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An Update for Pharmacists Fibromyalgia Syndrome: An Update for Pharmacists
Fibromyalgia syndrome (FMS) is a chronic, soft-tissue pain disorder that affects about 3.7 million people in United States, the majority (75%) of whom are women.1 The condition is characterized by fatigue and widespread pain in muscles, ligaments, and tendons and is a common cause of chronic musculoskeletal pain. Patients with FMS often report tender point pain that occurs in local sites –usually in the neck and shoulders–and radiates out into other regions of the body. Such pain can occur in areas where the muscles attach to bone or ligaments, but the joints are not affected. Pain resulting from FMS is similar to that of arthritis and has been described as stiffness, burning, radiating, and aching.
The generalized pain of FMS is often accompanied by many other symptoms, including depression, headache, paresthesias, fatigue, poor sleep, and morning stiffness (Table 1). As more attention is given to the pharmacological treatment of this disorder, pharmacists will likely receive questions from patients with FMS. This article will help pharmacists to effectively counsel patients with fibromyalgia and recognize patients with FMS-like symptoms who are self-treating, since some of these patients may need medical treatment.
The exact etiology and pathogenesis of FMS is essentially unknown. Due to its similarity to other disease states and lack of objective symptoms, the disorder is often difficult to diagnose. FMS affects about 2% to 3% of the general population and more than 5% of patients in general medical practice.1,2 The typical age of patients with FMS ranges from mid-30s to late-50s. One study found that generalized musculoskeletal pain in women was increasingly prevalent as age increased from 18 to 70 years.3 Patients often report that their pain is continuous and can vary depending on time of day, weather changes, physical activity, and the presence of stressful situations. Insomnia often exacerbates the pain.
Multiple physiologic alterations such as sleep disturbances, altered neurotransmitter metabolism, and muscle structure abnormalities have been proposed to account for the symptoms associated with FMS. Such theories involving sleep and neurotransmitter alterations are widely accepted. Poor sleeping patterns are very prevalent in patients with FMS and can affect their stress response system. This contributes to negative mood, cognitive difficulties, and increased pain perception.4-6 The stress response may become maladaptive in chronic pain syndromes and contribute to symptoms such as fatigue, poor sleep, low mood and/or anxiety, and "flu-like" illness. 4 Evidence suggests that psychological stress can initiate alterations of the stress response system, with multiple adverse effects on the neuroendocrine, immunologic, and autonomic nervous systems.5,6 Decreases in serum serotonin, which modulates pain and stage 4 sleep, have also been noted. In addition, levels of serotonin's precursor, tryptophan, may be low in patients with FMS.5 The theory that altered serotonin may be involved in the pathogenesis of FMS has led to the use of selective serotonin reuptake inhibitors (SSRIs) for treatment. Other biochemical abnormalities include an elevated level of substance P in cerebral spinal fluid (80% of patients).7 Hyaluronic acid levels are high early in the day, and changes in serum levels are related to the intensity of morning stiffness.7
The simultaneous processing of sensory and emotional aspects of pain may influence the subjective intensity of FMS symptoms. Patients with FMS have distorted central nociceptive processing, which alters the pain perception and pain tolerance thresholds. The two principal effectors of the stress response, the hypothalamic pituitary axis and the sympathetic nervous system, are activated in pain states.6 Negative emotions and psychological factors can heighten the pain experience and pain-processing systems. The four principal categories of pain are (1) nociceptive pain (matches the noxious stimulus), (2) neuropathic pain (may follow injuries/diseases that directly affect the nervous system), (3) psychogenic pain (occurs in disorders associated with psychological factors), and (4) complex pain of complex etiology (occurs in fibromyalgia). The number of painful tender points is strongly correlated with psychological distress in patients with FMS (table 2).
Aggravating Factors in FMS
Fibromyalgia is a chronic illness whose outcomes are influenced by the interaction of biological, psychological, and sociological factors.8 Important biological factors include gender, sleep, physical condition, neuroendocrine and autonomic dysregulation, and sensitization to pain. Female gender is associated with increased pain sensitivity. Clinical studies have shown that females have more pain, use analgesics more often, and are influenced by fluctuations in hormone levels.9 Stress and noxious stimuli are more likely to trigger a response in females than in males. Compared with men, women report more symptoms, including unexplained symptoms.9,10 Other variables such as environment and ethnicity can influence the course of pain and fatigue. Cognitive factors in the pain and fatigue associated with FMS include hypervigilance, management strategies, perceived pain control, mood, depression, anxiety, and personal behaviors. Psychosocial factors such as poor health of parents, poor family environment, and childhood abuse–particularly sexual abuse–may influence a patient's vulnerability or susceptibility to FMS. The disorder often has a high impact on the patient, the patient's family, and society. Physical functioning, emotional well-being, social functioning, and general health perception all contribute to the patient's quality of life. In approximately one half of cases, symptoms of FMS appeared to begin after a specific event, most often some form of physical or emotional trauma.11
Typical Clinical Presentation of FMS
The chief complaint of patients with FMS is diffuse musculoskeletal pain. Several characteristics and painful "trigger points" are associated with FMS (tables 1, 2 ). Although initially the pain may be localized, it can spread to many muscle groups. Patients typically complain of pain in the neck, back, chest wall, arms, and legs. The pain is recurring and fluctuates in intensity. Sensations of tingling and burning are often described. Patients with FMS may have a variety of symptoms that are not well understood, including abdominal pain suggestive of irritable bowel syndrome and bladder symptoms indicative of interstitial cystitis. Fatigue is one of the most common complaints. Most patients report light sleep and/or feeling groggy in the morning. Mood disturbances, short-term memory loss, headaches, and feeling faint and/or dizzy are also frequent complaints. Less common symptoms include ocular dryness, dysphagia, palpitations, dyspnea, dysmenorrhea, osteoporosis, weight fluctuations, allergic symptoms, and night sweats. Typically, the only helpful finding on physical exam is excessive tenderness. The rest of the exam is usually only helpful to rule out other conditions. Patients often have difficulty distinguishing joint and muscle pain and may complain of swelling, although the joints do not appear inflamed on exam. There is no evidence to indicate a connective tissue disorder unless the patient has an associated illness. FMS may occur with any rheumatic disorder.12
FMS frequently exists with other illness. In one study, 22% of patients with systemic lupus erythematosus met the American College of Rheumatology criteria for fibromyalgia.10 Coexisting connective tissue diseases, psychiatric illnesses, sleep disorders, and chronic infections complicate the assessment and diagnosis of FMS because of the similarities in symptoms. Approximately 30% of patients with FMS have major mood disorders.13 A change in affect is often the patient's primary complaint.14 The combination of poor sleep, fatigue, and widespread pain is observed in disorders such as restless legs syndrome and sleep apnea. Pain and tenderness are also present in some patients who have an infectious disease. FMS overlaps with other poorly understood syndromes. Patients with chronic fatigue syndrome often meet tender point criteria for FMS. Myofascial pain can also complicate assessment and diagnosis. Patients with chronic fatigue syndrome often complain of localized pain, and some consider it to be a localized form of FMS.15
Overview of Treatment of FMS
The classification and diagnosis of FMS is a critical step in improving a patient's quality of life. The goal of FMS therapy is palliation of symptoms, since there is no curative treatment of FMS and remission of all symptoms is rarely achieved. Since there is no consensus on effective pharmacological treatment for FMS, most patients are treated symptomatically for pain, insomnia, underlying depression, and muscle tension.
Treatment is multifaceted and includes patient education, pharmacotherapy, physical and occupational therapy, and occasionally behavioral or psychotherapy. A treatment program that incorporates physicians, rehabilitation, and mental health specialists will likely be more successful than drug treatment alone.16 Results of educational interventions alone are often superior to those in control groups, with respect to pain relief.16 Educational interventions should explain the nature of FMS and provide a rationale for the treatment program. A list of resources for patients with FMS can be found in Table 3. Patients should have an active role in the treatment plan, understand the role of stress, and learn techniques that can reduce it.
SSRIs and tricyclic antidepressants have proven to be somewhat effective. In one study, fluoxetine was superior to placebo at reducing pain and change in mood.17 Doses of up to 80 mg of fluoxetine per day were used in 60 women (ages 21 to 71 years) with FMS. Patients were randomly assigned to receive fluoxetine (10 to 80 mg/day) or placebo for 12 weeks in a double-blind, parallel-group, flexible-dose study. Women who received fluoxetine (mean dose, 45 mg/day) had a significant (P = .005) improvement of the Fibromyalgia Impact Questionnaire (FIQ) total score, compared with women who received placebo. The FIQ is a self-reported survey of 19 items that measure physical functioning and intensity of symptoms. The fluoxetine group also showed significant improvement of their pain (P = .002), fatigue (P = .05) and depression (P = .01) scores, compared with women who received placebo. The number of tender points and total myalgic scores improved more in the fluoxetine group than in the placebo group, but these differences were not statistically significant. Fluoxetine was generally well tolerated.
