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Fwd: {RMA} HCV Mother-To-Child Transmission Risk Factors
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Date: Mon, 31 Oct 2005 18:09:32 -0800 (PST)
Subject: {RMA} HCV Mother-To-Child Transmission Risk Factors
Risk factors for HCV Transmission from Mother-To-Child
Studies Clarify Risk Factors for Mother-to-Child Transmission of Hepatitis C Virus
Press release from the Journal of Infectious Diseases
Breastfeeding does not raise the risk of mother-to-child transmission of hepatitis C virus (HCV), according to two new studies published in the December 1 issue of The Journal of Infectious Diseases, now available online.
One study found that infant girls are twice as likely to be infected as infant boys. Both studies provide new information with which to counsel pregnant women infected with HCV. Taken together, the two new studies expand upon preliminary data from smaller studies of mother-to-child transmission of HCV.
The larger of the two studies, conducted by the European Paediatric Hepatitis C Virus Network, involved 1,479 mother-and-child pairs enrolled at 33 centers in Italy, Spain, Germany, Ireland, the United Kingdom, Norway, and Sweden. The other study, by Eric E. Mast, MD, MPH, of the U.S. Centers for Disease Control and Prevention and colleagues, followed 244 infants born to infected mothers in Houston and Honolulu.
The finding of gender differences in HCV infection was reported by the European authors, who hypothesized that their result may reflect hormonal or genetic differences between men and women in susceptibility or response to infection. Other risk factors significantly associated with transmission were the time in labor (a risk factor in both studies) and use of internal fetal monitoring devices (a risk factor in the U.S. study only).
Although breastfeeding is a known risk for HIV transmission, both studies found it was not associated with transmission of HCV. The European study also found that caesarean section delivery, infant prematurity, and maternal history of injection drug use were not associated with HCV transmission.
The overall rate of transmission of the virus from infected mother to child was 6.2 percent in the European study and 3.6 percent in the U.S. study.
"Our results strongly suggest that women should not be offered an elective caesarean section or discouraged from breastfeeding on the basis of hepatitis C infection alone," said Pier-Angelo Tovo, MD, the lead author of the European study.
"Our findings support existing recommendations to avoid internal fetal monitoring and prolonged laborâ¦in infected women," wrote the U.S. authors.
In an accompanying editorial, R. Palmer Beasley, MD, of the University of Texas at Houston, emphasized the European study's novel finding of a gender difference in transmission rates and suggested that higher HCV rates in female newborns may be due to excess mortality in infected males in utero. "Overall, the observation of higher hepatitis C virus infection rates in female infants is in accord with recent observations of similar excesses in HIV infection of female infants," Dr. Beasley said.
Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines. JID is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Alexandria, Va., IDSA is a professional society representing about 8,000 physicians and scientists who specialize in infectious diseases. For more information, visit www.idsociety.org.
Nature Usually Favors Females
R. Palmer Beasley
School of Public Health, University of Texas, Houston
This issue of the Journal treats us to articles from 2 large multicenter studies of vertical transmission of hepatitis C virus (HCV). The studies are complementary and have largely similar findings, although the European study [1], with 1787 mother-infant pairs of HCV-positive mothers from 33 centers in 7 countries, dwarfs the American one [2], which included 244 mother-infant pairs from 2 centers. Overall, the estimated frequencies of HCV transmission were 6.2% (95% confidence interval [CI], 5.0%7.5%) in the European study and 3.6% (95% CI, 1.3%6.0%) in the American study. Both studies found an increased risk of transmission from mothers with higher viral loads, earlier rupture of membranes, and coinfection with HIV. Neither study found a correlation between transmission and either breast-feeding or cesarean-section delivery. Also of interest is that both studies found that a small proportion of apparently infected infants subsequently lost all HCV markers on longer follow-up.
The most interesting observation from the European study is that HCV infection was twice as frequent among female than male infants (unadjusted odds ratio, 2.03 [95% CI, 1.303.15]; P = .001). The difference was similar in the American study (6 girls and 3 boys) but was not statistically significant, because of the much smaller sample sizes. The European investigators indicate that these are probably the first data suggesting a differential response to HCV between males and females. Sex differences are found in responses to most infectious agents, but these findings are interesting because there are more HCV infections among the female than the male infants. This is quite remarkable, since a male excess is found for most infectious agents, and, in general, males respond more poorly than females to most external challenges. Males have a shorter life expectancy, and males of all age groups have higher overall mortality than females. Except for female end-organ disease and those
illnesses explained by exposure differentials (e.g., skin cancer), there are relatively few conditions in which the incidence in females exceeds that in males. There are autoimmune diseases and a few cancers (e.g., of the thyroid and gall bladder) that are more common in females, but far and away most diseases, including infectious diseases, have a male excess. The extra X chromosome appears to be protective.
It is perplexing that the European investigators provide little information to help interpret the sex differences they observe and emphasize in the title of their article. They suggest that it "reflects hormonal or genetic differences in susceptibility or response to infection between males and females" (p. XXX), but they have not provided enough information to give reasonable assurance that these differences are not due to bias or confounding. However, if bias and confounding can be eliminated, then I believe that the most likely possibility is excess male mortality in utero rather than increased infections among females. The authors can help us interpret their findings by providing the complete sex distribution at birth of the infants in their study. Also absent is information about abortion rates, infection, and follow-up rates by sex at different ages, which must be available, since their protocol called for testing of infants at birth, age 6 weeks, and ages 3, 6, 9, 12, 18, and
24 months, as well as some beyond that. These deficiencies make it unnecessarily difficult to analyze the various possible interpretations.
If the sex ratio at birth in this study were decreased from the 1.05 (male : female) ratio found in the general populations of most Western countries, it would strongly suggest an adverse in utero effect on males. A decreased ratio was observed in the American study in Houston (the Hawaii component data were not available), where the birth sex ratio was 99 : 113, or 0.876. The sex ratio at enrollment in the European study was 668 : 802, or 0.833, which is probably the birth ratio, but the authors, unfortunately, do not define enrollment, so we cannot be certain what biases were introduced if the data were censored. In view of these numbers showing a low male : female ratio, I am unable to interpret the following statement by the European authors, which seems at odds with these data of theirs: "Because the male : female ratio in our study population was higher than that observed in the general population, this finding is unlikely to be due to excessive deaths of infected males in
utero" (p. XXX).
For hepatitis B virus (HBV), males of all ages have slightly higher infection rates than females and slightly poorer responses (titers and conversion rates) to HBV vaccination, and there appears to be no distortion of the sex ratio at birth of infants born to carrier mothers. The incidence of chronic liver manifestations of the HBV carrier state (chronic hepatitis, cirrhosis, and hepatocellular carcinoma) are much more common in males than females, at ratios of 2.53.5, depending on the population. Intrauterine infections make up a small proportion of perinatal HBV infections, so it is conceivable that a differential adverse sex effect in that small proportion could have been missed by such relatively crude measures as sex ratios at birth.
The authors of the European study reference 3 HIV perinatal transmission studies, which found higher frequencies of HIV infection in female infants and lower male : female birth ratios. Taha et al. [3] reported data from a large vertical transmission study in Malawi, which showed HIV positivity of 12.6% among 998 girls, compared with 6.3% among 966 boys, a male : female ratio at birth of 0.968 for enrolled infants. A final observation from the Malawi study deserves comment. Female infants had a smaller average birth weight than male infants, as would be expected if there were more in utero fetal deaths among males, if the infections were more common in the smaller and/or weaker ones.
In conclusion, the observation of higher HCV infection rates in female infants of HCV-infected mothers is interesting, provocative, and worth further investigation. It is in accord with recent observations of similar excesses of HIV infections in female infants of HIV-infected mothers. Future studies investigating infant sex differences in relation to perinatal infections need to plan carefully to collect and present sex data in a fashion that minimizes potential bias, such as skewed abortions and stillbirths, if sex is known before birth, and distorted follow-up by sex.
Risk Factors for Perinatal Transmission of Hepatitis C Virus (HCV) and the Natural History of HCV Infection Acquired in Infancy
The Journal of Infectious Diseases 2005;192:000
Eric E. Mast,1 Lu-Yu Hwang,3 Dexter S. Y. Seto,4 Frederick S. Nolte,2 Omana V. Nainan,1,a Heather Wurtzel,1,b and Miriam J. Alter1
1Centers for Disease Control and Prevention and 2Emory University, Atlanta, Georgia; 3University of Texas Houston School of Public Health, Houston; 4Kapiolani Medical Center and University of Hawaii School of Medicine, Honolulu
Background. The goal of the present study was to assess risk factors for perinatal hepatitis C virus (HCV) transmission and the natural history of infection among HCV-infected infants.
Methods. In a cohort study, 244 infants born to HCV-positive mothers were followed from birth until age >12 months. Maternal serum was collected at enrollment and delivery; infant serum was collected at birth and at 8 well-child visits. Testing included detection of antibody to HCV, detection of HCV RNA (qualitative and quantitative), and genotyping. HCV-infected infants were followed annually until age 5 years.
Overall, 9 of 190 (4.7% [95% confidence interval {CI}, 2.3%9.1%]) infants born to mothers who were HCV RNA positive at delivery became infected, compared with 0 of 54 infants born to HCV RNAnegative mothers (P = .10). Among HCV RNA positive mothers, the rate of transmission was 3.8% (95% CI, 1.7%8.1%) from the 182 who were human immunodeficiency virus (HIV) negative, compared with 25.0% (95% CI, 4.5%64.4%) from the 8 who were HIV positive (P < .05).
Three infected infants resolved their infection (i.e., became HCV RNA negative).
In multivariate analysis restricted to HCV RNA positive mothers, membrane rupture 6 h (odds ratio [OR], 9.3 [95% CI, 1.5179.7]) and internal fetal monitoring (OR, 6.7 [95% CI, 1.135.9]) were associated with transmission of HCV to infants.
Conclusion. If duration of membrane rupture and internal fetal monitoring are confirmed to be associated with transmission, interventions may be possible to decrease the risk of transmission.
The rates of HCV transmission to infants from HCV-infected, HIV-negative mothers (3.8%) and from HCV/HIV-coinfected mothers (25%) in the present study are consistent with findings from other studies [2]. Our results provide information that can be used for counseling regarding the risk of transmission through breast-feeding, the timing of follow-up to distinguish infected from uninfected infants, and the course of infection during the first 5 years of life. The study also provides insight into risk factors that might facilitate and interventions that might prevent perinatal HCV transmission.
Transmission occurred only from mothers who were HCV RNA positive, which is consistent with findings from other studies. The only 2 documented episodes of transmission from HCV RNAnegative mothers [11, 12] could be explained as resulting from the use of testing methods that were not sensitive enough to detect low levels of HCV RNA or from intermittent HCV RNA detection in an HCV-infected pregnant woman [13]. Although we detected HCV RNA intermittently among some women, >96% had consistent results when tested both prenatally and at delivery, indicating that a single HCV RNA test during pregnancy should be sufficient for diagnosis and counseling. Maternal HCV RNA testing should be required in studies of perinatal HCV transmission, and analyses should be restricted to HCV RNApositive mothers or stratified by HCV RNA status.
Although higher maternal viral levels increase the risk of perinatal transmission of HIV and hepatitis B virus (HBV) [1416], data on associations between maternal HCV RNA level and perinatal transmission have been inconsistent. In univariate analysis of HCV-positive, HIV-negative mothers, the risk of transmission has been found to increase with increasing maternal HCV RNA level, and mean levels were found to be higher in transmitting than in nontransmitting mothers. However, maternal HCV RNA level was not independently associated with transmission in multivariate analysis among HIV-negative women. A direct relationship between maternal viral level and increased transmission rates has been reported by some investigators [4, 5, 8, 1720] but not by others [10, 21, 22]. Furthermore, among the studies reporting an association, the threshold viral level associated with transmission has differed. Reasons for the inconsistencies could include the use of different methods to quantify HCV RNA
levels, combining HIV-negative and HCV/HIV-coinfected women in analyses, and unrecognized statistical interactions between viral level and other factors. Given the inconsistency of results and the evidence for transmission from women with HCV RNA levels <106 genome copies/mL, we believe that HCV RNA level cannot be used to counsel HCV RNApositive women about their risk for perinatal HCV transmission.
Perinatal HCV transmission could occur in utero, during the intrapartum period, or postnatally. We found no evidence for postnatal transmission, because all infected infants were HCV RNA positive by age 2 months, which is consistent with HCV exposure occurring at or before the time of delivery. This finding contrasts with the pattern of mother-to-child HBV transmission, in which as many as 40% of infants born to HBV-infected mothers who are not infected during the intrapartum period become infected during the first 18 months of life [23]. In addition, breast-feeding was not associated with transmission, which is consistent with findings of other studies [3, 12, 19, 22, 2427] and provides further support for recommendations that HCV-positive, HIV-negative women can safely breast-feed [28, 29]. Differentiation of in utero from intrapartum transmission is primarily based on detection of HCV RNA at the time of birth. Although HCV RNA was detected in peripheral venous serum samples from
