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text:
Thomsun Industries LLC, Dubai PPR pipes suppliers in UAE
Thomsun Industries LLC, a subsidiary of Thomsun Group, is Dubai PPR pipes manufacturers and Dubai ppr pipes suppliers in UAE. We have a history of over 40 years experience in United Arab Emirates with a large warehouse with huge stock of building materials in DIP-1, Dubai, UAE. We operate towards a vision to be the best and the most professional dubai ppr pipes manufacturers and ppr pipes suppliers in UAE. Thomsun invests considerably in its manufacturing facility and quality raw materials. By supported, T-Mech PPR piping system ppr water pipes are continuously expanding its production facilities and its product portfolio. We strongly believe that providing quality T-Mech ppr pipes and fittings will bring a lasting difference by increasing customer's satisfaction.
Thomsun was established in the year 1976 in Dubai UAE by directors Mr. K. V. Thomas, Mr. V. T. John and Mr. P. Srinivas. With strong history & credibility, Thomsun Group over the years has business interests in various industries in the Gulf and Indian subcontinent. Steered by visionary professionals and powered by the intelligent use of technology, Thomsun Group, with a turnover of US$400 million and a 2,500-strong workforce, has marked many entrepreneurial milestones in sectors as diverse as musical instruments retail, music education, professional & consumer electronics trading, audio visual & consulting, electromechanical products, printing & packaging, pre-press & digital printing, display solutions, logistics & distribution, supermarkets & bakeries, seafood processing & trading, meat and vegetable processing & trading, and home furniture. For more informations, please visit our Thomsun Group website.
T-Mech PPR water pipes provides Quality products.
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2) Product Guarantee. 10-year guarantee can be enjoyed For using T-Mech PPR pipes and fittings from the date of your purchase.
Competitive price, ppr pipe price list can be downloaded.
As Dubai ppr pipes manufacturers, we consider it our mission to offer competitive prices on the high-quality pprc pipes we sell. While our prices may not always be the lowest, we believe our price-quality ratio is unmatched. We strongly believe that T-Mech PPR water pipes and fittings are generally of better quality than our competitors. Thomsun Industries LLC are in PPRC pipes market for long history with rich experience. This valuable experience and stable raw material partnership helps to reduce the cost during the manufacturing process and production, which will directly lead to the competitive selling price.
Welcome to download T-Mech ppr pipes price list for future reference.
T-Mech PPR piping system provides fast delivery.
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1) Consulting Service. We have senior and qualified engineers and well-trained sales executives who can help our customers to solve their confusions and guide them how to solve the problems related to T-Mech PPR piping systems.
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How to cut ppr pipes, ppr pipe welding process and ppr pipe installation.

subset: commoncrawl


text:
From this profile you will find 2 photos, 8 lists, 1 relationship, and key facts about Maria del Refugio Abarca Villasenor!
Maria del Refugio Abarca Villasenor is a member of the following lists: Caucasian celebrities, Celebrities with dark brown eyes, Celebrities with average build, Female celebrities, Celebrities with first name: Maria, Dating Status: Married, Celebrities with light brown hair and Top 10,000 Celebrities.
Need more information? Read more about Maria del Refugio Abarca Villasenor »
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|53 points
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The 32-year-old actress says that letting go of 'narrow definitions' has allowed her to pursue important projects. Read More
The actress snapped photos with her famous friends to commemorate the historic multi-city protest march.Read More
Michael Urie, Mark Indelicato and Ana Ortiz all joined the actress at the nation's capital. Read More
Madonna delivered three F-Bombs on live TV before dedicating her performance of 'Human Nature' to President Trump. Read More
Famous faces like America Ferrera, Ashley Judd and Janelle Monae will be speaking and performing at the event on Saturday. Read More
The 32-year-old actress broke down in tears after Donald Trump beat Clinton as the president-elect.Read More
These starlets sure know how to embrace a new seasons.Read More
Amber Tamblyn gyrating on America Ferrera dressed as Donald Trump is a must-see.Read More
From grind to glam!Read More
The duo ripped Donald Trump in their tag-team speech at the Democratic National Convention on Tuesday. Read More
The crew is back together again.Read More
The 'Superstore' actress opens up to ET about the pressures of having to represent Latin women onscreen.Read More
It's a Mode Magazine reunion!Read More


text:
- Member since: December 2015
- Recent Delivery: 6 months
- Avg. Response Time: 4 Hrs.
shoaib01989's Gigs
shoaib01989's Reviews
Awesome work, clean coding and friendly guy, I will come back to you again
Great job. Thanks
Thanks good job
Outstanding Experience!
Outstanding Experience!
Good work. Thanks.
shoaib01989 will work on it until it's exactly right. Thanks


text:
Women's Baume & Mercier MOA10012 Watch
$1,599.99 $839.99
We currently have 1 in stock.
Baume & Mercier Women's MOA10012 "Linea" Stainless Steel Watch
Brand, Seller, or Collection Name: Baume & Mercier
Model number: MOA10012
Part Number: MOA10012
Item Shape: Round
Dial window material type: Anti reflective sapphire
Display Type: Analog
Clasp: Deployment Clasp
Case material: Stainless steel
Case diameter: 32 millimeters
Case Thickness: 10.5 millimeters
Band Material: Stainless steel
Band length: Women's Standard
Band width: 17 millimeters
Band Color: Silver
Dial color: Mother-Of-Pearl
Bezel material: Stainless steel
Bezel function: Stationary
Calendar: Date
Item weight: 15.84 Ounces
Movement: Swiss quartz
Water resistant depth: 165 Feet
*Slight scratches and scuffs on band of watch, see pictures. Discounted 30%


text:
A very interesting English double sided watch fob or awards metal. The hallmark dates the fob to 1914. Each side has a raised shield in the center.
The fob has a 1 1/2 inch drop, weight 13 grams and on one side there is evidence that there was a 9k gold wash attached to the silver shield.
This is a lovely two sided sterling silver fob that could be added to bracelet or on a necklace.
2 other shoppers have this item in their Cart or Wish List .
English Antiques & American Primitives


text:
Alternative websites for 1stchoice-music.co.uk
1. Result for 1stchoice-music.co.uk
Crotchet have now closed. Judy and Ian wish to thank all our customers for your loyal business over the years. It has been a pleasure serving you.
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With the Internet continuing to overtake high street stores as the leading source for purchasing specialist classical music, UK family mail order company, MDT ...
Alternative for mdt.co.uk
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Albeniz, Isaac Bach, Carl Philipp Emanuel Bach, Johann Sebastian Barber, Samuel Bartok, Bela Bax, Arnold Beethoven, Ludwig van Bellini, Vincenzo Berg, ...
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text:
Tim Robbins has joined the cast of Green Lantern in the role of Senator Hammond, whose disapproving parental style is one of the reasons that Dr Hector Hammond (Peter Sarsgaard) ends up turning evil.
The other reason, of course, is that Hammond Jr becomes infused with psychic powers from a strange meteorite and goes insane. As you do.
Martin Campbell has recruited Robbins to the cast to star alongside Ryan Reynolds (as our hero) and Blake Lively (as his love interest, Carol Ferris).
They'll be reporting to the set in March to start shooting and Robbins also be no doubt hoping that this comic book film appearance wipes his early dabble with the genre off his CV, in the infamous Howard The Duck.


