text:
Pediatric pituitary adenomas are rare, accounting for <3 % of all childhood intracranial tumors, the majority of which are prolactinomas. Consequently, they are often misdiagnosed as other suprasellar masses such as craniopharyngiomas in this age group. Whilst guidelines exist for the treatment of adult prolactinomas, the management of childhood presentations of these benign tumors is less clear, particularly when dopamine agonist therapy fails. Given their rarity, childhood-onset pituitary adenomas are more likely to be associated with a variety of genetic syndromes, the commonest being multiple endocrine neoplasia type 1 (MEN-1).
We present a case of an early-onset, treatment-resistant giant prolactinoma occurring in an 11-year-old peripubertal boy that was initially sensitive, but subsequently highly resistant to dopamine agonist therapy, ultimately requiring multiple surgical debulking procedures and proton beam irradiation. Our patient is now left with long-term tumor- and treatment-related neuroendocrine morbidities including blindness and panhypopituitarism. Only after multiple consultations and clinical data gained from 20-year-old medical records was a complex, intergenerationally consanguineous family history revealed, compatible with MEN-1, with a splice site mutation (c.784-9G > A) being eventually identified in intron 4 of the MEN1 gene, potentially explaining the difficulties in management of this tumor. Genetic counseling and screening has now been offered to the wider family.
This case emphasizes the need to consider pituitary adenomas in the differential diagnosis of all pediatric suprasellar tumors by careful endocrine assessment and measurement of at least a serum prolactin concentration. It also highlights the lack of evidence for the optimal management of pediatric drug-resistant prolactinomas. Finally, the case we describe demonstrates the importance of a detailed family history and the role of genetic testing for MEN1 and AIP mutations in all cases of pediatric pituitary adenoma.
Pituitary adenomas account for <3 % of all childhood intracranial tumors with an estimated incidence of 0.1 cases/million/year [1, 2]. Prolactin (PRL)-secreting tumors alone account for 50-70 % of pituitary adenomas in children <20 years of age [3–5]. These are further classified into microprolactinomas (≤1 cm in maximum dimensions), macroprolactinomas (>1 cm) and giant prolactinomas (>4 cm with a serum PRL of >5300-10600 mU/l) [6, 7]. First-line therapy consists of dopamine agonists such as cabergoline, with surgery and radiotherapy being reserved for drug-resistant tumors or neuro-ophthalmological emergencies. Whilst 20-30 % of patients with known multiple endocrine neoplasia type 1 (MEN-1) develop prolactinomas [4, 8, 9], up to 6.5 % of sporadic pediatric prolactinomas are associated with previously undiagnosed MEN-1 .
We report a patient presenting to our quaternary pediatric neuroendocrine and oncology units with a treatment-resistant giant prolactinoma. His complex genetic history and challenging management illustrates the necessity for thorough history-taking, specialist multidisciplinary management and the potential for long-term neuroendocrine morbidity in this rare tumor.
An 11-year-old Middle Eastern boy was referred to Great Ormond Street Hospital for Children with four years of headaches and 18 months of visual deterioration, previously investigated with a reportedly normal brain CT scan in his country of origin. There was no galactorrhea. At presentation he had a right-sided relative afferent pupillary defect, optic atrophy and could only perceive light with his right eye and count fingers with his left eye. Auxology was normal and he was in early puberty with testicular volumes of 4 mls bilaterally. Initial family history revealed an inter-generational multiply consanguineous family (Fig. 1a), with one maternal first half-cousin once removed treated with cabergoline at age 18 years and one paternal first half-cousin once removed undergoing transsphenoidal surgery at age 45 years, both for macroprolactinomas.
Magnetic resonance imaging revealed a large, avidly-enhancing heterogeneous sellar and suprasellar mass merging with the pituitary gland, compressing the optic chiasm and encasing both internal carotid arteries with a maximal transverse diameter of 5.5 cm (Fig. 2a-b). A provisional radiological diagnosis of craniopharyngioma was made with a plan for surgical resection. However, biochemical testing revealed marked hyperprolactinemia (PRL 23723 mU/l, normal range 55-318) leading to the revised diagnosis of a giant prolactinoma. Dynamic testing revealed deficiencies in growth hormone (GH, peak to glucagon stimulation 1.1 ng/ml; insulin-like growth factor-1 (IGF-1) 196 ng/ml, normal range 143-693) and thyroid-stimulating hormone (TSH 3.7 mU/l, normal range <6.0; free thyroxine (fT4) 10.3 pmol/l, normal range 10.8-19.0) but normal hypothalamo-pituitary-adrenal (peak cortisol 516 nmol/l to synacthen stimulation) and -gonadal function (luteinizing hormone 0.3 U/l, follicle-stimulating hormone 0.9 U/l, testosterone 1.68 nmol/l).
Our patient was commenced on 250 μg/week cabergoline and levothyroxine supplementation. Despite an initial excellent PRL reduction in response to therapy, his tumor became extremely drug-resistant despite cabergoline dose escalation to 3.5 mg/week (Fig. 2m). Multiple relapses threatening vision required two transcranial interhemispheric debulking procedures and adjuvant proton beam irradiation, with the second debulking and radiotherapy undertaken at the Children’s Hospital of Philadelphia (CHOP, Fig. 2c-l). Tumor histology confirmed a prolactinoma with a high Ki67 index (11 %). During the second surgical debulking he experienced a preoperative anesthesia-related hemorrhagic stroke causing a transient left hemiparesis, and post-operatively lost all residual vision. He now has panhypopituitarism but has demonstrated declining PRL concentrations (500 mU/l) whilst maintained on 5 mg/week of cabergoline.
His complex family history alerted clinicians to the likelihood of an underlying genetic diagnosis but despite repeated consultations with multiple specialists (HAS, MK, OJ) no common ancestor linking all three macroprolactinoma cases could be found. Genetic testing of our patient for both MEN1 and AIP mutations revealed a heterozygous MEN1 intronic splice site mutation (c.784-9G > A). This has previously been shown to result in alternative splicing, a premature stop codon and a truncated, inactive MENIN protein [11–13].
Subsequent questioning revealed a history of renal stones and primary hyperparathyroidism in our patient’s mother and two maternal aunts, as well as a history consistent with MEN-1 (macroprolactinoma, primary hyperparathyroidism and gastrinoma) in his deceased maternal grandmother (Fig. 1b) who had been managed by our adult colleagues in the United Kingdom two decades earlier. Genetic testing confirmed the same mutation in his sister, mother, maternal grandmother, one maternal aunt and her two children, but not in his father or his paternal uncle. Most recently, our patient has developed primary hyperparathyroidism, and a parathyroidectomy is being planned. He continues to undergo regular screening including gut hormone profiling and echocardiograms at CHOP, all of which have been normal thus far. We are in the process of collaboratively tracing and screening other asymptomatic relatives in the wider family at risk.
The rarity of pediatric pituitary adenomas means that they are often not considered in the differential diagnosis of suprasellar tumors in this age group, leading to the potential misdiagnoses of craniopharyngioma or low-grade glioma, for which primary treatments are predominantly surgical, chemotherapeutic and/ or radiotherapeutic in nature. This case highlights the importance of a routine endocrine evaluation in all such cases, not only to document potential tumor-related pituitary dysfunction but also to identify functioning pituitary adenomas by measuring serum PRL, GH and adrenocorticotropic hormone, particularly as non-functioning pituitary adenomas are rare in children [14, 15, 5]. It also emphasizes that macroprolactinomas often present with non-endocrine raised intracranial pressure symptoms particularly in prepubertal males [16–19, 15]. It is important to distinguish true prolactinomas from hyperprolactinemia from other causes, but concentrations >5300 mU/l are usually diagnostic . In all suspected cases, screening for macroprolactinemia , as well as serial serum dilution to exclude the hook effect – where extreme hyperprolactinemia causes falsely low assay results through interference of antibody-antigen complex formation [6, 21] – should always be performed.
Medical monotherapy with dopamine agonists is recommended as first-line treatment for all prolactinomas due to their excellent efficacy, likely preservation of residual pituitary function and low side-effect profile [7, 22]. Cabergoline in particular has an established record of being better-tolerated than bromocriptine with higher rates of resolution . Cardiac valve regurgitation with high cumulative doses (4000 mg) has been described in Parkinson syndrome patients , but this is usually not reached with prolactinomas, as demonstrated by several adult studies [7, 24–27]. However, young patients such as ours commencing treatment earlier in life are more likely to reach this critical threshold, and at the current dose of 5 mg/week our patient will be exposed to 4000 mg of cabergoline within 16 years post-diagnosis, unless doses can be reduced in response to the efficacy of radiotherapy. Dose-safety profiles have additionally not been established in children, in whom toxicity even at moderate cabergoline doses may be increased. Quinagolide, a more recent non-ergot derived dopamine agonist is purported to have fewer side effects but to our knowledge has not been used in children .
The mechanism for development of drug-resistance is not well understood, and is thought to relate to dopamine D2 receptor downregulation . MEN-1 is associated with larger tumors (84 % vs. 24 %) and treatment-resistance (56 % vs. 10 %) [29, 9]. Second-line management options for drug-resistant adult tumors include maximizing cabergoline dose to 11 mg/week, transsphenoidal or transcranial surgical resection, radiotherapy and the alkylating agent temozolomide [7, 6, 30, 31]. However, knowledge of the maximum safe therapeutic cabergoline dose, speed of dose escalation, long-term toxicities of temozolomide, and experience in pediatric transsphenoidal resections is limited. Consequently, optimal management of pediatric pituitary adenomas remains unclarified, suggesting the need for treatment in specialist neuroendocrine units with both adult and pediatric experience. Several authors report long-term tumor- and/ or treatment-related morbidities including hypopituitarism, obesity, dyslipidemia, infertility and reduced bone mineral density [16–18, 32, 6, 3].
9-22 % of pediatric pituitary adenomas are associated with genetic tumor-predisposing syndromes, the most well-known of which is MEN-1 with an estimated prevalence of 0.02-0.2 per 1000 [10, 29]. Whilst primary hyperparathyroidism is the commonest presenting manifestation, 17 % will present with a pituitary adenoma (classically a prolactinoma) . As illustrated here, MEN-1 is an autosomal dominant condition characterized additionally by enteropancreatic tumors, non-functioning adrenocortical adenomas, angiofibromas, collagenomas, thyroid adenomas, meningiomas and other neuroendocrine tumors . Other genetic endocrine syndromes associated with pituitary tumors are the familial isolated pituitary adenoma (FIPA) syndrome (of which AIP mutations are a subset), multiple endocrine neoplasia type 4 (CDKN1B), Carney complex (PRKAR1A), McCune-Albright syndrome (GNAS), SDH-related pituitary adenoma syndrome (SDHB, SDHC, SDHD), neurofibromatosis type 1 (NF1) and DICER1 syndrome [33, 34, 4, 35–37].
Several authors strongly suggest testing for both MEN1 and AIP germline mutations in all pediatric patients with PRL- and GH-secreting pituitary adenomas as they may be index cases for a given family [10, 33, 29]. A useful algorithm has been proposed by Korbonits et al. (2012). This is particularly important given that current guidelines recommend testing first-degree relatives of index cases and performing annual biochemical screening in carriers for insulinomas, PRL- and GH-secreting pituitary adenomas from age 5 years and for hyperparathyroidism from age 8 years .
Pituitary adenomas must be considered in the differential diagnosis of all pediatric suprasellar masses, therefore mandating a detailed endocrine review and an accurate serum PRL measurement as management differs markedly from that of other tumors. Optimal management of dopamine agonist-resistant tumors in childhood remains unclear. A detailed family history of brain tumors and MEN-1-associated symptoms such as renal stones must be obtained and may require several consultations before being fully elucidated. We recommend that all children with PRL- or GH-secreting pituitary adenomas undergo MEN1 and AIP mutation testing, with subsequent screening of first-degree relatives if found positive.
Written informed consent was obtained from the parent of the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We are very grateful to the patient and his family for consenting to the publication of his clinical and family history data. We are also thankful to Sian Conner, Niloofar Bozorgi and Rhonda Thomas for their assistance in obtaining clinical notes and radiological images.
HWG & CB obtained informed patient/parental consent, collated clinical, biochemical, radiological and genetic data, as well as drafted the manuscript. OJ was involved in the initial surgical care of the patient. MAL was involved in the endocrine management and follow-up of the patient, provided useful clinical, biochemical and radiological data. MK was involved in the genetic diagnosis, identifying and tracing of the family history, counseling and care of the patient and his family, providing detailed genetic and family data. HAS was involved in the endocrine diagnosis and management of the patient, interpretation of endocrine biochemistry and provided useful clinical data. All authors contributed to the edition and finalization of the manuscript. All authors read and approved the final manuscript.

