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Template:Infobox musical artist
Christian Chávez (born José Christian Chávez Garza on August 7, 1983 in Reynosa, Tamaulipas, Mexico) is a singer and Actor best known for his role as Giovanni Méndez López in the telenovelaRebelde and its spin off teen band RBD. After 2007, he has been open about his homosexuality.
The success of Mexican telenovela Rebelde led to the band RBD, which is gaining success in the United States. Although Chávez became famous with Rebelde, he appeared in another popular telenovela, Clase 406 as Fercho along with his Rebelde co-stars Dulce María, Anahí, and Alfonso Herrera. In June 2007, he appeared briefly in the stage show "Hoy No Me Puedo Levantar", and after May 2008 he participated in Avenida Q (the Mexican version of Avenue Q), where he played the main puppet characters Eugenio(Princeton) and Rodri(Rod), and his presence was meant to be one of the box office attractions to the show.
Personal life Edit
In early March 2007, a magazine published pictures of Chávez signing documents and exchanging rings with another man, allegedly his Canadian boyfriend, outing Chávez with them. The pictures had been taken in 2005, the year in which gay marriages became legal in Canada. Chávez declared in March 2007, that the photos showed a part of him that he had not been willing to discuss previously for fear of rejection, of criticism, and especially because of his family and the consequences that being gay would bring.[1][2]
On 30 March 2007, after Chávez's announcement of being gay, Ricky Martín told The Associated Press of his solidarity with Chávez's public declaration, saying, "Life is too short to live closed up, guarding what you say...(Chávez) has to be free in many aspects. I wish him much strength."[3]
In 2007 the singer was arrested for attempting to buy a marijuana cigarette in New York, he apologized for the event, and later his band mates made a statement giving him their support even though he had made a mistake.
In September 2007 Chavez was accused of being abusive to husband BJ Murphy. He denied the rumors as a "vile lie designed to hurt his career."[4]
In February 2008, Chávez fainted during an RBD concert in San Salvador, El Salvador. He was taken to a local hospital where he was treated for dehydration.
Though he is outspoken in supporting gay rights and opposing homophobia, he has said that he doesn't want to be seen as the representative of the gay community.[5] However in June 2008, he appeared in the front page of a new Mexican gay magazine (OHM), where he exposed a more relaxed and mature position about those subjects in an interview.
With RBDEdit
- Spanish Studio Albums
- Rebelde (2004)
- Nuestro Amor (2005)b
- Celestial (2006)
- Empezar Desde Cero (2007)
- English Studio Albums
- Rebels (2006)
- Portuguese Studio Albums
- Rebelde (Edição Brasil) – Portuguese version of Rebelde (2005)
- Nosso Amor Rebelde – Portuguese version of Nuestro Amor (2006)
- Celestial (Versão Brasil) – Portuguese version of Celestial (2006)
- Live Albums/DVDs
- Tour Generación RBD En Vivo CD/DVD (2005)
- Live In Hollywood CD/DVD (2006)
- ¿Que Hay Detrás de RBD? (2006)
- Live In Rio (2007)
- Hecho En España CD/DVD (2007)
- Rebelde DVDs
- Rebelde: Primera Temporada (2006)
- Rebelde: Segunda Temporada (2007)
- Rebelde: Tercera Temporada (2007)
- Compilations
- RBD: La Familia (2007)
References Edit
- ↑ Mexico rocked by gay pop-star
- ↑ Message from Christian Chavez on March 1st, 2007
- ↑ http://www.nytimes.com/aponline/arts/AP-People-Ricky-Martin.html "Ricky Martin Defends Gay Musicians"
- ↑ Christian Chávez niega haber abofeteado a su pareja : People en Español
- ↑ http://www.anodis.com/nota/11946.asp "No quiero ser standarte gay", afirma Christian Chávez
External links Edit
et:Christian Chávez es:Christian Chávez pl:Christian Chávez pt:Christian Chávez ro:Christian Chávez sl:Christian Chávez sr:Хосе Кристијан Чавез sh:Christian Chávez fi:José Christian Chávez Garza


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Palindrome Using BufferedReader
Write a program that reads in strings of characters and determines if each string is a palindrome. Each string appears on a separate input line. Echo-print each string, followed by " Is a palindrome" if the string is a palindrome or "Is not a palindrome" if the stringis not a palindrome. For example, given the input string Able was, I ere I saw Elba. The program should print "Is a palindrome." In detemining whether a string is a palindrome, consider uppercase and lower case letters to be the same and ignore punctuation characters and spares. The input file that you will be reading palindromes from is called "pals.txt". Look for methods like replace (), to lowerCase, to UpperCase,..etc. Write the output ( the string and if is a palindrome) to a file called "palsout.txt". Each line of text in the file pals.txt will contain a palindrome to test for. You can only use the BufferedReader class and not the Scanner class. Please examine the attachment, this is as far as I got, however I am able to compile but when executing I get and error. Please select palindrome files to save in the pals.txt file.
Solution Summary
Palindrome Using BufferedReader is utilized.

subset: commoncrawl


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Submitted by tonyhoare • May 30, 2012 www.hertz.co.nz
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AYGO x-cite
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LED daytime running lights
will make you more visible to other drivers during the day.
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Adjustable Speed Limiter (ASL)
Adjustable Speed Limiter (ASL)
This function is a control system that suppresses acceleration above a vehicle speed (speed limit) pre-set by the driver. Acting as a guide, it controls engine output so that the vehicle speed does not exceed that of the pre-set speed limit while the driver is pushing on the accelerator pedal. The pre-set speed is shown on the combimeter display and will begin flashing when the vehicle reaches this speed. Full acceleration will cancel the system.
|7" x-touch multimedia system
|Bluetooth® mobile phone connection


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Dennis Gilmore wrote:
One thing that needs consideration in the comparison is that debain splits things up in to the smallest possible binary package. We do not do that. the fairest comparison is to look at the Sources. by my count Fedora (core+extras) has ~3600 SRPMS by a count in #suse 3015 src.rpm, 54 nosrc.rpm (not sure what a nosrc.rpm is but i guess proprietary stuff)Debian im still looking to find numbers.
According to this (from cjb): http://glibc-bsd.alioth.debian.org/NOTES 5912 total source packages in unstable 157 total source packages in unreleased (includes kfreebsd specific, already removed from sid) 5495 sid source packages in unstable 112 sid source packages in unreleased ------------------------------------------- 5607 sid source packages of approx. 6800 So we're making a lot of progress, assuming this is correct. --Chris


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The technology road can be somewhat difficult to navigate as is the forever changing lanes of the finance freeway. Therefore it is our belief by partnering with our clients, we form a team which has one major objective, to drive a digital marketing campaign designed to attract and understand the consumer and their behavioural patterns.
