text:
Plus CBD Oil Drops 750 mg Goji Berry | 2 fl oz
Plus CBD Oil drops
750 mg
2 fl oz
Goji Berry
Plus CBD Oil Drops provide an easy way to enjoy CBD. Contains cannabidiol (CBD) from agricultural hemp, they provide enhanced CBD support using the best selling Gold Formula - the highest concentration of CBD offered.
-Gluten free
-Polysorbate 80-free
-100% Vegetarian
-Tested to ensure the best quality CBD available
$89.95 Regular Price
$80.95Sale Price


text:
- Sale
- Men
- Women
- Kids
- Jewelry
- Accessories
- Home Decor
- Shop by Theme
Your Cart is Empty
$24.00 $39.00 You Save 38% ($15.00)
Beware of the attraction of these beautiful yet deadly roses, their touch can be fatal.
Red Ripped Sleeveless Top is made of Top Quality 100% Cotton, Interlock using skin friendly, Azo-free, Reactive dyes.
The original design will guarantee a LOT of compliments, and a great gift that's sure to be a hit.

subset: commoncrawl


text:
Complete slump of a day. Bad dreams. Woke when Peter did + set up breakfast but went back to bed. Went to Contour at 10 o'clock. Home + read + slept. Tried to work in office – just not able. The heat unbearable – my state of mind more so. Mary called with Edith Warner's address – flowers instead of flowers send to Gateways Hospital I looked back in my diary to see when Peter + I had met the Warners and I was appalled at the record of our fights. I must copy alot of it down I guess for Bob Iverson. Spoke with Betty Lamm. Called Doug about my flea bite itch + he said I could use taccheril (sp.) Hadn't thought I'd make dinner – the thought was so oppressive but at the last minute made a tuna casserole. Peter working on Big Valley Monday – the Good Morning World has been postponed til [crossed out word] a week from next Tuesday Jim came in briefly. I went to bed early.
Wednesday, October 18, 1967
18 Thursday Oct 2012
Posted Diary Entryin


text:
custom wristbands uk
Author:Mushroom | 2019-11-20 10:07:30 | customwristbandsuk
Women"s Guide To Acquiring Men"S Bracelets
Not as well long ago a bunch of pals have been sitting outdoors on a sizzling summer time day grabbing their cans of beer or soda from the cooler. Being a scorcher of a day, you can think about that that chilled beverage was warm inside of seconds. For the duration of that distinct day, it made us start off pondering if there was anything we could use to keep our beer chilled and not leaving it soaking in the cold icy water. We required a way to keep it cold after currently being outdoors of the cooler. I bet many of you have had that same or equivalent type of experience. Properly, from that day on we realized what we constantly required to have if we have been going to be enjoying the outdoors; it is of program beer Koozies. So we went on our hunt for more info.
The trend for rubber band bracelets is a great deal like the ones from your childhood. We had them too, but they were a bit distinct. Ours have been simply round, cool wristbands that we stacked. Although the colours did not indicate significantly at first, they took on diverse meanings down the road, some of which had been not quite wonderful. You can nevertheless get this variety in the shops if you want to relive a minor of your previous. Just bear in mind to preserve an eye on your teens who are sporting them, since the shade code is still out there, and not all of it is PG-13.
So in which do you go to order your wristbands. simply Google debossed wristbands or promotional wristbands, there"s hundreds of suppliers out there, but do store about for your ideal price.
The guys"s bracelets are seen in a whole lot of intriguing finishes. Whilst gold and silver have been close to for a long time, you will see tungsten and titanium bracelets too. Stainless steel jewelry is accessible at a good deal less than gold and silver and nevertheless looks classy and elegant on anyone. They are also accessible in leather which are loved by the youthful crowd and can be worn with casuals. A dull finish is liked by a great deal of males who don"t like their jewelry to shine too considerably.
Quality - Make confident you buy printed wristbands that are manufactured with substantial high quality silicone and not cheap choices. The ideal way to check this is to inquire for a sample ahead of you place any large order. If they will not send a sample this need to increase a red flag.
Watch out for hidden fees. Any firm worthy of your time and income will offer you free of charge setup and shipping, and will By no means charge for artwork and revisions. Make certain you"re receiving a real "what you see is what you get" value quote.
Break out the parachute pants and stock up on the Aqua Net, the 80"s are back. 1980"s style trends hit their peak 25 many years ago, but that was still current enough for you to get some rad vintage things for your costume. Just believe neon, lace, Miami Vice, rubber bracelets and massive hair and you"ll do just fine.
cheap wristbands free shippingreebok crossfit rubber braceletcustom wrist bandsbuy wristbands onlinethin silicone wristbands


text:
Name That President!
Test your knowledge of U.S. Presidents. Answer the questions before you run out of time!
Russian Greetings
Check your knowledge of greetings in Russian
Tic Tac Toe: Types of Characters in Literature
Different ypes of characters in literature
Week 2 Vocabulary: Nouns
Given the definition, spell the correct vocabulary word that matches.
Hunger Games Characters
The characters from Chapters 1-7 of The Hunger Games
3rd grade students review phonological elements and basic figurative language.
Commonly Misspelled Words
You'll practice spelling these often misspelled vocabulary words.
The American Flag
Test your knowledge of the American Flag
The Bill of Rights
You'll learn more about the U.S. Bill of Rights.
Art History Timeline Review
This game is to review information found in the Art Historical Timeline


text:
HS BOYS BASKETBALL: Former Lee guard Phelps transfers to Dallas area school
Photo: James Durbin / Midland Reporter-Telegram
Former Lee point guard Zhuric Phelps has transferred to charter school Oak Cliff Faith Family Academy for the 2019-2020 season, according to Rebels basketball coach Doug Gordon.
Phelps joins an Oak Cliff Faith Family Academy program that won the 2019 UIL Class 4A state championship with a 34-6 record. Phelps averaged 15.8 points per game, 4.4 rebounds, 3.4 assists and 3.7 steals as a sophomore and was an All-District 2-6A first-team selection for the Rebels last season.
The recruiting website rivals.com lists the 6-foot-3 Phelps with Division I offers from the University of New Mexico and U.T.-San Antonio.
"We do wish Zhuric the best," Gordon said. "We wish him well."


text:
While you may have heard derogatory jokes about lawyers before, the fact remains that they are an integral part of our society. You should still learn more about lawyers even if you do not need one right now. The following tips will help you in your decision.
Don't just choose the first lawyer you talk to. Do some research since choosing the best results. Ask as many people as you can on any lawyers you're thinking about hiring.
Ask lawyers that you are considering for a list of their fees list. The charges widely vary from lawyer to lawyer, it is best to understand the fees prior to signing any agreement.You don't want to have to dismiss an attorney late in the game because you will be paying once it is too late.
Think about what your problem really is before you look for a lawyer. You need to know if a lawyer is even necessary. For most legal cases such as divorce, divorce cases, criminal cases and financial cases usually require an attorney.
You can speak up about a situation if there's anything that you don't like. Although you lawyer wants the best for you, they also have many clients.
When choosing a lawyer, do all the research you can on their background.
Ask a lot of questions to every lawyer that you interview many questions. During your first meeting, the attorney should answer any question you may have, even if you are not being charged for it. They are responsible for making you feel comfortable with their skills. If they don't, go with your gut and move on to find someone more suitable.
Stay away from lawyers who seem overly confident about their ability to win your case is a sure thing. Any lawyer who believes this is not the best choice.
Prepare yourself for any meetings you meet with a lawyer. They charge hourly and can be expensive. Therefore, every time you call, call back for advice or talk about questions you have.
Use the power of the Internet to find the best lawyer. Most attorneys will have a presence to promote their services. Look at the website of the firm to see how professional it is. If the website looks unprofessional, then this could indicate inexperience.
A useful tip to remember if you are skeptical about your lawyer is that you can always look for a second opinion. A second opinion is a good idea before you make any big decisions.
One great way to find a good lawyer is to see what referrals your friends have. If you know folks who've used certain lawyers they've been happy with, there is a better chance that his office staff are competent and highly focused on customer service.
Just because a lawyer in the world doesn't mean they'll be right for you. You need all their professional expertise, but it is also important to remember that you are going to be spending a lot of time working with them. You need to get along personally if you wish for things to function well.
If you get frustrated with your lawyer, keep in mind that they're as interested in winning the case as you are. They have experience in situations like these and know how to get a positive result or win.
Your attorney has malpractice insurance to deal with situations where they don't follow the law to a "T." They wound't want their insurance premiums to increase, so they try not to do anything wrong. Always know that your lawyer wanting to do their best by you.
Ask the lawyer you are considering for his client list. Good lawyers have no reason to fear you checking their abilities. This information should give you determine how satisfied past clients have been.
If you are paying your attorney by the hour, make sure he keeps you informed about mounting costs so you can control your spending. You should be able to find out exactly where and how your money is being used.
You should put together some questions ready for the lawyers you are considering hiring. You might consult with them or face to face.Ask beforehand if there's a charge for the initial consultation to avoid surprise bills.
Even when your need is urgent, you should speak with a number of them prior to hiring one. Interviewing several lawyers will allow you see what you are truly looking for. It also helps you identify the lawyers is trying to rip you off.
FindLaw is one example of a popular legal directory that lists lawyers from all over the US. It is a highly reputable directory, name or location. This will help you find relevant lawyers with lawyer that is right for your needs.
Get all the details of your legal assistance in writing to be safe. Having arrangements in writing ensures that you to get the final word on things. If you don't have it in writing, you will have no way to rein your lawyer in and keep your expenses in line.
You need to contact your lawyer of any changes in your situation changes. Even if it's bad news, your lawyer needs to be able to deal with this immediately. The longer time that your lawyer has to adjust to a change, the more effective he will be.
There is no denying the fact that society requires good lawyers. Choose a lawyer who is qualified and experienced to help you. Use the given tips to find a lawyer that can represent you in your time of need.