A meta-analysis of clinical trials using antidepressants for the treatment of FMS shows that these drugs have only modest efficacy in treating many of the symptoms of fibromyalgia. 18 Sixteen randomized placebo-controlled trials were identified, of which 13 were appropriate for data extraction. There were three classes of antidepressants evaluated: tricyclics (nine trials), SSRIs (three trials), and S-adenosylmethionine (two trials). Patients were more than four times as likely to report overall improvement and reported moderate reductions in individual symptoms, particularly pain. It is uncertain whether this effect is independent of depression. Doses lower than those required for depression should be used at bedtime (e.g., nortriptyline 25 to 50 mg at bedtime). However, the adverse side effects of some of these drugs may limit their use, especially the highly anticholinergic drug amitriptyline.
A number of medications, including analgesic, anti-inflammatory, and central nervous system (CNS) drugs have been used in the treatment of FMS. In 2003, a study assessed the efficacy of acetaminophen and tramadol in patients with fibromyalgia.19 The purpose of the study was to evaluate the efficacy and safety of a combination analgesic tablet (37.5 mg tramadol/325 mg acetaminophen) for the treatment of fibromyalgia pain. The 91-day, multicenter, double-blind, randomized, placebo-controlled study compared tramadol/acetaminophen combination tablets with placebo. The primary outcome variable was cumulative time to discontinuation (Kaplan-Meier analysis). Secondary measures at the end of the study included pain, pain relief, total tender points, myalgia, health status, and FIQ scores. There were 315 subjects enrolled in the study, 94% female. Tramadol/acetaminophen–treated subjects had significantly less pain at the end of the study, better pain relief, and better FIQ scores (all statistically significant). Indexes of physical functioning, role-physical, body pain, health transition, and physical component summary improved significantly in subjects receiving the tramadol/acetaminophen tablets. Discontinuation due to adverse events occurred in 19% (n = 29) of tramadol/acetaminophen–treated subjects and 12% (n = 18) of placebo-treated subjects. Patients who had experienced treatment failure on other medications were excluded. In addition, tramadol as a weak mu-receptor agonist has some abuse potential and should be prescribed with caution.
In a study of 58 females with fibromyalgia, 74.1% completed an eight-week treatment period testing the combination of carisoprodol, acetaminophen, and caffeine versus placebo.20 Twenty-three patients received placebo and 20 received active medication. In the placebo group, 56.5% of patients used additional analgesics, compared to only 20% in the active treatment group (P = .015). Forty-three percent of patients in the placebo group and none of the patients in the active treatment group used tricyclic antidepressants, anxiolytics, or sedatives (P = .0008). Patients receiving active medication reported statistically significant improvement for pain (P <.01), sleep quality (P <.01) and a general feeling of sickness (P <.05). An increased pressure pain threshold was found in the active treatment group after eight weeks in 70% of the sites measured, while the pressure pain threshold increased in only 30% of the sites in the placebo group. The authors concluded that the combination of carisoprodol, acetaminophen, and caffeine is effective in the treatment of fibromyalgia. However, the study's small sample size should be considered. A randomized crossover trial studied the use of fluoxetine and amitriptyline together.21 This combination provided better results than either drug alone. The use of a drug or combination of drugs that inhibit reuptake of both serotonin and norepinephrine may be more useful than a drug that targets only one neurotransmitter. Duloxetine and venlafaxine are two drugs that inhibit reuptake of both neurotransmitters and may be useful in the treatment of FMS. Pregabalin is an alpha-2 delta ligand being studied for chronic pain and epilepsy. A recent trial was conducted to evaluate the efficacy and safety of pregabalin for treatment of symptoms associated with FMS.22 The multicenter, double-blind, eight-week, randomized study measured the effect of pregabalin doses of 150, 300, and 450 mg/day on pain, sleep, fatigue, and health-related quality of life in patients with FMS (n = 529) against placebo. The primary outcome was the comparison of mean end-point pain scores, derived from daily diary ratings of pain intensity from the pregabalin treatment groups and the placebo group. Pregabalin at 450 mg/day significantly reduced the average severity of pain in the primary analysis compared with placebo. Significantly more patients treated with pregabalin had improvement in pain at the end point (29% vs. 13% in the placebo group; P = .003). Pregabalin at 300 and 450 mg/day was associated with significant improvements in sleep quality, fatigue, and global measures of change. Dizziness and somnolence were the most frequently reported adverse effects. Rates of discontinuation due to adverse events were similar across all treatment and placebo groups. The authors concluded that pregabalin at 450 mg/day was well tolerated and effective to treat FMS compared with placebo, resulting in reduced symptoms of pain, disturbed sleep, and fatigue. Duloxetine was studied in 207 patients with primary fibromyalgia, with or without current major depressive disorder.23 The study was a randomized, double-blind, placebo-controlled trial conducted in 18 outpatient research centers in the U.S. Subject charcteristics were as follows: 89% female, 87% white, mean age of 49 years, and 38% with a current major depressive disorder. After a single-blind placebo treatment for one week, subjects were randomly assigned to receive duloxetine 60 mg twice a day or placebo for 12 weeks. Compared with placebo, duloxetine-treated subjects showed significantly greater improvement of pain, fibromyalgia, and quality of life. Duloxetine treatment improved fibromyalgia symptoms and severity of pain regardless of baseline status of depression. Compared with placebo-treated females, duloxetine-treated females showed greater improvement on most efficacy measures, while duloxetine-treated male subjects failed to improve significantly. However, it is important to note that there were far fewer male subjects in the study. In females, the effect of treatment on pain reduction was independent of the effect on mood or anxiety. Duloxetine was well tolerated, with adverse effects being similar to those reported with placebo. Cyclobenzaprine has been shown to be mildly effective in a meta-analysis of placebo-controlled trials.24 The meta-analysis showed that when patients are treated with cyclobenzaprine, they are three times as likely to report an improvement in pain. Five patients would need to be treated with the drug in order for one to improve. According to this analysis, generalized pain improved early on with the drug, but there was no improvement in fatigue or tender points at any time. Using a variety of outcome measures, cyclobenzaprine-treated patients were three times as likely to report overall improvement and moderate reductions in individual symptoms, particularly sleep. A 5- to 10-mg dose three times daily was used. Patients should be warned of prominent CNS side effects with cyclobenzaprine, including dizziness, sedation, and dry mouth. There are a number of nonmedicinal options that may be effective for the treatment of fibromyalgia. FMS patients typically avoid exercise because they believe that their pain worsens after exercise. Aerobic activities such as biking, swimming, and running are sometimes successful in attenuating FMS symptoms. In controlled trials, aerobic exercise was able to decrease the amount of pain reported and increased the threshold for pain.25,26 Strength training using weights and elastic bands has been effective in reducing pain and the number of tender points.26 Complementary and alternative medicine (CAM) is sometimes used by FMS patients. However, evidence to confirm its effectiveness is limited. It is important that the physician and pharmacist be aware of all CAM substances the patient is taking, since some may have drug interactions with prescribed therapy. Some studies have shown that S -adenosylmethionine can reduce pain and improve quality of sleep and sense of well-being, while other studies have shown no benefit.27,28 In addition, 5-hydroxytryptophan (5-HTP), the precursor to serotonin, has been shown to have some benefit in FMS patients.29 Oral doses of 5-HTP 100 mg three times daily improved pain severity, quality of sleep, anxiety, and the number of tender points. Additional options include hypnotherapy, meditation, and cognitive behavioral therapy.30,31 These options have shown some usefulness in selected FMS patients.
Pharmacist-to-Patient Counseling
Pharmacists should reassure patients with FMS that improvement in pain tolerance, sleep, and fatigue is likely with appropriate comprehensive and multidisciplinary treatment. However, patients should understand that there is no cure for FMS, and complete pain relief is often not possible. Pharmacists should emphasize that active patient participation in the treatment program can help reduce symptoms and improve quality of life. Patients should be educated about the possible causes and aggravating factors of FMS.
1. Wolfe F, Cathey MA. Prevalence of primary and secondary fibrositis. J Rheumatol. 1983;10(6):965-968.
2. Campbell SM, Clark S, Tindall EA, et al. Clinical characteristics of fibrositis: a blinded controlled study of symptoms and tender points. Arthritis Rheum. 1983;26:817-824.
3. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160-172.
4. Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1994;6:223-233.
5. Russell IJ. Neurochemical pathogenesis of fibromyalgia syndrome. J Musculoskel Pain. 1996;4:61-92.
6. Clauw DJ, Chrousos GP. Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms. Neuroimmunomodulation. 1997;4:134-153.
7. Russell IJ. The promise of substance P inhibitors in fibromyalgia. Rheum Dis Clin North Am . 2002;28:329-342.
8. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129-136.
9. Konecna L, Yan MS, Miller LE, et al. Modulation of IL-6 production during the menstrual cycle in vivo and in vitro. Brain Behav Immuno. 2000;14:49-61.
10. Middleton GD, McFarlin JE, Lipsky PE. The prevalence and clinical impact of fibromyalgia in systemic lupus erythematosus. Arthritis Rheum. 1994;37:1181-1188.
11. Wolfe F, Ross K, Anderson J, et al. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38:19-28.
12. Wolfe F. When to diagnose fibromyalgia. Rheum Dis Clin North Am. 1994;20:485-501.
13. Hudson JI, Goldenberg DL, Pope HG, et al. Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med. 1992;92:363-367.
14. Giesecke T, Williams DA, Harris RE, et al. Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis Rheum . 2003;48:2916-2922.