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Evangel Church
Directions to our Kindermusik Room at Evangel Church
- Please enter parking lot and park near the last door you see - the door under the awning.
- Once inside the door, we are immediately to the right.
There will be Kindermusik signs on the door to help you, too.
Ms. Emily's text/cell phone number is 901-484-4106 in case you need to call.


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Product Details & Shipping Information
This Mizone Elliot Full Queen Comforter Set is perfect for any room. It is a mix of light blue and dark blue plaid with a hint of red stripes gives a little splash of color without overpowering the plaid pattern. The pillowcases have a solid dark blue on the back and a solid dark blue stripe on the front to tie it all together. One decorative pillow is also included in the set.
At DormSmart.com, we do our best to display product images with the most accurate color possible for our shoppers. However, due to differences in computer monitors, variations in color may occur between the actual product and your screen.


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Ford will receive a $250 million loan guarantee from the U.S. Export-Import Bank to sell 200,000 U.S.-made vehicles in Canada and Mexico, part of the Obama administration's drive to boost new hiring amid a lingering recession.
The loan announced today by the White House will finance $3.1 billion in sales of models built in six Ford plants in five states, including Wayne and Dearborn, and is expected to be paid back within a year with fees and interest.
President Barack Obama will tout exports during his speech today at Ford's plant in Chicago, which Ford retooled to build the 2011 Explorer, adding 1,200 jobs thanks in part to $5.9 billion in loans from the U.S. government for fuel-efficient vehicles. Obama has set a goal of doubling U.S. exports in five years as a way of boosting jobs among private employers who have remained reluctant to hire.
The Export-Import Bank provides financing to U.S. exporters, with $17.4 billion arranged through the first nine months of fiscal 2010:
While U.S. exports have grown this year, demand for imported goods and services have kept the national trade deficit from shrinking. In May, the U.S. trade deficit widened to $42.3 billion, its highest level in 18 months, and the deficit for automobiles and parts through March totaled $19.3 billion.
Obama administration trade officials have said the push for exports would include attempts to win congressional approval for the South Korean trade agreement, a deal backed by major business groups. But Michigan lawmakers, unions and Ford have objected, saying the deal would lower U.S. tariffs on Korean vehicles with no guarantee that U.S. vehicles could win access to South Korean consumers.
Ford will use the loan guarantees to export several models, including the new Explorer, F-150 pickup, Focus, Escape, Expedition, E-Series Van, Taurus, and Lincoln MKS and Navigator.
-- Justin Hyde/Detroit Free Press
Chris Woodyard is an auto writer for USA TODAY who covers all aspects of motoring. He revels in the exhaust note of a Maserati and the sharp creases of a Cadillac CTS. Chris strives to live a Porsche life on a Scion budget. More about Chris


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A great look for him or her, this stainless steel band features a ridged design and both a brushed and polished finish. The ring is available in size 9 only. Stainless steel rings cannot be resized after purchase.
Typographic errors are subject to correction. Merchandise enlarged to show detail and may not always be exactly as pictured. Promotions, prices, styles and availability may vary by store and online.


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This air-conditioned hotel provides a library and a business centre in addition to the other facilities. All the staff of the 137-room hotel are professionally trained to provide whole-hearted and first-rate quality service. Guests are welcomed in the lobby, which offers 24-hour reception and check-out service, a hotel safe, currency exchange facilities, a cloakroom and lift access. Dining, drinks and nightlife are provided by the caf�, bar, disco and restaurant. Conference facilities are available for business travellers, and for extra fees, guests may take advantage of room service and the laundry service.
The hotel is located in the centre of the ancient city of Xi'an, in the busiest section of the commercial centre. The hotel is just beside several well-known attractions, including the Bell Tower (around 50 m away), Drum Tower (around 100 m), ancient city wall (about 200 m) and Forest of Steles (roughly 300 m).
The hotel offers comfortable rooms including suites, big standard, small standard and single rooms, all featuring 24-hour hot water, centrally controlled air-conditioning and heating and ADSL Internet access. The en suite bathrooms are complete with a shower, bath and hairdryer. Other standard in-room features include double beds, direct dial telephone, satellite/cable TV, mini fridge and an ironing set. Non-smoking room and handicapped rooms are also available.
Table tennis facilities are available to guests.
The elegant and magnificent Ming Palace restaurant and La Pinata restaurant are located on the second floor. They serve a wide variety of deliciously flavoured dishes. Buffets are served at breakfast and lunch, lunch and dinner are offered � la carte, and a set menu is also offered in the evening. A professional sound system and supporting facilities can be provided for wedding parties, long-life parties, children's month parties and other group parties, whilst all kinds of buffets can also be arranged.
American Express, Diners Club, JCB, MasterCard and VISA are accepted as methods of payment.
Room Facilities:
Direct dial telephone
Satellite cable TV
Internet access
Mini fridge
Iron and board
Double bed
Central airconditioned
Central heating


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Entry requirements
Applicants should have an accredited BEng honours degree and be in relevant employment. Suitable applicants will then be invited for interview. Applicants who are IEng accredited or have completed an academic review by a professional body may also be considered.
Months of entry
September, August, July, June, May
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This innovative and flexible part-time course allows you to gain a Masters qualification and progress towards Chartered Engineer (CEng) status through activities undertaken in the workplace. The course meets the academic requirements of CEng status and is available to those currently in employment who are seeking to progress.
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The degree is part of the Engineering Council's Engineering Gateways initiative. To find out more, visit www.engineeringgateways.co.uk
Fees and funding
Qualification and course duration
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- Name
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Um okay more gruesome then watching a beloved character bludgeoned to death in front of those who care about them?
Many people being upset by the death of this character really wanted to lash out, cries of "This series is crap, its going down the toilet" are running rampant. As to the chants of "why couldn't have been less important characters." Well think about that for a moment. Would the hundredth issue really been that monumental to you if someone lesser had died? Would you really have thought this issue had any impact if it had just been a bunch of deaths at the Alexandria safe zone or Hilltop colony?
Sorry to say but Robert Kirkman did live up to the hyping, I will give my take on something I did not agree on in a moment but I'll explain exactly why I felt he did.
He said it was going to be the most gruesome violent issue ever. Now considering the bloodbath of issue 48 I can understand why people were thinking "were going to get another prison arc style mass murder fest." But what would have been the point? The whole point of the prison arc was killing off characters we had gotten to know somewhat. Their deaths had impact, not just Lori and Judith, but most who died in that issue had a story that we were following even if we did not get enough of their story yet (IE Alice). So yes that mass murder fest had a big impact. But if you put it in perspective if he had offed a ton of people in 100 (which he never made any inkling or promise to do so) would you really have cared? Who could he kill at the ASZ that would have made you cringe? Nicholas? Spencer? Most of the time those guys are nothing but background characters. None of their deaths would have move me in any way. And even out of the mains that are left only two or three of them would have pulled any emotion from me. So that is why I felt the one death in issue 100 really did live up to the hype. It was gruesome, gory and absolutely horrifying. It showed the darkest side of humanity and it snuffed out a light that shined on the group for so long.
