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Are you bored of your current watch? Do you want a watch with added functionality? Like a calculator, sleep monitor, calendar and alarm? Well, now you can get this, and at an incredible price, at just £15.98.
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About PSDT
PSDT has been providing Perl training and enterprise infrastructure development services since 1999. PSDT is the family partnership of Peter Scott, author of "Perl Debugged" and "Perl Medic".
Based in the Pacific NorthWest but offering services around the globe, Peter provides both traditional on-site training in the Perl language and customized mentoring and tutoring. He also consults on enterprise architecture (Zachman framework) and infrastructure (open-source-based).
PSDT specializes in solving the problems of "legacy Perl" - whether it's code that someone else wrote or merely ensuring that others can understand your own, we (literally) wrote the book on the topic!

subset: commoncrawl


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Aliso Black - Open Book [Unsigned Hype]
Song: Open Book by ALISO BLACK Additional Info: Go to www.alisoblack.com or www.myspace.com/alisoblack to download a free copy of SALESMAN FRIDAY this FRIDAY!!!!!! R.I.P. BASSIM CHMAIT
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Since the body can undergo substantial harm if toxic substances are allowed to accumulate in the blood, proper functioning of the kidneys is vital to health. Correspondingly, medical understanding of the many renal diseases and disorders that may occur is a matter of significant consequence. Among the most common kidney problems reported is nephritis, a condition that often appears shortly after other infections have taken hold on the body and which is characterized by glomeruli inflammation. Urinary tract infections and kidney stones are also frequently occurring renal conditions. Less common, but much more serious, is the disease nephrosis. This degeneration of kidney tissue that is characterized by lesions is often associated with a broad array of other disorders, including high blood pressure and diabetes. Frequently, nephrosis is not diagnosed until the condition is so far advanced that kidney failure takes place and wastes have accumulated in the body to a dangerous extent.
The culture of African green monkey kidney fibroblasts that appears in the digital image above was immunofluorescently labeled with primary anti-tubulin mouse monoclonal antibodies followed by goat anti-mouse Fab fragments conjugated to Rhodamine Red-X. In addition, the specimen was stained with DAPI (targeting DNA in the nucleus). Images were recorded in grayscale with a QImaging Retiga Fast-EXi camera system coupled to an Olympus BX-51 microscope equipped with bandpass emission fluorescence filter optical blocks provided by Omega Optical. During the processing stage, individual image channels were pseudocolored with RGB values corresponding to each of the fluorophore emission spectral profiles.
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Each December, Nettell, other businesses, and community members donate funding or directly purchase books for local school libraries. All total, more than 500 books were donated to local school libraries this year, said Kristine Post, who manages the Books for Tots program for Back of Beyond.
"It's been a really rewarding program to organize as it's such a beneficial merger between local businesses, an incredibly generous community, our underfunded local school programs and our fabulous librarians," Post said. "This year we also donated a number of games, activities and art supplies as well. We plan to continue making this program available and hopefully to expand the reach and possibilities each year."
GCMS officials said the books are always greatly appreciated.
"With limited funds with which to buy books, these donations make a huge difference in being able to bring our students the new titles they would like to read," said Joan Cannon, GCMS librarian. "Thank you, from the entire Grand County Middle School!"


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1310 Plays
919 votes
919 438
Help FireBoy and WaterGirl in this new adventure! Control both characters at the same time to solve platformer puzzles! Use WaterGirl to climb snowy slopes and Fireboy to slide through ice. Direct light beams to freeze and melt water, activate buttons and levers to move platforms, push boxes and roll balls, collect all the diamonds and get each character to his door!


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Just Another Busy Sunday: June 10, 2013 23:51 : News
The lab was a veritable hive on Sunday with some fantastic projects underway (Click images to see them larger).
The Bleacher Crew (their Web URL will come later) was hard at it constructing their Burning Man project. Will continue to to track their progress until the big event!
Jodi brought new life to an old chunk of wood with fine-grit sandpaper, a Dremel and a little tung oil. The result is slated to be a guitar mount.
Scott had a shelf for his apartment on the go made from pine plank, held together with his own brand of fine joinery.
Meanwhile, Charlotte was putting together a form for a concrete bench made of plywood, lacquered to give the bench a nice, smooth finish. Definitely something I'd like to try sometime.
A few others came and went in the hours I was there but I unfortunately was too busy to take pictures with my monthly key-holder task: making a few message boards out of chalkboard paint and cleaning the bathroom!


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Debris Dragon:
When this card is Normal Summoned, you can Special Summon 1 monster with 500 or less ATK from your Graveyard in Attack Position. That monster's effect(s) is negated. This card cannot be used as a Synchro Material Monster, except for the Synchro Summon of a Dragon-Type Synchro Monster. The other Synchro Material Monster(s) cannot be Level 4.
SP = Short Print (Common);
SSP = Super Short Print (Common);
DNPR = Duel Terminal Normal Parallel Rare;
DRPR = Duel Terminal Rare Parallel Rare;
DSPR = Duel Terminal Super Parallel Rare;
DUPR = Duel Terminal Ultra Parallel Rare;
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Find us at 'The Curious Citizen'
Once again we would like to remind you that we are now posting at The Curious Citizen, our new blog home.
If you have not visited our new site, please do.
We remind you that if you want email notification of new posts from that site, you will have to submit your email address in the sign up box provided at the new blog.


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Spacewalking repairmen replace space station's leaky pump
A pair of spacewalking astronauts wrapped up a hastily planned repair job on Saturday to replace a suspect coolant pump needed to keep the International Space Station at full power.
A pair of spacewalking astronauts wrapped up a hastily planned repair job on Saturday to replace a suspect coolant pump needed to keep the International Space Station at full power.
NASA astronauts Chris Cassidy and Tom Marshburn put on spacesuits and left the space station's airlock shortly before 9 a.m. EDT to attempt to stem an ammonia coolant leak that cropped up on Thursday.
Over the next four hours, they installed a spare pump, then positioned themselves to check for signs of escaping ammonia ice crystals when the system was turned back on.
"No flakes," Cassidy reported to flight controllers at the Johnson Space Center in Houston.
Engineers will monitor the system over the next several days and beyond to make sure the pump replacement fixed the problem.
"We certainly have come a long way in identifying a potential source," said NASA mission commentator Rob Navias as the astronauts returned to the station's airlock. The entire spacewalk lasted 5-1/2 hours.
The station crew discovered a steady stream of ammonia flakes flowing away from the far left side of the station's exterior frame on Thursday. Flight controllers spent the next 48 hours diagnosing the problem and coming up with potential solutions.
Engineers believed the leak most likely was coming from in or around a 260-pound (118-kg) pump that pushes ammonia throughout the system. The coolant dissipates heat from electronics in space station's solar-powered electrical system.
The station can be reconfigured to compensate for a system shutdown, but if a second problem should occur, that likely would mean a cutback in power available for the experiments.
The $100 billion station, which flies about 250 miles above Earth, is a research laboratory for biomedical, physics, astronomical and other experiments, as well as for technology development and demonstrations.
On Sunday, station commander Chris Hadfield, the first Canadian to lead the international outpost, turns over the helm to Russian cosmonaut Pavel Vinogradov. Hadfield, Marshburn and cosmonaut Roman Romanenko, who have been aboard the station since December, are scheduled to depart on Monday.
Their replacements - NASA's Karen Nyberg, Italy's Luca Parmitano and Russian Fyodor Yurchikhin - are due to launch on May 28.


