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Look For Leather-Free Boots This Fall
Now that fall is here, it seems more and more people are turning to boots. But not just any boots, they're black and most likely leather! Sure style is important to many people, but who says their style can't be … Continue Reading →


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Model Selection for Weakly Dependent Time Series Forecasting
Observing a stationary time series, we propose a two-step procedure for the predictionof the next value of the time series. The first step follows machine learning theory paradigmand consists in determining a set of possible predictors as randomized estimators in (possiblynumerous) different predictive models. The second step follows the model selection paradigmand consists in choosing one predictor with good properties among all the predictors of the firststeps. We study our procedure for two different types of observations: causal Bernoulli shifts andbounded weakly dependent processes. In both cases, we give oracle inequalities: the risk of thechosen predictor is close to the best prediction risk in all predictive models that we consider. Weapply our procedure for predictive models such as linear predictors, neural networks predictorsand non-parametric autoregressive predictors.
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Whiplash, injury to the cervical spine and its soft tissues caused by forceful flexion or extension of the neck, especially that occurring during an automobile accident. It may involve sprain, fracture, or dislocation and may vary greatly in location, extent, and degree. Sometimes it is accompanied by concussion. Whiplash is characterized by pain, muscle spasm, and limited motion. Treatment includes protective support for the neck and back and sometimes the attachment of weights to the head or legs to stretch the injured muscles and relieve pressure on nerves.
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MOVIE SYNOPSIS [ General Audiences ] Being a creation directed by Alexander Kane, this feature film in English (subtitles) was presented in 2015. This film, a creation of Alexander Kane, is an original production of USA. You can watch The Enemy online on TV cable or theaters with original audio in English at different dates. This film premiered in theaters in 2015.
Rating: 5 by 10 users./
Runtime: 100 minutes
Cindy Lucas, Brittany Athey, Deborah Funes, Robin Coleman, Andrew Roth, Jessica Chow, Serena Lorien, LaToya Ward, Gabriel Voss, Sara Stokes, Carissa Blades, Deirdre McCullagh, Mardell Elmer, Maya Tremblay, Dawn L. Hall and Leo Rogstad.
Terror, Thriller.
100-minute film (full movie) directed by Alexander Kane.
The original audio of The Enemy has dialogues in Dolby Digital, it was produced in USA.
It premiered in cinemas or television in 2015.
Screenplay written by Alexander Kane.
John McClung.
Kevin Pierce, Rob Andrews, Kim Kit, Alexander Kane, R.J. Cruz, Margarita Timothee and Romell Foster-Owens.
This film was produced and / or financed by Blitz Entertainment, Collaborative Effort Productions, R2R Media Group, DMV Entertainment Group and Midnight Oyl Entertainment.
Veritas Gold.
Without commercial breaks, the full movie The Enemy has a duration of 100 minutes; the official trailer can be watched in streaming on the Internet. You can watch this full movie free in EnglishDolby Digital in movie TV channels, renting the DVD or with VoD services (Video On Demand player, Hulu) and PPV (Pay Per View, Netflix).
See the page of this full movie, The Enemy in FULLTV Movies.


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All reviews seem negative
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In-house teams are increasingly demanding that their panel firms collaborate more on projects. This week has already seen significant moves by RBS and Barclays, which are now requiring law firms to partner with each other. This is the future.
RBS drafts in Richard Susskind as firms put on standby for panel cull
Barclays: work together to keep panel place
The in-house interview: Superdry GC Lindsay Beardsell
An open goal for regional players
Can the collaboration trend work in favour of the mid-size firm?


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Pakistani Prime Minister Raja Pervez Ashraf offered his prayers at the Ajmer Sharif dargah on Saturday amid protests by groups and a courteous welcome by the Indian government.
Ashraf, who arrived in Jaipur on Saturday with about 50 people including family members, was received by Indian External Affairs Minister Salman Khurshid.
Khurshid, who hosted a lunch for the Premier in Jaipur, said he did not discuss issues like terrorism with Ashraf because he was on a private visit to India.
"Today it was a private visit. There was no official talk. We will do it at the appropriate time," Khurshid told reporters after the lunch.
"This was a private visit. It was a pilgrimage (for Ashraf). This was not the occasion nor did I have the authority to discuss such issues," he said in response to questions about terrorism and border clashes.
Earlier, before Before leaving for Jaipur to receive the Pakistani PM, Khurshid said, "We welcome our guests with open arms. It's in our culture to welcome our guests with open arms. Whoever speaks about it, won't worry us."
Asharaf, on a private visit to the Sufi shrine of Khwaja Moinuddin Chishti, will not visit New Delhi.
Following his lunch, Ashraf and family left in three helicopters for Ajmer where he offered a green-coloured chadar (sacred cloth) to the dargah.
Security was heightened in Jaipur and Ajmer where several groups of people held protests against the Pakistani PM´s visit.
Ashraf´s route to go back to the helipad in Jaipur was changed after lawyers blocked the Ambedkar Circle route that he was originally supposed to take.
Asharaf also faced a symbolic boycott by the chief cleric at the dargah who had announced he would not assist him in prayers to protest the killing and mutilation of two Indian soldiers along the border earlier this year.
India´s main opposition Bharatiya Janata Party (BJP) slammed Salman Khurshid for his welcome spread for Ashraf.
Senior BJP leader Yashwant Sinha said, "This move is against the feelings of the people of the country who are deeply hurt over the January 2013 beheading of two Indian soldiers along the Line of Control in Jammu and Kashmir."
Earlier, the spiritual head at Ajmer Sharif Deewan Sayyad Zainual Aubedin Ali Khan said he he does not welcome the planned visit by Ashraf in protest of the killing and beheading of Indian soldiers by Pakistani troops along the border.
"I will not welcome the Pakistani Prime Minister during his visit here in protest against the beheading of Indian soldier by Pakistani Army on LoC. The incident hurt Indians but their government is not understanding our sentiments so I took the decision," Khan was quoted as saying.
"It will be a dishonor to the families of the Indian soldiers who were beheaded by Pakistani army...I have no idea why he is coming here," he said.
Salman Khurshid when approached by media said Indians know how to welcome their guests and the question should be asked to the cleric instead of him.
Khurshid on Friday said that he would receive and host a lunch at the Hotel Rambag Palace in Ajmer on that day for the visiting dignitary as a courtesy
"This is a private visit. I will be there briefly just to extend the courtesy of receiving him, that´s all," he said.
Ties between India and Pakistan had strained earlier this year after Pakistani troops killed and mutilated the bodies of two Indian soldiers along the Line of Control in Jammu and Kashmir.


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London, United Kingdom (PressExposure) February 15, 2013 -- TechNavio today launched its report, Tubeless Tire Market in India 2012-2016, based on an in-depth analysis exclusively focusing on India. The report aims to aid decision makers' understanding of the significant trends impacting this market.
Commenting on the report, an analyst from TechNavio's Automotive team said: "Radialization has been one of the major trends in the Tubeless Tire market in India. The effectiveness of radialization depends on various factors such as retreading facility, overload control, and road development. Radialization is being adopted at a relatively slow pace in India because of some issues such as the unsuitability of many Indian roads for radial tires, inappropriateness of the geometry of older vehicles for fitment, and the price-sensitive nature of consumers. However, despite these limitations, the tire manufacturers in India are improving their technical capabilities to produce radial tires."
According to the report, the growth of passenger vehicle production is one of the major drivers for the Tubeless Tire market in India. The Passenger Vehicle market in India is the largest consumer of tubeless tires in India. Hence, the growth of passenger vehicle production directly influences the demand for tubeless tires in the country.
Further, the report reveals that the increase in the cost of raw materials and commodity products is one of the major challenges in the Tubeless Tire market in India.
The study was conducted using an objective combination of primary and secondary information including inputs from key participants in the industry. The report contains a comprehensive market and vendor landscape in addition to a SWOT analysis of the key vendors. For further information on this report, please visit http://www.technavio.com/content/tubeless-tire-market-india-2012-2016
TechNavio, the market research platform of Infiniti Research Ltd, publishes periodic market research reports on niche and emerging technologies. For more information on our Automotive market research, please visit http://www.technavio.com/automotive
Follow us on Twitter https://twitter.com/TechNavio


