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Discover Why Master Magician Illusionist - Aedryan Methyus Differs From "The Norm"
If you are trying to find a magician for hire in Elmont, NY we invite you to see for yourself the many ways Master Magician Illusionist - Aedryan Methyus differs from "the norm". There are many different show plans and packages available for you to select from. No matter which one you choose, Aedryan's performance will be GUARANTEED "wow factor" for your venue or event!
How Does Aedryan Methyus Differ From Other Magicians For Hire In Elmont, NY?
. : The Experience : .
No matter what type of event you are planning, if you need to hire a magician in Elmont, NY that is guaranteed to add "wow factor" to your event and create memories for your guests that will last a lifetime, there is no need to look any further. Aedryan has been performing worldwide professionally for over 16 years. He has performed for some of the largest and most prestigious corporations and organizations in the world, for audiences of all ages from all walks of life in just about every imaginable performance environment.
. : Intimate Magic That Touches Audiences : .
Every one of Aedryan's magic and illusion shows contain highly interactive audience participation, hilarious comedy magic, captivating storytelling, mentalism and impossible predictions. And, for some of his special themed show packages - some very spooky and rare bizarre magic, which touches his audiences on even deeper emotional levels. No matter which show package you decide on, you can be certain that Aedryan's brand of magic will touch your guests and move them on many different levels.
. : Awe Inspiring Illusion : .
Aedryan has a wide array of different magic shows and illusion shows available for you to select from, ranging from small and simple to very large and technical with every size show in between. If you are searching magicians for hire in Elmont, NY with an act that is of larger proportions, Aedryan's larger illlusion shows consist of "Awe Inspiring" large-scale grand illusions and mega illusions, hypnotic, driving music, dance and theatrics galore. For larger venues, he can also incorporate entrancing video animation with 360 degree audience viewing of the magic and illusions on large screen projection monitors for a very up close and personal audience experience.
. : Lovable Charm : .
All of the magical elements in Aedryan's performances are presented with his lovable charm, witty character and comical antics. Aedryan never fails to connect with his audiences and leave them spellbound, as he takes them on a rollercoaster ride, full of mystery and wonder, with surprises around every corner.
"Aedryan Methyus was the best magician we have ever had at our annual Halloween party! All of our guests, including a state representative, members of the Pa. Attorney General's office and local friends and guests all raved about Aedryan. Don't make a mistake by getting anybody else for your event...
"Aedryan did a great job for our Corporate Christmas Party. Everyone seemed to enjoy the show and was truly amazed at some of his tricks. Aedryan was very professional and punctual for our event. I would recommend him to others who are looking for an entertaining magician/illusionist...
"Aedryan was excellent! We have a mixture of stuffy people and fun people, and he did really well in dealing with them all. He had comedy in the acts and was very professional. I would definitely use him again and recommend him to others, he was well worth the money...
"Aedryan was wonderful. He was professional, and definitely had a great impact on our group. Even with the 7 inches of snow that we received the day of the event, he made it up to the event. I'm sure others would have canceled, where Aedryan did not. I look forward to working with him again sometime in the future...
"Aedryan was engaging, friendly and put on an exceptional performance. We will definitely contact him to perform at our event next year...
"Great show for our employees. Thanks for getting everyone laughing and bewildered...
"Very pleased! I would recommend the 1/2 hour walk around before and after the show. It definitely added to the whole experience...
"He arrived on time and had no trouble setting up. He kept a crowd of 16 year olds happy for over an hour. There were several spontaneous ohs and ahs from the audience. So he must have stumped them with the tricks...
"I knew as soon as I first talked to Aedryan that I had nothing to worry about. He was very professional, returned my calls and emails promptly, and accommodated all requests that I had. His show was very entertaining combining both humor and mystery to create a memorable experience. I would definitely hire him again...
"Aedryan had performed a magical show for our company and the kids loved him! He did a great job...
"The performance was great. Aedryan Methyus is one in a million. Dealing with young children (9) takes alot of expertise and talent. His performance was both entertaining and magical. I would not think twice on recommending him to someone else for a party or event. I will personally use his service again. Number ONE top act...
"He was good with the kids and also got the adults involved. Everyone had fun...
. : Aedryan's Guarantee : .
Every one of Aedryan's performances come with a risk free 100% GUARANTEE! When you hire master magician/illusionist - Aedryan Methyus, you can be certain that he will provide a spectacular evening of intimate magic and illusion that suits your needs, as well as your budget. If Aedryan fails to create a magical experience for your guests that they will never forget and they do not laugh, clap and have a great time - the performance is FREE!
. : Options & Flexibility : .
Whether you need to hire a magician in Elmont, NY to perform at a major event in the largest of civic arenas or at a private event in the smallest of living rooms, Aedryan will provide a magic show that will be perfect for your event. Every one of Aedryan's magic shows and illusion shows have many different customization options and features, as well as upscale versions available.
Many of Aedryan's show packages can even be interchanged with other show packages. This allows Aedryan the flexibility to custom design and tailor his magic or illusion shows, so the performance will suit your needs, your budget, the audience and the venue exactly. Aedryan's clients always marvel over his flexibility and versatility, because when they were trying to find magicians for hire in Elmont, NY and comparing candidates, they found that other magicians in Elmont, NY simply did not have nearly as many options.
Be sure to visit Aedryan's Magic And Illusion Portal to find the perfect show package for your venue or event.
Thanks so much for checking out my website. I hope you will spend some more time here learning more about my arts, my passions and all that they entail. It is much... I truly hope to have the pleasure of speaking with you very soon, so we can discuss the many ways you can use my talents to help make your event spectacular. Until then, may your days be filled with magic and all of your night scenes be painted...
~ Aedryan
"Wow Factor" Entertainment Provided For:
And, so many more...
Let's Make Your Event the next!
Things You Should Know While You're Searching Magicians For Hire In Elmont, NY
If you have been elected to hire a magician in Elmont, NY to provide the highest quality entertainment for your event, we highly recommend taking a few moments to look through Aedryan's thoughtful and informative "Talent Buyer's Guide". You will above all, learn how Aedryan's magic and illusion shows differ from the "norm" you will find with other magicians for hire in Elmont, NY. You will also learn about different kinds of magicians, as well as the varying quality of the acts they offer. In addition, you will learn many important things to watch out for, because Aedryan knows you want to get the highest entertainment value possible when you spend your hard earned money to hire a magician in Elmont, NY and count on them to help make your event a HUGE success!.
Compare Before You Hire A Magician In Elmont, NY
We know that it can be stressful and confusing trying to find the best entertainment value when you are searching magicians for hire in Elmont, NY. Especially since most non-magicians are not familiar with the many different brands of magic there are. The best advice we can give you as an entertainment buyer is, to compare before you make the decision to hire a magician in Elmont, NY.
These gimmicky claims obviously do not have any credence. Any magician can simply pay a fee, as well as a commission to be listed on these websites and they are not screened in any way. Aside from the fact that they are ripping magicians off, these websites are not genuine talent booking agencies and they do not even have a working professional relationship with any of the magicians, who pay to be listed on them. The worst part is, talent buyers, who register on these websites and submit an inquiry form will have their emails spammed to death by a multitude of parties for many years to come.
The single most important thing you can do when you are looking to hire a magician in Elmont, NY and comparing candidates is, insist on seeing promo videos. While you are comparing promo videos make certain that they contain clips from actual live performances and not just "staged" video footage. It's very easy to tell the difference. Be sure to watch and listen to the audience member's reactions. There should be lots of laughter and clapping, as well as, "eeeews" and "aaaws". While you are comparing the available magicians for hire in Elmont, NY, one of your primary concerns should be that they are able to make the audience genuinely laugh. Without that ability it is very unlikely that the magician will be able to connect with your guests. Two of the other most important things are to ask for a resume' and references from past clients, along with their contact information. While you are looking the information over be sure to see if they have ever performed at an event/venue that is similar to yours. Contact at least a couple of their references by phone and speak with them directly. Ask for references from past clients, whose events were similar to yours if none were provided.
Only Consider Pro Magicians For Hire In Elmont, NY
One last thing you will want to find out before you hire a magician in Elmont, NY is, if they perform professionally for a living. Or, just for extra money or only as a hobby. Though, not always, it is much more likely that a working professional will have much more refined showmanship, choreography and experience in performing for people from all walks of life in many different performance settings than a hobbyist. You owe it to yourself, your guests and to the success of your special event to consider only working, professional magicians for hire in Elmont, NY!
