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Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial
Methamphetamine use is associated with HIV acquisition and transmission among men who have sex with men (MSM). Contingency management (CM), providing positive reinforcement for drug abstinence and withholding reinforcement when abstinence is not demonstrated, may facilitate reduced methamphetamine use and sexual risk. We compared CM as a stand-alone intervention to a minimal intervention control to assess the feasibility of conducting a larger, more definitive trial of CM; to define the frequency of behavioral outcomes to power such a trial; and, to compute preliminary estimates of CM's effectiveness.
We randomly assigned 127 MSM from Seattle, WA who use methamphetamine to receive a 12-week CM intervention (n = 70) or referral to community resources (n = 57).
Retention at 24 weeks was 84%. Comparing consecutive study visits, non-concordant UAI declined significantly in both study arms. During the intervention, CM and control participants were comparably likely to provide urine samples containing methamphetamine (adjusted relative risk [aRR] = 1.09; 95%CI: 0.71, 1.56) and to report non-concordant UAI (aRR = 0.80; 95%CI: 0.47, 1.35). However, during post-intervention follow-up, CM participants were somewhat more likely to provide urine samples containing methamphetamine than control participants (aRR = 1.21; 95%CI: 0.95, 1.54,
While it is possible to enroll and retain MSM who use methamphetamine in a trial of CM conducted outside drug treatment, our data suggest that CM is not likely to have a large, sustained effect on methamphetamine use.
Trial Registration
ClinicalTrials.gov Identifier NCT01174654
Men who have sex with men (MSM) who report using methamphetamine are 1.5 to 2.9 times more likely to acquire HIV than men who do not
Reductions in sexual risk accompany participation in substance abuse treatment and peer-support programs
Despite evidence supporting the potential effectiveness of CM, the intervention's effects on methamphetamine use and sexual risk have not been tested using a minimal intervention control. We conducted a randomized controlled trial of CM to reduce methamphetamine use and sexual risk among MSM outside of drug treatment. The goals of the study were to assess the feasibility of conducting a larger, more definitive trial of CM; to define the frequency of behavioral outcomes to power such a trial; and, to compute preliminary estimates of CM's effectiveness.
Study population
We enrolled MSM from Seattle, WA. Between June 2007 and August 2008, participants were recruited through referrals from an STI clinic; an HIV clinic; community-based organizations (CBOs); printed media; radio; community outreach; and, referral by peers participating in the study.
This study was initially designed to inform the design of a trial to test whether CM could prevent HIV acquisition among HIV-negative men who use methamphetamine. Therefore, from June 2007 to November 2007, we enrolled only HIV-negative men. Because of slow enrollment of HIV-negative men, in November 2007, we opened the study to HIV-positive men and revised the study objective to test whether a CM intervention could reduce HIV acquisition and transmission risk. Several studies illustrate that a considerable proportion of HIV-positive men use methamphetamine and that methamphetamine facilitates HIV transmission behaviors
Study intervention and design
The study intervention was a 12-week CM program, adapted from previous studies, in which vouchers of escalating value were offered for consecutive urine samples that did not contain methamphetamine or crack or cocaine (herein referred to as cocaine) metabolites
All seven participants enrolled in the study while the above procedures were in place reported difficulty adhering to the intervention schedule, and only two attended ≥12 of their 36 visits. In response, in September 2007, we reduced the number of weekly urine testing visits to two (24 visits over the 12-week intervention) and increased the value of vouchers for the first stimulant-free urine sample to $7.50; other studies have employed a similar schedule
Under the initial CM intervention schedule, drop-in urine-testing visits were available from 10:00 am to 6:00 pm on Tuesdays, Thursdays, and Saturdays; we offered extended hours for working participants. After the enrollment visit, we sent postcards or e-mails to all participants encouraging participation in the intervention. We reminded participants who did not attend urine-testing visits for the first week by phone or e-mail. We sent postcards, phoned, or e-mailed all CM participants again at the midpoint of the intervention period. Under the revised CM intervention schedule, drop-in urine testing visits were available from 10:00 am to 6:00 pm on Tuesdays and Saturdays with flexible hours for working participants. Postcard, phone, and e-mail reminder strategies remained the same.
We tested urine samples with the QuickScreen Pro Multi-Drug Screening Test (Phamatech, Inc., San Diego, CA), a point-of-care test used to qualitatively detect stimulant metabolites. For this assay, the estimated mean detection time in urine ranges from 43.6 to 66.9 hours for methamphetamine
Participants randomized to both control and CM arms received a printed list of local counseling, treatment, and outreach services at baseline and at each study visit. Study staff offered all participants assistance accessing services. Control participants did not submit twice-weekly urine samples and did not receive vouchers during the first 12 weeks of the study.
The study randomized participants using block sizes of two, four, and eight varied randomly with a pseudo-random number generator, a deterministic process use to generate an effectively unpredictable sequence of numbers
The same study personnel administered the CM intervention and conducted the study visits. These personnel also performed data entry of the results of the urine testing and HIV/STI testing. The behavioral endpoints were automatically transferred from the ACASI to a database without the potential for modification. It was not possible to blind those administering the CM intervention to a participant's study arm.
The University of Washington institutional review board approved the study protocol. All participants provided written informed consent.
Study procedures
All study procedures took place at a large, public-transport accessible, community-based AIDS service organization. We screened participants for eligibility by phone and in person. All participants attended scheduled study visits every six weeks for six months. At each study visit, participants completed an audio computer-assisted self-interview (ACASI) that used a 6-week recall period and included questions about sexual behavior and substance use at the respondent- and partnership-level. Participants submitted urine samples for methamphetamine and cocaine metabolite testing at each of these visits.
At enrollment, 12 weeks, and 24 weeks, participants were tested for HIV/STI after completing the ACASI
Study endpoints
The primary outcome was report of unprotected anal intercourse with a partner of unknown or discordant HIV status (non-concordant UAI) in the prior six weeks. The study included four secondary endpoints: the number of non-concordant UAI partners; results of methamphetamine urine testing; self-reported weekly or more frequent use of methamphetamine; and, self-reported use of >8 quarters (two grams) of methamphetamine. We chose non-concordant UAI as the primary outcome because this study was designed as a preliminary test of whether CM can be ultimately employed as an HIV prevention tool. We have previously shown this metric to be associated with HIV acquisition
Reliability of behavioral study endpoints
We conducted a test-retest reliability study of the behavioral endpoints assessed in this trial
Statistical analyses
The primary purpose of this trial was to gather data for the design of a phase IIb or III clinical trial. The study was originally designed to follow 60 individuals. Assuming that 14% of participants would report non-concordant UAI at baseline, this sample size was chosen to provide estimates of the proportion of men who report non-concordant UAI in the prior six weeks with an expected width of the 95% confidence interval (CI) of 0.085. We expected to lose 25% of our study population to follow-up and aimed to enroll 80 participants. Additional resources, however, allowed us to enroll 127 participants.
We used chi-squared tests and
We pre-selected baseline covariates that we thought would most strongly predict our outcomes of interest for adjusted analyses, including predictors of retention at the 24-week study visit. Of these covariates, we adjusted for variables that resulted in at least a 10% change in the adjusted RR (aRR) compared to the unadjusted RR
We assessed participants' stage of change for methamphetamine use by a single question
Enrollment, retention, and participant characteristics
Over our 15-month enrollment period, we screened 222 men for eligibility (14.8/month) and enrolled and randomized 127 men (8.5/month). Of these randomized participants, 107 (84%) attended the 24-week study visit; retention at 6-week assessments was similar for both groups (Figure
Figure 1
Participant flow through the study
Participant flow through the study.
The largest difference in follow-up between the CM and control group was for the first visit after baseline (69% v. 77%). Of the 22 CM participants loss-to-follow-up at this visit, one was incarcerated, one was in a drug rehabilitation program, three withdrew from the study, and 17 could not be located for study visit attendance. Among the 13 control group participants who did not complete the first follow-up visit, one had died, two withdrew from the study, and 10 could not be located for study visit attendance.