text:
Rich guy might be miserable, too
March 15, 2017
I've got a cold. My lower back is sending red alerts and I might have to see the doctor about a possibly infected sore.
This is the wrong frame of mind for viewing the Mansion section of the Wall Street Journal, which seems to be there to remind...
For access to this article please sign in or subscribe.


text:
- Solutions
- Platform
- Customers
- Explore
At a corporate level, quality and compliance management in heavily regulated healthcare environments is a tricky endeavour.
Following GxP guidelines is often complex to interpret and even more difficult to put into practice and ensure compliance.
In this video we will explore how the world's largest healthcare organizations use Storyteller for GxP Compliance to maintain traceability, accountability and data integrity in their development projects with Blueprint.
Please fill out the form on the right to watch the video today!


text:
Spinnin' Records uses cookies to ensure that we give you the best experience on our website and its services. For more information see our cookies policy.
iyla: https://soundcloud.com/iylablue
9 comments
Hello, Good job,
I gave you my vote.
Good luck in your ranking
If you have a moment, I would appreciate it if you would review my latest track.
"Touch My Body"
Let me know what you think with a comment or a vote.
Thank you very much for your support......👍
Great Work, we just Voted (Like) your Track!
Vote (Like) & Support Us on Tujamo Contest!
Crazy song!
Congratulations !
Are you check and vote my new track "Ryan Riback's - Kinder Eyes (Kytion Remix)" ?
Thank you..Linsoh
Awesome!!!!!! I really like the drop!!!!!!!
You have my support!!!!!!!!!!!
Can you check my remix of Milion Lights, please?
I really need some feedback!!!!!!!!!
Let me know what you think with a comment!!!!!!!!
Hey Linsoh, you have my vote ! Make sure to follow my Instagram 📲 and Soundcloud 📡: @maxmaddmusic
Good luck in the contest !
I LIKE IT ! Also followed your channel! Please vote for my new track " SORRY " . Thank you. Have a nice day.
Nice, I love this one! You really did a great job!
VOTED, definitely deserved it. Can't wait to hear more from you!
You can check out my new remix "Children Of Today" and give a vote to it if you like it!
Also you can follow my SoundCloud, I'll follow back!
Thumbs up, and good luck, :))))) )))))))))))))))))))))))
Did Like me your song 🔥 you have a my vote. Support me with your vote 👍🏻 In my remix children of today (djbryanxx) thanks. 🔥
It's awesome music Linsoh. I vote for you c:
Please check out my remix on Blasterjaxx - Children Of Today. I would be glad if you vote.
If you follow me to the soundcloud, I will follow you!


text:
Tactics Requests
Hi all! Can you help me please? I'm playing agains PSG and I'm Inter Milan, he's better than me. he's playing 442A SOS with zonal and offside trap on. I'm playing home. What should I use ?
Maurimammt last edited by
you tell me training to use against a 4-3-3 B, used 4-4-2 B but it was not very useful, used the 4-5-1 and the opponent dominated the game. Thanks
sergiu il last edited by SUPERNOVA 8
@maurimammt Hey could you provide more info for example, your squad value and the opponent ? Your sliders and tactical settings also please so we can help you
@John-Turner-69 in a formation with 3 strikers, never, but never make your forwards come back if you want to score goals, I tend to play 433A Wing Play with Forwards stay - Midfield stay - attacking fullbacks (if your fullbacks are stronger than the opponent) - Zonal / No off / 78 78 78, just won 9-0 at home vs a real manager as you can see in the print screen
wooper_NL Moderator NL last edited by
@maurimammt I always use a 4231 against a 433B
Need to beat a 451 CA , what do I use ?
sergiu il last edited by
@p0intzz66 4231 SOS
John Turner 69 last edited by
@gilbert-gentania done exactly what you said mate and I played a friendly against a mate who has M.United, much worse than Liverpool. I got beat 4-0 away and 1-3 at home. Thanks but no thanks
John Turner 69 last edited by
@sergiu-il my squad value is 529m and the other day in the league I drew 1-1 away to a mate with Arsenal (308m) and yesterday I drew AT HOME 0-0 to Bournemouth (175m). Just tried your tactics of Forwards attack only with Attacking Fullbacks, lost 1-2 in a home friendly to a mediocre mate of mine who has Spurs. It seems like nothing will work for me
sanlucarini last edited by
Hi, tomorrow I'm playing against Chelsea (away). His team is slightly better than mine. He plays 442B WP. Here I'll leave his team and mine (i got some players training, I usually play 442B)
jasperhhc_NL last edited by
@john-turner-69 i had the same problem, try 451 or 442
iiDarkMoon last edited by
how do i counter 433b passing game zonal marking no offside trap yellow ref
gilbert gentania Indonesian Moderator last edited by
@john-turner-69 aha, Don't forget to use players that come from same country.. That's why you inferior i think, because MU, Arsenal, and Bournemouth have so many local players..
Remember 5/6 players can significantly boost your team, however your squad value is higher or lower
Just my opinion mate, sorry if you lose again because of this!
sergiu il last edited by
@john-turner-69 Mate I lost vs a weaker team in friendlies yesterday, then I won in the league vs a stronger team, friendlies don't mean much generally, besides what tactic did the opponent use in the friendly?
RazorSamurai last edited by
guys why no one making some sort of tactics table for newbies?
i mean if you know who you playing versus, know his tactics and you can just check that table and use it
What should I use against a 442B WP ? I'm better than him. Still trying to figure a tactic to play against this 442B WP
Choukou_NL last edited by
@razorsamurai because it takes all the fun out of the game. You can use friendlies to see if your tactics work and check the results of matches played in your competition to see what formations are being used.
Hafti Abi last edited by
@razorsamurai You could set a good example and upload yours, sounds easy
GhostFM_NL last edited by SUPERNOVA 8
Hi guys,
Tonight I play against a 442b passing game no offside trap zonal. The opponent's team is a little better than mine. How do I counter this tactic?
Btw, it's an Away match.
GhostFM_NL last edited by GhostFM_NL
This post is deleted!
lorenzobaobab last edited by
Hello everyone, i'm Manchester city(every player over 100) and I'm gonna face Mutd. He has an average of 100 and he is going on a training camp. I think he is gonna play 3-4-3 with a high pressure.
I can play every tactic; but please tell me how I can beat this guy; it's crucial for the championship battle.
I was thinking of going on a 4-2-3-1 passing or Shoot on sight but I think i would get wrecked by his high pressure.
Thanks to everyone that'll answer.


text:
Results. Porn Movies with Johnny donovan. Gay DVD Men Hard At Work 5. Men Hard At Work Naughty America. €19, Trailer Gay DVD Men Hard. Kevin Falk fucks Johnny Donovan. Watch more free gay porn videos at Find Gay Tube. Jun 24, Title: John West Fucks Johnny Donovan; Description: Johnny's hot ass gets fucked by John West; Rate Video: Login to Rate Video; Current.
Leave a Comment Your Name:. Similar Pornstars. Remember Password? Email Address: No Account?
VIDEO-"Gay porn donovan johnny"Score (1973) Trailer *slightly edited*
Johnny donovan gay porn - rather valuable
Next Door Studios. Go Gay Tube TV. Boy gay male love have a huge free DVD selection that you can download or stream.
Active Duty. With Without.
Browse videos by: date category site. Free NextDoorBuddies gay porn video. Free NextDoorBuddies video. Download now! Video provided by: NextDoorBuddies Video description: Stationed in the bed this time around, Rocco has found himself a couple of studs.
Johnny Donavan
Other Free Gay Tube Tubes:
Hot Buy DVDs
Video Results For: Johnny Donovan (734)