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Siliguri, May 26: The Tea Board of India has decided to go in for a logo for brew produced in the gardens of the Terai and Dooars.
'The idea to have a separate logo for tea coming from these north Bengal regions (other than Darjeeling) came up during a discussion at a Tea Board meeting in Calcutta recently,' Basudeb Acharya, the chairman of the board, told The Telegraph. 'We have agreed in principle to go for it, but the discussions are at a very preliminary stage. Very soon, we will ask the producers of north Bengal for their opinion before the logo is designed and copyrighted.' The Dooars and Terai regions produce more than 200 million kg of tea every year. This amounts to more than 25 per cent of India's total tea production.
Tea growing zones like Assam, Darjeeling and Nilgiri have their own distinctive logos. When displayed on any package, a logo is a guarantee that the tea for sale has come from that region, and that it has not been blended with brew from any other source. All producers, manufacturers, packagers, blenders, exporters and traders need to apply for a licence to use the logo. When they do so, they must provide the Tea Board with a sample of their product and proof that it was grown where they claim it had been. Licence is granted if the board is assured that the product is good enough and is indeed genuine'for example'Assam, Darjeeling or Nilgiri tea.
Representatives of the Tea Board also conduct surprise checks to ensure that the sample, against which the licence was granted, matches the tea that finally goes on sale.
'When there are different logos for tea grown in Assam, Nilgiri and Darjeeling, it is only proper that a separate one be assigned for the Terai and the Dooars, which produce such large quantities of tea,' said Rajiv Lochan, the secretary of Siliguri Tea Traders' Association. 'There is a need to create a separate identity for this product. Recently, during a discussion on tea with local minister Asok Bhattacharya, we had informally raised this issue and were later told that he took the matter up with the tea board. We are happy that the tea board is working on this.
P.K. Bhattacharya, secretary of the Dooars Branch of Indian Tea Association, said the logo would help market the Terai-Dooars tea in the niche market. 'It will give a distinct identity to the tea that will help us market it both nationally and internationally.'
The tea from the plains of north Bengal is mainly of the CTC variety and is domestically consumed. 'There is a good market for this tea in Pakistan and the Middle East as well,' Lochan said.
'A logo will help us build a goodwill,' U.B. Das, secretary of the Terai Branch of Indian Tea Association. 'Given that certain quality standards need to be maintained in order to use the logo, it also means that the quality of tea from this region will improve.'


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The Victoria Jane collection uses the techniques and qualities of contemporary couture. Using only the finest fabrics, the Victoria Jane collection has something for every bride, whether it is a slim bias cut dress or a more classic, structured A-line. Designer Veni Infantino brings her knowledge and love of the bridal and fashion industry to create a collection that offers you a chance to be a beautiful bride with style and elegance.
A lace appliqued bodice with beaded neckline and illusion back sits on a full tulle & organza ball gown


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Released: 2011
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Philo residents who live near the Rockies Express Pipeline are back in their homes after a gas leak near Irish Ridge Road on Saturday, but some are still on edge.
Muskingum County Commissioner, Brian Hill, says that is completely understandable.
"I'm sure it made them nerous. It would make me as well. Again, I think the responders-as in any kind of accident-responded well and did their jobs. I guess that would help me feel somewhat settled, " says Hill.
Hill says it's unfortunate something malfuntioned at that particular compressor station.
"It's a huge project. I'm sure it's hard to go thousands of miles across this country and not have something like this happen. It's just unfortunate that it happened here in Muskingum County, " says Hill.
No one was injured in the incident.
Hill says Rockies Express Pipeline representatives are working to address exactly what happened.
The Rockies Express Pipeline is about 17 hundred miles long and extends through eight states.


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Is Your Toilet Working Correctly?
At Lenox Plumbing we are experts at helping you fix any and all plumbing problems!! In this blog you'll find the most common reasons your toilet may not be working correctly. If these quick fixes don't work or you are still having trouble, give us a call!!
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Michigan weather has been ever changing! Make sure you are checking your sump pump and basements regularly for any standing water. Also, check your outside discharge line and keep it clear of any debris.
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BRRRRR!! It's cold outside! We've recently replaced many water heaters and frozen pipes in the Metro Detroit area. Lenox Plumbing wants to remind you to keep an eye on your plumbing during these frigid temperatures! When temps drop below freezing it's very common for plumbing problems to occur.
Do you know about backflow prevention?
Did you know we are certified to do back flow testing? We can also install required valves to protect against back flow in your water system. In addition, many local towns require yearly testing. We can do that for you!…


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Cellet Blue 3.5mm Stereo Neckband Earhook Hands Free Headset with Microphone (on & off switch)
Conquer many tasks while talking on your phone hands free with the 3.5mm Stereo Hands-Free Headset. Featuring a sporty design, this headset provides clear stereo sound quality to your ears and to the end user. The convenient microphone allows you to make and receive calls at the touch of a button. Equipped with a 3.5mm pin, it it compatible with all universal 3.5mm headphone jacks.
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If an item you ordered from TextbookRush does not meet your expectations due to an error on our part, simply fill out a return request and then return it by mail within 30 days of ordering it for a full refund of item cost.
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All the information you need in one place! Each Study Brief is a summary of one specific subject; facts, figures, and explanations to help you learn faster.
List price: $40.50Edition: 1stPublisher: West Publishing Company, College & School DivisionBinding: HardcoverPages: 537Size: 8.00" wide x 9.75" long x 1.25" tall Weight: 2.838Language: English
Catherine Marshallis professor in the Department of Educational Leadership at the University of North Carolina, Chapel Hill. Once a teacher in Rhode Island, her studies include a doctoral degree from the University of California, Santa Barbara and a postdoctoral fellowship at the University of California, Los Angeles. She has published extensively about the politics of education, qualitative methodology, and women's access to careers as well as about the socialization, language, and values in educational leadership. She is the author ofReframing Educational Politics for Social Justice(Allyn & Bacon, 2004) as well as other books and numerous articles on the administrative career. nbsp; Maricela Olivais an assistant professor in the Department of Educational Leadership and Policy Studies at the University of Texas at San Antonio. With a doctorate in Educational Administration from The University of Texas at Austin, Oliva is the author of a number of journal articles, book chapters, and reports regarding curricular multiculturalism and social justice for educational leaders.
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QSAC Has a Picasso!June 28, 2010 3:21 pm Published by QSAC
Michael K.'s artwork "A Winter Landscape" was selected as 1 out of 800 participants for Exhibition at the MOMA for July 8-Aug 8th. "I drew this picture from my head, and did not have any challenges in creating it," said Michael. "I like to draw all the time and my teacher always inspires me to be creative." Michael is 14 years old and has been receiving waiver residential habilitation and MSC services from QSAC for over a year.
A Note from Michael's Teacher: Before students began their landscapes, they identified cool colors and discussed how these colors can invoke feelings of winter. Looking at Impressionist winter landscape paintings by Claude Monet and Alfred Sisley, they noted horizon lines and how each artist used white in his paintings to convey a sense of the season. We wove Blueprintstrand two, Visual Literacy, into our art making, and the visual interpretations helped students to develop descriptive language. Michael showed skill in manipulating the chalk and the paint. He used space well and developed an interesting composition with a strong sense of line.
Congratulations Michael!


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@mg wrote:
"Use a large town or city branch for your application, they usually have go-ahead managers who can push the application if a bit iffy, as head offices listen to good managers." – But when the finance market is in such a poor state of health, why should any manager "push" an "iffy" application.
If the applicant is "iffy", why not just show them the door. If they are "iffy" to start with, what happens if the market deteriorates?
A.) Hand the keys back and expect to walk away from debt. Like Hell. Don't lend to them.
There is iffy and there is iffy mg.
Using another case to illustrate. I had a client who owned 2 properties outright, total value 365,000€.
She works part time with no pay slips to prove personal income. She has the chance to buy the business she works for, which is very profitable.
So, any normal bank would refuse to look at it because there is no proof of income. Even though she is "equity rich" – the banls needed proof of earnings.
I took the modelos of the current owner to the bank to prove future/possible earnings to her existing local bank – they refused it. I took the same details to my preferred branch of the same bank and it was approved.
That is my kind of iffy mg, I don´t deal in the seedy world of no-hopers.
As I said, there is iffy and there is iffy!!


