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Risk Factor: BM
Class: Anti-infectives/ Antivirals
Contents of this page:
Fetal Risk Summary
Breast Feeding Summary
Fetal Risk Summary
Saquinavir, a synthetic peptide-like substrate analogue, inhibits the activity of human immunodeficiency virus (HIV) protease, thus preventing the cleavage of viral polyproteins and the maturation of infectious virus. The mechanism of action is similar to four other protease inhibitors: amprenavir, indinavir, nelfinavir, and ritonavir.
In reproduction studies in rats and rabbits, embryotoxicity and teratogenicity were not observed at plasma concentrations up to approximately 50% and 40%, respectively, of the human exposure based on area under the plasma concentration versus time curves (AUC) achieved from the recommended clinical dose (1). There was also no evidence that at this dose the drug affected fertility or reproductive performance in rats. A similar lack of toxicity, as measured by survival, growth, and development of offspring to weaning, was found in rats treated during late pregnancy through lactation with doses producing the same plasma concentrations as those above (1).
It is not known if saquinavir crosses the human placenta. The molecular weight of the free base is low enough (about 671) that some degree of transfer should be anticipated. In rats and rabbits, placental transfer of saquinavir is low (less than 5% of maternal plasma concentrations) (1).
The Antiretroviral Pregnancy Registry reported, for the period January 1989 through July 2000, prospective data (reported to the Registry before the outcomes were known) involving 526 live births that had been exposed during the 1st trimester to one or more antiretroviral agents (2). Nine of the newborns had congenital defects (1.7%, 95% confidence interval [CI] 0.83.3). There were 25 infants with birth defects among 1,256 live births with exposure anytime during pregnancy (2.0%, 95% CI 1.33.0). The prevalence rates for the two periods did not differ significantly nor did they differ from the rates expected in a nonexposed population (2).
There were 61 outcomes exposed to saquinavir (49 in the 1st trimester and 12 in the 2nd and/or 3rd trimesters) in combination with other antiretroviral agents (2). There was one birth defect in an infant exposed in the 2nd and/or 3rd trimesters, but the specific defect and treatment were not identified. In comparing the outcomes of prospectively registered cases to the birth defects among retrospective cases (pregnancies reported after the outcomes were known), the Registry concluded that there was no pattern of anomalies to suggest a common cause (2). (See Lamivudine for required statement.) A study published in 1999 evaluated the safety, efficacy, and perinatal transmission rates of HIV in 30 pregnant women receiving various combinations of antiretroviral agents (3). Many of the women were substance abusers. Protease inhibitors (nelfinavir N=7, indinavir N=6, and saquinavir N=1 in combination with nelfinavir) were used in 13 of the women. Antiretroviral therapy was initiated at a median of 14 weeks' gestation (range preconception to 32 weeks). In spite of previous histories of extensive antiretroviral experience and of vertical transmission of HIV, combination therapy was effective in treating maternal disease and in preventing transmission to the current newborns. The outcomes of the pregnancies treated with protease inhibitors appeared to be similar to the 17 cases that did not receive these agents, except that the birth weights were lower (3).
The experience of one perinatal center with the treatment of HIV-infected pregnant women was summarized in a 1999 abstract (4). Of 55 women receiving 3 antiviral drugs, 39 were treated with a protease inhibitor (11 with saquinavir). The outcomes included 2 spontaneous abortions, 5 elective abortions, 27 newborns, and 5 ongoing pregnancies. One woman was taken off of indinavir because of ureteral obstruction and another (drug therapy not specified) developed gestational diabetes. None of the newborns tested positive for HIV, had major congenital anomalies, or complications (4).
A public health advisory has been issued by the Food and Drug Administration (FDA) on the association between protease inhibitors and diabetes mellitus (5). Because pregnancy is a risk factor for hyperglycemia, there was concern that these antiviral agents would exacerbate this risk. An abstract published in 2000 described the results of a study involving 34 pregnant women treated with protease inhibitors (7 with saquinavir) compared to 41 controls that evaluated the association with diabetes (6). No relationship between protease inhibitors and an increased incidence of gestational diabetes was found.
A case of combined transient mitochondrial and peroxisomal b-oxidation dysfunction after exposure to nucleoside analog reverse transcriptase inhibitors (NRTIs) (lamivudine and zidovudine) combined with protease inhibitors (ritonavir and saquinavir) throughout gestation was reported in 2000 (7). A male infant was delivered at 38 weeks' gestation. He received postnatal prophylaxis with lamivudine and zidovudine for 4 weeks until the agents were discontinued because of anemia. Other adverse effects that were observed in the infant (age at onset) were hypocalcemia (shortly after birth), group B streptococcal sepsis, ventricular extrasystoles, prolonged metabolic acidosis and lactic acidemia (8 weeks), a mild elevation of long chain fatty acids (9 weeks), and neutropenia (3 months). The metabolic acidosis required treatment until 7 months of age, whereas the elevated plasma lactate resolved over 4 weeks. Cerebrospinal fluid lactate was not determined nor was a muscle biopsy conducted. Both the neutropenia and the cardiac dysfunction had resolved by 1 year of age. The elevated plasma fatty acid level was confirmed in cultured fibroblasts, but other peroxisomal functions (plasmalogen biosynthesis and catalase staining) were normal. Although mitochondrial dysfunction has been linked to NRTI agents, the authors were unable to identify the cause of the combined abnormalities in this case (7). The child was reported to be healthy and developing normally at 26 months of age.
