text:
Sudden Sensorineural Hearing Loss
SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology
DATE: June 13, 2001
RESIDENT PHYSICIAN: Christopher Muller,
FACULTY PHYSICIAN: Jeffrey Vrabec,
SERIES EDITOR: Francis B. Quinn, Jr., MD
"This material was
prepared by resident physicians in partial fulfillment of educational
requirements established for the Postgraduate Training Program of the UTMB
Department of Otolaryngology/Head and Neck Surgery and was not intended for
clinical use in its present form. It was prepared for the purpose of
stimulating group discussion in a conference setting. No warranties, either
express or implied, are made with respect to its accuracy, completeness, or
timeliness. The material does not necessarily reflect the current or past
opinions of members of the UTMB faculty and should not be used for purposes of
diagnosis or treatment without consulting appropriate literature sources and
informed professional opinion."
Sudden hearing loss (SHL) is a medical emergency for
which definitive diagnosis and treatment is still largely unknown. It was first described in the literature by
De Klevn in 1944. SHL generally a
refers to hearing loss of sensorineural origin. It has been defined for research purposes and has been accepted
by most authorities as 30 dB or more sensorineural hearing loss over at least
three contiguous audiometric frequencies occurring within 3 days or less.
Estimates report approximately 15,000 reported cases
of SHL per year worldwide with 4000 of those occurring in the United
States. One in every 10,000 to 15,000
people will suffer from this condition, with the highest incidence occurs
between 50 and 60 years of age. The
lowest incidence is between 20 and 30 years of age. Of the patient suffering from SHL, 2% are bilateral. In most
series, the incidence was nearly equal in men and women.
There are many potential causes of SHL, but despite
extensive evaluation, the majority of cases elude definitive diagnosis and
therefore, remain idiopathic. Reports
estimate that the etiology of SHL is diagnosed in only 10% of cases. Suggested causes of idiopathic sudden
sensorineural hearing loss (ISSNHL) include viral infections, immunologic,
vascular compromise, and intracochlear membrane breaks. It is unlikely that any single one of these
pathophysiologic processes explains all cases of ISSNHL. Treatment regimens aimed at addressing the
underlying problem in each of these states have been suggested including
decreasing cochlear inflammation, improving inner ear blood flow and
oxygenation, and reestablishing the endocochlear potential.
The etiology of SHL can be
broken down into broad categories: (1) viral and infectious, (2) autoimmune,
(3) labyrinthine membrane rupture/traumatic, (4) vascular, (5) neurologic, and
(6) Neoplastic. There are multiple
conditions within each of these categories that have been associated with
sudden hearing loss. The following is a
partial list of reported causes of SHL:
(simplex, zoster, varicella, cytomegalovirus0
immunodeficiency virus
Lassa fever
Autoimmune Autoimmune
inner ear disease (AIED)
Traumatic Perilymph fistula
Inner ear
decompression sickness
bone fracture
Inner ear
surgery (stapedectomy)
complication of nonotologic surgery
Vascular Vascular
disease/alteration of microcirculation
Vascular disease associated
with mitochondriopathy
Red blood
cell deformability
Sickle cell
Neurologic Multiple sclerosis
pontine ischemia
Neoplastic Acoustic
to internal auditory canal
deafness after acoustic neuroma surgery
Evaluation and management of SHL should be considered medically urgent, if not an emergency. The primary goal is to rule out any treatable causes.
Diagnostic evaluation of the patient with sudden hearing loss begins with a thorough history and physical exam. Details of the circumstances surrounding the hearing loss and the time course of its onset should be elicited. Associated symptoms, such as tinnitus, vertigo or dizziness, and aural fullness should also be asked about. Clinical experience has shown that about one-third of patients note their hearing loss upon first awakening in the morning, and that about one- half the cases will have associated vertigo. Patients should also be questioned about previous otologic surgery, ototoxic drug use, and previous or concurrent viral or upper respiratory tract infections. Any history of trauma, straining, diving, flying, and intense noise exposure should be noted. Past medical history of other diseases associated with sudden hearing loss should also be obtained such as diabetes, autoimmune disorders, malignancies, neurologic conditions (multiple sclerosis), and hypercoagulable states. African-Americans should be asked about sickle cell disease.
A complete head and neck exam should
be performed on all patients with sudden hearing loss. More often than not, the exam will be
unremarkable, however, any processes such as middle ear effusions, infections,
cholesteatoma, and cerumen impaction should be excluded. A thorough neurological exam including Weber
and Rinne, cerebellar and vestibular testing should be performed.
An audiogram (pure tone, speech, tympanometry, including stapedial reflex testing) should be performed on all patients with sudden hearing loss. The audiogram is the foundation of the diagnosis and provides prognostic information. Serial testing provides documentation of the progression or resolution of the hearing loss and response to treatment. In addition it may help exclude patients with secondary gain or with pseudohypacusis.
following is a list of laboratory studies that can be ordered. Initial screening tests should be directed
based on history and suspected conditions.
blood count (CBC)
sedimentation rate (ESR)
resonance imaging (MRI) is recommended by the majority of authors for patients
with asymmetric hearing loss. In one
survey of 79 otolaryngologists, 38% would order imaging on the patient's
initial visit. MRI is useful in
evaluating for acoustic tumors, multiple sclerosis and cerebrovascular
accidents. There are some proponents of
following these patients and imaging only if asymmetric hearing persists. However, Berg et al., in a series of acoustic neuromas showed that 13% presented
with sudden hearing loss, and of these 23% recovered auditory function.
Cogan's syndrome (CS) is an
autoimmune disease of the cornea and vestibuloauditory apparatus that was first
described by Cogan, an ophthalmologist, in the 1940s. It occurs primarily in young adults (average age of onset 22-29
years) and typically presents with interstitial keratitis (IK) and
Meniere's-like attacks of vertigo, ataxia, tinnitus, nausea, vomiting, and
hearing loss which develop within several months of each other. CS may also be associated with other
systemic manifestations of the inflammatory process such as Takayasu's-like or
medium-sized vessel vasculitis.
Approximately 10% of patients develop aortitis within weeks to years
after the onset. Hearing fluctuation in
CS coincides with disease exacerbations and remissions. Its course often culminates in
deafness. One series reported that 12
out of 18 patients (67%) developed bilateral deafness.
The cause of CS is unknown. Microbial etiology has been suggested by
some as URTI precede nearly 40% of patients who present with this disease. Clinical parallels between syphilis and CS
have led some to belief that CS may be caused by Borrelia burgdorferi. However, evidence so far has been
inconclusive. There have also been
links to Chlamydia species with CS and is an area of ongoing
investigation. Temporal bone
histopathologic studies done at autopsy of patients with CS are characterized
by chronic inflammation including: infiltration of the spiral ligament with
lymphocytes and plasma cells, endolymphatic hydrops, degenerative changes in
the organ of Corti, and demyelination and atrophy of the vestibular and
cochlear branches of the eight cranial nerve.
There is no criteria currently
established for the diagnosis of CS.
The general thinking is that the diagnosis requires clinical signs of
both eye and inner ear inflammation.
Work-up should include an audiogram and laboratory tests including CBC,
ESR, and RPR. Imaging including MRI
and/or CT should be done primarily to rule out cerebropontine angle tumors and
other disorders. MRI may show enhancement of vestibular and cochlear structures
with gadolinium.
The cornerstone of therapy is
corticosteroids: topical for IK and oral
for vestibuloauditory involvement. Most
authors suggest using prednisone 1mg/kg for 2-4 weeks with a subsequent rapid
taper for cases of complete resolution and slow taper for those with incomplete
response. The best outcome is in
patients in whom therapy begins shortly after the onset of symptoms. For patients who have failed steroid
treatment and developed bilateral deafness, cochlear implantation should be
considered and has been approved by the FDA in these patients.
Traumatic breaks in the membranous labyrinth are accepted causes of
sudden hearing loss. Cochlear membrane
breaks may be either intracochlear, as is thought to occur in Meniere's
disease, or involve the labyrinthine oval and/or round windows with a resultant
perilymph fistula. The patients history
will usually elicit an inciting event such as a blow to the head, sneezing,
bending over, lifting a heavy object, exposure to sudden changes in barometric
pressure (such as during flying or diving), or exposure to a loud noise. Patients who are theoretically at high risk
for fistulization are those who have undergone anatomical alterations such as
stapedectomy patients and in children with inner ear anomalies, such as the
Mondini malformation and large vestibular aqueducts where increases in CSF
pressure may be transmitted to the inner ear more easily. In clinical practice, however, patients who
have undergone stapedectomy who return to their normal lifestyles including
scuba diving and flying have not resulted in an obvious increase in development
of symptoms of perilymphatic fistulas.
Currently there is no definitive test to diagnose perilymph fistulae other than intraoperative observation of leakage of perilymph. Diagnosis is made by the clinical history of sudden or rapidly progressive hearing loss after one of the above listed inciting events. Inflammation, granuloma, or neoplasia disorders that can mimic a perilymph fistula should be ruled out (i.e. with MRI, MHATP, and ESR). Kohut proposes that two of the following vestibular symptoms are required for diagnosis: constant dysequilibrium, a positive fistula test (Hennebert's sign), and a positional nystagmus. Testing for Tullio's phenomenon should also be done.
Initial treatment should include 5 days of strict bed rest with the head of bed elevated thirty degrees. The patient should avoid straining or hard nose blowing. Stool softeners may be given. Some suggest daily audiograms. If the patient has improvement, 6 more weeks of modified physical activity should be followed. If no improvement is seen after five days, surgical therapy including middle ear exploration with patching of the perilymphatic fistula should be performed.
Acoustic neuromas are usually associated with gradually progressive
hearing loss. However, the increasingly
widespread use of CT and MRI imaging of patients has indicated that nearly 10%
to 19% of patients with acoustic tumors may present with SHL. The rationale for imaging patients with
unilateral hearing loss, accepted by most authorities is that, although
uncommon, their symptoms may be due to neoplasm. It has been estimated that 1% of patients with asymmetric SHL
will have an acoustic tumor. In
addition, these imaging studies can pick other neurologic disorders such as
multiple sclerosis and ischemic changes which may be associated with SHL.
Direct identification of
viruses or viral antigens from the perilymph of a affected patients provides
some of the strongest evidence for the involvement of viruses in hearing
loss. Also, animal studies that
demonstrate the ability of viruses to infect the inner ear lend further
support. Davis and Johnson demonstrated
the ability of rubeola and mumps to infect the inner ears of animal models
using immunofluorescent antigen studies.
Westmore et. al. subsequently
cultured the mumps virus from the perilymph of a patient suffering from SHL and in 1979, Davis and co-workers
cultured CMV from the perilymph of infant with congenital CMV infection. In 1981, further studies using
immunofluorescence showed CMV antigens on the stria vascularis, dark cells and
Reissner's membrane of an infant who died of a CMV infection.
The diagnosis of AIED is
based for the most part on the presence of bilateral progressive sensorineural
hearing loss and response to therapy.
Hughes proposes that the two most clinically helpful tests for diagnosing
AIED are the lymphocyte transformation test (LTT) and the Western blot
immunoassay, however, these are rarely used by most practitioners because of
availability. The sensitivity and
specificity for LTT are estimated to be 50-80% and 93% respectively with
positive predictive values ranging from 56-73% depending on the disease
prevalence in the tested population.
When applied to high risk populations (patients with bilateral
rapidly-progressive SNHL), the Western blot has a sensitivity of 88%, a
specificity of 80%, and an overall positive predictive value of 92%. The
natural history of AIED is not known, however, clinical experience reveals that
the disease waxes and wanes. Testing of
patients should, therefore, be performed during periods of disease activity and
before treatment is initiated.
Currently, tests for AIED
are not routinely used except at certain centers (Cleveland Clinic and the
Massachusetts Eye and Ear Infirmary) and in experimental trials. The major drawback to these studies is the
lack of availability. If testing is
desired, samples of whole blood from patients can be mailed to the Cleveland
Clinic Foundation Regional Laboratory by overnight carrier for LTT. The test costs $120.00 and results take
approximately seven days.
The best theoretical test for AIED
would be a test for marker specific for AIED.
Attempts have been made in this area and are promising. In 1990, Harris and colleagues published the
results of studies which discovered, using Western blot, an anti-68kd
autoantibody in the sera of patients with rapidly progressive SNHL. Since then, other studies have confirmed
these findings. Overall 22% to 58% of
sera of patients with rapidly progressive SNHL will contain this antibody. Harris has subsequently reported a 94%
specificity for test correlating results with responsiveness to therapy and
disease activity. Studies by Billings
and Harris are now searching for the specific antigen involved in AIED. So far they have isolated a 68kd protein
that is ubiquitous in the inner as well as other areas of the body, and have
recently reported evidence that links the 68kd antigen with heat shock protein
70 (hsp 70), a highly inducible stress protein. Further research is needed in this are to determine the exact
relationship of hsp 70 to AIED and whether it plays an important etiologic role
or whether it is just a bi-product of the disease itself. Theories proposed are that (1) human hsp 70
may have a similar amino acid sequence to an infecting agent resulting in
cross-reactivity or (2) that there may be a hsp 70 specific to the inner ear
that is seen as foreign when it is over-expressed during times of chronic
inflammation from an outside agent.
Treatment for AIED is
controversial and widely varied from practitioner to practitioner. This is largely due to the lack of
double-blind, prospective clinical trials on the matter. The general consensus is that steroids are
effective and should be used. Most
sources recommend prednisone 1mg/kg/day for 4 weeks followed by a slow taper if
the patient responds. If the patient
relapses on the taper, Harris recommends instituting high dose prednisone and
if continued recurrence occurs with tapering, a cytotoxic agent such as
methotrexate (MTX) at a dosage of 7.5-15 mg weekly with folic acid, or
cyclophosphamide (Cytoxan) should be instituted. If MTX is used, the steroids should be continued after starting
the MTX as it takes one to two months for the prednisone sparing affects of MTX
to begin. Most physicians begin with
MTX as it has fewer side-effects than Cytoxan.
If both prednisone and MTX are ineffective, cytoxan should be used. It is important to monitor for side effects
of both MTX and Cytoxan with routine monitoring of complete blood counts,
platelets, LFTs, UA, and electrolytes.
Those on Cytoxan should keep well-hydrated to prevent hemorrhagic
Other authors such as McCabe are more in favor of starting cytotoxic drugs at the onset of the illness. He believes that Cytoxan is the preferred treatment of AIED rather than steroids because there is a higher response rate to this drug. Because the diagnosis of AIED is based partially on response to therapy, fewer patients with this diagnosis would be missed.