some infected infants at birth by use of nested PCR in the present study, HCV RNA was also detected in uninfected infants, suggesting that HCV RNA positivity at birth may reflect passive transferral of maternal virus rather than intrauterine transmission.
Recommendations for screening and follow-up of infants born to HCV-infected mothers include anti-HCV testing at age >15 months or nucleic acid testing on 2 occasions between ages 2 and 6 months [30]. Our findings suggest that it may be prudent to delay anti-HCV testing until age >18 months, because 2 infected infants who were anti-HCV negative at 15 months subsequently seroconverted to anti-HCV positivity, one between age 15 and 18 months and the other between age 18 and 24 months. Testing at age >18 months also eliminated all false-positive results in infants with passively acquired anti-HCV, if RIBA testing was used to verify anti-HCV EIA screening testpositive results [31]. Our findings support the recommendation for nucleic acid testing, because all infected infants were HCV RNA positive at ages 2, 4, and 6 months. Testing before age 2 months cannot be recommended, because detection of HCV RNA in both cord and peripheral venous serum samples collected at birth is likely to
indicate contamination with maternal blood or passive transfer of maternal HCV RNA, rather than infant infection.
Although none of the infected infants in this study had clinical evidence of hepatitis during 5 years of follow-up, all had abnormal ALT levels at some point. These findings indicate that liver disease among HCV-infected infants is generally mild [32, 33]. The higher proportion of HCV-infected infants in the present study who resolved their infections, compared with those in follow-up studies of persons infected at older ages [5, 3235], demonstrates the importance of follow-up testing of HCV-infected infants to determine the clinical progression of infection.
Among infants born to HCV-infected, HIV-negative mothers, longer duration of membrane rupture and invasive fetal monitoring were associated with transmission. Of 2 studies that evaluated duration of membrane rupture [5, 36], 1 found increased transmission rates associated with longer duration [5]. One study found increased transmission rates associated with fetal scalp monitoring [37], and another found increased transmission rates associated with intrapartum exposure to maternal blood [4]. One hypothesis to explain these findings is that perinatal transmission generally occurs during the intrapartum period and is related to infant exposure to maternal genital tract secretions or blood. Although one study found no evidence of virus in genital tract secretions [38], another detected virus in the cellular fraction of cervicovaginal secretions of 27% of infected women [39]. Both longer duration of exposure of infant mucous membranes and percutaneous inoculation of the infant could
enhance transmission.
Our findings suggest that avoiding internal fetal monitoring and/or perfoming cesarean section before or soon after membrane rupture could decrease the risk of perinatal transmission from HCV-infected mothers who were identified prenatally. However, results from studies comparing risk for HCV transmission among infants delivered vaginally and infants delivered by cesarean section are conflicting [2, 3, 11, 12, 18, 26]. In addition, in virtually all of these studies, most study participants were HCV/HIV coinfected, coinfected and HIV-negative women were combined for analysis, and, in some instances, other potential risk factors were not accounted for. These features make it difficult to determine whether the results apply to infants born to women infected only with HCV. In addition, only 1 study differentiated elective cesarean sections performed before membrane rupture from emergency cesarean sections; that study found a lower transmission rate from mothers who delivered by elective
cesarean section than from mothers who delivered by emergency cesarean section, although the analysis also included HCV/HIV-coinfected women [3]. Among HIV-infected women, elective cesarean section performed before onset of labor and rupture of membranes not only was associated with lower HIV transmission rates but also was shown, in a randomized trial, to be an effective intervention [40, 41]. In our study, no transmission occurred from mothers who delivered by elective cesarean section, but the number of such deliveries was low.
Our findings support existing recommendations to avoid internal fetal monitoring and prolonged labor after rupture of membranes in HCV-infected pregnant women [30]. Current recommendations regarding the need for cesarean section versus vaginal delivery are not based on HCV infection status. Any changes in cesarean section practices for HCV-infected pregnant women should be considered cautiously and should be based on separate studies of HCV/HIV-coinfected women and women infected only with HCV. Ideally, prospective studies should be conducted to determine whether elective cesarean section delivery reduces the risk for perinatal HCV transmission.
A Significant Sexbut Not Elective Cesarean SectionEffect on Mother-to-Child Transmission of Hepatitis C Virus Infection
European Paediatric Hepatitis C Virus Networka
Background. Risk factors for mother-to-child transmission of hepatitis C virus (HCV) are poorly quantified.
Methods. We conducted a European multicenter prospective study of HCV-infected pregnant women and their infants. Children with 2 positive HCV RNA polymerase chain reaction test results and/or anti-HCV antibodies after 18 months of age were considered to be infected.
Results. The overall HCV vertical transmission rate was 6.2% (95% confidence interval [CI], 5.0%7.5%; 91/1479). Girls were twice as likely to be infected as boys (adjusted odds ratio [OR], 2.07 [95% CI, 1.233.48]; P = .006). There was no protective effect of elective cesarean section (CS) delivery on HCV vertical transmission (adjusted OR, 1.46 [95% CI, 0.862.48]; P = .16). HCV/human immunodeficiency viruscoinfected women more frequently transmitted HCV than did women with HCV infection only, although the difference was not statistically significant (adjusted OR, 1.82 [95% CI, 0.943.52]; P = .08). Maternal history of injection drug use, prematurity, and breast-feeding were not significantly associated with transmission. Transmission occurred more frequently from viremic women, but it also occurred from a few nonviremic women.
Conclusions. Our results strongly suggest that women should neither be offered an elective CS nor be discouraged from breast-feeding on the basis of HCV infection alone. The sex association is an intriguing finding that probably reflects biological differences in susceptibility or response to infection.
HCV infection is a major public health problem and is of particular concern during pregnancy. Identification of transmission risk factors is essential for the development of appropriate interventions. In this large, prospective European cohort, girls were twice as likely to be infected as boys. There was no evidence of a protective effect of elective CS delivery. However, the duration of ROM was significantly longer among mothers of infected children than among mothers of uninfected children. HCV/HIV-coinfected women were more likely to transmit HCV to their infants than were women with HCV infection only, although this was not statistically significant in multivariable analysis. An increased but not statistically significant risk of transmission was also observed among women who were HCV viremic during pregnancy or around the time of delivery, although a few children were infected by nonviremic women. Maternal history of IDU, prematurity, and type of infant feeding were not
significantly associated with transmission.
To our knowledge, this is the first report of a significant association between sex and HCV vertical transmission. Granovsky et al. reported an 8% transmission risk for girls, compared with 3% for boys, in a study of 122 mother-child pairs with 7 infected children, but this difference was not statistically significant [14]. A significantly higher susceptibility of females to vertically acquired infections has been observed for human T cell leukemia/lymphoma virus type I [15] and for HIV in Europe [16] and in Malawi [17], although the risk of postnatal HIV transmission was found to be significantly higher in males in a meta-analysis of African trials [18]. Because the male : female ratio in our study population was higher than that observed in the general population, this finding is unlikely to be due to excessive deaths of infected males in utero. It likely reflects hormonal or genetic differences in susceptibility or response to infection between males and females. Maternal
infections increase fetal cortisol and dehydroepiandrosterone synthesis [19]. Androgens may influence the immune response [20]; estradiol protects stimulated feline lymphocytes from apoptosis [21], and human male and female fetuses exhibit differences in regulation of the cytokine network [22]. Sex differences in mortality associated with routine childhood modified virus vaccinations may also indicate differential susceptibility to infection [23].
Until recently, maternal HCV/HIV coinfection was consistently found to be associated with an increased risk of HCV vertical transmission [4, 6, 7], thought to be mediated by the higher HCV load in immunosuppressed HCV/HIV-coinfected women than in women with HCV infection only. The attenuation of this association seen in the present study is likely to be due to the recent widespread use of HAART, which substantially improves HIV-induced immunosuppression and, consequently, may lead to better control of HCV replication; a similar finding was reported in a small study involving 15 HCV/HIV-coinfected ART-treated women [24]. Our results suggest that HAART may reduce both maternal HCV load and risk of HCV transmission. Since HAART causes prematurity [13], it can also account for the apparent protective effect of prematurity on HCV vertical transmission, seen only in HCV/HIV-coinfected women.
Although the risk of vertical transmission is likely to be substantially lower in nonviremic women, our results confirm our previous finding [9] that it cannot be ruled out, since a few children acquired infection from nonviremic women. Data on maternal HCV viremia must be interpreted with caution, since fluctuations may occur during pregnancy [25]. The results of 1 or 2 PCR tests during pregnancy or at delivery do not necessarily reflect viremia status at the relevant time for transmission. Viral load may be a better predictor of transmission than a qualitative test. However, even where viral load data are available, interpretation is problematic, especially in multicenter studies, because of interlaboratory and interassay variations [26].
The proportion of elective CS was high in our study among HCV/HIV-coinfected women, for whom a targeted recommendation exists [10], as well as among those with HCV infection only, especially in Italian centers, where this practice is common among the general population [11]. Our current findings make an important contribution to the debate [4, 5, 24, 2729] and strongly suggest that mode of delivery does not influence HCV transmission in women with HCV infection only or in HCV/HIV-coinfected women when they are receiving potent ART. This study would have been large enough to detect a 60% reduction in risk of transmission associated with elective CS delivery, from 6% to 2.5% (with 80% power and 5% significance). Consistent with the findings of Spencer et al. [30], it is of note that, despite the lack of a protective effect of elective CS, the duration of ROM was related to transmission risk. Finally, our results confirm [6, 12, 30, 31] that breast-feeding does not increase the risk of
HCV transmission, and, unlike Resti et al. [12], we did not observe an association between history of maternal IDU and HCV vertical transmission.
In observational studies, there is always a concern that unobserved factors may exist that could be related to the outcome of interest. However, although the goodness of fit of our models improved after the inclusion of a random effect in multivariable modelssuggesting that there may be small center-associated differences in vertical transmission riskthe estimated associations between the variables of interest here and the risk of HCV vertical transmission did not change.
What are the implications of our findings for the clinical management of HCV-infected women? The overall risk of vertical transmission is low for women with HCV infection only but cannot be ruled out even in nonviremic mothers. Given that there is no antiviral treatment available for use during pregnancy, there are currently no interventions to prevent mother-to-child HCV transmission. In particular, there is no evidence to suggest that women should be offered an elective CS delivery or be advised to avoid breast-feeding. HCV/HIV-coinfected women are currently treated with HAART during pregnancy to prevent HIV vertical transmission; this treatment may also have a beneficial effect on HCV vertical transmission.
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NYSE's New Chief Puts Focus on Individual Investors
Jeffrey Sprecher Envisions 'Dozens and Dozens' of Changes to Reorient the Business
The New York Stock Exchange's new boss, Jeffrey Sprecher , said he plans to reorient the exchange back toward individuals and away from the high-frequency traders who play an increasingly large role in the financial markets.
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Naruto: Nine Tails Chakra Mode by EuphadoraWatch
©2012-2017 Euphadora
I wanted to draw Naruto for his birthday. I spent a good amount of time on him in his nine tails chakra mode and tried to make him look his best. Tell me what you think.
Naruto (c) Masashi Kishimoto
Naruto (c) Masashi Kishimoto
Good job ^^ Would you like to work for a fan-project manga? (sequel of naruto) If you wish to read my last journal and my gallery!
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|All materials on this page are written by Byron Kho and are his sole property. For permission to quote or a list of citations for each essay, please contact him at email@example.com.
Section I: View Essays in Section I
Brief: Modern Iraqi Affairs (circa 2003)
Struggles in Palestine
Romantic Love and the Individual
Individuality in The Red and The Black
Obstacles to Unity
A Crisis in Europe
Economic Imperialism, Globalization and Threads of Resistance
Colonialism and Power Relations in Houseboy
War and the Destruction of the Politic
Reformations From Within
Social Objectives and the Usage of the Noble Savage
Echoing Empire: Frances Edens Tigers, Durbars and Kings
Erasmus on Folly
Folk Music and the Economics of Musical Heritage
Section II: View Essays in Section II
Thoughts on Blowback
The Census as Imperialism
When Corporations Rule The World
Prospectus on American Resistance to Imperialism
American Resistance to Imperialism: Public Response to the SpanishAmerican War
The Legacy of Maria Callas
The Everlasting Bohemian
The Origins of the Scientific Revolution
Technology Policy and the Economic Development of South Korea and Taiwan
Russian Music in the Nineteenth and Twentieth Century
Nationalism and the Protestant Reformation
Literary Points
Section III:
Cultures of United States Imperialism Before 1945
Talking Points
History of the Middle East: After the 1800s
International Politics
Capitalism in Asia
The Fountainhead
Clemens on Slavery
Life in Art
A Modernist Tragedy
Thoreau on Nature