tokenized:
Pediatric pituitary adenomas are rare , accounting for <3 % of all childhood intracranial tumors , the majority of which are prolactinomas . Consequently , they are often misdiagnosed as other suprasellar masses such as craniopharyngiomas in this age group . Whilst guidelines exist for the treatment of adult prolactinomas , the management of childhood presentations of these benign tumors is less clear , particularly when dopamine agonist therapy fails . Given their rarity , childhood - onset pituitary adenomas are more likely to be associated with a variety of genetic syndromes , the commonest being multiple endocrine neoplasia type 1 ( MEN-1 ) .
 We present a case of an early - onset , treatment - resistant giant prolactinoma occurring in an 11 - year - old peripubertal boy that was initially sensitive , but subsequently highly resistant to dopamine agonist therapy , ultimately requiring multiple surgical debulking procedures and proton beam irradiation . Our patient is now left with long - term tumor- and treatment - related neuroendocrine morbidities including blindness and panhypopituitarism . Only after multiple consultations and clinical data gained from 20 - year - old medical records was a complex , intergenerationally consanguineous family history revealed , compatible with MEN-1 , with a splice site mutation ( c.784 - 9 G   >   A ) being eventually identified in intron 4 of the MEN1 gene , potentially explaining the difficulties in management of this tumor . Genetic counseling and screening has now been offered to the wider family .
 This case emphasizes the need to consider pituitary adenomas in the differential diagnosis of all pediatric suprasellar tumors by careful endocrine assessment and measurement of at least a serum prolactin concentration . It also highlights the lack of evidence for the optimal management of pediatric drug - resistant prolactinomas . Finally , the case we describe demonstrates the importance of a detailed family history and the role of genetic testing for MEN1 and AIP mutations in all cases of pediatric pituitary adenoma .
 Pituitary adenomas account for <3 % of all childhood intracranial tumors with an estimated incidence of 0.1 cases / million / year [ 1 , 2 ] . Prolactin ( PRL)-secreting tumors alone account for 50 - 70 % of pituitary adenomas in children < 20 years of age [ 3–5 ] . These are further classified into microprolactinomas ( ≤1 cm in maximum dimensions ) , macroprolactinomas ( > 1 cm ) and giant prolactinomas ( > 4 cm with a serum PRL of > 5300 - 10600 mU / l ) [ 6 , 7 ] . First - line therapy consists of dopamine agonists such as cabergoline , with surgery and radiotherapy being reserved for drug - resistant tumors or neuro - ophthalmological emergencies . Whilst 20 - 30 % of patients with known multiple endocrine neoplasia type 1 ( MEN-1 ) develop prolactinomas [ 4 , 8 , 9 ] , up to 6.5 % of sporadic pediatric prolactinomas are associated with previously undiagnosed MEN-1 .
 We report a patient presenting to our quaternary pediatric neuroendocrine and oncology units with a treatment - resistant giant prolactinoma . His complex genetic history and challenging management illustrates the necessity for thorough history - taking , specialist multidisciplinary management and the potential for long - term neuroendocrine morbidity in this rare tumor .
 An 11 - year - old Middle Eastern boy was referred to Great Ormond Street Hospital for Children with four years of headaches and 18 months of visual deterioration , previously investigated with a reportedly normal brain CT scan in his country of origin . There was no galactorrhea . At presentation he had a right - sided relative afferent pupillary defect , optic atrophy and could only perceive light with his right eye and count fingers with his left eye . Auxology was normal and he was in early puberty with testicular volumes of 4 mls bilaterally . Initial family history revealed an inter - generational multiply consanguineous family ( Fig . 1a ) , with one maternal first half - cousin once removed treated with cabergoline at age 18 years and one paternal first half - cousin once removed undergoing transsphenoidal surgery at age 45 years , both for macroprolactinomas .
 Magnetic resonance imaging revealed a large , avidly - enhancing heterogeneous sellar and suprasellar mass merging with the pituitary gland , compressing the optic chiasm and encasing both internal carotid arteries with a maximal transverse diameter of 5.5 cm ( Fig . 2a - b ) . A provisional radiological diagnosis of craniopharyngioma was made with a plan for surgical resection . However , biochemical testing revealed marked hyperprolactinemia ( PRL 23723 mU / l , normal range 55 - 318 ) leading to the revised diagnosis of a giant prolactinoma . Dynamic testing revealed deficiencies in growth hormone ( GH , peak to glucagon stimulation 1.1 ng / ml ; insulin - like growth factor-1 ( IGF-1 ) 196 ng / ml , normal range 143 - 693 ) and thyroid - stimulating hormone ( TSH 3.7 mU / l , normal range < 6.0 ; free thyroxine ( fT4 ) 10.3 pmol / l , normal range 10.8 - 19.0 ) but normal hypothalamo - pituitary - adrenal ( peak cortisol 516 nmol / l to synacthen stimulation ) and -gonadal function ( luteinizing hormone 0.3 U / l , follicle - stimulating hormone 0.9 U / l , testosterone 1.68 nmol / l ) .
 Our patient was commenced on 250 μg / week cabergoline and levothyroxine supplementation . Despite an initial excellent PRL reduction in response to therapy , his tumor became extremely drug - resistant despite cabergoline dose escalation to 3.5 mg / week ( Fig . 2 m ) . Multiple relapses threatening vision required two transcranial interhemispheric debulking procedures and adjuvant proton beam irradiation , with the second debulking and radiotherapy undertaken at the Children ’s Hospital of Philadelphia ( CHOP , Fig . 2c - l ) . Tumor histology confirmed a prolactinoma with a high Ki67 index ( 11 % ) . During the second surgical debulking he experienced a preoperative anesthesia - related hemorrhagic stroke causing a transient left hemiparesis , and post - operatively lost all residual vision . He now has panhypopituitarism but has demonstrated declining PRL concentrations ( 500 mU / l ) whilst maintained on 5 mg / week of cabergoline .
 His complex family history alerted clinicians to the likelihood of an underlying genetic diagnosis but despite repeated consultations with multiple specialists ( HAS , MK , OJ ) no common ancestor linking all three macroprolactinoma cases could be found . Genetic testing of our patient for both MEN1 and AIP mutations revealed a heterozygous MEN1 intronic splice site mutation ( c.784 - 9 G   >   A ) . This has previously been shown to result in alternative splicing , a premature stop codon and a truncated , inactive MENIN protein [ 11–13 ] .
 Subsequent questioning revealed a history of renal stones and primary hyperparathyroidism in our patient ’s mother and two maternal aunts , as well as a history consistent with MEN-1 ( macroprolactinoma , primary hyperparathyroidism and gastrinoma ) in his deceased maternal grandmother ( Fig . 1b ) who had been managed by our adult colleagues in the United Kingdom two decades earlier . Genetic testing confirmed the same mutation in his sister , mother , maternal grandmother , one maternal aunt and her two children , but not in his father or his paternal uncle . Most recently , our patient has developed primary hyperparathyroidism , and a parathyroidectomy is being planned . He continues to undergo regular screening including gut hormone profiling and echocardiograms at CHOP , all of which have been normal thus far . We are in the process of collaboratively tracing and screening other asymptomatic relatives in the wider family at risk .
 The rarity of pediatric pituitary adenomas means that they are often not considered in the differential diagnosis of suprasellar tumors in this age group , leading to the potential misdiagnoses of craniopharyngioma or low - grade glioma , for which primary treatments are predominantly surgical , chemotherapeutic and/ or radiotherapeutic in nature . This case highlights the importance of a routine endocrine evaluation in all such cases , not only to document potential tumor - related pituitary dysfunction but also to identify functioning pituitary adenomas by measuring serum PRL , GH and adrenocorticotropic hormone , particularly as non - functioning pituitary adenomas are rare in children [ 14 , 15 , 5 ] . It also emphasizes that macroprolactinomas often present with non - endocrine raised intracranial pressure symptoms particularly in prepubertal males [ 16–19 , 15 ] . It is important to distinguish true prolactinomas from hyperprolactinemia from other causes , but concentrations > 5300 mU / l are usually diagnostic . In all suspected cases , screening for macroprolactinemia , as well as serial serum dilution to exclude the hook effect – where extreme hyperprolactinemia causes falsely low assay results through interference of antibody - antigen complex formation [ 6 , 21 ] – should always be performed .
 Medical monotherapy with dopamine agonists is recommended as first - line treatment for all prolactinomas due to their excellent efficacy , likely preservation of residual pituitary function and low side - effect profile [ 7 , 22 ] . Cabergoline in particular has an established record of being better - tolerated than bromocriptine with higher rates of resolution . Cardiac valve regurgitation with high cumulative doses ( 4000 mg ) has been described in Parkinson syndrome patients , but this is usually not reached with prolactinomas , as demonstrated by several adult studies [ 7 , 24–27 ] . However , young patients such as ours commencing treatment earlier in life are more likely to reach this critical threshold , and at the current dose of 5 mg / week our patient will be exposed to 4000 mg of cabergoline within 16 years post - diagnosis , unless doses can be reduced in response to the efficacy of radiotherapy . Dose - safety profiles have additionally not been established in children , in whom toxicity even at moderate cabergoline doses may be increased . Quinagolide , a more recent non - ergot derived dopamine agonist is purported to have fewer side effects but to our knowledge has not been used in children .
 The mechanism for development of drug - resistance is not well understood , and is thought to relate to dopamine D2 receptor downregulation . MEN-1 is associated with larger tumors ( 84 % vs. 24 % ) and treatment - resistance ( 56 % vs. 10 % ) [ 29 , 9 ] . Second - line management options for drug - resistant adult tumors include maximizing cabergoline dose to 11 mg / week , transsphenoidal or transcranial surgical resection , radiotherapy and the alkylating agent temozolomide [ 7 , 6 , 30 , 31 ] . However , knowledge of the maximum safe therapeutic cabergoline dose , speed of dose escalation , long - term toxicities of temozolomide , and experience in pediatric transsphenoidal resections is limited . Consequently , optimal management of pediatric pituitary adenomas remains unclarified , suggesting the need for treatment in specialist neuroendocrine units with both adult and pediatric experience . Several authors report long - term tumor- and/ or treatment - related morbidities including hypopituitarism , obesity , dyslipidemia , infertility and reduced bone mineral density [ 16–18 , 32 , 6 , 3 ] .
 9 - 22 % of pediatric pituitary adenomas are associated with genetic tumor - predisposing syndromes , the most well - known of which is MEN-1 with an estimated prevalence of 0.02 - 0.2 per 1000 [ 10 , 29 ] . Whilst primary hyperparathyroidism is the commonest presenting manifestation , 17 % will present with a pituitary adenoma ( classically a prolactinoma ) . As illustrated here , MEN-1 is an autosomal dominant condition characterized additionally by enteropancreatic tumors , non - functioning adrenocortical adenomas , angiofibromas , collagenomas , thyroid adenomas , meningiomas and other neuroendocrine tumors . Other genetic endocrine syndromes associated with pituitary tumors are the familial isolated pituitary adenoma ( FIPA ) syndrome ( of which AIP mutations are a subset ) , multiple endocrine neoplasia type 4 ( CDKN1B ) , Carney complex ( PRKAR1A ) , McCune - Albright syndrome ( GNAS ) , SDH - related pituitary adenoma syndrome ( SDHB , SDHC , SDHD ) , neurofibromatosis type 1 ( NF1 ) and DICER1 syndrome [ 33 , 34 , 4 , 35–37 ] .
 Several authors strongly suggest testing for both MEN1 and AIP germline mutations in all pediatric patients with PRL- and GH - secreting pituitary adenomas as they may be index cases for a given family [ 10 , 33 , 29 ] . A useful algorithm has been proposed by Korbonits et al . ( 2012 ) . This is particularly important given that current guidelines recommend testing first - degree relatives of index cases and performing annual biochemical screening in carriers for insulinomas , PRL- and GH - secreting pituitary adenomas from age 5 years and for hyperparathyroidism from age 8 years .
 Pituitary adenomas must be considered in the differential diagnosis of all pediatric suprasellar masses , therefore mandating a detailed endocrine review and an accurate serum PRL measurement as management differs markedly from that of other tumors . Optimal management of dopamine agonist - resistant tumors in childhood remains unclear . A detailed family history of brain tumors and MEN-1 - associated symptoms such as renal stones must be obtained and may require several consultations before being fully elucidated . We recommend that all children with PRL- or GH - secreting pituitary adenomas undergo MEN1 and AIP mutation testing , with subsequent screening of first - degree relatives if found positive .
 Written informed consent was obtained from the parent of the patient for publication of this case report and any accompanying images . A copy of the written consent is available for review by the Editor - in - Chief of this journal .
 We are very grateful to the patient and his family for consenting to the publication of his clinical and family history data . We are also thankful to Sian Conner , Niloofar Bozorgi and Rhonda Thomas for their assistance in obtaining clinical notes and radiological images .
 HWG & CB obtained informed patient / parental consent , collated clinical , biochemical , radiological and genetic data , as well as drafted the manuscript . OJ was involved in the initial surgical care of the patient . MAL was involved in the endocrine management and follow - up of the patient , provided useful clinical , biochemical and radiological data . MK was involved in the genetic diagnosis , identifying and tracing of the family history , counseling and care of the patient and his family , providing detailed genetic and family data . HAS was involved in the endocrine diagnosis and management of the patient , interpretation of endocrine biochemistry and provided useful clinical data . All authors contributed to the edition and finalization of the manuscript . All authors read and approved the final manuscript .