But I wont give Kirkman a complete pass...
That being said Mr. Kirkman did blunder a bit for me as well. Negan..yeah where do I start. A bit over the top for a villain then again who knows how batshit crazy we would all be after a zombie apocalypse? Seriously though as a major villain having a thug who is a sociopath is natural, but Negan is beyond ridiculous. His grinning while beating someone to death was off putting. Perhaps if he had clown makeup and green hair it would be more understandable. But to me only one villian could ever pull of that "I'm a happy maniac who grins uncontrollably while maiming and killing." So the jok..er Negan really does not come across as someone to fear to me. His organizational skills though..Not since the Gambino crime family have I seen such a well put together group of thugs. Lets face it organize crime surviving in this dead torn world is pretty interesting. And the extortion tactics of Negan makes me think thats exactly what our new bad guy used to do. Some people say military cause of his chiseled cut chin, but being a girl out of New York I can tell you, the fear tactics, use of a barbed wire bat, the F bombs (I dub Negan Captain F-Bomb) and just the way he organized a group of savages who really have no reason to follow him outside fear seems really mafia like to me. Just staring at him now, yeah he looks like a former enforcer who is now don capo.
Hoping he does not last too long as thorn in Rick's side
But even then how long will we have to put up with this goonish thugs bs? That is what worries me, I am not against the whole human's worst then zombies theme that is running. What I am against is Ricks group falling in line with something like this for too long. Negan is crazy, his group to and our band of survivors really do have something to fear with them. But I only hope that, this something does not last as long as the Woodbury arc. Why? Because Negan is no Govenor, not by a long shot. He is vile yes, he leads a big crew yes. But he is a goon, an unfunny sadistic clown and I cannot see myself finding him interesting due to that.
Still Issue 100 did the job to me for having impact
All in all issue 100 to me lived up to the hype, clownish goon villain and all. Losing a very important character to a horrifying death had more impact to me then a bloodbath could have. And it will have a lasting impact on those left behind to pick up the pieces. Just that dynamic alone has me itching for issue 101. So kudos to Mr. Kirkman and Adlard for this book and to all those who contributed variant covers. A little book about zombies has gone to 100 issues and I know I can't be the only one looking forward to 100 more.
My grade for this 9/10 would have been a perfect 10 if Negan didn't remind me of a Joker rip off.


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Month: March 2016
What Were They Thinking? Seneca Casino Sucks Life From City
What were they thinking?
Back in 2002, when the state of New York, under the leadership of then Gov. George Pataki, handed 50 prime acres of downtown Niagara Falls real estate to the Seneca Nation of Indians to settle the Grand Island land claim and allow the Seneca to open a tax free casino and hotel resort here, what was the logic?
Today, as dwindling casino revenues bite into the measly 25 percent of the slot machine take that Albany graciously allows the city to keep in return for police and fire protection, infrastructure and other amenities, and the Seneca recently announcing the opening of a tax free gasoline station and smoke shop to be opened downtown, many here are wondering how the powers that were could have entered into such a bad deal.
Urban Renewal, State Park, Power Project:, What Were They Thinking?
Stupidity and corruption of the part of city officials in Niagara Falls isn't a recent development. It is a tradition that goes back to even before the founding of this great metropolis, on March 17, 1897.
In fact, things started going downhill as early as 1885, with the creation of the Niagara Reservation, now known as Niagara Falls State Park, which is generally recognized as the oldest state park in the country.
The 435 acre park, which offers breathtaking views of the American Falls, the Bridal Veil Falls, and the Canadian Falls, as well as overlooking the Niagara River Gorge and allowing access to the Upper Rapids was once part of the city.
What Were They Thinking? Hamister Hotel Shows They Weren't Thinking At All
The Hamister Hotel deal is exactly the sort of fiasco that makes Niagara Falls such a special place. Choose a politically connected "developer" who apparently doesn't have any money, hand him a parcel of prime real estate for pennies on the dollar, along with tax breaks and other incentives, then sit back and watch the years roll by while absolutely nothing happens whatsoever.
What were they thinking?
Hamister got the nod nearly three years ago as the city's preferred developer for what is known as Parcel Four, a vacant piece of land on Rainbow Boulevard around 150 yards away from the entrance to the state park. The deal had to be done quickly, he said, so that construction could begin in the early spring of 2014.
Water Board Creation Leaves to Wonder What Were They Thinking?
At the behest of the Niagara Falls City Council, the New York State Legislature created the city Water Board back in 2002. Locally, the primary cheerleader for spinning off the city's water and wastewater treatment services was Paul Dyster, then a freshman Council member and now mayor of the city.
The board consists of five members, one appointed by the governor, one by the state Senate, one by the Assembly and one each appointed by the mayor and the Council.
In other words, Dyster and a majority of Council members, along with then mayor Irene Elia, thought it would be a great idea to give Albany effective control over the delivery of potable drinking water to the residents of Niagara Falls, as well as taking care of sewage treatment.
Terrapin Point….Off Limits
By Emma Gibbs
As another tourist season approaches, the New York State Parks Office is trying to fine tune a sale pitch explaining to some eight million annual visitors why the American side viewing area of the Horseshoe Falls is off limits.
Terrapin Point, located at the western end of Goat Island, has been cordoned off with chained link fence barricading visitors from the vista of the Falls and Lower Gorge.
The Parks is four years into a $50 million rehab project which includes renovations on Goat Island. At first glance, the project shows progress through the past winter. While numerous construction efforts on the Niagara Frontier have moved forward during the off season, the LiRo Group, prime contractor of the project, has little to show.
Great Lakes Water Withdrawal Scheme on Cuomo's Desk
Later this month, and for the second time during his five years in office, Gov. Andrew Cuomo will make a decision that has enormous implications for the future of Western New York's water resources. The Governor will either deny or support the application of the small city of Waukesha, Wisconsin, which lies outside the natural basin of the Great Lakes, to access water from Lake Michigan in order to replenish its rapidly depleting municipal water supply. While the city's request has been winding its way through the regulatory pipeline for a number of years, the governor's office has given no indication regarding his intentions in terms of whether or not, as one of eight Great Lake states governors with veto power over the proposal, he will vote to approve the unprecedented water diversion.
Tompkins, Scott Seek To Wrest Water Board Control From Albany
In addition to calling for the termination of Niagara Falls Water Board Executive Director Paul Drof, city Councilman Ken Tompkins has introduced a resolution with Councilman Ezra Scott asking that all five members of the Water Board by approved by the mayor and the Council, so as to regain city control of the municipal water supply and wastewater treatment facilities.