A multicenter, retrospective survey of pregnancies exposed to protease inhibitors was published in 2000 (8). There were 92 live-born infants delivered from 89 women (3 sets of twins) at six health care centers. One nonviable infant, born at 22 weeks' gestation, died. The surviving 91 infants were evaluated in terms of adverse effects, prematurity rate, and frequency of HIV-1 transmission. Most of the infants were exposed in utero to a single protease inhibitor, but a few were exposed to more than one because of sequential or double combined therapy. The number of newborns exposed to each protease inhibitor was indinavir (N=23), nelfinavir (N=39), ritonavir (N=5), and saquinavir (N=34). Protease inhibitors were started before conception in 18, and during the 1st, 2nd, or 3rd trimesters in 12, 44, and 14, respectively, and not reported in one. Other antiretrovirals used with the protease inhibitors included four NRTIs (didanosine, lamivudine, stavudine, and zidovudine). The most common NRTI regimen was a combination of zidovudine and lamivudine (65% of women). In addition, seven women were enrolled in the AIDS Clinical Trials Group Protocol 316 and, at the start of labor, received either a single dose of the nonnucleoside reverse transcriptase inhibitor nevirapine or placebo. Maternal conditions, thought possibly or likely to be related to therapy, were mild anemia in eight, severe anemia in one (probably secondary to zidovudine), and thrombocytopenia in one. Gestational diabetes mellitus was observed in three women (3.3%), a rate similar to the expected prevalence of 2.6% in a nonexposed population (8). One mother developed postpartum cardiomyopathy and died 2 months after birth of twins, but the cause of death was not known. For the surviving newborns, there was no increase in adverse effects over that observed in previous clinical trials of HIV-positive women, including the prevalence of anemia (12%), hyperbilirubinemia (6%; none exposed to indinavir), and low birth weight (20.6%). Premature delivery occurred in 19.1% of the pregnancies (close to the expected rate). The percentage of infants infected with HIV was 0 (95% CI 0%3%) (8).
In summary, although the limited human data do not allow an assessment of the safety of saquinavir during pregnancy, the animal data suggests that the risk may be low for the developing fetus. Two reviews, one in 1996 and the other in 1997, concluded that all women currently receiving antiretroviral therapy should continue to receive therapy during pregnancy and that treatment of the mother with monotherapy was inadequate therapy (9,10). In 1998, the Centers for Disease Control and Prevention (CDC) made a similar recommendation that antiretroviral therapy should be continued during pregnancy, but discontinuation of all therapy during the 1st trimester was a consideration (5). If indicated, therefore, protease inhibitors, including saquinavir, should not be withheld in pregnancy (with the possible exception of the 1st trimester) because the expected benefit to the HIV-positive mother probably outweighs the unknown risk to the fetus. Pregnant women taking protease inhibitors should be monitored for hyperglycemia. Possibly because of the poor bioavailability of saquinavir, one review suggested that during pregnancy ritonavir (see Ritonavir) was the drug of choice among the protease inhibitors (10). The efficacy and safety of combined therapy in preventing vertical transmission of HIV to the newborn, however, are unknown and zidovudine remains the only antiretroviral agent recommended for this purpose (9,10).
Breast Feeding Summary
No reports describing the use of saquinavir during lactation have been located. The molecular weight of the free base (about 671) is low enough that excretion into breast milk should be expected.
Reports on the use of saquinavir during lactation are unlikely because the drug is indicated in the treatment of patients with HIV. HIV type 1 (HIV-1) is transmitted in milk, and in developed countries, breast feeding is not recommended (9,10,11,12 and 13). In developing countries, breast feeding is undertaken, despite the risk, because there are no affordable milk substitutes available. Until 1999, no studies had been published that examined the effect of any antiviral therapy on HIV-1 transmission in milk. In that year, a study involving zidovudine was published that measured a 38% reduction in vertical transmission of HIV-1 infection in spite of breast feeding when compared to controls (see Zidovudine).
- Product information. Invirase. Roche Laboratories, 2000.
- The Antiretroviral Pregnancy Registry for abacavir (Ziagen), amprenavir (Agenerase, APV), delavirdine mesylate (Rescriptor), didanosine (Videx, ddl), efavirenz (Sustiva, Stocrin), indinavir (Crixivan, IDV), lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), saquinavir (Fortovase, SQV-SGC), saquinavir mesylate (Invirase, SQV-HGC), stavudine (Zerit, d4T), zalcitabine (Hivid, ddC), zidovudine (Retrovir, ZDV). Interim Report. 1 January 1989 through 31 July 2000. 2000(December);11(No. 2):155.
- McGowan JP, Crane M, Wiznia AA, Blum S. Combination antiretroviral therapy in human immunodeficiency virus-infected pregnant women. Obstet Gynecol 1999;94:6416.
- Stek A, Kramer F, Fassett M, Khoury M. The safety and efficacy of protease inhibitor therapy for HIV infection during pregnancy (abstract). Am J Obstet Gynecol 1999;180:S7.
- Centers for Disease Control and Prevention. Public Health Service Task Force recommendations for the use of antiretroviral drugs in pregnant women infected with HIV-1 for maternal health and for reducing perinatal HIV-1 transmission in the United States. MMWR 1998;47:No. RR2.
- Fassett M, Kramer F, Stek A. Treatment with protease inhibitors in pregnancy is not associated with an increased incidence of gestational diabetes (abstract). Am J Obstet Gynecol 2000;182:S97.
- Stojanov S, Wintergerst U, Belohradsky BH, Rolinski B. Mitochondrial and peroxisomal dysfunction following perinatal exposure to antiretroviral drugs. AIDS 2000;14:1669.
- Morris AB, Cu-Uvin S, Harwell JI, Garb J, Zorrilla C, Vajaranant M, Dobles AR, Jones TB, Carlan S, Allen DY. Multicenter review of protease inhibitors in 89 pregnancies. J Acquir Immune Defic Syndr 2000;25:30611.
- Carpenter CCJ, Fischi MA, Hammer SM, Hirsch MS, Jacobsen DM, Katzenstein DA, Montaner JSG, Richman DD, Saag MS, Schooley RT, Thompson MA, Vella S, Yeni PG, Volberding PA. Antiretroviral therapy for HIV infection in 1996. JAMA 1996;276:14654.
- Minkoff H, Augenbraun M. Antiretroviral therapy for pregnant women. Am J Obstet Gynecol 1997;176:47889.
- Brown ZA, Watts DH. Antiviral therapy in pregnancy. Clin Obstet Gynecol 1990;33:27689.
- de Martino M, Tovo P-A, Pezzotti P, Galli L, Massironi E, Ruga E, Floreea F, Plebani A, Gabiano C, Zuccotti GV. HIV-1 transmission through breast-milk: appraisal of risk according to duration of feeding. AIDS 1992;6:9917.
- Van de Perre P. Postnatal transmission of human immunodeficiency virus type 1: the breast feeding dilemma. Am J Obstet Gynecol 1995;173:4837.