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SEO & Web Marketing
Case Study: Pfeifer, Morgan & Stesiak
When using a search engine to find a specific product or service online, most users only click through to the first few search results, even if hundreds of results are displayed. This is why it's so important that you are able to know what keywords your potential customers are searching for, and how to get into the top results for those searches. At FindItLocal411, our SEO services are focused on delivering measurable results for our clients, providing the maximum possible visibility. We will also manage your pay-per-click advertising services, helping you get the most out of these important services.
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You'll hear a lot of discussion of marketing and advertising that focuses on how your ads and website look, or how catchy your tagline is, or what your call to action is, and these are all important aspects of a marketing campaign. Professional web design and a marketing campaign that focuses its efforts to where they are most needed are incredibly important. What is also important, and what is easy to overlook, is a relatively new (and increasingly important) marketing tool: Search Engine Optimization, or SEO.
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Simply put, SEO consists of an ongoing effort to make you more visible on the web, so that when someone searches for your business on using a search engine (like Google, Yahoo, or Bing), your business is in the top search results. Studies have shown that the vast majority of people who use search engines only click through to the first few results, so getting your site toward the top is crucial, and SEO is the process of increasing your site's visibility to search engines, and on the web in general.
It Starts With Keywords
Let's say you run a dry cleaning business called "Scrubbed Suits," in Valparaiso. You want potential clients to find your business on search engines, but the majority of the time, they don't know anything about you or your business. They're not going to search for the name of your business, or your address. They're going to search for "dry cleaning in Valparaiso," or any number of other combinations of keywords, which are unique and user-generated. At Find It Local 411, we begin our SEO process by determining which keywords are valuable to your business, and who's searching for them. We then integrate those keywords into your web identity, and make sure that search engines and their users are able to locate and use your site.
It's About Traffic
Traffic to your web site is divided (generally) into four categories: direct traffic from users manually entering your web site's url into their web browser, traffic from links to your site on other web sites, search traffic, and ad banner-generated traffic. Ad traffic is generally paid for on a per-click basis, and for some keywords (generally the most competitive) the cost per click can be very high, and getting the traffic your site needs could stack up quickly. AdWords (or other pay-per-click services) are often still a sound investment, but smart SEO is necessary for directing qualified organic traffic to your site, and can be a far more cost-effective way to draw a higher volume of traffic.
Chances are you're already running an efficient business which provides excellent services to its customers. What you need now is to get out there and grow your business, and Find It Local 411 is there to help, with a full suite of services designed to raise your profile, and your sales.