It is not surprising that
the cochleovestibular blood supply may be affected by circulatory disorders
such as embolic phenomenon, thrombosis, vasospasm, and hypercoagulable or high
viscosity states resulting in SSNHL.
The underlying pathophysiology can be explained by the occurrence of
sudden anoxic injury to the cochlea. The cochlea is extraordinarily intolerant of blood supply
disruptions. Early studies by Kimura
and Perlman in the1957 revealed that vascular occlusion of the labyrinthine artery
in guinea pigs for greater than thirty minutes led to irreversible loss of cochlear
function. Suga and co-workers performed
experimental embolizations of cochlear vessels and showed loss of cochlear
action potentials within 60 seconds.
Much of the hard evidence for a
vascular etiology of SHL comes from histopathologic comparison of a few human
temporal bones with those of animal models.
Belal, in 1980, looked at two temporal bones from patients suffering
from SHL. He found similar histologic
findings to those of animal models of vascular occlusion to the
cochleovestibular apparatus including extensive fibrosis and new bone
The blood supply of the membranous
labyrinth is predominantly derived from he labyrinthine (internal artery) which
is branch of the anterior inferior cerebellar artery. It may less commonly be a direct branch from the basilar
artery. The labyrinthine artery enters
the internal auditory canal and subsequently divides into the common cochlear
artery and the anterior vestibular
artery. The common cochlear artery
divides to form the main cochlear and vestibulocochlear branches. Division of the vestibulocochlear artery
results in the posterior vestibular artery and the cochlear ramus. The arterial supply to the cochlea is such
that the basal turn is fed first by the main cochlear artery with the cochlear
apex fed last. Based on this anatomy
one would expect occlusion of the labyrinthine artery to cause both vestibular
and auditory symptoms which is supported by histopathologic findings as
describe above. In addition, one would
expect temporary occlusion in blood flow to affect low frequency areas of the
cochlea first as these areas are the most distal in terms of blood supply.
SHL can develop as a result of a number abnormal circulatory states. Patients with diseases such a sickle cell anemia and Waldenstrom's macroglobulinemia have been shown to have a higher risk of developing SHL than the normal population. Hearing loss in these individuals is usually reversible with treatment: Oxygen for sickle cell disease and plasmapheresis for Waldenstrom's. Strokes involving the anterior inferior cerebellar artery are associated with auditory and vestibular symptoms but often also affect cerebellar function. SHL following cardiopulmonary bypass has also been reported, most likely resulting from embolic phenomenon.
The majority of cases of SHL
treated by otolaryngologist are for those with no definable cause. The treatments for cases with known
etiologies involve addressing the underlying condition (i.e. treatment of:
acoustic neuroma with excision, ototoxicity with cessation of ototoxic drugs,
multiple sclerosis with medical therapy, embolic disease with anticoagulants,
sickle-cell crisis with oxygen, bacterial meningitis with antibiotics and so
on). This discussion will be limited to
the treatments which have been proposed for patients with no underlying cause
for their hearing loss based on the previous mentioned theories addressing the
etiology of ISSNHL.
Diuretics Hydochlorothiazide/triamterene
agents Acyclovir
Vasodilators 5%
carbon dioxide with 95% oxygen
expanders/hemodilutors Hydroxyethyl
Defibrinogenators Batroxobin
antagonists Nifedipine
agents and procedures Amidotrizoate
review of the literature confirms that the level of evidence for treating this
condition is limited and consequently there is a wide disparity in consultant's
In 1987, Wilkins and associates treated 109 with a
"shotgun" regimen that included dextran, histamine, Hypaque, diuretics,
steroids, vasodilators, and carbogen inhalation. They found no statistically significant difference in outcome
between patients treated and those who were not treated. In this study there was no control group and
treatment was defined as receiving the drug for at least three days. Prospective, randomized, double-blind
studies have been done looking at the dextran 40, pentoxifylline, low-molecular-weight
dextran, and intravenous procaine. None
of these have shown significant differences in recovery compared to
Despite the disappointing results in early trials of
steroid therapy in which low doses were used for short duration, later studies
using higher doses for longer periods of time have been more promising in the
treatment of ISSNHL. In 1980, Wilson
and colleagues performed double-blind studies for the treatment of ISSNHL with
oral steroids. Their treatment consisted of a Decadron taper over 10-12 days.
They stratified their patients based on audiogram and found that steroids had a
significant effect on the recovery of hearing in patients with hearing loss
between 40 and 90 db. Moskowitz et al. confirmed Wilson's findings in
1984. He demonstrated an overall 89%
recovery rate for those treated with a twelve day Decadron taper compared with
44% recovery for those not treated with steroids. Again, these results were found in a patients with audiograms in
the so called "steroid effective zone". In both of these studies, they found that patients with profound
hearing loss did not benefit significantly from steroid use. They concluded that steroid appear to be of
benefit only if the injury is partial and reversible. In a recent review by Hughes, he recommended treating with
prednisone 1mg/kg/day for at least ten days and up to one month.
Hughes also advocates treatment with diuretics and
low salt diet. Athough there is no data
to support this treatment, his rationale is based on histopathologic studies of
temporal bones in patients with autoimmune SHL (mostly Cogan's syndrome) which
have shown endolymphatic hydrops. He
prescribes Maxide (Hydrochlorthiazide 25mg and triamterene) once a day.
Carbogen, which is a combination of 95% oxygen and
5% carbon dioxide has been used, and is still used by some physicians in
patients in whom a vascular etiology is suspected for their hearing loss. Studies have shown that carbogen increases
the partial pressure of oxygen in perilymph.
In addition carbon dioxide is a known potent vasodilator of the
vestibulocochlear vasculature, resulting in increased blood flow. Administration of Carbogen must be done
in-hospital over three days to monitor blood pressure which may increase. Insurance companies currently do not cover
this treatment because it is considered experimental. No conclusive data has shown Carbogen inhalation to be of any
benefit over spontaneous recovery .
Finally, antivirals have recently come into favor in
the treatment of ISSNHL. Animal models
of viral labyrinthitis treated with prednisone and acyclovir combined have
shown significantly higher rates of hearing recovery compared to either drug
alone. This combination therapy has
already proven its effectiveness in Ramsay Hunt syndrome and herpes zoster
oticus and has also been proposed for the treatment of Bell's palsy. Studies are now ongoing to look at the
efficacy of acyclovir in the treatment of patients with ISSNHL. In general, many authorities treat patients
empirically with acyclovir usually for ten days.
Recently, a survey was sent to 100 consultant
otolaryngologists in the United Kingdom inquiring about their assessment and
management of patients presenting with SHL.
Results showed that 78% would perform routine blood tests including CBC,
ESR, and syphilis serology. 38% would
order an MRI at the first presentation. 98.5% of the consultants would treat
with steroids alone or as part of a combination. 41% treat with Carbogen, 31% with acyclovir and 35% with
Sudden hearing loss is a
medical condition which can be particularly devastating to patients and
frustrating for the otolaryngologist to diagnose and treat. Despite extensive investigation, only
minimal data has been generated in the past thirty years to improve our
understanding of the etiology and appropriate treatment of this disease. Most authorities agree that all patients
should undergo audiometry, and imaging with MRI for those patients with
asymmetric hearing loss, however the etiology for the majority of patients will
go undiagnosed. Treatment is more
controversial. Steroids have been shown to significantly improve hearing
recovery in patients with moderate to severe hearing loss and seem to be
favored for the treatment of autoimmune and idiopathic forms of SSNHL. The remainder of proposed treatments for
this disease are based, for the most part, on theory and will require further
investigation to confirm or disprove their efficacy.
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Electronic Rulemaking:
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GAO-05-777, Sep 9, 2005
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The E-Government Act of 2002 requires regulatory agencies, to the extent practicable, to ensure there is a Web site the public can use to comment on the numerous proposed regulations that affect them. To accomplish this, the Office of Management and Budget named the Environmental Protection Agency (EPA) as the managing partner for developing a governmentwide e-Rulemaking system that the public can use for these purposes. Issues GAO was asked to address include: (1) EPA's basis for selecting a centralized system, (2) how EPA collaborated with other agencies and agency views of that collaboration, and (3) whether EPA used key management practices when developing the system.
E-Rulemaking officials and the e-Rulemaking Initiative Executive Committee considered three alternative designs and chose to implement a centralized e-Rulemaking system based on cost savings, risks, and security. Officials relied on an analysis of the three alternatives using two cost and risk assessment models and a comparison of the alternatives to industry best practices. Prior to completing this analysis, officials estimated the centralized approach would save about $94 million over 3 years. They said when they developed this estimate, there was a lack of published information about costs related to paper or electronic rulemaking systems. They used their professional judgment and information about costs for developing and operating EPA's paper and electronic systems, among other things, to develop the estimate. E-Rulemaking officials extensively collaborated with rulemaking agencies and most officials at the agencies we contacted thought the collaboration was effective. E-Rulemaking officials created a governance structure that included an executive committee, advisory board, and individual work groups that discussed how to develop the e-Rulemaking system. We contacted 14 of the 27 agencies serving on the advisory board and most felt their suggestions affected the system development process. Agency officials offered several examples to support their views, such as how their recommendations for changes to the system's design were incorporated. While managing the development of the centralized system, e-Rulemaking officials followed all but a few of the key practices for successfully managing an initiative. For example, officials did not have written agreements with participating agencies that included system performance measures. The first agencies began migrating to the centralized system in May 2005 with the public scheduled to have access in September 2005. Eventually, all rulemaking agencies will migrate to the centralized system; however, the schedule is tentative due in part to funding issues. As agencies migrate, e-Rulemaking officials are planning changes to the system including adding capabilities that exist in electronic systems operated by some agencies.
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- Open
- Closed - implemented
- Closed - not implemented
Recommendation for Executive Action
Recommendation: E-Rulemaking officials established a governance structure that allowed it to successfully collaborate with other agencies about how to develop and implement the centralized e-Rulemaking system and used most of the key practices included in this report for managing an initiative. To learn from how it managed this initiative and to build on the success of it, the Administrator of EPA, as managing partner of this initiative, should take steps to ensure that the written agreements between EPA and the participating agencies include performance measures that address issues such as system performance, maintenance, and cost savings. These measures are necessary to provide criteria for evaluating the effectiveness of the e-Rulemaking initiative as well as for determining if the initiative is operating in the most efficient and economical manner.
Agency Affected: Environmental Protection Agency
Status: Closed - Implemented
Comments: EPA's response to Congress was dated July 25, 2006, and we received a copy in August 2006. Per the response, EPA agreed with the recommendation. Once the performance measures are developed, EPA will include them in the annual agreements between the e-Rulemaking Initiative and the participating agencies. The letter did not include an estimated completion date. As of September 14, 2006, our liaison at EPA was trying to obtain an estimated completion date. After contacting EPA on January 23, 2007, and February 23, 2007, EPA promised to send information documenting the steps it had taken to implement the recommendation. We received the information on March 12, 2007. The information provided did not indicate that EPA implemented GAO's recommendation. EPA provided copies of the annual agreements for a few agencies and said the language in agreements with other agencies was very similar. The annual agreements did not include performance measures. The agreements stated that EPA would establish performance measures. We contacted EPA again on August 6, 2007, requesting an update, but EPA did not respond. On March 4, 2008, we contacted an official in the e-Rulemaking Program Branch, Office of Information Collection, Office of Environmental Information and requested an update of actions taken by EPA to address the recommendation included in GAO-05-777. He provided an example of the written agreements between EPA and the participating agencies which were used for fiscal year 2008. The agreement includes a section that outlines goals which will be achieved by implementing a range of performance measures related to technology, processes and activities, customer results, and mission and business results. The agreement provides details about each of these performance measures. For example, the Program Management Office (EPA - the managing partner of the e-Rulemaking initiative) will ensure that the system is available to the public and federal agencies 99.9 percent of the time. This measure includes a formula for determining the amount of time the system is available to the public and federal agencies. The 2008 agreements are different than the agreements used in the past. The 2008 agreements list specific performance measures and provide details. The older agreements did not include performance measures - they just stated that the managing partner (EPA) would establish performance measures.
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1.Location is in outskirt of Graz in imigrant area,with a few streeptease bar in the hood!!! 2.room was very small,and that is ok,but design of room -10 for bad taste!!! 3.there was ants in my room. 4.the floor was time-worn. 5.there was several recikling trash cans in my room. 6.if you try to call another room in complex,they will charge... More
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text: Murray Hill's newest eatery, Meli, honey in Greek, serves Manhattan diners authentic cuisines using the cultivated Greek flavors, traditions, and ingredients that have made the Greek-Mediterranean diet so popular among health nuts and foodies alike. The Konstantinos family, who has run multiple restaurants across the Aegean for decades, partnered with Greek Chef John Pilouras (formerly of Nisi and Molivos) to bring diners an authentic Greek dining experience by using the finest Greek imports available. An example of Meli's penchant for authenticity is the Goges ($12). This traditional Greek pasta dish is made of hand-made pasta shells in a creamy sauce made of vlahotiri cheese and imported goat and lamb's butter. If we know anything about Greek cuisine, we know this dish has got to be delish. According to my source of all things Greek, the best combination to make anything dairy-related of the Greek variety uses both goat and lamb's milk.