Table 1
Characteristics of the study population at baselinea
Total Sample (n = 127)
Contingency Management (n = 70)
Control (n = 57)
64 (50)
35 (50)
29 (51)
Healthcare provider, STD or HIV clinic
28 (22)
15 (21)
13 (24)
Self-referral via community advertising
21 (16)
13 (19)
8 (14)
Community-based organization
7 (5)
4 (6)
3 (5)
Other, unknown
7 (5)
3 (4)
4 (7)
100 (79)
50 (71)
50 (88)
27 (21)
20 (29)
7 (12)
Age (years, median [range])
39 (18-60)
40 (18-60)
37 (19-57)
Black, African American
10 (8)
2 (3)
8 (14)
Hispanic, Latino
17 (13)
12 (17)
5 (9)
Native American, Alaska Native
8 (6)
4 (6)
4 (7)
76 (60)
47 (67)
29 (51)
Other race/ethnicity, multiracial, unknown
16 (13)
5 (7)
11 (19)
Less than High School
19 (15)
10 (14)
9 (16)
High School
30 (24)
17 (24)
13 (23)
Some college, vocational/technical training
60 (47)
35 (50)
25 (45)
College or greater
13 (10)
6 (9)
7 (12)
5 (4)
2 (3)
2 (4)
Annual income less than $15,000
90 (71)
53 (76)
37 (65)
Homeless or marginally housed
27 (21)
17 (24)
10 (17)
Neither employed nor attending school
89 (70)
51 (73)
38 (67)
HIV status
57 (45)
30 (43)
27 (47)
70 (55)
40 (57)
30 (53)
Sexual orientation
Gay, homosexual
80 (63)
47 (67)
33 (58)
28 (22)
14 (20)
14 (25)
Straight, heterosexual
1 (1)
1 (1)
Queer, same gender loving, other
18 (14)
8 (11)
10 (17)
Sexual Behavior, prior 6 weeks
Number of sex partners (median [IQR])
3 (2-8)
4 (2-10)
3 (2-6.5)
Number of anal sex partners (median [IQR])
2 (1-5)
2 (1-6)
2 (1-5)
Number of nonconcordant UAI partners (median [range])
0 (0-35)
0 (0-35)
0 (0-16)
Nonconcordant UAI
35 (28)
21 (30)
14 (25)
Use of methamphetamine with anal sex
102 (80)
59 (84)
43 (75)
Exchanged sex for methamphetamine
20 (16)
11 (16)
9 (16)
Methamphetamine Use
Duration of methamphetamine use, years (median [IQR])
11 (5-19)
14 (6-19)
11 (5-16)
Weekly or daily methamphetamine use, prior 6 weeks
83 (65)
51 (73)
32 (56)
Used more than 8 quarters of methamphetamine, prior 6 weeks
59 (46)
37 (53)
22 (39)
Injection of methamphetamine, prior 6 weeks
69 (54)
41 (59)
28 (49)
Trans-theoretical stage of change: "Have you been trying to stop or cut down on your methamphetamine use?"
"Yes, I have been trying for more than 6 months" (Maintenance)
49 (39)
25 (36)
24 (42)
"Yes, I have been trying for less than 6 months"
24 (19)
12 (17)
12 (21)
"No, but I really want to start this month" (Preparation)
14 (11)
11 (16)
3 (5)
"No, but I really would like to try in the next 6 months" (Contemplation)
14 (11)
9 (13)
5 (9)
"No, and I am really not interested in trying" (Pre-contemplation)
6 (5)
3 (4)
3 (5)
20 (16)
10 (14)
10 (17)
Ever been in substance abuse treatment for methamphetamine use
32 (25)
17 (24)
15 (26)
Ever attended a support group for methamphetamine use
52 (41)
25 (36)
27 (47)
Other substance use, prior 6 weeks
35 (28)
17 (24)
18 (32)
53 (42)
26 (37)
27 (47)
Inhaled nitrites
59 (46)
35 (50)
24 (42)
Erectile dysfunction medications
39 (31)
26 (37)
13 (23)
19 (15)
8 (11)
11 (19)
25 (20)
16 (23)
9 (16)
Urine testing results
Urine positive for methamphetamine
44 (35)
28 (40)
16 (28)
Urine positive for cocaine metabolites
31 (24)
12 (17)
19 (33)
Urine positive for methamphetamine or cocaine metabolites
65 (51)
35 (50)
30 (53)
IQR, interquartile range; UAI, unprotected anal intercourse.
aData are n (%) unless otherwise noted.
CM intervention adherence
Table 2
Contingency management intervention metrics
Metric a
Participants (n = 70) b
% Visits attended, mean (SD); median (IQR)
37 (1.4); 25 (8-54)
% Visits attended, n (%)
4 (6)
32 (46)
15 (21)
10 (14)
6 (9)
3 (4)
% Metabolite-free urine samples out of those attended, mean (SD); median (IQR)
75 (3.6); 85 (0.5-1.0)
% Metabolite-free urine samples out of total possible visits, mean (SD); median (IQR)b
29 (1.3); 18 (8-42)
% Metabolite-free urine samples, n (%)c
7 (10)
37 (53)
13 (19)
5 (7)
6 (9)
2 (3)
Number of continuous metabolite-free samples, mean (SD); median (IQR)c
4.2 (5.5); 2 (1-5)
Number of continuous metabolite-free samples, n (%)c
Never submitted a metabolite-free sample
7 (10)
Submitted only single, non-consecutive metabolite-free samples
25 (36)
28 (40)
4 (6)
6 (9)
Earnings, US$ mean (SD); median (IQR)
112 (138); 50 (15-150)
IQR, interquartile range; SD, standard deviation.
aData are n (%) unless otherwise noted.
b63 participants had 24 possible visits, 5 participants had 36 possible visits, 1 participant had 33 possible visits, and 1 participant had 25 possible visits (mean = 25 visits).
cWe assumed that during visits the participant did not attend, he would have submitted a urine sample positive for methamphetamine or cocaine metabolites.
Sexual risk
At baseline, 6-weeks, 12-weeks, 18-weeks, and 24-weeks, the adjusted probabilities of reporting non-concordant UAI in the prior six weeks were 31.0% (95%CI: 27.6%, 34.3%), 19.7% (95%CI: 16.3%, 23.1%), 12.1% (95%CI: 9.9%, 14.4%), 9.1% (95%CI: 7.2%, 10.9%) and 10.2% (95%CI: 8.3%, 12.1%), respectively. Figure
Figure 2
Adjusted proportion of participants reporting non-concordant UAI in the prior six weeks, by study arm
Adjusted proportion of participants reporting non-concordant UAI in the prior six weeks, by study arm.
CM and control participants were similarly likely to report non-concordant UAI during the 12-week intervention period. CM participants were less likely than control participants to report non-concordant UAI during the subsequent 12-week follow-up period, and also reported fewer non-concordant UAI partners than control participants during both the intervention and follow-up periods. None of these differences were statistically significant (Table
Table 3
Effect of a contingency management intervention on reports of any non-concordant unprotected anal intercourse in the prior 6 weeks and the number of non-concordant unprotected anal intercourse partners in the prior 6 weeks
Proportion reporting any non-concordant UAI, n (%)
Contingency Management
Unadjusted RR (95% CI)
Adjusted RR a (95% CI)
35/127 (28)
21/70 (30)
14/57 (25)
Week 6
18/92 (20)
9/48 (19)
9/44 (20)
Week 12
12/102 (12)
8/56 (14)
4/46 (9)
1.13 (0.54, 2.37)
0.80 (0.47, 1.35)
Week 18
9/99 (9)
3/53 (6)
6/46 (13)
Week 24
11/107 (10)
6/60 (10)
5/47 (11)
0.67 (0.24, 1.85)
0.51 (0.21, 1.25)
Self-reported non-concordant UAI partners, mean (SD)
Contingency Management
Unadjusted Rate Ratio (95% CI)
Adjusted Rate Ratiob (95% CI)
1.35 (4.6)
1.70 (5.5)
0.90 (2.7)
Week 6
0.47 (1.5)
0.35 (0.9)
0.60 (1.9)
Week 12
0.19 (1.0)
0.09 (0.3)
0.30 (1.4)
0.46 (0.14, 1.52)
0.58 (0.17, 1.90)
Week 18
0.12 (0.4)
0.09 (0.4)
0.15 (0.4)
Week 24
0.11 (0.4)
0.10 (0.3)
0.13 (0.4)
0.70 (0.25, 1.95)
0.49 (0.18, 1.37)
CI, confidence interval; RR, relative risk; SD, standard deviation; UAI, unprotected anal intercourse.
aAdjusted for HIV status, report of non-concordant UAI in the prior 6 weeks at baseline and use of other substances (inhaled nitrites, gamma-hydroxybutyrate, ecstasy, or erectile dysfunction medications) in the prior 6 weeks at baseline.
bAdjusted for HIV status, number non-concordant UAI partners in the prior 6 weeks at baseline and use of other substances (inhaled nitrites, gamma-hydroxybutyrate, ecstasy, or erectile dysfunction medications) in the prior 6 weeks at baseline.
One man in CM arm and one man in the control arm acquired pharyngeal gonoccocal infection (3.4 v. 4.5 per 100 person-years;
Stimulant use
During the 24 weeks of follow-up at the 6-week study visits attended by both CM and control participants, 28 (49%) control participants and 44 (63%) CM participants submitted ≥1 sample containing methamphetamine metabolites; 26 (46%) control participants and 23 (33%) CM participants submitted ≥1 sample containing cocaine metabolites; and, 43 (75%) control participants and 55 (79%) CM participants submitted ≥1 sample containing methamphetamine or cocaine metabolites.
CM and control participants were comparably likely to submit urine samples positive for methamphetamine at study visits during the intervention period (Table
Table 4
Effect of a contingency management intervention on detection of methamphetamine use by rapid urine screen and on self-reported frequency and quantity of methamphetamine use in the prior 6 weeks
Positive methamphetamine urinalysis, n (%)
Contingency Management
Unadjusted RR (95% CI)
Adjusted RR a (95% CI)
44/127 (35)
28/70 (40)
16/57 (28)
Week 6
27/92 (29)
17/48 (35)
10/44 (23)
Week 12
33/100 (33)
20/55 (36)
13/45 (29)
1.39 (0.81, 2.38)
1.09 (0.76, 1.57)
Week 18
39/97 (40)
24/52 (46)
15/45 (33)
Week 24
39/105 (37)
29/58 (50)
10/47 (21)
1.77 (1.13, 2.78)
1.21 (0.95, 1.54)
Self-reported weekly or more frequent methamphetamine use, n (%)
Contingency Management
Unadjusted RR (95% CI)
Adjusted RRb (95% CI)
83/127 (65)
51/70 (73)
32/57 (56)
Week 6
32/92 (35)
20/48 (42)
12/44 (27)
Week 12
39/102 (38)
25/56 (45)
14/46 (30)
1.50 (0.93, 2.42)
1.29 (0.82, 2.04)
Week 18
37/99 (37)
26/53 (49)
11/46 (24)
Week 24
40/107 (37)
29/60 (48)
11/47 (23)
2.06 (1.29, 3.29)
1.76 (1.13, 2.73)
Self-reported use of more than eight quarters of methamphetamine, n (%)
Contingency Management
Unadjusted RR (95% CI)
Adjusted RRc (95% CI)
59/127 (46)
37/70 (53)
22/57 (39)
Week 6
22/91 (24)
14/47 (29)
8/44 (18)
Week 12
28/99 (28)
21/55 (37)
7/44 (16)
2.01 (1.09, 3.73)
1.80 (0.95, 3.40)
Week 18
23/97 (24)
19/52 (36)
4/45 (9)
Week 24
30/105 (29)
24/59 (40)
6/46 (13)
3.52 (1.70, 7.30)
3.02 (1.47, 6.23)
CI, confidence interval; RR, relative risk; one quarter of methamphetamine is equivalent to 0.25 grams. Statistically significant results (
aAdjusted for methamphetamine urinalysis result at baseline and stage of change for methamphetamine use at baseline (maintenance, action, preparation, contemplation, pre-contemplation, missing).
bAdjusted for baseline self-reported weekly or more frequent use of methamphetamine in the prior 6 weeks.