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The Urgency of My Hope: It's Almost Midnight
By Trevor Freeze
Nearly 300 pastors and denominational leaders from across the country gathered on a mountaintop in Asheville, N.C., where a movement to reach the United States and Canada began in earnest called My Hope with Billy Graham.
The grains of sands are quickly vanishing.
Nobody knows how much time believers have to tell their friends, neighbors, family members and co-workers about Jesus.
But most agree it's not much.
And that's why the nationwide outreach called My Hope with Billy Graham is so critical.
It's almost midnight," said Preston Parish, vice president of My Hope with Billy Graham. "It's time to do something so we're not scratching our heads after we've lost the battle and wondering what just happened."
As nearly 300 pastors and denominational leaders from 27 states gathered this week at The Billy Graham Training Center (The Cove) in Asheville, N.C., the urgency of reaching a nation for Christ became more apparent. Click to continue to full article


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Pure Play Media is back in the gay game. It's been a couple of years since the Chatsworth, California-based adult distribution company, which mostly produces straight porn, has given us a gay title (previous product includes the Bait Buddies series and Derec's Dilemma), but now it has returned with two. In late September, Pure Play released Game Boys through the newly formed Twink Boy Media. As you might expect, the film stars 11 twink models having suck-and-fuck fun in five scenes. Gay Diaries followed last month, and features young ethnic guys from around the globe, including Latinos, Asians and Europeans. Both films are directed by Kay Ray. Twink Boy Media plans to release one new gay title per month. For more information, visit Pure Play Media.
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Friday, October 29, 2010
Sunday, October 10, 2010
Sapa lagi kuat?
Saturday, October 2, 2010
لا حول ولاقوة إلا بالله
A Palestinian Brother - Crying Tears of Sorrow by Muslim Friend
La Hawla Wala Quwwata Illa Billah merupakan khazanah daripada khazanah-khazanah syurga, ia merupakan penyembuh untuk 99 jenis penyakit, sekurang-kurangnya penyakit dukacita, kesedihan dan kerisauan.
Berkata Abdullah bin Masoud r.a, pernah seketika beliau bersama Rasulullah SAW dan dia mengucapkan La Hawla Wala Quwwata Illa Billah. "Baginda SAW bertanya:"Apakah kamu mengetahui maksudnya?", "Aku menjawab: Hanya Allah dan RasulNya yang mengetahui"
Baginda SAW menerangkan maksudnya:"Ia bermakna tidak ada sesiapa yang mempunyai daya keupayaan untuk memelihara dirinya daripada menderhakai Allah melainkan dengan pertolongan dan perlindungan dari Allah, dan tidak ada sesiapapun mempunyai daya keupayaan untuk mentaati dan beribadat kepada Allah tanpa bantuan dan petunjuk daripada Allah.
Tidak ada daya keupayaan untuk mengelak daripada menderhakai Allah melainkan dengan perlindungan dan pertolongan Allah dan tidak ada daya keupayaan untuk mentaati dan menyembah Allah melainkan dengan pertolongan dan petunjuk daipadaNya, dan tidak ada tempat perteduhan yang selamat daripada kemurkaan Allah melainkan Allah"
A young man was jailed and his mother had no one else but him. She could not sleep and distress took hold of her completely. She wept until she could weep no more, then Allah guided her to say, La Hawla Wa La Quwwata Illa Billah (There is no power and strength except with AllahSubhanahu wa Ta'ala). She repeated these great words which are one of the treasures of paradise, and only a few days after she had despaired of her son ever coming out of jail, he was knocking at the door and she was filled with joy. Such is the reward of one who puts his trust in AllahSubhanahu wa Ta'ala, calls upon HimSubhanahu wa Ta'alaconstantly and delegates all his affairs to Him. So you should recite this Zikr, ''La Hawla Wa La Quwwata Illa Billah'' (There is no power and strength except with AllahSubhanahu wa Ta'ala). For these great words are the secret of happiness and success. Recite them a great deal, chase away the specters of grief and distress with them, and receive the glad tidings that AllahSubhanahu wa Ta'alawill soon grant you happiness and a way out. Beware of losing hope or becoming frustrated, for there is no hardship but it is followed by ease. This is how it has always been and there is no need to discuss it. Think positively of Allah, the Exalted, and put your trust in HimSubhanahu wa Ta'ala; seek that which is with HimSubhanahu wa Ta'ala, and wait for a way out.
Fi Aminillah
Read more:http://ashraf786.proboards.com/index.cgi?board=stories&action=display&thread=19078#ixzz112itnfZz
-The following is a true story-
Since I was born I suffered from Exema on my hands and arms and now I am 22 years of age and still suffering from such disease. Alhamdulelah it goes for a while but it comes back infected and inflamed.
I always looked around me and saw other people's hands and arms in perfect condition and I would go back home and cry so much that my tears would feel a bucket. I was bullied so much in Secondary School because of my Exema and I was treated like dirt and abused because of my belief in Islam. One day in class I cried for over an hour my eyes stung because of the class saying abusive things to me and the teacher did NOTHING because he hated my faith which was apparent.
Since I was small I always held the Quran each night and begged Allah for my suffering to end. Even as I write this my eyes are full of tears.
As I grew up my passion to marry grew. I always wanted to have a child to raise for the mercy of Allah. But because of my suffering from Exema that always stopped me from marrying.
One day in College I saw a really beautiful Sister in Hijab from Lebanon (I think) and I wanted to marry her, but because of my Exema I thought she would not want to even look at me. By Allah, through Halal ways she rejected me which I feel in my heart was because of my hands.
I feel so alone sometimes. I suffer SO much that I cannot go outside unless my sleeves of my shirt cover most of my hands. I cannot make Salat in the Masjid without worrying that someone is going to look at my hands and not want to shake them or that they will give me a bad look. I cannot eat outside or be with my friends without feeling worried that they are going to see my hands.
When I do Wudu with water, my hands sting so much I cry. After Wudu I will make my Salat trying to blot out the pain that I am going through with my hands.
I feel no Muslim Sister will ever marry me but I try to keep strong about it. My only wife I want is a wife of Paradise. I wish I was with Prophet Ayub (AS) as he suffered alot and I would not feel alone as he would be with me worshiping Allah.
My only dream now is to work hard and to die only for Allah.
Please Brothers and Sisters of Islam make Du'a for me and for all Muslims suffering from illness's that they keep strong.
I take this as a blessing from Allah as Allah tests those whom he truly loves.
About three year ago I was sinking into severe depression. I was suffering so much and everything was just sinking deeper and deeper. I would stay up every night just worshipping Allah, begging him for mercy and help.I really thought that Allah abandoned me and hated me.
Then one summer was a summer I would never forget. For six weeks in a row I had dreams that words would never be able to describe in 100% detail.
The dreams are too much to mention. But one of the first was when I was standing on a red land, and then two Muslim men with large dark beards approached me. They asked me do I want to see Hell? I said to them yes. They smiled and I then followed them.
In front of me was like a Hugh head with a wide open mouth. I can still picture this in my mind but I can never really describe it as it was so detailed. We went through its mouth and in it were all types of chambers of black fire. I saw people lying on their bellies on beds of spikes penetrating though their bodies while they were screaming.
Another chamber I saw people being crushed again and again in fire.
Another I saw their limbs being pulled off.
After a few more chambers we left and one of the Muslim's said to me, "Is your life worse than what you saw?" I said, "By Allah, no."
The best dream is of Prophet Muhammad (salla Allaahu 'alayhi wa salaam). In the dream I was sitting in a dark room crying. Suddenly a gold door appeared in front of me. The door said to me, "Don't cry and come inside."
When I went in, I was in such a beautiful garden. There were all sorts of flowers and different coloured streams of water and honey. I heard laughing and talking further on, so I walked through this garden, and each step I took the garden just got more beautiful and different in colour. I saw a really bright gold table with food I have never seen before on this table. There were sweets and different shapes of fruit on the table. There were also crystal cups with drinks with at least 100 different shades of colour.
Sitting around the table were all extremely handsome looking Muslims. I saw one Muslim holding a staff in his right hand so I was thinking that could be Musa ('AlyheeSalaam), and then another Muslim I saw with long wavy hair with pearls falling from his head, so I was thinking that was 'Isa ('AlyheeSalaam). There were at least 100 Muslims around this table. At the head of the table a Muslim turned around and faced me. Mashahallah I will never forget his face. His eyes were darker than black pearls and there was a beautiful light shining from his face. As he smiled at me I felt this warmth and this sweet smelling musk go over my body.
He said Salam to me and called me by my full name. I asked him who he was. He said, "I am the final Messenger of Allah and my name is Muhammad Ibn Abdullallah (salla Allaahu 'alayhi wa salaam). I want you to sit next to me."
A gold chair appeared next to him so I sat there facing him. He took my hand in his hand. It felt so warm and nice. He said something that even made me cry in my sleep. He said, "Dont cry because of the hardships of this life. Cry for the forgiveness of Allah. Don't cry and feel sad for Allah will never leave you alone to suffer. He is with the believer who calls his name. He smiles to the believer who repents. He loves the believer who runs to him in struggle. And on The Day that is coming, you will see how much love and comfort He gives to those Muslims who suffered for Him."
I closed my eyes and then I woke up with tears all down my face.
The Meaning Of La Hawla Wala Quwwata Illa Billah
By Imam Abdullah Ibn 'Alawi Al-Haddad
(Original Source: http://www.alhaddad.org/blog/?p=2300)
You should know that the most comprehensive and inclusive formula for expressing the repudiation of one's own claim to power and ability is La hawla wala quwawata illa billah (there is neither power nor ability save by God).
The Proof of Islam (Imam al-Ghazali), may God be pleased with him, said: "Power (hawl) is motion and ability (quwwa) is aptitude."
No creature possesses either ability or power over anything save through God, Who is Able and Capable. It is incumbent upon believers to have faith in whatever God permits them to do or abstain from – as for instance, in conforming to an injunction, whether by acting or abstaining, or in seeking their provision by resorting to action in the form of crafts and professions, and so on – it is God the exalted Who creates and originates their intentions, abilities and movements, and that the acts they choose to perform will be attributed to them in the manner known as 'acquisition' (kasb) and 'working', and shall be, in consequence, liable to reward and punishment; but that they exercise volition only when God Himself does so, and can neither do nor abstain from anything unless He renders them able to. They possess not a single atom's weight of the heaven or the earth, nor do they attain to any partnership in its governance, or become supports to Him.
It is on the ability and power to make choices, which God has granted to His servants, that commands and prohibitions are based. Things which are done intentionally and by choice are attributed to them, and they are rewarded and punished accordingly.
Hence the meaning of la hawla wala quwwata illa billah is the denial of one's possession of autonomous power and ability, and the simultaneous confession of the existence of that (relative) power and ability to make choices that He has given His servants to be their own.
He who claims that man has no choice or ability, that the acts he selects are identical with the acts he is compelled to do, and that he is in all circumstances coerced is a deterministic (jabri) innovator whose false claim would deny that there was any purpose in sending Messengers and revealing Scriptures. By contrast, he who claims that man possesses the will and power to do whatever he does by choice is a Mu'tazili innovator. But he who believes that a responsible (mukallaf) man possess power and choice to allow him to comply with God's commands and prohibitions, but is neither independent thereby nor the creator of his own acts, has found the Sunna, joined the majoritarian community, and become safe from reprehensible innovation. There is a lengthy explanation to this, which follows a rugged road where many have slipped and gone astray; and beyond it is the secret of Destiny, which has always perplexed intelligent minds and into which the Master of Messengers has commanded us not to delve. So let the intelligent be content with hints and let it suffice them to believe that everything was created by God, and nothing exists without His will and power. Then let them require their selves to conform to the commandments and prohibitions, and take their Lord's side against their selves in every circumstance. A hadith says that is one of the treasures of the Garden.' Understand the indication contained in terming it a 'treasure' and you will know that its meaning is among the mysteries; for reward is of the same species as the act. The Prophet s.a.w has also said 'Two raka'ats in the depths of the night are one of the treasures of goodness.' Their reward comprises a hidden treasure because the time of their occurence, namely the night implies this.
It is also reported that 'La hawla wala quwwata illa billah is a remedy for 99 ailments, the least of which is sorrow.' It is a remedy for sorrow because grief mostly occurs when one misses something one loves, or when a distressful thing occurs; and whenever either of these things occurs people perceive their helplessness and inability to achieve their desired aims; hence they feel sorrow. If at such times they repeat in their heart and with their tongues words which mean that they disavow the possession of any ability or power of their own, then this gives them certitude in their knowledge that they are helpless and weak except where God gives them power and ability, with the result that their sorrow is banished, and their knowledge of their Lord is increased. This can be clearly understood from the Prophet's s.a.w saying: 'When one believes in destiny, one's sorrow departs.' And in attributing ability and power to His Name, Allah, which is the axis of the Names and the most supreme of them, and in following it on most occasions with the two noble Names which indicate two of the attributes of the Holy Essence, namly those of Exaltation (Al-'Ali) and Magnitude (Al-'Azim), lies a sign that He totally transcends and is absolutely holier than the illusions of those who have strayed from the path, are blind to the evidence, and have delved without insight into the secret of destiny and the acts of God's creatures. So take heed!
- Imam Abdullah Ibn 'Alawi Al-Haddad
in 'Gifts for the Seeker'
Translated from the Arabic by Mostafa Al-Badawi
Publisher credit: Fons Vitae