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text: Hospital inpatient drug treatment is done in a hospital or similar setting and is supervised by doctors and other medical staff. Hospital inpatient treatment is often necessary in the beginning stages of abstinence when the person may encounter the onset of medically dangerous withdrawal symptoms, which is sometimes true when quitting alcohol as well as a category of prescription drugs known as benzodiazepines which should be monitored very carefully by medical professionals to minimize ant dangerous health complications. Hospital inpatient treatment is also administered to individuals who choose to undergo medication assisted withdrawal, as is the case with opiate addicted individuals who wish to use this type of detoxification technique to avoid the harsh withdrawal symptoms associated with heroin or other opiate withdrawal. This type of opiate detox is not treatment in itself however, and these people will require further counseling and therapy to fully recover from addiction.

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This adorable tee is so soft and light that you'll want to wear it again and again. It's classic and stylish at the same time. Comes pre-shrunk to ensure a constant size over time and multiple washes.
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Quick Overview
Raceway external bend, 15*10mm, Rectangular
General Information
Name: CW1510-C
Category: Accessories, Others, Trending
Name: CW1510-C
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1 - The Smart Way to Shop for Security Cameras
Many consumers are more confused at the end of shopping for a security solution than when they started. (video)
2 - Choosing the Right Technology
There are so many different technologies on the market: solar, battery, wireless, wired as well as Consumer Grade and Professional Grade versions of these products. How do you know which is right for you? (video)
3 - Industry Warranty's Indicate Quality
A security camera's warranty is a good indication of its quality and how long you should expect it to last. Industry warranties range from 1 to 10 years. Know the warranty before you buy! (video)
4 - The Pro's Golden Rules
There are golden rules that should be considered when designing or purchasing any security camera system. We explain each rule so you "Get It Right the First Time"! (video)
5 - Understanding Resolution & Frame Rates
Let's cut through the confusion and keep things simple when it comes to video clarity and resolution. Which resolution is right for your application? (video)
6 - Camera System Components
It's important to learn the basic parts that are used in all video security camera systems: camera components, cable, recorders, monitors and internet connection. This video covers it all. (video)
7 - Best Camera Locations & Heights
Learn recommended camera fields of view, installation locations and heights for best coverage. Your design should be flexible while following these best practices.
8 - Selecting the Right Camera & Mount
One size does NOT fit all! Learn how to select the right camera for each location. Optical Zoom vs Digital Zoom, how to capture license plates, color night vision & more. Follow the Pro's tips and get it right the first time. (video)
9 - Video Recorders & Best Locations
How to select the right security NVR (network video recorder) for your application. Click through to learn the best locations for video surveillance recorders.
10 - Video Storage, Hard Drives & Cloud
Use our storage calculator to easily calculate what size hard drive need. Learn how to expand storage, protect against theft and what cloud options we offer. (video)
11 - PoE Units & How to Use Them
PoE units make installation more cost-effective and provide flexible system design options. Learn what they are and how to use them.
12 - Wire & Cable - Alternative Transmission Options
Learn how to wire a system, plan cable runs and design efficiently. If the camera installation is difficult, our wireless transmission options will solve the problem. (video)
13 - Business System Design
Learn how to design an effective business security camera system. Effectively secure your assets and employees while managing your business operations from anywhere. (video)
14 - Home System Design
Learn how to design an effective home security camera system to secure your home, assets, and family. Monitor your home remotely from anywhere. (video)
15 - Interior Camera Placement
Learn how to effectively locate security cameras inside of your home or business for the best coverage while maintaining privacy.
16 - DIY Installation or Pro Install - You Choose!
Most of our customers install the system themselves with our expert factory support, but you may want that clean professional installation completed by a pro. We support both options nationwide and you choose which you prefer. (video)
17 - Live & Remote Viewing with Alerts
You choose how you interface with our state-of-the-art-systems. All options are available and any combination of viewing options can be used: direct connect monitors, personal computers, tablets, and smartphones - Super fast, clear, and no monthly fees.
18 - Capturing License Plates
One of the most common requests our customers have is the ability to identify and capture license plates. This can be achieved if you follow the rules and recommendations we detail. It is important that you follow them, simply because capturing a license plate is one of the most challenging tasks for security cameras.
19 - Customizing Kits - Sending Quotes - Financing
Learn how to customize any of our kits to meet your exact needs, then send a line-item PDF quote to any email you choose. Use our instant financing option during checkout to fit the budget. (video)
20 - ProVue vs. Cyber Secure - Feature Comparison
We offer two high performance series. Both are cutting-edge 4K solutions. Which series is right for you?
21 - Become Certified Design Consultant
Help secure your community and earn a great income on your schedule. Backstreet University offers a professional consultant training course.Design Tools & Resources
Expert System Design Service
Let one of our experts design your system. Its the sure way to get it right the first time at the lowest price. Book a 30-minute design appointment using our online calendar. You'll be glad you did!
Do-it-yourself System Designer
Design your home or business security system like a Pro. Locate cameras and their viewing areas to provide a visual of the effective coverage of each camera and evaluate the overall design. This surveillance system design tool covers it all.
Custom Kit Builder
Build a complete custom system for your home or business without any confusion or mistakes. This easy to use tool makes sure you select all the components you need for a complete system. You can even include installation!
Hard Drive Calculator
Use our video storage calculator to determine the size of the hard drive you need based on the number of cameras and the desired storage days.
Security Industry Terms
Not sure what Cat6 is? Would you like to know the difference between a DVR and an NVR? Here are simple and clear explanations of the industry terms.How to Troubleshoot Security Cameras & Systems
CCTV Security systems consist of several electronic parts. The system requires all of them to be operating flawlessly for reliable operation. When one item fails it can be difficult to find the issues because each part relies on the other for system-wide operation. Follow these simple step-by-step instructions and you'll quickly identify the part causing the problem.
Industry News & Events
Banned Security Brands
US government banned the use of Dahua, Lorex, Hikvision and other security cameras in federal facilities due to hidden backdoors. In June 2021, the FCC unanimously voted to start procedures to ban the sale of these brands to the general public by denying new products FCC approval.


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It's the day you've been waiting for. You paid off your car. Congratulations!
Now what?
As you enjoy the extra cash in your bank account, it may be a good time to take a look at another expense that impacts your budget: your auto insurance.
Now that you own your car, it's reasonable to ask:
- Which coverages are optional when you own your car?
- Which coverages do you need to keep?
- Are there any adjustments you could make to save you money in the long run?
Once your car is paid off, you do have the option to remove some optional coverages – and that could lower your premium. However, it might still be good idea to keep them for financial protection after an accident. Remember, if you don't have insurance, you can be stuck paying repair costs out of pocket.
Good news: When you're with ERIE, you don't have to go it alone. Your car insurance policy comes with your very own local insurance agent who can answer your questions, run the numbers and help you decide what's best for your unique financial situation.
Here's a guide to reassessing your coverage once you pay off your car.
How much car insurance is required in your state?
Before you start cutting any type of coverage from your policy, find out about your state's requirements for auto insurance. Your local ERIE agent can explain how things work where you live.
While you might be legally required to have coverages like personal injury protection or uninsured or underinsured motorist coverage in some states, they could be optional in others.
For a state-by-state list, check out this guide to state insurance requirements from the Insurance Information Institute.
Do you need collision coverage when you pay off your car?
Collision coverage helps you cover the costs of repairing or replacing your vehicle ‒ minus the deductible ‒ after it is damaged in an auto accident. It's often required by lenders, but once you own the vehicle, it may be optional.
But the question about whether or not to drop collision coverage isn't always an easy one to answer. Because even though your vehicle is paid off, it really comes down to your car and your circumstances. Here are a few questions you should ask yourself.
- How much money do you have on hand? If you had an accident tomorrow, could you come up with the funds to repair or replace your car? Consider this: More than 6% of people who have collision coverage file a claim, and the average claim amounts to $3,435, according to a study by the National Association of Insurance Commissioners. Can you afford to pay nearly $3,500 out of pocket?
- How much is your car worth? Some will tell you to rely on the age of the car. But it wasn't that long ago when most people thought about replacing cars when they reached the 10-year mark and racked up more than 100,000 miles. These days, many makes and models can outlast those old benchmarks. That means your 10-year-old car may have retained significant residual value.