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Print Free Card
All you have to do to print your free card is select the city, county or township you live in.
It's that simple! Tell all of your friends, neighbors or relatives that don't have prescription plan coverage about the Coast2Coast Rx Card so they too can save on their prescriptions.
By the way, anyone can print out any card even if they don't live in one of the listed cities, counties or townships as the cards are usable anywhere in the U.S.
Rx DISCOUNT CARDS FOR CITIES — CLICK HERE
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|OpenBSD General Other questions regarding OpenBSD which do not fit in any of the categories below.
|Thread Tools
|Display Modes
Mail server questions
I'm planning to make my first mail server but before I try it (besides waiting my parts to arrive) I want to clear up few details.
I have setup so that my connection from internet hit my soekris firewall which NAT's and allows specified services to my LAN. In my LAN I have my server, desktop and my laptop.
My first question would be about the spamd. I haven't read much how it works, just some details to get the general idea. Anyway, should I run the spamd on my firewall or on my server? The soekris isn't a powerfull computer and is running on CF disk so I'd avoid doing stuff with it.
If I choose to but run the spamd on my server what should I do with the firewall? Forward all ports incoming to smtp to my servers spamd port?
Then about the mail server itself,
I want to download messages from multiple hosts like mails sent directly to my server, mails on my gmail accond etc to my mail server. I want to be able to access these mails from remote locations but so that they stay on my server too. This to avoid things like using mail client on laptop to check messages and then going home and checking messages with desktop only to notice that messages checked out with laptop aren't listed.
I'd like to know few tips on how the above can be made.
Also I want to order the mails based on source and subject but I think procmail handles this.
I still haven't decided on which MTA to use.
But currently I can't think of other questions but I'm sure I'll have some once I get my server up and running and try to make this working.
The spamd daemon is designed to operate with a PF ruleset. It uses few resources, so I believe that unless you are managing hundreds of thousands of users, your Soekris box is likely a good candidate. If you are concerned about it at all, you could also run spamd on the same OS as your MTA.
See this 2005 presentation from Bob Beck: http://www.openbsd.org/papers/bsdcan05-spamd/
Mail Transfer Agents (e-mail servers):
I use sendmail for my MTA, but that's because I'm lazy. Many people have their favorites. Sendmail isn't anyone's favorite, but it is built-in.
For Mail User Agents (e-mail clients), you can use anything you want. From a shell, I like mutt, as it manages threads wonderfully. Note that mutt is is console based so it doesn't do html. (You can save html components of e-mail if you need to view it.) You can set up your MTA to provide (or integrate with) IMAP or POP, so you could use any client you wanted ... even MS Outlook if you desired.
For browser-based mail I use openwebmail, but again, you can pick and choose anything you want there, assuming there's a port/package for it.
As for mutt, it can now even view html mail in most cases. You add something like
text/html; w3m -T text/html -dump %s; copiousoutput
You can even view Word documents.
application/msword; catdoc %s; copiousoutput
(These lines would go into $HOME/.mailcap)
Thanks, Scott!
I have page with various other tricks. (Towards the bottom, the first part is for the mutt novice)
Last edited by Oko; 2nd July 2008 at 11:22 PM.
Well, actually I have a domain name but that maps only to an IP-address. Then I have it to map to my no-ip.com domain name which I can update to point to my IP-address. It's ugly but it works.
jggimi, thanks for the spamd info. I think I'll run the spamd on my soekris. I will probably run spamassassin on my mail server too to be on the safe side.
Last edited by Zmyrgel; 3rd July 2008 at 05:46 AM.
If you have a dynamic address, without a reverse address then you will have a problem delivering mail to other sites on the internet.
As an anti-spam measure, many mail servers are configured not to accept mail from such addresses.
You don't need to be a genius to debug a pf.conf firewall ruleset, you just need the guts to run tcpdump
Many won't accept mail from specific ISPs, certain countries, sometimes even certain continents. You can route outgoing mail through your ISP's mail service or a 3rd party mail service, the technique is called "smarthosting." Incoming mail may need a forwarding service, also, depending on your ISP and their policies / restrictions.
Setting up an MTA to send and receive mail on the Internet isn't necessarily difficult. But ... managing an MTA properly, and being a good network citizen takes effort. That discussion, however, is well beyond the scope of a BSD forum.
Shouldn't the emails work if I get my domain working properly and use the domain name on the configuration?
Your ISP's servers may still be blocked by some recipient mail servers, depending on how much of a spam pump they've been over the last decade or more.
If you're routing your outbound e-mail from MUAs through your ISP now, then that shouldn't change.Incoming:
An MX record in your Internet DNS entry is required.
You need static IP, reverse DNS and MX record to begin with. For all I know your internet provider might be unwilling even to provide you with those because he/she will be in trouble if your "mail server" becomes spam
zombie due to your incompetence to run mail server. DNS/Cable internet provider in US charge anywhere from $20 to upward of $60. No company will give you that price for essentially business account. You are looking at the best $40 more likely something around $100 in internet cost.
Unless you are providing email services to a small office or a group of people there is absolutely no reason for you to run real mail server just for the sake of doing it. You Internet provider will probably more than happy to provide you with couple email accounts that can be accessed via IMAP client and configured to send email via SMTP. Get your self a good email client and you will be happy camper.
Lots of people on this forum like Mutt and if you need real GUI interface on your email account sylpheed, clows, thunderbird, kmail or evolution are choices.
I personally like Nail. If I use GUI I use thunderbird.
Last edited by Oko; 4th July 2008 at 02:04 AM.
As other 'main' services are somewhat familiar to me I thought to try out an email server. You can't learn anything properly by just reading a book. Hands-on experience teaches better.
You'll need to spend time investigating these, if you want to be a responsible MTA administrator. There is no complete list, this short will just get you started. In no particular order:
|mail server, mta, mutt, spamd
|Thread Tools
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Linear Mode
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meta property="og:title" content="Of Mice & Men" />
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It's almost the halfway mark to Halloween, and it just happens to coincide with Zombie Jesus Day...I mean, Easter! To celebrate, FearNET invited Trick 'R Treat director Michael Dougherty to bring his special talents, and wish the FearNET viewers a happy Easter Holiday. And as a added treat, everyone's favorite mayhem causing, bag wearing, mischief maker Sam even makes an appearance. This video hit close to home, reminding me of the wholesome holidays spent with my family.
Enjoy! This is hilarious!


