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Studies suggest that the HIV-1 epidemic in the Netherlands may have become more virulent, leading to faster disease progression if untreated. Analysis of CD4 cell count decline before antiretroviral therapy (ART) initiation, a surrogate marker for disease progression, may be hampered by informative censoring as ART initiation is more likely with a steeper CD4 cell count decline.
Development of CD4 cell count from 9 to 48 months after seroconversion was analyzed using a mixed-effects model and 2 models that jointly modeled CD4 cell counts and time to censoring event (start ART, <100 CD4 cells/mm3, or AIDS) among therapy-naïve MSM HIV-1 seroconverters in the Netherlands. These models make different assumptions about the censoring process.
All 3 models estimated lower median CD4 cell counts 9 months after seroconversion in later calendar years (623, 582, and 541 cells/mm3 for 1984–1995 [n = 111], 1996–2002 [n = 139], and 2003–2007 seroconverters [n = 356], respectively, shared-parameter model). Only the 2 joint-models found a trend for a steeper decline of CD4 cell counts with seroconversion in later calendar years (overall p-values 0.002 and 0.06 for the pattern-mixture and the shared-parameter model, respectively). In the shared-parameter model the median decline from 9 to 48 months was 276 cellsmm3 for 1984–1995 seroconverters and 308 cells/mm3 for 2003–2007 seroconverters (difference in slope, p = 0.045).
Citation: Gras L, Geskus RB, Jurriaans S, Bakker M, van Sighem A, Bezemer D, et al. (2013) Has the Rate of CD4 Cell Count Decline before Initiation of Antiretroviral Therapy Changed over the Course of the Dutch HIV Epidemic among MSM? PLoS ONE 8(5): e64437. https://doi.org/10.1371/journal.pone.0064437
Editor: Weijing He, University of Texas Health Science Center San Antonio Texas, United States of America
Received: December 3, 2012; Accepted: April 15, 2013; Published: May 27, 2013
Copyright: © 2013 Gras et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The ATHENA observational clinical cohort is part of Stichting HIV Monitoring, Amsterdam, the Netherlands and is supported by a grant of the Netherlands Ministry of Health, Welfare and Sport. The Amsterdam Cohort Studies on HIV infection and AIDS, a collaboration between the Public Health Service of Amsterdam, the Academic Medical Centre of the University of Amsterdam, Sanquin Blood Supply Foundation and the University Medical Centre Utrecht, are part of Stichting HIV Monitoring and are financially supported by the Netherlands National Institute for Public Health and the Environment. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
The higher the HIV-1 plasma level, the more likely progression to AIDS is [1] and the higher the chance of HIV-1 transmission [2]. Previously, we found an increasing trend over time in plasma HIV-1 RNA concentration at set-point, i.e., 9 to 27 months after HIV-1 seroconversion and an accompanying decreasing trend of CD4 cell count measured at viral set-point [3]. In the Amsterdam Cohort Studies (ACS), a higher replicative fitness of HIV-1 isolates obtained from participants with seroconversion in more recent years was found [4]. Some cohorts have reported a similar increase in HIV-1 RNA concentration and decrease in CD4 cell count at viral set-point over time [5]–[7], whereas others found no evidence for such changes [8], [9]. The effect of higher viral load and lower CD4 T-cell count at set-point on progression to AIDS or death is difficult to study in the combination antiretroviral therapy (cART) era as these endpoints are hardly observed in effectively treated patients. A surrogate marker of disease progression is the rate of CD4 cell decline in patients not on therapy. Since individuals with low CD4 cell counts are more likely to start antiretroviral therapy (ART), the presence of informative censoring needs to be considered. Mixed-effects models, the standard method of analysis of longitudinal data, can give biased estimates when censoring (here: the start of ART) is not at random and depends on unobserved CD4 cell counts [10]. Joint-modeling of longitudinal CD4 cell counts together with the censoring process can give unbiased estimates, under certain assumptions. Therefore, we investigated trends in CD4 cell count decline between 9 months and 4 years after HIV seroconversion, using regression models that make different assumptions about the censoring pattern.
Patient Selection
Data were obtained from men having sex with men (MSM) participating in the ACS or the AIDS therapy evaluation in the Netherlands (ATHENA) cohort. ACS recruitment started in 1984, mainly among MSM living in or around Amsterdam. Inclusion criteria varied over time [11]. The ATHENA cohort has been described elsewhere [12] and includes anonymized data obtained from treated and untreated HIV-infected patients, who have been followed in or after 1996 in any of the 25 HIV treatment centers and also includes ACS participants in care in or after 1996.
From both cohorts, MSM from Western-Europe and North-America were selected with a maximum interval between the last negative and first positive HIV-1 antibody test of 1 year. The day of seroconversion was estimated as midpoint between both tests. Also included were MSM with serological evidence of acute infection in which case the day of seroconversion was set 1 month prior to the date of the first positive test. All MSM with seroconversion before 1996 were from the ACS. At seroconversion, all patients were 16 years or older. Patients had at least one CD4 cell count between 9 and 27 months after seroconversion while being ART-naïve. Subtype infections other than subtype B were excluded. MSM without subtype determination were included, since in our cohort the prevalence of subtype B infection among MSM from Western-Europe or North-America is 95% and therefore highly likely [12].
Ethics Statement
Informed written consent is obtained from all ACS participants, and the study has been approved by the Medical Ethical Committee of the Academic Medical Centre. Ethical approval in the ATHENA cohort is not obtained as data are collected from patients as part of HIV care. Patients can opt-out after being informed by their treating physician of the purpose of collection of clinical data.
CD4 cell counts in peripheral blood measured between 9 months and 4 years after seroconversion were used to model CD4 cell count decline. The 4-year threshold ensured a similar follow-up period for subjects seroconverting in early and in later years. Only CD4 cell counts obtained from samples taken prior to any of the following 3 dates were included for analysis: date of first starting ART, first date CD4 cell count had dropped below 100 cells/mm3 (other studies [5], [8] have censored CD4 cell counts after this date because of the possibility of an accelerated decline), and the date 1 year prior to AIDS diagnosis (CD4 cell count decline may accelerate around this date [13], [14]).
Statistical Analysis
Trends in CD4 cell decline over time were analyzed using 3 models with different underlying assumptions. All models assumed a linear decline and included a random slope and intercept for each patient. Age at seroconversion (linearly modeled and centered at 35 years of age) and timing of seroconversion (either in 3 categories 1984–1995, 1996–2002, 2003–2007, or as a continuous variable using natural splines with knots at January 1993, 2000 and 2005) were included as fixed covariates. cART was introduced in the Netherlands as standard of care in 1996 and this motivated our first group 1984–1995 (pre-cART era). The second cut-off was chosen a-priori so that each time period was sufficiently wide and included a sufficient number of patients. We used 3 different statistical models: 1) Mixed-effects models. These models can provide unbiased estimates if censoring only depends on the observed CD4 cell counts, given covariates included in the model (the censoring process is missing at random (MAR)). If instead censoring depends on unobserved CD4 counts, such as the underlying subject-specific CD4 cell count trajectories, estimates will be biased. Joint-modeling of longitudinal CD4 cell counts and the censoring process can give unbiased estimates under certain assumptions [15]. We used two joint-modeling approaches: 2) pattern-mixture models; and 3) shared-parameter models [16].
Pattern mixture model.
Pattern-mixture models quantify the longitudinal outcome conditionally on the timing of the censoring event. The censoring event was either ART initiation, CD4 cell count dropping below 100 cells/mm3 or an AIDS diagnosis (in which case CD4 cell counts were censored from the date 1 year before the AIDS diagnosis). We used seven distinct patterns: censoring between 9–21, 21–27, 27–33, 33–39, 39–48 months, lost to follow-up (including suicide). A seventh pattern was no censoring event within 48 months. The basic probability structure of the model is:(1)With i an arbitrary individual and a categorical variable representing the 3 seroconversion periods 1984–1995, 1996–2002 and 2003–2007. The joint distribution in (1) is obtained by multiplying pattern-specific probabilities of CD4 trajectories , modelled via a random effects model, by weights according to the probability distribution, . The parameter estimates of the CD4 trajectories, and their dependence on , are obtained via likelihood maximisation. The weights from the second term. are obtained by dividing the number of patients in each pattern and in each period by the total number of patients in each period [17].
Shared parameter model.
The basic probability structure of the model is:(2)with i and as above and Ti the time to the censoring event. in (2) represents a longitudinal random effects model for the longitudinal CD4 cell counts and a survival model for the time to censoring due to ART initiation, CD4 cell count dropping below 100 cells/mm3 or an AIDS diagnosis. Individuals that had complete follow-up were treated as censored cases. The survival model was regressed on the underlying CD4 cell count and age. We used a Weibull accelerated failure time model, but a Cox proportional hazards model gave similar results. In the shared-parameter model, the association between the censoring times and CD4 cell counts is modeled via a set of random effects. Conditional on the random effects, the longitudinal CD4 cell counts are independent of the censoring time, CD4 cell counts were cube root transformed to comply with normality assumptions. Both terms contribute to the likelihood, hence a joint likelihood was maximized.
Averaged mean estimates from the pattern-mixture model were estimated using PROC MIXED in SAS 9.2 (SAS Institute, Cary, NC). The obtained standard errors are slightly underestimated because the size of the patterns are assumed fixed. To correct for the uncertainty of pattern sizes, corrected standard errors can be obtained using the delta method [17], [18]. Shared-parameter modeling was done using the R (R Development Core Team 2010) package JM [19]. SAS and R syntax is given in Supporting Information S1.