cAdjusted for baseline self-reported use of more than eight quarters of methamphetamine in the prior 6 weeks.
Comparing participants at study visits six weeks apart, control participants at the later study visit were less likely to report either weekly or daily methamphetamine use or using >8 quarters of methamphetamine in the prior six weeks than participants at the earlier study visit (aRR = 0.77; 95%CI: 0.68, 0.88 and aRR = 0.69; 95%CI: 0.56, 0.86, respectively); although the frequency and quantity of methamphetamine use declined over time among men in the CM arm, these changes were not as large with respect to frequency (aRR = 0.89; 95%CI: 0.83, 0.96) and not statistically significant with respect to quantity (aRR = 0.93; 95%CI: 0.85, 1.02). CM participants were significantly more likely than control participants to report weekly or daily methamphetamine use and to report using >8 quarters of methamphetamine at each study visit; these differences were statistically significant during the 12-week follow-up period (Table
Accounting for baseline stage of change, control group participants were more likely than CM participants to report being in the action or maintenance stage of change for methamphetamine use during the intervention (74% v. 63%,
In this randomized controlled trial of CM, we enrolled 127 non-treatment-seeking MSM over 15 months and successfully collected follow-up data on over 80% of participants. These findings suggest that a randomized controlled trial that specifically seeks to enroll this population is acceptable and feasible. However, less than half of our participants were HIV-negative and restricting enrollment to HIV-negative MSM who use methamphetamine, the population of interest for a trial using HIV as an outcome, would be challenging. Unlike HIV-negative men, HIV-positive men are often enrolled in ongoing medical care and case management. HIV-positive men may also be more likely to recognize their methamphetamine use as problematic with some attributing their HIV infection to their methamphetamine use
Unfortunately, our findings related to CM are discouraging. First, a relatively small proportion of men consistently provided urine specimens for the intervention meaning that actual exposure to the intervention among men assigned to CM was quite limited. Several factors may contribute to CM participants receiving such a low "dose" of the intervention, including the location, the magnitude of the incentives, time limitations, and monitored collection of urine samples. Anecdotally, many men reported not attending urine-testing visits because they knew their urine would test positive. This anecdotal evidence is supported by our data. Out of all of the CM visits attended, a median of 85% of urine samples were free of stimulant metabolites. Second, and most importantly, our findings suggest that CM is very unlikely to be effective as a stand-alone intervention among MSM. While the 95% CI around the intervention-period aRR was very wide and does not rule out the possibility that CM could reduce methamphetamine use during the period of actual intervention, our follow-up period aRR and 95% CI exclude the possibility that CM would have a large, sustained benefit on methamphetamine use as a stand-alone intervention in a population like the one we studied. In addition, the control group reported larger declines in self-reported use over study follow-up than the CM arm. Although measures of sexual risk among our CM participants were similar to or lower than those among control participants, it is unclear how CM might result in lower or similar levels of sexual risk if it increases methamphetamine use.
We are aware of six studies evaluating CM among individuals who use methamphetamine in outpatient substance abuse treatment
Our study differs in four important ways from previous studies of CM. First, while we did not exclude participants who were receiving other substance use interventions, participants were not enrolled because they were seeking drug treatment. Second, we compared CM to a minimal intervention control arm. Third, CM was employed as a stand-alone intervention. Finally, CM participants were only expected to submit urines samples two times per week rather than three times, as has been done in some, but not all studies of CM
We found that self-reported methamphetamine use declined among control participants but remained relatively stable among CM participants. We cannot readily explain this effect. We do not believe that CM participants used vouchers to obtain methamphetamine, since the difference in drug use by study arm was only evident after CM recipients ceased to receive vouchers. Likewise, we do not believe our findings simply reflect more accurate reporting of methamphetamine use by CM participants since we found that CM recipients were also more likely to test positive for methamphetamine. Participants in the two study arms reported similar use of outside treatment and support services, making it unlikely that differential use of other treatments affected our results. It is possible that participation in the CM arm may have put participants in contact with other participants and CBO clients in ways that facilitated access to and use of methamphetamine. Similar phenomena have been reported in other studies
Similar to a study of CM and other psychosocial interventions in the substance abuse treatment setting
We note that the characteristics of our study population and the outcomes among CM participants were generally similar to those in a San Francisco public health program designed to reduce methamphetamine use among MSM (PROP) from December 2003 to December 2005. Our screening (14.8/month in the current study and 10.3/month in PROP) and enrollment rates (8.4/month and 7.4/month), attendance at CM visits (37% and 41%), and incentives earned (24% and 31% of the total possible) were similar
Our study has several important limitations. First, we did not power the current study to detect differences between study groups based on methamphetamine use or sexual risk. Instead, this study was powered to provide precise estimates of the proportion of methamphetamine-using MSM who report non-concordant UAI. Despite this limitation, the precision of our post-intervention period aRR rules out the potential of CM to effect a large, sustained reduction in methamphetamine use as a stand-alone intervention, at least in the population we followed. Second, randomization did not provide us with study arms balanced with respect several pertinent variables. In particular, persons assigned to the CM arm were more likely to use methamphetamine at baseline, and higher levels of drug use have been associated with inferior responses to CM in prior studies
In summary, our small, randomized trial found that a 12-week CM intervention was associated with a potential increase in methamphetamine use, but decreases in sexual risk that were not statistically significant. While our experience suggests that a larger, more definitive controlled trial of CM to decrease methamphetamine use and sexual risk may be feasible, our findings suggest that CM would be unlikely to effect large, sustained reductions in methamphetamine use among MSM.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
TWM participated in study design and coordination, performed the statistical analyses, and drafted the manuscript. DRJ participated in study coordination. JPH participated in the design of the study and provided statistical expertise. GNC and SS participated in the conception and design of the study. MRG conceived of the study and its design and helped draft the manuscript. All authors contributed to the interpretation of the study data, revised it critically for important intellectual content, and read and approved the final manuscript.
The authors wish to thank the men who participated in this study for their invaluable contribution to HIV prevention research. The authors are indebted to David Richart, Erick Seelbach, and the rest of the staff at Lifelong AIDS Alliance for opening their organization to the study participants and staff. Don Calsyn, PhD provided helpful feedback on the manuscript. This research was supported by the National Institute on Drug Abuse (R21 DA019420-01) and Public Health--Seattle & King County. TWM was supported by the National Institutes of Health (T32 AI07140). While Public Health--Seattle & King County influenced the 3:1 randomization scheme as noted in the
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The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change
Distribution of smokers by stage in three representative samples
Methods to account for attrition in longitudinal data: do they work? A simulation study
Experiences and sexual behaviors of HIV-infected MSM who acquired HIV in the context of crystal methamphetamine use
Recruitment of men who have sex with men for large HIV intervention trials: analysis of the EXPLORE Study recruitment effort
A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals
Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study
Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study
Randomized, placebo-controlled trial of sertraline and contingency management for the treatment of methamphetamine dependence
A systematic review of cognitive and behavioural therapies for methamphetamine dependence
MSM in HIV-prevention trials are sexual partners with each other: An ancillary study to the EXPLORE intervention
A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial
Principles of Exposure Measurement in Epidemiology: Collecting, Evaluating and Improving Measures of Disease Risk Factors
Effectiveness of abstinence-based incentives: interaction with intake stimulant test results
Pre-publication history
The pre-publication history for this paper can be accessed here:


