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Suspected Adverse Effects After Human Papillomavirus Vaccination: A Temporal Relationship Between Vaccine Administration and the Appearance of Symptoms in Japan
In Japan, after receiving human papillomavirus vaccination, a significant number of adolescent girls experienced various symptoms, the vast majority of which have been ascribed to chronic regional pain syndrome, orthostatic intolerance, and/or cognitive dysfunction. However, a causal link has not been established between human papillomavirus vaccination and the development of these symptoms.
The aim of this study was to clarify the temporal relationship between human papillomavirus vaccination and the appearance of post-vaccination symptoms.
Between June 2013 and December 2016, we examined symptoms and objective findings in 163 female patients who had received human papillomavirus vaccination. We used newly defined diagnostic criteria for accurate inclusion of patients who experienced adverse symptoms after human papillomavirus vaccination; these diagnostic criteria were created for this study, and thus their validity and reliability have not been established.
Overall, 43 female patients were excluded. Among the remaining 120 patients, 30 were diagnosed as having definite vaccine-related symptoms, and 42 were diagnosed as probable. Among these 72 patients, the age at initial vaccination ranged from 11 to 19 years (average 13.6 ± 1.6 years), and the age at appearance of symptoms ranged from 12 to 20 years (average 14.4 ± 1.7 years). The patients received the initial human papillomavirus vaccine injection between May 2010 and April 2013. The first affected girl developed symptoms in October 2010, and the last two affected girls developed symptoms in October 2015. The time to onset after the first vaccine dose ranged from 1 to 1532 days (average 319.7 ± 349.3 days).
The period of human papillomavirus vaccination considerably overlapped with that of unique post-vaccination symptom development. Based on these sequential events, it is suggested that human papillomavirus vaccination is related to the transiently high prevalence of the previously mentioned symptoms including chronic regional pain syndrome and autonomic and cognitive dysfunctions in the vaccinated patients.
Key Points
Using our new diagnostic criteria for adverse symptoms after human papillomavirus vaccination, 163 patients with various post-vaccination symptoms were examined and 72 were diagnosed with human papillomavirus vaccine-related symptoms.
The main symptoms consisted of chronic regional pain syndrome, and autonomic and cognitive dysfunctions. The most frequent objective findings were orthostatic dysregulation, flattened digital plethysmography, and focal abnormality of cerebral blood flow in single-photon emission computed tomography.
The time to onset after the first vaccine dose showed a wide range (average 319.7 ± 349.3 days).
The period of human papillomavirus vaccination in Japan considerably overlapped with that of the development of unique symptoms in the vaccinated patients.
1 Introduction
Human papillomavirus (HPV) vaccines have been introduced worldwide for the prevention of uterine and cervical cancer [1, 2]. In May 2010, Cervarix® (GlaxoSmithKline, Research Triangle Park, NC, USA), a papillomavirus recombinant bivalent vaccine, and Gardasil® (Merck & Co, Inc., Whitehouse Station, NJ, USA), a papillomavirus recombinant quadrivalent vaccine, were widely introduced for use in female Japanese teenagers, as the cost of this vaccination was largely borne by several local governments. From April 2013, female adolescents aged 13–16 years were legally required to undergo this vaccination, and its cost was fully covered by the government [3]. Soon after this law went into effect, a high incidence of chronic limb pain and weakness, frequently complicated by violent tremulous involuntary movement, was noted in Japanese girls after HPV vaccination. According to the reports of a special committee organized in the Japanese Ministry of Public Health, Labour and Welfare [4, 5], by the end of March 2013, 8,646,147 doses of HPV vaccines had been used in Japan; it was further estimated that 3.28 million girls received this vaccine. Based on medical institution reports, 1196 cases were reported to have adverse reactions, of which 106 cases were considered to be serious. These symptoms were largely reported by the Japanese mass media as possible adverse events of HPV vaccination. Additionally, a social community was organized in Tokyo (All Japan Coordinating Association of HPV Vaccine Sufferers) [6], and this voluntary community started to collect more information from all over Japan. At the end of June 2013, the Japanese Ministry of Public Health, Labour and Welfare, withdrew the recommendation for use of this vaccination [7], and our institution was asked by the ministry to examine these affected adolescent Japanese girls.
The number of adverse events after HPV vaccination has been increasing, although the use of this vaccine has dramatically decreased during the recent 3.5 years. According to the latest reports of a Japanese special committee [8, 9], by the end of November 2016, a total of 8,931,261 doses of HPV vaccines were administered to about 3.39 million girls in Japan; 2024 cases were reported to experience adverse reactions, of which 673 were considered to have serious symptoms. During this term, the increase in the number of vaccinated girls was about 0.11 million, while that of case reports with serious adverse reactions was 567. The affected vaccine recipients reported various symptoms such as intractable headache, long-lasting general fatigue, widespread pain involving the limbs, chest, and abdominal wall, and decreased learning ability; most of these symptoms were ascribed to orthostatic intolerance, chronic regional pain syndrome (CRPS) [10], and/or cognitive dysfunction [11]. Moreover, clinical manifestations of suspected vaccine-related adverse effects after HPV vaccination have been reported to be ascribed to abnormal autoimmune reactions [12, 13], but the affected patients do not present with any characteristic laboratory findings, including a lack of anti-neural autoantibodies in serum or cerebrospinal fluid [10].
Demonstrating a causal link between HPV vaccination and the development of these symptoms is a very challenging task, particularly because there seem to be few tools or applicable algorithms to demonstrate direct causation. Therefore, in this study, we attempted to clarify the clinical spectrum of HPV vaccine-related symptoms, and then investigated the temporal relationship between HPV vaccination and the appearance of these unique symptoms, which may provide valuable insight into the pathogenesis of this remarkable phenomenon that occurred after HPV vaccination.
2 Patients and Methods
Between June 2013 and December 2016, a total of 163 consecutive female patients visited our institution complaining of multiple symptoms after HPV vaccination. Among them, 114 had undergone vaccination with Cervarix® and 43 with Gardasil®. No accurate information was available on the type of vaccine administered to the remaining six patients. Using self-reported answers to printed questionnaires (Electronic Supplementary Material) for our institute and medical records from other institutes when available, we obtained a detailed history of the patients' symptoms to determine the duration between vaccination and the development of the first symptom(s) suspected to be related to the vaccine. The patients underwent complete physical and neurological examinations and routine laboratory screening, including measurement of the serum levels of C-reactive protein.
Patients with hypotension and/or coldness of the limbs were evaluated with the Schellong test and a digital plethysmogram. In the Schellong test, orthostatic hypotension was defined as a decrease of more than 20 mmHg in systolic blood pressure and/or 5 mmHg in diastolic pressure within a few minutes after standing [14]. Postural orthostatic tachycardia syndrome (POTS) was defined as an increase in heart rate of more than 30 beats per minute (bpm) within the first 10 min of standing or tilting the head upwards [15]. A digital plethysmogram was recorded from the right second finger and right first toe, while checking the patients' skin temperature. The digital plethysmogram findings were evaluated according to the classification of the wave pattern [16]. The presence of a peripheral plateau pattern showing a markedly reduced height of the waves, with loss of a notch in the latter half of the wave, was judged to be pathological [10]. No standard diagnostic criterion exists for diminished skin temperature; therefore, a value below room temperature was considered abnormal.
Neuropsychological tests and functional brain imaging were performed in patients who complained of decreased learning ability and/or memory loss, and those without a history of any psychiatric or anxiety disorders. The neuropsychological tests used were the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and the Trail Making Test (TMT). The WAIS-III scores were evaluated using the following intelligence quotient (IQ) scales: full scale IQ, verbal IQ, performance IQ, verbal comprehension IQ, working memory IQ, perceptual organization IQ, and processing speed. A score below 80 on each scale of the WAIS-III was determined to be abnormal. In the TMT, the time taken by study patients to complete part B was compared with the time taken by age-matched controls [17], and significant prolongation of the time taken to complete part B (>95.0 s average time ±2 standard deviations) was defined as abnormal. Finally, patients with abnormal results in either the WAIS-III or the TMT were considered to have impaired cognitive function. Functional brain imaging was performed using single-photon emission computed tomography (SPECT). Single-photon emission computed tomography was performed using a two-head rotating gamma camera (Symba T6; Siemens, Berlin, Germany) equipped with parallel hole collimators: these images were acquired 15 min after intravenous injection of body weight (kg) × 2.5−3.5 MBq N-isopropyl-123I-p-iodoamphetamine. The data obtained from 123I-p-iodoamphetamine SPECT were analyzed using the three-dimensional stereotactic surface projection technique to identify brain regions with abnormal perfusion. Focal hypoperfusion observed in any of the cerebral cortices except the occipital cortex was considered abnormal. Data are presented as mean values and standard deviations.
3 Results
Diagnostic criteria for suspected adverse effects after human papilloma virus (HPV) vaccination
I. Prerequisite
1. At least one exposure to HPV vaccination
2. No abnormality of a physical or psychological condition before HPV vaccination
3. Appearance of clinical manifestations after HPV vaccination
II. Major symptoms
1. Prolonged general fatigue (lasting for more than 4 weeks)
2. Chronic headache, especially after standing up
3. Widespread pain (migratory joint pain, limb pain, or myalgia)
4. Limb shaking (tremor or myoclonus like)
5. Dysautonomic symptoms (orthostatic fainting, postural orthostatic tachycardia, or delayed or rapid gastrointestinal motility)
6. Motor dysfunction (frequent sudden falls, limb weakness or paralysis, gait disturbance)
7. Abnormal sensation (coldness in limbs, limb paresthesia, photophobia)
8. Sleep disturbance (hypersomnia, insomnia)
9. Learning impairment (memory impairment, difficulties in concentration, verbal dyspraxia)
10. Menstrual abnormality (amenorrhea, hypermenorrhea, irregular menstruation)
III. Objective findings
1. Persistent hypotension
2. Orthostatic hypotension or postural tachycardia on standing or tilt table test (Schellong test)
3. Decreased skin temperature
4. Peripheral plateau pattern in digital plethysmogram
5. Decreased cognitive function test
6. Decreased regional cerebral blood flow as shown in brain single-photon emission computerized tomography
IV. Exclusion
1. Abnormality in routine blood laboratory data
2. Conditions compatible with diagnostic criteria of other diseases (e.g., juvenile idiopathic arthritis, epilepsy, and autism spectrum disorder)
3. HPV vaccination after 30 years of age
Percentage frequency of symptoms and signs in the study patients
General fatigue
Widespread pain
Limb shaking
Dysautonomic symptoms
Motor dysfunction
Abnormal sensation
Sleep disturbance
Learning impairment
Menstrual abnormality
Diagnosed 72 cases
Definite 30 cases
Probable 42 cases
Undiagnosed 48 cases
Percentage frequency (positive cases/total cases examined) of abnormal objective findings in the patients examined
Orthostatic intolerance
Decreased skin temperature
Flattened digital plethysmography
Abnormality in cognitive function test
Focal abnormality of CBF in SPECT
Diagnosed 72 cases (positive cases/total cases examined)
41.7 (30/72)
37.5 (21/56)
70.2 (40/57)
47.6 (10/21)
43.8 (7/16)
75.0 (12/16)
Definite 30 cases (positive cases/total cases examined)
46.7 (14/30)
62.1 (18/29)
86.2 (25/29)
58.3 (7/12)
50.0 (5/10)
88.9 (8/9)
Probable 42 cases (positive cases/total cases examined)
38.1 (16/42)
11.1 (3/27)
53.6 (15/28)
33.3 (3/9)
33.3 (2/6)
57.1 (4/7)
Undiagnosed 48 cases (positive cases/total cases examined)
29.2 (14/48)
28.0 (7/25)
36.0 (9/25)
25.0 (2/8)
14.3 (1/7)
50.0 (3/6)
Symptoms or signs frequently observed in these 72 girls were prolonged general fatigue, chronic headache, widespread pain, limb shaking, dysautonomic symptoms, motor dysfunction, abnormal sensation, sleep disturbance, learning impairment, and menstrual abnormality (Table 2). The affected girls usually stayed in bed until noon because of marked general fatigue, possibly combined with sleep disturbance, and upon awakening, they experienced a continuous headache of varying severity. Dysautonomic symptoms included frequent squatting or syncope during their daily activities. Bowel dysfunctions manifested as frequent abdominal pain with diarrhea or chronic constipation with the abdominal distension. They also experienced widespread pain involving the limbs and trunk. In the limbs, migratory joint pain with no signs of inflammation was typical, whereas in the trunk, intermittent neuralgic pain in the chest wall or abdominal wall was common, and back pain or lumbago was sometimes observed. Motor dysfunction showed variable patterns: distal dominant weakness of the limbs, mimicking the symptoms of polyneuropathy, hemiplegia closely resembling that observed after stroke, and paraplegia or tetraparesis. In these conditions, demonstrable classical neurological signs, such as areflexia, exaggerated deep tendon reflexes, or Babinski sign, were absent. Abnormal sensations were mainly reported in the thigh or lower legs: dysesthesia or allodynia was common, and shooting or burning pain and complaints such as restless leg syndrome were occasionally reported. However, we did not detect any objective sensory impairment upon pin-prick or vibratory stimulations. Regarding learning impairment, the affected girls claimed that they could not remember long sentences from their textbooks or understand different themes simultaneously.