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The shaded area represents 95% confidence intervals for Kaplan-Meier estimates.
Customize your JAMA Network experience by selecting one or more topics from the list below.
Pujades-Rodríguez M, Balkan S, Arnould L, Brinkhof MAW, Calmy A, AIDS Working Group of MSF FT. Treatment Failure and Mortality Factors in Patients Receiving Second-Line HIV Therapy in Resource-Limited Countries. JAMA. 2010;304(3):303–312. doi:10.1001/jama.2010.980
© 2019
Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings.
Objectives To investigate failure rates in patients receiving second-line therapy and factors associated with failure and death.
Design, Setting, and Participants Multicohort study of 632 patients >14 years old receiving second-line therapy for more than 6 months in 27 ART programs in Africa and Asia between January 2001 and October 2008.
Main Outcome Measures Clinical, immunological, virological, and immunovirological failure (first diagnosed episode of immunological or virological failure) rates, and mortality after 6 months of second-line therapy use. Sensitivity analyses were performed using alternative CD4 cell count thresholds for immunological and immunovirological definitions of failure and for cohort attrition instead of death.
Results The 632 patients provided 740.7 person-years of follow-up; 119 (18.8%) met World Health Organization failure criteria after a median 11.9 months following the start of second-line therapy (interquartile range [IQR], 8.7-17.0 months), and 34 (5.4%) died after a median 15.1 months (IQR, 11.9-25.7 months). Failure rates were lower in those who changed 2 nucleoside reverse transcriptase inhibitors (NRTIs) instead of 1 (179.2 vs 251.6 per 1000 person-years; incidence rate ratio [IRR], 0.64; 95% confidence interval [CI], 0.42-0.96), and higher in those with lowest adherence index (383.5 vs 176.0 per 1000 person-years; IRR, 3.14; 95% CI, 1.67-5.90 for <80% vs ≥95% [percentage adherent, as represented by percentage of appointments attended with no delay]). Failure rates increased with lower CD4 cell counts when second-line therapy was started, from 156.3 vs 96.2 per 1000 person-years; IRR, 1.59 (95% CI, 0.78-3.25) for 100 to 199/μL to 336.8 per 1000 person-years; IRR, 3.32 (95% CI, 1.81-6.08) for less than 50/μL vs 200/μL or higher; and decreased with time using second-line therapy, from 250.0 vs 123.2 per 1000 person-years; IRR, 1.90 (95% CI, 1.19-3.02) for 6 to 11 months to 212.0 per 1000 person-years; 1.71 (95% CI, 1.01-2.88) for 12 to 17 months vs 18 or more months. Mortality for those taking second-line therapy was lower in women (32.4 vs 68.3 per 1000 person-years; hazard ratio [HR], 0.45; 95% CI, 0.23-0.91); and higher in patients with treatment failure of any type (91.9 vs 28.1 per 1000 person-years; HR, 2.83; 95% CI, 1.38-5.80). Sensitivity analyses showed similar results.
Conclusions Among patients in Africa and Asia receiving second-line therapy for HIV, treatment failure was associated with low CD4 cell counts at second-line therapy start, use of suboptimal second-line regimens, and poor adherence. Mortality was associated with diagnosed treatment failure.
Universal access to combined antiretroviral therapy (ART) includes access to first- and second-line regimens.1 The use of standardized and affordable first-line fixed-dose combinations of antiretroviral drugs including 2 nucleoside reverse transcriptase inhibitors (NRTIs) and 1 nonnucleoside reverse transcriptase inhibitor (NNRTI) has been critical to allow the scale-up of combined ART in resource-limited countries with high human immunodeficiency virus (HIV) prevalence.2 Most countries currently provide guidelines for the use of second-line regimens, and extensive use of ART has led to increasing numbers of patients receiving second-line therapy for long periods. It is thus likely that increasing numbers of patients in these settings will have diminished response to second-line treatment.
The issue of second-line failure has been addressed for the first time in the recent 2009 revision of the World Health Organization (WHO) treatment guidelines, which recommend third-line regimens be made available in all countries.3 Experience in highly resourced countries has shown that triple-class experienced patients can be successfully treated with effective new antiretroviral regimens.3-5 However, because third-line regimens are costly and not readily available in resource-limited countries, second-line treatment is often the last therapeutic option available for patients in these settings. Maximizing the duration of second-line regimens, quantifying the need for third-line therapy in patients receiving ART in resource-limited countries, and decreasing the price of new well-tolerated antiretroviral regimens are therefore important.
In this study, we describe rates of failure for second-line therapy and investigate individual- and programmatic-level factors associated with second-line therapy failure and with death in patients treated with second-line therapy in 27 African and Asian ART programs supported by Médecins Sans Frontières (MSF).
Routine clinical and laboratory patient data (FUCHIA software, Epicentre, Paris, France) collected between January 2001 and October 2008 by 27 MSF-supported programs were compiled in February 2009 and analyzed. Some patients were included in a prior analysis of switch rates to second-line therapy, early second-line outcomes, and determinants of switching and early mortality in resource-limited settings.6 For the updated analyses with longer follow-up presented herein, 4 new cohorts are included, 2 from Africa and 2 from Asia. A total of 193 patients receiving second-line therapy for more than 6 months in these new cohorts are included herein. Two patients who initiated ART after December 2006 were treated with the prior cohort but were not included in the prior cohort analysis because the database had been censored in December 2006. Of the 437 patients included in both analyses, 132 were switched to second-line therapy after the time of the prior analysis. For 307 patients derived from the prior cohort, longer follow-up time while taking second-line therapy was available and analyzed herein (database update, October 30, 2008).
Programs have been described previously.6 Briefly, physicians, clinical officers (health practitioners receiving medical training who are more qualified than nurses but less qualified than physicians, with the level of training varying by country), or nurses provide free care and treatment to patients with HIV. WHO recommendations for ART were followed,7 and adherence counseling was offered before and after ART start. Generic antiretroviral drugs were prescribed, and CD4 cell counts were measured using automated or manual methods.
In agreement with health ministries, data were prospectively collected. No patient identifiers were kept in the data sets analyzed, and proposals for analysis were approved by the International Ethics Review Board of MSF. As advised by the National Commission of Informatics and Liberties, given the contexts in which MSF works, information for patients about the data collection system in the facility and its use was judged to be more effective than obtaining written informed consent.
All patients who were aged 15 years or older, had known sex information (all patients who had been switched to second-line therapy had sex information recorded), had initiated NNRTI-based ART, were antiretroviral-naive at the start of treatment, and were receiving a second-line protease inhibitor–based regimen for more than 6 months were eligible for inclusion. WHO treatment guidelines recommend allowing at least 6 months of treatment with a given regimen before diagnosing treatment failure. This is to avoid misclassifying patients who did not receive treatment for a sufficient length of time as having treatment failure (eg, patients need to be exposed to active drugs for a sufficient amount of time to show signs of immunovirological recovery and to reach the level of immunological recovery that protects against the development of opportunistic infections). Patients were considered lost to follow-up if the time between their last visit and the closing date of the corresponding cohort was more than 1 year.
Programs in which 50% or more of patients had 1 or more measurements of viral load 3 to 9 months after second-line therapy start were considered to have had their viral loads routinely monitored. Recorded values of CD4 cell count and viral load closest to the starting date of first-line or second-line ART (3 months before and up to 2 weeks after starting ART) were defined as initial counts. For CD4 cell counts lower than 25/μL and HIV viral load higher than 100 000 copies/mL, the time window for first-line treatment was extended to 1 year before starting therapy because these patients, who were eligible for ART at the time of testing, were likely to have received treatment for another infection or pathological condition before being prescribed ART. These patients might not have been retested for CD4 cell count, viral load, or either at the start of ART. In fact, only 5 patients had CD4 cell count values at ART start that were quantified between 3 and 6 months before the start of ART.
We defined clinical failure for those receiving second-line therapy as the diagnosis of a new WHO clinical stage 3 or 4 event after 6 months of second-line use; immunological failure as a decrease in CD4 cell count to its initial value or lower, decline of at least 50% from highest measurement while receiving treatment, or CD4 cell count lower than 100/μL (or <50/μL for sensitivity analyses) at 1 year of second-line therapy, confirmed within 6 months; and virological failure as a recorded plasma viral load value of more than 10 000 copies/mL confirmed within 6 months.8 Failure of any type was the earlier recorded failure event for each patient (clinical, immunological, or virological).
For the purposes of the analyses herein, we considered failure and mortality or retention as different outcomes in the analysis rather than considering that any death occurring after 6 months of second-line therapy start was due to treatment failure. The precise cause of death of the patients is not recorded in the data sets; thus, we were not able to distinguish between AIDS-related deaths attributable to treatment failure (eg, deaths occurring in the absence of biological confirmation of failure because testing was not performed or results not recorded) and non−AIDS-related deaths.
Information on the clinic appointment date for each patient visit was available for 433 patients (68.5%) analyzed (66.3% of those without second-line treatment failure, and 78.2% of those who had recorded failure). As a surrogate marker for treatment adherence, we created an index by dividing the number of scheduled visits attended with delay (>1 day after the corresponding appointment date) by the number of months receiving second-line therapy and multiplying this by 100. We considered that patients who attended fewer than 5% of their appointments with delay were 95% or more adherent, those with 5% to 19% of delayed appointments were 80% to 94% adherent, and those with 20% or more delayed appointments were less than 80% adherent to therapy. We grouped patients according to the incidence of appointments attended without delay (<80%, 80%-94%, or ≥95%). The cutoff values were selected based on previous studies investigating effects of adherence indicators on treatment outcomes for HIV patients.9,10 Previous research has shown that patients with 95% or better adherence had better rates of virological suppression, less resistance, greater increase in CD4 cell counts, and lower hospital rates than patients with lower adherence.9,11 Furthermore, patients taking NNRTIs or boosted protease inhibitors with adherence of 80% or more had failure rates of less than 10%.12
The adherence variable was created taking into account each consecutive date of appointment and the following recorded date of visit. For patients who did not return, the last recorded appointment date is not considered in the computation of the adherence index because there is no recorded clinical visit afterward for the assessment. These patients would have been considered lost to follow-up in the analysis.
We measured time from 6 months after starting second-line therapy to diagnosis of treatment failure, last clinical visit, or death. We split follow-up periods into 6 to 11, 12 to 17, and 18 or more months. We described characteristics of patients by failure status, calculated times to failure and rates per 1000 person-years with Poisson exact 95% confidence intervals (CIs), and fitted random-effect Poisson models using adaptive Gauss-Hermite quadrature methods13 to identify factors associated with treatment failure.
Factors considered were type of setting (urban or rural); health care level (tertiary or other); use of routine viral load monitoring; use of viral load testing for failure confirmation; sex; age group (15-29, 30-39, 40-49, and ≥50 years); calendar year of second-line therapy start (<2005, 2005, 2006, 2007-2008); split follow-up time on second-line therapy; imputed WHO clinical stage and CD4 cell count at ART start (stages 1 or 2, 3, and 4; <50, 50-99, and ≥100/μL, respectively) and second-line therapy initiation (stages 1 or 2, and 3 or 4; <50, 50-99, 100-199, and ≥200/μL, respectively); initial NRTI-backbone (stavudine and other) and NNRTI drug (efavirenz and nevirapine); duration on first-line therapy (as a continuous variable); type of second-line regimen, ie, type of protease inhibitor (lopinavir boosted with ritonavir, nelfinavir, and other) and number of NRTI changes at switch; and adherence index (≥95%, 80%-94%, and <80%), for the subgroup of patients with available appointment dates (68.5%).
Information on clinical stage and CD4 cell counts was missing in some patients (1% and 14%, respectively, for first-line therapy start; 24% and 32%, respectively, for second-line therapy start). To impute missing data we used multiple imputation by chained equation methods.14,15 Prediction equations included cohort (degree of urbanization for second-line imputed variables), age at ART start, sex, first CD4 cell count value and time to measurement after pretreatment CD4 cell count (for first-line or second-line regimens), patient outcome (death, lost to follow-up, or alive), and follow-up time on second-line therapy censored at 1 year of second-line therapy use. Equations for imputed second-line therapy-related data also included nadir CD4 cell count before second-line therapy start, and indicators for clinical, immunological, and virological failure. Before imputation, continuous variables were normalized using square-root transformation for absolute and nadir CD4 cell counts, and log-transformation for age, follow-up time, and time to first pretreatment CD4 cell measurement. We used interval censoring to ensure imputation of CD4 cell values within the appropriate range (0-800/μL). We generated 10 imputed data sets. Individual and programmatic factors associated with failure in univariable analyses (P < .2) were included in adjusted models. Estimates of coefficients were derived by averaging, and appropriate standard errors calculated applying Rubins rules.16-18 Two sensitivity analyses were performed, 1 for any type of failure using the definition of immunological failure as less than 50 cells/μL instead of less than 100 cells/μL,8 and 1 for immunovirological failure (first diagnosed episode of immunological or virological failure using the <100/μL definition). The WHO 2006 guidelines,8 in attempting to standardize treatment failure definition criteria, defined immunological failure as a decrease in CD4 cell count to or lower than baseline, a decrease of 50% from the treatment peak value reached, or a persistent CD4 cell count lower than 100/μL. The rationale for using the CD4 cell count lower than 100 cells was because the other 2 criteria would require either a CD4 cell measurement at the start of therapy or would be difficult to implement in practice. Because many patients initiate first-line therapy with very low values of CD4 cell counts (median of 45/μL; second-line therapy, with CD4 cell counts close to 100/μL) in our MSF sites, we used the 50-cell threshold to increase the specificity of the immunological criteria to correctly identify treatment failure in sensitivity analyses. Results from adjusted models are provided for the whole cohort; estimates further adjusted for adherence data are given only for patients with this information.
We also examined associations between mortality after 6 months of second-line therapy and the aforementioned factors, failure of any type (with sensitivity analyses using the 2 mentioned alternative failure definitions), and occurrence of change in the prescribed second-line regimen for any reason. Because of fewer deaths than failure events, we grouped patients in the following categories: follow-up time on second-line therapy: 6 to 17 months and 18 or more months; clinical stage at first-line therapy: stages 1, 2, or 3 and stage 4; CD4 cell counts at second-line therapy start: less than 50, 50-99, and 100/μL or higher; and adherence index: at least 95% and less than 95%. In our data set, only 5 patients who died had reported adherence of less than 80%. We used Weibull random-effect survival models19,20 and combined estimates from imputed data sets as before. We performed sensitivity analysis of associations using cohort attrition (combined mortality and care discontinuation) instead of death.
The objective of the study was to investigate the effect of a number of programmatic-level and individual-level factors on the 2 main outcomes, therapeutic failure and mortality. Because there was no specific hypothesis for testing, power was not calculated prior to data analysis. However, when the estimates of effect for the failure outcome were examined, no important effects appeared to have been missed. Analyses investigating effects on mortality showed statistically significant associations for diagnosed second-line therapy failure, sex, and type of setting. However, because of the small number of deaths during the time of study follow-up (n = 34) and the small number of sites using viral load monitoring, inability to detect a potential association between mortality and viral load monitoring could have occurred. When the power by simulation technique21,22 was applied to the sample herein using the Weibull model, it was estimated that the study sample size would allow a hazard rate ratio (HR) of 0.21 (estimate from our final model) to be found statistically significant in 7.4% of samples, assuming ±5% precision.
Analyses were performed using Stata version 10.1 (Stata Corp, College Station, Texas), with α = .05. Results are presented as adjusted incidence rate ratios (IRRs) or HRs with 95% CIs and P values from Wald tests for associations calculated across variable categories. Statistical significance was defined as P < .05.
Twenty-seven HIV cohorts from 13 countries were included (Table 1). All sites had access to second-line regimens and routinely performed CD4 cell count testing, 4 routinely monitored viral load, and 19 used viral load to confirm treatment failure. After excluding 335 patients (34.6%) who received second-line therapy for less than 6 months, we analyzed data from a total of 632 adults (>14 years).
A total of 516 patients (81.7%) were treated in urban sites and 77.7% in primary health care facilities. At second-line therapy start, the median age was 35 years (interquartile range [IQR], 30-42 years), median time using ART 24.1 months (IQR, 16.1-31.1 months), and median decrease in CD4 cell count since ART start −49/μL (IQR, −136 to 0/μL]. At second-line therapy start, 71.8% of patients received lopinavir boosted with ritonavir−containing regimens, and 79.3% had changed 2 NRTI drugs (eTable 1).
Cumulative probabilities of treatment failure from 6 to 30 months of second-line therapy are shown in the Figure. At 1 and 2 years of second-line start, 12% and 28% of patients, respectively, had recorded failure of any type; and 2% and 8% had immunovirological failure, respectively. During follow-up, 119 patients (18.8%) met failure criteria after a median time of 11.9 months of second-line therapy use (IQR, 8.7-17.0 months; Figure). Time to failure was similar when clinical- or laboratory-based criteria were used (Table 2). When the definitions immunological failure of less than 100/μL and less than 50/μL were applied, 30-month failure rates were 214.6 (95% CI, 178.9-257.4) and 205.9 (95% CI, 171.1-247.8) per 1000 person-years, respectively. Rates of immunovirological failure were 52.9 (95% CI, 37.4-74.8) and 46.0 (95% CI, 31.8-66.7) per 1000 person-years, respectively.
Rates of second-line therapy failure of any type were greater in patients who were treated in hospitals than in primary health care facilities (289.5 vs 173.6 per 1000 person-years; adjusted IRR, 1.61; 95% CI, 1.01-2.57; Table 3). Rates increased with lower CD4 cell counts at second-line therapy start, from 156.3 vs 96.2 per 1000 person-years; adjusted IRR, 1.59 (95% CI, 0.78-3.25) for 100-199/μL; to 336.8 per 1000 person-years; adjusted IRR, 3.32 (95% CI, 1.81-6.08) for less than 50/μL than with 200/μL or more. Estimates of effect for women compared with men, before and after adjusting for adherence data, are shown in Table 3. The rate of failure for women without adjustment for adherence information was not statistically significant (adjusted IRR, 1.28; 95% CI, 0.86-1.91, P = .23). The estimate when we adjusted further for adherence information was of borderline significance (adjusted IRR, 1.56; 95% CI, 0.99-2.44, P = .05).
Patients who changed 2 of their NRTI drugs at second-line therapy start were less likely to fail treatment than those who changed only 1 (179.2 per 1000 person-years; 95% CI, 144.9-221.7 vs 251.6; 95% CI, 179.8-352.1; adjusted IRR, 0.64; 95% CI, 0.42-0.96). Failure was most frequent during the 6- to 11-month period after switching regimens (250.0 vs 123.2 per 1000 person-years in ≥18-month period; adjusted IRR, 1.90; 95% CI, 1.19-3.02); and in patients with an adherence index of less than 80% (383.5 vs 176.0 per 1000 person-years in ≥95% adherent; adjusted IRR; 3.14, 95% CI 1.67-5.90). Use of second-line regimens containing lopinavir boosted with ritonavir was associated with lower rates of failure (226.9 vs 168.4 per 1000 person-years; adjusted IRR, 1.74; 95% CI, 1.14-2.67 for nelfinavir; 336.5 per 1000 person-years; adjusted IRR, 1.61; 95% CI, 0.73-3.56 for other protease inhibitor vs lopinavir boosted with ritonavir). However, this association was no longer significant after adjustment for adherence (P = .25).
Use of routine viral load monitoring and of viral load testing for confirmation of clinical and immunological failure were unrelated to failure diagnosis (P = .96 and P = .41, respectively). Analysis based on the definition of immunological failure as a CD4 cell count of less than 50/μL instead of less than 100/μL gave similar results (eTable 2). Rates of immunovirological failure were also higher in patients with lower CD4 cell counts at second-line therapy start (79.1 vs 23.5 per 100 person-years; adjusted IRR, 3.05; 95% CI, 1.19-7.83 for 50-199/μL; 83.8 per 1000 person-years; adjusted IRR, 3.41; 95% CI, 1.16-9.99 for <50/μL vs ≥100/μL; eTable 2).
A total of 34 patients (5.4%) died and 23 (3.6%) were lost from care after the first 6 months of follow-up taking second-line therapy. Fifteen of the deaths occurred in patients with no recorded failure. The death rate at 30 months of second-line therapy use was 44.2 (95% CI, 30.5-64.0), dropout rate, 33.2 per 1000 person-years (95% CI, 21.6-50.9), and attrition rate, 77.4 per 1000 person-years (95% CI, 58.5-102.4). Death occurred in a median of 15.1 months (IQR, 11.9-25.7 months), and care discontinuation, 12.2 months (IQR, 9.7-20.0 months) after second-line therapy start (Figure).
Mortality was lower in rural than in urban sites (33.6 vs 49.0 per 1000 person-years; adjusted HR, 0.33; 95% CI, 0.12-0.91), but was unrelated to use of both routine viral load monitoring and viral load testing for confirmation of clinical or immunological failure (P = .14 and P = .09, respectively; eTable 3). Women had lower rates than men (32.4 vs 68.3 per 1000 person-years; adjusted HR, 0.45; 95% CI, 0.23-0.91). Patients who met criteria for treatment failure of any type (91.9 vs 28.1 per 1000 person-years; adjusted HR, 2.83; 95% CI, 1.38-5.80 for <100/μL; 90.2 vs 29.6 per 1000 person-years; adjusted HR, 2.74; 95% CI, 1.35-5.58 for <50/μL; P = .005) and those diagnosed with immunovirological failure (91.5 vs 27.7 per 1000 person-years; adjusted HR, 3.17; 95% CI, 1.18-8.50; P = .02) were at increased risk of death compared with other patients. Length of time on first-line therapy before second-line therapy start was unrelated to mortality (P = .78).
Results from sensitivity analyses examining associations with cohort attrition instead of death were consistent with those for mortality (eTable 4). In addition, we found evidence of decreased attrition in patients who experienced a change in their second-line regimen during follow-up (70.3 vs 86.8 per 1000 person-years; adjusted HR, 0.42; 95% CI, 0.22-0.80).
In this prospective, multicohort analysis of 27 ART programs in resource-limited settings, 19% of patients receiving second-line therapy for more than 6 months experienced treatment failure, 5% died, and 4% were lost to follow-up. Higher failure rates were observed in patients who initiated second-line therapy at lower CD4 cell counts, in those who changed 1 NRTI drug instead of 2 at second-line therapy start, in those who did not receive lopinavir boosted with ritonavir−based second-line regimens, and during the 6- to 17-month period after second-line start. Furthermore, mortality was higher in men, patients with diagnosed second-line failure, and those treated in urban sites.
In our cohorts, the overall rate of failure using second-line therapy was 46% higher than failure using first-line (195 vs 134 per 1000 person-years).23 Others have reported failure rates on first-line ART of 24,24 and 78 per 1000 person-years.25 Possible explanations for the observed higher failure rates with second-line therapy than with first-line therapy are worse tolerability of regimens, acquired drug resistance in the course of therapy, or difficulty in maintaining adherence to therapy after a long time receiving ART. This is supported by our analysis in which poorly adherent patients were 3 times more likely to fail second-line therapy than those with optimal adherence to therapy. Patients switched to second-line therapy have already experienced a first episode of treatment failure, often resulting from episodic periods of suboptimal adherence to ART. In Western countries, worse patient outcomes are frequently observed in antiretroviral-experienced than antiretroviral-naive patients.26,27 In an urban South African cohort, higher rates of viral suppression for second-line therapy were achieved by patients who had switched to second-line therapy for reasons unrelated to nonadherence.28 Our findings highlight the need for strengthening of treatment adherence by counselors and support groups.
In the absence of specific criteria to diagnose second-line therapy failure, we chose to use the same definitions as failure for first-line therapy. Use of highly sensitive but unspecific criteria to define second-line therapy failure could partly explain the observed high failing rates during second-line therapy because the time needed to achieve immunological recovery might be longer for second than for first line. In resource-rich countries, the same definitions of failure are used regardless of therapy line.29 Furthermore, patients who met failing criteria with or without viral load confirmation were at increased risk of death and attrition, and findings were robust to changes in definitions of failure.
In our analysis, several factors were found to be associated with second-line therapy failure. Regimen potency was critical to prevent treatment failure. Hence, patients who underwent a change of at least 2 NRTIs instead of 1, and those who used lopinavir boosted with ritonavir−based therapy instead of other protease inhibitors, were less likely to fail second-line therapy. Most patients in resource-limited countries are only switched to second-line therapy after the diagnosis of clinical or immunological failure. Delayed treatment modification has been associated with poorer outcomes among patients failing NNRTI-based first-line therapy, as opposed to those receiving protease inhibitor–based regimens.30 Exposure to replicating virus for relatively long periods could lead to accumulation of mutations and compromise the efficacy of second-line regimens.31 In our analysis, we did not find evidence of association between duration of first-line therapy and rate of failure on second-line therapy, even after adjusting for differences in adherence. However, the absence of genotyping data did not allow differentiating patients who had developed mutations conferring resistance from those who did not.
We and others have previously documented the role of CD4 cell count nadir as a predictor of success of first-line therapy.6,25 Before the widespread use of genotyping in Europe, high CD4 count levels at the start of protease inhibitor–based therapy were found to predict subsequent virological suppression.32 Our findings suggest that CD4 count levels at second-line therapy start are more important determinants of failure than those observed at the beginning of therapy. This highlights the need for early detection of suboptimal adherence to first-line therapy.
We also observed relatively high mortality and loss to follow-up rates (attrition of 77 per 1000 person-years) after 6 months of second-line use. Although no similar data are currently available from resource-limited countries, our estimates are within the ranges of those reported for first-line therapy (30-370 per 1000 person-years during the first 6 months of therapy, and decrease to 13-100 per 1000 person-years in later periods33).
The strongest factor associated with death using second-line therapy was diagnosis of second-line therapy failure. Patients meeting failure diagnosis were nearly 3 times more likely to die than other patients.
Women and patients attending rural health facilities experienced lower mortality than other patients. Differences in overall patient adherence achieved by men and women could explain these findings. Studies conducted in Africa have reported poorer adherence to treatment34 and higher mortality and loss to follow-up rates among men than among women.35-38
The lower second-line therapy failure rates observed in rural settings might be explained by better access and closer monitoring of patients and better support to achieve second-line adherence than in larger health facilities.
Finally, we found lower attrition but not mortality in patients who had experienced a change in the initial second-line regimen prescribed. In the absence of differences in length of follow-up and in numbers of deaths and lost to follow-up patients between individuals who changed or not their second-line regimen, those who did (eg, because of toxicity) might have been more likely to continue taking their drugs and remain in care than those who were kept with the same regimen.
WHO 2006 guidelines recommended that patients receiving but not responding to second-line therapy continue the same drug regimen unless serious toxicity or drug interactions develop. In the past 3 years, the drug formulary against HIV/AIDS has increased dramatically, and viral load suppression can now be achieved regardless of presence of mutated virus. None of the newly developed drugs (ie, etravirine, darunavir, raltegravir) are currently registered and marketed in resource-limited countries, but new WHO guidelines will now recommend the provision of third-line regimens.39 Sequencing well-tolerated and efficient regimens from first-line to second-line therapy, and from second-line to third-line therapy, is critical, however, to ensure good therapeutic outcomes.
Other limitations of our analysis not yet discussed include residual confounding by incomplete estimate adjustment, limited time of follow-up, small number of sites using viral load monitoring, small number of deaths, and the possibility of bias by differential loss to follow-up. Complete and accurate recording of routine data are difficult to achieve in resource-limited countries; MSF invests considerable resources to improve and maintain the quality of the information collected. Analyses were adjusted for an important number of programmatic and individual factors, but information such as patient adherence or diagnosed clinical nonstaging conditions was unavailable for some or all the study patients. Finally, sensitivity analyses for which associations with attrition instead of death were investigated showed similar results.
The observed rates of second-line therapy failure and associated mortality in this multicentric study in resource-limited countries highlight the need for both strengthening patient adherence to second-line therapy and increased availability of alternative and better tolerated fixed-dose combinations of antiretroviral drugs. New drugs with different modes of action and without cross-resistance to NNRTI and protease inhibitor–based regimens are also needed for patients who live in resource-limited countries.
Corresponding Author: Mar Pujades-Rodríguez, MD, PhD, Epicentre, Médecins Sans Frontières 42-bis, Bd, 8 rue Saint Sabin, 75011 Paris, France (email@example.com).
Author Contributions: Dr Pujades-Rodriguez had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Pujades-Rodriguez, Calmy.
Acquisition of data: Pujades-Rodriguez, Balkan, Arnould.
Analysis and interpretation of data: Pujades-Rodriguez, Balkan, Brinkhof, Calmy.
Drafting of the manuscript: Pujades-Rodriguez, Calmy.
Critical revision of the manuscript for important intellectual content: Pujades-Rodriguez, Balkan, Arnould, Brinkhof, Calmy.
Statistical analysis: Pujades-Rodriguez, Brinkhof.
Obtained funding: Pujades-Rodriguez, Calmy.
Administrative, technical, or material support: Pujades-Rodriguez, Balkan, Arnould, Calmy.
Study supervision: Pujades-Rodriguez, Balkan, Calmy.
Financial Disclosures: None reported.
Funding/Support: This study was partly supported by grant 32473B-122116 from the Swiss National Science Foundation, from which external funds for this particular project were provided. Salaries of Drs Pujades-Rodriguez, Balkan, and Arnould are ensured by MSF (Drs Balkan and Arnould are employed by the Medical Department of MSF; Dr Pujades-Rodriguez is employed by Epicentre, a satellite nongovernmental organization closely linked to and funded by MSF).
Role of the Sponsor: The sponsor did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Additional Contributions: We thank our partners in the ministries of health of the countries and the MSF field teams for their daily work and efforts to provide care to the patients and for data collection; the members of the MSF AIDS Working Group for their advice and support; and the Epicentre FUCHIA team for their support in data collection and data quality maintenance. We also thank Oliver Yun, MA, ELS, Medical Editor of Doctors Without Borders/Médecins Sans Frontières (MSF), New York, New York, for his editorial work. Mr Yun, who is employed by MSF, did not receive compensation for his editorial work; he provides free editorial support to authors employed by MSF/Epicentre.
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Renee Radziwon, 36, of Portland, an employee at an animal sanctuary in Sherwood, Ore., was killed late Saturday by a wild cat at the facility.
PORTLAND, Ore. — The employee killed this weekend by a wildcat at an Oregon animal sanctuary was described as an experienced worker who was comfortable with the animals she cared for, but is believed to have been alone with an animal in the enclosure.
Renee Radziwon, 36, of Portland, died in the Saturday night attack, Deputy Mark Nikolai of the Clackamas County Sheriff's Office said in a statement Sunday.
KGW News reported a cougar was the animal that killed her.
"We are devastated by this loss. Not only was she one of our most dedicated staff members, we thought of her as family. We send our most heartfelt prayers to those she has left behind," said Cheryl Tuller, executive director of the sanctuary.
Tuller added that Radziwon had been working at the sanctuary as the head keeper for 8 years and was a certified tech.
The sanctuary is located in the suburb of Sherwood, outside Portland.
In a statement, the sanctuary said it has strict safety protocols ruling the entrance of a person into an enclosure. Its handbook specifies that two qualified staff members be present during the lock-out of a "dangerous" animal.
Sanctuary officials said they believe Radziwon was alone in the enclosure at the time of the attack. Officials said they are still investigating.
"Her relationship with the cats was amazing," Jim Caliva, a WildCat Haven Sanctuary board member, told The Oregonian. "She knew exactly what she was doing, but apparently there was a mistake. I don't know what it could be."
Sheriff's Sgt. Robert Wurpes said Saturday that the animal was locked in a cage following the attack.
WildCat Haven officials did not immediately respond to a telephone and email messages left by The Associated Press Sunday.
Its website describes the facility as a "last hope" for more than 60 wildcats that have been abandoned or abused, including bobcats, cougars, lynx and tigers.
Caliva said Radziwon worked with all the cats at the sanctuary.
"They knew her and walked up to the fence," he told The Oregonian. "She was one of the best people I've ever met."
Cheryl and Michael Tuller opened the facility in 2001.
Last summer, the sanctuary announced plans to move from its 8-acre facility in Sherwood to an 82-acre site near Silverton and launched a fundraising effort. The Tullers did not set a timetable for the move, The Oregonian reported.
The facility is not open to the public, but does provide on-site tours to donors.
In February, a 24-year-old woman interning at a California wildcat park was killed by a lion while she was cleaning the cage. The woman's family called the incident at Cat Haven an accident. In that case, investigators believed the 5-year-old male lion lifted the door of a partially closed feeding cage with its paw and killed Dianna Hanson as she cleaned a bigger enclosure area.
Family members said they didn't believe it was a mauling, but rather a lion's rough play that turned tragic.