In total, 606 patients were included in the study: 111 with seroconversion between 1984 and 1995, 139 between 1996 and 2002, and 356 between 2003 and 2007. Of all MSM, 9 (8%) out of 120 with seroconversion between 1984 and 1995, 122 (47%) out of 261 with seroconversion between 1996 and 2002, and 165 (32%) out of 521 with seroconversion between 2003 and 2007, were excluded because either the date of ART initiation, the date CD4 cell count had dropped below 100 cells/mm3, or the date 1 year prior to diagnosis of AIDS was before 9 months after seroconversion. A last negative HIV test within 1 year of the first positive test was available for 524 patients. The remaining 82 patients had serological evidence of acute infection (3 seroconverters between 1984 and 1995, 15 between 1996 and 2002, and 64 between 2003 and 2007).
Baseline characteristics are shown in Table 1. Subtype was not determined in 330 patients (54%). The percentage of samples measured using a single-platform method gradually increased from 0% prior to 1997 to 94% in 2010. Timing of the first sample taken after 9 months after seroconversion was similar between the 3 seroconversion periods. Overall, the median first CD4 cell count at 9 months was 540 cells/mm3 but it decreased with later periods of seroconversion. The proportion of patients with a censoring event increased over time. ART was started in 295 patients, in 30 patients AIDS was diagnosed, and in 14 patients CD4 cell count declined to below 100 cells/mm3.
Intercepts (estimated CD4 cell count at 9 months after seroconversion) were similar between the 3 models (see Table 2). All models showed a significant association of a lower CD4 cell count at 9 months with seroconversion in later calendar years. Estimates of the decline in CD4 cell count obtained with the mixed-effects model did not differ significantly between periods of seroconversion (overall p-value = 0.56). However, in the pattern-mixture model there was a significant association of an increasing CD4 cell count decline with seroconversion in later years (p = 0.002) whilst in the shared parameter model there was a borderline trend (p = 0.06). In both joint-models, the decline for 2003–2007 seroconverters was significantly higher than for 1984–1995 seroconverters. In the shared-parameter model, the difference was 0.12 /mm3/year (95% CI 0.00, 0.24). Estimates obtained with the pattern-mixture model showed a similar trend, although the rate of decline was steeper across all seroconversion periods compared to the shared-parameter model. In both joint models the decline did not differ significantly between seroconversion periods 1996–2002 and 2003–2007. Figure 1a–c shows the estimated decline in CD4 cell count graphically, on the original scale. When modeled using splines (Figure 2), the association between year of seroconversion and slope was borderline significant in the shared-parameter model (p = 0.06) but not in the mixed-effects model (p = 0.32). As expected, the estimates from the mixed-effects and the shared-parameter model differed least during the period when ART was not available. Shared-parameter model estimates suggest that the CD4 decline became smaller over time before 1993 and became larger thereafter. However, 95% confidence intervals were wide.
Dashed lines and shaded regions are 95% confidence intervals.
There was no significant association between age and the mean CD4 cell count 9 months after seroconversion in any of the 3 models. Nor did the mixed-effects and pattern-mixture models find an association between age and the slope of decline in CD4 cell count after 9 months (−0.03 /mm3/year, 95% CI −0.08, 0.02 and, 0.01 /mm3/year, 95% CI −0.03, 0.05 per 10-year increase in age, respectively). The shared-parameter model estimated a stronger association between decline in CD4 cell count and older age; −0.06 /mm3/year per 10-year increase in age, 95% CI −0.12, −0.01.
For a typical seroconverter, i.e., an individual 36 years of age at seroconversion, with a median CD4 cell count at 9 months, the median decline between 9 and 48 months (see Table 3) in the pattern-mixture model changed from 286 CD4 cells/mm3 for 1984–1995 seroconverters (on average 88 cells/mm3/year) to 363 cells/mm3 for 2003–2007 seroconverters (112 cells/mm3/year). In the shared-parameter model the estimated median decline was smaller (83 cells/mm3/year for 1984–1995, and 90 cells/mm3/year for 2003–2007 seroconverters) whereas the mixed-effects model decline estimates were substantially smaller (between 75 and 77 cells/mm3/year across the 3 periods) compared to the pattern-mixture model estimates. Table 3 also shows that the pattern-mixture model estimated the median time from seroconversion to the 350 CD4 cells/mm3 threshold was 2.2 years for 2003–2007 seroconverters compared to 3.8 years for 1984–1995 seroconverters. This compares to 2.7 years and more than 4.0 years for the shared-parameter model.
Using joint-models, we found a trend of a steeper CD4 cell count decline before the initiation of antiretroviral therapy in HIV infected MSM since the early nineties. This suggests, together with the earlier reported higher viral fitness and the plasma viral load and lower CD4 cell count at viral set-point, an increasing trend in HIV virulence in MSM followed in HIV treatment centers in the Netherlands over time [3], [4]. Likewise, a recent meta-analysis concluded that virulence may have increased over the course of the HIV-1 pandemic [20]. The trend of a steeper CD4 cell count decline over time was only apparent when timing of censoring (because of ART initiation or disease progression) was jointly modeled with longitudinal CD4 cell counts and not when mixed-effects models were used. Mixed-effects models can provide unbiased estimates when the probability of the censoring event only depends on the observed CD4 cell counts (the MAR assumption), given covariates included in the model. Provided that the model for the censoring event is correctly specified, joint-models can provide unbiased estimates both when data are MAR, and when censoring is informative (when censoring depends on aspects of CD4 cell count that are not observed). The different results obtained from mixed-effects models and joint-models in this study, indicates that censoring CD4 cell counts due to ART initiation or disease progression is informative and estimates from standard mixed-effects models are probably incorrect. Estimation of parameters in joint models, compared to mixed-effect models, is more complex and joint models are currently not routinely used.
Using the shared-parameter model, we estimated an annual CD4 cell count decline of around 90 cells/mm3/year for 2003–2007 seroconverters. The pattern-mixture model estimated a steeper decline. The reported decrease among Italian patients included in the MASTER cohort [5] was less steep compared to our findings (approximately 55 cells/mm3/year with a trend towards steeper decline in more recent years for MSM). The Swiss HIV Cohort Study (SHCS), using the same methodology as the MASTER cohort, found no significant evidence for a changing rate of decline between 1986 and 2002 [8]. Analyses in both these studies were restricted to patients for whom at least 5 CD4 cell counts were available at least 200 days after the date of confirmed HIV infection. Furthermore, analyses were not restricted to patients for whom the date of seroconversion could reliably be estimated. Finally, estimates from the SHCS and MASTER cohort were obtained using mixed-effects models, without correction for informative dropout. The CASCADE collaboration [21] estimated the median time between seroconversion and reaching 350 CD4 cells/mm3 in 30–35-year old MSM with seroconversion after 1996 to be 3.94 years, similar to our mixed-effect estimate of 3.8 years for 1996–2002 seroconverters. Our joint-model estimates of 3.1 and 3.0 years were substantially lower indicating the MAR assumption may not hold. The CASCADE collaboration did not find evidence for an increased rate of CD4 cell count decline in more recent calendar years. CD4 cell count decline was jointly modeled with survival time. However, no correction for informative censoring due to ART initiation was made.
The reason for the less steep CD4 slope estimates and stronger effect of older age with CD4 cell count decline in the shared-parameter model compared to the pattern-mixture model is unclear, but an effect of age on either CD4 cell counts at 9 months on the slope, or both is to be expected, as shown by others [21], [22].
Estimates obtained using shared-parameter models allowing the estimated underlying CD4 cell count to have a different association with censoring due to the start of ART and censoring due to disease progression (censoring because of <100 CD4 cells/mm3, or 1 year prior to AIDS) were similar to those presented (results not shown). Furthermore, estimates from models censoring only CD4 cell counts because of ART initiation were also similar to our main results (results not shown).
Combined together, the ACS and ATHENA cohorts span almost the entire period of the Dutch HIV epidemic. A potential weakness is that ACS participants (all 1984–1995 seroconverters were ACS participants) might have different socioeconomic status, race, overall health status, or might otherwise be different to ATHENA participants. We attempted to minimize bias because of population changes by restricting inclusion to a very homogeneous population: MSM from Western-Europe or North-America and likely to be infected with subtype B. Most patients from both cohorts were seroconverters, and thus, had been tested for HIV before, suggesting a similar health seeking behaviour. Still, the possibility that our findings are the result of changes in patient characteristics over time cannot be excluded. The proportion of patients in our study identified through serological evidence of recent HIV-1 seroconversion increased from 3% between 1984 and 1995 to 18% between 2003 and 2007. This could have biased our results if patients went to seek medical care because of severe acute seroconversion illness and would otherwise not have been diagnosed. The number of symptoms during primary infection is associated with viral load set-point [23] and some specific signs with faster disease progression [24]. However, when these patients were excluded, similar results were obtained (results not shown).
Single-platform techniques to determine CD4 cell counts, gradually introduced in the late nineties, reportedly measure lower CD4 cell counts than dual-platform techniques [25]. We did not find a significant association between the standard CD4 cell count measurement technology at the time of the CD4 cell count measurement and the level of CD4 cell counts, and estimates in all 3 types of models remained similar (results not shown). However, this adjustment may have been incomplete as CD4 cell counts may have been measured with other techniques than the standard method. Factors influencing the number of measured CD4 cells which we could not control for include gating strategy, tobacco use and the time of day that the sample was taken [25]–[27].