Objective findings that occurred at a high frequency were orthostatic dysregulation, abnormal digital plethysmogram recordings, and abnormalities on SPECT images (Table 3); POTS was detected in half of the girls with orthostatic dysregulation. In the SPECT images, focal hypoperfusion areas, which were located mainly in the medial fronto-parietal and temporo-parietal regions, were found in 12 of the 16 diagnosed patients who underwent nuclear scanning of the brain. Corresponding with the findings of SPECT images, decreased scores on cognitive function tests were seen: although the WAIS-III scores showed no consistent abnormality in the patients examined, a relatively high frequency of decreased scores was observed in performance IQ (6 of 21 girls; 28.6%), perceptual organization IQ (5 of 21; 23.8%), and processing speed test (5 of 21; 23.8%). In the TMT, about half of the patients tested revealed prolonged times (7 of 16; 43.8%).
Regarding symptom severity of these 72 patients at our initial examination, 30 patients had symptoms, but they could independently perform their daily activities including schoolwork. In 38 patients, daily activities were significantly impaired owing to the presence of symptoms: they were not able to wake in the morning and needed help to leave home. Four patients were confined to a wheelchair, and spent most of the day in bed.
3.1 Representative Case Report
In November 2014, a 17-year-old girl visited our institution because of limb pain, memory loss, and decreased calculation ability. She had received three injections of HPV vaccine by the end of July 2011. Two months after the third vaccination, she experienced pain and unpleasant coldness bilaterally in her shoulders and forearms, sometimes resulting in difficulty in writing. This symptom lasted for 6 months, followed by spontaneous relief. She subsequently experienced marked general fatigue, bowel dysfunction, tachycardia, hyperventilation, and irregular menstruation. Since April 2013, a marked increase in the number of episodes of severe headaches, especially in the occipital area, was noted. During these headaches, she experienced short-term asthenia with aphonia, and after repeated attacks, she experienced transient memory disturbance, including the inability to remember her address and name, difficulty in concentrating while studying, and sleep disorder. She underwent computed tomography, magnetic resonance imaging, and routine blood examinations at other hospitals, all of which revealed no abnormalities. Her symptoms resulted in frequent absenteeism at school in 2014.
Our physical examination revealed that the patient was 159.0 cm tall and weighed 46.1 kg. Her body temperature was 36.8 °C. Although she appeared to be in an asthenic state, a general physical examination and neurological examination showed no abnormality. Results of routine laboratory tests were all normal. In the Schellong test, her pulse rate was 90 bpm, with a blood pressure of 108/65 mmHg in the sitting position. 2 min after standing up, her pulse rate increased to 129 bpm, without a significant change of blood pressure, and this tachycardia continued for more than 10 min, causing her to squat and resulting in the termination of the examination. Her skin temperature was 24.8 °C in the right second finger and 24.0 °C in the right first toe, at a room temperature of 26.5 °C. Plethysmograms of the finger and toe showed markedly reduced wave heights. Based on her medical history and our objective findings, we concluded that she had POTS and disturbed sympathetic innervation on skin, and we performed further examinations.
4 Discussion
Vaccinations are generally safe and are expected to significantly reduce morbidity and mortality in the targeted infections, but they occasionally result in some adverse effects. For example, unexpected adverse effects following HPV vaccination were reported to the Japanese Ministry of Public Health, Labour and Welfare during 3 months after the national vaccination program, including HPV vaccination, started [3], and the mandatory vaccination with HPV vaccine was terminated at the end of June 2013 [7]. However, a causal relationship between HPV vaccination and various post-vaccination symptoms is controversial in Japan [19], and many of the affected girls were initially diagnosed as having psychiatric illness because of the absence of pathologic radiological images and specific abnormalities in laboratory test results. Thus, in this study, we first proposed new diagnostic criteria for adverse symptoms after HPV vaccination. Subsequently, using these criteria, 163 patients with various post-vaccination symptoms were evaluated and 72 were diagnosed with HPV vaccine-related symptoms. On the basis of these 72 the clinical spectrum of HPV vaccine-related symptoms was clarified, adding the frequent objective findings of orthostatic dysregulation, flattened digital plethysmography, and focal abnormality of cerebral blood flow on SPECT. Finally, we investigated the temporal relationship between HPV vaccination and the appearance of these unique symptoms for the purpose of addressing causality, and have revealed that the period of HPV vaccination in Japan considerably overlapped with that of the development of unique symptoms in the vaccinated patients.
The Vaccine Adverse Event Reporting System is available in USA to monitor the incidence of vaccine-related adverse events. Analysis of 12,424 Vaccine Adverse Event Reporting System reports following HPV vaccination revealed that syncope, dizziness, and headache were the most prevalent post-vaccination events [20]. The suspected HPV vaccine-related adverse events observed in this study are largely different from those mentioned above; estimating from the interval between the onset of symptoms and patients' visits to us, adverse events lasted for a long time and were severe enough to affect the patients' quality of life negatively. The female patients examined in this study presented with similar histories and pattern of clinical manifestations as the participants in our previous study: in our previous report that included 40 girls with possible HPV vaccine-related adverse effects, common symptoms were headache, general fatigue, limb pain, and weakness [10]. All of these symptoms could be explained by a combination of orthostatic dysregulation and CRPS [21]. In addition, peripheral sympathetic nerve dysfunction was responsible for the appearance of orthostatic dysregulation and CRPS [10, 22]. Recently, cognitive dysfunction has been noted as a possible adverse effect that manifests late after HPV vaccination [11]: it manifests mainly as memory impairment, decreased calculation ability, and transient prosopagnosia-like symptoms; affected patients experience difficulties in performing their schoolwork, with some being absent from school for long periods. Single-photon emission computed tomography imaging of the brains of these patients revealed a significant reduction in regional cerebral blood flow in functionally related cerebral gyri such as the right medial, frontal, and/or right rectal gyri [11]. Additionally, patients' conditions are more complicated with sleep disorders [23] and neuro-endocrine dysfunction [24]. Furthermore, abnormal immune responses were observed in cerebrospinal fluid samples collected from the patients with cognitive dysfunction [25].
Similar data were reported for patients from Denmark [26, 27], Italy [28], and the other countries [12, 29, 30, 31], and the pathogenesis of this post-vaccination syndrome has been postulated to be caused by an autoimmune disorder including autoimmune/inflammatory syndrome induced by adjuvants [12, 13, 32]. The clinical characteristics of autoimmune/inflammatory syndrome induced by adjuvants seem to be similar to that of possible HPV vaccine-related adverse events discussed here [33]. Additionally, causative autoantibodies for β-2 adrenergic and M2 muscarinic receptors were also detected in two female POTS patients with HPV vaccine-related adverse symptoms [34, 35].
In this series of the patients, it is notable that the time to onset from the first vaccine dose shows a wide range and the average of that is very long in comparison with the adverse effects of conventional vaccinations. Another Japanese research group reported that the time to onset from the first vaccine dose ranged from 1 day to 43 months with a mean period of 14.0 ± 11.6 months on the basis of the investigation of the post-vaccinated 35 girls [24]. Many symptoms after HPV vaccination are explainable by a combination of autonomic dysfunction, CRPS, and cognitive dysfunction, and all three disorders are characterized by insidious onset and progression. It is rather difficult to determine the exact time of onset in these symptoms. For example, some patients did not alter their lifestyle even with general fatigue and limb disorders, and only after repeated attacks of syncope did they recognize the possible adverse effects of HPV vaccination. Thus, the interval from an initial injection of HPV vaccine until the first awareness of these symptoms may vary among the involved patients.
In the analysis of the temporal relationship between HPV vaccination and the onset of symptoms, the peak onset of symptoms in the vaccinated girls occurred at an age similar to that in girls with HPV vaccination; the difference in average age between both groups was about 8 months, which is relatively similar to the average interval of 319.5 days between the first HPV vaccine administration and the onset of symptoms. Regarding the time course of HPV vaccination and symptom onset, most of the patients we examined received HPV vaccination between May 2010 and April 2013, the peak period being between July 2011 and September 2012. However, the development of symptoms after HPV vaccination in the same group of patients was between October 2010 and the same month 2015, the peak period being between September 2011 and August 2013; thus, all these four periods considerably overlapped, especially for the peak periods of both events. Therefore, these two events could be related to each other.
Among several iatrogenic disorders after injections, transmission of human immunodeficiency virus or hepatitis virus to individuals can be demonstrable after the appearance of virus-induced symptoms [36, 37]. Although there is no tool to obtain direct evidence of the role of HPV vaccination in the development of adverse symptoms in the present study, the time course of symptoms indicates that the manifestation of HPV vaccine-related symptoms terminated around October 2015, which was 28 months after the recommendation for HPV vaccination was withdrawn in Japan. However, POTS or CRPS occasionally develops in adolescent girls [14, 38], and a questionnaire-based study performed during July to December in 2015 reported that a group of symptoms including CRPS and POTS, which were seen in HPV-vaccinated girls, certainly occurred in Japanese girls with no history of HPV vaccination and its incidence was at least 5.3/100,000 [39].
This study has some limitations. We were unable to recruit a satisfactory control group from the general unvaccinated population. The next limitation is the small number of study subjects, all of whom were referred to us. The total number of Japanese girls with HPV vaccine-related symptoms would be much higher. Further large-scale studies are needed to elucidate the pathogenesis of this unusual phenomenon. To this end, a murine pathological model was recently established by combined administration of HPV vaccine and pertussis toxin [40], which might be helpful for investigating immune-related pathological conditions in this post-vaccinated disorder.
5 Conclusion
The present study revealed that the age distribution patterns in female adolescent patients who received HPV vaccination and that in the female patients who experienced HPV vaccine-related symptoms are very similar. Moreover, the period of HPV vaccination in Japan overlapped with that of the development of HPV vaccine-related symptoms in the vaccinated patients. Moreover, 28 months have passed since the recommendation for HPV vaccination was withdrawn, and new HPV vaccine-related symptoms have not been observed during our 14-month follow-up period. The sequence of these events suggests that HPV vaccination is temporally related to the development of these symptoms in Japanese adolescent girls. Further large-scale studies are required to clarify the pathophysiology of these symptoms and to establish the necessary treatment for affected patients.
The authors are most grateful to Dr. Shin Yanagisawa at the Department of Radiology in our hospital for conducting single-photon emission computed tomography examinations. The authors also thank Editage (http://www.editage.jp) for English language editing.
Compliance with Ethical Standards
This study was supported by a grant from a Health and Labour Science Research Grant on Emerging and Re-emerging Infectious Diseases (Establishment of Treatments and Providing Information on Symptoms after HPV vaccination, H28-001) to S.I. from the Ministry of Public Health, Labour and Welfare, Japan.
Conflict of interest
Kazuki Ozawa, Akiyo Hineno, Tomomi Kinoshita, Sakiko Ishihara, and Shu-ichi Ikeda have no conflicts of interest directly relevant to the content of this study.
Ethics approval
The study protocol was carried out in accordance with the Institutional Review Board approval (Nos. 3621 and 3659) of Shinshu University School of Medicine, Nagano, Japan.
Consent to participate
Written informed consent was obtained from the patient for publication of her case report. A copy of the written consent may be requested for review from the corresponding author.
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- 40.Aratani S, Fujita H, Kuroiwa Y, Usui C, Yokota S, Nakamura I, et al. Murine hypothalamic destruction with vascular cell apoptosis subsequent to combined administration of human papilloma virus vaccine and pertussis toxin. Sci Rep. 2016;6:36943.CrossRefPubMedPubMedCentralGoogle Scholar
Copyright information
Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