- How much does full coverage cost? Take the cost of your annual premium and weigh that against your deductible and your car's value. At a certain point, you and your agent may find there's not much financial benefit to paying the additional costs, and then, it may be time to consider removing collision coverage from your policy.
When you're with ERIE, your local agent can help you talk through these questions and determine if dropping collision coverage makes sense for you.
Do you need comprehensive coverage when you pay off your car?
Another coverage that's optional after you pay off your vehicle loan is comprehensive coverage.
It helps you pay for vehicle damage that's not caused by an auto accident. This includes things like:
- Fire and explosions
- Vandalism, including when someone keys or tags your car
- Theft-related damage, such as damage caused by someone breaking into your vehicle
- Storms, such as wind, hail, tornadoes, floods, earthquakes and hurricanes
- Falling objects like a tree limb falling on your parked car, or if someone's hauling materials and something falls and lands on your car
- Windshield cracks and chips
- Animal-related damage, such as damage caused by hitting a deer that jumps out in front of you on the highway
As your car gets older, the overall replacement cost can be a factor in whether you want to continue with comprehensive coverage.
Quick tip: Here's one measure offered by the Insurance Information Institute: Multiply your premium for comprehensive insurance by 10. If the value of the car is worth less than that total, it could be time to drop comprehensive coverage. Your local agent can help you run the numbers and make a judgement call.
Say 'Goodbye' To Gap Insurance
When you're paying on a car loan or a lease, your car may be valued for less than what you owe. So, if your car is totaled in an accident, gap insurance helps you pay off your loan or lease, minus the deductible.
Now that your vehicle is paid off, this coverage isn't necessary anymore.
Let your insurance agent know you paid off your car
With your vehicle paid off in full, it's time for your insurance agent to remove your auto lender's name from your insurance policy. This is an important step to take, especially if you're ever in an accident.
When it comes time for your insurance company to pay a claim, they're obligated to issue a check to the name listed on the policy. When the information isn't correct and your auto lender's name is still on the policy, there's typically a delay because they'll need to stop the check or get it back before issuing another one.
So make that phone call today to avoid any hiccups down the road.
Find The Right Balance
At ERIE, we know that life is all about balance. It's finding that sweet spot between your budget and getting the protection you need.
When it comes to the type of auto insurance you should have, rest easy that you don't have to figure it out on your own. Contact your local ERIE agent today. They can help you run the numbers and determine what's best for your unique financial situation.
A better insurance experience starts with ERIE.
Haven't heard of us? Erie Insurance started with humble beginnings in 1925 with a mission to emphasize customer service above all else. Though we've grown to reach the Fortune 500 list, we still haven't lost the human touch.
Contact Reiswitz Insurance Agency today to experience the ERIE difference for yourself.


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Corrugated iron is relatively light, portable and adaptable, which made it ideal for some traditional construction.
The Corrugated Iron 12ft was most frequently used for roofing and walling, and also for prefabricated buildings, especially in rural areas. All metals corrode. So the main aim with a corrugated iron roof is to slow down how quickly this happens.
Standard Parcel Delivery ChargeWe can offer free delivery for orders over €120 (excluding Bulky items)Orders under €120 can take 2/3 working days and a charge of €9.99
Bulk Delivery ChargesWe have 3 delivery charges for large or heavy products that require special handling by our couriers. These are for heavy products with larger dimensions (e.g. garden furniture) or orders that are over 20kg in weight (coals, salt). A bulk delivery charge details will appear in your basket when checking out. Bulky deliveries will take 3-5 working days.
Important: We have a Local Bulk Delivery Charge and a "Rest of Ireland/Standard" bulk delivery charge. Please select the correct delivery charge for your location. If you chose a local delivery charge but your eircode isn't a local eircode, you will be prevented from ordering. We reserve the right to contact a customer for an additional payment if the incorrect delivery charge is chosen at Checkout.
Some extra large/heavy products are marked as local products for local delivery in Meath and Dublin only.
If for any reason you choose to return an item, you can do so at either of our stores (Sandymount, Dublin 4 or Ashbourne, Co. Meath). All returned items must be returned in its original condition, within 60 days of purchase and with a valid receipt or order confirmation.
Returns can also be sent by to Topline Murtaghs, Main Street, Ashbourne, Co. Meath A84 DA06.
Please contact us at firstname.lastname@example.com for returns.
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0706-24 99 95
0706-24 99 95
The ability to manage money competently is especially valuable quality in the conditions of financial crisis, when the purchasing power of the population is shrinking, inflation is rising, and currency exchange rates are completely unpredictable. Below are the common mistakes related to money affairs along with financial planning advice to help manage your own finances properly.
The budget is the most basic thing in financial planning. It is therefore especially important to be careful when compiling the budget. To start you have to draw up your own budget for the next month and only after it you may make a yearly budget.
As the basis takes your monthly income, subtract from it such regular expenses as the cost of housing, transportation, and then select 20-30% on savings or mortgage loan payment.
The rest can be spent on living: restaurants, entertainment, etc. If you are afraid of spending too much, limit yourself in weekly expenses by having a certain amount of ready cash.
"When people borrow, they think that they should return it as soon as possible," said Sofia Bera, a certified financial planner and founder of Gen Y Planning company. And at its repayment spend all that earn. But it's not quite rationally ".
If you don't have money on a rainy day, in case of an emergency (e.g. emergency of car repairs) you have to pay by credit card or get into new debts. Keep on account of at least $1000 in case of unexpected expenses. And gradually increase the "airbag" to an amount equal to your income for up to three-six months.
"Usually when people plan to invest, they only think about profit and they don't think that loss's possible", says Harold Evensky, the President of the financial management company Evensky& Katz. He said that sometimes people do not do basic mathematical calculations.
For example, forgetting that if in one year they lost 50%, and the following year they received 50% of the profits, they did not return to the starting point, and lost 25% savings. Therefore, think about the consequences. Get ready to any options. And of course, it would be wiser to invest in several different investment objects.


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Regular price CHF 7.08 Save Liquid error (snippets/product-template line 120): Computation results in '-Infinity'%All measurements are approximate.
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Vol.1 No.1: Rise Up, Japan (The Premiere Issue)
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The Global Imperative for Japan-focused HR Professionals
Overcoming Nature's Wrath: Crisis Management for HR
Vol.1 No.3: Leaders and Leadership
Thankful The State of the JHRS Community Report 2012
Turning Strategies into Action through 3Cs
Leadership Global Conference 2011
Action Dialogue on Japan's New Global Spirit
Vol.1 No.4: High Performance Organizations
Reliving The Kizuna絆 Spirit A Challenge for Japan HR Professionals?
JHRS Panel Discussion on Leaders and Leadership
Vol.2 No.1: Employment Laws in Japan
Advancing the HR Agenda in Japan and A Time for Celebration
Launching of the JHRS Green HR Initiative
Vol.2 No. 2: Diversity & Inclusion
HR Certification A Step Forward for the HR Profession in Japan
Bringing HR Certification to Japan
Congratulations! Japan's First HR Management Professionals and HR Business Professionals
SSON Summit Addresses Outsourcing and Offshoring Challenges
Women in HR Advocating for the Broader Community
Vol.2 No. 3: HR Business Partnering
Onward and Upward! The State of the JHRS Community Report 2013
Kuala Lumpur calls HR Business Leaders Global HR Excellence Conference
Walking the Talk The HR Agenda goes Hybrid!