15. Wolfe F, Simons DG, Fricton J, et al. The fibromyalgia and myofascial pain syndromes: A preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. J Rheumatol. 1992;19:944-951.
16. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA . 2004;292:2388-2395.
17. Arnold LM, Hess EV, Hudson JI, et al. A randomized, placebo-controlled, double-blind, flexible-dose study fluoxetine in the treatment of women with fibromyalgia. Am J Med. 2002;112:191-197.
18. O'Malley PG, Balden E, Tomkins G, et al. Treatment of fibromyalgia with antidepressants: a meta-analysis. J Gen Intern Med. 2000;15:659-666.
19. Bennett RM, Kamin M, Karim R, Rosenthal N. Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study. Am J Med. 2003;114:537-545.
20. Vaeroy H, Abrahamsen A, Forre O, Kass E. Treatment of fibromyalgia: a parallel double blind trial with carisoprodol, paracetamol, and caffeine versus placebo. Clin Rheumatol. 1989;8:245-250.
21. Goldenberg DL, Mayskiy M, Mossey CJ, et al. A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum. 1996;39:1852-1859.
22. Crofford LJ, Rowbotham MC, Mease PJ, et al. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52:1264-1273.
23. Arnold LM, Lu Y, Crofford LJ, et al. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum. 2004;50:2974-2984.
24. Tofferi JK, Jackson JL, O'Malley PG. Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis. Arthritis Rheum. 2004;51:9-13.
25. Busch A, Schachter CL, Peloso PM, Bombardier C. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2002;CD003786.
26. Jones KD, Burckhardt CS, Clark SR, et al. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. J Rheumatol. 2002;29:1041-1048.
27. Tavoni A, Jeracitano G, Cirigliano G. Evaluation of S-adenosylmethionine in secondary fibromyalgia: a double-blind study. Clin Exp Rheumatol.1998;16:106-107.
28. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled crossover study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol. 1997;26:206-211.
29. Puttini PS, Caruso I. Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. J Int Med Res. 1992;20:182-189.
30. Haanen HCM, Hoenderdos HTW, Van Romunde LKJ, et al. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J Rheumatol. 1991;18:72-75.
31. Goldenberg DL, Kaplan KH, Nadeau MG, et al. A controlled study of a stress-reduction, cognitive-behavioral treatment program in fibromyalgia. J Musculoskel Pain . 1994;2:53-66.
Vol. No: 31:01 Posted: 1/17/2006
Fibromyalgia Syndrome: An Update for Pharmacists
Darrell Hulisz, RPh, PharmD
Associate Professor of Family Medicine
Case Western Reserve University School of Medicine, Cleveland, Ohio
Associate Clinical Professor of Pharmacy Practice
Ohio Northern University College of Pharmacy, Ada
John Komara, PharmD candidate
Ohio Northern University
Pharmacy Intern, Family Medicine Foundation
Cleveland, Ohio
US Pharm. 2006;1:HS-14-HS-22.
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After three long and challenging weeks, Sandy Hook Elementary students returned to class Thursday at a nearby middle school in Monroe, Conn., where they will remain until their old school is no longer designated a crime scene. NBC's Rehema Ellis reports.
The children of Sandy Hook Elementary School returned to class Thursday, filling buses that took them to a new building where they were thrilled to reconnect with their friends and teachers after three weeks of mourning.
"Most of the kids were excited," said Monroe, Conn., Police Lt. Keith White.
"They were anxious to get into the hallways and meet up with the other kids, and you could see the teachers had the same response."
The 400-plus students had not been back to school since Adam Lanza blasted his way into Sandy Hook and killed 20 first-graders, six staffers and himself with a semi-automatic rifle.
Their old school in Newtown is still a crime scene, so an unused middle school in nearby Monroe was refurnished for them.
Teachers tried to make the new surroundings as familiar as possible. Their old desks were brought in, along with backpacks, coats, and lunch boxes that were left behind as they fled on Dec. 14.
Even the new principal was a known face: Donna Page, who retired from the role at Sandy Hook in 2010, agreed to come back after her successor, Dawn Hochsprung, was killed in the rampage.
Yet there were also reminders of how much the Sandy Hook community has changed since the shooting rocked the nation and stirred debate on gun control.
Monroe Police Dept. / AP
This photo provided by the Monroe Police Department shows the new Sandy Hook Elementary School on the first day of classes in Monroe, Conn. The school, formerly known as Chalk Hill School, was overhauled especially for the students from Sandy Hook
Police officers and counselors were on hand. Parents were allowed to stay in the building for the day. And children cuddled with therapy dogs.
He said attendance was robust, with most school buses full as they rumbled down streets that had been decorated with balloons and welcome signs.
Andrew Paley said he waited for the bus with his 9-year-old twins at the bottom of his driveway Thursday morning.
"They just ran on. They didn't even look back," he said. "There was probably some anxiety but it was more excitement. They both love school, so they loved going back.'
PhotoBlog: See images of Sandy Hook students returning to class for first day
While security was very visible, it will become more low-key as the weeks pass in an effort to restore some normalcy.
"We don't want them to think this is a police state," White said. "We want them to know that this is a school and a school first, and that's a place that they are to come to learn, enjoy their friends and grow up.
"We want to move on and let the kids move on, too."
Lt. Keith White says Sandy Hook students were excited to see friends as they returned to school on Thursday for the first time since the Dec. 14 massacre in Newtown, Conn.
Connecticut Gov. Dannel Malloy said it took a "Herculean effort" to prepare the school in Monroe for the Sandy Hook kids.
He also announced a commission that will spearhead legislative and policy reforms designed to ensure no other children have to endure the horror they survived.
"We don't yet know the underlying cause behind this tragedy, and we probably never will," he said, referring the mystery of Lanza's motive for attacking the school. "But that cannot be an excuse for inaction."
He said the 15-member commission would look at three areas -- school security, mental health services, and gun laws.
"If 30-round clips had continued to be illegal in the nation or in our state, the availability of that clip to this particular perpetrator may not have existed," Malloy said.
"These things aren't used to hunt deer. You don't need a 30-round clip to go hunting ... to honor the Constitution of the United States."
The panel, which will issue recommendations in March, will be headed by Hamden Mayor Scott Jackson, who said the issues resonated with him personally.
"This is an issue that touches us all," Jackson said. "My son is in first grade."
NBC News' Joo Lee contributed to this report.
Shannon Stapleton / Reuters
Children from Sandy Hook Elementary School make their way to their new school in Monroe Conn. As they leave Newtown on Jan. 3.
More content from NBCNews.com:
- The angels had N.Y. accents, says senator who had stroke
- Sandy Hook students head back to school, search for 'new normal'
- Video: Al Jazeera buys Al Gore's Current TV channel
- 'Shame on you': Republicans in Sandy-hit areas blast House GOP for aid delay
- 'Disgusting': Families of massacre victims boycott Colorado theater reopening
Follow US news from NBCNews.com on Twitter and Facebook

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Originally published 13 May 2010
This month's panel of experts discusses the implications of the recent SAP acquisition of Sybase as key for evolving its mobile strategy and real-time delivery capabilities. The panel agreed there is no single ideal architecture for analytics, but there are a number of modern technologies that can work to meet the needs and resources of the business. On the topic of data integration strategies -semantics is one approach that enables better and faster integration.
SOURCE: May BeyePERSPECTIVE Topics: SAP acquisition of Sybase, current data management approaches, analytic database platforms and data integration strategies
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QuickTime Vulnerability and UltraKey
April 18, 2016 by Art Willer #QuickTime and UltraKey0
The real news we have heard is that Apple is no longer maintaining QuickTime for Windows, which includes addressing any vulnerabilities that may exist. This does create a security concern, which has to be weighed for what the threat amounts to, how quickly we have to address it, and what alternatives exist aside from complete removal.
Completely removing QuickTime is not necessary, particularly when we understand where the threat arises, and how we can eliminate it. That said, we are removing QuickTime use in UltraKey for Windows, because it clearly has no future on Windows.
Fixing the Vulnerability without Losing the Benefit:
A security problem can arise with QuickTime, by downloading a movie from an untrusted source, and playing the movie using the QuickTime plug-in in a browser, or using the QuickTime Player directly. The damage, if any, is carried out by playing the untrusted movie with these tools.
The browser plug-in for QuickTime is being removed by the browser vendors. You can simply delete the QuickTime applications as explained below.
Don't delete the QuickTime directory because the system accesses and loads certain DLLs that are located there. The DLLs provide the benefit that UltraKey utilizes. The QuickTime applications are the only thing that needs to go.
To be clear, movies are not self-executing. A player must be used to play them. Windows Media Player and some other proprietary players can be used to play QuickTime movies.
UltraKey does not use any QuickTime applications or plug-ins to play its movies. Nor is there any association established by UltraKey to play any movie. UltraKey plays its own movie collection through direct actions, using the QuickTime system capability, not the QuickTime Player or plug-in.
Your school or organization can safely delete the following executables from the QuickTime folder in the Programs (x86) directory, without affecting UltraKey:
Once these are deleted, QuickTime movies will no longer be played by QuickTime applications, but they may still be played by Windows Media Player or other proprietary technologies.