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Fabolous (Feat. Keri Hilson) - Everything, Everyday, Everywhere
The official music video for Fabolous' third official single "Everything, Everyday, Everywhere" featuring Keri Hilson, and prodcued by Ryan Leslie. It is featured on Fabolous' fifth studio album "Loso's Way" which hits stores today!
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The Internet and the History Classroom: Introduction
Just a few years ago, authors in Perspectives were debating strategies for holding the attention of history students raised on MTV. Connecting with students through the Internet seemed to provide a fresh avenue for building bridges to a generation brought up on the pervasive flash and thunder of the modern media.
As the authors of the articles in this forum attest, the problem of attracting and holding student attention persists, but teachers face a new challenge in the history classroom. Teachers and students alike find the Internet a vast and treacherous sea. The web now provides access to a wealth of data that extends well beyond the limits of many of the best research libraries. But it is a library in which only small pockets of material are properly catalogued, where documents and evidence are often deposited with little care for archival integrity or scholarly authenticity, and worse still, where cranks and ideologues are free to peddle falsified evidence.
Many—if not most—students now start their research on the Internet. This challenges us as scholars and educators to teach students to use these materials wisely, and teach ourselves how to critically assess their use of these materials. The articles that follow offer three approaches to these questions, providing assessment tools for the teachers and perhaps some useful guides for students as well.
John McClymer's essay sets a useful framework for reading the other two essays. Citing his own experience in the classroom, he suggests strategies for providing "structured access" to the abundance of materials on the Internet. He walks us through the process of developing a course syllabi that sets parameters on the ways students use the Internet, and demonstrates some useful strategies for developing a student's understanding about how to access and read materials on the web.
However, he advises us to see the abundance as an opportunity, as well as a problem—providing a fresh means to read deeply and see works in a larger context.
Of course, doing this places an added burden on those leading the class, as teachers need to be able to see the larger picture and differentiate the good from the bad in the wide range of materials available. The next two articles describe projects to assist in that process of discernment.
Kelly Schrum describes the work of the Center for History and New Media, which provides a rich base of materials, as well as analytical guides for students and teachers interested in using online materials.
William Paquette takes up some of the choices involved in establishing such an evaluative site—describing his involvement in the Merlot project based in the California State University Digital Learning Center. At the same time, he reminds us of some of the excitement that those earlier authors were seeking as an antidote to the competition from other media.
It is still too soon to tell whether the marriage between history and new media will be a long and happy one. But the early signs are promising.
—Robert B. Townsend is AHA assistant director for research and publications.
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June 9, 2018
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Summer Semester 2018 (8 Week Term)
Event Date(s): 05/14/2018-07/17/2018
Summer Semester 2018 (8 week term) will begin on May 14 and will end with final exams on July 18-20.
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Event Date(s): 05/14/2018-06/19/2018
Summer 2018 First Mini-mester begins May 14 and will end with final exams on June 20.