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We are very pleased to announce that Nick, the Fuss Free Phones guide dog, has passed his training and is about to start work with his new owner.
Both the owner and Nick will train together to learn about each other before Nick becomes a very different mobility aid to a Fuss Free Phone.
The wonderful trainer Laura sent us this picture and said that Nick had done "Really well in his training" and she added "I am sure that he will make a lovely guide dog and will fit into his new life well".
We looked after Nick for six weeks at the start of his training with Laura. This was under the boarders scheme where dogs in training live with a family at evenings and weekends while going to one of the Guide Dogs Association training centres during the day. It's a stage after Puppy Walking where guide dogs live with a family for the first year.
Nick, as you can see is a black Labrador. Guide dogs train a variety of different types of dog, most are Labrador/Golden retriever mixes but they also have Labradoodles for people with hair allergies and some German Shepard Dogs.
Fuss Free Phones likes to think that it makes life easier for blind people by helping the keep in touch with friends and family but you'll never get an affectionate lick from a Doro.
There is a shortage of people to train guide dogs, we saw just how hard Laura and the London mobility team worked to teach Nick, and all the other dogs.
If you too would like to do you bit you can contact Guide Dogs on their website.

subset: commoncrawl


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Ms Thomson, Lanarkshire
I could not have asked for a better marketing approach. I put my confidence in you and you delivered.
Upgraded and traditionally built one bedroom flat within central Wishaw. Set on the preferred first floor that sizeable and beautifully presented flat offers accommodation comprising; reception hall, fabulous lounge with bay window formation and window seat, fitted...
Hamilton 43, Cadzow Street, Hamilton, South Lanarkshire, ML3


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Dawn Kriebel, Ph.D.
Professor of Psychology
610-647-4400, ext. 3292
Program Overview
As a psychology major at Immaculata, you will gain an understanding of the major areas of psychology, psychological research methods, and how this knowledge translates into real-world clinical and research settings. Immaculata's program will help you investigate human behavior, explore the relationship between the mind and the body, and understand counseling theories.
You can develop a course of study that will best suit your career needs. You can choose to complement your knowledge of psychology with a variety of minors, such as social work, sociology, or business.
Our talented, dedicated faculty have expertise in clinical psychology, educational psychology, cognitive psychology and developmental psychology. You will receive personalized advice and support from faculty to help you develop a course of study that best suits your career needs. You can choose from a wide array of courses, including Industrial-Organizational Psychology, Sport Psychology and Health Psychology. Through courses like these, you'll learn how to apply psychological concepts to the business world, athletic performance and health.
Program Highlights
- Gain work experience through internships in a variety of contexts.
- Participate in research projects with psychology faculty, exploring topics such as test anxiety, self-defeating cognitions, and academic achievement among low-income children. You can work with a faculty mentor to gather and analyze data from real-life situations, which will provide valuable experience especially if you want to attend graduate school.
- Join the Psychology Club and get real-life experience in psychology through community outreach, scientific research, and program leadership.
- Earn a 3.0 GPA and join the Psi Chi Honor Society, which seeks to encourage scholarship and advance the science of psychology.
As a psychology major, you can become competent in:
- Cultural sensitivity
- Interpersonal communication
- Analytical and quantitative skills
- Problem-solving
- Showing empathy
- Conducting research and analyzing and explaining the results
- Understanding human development and behavior
Career Potential
If graduate study is your intention, Immaculata offers a variety of graduate certificates and master's and doctoral programs in psychology.
If immediate employment is your goal, you may seek employment in a multitude of careers, including:
Social or Human Services
- Case worker
- Child protection worker
- Community organizer
- Development officer
- Employment counselor
- Family services worker
- Gerontology aide
- Group home coordinator
- Hospital patient service representative
- Life skills counselor
- Mental health counselor
- Nursing home administrator
- Probation or corrections officer
- Rehabilitation officer
- Residential counselor
- Social worker
- Volunteer coordinator
- Arbitrator
- Community relations officer
- Consultant
- Customer relations representative
- Employee relations assistant
- Event planner
- Hotel manager
- Human resources recruiter
- Management trainee
- Marketing researcher
- Personnel administrator
- Staff training and development specialist
- Admission counselor
- Behavior analyst
- Grant/report writer
- Research analyst
- Research assistant
- Statistical assistant
- Social policy researcher
- Urban planning research assistant
- Academic advisor
- Camp staff director
- Career counselor
- Day care center supervisor
- Early education specialist
- Guidance counselor
- Housing/student life coordinator
- Tutor
- Youth director
Salary Ranges
- Entry-level positions (B.A. degree) range from $31,000 - $45,000
- Master's and doctoral level salaries range from $43,000 - $70,000
View the course sequence sheet for psychology.
You can choose to complement your psychology major with a variety of minors. Some of the most popular include social work, sociology, and business.
Internships are strongly recommended because graduate schools and employers show the most interest in graduates with practical experience. The Psychology Department has selected a variety of sites for students to choose from, including outpatient and residential treatment facilities that focus on addiction, traumatic brain injury, and developmental disabilities; senior centers; after-school programs; and industrial-organizational consulting firms.


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What would you honestly rate me 1-10? (I'm the girl obviously)
Most Helpful Guy
Link didn't work for me21|10|0
What would you honestly rate me 1-10? (I'm the girl obviously)
Link didn't work for me
Have an opinion?
you're chillin d00d
No you look good Alana. I told you that before and others told you that too so I'm not sure if that is not enough for you to know that you look good. :)
Your cool
I think you look cute maybe like a seven?
I can't say.
An 8
why are you worried?
You are pretty 7 from my side :)
no pics are public... so we can't help you.
Where is it? (Pointless post)
You seem like a nice person, I didn't get any bad vibes. You certainly don't look evil.
Damn you a 2
5/10 for me, but that's okay.
You have a very bright smile.
You are average looking but also cute.
I rate you a 6/7.
You look pretty cool.
No. You're pretty.
i think you look good..
Error 405 Page Not Found/10
No, you look great :)
No, dear
you are beautiful
You cannot undo this action. The opinion owner is going to be notified and earn 7 XPER points.


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Hi there, my name is Elliot Forbes and I'm a technical analyst at JPMorgan Chase.
If you are interested in what sort of projects I work on then check out my GitHub
Since my graduation I've worked at JPMorgan as a technical analyst working with every level of the tech stack.
Technologies Used:
After winning the Barclay's Openminds Hackathon my team and I were offered internships in the city of London. My time here was spent mostly in SQL developing and debugging large trading systems.
Technologies Used:
Tutorialedge.net is a hobby site of mine that focusing on delivering high quality technical content. I spend a lot of my free time improving my development skills and subsequently developing content on these new skills.
It first went live in the Spring of 2015 and now attracts well over 150,000 unique visitors and well over a quarter of a million pageviews every year.
Check Out My Github: Here


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Solomon's Stables (Template:He) is the popular name for an underground vaulted space on the Temple Mount in Jerusalem, Israel. Solomon's Stables are located under the southeastern corner of the Temple Mount, 12½ metres below the courtyard and feature twelve rows of pillars and arches.
The structure has been called Solomon's Stables since Crusader times. It is unlikely to date as far back as Solomon, and may have been built by Herod the Great, who leveled and substantially extended the Temple Mount platform. The theory is that arches would decrease pressure on the supporting walls and elevate the platform above the bedrock. According to the Mishna, however, the arches were built to keep the buildings on the mount from being defiled by "graves in the depth." (Mishnah, Tohoroth, 3).[1]
According to Islamic tradition, Caliph Marwan I transformed the vaulted structure into a series of usable rooms. It is believed to have been a place of worship and became known as the el-Marwani mosque. In 1996, the waqf built a modern mosque there, with a capacity for 7,000 worshippers.
In 1997, the waqf began digging up the southeastern area of the Temple Mount, drawing criticism from archaeologists, who said that archaeological finds were being damaged in the process and the excavations weakened the stability of the Southern Wall. . The soil removed from the dig was dumped near the Mount of Olives and a salvage operation was undertaken in order to sift through the debris for archaeological remains. Many important finds have turned up, backing claims that the waqf embarked on the project with the aim of destroying evidence of any Jewish presence on the Temple Mount.[2]
In popular culture, the area has become associated with the Knights Templar due to a claim in the 2003 novel The Da Vinci Code that the order maintained its headquarters here.
Coordinates: 31°46′34.92″N 35°14′13.24″E / 31.7763667°N 35.2370111°Ear:المصلى المروانيmk:Соломонови коњушници ru:Мечеть Эль-Марвана


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Roasted Carnitas
Be the first to review
READY IN: 2hrs 5mins
Recipe by cervantesbrandi
These carnitas are wonderful. Delicious served as a main entree or stuffed in corn tortillas and served as tacos. Definitely good on a summer day served with my pico de gallo The Perfect Pico De Gallo.
See Discussion:
Ingredients Nutrition
- 3 1⁄2 lbs pork shoulder (cut in chunks)
- 2 cups salsa verde (canned or homemade)
- 1 onion, finely chopped
- 2 cups chicken stock
- 1 cup beef stock
- 2 teaspoons cumin seeds
- 2 teaspoons coriander seeds
- 1 teaspoon oregano
- 1⁄2 cup cilantro (chopped)
- 4 jalapenos (roasted, peeled, and chopped)
- 1⁄2 orange (cut in thirds)
- salt
Directions See How It's Made
- Trim the excess fat from the roast. Put the meat in a large casserole or Dutch oven with salsa verde, onion, stock, cumin seeds, coriander seeds, jalapenos, orange chunks, and oregano. Bring to a boil over high heat; reduce heat, cover, and simmer until meat is very tender when pierced, about 1 hour.
- Preheat oven to 400°F
- Remove meat from liquid in pot and put the meat into a roasting pan. Remove the orange chunks and discard. Roast meat for 15 to 20 minutes until parts are brown and crispy.
- While the meat is roasting, skim and discard fat from liquid in the casserole pan. Boil juices, stirring, until reduced to 2 1/2 cups, 8 to 10 minutes.
- Return the meat to the Dutch oven. Stir in chopped cilantro. Season with salt.