text:
Learn more about Scribd Membership
Discover everything Scribd has to offer, including books and audiobooks from major publishers.
(A) Adrenaline 1mg IV (B) Amiodarone 300mg IV (C) Atropine 3mg (D) Coronary artery bypass grafting (E) Defibrillation 50J (F) Defibrillation 200J (G) Hydrocortisone 200mg IV (H) Primary angioplasty (I) Streptokinase 1.5 million Units IV (J) Synchronised DC cardioversion 100J
EMQ 1.2 Musculoskeletal pains; choose the SINGLE most likely diagnosis. 1. A 23-year old man with celiac disease complains of difficulty climbing stairs and generalised bone pain 2. A 50-year old woman with a history of mastectomy complains of back pain, worse at night 3. A 7-year old child presents with a 3-month history of a painful limp and swelling just above the knee. Her parents report that this is getting worse. 4. A 70-year old woman presents with kyphosis and acute on chronic thoracic pain 5. A 60-year old male smoker presents to A&E complaining of 10 hours progressively worsening but severe back pain. He has a history of poor circulation. The nurses report him to be hypotensive.
(A) Ankylosing spondylitis (B) Aortic aneurysm rupture (C) Metastases (D) Myeloma (E) Osteogenesis imperfecta (F) Osteomalacia (G) Osteomyelitis (H) Osteoporosis (I) Osteosarcoma (J) Systemic Lupus Erythematosus
EMQ 1.3 Itchy rashes; choose the most likely diagnosis 1. An 8-year old boy complains of generalised itching with an excoriated rash, mainly on the trunk, of 2-months duration. His mother has recently developed a similar rash 2. A 34-year old woman has experienced recurrent itchy weal of variable severity on her trunk and limbs on most days over a 6-month period. 3. A 2-year old child has an excoriated rash on the cheeks, trunk, antecubital and popliteal fossae, which is disturbing his sleep. 4. A chronically underweight 40 year old woman has recently developed a pruritic rash, especially affecting elbows and buttocks. There are a few small clear blisters, but most lesions are excoriations. 5. A 23-year old woman who is 35 weeks into her first pregnancy has an itchy popular eruption which began in the stretch marks but has spread to the lower limbs
(A) Acrodermatitis enteropathica (B) Atopic eczema (C) Cholestatic jaundice (D) Contact allergic dermatitis to biological washing powder (E) Dermatitis herpetiformis (F) Food allergy (G) Idiopathic urticaria (H) Iron deficiency (I) Polymorphic eruption of pregnancy (J) Scabies
EMQ 1.4 Child heath; choose the most likely diagnosis 1. A teenage girl aged 13 years with abdominal stretch marks and height tracking steadily along 50th centile since the age of 5, whose current weight is >99.6th centile. 2. A girl aged 9 years whose height has dropped from the 50th centile to below the 9th centile, but whose weight has increased to above the 75th centile. She has coarse hair and feels the cold. 3. A boy aged 5 years who eats next to nothing and whose weight and height are tracking along the 2nd centile. 4. A boy aged 14 years with no signs of secondary sexual development whose weight and height centiles have both dropped from the 50th to the 25th centile over the past 2 years. 5. A 1-year old baby who is reluctant to take solid foods, whose weight has dropped from the 75th to the 2nd centiles.
(A) Achondroplasia (B) Constitutional pubertal delay (C) Constitutional short stature (D) Craniopharygioma (E) Crohns disease (F) Cushings syndrome (G) Failure to thrive/weight faltering (H) Hypothyroidism (I) Prader-Willi syndrome (J) Simple obesity
EMQ 1.5 Management of infection; choose the most relevant statement. 1. Aciclovir 2. Gentamicin 3. Fluconazole 4. Erythromycin. 5. Penicillin
(A) Acts on bacterial cell wall synthesis (B) Acts only on gram positive bacteria (C) Levels should be monitored (D) Used as prophylaxis in close contacts of meningococcal meningitis (E) Used for treatment of norovirus (Norwalk virus/small round structured virus) infections (F) Used in the treatment of athletes foot (G) Used to treat hepatitis B infection (H) Used to treat Herpes simplex virus (HSV) infection (I) Used to treat HIV infection (J) Used to treat infection with campylobacter spp.
EMQ 1.6 Urological/abdominal problems; choose the most likely diagnosis 1. A 65-year old man attended his GP with increased difficulty in voiding over six months. He complains of hesistency, nocturia and on once occasion noticed some blood at the end of his urinary flow. He has also had backache for three weeks and on blood testing the GP noted his PSA to be 40ng/ml 2. A 73-year old man attended his GP complaining of three episodes of haematuria over the previous month. On each occasion he found it difficult to pass urine for several hours but was then relived by a sudden rush of blood stained urine. There was no pain. 3. A 55-year old woman attended her GP complaining of four episodes of dull aching pain in the left loin associated afterwards by blood mixed throughout the urinary stream. The GP checked her urine in the surgery and found blood but no leukocytes. 4. A 39-year old man attended his GP complaining of severe pain in the left loin radiating into his left testicle. There was no tenderness and on stick testing the urine the GP found traces of blood. 5. A 25-year old woman attended her GP complaining of a 6-hour history of lower abdominal pain associated with pain passing water. She was noticeable tender supra-pubically and in the right lower quadrant with some rebound tenderness at the latter site. On urine stick testing the GP found protein but no cells.
(A) Acute appendicitis (B) Acute diverticulitis (C) Acute pyelonephritis (D) Carcinoma of prostate with bony metastases (E) Localised carcinoma of prostate (F) Renal cell carcinoma of kidney (G) Testicular torsion (H) Transitional cell carcinoma of bladder (I) Ureteric calculus (J) Urinary tract infection
EMQ 1.7 Metabolic abnormalities; choose the most likely diagnosis 1. A 60-year old woman is found to have decreased bone density. Her serum calcium is 2.85mmol/L (normal range 2.1-2.5mmol/L) and her PTH level is raised. 2. A 74-year old woman has a large right breast lump and pain in her ribs severe enough to keep her awake at night. She is also found to have a raised calcium. 3. A 25-year old man is noted to have a neck swelling and a raised calcitonin. His father had an operation on his thyroid. 4. A 44-year old man has chronic renal failure and is receiving haemodialysis. He has developed painful muscles, osteopenia and some subcutaneous calcification. 5. A 30-year old man has recently developed a cough, and shortness of breath on exertion. Chest X-ray shows bilateral hilar lymphadenopathy. Routine blood tests show he is hypercalcaemic.
(A) Bone metastases (B) Follicular cancer (C) Meduallary cancer (D) Milk-alkali syndrome (E) Papillary cancer (F) Primary hyperparathyroidism (G) Sarcoid (H) Secondary hyperparathyroidism (I) Thyroid lymphoma (J) Tuberculosis
EMQ 1.8 Rectal bleeding; choose the most likely diagnosis 1. A 25-year old woman, 6 weeks post partum with rectal bleeding, pruritis and perianal pain. 2. A 65-year old man with a 6 month history of rectal bleeding, change in bowel habit, lower abdominal pain and weight loss. 3. A 21-year old lady with rectal bleeding and severe pain on defecation 4. A 30-year old male with bloody diarrhoea 20 times/day, weight loss and a colonoscopy showing inflammation from the rectum to the caecum. 5. A 90-year old lady with rectal bleeding and something coming down every time she defecated.
(A) Colon cancer (B) Crohns disease (C) Diverticular disease (D) Fissure in ano (E) Fistula in ano (F) Gastroenteritis (G) Haemorrhoids (H) Rectal prolapse (I) Sigmoid volvulus (J) Ulcerative colitis
EMQ 1.9 Obstetric conditions; choose the most likely diagnosis 1. A 30-year old multiparous woman presents with scant vaginal bleeding, severe hypotension and a tender uterus at 36 weeks gestation. Fetal heart sounds are not detected. 2. A 26-year old multiparous woman presents with irregular contractions causing discomfort only in third trimester of pregnancy 3. A 20-year old primigravid woman is brought into casualty following a fit in her 36th week of pregnancy. She is noted to have a blood pressure of 170/110mm Hg and 2+ of proteinuria. 4. A 22-year old primigravid woman is seen at clinic at 28 weeks. She is noted to have ankle oedema and a blood pressure of 160/110mmHg. Her urine demonstrates the presence of protein. 5. A 28-year old primigravid woman with lower abdominal pain and a spiking fever 24 hours after delivery of her baby.
(A) Abruptio placentae (B) Braxton-Hicks contractions (C) Endometriosis (D) Early pregnancy (E) Eclampsia (F) Ectopic pregnancy (G) Endometritis (H) Placenta praevia (I) Pre-eclampsia (J) Quickening
EMQ 1.10 Hepatomegaly; select the most likely diagnosis 1. A 76-year old lady is admitted with dyspnoea 3 days post MI, I found to have a palpable tender liver. 2. A male of 50 years of age with known non-insulin dependent diabetes mellitus is found to have Hepatomegaly at routine follow up. 3. At an insurance Medical Examination a lady of 50 years of age is noted to have xanthelasma, skin pigmentation and a palpable liver. 4. A 45-year old Publican, who attends to the Dermatology clinic with severe psoriasis, is noted to be jaundiced and have a large liver. 5. A 70-year old lady with constant upper abdominal pain and anorexia is found to have an enlarged irregular liver.
(A) Alcoholic liver disease (B) Auto-immune hepatitis (C) Chronic obstructive pulmonary disease (D) Congestive cardiac failure (E) Infective hepatitis (F) Lymphoma (G) Metastatic liver disease (H) Polycystic liver (I) Primary biliary cirrhosis
PAPER 2 EMQ 1.1 Psychiatric disorders; choose the most likely diagnosis. 6. 16-year old girl with paracetamol overdose following the break up of a relationship one week earlier Adjustment disorder 7. 75-year old woman with low mood and beliefs that her bowels have stopped working and her heart is no longer beating Depressive episode with psychotic features 8. 36-year old fireman with low mood, anxiety and flashbacks of disturbing work experiences Post-traumatic stress disorder 9. 24-year old woman with repeated self-injury, depressed mood and difficulty sustaining relationships Emotionally unstable personality disorder borderline type 10. 34-year old man with disinhibition, over activity and the belief that he has a mission to bring peace to the world. Manic episode (more severe episodes may have grandiose delusions)
(A) Adjustment disorder (B) Depressive episode with psychotic features (C) Emotionally unstable personality disorder borderline type (D) Generalised anxiety disorder (E) Manic episode (F) Non-psychotic depression (G) Post-traumatic stress disorder (H) Schizoaffective disorder depressive type (I) Schizoaffective disorder manic type
EMQ 1.2 The management of dysfunctional uterine bleeding; choose the SINGLE most appropriate answer. 6. A 25-year old married woman who presents with irregular menstrual cycles and menorrhagia. She would not like to start a family yet Oral contraceptives 7. A 50-year old woman present with irregular uterine bleeding. Hysteroscopy 8. A 14-year old female complains of heavy periods and pain. She is not sexually active. Oral contraceptives 9. A 40-year old woman presents with heavy, regular periods Mefenamic acid 10. A 33-year old woman presents with intermenstrual bleeding that is not controlled with oral contraceptives. Hysteroscopy
(A) Clomiphene citrate x (B) Ethinylestradiol x (C) Hysterectomy (D) Hysteroscopy (E) Measure progesterone levels at day 21 x (F) Mefenamic acid (G) Pipelle endometrial sampling (H) Provera (I) Oral contraceptives
EMQ 1.3 Genetics; choose the most appropriate mode of inheritance 6. Type II diabetes 7. Duchenne Muscular dystrophy 8. Cystic Fibrosis 9. Huntingtons disease 10. Myotonic dystrophy
(A) Autosomal Dominant (B) Autosomal recessive (C) X-Linked Dominant (D) X-Linked recessive (E) Mitochondrial (F) Mutlifactorial (G) Polygenic (H) No genetic factor involved
EMQ 1.4 Diarrhoea; choose the most likely diagnosis 6. A 32-year old woman presents with recurrent lower abdominal pain. Her bowels are all over the place with intermittent constipation and diarrhoea. The pain is often after eating and lasts for up to an hour. She is other wise well, and has lost no weight. Examination and barium enema are normal 7. A 28-year old woman presents with a history of sudden onset of vomiting and frequent watery stools 2 days previously. The vomiting has settled but the diarrhoea persists. A stool specimen taken at the time reveals no bacterial growth. 8. A 40-year old man presents with a 3 year history of weight loss, lassitude and the passage of bulky stools that are offensive and difficult to flush away. 9. A 73-year old woman develops intractable diarrhoea after leaving hospital where she was treated for pneumonia 10. A 26-year old man presents with a 6 day history of up to 10 episodes of watery diarrhoea containing both blood and mucus. He has had some looseness of his stools in the last 6 weeks, associated with cramping lower abdominal pain. He has previously been well. On examination he is afebrile, mildly dehydrated and tender in the LIF.
(A) Carcinoma of the colon (B) Diverticulitis (C) Irritable bowel syndrome (D) Ischaemic colitis (E) Laxative abuse (F) Malabsorption syndrome (G) Pseudomembranous colitis (H) Salmonella infection (I) Ulcerative colitis (J) Viral gastroenteritis
EMQ 1.5 Therapeutics; choose the most likely treatment. 6. A 62-year old man with an 8-week history of angina of effort, occurring several times per week. He has a past history of asthma. 7. A 22-year old woman with a 2 month history of weight loss, increased sweating, palpitation, and anterior neck swelling. 8. A 73-year old man with acute exacerbation of COPD associated with a purulent spit. He is known to have a penicillin allergy. 9. A 43-year old woman with a 4 month history of increasing pain and stiffness in both hands. Examination shows swelling and tenderness of the PIP and MCP joints of both hands. 10. A 40-year old man with a 20 year history of insulin dependent diabetes mellitus who has developed sustained, moderate hypertension (BP 140/105)
(A) Ampicllin (B) Atenolol (C) Benzhexol (D) Carbamazepine (E) Carbimazole (F) Enalapril (G) Erythromycin (H) Gentamicin (I) Ibuprofen (J) Isosorbide Mononitrate (K) Paracetamol
EMQ 1.6 Jaundice; choose the most likely diagnosis 6. A 40-year old woman presents with progressive jaundice and severe discomfort in the epigasgtrium. She is apyrexial. 10 months before she had undergone laparascopic cholecystectomy. 7. A diabetic 47-year old man presents with severe weight loss and painless progressive jaundice. His gallbladder is palpable on examination. 8. A 25-year old intravenous drug abuser in hospital with suspected appendicitis becomes suddenly unwell with a high swinging temperature, jaundice, and palpable tender hepatomegaly 9. A 53-year old hotel worker has a 10-day history of increasing jaundice and confusion. On examination he has spider naevi and palmar Erythema. The liver is not palpable. He also has glove and stocking loss of sensation 10. A 29-year old woman has a 2 week history of mild jaundice and pallor, dating from an upper respiratory infection. On examination the spleen tip is just palpable. Urinanalysis shows excess urobilinogen, but no bilirubin.
(A) Acute cholecystitis (B) Alcoholic liver disease (C) Carcinoma of the head of the pancreas (D) Choledocholthiasis (E) Haemolytic anaemia (F) Hepatic abcess (G) Metastatic hepatic disease (H) Pancreatitis (I) Portal vein thrombosis
EMQ 1.7 Trauma; choose the most likely diagnosis 6. A 70-year old woman presents with breathlessness, having fallen down stairs onto her left side. She has resonance over the left chest with absent breath sounds. 7. A 75-year old man falls 20 meters from a window and presents by ambulance 2 weeks later with a Glasgow Coma Scale of 7. 8. A child is struck by a car and presents with a Glasgow Coma Score of 4 and a fixed dilated right pupil. 9. A footballer is brought to casualty following a heavy challenge. He has a painful swelling in his upper thigh with limb shortning. 10. A student is brought to casualty following a road traffic accident. He is hypotensive and tachycardic with a swollen rigid abdomen and no bowel sounds.
(A) Extradural haematoma (B) Femoral fracture (C) Fractured rib (D) Haemothorax (E) Hip dislocation (F) Liver rupture (G) Pelvic fracture (H) Pneumothorax (I) Renal haematoma (J) Subdural haematoma