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Wanna win this cool poster, personalized to you by Mo Willems? Well, read on!
Back in 2009, as a great treat to The Carle, Mo Willems created this wonderful poster to commemorate our annual gala in New York. (You can read more about The Carle Honors here.) We sell the posters in the shop and people are always asking, "Which artists inspired Elephant Gerard's portraits?" Well, we know the answer. Do you?
In his poster Mo Willems pays homage to twentieth-century artists who have influenced his work, or whose work speaks to him, or are simply easy to spoof. Rather than just rattle off the names of these artists for you, Mo and I thought it would be fun to to test our art-savvy blog readers instead: Can you identify all the artists correctly? We think you can!
One lucky reader who identifies the greatest number of artists correctly will win a Carle Honors 2009 poster autographed and personalized by Mo Willems!
Here's how to enter:
- Look closely at all 16 pieces of art in the image below (click to enlarge) and use the numbered guide to tell us the name of the artist who inspired each numbered piece. (See hints below!)
- Identify all 16 portraits in a comment below before 12 pm EST Friday, January 11th. We will be keeping comments hidden until a winner is announced to keep guesses confidential.
If more than one entrant gets all sixteen answers correct, one winner will be selected at random from among the correct answers.
Need a hint?
Hint 1: One of the artists is featured more than once.
Hint 2: One of the pieces represents a genre, rather than a specific artist. (Okay, we're feeling nice. We'll just give it to you: #12 is "African Mask.")
Hint 3. All art is from the 20th century.
Good luck!