Our Plans for QuickTime:
Bytes of Learning will remove QuickTime use from its next major version of UltraKey (UltraKey 7) for Windows. This is less because of security threats, but because Apple's support for QuickTime has ebbed and flowed for several years. This latest announcement is really another reduction in support, that weighs against continued use of QuickTime.
UltraKey Online is entirely plug-in free, using the latest browser standards. In particular, all videos are played using native browser capabilities. We would be delighted to schedule a preview for you.


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It would be heartening to report that Libya's ragtag rebellion has pushed itself to the brink of victory using their wits to build weapons like this recoilless rifle in a chopped Chinese pickup. But it wouldn't be true.
Turns out the rebels are a little frustrated with NATO's promises of help turning into sporadic bombings that occasionally hit rebel units and in one case, a civilian neighborhood in Tripoli. Cash and supplies may be running low, and while NATO helicopters can drop leaflets on rebel-held areas, calling in timely air support seems vexing at best.
Which leaves the rebels with the weaponry we've featured before, along with these new twists; chopped pickups whose cabs no longer block the sweep of their big guns. That top pickup is a Zhongxing Auto GrandTiger, a Chinese import that's become go-to wheels for many insurgents thanks to cheap replacement parts. The Mitsubishi Triton is, well, a Mitsubishi.
Photos: Associated Press


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Bank statements for mortgage
Are bank statements for mortgage loans needed in the UK? Get the right advice on this here.
Mortgage Application Overview
Mortgage During or After a Furlough
Mortgage Approval
Mortgage Enquiry
Quick Mortgages
Had a Mortgage Application Declined?
Getting a Mortgage In Principle Online
Getting a Mortgage Quote Online
Transferring Mortgages
Mortgages with Friends and Family
Joint Mortgage Applications
Getting a Mortgage in Sole Name When Married
Multiple Applicant Mortgages
Tenants in Common
Joint Borrower, Sole Proprietor Applications
Single applicant mortgages
Single parent mortgages
What happens to a joint mortgage in the event of a death?
Mortgages and Bank Statements
What Happens To Mortgage After Death
Mortgages with a Visa
Mortgages for foreign nationals
Mortgages with Criminal Conviction
Mortgages in Northern Ireland
Lift Scheme
Mortgage When In Debt
Government Schemes
Mortgages In Scotland
Mortgage Retention
Redundancy and Mortgage Applications
Mortgages and Cancer
Mortgages and Disabilities
Mortgages in Wales
Can a mortgage cover Stamp Duty?
Mortgage Redundancy Cover
Mortgages with No Early Repayment Charges
Mortgages and Underwriting
Change of Circumstances
Mortgages for Young People
Co-signing for a Mortgage
Lodger Mortgages
Final Credit Check
Personal Loans and Mortgage Applications
Second Time Buyers
Life Insurance and Mortgages
Getting a Mortgage if You Have One Already


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Locks and Security News: your weekly locks and security industry newsletter
27th May 2020 Issue no. 509
Your industry news - first
We strongly recommend viewing Locks and Security News full size in your web browser. Click our masthead above to visit our website version.
Undercover locksmith investigation on TV
"I'm mad as hell," Jerry Goodwin exclaimed, standing on his back deck in Acworth, "They said it'd cost about 100 bucks." He was talking about a bill he got from a locksmith who replaced his lock, reports US TV Channel 11Alive.
"It was 424 dollars! They said, 'Oh yeah it'd cost a 100 bucks', a 30 dollar call out and 70 dollars, to replace the lock."
Jerry Goodwin is not alone. The Governor's Office of Consumer Protection has been getting complaints about locksmiths, accused of gouging customers.
That's why 11Alive set up 6 hidden cameras to reveal what can happen when you're desperate and locked out of your house.
We asked Carl Hinson of Decatur Lock and Key to assist. He's been in business since 1975 and has a Better Business Bureau rating of 'A'. He's also a member of the Associated Locksmiths of America. He put a cheap lock on the back door of an Atlanta house and showed us how easy it was to pick.
He said he'd only charge $75 for the job and he provided us invoices from house lockouts he had done before. We confirmed the price with another established locksmith, Rick Casper of Lock Doctor in Sugar Hill, who is also a member of the Associated Locksmiths of America and has a BBB rating of 'A+'.
"It'd be a flat fee of $79," Casper said.
However, after calling out a couple of locksmiths from random internet listings we got an eye-opener.
One wanted to charge us $179, another $155. Both locksmiths arrived in unmarked vehicles and both had been called out by a central dispatch even though we thought we were calling locally based companies.
One guy didn't even try to pick the lock. He just wedged it open with air bladders.
"This is supposedly going out throughout the country," Goodwin said.
He's right! Warnings have been placed on the Associated Locksmiths of America's website about mobile locksmiths masquerading as local companies.
"They couldn't give us a physical address. They, instead, gave us a bogus address of another competitor," Goodwin complained.
When we confronted the locksmiths who we called out, they couldn't give us a physical address either. However, after we complained, they did drop the price from $179 to $124 and $155 to $130.
One of the guys even tried to get us to scam our auto insurance for the bill by offering to charge it as a 'vehicle lockout' rather than a 'house lockout'.
"That's totally illegal, and totally unprofessional," Casper responded.
"I think we need to do something about getting these guys out of town," Hinson replied.
If you need a locksmith, take the time to find one you can trust. Search for one in your neighborhood and check out the BBB rating. Try to visit the actual store, or speak with friends and neighbors for referrals. Once you find one, keep the number stored on your phone, ready to call if needed.
5th June 2013


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UH Academy for Creative Media and Korean filmmaker partners select first screenwriting fellows
Public Symposium on Korean Film Industry planned for next monthUniversity of Hawaiʻi
The Korean Film Council (KOFIC) and the University of Hawaiʻi's Academy for Creative Media have selected five promising screenwriters to participate in the inaugural KOFIC Filmmakers Development Lab September 4 — 10 in Hawaiʻi.
Inspired by similar creative environments such as the Sundance Screenwriters Lab, the KOFIC/ACM Development Lab selected its first filmmaking fellows from the United States, Canada and Korea with a view to realizing projects that can find audience appeal in both Korea and North America.
The fellows will be intensely mentored by Korean producers, ACM faculty, U.S. film industry leaders, and KOFIC staff during the weeklong retreat. In October, the fellows will be brought to the Pusan International Film Festival in Korea to market their scripts to film industry representatives and potential producers.
The Lab mentors will also participate in an ACM public symposium on the Korean Film Industry Friday, September 8, 4-5:30 pm at the Center for Korean Studies on the Manoa campus, co-sponsored by the Center and KBFD-TV.
The five fellows are:
Philip Chung, a playwright and screenwriter, artistic director of the Asian American Lodestone Theater, and columnist for Asianweek newspaper. He has written and directed the acclaimed play "The Golden Hour." His Lab entry "The Crimson Flower" is a noir-inflected thriller.
Kim Young Il is a screenwriter and filmmaker whose work has been recognized by the Film Independent and Austin Screenwriting competitions. His Lab entry "Hyung's Overture" is a passionate family drama of the sacrifice that one brother makes for the musical career of the other.
Abraham Lim, a filmmaker and writer whose films "Fly," "Roads and Bridges" and "MVP" were well received at various film festivals. Lim also edited Robert Altman's "Cookie's Fortune." His Lab entry "Orientation" follows one woman's tragic journey into Alzheimer's disease.
Jinoh Park has made several internationally acclaimed short films "Lunch," "Request" and "Slowly Silently" that have screened at Cannes and Sundance.
He was also chosen for the Cinefondation and Residence du Festival de Cannes. His Lab entry "Proposal" follows a filmmaker who makes a mysterious deal with a man to finance his film.
Mora Mi-Ok Stephens' debut feature film "Conventioneers" won the 2006 Independent Spirit John Cassavetes Award for Best Feature, and following many festival screenings including Tribeca, Pusan, New York and Hawaii, will be theatrically released later this year. She is preparing her second feature with Billy Bob Thornton and Kim Yunjin. Her Lab entry "The 38th Parallel" is an action thriller set in Korea.
The Filmmakers Development Lab mentors include:
Johnathan Kim, chairman of the Korean Film Producer's Assocation and president of Hanmac Films, The producer of the contemporary classic "Silmido," he was awarded the Daejong (Korean Oscar) for Best Executive Producer in 2004.
Chul Shin, president of Shincine production company, has produced Gingko Bed, Hawai'i International Film Festival favorite My Sassy Girl, and A Good Lawyer's Wife. He is noted in the film industry for his use of advanced graphics technology.
Wimal Dissanayake, a highly recognized scholar of Asian film who teaches ACM courses and seminars in advanced cinema and cultural theories.
Barry Sabath, senior lecturer at the American Film Institute, and a former film development head at Twentieth Century Fox, Columbia Pictures and Robin William's Blue Wolf Productions.
Adam Novak, Story Department head at the William Morris Agency.
Henry Kim, director of the Korean Film Council.