Gender Diversity in the Boardroom It Matters and it can be Increased
Vol.2 No. 4: Governance & Ethics
Committing to a Code A Code of Ethics and Professional Conduct can Raise the Bar for HR
Green HR in 4D Four Dimensions and Six Personal Questions
JHRS' New Year ShinNenKai 新年会 and Panel Discussion on HR Business Partnering
Vol.3 No. 1: Selection & Staffing
Advancing HR Journalism in Japan The HR Agenda Moves Forward
The 5th GOLD Symposium Driving Innovation Through Inclusion
Vol. 3 No. 2: Talent Mobility
"Taking the Next Step" at WIN Conference
Vol. 3 No. 3: HR 2.0
Be Relevant. Be HR. The State of the JHRS Community Report 2014
Women's Leadership in 2014 Our Wish Lists
Taking Advantage of Outsourcing & Shared Services
Vol. 3 No. 4: Reward & Remuneration
Surviving Globalization in Japanese HR
JHRS Academy Accredited by SHRM
Expanding Possibilities A Women's Leadership Event The 4th Japan WINConference, 17, 18 & 19 April 20
Vol. 4 No. 1: Organizational Learning & Development
From Life Employment to Lifetime Employability How L&D Can Help You Make That Change
Women Connect at Japan's Spring 2014 WINConference
Vol. 4 No. 2: Workplace Wellness
Editor's Note 4-2
Mail Bag 4-2
Re-Working Work Achieving Work-Life Balance Through Workplace Wellness
Transformative Messages Take Center Stage at SHRM 2014
What Global HR Means for Japan
Vol. 4 No. 3: Global HR Leadership
Editor's Note 4-3
The State of the JHRS Community Report 2015
Viewing Diversity Through Different Lenses
Mail Bag 4-3
Vol. 4 No. 4: Employee Coaching & Mentoring
Editor's Note 4-4
Coaching And Coaches In Good Times and Bad Times
ANOTHER FIRST: SHRM's Strategic HR Workshop Held in Japan
Vol. 5 No. 1:Sucession Planning
Editor's Note 5-1
The HR Agenda Marks Anniversary, Moves Forward With Changes
Realizing Change
Nomadic Thinking in Tokyo: Mapping Territories, Breaking Taboos in Leadership
Vol. 5 No. 2:Workplace Discrimination, Harassment and Violence
Editor's Note 5-2
SHRM Conference Touts Teamwork, Leadership
SHIFTING GEARS: When Change is the Name of the Game
Vol. 5 No. 3: The Performance Management Reboot
Editor's Note 5-3
PERFORMANCE APPRAISALS Awakening the Force of Reason
Vol. 6 No. 1: The Engagement Triumvirate
Editor's Note 6-1
ALL FOR HR, HR FOR ALL The HR Agenda Triumvirate
Performance Reviews: Out with the Old, In with the New
Passion, Purpose, Possibilities Reflections on Magic and More with WIN's Kristin Engvig
Vol. 6 No. 2: The Great Leap Forward Via People Analytics
Editor's Note 6-2
HR METRICS AND ANALYTICS When facts and numbers matter…even in HR
Analytics a Focus at Asia's Biggest C&B Conference
Vol. 6 No. 3: RoboHR: The Future of HR Now
Editor's Note 6-3
Diversity-Driven Innovation: 2016 Women's Leadership Counts Conference
RoboHR: The Future of HR… Now Embracing the HRTech Imperative
Vol. 7 No. 1: Changing the way we change
The point is to change it.
Ten Years and Counting... JHRS 10th Year Anniversary
Vol. 7 No. 2: How the World Thinks: Cultural Intelligence for Global Orgaizations
Younger Boss, Older Subordinate
Cultural Mindfulness: Going Beyond Cultural Stereotyping
Editor's Note 7-2
Vol. 7 No. 3: Out and About: Tapping the LGBTQ Talent Pool (Japan's Hidden Workforce)
Pride and Prejudice Tapping the LGBTQ Talent Pool
What's Love Got To Do With It?
Vol. 8 No. 1: Positive HR: Positively Reinventing HR
The workplace of today needs an intervention.
Passing the Baton A Message of Thanks and Moving Forward
To All JHRS Members and The HR Agenda Readers
Vol. 8 No. 2: Brand HR: Raising the Visibility & Value of HR
What Do Perople Say When Talk Turns to HR?
Culture Defines Branding
JHRS Free Webinars Tackle the Difficult Conversations at Work
JHRS Tapped as Partner and Panelist at Exclusive London Talent Summit
Vol. 8 No. 3: The Fundamentals of HR
First, Who? Get the Right People on the Bus
Future Talent Summit to Tackle Career Strategies for CHROs, Offers Exclusive Discount for JHRS Membe
Fine-Tuning the Fundamentals of HR: Recruitment in 2019 & Beyond
Editor's Note: Brilliance at the Basics
Vol. 9 No. 1: Developing Leadership to Create the Future
Publisher's Message--How Can HR Maximize Leadership Development for Organizational Performance?
Love, Leadership & Other Lores of HR
Future Talent Summit Tackles Career Strategies for CHROs
JHRS and The HR Agenda Join SHRM2019 as Media Partner
Vol. 9 No. 2: Building Better Workplaces
Good Workplace, Good Business
Editor's Note
Whither the Ping-pong Table? Which Perks Matter Most to Employees
Vol. 9 No. 3: Welcome to the New World of Recruitment
Recruiting for Great Results
Editor's Note
Uncovering Bias: A New Way to Study Hiring Can Help
Positive Distancing: Combining Social Distancing and Mental-Emotional Distancing
Vol. 10 No.1: New Ways of Working, Leading & Winning in Turbulent Times
Publisher's Message--Building Anew: Designing New Work Styles
Virtual Passes, Takeaways for the New Normal Usher in the Next Era of HR Learning
Positive Distancing: Combining Social Distancing and Mental-Emotional Distancing
Vol. 10 No.2: Strengthening Company Culture in Difficult Times
Readers' Feedback
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WHAT'S NEW: The JHRS Academy Blog
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Women In HR
A JHRS advocacy to:
Raise awareness
of the contribution of women HR practitioners in organizations in Japan and of their unique opportunity to champion change;
Create professional development opportunities
that support the advancement of women HR practitioners; and,
Engage in research and community activities
that foster a workplace in which women can fully express their talents and career aspirations.
Professional Excellence:
Contributing to the dissemination of best practice HRM theory and method; commitment to high ethical standards in all we do.
Adapt and Innovate:
Translating global best practice into effective HR practice in the Japan environment.
of all interested parties in community development.
Participatory Approaches
to learning and problem solving.
Commitment to Universal Goal:
Advancement of women by advocating practices that foster professional opportunity for women in the workplace in Japan.
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text:
Probalan is used in the treatment of chronic gout or gouty arthritis. These conditions are caused by too much uric acid in the blood.
Use Probalan as directed by your doctor.
Take Probalan tablets by mouth.
Swallow the tablets with a drink of water.
Take your doses at regular intervals.
If you miss a dose of Probalan, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Probalan.
Store Probalan at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Keep Probalan out of the reach of children and away from pets.
Active Ingredient: Probenecid
Probalan works by removing the extra uric acid from the body. Probalan does not cure gout, but after you have been taking it for a few months it will help prevent gout attacks. Probalan will help prevent gout attacks only as long as you continue to take it.
Probalan is also used to prevent or treat other medical problems that may occur if too much uric acid is present in the body.
Probalan is sometimes used with certain kinds of antibiotics to make them more effective in the treatment of infections.


text:
Limpley Stoke Area Telephone Numbers
From the Local BT Exchange
Choose a genuine BT Local Exchange number from Limpley Stoke
You can choose the last digits of the number or have one automatically generated for you
Where should we direct your call?
please enter the telephone number where you would like us to divert your calls
Find a Local Exchange Number
Need Help? 0345 0178 179
Calls answered in the UK 24/7
Buying a Virtual Number on the Limpley Stoke BT Exchange
- 80% of services bought in the Limpley Stoke area are within a 10 mile radius of where we live or work.
- 77% of buyers prefer to buy a local Limpley Stoke area code to where they love.
- Advertise a local Limpley Stoke BT number and connect to your Limpley Stoke customers
- BT Exchange numbers in Limpley Stoke are known and trusted locally
- No installation required
- Inclusive minutes,call features and no contract call plans available
Limpley Stoke Landline Numbers For Your Mobile
Your Limpley Stoke Mobile Landline Number diverts calls directly to your mobile, office or home.
Have you ever wished for a direct link between your mobile device and your landline? With our Limpley Stoke Mobile Landline Numbers, your communication possibilities are transformed. Whether you're on the move, in the office, or at home, these innovative numbers ensure you're always reachable.Why Choose a Limpley Stoke Mobile Landline Number
- Two-Way Calling Convenience: Make and receive calls seamlessly through your mobile or fixed line, all while showcasing your Limpley Stoke number as your unique caller ID. Stay connected without missing a beat.
- On-the-Go Accessibility: Carry the essence of your Limpley Stoke number with you wherever you are. Stay in touch effortlessly, whether you're in the heart of Limpley Stoke or beyond.