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One year in office: Governor Snyder looks back at the last 12 months
By Christina Shockley and Zoe Clark
It's been almost a year, now, since Governor Rick Snyder took office. In the past 12 months, many long-time political observers have been more than a little surprised at the speed in which the Governor has been able to get his priorities through the legislature. The state has a new business tax and a balanced budget.
But, not everyone is happy with what the Governor has accomplished. The state now has some controversial new laws including new power for emergency managers and a law that taxes some senior citizens' pensions. Michigan Radio's Christina Shockley spoke with the Governor this morning, on his way to Lansing, about the challenges he's faced this year and what he hopes for in 2012.


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This adorable Full Comforter Set is Doc McStuffins' prescription for sweet dreams and super-comfy snuggles! The blue comforter is decorated with 'Smiles and hugs given here' text and graphics of Dottie and Lambie; the adorable shams feature a few of the doc's favorite pals. For extra fun, the set includes a matching miniature comforter and pillow for her favorite doll, and the box makes a great dollhouse too! The Doc McStuffins Full Comforter Set features:
"R"Web#: 562206
Manufacturer #: JF22392TRU
Product Weight:6.1 pounds
Product Dimensions (in inches):18.8 x 18.1 x 9.1
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A little disappointed!
By Korrey mother of 3
from Akron, Ohio
About Me Parent
Comments about Jay Franco & Sons Inc. 1012277 Doc McStuffins Full Comforter Set:
I bought this comforter for my daughter. She loves doc mcstuffins and has all the characters. I loved the fact that it came with a bed and pillow for lamby and that the box doubles as a dollhouse. The box has tape all over the door and I cannot remove without damaging the box! I looked at them in the store and they did NOT have tape all over the box. A little disappointed...
Comment on this review
Love it!!
By Sharr
from Atlanta, Ga
My 5 year old daughter loves this bedding! Especially since it comes with a miniature blanket and pillow for her doll. A definite hit!
Perfect bedding for Doc fans!
By The Diva's Mom
from Hurst, TX
Four year old daughter's roomStylish Very vibrant colors
Fun and functional bedding
By Amanda's Mom
from San Jose, CA
The comforter set is very good quality and keeps my daughter warm. My daughter has a twin size bed and the comforter is big enough to hang down on both sides of the bed so she isn't fighting to keep it on. My daughter LOVES LOVES LOVES the fact that it comes with a small comforter for her baby, or in her case Doc McStuffins. Overall great buy!
It's great.
By Bianca busy mom
from Corpus Christi, Texas
I bought this comforter set for my 4 year old daughter and she loves it.
Cute Comforter Set!
By AuBreysMom
from Pittsburgh Pa
Colors are bright, comforter and shams are good quality..Just wish it came w/ sheet set for the price..My 2 year old daughter loves it!
great alternative to princess bedding
By doc mcstuffins beddding
from toronto, ontario
Daughter loves the bedding.
(4 of 4 customers found this review helpful)
By mommy
from Elizabeth Indiana
Glad I finally found a full size
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Read "Traveling Full Circle", by Sherri Dalphonse, in the May 2013 issue of Washingtonian Magazine for advice on when and why you should consider using a travel agent. We are pleased and honored that Travel Place is included in the magazine's "recommended travel consultants and agencies" in the Washington DC metro area! Read more »
We provide professional travel services for individuals and groups for leisure trips, vacations, or incentive trips.
We handle individual and group humanitarian, mission and student travel for organizations, churches, colleges, and universities. We are advocates for our clients in dispute and problem resolution situations if necessary. We are here before, during, and after a trip.
As an American Express Travel Representative office, we have the buying power of preferred suppliers to provide the best value for your travel dollar as well as added-value in products and services.
I have to share with you, that Karen Kephart is amazing!!! I referred some friends for vacation travel to her. They are overwhelm with her, knowledge, friendliness and professionalism ! They Love Her ! They thank me every time I talk with them, and can't say enough about Karen, which is no news to me, I adore her too.. They are so excited about their trip, and already can't wait to plan another with her. They are frequent travelers, looking for a good agent, Karen has them now for life.


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Welcome to Oklahoma's Official Web Site file:///Y|/News_Letters/Newsletters/eGov/2008-07.html[9/25/2012 3:52:31 PM] Home / About /Media Center /Oklahoma eGovernment News Reports /2008 July Oklahoma eGov News Report eGovernment Services Customer Service Support Marketing/PR Services Media Center Partner Portal Please Give Us Feedback Please Give Us Feedback July 2008 OKLAHOMA'S eGOV NEWS REPORT Welcome Welcome to Oklahoma's eGovernment News Report providing you with up-to-date information on Oklahoma's eGovernment achievements. Oklahoma eGov News Online Reporting System Aims to Collect Agency's Suspected Fraud and Abuse Claims to Better Internal Operations State Encourages Chiropractors to Renew Online; Online Renewals are Secure, Convenient, and Reduce Paper Consumption As National Preparedness Month Approaches, Government Web Sites Provide Preparedness Tips Online Reporting System Aims to Collect What's Inside Welcome Oklahoma eGov News Agency Salutes How Do I? Upcoming State Holidays Upcoming Events Agency Salutes Oklahoma Department of Libraries "Oklahoma's public libraries rank in the top 10 nationwide for online connectivity, an accomplishment that NAVIGATE ADVANCED SEARCH


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Increases in prices for many commodities offset the wet spring that decimated the county's cherry crop and delayed growing of some other crops, reported San Joaquin County Agricultural Commissioner Scott Hudson.
In his annual report to county supervisors on Tuesday, July 24, Hudson said the record revenue from agricultural production of $2,238,688,000 was a 14.2 percent increase from 2010's total of $1,960,086,000.
"The figures obtained in this report are gross values rather than net returns to the grower," Hudson stressed.
The category of field crops, including alfalfa hay, grains and corn, was the biggest winner, increasing 47.2 percent in value in 2011 to $307,236,000.
The largest single-commodity revenue producer continues to be milk, which accounted for 20 percent of the total value at $452,880,000.
Revenue from hay — mostly alfalfa — reached record highs last year, increasing from $59,750,000 in 2010 to $89,577,000 in 2011. By year's end, alfalfa hay prices headed toward $280 per ton.
The fruit and nut crop category made up the largest slice of the county's ag-revenue pie, carving out 42.6 percent. Grapes ($286,728,000), walnuts ($278,857,000) and almonds ($187,748,000) led the way.


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Anne is the Internet Managing Editor for UpNorthLive.
GRAND TRAVERSE CO. -- A man is being charged with child abuse after he allegedly slapped a 6-year-old boy.
Officials at Cherry Knoll Elementary School notified authorities after the boy was dropped off to school late on April 17th. They say he had injuries to his face.
A teacher saw that they boy had a swollen lip and redness on one side of his face and when asked about it, the boy told the teacher he had been slapped the night before, police say.
David Wesley Orwin, 26, of East Bay Township, is being charged with child abuse in the case. Orwin told authorities the child threw a temper tantrum and fell onto the floor face-first after being disciplined for taking doughnuts without permission.
Orwin is charged with one count of misdemeanor child abuse, fourth degree. He was released on a $5,000 bond. Conditions of the bond require that he not have any contact with the boy.
A preliminary trial is scheduled for May 8.
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text:
What are the pluses and minuses of different software packages? Anything new worth checking out?
I'm especially interested in open source packages.
What are the pluses and minuses of different software packages? Anything new worth checking out? I'm especially interested in open source packages. |
If you haven't already, you should try Sage. Advantages:
(Possible) Disadvantage:
| |||||
Someone should also mention Axiom, which started out as commercial package developed by IBM but after a long and tortuous journey is now open source. As I understand it, it is built on a strongly typed, mathematically oriented and user extensible type hierarchy. So it knows what groups, rings and fields are, and it lets you define your own and do computation in them. | |||||||||
I tend to use Macaulay2 for research related stuff Some points about it.
I've also heard good things about Sage but haven't tried it. | ||||
I suggest you to try Reduce, it is OpenSource and there are RPM packeges. It looks like this: | |||||||||
The only open-source CAS (Computer Algebra System) that I know of is called Maxima, but as I have not used it, I cannot say whether it is any good. I own a copy of Mathematica 7.0, and can say that it is superb. The programming language is easy to learn, and in many ways quite similar to that of the TI-89. The university I attend uses Maple 13, which from my experience is not as strong as Mathematica in the area of purely symbolic manipulation, but is superior in terms of numerical modeling. | ||||
For quick calculations, I use Wolfram|Alpha, which is not open source but is a free web service. | |||||||||