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text: Halid Halid is 18 years old male from Moroni, Comoros. He is interested in meet new people. 18, male, Moroni Likes: 0x Facebook profile Who s/he liked? Send message Favorite May she/he ask you for a date? Never Maybe Sure Relationship: ShowSexuality: ShowHeight: ShowWeight: ShowBody type: ShowEye color: ShowHair color: ShowLiving: ShowKids: ShowSmoking: ShowDrinking: Show Report photo Sign up to see all photos Facebook Twitter Google+ Pinterest Similar users James 19, Texas City online 25 Cocktails Tyler 19, Miami 17 Darmony 21, Joliet 34 Patrick 20, Mount Vernon 136 Austin 21, Clarksburg 58 MetallicaSlipknotBlack Veil Brides+2 Scott 21, Glide 73 Juan 20, Los Angeles 43 John 21, Ogdensburg 35 Quis 21, Penn Run 36


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Congressional race reaches fire and brimstone temperatures
October 18th, 2012 under Top Stories
By ALBERTO TOMAS HALPERN
FAR WEST TEXAS, SAN ANTONIO – The hotly contested race for Texas' congressional district 23 between Republican Congressman Francisco "Quico" Canseco and his Democratic rival, State Representative Pete Gallego, has reached a boiling point.
Last week, Canseco's campaign released bilingual mailers to voters titled, "A man is known by the company he keeps." In the political flyer, Gallego is pictured along with President Barack Obama, United States House Minority Leader Nancy Pelosi, and Senate Majority Leader Harry Reid, all Democrats.
The paid political ad accuses Gallego and company of three things: wanting "Marriage to be between man and man," next to a photo of two men embracing and kissing; accusing Gallego of wanting "to provide abortions for underage girls;" and saying "No to God," three times, next to an image of Jesus Christ.
It is the use of Christ's image that has caused a firestorm among journalists, analysts and the candidates themselves.
"I think it's offensive," Gallego said this week. He said he couldn't believe "that someone would use Jesus for political profiteering." Gallego held a press conference in San Antonio this week to denounce the ad.
"I have never seen a picture of Jesus used in such a disrespectful and demeaning manner," he said to reporters at the news conference. "I doubt very much that Jesus would have been pleased."
Canseco and Gallego are both Catholic.
According to The Texas Tribune, Canseco stood by his political advertising, speaking before Gallego's press conference. "Pete Gallego can have all the press conferences that he wants. We need to talk about who we are and what we stand for and not hide behind all these antics."
Story filed under: Top Stories


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EAST RUTHERFORD, N.J. -- Former San Francisco 49ers receiving great Jerry Rice, now an ESPN analyst, describes massive New York Giants running back Brandon Jacobs as "a little soft." Jacobs isn't coming back hard at Rice.
"I grew up a San Francisco 49er fan. I've loved Jerry Rice. I still love Jerry Rice. I give him a lot of credit for the game being the way it is today. I have nothing negative to say about Jerry. If he feels that way, he feels that way," Jacobs said Thursday as the Giants prepped for their NFC title game against the 49ers.
Then, he added, "I'll bet you he won't tackle me."
Rice, a member of the Pro Football Hall of Fame, was asked on ESPN's SportsCenter whom he favors Sunday if rain in San Francisco puts emphasis on the running game.
"That goes to San Francisco," said Rice said. "I like Ahmad Bradshaw (another Giants running back), I like Brandon Jacobs but I feel like Brandon Jacobs is a little bit soft.
"He can't get away from a defender. This guy is 265, and it upsets me when I see him get tackled by a guy that's like 190 or 200 pounds."
Giants offensive coordinator Kevin Gilbride defended Jacobs, listed at 6-4, 264. The seven-year vet from Southern Illinois had a 14-yard touchdown run last weekend against the Green Bay Packers.
"Just because you see this big, hulking man and if he's not running over somebody every snap, then people are almost disappointed," said Gilbride.
"Well, it's unfortunate the people he's going against are big, powerful men as well. I think once gets going … I'm not sure there's many people that like to get in his way. It takes him, as it does any back, an opportunity to get his feet underneath him and get through the hole. But once he gets through the hole, he's really, and I man this is a positive way, a freak of nature.
Gilbride said he's seen smaller defenders "shying away" from Jacobs once he gets past the line.
"Until you get by the line of scrimmage, those guys are 300-plus pounds. They're bigger than he is … plus he hasn't had a chance to build up much momentum. But once he gets going, he's a powerful guy," said Gilbride.
During Rice's ESPN segment, he added with a smile, "Just a little big soft, I'm sorry. I'm sure he's going to be looking for me."
Nate Davis is a reporter, blogger and editor who's been at USA TODAY since 2000. He has covered the NFL since 2005. No, he did not play quarterback for Ball State. Davis' succession of our esteemed colleague Sean Leahy at The Huddle is considered a Brady-for-Bledsoe swap by most "insiders."More about Nate


text: I'm sure this has probably already been mentioned, but I'll say it anyway cause it's started to annoy me. "Your watched threads" link is located under the "Forums" tab, yet when you're on that page it shows the navigation for "Your Account", where it's not shown. Could you make up your mind please


text:
I Want to Marry A Prince — Do You Have A Problem With That?
When I was a teenager, I didn't dream of marrying a Hollywood star. I dreamed of marrying a prince. Like a real one. From Europe. Preferably from England.
And can you blame me? The boys that filled my junior high school consisted of three types: arrogant jocks, tiresome Bible-thumpers, and rambunctious cowboys. And when forced to choose, my answer was always "none of the above." Read more on Pop Sugar…


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Talking about revealing names of gun owners, Ann Coulter said we ought to publish lists of women who have had abortions so that their neighbors can know which women they live near who'd be willing to "murder a child."
She argued that public records of gun permit holders should not be available because "people with gun permits by definition do not have criminal records."
Last month, Coulter called for more concealed carry permits at the time of the mass shooting at Sandy Hook Elementary School.
A blogger Christopher Fountain also hit back against the gun owners' map by publishing addresses of the Journal News staff.