Currently, the governor, state Senate and Assembly name three of the board's five members, with the Council and the mayor appointing the other two.
Ortt: No State Funding for Sanctuary Cities
Please see the following statement from State Senator Rob Ortt (R,C,I – North To-nawanda) regarding the State Senate's Budget that seeks to prohibit local governments from adopting laws or policies that impede the enforcement of federal homeland secu-rity laws.
"New Yorkers are sick and tired of working hard, playing by the rules, and paying taxes only to see local, state, and federal politicians cower to reward illegal immigrants and those breaking our laws. Big cities across this nation are thumbing their noses at our rules, our laws, and our Constitution. It's time that we take a stand, here in New York, and say 'no more.' I understand that liberal special interest groups and the illegals' community in New York City have a problem with this, but I don't care. If you're a city in our state and if you refuse to follow our laws, then you shouldn't receive funding from state taxpayers. It's that simple."
Going on Two Years with the Water Board
Guest View
by Leo Zientara II
I do not know if this is something your paper is interested in covering, but no one at the water board cares so I thought maybe this would help
There is a broken water main under Pierce Ave right near Whirlpool. The leak has been there for about two years. The neighbors have called multiple times and the water board and city hall are well aware of the issue. There are holes on both sides of the street where the water comes up. There is only so much water coming up, however I am sure it is soaking into the dirt under the road. We are talking about thousands of dollars' worth of water. At this point the end of the concrete slab at the end of 721 pierce is starting to sink into the ground. The holes where the water comes up are about 6 inches deep and into loose gravel. The asphalt around them is caving in. The city cannot even fill the holes be-cause it is constantly under water.
Will Taxpayers Foot The Bill For Dyster's Personnel "Surprise"? Dyster Secret Plan To Give Raises To Appointees Requires Council Support
By Emma Gibbs
Nowhere in either his proposed or adopted 2016 Budgets did Niagara Falls Mayor Paul Dyster have the courage to introduce the plan he now wants to ask the City Council to approve sometime in April.
You read it here first.
Niagara Falls' Chief Executive has plans to present an agenda item asking the Council to sanction additional spending not authorized in any municipal spending plan.
According to city hall sources, Dyster plans to create a new job title for his current secretary, Nick Melson, purportedly relieving Melson of the traditional duties assigned to a Mayor's confidential secretary. The third term Mayor wants to name Melson as "Special Assistant to the Mayor" and give him a substantial raise.
Despite "Geno"…. Final Four Fever Spreads
By Emma Gibbs
The drama surrounding the NCAA basketball Final Fours, both Men's and Women's, approach what promises to be a frenzied finish.
On the Men's side Oklahoma faces Villanova, while the surprising 'tainted'' Orange of Syracuse University meets up with the number one-seeded Tarheels of North Carolina.
The Women's final quartet has Washington University battling the Lady Orange of Syracuse, while the ladies of Oregon State, the same group which eliminated local sweetheart St. Bonaventure in the second round, locks up with the undefeated, top-ranked ladies from the University of Connecticut.


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Congressman and Co-Chair of Travel and Tourism Caucus, Sam Farr (D-Carmel) today released the following statement hailing the Obama Administration's announcement of a national strategy to increase travel and tourism in the United States.
Earlier in the day, Co-Chairs of the House Travel and Tourism Caucus, Congressmen Sam Farr and Jo Bonner, hosted a roundtable discussion with Interior Secretary Ken Salazar, Commerce Secretary John Bryson and travel tourism industry executives regarding the challenges facing the tourism industry. The meeting also served as a platform for both Secretaries to preview the President's National Travel and Tourism Strategy to the over 40 tourism executives present.
"The United States is home to some of the most exciting and awe-inspiring tourist destinations in the world," said Congressman Sam Farr. "Our beautiful coasts, mountains, valleys and exciting cities have captivated the imagination of people all over the world. They want to come here, spend their money and have a good time. We need to let those people know that we are open for business. The President's national tourism strategy recognizes that international tourists contribute billions of dollars and create jobs in our local economies. I look forward to working with the Obama Administration to implement this strategy and increase domestic tourism."
Source: http://farr.house.gov/index.php?option=com_content&task=view&id=878&Itemid=115


text:
OK I will be betraying my ignorance on Win Server 2008 and IIS but I can't seem to find out why IIS is installed on a server at my work.
Basically all servers were installed/configured by a third-party (M.S.P.) before I started working here. And documentation is... spotty.
A file server we have (also a DC, I am aware that is not best practice) has IIS7 installed. The server is not public-facing and is a vm. The private IP address accessed by browser just ends up at the default IIS7 landing page.
How can you tell if it's being used to serve up anything? As far as I can tell there isn't but I don't want to go removing a server role willy nilly.
I looked through both IIS Manager and IIS6 Manager and don't really see anything of import but I don't really know what I'm looking for.
Thanks for any help!
Jul 14, 2011 at 1:15 UTC
SCVMM 2007 does have a user self service portal. That likely uses IIS.
7 Replies
Jul 14, 2011 at 1:05 UTC
What roles are installed on it?
If nothing that makes sense you can shut off IIS (disable service) and then see who or what screams :)
Jul 14, 2011 at 1:09 UTC
Yeah good idea.
The server has:
File Services
Also has SCVMM 2007 server installed (we got it cheap as a charity) but I don't think that uses IIS
Jul 14, 2011 at 1:15 UTC
SCVMM 2007 does have a user self service portal. That likely uses IIS.
Jul 14, 2011 at 1:22 UTC
I bet you are right-- when the MSP installed this server I'm thinking the SCVMM wizard probably prompted them to install IIS. The user portal is not enabled but I'm thinking during install they must've put in IIS.
I don't even know why SCVMM is on here, it looks like a huge enterprise management tool-- we only have 3 VMs :)
Jul 14, 2011 at 1:24 UTC
Well I went and just stopped the IIS and WWW services and no screaming yet. Thanks for the prompt reply.
Jul 14, 2011 at 1:29 UTC
Glad to help :)
Jul 14, 2011 at 2:11 UTC
We shut it off because we had an app that would not run because it was turned on at the time.
This discussion has been inactive for over a year.
You may get a better answer to your question by starting a new discussion.