- Setting Up Made Simple: Our dedicated team handles the entire setup process, ensuring a hassle-free experience. From basic services to custom call management apps, we've got you covered. Get up and running within a remarkably swift 1 to 3 hours.
- Reliability You Can Count On: Rely on the robustness of BT or C&W tier 1 networks to ensure the uninterrupted functionality of your Limpley Stoke Number. No need to fret about the drawbacks of VoIP or subpar internet telephony services.
- Real-Time Control at Your Fingertips: Take the reins of your Limpley Stoke number and associated apps through our intuitive online control panel. Effortlessly manage call routing in real time, giving you ultimate flexibility. And if you ever need assistance, rest assured, our support is just a click away.
How to Set up Your Limpley Stoke Number
Setting up your Limpley Stoke number is an easy process and we are here to help you through the whole process for your peace of mind.
Step 1: Initiation and Setup | Step 2: Personalisation and Control | Step 3: Seamlessly Connected Communication |
Choose Your Number: Select a Limpley Stoke Mobile Landline Number. Service Selection: Opt for desired services and functionality. Network Reliability: Utilise BT or C&W tier 1 networks for stability. |
Swift Setup: Our team ensures you're operational within 1 to 3 hours. Online Control Panel: Manage call routing and settings in real time. Customisation Options: Personalise your number's functionality. |
Two-Way Calling: Make and receive calls with your Limpley Stoke number as caller ID. On-the-Go Accessibility: Stay connected wherever you are. Ongoing Support: Our team is ready to assist you. |
Benefits of Limpley Stoke Virtual London Numbers
In today's fast-paced and interconnected business world, having a Limpley Stoke virtual phone number offers numerous advantages, allowing businesses to establish a professional presence in London without the need for a physical location. Some of the key benefits of Limpley Stoke numbers include:
- Enhanced Local Presence: Limpley Stoke Virtual London Numbers provide a local touch to your communication, allowing you to establish a strong presence in the Limpley Stoke area. This local association builds credibility and trust among residents and businesses alike.
- Global Accessibility: Despite its local focus, a Limpley Stoke virtual number can be accessed from anywhere in the world. This means you can cater to a broader audience, expanding your reach beyond geographical boundaries.
- Cost-Efficiency: Acquiring a virtual number eliminates the need for a physical landline, reducing infrastructure costs. You can effectively manage calls and communications without investing in additional phone lines.
- Flexibility and Mobility: Limpley Stoke Virtual London Numbers enable you to stay connected on the go. Calls made to your virtual number can be redirected to your mobile or fixed line, ensuring you never miss an important communication, whether you're in Limpley Stoke or beyond.
- Call Management Features: Virtual numbers often come with advanced call management features, such as call forwarding, voicemail, and real-time routing adjustments. These tools empower you to customise your communication strategy, ensuring calls are directed and managed efficiently.
Incorporating Limpley Stoke Virtual London Numbers into your communication strategy brings a host of advantages, from strengthening your local presence to embracing a dynamic and cost-effective approach to communication.
Will I be tied in to a long contract?
Our standard 30 day term means there is no nasty tie in or long term commitment - click on an Limpley Stoke exchange number and check out our great value call plans for more information.
Receiving Incoming Calls
Incoming Calls - The Facts About Limpley Stoke BT Exchange Numbers
- No Credit Checks, No Contracts – just simple, rolling monthly agreements made with Smart Numbers Ltd not with BT
- Divert to mobile, landline and international phones – we only Tier 1 telecom networks for guaranteed quality.
- Phone Numbers are initially built by us rather than leaving you to try and do it! We are also happy to carry out any call management requests for free too.
- We provide you with a dedicated web portal for free, if requested, where you can control the routing and management of your numbers and APPs, many of which are included free of charge in our call plans along with free incoming calls.
- Bespoke Agreed Rates can be negotiated and you can choose your own number on the exchange. Call 0345 0178 179 to discuss your needs.
- Live Call Answering now available on all discounted call plans – a real live person answering your calls, supporting your business from as little as 69pence per call
- An easy to use & revealing call stats package comes free with every Smart Number. Make the most of free features in the call plans by contacting one of our team.
- Per second billing. Every call itemised to 100th of a penny accuracy.
Reasons to Buy a Limpley Stoke Landline Numbers
- 80% of the things we buy in Limpley Stoke are within a 10 mile radius of where we live or work. Advertising yourself with a number from the Limpley Stoke BT Exchange connects you with your local customers.
- 77% of people in Limpley Stoke prefer to call a local area code number close to where they live than any other type of number. By presenting a Limpley Stoke local area number on your website, business cards, letterheads and advertising material, you could appear more familiar to your local target market and get more calls.
- Mobile Landline Numbers (link to mobile landline page) are available for every Town, City & County across the UK – not just Limpley Stoke. We can help you identify the relevant numbers and call management features required for your advertising and business needs.
- Virtual numbers, meaning no extra phones, lines or equipment needed – deliver calls to your mobile or landline regardless of your network.
- Buy a Limpley Stoke BT Exchange Number and future proof your business - you can move them to different destinations as often as you like and even install them into your premise anywhere in the world.
- If you have an existing BT Landline in Limpley Stoke - or on any other exchange – we can port the number in and manage it for you.
- Port Numbers away from us, should you wish to leave us yet retain the number.
Making Outgoing Calls
Making Calls - Displaying Your Mobile Landline as the Caller ID
Our latest product development allows you to make calls from your Mobile Landline Number as well as receive them.
- You selectively dial out from your mobile landline number, we overwrite or "Mask" your phone's actual caller id with that of your Smart Number.
- The calls you make to mobile or UK landlines are included free with in our discounted call plans.
- We don't ask you to change your mobile phone or network provider, you still keep your mobile number and we don't want you to change your SIM either - Both your personal 07 mobile number and your Mobile Landline from Smart Numbers work seamlessly together.
- It's simple and easy to use, no additional technology required – simply press a key to activate the product before a call.
- Create contacts or speed dials on your existing handsets for calls you want to make regularly.
Why Make Calls Using The Mobile Landline Number?
Following a survey of 2000 UK consumers, assessing how they would respond to calls from certain number types, the following information was found:
- 71% were unlikely or would not answer a call from a withheld or unfamiliar number.
- 75% said they would or were more likely to answer a call from a local geographic number.
By overwriting or "Masking" your mobile or home number with your "Business" Number as your caller ID, you are more likely to get answered, it is a more trusted number and hopefully familiar to those new or prospective clients that you are returning missed calls and messages from.
When calling someone's mobile, it is likely they will save your "Calling From" number to their contacts. If you are setting up a Smart Number for your incoming calls, taking advantage of our incoming call management products, presenting your Mobile Landline will keep calls coming in to your main/managed business numbers rather than on a private mobile, which could be turned off, out of signal or just not a convenient time to talk.
FAQs For Limpley Stoke Landline Numbers
We have put together some of our most communally asked questioned from over the last 20 years. The follow questions are mainly around our Virtual Landline and Smart VoIP solutions, If you can't find the answer you want, lets talk.
What is a Limpley Stoke Virtual Number?
A Limpley Stoke Virtual Number is a phone number with the Limpley Stoke area code and prefix that is not tied to a physical landline.
It operates through a virtual system, allowing calls to be forwarded to your mobile or fixed line, providing seamless communication.
How can a Limpley Stoke Virtual Number benefit my business?
A Limpley Stoke Virtual Number can enhance your business's local presence, enabling you to connect with Limpley Stoke residents and businesses more effectively.
It also offers global accessibility, cost-efficiency, and advanced call management features, contributing to improved communication and customer engagement.
Can I use my Limpley Stoke Virtual Number outside of Limpley Stoke?
Yes, absolutely! While Limpley Stoke Virtual Numbers have a local association with Limpley Stoke, they can be accessed from anywhere in the world.
This means you can stay connected and reachable no matter where you are, making it a versatile communication solution.
How do I set up a Limpley Stoke Virtual Number?
Setting up a Limpley Stoke Virtual Number is straightforward. You can choose a number, select desired services, and our team will handle the setup process.
Within 1 to 3 hours, you'll be ready to make and receive calls. You can also manage your number and call routing through an online control panel.
What happens if I need assistance with my Limpley Stoke Virtual Number?