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SAN DIEGO -- The San Diego International Auto Show is scheduled to open a four-day run at the convention center Thursday, with 400 new-model vehicles, alternative fuel cars, exotics, crossovers and classics on display.
Vehicles from 36 manufacturers will be shown, including, among others, a 2017 model year Porsche 911 Carrera coupe with new twin turbo engines, and a newly designed Lincoln Continental.
"The cars continue to be the stars," said Kevin Leap, show director. "Today's vehicles shine more brightly than ever with a level of quality, design brilliance, and tech savvy that has never been seen before."
Attendees will be able to test drive cars to experience various features first-hand, check out environmentally friendly vehicles and enjoy entertainment, according to the New Car Dealers Association of San Diego County, which organizes the event.
The show floor opens daily at 10 a.m. Closing times are 6 p.m. today, 9 p.m. Friday and Saturday, and 7 p.m. Sunday.
Admission for attendees 13 over is $12. The cost is $9 for seniors 62 and over and military with identification, and $8 for youth 7-12 years old. Children 6 and under are free when accompanied by an adult.
Children 12 and under are free on Ford Family Day on Sunday, when accompanied by a paying adult.
Parking is available for $15 at the San Diego Convention Center. Show organizers, however, encourage visitors to take the trolley to the Gaslamp stop.
Information on discount coupons or VIP e-tickets is available at SDAutoShow.com .

tokenized:
SAN DIEGO -- The San Diego International Auto Show is scheduled to open a four - day run at the convention center Thursday , with 400 new - model vehicles , alternative fuel cars , exotics , crossovers and classics on display .
 Vehicles from 36 manufacturers will be shown , including , among others , a 2017 model year Porsche 911 Carrera coupe with new twin turbo engines , and a newly designed Lincoln Continental .
 " The cars continue to be the stars , " said Kevin Leap , show director . " Today 's vehicles shine more brightly than ever with a level of quality , design brilliance , and tech savvy that has never been seen before . "
 Attendees will be able to test drive cars to experience various features first - hand , check out environmentally friendly vehicles and enjoy entertainment , according to the New Car Dealers Association of San Diego County , which organizes the event .
 The show floor opens daily at 10 a.m. Closing times are 6 p.m. today , 9 p.m. Friday and Saturday , and 7 p.m. Sunday .
 Admission for attendees 13 over is $ 12 . The cost is $ 9 for seniors 62 and over and military with identification , and $ 8 for youth 7 - 12 years old . Children 6 and under are free when accompanied by an adult .
 Children 12 and under are free on Ford Family Day on Sunday , when accompanied by a paying adult .
 Parking is available for $ 15 at the San Diego Convention Center . Show organizers , however , encourage visitors to take the trolley to the Gaslamp stop .
 Information on discount coupons or VIP e - tickets is available at SDAutoShow.com .


text:
Found Image Press - Collection: Greetings from . . .
Showing 1 to 500 of 2610 for Collection: Greetings from . . .
Greetings from the Rocky Mts.

tokenized:
Found Image Press - Collection : Greetings from . . .
 Showing 1 to 500 of 2610 for Collection : Greetings from . . .
 Greetings from the Rocky Mts .