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You may have been there before, but you have never experienced it like this. This is your "golden ticket" to experience the Bowery Hotel outdoor terrace. Take a drink, and you"ll sink, to a state of pure inebriation with DJ Stoon spinning, live performances by Jillian Lee, craft cocktails and proper bottle service.
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The next Ontario election campaign doesn't officially begin until Labour Day 2011, but Premier Dalton McGuinty got the ball rolling a full year early Tuesday by throwing down the gauntlet over all-day kindergarten.
Mr. McGuinty raised the election issue after joining students at Mount Joy Public School in Markham, Ont., for the first day of classes, and to mark the beginning of the all-day kindergarten program in 600 Ontario schools - although not at Mount Joy.
"It's not too soon for us to consider the choice we're going to have next October," said Mr. McGuinty.
"Ontarians will have a very clear choice when it comes to the future of publicly funded education: they can continue to make progress, whether it's test scores or graduation rates or full-day kindergarten, or they can put a stop to that and they can turn the clock back."
The all-day kindergarten program, which will expand to 800 schools next year, will cost the province $1.5-billion a year when it's fully implemented in all 4,000 elementary schools by 2015.
Mr. McGuinty's assertion that voting Liberal will help protect gains in public education is "a bunch of nonsense," said Progressive Conservative Leader Tim Hudak.
"Voting for Dalton McGuinty means higher taxes, more runaway spending while Liberal insiders get rich, and we have not seen the improvements in classroom testing scores," said Mr. Hudak.
However, the Opposition leader wouldn't say if a Conservative government would scrap all-day kindergarten, forcing parents back into more expensive, private day care for their children, or keep expanding the program as the Liberals plan.
There will be 50,000 kids in all-day kindergarten in 800 schools next fall, and a Conservative government would have to deal with that reality and spend its first year evaluating the success of the program, said Mr. Hudak.
"I expect because of the expensive and messy implementation, we'll be fixing this program and making sure dollars go into frontline education as opposed to the enormous cost of Dalton McGuinty's plan," he said.
"If a mom or dad feels their child is best served by a half-day (of kindergarten) they should be given that option."
Mr. Hudak said parents are now forced to either enroll their child in full-day kindergarten if it's offered at their school or drive their children to another school that still offers a half-day program, but the government points out kindergarten is optional for everyone.
Mr. McGuinty warned voters would jeopardize the future of the new all-day learning program if they elect a Conservative government.
"They think full-day kindergarten is an unnecessary frill," he said.
"I disagree fundamentally."
The self-described "education premier" said the Liberals had brought eight years of labour peace to Ontario schools after years of repeated teachers' strikes and lockouts under the Tories.
Mr. McGuinty also defended his emphasis on early education and his decision to implement such an expensive program when the province is facing a budget deficit of almost $20-billion.
"(U.S. President Barack) Obama is fond of saying those that out-teach us today will out-compete us tomorrow," said Mr. McGuinty.
"Well we are out-teaching them today."
Mr. Obama's Secretary of Education, Arne Duncan, will be among those in attendance next week when Mr. McGuinty hosts a two-day seminar in Toronto called Building Blocks for Education. Participants will come from many countries including Russia, France, Australia and Britain.Report Typo/Error
Follow us on Twitter: @GlobePolitics