Our study did not include patients who had started ART, or had a CD4 cell count below 100 cells/mm3 within 9 months or AIDS within 21 months after seroconversion. As we had to exclude a high proportion of seroconverters in the cART era for this reason, this may have biased estimates for the 1996–2002 and 2003–2007 periods. Patients starting therapy soon after infection, outside the setting of a randomized clinical trial, are more likely to have low CD4 cell counts and/or a more pronounced decline. Hence our estimates of the slope in 1996–2002 and 2003–2007 may have been upwardly biased. However, one could also argue that 1996–2002 and 2003–2007 estimates may be downwardly biased because patients with an early rapid CD4 cell count decline and starting ART before 9 months may have had a slower decline thereafter (because of regression to the mean effects) which is now not observed because of the early start of ART. Regression to the mean effects may have a dampening effect on bias resulting from exclusion of patients starting early treatment.
The probability of transmission of HIV is higher when the viral load is higher [28]. The duration of asymptomatic HIV infection increases with lower set-point viral load [14]. Together these factors determine the expected number of new infections an infected person will cause during the course of infection [29]. Evidence suggests that the level of set-point viral load may be largely determined by virus genotype [30] and that viral load between transmitter and recipient is correlated [31]–[35]. This may result in a selection of viral strains with higher set-point viral load because the infectious period is shortened in the cART era (transmission during successful ART is absent or near zero [36]). The proportion of transmitters with high set-point viral load among those transmitting HIV will increase and may lead, if viral load between transmitter and recipient is indeed correlated, to the observed increase in viral load and lower CD4 cell count at viral set-point [3] and a steeper decline in CD4 cell count.
Another explanation of our finding may be changes in host genetic factors or adaption of HIV-1 to host genetic factors [37] [38] or a rise in superinfection incidence, associated with a higher fitness [39]. Although dual infections can easily be missed, the incidence of 0% between 1984 and 1997 [40] and 1 to 1.5% between 1996 and 2007 in Amsterdam patients [41], [42] suggests that an increase over the years, caused by an increase in risk behavior [43], is unlikely to completely explain our findings.
In summary, to minimize bias it is important to jointly model timing of censoring because of ART initiation and/or disease progression in the analysis of longitudinal CD4 cell count trends. By doing so, we found a trend for a faster CD4 cell count decline in MSM with newly acquired HIV-1 infection between 2003 and 2007 compared to the pre-cART era. This could indicate an increase in HIV virulence over time. The higher rate of CD4 cell count decline, together with a lower CD4 cell count 9 months after seroconversion, results in a shorter time period between HIV infection and reaching the threshold of 350 CD4 cells/mm3.
Supporting Information
We would like to thank Professor Koos Zwinderman for helpful discussions on joint models, Dimitris Rizopoulous for help with the R package JM, and Susan T. Landry for editing the manuscript.
The ATHENA observational cohort has been made possible through the collaborative efforts of the following physicians (*site coordinating physicians) working at Netherlands HIV Treatment Centers:
Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam: Prof. dr. JM Prins*, Prof. dr. TW Kuijpers, Dr. HJ Scherpbier, Dr. K Boer, Dr. JTM van der Meer, Dr. FWMN Wit, Dr. MH Godfried, Prof. dr. P Reiss, Prof. Dr. T van der Poll, Dr. FJB Nellen, Prof. dr. JMA Lange, Dr. SE Geerlings, Dr. M van Vugt, Drs. SME Vrouenraets, Drs. D Pajkrt, Drs. JC Bos, Drs. M van der Valk. Academisch Ziekenhuis Maastricht, Maastricht: Dr. G Schreij*, Dr. S Lowe, Dr. A Oude Lashof. Catharina-ziekenhuis, Eindhoven: Drs. MJH Pronk*, Dr. B Bravenboer. Erasmus Medisch Centrum, Rotterdam: Dr. ME van der Ende*, Drs. TEMS de Vries-Sluijs, Dr. CAM Schurink, Drs. M van der Feltz, Dr. JL Nouwen, Dr. LBS Gelinck, Dr. A Verbon, Drs. BJA Rijnders, Drs. ED van de Ven-de Ruiter, Dr. L Slobbe. HagaZiekenhuis, Den Haag: Dr. RH Kauffmann*, Dr. EF Schippers. Isala Klinieken, Zwolle: Dr. PHP Groeneveld*, Dr. MA Alleman, Drs. JW Bouwhuis. Kennemer Gasthuis, Haarlem: Prof. dr. RW ten Kate*, Dr. R Soetekouw. Leids Universitair Medisch Centrum, Leiden: Dr. FP Kroon*, Prof. dr. PJ van den Broek, Prof. dr. JT van Dissel, Dr. SM Arend, Drs. C van Nieuwkoop, Drs. MGJ de Boer, Drs. H Jolink. Maasstadziekenhuis, Rotterdam: Dr. JG den Hollander*, Dr. K Pogany. Medisch Centrum Alkmaar, Alkmaar: Dr. W Bronsveld*, Drs. W Kortmann, Drs. G van Twillert. Medisch Centrum Leeuwarden, Leeuwarden: Drs. DPF van Houte*, Dr. MB Polée, Dr. MGA van Vonderen. Medisch Spectrum Twente, Enschede: Dr. CHH ten Napel*, Drs. GJ Kootstra. Onze Lieve Vrouwe Gasthuis, Amsterdam: Prof. dr. K Brinkman*, Dr. WL Blok, Dr. PHJ Frissen, Drs. WEM Schouten, Drs. GEL van den Berk. Sint Elisabeth Ziekenhuis, Tilburg: Dr. JR Juttmann*, Dr. MEE van Kasteren, Drs. AE Brouwer. Slotervaart Ziekenhuis, Amsterdam: Dr. JW Mulder*, Dr. ECM van Gorp, Drs. PM Smit, S Weijer. Stichting Medisch Centrum Jan van Goyen, Amsterdam: Drs. A van Eeden*, Dr. DWM Verhagen*. Universitair Medisch Centrum Groningen, Groningen: Dr. HG Sprenger*, Dr. R Doedens, Dr. EH Scholvinck, Drs. S van Assen, CJ Stek. Universitair Medisch Centrum Utrecht, Utrecht: Prof. dr. IM Hoepelman*, Dr. T Mudrikova, Dr. MME Schneider, Drs. CAJJ Jaspers, Dr. PM Ellerbroek, Dr. EJG Peters, Dr. LJ Maarschalk-Ellerbroek, Dr. JJ Oosterheert, Dr. JE Arends, Dr. MWM Wassenberg, Dr. JCH van der Hilst. Ziekenhuis Rijnstate, Arnhem: Dr. C Richter*, Dr. JP van der Berg, Dr. EH Gisolf.
Author Contributions
Conceived and designed the experiments: LG RBG FdW. Analyzed the data: LG RBG. Contributed reagents/materials/analysis tools: MB SJ. Wrote the paper: LG RBG. Revised the manuscript for important intellectual content: FdW BB JMP AvS DB CF.
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- 25. Levering WH, van Wieringen WN, Kraan J, van Beers WA, Sintnicolaas K, et al. (2008) Flow cytometric lymphocyte subset enumeration: 10 years of external quality assessment in the Benelux countries. Cytometry B Clin Cytom 74: 79–90 10.1002/cyto.b.20370 [doi].
- 26. Bekele Y, Mengistu Y, de Wit TR, Wolday D (2011) Timing of blood sampling for CD4 T-cell counting influences HAART decisions. Ethiop Med J 49: 187–197.
- 27. Santagostino A, Garbaccio G, Pistorio A, Bolis V, Camisasca G, et al. (1999) An Italian national multicenter study for the definition of reference ranges for normal values of peripheral blood lymphocyte subsets in healthy adults. Haematologica 84: 499–504.
- 28. Wilson DP, Law MG, Grulich AE, Cooper DA, Kaldor JM (2008) Relation between HIV viral load and infectiousness: a model-based analysis. Lancet 372: 314–320.
- 29. Fraser C, Hollingsworth TD, Chapman R, de Wolf F, Hanage WP (2007) Variation in HIV-1 set-point viral load: epidemiological analysis and an evolutionary hypothesis. Proc Natl Acad Sci U S A 104: 17441–17446.
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Alizon S, von Wyl, V, Stadler T, Kouyos RD, Yerly S, et al.. (2010) Phylogenetic approach reveals that virus genotype largely determines HIV set-point viral load. PLoS Pathog 6. 10.1371/journal.ppat.1001123 [doi].
- 31. Tang J, Tang S, Lobashevsky E, Zulu I, Aldrovandi G, et al. (2004) HLA allele sharing and HIV type 1 viremia in seroconverting Zambians with known transmitting partners. AIDS Res Hum Retroviruses 20: 19–25.
- 32. van der Kuyl AC, Jurriaans S, Pollakis G, Bakker M, Cornelissen M (2010) HIV RNA levels in transmission sources only weakly predict plasma viral load in recipients. Aids 24: 1607–1608 10.1097/QAD.0b013e32833b318f. [doi];00002030-201006190-00032 [pii]
- 33. Hecht FM, Hartogensis W, Bragg L, Bacchetti P, Atchison R, et al. (2010) HIV RNA level in early infection is predicted by viral load in the transmission source. Aids 24: 941–945 10.1097/QAD.0b013e328337b12e. [doi]
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Lingappa J, Thomas K, Hughes J, Baeten J, Fife K et al. (2011) Infected Partner's Plasma HIV-1 RNA Level and the HIV-1 Set Point of Their Heterosexual Seroconverting Partners.
- 35. Hollingsworth TD, Laeyendecker O, Shirreff G, Donnelly CA, Serwadda D, et al. (2010) HIV-1 transmitting couples have similar viral load set-points in Rakai, Uganda. PLoS Pathog 6: e1000876 10.1371/journal.ppat.1000876 [doi].
- 36. Attia S, Egger M, Muller M, Zwahlen M, Low N (2009) Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. Aids 23: 1397–1404 10.1097/QAD.0b013e32832b7dca [doi].
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van Manen D, Gras L, Boeser-Nunnink BD, van Sighem AI, Maurer I, et al.. (2011) Rising HIV-1 viral load set-point at a population level coincides with a fading impact of host genetic factors on HIV-1 control. Aids. 10.1097/QAD.0b013e32834bec9c [doi].
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Schellens IM, Navis M, van Deutekom HW, Boeser-Nunnink B, Berkhout B, et al.. (2011) Loss of HIV-1 derived CTL epitopes restricted by protective HLA-B alleles during the HIV-1 epidemic. AIDS. 10.1097/QAD.0b013e32834981b3 [doi].
- 39. van der Kuyl AC, Kozaczynska K, Arien KK, Gali Y, Balazs VR, et al. (2010) Analysis of infectious virus clones from two HIV-1 superinfection cases suggests that the primary strains have lower fitness. Retrovirology 7: 60 1742-4690-7-60 [pii];10.1186/1742-4690-7-60 [doi].
- 40. Rachinger A, Manyenga P, Burger JA, Derks van de Ven TL, Stolte IG, et al. (2011) Low incidence of HIV-1 superinfection even after episodes of unsafe sexual behavior of homosexual men in the Amsterdam Cohort Studies on HIV Infection and AIDS. J Infect Dis 203: 1621–1628 jir164 [pii];10.1093/infdis/jir164 [doi].
- 41. van der Kuyl AC, Zorgdrager F, Jurriaans S, Back NK, Prins JM, et al. (2009) Incidence of human immunodeficiency virus type 1 dual infections in Amsterdam, The Netherlands, during 2003–2007. Clin Infect Dis 48: 973–978 10.1086/597356 [doi].
- 42. Cornelissen M, Jurriaans S, Kozaczynska K, Prins JM, Hamidjaja RA, et al. (2007) Routine HIV-1 genotyping as a tool to identify dual infections. Aids 21: 807–811 10.1097/QAD.0b013e3280f3c08a. [doi];00002030-200704230-00003 [pii]
- 43. Jansen IA, Geskus RB, Davidovich U, Jurriaans S, Coutinho RA, et al. (2011) Ongoing HIV-1 transmission among men who have sex with men in Amsterdam: a 25-year prospective cohort study. Aids 25: 493–501 10.1097/QAD.0b013e328342fbe9 [doi].