text:
Times may change but our opinion of Kangana Ranaut as one of the sexiest actresses will never alter. Has there ever been a single moment in the recent past when the actress has given us a cringeworthy fashion outing? Ah, chuck that. Has there ever been a single photoshoot where she has let us down? None! Modelling and giving the shutterbug something to remember her by has been her plan, all along. Recently at GQ Awards, she was awarded with Woman of the Year. That should've been the talking point for all but no. It was her speech that made everyone salute this Queen! In her speech she had said, "I have to make a confession, my hotness is so underrated. Nobody talks about my abs, not that I have any, but nobody wants to know about my diet either. So I think it is a little unfair and shameful. No matter how many lingerie shoots do I do for you all, it is always with the spirit, han?" So thank you for this, I appreciate it. I believe that some of it belongs to my hotness quotient." The magazine soon did a photoshoot also with the actress. Like always, GQ gives us some sultry photoshoots and this one was no short of sexiness making October the hottest month!
We got our hands on the making video of the same photoshoot. Before we speak of the video, we'd like to get to you pics from the photoshoot. Although it the past, we did a piece on the pics from Kangana's GQ rendezvous. However, there are some that you might haven't come across yet. So we're gonna bring to you a set of pics from the GQ photoshoot that's gonna make you sweat. Yes, quite literally. Scroll below and check them out! (ALSO READ: Kangana Ranaut's HOT mag photoshoot will make you SWEAT – view pics)
There's absolutely nothing sexier than Kangs donning this hot sheer dress and posing like a sultry goddess! P.s. did you notice the fur piece on her shoulder?
Oh the sexiness keeps coming, especially when it's Kangana on the frame. There's something mystically alluring about this picture and if you give it some more thought, the outfit looks like a literal rip off of some of the Renaissance era remains! (In a good way, of course!)
Miss Ranaut is the Queen of fashion in Bollywood and that's her, sitting on her coveted throne, with a smirk. Could anything come close to how hot she's looking? Probably another pic of herself, nothing else!
While the Rangoon actress tries to keep it simple here in this shimmery gown, it's falling flat because she can never keep it simple, especially not since she's such an inspiration for glamour!
Finally, here's a Kangana Ranaut we all can relate to. Pretty, bold, fiesty, alluring and many more adjectives of the same words we've used! Hot no?
So much swag and panache is a very rare combination that not many can pull off. But Kangana here is a rockstar that way as she has both the abstract nouns wrapped safely in her kitty and time and again, she exhibits the same. Wouldn't you now want to watch the video we've been raving about? It has the actress embrace the beautiful era and in fact, add a touch of modernism to the same. Only Kangana can do that. We've attached the video below so you can check it out and marvel at the sight of this drop dead gorgeous diva. During her awards acceptance speech at GQ Awards 2016, she said that she is not used to award functions but this one was very special. "I got to know about it a few months ago – they tell you way in advance. I think at the beginning of the year, when I just declared myself to be a witch, I got a call from Che (GQ India editor) and he's like "You are our 'Woman of the Year'." (ALSO READ: Oh No! Kangana Ranaut meets with a road accident while shooting for Simran)
Miss Ranaut will soon be seen in Vishal Bharadwaj's Rangoon. Shooting for the same has been wrapped up. The period drama stars Saif Ali Khan and Shahid Kapoor as male leads while Kangana will be leading them both as the protagonist. Kangana has also started shooting for her next project already. Titled Simran, the movie is being directed by Hansal Mehta and kicked off the first shooting schedule in Atlanta on October 7. What are your thoughts on this video? Tell us in the comments section below! Stay tuned to this space for more deets and cues on style and fashion!


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text:
A solid dosage form in the shape of a small sphere. In most products a unit dose consists of multiple beads. The term, bead is used interchangeably with the terms, pellets and granules.
Sign up now to receive the free weekly newsletter, and more!
Fuji Chemical Industries USA, Inc. is a sales and marketing company servicing the North and South American markets.


text:
iHerb Goods, Stainless Steel, Snap Mesh Tea Infuser (Discontinued Item)
Shipping Weight:?0.17 lbsSwitch to Metric units
- Product Code: IHB-00875
- UPC Code: 898220008759
- Package Quantity:
6 x 1.7 x 1.7 in, 0.05 lbsSwitch to Metric units
- Loose Leaf Snap Mesh Tea Infuser
- Made of Food-Grade 304 Stainless Steel
- Enjoy loose leaf tea with the ease and convenience of tea bag teas!
- Dishwasher Safe
Enjoy your loose leaf teas with our Snap Mesh Tea Infuser. Simply scoop your favorite loose leaf tea in our Snap Mesh Tea Infuser and place into a cup of hot water. Ideal for use in a teapot or teacup. The spring handle allows you to easily open and close the spoon with one hand.
Makes brewing your loose leaf tea quick and efficient, with no mess.
Why we use Grade 304 Stainless Steel and not lower cost grades?
- Safe – Safe and used throughout the food industry.
- Easy – Easy to clean & sanitize.
- Durable – Last a lifetime if properly maintained!
- No Rust – Rust resistant.
Really light
Verified Purchase
Really light
Build quality is really light, and can't say for sure how long this will last. "Snap" isn't really that tight as I hoped. These snap mesh tea infusers are really handy, and you don't need spoon to stir your tea. If you wish to clean this in dishwasher (make sure you snap something between the jaws). This was previously "Just a Leaf Organic Tea" product, and now rebranded to iHerb. For a dollar this is must to get. My review was removed for some reason...hopefully this stays for a while.
Snap snap
Posted by getter90 on Dec 17, 2016
Light and strong, good
The spring is not that strong
Posted by 5219571874473907893 on Nov 24, 2016
Bad one
Posted by alinagoldie on Sep 25, 2016
This thing got broken at the very first use :D
iHerb Goods, Stainless Steel, Snap Mesh Tea Infuser
Posted by 4676117050751323210 on Sep 23, 2016
Spoil after a few tea drink
Don't think to buy it!
Posted by 5057840846900792375 on Jul 30, 2016
The worst quality ever seen in my life!!!


text:
Log in to create groups for projects or interests and save some images to them. More about groups.
Wookmark is your creative archive. Sign up Log in Learn more
GBKS – Great shot and composition, although the variation in stroke thickness works much better on V and E than on O and U.
Saved fromTypography Served


text:
I love your story. It's a
story of how life sometimes goes.
Those who have the $$$'s do
not have a "clue" and those who do, don't have the $$$'s. All of us, with the
work we are doing, need to recognize the importance the situation we have
laid out in front of us. Often times we all speak from the heart, which always
(but sometimes does) doesn't bring us the funds we need. One little clue I
have learned along my travels is: "Know who you are speaking to". In one
public meeting, I couldn't stand it any longer, I got up and spoke from the
heart. I clearly stated that community gardens are my passion, to try to drive
home my point. Afterwards, a person "in standing" pointed out that chocolate
can also be a passion. I should use the term "business" and not passion.
Try it sometime.
Let me expand upon this
concept. Often times many of us who do things from the heart, people do
not place a value on it. I have learned that many people and groups love
the concept of community gardening and/or gardening programs but
they want us to do it all as a volunteer. Not only are we suppose to run
the program we are also suppose to secure the funds etc. The way I have nipped
this problem in the bud is by clearly stating, "Well of course this project
sounds terrific and it can happen since this is what I do for a living!". The
magic words are: "what I do for a living". Do not paraphrase it with other
words. They have to be exact. When people hear these words they know a dollar
amount is attached and if they expect you to do it for free, they will
immediately shut-up and it goes no further.
I apologize for my rambling
but age (one good thing about getting older) does have wisdom. We don't have
the time to try to convince people of the "good" we do. They either "get it"
or they don't. Move on.
This story reminds me of
when I was in the restaurant business. Everyone in the world thinks it would
be fantastic to own a restaurant. The vision of being the "owner"
outweighs the fact of long hours, scrubbing floors and cleaning toilets. Not
too glamorous. It's a nice thought but many don't want to go
As we all know, community
gardens do come from the heart, we just need the right buzz words to
get them going. As to the big $$'s, it's a moment in time and not based in
reality. They missed the point completely. If we could learn how to secure the
big $$'s we wouldn't have the opportunities to do the work we do because most
likely we would have "sold out". It's like the Twilight Zone.
Thanks again Jim.
All my best,
Deborah Mills
Green Cure,
PS Maybe this is my way of
soothing the pain from missing out on all that dough! =)
As previously promised (for Deborah
Mills), the 150K Community Garden story (go get some coffee, this may take a
while... AH).
A Little Background: As many of you know, Alabama,
for the most part is not exactly the metropolis of many of our
northern states so therefore the term "community garden" for the most
part is unknown in this state. In fact, most of the folks in my city of
Huntsville are unaware of the CASA Community Garden. Ninety-eight
percent (98 %) of those who know of our garden call it the CASA Garden, its
original name. About 3 or so years again, I asked CASA to change its
name to the CASA Community Garden because its exist only because of
community volunteers.
Here we go: This past April, I received a call
from a Master Gardener in a small town in LA, that's Lower Alabama in these
parts. This lady had been in the audience when I was conducting a
session at our state MG conference. She called to asked for help for a
lady who was starting up a community garden in her small town of less than
5,000 (for privacy purposes, all names will remain anonymous). So she
begins to describe how this particular lady who hadn't lived in the town too
long had received a federal grant for 150K to start up a community
garden. She had to spend about 50K per year (3 years) on this
program. So as I understood it, she had been granted the used of an
abandoned football field (hard to believe in Alabama) and had spent money
on prepping the site and installing an underground sprinkler system with
individual spigots for individual plots. The purpose of the grant
was to help provide vegetables to the poor (most were) in this rural
Envision This: So... here we sit with a huge open
field primed for planting in the height of spring all ready for
these community gardeners to pay $25.00 per year to garden in their
individual irrigated plot. What a deal, if you live in downtown NY, but
in rural Alabama, well you guessed it, nobody was interested. This lady
had group meetings with church and civic groups to try to convince them to
come to her "community" garden. So, this lady on the phone was asking me
for advice on correcting the problem. I told her "you can't put a round
peg in a square hole". Period. I asked her
why would anyone in their right mind want to drive their old broken
down gas guzzler (most rural poor do not own the most gas
efficient vehicles) half away across the county to garden in a small
plot. Plus, someone is asking them to pay money to use this tiny
plot. You got to be kidding. Most small town folks have a
garden 10 times this size in their backyard. It's right outside their
backdoor and "Hey, its free!".
I asked how this lady had gotten the idea that
a "community garden" of this type would work in this
environment? "Well" she said. "she doesn't come from these parts".
I said, "where did she come from?". She said she lived most of her
life in a northern state where they used to have gardens like this.
I'm not sure how they resolved their dilemma, but I wish (as most of you
do) the CASA Community Garden could have some of that grant money. I
never heard from her again.
When I get some time, maybe I will tell about: Gino, the
Italian photographer and his models comes to the garden
Seinfeld (well kind of, NYC) volunteers in the garden
The Okra Pickin' Engineer or
Community Garden harvested record tomato crop after
spraying the plants with a defoliant.
Most stories are not as long as the one
above. I plan to update the www.casagarden.com
website this winter. I want to add a special
page dedicated to short stores and advice in the garden.
Hope you enjoyed,
Jim Call, CASA Community Garden Volunteer Director
PS - cross your fingers, if it doesn't rain tonight, the "ripper" is
coming to the garden. (http://www.casagarden.com/ripper.html)
Film at 11.