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Sathers Peppermint Twists are a a bite-size peppermint hard candy made with only the finest ingredients. The candy makers of start with small batches of natural cane sugar syrup and then add real peppermint oil - no artificial flavors. The skilled candy makers create their trademark red and white stripes and then individually twist wraps each piece. These perfect bites of peppermint are a staple of candy dishes around the country, and can be enjoyed by people of all ages.


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- duration:
- One-year course with 3 terms, 10 weeks per term, 2 hours per week
SOAS Language Centre
Arabic (Colloquial Levantine) Beginners Course
2017 Entry requirements
Featured events
- Overview
- Syllabus
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Mode of Attendance: Part-time
A one-year course in Levantine Arabic for beginners.
The course is aimed at complete beginners and is designed to enable learners to communicate in spoken Levantine Arabic within a limited range of everyday situations using the four skills: reading, writing, listening and speaking. The course introduces the students to the Arabic writing system and enables them to read and write basic words and sentences. Emphasis is placed on the learner's ability to speak and listen.
The course is taught in English and Arabic and includes coverage of the four skills of listening, speaking, reading and writing and a good balance between understanding the systems of Arabic grammar and vocabulary, developing the skills of comprehending and producing Arabic in speech and writing, guided practice in language usage and use and authentic communicative activities. Class size is limited to fifteen to allow intensive interactive practice with individual feedback and advice on progress.
Related Information:
Back to the Language Centre Homepage
Arabic (Levantine) Beginners 1 Course Content and Synopsis
Arabic (Levantine) Beginners 2 Course Content and Synopsis
Arabic (Levantine) Beginners 3 Course Content and Synopsis
MaterialsOur course materials page shows you what you need to buy for this course.
Fees and funding
Course fees quoted are per term of 10 weeks.
For further details and information on external scholarships visit the Scholarships section


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Kanex iAdapt VGA Cable 3m
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The More The MerrierFavorites [+]
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Running Time: 125 minutes
Released: 02/2008
Studio Name: Colossal Entertainment Visual Purr-Suasion
Stars: Audrey Hollander Valentina Velasquez Sascha Libido Cynthia Pendragon Kurt Lockwood Benjamin Brat ...More
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Our Connecticut Thrill Seeker Experiences make for truly unique gifts they're sure to remember forever.
Cloud 9 Living's experience gifts are the perfect solution for anyone on your list and are guaranteed to bring a smile to your gift recipient's face.
Create a memory. Give the gift of experience!
Make your dream of becoming a professional racecar driver a reality with the Drive a Stock Car experience at the Thompson International Speedway! Get behding the wheel of a real 500 horsepower Sprint Cup style stock car, and experience the thrill that is only known to professional drivers!
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Experience the thrill of flying an airplane as you take the controls during an exciting introductory flight lesson!
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If you've ever dreamed of flying a helicopter, this learn to fly experience in Connecticut is your chance to make those dreams come true!
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Get ready to experince the adrenaline rish of a lifetime as you ride shotgun in a Sprint Cup style stock car! Let your professional driver get you as close to the action as possible at the Thompson International Speedway!
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Experience the beauty of the Hudson River Valley in a whole new way with this scenic helicopter tour!
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Avoid the crowded city sidewalks and never-ending lines of Manhattan and see the city's major landmarks from above with this NYC Helicopter Tour!
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Experience real life racing thrills by riding shotgun in a 600 horse power Sprint Cup style stock car on the legendary 2.5-mile Pocono Raceway.
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Are you ready for the driving experience of a lifetime? Take the wheel and hit top speeds at the famous 2.5-mile Pocono Raceway.
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Gain a bird's eye view of the Connecticut shore during this approximately 45-minute helicopter tour!
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Fly high above Candlewood Lake during this scenic helicopter tour and experience the vast beauty of Connecticut's largest lake!
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With a world-class vehicle at your command and a professional driving instructor by your side, take advantage of this Land Rover Adventure in Vermont!
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With a world-class vehicle at your command and a professional driving instructor by your side, take advantage of this Land Rover Off-Road Lesson in Vermont!
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Make your home as cool as Deadpool himself with this awesome and officially licensed plasma light! Featuring Deadpool's logo on the base and top, with a cool plasma show going on the middle, this light is the perfect addition to any Marvel fan's home!
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Comments about Spencer's Deadpool Plasma Lamp - Marvel Comics:
My son loves dead pool so when he opened the box and found the plasma light he thought that was his greatest gift. Thank you for having it online.
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Party Equipment Rental $25.00
We are Renting out Tables and Chairs for all kinda Events and Festivals.
The charge on 1 Set, which includes 1 Table and 8 Chairs runs for $13, delivery and pick up Fee is $20.
If you decide on having only Chairs or Tables without the Set offer , we will charge $7 per Table and $1 per Chair. Also Canopy rentals available now $15 ! AND Sno cone Machine (inc.2 Flavor and 30 cups) $25
* Canopy 10x10
* Metal folded Chairs
* 6 Foot Plastic Tables


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At Meijer we got two more deals for you. They are pretty hot and would be handy to keep these coupons close when going there. Check scenarios below.
Buy one V8 Veggie Blends Juice 46oz $2.69
Get $1/1 cashback from Ibotta for buying V8 Veggie Blend
Use one $1/1 V8 Veggie Blends 46oz, 1/1 SS
Price at register: $1.69 but you get $1 cashback from Ibotta
Buy one Johnson+Johnson First Aid Kit $4.99
Buy two Band-Aid Bandages $2.89
Buy one Band-Aid Bandages $1.99
Get $3.00 Off Instantly for buying $12 on Johnson+Johnson First Aid Products
Use one FREE First Aid Kit (WYB3) Band Aid Products (peelie on kit) $4.99 off
Use one $4/3 Band-Aid Products (coupon booklet inside the first aid kit)
NET PRICE: $0.77 $2.87($0.19 each!)
Thanks Meijer MadnessExtreme Couponing Tip: You can usually get two prints of most internet coupons. To find them in the easiest possible way, use our preclipped links that take you right to the coupon. Then come back and click the same link to get your 2nd print. This will save you the time spent searching for the coupon.
Never miss another hot coupon, deal or freebie again! "Like" Couponaholic .NET on Facebook, Follow us on Pinterest, Follow us on Twitter, Follow us on Instagram or Subscribe to our Daily Email Newsletter!