EMQ 1.8 Headache; choose the most likely diagnosis 6. An 80-year old woman has pains over her forehead which was previously the site of an episode of shingles 7. A 40-year old man presents with a 2-day history of pain in the mandible at the site of a recent tooth filling 8. A 75-year old woman complains of severe dull headache with scalp tenderness when she combs her hair 9. A 16-year old girl give a 2 year history of episodic unilateral throbbing headache associated with vomiting and photophobia 10. A 60-year old woman presents with a 2-week history of gradually worsening occipital headache. The pain is made worse by coughing, and tends to improve as the day goes on.
(A) Acute bacterial meningitis (B) Cervical disc protrusion at C5/6 (C) Dental abscess (D) Migraine (E) Post herpetic neuralgia (F) Raised intracranial pressure (G) Sub-arachnoid haemorrhage (H) Temporal arteritis (I) Tension headache (J) Trigeminal neuralgia
EMQ 1.9 Patients presenting as an emergency with abdominal pain; choose the SINGLE most likely diagnosis 6. A 74-year old man presents with sudden onset of severe abdominal pain radiating to his back. On examination he is profoundly shocked and has a distended tender abdomen 7. A 40-year old woman present with right upper quadrant pain and vomiting. On examination she is afebrile and has localised tenderness below the right costal margin 8. A 67-year old woman presents with upper abdominal pain and rigors. On examination she is jaundiced and has a temperature of 40oC 9. A 23-year old medical student presents with epigastric pain and vomiting of altered blood following a weekend of heavy drinking after passing his final exam. 10. A 56-year old man with a history of several previous operations for Crohns disease presents with colicky abdominal pain and bilious vomiting
(A) Acute cholecystitis (B) Acute pancreatitis (C) Ascending cholangitis (D) Empyema of gallbladder (E) Gastritis (F) Perforated peptic ulcer (G) Ruptured aortic aneurysm (H) Sclerosing cholangitis (I) Small bowel obstruction (J) Viral hepatitis
EMQ 1.10 Respiratory problems in childhood; select the SINGLE most likely diagnosis 6. A 16-month old boy is admitted with a weeks history of wheeze, not helped with salbutamol (ventolin) administration. On examination he has dyspnoea, and a pyrexia of 38.2oC. The right hemithorax is hyperinflated compared with the left. 7. A newborn infant is admitted to the special care baby unit aged 12 hours with tachypnoea, grunting and poor feeding. He is the first baby of a 19-year old mother, in good health, whose membranes ruptured 48 hours before delivery. The birth was normal and the baby weight 3.5kg at 41 weeks gestation. 8. An 8-year old girl is admitted with a one week history of cough and pyrexia with no clinical improvement following a 5 day course of amoxicillin. On examination she looks well, but chest auscultation shows bilateral basal crepitations. 9. A 2-year old boy in admitted with a history of coryzal symptoms for two days followed by a sudden onset of difficult breathing at night. On examination he is pyrexial (38.5oC) but alert, and has inspiratory stridor with intercostals and subcostal recession 10. A 3-year old girl is readmitted with her third episode of cough and wheeze in 6 months. Her mother says that she eats reasonably well but has loose stools and is not putting on weight. Examination shows a thin child with no finger clubbing, a hyper-inflated chest with widespread wheeze and crepitations, and some abdominal distension.
(A) Asthma (B) Atypical pneumonia (C) Bronchitis (D) Croup (E) Cystic Fibrosis (F) Epiglottitis (G) Inhaled foreign body (H) Lobar pneumonia (I) Meconium aspiration (J) Neonatal pneumonia
(K) Respiratory distress syndrome ANSWERS: - Check against a book (I have not check the accuracy of these.
PAPER 3 EMQ 1.1 Findings on cardiovascular system examination; choose the most likely diagnosis. 11. 55-year old lady with a ten-year history of scleroderma with lung fibrosis attends your clinic for routine follow-up. Her blood pressure is 140/88, the apex beat is in the normal position, JVP is not elevated but her second heart sound is loud in the 3rd left intercostal space. 12. A 75-year old lady is found to have an irregularly irregular pulse. Her blood pressure is 150/85. The JVP is not elevated, she has a pan systolic murmur, loudest at the apex beat radiating into the axilla. Chest X-ray shows pulmonary oedema 13. A 25-year old man is found to have a systolic murmur at routine health screening. His blood pressure is 125/75, he has no elevation of JVP or ankle swelling. The apex beat is in the 5th intercostal space and he has no basal crepitations. The systolic murmur is loudest in the 2nd right intercostals space and radiates to the carotids. 14. A 55-year old man presents with crescendo angina. His blood pressure is 110/90. His JVP is not elevated and there is no ankle swelling. The apex beat is in the mid-clavicular line in the 6th intercostal space. He has no evidence of left ventricular cardiac failure. There is a systolic murmur loudest in the 2nd right intercostal space radiating to the carotids. 15. A 45-year old lady with previous rheumatic fever presents with increasing shortness of breath. She has a collapsing pulse, blood pressure is 160/60 and, although there are no signs or right ventricular failure, she has bilateral basal crepitations. There are no systolic murmurs to be heard but on sitting the patient forward you can hear a diastolic murmur in the 2nd right intercostal space and down the left sternal edge. (A) Aortic incompetence (B) Aortic Stenosis (C) Atrial septal defect (D) Bicuspid aortic valve (E) Mitral incompetence (F) Mitral stenosis (G) Pericarditis (H) Pulmonary artery hypertension (I) Pulmonary stenosis (J) Tricuspid stenosis
EMQ 1.2 Child and adolescent psychiatry; choose the most likely diagnosis. 11. Amanda, an eight-year old, complains of epigastric abdominal pain that is usually worse at about 0800 hours in the morning. Extensive investigation was normal. This confines her to the home. 12. Helen was well until 2 years ago following an off chance remark in the school gym about her size started obsessive dieting. She weighs less than the 3rd percentile and exercises vigorously. Family meal times are a nightmare. 13. Adam is a 3-year old, he wets the bed most nights however, he is dry during the day. He has no development problems. His parents are very anxious that he is not yet dry. 14. A 15-year old girl was brought to the A&E unit at 10.00pm swearing, cursing and swaggering. There was a disagreement the previous night because parents disapprove of her new-found friend. Fifteen minutes later she collapsed. 15. Ryan is 9-years old, he has few friends because of his emphasis on exactitude. He lacks warmth towards his siblings. He does not miss friends as he spends most of his time obsessively studying his special interest in local bus services. Intellectual functioning is normal.
(A) Accidental poisoning (B) Anorexia nervosa (C) Aspergers syndrome (one of the autism disorders) (D) Bulimia nervosa (E) Nocturnal enuresis (F) Obsessive compulsive disorder (G) Physiological immaturity (H) School refusal (I) Substance abuse (J) Truancy
EMQ 1.3 Endocrinology (thyroid disease); choose the most likely diagnosis 11. A 14-year old girl presents with a smooth, enlarged goitre. Her weight is normal, pulse is 75/min and she has no heat or cold intolerance. 12. A 35-year old patient presents with weight loss, diarrhoea and a defined tremor. She has exophthalmos but no lid lag. 13. A lady with proven thyrotoxicosis with exophthalmos complains to you of a skin rash on the lower limbs. Examination demonstrates a thickened area of skin, which is raised on the anterior aspect of the lower limb. 14. Five years after radioactive iodine treatment for thyrotoxicosis, a patient complains of weight gain and an increased sensitivity to cold. You find her bradycardic. 15. A 75-year old lady presents with a rapidly developing swelling in her neck, together with some hoarseness and some difficulty with swallowing. Examination reveals a goitre and some skin tethering to the underlying lesion.
(A) Anaplastic carcinoma of the thyroid (B) Juvenile myxoedema (C) Myxoedema madness (D) Papillary carcinoma of the thyroid (E) Post radiation myxoedema (F) Pretibial myoedema (G) Riedels woody thyroiditis (H) Simple non-toxic goitre (I) Thyroid crisis (J) Thyrotoxicois
EMQ 1.4 Infections (viral); choose the most likely , causative or predisposing virus from the options listed. 11. A two year old child with croup 12. A 56-year old man with cirrhosis and liver failure he was an intravenous drugs used in the 1970s 13. A 45-year old homosexual man who has always lived in Scotland with Pneumocytis carinii in a broncoalveolar lavage. 14. A 19-year old student with warts on his fingers 15. A 19-year old man with a painful sore on his lower lip
(A) Astrovirus (B) Hepatitis A virus (C) Hepatitis C virus (D) Herpes simplex virus 1 (E) Human immunodeficiency virus type 1 (F) Human immunodeficiency virus type 2 (G) Human papillomavirus type 1 (H) Human papillomavirus type 16 (I) Parainfluenza virus (J) Measles virus
EMQ 1.5 Obstetrics and Gynaecology: Problems in pregnancy; choose the most likely diagnosis. 11. A 16-year old unbooked nullipara presents at 33 weeks gestation (by her dates). Abdominal examination shows a fundal height measurement of 37cm with a cephalic presentation. 12. A 26-year old para 3 presents with a light painless bleed at 30 weeks gestation. Examination reveals her to be undistressed, with no signs of shock, and a non-tender abdomen. The fetal lie is transverse. 13. A 40-year old primigravida, with a twin pregnancy at 36 weeks gestation, gives a two-day history of troublesome itch of the palms and soles. There is no obvious rash and no jaundice, although her transaminases levels and serum bilirubin are elevated. 14. An 18-year old primigravida, estimated to be 30 weeks gestation, is admitted with acute onset of lower abdominal pain and slight vaginal bleeding. Her blood pressure 100/60 and she has a tense, tender abdomen and the fetal heart cannot be heard. 15. A 28-year old para 1 has has an uneventful pregnancy and a normal detailed US scan at 18 weeks gestation. At 35 weeks, the fundal height measures 28cm and the liquor volume is clinically reduced.
(A) Abruptio placentae (B) Cervical cancer in pregnancy (C) Cholestasis of pregnancy (D) Fatty liver of pregnancy (E) Hepatitis C in pregnancy (F) Hydatidiform mole (G) Placenta praevia (H) Placental insufficiency (I) twin-to-twin transfusion syndrome (J) Wrong dates
EMQ 1.6 Drug side effects; choose the most likely culprit drug 11. Bronchospasm 12. Pneumonitis 13. Jaundice 14. Anaphylaxis 15. Retroperitoneal fibrosis
(A) Aminophylline (B) Amiodarone (C) Captopril (D) Chlorpromazine (E) Insulin (F) Methysergide (G) Metoclopramide (H) Penicillin (I) Pizotifen (J) Propanolol
EMQ 1.7 Anorectal symptoms; choose the most likely diagnosis 11. A 35-year old man presents with fresh rectal bleeding at the time of defecation. This is accompanied by a sense of local itch and irritation, but no alteration in bowel habit and no systemic upset 12. A 15-year old boy presents acutely with blood stained perianal discharge. He has a two year history of episodes of mouth ulceration, colicky abdominal pain and intermittent bloody diarrhoea. He is on the 10th centile for growth. 13. A 40-year old lady presents with a history of severe pain at the time of defaecation which typically lasts for 45 minutes thereafter. Her bowel habit has become sluggish. 14. A 55-year old female present with a history of intermittent abdominal bloating, crampy left-sided abdominal pain and the discharge of mucus per rectum. Sigmoidscopy and colonoscopy are both normal. 15. A 25-year old man presents with a sudden onset of an acutely painful swelling at the anal verge. There is no history of discharge and no rectal bleeding.
(A) Anal fissure (B) Clotted venous sacule (C) Crohns disease (D) Fistula in ano (E) Internal haemorrhoids (F) Irritable bowel syndrome (G) Proctalgia fugax (H) Prolapsing haemorrhoids (I) Rectal adenoma (J) Ulcerative colitis
EMQ 1.8 Neurological problems in the upper limbs; choose the most likely diagnosis 11. A 34-year old lady presents to her General Practitioner with a 6-month history of pins and needle in her right hand and she has some diminished sensation in the thumb and index finger. Thumb movements appear normal but there is slight muscle wasting of the thenar eminence on the right. 12. A 65-year old lady presents complaining of numbness in both her hands. She admits to a high alcohol intake. On clinical examination there is no wasting of musculature in the forearm of hands. Her reflexes are normal. She has a sensory disturbance to pinprick sensation affecting the thumb and all the fingers of both hands to the level of the metacarpophalangeal joints. 13. A 47-year old woman is admitted to hospital for major abdominal surgery. On discharge two weeks after the operation she complains to the House Officer that she has developed paraesthesia affecting the ring and little finger of her left hand. There is some numbness and weakness of flexion in these two fingers. 14. A 65-year old smoker presents with progressive weakness in the right hand, which has been going on for the last 6 weeks. Clinical examination reveals generalised wasting of the small muscles of the hand and she has an area of diminished sensation in the inner aspect of the upper arm. 15. A 42-year old accountant presents with paraesthesiae in the fingers and weakness at the wrist. Examination shows Grade 3/5 wrist extension and Grade 4/5 elbow extension and the triceps jerk is absent. He gives a history of acute neck pain about 10 days prior to his attendance in surgery.
(A) C5 radiculopathy (B) C7 radiculopathy (C) Carpal tunnel syndrome (D) Infective polyneuropathy (E) Motor neurone disease (F) Multiple sclerosis (G) Pancoasts tumour (apical tumour in the lung) (H) Peripheral neuropathy (I) Radial nerve palsy (J) Ulnar nerve entrapment at the elbow.
EMQ 1.9 Jaundice; choose the most likely cause; ALL the patients have a mild jaundice with a serum bilirubin of <80umol/L 11. A 72-year old lady complains of upper quadrant abdominal pain, fever and rigors. She is tender in the right upper quadrant but no mass is palpable. Serum alkaline phosphatase is 950U/L (normal <280U/L), AST 76U/L (normal <35U/L) and ALT 65U/L (normal <50U/L) 12. A 29-year old male attends his GP with a 48-hour history of influenza-like symptoms. He has not eaten much recently and physical examination is normal. His GP noticed mild jaundice. His liver function tests are otherwise normal. 13. A 55-year old man with a previous history of lung resection for carcinoma of the bronchus presents with weight loss, upper abdominal pain and 2cm enlarged liver. His alkaline alkaline phosphatase is 670U/L (normal <280U/L), the AST 48U/L (normal <35U/L) and ALT 55U/L (normal <50U/L) 14. A 40-year old female health care worker presents with anorexia, nausea and mild jaundice. She has a liver edge two fingers palpable and slight ankle oedema. Her serum transaminases are elevated AST 560U/L (normal <35U/L), ALT 742U/L (normal <50U/L), IgG was 35g/L and anti HBs positive. Prothrombin time is prolonged to 18 seconds. Her liver function test had been recorded as mildly abnormal 3 months ago. 15. A 73-year old woman complains of pruritis, anorexia and weight loss of 5kg. She denies significant abdominal pain. On physical examination there is a mass palpable in the right upper quadrant.
(A) Acute viral hepatitis (B) Alcoholic hepatitis (C) Auto-immune hepatitis (D) Budd-Chiari Syndrome (hepatic vein thrombosis) (E) Carcinoma head of pancreas (F) Common bile duct stone (G) Drug cholestasis (H) Gilberts disease (defective UDP-glucuronyl transferase) (I) Primary biliary cirrhosis (J) Secondary deposits in the liver
EMQ 1.10 Abdominal pain; select the most likely diagnosis 11. A 48-year old man with a past history of alcohol abuse presents with a 12 hour history of vomiting and epigastric pain radiating to his back 12. A 15-year old girl gives a 24-hour history of central abdominal pain. On examination she is tender in her right iliac fossa with guarding and rebound. 13. A 40-year old woman underwent a total abdominal hysterectomy 12 months ago. She now presents with a 36-hour history of colickly central abdominal pain and profuse vomiting. Clinical examination reveals a distended tympanic abdomen. 14. A 64-year old woman present with a 12-hour history of severe epigastric pain. On examination she is pyrexial with tenderness in the right upper quadrant 15. A 12-year old girl has a sore throat and a cough and she present with right iliac fossa pain. Clinically she is mildly tender in the right iliac fossa.
(A) Acute appendicitis (B) Acute cholecytitis (C) Acute pancreatitis (D) Adhesive small bowel obstruction (E) Large bowel obstruction (F) Mesenteric adenitis (G) Obstructed femoral hernia (H) Perforated peptic ulcer (I) Renal colic (J) Torsion of ovarian cyst.
ANSWERS: - Check against a book (I have not check the accuracy of these.