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text:
Today, let's talk about Kei Nishikori. The video above is transcribed almost word for word below. Listen/read/learn/enjoy!
For now, have a look at the Kei Nishikori word list, and explanation YouTube. The article the words are from is at the top of the Word List, or here. If you watch the explanation YouTube on a computer, you can see subtitles of the example sentences I use.
Transcription from here:
Good morning. Welcome to my blog post for today. Today I'm going to talk about Kei
Nishikori. On the blog you can find links to the Word List, the article, the transcription. This
month it's all for love; but please do understand, with Vocab Voyage this morning so far I've been at it for two hours, so from next month on there's just going to be a little way to make it a little worth my while, and maybe buy a nicer camera, and nicer speaker (I meant
microphone). OK. Let's talk about Kei Nishikori.
2012 he reached the quarters in a tournament against Andy Murray. NHK was so excited
they bought all the rights. So that was when he started.
He was in the Australian Open. He lost in the quarters, but this reporter in this article is
saying, 'Don't worry about it!' He's only just starting. The first thing he talks about is maybe
Kei Nishikori had a bit of bad luck. He was on the tough side of the draw. He had to get
through some tough players. If he was on the other side of the draw he could have very
easily been in his first final.Because he was in a final against Djokovich, so people are saying it's only a matter of time. The professional tennis reporters talk about him being 'lightening
fast', 'quickest player on the tour'. Andre Agassi, the tennis great, he said, 'Kei is one of the only players I'd pay to see. He's one of the great shotmakers in the game.' So Andre Agassi talks him up for sure. This article, then it carries on to talk about the Samurai Blue, if you
want to read about some soccer.
Next story, very embarrassing for an ESPN reporter. He got some information from a satire website. A satire website is a joke website. These people make these websites with funny
information. Theonion.com is one. Have a look. This reporter got these facts from a satire
website, and read them off as true. Fact 1: Kei Nishikori is the richest man in tennis, the
highest paid. That's not true. Fact 2: Kei Nishikori owns a burger chain called 'The Fat
Nishikori Burger', which is Japan wide. We all know that's not true. Fact 3: Kei Nishikori owns his own soccer team. No. And Fact/s No 4: He owns his own vodka brand, his own perfume line, and his own clothing brand; which we all know is not true. So reporters need to check
their sources first and/but admittedly he got given the information from his P.A, and as he
was reading it he sounded a bit dubious about the whole thing.
Last thing today, two very cool ads. The first ad, to do with this subject, is Kei Nishikori
playing tennis with a samurai sword; and the article's got a link to another ad that was when
the World Cup was on of a samurai doing really clever soccer tricks, which was actually a
real person. It's called freestyle soccer, doing flash tricks. That was an ad for Nissin Noodles,and have a look; it's quite funny.
OK, thank you very much. Have a good day.


text: Linda Cheng is a word nerd with a particular fondness for anagrams, acronyms and alliteration. She is former editorial assistant of Habitus Magazine (issues 9-15). By day Linda is a freelance writer of architecture and design. By night, she can be found at the stove, attempting to cook her way around the world with at least one dish from every country. Linda is looking forward to being old and having the free time to bake cupcakes, grow tomatoes, crochet and write angry letters to the editor on the sorry state of contemporary politics.


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Customer satisfaction surveys & online reviews: additional sources of information
Online review sites, social networks, satisfaction barometers, complaints... more and more channels are available for your customers to express their discontent or dissatisfaction following an experience.
Taken individually, these means of communication seem to differ both in terms of their tone and in terms of topics discussed.
Below we offer a more detailed insight into the differences between the results of a customer satisfaction survey and the ratings on an online review site.
One of our clients specialising in the tourism industry offers its customers the opportunity to both answer a satisfaction barometer and leave an online review. The results of the satisfaction barometer are used by the company, whereas the online review is used as feedback intended for other internet users. Through this mechanism, the customer is only solicited once, but the information gained can be used by different parties. Thus, our client gives its customers the opportunity to address other internet users (who are also potential clients) without him or her initially intending to do so.
Technically speaking, the company first sends its customers an e-mail inviting them to take part in the satisfaction survey. Once they have completed this step, a TripAdvisor form appears. The user can then choose whether to leave a review or not. There are two advantages to this mechanism. First it reduces the solicitation of customers; and second, it improves the establishment's visibility on the internet.
Thus, this study compares the comments and ratings from the two communication channels (the customer satisfaction barometer and TripAdvisor). The information gathered from this study teaches us three things which are just as important in qualitative terms as they are in quantitative terms.
Information gathered
• Tone
The opinions communicated through the satisfaction barometer are more critical than the reviews on TripAdvisor - the satisfaction barometer responses contain 10% fewer positive concepts than the online reviews. Customer reviews intended for the company use a harsh tone, the goal being to highlight areas where improvements can be made, whereas reviews intended for the public tend to be more advisory; the tone is slightly different.
• Topics
For holidays, the message to the company mainly focuses on the accommodation, its cleanliness, comfort and amenities.
However, when it comes to feedback intended for the public, the main focus is on the environment (the setting, access, the complex...).
In this way, the focus of the customer's message varies depending on who it is intended for: technical issues will be mentioned as feedback which the company can react to directly, whereas aspects relating to opinion and experience will be used as advice intended for internet users.
• Ratings
Filling out a TripAdvisor form improves establishments' visibility on the internet. However, that's not the only advantage. As noted in the article « What's the future for customer satisfaction surveys ? », for a customer, leaving a review on a specialised website requires a certain amount of motivation. Making it easy for the customer to leave a review improves the diversity of the ratings and avoids the establishment having a lot of extreme ratings (which tend to be more spontaneous, and thus are over-represented on the internet).
Nevertheless, the proportion of ratings on TripAdvisor reveals that those customers who do leave a review represent extreme cases (very happy or very dissatisfied customers). For the criteria studied, "mid-table" responses are under-represented.
Ratings of criterion 1 according to channel
For each criterion, we have compared the following: 1) Respondents to the TripAdvisor form; 2) Respondents to the satisfaction barometer and the TripAdvisor form; 3) Respondents to the satisfaction barometer alone.
This chart effectively shows the equivalency between the satisfactory and dissatisfactory ratings from one group of people to another, and also reveals that the reviews on online review sites are more extreme (offering an over-representation of TERRIBLE/POOR and EXCELLENT ratings).
In conclusion
The respondent's message varies according to who it is intended for. Messages communicated through a customer satisfaction survey generally concern improvements a company can make, whereas reviews on specialised sites are more often intended as advice for internet users.
It needs to be pointed out, however, that the questions differ depending on the communication channel used. The satisfaction survey asks for "suggestions" or "comments", whereas TripAdvisor asks for the customer's "opinion". This detail must be taken into account when analysing the results in the same way as ratings (see below the section on understanding rating).
Methodological information
• Scope
The verbatim analysis was performed on a group of 546 respondents whose stay occurred in February, 2014.
Analysis of ratings takes into account visits between January and September, 2014.
• Understanding verbatim
Systematic analysis enables customer comments to be classed according to: 1) tone; 2) predefined concepts. We applied the same algorithm to the TripAdvisor reviews as that used for the satisfaction barometer.
• Understanding ratings
The criteria evaluated and the scale of ratings differ from one communication channel to the other. Customer satisfaction is rated on a scale of 1 to 10 in the satisfaction barometer, whereas it is rated on a scale of 1 to 5 on TripAdvisor. The following table indicates that there are still similarities between the two channels.
Similarities of ratings between the satisfaction barometer and TripAdvisor
The percentages are to be read horizontally: 57% of respondents who answered 1 in the satisfaction barometer also answered 1 on TripAdvisor. The ratings of the satisfaction barometer have been recalculated in the blue cells.
Noëllie PILANDON
R&D manager
Do you need more information ? Contact the author : email@example.com
Understanding customer satisfaction