We're here to help! If you have any questions or need support with your Limpley Stoke Virtual Number, our dedicated team is just a click or call away.
We provide ongoing assistance, ensuring your communication remains seamless and hassle-free.


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Best Internet Providers in Normandy Park, Washington for 2024
Compare the Best Internet Service Providers in Normandy Park, WA
Not all plans are available in all areas. Provider plan, availability, and speed tier data provided by BroadbandNow.com. Speedtest real-world data is only present where sample size has reached significance within a region. Additionally, averages may include aggregated tests across multiple Internet Types (Fiber, DSL, Cable, etc.).
At Speedtest we pride ourselves on providing accurate and trustworthy data that forms the backbone of our ISP recommendations. Our real-world data is collected from millions of people worldwide who choose to take a Speedtest. This means our insights into ISP performance are reliable and current, allowing us to offer a clear, unbiased picture of ISP performance.
Three metrics will help you gauge the performance of an ISP: download speed, upload speed, and latency. Download speed is critical for tasks like streaming and downloading content, determining how swiftly data is transferred to your device. Upload speed is key for uploading content and engaging in online interactions, reflecting how quickly data is sent from your device to the internet. Latency, or ping, is essential in online gaming and video conferencing, influencing the responsiveness of your connection. With this comprehensive understanding of an ISP's capabilities you have the data you need to make an informed choice based on your specific internet usage.
ISP technology plays an important role in determining the quality of your internet experience. Technologies like fiber optics typically offer the fastest speeds, making them ideal for high-demand online activities. Cable internet, a more widely available option, usually provides good download speeds but upload speeds may lag. DSL (digital subscriber line) offers moderate speeds sufficient for basic browsing and streaming. In contrast, satellite internet, often the only choice in remote locations, tends to have higher latency and slower speeds.
How Much Speed Do I Need?
Download speeds of at least 100 Mbps and upload speeds of at least 10 Mbps are widely considered fast enough to handle nearly any online activity. A quick guide to what speeds you need for different online activities is below, and you can read our full guide to internet speeds and performance for more information. Keep in mind that the numbers below are the bare minimum for one device at a time. If you're trying to use multiple devices on a network at the same time, you'll want higher speeds.
0–5 Mbps (Slow)
- Stream SD video
- Connect on Slack
- Use Microsoft Teams
- Write and read email
- Scroll social media
- General web browsing
5–20 Mbps (Better)
- Stream HD video at 1080p
20–40 Mbps (Solid)
- Stream 4K video
- Play games online
40–100 Mbps (Good)
- Stream HD games
100+ Mbps (Fast)
- Engage in multi-player gaming
- Download huge files
1+ Gbps (Very fast)
- Do anything you want on multiple devices
Normandy Park Fixed Speeds
Download Mbps
Median download speed
Upload Mbps
Median upload speed
Latency ms
Median latency
To be added to this list for mobile or fixed broadband, 75% of a city's monthly unique user totals over a 13-month period must have a minimum of 200 monthly unique user results. To be updated for mobile or fixed broadband, 75% of a city's monthly unique user totals over a 13-month period must have a minimum of 100 monthly unique user results.
An operator or ISP must account for 3% or more of total test samples in the market to be on this list. We display data if at least two operators or ISPs meet this threshold in a designated region or city.
Internet Providers in Nearby Cities
- Aberdeen
- Alderwood Manor
- Anacortes
- Arlington
- Artondale
- Auburn
- Bainbridge Island
- Barberton
- Battle Ground
- Bellevue
- Bellingham
- Bonney Lake
- Bothell
- Bremerton
- Bryn Mawr-Skyway
- Burien
- Camano Island
- Camas
- Cascade-Fairwood
- Cheney
- Cottage Lake
- Covington
- Des Moines
- East Wenatchee
- Edmonds
- Elk Plain
- Ellensburg
- Everett
- Federal Way
- Felida
- Ferndale
- Five Corners
- Frederickson
- Gig Harbor
- Hazel Dell
- Issaquah
- Joint Base Lewis-McChord
- Kenmore
- Kennewick
- Kent
- Kirkland
- Lacey
- Lake Forest Park
- Lake Morton-Berrydale
- Lake Stevens
- Lakeland North
- Lakeland South
- Lakewood
- Longview
- Lynnwood
- Maple Valley
- Martha Lake
- Marysville
- Mercer Island
- Mill Creek
- Mill Plain
- Moses Lake
- Mount Vernon
- Mount Vista
- Mountlake Terrace
- Mukilteo
- Normandy Park
- North Creek
- North Marysville
- Oak Harbor
- Ocean Shores
- Olympia
- Orchards
- Paine Field-Lake Stickney
- Parkland
- Pasco
- Picnic Point-North Lynnwood
- Port Angeles
- Port Orchard
- Poulsbo
- Pullman
- Puyallup
- Redmond
- Renton
- Richland
- Salmon Creek
- Sammamish
- SeaTac
- Seattle
- Sequim
- Shoreline
- Silverdale
- Snohomish
- Snoqualmie
- South Hill
- Spanaway
- Spokane
- Spokane Valley
- Tacoma
- Tukwila
- Tumwater
- Union Hill-Novelty Hill
- University Place
- Vancouver
- Vashon
- Walla Walla
- Walnut Grove
- Wenatchee
- West Richland
- White Center
- Woodinville
- Yakima
How we test the speed of ISPs
Speedtest is the definitive way to test the performance and quality of an internet connection. Millions of users like you use Speedtest.net and our Android and iOS apps every day to test internet performance (including bandwidth, latency, coverage, video metrics, and more) in real world situations. We then use rigorous scientific approaches to aggregate and anonymize those results to empower people like you with content like this so you can understand and optimize your internet experience.
The data found within has not been subjected to the rigorous Speedtest marketing claims and data methodology, and therefore cannot be used in commercial applications. Additionally, promised speeds and plans offered are always subject to change.
How to test your internet speed
Speedtest can help you test the speed and overall performance of your internet for free from any device. Click here to open a new page and take a Speedtest. You can then compare your results with what you've learned about internet performance near you. If you aren't getting the results you expect, you can either use this guide to use your Speedtest results to talk to your internet provider or you can shop for a new provider.


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This feature is sometimes referred to as a 'Browser Buddy'.
At the top it tells you how many posts have been made since you last visited the board.. Also underneath this the number of posts with replies that have been made in topics that the individual has also posted in.
Click on the 'View' link on either of the two sentences to see the posts.
The next section is five links to useful features:
The link to the moderating team is basically a quick link to see all those that either administrate or moderate certain forums on the message board.
The link to 'Today's Active Topics' shows you all the topics that have been created in the last 24 hours on the board.
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What is a bone marrow transplant?
Bone marrow transplantation (BMT) is a special therapy for patients with certain cancers or other diseases. A bone marrow transplant involves taking cells that are normally found in the bone marrow (stem cells), filtering those cells, and giving them back either to the patient they were taken from or to another person. The goal of BMT is to transfuse healthy bone marrow cells into a person after his or her own unhealthy bone marrow has been eliminated.
What is bone marrow?
The bone marrow is a soft, spongy tissue found inside the bones. The bone marrow in the hips, breast bone, spine, ribs, and skull contains cells that produce the body's blood cells. The bone marrow is responsible for the development and storage of most of the body's blood cells. The three main types of blood cells produced in the bone marrow include:
- Red blood cells (erythrocytes). These cells carry oxygen to the tissues in the body.
- White blood cells (leukocytes). These cells help fight infections and aid in the immune system.
- Platelets. These help with blood clotting.
Each of these cells carries a life-maintaining function. The bone marrow is a vital part of the human body.
What are stem cells?
Every type of blood cell in the bone marrow begins as a stem cell. Stem cells are immature cells that are able to produce other blood cells that mature and function as needed. Stem cells also may mature into lymphocytes, the source of a person's immune system.
Stem cells are the most important cells needed in a bone marrow transplant. Stem cells, when transplanted, find their way to the recipient's marrow and lymphoid tissue and begin to differentiate (mature) and produce all types of blood cells that are needed by the body.
Why is a bone marrow transplant needed?
The goal of a bone marrow transplant is to cure many diseases and certain types of cancer. When a child's bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer, a bone marrow transplant may be needed.