text:
The Marvel Cinematic Universe may be a fantasy, but it is always worth it to analyze the ways in which media narratives align with, highlight, and bring into question the dynamics of our reality. "Overpopulation ...
It needs to be understood that this fight isn't about a "battle of the sexes" but about revolutionizing our understanding of gender structures. By Danny Reneè It's no surprise, in an age where we spend so 14K Yellow gold February CZ Birthstone Flip Flop (25x8mm) Pendant Charm
The simple act of featuring both Christine Blasey Ford and Brett Kavanaugh within the same pages shows how unwilling society is to dismantle r/pe culture. By Anuhya Bobba This essay contains mentions of r/pe, 14K Yellow gold Figaro Link 10.5 MM Engravable ID Medical Alert Bracelet, 8
"I don't wanna have to teach a lesson on Health At Every Size just to get through every conversation in my day. I'm just trying to live my life." This interview contains spoilers for season one of Hulu's "Shrill" ...
Even within the LGBTQIA community, non-binary issues are largely misunderstood, or ignored altogether. "There were days I felt like a girl and days I felt like a boy, and those days wouldn't always correspond 14K YELLOW gold FILIGREE CURVED DESIGN POST EARRING -JUST ONE
New with tags: A brand-new, unused, and unworn item (including handmade items) in the original packaging (such as ... Read moreabout the condition
Jewerly Stores Network
|Metal Purity:
|Country/Region of Manufacture:
|United States
|Yellow Gold
Black women, girls, gender non conforming people and femme folk need options beyond the police when dealing with gender-based violence. This essay contains discussions of sexual violence. On April 8, the 14K YELLOW gold FILIGREE HEARTS HOLLOW ROUND HOOP EARRINGS 19mm X14-1959