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Anybody remember that one of the issues that The Keith raised on March 3rd during his Motion of No Confidence address was the issue of procurement procedures that are affecting the rate and frequency with which foreign investment taking place?
Well, the UNC-led Govt has just changed the procurement rules again...They have removed the requirement of a quorum that comprised 4 members of the Govt and 1 member of the Opposition/1 Independent Senator. As the law now stands, only 4 members of the Govt are required. You know who was part and parcel of that legislation change? Minister of Planning and the Economy Dr Bhoe Tewarie...yes the same Bhoe whowatch CLICO sink and said not one word....Now study yuh head good and tell me what you think going to happen with tendering and procurement procedures with a quorum that does not have a representative from the Opposition or an Independent member of Parliament?
Little bit by little bit this current government is undermining our Parliament and our legal checks and balances. Last year when people kick up fuss about procurement procedures over the Pt Fortin Highway, Kamla Persad set up an inter-ministerial committee to oversee that things were transparent...guess who chairs the committee....The Prime Minister....guess who has the contracts worth $600m to provide the highway project with aggregate....Gopaul!
What happened to all the transparency and accountability talk from 2010? And why aren't we making more noise about all of these breaches?
Imagine the Minister of Public Utilities, Senator George, says Hinds must go before the Privileges Committee for quoting from a newspaper article, while Moonilal and Ramlogan can lie on private citizens under the protection of Parliament and never have to answer a question or even issue an apology!
And while we on the topic of questionable information being disseminated in Parliament...Dr Goopeesingh, can you tell me which report you got the figures from about national depression? You estimated 100,000 people. Was a survey done? Were all of these people diagnosed? And where were they diagnosed? At private offices? Public hospitals? Or were you taking foreign figures ad applying it to the local mileu?
Balo Maharaj's wife got extradited....But Ish and Steve still here and the talk is tendering for hefty government contracts.
Dookeran boof Volney without actually using his name. And Pastor Volney officiate at Atiba Duncan's funeral.
The Dangerous Dogs Act is closed to being passed and it only names specific breeds....which is stigmatising them....and to the best of my knowledge, all dogs can attack and maul a human and more likely than not, it's the owners who cause dogs to be dangerous. I think this Act needs some adjustments for it to be fair all around as well as protect people from careless owners.
And of course we have the perennial problem of bobol in Licensing Office that no govt is ever going to actually tackle....why? Because...
De Vice Cyah Done!


