2016.
Medicaid Managed Care:Trends in Federal Spending and State Oversight of Costs and EnrollmentGAO-16-77: Published: Dec 17, 2015. Publicly Released: Jan 19, 2016.
Jan 14, 2016
Drug Safety:FDA Expedites Many Applications, But Data for Postapproval Oversight Need ImprovementGAO-16-192: Published: Dec 15, 2015. Publicly Released: Jan 14, 2016.
Jan 5, 2016
DOD and VA Health Care:Actions Needed to Help Ensure Appropriate Medication Continuation and Prescribing PracticesGAO-16-158: Published: Jan 5, 2016. Publicly Released: Jan 5, 2016.
Dec 18, 2015
Defense Health Care:Research on Hyperbaric Oxygen Therapy to Treat Traumatic Brain Injury and Post-Traumatic Stress DisorderGAO-16-154: Published: Dec 18, 2015. Publicly Released: Dec 18, 2015.
Medicare:Increasing Hospital-Physician Consolidation Highlights Need for Payment ReformGAO-16-189: Published: Dec 18, 2015. Publicly Released: Dec 18, 2015.
Dec 7, 2015
Medicaid Financing:Questionnaire Data on States' Methods for Financing Medicaid Payments from 2008 through 2012 (GAO-15-227SP, March 2015), an E-supplement to GAO-14-627 [Reissued on December 7, 2015]GAO-15-227SP: Published: Mar 13, 2015. Publicly Released: Mar 13, 2015.
Dec 2, 2015
Centers of Excellence:DOD and VA Need Better Documentation of Oversight ProceduresGAO-16-54: Published: Dec 2, 2015. Publicly Released: Dec 2, 2015.
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text:
I'm concerned about my niece. Her mother committed suicide and she is blaming herself. How can I help her to deal with her mother's death?
- Lita
Talking with your niece and encouraging her to share her feelings can be a big help. Let her know that it's not her fault, and that many children of parents who commit suicide feel the way she does.
While it's natural to feel guilty and to wonder if there's anything that could have been said or done to prevent it, her mother's suicide wasn't the result of anything your niece did. It's also natural to feel some anger at what happened — and even some embarrassment.
Dealing with a parent's death is difficult for anyone. Your niece needs your understanding and support. If possible, she should talk with a mental health professional, such as a psychologist who is experienced at working with young people.
Group therapy can be helpful since your niece will meet others in a similar situation to hers, which can make her feel less isolated. It's also sometimes easier to listen to advice from other people who have been through the same experience.
Your niece's doctor can help her find someone appropriate to talk to.
Reviewed by: D'Arcy Lyness, PhD
Date reviewed: August 2015
|American Foundation for Suicide Prevention This group is dedicated to advancing the knowledge of suicide and the ability to prevent it.
|American Academy of Child & Adolescent Psychiatry (AACAP) AACAP offers up-to-date information on child and adolescent development and issues.
|Friends for Survival Friends for Survival is a national outreach program for survivors of suicide loss.
|American Association for Marriage and Family Therapists This organization provides listings of marriage and family therapists nationwide.
|Kids Talk About: Death (Video) It's a deep sadness when someone you love dies. Hear what real kids had to say.
|Helping Your Child Deal With Death It can be difficult to know how to help kids cope with a death, particularly as you work through your own grief. Here are a few important things to consider.
|Kids Talk About Death Kids talk about what it feels like to lose a loved one, and how they handle their grief and help others.
|Somebody in My Friend's Family Died. What Should I Do? Someone important to your friend has died. What do you do?
|5 Ways to Cope When a Loved One Dies We all face grief at some point. Here are 5 ideas that might help you cope when someone you love has died.
|Death and Grief If someone close to you has died, you probably feel overwhelmed with grief. Read about some things that might help you cope.
|Getting Help for Intense Grief Going through grief and loss is never easy. But in some situations, grief can feel especially intense – even overwhelming. Find out what to do in this article for teens.
|Going to a Therapist Getting help with emotions or stress is the same as getting help with a medical problem like asthma or diabetes. This article explains how therapy works and how it can help with problems.
|Posttraumatic Stress Disorder (PTSD) Kids and teens who live through a traumatic event can develop posttraumatic stress disorder (PTSD). Healing is possible with the help of professional counseling and support from loved ones.
|How Can I Cope With My Dad's Death? Find out what the experts have to say.
|How Can I Help My Child Cope With a Friend's Death? Find out what the experts have to say.
|How Can I Help My Daughter Cope With the Death of Her Father? Find out what the experts have to say.
|When Somebody Dies It's difficult, even for grownups, to understand why death must happen. It may be the hardest thing of all to understand. We'll try to help you understand a little bit more in this article for kids.
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Future of Higher Education
California Lieutenant Governor Gavin Newsom and Sebastian Thrun, the founder and CEO of Udacity, a for-profit educational organization… read more
California Lieutenant Governor Gavin Newsom and Sebastian Thrun, the founder and CEO of Udacity, a for-profit educational organization offering massive open online courses (MOOCs), talked about the future of higher education.
This event was part of the annual Tech Crunch Disrupt Conference. close
People in this video
- Gavin Newsom Lieutenant Governor California
- Sebastian Thrun Founder and Chief Executive Officer Udacity
- Alexia Tsotsis Co-Editor TechCrunch
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text:
1 Kings 8:46-51New International Version (NIV)
46 "When they sin against you—for there is no one who does not sin—and you become angry with them and give them over to their enemies, who take them captive to their own lands, far away or near; 47 and if they have a change of heart in the land where they are held captive, and repent and plead with you in the land of their captors and say, 'We have sinned, we have done wrong, we have acted wickedly'; 48 and if they turn back to you with all their heart and soul in the land of their enemies who took them captive, and pray to you toward the land you gave their ancestors, toward the city you have chosen and the temple I have built for your Name; 49 then from heaven, your dwelling place, hear their prayer and their plea, and uphold their cause. 50 And forgive your people, who have sinned against you; forgive all the offenses they have committed against you, and cause their captors to show them mercy; 51 for they are your people and your inheritance, whom you brought out of Egypt, out of that iron-smelting furnace.
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New International Version (NIV)
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The World's Largest Coalition of Nontheists and Nontheist Communities!
cool story. the other instances mentioned are also proof that the bible is NOT the morality instructor!
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Tags: animals, animals nursing other species, bible is not morality book, dog, fawn, More…kittens, nature, shelter
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Gov. Chris Christie kicked off Labor Day weekend at the beach.
The governor traveled Friday morning to Seaside Heights for a stroll along the boardwalk and then headed to Point Pleasant Beach on Jenkinson's Boardwalk.
Christie was pleased with what he saw. "Gosh, things have gotten so much better this summer," he said. "You can see the beaches look great. I don't think I've seen this...
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