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OUR girls wanted to learn to play the piano. I had taken lessons some years earlier, so I felt I could start teaching them myself. We got off to a great start. In fact, they learned so quickly I could see I needed to start practicing regularly.
Finding a song, I began to play. To my dismay, my fingers would not do what they were supposed to! I remembered fairly well how the song should sound, and I could see that there was only one way for that to come about. I needed to start at the beginning, just as my own teacher had made me do, and play very slowly, getting each note right. I paid attention to the decrescendos and staccatos, counted for correct timing--in other words, I followed the rules. I did this over and over until the true song fully came forth.
In our everyday lives, the Ten Commandments and Christ Jesus' teachings, which urge us to love God and our neighbor, are the rules to follow that bring out the kingdom of heaven on earth. Reading and studying the spiritual import of the Bible show us the way to the correct practice of God's Word.
Mary Baker Eddy discovered the divine laws of harmony, heaven, in her lifetime search of the Scriptures. She shared her discovery of Christian Science with us in her book Science and Health with Key to the Scriptures. One of the things I've learned from this book is that not only can mistakes be avoided, but also sickness. For example, Mrs. Eddy explains: ``Jesus demonstrated the power of Christian Science to heal mortal minds and bodies. But this power was lost sight of, and must again be spiritually discerned, taught, and demonstrated according to Christ's command, with `signs following.' Its Science must be apprehended by as many as believe on Christ and spiritually understand Truth'' (p. 110).
Jesus was so endowed with the Christ-spirit that he is our Way-shower. He lived the right, or correct idea of man as God's image and likeness. But Christ, Truth, isn't limited to a single individual. Jesus made plain through example and precept how we can practice this true idea, as well. Certainly it takes diligent and continuous practice to keep the direction of God always uppermost in thought. But it's always possible to renew our practicing and refresh our ability to turn confidently to God.
For example, one night I was fine when I went to sleep. Later in the night, however, I woke up suddenly very ill and in pain. I knew it would be unproductive to rehearse the why and where of sickness. I needed to practice. I got up to read from the Bible. I read the story about how God gave Daniel the understanding he needed to interpret the king's dream (see Daniel, chap. 2). It starts: ``And in the second year of the reign of Nebuchadnezzar, Nebuchadnezzar dreamed dreams, wherewith his spirit was troubled, and his sleep brake from him.'' Nebuchadnezzar brought in astrologers and magicians to interpret his dreams. But when he could not remember what the dream was, they told him that no one on earth could ``shew the king's matter.'' To them, the unrest was unexplainable. However, Daniel came and asked Nebuchadnezzar to give him an opportunity to make the dream clear.
Daniel turned to God in prayer to understand what he needed to know. Because true rest is found in understanding God, Spirit, and God is All, there is nothing to sustain unrest. The Bible tells us the result of Daniel's prayer: ``Daniel answered and said, Blessed be the name of God for ever and ever: for wisdom and might are his.'' And Daniel told the king both what his dream had been and what it meant.
This story helped me pray for myself. I practiced beholding the Christ-idea. I mentally affirmed that rest and peace are as eternal as the eternal God. I saw that God's wisdom and might don't include weakness.
As I continued praying, I understood better the reality of the concepts I was practicing. Within half an hour I was completely free and slept normally the rest of the night.
Just as the perfect song is not lost when a mistake is made at the piano, spiritual power is never lost.
The Christian Science Sentinel, a weekly magazine, contains more articles about God's power to heal.