"Our strong partnership with Korean Film Council reflects both our international reach, and the recognition that the Academy for Creative Media is a center for excellence in filmmaking and film study," said Chris Lee, ACM director. "We appreciate the efforts of KOFIC chairwoman Ahn Cheong-sook and Lab organizer Roger Garcia in creating this intercultural bridge of story-telling."


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2016 Republican Primary Runoff Results
About the Board of Voter Registration and Elections of Pickens County, South Carolina
Copyright Board of Voter Registration & Elections of Pickens County. All Rights Reserved.
Disclaimer: Information presented on the PickensElections.org website is collected, organized, and provided for the convenience of the user. While the Board of Voter Registration & Elections of Pickens County (hereafter Board) attempts to keep such information accurate and up-to-date, it cannot warrant the authenticity or reliability of such information. This publication is provided "as is" without warranty of any kind, either expressed or implied, including, but not limited to, the implied warranties of merchantability, fitness for a particular purpose or non-infringement. The Board maintains all immunities as provided in the S.C. Tort Claims Act. Under no circumstances will the Board, the County, the State, or their agents and/or employees be liable for any actions taken, or omissions made, from reliance on any information contained on, or linked to, PickensElections.org from any source nor shall the Board, the County, the State, or their agents and/or employees be liable for any other consequences from any such reliance. A link from PickensElections.org is not an endorsement of the content, viewpoints, products, or services at the remote site. Users are responsible to determine for themselves which web pages are part of the official PickensElections.org website and which are merely convenient links. Email addresses obtained are subject to the access and confidentiality provisions of the State's Freedom of Information Act and other applicable sections of the South Carolina Code of Laws and/or federal law. No person or private entity shall knowingly obtain or use any personal information obtained from PickensElections.org for commercial solicitation directed to any person in this State. By using PickensElections.org, the user acknowledges and agrees to be bound by the terms of the above disclaimer. Any questions should be directed to the Executive Director of the Board.
This institution is an equal opportunity provider and employer.
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form (PDF), found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected]


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West Florida is in the Florida Panhandle region of Florida. This area is comprised of Calhoun, Escambia, Gulf, Holmes, Jackson, Santa Rosa, and Washington counties.
- 1 Cantonment
- 2 Gulf Breeze
- 3 Marianna
- 4 Milton
- 5
- 6 Pensacola
- 7 Pensacola Beach
- 8 Perdido Key
- 9 Port St. Joe
Other destinations[edit]
- 1 Big Lagoon State Park is a 733-acre (2.97 km2) Florida State Park located on the northwestern Florida coast, approximately 10 miles southwest of Pensacola on Gulf Beach Highway. It encompasses the northern boundary of Big Lagoon as it snakes toward Pensacola Bay to the east. Wild Grande Lagoon and its minor tributaries lay within the boundaries of the park, as does the alligator-inhabited Long Pond that covers a coastal slough. The park is a "gateway site" for the Great Florida Birding Trail. It features four distinct natural communities including estuarine tidal marsh, mesic flatwoods, wet flatwoods, and is dominated by coastal scrub. The park features a number of threatened and endangered species such as the Eastern Indigo Snake, Gopher Tortoise, migratory shorebirds such as Snowy Plover, Least Tern among some twenty other listed species. The park has such amenities as beaches along the shoreline of Big Lagoon, bicycling down the 2.6 mile park drive, boating from a 40-slip boat ramp, canoeing along Big Lagoon, fishing, hiking along 4 miles of trails, kayaking in Grande Lagoon, wildlife viewing from a four story observation tower and footbridge overlooks at Long Pond and Grande Lagoon, picnicking at 21 shelters, swimming in Big Lagoon and 75 electrified camping sites and a group camp.
- 2 Blackwater River State Park is a Florida State Park located fifteen miles northeast of Milton, near Harold, off U.S. 90. A favorite destination for canoeists and kayakers, Blackwater River offers opportunities for a variety of outdoor recreation. The river is one of the purest sand-bottom rivers in the nation. The park has such amenities as birding, boating, canoeing, fishing, hiking, kayaking, picnicking areas, swimming, tubing, wildlife viewing and full camping facilities. The main picnicking area has covered picnicking pavilions, restrooms, and a spacious parking lot. Bring your tubes and enjoy a leisurely float down the river to the Deaton Bridge. It is a short 1 mile hike back to the parking lot to retrieve your vehicle. Very kid friendly park with a variety of areas for swimming.
- 3 Falling Waters State Park - a 171-acre Florida State Park located three miles south of Chipley, off State Road 77A, in northwestern Florida. The park contains a 73-foot waterfall, the highest in the state. The park has such amenities as birding, fishing, hiking, picnicking areas, swimming, wildlife viewing and full camping facilities. Concessions are also available.
- 4 Florida Caverns State Park
- 5 Fort McRee
- 6 Gulf Islands National Seashore
- 7 Perdido Key State Park
- 8 Ponce de Leon Springs State Recreation Area
- 9 Three Rivers State Park
It is a narrow strip lying between Alabama and Georgia to the north and the Gulf of Mexico to the south. Culturally and in terms of history and climate, the region is more closely tied to the Deep South than to peninsular Florida.
West Florida draws more than seven million visitors annually from around the world. Attractions include golf courses, zoos, world-class beaches, water sports and fine restaurants. It is second only to Orlando's Walt Disney World in terms of visitors traveling to Florida and is one of the most popular vacation destination in the country.
The Emerald Coast, which is slowly becoming the American Riviera, is an area in the southeastern United States on the coast of the Gulf of Mexico, roughly bounded by Pensacola, Florida on the west and Panama City, Florida on the east. The area is known to have some of the most stunning and finest beaches in the world, famous for their sugar-white sands and warm, emerald-green waters. The beaches were also deemed to have the whitest sand in the world where it sparkled in the sun and squeaked when walked on. Contrary to popular belief, the sand is not bleached by the sun, but is comprised of Appalachian quartz that filters down to the coast from the mountains. The emerald-green color of the water is due to the sugar-white color of the sand laying beneath the clear blue water thus providing the area's namesake feature. The quartz sand on the beaches of the Panhandle is so white that some traders reportedly sold it as sugar in World War II.
The beach towns, many of which play host to college students during spring break. Popular vacation destinations include Pensacola Beach, Gulf Breeze, Navarre Beach, Fort Walton Beach, Panama City Beach, relative newcomer Destin, and Seaside, a development community whose iconic pastel-paint and tin-roof construction was made famous in the Jim Carrey movie The Truman Show, filmed in the area from 1996-1997. Other communities on the Emerald Coast include Perdido Key, Navarre, Sandestin, Grayton Beach, Santa Rosa Beach, and Seagrove.
The area is known as a family drive destination, although in the past decade, its popularity has expanded greatly, leading to new construction booms and seemingly overnight changes. Many development communities similar to Seaside have sprung up in Walton County and the west end of Panama City Beach, raising property values, and some might argue, aesthetic appeal.
Deep-sea fishing is a huge draw for the area, with Destin holding the nickname "World's Luckiest Fishing Village" (and several saltwater world records) and Panama City Beach hosting the annual high-dollar Bay Point Billfish Invitational. Eating seafood is perhaps even more popular than catching it, with a seafood restaurant and/or oyster house seemingly on every other corner.
This roughly 100-mile stretch is home to several military bases, with installations including Pensacola Naval Air Station (home of the Navy's famed Blue Angels flying squadron and the initial training site where all naval aviators earn their "wings of gold"), Hurlburt Field, Eglin Air Force Base (one of the largest military bases in America), Tyndall Air Force Base (home to the Air Force's new F-22 Raptor fighter jets), Coastal Systems Station-Naval Surface Warfare Center (home to the Navy Experimental Diving Unit and Naval Diving & Salvage Training Center), and Corry Station Naval Technical Training Center. The Florida Panhandle has been marked by upscale developments in recent decades. These include Seaside, Sandestin, and countless others. In fact, development in the coastal area has become so commonplace that very little beachfront property remains untouched, unless it is under the stewardship of the Federal or State Government.
Get in[edit]
By Air[edit]
- Pensacola International Airport - the gateway to the Western Florida Panhandle, and the largest airport in West Florida. Pensacola International will have flights to 18 destinations, across the United States, starting in Summer of 2018.
- Fort Walton Beach-Destin Airport - this airport, while smaller than Pensacola's airport, still serves a number of destinations, and is a focus city for Allegiant.
Get around[edit]
- Escambia Bay
- Fort Pickens
- Naval Air Station Pensacola
Stay safe[edit]
Go next[edit]


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LEVEL 1 – Book 1: Financial Literacy – Understanding Precious Metals Investments
This book uncovers the facts about popular and lesser known precious metals. This book examines the historical facts behind the driver's of precious metal values.
You will learn about lesser know exotic precious metals as well as well-known metals like Platinum, Gold, and Silver.
*LEVEL 1 – Bonus 1: Financial Literacy – The Essentials
Chapter 1: Home Based Business: Ten Tips For Success
Chapter 2: Tips And Strategies On How To Maximize Your Personal Finances
Chapter 3: Debt Restructuring – Helping You Gain Control Of Finances
Chapter 4: The Importance Of Planning Your Retirement And The Consequences Of Not!