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Apple to use drones, indoor navigation data to improve Maps in 2017
Apple is preparing to use drones, indoor mapping, and better car navigation to improve its Maps apps for iOS and macOS, a report said on Thursday.
Apple is preparing to use drones, indoor mapping, and better car navigation to improve its Maps apps for iOS and macOS, a report said on Thursday.
As rumored, Apple on Thursday debuted Apple Pay in Spain with support for Mastercard and American Express credit cards issued through Santander bank, Carrefour Pass and Ticket Restaurant.
Apple on Wednesday released a statement regarding a recent spate of spam iCloud Calendar invitations, saying it is working to address the issue by identifying and blocking suspicious invite senders.
Netflix has deployed the ability to download select TV shows and movies from its catalog, with most of the initial offerings coming from the company's unique programming.
The latest --�and more affordable -- high-profile entrant into the emerging virtual reality space, PlayStation VR, is off to a successful start, suggesting consumers are more interested in advanced VR technology if it's available in a simple and economical product.
Supplementing its efforts in Indonesia, Apple appears to be on the cusp of setting up a research and development center in Jakarta, with plans and locations said to be finalized before the end of 2017.
In an interview on Tuesday, President-elect Donald Trump noted that Apple CEO Tim Cook had called him, but no mention was made about the topics of the conversation the pair may have had, following Trump's contentious remarks on the campaign trail.
The deal-grabbing frenzy known as Black Friday is just a few days away, and shoppers looking to nab the best deals on Apple products and accessories can get ahead of the game with a number of apps that help organize ads and track the best deals.
In a weekend profile of Apple's campus in Austin, Tex., the company claimed that it has created over 2 million jobs in the U.S. since the iPhone first went on sale in 2007.
Following availability on iOS and the PlayStation 4 game console, Sony on Thursday expanded its PlayStation Vue cable cutting service to the Apple TV.
Adding to rumors of Apple's augmented reality ambitions, a report on Wednesday claims the company is working to bring unspecified AR features to its first-party camera app on iPhone.
Apple is reportedly planning an App Store fee schedule revision that will see its slice of revenue from subscription video services, and potentially other non-video providers, drop from the customary 30 percent to only 15 percent.
The Touch Bar input strip on new MacBook Pro models is itself a Retina Display, but it doesn't show up as a display in System Report. That's prompted Apple to create specialized support in its Grab app to enable capture of screenshots of its current status.
Apple began its promised purge of the iOS App Store in October, pulling some 47,300 titles, according to third-party research data published on Tuesday.
Apple's new Late 2016 15-inch MacBook Pro is the lightest and thinnest MacBook Pro ever, but unlike the company's earlier ultralight MacBook Air, it packs a fast, quad-core Intel CPU and a dedicated AMD Radeon Pro GPU along with 16GB of high speed RAM and other "pro" level niceties. After spending some time with the new flagship, AppleInsider came away impressed at what Apple was able to achieve.
Anticipating the full impact of the election of Donald Trump is difficult because his campaign offered little in terms of real policy proposals, instead favoring high energy crowd rallies and the drawing of media attention through the use of incredible and often shocking comments. There are some clues as to what he might make priorities in his administration however.
One of the regular problems of a multi-platform universe is that sometimes, you'll stumble across a link or file that's better simply viewed on another device. Pushbullet's self-titled app can be a good solution, especially if you live at least partly outside of the Apple ecosystem.
Apple has performed what may be a soft launch of a new Apple Service app in the Netherlands, allowing users in that country to schedule Genius Bar appointments, as well as get live chat-based support for Macs, iPads, and iPhones.
Apple on Tuesday was granted a patent detailing an augmented reality mapping system that harnesses iPhone hardware to overlay visual enhancements onto live video, lending credence to recent rumors suggesting the company plans to implement an iOS-based AR strategy in the near future.
Samsung on Monday confirmed plans to include a new AI assistant with its upcoming Galaxy S8 smartphone, which should make use of the technology it acquired from Viv -- a firm founded by some of the people behind Apple's Siri.
News quieted down in a bit in the wake of Apple's Oct. 27 MacBook Pro event, but as usual in the Apple world, there were still rumors about the company's plans -- among them talk about wireless charging in the "iPhone 8," and the unexpected delay of its AirPods.
Now through Nov. 7 (or while supplies last), Apple authorized reseller B&H is offering readers $500 off last year's 12" MacBooks, bringing the cost down to a record low of $1,099 for 1.2GHz, 8GB, 512GB models. B&H also has new 2016 13" MacBook Pros (without Touch Bar) in stock with no tax outside NY.
Live streaming service Sling TV on Wednesday began rolling out Sling Kids, a completely on-demand channel aimed at making it easier to find child-friendly video.
Microsoft on Wednesday announced Teams, its own attempt at a workplace chat platform akin to rivals like HipChat and Slack, with support for Mac, iOS, Windows, Android, and the Web.
Less than a week after its launch, Apple has banned a crime-reporting app called Vigilante from the App Store, which may have raised concerns over potential risks and abuses.