subset: commoncrawl


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The South End has only six percent open space which may be why its parks are so treasured, even when the pavement is cracked and the weeds at times more prominent than plantings. Summer arrived in Library Park today when the first of a series of children's events planned by the South End library staff kicked off with a much-appreciated return by musician David Polansky.
The performance is one of the many sponsored by the Friends of the South End Library. It was attended by some forty children accompanied by parents, nannies and teachers, and elicited enthusiastic sing-along responses and curious investigations by young Southenders of instruments, stuffed animals used to illustrate songs, and other props.
Other programs for babies, toddlers and pre-schoolers coming up are:
*Sing and Dance Along with Little Groove, a Boston-based Music and Art Enrichment group, Mondays, June 20, July 18 and August 15 at 10:30 AM
*English-Spanish Story Time with Pine Village Preschool, a Boston Parents Paper Family Favorite Language Immersion program with songs, stories and crafts, Wednesdays June 15, August 17, September 21 at 10:30 AM.
*Jouvet Shortell and Spanish in Motion for pre-schoolers, Wednesdays, July 13, July 20 and July 27 at 10:30 AM
*A Music Concert for Pre-schoolers with the Community Music Center of Boston in Library Park, Wednesday, August 10 at 10:30 AM
All events are free. For further information, contact the South End library at 617 536-8241 or check their web site, linked here.


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|Billy Crystal, digging his own grave
The other fella says, "The gallows-maker, for that frame outlives a thousand tenants."
It was a pretty witty reply, but not the correct answer. The first gravedigger twists the answer to seem sacrilegious and then gives the correct answer: "A grave-maker. The houses that he makes last till doomsday."
Indeed, three of the five oldest structures in Britain are graves of one kind or another, each more than 5000 years old. These are not just bones in the mud; they are cairns and tombs built, as the Clown said, to last until doomsday.
|A monk's beehive cell
A Northumbrian nobleman, he accompanied his friend on a pilgrimage to Rome when he was twenty-five. Actually, his friend didn't go the distance, but Benny did, after which he was all caught up in God. He went on another pilgrimage to Rome twelve years later, and on his way home, stopped off at a monastery for a couple years monastic instruction. Then he went back to Rome, picked up the next Archbishop of Canterbury (Theodore of Tarsus) and headed for Britain.
|Appropriately reflected in glass
If you are a mason, a glassworker, a musician, or a painter, take a moment to appreciate the contribution of your patron, Saint Benedict Biscop.


text: What Constitutes as an AC Emergency Published on May 13, 2016 Heat has arrived. You have probably already switched over to your air conditioning system to make sure the system is running right. But what do you do if it's not? It's uncomfortably warm, your AC system is not working, and you want to call someone but it's nighttime and you aren't convinced this is considered an AC emergency that comes with an upcharge. You may have heard that Service Experts Heating & Air Conditioning is available all day every day for emergency AC repair, but what actually constitutes a 24 hour AC repair emergency? And how much will is cost? Keep in mind, you can always call Service Experts Heating & Air Conditioning, day or night, every day of the year. Our customer service team is available live, around the clock to help decide if someone needs to come check it out ASAP or if it's something that can wait until morning. When trying to evaluate the severity without an expert, here are a couple matters where you should go ahead and give us a call. Strange SoundsThere are several reasons that your AC system might be making unusual, screaming noises. One common problem could be that the fan belt got loose. Seasonal maintenance can help avoid this situation, but sometimes things happen and you need to call for an AC repair appointment. Another reason your air conditioning unit could be making a loud, screeching noise is that the compressor is running at a high level of pressure, which can be hazardous. If a sound seems excessive, shut off your AC system immediately and call Service Experts Heating & Air Conditioning for an emergency AC repair service. Stinky SmellsA burning smell coming from your air conditioner is usually a sign of an electrical complication or a part has become so overheated that it's seriously burning. If your air conditioner smells like it's burning, that is certainly an emergency AC repair. Call Service Experts Heating & Air Conditioning immediately for 24/7 AC repair.No Air FlowIf your air conditioner doesn't seem to be turning on, or you can't feel any air blowing, this could be a sign that the cooling system has failed. The cause could be a poorly calibrated thermostat, a complication with the blower, or your air conditioning unit could have finally met its maker. If the AC isn't generating air flow, or the air that's blowing is too hot, go ahead and call Service Experts Heating & Air Conditioning, especially if there is extreme weather, so we can get someone out to make sure your family is safe and comfortable. Not having a functioning A/C in severe temperatures for sure constitutes a 24 hour AC repair. Back To BlogContact Us