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White Denim | "I Start To Run" Video (Version #2)
Sure White Denim already made a video for their first single, "I Start To Run" off their off their most recent album Fits, but who says you can't make a second? This time instead of being shot in the desert, it was recorded at the Austin City Limits studios. The album has been on repeat as of late, we recommend picking yourself up a copy.
Also, not sure if you've already heard but White Denim, Hockey, and Phoenix will be performing at this year's 101X Xmas party on Dec. 17th at La Zona Rosa. Tickets go onsale this Sat. at 10am, purchase them here.

subset: commoncrawl


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Do your internal customers view you as a long-term partner? It's an important question because your ability to gain their trust, and build rapport with people may decide your success as an IT professional.
Think about it for a moment: if you have a major decision to make in your life –personal or professional – what are the characteristics that you would like to see in the person you engage with for advice?
Of course, you want them to have the expertise required, but don't you also need someone who takes the time to understand your wishes, concerns, goals, and desired outcomes?
This is what a true consultant does; they employ the skills necessary to build trusted partnerships.
In fact, everyone in the IT organisation from the CIO down to entry-level staff can expand their level of influence by being a consultant, someone who has no direct authority or power over the people he or she works with but who instead uses influence to guide their decisions and actions.
People want to see consultants who are enthusiastic, accessible, responsive, and have confidence in their own abilities without being arrogant. Consultants also need to have knowledge of their customer's business and a willingness to learn more.
When looking at these characteristics how would you score yourself and your team? If I asked your customers, how would they score you and your team? Would the scores match?
A business exec at one of my organisation's major clients announced to a new group of employees: "I get really nervous when someone from IT comes in and says, 'I have a great idea' because I get the feeling they're probably excited about some new technology advancement.
"But when they come in and say they have an idea on how we can accomplish some business goal or objective, I'm all ears. I need people who are committed to helping me drive the business goals, not the latest and greatest technology."
So how do you develop these characteristics? Here's my top ten tips for evolving into the role of a consultant.
10. Stop making assumptions
Consultants take the time to truly listen, without jumping to conclusions. Pay attention to what the client has to say before you assume you know what is going on. Ensure the client feels heard and understood.
9. If you call a meeting, make it a good one
Have a clear communicated purpose, agenda and intention. Unproductive meetings are motivation and morale killers.
8. Bring enthusiasm
Don't wait for others to be enthusiastic; you bring the enthusiasm and it will become contagious.
7. Ask good questions
Ask questions to uncover the issue; don't rush in with a fix too soon.
6. Be diplomatic
Learn to be respectful even if you disagree. No one likes to be made to feel wrong.
5. Target your message to your audience
Speak to their level of expertise and in their language. Avoid appearing arrogant and condescending.
4. Talk about what you can do
People want assistance in solving problems; they don't want reasons, justifications or excuses. Focus on finding solutions to problems and stop talking about what you can't do. This is a sure-fire way to close down a conversation.
3. Build trust
When they're making technology decisions, your customers need to work with someone they trust – a partner who will help them reach their desired outcomes. It takes time to build and can be lost in a moment. If trust breaks down, don't ignore it. Ask the client what they need to rebuild it.
2. Educate
Lead through teaching. Educate your clients to be better consumers. The more you teach them, the more their confidence in you will increase.
1. Get in their world first
Avoid taking the position of "being right"; understand their perspective first.
Like a good financial planner, doctor or contractor, the IT professional needs to become that kind of partner – someone with the required expertise and also the ability to apply it in a way that makes them an invaluable asset to the business.
IT is such a large part of what makes modern organisations tick, so you really have no other choice but to develop the business acumen and human interaction skills that will make you a trusted partner.
Lou Markstrom is the co-author of "Unleashing The Power of IT: Bringing People, Business, and Technology Together", published by Wiley as part of its CIO series. He is also a professional development specialist at DDLS.
Join the CIO Australia group on LinkedIn. The group is open to CIOs, IT Directors, COOs, CTOs and senior IT managers.


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Havok® Dublin
Havok Dublin is the company headquarters, and is located centrally off Grafton Street in Dublin City Centre. Here, the development team works on award winning products such as Havok Physics, Havok Destruction, Havok Cloth and Havok Script. Havok's Developer Relations team collaborates closely with our partners in European studios such as Guerrilla Games, Rare and Creative Assembly. Dublin is also home to our HR, Finance, and IT teams.
Our team is multicultural, with many different nationalities represented and made up of some of the very best developers in the industry, including many of the original founding members of Havok. We work in small teams in a relaxed but challenging environment, gaining access to the very latest cutting edge hardware. Our office is a modern, high-spec, open plan building located in the heart of Ireland's capital city. It is surrounded by popular destinations such as the main shopping area in Grafton Street, restaurants & bars in Temple Bar, and the culture and history of medieval architecture, historical museums, modern art and Trinity College. It is served by all major transport routes into the city including LUAS (Tram), DART (Rail) and Dublin Bus.


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Book with confidence! Magnolia House is one of Napa's only 41 legal whole~home, non-hosted Vacation Rentals (since 2008). City of Napa Vacation Rental Permit # VR09-0015; City of Napa Business License #26780.
Situated on a quiet tree-lined street in Downtown Napa, is Magnolia House, your home-away-from-home in the heart of the beautiful Napa Valley! Magnolia House guests enjoy the convenience of being a 2-block walk to the Napa Riverwalk Shopping and Dining District. The home is an 1890 Victorian farmhouse that has been tastefully restored and updated to feature today's modern conveniences, and has been well-stocked and equipped to provide our traveling guests with everything they would need to make it the perfect home base while they explore all that Wine Country has to offer!
Enjoy being steps away from 5-star dining, live music, wine bars, shopping, and galleries. The Oxbow Market is also a short walk from Magnolia House as is the new Napa River Trail on the east side of the river, southbound, which will bring you to the new Cinemark Movie Theatre Complex, Velo Bike Rental, Forge Pizza, In-Shape Gym, and the Farmer's Market on Saturdays. The corner grocer is only a block away from Magnolia House where you will find some of the finest meats and poultry in Napa, then return to bbq in Magnolia House's welcoming, spacious back garden. A short morning stroll will bring you to Sweetie Pies--a local favorite--for morning coffee, scrumptious quiche and baked goods, then head back to the charming front porch of Magnolia House to enjoy a good book, good friends and plan your activities for your day in the wine country. Just blocks away from the house, you'll discover world class dining: some Napa favorites are Morimoto's, Angele, Cole's Chop House, Basalt, Celadon, Allegria's, Napkins, ZuZus. (Dining and winery maps and guides are provided at the house and the Napa Visitor's Center is 3 blocks away on Main Street.) When staying at Magnolia House, all that Napa Valley has to offer are easily within your reach. Wineries are a 10 minute drive from the house in any direction, and San Francisco and the Bay Area are one hour to the south.
Owned and operated by a local Napa fine artist and wine label illustrator, Magnolia House sleeps up to seven adult guests and 2 children in beds and consists of a ground floor queen bedroom suite with a spacious, light~filled bathroom featuring a tub/shower combo. Also, there is a downstairs half bath and washer/dryer with detergent provided. Upstairs features two charming bedrooms (one furnished with a pillow top queen bed, the other features a pillow top full-size bed and a twin daybed) which share a hall bath with shower (baths furnished with hair dryers and plenty of extra towels). We furnish Magnolia House with high thread-count sheets, comfy faux down pillows, and fresh towels, as well as bath sheets for out guests using the spa, and all of the paper goods and detergents you would expect to have in your own home--toilet paper, paper towels, napkins, soaps and shampoos, etc. During your stay, you'll enjoy free wifi, a new 43"' flat screen cable TV with a DVD library, central A/C and ceiling fans throughout, a comfortable living area, wood~burning fireplace, spacious indoor dining for 8, a fully-equipped cherrywood kitchen featuring all stainless appliances, granite countertops, and gas range. The kitchen is well stocked with everything one might need to cook including most condiments, spices, coffee supplies, as well as some staple food items. Magnolia House offers off-street parking for up to 4 cars in its generous driveway. The backyard features lawns, deck and paved areas with tables and chair and lounge seating, bbq, fire pit, a corn hole bean bag game, and a hot tub that seats up to 6.
Magnolia House is close to easy access to Highway 29 and the Silverado Trail, home of the finest wineries in the world. Drive time: 5 minutes to Carneros Region wineries (southwest Napa) and 5 minutes to Napa wineries off Silverado Trail, 20 minutes to Sonoma Square, 15 minutes to Yountville, 25 minutes to St. Helena, 40 minutes to Calistoga. For the family with fun on its mind, the local playground is 5 blocks away at historic Fuller Park and Six Flags amusement park is 20 minutes south. It's a 55 minute drive to San Francisco, 55 minutes to Oakland International Airport, and 75 minutes to San Francisco International Airport.
To enhance your wine country experience, upon request, we are happy to supply our guests with concierge links on local activities and services such as wine tours and day spas, in advance of your visit to the Napa Valley.
**In Napa, rent ONLY from legally permitted City vacation rentals to ensure your reservation will be honored and available when you arrive.**