text:
Post Office Management System Project is designed for automation of existing post office system in VB. Managing works like storing data, retrieving old data, updating data at fast pace will help in improving quality service for a post office.
Design and Development Details:
Post office system is developed in visual basic language for front end design and MS – Access for back end database.
Detailed design is explained with data flow diagram and post office data base design is explained by providing details of speed post table, sales table, money saving table and register post database table.
Post office system DFD:
Module Screen Shot:
System Implementation:
Proposed system will help to manage work easier by designing different modules. There are six forms in post office system for handling sales, register, speed post, money order , money saving and report generation.
Projects like e – post office management system project is developed with same concept for providing same services through online.
Project Title: VB Post office management system project
Existing system:
In existing system manual methods are used where data is saved in form of records which time is taking a not secure.
Proposed System:
Post office management is done through centralized database where it is easy to maintain and retrieve records. No chances of losing data.
Download Post office management system project visual basic source code and project Report.
Also Refer to: Payroll Accounting System Project
Related VB.Net Projects:


text:
Top Definition
A sweet but very boring place to live in Ulster County, NY
Shokan has nice old people and charming little stores but it is boring as hell. o and P.S. OCS sucks!
by DontComeToShokan July 30, 2004
The Urban Dictionary Mug
One side has the word, one side has the definition. Microwave and dishwasher safe. Lotsa space for your liquids.Buy the mug
The Urban Dictionary T-Shirt
Smooth, soft, slim fit American Apparel shirt. Custom printed. 100% fine jersey cotton, except for heather grey (90% cotton).Buy the t-shirt


text: Venditore: horrice007 (792) 96.9%, Luogo in cui si trova l'oggetto: BN41 2EQ, Spedizione verso: GB e molti altri paes, Numero oggetto: 122225932041 Girls finding memo outfit from disney store age 2-3 Any questions please ask. I am having a huge clearout and selling many items over many catagories. Please check out my other items as I will combine postage for multiple items. Please note unless stated otherwise stated all items are in used condition. Any marks or blemishes I notice will be mentioned in the listing but I may miss the odd things as I am only human. Sorry but I will only post to a paypal verified uk address. HAPPY BIDDING!!!


text:
Online 5 months ago
Rent budget
Preferred stay length
Move date
I am looking for a place that will be very welcoming of myself and my little dog Lady who is a chihuahua x b. She is a little ball of energy and also my best friend.
I have been independently living with my sister, her husband and 2 children for the past 3 years and think it's about time to move. I want to experience something different and also be able to be social but not have to leave the house (I do leave the house on occasion fyi, I'm not that creepy). Also something closer to work in the city to make life that little bit easier. Driving 40 - 60 minutes a day is taking it's toll on me.
I am working full time as a receptionist for an ENT doctor. I am also applying for university in the medical field to start next year or the year after depending on what I get accepted into.
I'd be interested in team ups as well so I can open up my hoard of kitchen accessories and the fancy wine glasses (everything is already in this house).
Brianne is also interested in Teaming-Up and starting a new share house.


text:
11508 Sw Lake Park Drive, Port Saint Lucie FL, 34987
Sold Price:
3 beds , 2 Full baths
1,565 sqft
Status: Sold
Last Updated: 2/25/2017 7:23 PM
Description for 11508 Sw Lake Park Drive Port Saint Lucie, FL 34987
Come learn about Tradition's newest senior lifestyle community, LakePark! $15,000 in free upgrades!
Sold Price:
Sold Date:10/31/2016
Lakepark At Tradition Plat 1
St. Lucie
2 Full
1,565 (approx)
Come learn about Tradition's newest senior lifestyle community, LakePark! $15,000 in free upgrades!
Listing Information
Lakepark At Tradition Plat 1
Electric Water Heater, Public Water Service
Public Sewer
Cable TV, Electric service available, Underground
Room Information
Kitchen/Dining Combo
Split Plan
Dual Sinks
Interior Features
Dishwasher, Disposal, Dryer, Microwave, Electric Range/Cooktop, Refrigerator, Washer, Laundry Tub
Central Air, Electric
Electric Heating, Central
Burglar Alarm, Guard At Gate
Smoke Alarm, Unfurnished, Foyer, French Doors, Pantry, Walk-in Closets
Exterior / Lot Features
2 Garage Spaces, Driveway
Sprinkler System
Water Front, Lake, Room For Pool, Garage, Tennis Court
Community Features
Community Spa
Driving Directions
95 to Gatlin Blvd exit 118, west to Tradition through roundabout-LakePark on left
Financial Considerations
Market Trends and Price History
Current market conditions for 11508 Sw Lake Park Drive
Active Market Trends
Source: MLS DATA
Median list price$274,900
Days on market140
Properties for sale210
Sold Market Trends
Source: MLS DATA
Median sold price$269,255
Sales to list price97.0%
Properties sold68
Median sq ft price$134
Arrows indicate 90 day trend
Listing Price History
Port Saint Lucie Real Estate
Port Saint Lucie is located in Florida. Port Saint Lucie, Florida 34987 has a population of 181,045.
The median household income in Port Saint Lucie, Florida 34987 is $50,235. The median household income for the surrounding county is $43,923 compared to the national median of $53,046. The median age of people living in Port Saint Lucie 34987 is 42.1 years.
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PAAA presents awards every Spring to the faculty and staff advisor of the year who demonstrates hard work and meets the needs of the students. The campus is able to vote which is then determined by a team of judges. The goal of the awards is to enhance the UWG campus by promoting excellence, innovation and effectiveness in academic advising.
2015 PAAA Advisors of the Year
(L to R) Dr. Joseph Hendricks, PAAA Faculty Advisor of the Year, and Megan Groninger, PAAA Staff Advisor of the Year.
2014 PAAA Advisors of the Year
(L to R) Elaine Heath-Ward, Treasurer; Beth Freeman, President; Dr. Vanessa Woodward, PAAA Faculty Advisor of the Year; Danny Gourley, PAAA Staff Advisor of the Year; Katie Hiers, Vice President of Communications; Ashley Hodges, Vice President of Assessment and Recognition.


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Lucent Light Mandala Earrings
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A striking design reminds us that against the darkness of life's challenges, our light becomes more brilliant. Black enamel forms the backdrop for a gleaming gold mandala jacket earring; gold accent beads draw the eye in.
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- 18kt gold plated over brass
- Mandala - knowledge, balance