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Californian MoFo has no shortage of European work coming through. "That's the beauty of being tech-focused: it permeates so many more practice areas than people think."
One lucky MoFo
A big name in the technology sector, Morrison & Foerster (MoFo is its official nickname) is a San Fran-HQed firm that's known in the US for its IP, TMT and data protection prowess. "We are a US firm in London, but we regard ourselves as MoFo in Europe," London co-managing partner Alistair Maughan says, "and the strategy is to continue to act as the gateway into Europe for the firm's global clients." One recent work highlight illustrates this: the London team advised Japanese tech giant SoftBank on its acquisition of Cambridge-based smartphone chip designer ARM for a cool £24 billion. Not too shabby for a 50-lawyer office. Other well-known clients include Standard Chartered, Just Eat, Toshiba, Novartis and Panasonic.
"The best of both worlds."
The London office continues to bolster its size, doubling the headcount in the past few years. Recent laterals have come from the likes of Clifford Chance and Latham. "They're adding partners every other month!" one trainee exclaimed. "We have new departments, like funds and derivatives, that we didn't have when I applied, which is really encouraging." The London office wins Chambers UK rankings for its capital markets, outsourcing and IT work. Trainees felt MoFo offers "the best of both worlds: I knew I wanted to be at a smaller American firm in London, and MoFo stood out as being a West Coast firm with a relaxed vibe."
MoFo fo' shoes
We heard trainees are typically allocated to corporate, TMT or litigation as their first seat, while "second-years typically get funds or finance because they're trickier." Trainees are asked for their seat preferences midway through each one, and while we heard TMT is in high demand, one insider pointed out that "the funds seat is very popular because the two partners are brilliant." Trainees also submit their preferences for client secondments and overseas seats, but sources found allocation in this respect to be "a bit unclear... things tend to be decided based on a combination of performance and discretion." The firm tells us that a range of factors are considered when deciding which trainees get to experience these opportunities, as spaces are limited.
The corporate seat offers a raft of transactions to get involved with, spanning private and public M&A, venture capital and corporate reorganisations. We mentioned the SoftBank-ARM acquisition the firm worked on above – that was the biggest deal to be announced since the Brexit vote. Since then, the team has also advised US-based clothing retailer Cherokee on its acquisition of Essex-founded hiking boots maker Hi-Tec Sports for $96 million. And London lawyers teamed up with corporate and capital market colleagues in Tokyo, Berlin, Brussels and New York to advise Toshiba on its $2.4 billion divestment of smart meter manufacturer Landis+Gyr. Trainee tasks include "drafting ancillary documents for larger transactions, drafting resolutions and drafting disclosure letters." Another insider attended "several meetings with CEOs of large businesses," as well as "helping associates in other teams with random queries and drafting board minutes or filings for Companies House."
The capital markets team advises banks like Barclays Capital, Scotiabank and Ally Financial on organising a range of structured products, hybrid offerings and international financings. The team also has experience advising clients in the life sciences, energy and technology sectors. A recent highlight saw the team advise Merrill Lynch on updating a $65 billion European bond programme for Bank of America. A trainee reported: "I did a lot of drafting – and not just of ancillary documents, but also of structured notes and purchase agreements coming out of New York and Tokyo." Due to the small size of the team, "I'll often be working side by side with a partner," one interviewee said. "So I'm expected to call clients and liaise with the other side."
MoFo's sizzling reputation for technology transactions makes this seat a popular destination for trainees. "The firm calls it technology transactions, but it's the same as TMT really," one newbie clarified, meaning the work covers both corporate and commercial stuff. Big names like AIG Europe, Novartis and Fujitsu all come looking for help with licensing, outsourcing and e-commerce agreements. The team recently advised Panasonic on the rights associated with open source software licences in the UK and Japan, as well as assisting Outlier, the blockchain ventures company, on its collaboration with Imperial College London. "I was drafting IP licensing agreements and transitional services contracts," one insider reported. Trainees may also work with certain clients again and again, "because they've got us on retainer, so there's a constant stream of work. I was making amendments to the contracts with global suppliers, and at one point I was dealing with over 50 countries which was madness!"
"At one point I was dealing with over 50 countries which was madness!"
Over in banking and finance, trainees have a crack at acquisition finance, real estate finance, corporate banking and derivatives. Clients include Bank of America, Standard Chartered and mobile advertising company Fyber. The team also advised Just Eat on a loan to support its potential £200 million acquisition of Hungry House and Skip the Dishes, as well as representing Barclays on a cross-border revolving loan facility for clothing retailer Boden. "The team is really busy," one insider shared, "so there's a constant churn of deals." Another reported that "you're not there to push paper around and manage comments – the partners take you to all the client meetings and show you how it's done." Trainees are at those meetings to take notes, listen and learn.
At the time of our research, the only overseas seat option was a six-month stint in Singapore. "It was a really awesome experience," one insider cooed. "They put you up in a super-swanky apartment. It's really high up and stunning, bang in the centre of the town." The Singapore office holds around 15 lawyers, and a trainee here might work on "client alerts, publications, guides and large transaction documents." In the past, overseas seat options have also included Hong Kong and Tokyo. While New York is not currently an option, the firm is looking for an English-qualified supervisor for Big Apple secondees.
YOLO MoFo
When it comes to hours, trainees noted that the occasional all-nighter is required. In banking an average working day is 9am to 8pm, and one insider shared: "I did stay until 6am once, because the client was extra demanding." Over in capital markets, we heard a similar refrain, with an average day lasting from 9am to 10pm. Less stringent hours can be found in tech transactions, where a typical day spans 9am to 7.30pm. "The hours in the corporate team are longer and more consistent than in other seats," we heard, with average days balancing out as 9am to 10pm. A source reported: "There have been occasions where I've been in till 3.30am every day for a couple of weeks because of a deal closing."
"There's definitely a cool techy approach going on."
Located in Moorgate, "the London office isn't the flashiest place on earth like the offices in Tokyo and Singapore." Sources pointed to MoFo's California roots when asked about firm culture – "there's definitely a cool techy approach going on and it's incredibly friendly here." Interviewees said MoFo works hard to maintain its culture. "That's why we only hire through our vacation schemes," one newbie announced, "because we want to make sure you'll fit in well." Rookies really get into the Cali groove after qualification, when the firm sends all NQs to San Francisco for a week of training.
"We get on really well and like to go out for one or two drinks on a Thursday," interviewees said of their colleagues, with the Rack and Tenter and Refinery pubs taking preference. The London office also hosts fortnightly cheese and wine nights which are "always well attended." In addition, trainees get a budget every quarter to socialise. "We'll organise dinners and do something special to catch up," a source reported. There's even time to kick back a bit during the working day, as the office has "a games room with air hockey, snooker and ping-pong, so it's not uncommon to catch people having a 15-minute break in there."
We heard that the NQ process is "quite fluid, so if you're interested in qualifying into a particular team, you're encouraged to voice that quite early on. Most people tend to get their first choice." While there is no formal jobs list, trainees are invited to have an informal chat with the training principal during their fourth seat to discuss preferences. In 2018 the firm kept three of four qualifiers.
The firm will be increasing its trainee intake to six for 2021.
You may also be interested in...
These US firms with small London trainee intakes:
• Cooley
• Curtis
• Dechert
• Goodwin
• Orrick
How to get a Morrison & Foerster training contract
Vacation scheme deadline (2019): 6 January 2019 (opens 1 September 2018)
Apply for 2021 training contracts via the firm's 2019 vac scheme
Online application form
MoFo only recruits trainees through its vacation scheme and asks candidates to apply by completing its online application form on the careers section of the MoFo website. A 2:1 degree and As and Bs at A level are a must at this stage; any work experience is a plus, but not a requirement. When it comes to extracurricular activities, head of legal talent and recruitment Lynnsey McCall tells us that "applicants who can demonstrate interests that reflect the firm's core areas, or its long-standing commitment to diversity and pro bono, also help an application to stand out." McCall adds that "significant sporting, musical or charitable achievements can also provide evidence of focus, commitment and determination, which MoFo lawyers need to have."
Forty of the initial 1,000 applicants are invited for a first-round interview in March or April. This takes place with McCall and two associates and covers the usual 'why law?' and 'why MoFo?' questions. There is also a straightforward legal question for those who have already studied law, as well as a question designed to ascertain commercial awareness. In addition, McCall tells us that "we'll ask quite open-ended questions about a candidate's application to get to know them better. Our trainees come from a diverse range of backgrounds so there's not one key trait we look for, but we do like to see an ability to get on with other people and evidence of a genuine interest in the law." McCall continues: "Those who strike the right balance between being prepared but not having overly scripted answers tend to make the best impression."
Twenty aspiring recruits survive to attend a two-stage second interview at the end of April with MoFo's training principal, another partner and one current trainee. Firstly, candidates are tasked with creating a five-minute presentation on a non-legal topic based on current affairs. In 2016 candidates were invited to take a position on either the junior doctors' strike, the use of tax havens or the refugee crisis. Interviewees are then quizzed on their presentation. Co-managing partner Alistair Maughan says: "You don't have to be right but being able to engage in a sensible and mature discussion is the mark of someone who will do well at MoFo." The second part of the process involves reviewing a non-legal case study and discussing it with two associates. "We are looking for people who can identify the key issues and discuss them in a logical way," McCall reveals.
The vac scheme
Between eight and 12 candidates make it onto either of the firm's two, fortnight-long vac schemes in June and July. Attendees sit in one department per week and tackle tasks which are usually given to trainees. "I was proofreading, researching and writing articles," one trainee recalled. Students are also set an assessed research project and tasked with organising a themed cheese and wine evening. "The students can have a bit of fun with it but it is also an opportunity to evaluate how they work together in a team and how they manage their time," McCall explains.
Throughout the fortnight, recruiters are keen to see students "building relationships across the whole office, demonstrating their initiative and enjoying themselves." Feedback on performance during the vac scheme forms the basis of training contract offers. "We invite feedback from everyone in the office – not just partners and associates," McCall says. So no sucking up to the partners while shoving past the secretaries.
US firms in London
Morrison & Foerster (UK) LLP
One Ropemaker Street,
Website www.mofo.com
- Partners 19
- Associates 42
- Total trainees 9
- UK offices London
- Overseas offices 15
- Contacts
- Graduate recruiters: Lynnsey McCall or Rebecca Nasskau, [email protected], 020 7920 4000
- Training Partner: Jeremy Jennings-Mares
- Application criteria
- Training contracts pa: 6-7
- Applications pa: 400
- Minimum required degree grade: 2:1 or equivalent
- Minimum A levels: AAB
- Vacation scheme places pa: 15
- Dates and deadlines
- Training contract applications open: September 2018
- Training contract deadline, 2021 start: 6 January 2019
- Vacation scheme applications open: 3 September 2018
- Summer vacation scheme 2019 deadline: 6 January 2019
- Salary and benefits
- First-year salary: £46,000
- Second-year salary: £50,000
- Post-qualification salary: £115,000
- Holiday entitlement: 25 days
- Sponsorship
- LPC fees: Yes
- GDL fees: Yes
- Maintenance grant pa: Yes
- International and regional
- Offices with training contracts: None
- Overseas seats: Singapore
- Client secondments: From time to time subject to client requirements
Firm profile
In Europe we have a team of 120 lawyers in our strategic hubs of London, Berlin and Brussels. We work alongside our colleagues in the US and Asia, drawing on cultural, jurisdictional and market knowledge to deliver the best advice and client service with a global approach.
Dynamic technology companies, significant financial investors and financial institutions, leading consumer product companies and other market leaders come to MoFo for our expertise, knowledge, advice, commerciality, transaction support and individually tailored client service. We handle some of the world's largest cross-border transactions and resolve some of the biggest disputes across multiple jurisdictions.
Our firm was built on and continues to succeed because of the talent of our lawyers and their innovative approach to the practice of law. We offer a collegial environment where we value teamwork and diverse perspectives and operate as one firm.
As our nickname suggests, we take our work seriously but we don't take ourselves too seriously.
Main areas of work
Training opportunities
Vacation scheme
Other benefits
University law careers fairs 2018
• University of Cambridge, 18 October 2018
• Warwick University, 23 October 2018
• University of Oxford, 3 November 2018
• University of Manchester, 13 November 2018
• Durham University, 20 November 2018
• King's College London, 24 October 2018
Social media
Facebook MoFoLLP
Instagram @mofollp
This Firm's Rankings in
UK Guide, 2018
Ranked Departments
London (Firms)
- Capital Markets: Debt (Band 5)
- Information Technology (Band 4)
- Outsourcing (Band 3)