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"A & E/ CCU Tameside hospital"
About: Tameside General Hospital / Cardiology Tameside General Hospital Cardiology OL6 9RW
Posted by Berkeley (as ),
My son became breathless and had an erratic heartbeat early hours of the morning. His partner saw he looked unwell and at 7am took him straight to Tameside Hospital, Ashton under Lyme A&E. He was seen immediately and as soon as he explained his symptoms he was attended to by a team of staff. He had several tests in quick succession and was diagnosed with an irregular heartbeat which was fluctuating wildly.
He was put on the Coronary Care Unit and seen by the consultant quickly. Myself and my wife arrived at 5pm after traveling and we were immediately updated by the Ward sister on his condition. His partner had remained with him all day and her exact words were " Considering Tameside hospital has been heavily criticised for a long time, we cannot fault the speed and quality of care we have had since we got here"
He was given medication as we got there which worked at 4am and flipped his heart rate back to normal. He was seen by the consultant the following morning and discharged.
We can only repeat his partners words, the care, attention and diagnosis was outstanding and all who were involved should be notified officially not by us just sending a card that is pinned on the wall.
Give the staff a morale boost in light of the publicity surrounding the hospital.
Excellent, many thanks.
Response from John Goodenough, Director of Nursing, Tameside Hospital NHS Foundation Trust 3 years ago
Thank you for taking the time to pass onto us these positive comments. I will ensure that these are passed to the teams concerned. I hope your son is now on the road to recovery.
Kind regards,
John Goodenough
Director of Nursing
''Would you like to help the hospital to improve its services further? We are currently looking for patients and carers to become involved in a development called "Patient Stories". We want to know more about our services from the point of view of those who received them – what was good, bad, what could be improved, what should be changed. Want to know more about what's involved? Please contact John Goodenough, Director of Nursing at
- {{helpful}} of {{total()}} people think this response is helpful
- Was this response helpful? Yes | No
Thank you for your feedback.
See more responses from John Goodenough


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Rangers Starting Rotation
For the Rangers, 2011's Spring Training was always about the rotation. The Michael Young side show stayed just that. Nothing developed from it and more than likely nothing will. Chuck Greenberg's departure was another issue that popped up, but once again the rotation debates trumped that during the pre-season. Why? To men like Nolan Ryan, Mike Maddux, Jon Daniels, and Ron Washington baseball is won with pitching and defense. In the deepest rotation battle the Rangers have ever seen, Matt Harrison, Tommy Hunter, and Derek Holland were named as starters filling out the rest of the spots behind Colby Lewis and C.J. Wilson. So what does this rotation look like for the 2011 season?
The Rangers have an unusual top of the rotation. Their best two pitchers have only one season of quality work as starters. Lewis has been unable to pitch a full season in the United States, because of injuries and poor performances.
Wilson was a middle reliever and closer prior to his move to the rotation. 2010 was a career year for the convert. Wilson has always been a quality pitcher, but his innings are a primary issue. Moving from the bullpen to the rotation is never easy and has resulted in some untimely injuries during the second year for some well known names, including Justin Duchscherer.
Lewis struggled with injuries and performance prior to pitching in Japan. His time in Japan revitalized his career and the Rangers gave him an opportunity. Lewis not only earned it, but 2010 was a statement for Lewis. He finally became the pitcher the Rangers envisioned when the drafted him in 1999.
Harrison will try to pitch his first full season as a starter at the major league level. He has failed in previous seasons due to injuries. Last year a stint on the disabled list cost him his job as Hunter and Holland both forced their way onto the rotation. The young left hander will try and prove that this time around he can pitch consistently and for a full season.
Holland had the best stuff amongst those that vied for a rotation spot this spring. He has always had good stuff, but his issues seem to be linked to injuries and consistency. Holland also has a history of giving up a lot of home runs. In the hitter friendly confines of Arlington this could prove fatal.
Hunter was supposed to have a spot in the rotation, but according to Yahoo Sports he suffered a moderate right groin strain and is out until May at the earliest. That leaves Alexi Ogando and Michael Kirkman as the two possible choices. According to T.R. Sullivan, the Rangers announced that Dave Bush will be the long reliever. Ogando is supposed to start in Hunter's place this week. If everything goes as scheduled expect Ogando to become the fifth starter. He has a nasty slider and a mid 90s fastball. There is a chance that Ogando may make the rotation if he pitches well. He has the fastball and secondary pitches to be a major league starter, but it all comes down to execution. The right hander has until May to prove that he belongs in the rotation.
With the injuries suffered by the Rangers this late into Spring Training another name that can crop up is Scott Feldman. The former 17 game winner lost his spot last year when he couldn't control his sinker. During the off-season he underwent knee surgery that will likely keep him out until June. If there is still uncertainty about the last spot in the rotation by June or July, then Feldman has a fair chance of returning as a starter.
Overall this isn't a dominate rotation, but that doesn't mean it can't be. There are just a lot of question marks for the Rangers going into the 2011 season. The Rangers have a lot of upside with this rotation, but they haven't shown the ability to be healthy or consistent. That is where depth comes in. The team has a lot of depth in the minors with Kirkman and Hurley. If those two put together a strong couple of months there is a high possibility one of them may come back. As Opening Day nears, the Rangers biggest question is the same that they've had for decades. Do they have enough pitching to win the division?
By: Luke Truxal
> View all of the 2010 MLB team previews from MLBCenter.com!


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Most Helpful Girl
I don't know, never been.10|10|0
I don't know, never been.
Have an opinion?
San Francisco seems awesome, never been though.
I've never been to California. One day I'd like to go.
Never been. Heard it was pretty cool though.
I have never been there.
I have never been there and don't know much about the city. So can't really comment.
I've never been there but I've seen images and video and it seems ok. Plus I've seen them niners fans lol
Love it, miss living there, some of the best times of my life are when I lived in the bay.
Yeah I had a blast going there and one of my cousins live there as well
I visited briefly and I think it's nice.
As a current Clevelander, no, I don't
I like the song and I think Alcatraz is there, I'd like to go and have a look.
You cannot undo this action. The opinion owner is going to be notified and earn 7 XPER points.


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Bruno ist Coming - Three Crazy New TV Spots for Bruno
by Alex Billington
June 9, 2009
Source: Yahoo
Universal has debuted three crazy new TV spots for Bruno, the summer comedy that I know everyone is just waiting to see. How far does he go this time? We've all watched that red band trailer over and over, so it's good to finally see more new footage that no one out there has seen yet. It looks like Bruno really does go farther than he's ever gone before, which is what he really needs to do to kick Borat's ass! The first TV spot is the best of the three, though it's great hearing "Numa Numa" in the last one and seeing Ron Paul in the second one. All three of the new TV spots can be seen below or in high definition on Yahoo. Enjoy these!
Watch the first new TV spot for Brüno:
Watch the second new TV spot for Brüno:
Watch the third new TV spot for Brüno:
Bruno is directed by Larry Charles, of Borat, Bill Maher's Religulous, and "Curb Your Enthusiasm" previously. The character was created by Sacha Baron Cohen, the comedic mastermind behind Borat, Signor Adolfo Pirelli in Sweeney Todd, and, of course, "Da Ali G Show". Cohen and his cohort Dan Mazer are credited for the majority of the writing in this. After the huge success of Borat, Cohen sold the distribution rights for Bruno to Universal for a reported $42 million and began production last year, prey on more unaware Americans and other idiots. Universal will debut Bruno in theaters everywhere on July 10th.
Follow Alex's main profile on :


text:
With First Tutors: Music you can find a Barnes flute teacher. Flute tuition are the perfect way to begin a fun new hobby, pick up a new skill and attain confidence with flute. Use our site to find Barnes flute tutors and choose which best matches your requirements so you can start your flute tuition in Barnes immediately!
First Tutors: Music is the best way to find Barnes flute tutors in the UK, helping you find Barnes flute lessons in your area and Barnes teachers to help with any instrument like piano, violin or guitar. We can help you find Barnes flute tuition or a Barnes flute teacher to prepare for flute grades and improve your flute skills! We order Barnes flute teachers local to you according to their hourly charges and proximity to you.
If you are a flute teacher wishing to offer flute lessons in Barnes or anywhere else across the UK, please register with First Tutors: Music or learn about us here. Becoming a Barnes flute teacher is a fantastic way to re-affirm your own skills by giving flute lessons while helping someone else, all in your local Barnes area!