text:
Optimizing Chlamydia trachomatis. pallidum. diagnostics Laura van Dommelen. and Treponema
- Marcus Pierce
- 2 years ago
- Views:
1 Optimizing Chlamydia trachomatis and Treponema pallidum diagnostics Laura van Dommelen
3 OPTIMIZING CHLAMYDIA TRACHOMATIS AND TREPONEMA PALLIDUM DIAGNOSTICS Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Maastricht, op gezag van de Rector Magnificus, Prof dr. L.L.G Soete volgens het besluit van het College van Decanen, in het openbaar te verdedigen op donderdag 31 oktober om door Laura van Dommelen Geboren te Eindhoven
5 PROMOTOREN Prof. dr. C.J.P.A. Hoebe Prof. dr. C.A. Bruggeman COPROMOTOR Dr. F.H. van Tiel BEOORDELINGSCOMMISSIE Prof. dr. N.K. de Vries (voorzitter) Prof. dr. J.E.A.M. van Bergen (AMC-UvA) Prof. dr. P.C. Dagnelie Prof. dr. G.J. Dinant SPONSORS Financial support by Stichting PAMM, MSD BV, Mediphos Group BV, apdia BV, Roche Diagnostics Nederland BV, Pfizer Nederland, BD Diagnostics, Check-Points BV, DiaSorin SA/NV, biomerieux Benelux BV is gratefully acknowledged.
7 ABBREVATIONS CDC CI Ct/CT EB ELISA FCU HBV HIV HSV IFU LGV MSM NA NAAT ND Ng NPV nvct Omp A PCR PID POC(T) PPV qnaat RB SOA SDA STD STI SVS swct Tp Tv VDRL Centers for Disease Control and Prevention Confidence interval Chlamydia trachomatis Elementary bodies Enzyme-linked immunosorbent assay First-catch urine Hepatitis B virus Human immunodeficiency virus Herpes simplex virus Inclusion forming units Lymphogranuloma venereum Men who have sex with men Not assessed Nucleic acid amplification test Not detected Neisseria gonorrhoeae Negative predictive value New variant Chlamydia trachomatis Outer membrane protein A Polymerase strain reaction Pelvic inflammatory disease Point-of-care (test) Positive predictive value Quantitative nucleic acid amplification test Reticulate bodies Seksueel overdraagbare aandoeningen Strand displacement amplification Sexually Transmitted Diseases Sexually Transmitted Infections Self-taken vaginal swab Swedisch variant Chlamydia trachomatis Treponema pallidum Trichomonas vaginalis Venereal Disease Research Laboratory test
9 Part A. Introduction 1. Introduction on sexually transmitted infections with a focus on Chlamydia trachomatis and Treponema pallidum. 10 Part B. Different Sample Types and Chlamydia trachomatis Detection 2. Evaluation of one-sample testing of self-obtained vaginal swabs and first catch urine samples separately and in combination for the detection of Chlamydia trachomatis by two amplified DNA assays in women visiting an sexually transmitted disease clinic. 30»» Sex Transm Dis Jun;38(6):533-5 Part C. Newly Developed Nucleic Acid Amplification Tests to Detect Chlamydia trachomatis 3. TaqMan assay for Swedish Chlamydia trachomatis variant. 38»» Emerg Infect Dis Sep;13(9): High concordance of test results of the rapid and easy Chlamydia trachomatis Detection and genotyping Kit compared to the COBAS Amplicor CT/NG test in females visiting an STD clinic. 42»» Submitted Part D. Point-of-Care Tests to Detect Sexually Transmitted Infections 5. Alarmingly poor performance in Chlamydia trachomatis point-of-care testing. 50»» Sex Transm Infect Oct;86(5): Evaluation of a rapid one-step immunochromatographic test and two immunoenzymatic assays for the detection of anti-treponema pallidum antibodies. 60»» Sex Transm Infect Aug;84(4):292-6 Part E. Validation of Methodology Used in Sexually Transmitted Infections Research 7. Confirmation of high specificity of an automated ELISA test for serological diagnosis of syphilis - results from confirmatory testing after syphilis screening and sensitivity analysis in the absence of a gold standard. 74»» Submitted 8. Chlamydia trachomatis DNA stability independent of preservation temperature, type of medium en storage duration. 82»» J Clin Microbiol Mar;51(3):990-2 Part F. Discussion and Summary 9. Discussion and Summary Samenvatting 106 Part G. Addendum 11. Dankwoord Co-authors (in alphabetical order) About the author List of (peer reviewed) Publications 123
11 Introduction
12 1. Introduction on sexually transmitted infections with a focus on Chlamydia trachomatis and Treponema pallidum. Laura van Dommelen
13 GLOBAL BURDEN OF SEXUALLY TRANSMITTED INFECTIONS WITH A FOCUS ON CHLAMYDIA TRACHOMATIS AND TREPONEMA PALLIDUM Sexually transmitted infections (STI) are a major medical and public health challenge, due to their high incidence and emerging threat of drug resistance. In 2008, WHO estimated million curable STI, caused by Treponema pallidum (Tp), Neisseria gonorrhoeae (Ng), Chlamydia trachomatis (Ct) and Trichomonas vaginalis (Tv). Moreover, millions of viral STI occur every year, mainly caused by human immunodeficiency virus (HIV), herpes simplex viruses (HSV), human papilloma viruses en hepatitis B virus (HBV). The number of newly acquired infections was million for Ct and 10.6 million for syphilis according to WHO. Most curable STI occur in sub- Saharan Africa (incidence 92.6 million) and the Americas (incidence million). All figures however are hampered by the lack of good prevalence studies, limited healthcare seeking and inadequate access to healthcare, among others. 1 Syphilis infection, caused by Tp, during pregnancy contributes to 650,000 fetal and neonatal deaths in developing countries, while prevention of congenital syphilis only costs $1.50 per person. Large scale screening in pregnant females in high burden countries is however not practised yet. 2 With Ct infection, under-reporting is huge because most people are not aware of their infections and do not seek help. People with genital chlamydia may experience symptoms of genital tract inflammation including urethritis and cervicitis, but the majority remains asymptomatic. Ct is a significant public health problem because untreated Ct may lead to pelvic inflammatory disease, subfertility and poor reproductive outcomes in some women. 3 Concurrent STI facilitates the transmission of HIV, which is the case in 40% of all newly acquired HIV infections, which is a concern in countries with high HIV prevalence. Furthermore, when STI coexist with HIV, higher loads of HIV are shed into genital fluids, compared to individuals who do not have a coexisting STI. All STI together cause 17% of the economic loss due to health related causes in developing countries. In developed countries, the costs for STI screening, HIV treatment, managing infertility due to STI and cervical cancer treatment are substantial. 4 Sexually Transmitted Infections in The Netherlands STI s continue to be a serious health problem in the Netherlands. Certain ethnic minorities (especially (former) inhabitants of Surinam and the former Netherlands Antilles), young persons (<25 years of age) and men having sex with men (MSM) are important risk groups for STI. 5 Ct is the most prevalent STI in the Netherlands and the incidence is highest in the heterosexual population under 25 years of age. At the different STI centres, the test positivity rate was 11.5% in the year Lymphogranuloma venereum (LGV) was only detected in MSM and 79% is known to be also HIV positive. The test positivity rate for Ng was much lower, 3.2%, and was mostly detected in MSM. Syphilis was rare: only 476 cases were detected in Almost 90% of the cases concerned MSM and the positivity rate has decreased since 2007 (from 4.3% to 2.0% in 2011). The prevalence of syphilis among pregnant women was estimated at 0.2% in 2009, which is a slight increase compared to previous years. 5 Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum 11