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Harleigh has just moved into her own room. She may only be 4 months old but after our holiday we realised that she just needed more space than her basket offered. I'm hoping that this helps improve her sleep a little. When we moved her into her room we also added an extra element into her bedtime routine. While she drinks her milk in her dark room we use the new Moonlight & Melodies Projection soother from Skip Hop.
With one click of the button it projects a gorgeous starry night sky onto the ceiling. The lights change colours and are very soothing and calming. Harleigh loves staring at the lights while she drifts off to sleep.
Another great feature is that there's a fabric pocket which can be flipped over the projector to transform the soother into a soft cuddly friend. This turns the projector into a soft glowing nightlight. We haven't used it in this mode yet for sleep as Harleigh is only 4 months old but Paige and Parker both enjoy it. The nightlight features stay-cool LED lighting so there is so worry about it getting hot whilst in use which is a must have feature.
There are also four melodies which play when you press the button twice. They are very sweet but i feel like they are a little too loud to be calming for Harleigh, she is used to white noise so any other sounds keep her awake and entertained rather than soothing her.
The bear is cute and very portable which is handy for trips away and helps to soothe your baby on the go. It also turns off after 20 minutes which is the perfect amount of time to help baby drift off to sleep but to also save the batteries. It does take 2 AAA. Our little bear will be used as part of Harleighs bedtime routine for many months to come and as she grows he will become a cuddly friend she can snuggle up to.
Does your child use a night time projector? Paige and Parker actually use one in their room too!
Nicola Xx
*Disclaimer - We were sent the above item for the purpose of this review but all views and opinions are my own*
Wednesday, 29 March 2017
Review - Moonlight and Melodies Hug Me Projection Soother Bear
Posted by Life Through My Eyes at 19:54
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PA - Predator priest arrested, SNAP urges Scranton bishop to do outreach
It is ironic that while America's bishops pat themselves on the back for their alleged clergey sex reforms, another arrest of a priest for serial sexual abuse hits the news. We hope that as the bishops leave Atlanta and return to their home dioceses, they see this story as a sobering reminder of how far church officials really do have to go.
We are grateful to the police for apprehending Fr. Thomas Shoback and preventing him from abusing any more kids. The fact that he is currently facing more than 30 charges is indicative of the lack of oversight and care by church officials at the Diocese of Scranton.
Shoback abused kids on church grounds and in the rectory. It is hard to imagine, therefore, that no other employee or parishioner saw his crimes and failed to report them. We hope that this is not the case, but we expect it is.
We urge anyone who saw, suspected, or suffered crimes by Shoback to come forward immediately to the Pennsylvania State Police. Bishop Bambera should also do everything he can to help law enforcement. Issuing a short statement urging people to "pray for healing" does nothing. Instead, he should use all the resources available to him (including the diocesan website and newspaper) to reach out to others who may have been hurt by Shoback or any other employee of the Diocese of Scranton.
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I recognize there are so much common things in between two of us, we have shared almost every thing and spend lot of time together that some time pushed me to get in touch to say whats in my mind and heart these are only cute and interesting things that we enjoyed and come up with an amazing solution and I know and observed my ex didn't forget all and want to break silence. I want my ex back and know my ex wants me back too. This is the reason why I want to get back with my ex. Why you should get back with your ex if you're confident and have mutual good understandings that you know there is no one else match with those. If you cant understand the deep relationship issue and feeling less confident then try to consult some kind of expert relationship advice to fill the gap. If you're both missing for each other then you should not delay in getting back together with each other. Why should I want to get back with my ex has a solid reason that you can also come up while thinking right! Here are some of the great suggestions you should observe and proceed.
How to know if you should get back with your ex or not? Clear your doubts first because uncertainty play a negative role like whether you try or not to get back together. If you're unsure you will not make right decision. There is nothing to get worried on, as there are some ways that you can easily follow to get your doubts clear and indeed it will make confidence in you in making up your decision about why you want to get back with your ex. If i have controlled my doubts that automatically delivered me my strong determination; I made it because I want to get back with my ex, I hope you will also get the same feelings about; Why should I want to get back with my ex? Just control your doubts and go through with these following special notes.
You Want To Get Back Together With Your Ex
It's right because you're thinking so! The first reason that should push you to want to get back together with your ex is the fact that you yourself want to get back together. If you are unwilling, or if you even have doubts about it, then getting back with your ex is probably not the best thing for you to do. You will only end up breaking up once again. It is difficult to make a relationship work if you are not willing to make it work in the first place, so make sure that your heart is set on getting back together with your ex.
Your Ex Wants To Get Back
If your ex is giving you signs that she wants to get back together, such as talking about your past relationship or wanting to go on dates with you still even after you're broken up, then that is an indication that your ex probably still wants to get back together with you. Wanting to get back together relies not only on your decision, but also relies on your ex's, especially since it takes both of you to make the relationship work. If one party is not willing to get back together, then the entire process won't probably work.
There Should Be Willingness To Resolve Issues
Getting back together with your ex requires that both of you need to be willing to resolve whatever issues you have in your relationship that caused you to have problems and break up. If you and your ex are expressing that you are both willing to sit down and talk and try to fix your issues and come up with a resolution for them, then that is a good indication that you might be able to successfully get back together.
Both Of You Believe In Willing To Compromise
Once you have come up with a resolution for your issues, you both need to know to learn how to compromise in order to resolve your issues and successfully get back together. Willingness to compromise should come from both of you, doing this will ensure that you and your ex will have a smooth transition from a break up to getting back together.
If not even me but my ex back shows same kind of behavior then anyone of you can proceed then why not me. I know my Ex wants me back so do I; that's why – why should I want to get back with my ex.
Should I get back with my ex? Ask yourself first, as getting back together with your ex is not an ordinary decision that you need to make, so you need to be able to make sure that making decision to get back together is the right choice for you to make to continue the relationship you really deserve and cant live without it. Hopefully, these hints will help you in finding your way in getting a right decision for you. Get your ex back – best of luck!