text:
With First Tutors: Music you can locate a Sleaford trombone teacher. Trombone lessons are an excellent method to begin an entertaining new hobby, acquire a new talent and gain confidence in trombone. Use our service to search for Sleaford trombone tutors and determine which suits your needs so you can start your trombone tuition in Sleaford today!
First Tutors: Music is the best place to discover Sleaford trombone tutors in the UK, helping you discover Sleaford trombone lessons in your area and Sleaford tutors to assist with any instrument like piano, violin or guitar. We can help you find Sleaford trombone lessons or a one-to-one Sleaford trombone teacher to prepare for trombone exams and develop your trombone skills! Our search will order Sleaford trombone tutors local to you according to their lesson prices and proximity to you.
If you are a trombone teacher and would like to offer your trombone lessons in Sleaford or anywhere else across the UK, please register with First Tutors: Music or learn about us here. Becoming a Sleaford trombone teacher is a fantastic way to improve your own knowledge through providing trombone lessons while assisting someone else, all in your local Sleaford area!


text:
Hey there, time traveller!
This article was published 1/8/2013 (1477 days ago), so information in it may no longer be current.
ST. JOHN'S, N.L. - The Newfoundland and Labrador government is launching a new program to follow up with people who leave emergency rooms without being seen by a health professional.
The province says that as of Monday, a nurse will contact anyone who left one of 12 Eastern Health emergency departments due to long wait times or other reasons.
A HealthLine nurse will make the call within 24 hours to check on the person's symptoms and make sure they receive treatment if required.
The program could be expanded to the rest of the province if the Department of Health and Community Services deems it a success.
The province says it is developing other services for the program to help people with mental health and other chronic conditions.