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Harpo Studios The Dr Oz Show Tv Show Reviews
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I will never again watch their shows or trust Dr.Oz or Ophrah again. They want more and more money for themselves and could care less about people. I ordered a sample and aI immediately sent an email to cancel my order. I support myself and my husband on my social security check and for the past 2 months I have been overdrawn at my bank by $250.00. I never authorized any of these charges. The sample did absolutely nothing to make my skin look...Read more
Anonymous Something needs to be done about this.
I ordered a sample product for 4.95 and I was charged 132.80 and 152.66 on August 22nd and then again the same amounts on Sept 4th an...
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Operations Support Coordinator Salary
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Job Description for Operations Support Coordinator
Operations support coordinators are responsible for coordinating support tasks related to operations in their organization. They oversee tasks to completion and report their progress to the operations manager in their company. Operations support coordinators handle incoming calls and respond to client inquiries; in these tasks, they must use a professional demeanor and follow company procedures. One of their main tools is a personal computer to communicate with outside partners, and vendors. These coordinators also coordinate company meetings and organization events.Read More...
Often, operations support coordinators prepare activity reports for their superiors. They research techniques for better coordinating day-to-day operations, as well as document client interaction to provide excellent customer service and increase company awareness. Operations support coordinators provide recommendations for logistics changes to reach company goals; review and respond to correspondence in a timely manner; maintain accurate operations records; complete required documentation; and assist operations managers in prioritizing workload. Operations support coordinators also provide support to other teams within their organization. In all tasks, they must follow safety policies and privacy procedures when handling company data.
A high school diploma or equivalent is generally required for this position. Previous experience in a operational support capacity may be preferred. They should possess strong interpersonal skills when interacting with staff, clients, or external partners. They also must be highly organized individuals that are multitask on many different projects at the same time. They must work well in a team setting, be results-oriented, and work effectively on their own with minimal supervision.
Operations Support Coordinator Tasks
- Respond to customer questions and requests, resolve complaints, and escalate isses as needed.
- Identify ways to streamline operational procedures between or within departments.
- Participate in the planning, development, implementation and support of operational activities.
- Answer incoming calls, refer calls to appropriate person, and take messages.
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1229 West Avenue, Ocean City, This vacation rental property sleeps 8 with 3 bedrooms and 2 baths. This charming, clean, bright, and well maintained 3 bedroom and 2 bath first floor unit is located on the beachside of West Avenue. Only a few blocks to → Read More
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Senior .Net Developer
The Healthcare IT group within TransUnion provides strategic engineering, quality assurance and technical support for TransUnion's fastest-growing division—Healthcare. This .NET Developer role will focus on one of our wide range of solutions: eScan Coverage Discovery, a services platform to find insurance coverage for uncompensated care. This will be done through the use of your knowledge in .NET technology specifically C#, and SQL Server, or other similar capabilities. Our leadership values associates' ideas, teamwork and self-motivation. Our work environment is relaxed, but we're serious about what we do and pride ourselves in innovation and open communication. We strive to foster an entrepreneurial atmosphere where obstacles to success are removed and your career can flourish.
How You'll Contribute:
- Coding: A passion for building solutions that are simple for end users but implement complex business processes. Independently develop code, test, debug, maintain, modify, and install complex software programs. Apply structured programming techniques and adhere to coding standards. Participate in code walkthroughs.
- Testing: You will develop and maintain unit tests and provide top notch technical support to our client support staff.
- Analysis/Design: Analyze complex technical requirements and make determinations for modifications of existing programs/modules. Create technical designs. Make recommendations for re-design and/or re-coding of programs that do not meet desired specifications.
- Communication: Collaborate with team members. Convey problems, solutions, updates and project status to peers and management. Develop and maintain clear and succinct documentation. Help train new team members as needed.
- Planning: You will develop and maintain unit tests and provide top notch technical support to our client support staff.
- Production support: You will provide production support when an issues is too complex for tier 3 to handle.
- Performs other related duties as assigned.
What You'll Bring
- Bachelor degree in computer science or a related discipline preferred
- 7 years of software development experience.
- Must have knowledge or experience using various Microsoft and web development technologies including but not limited to: ASP.Net, C#, MVC, WebForms, WebServices, Sql Server, T-SQL, LINQ, HTML5, jQuery, Ajax
- Must have a strong understanding of agile software development.
- Must be able to apply Object Oriented Development and Design methodology.
- Excellent communications and interpersonal skills.
Who We Are
At TransUnion, we are dedicated to finding ways information can be used to help people make better and smarter decisions. As a trusted provider of global information solutions, our mission is to help people around the world access the opportunities that lead to a higher quality of life, by helping organizations optimize their risk-based decisions and enabling consumers to understand and manage their personal information. Because when people have access to more complete and multidimensional information, they can make more informed decisions and achieve great things.
Every day TransUnion offers our employees the tools and resources they need to find ways information can be used in diverse ways. Whether it is helping businesses better manage risk, providing better insights so a consumer can qualify for his first mortgage or working with law enforcement to make neighborhoods safer, we are improving the quality of life for individuals, families, communities and local economies around the world.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Meet Some of TransUnion's Employees
Technical Systems Engineer
TC's main responsibility is to make sure all of the TransUnion Windows-based systems, across every office, are fully operational and available at all times.
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Hi Everyone
My husband and I are TTC (since June 2012). We couldn't before that as I had endometrial hyperplasia (pre cancerous cells). We have had 4 months on clomid 50 100 150 and 200, I only O'd on the 50mg. Our FS is suggesting straight to IVF, but I think he has his bank account in his best interest as opposed to us.
A little backstory about me, at the start of 2011 I weighed 103kg! was not on any bcps and had no period for 9 months (my head was in the sand). By December last year I weighed 68kg (happy dance!), to which I still currently weigh!
I have been diagnosed with PCOS and am on 1500mg met a day. No other health probs. I did have a regular 30 day cycle before I stacked on the weight.
So my question is should we wait a little while and see if I get a cycle or just jump into IVF. We are very ready for a baby but don't want to muck around too long....


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The commotions began early last week when the human rights group Humans Against Death And Discrimination, led by John Wilkins, launched a series of protests against the National Park Service for refusing to accept the demands that included the "bulldozing of wild forests," "extermination of all deadly animals with sharp teeth," "lowering of water levels in rivers to 12 inches" and "paving of green fields to build hospitals and handicap centers." Wilkins commented to the National Park Tribune:
"Where is our freedom in this country? Millions of obese, stupid, deformed and otherwise handicapped American citizens and foreign tourists alike are being discriminated by the uncontrollable forces of nature. What happens if a dangerous tree suddenly falls down and kills someone or if any of those blood thirsty bears come up and swallow a poor autistic child alive! America, take your responsibility!"


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More choices at Victor Chandler
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- September 16th, 2010
- By Natalie Stephanopoulos
The internet gambling sites of the Victor Chandler group will soon be offering their 500 000 players in 160 countries additional game choices, following an agreement with software developer Wagerworks.
The software provider, which is a subsidiary of IGT, announced the deal this week, revealing that it will be supplying a portfolio of popular Wagerworks titles via the Openbet Fixed Odds Gaming Framework.
The selection includes Cleopatra, MONOPOLY with Pass "Go" Bonus, MONOPOLY on a Roll, CLUEDO, Rainbow Riches, Pots of Gold, Elvis Top 20, Ca$hino and Wheel of Fortune Hollywood Edition.
Oliver Lofthouse, director and general manager at Wagerworks said, "Continuing to gain distribution of our market leading slot content with a company such as Victor Chandler, a company known for the quality of their online gaming, is a pleasing result."
"Wagerworks are one of the leading games suppliers and have a fantastic portfolio of entertaining titles," said Andrew Dymock, head of casino and games for Victor Chandler. "We are thrilled to be able to utilise them via Openbet and expect they will be very popular with our customers on victorchandler.com."
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|Science & Medicine
The Skeptics' Guide to the Universe is a weekly science podcast discussing the latest science news, critical thinking, bad science, conspiracies and controversies. -The Skeptics' Guide to the Universe: Your escape to reality - Produced by SGU Productions, LLC: http://www.theskepticsguide.org
April 21st, 2012
Episode 353 of 608 episodes
This Day in Skepticism: The Surgeons Photo; News Items: Life on Mars, Indian Skeptic Charged with Blasphemy, Multitasking, Monkeys Recognize Words, Cosmic Superwinds; Who's That Noisy; Your Questions and E-mails: Titanic Correction, Advanced Dinosaurs; Science or Fiction
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We demonstrate a photonic approach to simultaneously realize a frequency-multiplied and phase-shifted microwave signal based on the birefringence effects in the high nonlinear fiber. The phase shift caused by asymmetric variations in refractive indexes of fiber between two orthogonal polarization states is introduced into two coherent harmonic of the modulated signals. By beating the phase-modulated sidebands, a frequency-multiplied microwave signal is generated and its phase can be adjusted by simply controlling the pump power. A microwave signal at doubled- or quadrupled-frequency with a full 2π phase shift is obtained over a frequency range from 10 GHz to 30 GHz. The proposed approach has the potential applications in the system with larger-broadband, higher-frequency and -data-rate system, even to handle a multi-wavelength operation.
© 2014 Optical Society of AmericaFull Article | PDF Article
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Original article available at ZETA
Translated by El Wachito
During Wednesday afternoon of October 18 in the area of La Mesa de Tijuana, Federal Ministerial Police and elements of the Preventive State Police (PEP) pointed their firearms at each other after an argument that led to hand to hand combat. PEP officers accused the Ministerial officers of attempting to rescue 3 criminals who were in their possession. Meanwhile, Ministerial officers accused PEP of trying to extort criminals by stealing from them, and lying about being Ministerial officers.
|Criminals detained during the operation
In front a house located in 12850 of the Las Ferias avenue of the Colonia Lomas de Agua Caliente, the State police had laying on the ground 3 criminals, identified as Arturo Felix, Rigoberto Mendoza and Jonathan Flores. They were found in possession of meth and the house in front was identified as a possible laboratory of drugs.
At the moment a meeting was taking place at the Second Military Zone Base. A meeting of coordination with the members of the area of operations of the Consejo Estatal de Seguridad de Baja California (Security council), in the meeting the boss in charge of Minor Scale Drug Dealing "received a phone call" informing him of the address, and that a small group of man who identified themselves as elements of the Minor Scale Drug Dealing Department of the PGJE were asking 50000 USD to the detainees in order for them to be liberated. Therefore a group of man were sent to confirm the facts and stop the extortion, according to the PGJE.
Meanwhile from the Secretaria the data regarding this event is different, there is no complaint phone calls, and the PEP were conducting an operation that only the superiors knew of, and they assured that there is a registry of calls.
According to the State Police the Ministerial officers failed to identify themselves, and were trying to take the detainees with them "rescue" therefore PEP elements assumed a defensive position. They pointed their guns, insulted and accused each other of forming part of the criminal organization; PEP asked for reinforcements, and "two Ministerial officers were man handled".
The bosses communicated themselves through phone lines, and they demanded a change in attitudes and a claimed that there was a lack of coordination between corporations. It was confirmed that in both cases the personnel were part of the security of the State Government, and proceeded to arrest the criminals until they were turned over this morning to the Public Ministry of the Procuraduria General de la Republica (PGR).
Additional Info from "El Mexicano"The ministerial Police defended Rigoberto Mendoza Gonzales, who according to El Mexicano (Local Newspaper) independent sources had in his cellphone the phone number of a Ministerial Officer.
The cook was Jesus Jonathan Flores Mendivil. The owner of the house 12850 was Arturo Felix Felix.
It is believed that the "Narcolaboratorio" (Drug Lab) belongs to CJNG.
860 grams of meth and a 2009 Dodge Ram white pick up truck with a cooler that contained 430 grams of meth were confiscated.
In the patio of the house plastic containers with 200 liters of an illegal liquid substance and another 200 kilos of the synthetic drug and chemicals were found.