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One of the players I most enjoyed covering was Robin Ventura for those two years he played for the Yankees. In that clubhouse full of stars and egos, Ventura was a voice of calm, reason and humorous relief.
I enjoyed stopping by his locker to shoot the breeze for a minute or two, talking about things other than baseball. Very smart, clever and possessing an insight on numerous issues. When there was the inevitable blow up or moment of absurdity, Ventura was always there to put it into perspective with a quip as short and hard-hitting as his swing.
Once I asked him about his fight with Nolan Ryan, and his response was he knew he had made a mistake halfway out to the mound, but couldn't turn around. You'll even notice in the video he slowed down.
Was it an embarrassing moment? Yes, but years later he handled it with humor. He even joined with Ryan to autograph photos of the brawl.
When I covered the Orioles and he was with the White Sox, I'd make time to go over to his clubhouse for a few moments. He was accessible to anybody who would take the time to ask a question.
I am sure there will be a lot of questions for Ventura pre-game tonight when he brings his White Sox into town. There will be rehashing about his time with the Mets and Yankees, about being in New York during September 11 and what he remembers about Mike Piazza's homer the first game back in the city.
He'll also get a question or four about his grand-slam single against the Braves in the 1999 playoffs.
That night is one of the greatest team displays of enthusiasm outside of winning a championship I have ever seen. That, and I suppose, the Piazza post 9-11 homer. Both were amazing to watch.
Ventura wasn't a five-tool player, but was consistent and clutch. With a runner in scoring position you wanted him at the plate because he'd usually make contact.
Ventura was a .267 lifetime hitter and only once hit over .300, that being .301 in 1999, his first season with the Mets. Considering his 66-game hitting streak in college, I always wondered if he thought he should have hit for a higher average. He also hit 32 homers with a career-high 120 RBI in his first year with the Mets.
What the Mets wouldn't give for a player with that production now.
Ventura had three solid years with the Mets, who, during that span had arguably one of the best defensive infields in history. Few balls got by Ventura, Rey Ordonez, Edgardo Alfonzo and John Olerud.
Both Olerud and Ventura would later play for the Yankees. When they left the Yankees, I believed I'd see both again managing in a major league dugout. I'm still waiting on Olerud.