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"More than 20 years ago, a psychology student doing his training at one of Argentina's oldest psychiatric wards kept being asked by his family and friends what it was like to work in there. So he came up with an idea: to let the patients explain in their own words.
The first radio station to broadcast from inside a mental hospital was born. Radio La Colifata - slang for loon, crazy person, has been on air from Hospital Jose Borda in Buenos Aires every Saturday afternoon for 23 years - to confront the stigma around mental illness, breaking through the wall in AM, FM and now online."
"EBN works to harness the power of multimedia audio–visual technology into the most effective electronic behavior control system.
EBN's techniques involve a collection and analysis of massive amounts of randomly recorded audio and video television programming. After a careful screening internal process, the choicest bits are chosen for inclusion in compositions using internal digital sampling and video editing in their own production facility."
(fUSION Anomaly, 12 January 2003)
"Sketches are obviously pictorial, for they refer to shape and orientation, and often to approximate size even if they maintain a varying degree of abstractness. Yet it is impossible to confirm that there is a direct one–to–one correspondence between shapes and figures on paper and the images they stand for. It is therefore proposed to refer to the (pictorial) reasoning evident in interactive imagery at the time of sketching as consisting of two modalities. The designer is 'seeing as' when he or she is using figural, or 'gestalt' argumentation while 'sketch–thinking'. When 'seeing that', the designer advances no figural arguments pertaining to the entity that is being designed. The process of sketching is a systematic dialectics between the 'seeing as' and 'seeing that' reasoning modalities. To examine this proposition, design moves and arguments were inspected as they are established through protocol analysis. The notion of 'seeing as' and 'seeing that' will be further elucidated as we proceed, so as to best exploit documentation from the protocols."
(Gabriela Goldschmidt 1991, p.131)
Goldschmidt, G. (1991). "The dialectics of sketching." Creativity Research Journal, Routledge 4(2): 123–143.
Fig.1 Donald Owen Colley [http://buttnekkiddoodles.com/2012/12/26/knockin–about–chicago/]
"Metal setting is practised today by only a handful of specialists, but it continues to provide the standards by which good typesetting is judged. Photosetting, and the computer setting which has largely displaced it, are criticised for being too perfect and lacking the character of hand–crafted type. Now, increasingly, designers are using desktop publishing systems such as the Macintosh to do their typesetting. The technology has matured considerably over the last two years and the time is ripe for a reassessment: is good typesetting possible on the Macintosh?"
(Andy Benedek, 1991)
Andy Benedek (1991). "The craft of digital type" Winter no. 2 vol. 1, Eye Magazine.
"From humble country road to the the most fashionable street in Europe, Oxford Street has been home to such colourful characters as highwayman Jack Wild, writer and opium addict Thomas de Quincy and shopping impresario Gordon Selfridge.
The Happy Mondays, Rebel MC, Tom Jones and Sinead O'Connor join in a unique and eclectic musical celebration of this retail mecca and its history."
(Channel 4)
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A project by Walker Smith-Williams, Billy Erhard and Gage Holden for FILM 3250, Animation History and Practice. Summer 2008.


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PennDOT Opens U.S. 202 to 6 Lanes between Route 401 and U.S. 30 in Chester County
The Pennsylvania Department of Transportation this morning (Aug. 3) opened 2.5 miles of U.S. 202 to six lanes between the Route 401 (Conestoga Road) and U.S. 30 interchanges in East Whiteland Township, Chester County, substantially completing construction on a $63.3 million improvement project that began in April 2013.
Crews worked Tuesday night, Aug. 2, into this morning to complete line striping and other operations for opening the rebuilt and widened expressway by 5:00 AM. The opening caps several weeks of nighttime activities by the contractor to complete the installation of the concrete median barrier, removal of construction barriers, and repainting of traffic lines in the work zone.
Under this second mainline widening contract, PennDOT rebuilt and widened northbound and southbound U.S. 202 to three lanes in each direction from just north of the Route 401 Interchange to approaching the U.S. 30 Interchange; reconstructed the Route 401 (Conestoga Road) Interchange; rebuilt U.S. 202 bridges over Route 401 and Planebrook Road; installed a culvert to carry the Chester Valley Trail under U.S. 202; upgraded the highway drainage system; and installed sound walls, Intelligent Transportation System (ITS) components, and new highway signs.
Crews will continue to work and close lanes at night periodically for the next several weeks to complete miscellaneous construction activities and clean-up operations in the work zone. Allan A. Myers, LP, of Worcester, Montgomery County, is the general contractor on the $63,381,084 project.
PennDOT utilized two mainline construction contracts for the expansion of 6.5 miles of U.S. 202 to six lanes in East Whiteland and Tredyffrin Townships. PennDOT opened four miles of U.S. 202 to six lanes from just south of the Route 252 Interchange to just north of the Route 401 Interchange in September 2014. Construction on the first mainline contact, worth $105.4 million, began in April 2011.
Prior to starting construction to widen this section of U.S. 202 in 2011, PennDOT replaced six overhead bridges under two contracts worth $45 million to create space needed to expand the expressway. PennDOT also installed Intelligent Transportation System equipment along the corridor under a $14.7 million project.
For more information on the expansion of U.S. 202 in East Whiteland and Tredyffrin townships, visit www.us202-300.com.
Motorists can check conditions on more than 40,000 roadway miles by visiting www.511PA.com. 511PA, which is free and available 24 hours a day, provides traffic delay warnings, weather forecasts, traffic speed information and access to more than 770 traffic cameras.
For more PennDOT information, visit www.penndot.gov. Follow Local PennDOT Information on Twitter at www.twitter.com/511PAPhilly, and follow the department on Facebook at www.facebook.com/pennsylvaniadepartmentoftransportation and Instagram at www.instagram.com/pennsylvaniadot.


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This extension will helps you increasing your Linkedin connections.
Use this extension with English interface
Features & Benifits
- Increase your likedin connections
- With many contacts you can:
- Increase your job opportunity
- Increase your post views
- Increase Profile Views
- Increase your profile rank among your connection
- by increasing your post views, you can increase your website traffic, youtube view .. etc
- Delete all pending sent requests to keep your account clean.
- It will send 150 request per use, to avoid block use it daily to send 150 requet .
This extension is totally free .
Manual Installation:
2- How To Install : Watch YouTube Installation Tutorial شاهد شرح التحميل و التثبيت


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Week 14... Calgon Take Me Away
This week has been a slower week than ones in the past and I am ok with that. Many were celebrating the Easter holiday. Work was slower than the normal slow, due to everyone cooking up delicious meals at home. Which is probably what I should have been doing instead of stuffing my face with onion rings. My appetite has been terrible. I can go hours without being hungry while the thought of any food grosses me out. However during the most random and inconvenient times, I will all of a sudden be starving. Which led me to order some food at work, where not long after, I started to get violently ill. My holiday weekend consisted of a me feeling down right awful. No candy, no dinner, no desserts. Just the left overs my mom and her boyfriend brought home. My mom wanted me to go to the hospital, right when she realized something was not right. This was not your run of the mill morning sickness. I am so glad I have been, at least, lucky enough not to deal with much of that. Plus, I am now in my second trimester, the morning sickness and nausea should be subsiding. However, I hate hospitals, waiting for what seems like forever, uncomfortable seating, the cold medical staff, and that smell. If I'm going to be miserable I am at least going to be miserable in my own bed. During day two of this absolutely horrendous start to the weekend, I decided to call the nurses station at my hospital. I was not getting any better. They informed me it was food poisoning and even though I am pregnant I must let it run it's course. She also said that they have received some other patients and calls referring to the same symptoms with the same establishment in common.
Like my lowered appetite wasn't bad enough, food poisoning really!? Since then I have been paying more attention to the kitchen staff. I brought it up to my boss when he asked about my Easter and of course he got defensive and denied it. I have been in restaurants for ten years and in various employment positions. I have been certified by almost every health and safety service out there. I didn't like what I witnessed after paying closer attention. The breeding ground for cross contamination and poor hygiene almost blew my mind. I have never seen anything like it before. So, I went to the market and picked up some groceries. I am going to be bringing my own snacks and meals to work from now on. I don't want anything, especially bacteria or food born illness, from naive carelessness to harm me during my pregnancy. I am already limited on the medications and medical treatments available to me, and my immune system is weakened during this time. I know, this is my first child and maybe I am taking extra precautions, but I am ok with that if it insures our safety during this pregnancy.
Also, this week I have not heard a single peep from Michael. I was not surprised to find that egg empty. (puns intended) Not even a "Happy Easter", "how are you", or "anything new" text. I think I will always hold out some kind of hope that we will make this work or find some miracle way to be a family, till someone else gives me a reason to put that energy elsewhere. It's a nice thought having my son be with both of his parents, but it's an even nicer thought having him grow up to be a happy and confident man. I am no fortune teller but what I have experienced from Michael the entire time we spent together is that he is not the kind of person I want my son looking up too.
These past couple weeks have made me think of what I miss most about not being pregnant. The answer to that are nice long, hot, steamy bubble baths. During pregnancy I can not raise my body temperature over 101 degrees, due to the harm it can cause the baby. So I said bye bye to hot tubs and bubble baths a while ago. Warm showers for this momma for now. I have been checking things off my "to do" list left and right lately and when I get some time to chill and breathe I spend it hurled over a bucket. Not my idea of a relaxing weekend. Before my pregnancy I would have rushed straight for an essential oil infused soak, to make myself feel better. I wish I could just sit in a giant tub with a glass of wine, a nice book, and some lilac scented bubble bath and let it melt my stress away. Only 25 weeks left till that wish can come true, but who's counting.


text: If your employees spend a lot of time on the road, make sure your service vehicles are prepared for every job. Choose Western Truck Body for fleet upfitting. Edmonton businesses in various industries have partnered with us to design, manage, and maintain industrial work vehicles. Trust us to design a vehicle line that's as unique as your company. Our inventory includes service units, decks, tool boxes, dump bodies, cranes, tailgates, lighting, and other accessories. Tell us your business needs, and we'll plan a custom modification for your vehicles. We supply, manufacture and install each … [Read more...]