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A blonde haired flammer that cheerleads and yells alot when he gets mad and laughs histerically when its not funny at all!
Anthony is a yante because he fucked Vir while laughing like a bitch and yelling
by Lloyd Banks July 24, 2004
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Comverge Announces New IntelliSOURCE Applications for iPhone to Help Field Technicians Streamline Device Installations(January 24, 2012)
SAN ANTONIO, Jan. 24, 2012 (GLOBE NEWSWIRE) -- Comverge, Inc. (Nasdaq:COMV), the leading provider of Intelligent Energy Management solutions for Residential and Commercial & Industrial (C&I) customers, today announced the release of a new set of applications for the iPhone that are designed to help field technicians better manage the scheduling, device commissioning, testing and inventory management aspects of energy management device installation. The easy-to-use applications for scheduling, device commissioning, and inventory management are included as part of IntelliSOURCE, Comverge's industry-leading enterprise-class software platform and operating environment.
IntelliPORT, which enables both Comverge and non-Comverge technicians to test installation of Comverge's IntelliPEAK digital control units (DCUs) using an iPhone or iPod touch, is available exclusively on Apple's online App Store. IntelliPORT requires an infrared adaptor that attaches directly to the hand-held device.
"With 87 percent of all residential demand response devices deployed in North America, Comverge provides the industry's most widely deployed intelligent energy management solutions," said R. Blake Young, president and chief executive officer of Comverge. "Our new set of applications for the iPhone represents our focus on delivering solutions that are designed to help customers and Comverge field technicians operate more efficiently. We believe the solutions will also help Comverge more effectively deliver on its programs through better management of technician time as well as improved inventory management."
The IntelliPORT App is available for free from Apple's App Store on iPhone and iPod touch or at www.itunes.com/appstore/. Terms, conditions and restrictions apply.
About Comverge
With more than 500 utility and 2,100 commercial customers, as well as five million residential deployments, Comverge brings unparalleled industry knowledge and experience to offer the most reliable, easy-to-use, and cost-effective intelligent energy management programs. We deliver the insight and control that enables energy providers and consumers to optimize their power usage through the industry's only proven, comprehensive set of technology, services and information management solutions. For more information, visit www.comverge.com.
Caution Regarding Forward Looking Statements
This release contains forward-looking statements that are made pursuant to the safe harbor provisions of Section 21E of the Securities Exchange Act of 1934, as amended. The forward-looking statements in this release are not and do not constitute historical facts, do not constitute guarantees of future performance and are based on numerous assumptions that, while believed to be reasonable, may not prove to be accurate. These forward looking statements include successful implementation of the program, anticipated results, expectations of future performance under the program and certain assumptions upon which such forward-looking statements are based. The forward-looking statements in this release involve a number of factors that could cause actual results to differ materially, including risks associated with Comverge's business involving our products, the development and distribution of our products and related services, regulatory changes, economic and competitive factors, our key strategic relationships, and other risks more fully described in our most recently filed Quarterly Report on Form 10-Q and Annual Report on Form 10-K. Comverge assumes no obligation to update any forward-looking information contained in this press release or with respect to the information or announcements described herein.
CONTACT: Jason Cigarran
Vice President, Marketing and Investor Relations
Comverge, Inc.
Page: 1
Related Keywords: ENERGY, SOFTWARE Inc., , Apple Computer, Business, Other,