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Fashion Designer
A Fashion Designer can make 127,820 or more per year. the begining salary is around 73,000 to 80,000
A Fashion Designer uses fabrics, thread, needle, paper ,pencil, cotten, manican, and models. I'm in Communication and information systems.
In high school you take home economics. There's no real traning in this.


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If an item you ordered from TextbookRush does not meet your expectations due to an error on our part, simply fill out a return request and then return it by mail within 30 days of ordering it for a full refund of item cost.
Learn more about our returns policy
Description: The need to understand and address large-scale environmental problems that are difficult to study in controlled environments—issues ranging from climate change to overfishing to invasive species—is driving the field of ecology in new and important directions.Observation and Ecologydocuments that transformation, exploring how scientists and researchers are expanding their methodological toolbox to incorporate an array of new and reexamined observational approaches—from traditional ecological knowledge to animal-borne sensors to genomic and remote-sensing technologies—to track, study, and understand current environmental problems and their implications. The authors paint a clear picture of what observational approaches to ecology are and where they fit in the context of ecological science. They consider the full range of observational abilities we have available to us and explore the challenges and practical difficulties of using a primarily observational approach to achieve scientific understanding. They also show how observations can be a bridge from ecological science to education, environmental policy, and resource management. Observations in ecology can play a key role in understanding our changing planet and the consequences of human activities on ecological processes. This book will serve as an important resource for future scientists and conservation leaders who are seeking a more holistic and applicable approach to ecological science.
Limited time offer:
Get the first one free! (?)
All the information you need in one place! Each Study Brief is a summary of one specific subject; facts, figures, and explanations to help you learn faster.
List price: $30.00Copyright year: 2012Publisher: Island PressPublication date: 7/16/2012Binding: PaperbackPages: 232Size: 6.00" wide x 8.75" long x 0.50" tall Weight: 0.682Language: English
*A minimum purchase of $35 is required. Shipping is provided via FedEx SmartPost®
and FedEx Express Saver®. Average delivery time is 1 – 5 business days, but
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Hawaii, Alaska and Puerto Rico. FedEx service marks used by permission."Marketplace"
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Premium Light Leaks 2 PS Actions - Creativemarket 441957
ATN | Adobe CS3+ | 5.41 KB
ATN | Adobe CS3+ | 5.41 KB
Need another touch of awesomely random color for your photos? Premium Light Leaks Photoshop Actions Volume 2 has arrived! This bundle includes 15 light leak actions and is perfect for finishing your images with a colorful, yet professional look. All actions are repeatable, but with just enough randomness to make the process fun. Every action can be fine tuned to give you the exact placement, color, and Intensity desired for each light leak.


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Hi Rick, thanks for your help once again. I have now created my first procedure and have paid attention to the link you provided to guide me regarding argument matching. Even after having read the documentation multiple times and checking my code again and again, I am stuck again and can't figure out why I am getting an 'No method was found that matched the method call void derbyPk.Functions.spGetNextID(int[], java.lang.String) error. This is my procedure definition: CREATE PROCEDURE spGetNextID(OUT iOut integer, IN vcIn character varying(128)) LANGUAGE JAVA PARAMETER STYLE JAVA MODIFIES SQL DATA EXTERNAL NAME 'derbyPk.Functions.spGetNextID'; This is my Java method: package derbyPk; import java.sql.*; public class Functions { public static int spGetNextID( int iNextVal[], String vcIDName ) throws SQLException { Connection conn = getDefaultConnection(); int column = 1; PreparedStatement ps = Utils.prepare ( conn, "select \"NextVal\"\n" + "from rte.\"IDs\"\n" + "where \"IDName\" = ?\n" ); ps.setString( 1, vcIDName ); ResultSet rs = ps.executeQuery(); rs.next(); iNextVal[0] = rs.getInt( column++ ) + 1; return iNextVal[0]; } /*
Get the default connection, called from inside the database engine.*/ static Connection getDefaultConnection() throws SQLException { return DriverManager.getConnection("jdbc:default:connection"); } } and this is the application code to call the procedure: public static void main(String[] args) throws SQLException { // TODO Auto-generated method stub String driver = "org.apache.derby.jdbc.EmbeddedDriver"; try { Class.forName(driver); } catch(java.lang.ClassNotFoundException e) { } String dbName = "pmsdev"; String connectionURL = "jdbc:derby:" + dbName + ";create=true"; try { Connection conn = DriverManager.getConnection(connectionURL); System.out.println("... Connection successful"); String vcIDName = "Transaction"; CallableStatement cstmt = conn.prepareCall("{ call DERBY.spGetNextID(?, ?)}"); cstmt.registerOutParameter(1, Types.INTEGER); cstmt.setString(2, vcIDName); cstmt.executeUpdate(); int retVal = cstmt.getInt(1); System.out.println(retVal); } catch (Throwable e) { System.out.println(e); } } } Seems I need to call the procedure fully qualified as 'DERBY.spGetNextID' as otherwise I am getting an error that no procedure or funtion was found. Hope you can easily spot what I am unable to find..... Regards Thomas


text: The hotel has a total of 115 rooms on 5 floors, of which 16 are suites. There is a spacious landscaped garden with a furnished sun terrace and a pool for guests to enjoy, as well as a considerable reception hall with lifts, a 24-hour reception and safes. Furthermore there is a games room, TV room, caf�, a cosy bar and an air-conditioned non-smoking restaurant with children's highchairs available on request.It is mandatory to wear long trousers for dinner.The stylish en suite rooms are fitted with bathroom, hairdryer, air conditioning or heating, mini fridge, safe (for a fee), telephone, music channel, LCD satellite TV and balcony. All double rooms have spectacular sea view (direct or lateral) and Junior Suites with direct sea view. Wifi available with additional charge.