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The global media economy is being transformed. With major changes in the way stories are produced, circulated and consumed, today’s visual journalists and storytellers need new skills to meet the challenges and take advantage of new opportunities. Students on the MA in International Multimedia Journalism learn how the new media economy works and develop high-level skills in audio, photography, video, writing, infographics, social media and editing. Based in Beijing, China, with the degree awarded by the University of Bolton in the UK, the MA in International Multimedia Journalism offers a unique, cosmopolitan approach to visual storytelling.
The School of Journalism and Communication at Tsinghua University was founded in April 2002. Inheriting Tsinghua’s tradition of comprehensive and interdisciplinary education, TSJC aims to give students world-class journalism and communication education guided by advanced educational concepts and international standards. Every year, hundreds of graduates leave TSJC to take top-level journalism and communication jobs in and outside China. Students at TSJC are offered abundant opportunities to not only sharpen their professional skills, but also develop acute social responsibility crucial for their future success.
In line with programs at Columbia University and the University of Missouri, the School of Journalism and Communication has developed a“fundamental but practical” curriculum, with international and practice-oriented features. It has adopted the “Platform Module” curricular system used worldwide and offers small-group classes, along with both English-immersion and bilingual courses. A four-year program of Journalistic English is currently being developed. Against the backdrop of globalization, the School is committed to training high-caliber professional journalists with an international outlook, strong communication skills, mastery of modern broadcasting technology, and an innovative spirit.
The School of International Journalism at Shanghai International Studies University trains and educates students to become accomplished journalistic professionals, and prepares them with foreign language and journalistic skills as well as a global vision to achieve quality journalism practices in media organizations both in China and beyond.
The School has cherished a global teaching and research tradition within the Chinese journalism system that was started in 1983 when the Program of International Journalism was set up as the first multi-disciplinary program at this language university and has since become one of the top-notch international journalism programs in China.
The School offers two undergraduate degree programs and one MA degree programs. The undergraduate degree programs include International Journalism and Internet & New Media, which will start enrollment in September 2014. Its MA program has concentrated on global communication theories, English news writing and editing as well as global public opinion & media. During the past three decades the School has educated more than 1000 graduates and prided itself on their competence, devotion and reputation showcased in the media community in Shanghai, China and the world.
Amid innovations spawned by digital technology, heightened restraints to press freedom, and the surge in news and issues with cross-border ramifications, the idea of reviving “pure” journalism education emerged in the agenda of the Ateneo de Manila University. Added impetus came from the Konrad Adenauer Foundation, which has an international reputation for development work in emerging democracies. Seeking to help raise the standards of Asian journalism, the foundation entrusted the Ateneo, a long-time partner in social development, with its regional journalism training program. In June 2000, the Konrad Adenauer Center for Journalism at the Ateneo de Manila University was inaugurated. It was envisioned as a hub of journalism education in the region, an oasis of learning for working journalists. In May 2006, “Asian” was added to the center’s name to accurately reflect the true geographical scope of its mandate.
Today, the Konrad Adenauer Asian Center for Journalism at the Ateneo de Manila University (ACFJ) promotes good journalism by providing training to and educational opportunities for working journalists in Asia.
The Asian Institute of Journalism and Communication (AIJC) is a Knowledge Management Center organized in 1980 as a graduate school of journalism, founded on the philosophy that communication is a vital development resource to be used to advance the common good.
Today AIJC has a solid record of more than thirty years in the communication field – as a graduate school for communicators and journalists, a center for continuing education in journalism, communication, and knowledge management, and a research and consulting firm advocating policies and implementing programs and projects that address development issues and concerns both at the levels of national decision-making and community-based initiatives.
The name Pathshala comes from the ancient education system that prevailed in South Asia. It brings to mind classes held underneath a large tree; conjuring up learning spaces without walls, in the cool shade of its leaves. The South Asian Media Institute not only allows students to explore the world of image making but provides them opportunities to question beyond the confines of the discipline. The conceptual absence of classroom walls enables 1st year students and 3rd year students to attend the same classes and work together on collaborative projects together with visiting faculty. This enhances and complements each student’s learning experience.
The institute started in 1998 in conjunction with a three-year World Press Photo (WPP) educational initiative. It was launched to coincide with the Dhaka’s annual WPP exhibition. This exhibition was also replicated in other countries like Peru, Bosnia and Zimbabwe. The British Council, The Thomson Foundation and Panos South Asia supported this initiative of WPP and Drik Picture Library Ltd. The first group of six students is now among prominent photographers whose photographs have been published in some of the leading publications worldwide. From its modest beginnings Pathshala expanded attracting students from within Bangladesh as well as outside.
Many of the graduated photographers have become internationally renowned photographers and the number of students that have joined the World Press Photo Masterclass is unusual for any photography education in the world.
On 22 March 2010, Pathshala launched a new Department: Broadcast and Multimedia. This department currently offers basic training in filmmaking, cinematography, video editing, motion graphics, animation, news presentation and reporting.
This media institute designs the courses and training programs for local and international clients: individuals, companies, and organizations. Part of the long-term plan is to disseminate our unique expertise across the region through master classes, special events, and conferences focused on the issues faced by journalists and media professionals in South Asia.
The photography department of Counter Foto was born on November 23, 2012. But within such a short period of time, it has become the most sought after school as the good words about its world class teaching system is spreading around. Having many Master photographers of the world involved in the teaching faculty, the photography department has more than twenty local teachers all of whom are crème de la crème of Bangladeshi Photography.
Journalism was the first course offered by the Department of Communication when it was founded in 1968, and remains the best-known course in the University. The course became a Department of its own within the new School of Communication in 1991. Today the Department of Journalism offers three concentrations in its three-year undergraduate programme: Chinese Journalism, International Journalism and Broadcast Journalism.
The programme’s special characteristic is that it emphasises both theory and practice, covering professional journalistic knowledge, academic subjects, critical thinking, analytical skills and media ethics. Graduates of the Journalism programme fill many leadership roles in the Hong Kong media industry and the Department continues to be an important and valued source of recruits to the journalism profession.
Creative Media is all about human creativity responding to the technological, social and environmental challenges of our time. It is a catalyst for new synergies across the sciences, arts, and humanities. By experiencing and thinking in new ways, creative media provides students with a dynamic and responsible context for innovation in a digital world. It creates promise and gives meaning to our lives.
City University of Hong Kong’s School of Creative Media is recognized to be an international hub for discovery and innovation in Asia. Here creativity is nurtured as a cornerstone of Hong Kong’s social and economic advancement in the 21st Century. It is a place where students from across the globe can encounter the wealth of opportunity afforded by digital media, and where graduates attain those artistic, intellectual and technical skills that enable them to take positions of creative leadership in a global society.
The Journalism and Media Studies Centre brings professional journalism education to Hong Kong’s premier university, creating an environment for vibrant interaction among students from Hong Kong, mainland China, Asia and the rest of the world.
The curriculum, with instruction in English, is designed to produce graduates for all types of local, regional and international media, whether the graduates ultimately practice in English, Chinese, or some other language.
From day one, students develop convergent skills enabling them operate comfortably in all aspects of the industry, ranging from print, audio, video, multi-media to online journalism.
In 2006, we drew on the success of our Thai language program to enact an international English program, known as the Bachelor’s of Arts program in Journalism and Mass Media, or B.J.M. Even in this short time, our graduates and current students have won prestigious awards, they have been accepted at top graduate programs throughout the globe – in countries such as the US, UK, France, Korea, to name a few – and our graduates have also made profound impacts at top print and broadcast media companies, as well as advertising agencies, and PR and marketing firms.
We are proud of our achievements thus far, but we will not rest on our laurels as we continue to work hard to provide our students the best education we can. We boast top-notch modern facilities and excellent professors to ensure that our graduates have the proper foundation to enjoy flourishing careers in whatever area they choose, along with a deep academic knowledge, a useful skill set, and a strong moral compass. And as the world of communication and media studies continues to develop through technological advances, we continue to stay ahead of the curve so our students are prepared to become thought and communication leaders in society.
The Graduate School of Journalism seeks to cultivate professionals with a practical approach to ethics, knowledge and technology. It aims to produce outstanding journalists who distinguish themselves in terms of specialized knowledge, who are able to promote public communication and thereby create a bridge between specialized knowledge and civil society. At the same time, the Graduate School of Journalism cultivates those who will promote journalism-related research and those who will instruct future generations of researchers and journalists.
Today, communication is getting increasingly digitalized and diversified while culture and knowledge based products are dominating the world’s market. By studying and teaching the theories and practice of communication, the Graduate School of Mass Communication strives to nurture journalists who will lead in setting up a desirable journalism culture in Korea. The school also gives re-education to professional journalists on the rapidly changing media environment.
The ACJ Programme seeks to combine the “How To” aspect of journalism with a critical and reflective “Why” perspective which enables the young journalist to keep up with the demands made by a dynamic work environment and, as importantly, by a changing society.
The Department of Media and Communication (DMC) was established in 2001, under the Royal University of Phnom Penh, primarily as an academic training ground for journalists and communication practitioners. Since its inception, DMC has received funding from Konrad Adenauer Foundation and technical support from German Development Service (DED), German Academic Exchange Program (DAAD), Ohio University, Mittweida University, University of Hamburg, Ateneo de Manila University, and DW. Throughout the years, DMC has evolved from merely a school for undergraduate course in media and communication into a more dynamic institute in terms of teaching and learning, social issues, and research. We have at the moment a balanced mix of international and local educators, are running Cambodia Communication Institute as a journalism training center, and have regularly been organizing workshops for working professionals in such topics as online blogging, community media, journalism for peace and development, and documentary production.
DW Akademie is Germany’s leading organization for international media development. Our experts have been supporting and developing free and independent media since 1965.
We support the development of free and transparent media systems, quality journalism and advanced media skills. We conduct long-term projects in Africa, Asia, Europe, Latin America, the Middle East and Central Asia and work closely with local partners. DW Akademie focuses on professionalizing media workers and managers, and training up-and-coming journalists.
We offer intercultural and professional media training workshops in our centers in Bonn and Berlin, as well as traineeships for future DW journalists. DW Akademie also established the “International Media Studies” Master’s program in 2009 which combines the areas of media development, media management, journalism and communications.
Mass Communication takes specialist areas which are normally studied in isolation and combines them in ways that offer an abundance of choice. You will develop your own program of study to meet your own specific interests and needs.
This course will enable you to think and study across more than one area in the rapidly expanding world of media and corporate communication. It will provide you with the key technological skills and knowledge for work in corporate media and communication fields, with breadth across a number of disciplines.
Your learning in your chosen streams will be underpinned by core studies in theory, ethics and critique of media, communication and information.
At the Singapore crossroads, communication teachers and scholars from around the world have coverged to form an outstanding faculty.
The school has a faculty that takes teaching seriously, pursues individual and collaborative research and creativity activity and builds ties with the media and Information industries in Singapore and beyond.
It was on January 2001 that I founded College of Journalism and Mass Communication (CJMC) with mere $250 and started courses at the Master’s level in Mass Communication and Journalism (MA MCJ), Masters in Development communication and Bachelor’s in Mass Communication and Journalism (BA MCJ) – the first by a private college – and we take pride in the fact that it remains the only college focusing entirely on media education in the country. We are pleased to say that around 400 of our graduates and post-graduates are serving the nation as media communication professionals.