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China media ethics debate rages as beverage giant slams paper for alleged smear
Nongfu Spring says Beijing Times reports on its water quality were orchestrated attack
Nongfu Spring, a leading national seller of bottled drinking water, has filed a complaint against the Beijing Times for publishing "false reports" about its water quality for a whole month, the company said in a weibo post on Monday.
The Hangzhou, Zhejiang-based company says it was retaliating against a series of 76 incriminating reports in the influential metropolitan subsidiary of the People's Daily earlier this year.
Sales reportedly came to a standstill in the city after the Beijing Times alleged that the water standard used by the company was inferior to Soviet standards in a series of articles that spanned over a month between April and May.
Nongfu says the 76 articles of reporting by the Beijing daily were false and constituted an orchestrated attack against the company. It has filed a complaint with the General Administration of Press and Publication, the state press regulator in charge of issuing publication licences, it said.
Representatives of the Beijing Times have not yet responded to the allegations. They have previously stood by their reports.
Nongfu's counter-attack comes half a year after the reports began, but just one day after a national meeting between senior editors and state regulators at the All-China Journalists Association in Beijing. Di Huisheng, the association's Communist Party secretary, announced measures taken by the central government to curb "targeted news extortion", namely incriminating reports on companies by journalists who were tipped off and, allegedly, handsomely rewarded by competitors.
In addition to ongoing Marxism classes for all of China's roughly 300,000 accredited reporters, producers and editors, Di said five provinces were leading a pilot project with the establishment of "news morality committees". The party's Central Discipline Inspection has also hired 40 staff to better oversee the nation's journalists, he said.
He referred to the case of Chen Yongzhou, a reporter with the Guangdong-based New Express newspaper, as an example of how journalism had been corrupted in the country. Chen was detained in October for "harming the commercial reputation" of Zoomlion, China's second-largest maker of construction equipment, in a series of reports which alleged accounting fraud.
His newspaper rushed to his defence and called for his release in two front-page editorials, and other newspapers followed suit. Di's national journalism association in a rare move also called for an investigation into his detention.
However, a week later, China Central Television aired an interview with the journalist, wearing prison clothes, in which he admitted that he had been paid by an unnamed third party to publish these articles under his name, once even without reading it.
The extra-judicial confession, which violates the new criminal procedural law, led Di's association to condemn Chen's behaviour. The New Express recanted its defence of its reporter and published a front-page apology.
"Some journalists don't understand that they should pass on positive energy to realise the 'Chinese Dream'," Di said, referring to a recent party slogan. He added that journalists violating this principle would face administrative and legal repercussions.
Curiously, he mentioned another journalist's case along with Chen: that of Xi Yongfen, the China Economic Times bureau chief in Henan province. So far, little is known about his fate.
Xi's name has not appeared in news reports and staff reached in the paper's editorial department in Beijing referred questions on his whereabouts to the Henan provincial government's Press and Publication Bureau, which declined to comment. His mobile phone and his office phone numbers have both been deactivated.
For Florian Schneider, a lecturer in politics of modern China at Leiden University, the new measures will not make journalism any better in China. "Professionalism in journalism cannot simply be dictated top-down, particularly in a media system that prompts journalists to produce commercially motivated articles, and that regulates their performance with bonuses structures and other financial incentives," he said.
"Rather than punishing journalists for chasing after the money, it might be wise to ask why they need to chase after the money in the first place."
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Leah Remini & Sofia Bella Pagan (Getty)
1. Miley's performance at the VMAs did NOT rub Liam the right way. (AP/Invision)
2. You could say Miley sort of has a different interpretation of privacy than Liam. (Courtesy Of Instagram)
3. Miley and Liam's careers are definitely headed in different directions. (Courtesy Of Hollywood Records, Lionsgate Entertainment)
Miley Cyrus & Mike Will Made-It at the VMAs on Aug. 25 (Getty)
5. A source tells HollywoodLife.com that Liam isn't even putting effort into the relationship anymore. And it shows. (FameFlyNet)
6. Did Miley kiss someone else?! (Twitter)
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Can a vegetarian person get a good meal at this restaurant?
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Thanks for helping!
Good, solid food, good, solid, friendly service. the kind of place you don't go to for fine dining or to impress the boss, but once a week, because the food and the people are great. We love it and it's very popular.
In the evening, we had been there for a short break. Good pizza, friendly service and a Grappa before we left. Enjoyed the evening
We were taken to this restaurant whilst on a business trip near Dusseldorf for a bite to eat.
The ambiance and décor of the interior was old and rustic with a quaint Italian charm. We were greeted by the owner as he tries to welcome all newcomers to the restaurant and being the middle of the day and the place...
this was our second visit in this restaurant, the food is okay, but one of the persons working there is not very nice trying to get to private with the customers and was very rude to me and do to that person we will not go there again. The food taste good and the place looks okay but the atsmofere...
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$339.56Go to Jet.com
Versatile 72in high Combination Cabinet can handle coats, hats, supplies and much more. Ideal where space is at a premium. Shelves adjust in 2in increments. Offers heavy-duty construction, reinforced...More
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Schneider Xpress Porous Point PensFelt-tip/Porous Point Pens
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Hotels in La Serra
Hotel reservation
La Serra
Hotel rooms in La Serra
There are not so many hotel rooms in La Serra, just 8, still everyone can find an offer to suit his choice. The most common offers in this city are 3 и 4 stars, they count 1 out of 8, and their prevalent location is central district. According to our practice, it is the most profitable to book a hotel in the north of La Serra, as it is the location of the hotels with optimal cost and quality offers along with the cheap hotels. Taking into account the small size of the city, there is no need to dwell hotel reservation on the location: the road to the city center would take less then half an hour, so one can book a hotel in any district of La Serra. The most populated with hotels district of La Serra is the center, 62% of cheap hotel rooms are concentrated here. La Serra is an ideal place for couple and business, such travellers rate hotels there 8.2 out of 10 on average. The view to sea from the hotel room can serve as a pleasant addition to the journey. Apart from all these, hotels in La Serra offer their customers concierge service, laundry service, pets allowed and bar. The most appreciated amenities in La Serra hotels are food and service. According to the visitors reviews, hotels in La Serra has fantastic service, delicious food and beautiful beach. Take a look at our selection of the cheap hotel rooms in La Serra to make a well-informed choice for your reservation!
La Serra cheap hotels
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La Serra
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Best hotels in La Serra
Hotels in La Serra are spread around the city within the distance of 1 kilometers, while 5 hotels are located directly in the city center. Those who are keen on antique should definitely fall in love with
Hotel Il Vascello
, the oldest hotel of La Serra, constructed in 1972. This hotel is located 0.4 km away from the city center. The most popular accommodations in La Serra is
Casa Vacanze al Mare in Salento
located in a 1 kilometers from the city center.
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Genital funsi
Hello doctor, i have a small funsi like thing on my genital. It is since past 5-6 years. It does not pain. But it itches. Should i consult a doctor regarding this ?
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Doctor Answers (1) on Genital funsi
Hi there, it's unfortunate that you are suffering from it since years. Please keep good personal hygiene, keep the part dry always, dry your undergarments in sun and wash it separately. I suggest it's better you consult a doctor as soon as possible instead of using some otc medications. Hope it helps.
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from £0 / night help Price for guests, Nights
- 2 bedrooms
- 4 sleeps
- min stay varies
- Condo
- 2 bedrooms
- 4 sleeps
- min stay varies
Condo / 2 bedrooms / 2 bathrooms / sleeps 4
Key Info
- Beach / lakeside relaxation
- Nearest beach 8 km
- Child friendly
- Car essential
- Ask about pets
Description from owner
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- Great for children of all ages
- Some pets are welcome - please contact the owner
Bed & bathroom
- 1 Double Bed, 2 Single Beds
- 1 Family bathroom, 1 Shower room
- Jacuzzi or hot tub
- Balcony or terrace
- Fireplace
- Cooker
- Fridge
- Freezer
- Kettle
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- Parking
- Secure parking
- Not suitable for wheelchair users
- Payment
- This rental can only be paid for online through Holiday Lettings using your credit/debit card or PayPal (never by bank or wire transfer).
- Smoking
- No smoking at this property
- Cancellation policy
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About the owner
Giuseppe D
- Response rate:
- 40%
- Calendar updated::
- 27 Feb 2017
Languages spoken: English, French, Italian
This Condo has 2 bedrooms, 2 bathrooms and sleeps 4. It's been listed on Holiday Lettings since 02 Apr 2014. Located in Casal Velino, the average weekly rate is £0.
The Owner has a response rate of 40% and the property's calendar was last updated on 27 Feb 2017.
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The main histologic feature of celiac disease is increased intraepithelial lymphocytes (IELs) with or without villous atrophy of the duodenal mucosa. The aim of this study was to document a broad range of additional morphologic changes in intestinal mucosa biopsy specimens from patients with celiac disease. Our cohort comprised 150 patients with positive tissue transglutaminase serologic findings; 7 were at Corazza stage A1, 58 at stage B1, and 85 at stage B2. IEL counts per 100 epithelial cells ranged from 34 to 156 (mean, 88.6); a significant neutrophilic infiltrate was present in 85 cases (56.7%); eosinophil count ranged from 3 to 50 per high-power field (mean, 14.6). Additional findings included morphologic changes in enterocytes in 68.7%, subepithelial collagen thickening in 45.3%, and associated lymphocytic gastritis in 30.4% of patients. We demonstrated that these underrecognized features, which can be misleading, are not uncommon in celiac disease and were positively associated with more advanced stages of the disease (P < .0001).
Upon completion of this activity you will be able to:
describe a broad range of morphologic features that can be found in duodenal biopsy of patients with celiac disease.
correlate the presence of histologic features in duodenal mucosa of celiac disease patients with the severity of the disease.
discuss extraduodenal gastrointestinal conditions in celiac disease patients.
The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.
The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.
Questions appear on p 158. Exam is located at www.ascp.org/ajcpcme.
Celiac disease is a chronic immune-mediated disorder induced by dietary exposure to gluten in genetically predisposed individuals. It may affect as much as 1% of the population, with many cases remaining undiagnosed.1–3 The proximal small intestine is the major site of disease. Increased intraepithelial lymphocytosis, with or without concomitant villous atrophy, is the characteristic histologic finding. While histologic examination remains the "gold standard" for diagnosis of celiac disease, changes can be subtle when duodenal villous architecture is intact,4 and villous atrophy may also be encountered in various other conditions.5 Similarly, serologic testing using an enzyme-linked immunosorbent assay for antitissue transglutaminase (tTG) antibodies, which recognizes an important enzyme in celiac disease pathogenesis, is not fully sensitive or specific for the disease.6 In practice, a combination of clinical suspicion, morphologic abnormality, and positive serologic findings is used for the initial diagnosis of most patients with celiac disease. Subsequent clinical, serologic, and/or biopsy demonstration of improvement with a gluten-free diet is necessary for a definitive diagnosis of celiac disease.1,3,7
Interest in the morphologic features of celiac disease has renewed as we endeavor to identify cases with atypical biopsy findings that may lead to misdiagnosis. The recognition of disease patchiness, variability in villous architectural change, and cases with no architectural disturbance are among these atypical patterns.4,8–11 Likewise, while much attention has focused on intraepithelial lymphocytosis in celiac disease, there is less quantified information on the presence and significance of the lamina propria inflammatory infiltrate that is a common part of the disease.
This study was undertaken to document a large range of histologic features noted on initial gastrointestinal tract biopsy in a series of consecutive patients. These patients were diagnosed as having celiac disease on the basis of clinical suspicion, raised tTG level, and intraepithelial lymphocytosis in the proximal small intestine. The study focused on the presence and significance of morphologic changes in proximal small intestinal biopsy specimens and their correlation to the presence of extraduodenal lymphocytic inflammation.
Materials and Methods
The primary aim of this study was to examine the histopathologic features in initial index small-bowel biopsy specimens from patients with celiac disease. The study cohort was obtained by searching the laboratory database of Sullivan Nicolaides Pathology (Taringa, Australia) to identify histologic specimens containing the words "celiac disease" over a 12-month period, in the clinical notes, body of report, or final diagnosis. All pathology reports were reviewed. Levels of tTG for each patient displaying intraepithelial lymphocytosis with or without villous atrophy were checked and only those with an elevated level were included. Patients who had had a previous diagnosis of celiac disease were excluded. The ultimate study group comprised a consecutive cohort of patients with elevated tTG levels and abnormal proximal small intestinal biopsy findings.