text:
ORICA has been cleared for a full restart of its Kooragang Island operations.
EPA director Gary Davey said the Orica start-up committee had recommended the ammonia plant, which has been shut since August, be cleared to restart.
Mr Davey said Orica had done all that was required of it.
He said Orica had been issued with a notice that allowed it to restart the ammonia plant from tomorrow.
It was a start-up of the ammonia plant that began the controversy over Orica from early August.
The ammonia plant makes ammonia from a feedstock of natural gas, with the nitric acid and ammonium nitrate sections of the plant converting the raw ammonia into explosives and other products.
These sections are already operating using ammonia brought onto the site as feedstock.
Mr Davey said the EPA had put extra conditions on Orica's operating licence to ensure its operation met acceptable standards.
Resumption of production from the Kooragang Island plant will start to ease an acute shortage of explosives for the Hunter's open-cut coalmines.


text:
Recommended by 100% of couples
6 User photos
taylor · Married on 10/18/2019
Couldn't Say Anything Less Than Amazing
Working with Lauryn was amazing from the very start. At the last minute during a difficult pregnancy Lauryn was able to squeeze me in. She made the whole experience amazing even though it was thrown together on both our sides. Almost a year and my darling daughter later, I got engaged! The first person we told was Lauryn. Seriously, even before my best friend. I knew immediately that she would be perfect for our engagement photos. She made it so easy for Riley considering he's never had photos taken. Our family and friends love our photos, more importantly we do! I can't wait to continue sharing our life with Lauryn.Sent on 01/20/2019
Lauryn Kay Photography's reply:Taylor, I feel so lucky that i got to work with you during your maternity shoot. It was such a special session and I am so happy to have your support and friendship. You're the best!
Erica Pugh · Married on 09/28/2019
Lauryn & Bob are the BEST!
We are so thankful for Lauryn and Bob and the beautiful photos they captured of our big day! I first contacted Lauryn through her website after seeing her name pop up on WeddingWire. She promptly responded and sent me all of the details needed to book our wedding day. She even jumped on the phone with me to talk through a couple of wedding planner recommendations she had for me based on the vision and vibe we had in mind for our wedding. I'm so glad she had our date open because having Lauryn and Bob capture our big day was the best decision we've ever made! They are fun, creative and a joy to work with! Lauryn has a way of making you feel calm in front of the camera, and offers engagement sessions for her wedding clients to ease your nerves and to just get to know you as a person. We received our wedding album about 2 weeks after our wedding and the photos could not have been more perfect! We can't get over how beautiful every single photo turned out, especially the golden hour photos! The photos Lauryn and Bob captured will help us relive the joy of our wedding day for years to come!Sent on 11/10/2019
Ariel Valdivia · Married on 09/23/2018
Beautiful photos I will cherish forever!
First off, Lauryn and Bob are the BEST!! Definitely book them!!Sent on 01/11/2019
They really came to my rescue. I was having a hard time finding a photographer for my wedding day. There are an overwhelming amount of options for the Portland area and I'm very particular about the photography style I like. I looked at a lot of options, but I just wasn't finding anyone that stood out to me. After months of indecision, my wedding day was dangerously close and I was still without a photographer. I was so worried I wouldn't be able to find anybody (because everyone would be booked for that day already) or that I'd find someone but they wouldn't live up to my expectations and I'd have to compromise my vision, that I started to lose hope. I decided to post on a Facebook wedding page to see if any photographers were still available for that day and I was surprised how many comments I got.
Even though dozens of photographers contacted me, it was when I saw Lauren's web page that I knew I could still have the wedding day I dreamed of! Looking through her gallery, I knew instantly that I wanted her to photograph my wedding! Her photography style is so beautiful and was EXACTLY what I was looking for! I honestly couldn't believe how great things had worked out! I booked her right away (I'm so happy she was available last minute!) and she graciously agreed to work with my budget.
Lauryn was truly a joy to work with. The planning process went seamlessly, she was always super responsive to emails and offered to help in any way she could, and she was so easy to talk to. She has an infectiously happy and bubbly personality and you can tell she is genuinely interested in the people she meets and works with. Also (as is apparent by her portfolio) she really knows her stuff! I knew my wedding day was in good hands and my mind was finally at ease.
As expected, Lauryn and Bob were a delight to have around on our wedding day! It's the best day of your life and A LOT of pictures are going to be taken, so it's important to have a photographer with a good personality who knows what they're doing! My husband and I are not usually comfortable in front of a camera, but Lauryn and Bob expertly guided us through the process and helped us feel at ease. The pictures turned out AMAZING and they're EXACTLY what I hoped for! Not a moment of our wonderful day was missed and now we have beautiful memories to look back on. I'm so grateful for how things worked out and if I ever need pictures taken again, I know who to go to!!
Lauryn Kay Photography's reply:Thank you so much for this amazing review. It was such a pleasure working with you and Tim on your wedding day! I'm so grateful for having met you.
Mariah Woodbury · Married on 08/13/2018
My husband and I were honored to have Lauryn photograph our wedding and I cannot say enough positive things about her work. She made our big day that much more special by documenting the moments we were too busy to notice and made us very comfortable being in front of the camera. She was even willing to travel to Idaho for our wedding and spent a second day with us for a "trash the dress" session. We cannot thank her enough for the amount of time she spent before, during and after our big day to bring those photos so close to our hearts. She is a wonderful photographer, artist and all around human and we look forward to more photo sessions in the future with her!Sent on 01/13/2019
Lauryn Kay Photography's reply:Thank you for taking the time to write this Mariah! Your wedding was a dream and we feel so fortunate to have been included in it.
kayla · Married on 04/13/2017
More then I could wished for! Fun, effortless and beautifu!
Lauryn was more then I could expected. She captured out wedding perfectly. Anyone who's had there picture taken professionally knows it can be a little nerve wrecking ... but Lauryn made it fun and effortless, she's someone you want to be friends with. I could not of imagined having anyone else on our special day. We are so happy that we found her!! If you are planning any special occasion, hire her. She's a true professional with a bright spirit and will make you and your event look and feel like a million bucks!Sent on 01/06/2019
Lauryn Kay Photography's reply:Kayla, Thank you so much for your review! We loved being a small part of your wedding day! Getting to know you and your husband was such an absolute joy!
Britt · Married on 09/26/2016
Amazing, dreamy photos!
Booking Lauryn & Bob for our wedding was one of the best vendor decisions we made. It didnt occur to me that wed be spending nearly every moment of our wedding day with our photographers, but now that I know that, Im so grateful it was them. When little things went wrong, Lauryn distracted me by asking me to pose for fun photos. They worked magic with our large wedding party & family; making jokes as necessary to lighten the mood. Neither my husband nor I feel particularly comfortable in front of a camera, but we felt totally at ease with these two and it showed in the end product. The photos are absolutely stunning. We received them in a timely manner and the hard copies were delivered in such a thoughtful way! If you need a wedding photographer, book Lauryn Kay Photography youll be so glad you did!Sent on 01/10/2019
Lauryn Kay Photography's reply:Britt, we loved being involved in your wedding! Thank you so much for taking the time to write this! We can't wait to work with you again in the future!
Zoe Atallah · Married on 07/02/2016
Wedding Photography Review
Hiring Lauryn Kay Photography for our wedding was - by far - the best vendor decision my husband and I made! Lauryn is technically brilliant with her camera, lighting exposure, and photo editing, which is wonderful, but even more impressive is her incredible eye and talent for capturing not just an event, but the amazing experience of love and human relationships. The thing that sets her apart is who she is - she brings her whole, lovely self into her work and through her compassion and understanding captures more than just people and settings, she sees beauty and delight and reflects it back to us in her work.Sent on 01/06/2019
My husband and I, who are not particularly comfortable with being in the spotlight, felt so at ease working with Lauryn and her husband, Bob. On our wedding day, Lauryn and Bob demonstrated their professionalism, flexibility, and creativity; not only did they fit right in with our family and friends, they also blended right in - they were totally unobtrusive. The end result was a collection of photographs that are truly unique, touching, and absolutely priceless.
Thank you, Lauryn and Bob, for beautifully capturing so many special moments from our big day!!! Without a doubt, these photographs will be treasured for a lifetime.
Lauryn Kay Photography's reply:Zoe, thank you so much for taking the time to post this. Bob and I loved working with you and Alex and are so thankful we were included in your special day!
Nichole Hermens · Married on 08/28/2015
A truly wonderful decision!
I could not be happier with the team at Lauryn Kay Photography. Lauryn and Bob photographed our Portland wedding in August of 2015. We had no doubts of choosing Lauryn Kay Photography to photograph the most important day of our lives. They made us feel tremendously comfortable before the wedding by listening to our expectations, wants and needs and those were honored on the actual day and our pictures were exactly what we wanted and hoped for. We also went over a photo timeline beforehand, and a list of all the pictures needed or wanted, the name of the family or people, and possible combinations. That was helpful and calmed our stress and nerves because we knew Lauryn Kay Photography had it handled. Lauryn and Bob were professional, on time, worked hard and extremely helpful on the day of. They captured all the perfect moments from all the traditional shots to all the shots we had asked for and the end product was absolutely stunning and perfect. We are so glad and thankful that we chose Lauryn Kay Photography because photos are forever and capture such sweet moments in time and this team does it best! Thank you Lauryn Kay Photography, Lauryn and Bob, our photos are wonderful and your care and expertise in photography made our wedding day just that much more perfect. Much love and thanks, Casey and Nichole HermensSent on 01/22/2019
Lauryn Kay Photography's reply:Thank you so much for taking the time to write this review. We are so thankful you and Casey chose us to photograph your wedding day! Sending so many hugs!
Shauna · Married on 06/29/2013
A Wedding Planner's Dream Vendor
Words cannot express how incredible Lauryn is to work with. She's direct and tells you exactly what needs to be done (ideal for those of us who are awkward in front of the camera), she's quick but extremely thorough, professional and prompt, and above all, her photos are amazing! We can't wait to work with you again!Sent on 01/09/2019