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When someone is staring at me with their head cocked like a confused dog with their eyes glazing over, it is then realized that I may have let some misc. babble slip from my brain, & out through my mouth.
Tuesday, September 20, 2011
Using Keyword Bubble
In the year 2012, I hope that supernatural abilities evolve for anyone who uses adsense. The wrong advice given in the opportune moment can be amazing! When given bad advice by a group of assweeds, you find yourself with your brain shrunken just a bit, and babble dribbles out of your face like a fountain. When encountered with this sort of bad luck, bikes are out of the question since you may be killed.
If you tend to block reality, blogging may very well be the answer to all of the aforementioned issues. Instead of staring at your walls like a bobble head, try books! Or, you may feast your brain on this kind of BS. If you want to change your life, fashion a complaint of some sort, and get in the game!
Are you the type that finds conspiracy in everything you see? Well, you're probably crazy. But rejoice because they make a cream for that and can be found in any region at your local Walmart! That's right! For a measly 50 credits, definition of such a condition can be changed to fit your needs.
Side effects are violent deja vu episodes of becoming a Disney character. Driving is not recommended while using this miracle, because it tends to make you evil. If you fancy the falling game, this also may be a side effect that will lead down the trail of the goofy.
If you choose to research this miracle cure via Google, you may run into some undesirables. You may bump into someone who decides to call you a hairliphammerjackcolon, but use kid gloves with such a person, as hangnails tend to mess with a people's heads. Do not use the high beams on the way to Walmart, you may stir the hornets.
A sense of humor should never be used while eating ice icecream, because it may distract and kill joggers. Jogging can be very dangerous, and in life, you should be creating a list of these dangers that come with exercise. If you keep it in your lunchbox, money pours out of your thermos like water from a fall, from there your ready for the movies! Political music is harmful to listen to while exercising, as the nerves begin to exit the nervous system.
Another note... Bad news over an online job creates too mush pain for paranormal people. If you are powerful, a prediction from a psychic may cause you to hide from the public. So be sure to leave a quarter as a tip. Quitter Socks are ill advised while dealing with that medium, and may cause him to rant over his sandwich.
If you search online for a story, teeth begin to grow in the heads of terrorists giving them thoughts of eating food. This time, the toothache is all theirs, and may cause traffic in the space between their ears which may prevent them from being able to travel.
If you feel like being alongside trees, try taking a trek through the woods. While trekking, Don't be wacky and walk weird like an idiot. Use words that writers would be proud of when not suffering from writers block If you follow all the instruction given on this post, you will deserve to be committed to the nearest psychiatric, mental facility.
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How many of you stayed up and watched the special episode after the Super Bowl! (I'm the obnoxious one in the front row raising her hand a bit too vigorously...)
I thought it was great. My favorite line was the last one, "But I call her Amanda" or something of the sort. I didn't see it coming! Now I'm really tickled, because the Knight pointed out that tomorrow night, we get another new episode. Goody, goody.
Maybe THIS time, I won't be grumbling while I re-knit the two days of knitting I'd had to frog because I can't read a pattern. Sigh.
See the upper right corner, with the rolling under stockinette? Yeah, I know. I've certainly been knitting long enough to know that stockinette requires a couple of garter stitches on the side to hold it down. Duh?? I changed needles too. I switched up to my #8 Bryspuns, and all in all, I'm much happier, aside from the fact that I'd done about a quarter of the thing before I realized the problem! At least I have another night of House to knit through...


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Here is a Link also detailing Jesus teaching the Rapture
- Jesus taught the Rapture
The biblical account of what is happening today is the truth, you are willing to search down as many other routes as you like i only ask is you deeply research the Bible! (King James Version 1611 to be exact). This Blog's purpose is to save people to the Lord Jesus Christ who is our only chance at heaven and also educate warn and prepare people for the great times of tribulation we have ahead, Please look through our blogs, share.
(John, can I have your opinion of the following? It was seen on the web. God bless.)
How can the "rapture" be "imminent"? Acts 3:21 says that Jesus "must" stay in heaven (He's now there with the Father) "until the times of restitution of all things" which includes, says Scofield, "the restoration of the theocracy under David's Son" which obviously can't begin before or during Antichrist's reign. ("The Rapture Question," by the long time No. 1 pretrib authority John Walvoord, didn't dare to even list, in its scripture index, the too-hot-to-handle Acts 3:21!) Since Jesus can't even leave heaven before the tribulation ends (Acts 2:34,35 echo this), the rapture therefore can't take place before the end of the trib! (The same Acts verses were also too hot for John Darby - the so-called "father of dispensationalism" - to list in the scripture index in his "Letters"!)
Paul explains the "times and the seasons" (I Thess. 5:1) of the catching up (I Thess. 4:17) as the "day of the Lord" (5:2) which FOLLOWS the posttrib sun/moon darkening (Matt. 24:29; Acts 2:20) WHEN "sudden destruction" (5:3) of the wicked occurs! The "rest" for "all them that believe" is tied to such destruction in II Thess. 1:6-10! (If the wicked are destroyed before or during the trib, who'd be left alive to serve the Antichrist?) Paul also ties the change-into-immortality "rapture" (I Cor. 15:52) to the posttrib end of "death" (15:54). (Will death be ended before or during the trib? Of course not! And vs. 54 is also tied to Isa. 25:8 which is Israel's posttrib resurrection!)
Many are unaware that before 1830 all Christians had always viewed I Thess. 4's "catching up" as an integral part of the final second coming to earth. In 1830 this "rapture" was stretched forward and turned into a separate coming of Christ. To further strengthen their novel view, which the mass of evangelical scholars rejected throughout the 1800s, pretrib teachers in the early 1900s began to stretch forward the "day of the Lord" (what Darby and Scofield never dared to do) and hook it up with their already-stretched-forward "rapture." Many leading evangelical scholars still weren't convinced of pretrib, so pretrib teachers then began teaching that the "falling away" of II Thess. 2:3 is really a pretrib rapture (the same as saying that the "rapture" in 2:3 must happen before the "rapture" ["gathering"] in 2:1 can happen – the height of desperation!).
Other Google articles on the 182-year-old pretrib rapture view include "Pretrib Rapture Politics," "Pretrib Rapture Scholar Wannabes," "Famous Rapture Watchers," "Pretrib Rapture Diehards," "X-Raying Margaret," "Edward Irving is Unnerving," "Thomas Ice (Bloopers)," "Walvoord Melts Ice," "Wily Jeffrey," "The Rapture Index (Mad Theology)," "America's Pretrib Rapture Traffickers," "Roots of (Warlike) Christian Zionism," "Scholars Weigh My Research," "Pretrib Hypocrisy," "Appendix F: Thou Shalt Not Steal," "Thieves' Marketing," "Pretrib Rapture Secrecy," "Deceiving and Being Deceived," "Pretrib Rapture Dishonesty," and "Christ's return is NOT imminent!" – all by the author of the bestselling book "The Rapture Plot" (see Armageddon Books).
what do you thinkof this video???
I watched the video brother, the maker of the video has a misunderstanding on the time line of events, he is getting mixed up with the second coming and Jesus returning to the earth, and the twinkling of an eye gathering spoken of in 1st Thessalonians, its really simply a misunderstanding its hard to explain to people who will close their minds off, but these teachings really showed me i was wrong when i did not believe in pre tribulation rapture... this post was posted right when i started believing it lol
God bless brother pray to God for wisdom understanding and knowledge in all things!!
"If any of you lack wisdom, let him ask of God, that giveth to all men liberally, and upbraideth not; and it shall be given him." - James 1:5
Your claims of a pretrib rapture are nothing short of Christ predicting the fall of Jerusalem and the destruction of the temple in A.D.70
Matthew 24, Luke 21,& Mark 13 Jesus is talking to a first century audience here and is quite clearly referring to those disciples who asked him what would be the sign of his coming and the end of the world translated -(age).
This is referred to in the epistles of Paul & Peter as the day of the Lord.
The day of the Lord would come as the predicted judgement on Israel.
This was not to be a physical coming by Christ himself but a judgement sent from heaven while at the right hand of the father. Read Matthew 24:29-36 this is referring to old testament type of imagery. Christ was quoting the old testament scriptures! Example:The Lord came down to Egypt on a cloud in a form of his judgment. (Isaiah 19:1 (KJV) The burden of Egypt. Behold, the LORD rideth upon a swift cloud, and shall come into Egypt: and the idols of Egypt shall be moved at his presence, and the heart of Egypt shall melt in the midst of it. Did God himself literally come down? (Isaiah 13:10 (KJV) For the stars of heaven and the constellations thereof shall not give their light: the sun shall be darkened in his going forth, and the moon shall not cause her light to shine. This is just a couple of many examples
So Matthew: 24, Luke :21, & Mark :13 cannot and do not apply to a 21st century people. Go back and see Matthew :23:30 -36 (the term generation) is referring to that generation and no other at the time! Read the entries chapter in its context. There is absolutely no where in the scriptures that a pretrib rapture is mentioned at all. 1 Corinthians 15:52 is speaking on the resurrection. When you read all 1 Corinthians chapter 15 it is clear that Paul was correcting and teaching on the resurrection. (1 thessalonians 4:16-17) does not say anything about a pretrib rapture at all it is stating that the dead in Christ would rise first! This clearly takes place at the resurrection and is the resurrection and those who are alive at the time will be caught up simeatainiosy and is in perfect harmony with 1 Corinthians 15. This is just some scriptural truth to a false oral tradition that I too once was fooled by from the modern teachers of our day until I saught the Lord and searched for my self. We should never ever let anyone get in between us and a bible ever.
If we were all honest with ourselves and one another we would recognize that as soon as one becomes a child of God these churches and bible teachers already have a curriculum for you to follow! I wrote because I care! Pray ask God, Lord what if I am wrong about everything I was taught and believe! This is what I did and is my prayer for all the Lord's chosen. G.M.
We also must keep in mind that very few if any churches- congregation- translated-(ekklesia ek-klay-see) teach how to interpret scripture! Example: if you were taking a course to study litture you would most certainly be taught how to interpret Shakespeare. How much more is scripture a course for our lives! We Must let the Bible interpret the Bible!Delete
Get your story straight he said he believes the dinosaurs died at the flood from the bible he said it's the scientists are the ones say 65 million years he was being sarcastic to them when he acts like he is agreeing with them he also prays on screen to Jesus Christ our lord and savior that's not something the illuminati would doReplyDelete
And furthermore why is he the only one talking bout there agendas and trying to wake the people up and not let the nwo and illuminati take over and furthermore he has been threatened with his life and was beaten up in the 90's for exposing them again do your research because I am a man of God I do mine be for opening my mouthReplyDelete