14 Most first-line STI related consultations are handled by the general practitioner (63%) 6 ; the remaining consultations are mainly managed in STI clinics (e.g. Public Health Service). Standard STI testing includes Ct, Ng and syphilis. HIV opting out is now widely practiced, which means HIV testing is performed unless the client refuses. 7 HBV, hepatitis C virus, genital herpes and Tv are only tested when deemed necessary. 5 Pregnant women are all screened for syphilis, HBV and HIV before the 13th week of pregnancy. The prevention and control of STI is based on five major strategies described by the Centers for Disease Control and Prevention (CDC): education and counselling of persons at risk in order to achieve changes in sexual behaviour; identification of asymptomatically infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services; effective diagnosis and treatment of infected persons; evaluation, treatment, and counselling of sexual partners of persons who are infected with an STI and pre-exposure vaccination of persons at risk for vaccine-preventable STI. 8 In general, the Dutch population is well informed concerning sexual health, although this is not the case in adolescents, lower educated individuals and men with a Turkish or Moroccan background. National campaigns on sexual health are effective in creating awareness and condom use is considered important to prevent STI, but its use is not always practiced. The number of STI consultations are increasing every year and the percentage of positive STI tests has increased from 12% to 14% between 2004 and (Figure 1). MSM have a higher percentage of positive STI tests compared with heterosexuals. CHLAMYDIA TRACHOMATIS Ct infection is the most prevalent bacterial STI worldwide and causes most cases of infectionrelated female infertility worldwide. 4 Organism Ct is an obligatory intracellular, non-motile, Gram negative organism. The developmental cycle consists of an extracellular and an intracellular part (Figure 2). The extracellular form of Ct consists of elementary bodies (EB). The cell wall of EB does not contain peptidoglycan, but has a rigid wall as a result of a highly cross-linked outer-membrane complex. 9 EB are able to survive outside the cell and stay dormant until entering the host cell. Cell entry consists of two stages; in the first stage, the EB attaches through reversible electrostatic interactions 12 Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum
15 between the outer membrane protein A (OmpA), expressed on the Ct cell surface and the heparan sulphate containing glycosaminoglycans on the cell. During the second, irreversible binding stage the EB probably interact with protein disulfide isomerase, although this has not yet been fully elucidated. 9 After this step, translocated actin-recruiting phosphoprotein is released into the host cell via type three secretions system, leading to actin remodelling, which in turn allows EB to enter the host cell and inhibits apoptosis. 10 Intracellularly, EB transform into metabolically active, non infectious, reticulate bodies (RB). RB replicate and in the end of the intracellular cycle transform back into EB. The EB are again released into the extracellular space by exocytosis or cell lysis, able to infect other epithelial cells. This replication cycle takes about hours. Figure Number of consultations and percentage of positive STI tests (chlamydia, gonorrhoea, infectious syphilis, HIV, infectious hepatitis B) in the national STI surveillance in the Netherlands, nr of consultations % positive STI Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum
16 Figure 2 Chlamydia trachomatis developmental cycle 11 Entry into host cells EB sequestered in inclusion Exit to infect other host cells RB Differentiation into RBs EB Replication Figure is placed by courtesy of Nature Publishing Group The family Chlamydiaeceae consists of three genera: Chlamydia, Chlamydophila and Clavochlamydia. The genus Chlamydia can be subdivided in three species: C. trachomatis (human), C. suis (swine) and C. muridarum (mice). The human variant comprises of biovar trachoma and lymphogranuloma venereum (LVG). The biovar trachoma consists of 14 serovars (A, B, Ba, C, D, Da, E, F, G, H, I, Ia, J, K) of which A-C have most affinity to conjunctivae and D-K to urogenital epithelium; LGV consists of serovar L1, L2, L2a and L3. Serovars E and F are most prevalent in The Netherlands. 12 This thesis will focus on C. trachomatis biovar trachoma serovars D-K. 14 Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum
17 Pathogenesis Histological studies on Ct infection show both signs of acute and chronic inflammation in the affected tissue. Epithelial cells are the primary target of Ct and initiate the immune response. 13 Secondly, neutrophils infiltrate the vagina and subsequently the uterus during the first week after infection. 14 Subsequently, epithelial cells and innate immune cells produce proinflammatory cytokines and chemokines which further activate the innate and adaptive immune cells. Ultimately, resolution of infection occurs, but sometimes leaving a destroyed oviduct. Tissue damage can be the result of chronic infection (continues low grade tissue damage) and/or reinfections which leads to the predominance of CD8 T-cell, associated with scarring and fibrosis. 15 The mechanisms behind chronic infection due to Ct infections are not clear. The degree of infection is host dependent and may be dependent on genetic polymorphisms Cervical lymphocytes of females with or females without fertility problems, for instance, produce different cytokine profiles when stimulated with Ct elementary bodies. 16 Also, a study on monozygotic and dizygotic twins on the influence of genetic trait on the immune response to Ct (serovar A), suggested that genetic factors contribute for 39% to the variation in lymphoproliferative responses. 19 Transmission and natural course Ct can be transmitted via sexual contact or perinatally. The incubation period for acute infection is 7-14 days. Infection concordance for Ct between sexual partners is approximately 70% The transmission and natural course of Ct infection depends on Ct virulence factors, host immune response and the presence of co-infections. Approximately 50% of all uncomplicated Ct infections in females resolves without therapy during the first year after acquisition. 23 Almost 20% of all infections is already cleared within the interval between testing and treatment, which is on average 13 days. 24 Clinical manifestations and complications Infection with Ct is asymptomatic in the majority of the women and in more than 50% of the men. When symptomatic, women can experience abnormal vaginal discharge, abdominal pain or post-coital bleeding for instance. Other clinical manifestations in women include cervicitis, urethritis, conjunctivitis, endometritis and pelvic inflammatory disease (PID). The incidence of PID is heavily debated, since methodology and results vary between different studies and is suggested to be between 5 and 20% PID due to Ct can progress subclinically and may eventually might lead to tubal infertility. 30, 31 It is also associated with chronic abdominal pain. 32, 33 Another important complication is adverse pregnancy outcome. In neonates, perinatally Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum 15