text:
Protest at Rustaveli Avenue
18:51, 02.06.2018
Protest has resumed in front of Parliament building at central Rustaveli Avenue in Tbilisi. Zaza Saralidze, father of Davit Saralidze, school student killed at Khorava Street in Tbilisi in a bloody conflict among peers on December 1, 2017, is holding a rally with demand to establish justice into his son's murder case. He also demands resignation of the government.
Leave comment


text:
Indoor Plants for Apartment Living
Houseplants are a trustworthy way to bring vibrant colour to your home and also to bring nature indoors. And of course, plants are a terrific way to purify the air in your house .
But, huge plants like that aren't necessarily the best for tiny apartments and less-than-spacious homes. Luckily, there are plenty of choices for little indoor plants which may help provide the ideal touch of green without taking a large chunk of your area!Lets follow this Hieta garden article.
Slightly larger plants such as peace lilies can occupy some floor area, but they won't conquer any part of the space with lush leaves or big roots.
The best thing about most small potted plants is that they can fit nearly anywhere in your home. You may even get creative! Think about adding some adorable plants in sudden places like near your bathroom window, in a hanging planter or even on your wall with a space-saving vertical wall garden!
21 Small Indoor Plants to Spruce Up Your Space
To assist you begin, we rounded up our favorite small indoor plants and contained a couple of tips for styling them at a small space. Take a look and see which ones that you can apply to your own space.
1. Air Plant
Air plants are interesting plants since they don't need soil to survive. These are great if you're trying to find a little plant and do not want to deal with pots or dirt. In the event you decide to house your air plant at a terrarium, then make certain it comes with an opening so it gets plenty of circulation.
2. Aloe Vera
Did you know that aloe vera plants are part of the succulent family? Exactly like their relatives, they enjoy the sun and prefer that their soil is totally dry between waterings. These tiny potted plants are convenient to keep around in the event that you have some slight burnsoff, like a sunburn. Have a peek at our list of medicinal plants to find out what other crops you should keep around your property.
3. Anthurium
4. Asparagus Fern
If possible, give this plant some breathing space on each side so that its leaves may fan out. It'll add a gorgeous splash of green on any table or shelf.
5. Baby Toes
These adorable plants also hail out of the family. Their name derives from their small stature and similarity to an infant's toes. Baby feet are perfect conversation starters due to their unusual appearance.
6. Cast-Iron Plant
They are the plant to choose if you're prepared to give up a small floor space in exchange for a virtually indestructible plant.
These cute plants are known for their beautiful round leaves and the way for how hard they are to get. Chinese money plants can also be called missionary plants. This is how the plant spread throughout the world. These plants are easy to disperse, so the simplest way to acquire your own is to find a friend or Internet exchange willing to assist y
8. Echeveria
The echeveria is one of the most common types of succulents. Little plants like these are more commonly seen at home and office desks due to their easy care and small size. A typical reason for death, however, is overwatering. Make certain that you let your plants' soil dry completely before giving them another beverage.
9. Jade Plant
Jade plants are known for their thick, oval-shaped leaves. Jade plants can live for many years provided that they are given the appropriate care. To maintain your plant leaves nice and shiny, wipe down them every once in a while to combat dust develop. This is going to keep the leaves glossy and boost its capacity to absorb sun.
10. Kalanchoe
Kalanchoes are a variety of flowering plants which are known for their beautiful blossoms. Put them near a window so that they have loads of energy to flower. The kalanchoe is also from the succulent family, so it prefers to get sterile, well-drained soil.
11. Lithops
Many refer to lithops as"living stones," since these plants resemble pebbles and tiny stones. Much like succulents, these tiny outdoor pots plants may survive in warm temperatures and little water. Lithops are fantastic for displaying to guests because of their deceiving look!
12. Lucky Bamboo
If you choose to cultivate your lucky bamboo in water, then ensure you replace the water every 7 to 10 days and use filtered water if at all possible.
13. Oxalis
It made its name because of its resemblance to the Irish shamrock that is more commonly called the three-leafed clover. In addition to its title, its also famous for its photophilic character. This means that both its blossoms and leaves open and shut in response to light.
14. Peace Lily
Peace lilies are one of the best houseplants you can have in your house because of their variety of sizes, appealing look and ability to clean the atmosphere. Peace lilies may also flourish under fluorescent lighting, so they're perfect for rooms that have little to no natural lighting. Have a peek at our peace lily care guide to learn how to help them flourish.
15. Peperomia
Their thick leaves can hold water and allow them to endure intervals . They're also able to survive under fluorescent light, but grow best with bright indirect sunlight.
16. Polka Dot Plant
Polka dot plants are colorful plants which provide an unexpected dash of colour to any table or shelf. These tiny plants are commonly known for their pink color, but they've more recently become available in different colors (such as red and white). Even though it prefers indirect sunlight, some direct sunshine during the daytime is fine to your plant if it is not very vibrant yet. Just remember to bring it back out of the direct sun to avoid scorched leaves.
17. Pothos
Pothos plants are plants that could quickly dress up a bookcase or a plain wall with their trailing leaves. They are just another popular plant that purifies the atmosphere. Their classy appearance and air-purifying abilities make them a good choice for a house office or living space. Take a peek at our pothos plant care guide to learn more in-depth information regarding their care guidelines.
18. Rubber Tree
Rubber trees are indoor plants that could pull any space with their large leaves and vibrant colour. To maintain them in a smaller height, prune the leaves and branches regularly. New branches may sprout from these prunings if you tend to them.
19. Snake Plant
Snake crops are easy to take care of and are also useful for purifying the air. These plants grow vertically, so they are ideal for tight corners in need of some greenery. Snake plants can grow in a variety of light conditions, but thrive best in indirect sunlight. Because they arise from the desert, they can also withstand long periods of time without water. You ought to let their soil dry between waterings. Have a look at our snake plant maintenance manual to find out more in-depth information regarding snake plants.
20. Spider Plant
These plants have lots of long, skinny leaves which poke out of their pots. Spider plants make interesting hanging plants thanks for their own dangling leaves. The spider plant's other nicknames include the"airplane plant" and the"ribbon plant" — thanks to the counterparts that are iconic.
The series of pearls plant is a increasingly common plant with a exceptional appearance. This adorable plant is still another member of the family and so requires lots of light and small water.
The Way to Style Small Indoor Plants at Tiny Spaces
A lack of space is an invitation to get innovative and see ways to add leaves to your home! Little DIY projects like contemporary plant terrariums and kokedama chain gardens are other ways to incorporate little indoor plants into your small space. Look through our hints and tricks to see how you can benefit from your little space.
Small indoor plants are a few of the most versatile greenery you'll be able to find. Begin by picking a few of your favorites to see where they can match. From that point, you will get an idea about what works best on your area and what other crops that you would like to include! If you are up for getting a little more creative, why not try your hand at building a DIY ladder plant rack or DIY succulent wall backyard ? These jobs allow you to have an enjoyable indoor garden without taking up too much space! Unique wall and hanging planters are the way to go if you are tight on floor area.