A bone marrow transplant can be used to:
- Replace diseased, nonfunctioning bone marrow with healthy functioning bone marrow (for conditions such as leukemia, aplastic anemia, and sickle cell anemia)
- Replace the bone marrow and restore its normal function after high doses of chemotherapy or radiation are given to treat cancer. This process is often called rescue (for diseases such as lymphoma and neuroblastoma)
- Replace bone marrow with genetically healthy functioning bone marrow to prevent further damage from a genetic disease process (such as Hurler's syndrome and adrenoleukodystrophy disorder)
Bone marrow transplant has risks involved, some of which are life-threatening. The risks and benefits must be weighed in a thorough discussion with the bone marrow transplant team prior to the procedure.
Each child experiences diseases differently and a bone marrow transplant may not be appropriate for everyone who suffers from these diseases. Some of the diseases that have been treated with bone marrow transplant include the following:
- Leukemia
- Lymphomas
- Some solid tumors (for example, neuroblastoma, rhabdomyosarcoma, brain tumors)
- Aplastic anemia
- Immune deficiencies (severe combined immunodeficiency disorder, Wiskott-Aldrich syndrome)
- Sickle cell disease
- Thalassemia
- Diamond Blackfan anemia
- Metabolic/storage diseases (for example, Hurler's syndrome, adrenoleukodystrophy disorder)
- Cancer of the kidneys
What are the different types of stem cell transplants?
There are different types of stem cell transplants depending on the source of stem cells. The different types of transplant include the following:
- Autologous bone marrow transplant. The donor is the child himself or herself. Stem cells are taken from the child either by bone marrow harvest or apheresis (a process of collecting peripheral blood stem cells) and then given back to the child after intensive treatment. Sometimes the term rescue is used instead of transplant.
- Allogeneic bone marrow transplant. The donor shares the same (or similar) genetic type as the child. Stem cells are taken either by bone marrow harvest or apheresis from a genetically-matched donor, often a brother or sister. Other donors for allogeneic bone marrow transplants may include:
- A parent. A haploid-identical match is when the donor is a parent and the genetic match is at least half identical to the recipient. Unfortunately, parents may not be a good enough match to be donors in many cases.
- Unrelated bone marrow transplants (or MUD for matched unrelated donor). The genetically matched marrow or stem cells are from an unrelated donor. Unrelated donors are found through the national bone marrow registries.
- Umbilical cord blood transplant. Stem cells are taken from an umbilical cord immediately after delivery of an infant. These stem cells reproduce into mature, functioning blood cells quicker and more effectively than do stem cells taken from the bone marrow of another child or adult. The stem cells are tested, typed, counted, and frozen until they are needed for a transplant.
- Because the stem cells are "new," they are able to produce more blood cells from each stem cell. Another advantage cord blood has is that the T-lymphocytes (part of the immune system that causes a transplant-related problem called graft-versus-host disease) are not completely functional at birth. Recipients of cord blood transplants have a decreased risk for severe graft versus host disease.
The bone marrow transplant team
The group of specialists involved in the care of children who are undergoing a transplant procedure is often referred to as the transplant team. Each individual works together to provide the best chance for a successful transplant. The bone marrow transplant team consists of:
- Doctors. Doctors who specialize in oncology, hematology, immunology, and bone marrow transplantation and advanced care practitioners who support the doctors.
- Transplant coordinator. A professional who organizes all aspects of care provided to your child before and after the transplant. The coordinator will provide patient education and coordinate the diagnostic testing and follow-up care.
- Social workers. Professionals who will provide support to your family and help your family deal with many issues that may arise, including lodging and transportation, finances, and legal issues. They can also help coordinate alternative means for school, so that your child does not get behind.
- Dietitians. Professionals who will help your child meet his or her nutritional needs before and after the transplant. They will work closely with you and your family.
- Clinical pharmacists. Pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention.
- Physical therapists. Professionals who will help your child become strong and independent with movement and endurance after the transplantation
- Pastoral care. Chaplains who provide spiritual care and support
- Other team members. Several other team members will evaluate your child before transplantation and will provide follow-up care, as needed. These include, but are not limited to, the following:
- Physical therapists
- Respiratory therapists
- Lab technicians
- Infectious disease specialists
- Dermatologists
- Gastroenterologists
- Psychologists
- Child life specialists
An extensive evaluation is completed by the bone marrow transplant team. The decision for your child to undergo a bone marrow transplant will be based on many factors including:
- Your child's age, overall health, and medical history
- Extent of the disease
- Availability of a donor
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Expectations for the course of the transplant
- Your opinion or preference
Preparation for the recipient
For the child receiving the transplant, the following will occur in advance of the procedure:
- Prior to the transplant, an extensive evaluation is completed by the bone marrow transplant team. All other treatment options are discussed and evaluated for risk versus benefit.
- A complete medical history and physical examination are performed, including multiple tests to evaluate the child's blood and organ functions (for example, heart, kidney, liver, and lungs).
- A child will come into the transplant center in advance of the transplant for evaluation and other preparations. A peripherally inserted central catheter, also called PIC line, is surgically placed in a peripheral vein and threaded to a central location. Blood products and medications will be administered through the PIC line.
- A suitable (tissue typed and matched) donor must be available. Finding a matching donor can be a challenging and lengthy process. Voluntary marrow donors are registered in several national and international registries. A bone marrow search involves searching these registries for donors whose HLA system most closely resembles or matches the child needing the transplant.
Preparation for the donor
- Donor sources available include self, sibling, parent or relative, nonrelated person, or umbilical cord blood from a related or nonrelated person. There are national and international registries for nonrelated persons and cord blood. Family members may be tested for a match (typed) because of the desire to help. These relatives may or may not elect to have their type registered for use with other recipients.
- If the potential donor is notified that they may be a match for a child needing a transplant, they will undergo additional tests. Tests related to their health, exposure to viruses, and complete genetic analysis will be done to determine the extent of the match. The donor will be given instructions on how a bone marrow donation will be made.
How are a donor and recipient matched?
Matching involves typing human leukocyte antigen (HLA) tissue. The antigens on the surface of these special white blood cells determine the genetic make-up of a person's immune system. There are at least 100 HLA antigens, however, it is believed that there are a few major antigens that determine whether a donor and recipient match. The others are considered "minor" and their effect on a successful transplant is not as well defined. Because HLA markers are inherited, an identical twin is the best donor match.
Medical research is still investigating the role all antigens play in the process of a bone marrow transplant. The more antigens that match, the better the engraftment of donated marrow. Engraftment of the stem cells occurs when the donated cells make their way to the marrow and begin reproducing new blood cells.
How are the stem cells collected?
A bone marrow transplant is done by transferring stem cells from one person to another. Stem cells can either be collected from the circulating cells in the blood (the peripheral system) or from the bone marrow.
- Peripheral blood stem cells (PBSCs). PBSCs are collected by an apheresis, a process in which the donor is connected to a special cell separation machine via a needle inserted in the vein. Blood is taken from one vein and is circulated though the machine which removes the stem cells and returns the remaining blood and plasma back to the donor through another needle inserted into the opposite arm. Several sessions may be required to collect enough stem cells to assure a chance of successful engraftment in the recipient.
A medication may be given to the donor for about one week prior to apheresis that will stimulate the bone marrow to increase production of new stem cells. These new stem cells will be released from the marrow and into the circulating or peripheral blood system.
- Bone marrow harvest. Bone marrow harvesting involves collecting stem cells with a needle placed into the soft center of the bone, the marrow. The sites most commonly used for bone marrow harvesting is located in the hip bones. The procedure takes place in the operating room. The donor will be anesthetized during the harvest and will not feel the needle. In recovery, the donor may experience some pain in the areas where the needle was inserted.
- If the donor is the child himself or herself, it is called an autologous bone marrow transplant. If an autologous transplant is planned, previously collected stem cells from either peripheral (apheresis) or harvest, are counted, screened, and ready to infuse.
- Umbilical cord blood. For umbilical cord blood transplants, blood has been collected at the time of a birth and stored. Cord blood is collected after delivery, when the placenta and umbilical cord are separated from the infant. The site of collection is cleaned to prevent bacteria from entering the collection process. The blood that is contained in the cord is collected in a sterile container. The blood is then tested for type and the presence of viruses or disease, and the stem cells are counted. The cord blood is then stored in special freezers and is registered in a national registry for potential recipient matches.