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You're watching...
Winter storm slams Northeast with heavy snow, high winds
Anna Kooiman reports from Pennsylvania
Dec 27, 2012
You're watching...
Anna Kooiman reports from Pennsylvania
Dec 27, 2012
Also in this playlist...
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Auto-advanceThis transcript is automatically generated
And we are tracking a dangerous winter storm now blamed for nine deaths at this hour that storm is slamming.
The northeast this is video from Worcester Massachusetts.
This was actually the supporting you can see what folks are trying to deal with there -- -- storm hitting.
The middle of the country overnight dumping more than afford -- and a half of snow in some areas grounding flights up in the air stranding travelers.
Leaving hundreds of thousands of folks without any power.
And appointment of sliding clarks summit that's just north of Scranton Pennsylvania.
And have -- what's it like there.
Well -- -- can tell you this storm is expected that between a foot or two of snow and it's all said that in parts of the northeast but here.
And clarks summit which is in that northwest at Pennsylvania did have to stop here.
Last night that the -- the roads were simply getting.
Too bad there still is about 48 inches of snow on the ground though.
In this area really causing problems for commuters this morning now the tell clarks summit though had a budget surplus last year because of the lack of snow also able to stockpiles of the salt -- Roadways and they're using for this storm.
On the disorder has claimed seven lives the -- resident here tells me they are happy this first snow of the season.
I've been -- there blizzard for them so far.
We're we're out of -- -- this year and you know whether you take we get.
And dad -- gonna make lemonade out of -- -- yes.
And all the roadways are real problem for commuters try -- get to work -- The kids who are still out of school for winter break -- really enjoying.
The nice white fluffy stuff even -- -- their snow -- that some of them got for Christmas and Chanukah.
-- yeah good for them.
-- you know him and the storm is not finished though with the northeast right.
Yeah it's even so coming down here you see it's -- -- be a date is twelve to 24 hours.
For some portions across the northeast and back it is still snowing.
And parts of eastern and northern New York as well in some of the New England states also some of the coastal states like.
Maine and Massachusetts and M Rhode Island they're dealing with.
Freezing rain and sleet and an even more snow and high winds that are causing problems for commuters as well.
-- in New York State governor Andrew Cuomo has activated his emergency operation center and also notified our companies that have been criticized for being.
Slow to respond -- super storm sandy that they need to be on their toes back to you.
They surely do and employment.
Live just.
North of Scranton Pennsylvania thanks for.
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Skateboarders are a fanatical bunch, warriors on wheels who'll ollie and grind whenever and wherever they can. Any urban space will do, but if it's raining or there isn't a skate park nearby, what's a skater to do? Answer: live in the Ramp House, newly completed by Acrhivirus Architecture and Design. The Ramp House is exactly what it says it is: less a residence with a ramp than a seamless integration of half-pipe and homestead.
Given the brief of creating a "skatable habitat", architect Athanasia Psaraki launched into creating "a curved form interior which set the whole house as well as the inhabitant's life into motion." She tells Environmental Graffiti: "It was more a project of passion and creativity than functionality."
This was an undertaking that could genuinely claim to redefine a living space – actually a roof addition to a three-storey building – given that homes are not designed for skating, just as skate parks tend not to be the homeliest places.
Psaraki strove to achieve a harmonious balance between the old and the new. A wooden pergola and wooden horizontal louvers envelop the entire structure, connecting the building as it was with the way it is now – while also offering an airy spot from which to watch the action.
Far from simply having a mini-ramp installed in a living room, the skateboarding factor was incorporated into the very design details, making a home fully capable of being skated – frontside, backside, anyside. As the architect says:
"For me, the challenge of this project was to make a living space where the ramp, the bowl and all the interpretations of those terms would actually become the building elements for this space."
Thus, by way of the architect's imagination, straight lines became curved, and flat surfaces found new meaning as part of a ramp or a bowl. Psaraki says:
"Playing with these forms and with the variable transitions which they offer, my main goal was to create a functional open space where aspects of daily life would adopt 'the feeling of acceleration.'"
With this in mind, Psaraki designed a home where the living room is no longer just a living room but a mini-ramp that turns into a bowl – which in turn creates a partition with the bedroom and bathroom. Meanwhile, elements like the fireplace and storage units are hidden within the ramp structures.
Through a merging of styles, concrete supplies the street skate aesthetic while wood provides a warm ambiance. Concrete walls mould into the floor, which then becomes wood, forming a ramp separating the kitchen. In this last space, at least, surely the crockery makes kick-flips a faux pas? But no.
Psaraki also reveals that experts were very much – sorry – on board: "The ramp transitions were made on site by skater friends who had experience skating mini ramps while construction details were drawn after extensive research via the internet and people who might know!
The final effect? A skater's dream that wouldn't alienate those who just want an environment to chill in; a smooth environment where you "can flow from one space to the other, skating or walking".
Turning a home into a play park for your pastime of choice is probably not a luxury everyone can aspire to, but for those who can it's a pretty rad idea. It more than set Psaraki's creativity in motion, with the architect concluding: "At the end of this project I definitely adopted 'the feeling of acceleration.'"
With special thanks to Athanasia Psaraki for her insightful comments and kind permission for use of the images.
If you want to find out all the latest news on the environment, why not subscribe to our RSS feed?


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Adult Contemporary, Pop, Rock, Top 40
London, United Kingdom
Bossa Nova, Jazz, Lounge
Hilversum, Netherlands
United States
Dance, Electronica, Progressive, Trance
New York City, NY, United States
Hip Hop, Rap, RnB, Urban
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Last played: Nicholas Cole - Between Us (f. Michael Stever) - Endless Possibilities
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text:
Abel City Outskirts 50 miles out from the city
Posted 13 December 2009 - 02:38 AM
Tomas picked up the container of weapons and ammo now securely locked and turned it's back towards him. He tugged on what looked like seat belts looped into a form of strap. He brought a large portion of the loop out and slid each arm into a strap and hefted the container onto his back. He stepped out of the cave with the heavy equipment and waited for Vivian to show the way.
Posted 13 December 2009 - 05:17 AM
[Heads to Wind Temple]
OOC: Sorry for posting so late. Been busy lately and studying for Mid-Term Exams...
Posted 13 December 2009 - 05:22 AM
Tomas took a deep breath and gently tugged on the straps of the equipment pack and followed Vivian to the temple. He really didn't know how things would bode, but at the very least he'd have a place to rest and he'd know his gear was safe. If anything, some of it might give the people in the temple a fighting chance. Including all the grenades.
[To, Wind Temple]
Posted 09 January 2010 - 07:59 PM
Price kept struggling. The darkness was rising...
He yelped. "Uncle!" He realized he was on the side of an old creek. They must've dumped his body. How half-assed. He coughed, the wound in his stomach was aching and searing badly. He couldn't move..
He looked to the left, he still had his plasma-blade. Stephens couldn't remove it. Heh..
He then passed out again. He just lost everything but his hidden blade. And he knew what to do... But for now, rest. Just a long... rest.............
Posted 13 January 2010 - 10:14 PM
Hajime arrived near the outskirts of the city, using his rocket booster attachments to speed him up until he reached the last roof of the area.
Now closer to the area, the faint spirit seemed to be more easy to locate. He unbuttons the collar on his coat and pulls it down before pulling out a vermillion medallion with the carving of Suzaku in the center, and sticking it on his chest, causing his Vermillion robe to form around his Blazkrieg uniform. He wants to avoid being seen as a threat since he doesn't know what kind of human he was about to help.
Dropping down to ground level, he begins to saunter around the ourskirts, using his spirit reading to detect how close he is to the weakened human. He eventually comes across a creek were a body laid seemingly drenched in more blood than water. The sight itself was enough to make him shudder in fright, but he quickly suppresses it as he moves closer to the body and lifts it up slightly to check for any physical damages.
Posted 14 January 2010 - 12:32 AM
You idiot! Wake up!
Zitto, asino! Price responded to that voice in his head. He rose his head to mayhem. He was... in Abel City. It appeared a massive operation was happening. But the pain from his wound was too much! He clutched it, and cringed.
"Is anybody... anyone there?"
Posted 14 January 2010 - 01:47 AM
He should be taking this man to the hospital, but with the swarm growing in numbers, there was no telling which hospital would be farthest enough to avoid getting sucked into the conflict.
He grips the pieces of PRice's ripped shirt and teras it further apart, revealing more of the wound in his gut. He then places his hands on the wound and begins massaging it in and out as the palms of his hand glowed a warm, tranquil light, dulling the pain while an invigorating sense of energy flows through his veins.
The gashes in the wound began to shrink the more he squeezed at them until all that remained is a scar; the pain had all but numbed away completely.
Posted 14 January 2010 - 02:03 AM
In the distance he could hear the cries of nightmarish creatures. He still had his wrist-blade.
Posted 14 January 2010 - 02:08 AM
"The introductions'll have to wait," he said, "This city is infested with Godzilla-size creatures. You need to get somewhere safe before their increasing numbers reach the borders of this city."
Posted 14 January 2010 - 02:30 AM
Posted 14 January 2010 - 02:51 AM
Posted 14 January 2010 - 12:54 PM
Just because Stephens has broken his oath does not mean that Price needs to.
Posted 14 January 2010 - 09:50 PM
"I don't think that's such a good idea," Hajime mutters, "You were stabbed pretty good. Even with Vermillion's tranquil healing, you still need at least a couple more hours before you're back to full energy. And besides, we might give the Hunters grief if they saw two humans fighting off the swarm."
Posted 15 January 2010 - 02:08 AM
"So you have no place we can evacuate to? No place where the civilians might be? They may be in danger, even in shelter."
He did feel slightly tired, though. He was right. So he let the idea drop. They had to at least get somewhere safe. And let him collect his thoughts.
Posted 15 January 2010 - 02:43 AM
He walks over to a nearby manhole and used two of his wires to twist and pull the lid off.
"We'll have to make do here until the situation's under control," he said, "We better hurry, though. One of the Hunter's is about to unleash a giga crush that might raise the temperature beyond normal human tolerance if the flames don't reach us first."
Posted 15 January 2010 - 03:16 AM
White-Jet, on 15 January 2010 - 02:43 AM, said:
He walks over to a nearby manhole and used two of his wires to twist and pull the lid off.
"We'll have to make do here until the situation's under control," he said, "We better hurry, though. One of the Hunter's is about to unleash a giga crush that might raise the temperature beyond normal human tolerance if the flames don't reach us first."
"Then, by all means, Dobbiamo sbrigarci." Price allowed him to go first. Then he lowered himself, and dropped into the sewers. Nasty place..
Posted 15 January 2010 - 03:41 AM
Now sure they were safe from danger, the only thing left is to wait until Magnus unleashes his attack before checking to see if it was safe to come back up.
Posted 15 January 2010 - 01:09 PM
White-Jet, on 15 January 2010 - 03:41 AM, said:
Now sure they were safe from danger, the only thing left is to wait until Magnus unleashes his attack before checking to see if it was safe to come back up.
Price started to think about this "invasion". He slowly craned his neck around to see his savior... "What kind of creatures are these?" He asked. "I feel a tad.. at the disadvantage if any stragglers decide to follow in."
Posted 15 January 2010 - 09:10 PM
Hajime looks towards the lid of the manhole, "The only thing you need to worry about is the acid they spit out. A single drop could burn the skin right off your body. But I doubt they'll be able to fit through the manhole even if they melt the lid off."
Posted 17 January 2010 - 04:34 AM
Something appears to be infurating him into putting himself back in the line of danger to ward off the creatures that were closing in around them, but his reasons were not because he didn't trust Magnus' intentions, they seem to be focused on two other undetectable beings in the area, most likely reploids.
Hajime grit his teeth, there was barely little he could do at the moment due to his current position away from the point of disaster, even with his rocket boosters, it would still take him a while to get to the area without crashing into every single corner or pipe that stuck out of the sewage system.