text:
If you happen to could require a fabulous breather once you have paid hours earning a handful of assessments intended for work functions, distinct matter of minutes of one's taking part in online games. You are sure to make sure you attain the best wonderful and additionally celebration you'll merit after the very long visit to work.
Person and additionally young children as well seem to be hooked to help you using online games considering apart from the basic fact that must be no charge to learn, those online games may be entertaining and even difficult during the person same exact time frame also, encouraging people complete instance separate without the boredom. But a lot of folks believed that a great alternative that will performing activities is to become a fabulous video game control unit these can start to play inside your house each and every time they gotta have to. You will find small amount of noteworthy merits activities need of which make it the a good deal more sensible choice when compared to paying for games console.
With internet 100 % free games, there isn't an starting costs needed to have gaming. Because of on the net pen game titles, children will be active all day with no need to put in wherever around how much money is you are spending for those who might purchase for them some video gaming console. With online video games, your children can select to try out the Leading 10 Online games on the net to include athletics, challenge, interior decoration, trip many others. There are plenty of online for free video game webpages they are peruse gain access to a variety of games.
Together with the options available online, you'll can start to play these products actually you are looking for; you will definitely look for may video game they play. If certainly,there is connection to the internet, you will get a satisfying along with simple gaming.
If you should could possibly expect how much money is it would be easiest spending on most of the man or woman video games who you would have to purchase for any control system, you should know simply how much price savings you are able to make. And also you also have to think about space that needs. Though with matches a person can enjoy online for free; you don't need to get a space for storage considering you just need your personal machine places to clear any sort of video game who you need to play. It again may possibly be a serious spot saver and also is perfectly for you minus sufficient area at your residence to commence with.
Free online splash activities give you a large selection of mmorpgs this aren't just ideal for adult, however children mainly because well. This implies that you may find the pastime regarding your child, one particular without fury situation which in turn belongs to the issues when considering gaming consoles. You'll certainly be self-confident that this young children are receiving real pleasure plus entertainment.
A variety of amazing and Finest Activities Online via the web in these days that happens to be perfect for virtually any age. People can pick one up that meets ones feelings, attraction and additionally age. With young lady games that will activities pastime, you'll are not feeling whatever monotony if you expend a lot of time enjoying most of these games. Have fun with most of these games while not having to pay a penny.


text:
Congratulations to Robert Bonomo, MD, ARLG Laboratory Center Co-Director, who was named a Distinguished University Professor at Case Western Reserve University (CWRU) during its fall convocation on August 28, 2019. CWRU awards the title of "Distinguished University Professor"— a permanent, honorific title, to acknowledge contributions of full-time, tenured faculty with exceptional records of research, scholarship, teaching, and service.
Bonomo, a professor of medicine, pharmacology, molecular biology, and microbiology at the CWRU School of Medicine, has dedicated his research career to addressing the mounting problem of antibiotic resistance. "Infections previously brought under control can resurface in resistant and more virulent new forms," he said, "allowing disease to proliferate — potentially unchecked."
Among his investigations, Bonomo works to uncover the genetic and amino acid determinants of bacterial enzymes that create multi-resistance to such widely used antibiotics as penicillins and cephalosporins. Nailing down these sequences and using an integrated approach can lead to new medications that overcome the antibiotic resistance, and his work is paying off. Because of his collaboration with colleagues at CWRU and elsewhere, five new antimicrobials have been approved to date. "We're always trying to stay a step ahead of the bacteria," he said. "Evolution rewards organisms that adapt to their environments, including those that fend off antibiotics, so there is a fundamental natural mechanism that we have to overcome." Bonomo said his teaching and mentoring are as meaningful to him as his research. "Providing intellectual prep for the next generation helps ensure that future patients live longer, healthier lives," he said. "Nothing can be more crucial than that."
Read the complete article from CWRU.


text:
Global Contract Research Organizations Services Market: Snapshot
Contract research organizations (CROs) have transformed the way research are conducted by several pharmaceutical, biotechnology, and medical devices companies in ways more than one. These organizations offer a variety of services such as biopharmaceutical development, clinical trials conduct and other endeavors, drug discovery activities, product commercialization, assay development, and pharmacovigilance. The intensifying demand for new therapies and devices has mounted pressures on research and development (R&D) budgets of these organizations. Coupled with this, the increasing complexity of clinical trials and fast-paced changing regulatory framework associated with commercialization of new products are crucial factors propelling the demand for CROs services world over. CROs are equipped with skill and potential to offer time-bound services for the completion of clinical trials and help reinforce confidence among stakeholders and sponsors. In addition, the role of CROs services include helping companies partake in endorsing new treatment regimes.
CRO services may be sought by large pharmaceutical and biotech companies and small players essentially for different reasons. Large-scale patent expiries of a number of blockbuster drugs and rising initiatives of generic drug companies have led to dwindling revenue margins for prominent pharmaceutical companies in recent years. As a consequence, R&D funding has also diminished proportionately. This has led to limited scope for these companies for innovations and keep up the trend for aggressive growth. This has propelled the demand for CROs among these players. Several small and medium enterprise focused on conducting trials on new therapies, assays, and devices seek advanced research expertise, thereby bolstering the demand for various CRO services.
Contract research organizations (CROs) are support systems for the pharmaceutical, biotechnology, and medical device industries. These organizations facilitate research services outsourced by companies on contractual basis. CROs provide services such as biopharmaceutical drug development, biologic assay development, preclinical, clinical and post clinical trials, pharmacovigilance, and others. CROs also provide services to NGOs, foundations, research institutions, universities, and government bodies. The structure of CROs range from large international full-service organizations to small niche specialty groups. CROs that provide specialty services such as clinical trials offer expertise in the process of new drug or device from its time of conception till FDA / EMA marketing approval.
Rising prevalence of diseases such as cardiovascular, diabetes, and oncological, robust pipeline of pharmaceutical and biopharmaceutical products, increasing expenditure on research and development, rising emphasis on innovative treatment therapies for existing as well upcoming diseases, growing demand for outsourcing analytical testing, and optimal service provided by the CROs are the major factors driving the global CRO service market. However, restraining factors such as difficulty in aligning personnel expertise for specific projects and unavailability of highly skilled scientists causes inability to meet the requirement.
The global CRO services market has been segmented based on product type, therapeutic area, end-user, and region. In terms of product type, the market has been segmented into early phase development, clinical research, laboratory, and consulting services. Based on therapeutic area, the market has been segmented into oncology, central nervous system disorders, respiratory diseases, cardiovascular diseases, diabetes, and others. In terms of end-user, the market has been segmented into pharmaceutical and biopharmaceutical companies, medical device companies, academic and research institutes, NGOs, and others. In terms of region, the global CRO services market has been segmented into North America, Europe, Asia Pacific, Latin America, and Middle East & Africa.
The contract research organizations (CROs) services market is witnessing strong growth owing to increasing complexity of clinical trials, greater number of regulatory hurdles, and high investment required for infrastructure that results in greater clinical trials cost. As a result, rising number of pharmaceutical companies are partnering with CROs having the requisite infrastructure and expertise to manage costs and deadlines. Moreover, increasing focus on specialty drugs is likely to fuel the market as specialty drugs require scientific expertise and highly tailored clinical trials that significantly increases costs.
North America dominated the global CRO services market. High quality standards in the pharmaceutical industry, increased expenditure by governments on research and development in health care, rapid growth in the biosimilars and biological market, emerging biopharmaceutical industry, and rising demand for outsourcing are the major factors accelerating the growth of the CRO services market in North America. Europe is the second largest market due continuous innovation in medical technology with increasing investment by key players for research and development. Asia Pacific has significant potential in the CRO services market due to high availability of subjects for preclinical and clinical trials due to rising populations and increasing prevalence of diseases.
Major players in the global CRO services market are Quintiles Transnational Holdings Inc., Laboratory Corporation Of America Holdings, Pharmaceutical Product Development, LLC, PAREXEL International Corporation, ICON plc, PRA Health Sciences, Inc., InVentiv Health, Inc., Charles River Laboratories International, Inc., INC Research Holdings, Inc., and Wuxi PharmaTech (Cayman) Inc., among others.
The report offers a comprehensive evaluation of the market. It does so via in-depth qualitative insights, historical data, and verifiable projections about market size. The projections featured in the report have been derived using proven research methodologies and assumptions. By doing so, the research report serves as a repository of analysis and information for every facet of the market, including but not limited to: Regional markets, technology, types, and applications.
The study is a source of reliable data on:
- Market segments and sub-segments
- Market trends and dynamics
- Supply and demand
- Market size
- Current trends/opportunities/challenges
- Competitive landscape
- Technological breakthroughs
- Value chain and stakeholder analysis
The regional analysis covers:
- North America (U.S. and Canada)
- Latin America (Mexico, Brazil, Peru, Chile, and others)
- Western Europe (Germany, U.K., France, Spain, Italy, Nordic countries, Belgium, Netherlands, and Luxembourg)
- Eastern Europe (Poland and Russia)
- Asia Pacific (China, India, Japan, ASEAN, Australia, and New Zealand)
- Middle East and Africa (GCC, Southern Africa, and North Africa)
The report has been compiled through extensive primary research (through interviews, surveys, and observations of seasoned analysts) and secondary research (which entails reputable paid sources, trade journals, and industry body databases). The report also features a complete qualitative and quantitative assessment by analyzing data gathered from industry analysts and market participants across key points in the industry's value chain.
A separate analysis of prevailing trends in the parent market, macro- and micro-economic indicators, and regulations and mandates is included under the purview of the study. By doing so, the report projects the attractiveness of each major segment over the forecast period.
Highlights of the report:
- A complete backdrop analysis, which includes an assessment of the parent market
- Important changes in market dynamics
- Market segmentation up to the second or third level
- Historical, current, and projected size of the market from the standpoint of both value and volume
- Reporting and evaluation of recent industry developments
- Market shares and strategies of key players
- Emerging niche segments and regional markets
- An objective assessment of the trajectory of the market
- Recommendations to companies for strengthening their foothold in the market
Note: Although care has been taken to maintain the highest levels of accuracy in TMR's reports, recent market/vendor-specific changes may take time to reflect in the analysis.
Contract Research Organizations Services Market