tokenized:
The global media economy is being transformed . With major changes in the way stories are produced , circulated and consumed , today ’s visual journalists and storytellers need new skills to meet the challenges and take advantage of new opportunities . Students on the MA in International Multimedia Journalism learn how the new media economy works and develop high - level skills in audio , photography , video , writing , infographics , social media and editing . Based in Beijing , China , with the degree awarded by the University of Bolton in the UK , the MA in International Multimedia Journalism offers a unique , cosmopolitan approach to visual storytelling .
 The School of Journalism and Communication at Tsinghua University was founded in April 2002 . Inheriting Tsinghua ’s tradition of comprehensive and interdisciplinary education , TSJC aims to give students world - class journalism and communication education guided by advanced educational concepts and international standards . Every year , hundreds of graduates leave TSJC to take top - level journalism and communication jobs in and outside China . Students at TSJC are offered abundant opportunities to not only sharpen their professional skills , but also develop acute social responsibility crucial for their future success .
 In line with programs at Columbia University and the University of Missouri , the School of Journalism and Communication has developed a“fundamental but practical ” curriculum , with international and practice - oriented features . It has adopted the “ Platform Module ” curricular system used worldwide and offers small - group classes , along with both English - immersion and bilingual courses . A four - year program of Journalistic English is currently being developed . Against the backdrop of globalization , the School is committed to training high - caliber professional journalists with an international outlook , strong communication skills , mastery of modern broadcasting technology , and an innovative spirit .
 The School of International Journalism at Shanghai International Studies University trains and educates students to become accomplished journalistic professionals , and prepares them with foreign language and journalistic skills as well as a global vision to achieve quality journalism practices in media organizations both in China and beyond .
 The School has cherished a global teaching and research tradition within the Chinese journalism system that was started in 1983 when the Program of International Journalism was set up as the first multi - disciplinary program at this language university and has since become one of the top - notch international journalism programs in China .
 The School offers two undergraduate degree programs and one MA degree programs . The undergraduate degree programs include International Journalism and Internet & New Media , which will start enrollment in September 2014 . Its MA program has concentrated on global communication theories , English news writing and editing as well as global public opinion & media . During the past three decades the School has educated more than 1000 graduates and prided itself on their competence , devotion and reputation showcased in the media community in Shanghai , China and the world .
 Amid innovations spawned by digital technology , heightened restraints to press freedom , and the surge in news and issues with cross - border ramifications , the idea of reviving “ pure ” journalism education emerged in the agenda of the Ateneo de Manila University . Added impetus came from the Konrad Adenauer Foundation , which has an international reputation for development work in emerging democracies . Seeking to help raise the standards of Asian journalism , the foundation entrusted the Ateneo , a long - time partner in social development , with its regional journalism training program . In June 2000 , the Konrad Adenauer Center for Journalism at the Ateneo de Manila University was inaugurated . It was envisioned as a hub of journalism education in the region , an oasis of learning for working journalists . In May 2006 , “ Asian ” was added to the center ’s name to accurately reflect the true geographical scope of its mandate .
 Today , the Konrad Adenauer Asian Center for Journalism at the Ateneo de Manila University ( ACFJ ) promotes good journalism by providing training to and educational opportunities for working journalists in Asia .
 The Asian Institute of Journalism and Communication ( AIJC ) is a Knowledge Management Center organized in 1980 as a graduate school of journalism , founded on the philosophy that communication is a vital development resource to be used to advance the common good .
 Today AIJC has a solid record of more than thirty years in the communication field – as a graduate school for communicators and journalists , a center for continuing education in journalism , communication , and knowledge management , and a research and consulting firm advocating policies and implementing programs and projects that address development issues and concerns both at the levels of national decision - making and community - based initiatives .
 The name Pathshala comes from the ancient education system that prevailed in South Asia . It brings to mind classes held underneath a large tree ; conjuring up learning spaces without walls , in the cool shade of its leaves . The South Asian Media Institute not only allows students to explore the world of image making but provides them opportunities to question beyond the confines of the discipline . The conceptual absence of classroom walls enables 1st year students and 3rd year students to attend the same classes and work together on collaborative projects together with visiting faculty . This enhances and complements each student ’s learning experience .
 The institute started in 1998 in conjunction with a three - year World Press Photo ( WPP ) educational initiative . It was launched to coincide with the Dhaka ’s annual WPP exhibition . This exhibition was also replicated in other countries like Peru , Bosnia and Zimbabwe . The British Council , The Thomson Foundation and Panos South Asia supported this initiative of WPP and Drik Picture Library Ltd. The first group of six students is now among prominent photographers whose photographs have been published in some of the leading publications worldwide . From its modest beginnings Pathshala expanded attracting students from within Bangladesh as well as outside .
 Many of the graduated photographers have become internationally renowned photographers and the number of students that have joined the World Press Photo Masterclass is unusual for any photography education in the world .
 On 22 March 2010 , Pathshala launched a new Department : Broadcast and Multimedia . This department currently offers basic training in filmmaking , cinematography , video editing , motion graphics , animation , news presentation and reporting .
 This media institute designs the courses and training programs for local and international clients : individuals , companies , and organizations . Part of the long - term plan is to disseminate our unique expertise across the region through master classes , special events , and conferences focused on the issues faced by journalists and media professionals in South Asia .
 The photography department of Counter Foto was born on November 23 , 2012 . But within such a short period of time , it has become the most sought after school as the good words about its world class teaching system is spreading around . Having many Master photographers of the world involved in the teaching faculty , the photography department has more than twenty local teachers all of whom are crème de la crème of Bangladeshi Photography .
 Journalism was the first course offered by the Department of Communication when it was founded in 1968 , and remains the best - known course in the University . The course became a Department of its own within the new School of Communication in 1991 . Today the Department of Journalism offers three concentrations in its three - year undergraduate programme : Chinese Journalism , International Journalism and Broadcast Journalism .
 The programme ’s special characteristic is that it emphasises both theory and practice , covering professional journalistic knowledge , academic subjects , critical thinking , analytical skills and media ethics . Graduates of the Journalism programme fill many leadership roles in the Hong Kong media industry and the Department continues to be an important and valued source of recruits to the journalism profession .
 Creative Media is all about human creativity responding to the technological , social and environmental challenges of our time . It is a catalyst for new synergies across the sciences , arts , and humanities . By experiencing and thinking in new ways , creative media provides students with a dynamic and responsible context for innovation in a digital world . It creates promise and gives meaning to our lives .
 City University of Hong Kong ’s School of Creative Media is recognized to be an international hub for discovery and innovation in Asia . Here creativity is nurtured as a cornerstone of Hong Kong ’s social and economic advancement in the 21st Century . It is a place where students from across the globe can encounter the wealth of opportunity afforded by digital media , and where graduates attain those artistic , intellectual and technical skills that enable them to take positions of creative leadership in a global society .
 The Journalism and Media Studies Centre brings professional journalism education to Hong Kong ’s premier university , creating an environment for vibrant interaction among students from Hong Kong , mainland China , Asia and the rest of the world .
 The curriculum , with instruction in English , is designed to produce graduates for all types of local , regional and international media , whether the graduates ultimately practice in English , Chinese , or some other language .
 From day one , students develop convergent skills enabling them operate comfortably in all aspects of the industry , ranging from print , audio , video , multi - media to online journalism .
 In 2006 , we drew on the success of our Thai language program to enact an international English program , known as the Bachelor ’s of Arts program in Journalism and Mass Media , or B.J.M. Even in this short time , our graduates and current students have won prestigious awards , they have been accepted at top graduate programs throughout the globe – in countries such as the US , UK , France , Korea , to name a few – and our graduates have also made profound impacts at top print and broadcast media companies , as well as advertising agencies , and PR and marketing firms .
 We are proud of our achievements thus far , but we will not rest on our laurels as we continue to work hard to provide our students the best education we can . We boast top - notch modern facilities and excellent professors to ensure that our graduates have the proper foundation to enjoy flourishing careers in whatever area they choose , along with a deep academic knowledge , a useful skill set , and a strong moral compass . And as the world of communication and media studies continues to develop through technological advances , we continue to stay ahead of the curve so our students are prepared to become thought and communication leaders in society .
 The Graduate School of Journalism seeks to cultivate professionals with a practical approach to ethics , knowledge and technology . It aims to produce outstanding journalists who distinguish themselves in terms of specialized knowledge , who are able to promote public communication and thereby create a bridge between specialized knowledge and civil society . At the same time , the Graduate School of Journalism cultivates those who will promote journalism - related research and those who will instruct future generations of researchers and journalists .
 Today , communication is getting increasingly digitalized and diversified while culture and knowledge based products are dominating the world ’s market . By studying and teaching the theories and practice of communication , the Graduate School of Mass Communication strives to nurture journalists who will lead in setting up a desirable journalism culture in Korea . The school also gives re - education to professional journalists on the rapidly changing media environment .
 The ACJ Programme seeks to combine the “ How To ” aspect of journalism with a critical and reflective “ Why ” perspective which enables the young journalist to keep up with the demands made by a dynamic work environment and , as importantly , by a changing society .
 The Department of Media and Communication ( DMC ) was established in 2001 , under the Royal University of Phnom Penh , primarily as an academic training ground for journalists and communication practitioners . Since its inception , DMC has received funding from Konrad Adenauer Foundation and technical support from German Development Service ( DED ) , German Academic Exchange Program ( DAAD ) , Ohio University , Mittweida University , University of Hamburg , Ateneo de Manila University , and DW . Throughout the years , DMC has evolved from merely a school for undergraduate course in media and communication into a more dynamic institute in terms of teaching and learning , social issues , and research . We have at the moment a balanced mix of international and local educators , are running Cambodia Communication Institute as a journalism training center , and have regularly been organizing workshops for working professionals in such topics as online blogging , community media , journalism for peace and development , and documentary production .
 DW Akademie is Germany ’s leading organization for international media development . Our experts have been supporting and developing free and independent media since 1965 .
 We support the development of free and transparent media systems , quality journalism and advanced media skills . We conduct long - term projects in Africa , Asia , Europe , Latin America , the Middle East and Central Asia and work closely with local partners . DW Akademie focuses on professionalizing media workers and managers , and training up - and - coming journalists .
 We offer intercultural and professional media training workshops in our centers in Bonn and Berlin , as well as traineeships for future DW journalists . DW Akademie also established the “ International Media Studies ” Master ’s program in 2009 which combines the areas of media development , media management , journalism and communications .
 Mass Communication takes specialist areas which are normally studied in isolation and combines them in ways that offer an abundance of choice . You will develop your own program of study to meet your own specific interests and needs .
 This course will enable you to think and study across more than one area in the rapidly expanding world of media and corporate communication . It will provide you with the key technological skills and knowledge for work in corporate media and communication fields , with breadth across a number of disciplines .
 Your learning in your chosen streams will be underpinned by core studies in theory , ethics and critique of media , communication and information .
 At the Singapore crossroads , communication teachers and scholars from around the world have coverged to form an outstanding faculty .
 The school has a faculty that takes teaching seriously , pursues individual and collaborative research and creativity activity and builds ties with the media and Information industries in Singapore and beyond .
 It was on January 2001 that I founded College of Journalism and Mass Communication ( CJMC ) with mere $ 250 and started courses at the Master ’s level in Mass Communication and Journalism ( MA MCJ ) , Masters in Development communication and Bachelor ’s in Mass Communication and Journalism ( BA MCJ ) – the first by a private college – and we take pride in the fact that it remains the only college focusing entirely on media education in the country . We are pleased to say that around 400 of our graduates and post - graduates are serving the nation as media communication professionals .