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The Must-Have Social Media Management Tools for Writers
A Product Review of the Great (and Not So Great) Social Tools
Social media is a must for every author in today's tech-consumed culture. But trying to manage multiple accounts, passwords, logins, and posts across several platforms doesn't have to be tiring and time-consuming. These (mostly) free, easy-to-use tools can seriously simplify your social media efforts so you can get back to more important tasks—like writing.
Hootsuite is the tool for scheduling posts and managing multiple social network platforms all in one place.
Hootsuite can help you manage:
- Facebook: Profiles and Pages
- LinkedIn: Profiles and Pages
- Google+: Company Pages
- WordPress blogs
- Pinterest, Tumblr, Vimeo, Evernote, Flickr, MailChimp, SlideShare, Storify, and more via third-party apps in Hootsuite's App Directory
Pros: You can post easily to most major platforms, schedule posts, listen in on hashtag conversations, and manage replies to your followers. You can even read feeds of the people and companies you follow right in Hootsuite, which is perfect for discovering additional content to retweet or share with your followers. There's also a suggestions section that will feed you relevant content based on keywords you select. The Hootsuite has an in-house URL shortener ow.ly that's helpful for tracking performance and gathering analytics. The calendar is also a really great feature for scheduling out content across many platforms.
Cons: Instagram access is limited. It's still helpful because you can upload the photo and text on your desktop, and Hootsuite will send them to your smartphone via its app. But from there, you have to manually set up the post in Instagram and hit share yourself. Additionally, some of the third-party apps can be clunky, buggy, and honestly more work than they're worth. The Hootsuite interface is also in serious need of a facelift—it's a little hard sometimes to find what you want and even when you get there, it's still confusing.
Plans: Free, Pro, and Business
Buffer is similar to Hootsuite in that you can schedule a bunch of posts and manage most of the major platforms in one place.
Buffer helps with:
- Facebook: Profile, Page, and Group (for groups you have to be an admin)
- LinkedIn: Profile, Company Page, and Group (for groups you have to be an admin)
- Twitter: Profile
- Google+: Company Pages
- Pinterest accounts (On Awesome and Business level packages)
Pros: The interface is clean and fairly simple to navigate as opposed to Hootsuite's difficult to manage layout. You can "re-buffer" posts, meaning any posts that you've scheduled and sent out to the world can be reloaded into your scheduler with the click of a button. This is great for recycling recent updates to make sure you get the most out of your content or popular content on your page.
Cons: The lack of Instagram access and third-party apps means Buffer has pretty narrow social media capabilities.
Plans: Individual to Large Business—read more about the different perks on Buffer's pricing FAQs.
- Individual Plan: Free!
- Awesome Plan: $10/month or $102/year
- Small Business Plan: $50/month or $510/year
- Medium Business Plan: $100/month or $1,020/year
- Large Business Plan: $250/month or $2,550/year
IFTTT (If This Then That)
IFTTT is a cool tool that can automate activities for you between Internet connected services. IFTTT is currently hooked up to 211 different web services—including major social media sites. Example: If you want to receive an email every time it's going to snow, you can set up one of their formulas, called recipes, to trigger an email every time it's going to snow in your area.
Pros: There are lots of ready-made recipes to choose from, making it super simple to sign up and get going with automated recipes. The search bar allows you to look for recipes like "Get an email if there will be rain in your area tomorrow" or "Post my tweets to Tumblr." You can also create your own recipes for a totally customized experience.
Cons: It's a bit tedious at first to connect all your Internet accounts through IFTTT. You'll need to have a native account on sites that require a login (like Buzzfeed, Facebook, and Reddit) for the recipes to connect and work properly. It's great that there are so many ready-made recipes ready to go, but the list is a bit overwhelming unless you know what you're looking for.
Plans: Free
Pictures are a huge part of social media. Although photos are no longer the top performer (hello videos!), they're still an important part of developing the visual side of your social media brand as an author. Canva is an awesome graphic design tool that lets you create and manage customized images with text, brand colors, and more.
Pros: You can make professional looking images in minutes without having to know much about graphic design. They make it easy with templates to choose from or you can create images from scratch.
Cons: The free version is good, but you can really dig into branding with a paid account.
Plans: Free with premium add-ons and Canva for Work
- Free Plan: Access to basic templates and $1 premium add-ons
- Canva for Work Plan: $12.95/month or $119.40/year
Social Media Marketing and Management Tool Recommendation
I'd definitely recommend starting off with Hootsuite and Canva. I love the calendar view and the content suggestions feature in Hootsuite. You can type in three keywords and Hootsuite will pull fairly recent articles from around the web that might be good for sharing.
They're not all home-runs, but definitely help when you're in a content pinch. I especially love using suggestions for Twitter content, since the platform is designed to take lots of tweets throughout the day, as opposed to Facebook, where you want to really zone in on quality over quantity.
And Canva is a gift from technology heaven. It's the easiest and quickest way I've found to make high-quality images without having to buy a design program or know much about design in the first place. Their templates are modern and easy to use, and even include templates based on which platform you're creating images for.
The others are great tools, too—it's more about figuring out what you need to make your social media presence easy peasy.
With new tools popping up every day that could seriously elevate your social media game, it's important to stay up-to-date with the latest and greatest. Subscribe to our newsletter and find us on Facebook and Twitter for updates on the best new social media tools for writers.
Katie is a social media & advertising strategist.


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A fantastic challenge for any budding engineers, the Build Your Own Robot Lizard Construction Kit contains step-by-step pictorial instructions to guide you through every step of the build. The result is a fully functioning robot that you can program to interact just like a real pet. Switch to Follow Me mode to see your lizard pop up his frill to foil any attacker before following you loyally around; or choose Escape to see him look shocked, drop his frill and flee for safety.
37cm long. Suitable for ages 10 years and over.
Requires 4 x AAA batteries (not included).


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Teddy Maximus
Pink Signature Print Dog Bow (for the lady pups)
- Strike a pose with this stunning sugar pink dog bow which can be worn in a variety of ways around the dog collar - including to the front, stylishly to the side or even on top of the collar.
The eye-catching iconic print is offered in a variety of other seasonal colors.
Made from hard wearing cotton, this bow tie sits on most collars through two elastic loops. Simply loop the bow through your dog's collar and they are ready to walk the walk!
For a tighter fit, loop the elastic around the collar twice.
Made in London, UK by Puppy Mama partner Teddy Maximus.


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Everyone who visits and uses our blog is expected to follow the guidelines below. They have been created so that we can all be 'cyber smart' and stay safe online.
1. Only use your first name
2. Keep all other personal information a secret
3. Parents and family friends of students in 3/4 are asked to use their first name only or to call themselves ______'s Mum/Dad etc.
4. All comments added to our blog will be read by Mrs Cosgrave before they are approved and appear on the blog.
6. Try to make sure you write a 'quality' comment. Quality comments have a beginning, middle and end.
They relate to the post, contain information and often a question for us to respond to.
Thank you for following these guidelines!
We can't wait to read your comments


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Ferrari 488 GTB Named Best Driver's Car by Motor Trend
GT & Sport Cars
The Ferrari 488 GTB has taken top honors at Motor Trend's Best Driver's Car competition.
Motor Trend's 2017 Best Driver's Car program hosted a dozen cars from 10 automakers at several locations in California, with the 488 GTB coming out victorious. "The Ferrari 488 GTB is one of the purest distillations of driving enjoyment ever created," says Motor Trend Editor-in-Chief Ed Loh. "The way the engine, transmission, and chassis systems all work together reflects Ferrari's deep understanding of high-performance road cars and long history in racing at the highest level."
In nominating the Ferrari 488 GTB as its Best Driver's Car, Motor Trend celebrates those characteristics Ferraristi recognize and demand: excellence in terms of driving pleasure—usable performance, razor-sharp responses, and great handling. In other words, the quintessential sports car.
Ferrari has won the Best Driver's Car award before, in 2011, with the 458 Italia.