*LEVEL 1 – Bonus 2: Financial Literacy – How To Start Your Own MLM Business
LEVEL 2 – Book 1: Binary Options and Strategies Simplified
This is where we demystify these limited risk contracts so that you can better understand the risks and rewards associated with these exciting strategies. You will discover how to watch for illegal activity, how to invest through regulated entities, how to realize huge investment gains and much more!
LEVEL 2 – Book 2: Bitcoin and Crypto: A Guide for the Rest of Us
Could this be the next ATM? Is Crypto the future of currency? Is Bitcoin all it's cracked up to be? These questions and many others are answered in this straightforward, robust guide that will help you navigate the choppy waters of Bitcoin and Crypto and come out ahead—way ahead—of those who are not in the know. This guide even includes an incredible infographic on how a Bitcoin transaction works!
LEVEL 3 – Book 1: Credit Card Debt
(Also available in Spanish)
Chapter 1: Credit – understanding the genesis of bad credit.
Chapter 2: Credit rating: – how you are scored.
Chapter 3: Your credits score – how you can improve it.
Chapter 4: Credit report – its effect on your personal credit
Chapter 5: Your personal credit report: – how you can correct errors
Chapter 6: Credit Repair Company: – a blessing or a curse.
Chapter 7: Absolute truth about credit repair companies
Chapter 8: Credit cards: – types and what you need to know about them
Chapter 9: Shopping for a new Credit Card: – Important tips to consider.
Chapter 10: The Do's and don't of the credit card game.
Chapter 11: How to get the credit card of your choice.
Chapter 12: Buy Now Pay Later – Disadvantages of using a credit card and how to get over it.
Chapter 13: How to avoid high interest charges on your credit card.
Chapter 14: How to get a loan even if you have bad credit.
Chapter 15: Important Credit Card Plan terms you must consider.
*LEVEL 3 – Book 2: Exchange Traded Funds: The Inside Story
The more you know about exchange traded funds, the the more you will be inspired to take action with your own financial goals. This remarkable guide will provide you with all the insider information you've been missing, while giving you a clearer path to charting your own course for long term growth.
*LEVEL 3 – Book 3: Economics – The truth behind the spin
- The World Economies today
- Definition of Economics
- Technical definition of Economics
- How Markets Work
- Economic Cycle
- Gross Domestic Product (GDP)
- Effect of Lowering Interest Rates
- Effect of Raising Interest Rates
- Demand for goods and services
- Definition of Demand
- Supply of goods and services
- Definition of Supply
- Money and Banking
- So how did money come to be?
- So how do Central Banks actually move Interest Rates?
- Money Supply!
- Banking
- Measuring Economic Performance
- Gross Domestic Product
- Business Cycle
- Economic Growth
- Definition of the Business Cycle
- Government and the Economy
- The Global Economy
- Contrasting two Economic Powerhouses: USA and China
- Conclusions
*LEVEL 4 – Book 1: Multiple Streams of Income
Developing and solidifying numerous lucrative income streams is the holy grail of every forward thinking investor, and this guide will walk you through how to make that happen with less risk and more benefit than if you attempted to do it on your own. This is a must read if you want to feel better about your future in an uncertain financial climate.
*LEVEL 4 – Book 2: Hedge Funds – Why Investors Love Them And Why You Should Too
Hedge funds can make people rich, it's that simple. Or is it? The fact is, there's a lot to know about how to make these enigmatic funds work in your favor. That's what this guide is all about.
LEVEL 4 – Book 3: The Insiders Guide to Swing Trading
What's the difference between swing trading and day trading? Is it more or less risky? How can I make it work in my favor? In this guide you'll discover all you need to know about this fascinating trading strategy while arming yourself with swing trading techniques normally reserved for the seasoned pros.
LEVEL 4 – Book 4: Debt Crisis
- Understanding Debt
- What Are Expenses?
- Exploring your own debt
- Create A Budget
- Control High Interest Debt
- Find Your Hidden Money
- Debt Counseling
- Refinancing A Mortgage
- Know Your Rights
- How To Deal With Creditors
- Debt Consolidators
- Sell Off Assets
- Bankruptcy
- Lifestyle Changes
- Start Saving
LEVEL 4 – Book 5: How to Get Out of Debt and Avoid Getting Ripped Off
There is 11 trillion dollars worth of debt in the world today, so getting yourself out of your own piece of this pile should be a top priority if you are serious about financial security in the long term. This guide will give you the ins and outs of managing your loans, dealing with collectors, debt consolidation, setting a budget and much more. It will also tell you when the red flags should go up when it comes to dealing with those dubious debt settlement companies.
LEVEL 4 – Book 6: Binary Options: 5 Valuable Lessons Learned in the Trenches
Binary options trading has had a checkered past in recent years, so it's critical that you equip yourself with these cautionary tales so you don't find yourself in a similar situation. These lessons are straight from the real world marketplace and will provide you with the personal power to weave your way through volatile markets in the best and worst of times.
*LEVEL 5 – Book 1: Residential Real Estate – The Essential Guide To Investing In Residential Real Estate
When you possess the know-how for real estate investing, you hold the keys to a brighter, more lucrative future. This essential guide will steer you in the right direction.
*LEVEL 5 – Book 2: Commercial Real Estate – The Essential Guide To Investing In Commercial Real Estate
Some feel intimidated by commercial real estate investing, which leaves more room for the adventurous, success-minded investors. If that's you, then this guide is a must have.
*LEVEL 5 – Book 3: Forex Trading Series – How to Trade Forex With The Big Guys.
Trading Forex is not for the squeamish. The first in this series will make it look easy as you dip your toe in the deep end.
*LEVEL 5 – Book 4: Forex Trading Series – Forex Trading Simplified
This guide brings Forex down to earth, putting it in historical perspective and helping you to grasp its complexities so you can better position yourself for bigger rewards.
*LEVEL 5 – Book 5: Forex Trading Series – How To Trade Forex Like A Seasoned Pro
The third installment in this incredible series, you will discover the inner workings of Forex trading so you can leapfrog ahead of the status quo.
*LEVEL 5 – Book 6: Knowledge is Power: The Dow Theory Revealed
Once you know the Dow Theory it will level the playing field. Whether it's understanding market trends, secondary reactions, or buy and sell signals, this guide will give you the power to trade with more confidence.
*LEVEL 5 – Book 7: Just the Facts About American Depository Receipts (ADRs)
American Depository Receipts (ADRs) represent a global trading alternative that can work in your favor IF you know what you're doing.This guide will lay out the 3 levels of ADR Programs while explaining the fees, rates and risks involved. Buying shares in foreign companies can be cost effective when you know the facts, which is what this informative guide is all about.
*LEVEL 5 – Book 8: Secrets To Getting Traction With Momentum Trading
Day trading used to be reserved for the professional speculators. Not anymore. When you know the history, techniques and strategies of Momentum Trading you will quickly see the bigger picture, and be better prepared for entering this risky but potentially highly profitable arena.
*LEVEL 6 – Book 1: Investment Principles
- Investing Principles You Use To Multiply Your Future
- Buffett's Rule About Playing Chess
- Chess Applies To You, Too
- Here's Why You Leave The Analysis To Your Expert Advisor
- Remember How Experts Look At a World Class Mutual Fund?
Investment Personality Test
- Part 1: Investment goals
- Part 2: Risk tolerance
- Part 3: Ability to cope with uncertainty
- Life Changes
- You May Start Aggressive And Wind Up Conservative
- Your Moderate Approach Trends Towards The Balanced Mode
- You Should Measure Your Risk Tolerance
- Strong Recovery Based On Astute Fund Management
- Terms most frequently used relating to Retirement Investments
- Insurance Products Investment-Related Terms
*LEVEL 6 – Book 2: Time Value of Money
- Your Personal Starter Guide To Investing
- Your money will grow
- The world has grown smaller
- Before you choose an expert
- Banks, Credit Unions, Savings & Loans
- Investments are a part of your life
- How you can start investing wisely
- You are part of the world market
- Don't believe those wild stories
- More about Retirement Accounts
- Guess what's the odd truth?
- The alphabet soup of numbered titles
- You add to your ways to invest
- Investing beats going into debt
- You need to be aware of hidden costs
- Exploring the unknown may pay off
- You may want to explore options
- Taking the mystery out of ETFs
- Your needs create improvements
- You can learn details that are simple
- The changing picture for 401 (k)
- Just when does the taxman cometh?
- You can almost hear the boom!
- Welcome to the brave new world of investment change
- You boomers will live longer
- The high cost of health care
- Removing the Safety Net
- What does this mean to you?
- Converting savings into income
- Your own personal pension
- Economic Growth
- Exploring modern annuities
- Learn how annuities work
- Perks in tax deferral
- Retirement income
- Fixed and variable annuities
- Tax provisions mean a lot
- The basis for your stability
- A bullet-proof system
- Guarantees
- General Investment-Related Terms
- Insurance Products Investment-Related Terms
*LEVEL 6 – Book 3: Real Estate Investment Trust (R.E.I.T.)
- Real Estate Investment Trusts (REIT) – Your Guide To Wealth
- Where there is fear there is opportunity!