text:
FILE — Michael Larobina, Director of Legal Affairs.
STAMFORD -- Director of Legal Affairs Michael Larobina defended his handling of legal issues related to the ongoing ethics proceedings and explained the city's settlement with former Board of Finance Chairman Joe Tarzia during a meeting with city representatives last week.
Larobina appeared before the Board of Representatives Legislative and Rules Committee on April 25 to explain the February arrangement that resulted in Tarzia's abrupt resignation from public office. Tarzia, first elected to the Board of Finance in 1987, had been battling several ethics violation charges at the time of his departure.
One charge, filed by Human Resources Generalist Tania Barnes in April 2010, alleged Tarzia asked two city employees, Director of Operations Ernie Orgera and Parks Superintendent Mickey Docimo, to intervene in the disciplining of a vehicle maintenance worker.
Another complaint, filed by City Fleet Manager Michael Scacco, alleged Tarzia, along with City Rep. Sal Gabriele, R-16, and Republican finance board member Bob Kolenberg, "led a campaign of harassment and retaliation" against him after he attempted to discipline city equipment mechanic James Fasoli.
The city's deal with Tarzia ended public ethics hearings on the complaints. The arrangement was a settlement of a federal lawsuit Tarzia had filed against the city in October 2010, Larobina said.
An ethical dilemma: Who should pay?
Tarzia was paid $45,000 in exchange for dropping the lawsuit, resigning from municipal office, and withdrawing all ethics complaints and Freedom of Information requests he had filed.
"In my mind, it was simply a question of stemming the hemorrhaging of taxpayer dollars to defend and pay legal fees to outside counsel to defend this frivolous lawsuit, that, in our opinion had no merit," Larobina said. "The decision was that we would spend more money litigating and defending this suit than we would to settle it. And we do that every day. We settle lawsuits every day."
Committee Chair Eileen Heaphy asked Larobina how much money he estimated the settlement saved taxpayers.
"I'm sure that we would have expended at least twice or three times the amount of what we paid out in legal fees," Larobina said. "The case really hadn't gone very far at that point. We spent a significant amount of money."
A breakdown of the more than $130,000 Stamford has spent on legal fees related to the past year's ethics proceedings shows the city paid the Law Office of Byelas & Neigher $42,390 for legal representation related to the federal lawsuit, in addition to the $45,000 settlement. It also spent an estimated $30,000 on legal fees incurred by the Board of Ethics in connection with the complaint filed against Tarzia and Kolenberg.
Arthur Layton, the committee vice chair, asked Larobina if the settlement stipulated Tarzia could not run for municipal office again or speak adversely about the city following his resignation. Larobina said the agreement did not include these requirements.
City Rep. Jay Fountain, D-7, asked about the status of the ethics complaints filed against Tarzia. Larobina said they had been withdrawn.
"Contrary to what some people have suggested, if you look at the ordinance, the Board of Ethics only has what we call in the law jurisdiction over individuals if they are a city employee, officer or elected official," Larobina said. "Once you cease to become one of those things, the board has no jurisdiction over you."
The Stamford Code of Ethics section on "continuing investigations," however, gives the Board of Ethics jurisdiction to pursue ethics inquiries even after the person in question has left a position with the city.
"If an officer or employee under investigation leaves office or employment, the Board by a majority vote shall have the power to continue the investigation," the Code says.
Heaphy said she was glad Larobina clarified the circumstances surrounding the settlement.
"I think that the important thing was getting it on the record and in the open," she said. "I think they did a fair and honest job with it. They came to a conclusion that saved the city a lot more problems, so I have to say that was wise on their part."
City Rep. Harry Day, R-13, said he was happy with Larobina's explanation.
"I'm a lawyer also and if I had been in Mike's shoes, I would have done exactly what he did," Day said. "It was a deal that was premised on here we are, and let's just resolve where we are. It didn't look back, it didn't look forward. It just resolved what was in front of them."
Larobina also answered questions from committee remembers regarding his department's stance on providing legal representation to city officials accused of ethics violations. Last spring, the city paid $3,000 for an attorney for Tarzia before deciding he would be responsible for his own legal fees unless he was cleared of the ethics charges against him.
"Initially Mr. Tarzia made a demand for his legal representation to be paid by the city," Larobina said. "Our initial position was that we would do that. Upon my insistence, I gathered the senior attorneys in the law department and asked for further research on this matter."
Larobina said he spent four or five hours researching the issue with three other attorneys in his office. They concluded the city was not legally obligated to provide upfront legal representation for city officials accused of ethics violations.
"We made a decision to change course," he said. "Practicing attorneys do this all the time. You take a position, you do further research, you reflect and you decide that you're going to go in a different direction."
City Rep. John Zelinsky, D-11, said he was concerned volunteer elected officials would be deterred from serving on Stamford boards and commissions if they felt they could be liable for large legal expenses.
"What's to stop somebody from filing an ethics complaint against anybody ... and we have to go out and retain an attorney to defend us possibly in a suit that really has no merit?" Zelinsky said.
Larobina said the issue would need to be taken up with the state Legislature.
"As your legal representation, let me tell you what your options are," he said. "You need to address this with the Connecticut General Assembly. Those are your options."
Board of Ethics Chair Dan Young said Wednesday he intends to address the subject at Thursday's meeting, which will be held in part to discuss possible recommendations for improvements to the ethics code.
"I don't know what other board members will think, but I intend to raise the issue of whether we should recommend to the Board of (Representatives) that they make a rule about when/whether participants get their attorneys' fees paid for," Young said in an email.
Thursday's Board of Ethics meeting will be held at 7 p.m. in the Board of Representatives, legislative chambers at the Government Center. It is open to the public.
Staff Writer Kate King can be reached at kate.king@scni.com or at 203-964-2263.

tokenized:
FILE — Michael Larobina , Director of Legal Affairs .
 STAMFORD -- Director of Legal Affairs Michael Larobina defended his handling of legal issues related to the ongoing ethics proceedings and explained the city 's settlement with former Board of Finance Chairman Joe Tarzia during a meeting with city representatives last week .
 Larobina appeared before the Board of Representatives Legislative and Rules Committee on April 25 to explain the February arrangement that resulted in Tarzia 's abrupt resignation from public office . Tarzia , first elected to the Board of Finance in 1987 , had been battling several ethics violation charges at the time of his departure .
 One charge , filed by Human Resources Generalist Tania Barnes in April 2010 , alleged Tarzia asked two city employees , Director of Operations Ernie Orgera and Parks Superintendent Mickey Docimo , to intervene in the disciplining of a vehicle maintenance worker .
 Another complaint , filed by City Fleet Manager Michael Scacco , alleged Tarzia , along with City Rep. Sal Gabriele , R-16 , and Republican finance board member Bob Kolenberg , " led a campaign of harassment and retaliation " against him after he attempted to discipline city equipment mechanic James Fasoli .
 The city 's deal with Tarzia ended public ethics hearings on the complaints . The arrangement was a settlement of a federal lawsuit Tarzia had filed against the city in October 2010 , Larobina said .
 An ethical dilemma : Who should pay ?
 Tarzia was paid $ 45,000 in exchange for dropping the lawsuit , resigning from municipal office , and withdrawing all ethics complaints and Freedom of Information requests he had filed .
 " In my mind , it was simply a question of stemming the hemorrhaging of taxpayer dollars to defend and pay legal fees to outside counsel to defend this frivolous lawsuit , that , in our opinion had no merit , " Larobina said . " The decision was that we would spend more money litigating and defending this suit than we would to settle it . And we do that every day . We settle lawsuits every day . "
 Committee Chair Eileen Heaphy asked Larobina how much money he estimated the settlement saved taxpayers .
 " I 'm sure that we would have expended at least twice or three times the amount of what we paid out in legal fees , " Larobina said . " The case really had n't gone very far at that point . We spent a significant amount of money . "
 A breakdown of the more than $ 130,000 Stamford has spent on legal fees related to the past year 's ethics proceedings shows the city paid the Law Office of Byelas & Neigher $ 42,390 for legal representation related to the federal lawsuit , in addition to the $ 45,000 settlement . It also spent an estimated $ 30,000 on legal fees incurred by the Board of Ethics in connection with the complaint filed against Tarzia and Kolenberg .
 Arthur Layton , the committee vice chair , asked Larobina if the settlement stipulated Tarzia could not run for municipal office again or speak adversely about the city following his resignation . Larobina said the agreement did not include these requirements .
 City Rep. Jay Fountain , D-7 , asked about the status of the ethics complaints filed against Tarzia . Larobina said they had been withdrawn .
 " Contrary to what some people have suggested , if you look at the ordinance , the Board of Ethics only has what we call in the law jurisdiction over individuals if they are a city employee , officer or elected official , " Larobina said . " Once you cease to become one of those things , the board has no jurisdiction over you . "
 The Stamford Code of Ethics section on " continuing investigations , " however , gives the Board of Ethics jurisdiction to pursue ethics inquiries even after the person in question has left a position with the city .
 " If an officer or employee under investigation leaves office or employment , the Board by a majority vote shall have the power to continue the investigation , " the Code says .
 Heaphy said she was glad Larobina clarified the circumstances surrounding the settlement .
 " I think that the important thing was getting it on the record and in the open , " she said . " I think they did a fair and honest job with it . They came to a conclusion that saved the city a lot more problems , so I have to say that was wise on their part . "
 City Rep. Harry Day , R-13 , said he was happy with Larobina 's explanation .
 " I 'm a lawyer also and if I had been in Mike 's shoes , I would have done exactly what he did , " Day said . " It was a deal that was premised on here we are , and let 's just resolve where we are . It did n't look back , it did n't look forward . It just resolved what was in front of them . "
 Larobina also answered questions from committee remembers regarding his department 's stance on providing legal representation to city officials accused of ethics violations . Last spring , the city paid $ 3,000 for an attorney for Tarzia before deciding he would be responsible for his own legal fees unless he was cleared of the ethics charges against him .
 " Initially Mr. Tarzia made a demand for his legal representation to be paid by the city , " Larobina said . " Our initial position was that we would do that . Upon my insistence , I gathered the senior attorneys in the law department and asked for further research on this matter . "
 Larobina said he spent four or five hours researching the issue with three other attorneys in his office . They concluded the city was not legally obligated to provide upfront legal representation for city officials accused of ethics violations .
 " We made a decision to change course , " he said . " Practicing attorneys do this all the time . You take a position , you do further research , you reflect and you decide that you 're going to go in a different direction . "
 City Rep. John Zelinsky , D-11 , said he was concerned volunteer elected officials would be deterred from serving on Stamford boards and commissions if they felt they could be liable for large legal expenses .
 " What 's to stop somebody from filing an ethics complaint against anybody ... and we have to go out and retain an attorney to defend us possibly in a suit that really has no merit ? " Zelinsky said .
 Larobina said the issue would need to be taken up with the state Legislature .
 " As your legal representation , let me tell you what your options are , " he said . " You need to address this with the Connecticut General Assembly . Those are your options . "
 Board of Ethics Chair Dan Young said Wednesday he intends to address the subject at Thursday 's meeting , which will be held in part to discuss possible recommendations for improvements to the ethics code .
 " I do n't know what other board members will think , but I intend to raise the issue of whether we should recommend to the Board of ( Representatives ) that they make a rule about when / whether participants get their attorneys ' fees paid for , " Young said in an email .
 Thursday 's Board of Ethics meeting will be held at 7 p.m. in the Board of Representatives , legislative chambers at the Government Center . It is open to the public .
 Staff Writer Kate King can be reached at kate.king@scni.com or at 203 - 964 - 2263 .