text:
On behalf of the Party and State, Mr Nghi praised the achievements made by the province in 2010 and expressed his delight at the province's socio-economic development. Politburo member Pham Quang Nghi He added that the city's people and cadres should promote the province's advantages, fully tap its potential for industrial development, build new rural areas and roads, and pay a special attention to the development of human resources. To fulfill the goals, Ha Nam province should work in co-ordination with other localities, particularly Hanoi, in developing infrastructure, and training high quality human resources. *** General Le Hong Anh paid Tet visit to Gia Lai province The same day, Le Hong Anh, Politburo member, General, and Minister of Public Security paid a Tet visit to Gia Lai province. Ha Son Nhin, member of Party Central Committee, and Secretary of the Gia Lai province's Party Committee briefed General Le Hong Anh on achievements made by … [Read more...]
Lao Cai Fostering Tourism Development and Cultural Preservation
Lao Cai Fostering Tourism Development and Cultural Preservation The mountainous frontier province of Lao Cai has a lot of particularly comparative advantages to develop tourism economy as it lies on Kunming (Yunnan) - Lao Cai - Hanoi - Hai Phong - Quang Ninh Economic Corridor and has Sa Pa, a very popular tourist destination in Vietnam. Thus, the provincial government has defined tourism as an engine of economic growth. The Resolution of the 15th Provincial Party Congress stated that "trade, tourism and service are breakthrough stages. Accordingly, the province will focus on tapping cultural identity of 25 ethnic groups and see it as an important humanity resource for tourism development. The policy on tourism development in combination with regional cultural preservation has been specified by the Provincial Party Committee with Scheme No. 8 on "Cultural and sport institution development and cultural identity conservation and promotion in Lao Cai" and Scheme No. 3 on "Tourism … [Read more...]
Blacking out the vision
Blacking out the vision By Son Nguyen in HCMC The story of Vietnam's coal industry group Vinacomin importing a coal shipment worth some US$1 million a fortnight ago – having been front-paged on local media these days – is quite good food for thought as what it exposes is beyond the normal business of an enterprise. While Vinacomin defends its activity as merely a matter of cost-effectiveness on one hand and as part of a strategy to ensure energy security for the economy in the long term on the other, local media backtracks the group's business and points out that the import is a bad consequence rather than a wise business decision. The shipment, papers say, reflects nearsightedness, or rather, the lack of vision. On the part of Vinacomin, all are quite logical. Vietnam will have to increasingly import coal for its energy demands, and the imported amount will be some six million tons by 2015, which will rise by more than tenfold after five more years to 66 … [Read more...]
Social News 30/5
Over one million people jobless in Q1 A little more than one million people of working age nationwide were unemployed in the first quarter, up by 20,700 compared to the last quarter of 2015, according to an updated report of the Ministry of Labor, Invalids and Social Affairs. The overall unemployment rate in quarter one was 2.25%, up from 2.18% in the previous quarter. There were 540,700 unemployed people aged from 15 to 24 in the period, down by 18,700 quarter-on-quarter but still accounting for over half of the total. The jobless rate for this group was 6.63%, lower than in the last quarter of 2015 and the same period last year. However, the rates of young people in urban areas, people aged from 20 to 24 with college degrees, and holders of university decrees or higher remained high at 10.2%, 16.3% and 19.6% respectively. In quarter one, skilled workers accounted for 441,100 or 44% of the unemployed, up by 23,700 over the previous quarter. Among them, 190,900 had bachelor's decrees … [Read more...]
Social News 8/5
French building to be moved for Kinh Thien Palace restoration The Prime Minister has approved the moving of the two-storey building of the Department of Operations to a new location for the restoration of Kinh Thien Palace of Thang Long Citadel Complex in Hanoi. The French-built building where the Department of Operations was located during wartime blocks the front view of Kinh Thien Palace and disrupts the direct link between the palace and Doan Mon (South Gate) of the citadel. According to Dai Viet Su Ky Toan Thu (Complete Annals of Dai Viet), construction of the palace began in 1428 under the reign of King Le Thai To and was completed under King Le Thanh Tong. The palace is among the most important buildings in the citadel complex which was often used for royal meetings during the Ly (1009-1225), Tran (1226-1400), Le (1428-1789) and Nguyen (1802-1945) dynasties. Most of it was destroyed by French in 1886. They left behind only the floor and a staircase bordered by two stone … [Read more...]
Social News 2/5
Stone-carrying lorries stir up dust, loud noise Heavy lorries carrying stones have been driving around the clock and making a terrible and dusty environment in Phú Mãn Commune, in Hà Nội's Quốc Oai District. Over recent years hundreds of households in the commune, 30km from Hà Nội's centre, have suffered from serious pollution, but local authorities have not helped them. Stone exploitation at local mines was to blame according to local residents; some enterprises have been licensed to exploit stone since 2007. Before 2007, the environment of the six villages in Phú Mãn Commune was healthy, local residents said. Things started to get worse when stone mining began. Local people's daily activities were affected as were schools and health centres by the loud lorries. The 2.7 km main road linking the commune centre with the villages was seriously damaged, causing traffic jams. Early last year, Quốc Oai District authorities invested money from the local budget to upgrade the … [Read more...]
Saline intrusion hits shrimp farmers in Mekong Delta
Many farmers who breed brackish-water shrimp in the Mekong Delta have cut back on production because of high salinity this year. Many farmers who breed brackish-water shrimp in the Mekong Delta have cut back on production because of high salinity this year. Ly Thanh Dan, who has four ponds to breed shrimp in Bac Lieu Province's Hoa Binh District, is now breeding shrimp in only one pond. "I've stored water with low salinity since the last rainy season, but the water is only sufficient for breeding shrimp in one pond," Dan said. "Shrimp will grow very slowly in water with a high level of salinity." The industrial shrimp area in Bac Lieu covers about 2,500ha, accounting for less than 15 per cent of the province's total area devoted to shrimp breeding, according to the province's Aquaculture Sub-department. Pham Hoang Son, head of the province's Aquaculture Sub-department, said the salinity was expected to continue to be high in the coming time. "We have warned farmers, except … [Read more...]
Cambodian honourable order conferred on Vietnamese
PANO - General Huot Chheang, Deputy Commander of the Army and Chief of Military Region 1 of Cambodia on February 9th visited and extended new-year greetings to Gia Lai province and Corps 15. On this occasion, on behalf of the Royal Cambodian Government, the General conferred the Cambodian Friendship Order to Ha Son Nhin - Party Secretary of Gia Lai province, Pham The Dung - Chairman of the Gia Lai provincial People's Committee, Major General Dang Anh Dung - Commander of Corps 15, Major General Nguyen Duy Ngo - Corps 15's Political Commissar, and Major General Nguyen Xuan Sang - Former Commander of Corps 15. The honourable order was awarded to the leaders of the province and Corps 15 for their outstanding contributions to the construction of Cambodia. General Huot Chheang congratulated the leaders of Gia Lai province and Corps 15 and wished the people, armed forces of Gia Lai province and Corps 15 a cozy traditional new year and hoped that the friendship between the two … [Read more...]
Social News 30/1
Canadian man arrested for drug Customs officials at the Tan Son Nhat International Airport in Ho Chi Minh City January 28 released that they arrested a Canadian man for drug trafficking. He was found hiding nearly 50,000 tablets of methamphetamine at the bottom of his suitcases when he was checked upon arriving in the country. The drug is estimated to sell for over VND20 billion (US$952,000) in the Vietnamese market. Project launched to support high-quality vocational training in Vietnam The British Council will co-ordinate with the General Directorate of Vocational Training (GDVT) to implement a programme starting this March to improve the quality of vocational training at nine high-quality vocational training colleges across Vietnam. The above goal is part of the content of a Memorandum of Understanding signed between the two sides in Hanoi on January 28, aiming to develop vocational training quality assurance in vocational training facilities in Vietnam that are being … [Read more...]
Social News 21/12
USAID supports farmers to understand land rights The U.S. Agency for International Development (USAID) has launched a first-of-its-kind project worth US$800,000 in Vietnam to empower farmers, especially women, to enhance their access to land by increasing their awareness of existing land rights under current legislation. The two-year pilot project will help set up and train teams of grassroots community volunteers to assist farmers, particularly women, in the northern province of Hung Yen and the Mekong Delta province of Long An in improving their knowledge of land rights. In addition, the project will support the work of researchers to better understand documents and gender-specific barriers to realizing the land rights in rural areas. This project combines commune-level legal rights counseling and education with advocacy efforts with a focus on increasing the capacity of social and mass organizations to advocate for gender equitable implementation of land regulations, as well as … [Read more...]
Art & Entertainment News 17/12
First private war remnants museum opens in Hanoi The first-ever private war remnants museum just opened in downtown Ha Noi. The museum features thousands of war objects gathered across the country over the past 20 years by Nguyen Manh Hiep, a war veteran. The collection, which includes bomb shells, soldiers' utilities and photos, is being displayed in a 30-sq.m yard in front of Hiep's house, No 9, lane 144/2, An Duong Vuong Road. Young talents gather at HBSO concert Local young music talents will play at a concert hosted by the HCMC Ballet Symphony Orchestra and Opera (HBSO) at the City Opera House at 8 p.m. on Friday. Audiences will have a chance to admire beautiful and lively melodies of Wind quintet No. 1 in B-flat Major by Italian composer/violinist Giuseppe Maria Cambini by the performance of young talents of the HBSO Wind Quintet. Previously, the quintet took part in the Asian Orchestra Week in Tokyo, Japan in early September and had a solo concert in Natori City of … [Read more...]
First private war remnants museum opens in Hanoi
First private war remnants museum opens in Hanoi The first-ever private war remnants museum just opened in downtown Ha Noi. The museum features thousands of war objects gathered across the country over the past 20 years by Nguyen Manh Hiep, a war veteran. The collection, which includes bomb shells, soldiers' utilities and photos, is being displayed in a 30-sq.m yard in front of Hiep's house, No 9, lane 144/2, An Duong Vuong Road. Young talents gather at HBSO concert Local young music talents will play at a concert hosted by the HCMC Ballet Symphony Orchestra and Opera (HBSO) at the City Opera House at 8 p.m. on Friday. Audiences will have a chance to admire beautiful and lively melodies of Wind quintet No. 1 in B-flat Major by Italian composer/violinist Giuseppe Maria Cambini by the performance of young talents of the HBSO Wind Quintet. Previously, the quintet took part in the Asian Orchestra Week in Tokyo, Japan in early September and had a solo concert in Natori City of … [Read more...]
Lawmakers discuss State budget spending priorities
VietNamNet Bridge - National Assembly deputies looked into the spending of the 2013 State budget and the State budget estimates and allocation for the next year at their sitting last Saturday. Discussing the plan of issuing Government bonds and allocating the capital to important projects in the 2014-16 period, deputies agreed to prioritise capital to projects on National Highway 1A expansion and National Highway 14 construction. They suggested total investment in a number of sub-projects should be reviewed and their design should be adjusted so as to cut wasteful expenditures. In addition, the Government must ensure the progress and quality of projects to prevent exceeding the total funds allocated. The money collected from bond issuance should be instead channelled into hospital and irrigation projects which were slated to be concluded by 2014-2015 and had large effects on the economic development of localities, they said. Deputy Le Van Hoc from Central Highland province of Lam Dong … [Read more...]
Bicycle trips geared towards fit tourists
Photo book about diplomatic activities to be exhibited
Photojournalist Gian Thanh Son, who became famous for covering local politics with photography, will start an exhibition about his latest photo book, titled Dau an hoi nhap (Integration Milestone) at Rex Hotel on August 26. The exhibition will welcome the attendance of former President Nguyen Minh Triet and former Deputy Prime Minister Pham Gia Khiem. The two leading politicians' diplomatic trips and official visits are mostly reflected in the book through Son's lens. The 400-page-book, released last week and published by the Vietnam News Agency Publishing House in both English and Vietnamese, documents the country high-level leaders' diplomatic trips throughout Asia, Europe, America and Africa from 2005- 2010 period. Son said he will use all the profits from the book to help the underprivileged students in his homeland, Long An Province's Can Giuoc remote areas. The 54-year-old photojournalist began his career in 1975 and was recognized as one of the top leading … [Read more...]
Legislators see canaries in the mines
Lawmakers have lambasted the government for allowing ineffective mining operations to pollute local communities without bringing in funds to the state. "In mineral-rich areas, residents are often poor ones and authorities generate low revenues. These people have been suffering from a paradox as they live among rich mineral resources with nothing to show for it," said representative Ha Son Nhin of Gia Lai Province at a National Assembly meeting on June 16. "Mining activities have polluted the environment, damaged roads and destroyed arable land," he said as the assembly met to discuss a draft of the revised Minerals Law. Assemblyman Nguyen Dinh Nha of Ba Ria-Vung Tau Province echoed Nhin's sentiments. "Residents are terrified when minerals are discovered in their locality because they know they'll have to suffer pollution and relocation without any benefits," he said. Nha and many other representatives said the draft law should have stricter regulations to increase the … [Read more...]
To Huu – the people's poet
Revolutionary poet To Huu was born on October 4, 1920 in the imperial capital city of Hue as Nguyen Kim Thanh. Despite being poor, his family was quite artistic. His father was good at writing poems and his mother was well-known in the region as a singer of traditional songs. To Huu was brought up in a creative family environment, and started writing poetry at the age of six under the supervision of his father. At the age of 12, his mother died and a year later, To Huu went to Quoc Hoc - Hue High School. It was there that he started to learn about the plight of his country and Communist ideology. To Huu soon became a leader in the Democratic Youth League in Hue and in 1938 he was admitted to the Indochinese Communist Party. In April 1939, To Huu was arrested by the French colonial authorities and detained in several prisons in the central region, including at prisons in the Tay Nguyen Central Highlands. Despite the harsh conditions in jail, To Huu maintained his … [Read more...]
French jazz pianist to perform in Ho Chi Minh City French jazz pianist, composer and singer Franck Amsallem will give a special performance at the Institute of Cultural Exchange with France (IDECAF) in Ho Chi Minh City on March 10. Amsallem has released eight CDs under his name, including well-known pieces such as "I got Rhythm", and "Summer Times". He has also collaborated with famous musicians like Gary Peacock and Bill Stewart to have first albums. He has performed at major festivals in Europe, South America, Africa and Asia. He won the second prize at Jacksonville Great American Jazz Piano Competition in 1992. Amsallem spent 20 years in the US working with artists like Gerry Mulligan, Charles Lloyd, Joshue Redman, Maria Schneider and Harry Belafonte. The capital city of Hanoi will host a UNESCO Cultural and Development Week from March 5-9, according to the United Nations Education, Scientific and Cultural Organisation (UNESCO). The event, co-organised … [Read more...]
Nominees wait with bated breath
The 17th National Film Festival kicks off tonight, Dec 15, in the central province of Phu Yen, promising a tough competition with many productions from non-state studios participating. Ladies man : A scene from the film Nhung Nu Hon Ruc Ro (Bright Kisses) produced by the BHD studio. — File Photo The three-day festival, running through Saturday, has lured about 108 entries in the categories of feature, documentary, scientific and animated films, and will recognise and honour the best works of the past three years. Among the most anticipated features are the films Mui Co Chay (The Scent of Burnt Grass) and Tam Hon Me (Mother's Heart), both produced by State-run studios and not yet commercially screened. The film Long Thanh Cam Gia Ca (The Song about a Musician in Thang Long Citadel) is a strong contender for the Golden Lotus, with Nhat Kim Anh's performance in the film having already won the best actress award at the First Viet Nam International … [Read more...]
Photos document leader's trips
VietNamNet Bridge -Photojournalist Gian Thanh Son will release next month a book with photographs he took during former President Nguyen Minh Triet's overseas trips made over the 2007-10 period. Titled Dau An Hoi Nhap (Integration Milestones), the book, published by the Vietnam News Agency Publishing House in both English and Vietnamese, takes readers on a diplomatic journey through Asia, Europe, America and Africa. It records images of talks and meetings held by former President Triet with leaders and residents of the host countries and overseas Vietnamese communities. The president was accompanied by his wife and delegations of senior officials during these visits. In the introduction, Deputy Prime Minister and Foreign Minister Pham Gia Khiem says the book captures the diligence and passion of the photojournalist as he works to highlight the diplomatic achievements of Viet Nam during the integration and development period. Born in the southern province of Long An, the … [Read more...]