18 acquired infection may result in for instance pneumonia and/or conjunctivitis. 34 In men, Ct can cause urethritis, prostatitis, epididymitis, conjunctivitis and Reiter s syndrome (arthritis, conjunctivitis and urethritis). Diagnosis The mainstay for the diagnosis of Ct are nucleic acid amplification tests (NAAT). Table 1 gives an overview of the different, commercially available, NAAT used to detect Ct. NAAT are usually performed on self-taken vaginal swabs (SVS) in females and on urine in men. When indicated, NAAT can also be performed on many other materials, for instance pharyngeal, rectal of corneal swabs and peritoneal fluid although these samples are not always officially validated and approved by the manufacturer. Table 1 Currently most used commercially available NAAT to detect Chlamydia trachomatis System Assay Company Technique Target Validated material ProbeTec ET or VIPER- XTR ProbeTec CT/GC Beckton Dickinson (BD) SDA Cryptic plasmid Endocervical swabs, vaginal swabs, male urethra swabs, urine COBAS Taqman COBAS CT/NG Roche Real-time PCR Cryptic plasmid and CT genome (MOMP gene) Endocervical swabs, urine COBAS 4800 COBAS CT/NG Roche Real-time PCR Cryptic plasmid and CT genome (MOMP gene) Endocervical swabs, urine M2000 RealTime Versant kpcr RealTime CT/NG Versant CT/GC DNA 1.0 Abbott Real-time PCR Cryptic plasmid Endocervial, male urethra swabs, vaginal swab, urine Siemens Real-time PCR Cryptic plasmid Endocervical swab, urethral swabs, urine TIGRIS or Panther Aptima Combo AC2 Hologic/ Gen-Probe TMA CT rrna NG rrna Endocervical swabs, male urethra swabs, urine GeneXpert Xpert CT/NG Cepheid Real-time PCR CT genomic DNA NG genomic DNA Urine (male and female), endocervical swab, and patientcollected vaginal swab SDA = strand displacement amplification, TMA = transcription mediated amplification 16 Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum
19 The overall sensitivity and specificity of NAAT for Ct detection in SVS ranges between 97-99% and % 36,37 and between % and % for urine, respectively. 38 Ct detection in SVS is equally sensitive as detection in endocervical specimens. 39 Furthermore, SVS is an acceptable and feasible specimen in women. 40 Before NAAT became available, Ct culture was considered as the gold standard. The sensitivity of culture however is low and is no longer practised in clinical laboratories. 41 Another technique to diagnoses an infection due to Ct is direct fluorescent antibody testing, but as with Ct culture, this technique is laborious, requires experienced technicians, is less sensitive than NAAT and not necessarily detects acute infection. Also, enzyme immunoassays to detect chlamydial lipopolysaccharide are widely available, but these again are less sensitive than NAAT. Point of care tests (POCT) are upcoming and are currently being evaluated. However, results obtained thus far do not warrant their use, instead of NAAT, in clinical practice yet. 35,42,43 For research purposes, Ct typing methods are available. Results can be used to reveal transmission patterns, can be useful to detect associations with clinical manifestations, to study pathogenicity and can help to differentiate between persistent or new infections. 44 Variants in the major outer membrane protein (MOMP), encoded by the omp1 (ompa) gene, are used for decades to serotype, or genotype, Ct. Several typing methods have been developed, with different capabilities and limitations and variation in laboriousness. 44 Also, typing can be useful in identifying new Ct variants. In 2006, an unexpected drop in Ct prevalence was noticed in Halland County, Sweden. 45 Thorough analysis revealed the existence of a new variant of Ct, the so-called Swedish variant of Ct (swct), which was not detected by the most commonly used NAAT. This was due to a deletion on the Ct plasmid which is the target of the used NAAT. Treatment, follow-up, antibiotic resistance and prevention According to the guidelines of the Dutch Society of Dermatology and Venereology, urogenital infections due to Ct are treated with azithromycin 1g orally, once only (www.soaaids.nl). Anal infections (non-lgv) are treated with doxycycline 100mg twice daily for 7 days. Azithromycin is also first choice in pregnant women. Patients are advised not to have sexual contact during and one week after treatment. 46 Re-testing after treatment is not advised, except when amoxicillin has been used in pregnant women ( 46, It is important to trace and test all sexual contacts, since at least 1 out of 2 of these contacts on average are Ct positive and can again lead to additional cases and repeat cases. 47 Additionally, re-testing within one year after the first positive Ct test is advisable, since the percentage of positive patients is much higher in case of a previously positive Ct test compared to patients with a negative Ct test (10.4% vs 2.9% respectively). 48 The challenges of repeat and persistent infections after Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum 17
20 single dose treatment with azithromycin have emerged over the past 10 years. Treatment failures might occur due to reduced effectiveness of azithromycin and doxycycline in a hypoxic environment. 49,50 Increasing number of studies suggest that more than 5% treatment failure can occur during use of azithromycin. 51 Although inexpensive and effective treatment of symptomatic patients is available, control of Ct is challenging since most infected persons are asymptomatic. Despite the fact that over the past two decades huge resources were put into attempts to reach these asymptomatic patients, the impact of widespread screening for Ct has been disappointing. The reason for this is that screening has not been shown to reach sufficient numbers of participants and thereby reduce either transmission of infection 52 or the incidence of reproductive complications. Besides screening and early treatment, effective prevention obviously relies on having safe sex, e.g. using a condom. Another potentially effective measure may be offered by vaccination. A good vaccine against Ct could eliminate Ct within 20 years after its introduction and high coverage. 10 Vaccination could potentially prevent Ct to pass the cervix and cause damage to the oviduct. Many candidate proteins have been explored for their vaccine capacity, but no vaccine is yet available nor expected in the near future. 10,53 TREPONEMA PALLIDUM Early syphilis infections during pregnancy cause 25% of stillbirths and 14% of neonatal deaths. 4 Organism Treponema pallidum (Tp) belongs to the family Spirochaetaceae which is characterized by its typical spiral configuration. Other species belonging to the Spirochaetaceae are for instance Leptospira spp. and Borrelia spp. Tp can be subdivided in the subspecies pallidum, endemicum, pertenue and carateum which cause the disease syphilis, bejel, yaws and pinta, respectively. In this thesis, the primarily focus is on Treponema pallidum subsp. pallidum. 54 Tp has an cytoplasmic membrane which is surrounded by an outer membrane. Within these membranes, there is a thin layer of peptidoglycan. At both ends of the spirochete, flagellar motors are present. Tp has only few intergral proteins in its outer membrane. 55 The genome of Tp is very small compared to other bacteria, e.g. Escherichia coli: 1.14 Mb vs. 4.6 Mb. The metabolic activity of Tp is very limited Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum
21 Pathogenesis Tp is capable of attachment to a variety of cell types, including epithelial and endothelial cells. 56 It is very motile, even in less fluid material, due to its corkscrew-like movements using its endoflagella. 55 Compared with other bacteria, the flagellar construction of Tp is well developed and comprises several proteins instead of just one. These proteins have strong antigenic properties. Tp is extremely invasive. It induces the production of matrix metalloproteinase-1 which is involved in collagen breakdown, which facilitates penetration and Tp is found in deeper tissues, just hours after (mucosal) inoculation. 54 Endothelial cells are promoted to express adhesion molecules (intercellular adhesion molecule 1, vascular cell adhesion protein 1 and E-selectin) which cause migration and adhesion of leukocytes. 56 Although polymorphnuclear lymphocytes are able to reduce the infectivity of Tp 57, these do not halt disease progression. TLR-2 (toll like receptor 2; present on human cell surface) is essential in recognising Tp, for instance by immature dendritic cells (DC s ). 58 Immature DC s subsequently activate T-cells by taking up Tp and migrating to the lymphnodes. After maturation, the DC s produce inflammatory cytokines (interleukin 12 and tumor necrosis factor alfa) and express maturation markers. A delay in this process, facilitates Tp dissemination. Macrophages opsonise and kill Tp, although it has been shown that a subpopulation of organisms is resistant to ingestion, a phenomenon which is unexplained thus far. 59 The most important lipoproteins for the immune response, are TpN47, TpN17 and TpN15. At approximately day 10 after infection, the number of T-cells and macrofages reaches its peak, after which the Tp load decreases. 54 After dissemination, Tp is also capable of causing chronic infection, as will be discussed in the next sections. The latent phase is possibly due to the small numbers of organisms present at different anatomical sites and (very) slow replication during this stage and its relatively non-antigenic surface. There are, however, outer membrane proteins on its cell surface which are encoded by the tpr gene family. Gene conversion occurs and gene expression can vary depending on the human immune response. This variable gene expression is called phase variation and helps Tp to constantly evade the immune system. 54 Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum 19
22 Transmission and natural course Tp can only infect humans and can be transmitted via contact between lesions in the primary and secondary stage and mucosal membranes. The incubation period is between days. At least 60 organisms are needed to cause an infection 54 and approximately 60% of the sexual partners will become infected. 60 Clinical manifestations In primary syphilis, a lesion, so called chancre, develops at the inoculation site and is usually accompanied by regional lymphadenopathy. The chancre usually occurs 3 weeks after exposure, is painless and heals spontaneously within 4-6 weeks. Due to is painless presentation and rapid resolution, diagnosis of primary syphilis is hampered. Secondary syphilis presents approximately 3 months after initial infection. The most classical finding is maculopapular rash which can also be present on palms of hand and soles of feet. Other accompanying symptoms are sore throat, muscle aches and lymphadenopathy. Sometimes the dermal lesions can become necrotic, which is called lues maligna. Condylomata lata can be present in the anal region in 10% of the patients and are highly infectious. The kidneys and liver can be involved. Neurosyphilis occurs in 40% of patients with early syphilis and in 25% of individuals with late syphilis. Most patients can resolve the infection by themselves and never become (noticeably) symptomatic. After the secondary stage, the latent phase starts which is variable in duration. In the first year after secondary syphilis, it is considered the early latent phase and afterwards the late latent phase (also if duration is unknown). Sexual transmission is not likely during the latent phase, although foetal infection can occur. Before the use of antibiotics, approximately 30% of the patients with latent syphilis, subsequently developed tertiary syphilis. Symptoms can occur as long as 40 years after initial infection and can include gummata, cardiovascular infection and neurological complications. The probability of congenital infection is highest when the mother is in her first year of infection. Treatment in the first or second trimester usually prevents the newborn from being symptomatic. In the third trimester, primary syphilis can result in abortion or stillbirth. Symptoms of congenital syphilis resemble those in adults only worse, and become apparent 2-10 weeks after birth. The baby can suffer from chronic rhinitis (snuffles), skin lesions, condylomata lata, osteochondritis, among other symptoms. Late manifestations, occurring after 2 years, are for instance keratitis, damage of the vestibulocochlear nerve, neurosyphilis, arthropathy and gummata Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum
23 Diagnosis Treponema pallidum cannot be cultured in vitro. Darkfield microscopy is still practised, but can only visualize spirochetes in fresh lesions. NAAT is not currently available in most laboratories, thus, diagnosis relies on serology. IgM antibodies can be detectable as early as 2 weeks postinfection and are produced in response to Tp surface lipids, flagellar proteins and lipoproteins, among others. IgG is formed 2 weeks hereafter and is capable of blocking the binding capacity of Tp and causes organism to be unable to produce dermal lesions, but do not kill Tp nor prevent infection. The IgM response wanes when infection persists for longer periods of time or when a patient has been adequately treated. 61 The attributes of the serological assays are displayed in table The first serological assay for diagnosing syphilis was developed in the beginning of the 20th century and was called the Wasserman test. It detects antigens in the Tp membrane which is originally derived from the host. These antigens comprise of lecithin, cholesterol and cardiolopin, are not is not unique for Tp, therefore the Wasserman test is called a nontreponemal assay. Other non-treponemal tests are the rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) which utilize the same antigens and are still used to determine disease activity. 61 Unfortunately, these antigens are also released in different other (infectious) diseases, causing false positive results Specific Tp immunoglobulins (Ig), IgM and IgG, are detected in the fluorescent treponemal antibody absorption test (FTA-ABS) and Treponema pallidum hemagglutination assay (TPHA) and Treponema pallidum particle-agglutination assay (TPPA). The FTA-ABS utilize anti-human Ig to detect antibodies attachted to Tp fixed on slides. The TPHA is based on red blood cells sensitized with Tp antigen which agglutinate in the presence of specific antibodies. TPPA uses gel particles instead of red blood cells. During recent years, enzyme-linked immunosorbent assays (ELISA) are upcoming. ELISA are designed to detect IgG or IgM antibodies, or both. These assays have the great advantage that these can be performed on an automated system. 61 Introduction on STI with a focus on Chlamydia trachomatis and Treponema pallidum 21
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I add questions to a form, but the questions do not appear on the live form.Asked by pubserv on March 26, 2014 at 06:19 AM
I need to add questions to an exisiting form, but when I do, they don't show up on the webform. The form has received some responses, but I cloned that form, and that form had no responses, and the new question still did not show up on the actual presented webform of the clone.
I put a lot of work into the form.
I did move from a normal jotform account to a jotform pro account...could that be an issue?
JotForm Support
Currently this is the form http://www.jotform.com/40096850401953
Are you saying that there are missing updates or fields on this form?
Can you tell us what were the changes that do not show up on this form?
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That is the form - when I put a new field in it would not update on the
presentable form.
Greg Anderson, MPA, CPPB
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Hi, I see the standalone version of your form, have you checked if in the standalone version of it, the new field that you added appears? or is this something that does not show only when the form is embedded on your site?
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If the field does not appear in the standalone version as well, please specify what is the field tha should appear.