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Two Asian Carp species, Silver and Bighead Carp were imported from China in the 1970’s escaped from their pens at fish farms in Arkansas and Kentucky. Because of how much the carp eat and how quickly they grow and reproduce, the foreign carp wreak havoc on the foreign eco-systems in the United States.
The Asian Carp eat plankton and algae that native fish and organisms need to survive. These native organisms have a hard time competing with these carp for survival. The Asian Carp have disrupted the Mississippi and Illinois rivers and other waterways in the region. The Asian Carp are making there way towards the Great Lakes, threatening one of the United States most valuable water resources.
The Resources Defense Council would like to erect barriers to separate Chicago waterways and Lake Michigan from the Mississippi to keep the Carp out. No major action can be taken until the U.S. Army Corps of Engineers releases its comprehensive study into the blockage of aquatic pathways between the Great Lakes and the Mississippi. The findings are due out in 2015.

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Two Asian Carp species , Silver and Bighead Carp were imported from China in the 1970 ’s escaped from their pens at fish farms in Arkansas and Kentucky . Because of how much the carp eat and how quickly they grow and reproduce , the foreign carp wreak havoc on the foreign eco - systems in the United States .
 The Asian Carp eat plankton and algae that native fish and organisms need to survive . These native organisms have a hard time competing with these carp for survival . The Asian Carp have disrupted the Mississippi and Illinois rivers and other waterways in the region . The Asian Carp are making there way towards the Great Lakes , threatening one of the United States most valuable water resources .
 The Resources Defense Council would like to erect barriers to separate Chicago waterways and Lake Michigan from the Mississippi to keep the Carp out . No major action can be taken until the U.S. Army Corps of Engineers releases its comprehensive study into the blockage of aquatic pathways between the Great Lakes and the Mississippi . The findings are due out in 2015 .


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throughout Latin America to prepare trip packages for individuals traveling to Brazil for the World Cup and Olympics.
You have been recruited by a new travel agency, Latin American Expeditions, to prepare a Latin American trip package. The packages must highlight the country’s physical characteristics, historical landmarks, cultural heritage, and modern life. You may select from the provided countries. Your purpose is to expose tourists to the variety of land and human characteristics that make the countries throughout Latin America unique. Tourists may also discover some of the challenges Latin Americans face.
Once you’ve determined your packages, you will prepare a brochure to share them with potential customers. Your final task is to present your trip packages to the agency’s leaders and persuade them to offer your packages to customers.
You will find specific directions for how to complete these tasks on the Process 1 or Process 2 pages.

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throughout Latin America to prepare trip packages for individuals traveling to Brazil for the World Cup and Olympics .
 You have been recruited by a new travel agency , Latin American Expeditions , to prepare a Latin American trip package . The packages must highlight the country ’s physical characteristics , historical landmarks , cultural heritage , and modern life . You may select from the provided countries . Your purpose is to expose tourists to the variety of land and human characteristics that make the countries throughout Latin America unique . Tourists may also discover some of the challenges Latin Americans face .
 Once you ’ve determined your packages , you will prepare a brochure to share them with potential customers . Your final task is to present your trip packages to the agency ’s leaders and persuade them to offer your packages to customers .
 You will find specific directions for how to complete these tasks on the Process 1 or Process 2 pages .


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How to impress girl in 10 seconds.
How to Improve Business Efficiency?
How to Improve Kidney Function - Eat These 5 Super foods for Healthy.

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How to impress girl in 10 seconds .
 How to Improve Business Efficiency ?
 How to Improve Kidney Function - Eat These 5 Super foods for Healthy .


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856-881-3185 x8025 SKU: AJL222 ITEM TITLE McGill Style 2″ Cam FolloLion Bearing Industrial Co.ltdr Bearing CF-2-SB Brand: Generic Condition: New Model: CF-2-SB Lot# AJL222 C31 & 20.4.C MPN: 658306 Lion Bearing Industrial Co.ltd strive to deliver 5-star customer service, Bid with confidence! • Orders paid for by 2:00 EST will ship same day. Lion Bearing Industrial Co.ltd ship UPS & USPS Priority Mail. Lion Bearing Industrial Co.ltd can ship DHL if requested. If you provide yLion Bearing Industrial Co.ltd account number Lion Bearing Industrial Co.ltd can ship UPS or DHL collect. • Large/bulky items will ship Truck Freight. Contact us for rate quotes. Freight items typically ship within 1 day. Must ship to a commercial address with forklift. If you cannot provide a commercial address you can pickup at the local freight terminal. You are Lion Bearing Industrial Co.ltdlcome to use yLion Bearing Industrial Co.ltd own carrier as Lion Bearing Industrial Co.ltdll. • All items are located in Glassboro, NJ. – You are Lion Bearing Industrial Co.ltdlcome to pickup there, from 7:30-4:00 M-F & SAT 8-11:30. Please call ahead so Lion Bearing Industrial Co.ltd can have it ready.• SHIPPING WILL NOT TAKE PLACE UNTIL PAYMENT IS RECEIVED. • ATTENTION INTERNATIONAL BUYERS: Please provide a phone number and shipping address. Please Do not forget about any additional charges which are charged by the carrier. This is something Lion Bearing Industrial Co.ltd have no control over and is an additional charge to the shipping. Lion Bearing Industrial Co.ltd DO NOT ACCEPT RETURNS. ITEMS ARE SOLD “AS IS”. IF FOR SOME REASON YOU RECEIVE SOMETHING THAT DOSENT RESEMBLE THE PHOTOS AND DESCRIPTION IN THE LISTING Lion Bearing Industrial Co.ltd WILL MAKE AN EXCEPTION. • Auctions Without A Bid May End At Any Time As The Items Are Also For Sale At Lion Bearing Industrial Co.ltd Local Facilities. • Lion Bearing Industrial Co.ltd Accept Paypal Payments And Credit Cards Visa / Master Card / Discover. For large purchases please request wire transfer instructions. PLEASE NOTE THAT Lion Bearing Industrial Co.ltd ARE NOT AN AUTHORIZED DEALER FOR ANY OF THE ITEMS Lion Bearing Industrial Co.ltd LIST ON EBAY. THEREFORE Lion Bearing Industrial Co.ltd DO NOT GUARANTEE THAT THE ITEM FEATURED IN THIS LISTING WILL BE COVERED BY THE MANUFACTURER’S WARRANTY OR SUPPORT. HOLion Bearing Industrial Co.ltdVER, CUSTOMER SATISFACTION IS VERY IMPORTANT TO US. PLEASE FEEL FREE TO SEND US AN EMAIL OR A MESSAGE THROUGH EBAY WITH ANY QUESTIONS, COMMENTS, OR CONCERNS. • Buyers: Check Lion Bearing Industrial Co.ltd Feedback And Bid With Confidence. Should A Problem Arise Please Contact Us Before Leaving Neutral Or Negative Feedback; This Will Allow Us To Work With The Buyer To Resolve Any Problems. • BY PHONE: Call 856 881-3185 x8025, Monday thru Friday 8:00 am to 4:00 pm EST, to speak with a Customer Service representative who can help you with any questions regarding yLion Bearing Industrial Co.ltd order.• BY FAX: Fax you concerns to 856 881-6150. • BY MAIL: Write to: Joseph Fazzio, Inc. Surplus Department, 2760 Glassboro-Cross Keys Rd., Glassboro, NJ 08028. • eBay Message: Messages are typically ansLion Bearing Industrial Co.ltdred within 2 business days. Note: Never send credit card data in an email. If yLion Bearing Industrial Co.ltd email is regarding an issue that requires yLion Bearing Industrial Co.ltd credit card data, provide yLion Bearing Industrial Co.ltd telephone number and Lion Bearing Industrial Co.ltd will contact you to better serve yLion Bearing Industrial Co.ltd issues/concerns. Ebay Sales – Send a message for anything related to Ebay sales. Be sure to add us to yLion Bearing Industrial Co.ltd favorites list!
BOYA Singapore is an international trading Lion Bearing Industrial Co.ltd specialized in importing and exporting bearing and industrial machinery and equipment parts. In the industrial fields,Lion Bearing Industrial Co.ltd have 20 years’ experience of McGill Style 2" Cam FolloLion Bearing Industrial Co.ltdr Bearing CF-2-SB supporting and industrial service.