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Love Finds You in Golden, New Mexico(2010)
(A book in the Love Finds You series)
A novel by Lena Nelson Dooley
All that glitters is not gold. It's 1890, and Golden, New Mexico, is a booming mining town where men far outnumber women. So when an old wealthy miner named Philip Smith finds himself in need of a nursemaid, he places an ad for a mail-order bride - despite the protests of his friend Jeremiah. Hoping to escape a perilous situation back East, young Madeleine Mercer answers the ad and arrives in town under a cloud of suspicion. But just as she begins to win over Philip - and Jeremiah himself - the secrets she left behind threaten to follow her to Golden...and tarnish her character beyond redemption.
Genre: Inspirational
Genre: Inspirational
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Used availability for Lena Nelson Dooley's Love Finds You in Golden, New Mexico
See all available used copies of this book at Abebooks UK or Abebooks US
Paperback Editions
May 2010 : USA Paperback
|Title: Love Finds You in Golden, New Mexico
Author(s): Lena Nelson Dooley
ISBN: 1-935416-74-X / 978-1-935416-74-6 (USA edition)
Publisher: Summerside Press
Availability: Amazon Amazon UK Amazon CA
Genre Pages


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YPI's 7th Annual Gala takes place on Thursday, October 6—a beautiful outdoor celebration in the courtyard of historic Paramount Pictures in Hollywood. This year's honorees are Antonia Hernández, President & CEO, California Community Foundation; and Joseph Sanberg, Co-founder & Chair, Aspiration.com. Special guests include actors Chris Pine, Tim Robbins and Reid Scott, Mayor Eric Garcetti, celebrity chef Aarón Sánchez, the Vaughn High School Jazz Band, and the inspiring youth and families YPI serves.
Antonia Hernández
Nationally regarded for a career spanning decades in social justice, expertise in philanthropy and the nonprofit sector, and a lifelong devotion to underserved communities in Los Angeles County and beyond, Antonia Hernández joined the California Community Foundation as President and Chief Executive Officer in 2004.
Established in 1915, the California Community Foundation is one of the largest and most active philanthropic organizations in Southern California, with assets of more than $1.5 billion, and supports nonprofit organizations and public institutions with funds for health and human services, affordable housing, early childhood education, community arts and culture and other areas of need.
Previously, Hernández was president and general counsel of the Mexican American Legal Defense and Educational Fund (MALDEF), a national nonprofit litigation and advocacy organization dedicated to protecting the civil rights of the nation's Latinos through the legal system, community education, and research and policy initiatives.
An expert in philanthropy, civil rights and immigration issues, Hernández began her legal career as a staff attorney with the Los Angeles Center for Law and Justice and worked as counsel to the United States Senate Committee on the Judiciary before joining MALDEF in 1981 as regional counsel in Washington, D.C.
Hernández is a member of the boards of directors of the national American Automobile Association, the Automobile Club of Southern California, Council of Foundations, Center on Budget and Policy Priorities, Council on Foundations, Forest Lawn Memorial-Park Association, Grameen America and The Colonial Williamsburg Foundation.
She currently serves on advisory boards and committees including the Commission on Presidential Debates, the JFK Library Foundation Profile in Courage Award Committee and UCLA Board of Advisors among others. She is a frequent public speaker and has been awarded a number of honorary degrees and awards.
Hernández is a member of the State Bar of California, District of Columbia Bar, American Bar Association and the Mexican American Bar Association of Los Angeles and a fellow of the American Law Institute. She earned her B.A. in History at UCLA in 1970 and J.D. at the UCLA School of Law in 1974.
Joseph Sanberg
Co-Founder and Chair of Aspiration.com, Joseph Sanberg is a public and private-sector entrepreneur harnessing the power of technology to improve quality of life for all.
Aspiration.com is a consumer financial services company that was recently recognized as one of the World's 50 Most Innovative Companies by Fast Company Magazine in honor of its business model that empowers customers to choose their fees.
Sanberg is also a founding investor of Blue Apron, the leading meal-kit delivery service in the United States.
This past year, Sanberg founded and chaired CalEITC4Me, a community organizing campaign to connect low-income families with California's new Earned Income Tax Credit.
Sanberg was raised by his mother in a single parent household in Orange County. He earned his A.B. from Harvard University.


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Subscribe to JotForm and Pay via Brank Transfer?Asked by EquipeAc on January 16, 2013 at 08:06 PM
Quero pagar com boleto bancário, tem como?
JotForm Support
Can you please clarify if you'd like to subscribe to one of our paid plans and pay via Bank Tranfer? If so, bank transfer might be possible but I have to address your inquiry first to our higher management so they'd be able to guide you with this, if it's really possible. They'll get back to you once they're notified about this.
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We wish to receive bills at a law firm, as this can be done? We hope that you will issue an invoice for 1 year.
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Bangkok Dangerous (2008) BRRip 720p Dual Audio [English-Hindi] Movie Free Download
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10 photos
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Tablet PCs received the most number of buyer inquiries among all consumer electronics, computer, and telecom products on the Global Sources website in June 2012. The category accounted for 43 percent
Hot product: Tablet PCs most searched electronics on Global Sources for 10 months in a row Buyer inquiries for tablet PCs remain high; demand for iPhone accessories growing as iPhone 5 launch nears. Tablet PCs received the most number of buyer inquiries among all consumer electronics, computer, and telecom products on the Global Sources website in June 2012. The category accounted for 43 percent of total inquiries received by the top 20 products. Driven by new releases from industry giants such as Apple, Samsung, Amazon and Microsoft, inquiries for tablet PCs have soared 97 percent from the same month a year ago. Most searches focused on less-expensive China-made white-box tablets priced about $200. And although June 2012 figures dropped 23 percent from the previous month, the line remains red hot, consistently receiving the biggest number of inquiries for the past 10 months. China suppliers are expected to turn out 40 million tablet PCs this year, with 30 million units shipped abroad. USB flash drives placed second in June, with inquiries jumping 25 percent from May. Novelty designs and USB 3.0 are the current trends in the line, with China makers leveraging their strength in aesthetics and OEM capability to capture a significant share of orders. Hard drives are the standout, with inquiries surging more than 600 percent YoY. Buyers turned to China to fulfill sourcing requirements as production in Thailand, the world's key hub for hard drives, practically ground into a halt in October 2011 after months of pervasive flooding. Anticipation for the iPhone 5 is spurring searches for related products on the Global Sources website such as accessories for the iPhone, mobile phone cases and chargers, and power banks. Inquiries for the first soared 78 percent month-on- month in June. Leather cases for the iPad, wired headphones and microSD cards are also highly in demand among international volume buyers. Read the full report on Global Sources top 20 electronics products: June 2012. Global Sources is a leading B2B portal and a primary facilitator of trade with China manufacturers and India suppliers, providing essential sourcing information to volume buyers through our e-magazines and trade shows.


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Westfield, New Jersey (PressExposure) August 01, 2011 -- Milestones are celebrated because they represent an accomplishment in terms of experience. This is even more true as BOC Partners celebrates its10th year of being in business as an Automotive Advertising Agency.
BOC Partners started ten years ago as the brain child of Britain O'Connor, a person who had many years of experience within the advertising industry. However, all these years of experience were as a worker within a larger firm. After many years of learning the ins and outs of the automotive and advertising industry, he decided that he was ready to go on his own and create an automotive ad agency. The result was BOC Partners. For more information about their background story, please visit [http://bocpartners.com/about-us].
At the present, BOC Partners is based in NJ, but it serves clients in the greater New Jersey area including Pennsylvania (PA), New York (NY), and Delaware (DE). It runs advertising for all different types of car brands. There are foreign brands like BMW, Mercedes Benz, Lexus,Toyota and Honda while there are also domestic brands like Ford, Jeep, Land Rover and Chevrolet. Furthermore, there is even advertising for extreme luxury car brands like Porsche.
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Welcome to BOC Partners, Inc. We're a unique advertising agency that specializes in both traditional media and online marketing. We have been around for 25 years and our focus is on building traffic, be it showroom traffic, phone traffic, or online traffic. We not only practice the art of traffic building, but also the art of increasing conversions while focusing on quality. Located right in the middle of New York City and Philadelphia, we are sitting in two of the top markets in the country, but our great ideas and tracking techniques will work anywhere. To see our work and learn more about us, please visit our website at http://bocpartners.com


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Sherwood by Susan Pandorf
Welcome! You are browsing as a guestWould you like to see 12 projects made from this pattern and much more? create a free account What am I missing?
This pattern is available for $8.00 USD
buy it now or visit pattern website
buy it now or visit pattern website
Long, rectangular stole features leafy patterns with bronze beading.
Robin Hood - eat your heart out!
For more information, see: http://afewstitchesshort.blogspot.com/


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The Story Of My Life
My name is Angela Garza,but everybody calls me Angie. My favorite thing to do is sing and be on my phone. I love to go to the beach and just sit in the sand while listening to music. My favorite color is red. I dislike having to straighten my hair because it takes forever.
I watched almost 2 full seasons of Orange is the New Black in less then 2 days.


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Added: Wednesday, June 26, 2013
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