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Governor C.L. "Butch" Otter announced the appointment today of Caldwell attorney Christopher Nye to a new Third Judicial District judgeship created by the Idaho Legislature last winter.
Nye, a partner with White Peterson Attorneys at Law in Nampa, is a Kansas native who received his bachelor's and law degrees from Kansas University. He has been practicing law in Idaho since 1983, first as a deputy prosecutor for Canyon County, then as a deputy public defender in Nampa before entering private practice in 1990. His practice has focused on civil litigation and family law.
Nye was among three candidates nominated by the Idaho Judicial Council for the new position. .
"I'm confident that the steady, consistent quality of Chris's work, and his fair and evenhanded judicial temperament, will serve the people of Canyon County well," Governor Otter said. "He'll make a great addition to the Third District bench."
Nye and his wife of 34 years, Vicki, have one son who is a student at the College of Idaho in Caldwell.
Source: http://gov.idaho.gov/mediacenter/press/pr2013/11%20Nov/pr_64.html


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text: The Cost and Cost-Effectiveness of Expedited Partner Therapy Compared With Standard Partner Referral for the Treatment of Chlamydia or GonorrheaGift, Thomas L. PhD*; Kissinger, Patricia PhD†; Mohammed, Hamish PhD, MPH‡; Leichliter, Jami S. PhD*; Hogben, Matthew PhD*; Golden, Matthew R. MD, MPH§¶Sexually Transmitted Diseases: November 2011 - Volume 38 - Issue 11 - pp 1067-1073 doi: 10.1097/OLQ.0b013e31822e9192 Original Study Abstract In Brief Author Information Article Outline Background: Partner treatment is an important component of sexually transmitted disease control. Several randomized controlled trials have compared expedited partner treatment (EPT) to unassisted standard partner referral (SR). All of these trials found that EPT significantly increased partner treatment over SR, whereas some found that EPT significantly lowered reinfection rates in index patients. Methods: We collected cost data to assess the payer-specific, health care system, and societal-level cost of EPT and SR. We used data on partner treatment and index patient reinfection rates from 2 randomized controlled trials examining EPT and SR for patients diagnosed with chlamydia or gonorrhea. Additional elements were estimated or drawn from the literature. We used a Monte Carlo simulation to assess the impact on cost and effectiveness of varying several variables simultaneously, and calculated threshold values for selected variables at which EPT and SR costs per patient were equal. Results: From a health care system or societal perspective, EPT was less costly and it treated more partners than SR. From the perspective of an individual payer, EPT was less costly than SR if ≥32% to 37% of male index patients' female partners or ≥29% of female index patients' male partners received care from the same payer. Conclusions: EPT has a lower cost from a societal or health care system perspective than SR and treats more partners. Individual payers may find EPT to be more costly than SR, depending on how many of their patients' partners receive care from the same payer. Expedited partner treatment for partners of patients diagnosed with chlamydia or gonorrhea has lower societal costs than standard partner referral, but payer-specific costs can be higher for expedited partner treatment. *Centers for Disease Control and Prevention, Atlanta, GA; †Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; ‡The University of Trinidad and Tobago, Trinidad, West Indies; §University of Washington Center for AIDS & STD, Seattle, WA; and ¶Public Health Seattle-King County, Seattle, WA Supported by the National Institutes of Health (Grant Number R01AI068107) (to M.R.G.). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Correspondence: Thomas L. Gift, PhD, Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA 30333. E-mail: firstname.lastname@example.com. Received for publication April 13, 2011, and accepted July 18, 2011. Abstract MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES Cited By Partner treatment is a longstanding and critical part of public health efforts to control the spread of curable sexually transmitted diseases (STDs).1 However, relatively few health departments in the United States routinely assure that the partners of persons with gonorrhea or chlamydia are treated. The failure to treat infected sex partners is known to be one factor underlying the persistence of high rates of STD in the United States.2 Unassisted standard partner referral (SR), in which STD patients are counseled to refer their partners for examination and treatment, is also the norm with private providers.3 In the late 1990s, the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) funded 4 randomized trials to help define a new, low-cost approach to increase partner notification and treatment for gonorrhea, trichomoniasis, and chlamydia. These studies evaluated what is now referred to as expedited partner treatment (EPT) or patient delivered partner therapy. EPT typically involves giving infected patients medication for their sex partners. EPT increased the proportion of partners treated in all 4 trials, and 2 of the 3 trials evaluating EPT for gonorrhea or chlamydia found that EPT significantly reduced the risk of persistent or recurrent infection in index patients.4–7 Another trial in the United Kingdom found that EPT for partners of female patients with chlamydia improved partner treatment over SR, but did not find a significant difference in persistent or recurrent infection.8 EPT is permitted in some form in a majority of US states; however, but its use may not be widespread even where it is legal.9,10 One factor thought to limit widespread adoption of the intervention is cost. Some health plans have been reluctant to assume the costs of providing medication for sex partners who may not be in the same plan. In this analysis, we examine the cost of EPT for partners of patients diagnosed with chlamydia or gonorrhea. Back to Top | Article Outline MATERIALS AND METHODS Cost data were collected in 2003 in EPT randomized controlled trials in King County, WA, and New Orleans, LA. Both trials have been previously described; both randomly assigned patients to receive either SR or EPT.5,6 In Seattle, male and female patients diagnosed with chlamydia or gonorrhea were contacted by the health department using case and laboratory reports.5 Index cases providing oral informed consent and randomized to EPT were able to pick up partner packs at selected high-volume clinics, participating commercial pharmacies, the Public Health Seattle-King County (PHSKC) STD clinic, or via direct mail. PHSKC staff contacted partners at patients' request. Partners of persons in the EPT arm could obtain partner packs at pharmacies, the PHSKC STD clinic, or via the mail. In New Orleans, men diagnosed with urethritis at a public STD clinic were invited to participate in the trial.6 Patients providing written informed consent and randomized to EPT were given up to 4 partner packs for their sex partners. To determine the labor cost associated with conducting the SR and EPT interventions, staff collected time-motion data. Because the case and laboratory reports were used to facilitate contacting patients in the Seattle study, the time spent entering the reports was tracked, in addition to the time spent interacting with the patients. Staff in Seattle also tracked the amount of staff time used to contact partners and pharmacies, and assemble and deliver partner packets to pharmacies. Staff also kept track of all activities in time diaries for 1 week. The proportion of the day devoted to administrative activities was determined (this included activities like answering e-mail and shredding documents). Time spent on these administrative duties was apportioned to other activities as an overhead cost. In New Orleans, staff collected time-motion data to determine the staff time required to counsel patients. At each site, the time cost per enrolled patient was adjusted by the participation rate. Time spent in contacting patients not enrolled in the study was apportioned among those who did enroll to get a final time cost per patient enrolled. Differences in time spent on patients in EPT and SR were tested for statistical significance using t tests. We assumed that disease investigation specialists would be paid at the federal employee GS-9, Step 3 level and that supervisors would be paid at the GS-11 Step 3 level.11 Time-motion data collection procedures were approved by institutional review boards at the CDC. Additional costs came from the literature or from data available from the study. These included estimates of the cost to treat partners and the cost of sequelae of chlamydial and gonococcal infection in women (pelvic inflammatory disease [PID] and its sequelae of chronic pelvic pain, ectopic pregnancy, and infertility).12–17 The upper bounds for partner examination and treatment costs were taken from studies of the cost of care for chlamydia and gonorrhea among privately insured persons and were selected to depict the cost structure private providers might face when assessing EPT and SR. The percentage of partners treated in each arm was based on index patient self-report. Because a proportion of partners treated through EPT may also have visited a health care provider after receiving a partner pack, a variable controlling for this was included. Estimated productivity losses associated with health care visits and sequelae were drawn from the literature.18–20 Costs were adjusted to 2008 US dollars using the Consumer Price Index for All Urban Consumers (productivity costs) and the Medical Care component of the CPI (costs of testing, treatment, sequelae, and clinical health care visits).21 We used multiple cost perspectives. The baseline used a health care system perspective, including all direct medical costs for counseling, treatment, and sequelae. A societal-perspective analysis added patient productivity losses to the health care system costs. A payer-perspective analysis included direct medical costs for index patients, EPT, and partner visits and sequelae only to the extent that partners would seek clinical care paid by the same payer. The payer-perspective analysis was included to assess the impact of EPT compared with SR from the perspective of an individual organization, such as a health insurer or county or state health department. The time frame of the cost analysis was bounded by the follow-up times in the studies: 3 to 19 weeks in Seattle-King County and 4 to 8 weeks in New Orleans. The analytic horizon included lags of up to 10 years for sequelae of PID, although for the payer-perspective analysis, we used an analytic horizon of 5 years.12,14 Because patients change insurers frequently, care for sequelae developing with a large time delay may not be directly paid by the insurer at the time of the initial chlamydial or gonococcal infection. Cases of PID were converted to quality-adjusted life-years (QALYs) lost using previously published health utility index values.22,23 We did not assess any QALY loss due to acute chlamydial infection. We conducted Monte Carlo simulations (10,000 iterations) in which the variables used in the analysis were simultaneously varied over ranges. Monte Carlo simulations allow the simultaneous varying of all uncertain variables in a model.24 We used a uniform distribution for the proportion of partners receiving care from the same payer. All other variables were assumed to follow a triangular distribution, which can be characterized with only a maximum, minimum, and median.25 We also conducted univariate sensitivity analyses, including an analysis in which we set the proportion of index patients infected at follow-up equal to each other for Seattle at 0.12, the combined average rate for EPT and SR for index patients initially diagnosed with chlamydia. We further used Seattle data to examine the cost difference between EPT and SR under varying assumptions about how EPT might be implemented. First, data entry costs were eliminated for both EPT and SR, and counseling costs were eliminated from SR. This analysis depicted 2 systems for comparison. First, it depicted a system in which public health staff provides EPT to persons with gonorrhea and chlamydia. Second, it depicted a system that maintains case report information but provides no public health partner services. Second, all counseling and data entry costs were eliminated for both EPT and SR. This depicted a partner notification system in which providers use EPT but do not elicit information about partners or counsel patients beyond that typically done following an STD diagnosis. In this analysis, we assumed health departments would not perform partner notification for partners of patients with gonorrhea or chlamydia. Data were analyzed using Stata 11.0 (StataCorp LP, College Station, TX) and Excel 2007 (Microsoft Corporation, Redmond, WA). Back to Top | Article Outline RESULTS The variables used in the analysis are shown in Table 1. The staff time spent per patient did not significantly vary between the standard referral and expedited partner therapy arms at either site (P < 0.05). The costs, partners treated, and QALYs lost in index patients and their partners are shown in Table 2. At baseline, EPT was more effective in treating partners, resulted in the loss of fewer QALYs, and was lower in cost than SR (whether considering health care system costs or societal costs); therefore, EPT was cost saving. The Monte Carlo simulation varied all variables over the ranges in Table 1 and calculated the cost per index patient for SR and EPT. EPT was less costly from a health care system perspective than SR in all but an average of 3 per 10,000 simulations or fewer when considering Seattle data (for men or women), and an average of 144 per 10,000 simulations when using New Orleans-specific data over 10 iterations. Table 1 Table 2 To compare the cost per index patient of SR and EPT from the perspective of an individual payer, we included a variable to control for the proportion of partners of the index patient whose costs for medical care would be paid by the same payer as that of the index patient. A Monte Carlo simulation including this variable yielded the costs per index patient shown in Figures 1A (Seattle) and B (New Orleans). The horizontal axis of each graph indicates the proportion of partners whose costs for care would be paid by the same payer as that of the index patient. The vertical axis indicates the cost per index patient of EPT minus SR: a negative value indicates that EPT would cost the payer less per index patient than SR. Trend lines are shown on each figure. The point at which the trend lines in each figure cross the horizontal axis shows the proportion of partners at which the costs of EPT and SR are equal—these are 0.32 and 0.37 for female partners of index men (Seattle and New Orleans, respectively) and 0.29 for male partners of index women (Seattle). Figure 1 Figure 1 In Table 2, we assumed that 25% of partners receiving EPT also sought medical evaluation (clinical care). Changing the distribution of the variable for the proportion of partners of the index patients receiving EPT who would also seek clinical care to a baseline of 0.50 (range, 0.25–0.75) yielded Monte Carlo results qualitatively similar to those in Figures 1A and 1B, with the exception that the threshold values for cost equivalence changed to 0.48 (from 0.32) and 0.54 (from 0.37) for female partners of index men (Seattle and New Orleans, respectively) and 0.52 (from 0.29) for male partners of index women (Seattle). When the partner care-seeking proportion was lowered to a mean of 0.10 (range, 0.0–0.25), the threshold values for cost equivalence changed to 0.28 (from 0.32) and 0.32 (from 0.37) for female partners of index men (Seattle and New Orleans, respectively) and 0.23 (from 0.29) for male partners of index women (Seattle). A Monte Carlo simulation was also used to compare the payer-perspective costs "per partner treated" (rather than "per index patient") of EPT and SR. This is a different analysis than the cost per index patient because the number of partners treated by EPT is greater than the number of partners treated by SR. The cost per partner could be lower with EPT than with SR even though the cost per index patient might be higher with EPT than with SR, because more partners are treated with EPT than with SR. The payer-perspective cost per partner treated using EPT or SR was equal when the proportion of partners of index men receiving care funded by the same payer as the index man was 0.03 and 0.07 (Seattle and New Orleans, respectively). At higher proportions of partners receiving care funded by the same payer as the index, EPT was less costly per partner than SR. For index women, the payer-perspective cost per partner treated was lower using EPT than when using SR, regardless of what proportion of men received care from the same provider (Seattle). In univariate sensitivity analysis, EPT treated more partners than SR across the entire ranges of the proportions