- Tax Benefits
- Long Term Benefits
- Building a Cash Flow Machine
- International Housing Price Trends
- Real Estate Investment Trust's
- (REIT'S) Explained
- Benefits of Investing in Real Estate Investment Trusts
- Professional Management
- Taxation
- Retirement or income for living expenses
- Real Estate Investment Trust Sectors
- Example Of The Revenue And Expenses Of a 250 Unit Project
- Terms most frequently used relating to Real Estate Investment Trusts
LEVEL 6 – Book 4 : ETF Trading Series Part 1 – Knowledge Is Power
Yes, knowledge is indeed power when it comes to Exchange Traded Funds. You'll be in the know when you begin devouring this amazing series.
LEVEL 6 – Book 5: ETF Trading Series Part 2 – The Hidden Keys To Success
Ready for more ETF? This installment will reveal hidden pathways to trading that may have eluded others.
*LEVEL 6 – Book 6: ETF Trading Series Part 3 -Know What The Experts Know
This is the quintessential manual for expert ETF comprehension as you move toward a higher plateau in your quest for total financial freedom.
*LEVEL 6 – Book 7 Options Trading – A Birds Eye View
Discover how to increase income against current stock holdings, learn about buying and selling, the value of options, the details of calls and puts, and much more. Once you know the overview, you will be able to advance into options trading more quickly and easily.
*LEVEL 6 – Book 8: Options Trading – The Ins and Outs of Options Trading
Options trading has made dramatic shifts in people's financial fortunes, for better and worse. Your knowledge of the inner workings of this technique will give you the positive shifts you're looking for.
*LEVEL 6 – Book 9: Options Trading – The Options Trading Deep Dive
What is the Black-Scholes model? How about the Cox-Rubenstein Option Pricing Model? Put/Call Parity? When you have this guide at your disposal you will gain this insider knowledge and a deeper mastery of options pricing, profit and loss diagrams and much more.
Level 6 – Book 10: Forex Trading Series – Thriving in the Forex Marketplace
Can you be a big fish in a big pond? You can if you know the history and can put in in the right present-day marketplace perspective. This guide will show you the way, with information on the Bank for International Settlements, steps for building a Forex trading model and much more.
Level 6 – Book 11: Forex Trading Series – Advanced Forex Techniques
Go inside the "shadow banking system" and into the world of derivative contracts and you will open up a new world of Forex trading opportunities based on real world knowledge and expertise. This guide will give you that ability, as you explore common derivative contract types, currency trading and much more.
Level 6 – Book 12: Forex Trading Series – The Ultimate Forex Trading Resource
This comprehensive guide will give you in depth reviews and comparisons of the top Forex brokers and platforms so you can make the most informed decisions possible when it comes to Forex trading. You will even learn how to choose a trading computer and how to trade through your bank. This guide is a must for anyone even remotely interested in the world of Forex trading.
Level 6 – Book 13: Bond Investing Secrets Part 1
Learn the fundamentals of bond investing, discover the different types of bonds and understand the financial terms of a bond as you start your journey into a deeper knowledge of this critical investment option in your portfolio.
Level 6 – Book 14: Bond Investing Secrets Part 2
Level 6 – Book 15: Bond Investing Secrets Part 3
Level 6 – Book 16: Elliot Wave Theory Demystified: Practitioners Tell All
In his 1938 book The Wave Principle and his 1946 work Nature's Laws: The Secret of the Universe, RN Elliot introduced and then expanded on his Wave Theory that would become one of the most prolific ways of watching market trends, and market technicians still use it today. This guide will explain each wave and give you a working knowledge of why it's such a significant approach to market tendencies.
Level 6 – Book 17: Mature Investor Series – Change Your Investments
Life is all about change, and in this volume we deconstruct all the ways that life changes, and market changes, can have an impact on how you invest. Whether it's saving for college, preparing for a comfortable retirement, or adjusting to market fluctuations, this guide will give you a nice comfort level.
Level 6 – Book 18: Mature Investor Series – Dividend GoldMine
From dividend reinvestment plans to Money Tree rules and much more, this is a must have guide to making smart decisions with dividends. This handy resource even includes a list of dividend growth calculators you can find online, as well as a multitude of charts that brings it all down to earth.
Level 6 – Book 19: Mature Investor Series – Real Estate
In this volume we examine the world of Real Estate Investment Trusts, from its history all the way to present day investment strategies and even real life decision scenarios. This is the perfect way to kick off this investment series designed to help Baby Boomers make their best retirement decisions.
Level 6 – Book 20: Critical Tips for Investing in the Healthcare Insurance Sector
Competition has driven Healthcare insurance companies to merge at a rate that complicates standings for investment purposes. Today's leaders may not be tomorrow's leaders. But in the healthcare industry that generates $2.7 trillion each year, the size of the insurer begins to emerge from investment analysis as a critical factor. The reason keeps popping up wherever you look. As Mark T. Bertolini, Chairman and Chief Executive Officer at Aetna likes so say, "like politics, all healthcare is local."
Level 6 – Book 21: Fundamentals of Investing in the Lucrative Healthcare Industry
The healthcare industry is becoming the most dominate sector of the American economy, employing one out of every eight American workers, includes 16 million jobs, generates approximately $2.7 trillion each year, and for investment analysis can be divided into 16 functioning parts or sectors. This exclusive series titled Cycle Analytics will help the investor identify investment opportunities within that $2.7 trillion complex sector by sector. The largest single piece of that investment pie is created by private health insurance premiums of $1 trillion a year and is projected to grow 6.4 percent in 2015.
Level 6 – Book 22: How to Start Investing in Many of the 16 Healthcare Sectors
At the beginning of 2015 popular media sites proclaimed, "Obamacare isn't the only reason why health insurer stocks have been so hot though. They are part of a broader rally in the health care sector." The Health Care Select Sector SPDR (XLV) exchange-traded fund, which owns most of the big insurers but also holds drug giants like Pfizer (PFE), Merck (MRK) and Bristol-Myers Squibb (BMY), had beaten the market in 2014. It was up early in 2015 while the S&P 500 declined.
Level 6 – Book 23: Fundamentals of Investing in the Consumer Discretionary Sector
Among the different market types the Consumer Discretionary Sector is closely watched during a recession because its components are the first to turn up in anticipation of a bottom in the economy. That's why the sector is also known as the Cyclicals. When stocks in the sector start up, then in general technology stocks are not far behind. These two groups are the big leaders at the beginning of a bull run in the stock market. The Consumer Discretionary Sector encompasses those industries that tend to be the most sensitive to economic cycles. Its manufacturing segment includes automotive, household durable goods, textiles & apparel and leisure equipment. The services segment includes hotels, restaurants and other leisure facilities, media production and services, and consumer retailing and services.
Level 6 – Book 24: The Consumer Discretionary Sector – Addressing the Impacts of Investing
Among the different market types the Consumer Discretionary Sector is closely watched because it has always been particularly sensitive to many different weathervane changes. If you want to know what's going to happen a few months down the road, keep your eye on the Cyclicals. As noted in the first installment of this series, the Consumer Discretionary Sector encompasses both manufacturing and services segments. Its manufacturing segment includes automotive, household durable goods, textiles & apparel and leisure equipment. The services segment includes hotels, restaurants and other leisure facilities, media production and services, and consumer retailing and services.
Level 6 – Book 25: How to Invest in Consumer Discretionary Sector Companies
Level 6 – Book 26: Fundamentals of Investing in the Basic Materials Sector
Basic Materials are fundamentally what the world is made of and offer solid investment opportunities depending on where the economy appears to be at any given time during the ever-moving economic cycle. Your fundamental investing approach therefore should be to keep an eye on economic indicators to help predict the cycle's rotation. Among the different market types the Basic Materials Sector often signals progress in emerging from a recessionary dip in the business cycle. Fundamentally it indicates businesses and governments are spending money on building which obviously requires Basic Materials with which to build. But there are 17 categories of Basic Materials to track. They don't all respond to early demand in the same way. That's why investors should learn a little more about tracking the broader picture as sketched by the leading indicators. Learning to read leading indicators helps you anticipate what's likely to happen next.
Level 6 – Book 27: Understanding the Basic Materials Sector as an Investment
Basic Materials are separated into 17 categories. Each group has its own investment attractions. This second installment in this three-part series will briefly sketch each of the categories so investors will have a better understanding of what they might be investing in. As previously stated Basic Materials are fundamentally what the world is made of and offer solid investment opportunities depending on where the economy appears to be at any given time during the ever-moving economic cycle. Your fundamental investing approach therefore should be to keep an eye on economic indicators to help predict the cycle's rotation.
Level 6 – Book 28: The Basic Materials Sector as an Investment – Advanced Methodologies
This series of three installments has looked first at the fundamentals of Basic Materials. Part II examined the intermediate view of what impacts different elements within the sector. This third installment will show some of the companies in many of the 17 segments of Basic Materials that may offer investment opportunities. Investors are reminded that investors should learn to consider all aspects of a company, including market price, market cap, price/earnings ratios, return on equity, dividend yield, long-term debt to equity, price to book value, net profit margin, price to free cash flow, and anything else that matters. To really get a solid perspective on the tons of data available, investors should check the possibility of using the SNL Financial resources.