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31 comments
Condolences to the family. So glad they found him.Theres far to many missing persons in HUMBOLDT!! I still hope and pray for those souls not found yet to be next to be discovered!🕊
Those things are dangerous. Almost died once myself. Sorry for the loss.
Them quads be dangerous. Hicks learn their lessons the hard way. Britney Spears niece nearly got killed 'cause her hick parents wanted her to look kewl.
Parenting is a bitch. Bytches shouldn't be parents.
You are ignorant and unkind. Guess you were describing yourself there.
You're a special kind of stupid aren't you?!
she did not die. Johnny Reb, you're too ignorant & foul to be taken seriously.
Was this the fatality reported at Briceland and Seeley Creek?
My sympathies to those who had such a sad conclusion to their efforts to locate him.
Hmmmm reminds me of a past swithenbank situation up AP way a few years bk, there was also a four wheeler involved .
Less paper work if it's declared a accident……
Am guessing that it's not quads that are so "dangerous", but rather the people riding them at high speeds, losing control. 3-Wheelers, on the other hand, are dangerous by design.
Whatever the cause, my his family and friends find peace, and maybe some lessons learned, from his tragic death.
Wow! Keep your two cents next time if all you can do is lecture the dead on how they died. Apparently, you're that one know it all that nobody likes and who doesn't actually know it all!
Sorry you were displeased with my comment 'M'.
I notice that on RHBB (LoCO, etc) comments tend to shoot off in their own direction, often away from the original story. So, knowing that is common, I was responding to a related, and I think worthwhile 'conversation' thread about quad-type vehicles. Earlier someone had said 'quads are dangerous'. I suggested they are not dangerous, and went on to site that similar vehicles are dangerous (thus, maybe there is some confusion). I also made it a point to give difference to the tragic death in the story all our comments followed.
BTW. Not sure how a person can "lecture the dead on how they died". I do know that calling some attention to tragedies can, with some sensitivity, help prevent other such needless deaths.
Oh. And. Are you a Troll???
I agree wholeheartedly with you Ben. In the wake of a tragedy sometimes the harsh realities need to be looked at. Maybe the family/friends/loved ones of this man will find something positive, maybe the young children in this family will always wear a helmet while on a quad because of this. I appreciate that you did not place blame on the victim or jump to conclusions, because none of us know what lead to this accident. Lots of things could have lead up to this. AND you make an excellent point… 3 wheelers are inherently dangerous, quads are not nearly as dangerous when ridden in a responsible manner!
M – I would guess by your defensive response that you knew the victim, (yes this is just my assumption so if its wrong I apologize). If that is the case, I am sorry for your loss. Losing someone in an accident is so difficult, no warning, just one day life is normal and the next day it has changed completely. Prayers to this mans family.
What a crazy story. Condolences to his family and friends.
So sorry for the rider and the family…very sad situation.
To all you people that think it is appropriate to make rude comments …what if this was your loved one? Shame on you!
you gotta be super careful with ATVs. people think, oh ive got 4 wheels im safe. NOT! i have had a very close experience with death after flipping an atv, and i lost my cousin to an atv accident.
My condolances to the family, i know your pain
My condolences to his loved ones. I hope he's the type who've left smiles on faces with his "Wow! What a ride!"
RIP my good friend. U were the best. I still have ur furniture. Thank u. Dave u will b greatly missed.


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Nas walks the line. Between gangsta-leaning and Godfearing, between lustful and romantic, between the poetic and the scatological. He has starred in a movie (director Hype Williams' Belly), performed high-profile duets (with Mary J. Blige and Lauryn Hill), and dodged death (when his friend and fellow New Yorker Biggie Smalls was shot and killed in 1997, Nas went into virtual seclusion, fearing for his life). He's proud but not bombastic, he's casual in tone but almost always serious in content, and although his raps are deeply personal, he strives for the prophetic. He's a craftsman of words; he wants to tell...
Music: Staying Cool Under Fire
Rapper Nas smartly documents his mad world
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Virgin Trains charity to benefit from Thunderbird nameplate sale
Virgin Trains supported charity CLIC Sargent will benefit from the sale of 12 sets of 'Thunderbird'-themed nameplates following its withdrawal of six Class 57 locomotives from service..
CLIC Sargent, the UK's leading cancer charity for children and young people, is Virgin Trains' supported charity. The partnership has raised more than £310,000 since 2009 and Virgin Trains is continuing to support CLIC Sargent until 2012.
The nameplates will be sold at a specialist railwayana auction in Derby on 10 December 2011 by Sheffield Railwayana Auctions Limited.
The locomotives involved are:
57301 Scott Tracy
57303 Alan Tracy
57305 John Tracy
57306 Jeff Tracy
57310 Kyrano
57312 The Hood
Network Rail is looking to take over the six Class 57 locomotives for specialist seasonal duties south of the River Thames. The locomotives have previously been part of Virgin Trains' 16-Stong Class 57/3 fleet, but are no longer required by the West Coast train operator.
The six locomotives were specially lined up for inspection by Simon Whitehorn, Network Rail's LNW South Area General Manager and Virgin Trains' Production Director Phil Bearpark at Alstom's Wembley depot on 22 August 2011. Their main role at Network Rail will be to provide traction for six new carriages which are being specially built to clear snow and ice from the tracks in the south east, however, they will also undertake a range of other duties as required.
The Class 57s were required when the Pendolino trains entered service with Virgin Trains in 2002. Their primary role was as a strategic rescue fleet, hence the 'Thunderbird', 'International Rescue' naming theme. The first locomotive was officially named by Thunderbirds creator Gerry Anderson at London's Euston station on 17 June 2002.
At the unveiling of the first locomotive, 57301 named after Thunderbird 1 pilot Scott Tracy in June 2002, Gerry Anderson said: "The Tracy boys are delighted to hear that the Virgin Trains rescue vehicles are to be named after them. They said that it is a great honour. Brains, who has had a great deal of experience in maintaining rescue vehicles, has offered to help the Virgin engineers and crews in any way he can. I consider it to be a great honour too and I wish them good luck with their rescues. F A B."
Following the transfer of more Super Voyager trains to the West Coast route in 2007 eliminating daily haulage of Pendolino trains into North Wales, Virgin Trains reduced its requirement for rescue locomotives and placed a number of its Class 57 locomotives into store.
Virgin Trains Production Director Phil Bearpark said: "We are delighted to be able to support Network Rail's plans to improve its contingency planning this Winter. We no longer need these locomotives, but recognise the role that they will be able to play elsewhere on the railway network. I would also like to thank staff at Alstom, who have maintained these locomotives and also the depot staff at Wembley depot for their support in staging the handover of the locomotives."
Simon Whitehorn, Area General Manager, Network Rail said: In the last three years, Britain has experienced particularly harsh winter weather causing significant disruption, particularly in the south east. As performance has improved on the West Coast Main Line, we intend to take on these vital resources to be used elsewhere on the network. We anticipate the six locomotives will become a vital part of our winter weather plans which we hope will add much needed resilience to the third-rail powered network and allow passengers to make their journeys with minimal disruption."
Also in Europe today, City.Mobi is celebrating the success of its new guide to London.
City.Mobi offers the most comprehensive mobile travel guides available, with over 800 cities in 200 countries listed. Each is developed by the City.Mobi team to combine into a single global travel directory.
However, each city retains its own mobile identity via a dedicated domain. Already on offer are Brussels.Mobi, Paris.Mobi, Sanfrancisco.Mobi and Sydney.Mobi.
London.Mobi is the latest in this illustrious line up, offering click to call functionality – which means no scribbling down telephone numbers.
Most entries are also linked to websites where users can quickly access more detailed information if needed.
Other key features include information on accommodation, restaurants, attractions, entertainment, nightlife, shopping, and transport.
City.Mobi guides include user reviews and traveller utilities such as a translation guide, currency converter, news and local weather guide.