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856 - 881 - 3185 x8025 SKU : AJL222 ITEM TITLE McGill Style 2″ Cam FolloLion Bearing Industrial Co.ltdr Bearing CF-2 - SB Brand : Generic Condition : New Model : CF-2 - SB Lot # AJL222 C31 & 20.4.C MPN : 658306 Lion Bearing Industrial Co.ltd strive to deliver 5 - star customer service , Bid with confidence ! • Orders paid for by 2:00 EST will ship same day . Lion Bearing Industrial Co.ltd ship UPS & USPS Priority Mail . Lion Bearing Industrial Co.ltd can ship DHL if requested . If you provide yLion Bearing Industrial Co.ltd account number Lion Bearing Industrial Co.ltd can ship UPS or DHL collect . • Large / bulky items will ship Truck Freight . Contact us for rate quotes . Freight items typically ship within 1 day . Must ship to a commercial address with forklift . If you can not provide a commercial address you can pickup at the local freight terminal . You are Lion Bearing Industrial Co.ltdlcome to use yLion Bearing Industrial Co.ltd own carrier as Lion Bearing Industrial Co.ltdll . • All items are located in Glassboro , NJ . – You are Lion Bearing Industrial Co.ltdlcome to pickup there , from 7:30 - 4:00 M - F & SAT 8 - 11:30 . Please call ahead so Lion Bearing Industrial Co.ltd can have it ready.• SHIPPING WILL NOT TAKE PLACE UNTIL PAYMENT IS RECEIVED . • ATTENTION INTERNATIONAL BUYERS : Please provide a phone number and shipping address . Please Do not forget about any additional charges which are charged by the carrier . This is something Lion Bearing Industrial Co.ltd have no control over and is an additional charge to the shipping . Lion Bearing Industrial Co.ltd DO NOT ACCEPT RETURNS . ITEMS ARE SOLD “ AS IS ” . IF FOR SOME REASON YOU RECEIVE SOMETHING THAT DOSENT RESEMBLE THE PHOTOS AND DESCRIPTION IN THE LISTING Lion Bearing Industrial Co.ltd WILL MAKE AN EXCEPTION . • Auctions Without A Bid May End At Any Time As The Items Are Also For Sale At Lion Bearing Industrial Co.ltd Local Facilities . • Lion Bearing Industrial Co.ltd Accept Paypal Payments And Credit Cards Visa / Master Card / Discover . For large purchases please request wire transfer instructions . PLEASE NOTE THAT Lion Bearing Industrial Co.ltd ARE NOT AN AUTHORIZED DEALER FOR ANY OF THE ITEMS Lion Bearing Industrial Co.ltd LIST ON EBAY . THEREFORE Lion Bearing Industrial Co.ltd DO NOT GUARANTEE THAT THE ITEM FEATURED IN THIS LISTING WILL BE COVERED BY THE MANUFACTURER ’S WARRANTY OR SUPPORT . HOLion Bearing Industrial Co.ltdVER , CUSTOMER SATISFACTION IS VERY IMPORTANT TO US . PLEASE FEEL FREE TO SEND US AN EMAIL OR A MESSAGE THROUGH EBAY WITH ANY QUESTIONS , COMMENTS , OR CONCERNS . • Buyers : Check Lion Bearing Industrial Co.ltd Feedback And Bid With Confidence . Should A Problem Arise Please Contact Us Before Leaving Neutral Or Negative Feedback ; This Will Allow Us To Work With The Buyer To Resolve Any Problems . • BY PHONE : Call 856 881 - 3185 x8025 , Monday thru Friday 8:00 am to 4:00 pm EST , to speak with a Customer Service representative who can help you with any questions regarding yLion Bearing Industrial Co.ltd order.• BY FAX : Fax you concerns to 856 881 - 6150 . • BY MAIL : Write to : Joseph Fazzio , Inc. Surplus Department , 2760 Glassboro - Cross Keys Rd . , Glassboro , NJ 08028 . • eBay Message : Messages are typically ansLion Bearing Industrial Co.ltdred within 2 business days . Note : Never send credit card data in an email . If yLion Bearing Industrial Co.ltd email is regarding an issue that requires yLion Bearing Industrial Co.ltd credit card data , provide yLion Bearing Industrial Co.ltd telephone number and Lion Bearing Industrial Co.ltd will contact you to better serve yLion Bearing Industrial Co.ltd issues / concerns . Ebay Sales – Send a message for anything related to Ebay sales . Be sure to add us to yLion Bearing Industrial Co.ltd favorites list !
 BOYA Singapore is an international trading Lion Bearing Industrial Co.ltd specialized in importing and exporting bearing and industrial machinery and equipment parts . In the industrial fields , Lion Bearing Industrial Co.ltd have 20 years ’ experience of McGill Style 2 " Cam FolloLion Bearing Industrial Co.ltdr Bearing CF-2 - SB supporting and industrial service .


text:
ORTHO EVRA 21 Day is a small, thin patch that is placed on the skin for the purpose of contraception. The patch slowly releases small amounts of the hormones estrogen and progesterone, which are then absorbed through the skin. These hormones have the effect of suppressing ovulation, thickening the cervical mucus, and changing the uterine lining. These combined effects make the ORTHO EVRA patch as much as 99% effective at preventing pregnancy when it is used correctly.
The ORTHO EVRA patch is used as follows: it is applied on the first day of your menstrual cycle or the first Sunday following that day, whichever is preferred. From this time on, that day is considered "patch change day." When patch change day rolls around the following week, the first patch is removed and replaced with another. This happens once more. On the fourth patch change day the patch is removed and left off for one week, until the next patch change day when the cycle begins again.
The ORTHO EVRA 21 Day can be applied to your buttocks, thigh, upper arm, abdomen, or upper torso. DO NOT apply the ORTHO EVRA patch to your breasts. You should apply the patch directly to the skin and press for 10 seconds to make sure it is securely in place.
The ORTHO EVRA patch should not affect your daily activities. You can swim, bathe, shower, and exercise without worry, though it is a good idea to check the patch every day to ensure it is still in place, particularly after more strenuous activities.
Patch side effects can include nausea or vomiting, breast discomfort or pain, headache, nausea, or upper respiratory tract infection.
ORTHO EVRA 21 Day, also known as the pregnancy patch is available right here, with a prescription, at BirthControlBuzz.com. We are proud members of CIPA, (the Canadian International Pharmacy Association) and maintain strict safety standards. That’s why we ask for a prescription when you buy birth control such as the ORTHO EVRA 21 Day from BirthControlBuzz.com. Online pharmacies that sell the ortho evra patch without a prescription should be avoided for safety reasons: they are not likely associated with a licensed pharmacy. However, when you buy birth control like ORTHO EVRA 21 Day at BirthControlBuzz.com, you can rest assured that you are buying from the best!
Aside from the fact that BirthControlBuzz.com is a safe and trustworthy online pharmacy offering ortho birth control at discount prices, we are also committed to customer service. That’s why our friendly staff is available toll-free at 1-866-868-8850, 7 days a week. They will be able to help you with any questions you have about the evra patch or birth control in general. The online shopping cart process as BirthControlBuzz.com is secure and will make shopping easy. There are many reasons you won’t be sorry you shopped at BirthControlBuzz.com!

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ORTHO EVRA 21 Day is a small , thin patch that is placed on the skin for the purpose of contraception . The patch slowly releases small amounts of the hormones estrogen and progesterone , which are then absorbed through the skin . These hormones have the effect of suppressing ovulation , thickening the cervical mucus , and changing the uterine lining . These combined effects make the ORTHO EVRA patch as much as 99 % effective at preventing pregnancy when it is used correctly .
 The ORTHO EVRA patch is used as follows : it is applied on the first day of your menstrual cycle or the first Sunday following that day , whichever is preferred . From this time on , that day is considered " patch change day . " When patch change day rolls around the following week , the first patch is removed and replaced with another . This happens once more . On the fourth patch change day the patch is removed and left off for one week , until the next patch change day when the cycle begins again .
 The ORTHO EVRA 21 Day can be applied to your buttocks , thigh , upper arm , abdomen , or upper torso . DO NOT apply the ORTHO EVRA patch to your breasts . You should apply the patch directly to the skin and press for 10 seconds to make sure it is securely in place .
 The ORTHO EVRA patch should not affect your daily activities . You can swim , bathe , shower , and exercise without worry , though it is a good idea to check the patch every day to ensure it is still in place , particularly after more strenuous activities .
 Patch side effects can include nausea or vomiting , breast discomfort or pain , headache , nausea , or upper respiratory tract infection .
 ORTHO EVRA 21 Day , also known as the pregnancy patch is available right here , with a prescription , at BirthControlBuzz.com . We are proud members of CIPA , ( the Canadian International Pharmacy Association ) and maintain strict safety standards . That ’s why we ask for a prescription when you buy birth control such as the ORTHO EVRA 21 Day from BirthControlBuzz.com . Online pharmacies that sell the ortho evra patch without a prescription should be avoided for safety reasons : they are not likely associated with a licensed pharmacy . However , when you buy birth control like ORTHO EVRA 21 Day at BirthControlBuzz.com , you can rest assured that you are buying from the best !
 Aside from the fact that BirthControlBuzz.com is a safe and trustworthy online pharmacy offering ortho birth control at discount prices , we are also committed to customer service . That ’s why our friendly staff is available toll - free at 1 - 866 - 868 - 8850 , 7 days a week . They will be able to help you with any questions you have about the evra patch or birth control in general . The online shopping cart process as BirthControlBuzz.com is secure and will make shopping easy . There are many reasons you wo n’t be sorry you shopped at BirthControlBuzz.com !


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Contact information of Lau & Ren Construct like detailed information (balance sheets, court cases, registered trademarks, etc.) are available only for registered members. In order to get in touch with Lau & Ren Construct or other companies included in catalog please login with your account. The active companyes are included on the Romanian-Companies CD and new features are available according the chosen access plan.
Localization of LAU & REN CONSTRUCT SRL - contact information.

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Contact information of Lau & Ren Construct like detailed information ( balance sheets , court cases , registered trademarks , etc . ) are available only for registered members . In order to get in touch with Lau & Ren Construct or other companies included in catalog please login with your account . The active companyes are included on the Romanian - Companies CD and new features are available according the chosen access plan .
 Localization of LAU & REN CONSTRUCT SRL - contact information .