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Nutritional Info
Per 100g
Energy(kjoules) 996Kj
Energy (Kcal) 239kcal
Fats <0,1g Carbs 98.6g Sugars <0,1g Polyols 98.4g Fibre <0.1g Protein <0.1g Salt <0.1g warnings Not to be eaten by children under 3 years (choking hazard). Excessive consumption may cause a slight laxative effect. Ingredients Isomalt, Citric Acid, Natural flavouring, Colours: Copper Chlorophyll,(Natural Green) Natural Colourings (Anthocyaninen), Stevia.
Sugar Free Rosie Apples
Candy Shack Sugar Free Rosy Apples 120g
Sweetened with stevia a sugar substitute these sugar free sweets do not lose any of their taste.
Candy Shack Rosy Apple sweets are suitable for vegans, vegetarians and those who are following a low sugar diet.
Gluten, dairy and nut free.
Half the calories of sugar.
tooth friendly.
Nutritional Info
|0.32 kg
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dmdiroll necesitaba un nuevo diseño de página web y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 91 diseños de 14 diseñadores freelance.
Toeheadz is a hip and trendy website for children's clothing & shoes (and eventually toys). We want to come across as cool and hip, but not too kid-like, as we are marketing mostly to mom's. Funky, cool, and fun is our personality. We want kids to have the opportunity to be just as stylish as adults.
Typically mothers or very hip fathers (or any person) buying hip clothing for a child. The audience is stylish and hip and someone who appreciates cool clothing for kids.
We are currently working with Yahoo to create the functionality of the website; however, we need to provide them with the overall design layout. We want the website to be funky and fun and very appealing to mothers who are shopping for cool & fashionable kids.
We currently have a logo that simply states the name of our company (rather than an image or graphic element). We would like to come up with a design element for the website that helps to defines us.
At one point a designer presented us with an image of owl that was rather interesting. We were intrigued by this and thought it was an interesting concept. We have seen cool sites with trees and owls and other interesting elements that are built into the site (rather than just the logo), so perhaps we can move in that direction. However, it doesn't necessary have to be an owl, tree, etc...we are very open.
Keep in mind that this a retail site and will have many different images with clothing and shoes and so we also don't want it too be too busy.
We like our logo, but the plaid around the logo can be broken up and integrated into the site in some other capacity. However, we want it known that we really like the plaid.
Below are a few pages that Yahoo put together for us. We like the functionality but NOT the design. Also, our logo is attached as "toeheadz winner". Some product photos included as well.


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NEW YORK (AP) - The U.S. stock market is ending slightly lower after a choppy day of trading.
NEW YORK (AP) � The U.S. stock market is ending slightly lower after a choppy day of trading.
Major indexes moved between small gains and losses for much of the day Tuesday, then drifted steadily lower in the last hour of trading.
Traders were discouraged by a surprisingly large drop in consumer confidence in February. The worst drops were in areas affected by the extreme cold weather and storms of the past few weeks.
The Standard & Poor's 500 index declined two points, or 0.1 percent, to close at 1,845.
The Dow Jones industrial average fell 27 points, or 0.2 percent, to 16,179. The Nasdaq composite fell five points, or 0.1 percent, to 4,287.
Tenet Healthcare fell 9 percent after the hospital management company reported a loss in the fourth quarter.


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2006 Grand National Roadster Show - Friday
1:00 PMThe Grand National Roadster Show opened the doors this afternoon to excited crowds eager to get their first glimpse of rows and rows of hot rods, customs, motorcycles and old race cars. This year's show has grown to six buildings packed wall to wall.
Thursday night set-up was the usual last minute thrash as vehicle owners and builders put the final touches and polish on their cars in preparation for the today's crowds and judges. The show cars ranged from one-off creations that cost more than most people's house to low-buck home-built bare-bones hot rods.
Be sure to check back as we update you a couple of times a day over the weekend.
4:30 PMIt's late afternoon at the Grand National Roadster Show and there is plenty of awesome cars, roadsters, coupes, trucks, motorcycles and more to look at, so we'll get right to it with a glimpse of what we've been able to capture so far.
Keep checking back as we'll have tons more photos and news throughout the weekend.


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WASHINGTON (Reuters) - U.S. job growth likely slowed sharply in November as superstorm Sandy disrupted economic activity, making it hard get a clear picture of a labor market that has also been hobbled by fears of government austerity.
Nonfarm payrolls are expected to have increased only 93,000 last month, a sharp step-down from October's 171,000 job gain, according to a Reuters survey of economists. The unemployment rate is seen holding steady at 7.9 percent.
That would be the fewest number of jobs in five months, but economists blame the anticipated pull-back on the monster storm, which lashed the densely populated East Coast late in October.
While they expect a bounce-back in December, the pace of job growth is expected to remain languid given the economic uncertainty created by the so-called fiscal cliff.
"It is important to remember that the impact of Sandy on total nonfarm payrolls is temporary and should not be blamed for the woes of the current labor market recovery," said Lewis Alexander, chief economist at Nomura Securities in New York.
The Labor Department will release the November jobs data on Friday at 8:30 a.m. EST (1330 GMT). The late October storm helped hold back consumer spending and industrial production during the month, while spurring a drop in wages.
While it is difficult to quantify the storm's influence on payrolls in November, economists estimate it could subtract anything between 25,000 and 75,000 jobs.
But businesses already had been showing a reluctance to spend and hire, fearful the government may fail to steer clear of the $600 billion in automatic tax hikes and government spending cuts set to take hold at the start of next year.
Payroll growth averaged 170,000 per month over the last three months, but economists said Sandy put that out of range for November.
"Had we not experienced the kind of disruption that Sandy brought to bear, we would have seen at least a recurrence if not an increase in the number of jobs added in November," said Patrick O'Keefe, head of economic research at J.H. Cohn in Roseland, New Jersey.
"The underlying trend temporarily got disrupted by the storm, but it's still a very tepid recovery."
Given the anticipated volatility in the report, policymakers at the Federal Reserve are unlikely to attach too much weight to it when they meet next Tuesday and Wednesday to assess the economy and deliberate on monetary policy.
Economists said officials at the U.S. central bank would keep a close eye on the budget talks in Washington, where lack of progress should encourage them to stay on their ultra-easy monetary policy path.
A persistently weak labor market led the Fed in September to launch a program to buy $40 billion worth of mortgage-backed securities every month. It said it would keep buying until there was a sustained improvement in the jobs market.
Those purchases, aimed at driving down borrowing costs, come on top of the $45 billion a month the Fed is buying in long-term Treasuries with proceeds from sales of shorter-term debt.
That program expires at the end of the year and the Fed is expected to replace it by creating money to buy more Treasuries.
"Even absent Sandy, the economy is not growing at the rate they would like to see so that is reason for them to continue with more quantitative easing," said Torsten Slok, chief international economist at Deutsche Bank Securities in New York.
A spike in first-time applications for state unemployment benefits, especially in New York and New Jersey, in the two weeks after the monster storm, probably offered an early glimpse into the Sandy's potential toll on November payrolls.
Economists said some employers affected by the storm were probably unable to respond to the Labor Department's monthly jobs survey, and that the government would likely have to make some guesses as to the storm's impact.
According to economists, the department faced this problem in 2005 when Hurricane Katrina devastated the Gulf Coast. In that instance, it greatly over-estimated the storm's impact and some economists think it may do so again, with subsequent payroll data being revised higher.
Sandy may have hurt retail employment, while temporary help hiring and construction payrolls probably got a boost from storm-related clean-up and rebuilding efforts. A rise in homebuilding, thanks to the Fed's loose policy stance, is another reason to look for an increase in construction jobs.
Manufacturing employment was probably flat in November, while economists said government payrolls likely fell by 2,000. While average hourly earnings are expected to have edged up and the workweek to have held steady, the risks are to the downside, economists said.
Reporting by Lucia Mutikani; Editing by Tim Ahmann and Leslie Gevirtz


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As the competition between the Baltimore Ravens and the San Francisco 49ers heats up in anticipation of Sunday's Super Bowl XLVII, the National Aquarium, Baltimore and the California Academy of Sciences in San Francisco are enlisting the help of their aquatic animals to take their own friendly rivalry off the green and into the blue in the Super FISH Bowl!
You can't have a #SuperFISHBowl without a strong team! As part of our fun wager, each organization is building their ultimate fantasy animal line-up!
Here's who we've got out on the field:
Kicker – Blue Crab
Cornerback – Golden Lion Tamarins
Defensive Line – Sand Tiger Sharks
Fullback – Dolphins
Linebacker – Porcupine Fish
Quarterback – Blue Hyacinth Macaw (Margaret)
Center – Snapping Turtle
Wide Receiver – Tarpon
Tight End – Roughtail Ray
Coach – Octopus (Poulpe)
Referees – Banggai Cardinalfish
Cheerleader – Green Sea Turtle (Calypso)
Tell us your favorite player & they could be our fan-voted MVP!


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Strizzy Kastro (Feat. P. Reign, Belly & Jay-Ny) - Go Hard [Label Submitted]
"1st Single Off Strizzy Kastro's Highly Anticipated Mixtape twitter.com/StrizzyKastro twitter.com/Preign twitter.com/Rebellyus twitter.com/Jstaffz"
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