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Hi everyone. If this post is in the wrong forum, please forgive me as this is my first post here. I am after some info on the above regarding using bio. I have been making bio for over 10 years and my hilux has done over 350,00 on it without any problems. I use minimal methanol, hence it has never passed a 27/3 test.I have just purchased a 2006 Terrcan. Its a common rail , turbo diesel.Other than making my bio better so it can pass the 27/3 test , are there any mods that need to be done to the mechanics of the car, ie, change fuel lines or seals in the fuel pump?..etc, etc.
Cheers Terracan
Hi Terrican,
Your name has lately caught my attention here.
I have always thought the Terracan was a nice looking vehicle and have often wondered how it would go on biodiesel.
I doubt that Terricans, diesel or otherwise, have been sold into the USA
That is correct.
On other vehicles, my experience with common rail and unit injectors is positive -- quality biodiesel seems to work just fine. The issues generally will be with material compatibility, such as hoses and seals made from various rubbers, plastics, Viton, and other compounds. Some will be fine indefinitely, some work for a while and then weep or fail, and some don't last at all. I don't know anything about your particular vehicle so I can't be any more specific.
Whatever you do, I would focus on getting the quality of my fuel up to the highest practical standard. Once or twice I had my homemade biodiesel tested by gas chromatograph, and to memory it passed all the ASTM specs for biodiesel. Obviously it is impractical (or at least unnecessarily expensive) to test every batch that way, and I have always confirmed that my homemade fuel passed the very basic and simple 3/27 test. Over a period of years that fuel has powered my various vehicles more than 100,000 total miles without a fuel-related failure.
EDIT: I don't know anything about regulations wherever you live. Also do your research about the exhaust system on the vehicle -- for example, whether it has a diesel particulate filter (DPF), and how it is purged (dedicated injector or in-cylinder post-injection). These can be important issues, and in some cases have led to crankcase lube oil dilution, etc.
Cheers, JohnThis message has been edited. Last edited by: dukegrad98,
Thanks for the replies. The car does have all the emissions stuff on it, so I will do the research and find out all I can.Thanks again.
Cheers Terracan.
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Tanner was the first black American painter to gain international acclaim.
He moved to Paris in 1891 to study, and decided to stay there, being readily accepted in French artistic circles. His painting entitled Daniel in the Lions Den was accepted into the1896 Salon. He married Jessie Olsson, a white Swedish-American opera singer. The son of a Minister, in his later years his subjects were Biblical. I chose "Fishermen at Sea".
Luke 8: 23 - 25 But as they sailed he fell asleep: and there came down a storm of wind on the lake; and they were filled with water, and were in jeopardy. And they came to him, and awoke him, saying, Master, master, we perish. Then he arose, and rebuked the wind and the raging of the water: and they ceased, and there was a calm. And he said unto them, Where is your faith? And they being afraid wondered, saying one to another, What manner of man is this! for he commandeth even the winds and water, and they obey him.
No matter what storms come our way we can have Jesus still our heart while we go through them.


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Dusan Sakota and Nondas Papantoniou said that AEK have the potential to win the gameday 5 match against Neptunas for Eurocup.
Coach Sakota said: "The game against Neptunas is really important for our team. We are expecting a tough game. If we play our game we will increase our percentage of winning."
On the other hand, Nondas Panantoniou said: "It is going to be a difficult game. We know that they are tough at home. We will try to play our game".
Αν σου άρεσε κάνε


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Secunia has announced an alert for five Mac OS X vulnerabilities uncovered by Tom Ferris, who runs the Security-Protocols Web site. The weaknesses could enable an outsider to launch a denial of service attack and compromise a useris computer, according to Secunia.
The issues include errors in Safari when handling malformed HTML tags and malformed GIF images and a problem when decompressing malformed ZIP archives through the Finder. In addition, an issue exists with processing malformed BMP images in Safari or Preview, and errors exist in two functions for handling malformed TIFF images in Preview, Finder, QuickTime, or Safari.
Users are advised to not visit untrustworthy Web sites and to avoid opening images and ZIP archives from unknown sources. Secunia noted that these issues appear in Mac OS X v10.4.6 and that "other versions may also be affected."


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So your back for day two!! I hope you enjoyed all the projects yesterday, I know I did!! So many talented ladies on this hop. If you are here from Vicki's blog then you are ready to roll with me. If not then start back at the beginning with Debbie
For my day two project I made a chipboard mini album. I love MINI's . Things are so cute when they are in a small version. I took square chipboard pieces and covered them with paper, put some matting for photos on the pages and added a little embellishment. I could not add to much embellishments because of the size, I wanted to make sure there was enough space for a photo. That's the most important part. RIGHT...
So here are a couple of pics to show the project. Hope you like.
Ok now you are off to see what Crazyabout Cricut has for you today. And remember, leave a comment to be eligible for the blog candy on Debbie's blog. And If you are not a follower of mine, I would love for you to be one. I will be giving away a little blog candy as well. Come back for day 3 and see what it is!!!


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By George Ziemann 9/01/03
Having become totally disgusted with the music business, I'm about to go offline forever and pursue a more noble career, like flipping burgers at McDonalds or becoming a mental patient in a padded cell. But I've been asked to write one last article.
The iRiver iFP-195T is a 512MB Flash unit and is available on Amazon
I've seen the ridiculous explanation the national media has bought into hook, line and sinker describing the RIAA's "ingenious" and "surprisingly technical" approach to identifying how to tell the difference between mp3 files which were obtained from legally purchased CDs and those which came from "pirated" sources.
The RIAA's explanation of how they've made their technical deduction is exactly
the same sort of misdirection that's apparently fooled the entire country.
I've watched on the pages of even Boycott-riaa, which I thought comprised humans with a speck of intelligence, as they ponder the technical wherewithal and mystery surrounding the RIAA's brilliant masterpiece, which allows them to trace the origin of a file back to the time of Napster, using this as their "evidence" of wrongdoing.
To put it bluntly: How stupid are you all?
The fact there's post after post of concern and worry over this magical technological marvel, concocted by one of the world's most technologically inept organizations, led only in their ignorance by the US Congress and the US Copyright Office, makes me certain that the RIAA will win this battle because no one has asked the incredibly obvious question.
In all the news articles, television reports, comments and posts, not one of you has asked this magic question. You have all bought into this misdirection like trout going for bait. You have given the word of known liars more credence than you would give a streetcorner magician.
Let me run the important phrase of a previous story past you - "By comparing the fingerprints of music files on a person's computer against its library, the RIAA believes it can determine in some cases whether someone recorded a song from a legally purchased CD or downloaded it from someone else over the Internet."
Although this lie has already propagated to such lengths that it will now be impossible to convince anyone of the truth, allow me to explain how everyone has been baffled by this bullshit.
Since a digital copy of an mp3 is not a perfect copy of a CD track, as the industry has led so many to believe, once it's been created and placed on the Internet, each recurring copy of this file WILL be an exact duplicate of the original mp3. If this were not true, the RIAA's statement would fall apart at this point in the logic. If it were altered in any way, this entire wild theory about hashes and digital fingerprints would be quickly proven false.
While you've blindly accepted this theory, no one has raised the issue of where that original mp3 came from.
I don't want to be overly technical here, but ask yourself this: If the mp3 was not created from a legally purchased CD, where the hell DID it come from?
What can the origin of an mp3 file be if no one possessed the physical CD? Magic? It just appeared on their computer one day? They hacked into the recording studio's computer? Broke into the studio in the dead of night and stole the master recordings?
If an mp3 was not created from a legally purchased CD, then there's only one other possible source - the record label itself, if not the artist.
Oh wait, there's another possibility.
If the song is out of print, and NOT available on CD, it may have come from a legally purchased vinyl album. With more thought, myriad possibilities come to mind, none of which point to the consumer as the guilty party. Were they recorded off the radio? If so, the Home Recording Act comes into play.
Do the $4 billion a year in free promotional copies have different digital fingerprints that the legal CDs? Can you tell a shoplifted CD from one which was legally purchased?
Unless the recording industry itself is responsible for creating mp3s from the master recordings and distributing them over the Internet, ALL mp3s MUST, by definition have come from purchased CDs. To entertain any other definition is blind ignorance. There is no magic. Just more lies and deceit.
And everyone fell for it - again.
You've been arguing everything over the past week since this announcement except the obvious.
Has the lowest common denominator really fallen faster that the recording industry's sales?
It would appear so.
The 128MB Philips PSA MP3 player for the gym is available on Amazon
Other MP3 stories:
Copy Protection and the Reasonable Man
Review: Neuros MP3 Digital Audio Computer