of partners treated for EPT and SR. However, even if the proportion of partners treated for EPT was set equal to those treated for SR, EPT was less costly using either a health care system or societal perspective, meaning that EPT was still cost saving even when it was not more effective in terms of the number of partners treated. In terms of cost per index patient, EPT was less costly than SR unless the proportion of partners receiving EPT who also sought clinical care exceeded 0.66 from a health care system perspective or 0.82 from a societal perspective using Seattle data. When we set the infection rates at follow-up for EPT and SR equal to each other, EPT remained cost saving from the health care system and societal perspectives. We conducted additional sensitivity analyses using Seattle data to estimate the cost-effectiveness of EPT in different health care systems. First, we eliminated data entry costs for EPT and SR, and also eliminated costs associated with contacting and counseling persons receiving SR. These assumptions simulated a system in which a health department maintains a case reporting system but provides no partner services to a system which provides partner services that include EPT. Under these assumptions, EPT was less costly than SR from the health care system and societal perspectives for both index men and index women. Overall health care system costs for EPT compared with SR were 10% lower for index men and 8% lower for index women. Societal costs for EPT compared with SR were 17% lower for index men and 26% lower for index women. Considering only payer-perspective costs, the magnitude of the cost difference would depend on the proportion of partners receiving care from the same payer. However, the incremental cost of EPT was less than $13,000 per QALY saved for index women over SR, regardless of what percentage of partners sought care from the same payer. We then eliminated counseling and data entry costs for both EPT and SR to assess the cost effectiveness of a system in which medical providers use EPT with minimal counseling. This made EPT less costly than SR from all perspectives, ranging from 15% lower from the health care system perspective for index men to 36% lower from the societal perspective for index women. From the payer perspective, EPT cost less than $8000 per QALY gained over SR (the exact magnitude varied depending on the percentage of partners seeking care from the same payer. Back to Top | Article Outline DISCUSSION EPT is cost effective under a wide range of assumptions, however, the magnitude of the cost-effectiveness is dependent on analysis perspective. From the health care system- or societal-perspective, EPT was cost saving: it resulted in more partners treated at lower cost than SR. In contrast, EPT was not cost saving in all sensitivity analyses for individual payers. When EPT was not cost saving compared with SR from the individual payer perspective, the incremental cost per QALY gained through EPT compared with SR was less than $13,000, a cost per QALY that is typically considered to be very cost effective.26,27 A payer such as a state Medicaid program would realize a direct cost saving only if a substantial proportion of an index patient's partners would seek care through the same payer (at least 29%, in the case of female index patients, when assuming that 25% of partners treated through EPT would also seek clinical care; Fig. 1A). The payer-perspective cost advantage of SR relative to EPT was greatly reduced or eliminated in the sensitivity analysis that was designed to depict the circumstances under which EPT might be implemented in most settings: where the payer would not incur costs for data entry for either SR or EPT, and would only incur costs for patient counseling for EPT. However, even with reduced costs for implementation of EPT, the relative costs of EPT and SR will depend on patient and partner patterns that can vary. EPT is always more cost effective from a health care system and societal perspective than from the perspective of an individual payer. This disparity between societal and individual payer perspectives illustrates how the fragmentation of health care financing in the United States creates a situation in which decision-making by individual organizations to minimize their own costs can increase costs for the health care system and for society as a whole. Economists describe this as an externality; the cost individual payers incur for EPT do not fully reflect the benefits it delivers; therefore, individual payers may underuse the intervention. Another intervention that has beneficial externalities is vaccination. In instances with beneficial externalities, subsidies are often used to encourage optimal allocation of the resource creating the benefit.28 Recently enacted health care legislation may change the calculus related to EPT for large insurers like Medicaid due to changes in enrollment. This could lead to large payers finding EPT to be cost-minimizing for their own programs, because as they gain market share, the proportion of their enrollees' partners who have the same insurer could also increase. Even if EPT is not less costly to Medicaid programs, our findings indicate that increasing the usage of EPT is still optimal because under most circumstances it will be lowest cost to the health care system and will increase QALYs over SR. Its adoption can be encouraged through subsidies or regulation. Our analysis is limited by our exclusion of the potential population-level transmission effects of the intervention. Optimally, population-level effects would be included in a consideration of cost effectiveness. Transmission modeling would require additional data on sex partners.29 Preliminary transmission modeling has suggested that EPT could have a substantial impact on population prevalence of chlamydia if widely implemented.30 To date, chlamydia transmission models have yielded greatly differing predictions about the population-level impact of interventions; therefore, it is uncertain whether incorporating transmission effects in this analysis would improve or reduce its validity.31 Although these results do not capture all of the potential effects of EPT, they provide useful information for policy makers assessing whether to adopt EPT. Another limitation is that individual payers might incur different costs than we assessed for clinical services, leading to different payer-perspective results. When considering intervention cost, repeat visits by index patients, and the cost of sequelae, EPT is less costly and improves partner treatment compared with SR. These findings should prompt health departments, insurers, and policy makers to develop approaches to ensure that EPT is widely available. Back to Top | Article Outline REFERENCES1. Institute of Medicine. Prevention of STDs. In: Eng TR, Butler WT, eds. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press, 1997:118–174. Cited Here... 2. Golden MR, Hogben M, Handsfield HH, et al. Partner notification: Low coverage for gonorrhea, chlamydia, and HIV. Sex Transm Dis 2003; 30:490–496. Cited Here... | View Full Text | PubMed 3. St. Lawrence JS, Montano DE, Kasprzyk D, et al. STD screening, testing, case reporting, and clinical and partner notification practices: A national survey of US physicians. Am J Public Health 2002; 92:1784–1788. Cited Here... | View Full Text | PubMed | CrossRef 4. Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women. Sex Transm Dis 2003; 30:49–56. Cited Here... | View Full Text | PubMed | CrossRef 5. Golden MR, Whittington WLH, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005; 352:676–685. Cited Here... | View Full Text | PubMed | CrossRef 6. Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: A randomized, controlled trial. Clin Infect Dis 2005; 41:623–629. Cited Here... | PubMed | CrossRef 7. Kissinger P, Schmidt N, Mohammed H, et al. Patient-delivered partner treatment for Trichomonas vaginalis infection: A randomized controlled trial. Sex Transm Dis 2006; 33:445–450. Cited Here... | View Full Text | PubMed | CrossRef 8. Cameron ST, Glasier A, Scott G, et al. Novel interventions to reduce re-infection in women with chlamydia: A randomized controlled trial. Hum Reprod 2009; 24:888–895. Cited Here... | View Full Text | PubMed | CrossRef 9. Hodge JG, Pulver A, Hogben M, et al. Expedited partner therapy for sexually transmitted disease: Assessing the legal environment. Am J Public Health 2008; 98:238–243. Cited Here... | View Full Text | PubMed | CrossRef 10. Centers for Disease Control and Prevention. Legal status of expedited partner therapy. Database on the Internet. Available at: http://www.cdc.gov/std/ept/legal/default.htm. Accessed February 1, 2011. Cited Here... 11. US Office of Personnel Management. Salaries & wages, 2008. Database on the Internet. Available at: http://www.opm.gov/oca/08tables/indexGS.asp. Accessed March 19, 2010. Cited Here... 12. Yeh JM, Hook EW III, Goldie SJ. A refined estimate of the average lifetime cost of pelvic inflammatory disease. Sex Transm Dis 2003; 30:369–378. Cited Here... | View Full Text | PubMed | CrossRef 13. Begley CE, McGill L, Smith PB. The incremental cost of screening, diagnosis, and treatment of gonorrhea and chlamydia in a family planning clinic. Sex Transm Dis 1989; 16:63–67. Cited Here... | View Full Text | PubMed | CrossRef 14. Gift TL, Gaydos CA, Kent CK, et al. The program cost and cost-effectiveness of screening men for chlamydia to prevent pelvic inflammatory disease in women. Sex Transm Dis 2008; 35:S66–S75. Cited Here... | View Full Text | PubMed | CrossRef 15. Medical Economics Company. Red Book. Montvale, NJ: Thomson Healthcare, 2008. Cited Here... 16. Owusu-Edusei K, Gift TL, Chesson HW. Treatment cost of acute gonococcal infections: Estimates from employer-sponsored private insurance claims data in the United States, 2003–2007. Sex Transm Dis 2010; 37:316–318. Cited Here... | View Full Text | PubMed 17. Owusu-Edusei K, Doshi SR, Apt BS, et al. The direct cost of chlamydial infections: Estimates for the employer-sponsored privately insured population in the United States, 2003–2007. Sex Transm Dis 2010; 37:519–521. Cited Here... | View Full Text | PubMed 18. Gift TL, Malotte CK, Ledsky R, et al. A cost-effectiveness analysis of interventions to increase repeat testing in patients treated for gonorrhea or chlamydia at public sexually transmitted disease clinics. Sex Transm Dis 2005; 32:542–549. Cited Here... | View Full Text | PubMed | CrossRef 19. Blandford JM, Gift TL. Productivity losses attributable to untreated infection with Chlamydia trachomatis and to associated pelvic inflammatory disease in reproductive-age women. Sex Transm Dis 2004; 33:S117–S121. Cited Here... | View Full Text | PubMed | CrossRef 20. Bureau of Labor Statistics. Employer Costs for Employee Compensation. Report on the Internet. Available at: http://www.blsgov/news.release/ecec.toc.htm. Accessed April 12, 2010. Cited Here... 21. Bureau of Labor Statistics. Consumer price index - all urban consumers. Database on the Internet. Available at: http://www.bls.gov/cpihome.htm. 2007. Accessed July 1, 2010. Cited Here... 22. Anonymous. Chlamydia. In: Stratton KR, Durch JS, Lawrence RS, eds. Vaccines for the 21st Century: A Tool for Decision Making. Washington, DC: National Academy Press; 1999:149–158. Cited Here... 23. Smith KJ, Tsevat J, Ness RB, et al. Quality of life utilities for pelvic inflammatory disease health states. Sex Transm Dis 2008; 35:307–311. Cited Here... | View Full Text | PubMed | CrossRef 24. Doubilet P, Begg CB, Weinstein MC, et al. Probabilistic sensitivity analysis using Monte Carlo simulation. Med Decis Making 1985; 5:157–177. Cited Here... | PubMed | CrossRef 25. Kotz S, van Dorp JR.The Triangular Distribution. Beyond Beta. Hackensack, NJ: World Scientific Publishing Co Pt Ltd, 2004:1–32. Cited Here... 26. Maciosek MV, Coffield AB, Edwards NM, et al. Priorities among effective clinical preventive services. Am J Prev Med 2006; 31:52–61. Cited Here... | PubMed | CrossRef 27. Grosse SD, Teutsch SM, Haddix AC. Lessons from cost-effectiveness research for United States public health policy. Annu Rev Public Health 2007; 28:365–391. Cited Here... | PubMed | CrossRef 28. Cook J, Jeuland M, Maskery B, et al. Using private demand studies to calculate socially optimal vaccine subsidies in developing countries. J Policy Anal Manage 2009; 258:6–28. Cited Here... | PubMed 29. Welte R, Postma M, Leidl R, et al. Costs and effects of chlamydial screening: Dynamic versus static modeling. Sex Transm Dis 2005; 32:474–483. Cited Here... | View Full Text | PubMed | CrossRef 30. White PJ, Golden MR, Turner KME, et al. Patient-delivered partner therapy: When and where should it be used? Predicting its impact in the USA and UK. [Abstract] 2005. 16th Biennial Meeting of the International Society of Sexually Transmitted Disease Research; 10–13 July; Amsterdam, Netherlands. Cited Here... 31. Kretzschmar M, Turner KME, Barton PM, et al. Predicting the population impact of chlamydia screening programmes: Comparative mathematical modelling study. Sex Transm Infect 2009; 85:359–366. Cited Here... | View Full Text | PubMed | CrossRef 32. Quinn TC, Gaydos CA, Shepherd M et al. Epidemiologic and microbiologic correlates of Chlamydia trachomatis infection in sexual partnerships. JAMA 1996; 276:1737–1742. View Full Text | PubMed | CrossRef 33. Rogers SM, Miller WC, Turner CF, et al. Concordance of Chlamydia trachomatis infections within sexual partnerships. Sex Transm Infect 2008; 84:23–28. View Full Text | PubMed | CrossRef 34. Washington AE, Johnson RE, Sanders LL Jr. Chlamydia trachomatis infections in the United States: What are they costing us? JAMA 1987; 257:2070–2072. PubMed | CrossRef 35. Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower genital tract infection and endometritis: Insight into subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100:456–463. View Full Text | PubMed | CrossRef 36. Douglas JM Jr, Newman D, Bolan G, et al. Low rate of pelvic inflammatory disease (PID) among women with incident Chlamydia trachomatis (CT) infection [Abstract]. Int J STD AIDS 2001;12(suppl 2):65–67. View Full Text | PubMed 37. Low N, Sterne JAC, Harbord RM, et al. Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection: The Uppsala women's cohort study. Sex Transm Infect 2006; 82:212–218. View Full Text | PubMed | CrossRef 38. Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: The POPI (prevention of pelvic infection) trial. Sex Transm Infect 2010; 340:c1642.39. Smith KJ, Cook RL, Roberts MS. Time from sexually transmitted infection acquisition to pelvic inflammatory disease development: Influence on the cost-effectiveness of different screening intervals. Value Health 2007; 10:358–366. View Full Text | PubMed | CrossRef 40. Farley TA, Cohen DA, Elkins W. Asymptomatic sexually transmitted diseases: The case for screening. Prev Med 2003; 36:502–509. PubMed | CrossRef 41. Harrison William O, Hooper RR, Wiesner PJ, et al. A trial of minocycline given after exposure to prevent gonorrhea. N Engl J Med 1979; 300:1074–1078. PubMed | CrossRef © Copyright 2011 American Sexually Transmitted Diseases Association Article Outline Abstract MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES Cited By Source The Cost and Cost-Effectiveness of Expedited Partner Therapy Compared With Standard Partner Referral for the Treatment of Chlamydia or Gonorrhea Sexually Transmitted Diseases38(11):1067-1073, November 2011. 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About Jess
I am a blogger. I am very lucky that this (along with a few other things) is my full time job. I can often be found out and about taking photos, tapping away on my iPad and eating out with gorgeous, stylish people.
I love: Formula One, curry, dancing, writing, Sci-Fi and things that scare me.
Not so keen on: People who don't indicate in car parks, leggings worn as trousers, and lecherous men in clubs.
Get in touch: email@example.com
How Feeling Stylish Started
This blog came about to try and help me lose weight. In April 2009 a package arrived from ASOS.com it contained THE belt. The belt is a wide, leather waist belt by Ted Baker. Bought in a m/l when it was reduced from £60 to £16. I was 17 stone back then.
The belt looked awful. I put a vow to lose weight and look fabulous in the Ted Baker belt forth to the world. This blog is a culmination of those efforts paired with a love for fashion, makeup and style.
That belt is now too big. I'm fitter and healthier than ever and I'm looking to share that with all of you. This is part fitness blog part style blog. They can go hand-in-hand, I promise.
What's Next?
I'm always attending events, taking even more pictures and blogging about getting fit. There's a long way for this blog to go and I hope to see you there.
Since starting this blog I've had the pleasure of working with some great brands and have been featured in some amazing lists. Here are just a few great things to happen to and come from this little style blog:
- One of the top 50 fashion insiders according to the Telegraph
- Navabi Curvy Blogger nominee 2012 and 2013
- The East Anglian Blogger Cocktail Party
- Shopcade Influencer
- Weight Watchers Ambassador 2013