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- 0
Pico's "Oration on the Dignity of Man"
Often called "the Renaissance Manifesto," Pico's Oration on the Dignity of Man" reinterprets the Biblical text about divine creation to unhinge humanity from the medieval Chain of Being.
- 5
Is Beauty in the Eye of the Beholder?
It is a tired cliche already that "beauty is in the eye of the beholder" but what are the logical implications of this position - which we may called Aesthetic Subjectivism?


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|Sabrina Carlyle
|Sabrina Carlyle
|Malibu, CA, USA
|Owns a Chain of Wedding Planners
|Adam Rutherford
| Boone Carlyle
Shannon Rutherford (Step-Daughter)
|Played By
|Lindsay Frost
Sabrina Carlyle was the wealthy mother of Boone Carlyle; Sabrina owns a very large Wedding Business. When her son was 10, she married a man named Adam Rutherford, because of this she would gain a step-daughter Shannon Rutherford. Throughout their lives together, Sabrina would have an animosity towards Shannon and would have feelings of resentment toward Shannon's relationship with her father.
When her husband passed away from his injuries received in a car collision, Adam's money was passed to Sabrina through their living trust. When Shannon confronted Sabrina over the money that her father left her in the will, Sabrina informed Shannon that a will did not exist, and that she would receive none of the money. When she was requested money to help Shannon pursue her Dance Internship in New York, Sabrina denied claiming that Shannon would never pay her back, and that perhaps it was Adam's wish for her to find her own way. When Sabrina was approached by Boone, who was put up by Shannon to get the money, Sabrina denied this as well; fully aware of what Shannon was doing. To spite Shannon further, Sabrina offered Boone a very high job at her company to run one of the subsidiaries to pressure him into leaving New York, and giving Shannon no options in her favour.


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Pay-Per-Minute Viewing
This premium movie consumes minutes at 2.0 times the normal rate. Why?
In an effort to encourage studios to send us their newest and best movies as close to their street release dates as possible, we must offer certain titles at a premium rate. Other content is placed at a premium rate because studios consider those videos to be rare, hard to find or special in some other way. While many premium titles revert to the regular price over time, some studios with rare content, require us to keep their content at premium prices for even longer. Movies at less than 1.0x rate are a limited time special discount streaming rate.
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DRM-free downloads offer content that is not limited by standard Digital Rights Management (DRM) access technologies. These technologies allow hardware manufacturers, publishers, copyright holders and individuals to limit the usage of digital content.
When you purchase DRM-free downloadable content, that content is available for you to download on any computer and save to a disk whenever you like. You can also download to multiple computers. There is no timeframe associated with your purchase and the content will not expire.
Running Time: 81 minutes
Released: 10/2013
Studio Name: Digital Sin
Series: A Gangbang Movie
Director: Eddie Powell
Categories: GangBang Anal Gonzo Double Penetration High Definition
Description: One dick is not nearly enough for these ladies. So we brought them four! Get ready for genuine gangbang bliss with super sluts Luna C. Kitsuen and Mia Rider. No hole will go untouched by these massive cocks and it's time to go all in!
2 Scenes from All In... A Gangbang Movie
All In... A Gangbang Movie: Scene 1 Free Preview
Starring: Tommy Pistol Michael Vegas ... More Details
Stars: Tommy Pistol, Michael Vegas, Mia Rider, Jordan Ash, Xander Corvus
Sex Acts: Breast Play, Anal Sex, Rim Job, Handjob, Jousting, Masturbation, GangBang, Double Penetration, Vaginal Sex, Choking, Deep Throating, Oral Sex
Positions: Standing Doggy Style, Standing, Standing Missionary, Side Saddle, Laying, Reverse Cowgirl, Cowgirl, Kneeling
Settings: Living Room
Studio: Digital Sin
All In... A Gangbang Movie: Scene 2 Free Preview
Starring: Luna Kitsuen Mark Davis ... More Details
Stars: Luna Kitsuen, Mark Davis, Mikey Butders, Jordan Ash, Carlo Carrera
Sex Acts: Anal Sex, Handjob, Jousting, Masturbation, GangBang, Gapes, Double Penetration, Vaginal Sex, Squirting, Choking, Deep Throating, Oral Sex, Bondage
Positions: Standing Side Saddle, Standing Doggy Style, Standing Cowgirl, Standing, Sitting, Laying, Reverse Cowgirl, Cowgirl, Kneeling, Doggy Style
Settings: Living Room
Studio: Digital Sin
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login with
Oh how I hate summer sometimes!
I know, I know. We all wait for summer to get here and there's so many things to LOVE about it. But here's what I hate. The cooking issue.
I love grilling so that's not a problem for dinner. It's the rest of the day. I hate turning on the oven for any reason.
I want blueberry muffins right now. BAD. And I have to weigh that against heating up the kitchen. lol grrr
So yes, as rough as the winters are here in Montana, there are reasons to hate summer.
Do you hate summer sometimes, too?
I hate cooking in the summer. It's not so much about heating up the kitchen as it's I don't want to sit inside and come up with something to eat when it's so nice out. I want to go play while I can, LOL
lol ac.. there is NO WAY Ed would let us run that...hahaha
I couldn't do that. Nope, no AC would kill me. I can't sleep in a really hot house.
Do your summers not get very hot? We've been in the 100"s and upper 90's.
Do your summers not get very hot? We've been in the 100"s and upper 90's.
NO, lol. I hate the winter. I used to love it but as I got older the cold wreaks havoc on my body. I can deal with the heat so much better.
I do wait until night time to run my dryer though. If I do during the day it gets warm in the house.
I do wait until night time to run my dryer though. If I do during the day it gets warm in the house.
I suppose if I paid the bills.... Or anything for that matter... I would just run the air, pay the bill and be done with it. But since I don't I would feel awful about running up the electric bill. It's fine for now, I just walk around with a fan all the time :)
I live in Arizona. Yes. lol :)
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About Alissa
Current: Chinook, Montana
Birth: September 17
On Moms.com since: Jan 30, 2014
*Site Hostess* I am a first time mom living in North Central Montana. I have a fiance, the most gorgeous baby boy, and a goofball dog named Lexi to fill up my plate :)