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I am a software architect, have been working hands-on on storage softwares for last 10+ years. All I know at the moment is, the problem, and the software solution to it.
Appreciate your help in making decisions on several factors.. like:
Would there be a need of a co-founder?
How do I accomplish all the legal formalities (based in India)?
How do I decide whether to develop it on Windows or go for Open-Source (personally I'm a big fan of and believer in Open-Source)
How to setup the marketing strategies?
How do I approach VCs?
In short if you could give me a recipe, that would be a great help for me.


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Anti-gun NFL: National Frauds' League
Michelle Malkin
The National Football League's hypocrisy and selective decency standards reek like a post-game locker room. On the one hand, the organization refuses to run a firearms manufacturer's self-defense Super Bowl ad under the guise of neutrality and taste. Yet the professional football conglomerate routinely revels in raunchiness, gratuitous physical violence and anti-gun screeds.


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StartUpHire is the place to find IT jobs in and near Clark. Review the list of IT Clark career opportunities to the left. These IT jobs represent some of the most rewarding careers available.
You can refine your job search for IT career opportunities in Clark by adding a job title, company name, or keyword to the search box above … or click the "Advanced Search" link for more options.
Don't see the employment opportunity you're looking for? Check back soon for more IT jobs in Clark, or sign up for an email alert (link below) to receive periodic updates on new IT jobs in Clark, NJ.
Do you want to have meaningful global impact and be an integral part of a fast growing business? Then Appway is looking for you!
11/21/2013 New York, NY Save This JobJob Description All Covered, a division of Konica Minolta, is focused on enabling the success of small and medium-sized businesses through the effective use and management of technology. The company is the US industry leader in the provision of IT Services for companies with
10/30/2013 Ramsey, NJ Save This JobBrief Summary: The IT Help Desk Associate will be providing support to 2U?s internal employees worldwide. They will be assessing and resolving technical issues and implementing fixes to completion. This individual will be responsible for the installation, configuration,
10/29/2013 New York, NY Save This JobRightAnswers delivers knowledge management, self-service, and knowledge base development tools to enable enterprise organizations to optimize their internal support and external customer service operations. Designed for internal support, the company?s flagship software ?
11/29/2013 New York, NY Save This JobTumblr is looking for an IT Systems engineer with a customer service focus to help keep our team happy. Responsibilities and Duties: Field support request from the internal Tumblr team. Troubleshoot everything from hardware to VPN connections to audio/video
10/1/2013 New York, NY Save This JobTremor Video is seeking a very strong, desktop support administrator. As a Desktop Administrator, you will be supporting and maintaining the desktop environments of Tremor Video?s Corporate offices, as well as the VOIP telephony service (a hosted service) and the A/V
12/4/2013 New York, NY Save This Job% of Travel Required : 10-20% Job Type : Full Time Shift/Hours : First Shift (Day) Career Level : Experienced (Non-Manager) Education : Bachelor's Degree Skill : Engineering -> Design, Fixed Equipment, Applications / Technical Support Information Technology -> Networking, MCSE,
11/30/2013 Eatontown, NJ Save This JobLocation : Florham Park NJ US 07932 Job Type : Full Time Shift/Hours : First Shift (Day) Career Level : Experienced (Non-Manager) Education : Bachelor's Degree Skill : Information Technology -> Networking, Hardware Troubleshooting, User Support Skills Customer Service ->
10/31/2013 Florham Park, NJ Save This Job% of Travel Required : None Job Type : Full Time Shift/Hours : First Shift (Day) Career Level : Experienced (Non-Manager) Education : High School or equivalent Skill : Information Technology -> Software Installation/Configuration, User Support Skills Category : AV Technology Job
11/30/2013 Eatontown, NJ Save This JobLocation : Ny NY US 10001 % of Travel Required : 50-60% Job Type : Full Time Shift/Hours : First Shift (Day) Career Level : Experienced (Non-Manager) Education : Bachelor's Degree Skill : Sales -> Outside Category : Sales/Retail/Business Development Job Description : At Yorktel
10/31/2013 New York, NY Save This JobLocation : Eatontown NJ US 07724 % of Travel Required : None Job Type : Full Time Shift/Hours : First Shift (Day) Career Level : Manager (Manager/Supervisor of Staff) Education : Master's Degree Skill : Technical Support -> Call Center Information Technology -> User Support
10/31/2013 Eatontown, NJ Save This JobThe Business Systems Analyst?s role is to plan, design, develop, and launch efficient business, financial, and operations systems in support of core organizational functions and business processes. This includes gathering and analyzing data in support of business cases, proposed
11/29/2013 Holmdel, NJ Save This JobJob TypeContract Full-Time Position Id22005 Job Description Manages and maintains all production and non-production databases. Responsible for standards and design of physical data storage, maintenance, access and security administration. Performs backup and recovery on Database
11/20/2013 Hightstown, NJ Save This JobJob Description RealMatch Inc. is currently looking for a dynamic Pre-sales technical support specialist. Join a high impact team that is on a relentless mission to revolutionize online recruitment advertising. The Pre-Sales Technical Support specialist is responsible for
12/8/2013 New York, NY Save This JobOverview: The Senior Software Engineers (multiple open positions) at Everyday Health Media, LLC in New York, New York Responsibilities: he Senior Software Engineers at Everyday Health Media, LLC in New York, New York will be responsible for communicating complex concepts in a
11/21/2013 Manhattan, NY Save This JobJob Type : Full Time Shift/Hours : First Shift (Day) Career Level : Experienced (Non-Manager) Education : Bachelor's Degree Skill : Engineering -> Applications / Technical Support, Electrical, Fixed Equipment Information Technology -> Hardware Troubleshooting, Networking, User
10/31/2013 Eatontown, NJ Save This JobAre you excited about the latest technology trends? HTML5? Mobile? Ruby on Rails? MongoDB? Do you like learning new programming skills and solving interesting problems? Would you like to work in an agile environment where creativity and technical expertise come hand-in-hand?
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11/28/2013 Yonkers, NY Save This JobDescription Granicus is the leading provider of Software as a Service (SaaS) that helps promote government transparency, encourages citizen participation, and increases workflow efficiency. We are the market originator and award winning provider of an integrated platform that
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11/29/2013 Ramsey, NJ Save This Job