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When I think of the word "moxie" I always fantasize about a Humphrey Bogart type with a cigarette dangling from his lips, passionately embracing a beautiful woman, saying, "You got moxie kid". In my fantasy, there is always romantic music, it's always in black and white, and he always kisses her immediately afterwards. There is fever between them.
However, this is not that type of website.
This website focuses more so on what happens when the man, the fever, the relationship or the marriage leave you out in the cold. And you have to pull up your bootstraps and get back on the pony all alone. I want to remind women, and in the process myself, how having a perfect life is all relative to your attitude and your "moxie". You create your perfect life. It's something that comes from a honest heart, a courageous soul, and caring about the world around you.
Why Moxie Girl?
I hope people find this site funny, inspirational, and informative, as I very much enjoy writing these blogs. I will write about my life, what I know (and what I am learning) about single motherhood, furniture renovation, clean eating, weight lifting, and other various interests. I cannot guarantee anything but what is real in my life. I will probably have greasy hair in some of these photos and my daughter will probably have peanut butter on her face. I will also shamelessly use quotes from other successful people. I believe it helps knowing what is possible for us out there (everything) and also what is impossible (nothing).
We all need that reminder.
Good golly my Moxies! Interested in reading some of my personal favorites? Click on the images below! Read and subscribe today.
All photos edited with love and Pic Monkey. Click my link below and start your free trail!