The bone marrow transplant procedure
The preparations for a bone marrow transplant vary depending on the type of transplant, the disease requiring transplant, and your child's tolerance for certain medications. Consider the following:
- Most often, high doses of chemotherapy and/or radiation are included in the preparations. This intense therapy is required to effectively treat the malignancy and make room in the bone marrow for the new cells to grow and to prevent rejection of donor cells by the patient. For patients with cancer, this therapy is often called ablative, or myeloablative, because of the effect on the bone marrow. The bone marrow produces most of the blood cells in our body. Ablative therapy prevents this process of cell production and the marrow becomes empty. An empty marrow is needed to make room for the new stem cells to grow and establish a new production system.
- After the chemotherapy and/or radiation is administered, the transplant, either from bone marrow, cord, or from peripherally collected stem cells, is given through the central venous catheter into the bloodstream. It is not a surgical procedure to place the marrow into the bone, but is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
- Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, weighing your child daily (or twice daily), and providing a protected and clean environment.
The days before transplant are counted as minus days. The day of transplant is considered day 0. Engraftment and recovery following the transplant are counted as plus days. For example, a child may enter the hospital on day -8 for preparative regimen. Days +1, +2, etc., will follow the transplant. There are specific possible events, complications, and risks associated with each day before, during, and after transplant. The days are numbered to help the child and family understand where they are in terms of risks and discharge planning.
During actual infusion of the bone marrow, your child may experience any, or all, of the following symptoms:
- Pain
- Chills
- Fever
- Hives
- Chest pain
During the post transplant period, your child may:
- Spend several weeks in the hospital
- Be very susceptible to infection
- Be susceptible to bleeding
- Need blood transfusions
- Be confined to a very clean environment to minimize the chance of infection
- Take multiple antibiotics and other medications
- Be given medication to prevent graft-versus-host disease (if the transplant was allogeneic). The transplanted new cells (the graft) tend to attack the child's tissues (the host), even if the donor is a relative, such as a brother, sister, or parent.
- Undergo continual laboratory testing
- Experience nausea, vomiting, diarrhea, mouth sores, and extreme weakness
- Experience temporary emotional or psychological distress
Your child's physical and mental health are important in the success of a transplant. Every measure is taken to minimize complications and promote a healthy, happy, safe environment for your child.
When does engraftment occur?
Engraftment of the stem cells occurs when the donated cells make their way to the marrow and begin producing new blood cells. Depending on the type of transplant and the disease being treated, engraftment usually occurs between day +15 and +30. Blood counts will be performed frequently during the days following transplant to evaluate initiation and progress of engraftment. Platelets are generally the last blood cell to recover.
Engraftment can be delayed because of infection, medications, low donated stem cell count, or graft failure. Although the new bone marrow may begin making cells in the first 30 days following transplant, it may take months, even years, for the entire immune system to fully recover.
What complications and side effects may occur following BMT?
The following are complications that may occur with a bone marrow transplant. However, each child may experience symptoms differently. Complications may vary depending on the following:
- Type of marrow transplant
- Type of disease requiring transplant
- Preparative regimen
- Age and overall health of the recipient
- Variance of tissue matching between donor and recipient
- Presence of severe complications
Possible complications may include, but are not limited to, the following. These complications may also occur alone, or in combination:
- Infections. Infections are likely in the child with severe bone marrow suppression. Bacterial infections are the most common. Viral and fungal infections can be life threatening. Any infection can cause an extended hospital stay, prevent or delay engraftment, and/or cause permanent organ damage. Antibiotics, antifungal medications, and antiviral medications are often given to prevent serious infection in the immunosuppressed child.
Preventative measures for common sources of infection are also a part of transplant. This may include any or all of the following:
- Special air filtered rooms
- Diet restrictions
- Isolation requirements
- Restriction of visitors
- Strict hygiene regimen
- Frequent linen changes
Blood tests are performed to prevent, detect, and treat infections. Often, multiple antibiotics are started if an infection is suspected.
- Low platelets and low red blood cells. Thrombocytopenia (low platelets) and anemia (low red blood cells), as a result of a nonfunctioning bone marrow, can be dangerous and even life threatening. Most children will require multiple blood product transfusions. Low platelets can cause dangerous bleeding in the lungs, gastrointestinal (GI) tract, and brain.
- Pain. Pain related to mouth sores and gastrointestinal (GI) irritation is common. High doses of chemotherapy and radiation can cause severe mucositis (painful inflammation or ulceration of the mouth and GI tract). Without the normal immune system functioning, your child is unable to heal these irritations quickly. Often, pain medication is required. Mouth care is needed to prevent infection and injury when mucositis is suspected.
- Diarrhea, nausea, and vomiting. These may occur with chemotherapy, radiation, and/or GI irritation. Calories and proteins may be given through an intravenous (IV) line until your child is able to eat again and the diarrhea has resolved.
- Fluid overload. Fluid overload is a complication that can lead to respiratory disorders and high blood pressure. The primary reason for fluid overload is because the kidneys cannot compensate for fluid being given intravenously in the form of medications, nutrition, and blood products. The kidneys may also be damaged from disease, infection, chemotherapy, radiation, and/or antibiotics.
During transplant and recovery, your child will be assessed for signs and symptoms of fluid overload. He or she may be weighed at least daily, often twice or three times daily, and blood chemistries and input and output will be measured frequently. Medications that help kidney function and elimination of excess fluid may be given.
- Respiratory distress. Respiratory status is an important function that may be compromised during transplant. Infection, inflammation of the airway, fluid overload, graft-versus-host disease, and bleeding are all potential life-threatening complications that may occur in the lungs and pulmonary system. Supplemental oxygen may be needed to help your child breathe better until problems are corrected.
Close monitoring of your child's respiratory status may include:
- Chest X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film
- Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor that looks like a Band-Aid is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.
- Organ damage. The liver and heart are important organs that may be damaged during the transplant process. Temporary or permanent damage to the liver and heart may be caused by infection, graft-versus-host disease, high doses of chemotherapy and radiation, or fluid overload.
Close monitoring of your child's blood work and vital signs is important in minimizing and detecting any organ damage that has occurred.
- Graft failure. Failure of the graft (transplant) taking hold in the marrow is a potential complication. Graft failure may occur as a result of infection, recurrent disease, or if the stem cell count of the donated marrow was insufficient to cause engraftment. Graft failure may be treated with an additional marrow transplant if a source is available.
- Graft-versus-host disease. Graft-versus-host disease (GVHD) can be a serious and life-threatening complication of a bone marrow transplant. GVHD occurs when the donor's immune system reacts against the recipient's tissue. The new cells do not recognize the tissues and organs of the recipient's body. The most common sites for GVHD are the GI tract, liver, skin, and lungs. GVHD is graded from I to IV and can be acute (occurs early at the transplant) or chronic (occurs later; over 5 days post transplant). Your child will be monitored closely for signs and symptoms of GVHD. Diarrhea, fever, rash, skin changes, abdominal pain, respiratory complications, and decreased liver function may be present with GVHD. Medications will be given prior to transplant to reduce the risk of this complication.
When will my child be discharged?
When your child is discharged following a bone marrow transplant depends on many factors, including the following:
- Extent of engraftment
- Presence of complications
- Your child's overall health
- Distance from the facility. (This may be specified by your child's team of doctors. Occasionally, a bone marrow transplant patient will be required to stay within a certain distance or travel time from the facility to ensure safety if complications arise.)
Frequent visits to your child's transplant team will be required after discharge to determine effectiveness of treatment, detect complications, detect recurrent disease, and to manage the late effects associated with a bone marrow transplant. The frequency and duration of visits will be determined by your child's transplant team.
Long-term outlook for a bone marrow transplantation
Prognosis greatly depends on the following:
- Type of marrow transplant
- Type and extent of the disease being treated
- Disease response to treatment
- Genetics
- Age and overall health of the child
- Your child's tolerance of specific medications, procedures, or therapies
- Severity of complications
As with any procedure, such as bone marrow transplant, prognosis, and long-term survival can vary greatly from child to child. The number of transplants being done for an increased number of diseases and ongoing medical developments have greatly improved the outcome for bone marrow transplant in children and adults. Continuous follow-up care is essential for the child following a bone marrow transplant. New methods to improve treatment and decrease complications and side effects of a transplant are continually being discovered.


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