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What a great season these angels had thanx to two wonderful coaches.Coach Marcy and Kim.Let them have the best of luck into the playoffs and many more seaons.My daughter and the rest of the girls had learned alot from you.Thank you.
River Rock Softball Ponytail jrs.Angels!
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says ... on Saturday, Jul 31 at 9:02 AM
My daughter Chloe is a first year player and has learn alot from marcy,kim, bart and ken lets not forget them and without the four of them the girls wouldnt be where they r today! So win or lose today we had a great season,Go Angels!
says ... on Saturday, Jul 31 at 12:29 AM
how great is this dave you realy are a great person!!!!!!
says ... on Saturday, Jul 31 at 12:26 AM
what a great group of girls and 2 wonderful coaches!!! good way too end a season 4 some reason if they dont come out on top i want each and everyone of them to know how much i am proud of them and love them!!!!! kim and marci rock!!!!! !!!!!!!xoxo
says ... on Friday, Jul 30 at 11:33 PM
wtg angels!!!!!!!!!!!!!!!!!
says ... on Friday, Jul 30 at 11:33 PM
wtg angel!
says ... on Friday, Jul 30 at 11:17 PM
yes I am sabres123 and I appreciate these coaches.Because of them my daughter came a long way!thank you
says ... on Friday, Jul 30 at 10:54 PM
It has been a pleasure to coach these girls this season!! And we could not have asked for a better set of parents, they put their confidence and trust in us, and supported us 150% each and every game. I hope we can see them back again next year.


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Please be aware that if a large number of caches are placed NAP may have to put limits on the number of caches allowed in each park.
The City reserves the right to remove any cache that is in an inappropriate location, causing undo impacts on the ecosystem, or deemed unsafe.
These guidelines were written to protect the well-being of our natural areas, the safety of all park users, and allow for the future use of the Ann Arbor park system for geocachers.
Application for Orienteering permit (pdf)


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Arrangements for admissions to schools in September 2012
The specifications, processes and guidance for the electronic transfer of data to enable implementation of coordinated admissions, are available to download from this page.
Documents available for download include
- revised guidance notes for the 8 series files that bring together in one place the various documents and clarifications issued over the last three years and hold all of the information concerning the use and specification of these files
- a separate document detailing major changes included in the series 8 files
- example files and xml schema for admissions message files
- advice and guidance on statutory reports
- other information relevant to the coordination of admissions in England
The percentages of parents obtaining a preferred secondary school, March 2012
(As required by the Provision of Education (England) Regulations 2008.)
You can now download notes on the specification and technical definition of the file to be sent to the Department on percentages of parents obtaining a preferred secondary school in March 2012. Guidance from the Department (including frequently asked questions and how to provide the data via a web form) will be available early in 2012.
ATF schema: new version published November 2011
As a result of a change in the definition of the <Country> field in CTF 11 and the move of the <FSMhistory> container out of the <BasicDetails> container in ATF 8 a new schema has been produced. This replaces all previous versions.
The revised XSD for ATF version 8.1 for use in the 2011/2012 admissions round for offers to pupils starting school in September 2012 is available. The following items are available:
- ATF 8.1 xsd
- CTF 11 includes (these must accompany the above)
- ATF 8.1 example file
- ATF 8.1 validated xml example file
- Updated changes log
Admissions schema (not including ATF)
XSD schema files for admissions transfer files (APT, ADT, AOT, ASL and ALT) version 8.1 for use in the 2011/12 admissions round are now available. The following items can be downloaded from this page:
- XSD schema and includes (XSD file types) that support the 8.1 series specification and a readme file to accompany the schema. Note: these XSD files must be stored in a separate folder from those used in earlier years as some of the files have the same names but contain different definitions
- example files that accompany the schema. These are for admissions transfer files (APT, ADT, AOT, ASL and ALT) version 8.1 for use in the 2011/12 admissions round (resulting in admissions to schools from September 2012 and in year admissions during the academic year 2011)
- supporting documentation
- a changes log


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This is NEClimbs and White Mountain Report 2012/2013 Annual Fundraiser. PLEASE make your contribution today!
I'm slowly starting to put together a trad rack, so that when I finally get around to learning to lead trad, I'm not faced with a massive list of gear to acquire. I have an opportunity to get a whole set of good condition used hexes for $50.


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Hangout @ Jonker Reviews
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Very clean facilities, probably the cleanest hostel I've ever stayed in. Was greeted by the warmest, friendliest smile from the night staff who was also very helpful. Could use a second toaster for breakfast though. Hangout @ Jonker also has a very secure safety deposit to hold your valuables where the guest keeps one key and the staff has a master, both of which are needed to access the box. I would definitely stay here again and wish I was there for longer than one night.
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the picture Do not have the same feeling when c the actual room
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Basketball Buford Jocelyn Danley scored 21 points in Buford's 66-47 win against Decatur last Tuesday night. Chestatee In Chestatee's 47-38 win against White County last Tuesday, freshman forward Peyton Robertson scored 19 points and pulled down 11 rebounds. Freshman guard Chelsea Wilson scored 17 points in Chestatee's 49-38 loss to Gilmer last Friday. <p ...
Unseasonably warm, that's the proper description for Tuesday, Dec. 18, 2007, but Josh Barrett proudly wore his Flowery Branch letterman jacket.
Buford High girls basketball coach Gene Durden has deliberately tried to create a little chaos during practice this week. The Class AA fourth-ranked Lady Wolves' (14-2) third-year coach has done his best to test his team's attention to detail. Whether it be full-court press on defense, seven defenders to try to disrupt the flow of the offense or loud noise with whistles and constant instruction, it's all a ...
OAKWOOD - This week certainly proved to be a welcomed change of pace for the West Hall High boys.
The West Hall High girls defeated Pickens 52-47 in overtime thanks in large part to some clutch free-throw shooting. The Lady Spartans (8-7, 2-1 Region 7B-AAA) hit 6-of-8 from the line in the closing moments of the game.
GAINESVILLE -- It takes more than one strong smack to create a hole in a cement wall. It's the consistent chipping away of one area that does the trick.
Basketball Buford Blanch Alverson scored 22 points to lead the Lady Wolves to a 61-49 win against Avondale last Friday night. She also scored 16 in Buford's 60-51 loss to GAC last Tuesday. Chestatee Tennessee State signee Parker Smith scored 30 points to lead the War Eagles past Lumpkin County 67-58 last Tuesday. Senior guard Branden Jovaag added ...
GAINESVILLE - Just the thought of having Peyton Robertson around for three more years makes Chestatee High girls basketball coach Web Daniel smile.
Stuck with the subregion setup, Region 7-AAA's football coaches decided on a schedule for the 2008 season Monday and the plan is expected to be ratified by the region's principals today.
First things first, I am a fan of Mark Twain.
ELLIJAY – It wasn't exactly what West Forsyth coach Dennis Stromie was hoping for: nobody wants to lose 73-3 in the finals. But the Wolverines' second-place finish at Saturday's Area 7-AAA Duals championship was more than the veteran coach expected from his first-year program. "I coached at Parkview for 22 years and won two state duals championships, and this is right up there with those," Stromie said ...
The East Hall and Gainesville boys basketball teams appear to be ships headed in different directions.
Flowery Branch's Josh Barrett had 26 points and two steals to lead the Falcons to a 84-62 win over Buford on Saturday night in Buford.
BY BILL MURPHY firstname.lastname@example.com Micah Owings would rather avoid the public spotlight for his individual accomplishments. But Gainesville High's most decorated baseball player in school history was front and center of a packed house at Gainesville High's gym to have his baseball jersey retired Saturday night during halftime of the boys' basketball game against East Hall. Owings' jersey was retired during basketball season ...
GAINESVILLE- Mary Mancin and Tess Patton know a good deal when they see it. Both of these North Hall High soccer players were among 800 girls on hand at the Allen Creek Soccer Complex on Saturday morning for a special opportunity to take part in an Olympic Development Program soccer camp right here in their own backyard. This weekend's camp brought in players from Olympic ...
Avery Cagle poured in 31 points for Riverside Military in a 65-27 victory over Atlanta International on Saturday in Atlanta. C.J. Howarded added 12 points and 13 rebounds for the Eagles (3-1). Riverside hosts Towns County on Tuesday at 6 p.m.
James Hodges recorded his third-straight double-double for Johnson with 32 points and 10 rebounds in a 65-51 win against Lanier on Friday in Oakwood.
Although the 2013 sports season hasn't yet drawn to a close, the Georgia High School Association's recent reclassification and region alignment procedures already have schools making plans for Fall 2014 and beyond.
Two local regions are scheduled to undergo dramatic shakeups, while several others will experience more subtle changes in the latest Georgia High School Association realignment.
The Jefferson boys basketball team is preparing for its move to Class AAA next year with a simple strategy: Play Class AAA teams now.
Paisley Lee tallied 12 points for the Gainesville girls in a 57-19 win against Apalachee on Tuesday in Winder.
Sydney Cleveland tallied 28 points for North Hall in a 73-41 win against Lakeview Academy on Monday in Gainesville.
David Sokol led South Forsyth's boys basketball team to its fair share of signature wins during a successful seven-year stint as the War Eagles' coach.
Jordan Stubblefield scored 19 points, including three 3-pointers, to lead the Chestatee boys basketball team to a 73-64 win over Franklin County and its first victory of the year at a tournament Saturday in Jefferson.
Lucas Pain scored a game-high 21 points and Cameron Millholland added 11 as the Dawson County boys played stingy defense, limiting Social Circle to just five first-half points to earn a 52-32 win on Tuesday night at the Walnut Grove Thanksgiving Tournament.
Kayla Watson notched 18 points to lead Chestatee to a 53-39 win against Jefferson in Tabo's Tip-Off Tournament on Tuesday in Jefferson.
Fresh off a region championship and with all but one starter back, expectations are skyrocketing for the Johnson boys basketball team in the 2013-2014 season.
Jensen Hall and Maia Booker each tallied 12 points to lead West Hall's girls basketball team to a 46-34 win against Hart County in the White County Tip-Off Tournament on Monday in Cleveland.
Page 1 of 1
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Jun 27 2012
There's nothing like a book.
By Kristen Chase. As much as I love technology and support its use for kids, especially my own, there's just nothing like a real book. I realized this when I experienced a wave of nostalgia this past week as I spent them cleaning out my mom's house while she recovered from open [...]
Keep Reading