For evaluating each level, 3 sections from each tissue block were routinely stained with H&E. Further levels were evaluated in cases in which the biopsy orientation was suboptimal in the initial sections and when additional staining was performed. Patient age and sex were documented. The serologic status of tTG was recorded from the laboratory information system; tTG levels greater than 100 were reported as ">100." All biopsy specimens were reviewed by one of the authors (I.S.B.) to assess for the following 10 features: (1) number of biopsy fragments received; (2) modified Marsh-Oberhuber stage12 and Corazza stage13 for each biopsy fragment Table 1 and Table 2; (3) intraepithelial lymphocyte (IEL) density, counted on H&E-stained sections as number of IELs per 100 epithelial cells in the biopsy fragment with the highest density of IELs (the IELs were counted at ×400 magnification along the luminal border, avoiding the crypts); (4) lymphoplasmacytic infiltration, graded in 3 tiers: grade 0 for inflammatory cells in less than 1/3 of the lamina propria surface, grade 1 for inflammatory cells in up to 2/3 of the lamina propria surface, and grade 2 for full thickness of lamina propria occupied by inflammatory cells14; (5) neutrophilic infiltration, graded by the finding of any neutrophil collection (≥5 cells) in lamina propria only for grade 1, or multifocal infiltration including neutrophilic exocytosis, cryptitis, and crypt abscess for grade 2; (6) eosinophilic infiltration, counted as maximum number of eosinophils per high-power field (hpf; ×400; Olympus BX 41 microscope [Olympus America, Center Valley, PA]); (7) presence of abnormal surface enterocytes defined as a loss of the normal columnar appearance leading to a more cuboidal shape ("cuboidalization") with loss of cytoplasmic mucin (the presence of prominent cytoplasmic vacuolization ("lipid hang up"), defined as present in most of the cells in at least 1 biopsy specimen, was also considered an enterocyte abnormality); (8) Paneth cell density, counted as maximum number of Paneth cells per high-power field on H&E sections (×400; Olympus BX 41 microscope); (9) appreciable thickening of the subepithelial basement membrane in well-oriented biopsy specimens (Trichrome stain and HVG stain were used in cases with this feature only; maximum thickness of the collagen band was assessed via an ocular micrometer); and (10) concomitant biopsy findings in other parts of the gastrointestinal tract were also recorded where available, with respect to the presence of increased IELs and diagnostic features of lymphocytic gastritis and lymphocytic colitis. Criteria for significantly increased IELs were more than 20 IELs/hpf in the esophagus,15 more than 25 IELs/100 epithelial cells in the stomach,16 more than 25 IELs/100 epithelial cells in the ileum,17 more than 10 IELs/100 epithelial cells in the colon.18 Gastric biopsy specimens with nonspecific chronic gastritis or lymphocytic gastritis were examined for Helicobacter pylori using a Romanowsky stain and/or immunohistochemical examination.
Statistical analyses were performed with SPSS statistics software version 17.0 (SPSS, Chicago, IL). Categorical variables were compared using the χ2 test. Means of 2 or more groups were compared using the Mann-Whitney U test or analysis of variance 1-way test as appropriate. A 2-tailed P value was used in all analyses and a P value of less than .05 was used to determine statistical significance.
The study group of 150 patients consisted of 103 female and 47 male patients (female-male ratio, 2:1). Patients ranged in age from 1 to 84 years (mean, 37.9 years). Twenty-two patients (14.7%) were 60 years of age or older while 29 patients (19.3%) were 20 years or younger. The number of biopsy fragments received per case ranged from 1 to 8, with a median of 4, comprising a total of 576 biopsy fragments in this series. In 38 cases (25.3%), fewer than 3 biopsy fragments were received.
The main clinical and pathologic characteristics are summarized in Table 3. The distribution of the histologic stages was as follows: 7 patients had Corazza stage A1 lesions, comprising 5 with modified Marsh stage 1 and 2 with modified Marsh stage 2 lesions; 58 patients had Corazza stage B1 lesions comprising 22 with modified Marsh stage 3a and 36 with modified Marsh stage 3b lesions; and 85 patients had Corazza stage B2 lesions, all corresponding to modified Marsh stage 3c. Of 146 patients with more than 1 small bowel biopsy specimen, 35% had modified Marsh stages: variability of 1 stage in 30 cases (20.6%), 2 stages in 15 (10.3%), and 3 or more stages in 6 cases (4.1%). In 1 biopsy set, a Marsh stage 0 was encountered in 1 fragment while other fragments displayed Marsh 3b and 3c patterns. A Marsh stage 1 lesion was encountered in at least 1 biopsy specimen in 11 cases (7.3%).
Levels of tTG ranged from 7 to more than 100, with 68 patients having more than 100 tTG levels. Patients with a tTG level of 20 or more were significantly older than patients with a tTG level less than 20 (mean age, 47.3 vs 35.2 years, P = .002). A positive correlation was found between the level of tTG and the severity of architectural changes as measured by the Corazza staging scheme (P < .0001).
The degree of inflammation in the duodenal mucosa was assessed by the number of IELs per 100 epithelial cells, the density of lymphoplasmacytic infiltration, the grade of neutrophilic infiltration, and eosinophil counts. The number of IELs ranged from 34 to 156 (mean, 88.6). A higher IEL density was positively associated with increasing Corazza stage (P < .0001) Table 4. A significant increase in lamina propria infiltration by lymphoplasmacytic cells was observed in 137 cases (91.3%), with 114 cases showing mild grade 1 infiltration and 23 cases showing grade 2 infiltration, which correlated with advanced Corazza stage (P < .0001). Of the 13 cases without appreciable chronic inflammation, 5 were Marsh stage 1 lesions. Neutrophil collections were observed in 85 cases (56.7%), with 62 cases (41.3%) showing focal infiltration in the lamina propria and 23 cases (15.3%) with multifocal infiltration, including crypt abscess in 2 cases (1.3%) Image 1A. No ulceration was seen in any case. Eosinophilic infiltration ranged in number from a maximum of 3 eosinophils up to 50/hpf (mean, 14.6) Image 1B. An eosinophil count of more than 20/hpf was found in 37 cases overall (24.7%). No increased eosinophil counts in peripheral blood or in the mucosa of other intestinal parts were found in these patients. Higher eosinophil count or increased neutrophil density had a strong statistical association with advanced Corazza stage (P < .0001) (Table 4).
Surface enterocytes displayed abnormal morphologic features, such as cuboidalization in all biopsy fragments, in 103 cases (68.7%). None of the Corazza stage 1 cases showed this feature. Cytoplasmic vacuolization was a widespread, prominent feature in 3 cases. Most biopsy specimens displaying enterocyte abnormalities showed at least focal cytoplasmic vacuolization. Surface enterocyte abnormalities were more frequently found in Corazza stage B2 cases than in stage B1 cases (P < .0001) (Table 4). Paneth cell count ranged from 0 to 44/hpf (mean, 14.9/hpf). The number of Paneth cells in advanced stages of celiac disease decreased nonsignificantly (mean, 19.1/hpf in stage A1, 15.7/hpf in stage B1, and 14.0/hpf in stage B2; P = .17) (Table 4). No correlation was found between Paneth cell count and the density of any inflammatory infiltrate.
A subepithelial band thickening greater than 1.5 μm was seen in at least part of 1 biopsy fragment of 68 cases (45.3%) Image 1C and Image 1D. The band measured up to 20 μm in thickness, but was less than 10 μm in all but 4 cases. This feature was mostly encountered in B2 rather than in B1 stage cases (63.6% vs 24.1%, P < .0001). The appearance of the subepithelial thickening on the special stains was consistent with minimal collagen deposition. Capillary vascular congestion did appear to exaggerate the impression of an expanded subepithelial collagen plate in most cases.
Biopsy specimens from at least 1 other gastrointestinal tract site (esophagus, stomach, ileum, and colon) were available in 99 patients. A significant increase in IELs was found in 7 (28%) of 25 esophageal biopsy specimens, most of which were from the distal esophagus and likely to be related to reflux disease. Twenty-four (30%) of 79 gastric biopsy specimens demonstrated increased IELs with chronic inflammation in the lamina propria in keeping with lymphocytic gastritis Image 2A. No case of Helicobacter pylori infection was found. In 1 (17%) of 6 ileal biopsy specimens, and in 7 (54%) of 13 colonic biopsy specimens, IEL count was found to be increased. Of the 7 positive colonic biopsy specimens, 4 had additional inflammatory changes of lymphocytic colitis (4 [31%] of 13) Image 2B while 3 were considered intraepithelial lymphocytosis only. Interestingly, a significant positive association was found between the presence of lymphocytic gastritis and the degree of neutrophilic inflammation in the duodenal biopsy specimen (P = .006) Table 5. A trend for a positive association between the presence of lymphocytic gastritis and IEL count (P = .08) or eosinophilic infiltrate (P = .1) was also noted. In addition, lymphocytic gastritis was more likely to be found in patients with more advanced stage celiac disease (0% of Corazza stage A1, 14.3% of Corazza stage B1, 47.6% of Corazza stage B2 patients, P = .002). No association was found between histologic variables in the duodenal mucosa and the presence or absence of lymphocytic colitis.
This study examined a comprehensive range of histologic features of celiac disease in duodenal biopsy specimens and associated changes in specimens taken from other gastrointestinal tract sites, in a series of 150 consecutive, serology-positive, first-time cases seen in a community-based laboratory setting. We chose these criteria to focus on additional inflammatory changes not commonly described in the duodenal mucosa of patients with celiac disease. Our findings confirm previous reports that celiac disease is at least twice as commonly seen in female patients, though the reason for this is uncertain.2 The age range at the time of diagnosis was 1 to 84 years, with 14.7% of patients aged 60 years or more, confirming that presentation in later life is not uncommon.19
Recent studies have highlighted histologic variability in celiac disease severity. Up to 25% of adults and 50% of children have been reported to exhibit variable degrees of villous architectural changes in multiple biopsy fragments.20,21 We found variability of at least 1 Marsh stage in 35% of biopsy specimens we examined. This figure may underestimate the true degree of variability in the proximal small intestine in celiac disease because fewer than 3 biopsy specimens were received in 25.3% of cases. In a retrospective study, Pais et al22 reported 25% of duodenal biopsy specimens to have at least 1 Marsh stage difference between biopsy fragments. The problem of variability has led to calls for at least 3 or 4 biopsy specimens20,21 to be taken to avoid possible underdiagnosis. A previous series reported a histologically normal biopsy finding in up to 36% of otherwise abnormal specimens.11 In our series, the rate of normal biopsy specimens or specimens with only intraepithelial lymphocytosis was low. This is possibly caused by our study selection criteria because we only included cases with positive serologic findings and abnormal duodenal biopsy findings suggestive of celiac disease.
An important aspect of our study is the careful description of various types of inflammatory infiltrate encountered in celiac disease. Lymphocytes and plasma cells are typically conspicuous in the lamina propria of the duodenal mucosa; however, as highlighted in our series, cases without villous change usually do not display this feature. A neutrophilic infiltration is also a common feature in duodenal biopsy specimens from patients with celiac disease.23 We found at least focal lamina propria neutrophilic infiltrate in 56.7%. The presence of neutrophils may cause confusion with peptic duodenitis, particularly in biopsy specimens from the duodenal bulb.24,25 Because crypt abscess formation was rarely seen and true erosion was not encountered, we believe the presence of these features should suggest an alternate diagnosis such as peptic duodenitis or nonsteroidal anti-inflammatory drug injury. Accumulation of eosinophils in the gastrointestinal tract is known to be associated with allergy, inflammatory bowel disease, infection, and neoplasms and is the main feature of eosinophilic gastroenteritis.26 Celiac disease is underrecognized as a cause of duodenal mucosa eosinophilia, probably because of the associated architectural and other inflammatory changes. An eosinophilic infiltrate of 20/hpf or more in the duodenal mucosa was encountered in 24.7% of our cases and correlated with advanced Corazza stage. Patients younger than 20 years old were found to have a particular predilection for this finding, as seen in 47% of our cases. To our knowledge, this is the first time an association between eosinophil density and stage of celiac disease is shown in a large case series. The role of eosinophils in celiac disease may involve the release of toxic cationic proteins, accounting for more severe histologic findings in patients with high eosinophil density on the small bowel mucosa.27,28 Recently, De Re et al29 found that galectin-10 expression correlated with celiac disease stage and the density of eosinophil infiltrate, suggesting that galectin-10 may be a marker of disease severity and that eosinophils can be a therapeutic target for severe celiac disease.
It has long been recognized that minimal thickening (≤5 μm) of the subepithelial collagen layer occurs in about 40% of the duodenal mucosa in celiac disease, and up to 3% of cases display collagen thickening beyond this.14,30–32 A significant proportion of our cases demonstrated thickened subepithelial collagen band, a common feature in patients with Corazza B2 stage lesions (63.6%). Celiac disease is a common underlying condition of collagenous sprue; however, there are no uniform criteria for this diagnosis.31 Because subepithelial collagen deposition is a common feature of celiac disease, it would seem prudent to require a more rigorous definition for a diagnosis of collagenous sprue.
The role of Paneth cells in immune-mediated disease of the intestines is now receiving attention.33 Data on the role of Paneth cells in celiac disease have been conflicting. Some studies reported a decrease in the number of duodenal mucosa Paneth cells in patients with celiac disease while others have not found any changes compared with normal mucosa.34–36 Other studies using different methods to quantify Paneth cells are necessary to validate this observation.
Celiac disease may be associated with lymphocytic, collagenous, and neoplastic disease in the luminal gastrointestinal tract beyond the small intestine. In our series, a gastric biopsy was performed in 79 patients, with lymphocytic gastritis found in 30.4%. This is in agreement with previous studies reporting this association in 10% to 45% of patients, with an antral predominance for gastric lesions and regression of lesions after patients followed a gluten-free diet.16,37,38 Interestingly, the presence of concurrent lymphocytic gastritis was associated with the severity of inflammation in the duodenal biopsy specimen in terms of IEL density and neutrophil and eosinophil infiltration. Bhatti et al39 also found that lymphocytic gastritis was commonly associated with severe celiac disease at the time of diagnosis.15,40 We also observed lymphocytic colitis in 31% and lymphocytic ileitis in 17% of concurrent biopsy specimens. However, only a small number of biopsy specimens were available from these sites and a definitive statement for these associations cannot be made.
In summary, histologic characteristics of celiac disease are not limited to villous atrophy and intraepithelial lymphocytosis. We report the occurrence of commonly associated features that may lead to misdiagnosis, such as prominent neutrophilic and eosinophilic infiltration, surface enterocyte changes, and subepithelial collagen thickening, all of which are more frequently found in advanced stage disease.