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YSL Residences Condo VVIP Register,pls call:416-826-0168
This is a new condo development by Cresford currently in pre construction at 385 Yonge Street.
ABOUT THIS PROJECT:YSL Residences is a new mixed-use of office, retail and residential development. It is a proposed towers of 98 storeys with 1,106 dwelling units designed by Quadrangle Architects Inc. There will be approximately 100,000 square feet of retail space within the first three floors and 186,000 square feet of office use space from the fourth floor to the ninth floor proposed. There are also 1,106 residential units proposed starting on the 10th and 11th floors of the podium that will consist of 26 two-storey townhomes with terraces situated above the podium floors and in the two residential towers of 62 and 73 storeys in height. Of the 1,106 units, 107 are bachelor units, 648 are 1-bedroom units, 241 are 2-bedroom units and 110 are 3-bedroom units. YSL Condos are connected at the 51st and 52nd storeys. This is where the proposed two-storey amenity sky-bridge to link the two buildings at 580 feet is located that gives "access to the rooftop amenity on the taller of the two towers to create a vibrant and active zone on the skyline". There is 2,212 square metres of indoor amenity space and 910 square metres of outdoor amenity space. There are also 6 levels of proposed below grade space for 289 parking spots of which 221 are for the residents of the building, 23 for visitors and 45 for non-residential. There are also 1,231 bicycle spaces,The primary entrance for the north tower would be from Gerrard Street East and the primary entrance for the south tower would be from Yonge Street. YSL CONDOS Highlights: -Walkscore of 99/100 -World-class public transportation -2 Top universities (U of T & Ryerson) are withing a 5-10 minute walk -Five Canada's top hospitals are within 1 km -Surrounded by office building,shopping mall and entertainment area.-Nearby parks include Alexander Street Parkette, Joseph Sheard Parkette and College Park FOR MORE INFORMATION ABOUT THIS PROJECT, AND TO GET FLOOR PLANS & VIP PRICING, CONTACT ME:416-826-0168!
Register with BELLE LAN now for Platinum VIP Access to Hundreds of Hot New Condos Development Projects in GTA!
Belle Lan
Direct: 416-826-0168
Bus: 905-940-3428
E-mail: firstname.lastname@example.com
Frank Zhao
Sales Representative
Direct: 416-823-6866
We Chat: bellelan
We Chat: frankzhao123
*We do not represent the builders.
Century 21 King's Quay Real Estate Inc., Brokerage, Independently Owned & Operated


text: Tate and Forrest Bareback | Video Preview >>> Visit Sean Cody <<< Tate and Forrest Bareback | Photo Set >>> Visit Sean Cody For The Full Scene <<< Follow Tate and Forrest Bareback | Sean Cody It's the holidays and these two wanted to do something a little more fun than just a quick interview. Surprisingly it was the quiet Tate that suggested an idea. "Lets do something to get in the holiday spirit, you know, really bring some damn holiday cheer to SeanCody. So we packed up the car and went off to buy the fixings to make some gingerbread houses. "I have a feeling this is going to get messy!" Forrest laughed. It was fun watching these two attempt to make some holiday décor. Lets just say they are much better at fucking. When it came time to get down to business, Forrest and Tate hit it out of the park and really nailed a great film. 0 Average User Rating 0 votes Rate This Item Your Rating: 0 Submit Porn Studio:Sean CodyPorn Models:Forrest (Sean Cody), Tate (Sean Cody)Porn Genres:Anal Sex, Bareback, BlowJob, Rimming, Studs Spread the Love, Share Us!


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Re-write and publish a page in Wikipedia
Ngân sách €30-250 EUR
My client's page on Wikipedia was deleted for being too promotional. I need someone to help me re-write the article (the original article is approx. 650 words) and, very important, publish it back in Wikipedia. Only some Wikipedia editors have the power to publish my client's page back on Wikipedia. Please make a bid if you are able to complete the whole work (re-writing and publishing).
Được trao cho:
Hi, I am aware of all rules and regulations of Wikipedia and posted many biographies and articles. I can help you with this. Reply to see my work examples. I'll guide you step by step.
30 freelancer đang chào giá trung bình €99 cho công việc này
Hi Thanks for posting the project! My bid is for re-writing and publishing the Wikipedia page. I'm a Wikipedia editor. I've completed several wiki tasks on this platform. Here is my profile link: http://www.f Thêm
I try to ensure that my passion for writing comes through in what I write and I am dedicated to being the best writer I can be. I'm always looking to expand my horizons by learning new writing styles and genres and tak Thêm
I am extremely confident that I can write professional and engaging articles for your project. I understand that quality content takes time and research, so I will work hard to ensure that you get what you pay for. Thêm
I have written brand stories, some can be found in my portfolio and there are others that I may submit in attachment. Please text me if you need to have a look I am Trusted Researcher, Creative and Technical Writer / Thêm
Hi, You are looking for a Wikipedia page for your client. I can write and publish the page for you and I am highly confident that I will complete this project perfectly. I just want to say upfront that I have writt Thêm
Hello there, Does your article need to be 100% original and able to pass Copyscape? You came to the right place! All of my articles are well-written, grammatically correct, and are created completely by hand.I don't us Thêm
Why benefits you to hire me: I am currently dedicated to independent telecommuting by writing, reviewing and editing text content for web page, e-book, e-magazine and blog. As a graduate in History and having been a Thêm
We are highly experienced Post Graduate Engineers, Doctors, IT, ITES, Software, Infrastructure Professionals, Web Designers and IT Architects. We can redo, improve, and publish any engineering, scientific MATLAB, S Thêm
I am hardworking man and i never back down from a challenge. I like writing articles, i like the English language and i like to share my experience. I am meticulous and passionate about my work.
Hello, As an experienced and expert article writer I can write an article for you in the more reasonable price. I hope to hear from you soon! Thank you Best Regards Furqan
Dear Hiring Manager, I can write 2-3 high quality 600- 900 words articles per day. I am a professional writer from 5 years who loves to work creatively on different topics. I have written countless articles till da Thêm
I have worked as a digital marketer for 3 years. I also have experience writing business profiles. I will be able to create this page without sounding too promotional.


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The flat shape of on and off push-button switches accommodates the human hand or finger and allows them to be easily depressed or pushed. These switches are compact alternatives to bulky mechanical switches.
On and off push-button switches can be interconnected so that pushing one button causes the other button to be released. Color coded switches rule out the risk of erroneous operation. These switches remain depressed when they are pushed on, and pressing them again turns them off, switching off their connected circuits. Illuminated on and off push-button switches are useful for home installation and can be easily located in the dark or at night.


text:
I know what you're expecting to read after last night's episode of Kate Plus 8. You're expecting me to go on a Kate Gosselin lost it again rant, complete with references to every temper tantrum, snide remark, and seemingly diva-esque display from the family's disastrous cross-country RV trip. And I'll admit Kate was not exactly bursting with benevolence on this particular vacation ... okay fine, she was in a pretty bad mood.
But I think I know why Kate was being particularly prickly. In fact, I know I know why. It's no big mystery ... Kate tells us herself, more than once.
The woman was tired! She was freakin' exhausted. That's why she kept mentioning, almost as an apology-in-advance, that she was only getting three to four hours of shut-eye per night and really, really wanted to just go to sleep.
I'm not saying that tired moms get carte blanche to indulge in whatever bad behavior they want (wouldn't that be awesome?!?!), but there's no denying the kind of havoc chronic sleep-deprivation can wreak on a mother's mental state.
Add to that drawback the inherent difficulty of traveling with kids -- multiplied by eight -- plus Kate's unwavering tendency towards perfectionism, and of course, you're gonna get some unhappy campers.
Then there was the tension between Mady and the son of Kate's best friend, Jamie. There's nothing like a my kid vs. your kid throw-down to cause a rift between two moms, and that's under the best of circumstances. I actually think Kate did the right thing by "running away," i.e., taking off to buy groceries. At least she removed herself from the situation before things got even worse.
Was Kate at her best on the RV trip? No. But god forbid somebody stuck an overtired me in an RV with eight kids and turned on the cameras. Would it be any different for you?
Do you understand why Kate lost it last night?
Image via TLC


text: So now that I have almost doubled my lighting & flow it seems that little air bubbles are forming on the reef. At first I thought it was caused by flow issues but now I am wondering if it is the lighting? Anyone else had this problem? Will it go away?


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If you've heard of 0.06 millimeter condoms from Japan and you were pretty amazed, prepare to be shocked by a 0.01 millimeter condom made by Japanese condom company Sagami. According to the site ZakZak, it took the Japanese brand approximately 10 years to create these thin rubbers. And they actually work! Apparently, to ensure the safety of rubber protection, the Japanese company has tested over 20,000 condoms, leakage tests, burst tests and other trial and error experiments. The condoms are also colored, making Sagami the world's first manufacturer to make insanely thin and colored condoms!
On being asked in the future of making even thinner condoms, a Sagami researcher says, "[h]onestly, I don't how we can make them thinner than this, but as long as there is a need for thinner, we will continue researching 0.009 millimeter and 0.008 millimeter thinness."
Record-Breaking Thin Condoms
More Stats +/-
Pun-Filled Protection Packaging
Transparent Silicone Coats
Female Condom Fashion
Compatible Astrological Sign Ads
Thought-Provoking Still Life Photography
Sagami's 0.01 MM Condom Took Ten Years to Perfect
- By: TiffanyMar 2, 2014
References: zakzak.co.jp & kotaku
References: zakzak.co.jp & kotaku