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EXCLUSIVEHeidi Klum's not afraid of a little PDA -- donating some fresh spit to her young art dealer boyfriend Saturday night at a Hollywood nightclub ... in the middle of the crowded dance floor ... and TMZ has obtained photos.
The DFMO (dance floor make out) went down at 1 OAK -- Klum grabbed 27-year-old Vito Schnabel's face and passionately kissed him in front of everyone.
She looks really into it. Vito looks like a prom virgin.
Then again, he's the one dating a supermodel.


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'Abilene Antique Trader' Facebook Page Reaches Buyers CraigsList and eBay Can't
If you like to buy or sell antiques and similar unique items, there's a Facebook page for people just like you, based in Abilene. 'Abilene Antique Trader' is a closed group site dedicated to the buying, selling and trading of old, antique, collectible or unique items.
The new site has just over 2,000 members (as of 7/22/14), and features a lot of variety. If you're looking for antique furniture, there's plenty available. Some restored, and others still requiring work to be brought back to life. So, if you're looking for a piece to fit into your living room today, or interested in a weekend project, Abilene Antique Trader is a good place to look.
If you're looking for oddball things that you just won't find anywhere else, conversations pieces to display in your home, or something that reminds you of your childhood like this old console stereo, Abilene Antique Trader is a good place to look.
A visit to the site is like a trip down memory lane for me. I came across a Remington Skylark portable typewriter that was very similar to the one my family had when I was growing up. I remember using it to help me read, write and spell when I was a kid, and think it would be a cool (and pretty much indestructable) thing to have around the house for my kids to learn from.
This site probably isn't going to satisfy the shopper who is looking for amazing deals on everything and anything. There are other Facebook pages for that, like Abilenee Swap Meet. Abilene Antique Trader is specialized, and that's the way it was intended to be. It's definitely worth taking a moment each day to see the new items posted on the site.
If you've tried unsuccessfully to sell antiques at yard sales or online sites like CraigsList or eBay, you should definitely consider posting a photo of your items on this site.


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A unique exhibition is opening in London, containing more than 50 photographs taken by Drivers and Team Principals for Charity. These images will then be auctioned off to benefit a London children's hospital.
Leading names from F1 put their photography skills to the test with the launch of Zoom. The project is in aid of the Great Ormond Street Hospital Children's Charity (GOSHCC).
For a change, the drivers and teams will be behind the lens, bringing new insight into the world of F1 through a collection of photographs taken by celebrated names from the sport.
The collection covers subjects from both racing and their personal lives. Some highlights include Lewis Hamilton's driver's eye view from the cockpit in the pits at Spa-Francorchamps, as well as Sebastian Vettel's Alpine scene, and Bruno Senna's beach image.
Every photo was signed by the contributor and will be auctioned by Coys (http://www.coys.co.uk/), with the proceeds going to GOSHCC, the official charity of the British Grand Prix. Details of the auction can be found on the website.


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Last month, I had the pleasure of visiting the OtterBox headquarters in Fort Collins, CO and it was bigger and nicer and more fun than I ever imagined. There are very few right angles in the building and the architecture and interior design is just gorgeous. As if the multiple mini-kitchens, work-out gym, bike room, and pinball machine wasn't enough, OtterBox headquarters also features a slide. Yes, a giant, awesome, circular indoor slide. iMore and Mobile Nations better watch out, because if OtterBox offers me a job, I'm there!
After watching the video, head over to Otterbox's website for videos about the headquarter's design and photo gallery. You'll be nothing short of impressed.
Now go enter our big Otterbox case giveaway
This post may contain affiliate links. See our disclosure policy for more details.


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Libraries are incubators of innovation. Students, scholars, inventors, writers and leaders throughout history have turned to libraries for information, assistance and inspiration. In order to help foster that spirit, OCLC explores new and changing technologies that improve information services for libraries and their users.
Here you can find some of the beta services that we're working on. These services have emerged from their experimental origins are are on a path to becoming fully production services in the near future. They embrace new and emerging technologies in order to discover ways to better enable data sharing, cooperative services and community growth within the profession.


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We use cookies to ensure that we give you the best experience on our website. If you continue without changing your browser settings, we'll assume that you are happy to receive all cookies on the Knight Frank website.
Find out more about how Knight Frank uses cookies
The Wealth Report
From geopolitical changes to luxury spending trends, discover the issues that matter most to the world's wealthiest individuals
International View
A selection of the finest properties currently available across the world
Global Cities
New business hubs that are transforming the geography of our global cities
Private View 2017
Discover extraordinary living in extraordinary spaces in the UK and internationally
Move fast, search faster
Download our new Global Property App
On Facebook
Did you know?
A city for the super rich?
Cape Town has been placed 3rd in the world for property price growth
On Twitter
Make a small room feel bigger - some clever colour ideas to make the most of the space you've got
Monthly updates on the South Africa property market
On the blog
Co-friendly abodes for the future


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The House of the Dead 2 & 3 Return
What do you need help on?Cancel X
Two grisly titles from the popular THE HOUSE OF THE DEAD series are being compiled into one action-packed horror shooter for the Wii. Both THE HOUSE OF THE DEAD 2 and III will feature the original arcade experience, complete with branching storylines, over six ghoul-filled game modes and bonus content. Re-live your glory days in the arcades and mow down packs of clawing, biting undead with the new rapid-fire Wii Zapper!
If you're stuck in The House of the Dead 2 & 3 Return, ask your fellow GameFAQs members for help.
Game News
Game List Statistics
Now Playing
50 Users
Wish List
77 Users
Hot List
3 Users


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Welcome to The PC Guide!
It seems that either your browser does not support frames, or you have them
disabled. The PC Guide makes extensive use of frames to facilitate easier navigation
through the site. The PC Guide site uses a hierarchical structure of pages. The general
rule of thumb is that the information on the site is displayed in the "Contents"
frame, called "C", while the links deeper into the structure are in the
"Index" frame, called "I".
You can find information on the site without using frames in three different ways:
Charles M. Kozierok
Webslave, The PC Guide
Home - Search
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The PC Guide (http://www.PCGuide.com)
© Copyright 1997-2004 Charles M. Kozierok. All Rights
Not responsible for any loss resulting
from the use of this site.
Please read the Site Guide before using
this material.


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Vimax Detox Price Islamabad, Lahore, Karachi
Chat now on Whatsapp: +92310-4080037
Product Available
Vimax detox price price in Pakistan, mardan
(0345-2222646), Clickbuy.pk, First off, The Vimax Detox ingredient are the golden seal, aloe vera, blues vervain, senna leafs, white oak bark, the psyllium husk, gentian roots, and slippery elm. You'll take two the capsules per day, the supposedly helping to the eliminate digestives toxins and boost energy level. Both women and the men can use this detox Read more »


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Make your own embroidered portraits of family and friends
Jan 2, 2011
For Christmas, I made embroidered portraits of my nephews and nieces. The project is more time-consuming than the silhouette portraits, but still relatively easy if you are familiar with embroidery. Each 5" x 5" portrait took about an hour and a half to complete, which includes framing the work.
Here is a list of materials and equipment needed to make a 5" x 5" embroidered portrait:
computer with photo editing application
white printer or copy paper
black felt tip pen
10" square of linen fabric
10" x 10" IKEA Ribba frame
black embroidery floss (I used DMC perle cotton 12)
embroidery needle
embroidery hoop
fabric scissors
art tape
1. Take the mat out of the frame and trace the mat opening onto the white copy paper. Then, choose a photograph on your computer to use as a template. If necessary, resize the picture so that it fits within the 5" x 5" mat opening.
2. Secure the white paper over your monitor with removable tape. Carefully trace the outline of the portrait with a felt tip pen.
3. Take your fabric and line drawing to a bright window. Center the fabric over the portrait and trace the line drawing with a black pen.
4. Secure fabric in an embroidery hoop. Using a backstitch, embroider over the line drawing. (Periodically refer to the actual photograph when working on fine details.)
5. Iron the finished portrait. You'll want to trim the edges of the fabric so that it can be taped to the back side of the mat.
6. Arrange the portrait and mat so that they sit in the back of the frame, like a shadow box. Secure the back of the frame and you're done!
Since the frame is deep, you can add small memorabilia or decorative details to personalize the portraits even more. For my nephews and nieces, I painted small wooden letters (just the first letter of each name) that could be glued to the bottom ledge of each frame. I included the letters with each framed portrait.
Labels: creative crafts, embroidery
5 comments:
- Colleen said...
That's such a fabulous idea! Thanks for sharing the step-by-step instructions. Happy New Year!
- 1/02/2011
- Kristen Donegan said...
I love this idea! now to try and make time to do it. great instructions thank you:)
- 1/02/2011
- **We BLOG ARTISTS** said...
OMG this is brilliant, thanks for sharing the "How to"!
- 1/02/2011
- flyhoof said...
What a great idea and such a thoughtful gift! Thanks for sharing your tutorial too... I might give this a go once some of my friend's babies get older :)
- 1/05/2011
- Galit said...
This is such an awesome idea!! So simple and great!
- 1/14/2011
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Class Mysteries
Shop Mysteries
Finished size: 70" x 85". Finished block size: 15". Detailed instructions are in full color. This pattern is a very popular fat quarter pattern. A bundle of twenty fat quarters and the star and border fabrics are all you will need to duplicate this "classy" quilt.
Copyright © 2019 Debbie's Creative Moments Website Developed by Duke City Software, Incorporated