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FREE WORLDWIDE SHIPPING for ALL ORDERS OVER US$40
[TONYMOLY] Timeless Fermented Snail Cream
$42.75 $35.98
Brand TONYMOLY
Containing a slime of 5-to-6-month-old snails fed with gold green tea, it prevents dryness of your skin and skin damge. It also contains chondroitin sulfate to moisturizing skin. Allantoin's soothing effect + Glycolic acid's brightening effect + Collagen's elasticity + Elastin's elasticity This high moisturizing ampoule cream with 70% of gold greentea fermented snail slime helps to control moisture-oil balance and makes your skin more strong.


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Online English Chinese Dictionary. Chinese integrates both meaning and pronunciation information in its characters. You can search in the dictionary in Chinese, English, Pinyin, or by radical, stroke number, Cangjie, Sijiao, Wubi... You can use the Hand Writing Recognition too.
|duì kàng
|to withstand / to resist / to stand off / antagonism / confrontation
|rǎng bì
|to stand off / to make way


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by Kimberly
(Horn Lake MS)
My brother Tim recently passed away. We are 3 ½ years apart in age with me being older. I can remember the day my Mom and Dad brought him home from the hospital like it was yesterday. They come into the house and he was asleep. My Dad sat down on the couch holding him and had me climb up in his lap. We held him together. From that moment on he held my heart in his hands.
We were always close. My Dad has three brothers and my Mom is an only child so neither believed in siblings fighting. We just weren't allowed to fight, argue or have a cross word with each other. When we were young (9 and 5 ½) we shared a bedroom. His twin bed was by the closet door and mine was just a few feet away on the other side of the bedroom door – it was a tiny room. At night I would start telling him about the monsters in the closet. He would get scared. Eventually he would stand up on his bed and jump up and down and then take a flying leap. He would always land on my bed and then crawl in bed behind me – between me and the wall. That way he was safe because his big sister wouldn't let the monsters get him.
We moved one day into a house where we were going to each have our own rooms. I told him, " You are not allowed in MY ROOM. You have to STAY OUT!!!!" He cried the whole time we moved. When my Mom asked him why he was crying he said, "Because I'll never see Kim again when we move because I can't come into her room." Needless to say… that didn't happen. He was always allowed in my room and vice versa.
We stayed close our whole lives and promised to always be there for each other. We even made a pack that as long as one of us had a place to live, so did the other; as long as one of us had food to eat, so did the other; as long as one of us had a car, so did the other. And that's how we always were – a team.
About 7 years ago Tim contracted Antibiotic resistant staph infection. This left him in a coma and in the hospital. He was in a coma for about 6 months. Finally they found a combination that worked and he started getting better. However, he was left in a wheelchair and completely unable to do anything for himself. My Mom and I worked with him, got him therapy and eventually took him home. Since I worked everyday my Mom was his caregiver. My Dad had been away and when he returned he helped get Tim "back to normal". Life was rough for him, but he never gave up. He would gain weight because of the meds and then work hard working out to loose it all. He was amazing. Never once did He and I stop laughing or talking.
At the beginning of this year he was in the hospital again – he was almost constantly in and out of the hospital. He had developed heart issues and gained weight, he was weak and not eating. Always being the pushy older sister, I never gave up. I took him meals. My husband and I would make trips to the hospital on Saturdays with Chick-fil-a chicken biscuits just for him. We pushed and tried everything to get him better.
Finally the doctors told my parents that he needed a very high risk and specialized heart surgery and that they couldn't do it. They sent us searching the country for a doctor that could do this and would take him on as a patient. We talked to all our friends and family and their friends and families trying to find someone. The doctors who had been treating him locally decided that as a stop gap measure they were going to put a pacemaker in to help with his heart rhythm.
The night before his surgery he took a turn for the worse and they put him in ICU. We rushed to the hospital. When we got there he was sitting in the bed smiling and laughing and cutting up like always. My husband and I were scheduled to leave the next morning to go visit our grandson for his first birthday. Tim said "GO. You only have one first birthday and you should be there for his." That was Tim, always thinking of others. I told him "I love you." And gave him a big kiss and a hug. We left and drove 8 hours to see our grandson.
The next morning my Dad called us at the hotel and told us that Tim had gone into surgery and passed away. My parents had to deal with that terrible day without me. My husband and I left immediately and headed home. I feel so guilty for not being there that last morning. I know I got to say goodbye the night before but still… I wasn't there.
We cremated him. But everyday I think of a funny story or something that happened and I start crying all over again. I miss him. I want him back, but I know he's better off in heaven. Things happen in my day and I think, "I need to tell Tim he will get a kick outta this." Then I remember he's not here and I cry.
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Paintless Dent Repair Winston-Salem North Carolina
Paintless dent repair Winston-Salem NC is unlike regular vehicle dent removal, which requires fillers, sanding and painting to match the rest of the Automobile. The problem with this is, it does not address the underlying problem or the structural damage caused by the ding, it is just a cover up and very much expensive than paintless dent removal PDR. Which is a fraction of the cost.
What is Mobile Paintless Dent Removal?
This is simply using techniques and tools to get rid of the dent. Dents, body creases, dings and hail damage can be easily removed using this techniques. It is very much cheaper, but still labor intensive. Don't go to a body shop that wants to replace a part just because of a ding.
How Dent repair works PDR?
Technic 1 RECOMMENDATION: First the technician would gain access to the back side of the affected automobile body part. After examining the size and location of the damage. Specialized tools are used to slowly massage the affected area back to its original form. If not done right the paint around the area would crack or chip off. That is why you need a professional to handle it.
- Fraction of the cost compare to body shops in Winston-Salem NC doing car ding and dent repairs
- Faster Service, get you car in shape in just one day.
- If it is a leased vehicle, you get to avoid penalties for vehicle damages and fix it pennies on the dollar.
Technic 2: What You might see in a regular repair shops
It requires a heat gun and a can of coolant. DO NOT TRY this yourself. A heat gun is used on the affected surface for about 2-3 mins. A liquid coolant can turned upside down is used for about 10 seconds. carefully tap around it and repeat the whole process. You would not try this and risk causing a damage or waste your time using this technique on a car panel that requires a slow massage by special tools. Leave it up to the expert. The cost to you is very low.
Cost of a Paintless dent Removal in Winston-Salem NC
Size and area matters, here are some estimates.