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Mr. KINGSTON. Mr. Speaker, I want to point out that this is a debate which so many of us feel passionately about on both sides. It is such a shame, though, that it was not allowed to go to committee. I hear over and over again how important this bill is and actually to both sides, proponents and opponents, yet no committee, no hearing, no amendments. It is a pity. I certainly hope that the Democrats do go back to their party's promise of last week and start opening things up.
Now, having said that, I wanted to make two points, and then I am going to extend my remarks. But there is no Federal law against embryonic stem cell research right now. Many people seem to think that this will allow something to happen that it doesn't. The debate is more about what types of lines.
Now, as you know, the President has approved research on 78 lines. Twenty-two of them are being used currently in Federal funding, and I have the list of where those 22 are, their locations, which I will submit to the RECORD.
Mr. Speaker, I also want to say that $200 million is being spent by private foundations and institutions on stem cell research, in addition to $39 million over at the National Institutes of Health; in addition to that $39 million, on nonhuman embryonic stem cell research, $96 million; on human nonembryonic stem cell research, $200 million; on nonhuman nonembryonic stem cell research, $273 million. This is very important.
The other thing that we keep hearing over again is that these are leftover embryos. In fact, of the 400,000 embryos which keep getting referred to, the RAND Corporation, which is nonpartisan, says only 11,000 have been designated for research, and of those they will probably yield 275 stem cell lines.
And why is that important? It is important because eventually you run out and then you start deciding to produce something. And I want to point out, England has already crossed this path. They have already voted on an H.R. 3, and today they are debating the hybrid stem cell creation of an animal-human embryonic stem cell. That is a debate going on in England today. So don't think that this bill will stay within the boundaries of the bill if it is passed.
My colleagues today will try to tell you that all of those against this bill are against science. That is just not the case. You can be pro-life and pro-science; the two are not mutually exclusive. To say we are anti-science is just a complete falsehood.
Stem cells are cells with the unique ability to divide and grow colonies of the specialized cells that make up the tissues and organs of the body.
Adult stem cells: unspecialized cells that can reproduce and mature into the specialized cells of the surrounding tissue. For example: Stem cells found in the heart can divide into more heart tissue cells.
Embryonic stem cells: unspecialized cells found in the early stages of an embryo that can reproduce and mature into the specialized cells of any organ or tissue in the body. For example: Stem cells found in the early stages of an embryo can divide into and create more cells of heart tissue, liver tissue, or any other tissue in the body.
Stem cells have been found in many tissues in the developed human body (adult stem cells), and are found in the largest quantities in the early stages of embryonic development in: the umbilical cord (cord cells), embryos (embryonic stem cells), and just this week, it was announced that stem cells have been discovered in the amniotic fluid (amniotic stem cells) that surrounds an unborn child in the womb.
A ``stem cell line' is created by removing a cluster of cells from an embryo in its early stages of development. The embryo is destroyed and the cells are grown in a culture that under the right conditions will yield colonies of stem cells. Once the initial stem cells are isolated they can be manipulated to reproduce over and over again.
While the Democrats will try to make this a vote for or against embryonic stem cell research that is just a falsehood. There is no federal law against embryonic stem cell research. On August 9, 2001, President Bush announced that his administration would allow federal funding for research using the 78 approved lines. Of the 78 original derivations held to meet the August 9, 2001 criteria, there are now twenty-one embryonic stem cell lines available and in use.
This has been the number available for about a year now, up from 17 in 2004 and just 1 in 2002. The 78 eligible lines break down as follows:
Twenty-one available and used.
One in development (which could yet become available, that remains unclear).
One temporarily on hold due to irregularities in its use (this is a South Korean line, NIH investigation continues).
Thirty-one owned by foreign institutions that have not made them available.
Sixteen of these are frozen in an undeveloped state for use when culturing methods are perfected. These are owned by a Swedish institution, they could very well become available when that institution decides techniques for developing them are sufficiently developed (i.e. high efficiency, no animal cells
etc.) but we have no control over that and cannot know how many of them will prove viable when they are thawed.
The remaining 15 have never been made available and NIH suspects (reasonably) they are not viable.
Seventeen have proven unviable and cannot be made usable.
Seven are duplicates of some of the 22 available lines, and are being held in reserve to avoid over-development of those lines. These are not being distributed and not counted among the available lines (a common and logical practice in cell biology.)
Since each line can be replicated almost without limit, these 21 lines have made for more than 700 shipments to individual researchers since 2001.
NIH has the capacity to make more than 3,000 more shipments available upon request. There has been no shortage of lines.
Funding for use of the lines has been growing each year.
In FY 05, NIH spent $39 million on human embryonic stem cell work, an increase of 61 percent over FY 04. In total, more than $130 million have been spent.
Now, to me, it seems the Democrat party, who chose to vote against the Alternative Pluripotent Stem Cell Enhancement Act by a vote of 273-154 under suspension, would be the party against science. This bill, which was supported by the President and was voted for unanimously by the Senate, would have directed HHS to research and develop techniques for ``the isolation, derivation, production, or testing of stem cells that are capable of producing all or almost all of the cell types of the developing body, but are NOT derived from a human embryo'. And on H.R., once again, the Democrats are NOT allowing for an open and transparent process which would allow amendments in the form of the substitute of some of this language.
While any potential treatments from embryonic stem cells are decades away at best (in fact, there have been no therapeutic applications or even human trials at this point) patients being treated today with adult stem cell treatments have been found to benefit 72 different ailments, ranging from cancers, auto-immune diseases to wounds and injuries. (Note that though none of these are cures, peer journals show adult stem cells benefit Leukemia and Parkinson's patients, who have gone into remission, and those who have MS can walk more, etc.) Embryonic stem cells have the capacity to grow and reproduce rapidly, but that same tendency causes them to form tumors.
When cells derived from embryonic stem cells are transplanted into adult animals, their most common fate is to die. This is in striking contrast to the survival of adult cells when transplanted in adult tissue. This failure of embryonic stem-cell derived tissue to survive when transplanted seems to show that science hasn't determined how to generate normal adult tissue from embryonic stem cells.
Embryonic stem cell science relies on the assumption that embryonic stem cells can grow into any type of cell just because they can within the embryo. But in reality, scientists have found that it is hard to control the direction of the cells, and they often grow faster than surrounding tissue, forming tumors.
Proponents of embryo-destructive research claim that there are 400,000 leftover embryos that could be used for research.
It's deeply troubling to describe any human being as ``leftover'. This is not a matter of religious belief but of biology. A human embryo is a human being, and each of us was once an embryo.
However, according to the non-partisan RAND corporation, the ``vast majority of frozen embryos are held for family building' and ``only 11,000 have been designated for research, and those 11,000 embryos will likely yield just 275 stem cell lines'. This same study found that of the roughly 400,000 human embryos currently frozen in storage; only 2.8 percent have been designated for research.
In Vitro Fertilization clinics are most commonly used by Caucasian Americans--not the diverse population that the scientists claim to need for research purposes.
As of 2006, 110 children have been born through the Nightlight Christian Adoption agency's Snowflake Baby program.
The NIH spent 38 million federal taxpayer dollars for human embryonic stem cell research in 2005 and through 2006, they spent $122 million on human embryonic stem cell research. The Bush policy does not limit the level of NIH funding and NIH determines how many grant proposals to give. Additionally, the Journal of the American Medical Association published an article in September 2005 that found when public funding for research lapses, private funders almost always step in to take up the slack.
The President will stand firm in his stance that it is possible to advance scientific research ``without violating ethical principles by enacting appropriate policy safeguards and pursuing appropriate scientific techniques' (statement of Admin. policy).
Proponents of this research will not be satisfied with the 275 stem cell lines they may be able to get from frozen embryos. They will move to the next step, human cloning, and begin to create custom ordered embryos on which to experiment. In fact, Diana DeGette herself has said ``therapeutic cloning is the way to take stem cell research and all of its promise from the lab to the patient' (July 31, 2001 floor debate).
Harvard scientists already want to grow disease specific lines of stem cells, which of course you would need cloning to do. According to their website, ``To be maximally useful, stem cell science requires using a process in which the nucleus of an egg, which contains its genetic material, is removed and replaced by the genetic material from an adult cell. This egg, with its new nucleus, then grows into a cluster of cells from which investigators can derive stem cells matching the genetic identity of the patient who donated the implanted cells, and which are therefore unlikely to be rejected by the patient's immune system. This technique is called somatic cell nuclear transfer, or therapeutic cloning'.
Proponents claim that adult stem cells are no match for embryonic stem cells. I guarantee you that those who vote in favor of this bill today will then say embryonic stem cells are no substitute for cloned cells. It will never be enough.
Democrats will also argue that our current quote restrictions are causing us to fall behind other countries in research in this arena. This is just not the case. Of the number of scientific publications on the matter, 40 percent of those on embryonic stem cells are by researchers in the U.S. and the others are divided by 20 countries.
A paper in the April issue of Nature Biotechnology showed that 85 percent of all human embryonic stem cell publications in the world have used the approved lines, with the great bulk of them appearing between 02 and 05. This is a much higher number than expected.
The same study also showed that American researchers easily lead the world in human ES cell publications, and the number of American publications has been growing each year of this administration (as has the number of foreign publications).
The Stem Cell Therapeutic and Research Act of 2005--which is now public law--made genetically matched cord blood stem cells available to patients who need them.
Cord blood is the blood leftover from the placenta after the birth of a child and has been used for years. In fact, it has been used to treat more than 70 diseases including sickle cell disease, cancer, and genetic disorders. These cells have the ability to change into many different types of cells in the body.
The Act is beginning to be implemented into the National Cord Blood Inventory. HHS has begun developing contracts which are then authorized by the Stem Cell bill to collect and store 150,000 new units of cord blood. Cord blood stem cell research and treatment is a good way to promote cures while still maintaining ethics.
One example of a patient who has benefited: Nathan Salley, who had leukemia at age 11, did not respond to intense chemotherapy sessions. When this treatment didn't work, doctors performed a cord blood transplant which involved killing off Nathan's bone marrow cells, then regrowing new (healthy) ones by injecting healthy umbilical cord blood stem cells. Nine years after his initial diagnosis, Nathan is preparing for his final year of college.
PrimeCell Therapeutics has created the first non-embryonic, adult-derived stem cell showing the ability to transform into any cell type found in the body (pluripotency). They have taken stem cells from one part of the body and turned them into cells from another part of the body, including into beating heart cells as well as brain, bone and cartilage cells.
They are derived from the germ line, which is the most protected and genetically pure cell line in the body, since they normally would develop into eggs and sperm. This is the one line that remains unaffected by the aging process.
They are autologus, meaning they come from you and are transplanted back into you for treatment. Therefore, there is a reduced chance of infection following transplantation and there is no risk of rejection--meaning there will no longer be the worries involving immunosuppressant drugs.
Other successful treatments: Scientists have grown human heart valves using stem cells from amniotic fluid. The new valves are created in the lab while the pregnancy progresses and are then implanted in a baby with heart defects after it is born (AP/Wash Post).
On January 8, 2007, scientists from Wake Forest University reported that these amniotic cells, which are easily retrieved during routine prenatal testing and can be isolated as early as 10 weeks after conception, were ``easier to maintain in laboratory dishes than embryonic stem cells' (Wash. Post). They also grow ``as fast as embryonic stem cells, show great pluripotentiality, and remain stable for years without forming tumors' (Dr. Anthony Atala, Wash. Post). If the goal of using embryonic stem cells (versus adult stem cells) is pluripotency, we may have an even better and more flexible solution with these amniotic cells without the complications of tumor formation.
Researchers at Northwestern have found that adult stem cells derived from bone marrow gives rise to blood cells, which can then be transformed into a wide variety of tissue types. In fact, they have found like a certain type of bone marrow cell has been transformed into white blood cells that are Ðresponsible for fighting infections (medicalnewstoday).
Bone marrow cells have also been shown to be stretched into patterns that could potentially transform them into smooth muscle cells similar to blood vessel tissue (DC-Berkeley experiment, medical news today).
In conclusion, science has shown us that there are several alternative ways to explore stem cell research without destroying an embryo. We need to direct the NIH to fund and research these alternatives and make them a priority. Science is flexible, and researchers need the incentive to pursue the already proven research of adult stem cells--not the questionable and unproven helpfulness of embryonic stem cells.