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Tan Hainanese Cafe
Hainanese Resataurant, Cafe, White Curry Mee, Hainanese Chicken Rice, Chicken Chop, Taiping Hor Fun
Launch of new Tan Hainanese Cafe, Taman Rawang Tin - Sunday 28 August 2016
Delicious dishes on this Hainanese Cafe menu includes :
White Curry Mee - RM 6.90
Hainanese Chicken Rice - RM 6.90
Chicken chop - RM 11.90
Fish Fillet - RM 12.90
kway teow soup / Taiping Hor Fun - RM6.90
Mushroom Soup with Garlic Bread - RM 5.90
All the dishes above will be available at Tan Hainanese Cafe,at new Taman Rawang Tin, Jalan 8a (after the school & Tenaga Nasional) on Sunday, 28 Aug 2016. Currently, the Operating hours are: 7am -12 midnight.
Prices are affordable; making it an enjoyable outing for the whole family during meal times.
Dishes are currently offered at promotional prices...if you are looking to try a new restaurant or Hainanese food, look for this Cafe and try your favourite fare!
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Hainanese Cafe, Hainanese Chicken Rice, Chicken Chop, White Curry Mee. A Cafe with beautiful Mural Painting. Dine with Hornbills (Painting) Jln 8a, new Taman Rawang Tin. 28/8/16 Launch. 7am-12 midnight.
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Namibia 1 Dollar 1993 to 2010
Namibia was a German colony in 1884 under Otto von Bismarck and was known as German South-West Africa (Deutsch-Südwestafrika). South Africa occupied the colony in 1915 after defeating the German force during World War I. Namibia it gained it sindependence from South Africa in 1990, following the Namibian War of Independence.
Coin: 19085 , Genre: Modern
Requested by: Jimmy, Mon, 13-Apr-2015 02:53:48 GMT
Answered by: Andrei, Mon, 13-Apr-2015 06:20:09 GMT
Requester description: 1998 Republic of Namibia 1998 1$ 1$ .frt
Republic of Namibia 1998
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