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What is a graphics card?
Strike M Bluetooth Gaming Keyboard...
- Centralises Media Control
- Lightweight and Portable
- Enables Fluid Typing
Logitech G910 Orion Spectrum - RGB...
- Ultra-fast RGB mechanical gaming keyboard
- Exclusive Romer-G mechanical switches
- Up to 25% faster actuation
ASUS Gladius ROG Gaming Mouse
- 6400 DPI Sensor
- 6 Buttons
- Built-in flash memory
RAZER Abyssus V2 Gaming Mouse
- Ambidextrous form factor
- True 5,000 DPI optical sensor
- In-mould rubber side grips
Founded in 2005 in San Diego, California by CEO Min-Liang Tan and Robert Krakoff, Razer began in a tiny shared office of gamers, with a mission to create high quality products designed solely to meet the demanding needs of gamers like themselves.
Today, with hundreds of employees in offices all around the world, Razer is known for its relentless pursuit of perfection, innovating to produce a unified platform of connected devices and software. The use of cutting edge technology, together with contributions by top eSports athletes, followed by constant fine-tuning, has resulted in an interactive, competitive, and immersive experience that is designed for gamers, by gamers.
Over the years, Razer has evolved into the gaming lifestyle brand that connects with all gamers, regardless of age, gaming genre, and console, by staying true to its core values, and continually delivering the best. Razer's commitment to the gamer community can also be seen in its sponsorship of gaming events, eSports tournaments, and a diverse group of professional eSports athletes - Team Razer. All this, has earned Razer a formidable following of devoted fans, both on- and offline.
As the gaming industry continues to grow, Razer is positioned firmly on the forefront, armed with passion, determination, and gaming innovations that are truly made for gamers, by gamers.
Naga MMO Left-Handed
Gaming Mouse
- Razer Synapse 2.0 enabled
- Green LED backlighting
- Zero-acoustic Ultraslick mouse feet
BlackWidow Ultimate 2016 Keyboard
- Multi-Award Winning Razer Mechanical Switches
- Engineered for Durability
- Individually backlit keys with dynamic lighting effects
- 10 key roll-over anti-ghosting
BlackWidow Chroma Mechanical
- Razer Mechanical Switch
- 16.8 Million Colour Options
- Great Durability
- 10 Key Rollover
Deathadder Chroma Gaming Mouse
- Razer Synapse Enabled
- 16.8 Million Colour Options
- On-the-fly sensitivity adjustment
- PC and Mac Compatible
Focused on innovation and quality, Logitech designs personal peripherals to help people enjoy a better experience with the digital world. We started in 1981 with mice, which (new at the time) provided a more intuitive way of interacting with a personal computer. We became the worldwide leader in computer mice, and have reinvented the mouse in dozens of ways to match the evolving needs of PC and laptop users.
F310 Gamepad - Blue
- Broad game support
- Profiler software
- Familiar layout
- Floating D-pad
- Features 1.8 m (6-foot) cord
Logitech G303 Daedalus
- Designed for the Performance Enthusiast
- Customize from 16.8M colors
- 32-bit microcontroller
- 3 onboard profiles
G430 Surround Sound Headset
- Lightweight design lets you play comfortably for hours
- Performance-sport cloth earcups are removable for cleaning
- Features 7.1 surround sound using Dolby technology
G933 Artemis Spectrum Wireless Headset
- High audio quality
- One headset for all game platforms
- Audio from up to three devices
- Use your wired devices wirelessly
Corsair are rightly regarded as a leading light in technology and have established their reputation by delivering fast and reliable PC memory. But Corsair have now expanded into many more areas of tech and bring their tried and trusted blend of high-performance, reliability and efficiency into the worlds of gaming, cooling and storage.
Raptor HS40 Headset
- 7.1 Channel Surround Sound
- Circumaural, closed-back design
- Padded earcups and headband
VOID Stereo Gaming Headset
- PC/Mac, PlayStation 4, Xbox One, and mobile compatible.
- Microfiber/memory foam earpads Play in comfort for hours. And hours.
SCIMITAR RGB MOBA/MMO Optical Mouse
- 12 optimized mechanical buttons
- 12000 DPI pro-proven sensor
- Dynamic multicolor backlighting
- Ultra fast 1ms response