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Cranes on the Plain
The cranes are marching across the plains looking for greener pastures.
This image was created while I was waiting for my mother to undergo tests at the hospital - I guess there was some wishful thinking going on here...
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Rooms, services The guests of Beihai Luckycloud Hotel Beihai may stay in 120 nicely furnished, comfortable rooms in Beihai. In the safe your valuables may be the safely secured. Wireless Internet connection (WiFi) is available at the hotel, enabling portable devices and smartphones to go online. If you wish to learn more about the exact scope of services provided by Beihai Luckycloud Hotel Beihai (including any available for an extra fee), you will find them on the information sheet below.
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6532 ADAIR AVE, Norfolk, Virginia 23502 - Lovely home situated on a beautiful shaded lot! Home features an enclosed front porch, large living area, spacious/updated kitchen, good size bedrooms, and a gorgeous backyard. HUD case# 544-070031, HUD homes are sold as-is.
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Nov 02, 2012 - 3:03 pm
Pre surgery notes:PSA 5.1, no modules felt digital rectal exam. Carcinoma in 5 of 12 cores from the right side in 70% of the tissue.
From Post surgery specimen - Gleason score 3+4 = 7. With Focal pattern 5. Involving approximately 20% of bilateral prostate.
Bilateral seiminal vesicles negative for tumor. Negative for extraprostatic extension.
Margin: focally positive a tright apex.
Yes, I've always known about the focal pattern 5. Posting as promised for a few friends that I know are interested.
38 month PSA post davinci surgery .2
Nov 02, 2012 - 4:40 pm
Not much to comment on your original notes. The positive margins at the right apex could have been the "door", for spread if recurrence is confirmed. In any case, you have mention on another post about perineural invasion (http://csn.cancer.org/node/168903). Probably that was informed to you by your doctor but it is not stated in the path report.
Wishing you good results in your next test.
(I believe you wanted to write PSA instead of Gleason at the last sentence above)
Nov 03, 2012 - 7:13 am
You are correct Vasco, in the original diagnosis perineural invasion was noted. I only pulled the post surgery notes paperwork when I was giving the update.
Also You are correct it should have read PSA. Sometimes my fingers are faster than my brain on the keyboard!
I believe the recurrance is local from the positive margin. Though it is possible it could be related to the perineural invasion. It seems like anything is possible with this beast!
The past three months have been a whirlwind of activity for me. (Three surgeries - repair to my foot for some issues, followed by an achilles tendon rupture and repair, Same foot! Then a surgery to remove three tumors from my left wrist -found to be non cancerous, one was growing in the main nerve bundle that goes to the left hand and the size of a marble). About 12 days ago I was laid off from work and found new work six days later doing contract work on a computer software package that I have worked on in the past.
Then the news of my .2 PSA! :)
Nov 03, 2012 - 5:24 pm
Bad times procede the Good ones. Hope all returns into your favour.