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Samsung Memory has been number one since 1992, and no one has produced memory cards with better performance or reliability than the engineers of Samsung Memory. With proven experience for 19 consecutive years, Samsung memory delivers the highest level of performance with unmatched style.
Samsung's Standard microSD card lineup is the perfect solution for casual mobile device users. With solid transfer speeds of up to 24MB/s, they work great to expand the capacity of a tablet computer or celluar phone.
Samsung microSD Memory Cards are designed to withstand water, shock, magnets, temperature, x-rays and just about anything else.
Features and specifications are subject to change without prior notification |


text: Fox News -- SINGAPORE – Oil dived below $97 a barrel Monday in Asia, bringing its fall over three trading days to about 8 percent, as a slowdown in U.S. hiring and election results in Europe dimmed expectations of stronger economic growth.Benchmark oil for June delivery was down $1.87 to $96.62 a barrel in electronic trading on the New York Mercantile Exchange. The contract plunged $4.05 to settle at $98.49 in New York on Friday. Brent crude for June delivery was down $1.81 at $111.37 per barrel in London.Crude has slumped about 8 percent over the last three trading sessions amid signs oil demand may be weaker than previously expected.The Energy Department said last week that U.S. crude inventories have risen to the highest since 1990. That was followed by the Labor Department on Friday Read the Full Article


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CENTURY OAK of FAIRFAX Virginia Homes For Sale and Real Estate Statistics. Below is a LIST of SOLD Homes and Home Sale Prices, Seller Subsidy, Days on the Market, and Age of the Sold Homes in CENTURY OAK of FAIRFAX VA 22033 for the months of JANUARY 2011 thru DECEMBER 2011.
The SOLD LIST below applies only to properties in CENTURY OAK of FAIRFAX VA 22033 that were SOLD during the month of JANUARY 2011 thru DECEMBER 2011 through the MULTIPLE LISTING SERVICE, MLS, and does NOT take into account For Sale By Owner, FSBO, and other privately sold properties.
To search all Washington, D.C. area, Northern Virginia, FAIRFAX COUNTY & FAIRFAX va MLS listings and homes for sale by MAP, COUNTY, TOWN, ZIP CODE, or LISTING NUMBER visit my web site: http://www.RealtorVivianneRutkowski.com/ or www.RealEstateWithViv.com
To save your searches in Property Wizard and receive automated e-mail market updates and new listings that meet your criteria: http://www.realtorviviannerutkowski.com/pw_login.shtml
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CENTURY OAK of FAIRFAX Virginia SINGLE FAMILY HOMES for sale and real estate for sale. SINGLE FAMILY HOME SALE PRICES, SELLER SUBSIDY, DAYS on MARKET, AGE of SOLD HOMES and Real Estate Properties SOLD in CENTURY OAK of FAIRFAX VA 22033 for the months of JANUARY 2011 thru DECEMBER 2011:
- Millpond Court ——– $480,000 —- $0.00 —- 15 days — 18
- Old Plains Road ——–$520,000 —- $0.00 —- 19 days — 18
- Lee Side Court ——— $550,000 —- $0.00 —– 2 days — 17
- Millpond Court ——– $585,000 — $17,550 —– 8 days — 17
- Wheatland Road —— $634,000 —- $0.00 — 138 days — 17
- Millpond Court ——– $650,000 —- $0.00 —- 12 days — 17
- Dusty Wheel Lane —– $752,500 —- $0.00 —– 6 days — 18
- Wheatgrain Lane —– $740,000 – $7,500 —– 46 days — 16
- Curtice Farm Dr. —– $830,000 —- $0.00 —- 54 days — 16
FAIRFAX COUNTY Virginia Residential Real Estate Statistics for SINGLE FAMILY HOMES, TOWNHOMES, and CONDOMINIUMS: Average & Median Home Sale Prices, Average Days on the Market and Active MLS Inventory of Homes For Sale. Visit here for the list of the latest home sales in FAIRFAX Virginia Homes For Sale & NEIGHBORHOODS
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Customizing SMF > Building Your Community and other Forum Advice
20 reasons for members to start a new topic on your forum
--- Quote from: Kindred on August 18, 2012, 12:25:26 PM ---I don't know about that... personally, your post seems kinda pointless... anyone who makes their way to my forum alreayd knows WHY they want to post....
--- End quote ---
They ought to anyway ;).
It must be said, I've never seen any post on any forum I've been a member of which has stated something along the lines of 'help, what should I post?'.
It seems to me that having such a great long list of reasons for posting might be a bit off putting to new members, and would probably not be read by many in any case. Members who post usually post because they have some kind of interest in the forum, so advising them what to post seems to be a bit unnecessary, and could possibly come over as being rather patronising.
Don't you think that you can help members by giving them some ideas?
Some members don't have a question and post nothing. But often they have some knowledge
or good idea where the whole group can benefit from. This post is meant information purposes,
just to give members some inspiration.
It depends on the type of forum you have, but in general, you're likely to have those who are inexperienced, or new to the subject(s) discussed on the forum, and they will naturally ask questions, which more experienced members will then respond to (in all probability), even if they don't start threads themselves.
I just don't see any reason to force the issue. Members will post without needing guidelines about what to actually post. If you want to have guidelines about how best to format a post, or structure arguments, and so on, then that's okay, but that's as far as you need to go in my opinion.
ChalkCat @Christmas:
I think that list looks a bit patronising. Surely those who are interested in posting will already know what they want to post, otherwise they'll just read and not even give a thought to posting, if they bother with the forum at all.
In my experience, the only members who look for inspiration for what to post are the admins ;)
I forgot...
21 - Pr0n. :)
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Halston Heritage
Sleeveless V Neck Dress with Twisted Front in Slate/Violet
Launched in 2009, Halston Heritage takes the iconic silhouettes from designer Roy Halston Frowick and reinterprets them for the modern woman. Expect a timeless approach to style along with luxurious designs that reference pieces worn by Bianca Jagger, Liz Taylor, and Anjelica Huston.
- Self & Combo: 68% acetate 24% nylon 8% spandex
Lining: 91% nylon 9% spandex - Shoulder seam to hem measures approx 33" in length
- Fully lined
- Dry clean only
- Draped detail throughout
- Side seam zipper closure
- Styled with Pour La Victoire Irina Pump in Black Suede.
- Styled with House of Harlow Zig Zag Tribal Cuff in 14k Gold.
- Styled with House of Harlow Bone Stack Ring Set in Gold.
- Styled with House of Harlow Faceted Metal Cross Ring in Rose Gold.
- Modeled in size 4. See fit guide for model's dimensions.
- Revolve Style No. HALS-WD145
- Manufacturer Style No. AJ150111CB


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Cycle for Survival is the high-energy indoor team cycling event that has raised more than $17.5 million for rare cancer research. 50% of people diagnosed with cancer suffer from a rare form of the disease. Make an impact and join the battle to beat rare cancer with Cycle for Survival.
Online registration is now open for Cycle for Survival 2013, the national indoor team cycling event that raises money for rare cancer research at Memorial Sloan-Kettering. Since its inception in 2007, the event has generated more than $17 million, funding 53 clinical trials and research studies.
Cycle for Survival 2013 is expected to be the largest event yet, taking place in ten locations in eight states. Four cities, including Boston and Miami, have been added to the roster of cities, which began with New York and now extends from coast to coast.
More than 13,000 cyclers are expected to join Cycle for Survival in the coming months to raise critical funds for clinical trials and research studies aimed at discovering new treatment options and providing hope for the millions touched by rare cancers around the world.
Cycle for Survival was co-founded in 2007 by Jennifer and David Linn after Jennifer was diagnosed with a rare cancer. It became an official Memorial Sloan-Kettering Cancer Center event in 2009. Cycle for Survival has nearly doubled in size and fund-raising totals each year, with all funds directed toward rare cancer research within six months of each ride.
Although more than half of people diagnosed with cancer have a rare form of the disease, research on many rare cancers is underfunded, leaving patients with limited treatment options. Memorial Sloan-Kettering is committed to increasing the focus on rare cancers.
Over the past five years, funds raised by Cycle for Survival events have contributed to numerous research studies and discoveries on topics including:
To learn more, register to ride, or donate, visit Cycle for Survival and join the battle against rare cancers.