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*Don't forget to grab that electronic device and join us for live spoilers and discussion during the Sister Wives new episode, Sun at 9 ET. Lots of fun!
New Post Soon! Twisted Sister Picture Fun and items to buy! Watch for it!
"@KingOJungle: @JanelleBrown117 Do you guys have jewelry for men as well? #GodBless". Kody has an awesome men's line coming soon!
— Janelle Brown (@JanelleBrown117) September 1, 2013
First day of college sibling pic! http://t.co/xW01sUgKDw
— Aspyn Brown (@AspynBrown) August 27, 2013
And all us mothers unite and say Aw.........Adorable! Even my little heart feels Janelle's pride.
Really there are just so many beautiful men walking around my campus.Have fun! That's what college is all about! Gosh I miss those fun years.
— Aspyn Brown (@AspynBrown) August 31, 2013
Small personal victory 2night because went 2 gym after work - sure didn't want to. Finally a pre-workout for women! pic.twitter.com/r8vtYKCd8n
— Janelle Brown (@JanelleBrown117) August 30, 2013
@JanelleBrown117 Please tell me how to get "ignite for women.
— Diane S. Chance (@RNdsCh) August 30, 2013
"@RNdsCh: @JanelleBrown117 Please tell me how to get "ignite for women." I got mine at http://t.co/PWVVdnxJQ2 - love that website!Odd. LIV has pre workout packets. However, whatever works for you Janelle!
— Janelle Brown (@JanelleBrown117) August 30, 2013
— mariah brown (@mariahlian) August 30, 2013I guess Christine is the "all around mom" for the kids to get some comfort food.
Is It Tater Tot Casserole tonight?
@MeriBrown1 Love this new piece by @realkodybrown! Love your show too! http://t.co/fyrAVfS29Ahttp://www.mysisterwifescloset.com/product_p/fidelis-pendant-and-box-chain.htm#.UhzxZsvcLBE.twitter
— ⚓Rachel⚓ (@RachelRinow) August 27, 2013
Wow. Don't know what to say about that necklace. Makes me think he was sitting around thinking about the Navy. Why do they keep trying to use such "insightful" words, hell, Robyn can't even say them. While i'm thinking about it, what happened to Elisa Furr?
There she is!
@MaddieR_Brown Yeah! I enjoy your antics.. LOL & seeing you acclimate to our town. U always know that u and ur family have friends here. :)
— Elisa Furr (@elisafurr) August 29, 2013
This past week we lost Kody's father. Here is a picture by a granddaughter of the of the 2 now missing from us. pic.twitter.com/lg1uMDR4xe
— Janelle Brown (@JanelleBrown117) August 28, 2013
A favorite picture of the late Curtis Taylor Brown & our late father William Winn Brown. Missing them now. pic.twitter.com/pdDw8caori
— Kody Brown (@realkodybrown) August 31, 2013
455 (24%)
865 (46%)
747 (40%)
307 (16%)
I have a Brown Gossip Exclusive! A neighbor peeked and saw what Kody put in the time capsule! Here it is!!
Watching Kody & Robyn tell their daughter that their hymens are more important in a relationship than their personalities. #SisterWives
— Nikki (@AYTYNikki) August 30, 2013
The guy on "Sister Wives" is either the smartest guy ever or the dumbest. I can't decide. #gross
— daniele (@pointeplease03) August 30, 2013
Now will @realkodybrown have to add a 5th wife to save his show? o.O http://t.co/RiZ6xFrwmo #SisterWives
— NONOBADKITTY! (@surfkitty) August 30, 2013
Sister wives is one DISGUSTING ass show .
— Sarah® (@MissPersuasion_) August 30, 2013
My surprise for the day, @mariahlian home for the long holiday weekend! Super excited! :) pic.twitter.com/D6URrE8EsIBut Meri is! Mariah is lucky to go where she has such support. Grandmother, uncles, cousins. We wish her the best. No tantrums now.
— Meri Brown (@MeriBrown1) August 30, 2013
Sister Wives is blowing my mind right now!!He must be watching Robyn watching Robyn.
— ImNotTHATGay (@ImNotThatGay) August 30, 2013
Scandal? : Is Mariah from 'Sister Wives' Getting Free College Tuition in Exchange for TV Mentions? http://t.co/08UiFBgPQr @PatheosNoooo. we only heard Westminster College 100 times. Did everyone get a sweatshirt? Seriously, EDUCATION is the one good thing that will come out of this show for the kids. So I say, who really cares? All of us would do the same, go for it! Note to parents: If true, quit talking about how you are figuring out how to pay for it. Lying is a sin too last time I checked.
Rebecca Cusey (@Rebecca_Cusey) August 28, 2013
MOMS? MOMS? Give Christine some credit. Often having 6-10 kiddos at a time home schooling; making suppers, and yes, she is just too beautiful to cook.@LuvgvsUwngs I think it's stupid that you have to keep repeating your self & clarifying what you regret you are allowed to regret thingsWhat I regret is the you exposed your children to embarrassment; that you were unprepared; but it gave us great fodder. Don't do that again to the kids. It pisses me of. STOP STOP STOP STOP talking. NOW. You are not mother of the year in the Brown group. In fact, that sounds like a good new poll.Who do you think is the best mother? Vote at the right!
— Krista (@KristaGogo) August 26, 2013
"@KristiHarris11: @LuvgvsUwngs.Are you all supportive of any choice should the kids choice to live differently then they were raised?" Yes!I sure hope so. I promote sanity. Ever hear the phrase, "Don't do as I do, do as I say?" Start using it. Better yet, let Christine help you learn parenting.
— Robyn Sullivan Brown (@LuvgvsUwngs) August 26, 2013
Layover at airport in Seattle, WA. Such stereotypical weather. On my way to Wyoming. pic.twitter.com/xuG2nE40glI bet you didn't fly in the good ole days. Seriously, your topic is the weather? WEATHER?
— Kody Brown (@realkodybrown) August 28, 2013
"@gravenbabies: @realkodybrown are any of your kids homeschooled?" Home schooled all of them until seven years ago. Very hard work for moms.
— Kody Brown (@realkodybrown) August 27, 2013
@SisterWivesBlog So what's that about back order items. Wanted to buy something, so how long is the wait?Seems some folks are unhappy with the MSWC site. I re-directed her directly to Robyn.
— Wanda (@wanda290) August 29, 2013
@SisterWivesBlog well yeah but he's too shy to talk about it. Tho Robyn can talk to preschoolers about virginity.#double standardCan I get a WootWoot!! EXACTLY. Go Girl.
— Ayce of Hearts (@ayce325) August 26, 2013
This is a great concept. At 29 I stopped waiting for others tell me I was special and went out and spoiled myself. pic.twitter.com/M11WD7ulAuOk, Ro-Bun, great idea!!!!!!
— Robyn Sullivan Brown (@LuvgvsUwngs) August 30, 2013
Go, go, go, go, go, go
Go Shawty, it's your birthday
We gonna party like it's your birthday
We gon' sip Bacardi like it's your birthday......
RIP Winn...
*Shameless Plug Alert* Please retweet us on twitter, facebook, etc. link our posts, etc. etc. Share the good news of SWB snark!
Free Discussion. Please stay within the posting rules of SWB at the top right side of the blog.
***Vote for who you think is the best Brown mother in the same spot.


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N.D. Supreme Court
Lawrence A. Leclerc
District Judge 1979-2004
East Central Judicial District
Fargo, N.D.
Cases reviewed
Lawyer record
Born in 1934, Fargo, N.D. Graduate: Shanley High School; U. S. Army 1953-56; BA and JD from University of North Dakota. Private practice 1966-79, Fargo. Appointed District Judge 1979 by Governor Arthur A. Link. Elected 1980, 1986, 1992, and 1998. Member: Joint Procedure Committee; Judicial Conduct Commission. Married: Wife, Kathryn. Four children. Retired as District Judge Dec. 31, 2004. Appointed Surrogate Judge, 2005. Judge Leclerc died in October 2015.
Biographical Sketches of the North Dakota District Court Judges


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H&S needed a new logo design and created a contest on 99designs.
A winner was selected from 424 designs submitted by 145 freelance designers.
Clean, professional, creative, elegant, high-end feel, corporate logo designed for an international trading company.
Don't be afraid to be experimental.
H&S Trading Co. Ltd.
H&S Trading should be incorporated in the logo itself, giving emphasis to H&S as they are surnames of the co-founders.
Suggested colours: blue and black, but feel free to explore and propose other combinations.
Fell free to apply to any business card templates (or your own designs) you have just to demonstrate how it could look like.
- usable on white and black background (examples please)
- usable in black & white
- eye catching
- print ready
- logo must be in vectorial
- accepted formats: AI, EPS
- a lot of colours
- illegible
- hard to print
- clip arts
- mascots
- photographs
- unlicensed graphics
Find out how a design contest works or learn more about our logo design services.