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Albuquerque, NM (PressExposure) June 01, 2011 -- Love Handles motorcycle passenger armrests is introducing a new Duffel Caddy accessory to provide riders with extra space when they are traveling solo. If a rider is without a passenger and requires extra room for their gear, they can simply reverse the Love Handle armrests and slide on a custom Duffel Caddy for added capacity.
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|23 Jan 2011
Windows Explorer Default Window Size
I'm not sure if I'm in the right category with this but, I would really like to know how to reset the windows explorer windows sizes to the default size. My video card drivers were updating and I guess it changed it's resolution to a really small one and it made my explorer window smaller as well. If anyone could help me with this, I'd be very grateful.
|My System Specs
|23 Jan 2011
Windows 10 Pro x64 EN-GB
Just resize the Explorer window, make it as big or small you want to, and close it. Explorer remembers the last window size, and now all opened Explorer windows open in that size.
For example, open Libraries window. Resize it and close. Open now the Computer window and you'll notice it opens as big as the Libraries window was when you closed it.
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|23 Jan 2011
Nevermind, I found a .reg file that resets that sizes to default. Thanks anyways.
Folder View Settings - Reset All to Default
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Start Menu, default window size and sidebar got bigger!
Hello everyone, Last night, I caught my keyboard by accident (I think!). Since then, my start menu and sidebar got bigger; in addition, when default windows open, they too are bigger than before, as are other menus like the drop down Norton menu which is accessed from the the Norton logo on my...
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Icon Size - Change in Windows Explorer Window
How to Change the Icon Size in a Windows 7 Explorer Window When you open a folder or library in Windows 7, you can change how the files look in the window. This will show you how to change the file and folder icon size in that window to be either Extra Large Icons, Large Icons, Medium...
Default area selected for folders in explorer window??
:cool: So i have created some shortcuts to quicklaunch certain folders. Some of them open and i can use the arrow keys to scroll through the items in the folder. Some of them open with the "Name" column selected, so the arrow keys don't initially scroll through the items in the folder. ...
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Default window size is incorrect
I recently did a clean install of Windows 7. I had run into an issue where certain UI elements would ignore DPI changes. Eventually, text looked like this: http://i.imgur.com/LUUzt.png Not exactly ideal. I couldn't find a solution, so I was forced to do reinstall. Instead of using my pre-SP1...
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Windows Explorer window size.
Greetings, here I come with a very simple question. I'll also try to describe my whole issue as much as I can, here it is. Until now, I've been using the default Windows Explorer window size, but I ran an application, one game particularly and in that game I tried to adjust the resolution...
How to change default window size ?
Hi everyone , Please show me how to change default size of the occurred window when I select "browse" in other apps, because it so small and hide some folder. Thanks .
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Demonstrators may be asked to leave St. Paul's in London
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Aug 14, 2013 10:24
Category: General News
Category: General News
Clash in Egypt
The situation in Egypt boiled over today. Supporters of the Islamist president of Egypt that was ousted were staging sit-ins when police representing the new government stormed. Government officials say 56 people were killed at the protest sites, but the Muslim Brotherhood staging the sit-ins put that number at over 500.


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Au revoir les enfants Trailer (1987)
06 October 1987 Drama, War 104 mins
A French boarding school run by priests seems to be a haven from World War II until a new student arrives. He becomes the roommate of top student in his class. Rivals at first, the roommates form a bond and share a secret.
Watch the official Au revoir les enfants 1987 trailer in HD below or find more Au revoir les enfants videos on Vidimovie.


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International treaty
Armenia: tax treaties
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Tax treaties and related documents between the UK and Armenia.
2011 Armenia-UK Double Taxation Convention - in force
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