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About the Book
In Timeless: Photographs of Italy Barry Chin focuses on the classical landscape of Italy. From the active city of Rome, to the remote hilltowns, to the tragic remnants of lost Pompeii he presents a timeless vision of Italy.
Features & Details
- Category Arts & Photography
Standard Landscape, 10×8 in, 25×20 cm
118 Pages
- Publish Date Nov 19, 2007
- Tags Photography, Europe, Italy
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About the Creator
Barry Chin
San Francisco, California, USA
Barry Chin is a graduate of the University of California, Berkeley in Architecture. He is a licensed architect and practices architecture and construction project management. He is the co-author of a series of successful professional practice books including the Licensed Architect: Building Design Examination Primer and the Building Design Vignette Primer series.
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Pay-Per-Minute Viewing
You can now enjoy this movie on your iPhone®, iPad®, or compatible Smart TV & Android devices.
Purchase Options
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Available MP4 sizes:SD 480p (1.74 GB)
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DRM-free downloads offer content that is not limited by standard Digital Rights Management (DRM) access technologies. These technologies allow hardware manufacturers, publishers, copyright holders and individuals to limit the usage of digital content.
When you purchase DRM-free downloadable content, that content is available for you to download on any computer and save to a disk whenever you like. You can also download to multiple computers. There is no timeframe associated with your purchase and the content will not expire.
Running Time: 111 minutes
Released: 09/2015
Studio Name: Porn Star Empire
Director: Ivan
Categories: Gonzo High Definition
Description: Horny sluts are down for a good time and that means sex, sex, and some more sex. These gals never stop and want to fuck all day long!! That sounds like A Good Fucking Time!!
6 Scenes from A Good Fucking Time
A Good Fucking Time: Scene 1 Free Preview
Starring: Britney Amber Carson Grundle ... More Details
Stars: Britney Amber, Carson Grundle
Sex Acts: Oral Sex, Deep Throating, Vaginal Sex, Handjob, Masturbation, Breast Play
Positions: Cowgirl, Doggy Style, Laying, Missionary, Reverse Cowgirl, Sitting, Standing
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Starring: Mark White Jessica Jaymes ... More Details
Stars: Mark White, Jessica Jaymes, Dava Foxx
Sex Acts: Oral Sex, Tittie Fucking, Deep Throating, Handjob, Masturbation, Breast Play, 3-Way
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Starring: Romi Rain ... More Details
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Positions: Laying
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Sex Acts: Oral Sex, Choking, Deep Throating, Vaginal Sex, Handjob, Masturbation, Breast Play, Anal Sex
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Opinion + Fish
Yes, stocks may have recovered in the North Sea, but overfishing is not the problem in sustaining marine health
Jut when we need it most, the very future of seafood is in doubt. How did the official figures get it so wrong – and can anything be done before it's too late?
You'll never see fish owners grumbling about the need to vacuum all the scales off the couch and out of the rug
Editorial: A fishmonger's stall is one of the great refreshments of civilisation. It brings the unmediated wild into the middle of the city
Why we at Tesco are not boycotting Thai fishmeal suppliersKevin Grace, group commercial director, TescoKevin Grace: There has rightly been pressure on supermarkets to cut off offending suppliers, but Tesco can better help to end slavery by looking beyond short-term PR relief
One rule for our navy, another for Indonesian fishermenEmily MitchellEmily Mitchell: Indonesian fishermen who inadvertently breach Australian waters suffer punitive circumstances, but Australian warships receive differential treatment
Ian Jack: Living among wealth can be alienating, but not all its effects are malign. The return of high-end independent food shops seems, on balance, a good thing
Editorial: George Orwell warned that without empire, the UK would be forced to live on 'herring and potatoes'
The fishy caviar topping the canapés of the rich and famousDebora Robertson
Debora Robertson: If it takes a lab technician to determine that one's pricy sevruga is fake, perhaps it's time to tuck into less stellar snacks
Eating fish: it's complicatedJames RamsdenJames Ramsden: With all these tales of fishy labelling floating around, how can we tell the codliness or otherwise of our fish suppers?
Callum Roberts: It may be the end of fish discards, but now we need more marine conservation zones to stop our seabeds becoming a wasteland
Food shopping is full of ethical grey areas. Be careful what you buy – or fish will be a luxuryJay Rayner
In the great mackerel row, consumers are caught in the middle desperately trying to work out what they should and shouldn't be eating
Anywhere but Westminster Who gets a fair share of Britain's fishing quota? Not the small boats - video
Anywhere but Westminster: As the EU reviews its common fisheries policy, John Harris goes to Hastings to find out how fishing quotas are crippling the local fishing industry
On polling and politics 2012 Shark attacks create feeding frenzy as media smells blood in the waterHarry J Enten
Harry J Enten: You know what's more likely to kill you than a shark? Digging a hole on the beach. For real
Aniol Esteban: Simply encouraging people to be more adventurous with new species will not ease the pressure on fish stocks
Britain's real fish fightCallum Roberts
Cif green Fishing in troubled watersSylvia Earle and Susan Lieberman
Sylvia Earle and Susan Lieberman: Fish populations once thought to be inexhaustible now face the prospect of becoming extinct if policy changes are not made soon
Cif green Are fishes' feelings a red herring?Ariane SherineAriane Sherine: Scientists have solved the moral conundrum of whether fish suffer pain. But never mind, there's probably no cod


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3 total
Conservation Easements and the Law CONSERVATION EASEMENTS The subdivision of land is subject to municipal regulations. Conservation easements control the use of land by prohibiting developme
Liability and the Operating Agreement The popularity of LLC's arises from its simplicity and the traditional "corporate veil", protecting individuals from personal liability. It's a streamlined bus
Assemble Financial Records A financial affidavit is required. It must list all weekly income, expenses, debts, assets, and savings. This is used to determine child support, alimony and property dis


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Product Spotlight
Featured Research
Quick Stats
You are here
Harris Teeter Collects $594K-plus to Fight Hunger
Funds raised equal 5.9 million meals
Shoppers and associates of Matthews, N.C.-based Harris Teeter Supermarkets Inc. donated more than $594,000 to local food banks during the grocery chain's Harvest Feast Food Drive and Donation Card campaign, which ran during the month of November in all store locations.
During the campaign, shoppers could purchase $1, $5 or $20 donation cards at checkout, in addition to donating food to the companywide food drive.
According to Harris Teeter, the money raised in the campaign equates to 5.9 million meals, which food banks and food pantries in the grocer's Southeast marketing areas can supply to the communities they serve.
The company's media partners in the effort were Comcast, Cox Cable, WCSC, WGHP, WILM, WRAL and WBTV, all of which assisted in the promotion of the food drive and donation card campaign.
Harris Teeter, a wholly owned subsidiary of The Kroger Co., in Cincinnati, employs about 26,000 associates at stores in North Carolina, South Carolina, Virginia, Georgia, Tennessee, Maryland, Delaware, Florida and the District of Columbia.


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What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you're getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you'd like help immediately, feel free to search for a similar question, or submit your question or concern.
Form design is not showing up in the form builder and designer but good in previewAsked by igichaife on January 19, 2016 at 06:07 AM
In the editor, I do not have the colors that are in the actual page. In preview and using the URL the colors are fine.
This occured after the CDN problem - can't figure out why this would be an issue. I reopened the form in editor a couple times, but still the same lack of chosen colors.
Again, this is only in the editor not in the actual form.
Thanks ...
JotForm Support
A theme is applied in the form and the theme is not rendered in the form builder and form designer. If you wish to override the theme design, please do so in the form designer:


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Chemical peel before wedding 2 weeks away? Prestige peel. Should I get one?
Doctor Answers 3
Getting Ready for the Wedding
The wedding is a big day and your skin has to be equally ready. I would advise against doing a chemical peel 2 weeks before the wedding or something that you have never had before. Chemical peels or Clear and Brilliant (which is a mini-fraxel) are all excellent treatments. But if you have never done these before I would not do it right before the wedding. As with all cosmetic procedures please find a board certified dermatologist for the best results.
Learn more: http://www.michelegreenmd.com/chemical-peels
With only 2 weeks, time is of the essence for chemical peel
With only two weeks, a 2-3 day recovery is needed. If you are going to do anything, a Nano Laser Peel might give you the radiant skin you are looking for.
To be sure, see two or more board certified and experienced plastic surgeons in your area for a full and complete evaluation.
I hope this helps.
Learn more: http://www.drjjwendel.com/laser-skin-resurfacing
2 weeks way!!! Are you crazy??
Learn more: http://www.lidlift.com
You might also like...
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.


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GiggleSugar Best Pics of the Week
Start Slideshow
GiggleSugar Best Pics of the Week
From tiny red pandas to big ol' douchebags, GiggleSugar has no shortage of adorable and disturbing visuals. So relive some of the week's most atrocious fashions, questionable tattoos, and just plain weird finds from the web. Here's a look back at the week in photos.


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The history of Park City Mountain resort is rich, and Mid-Mountain Lodge is no exception. Come and enjoy your lunch here and take in the story and images of the Silver King mining days when the lodge serviced over 1,000 miners a day. The building was carefully renovated and now stands proudly as a beautiful restaurant for our guests. Featuring toasted gourmet sandwiches, homemade soups and the Mid-Mountain burger loaded with sautéed mushrooms, grilled onions and white cheddar cheese, this is a special spot on the mountain. We also offer an espresso and snack bar for an early morning bite or late afternoon refuel. Come and enjoy the spectacular views on the expansive deck and the new 10th Mountain outdoor grill serving hamburgers, brats, reubens & French fries.
© 2015 Park City Chamber of Commerce | Convention & Visitors Bureau


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|By Sequoya89
|Part of the The Story of Kai Leu continuity.
Kai Leu Age:11
Kai Leu discovered she was the Avatar at age 9. Now at age 11 her governess still keeps it away from her. During her parents political meeting Kai Leu meets two new people who soon become her most loyal of friends, Kaino and Kyalin. Kai Leu leaves learning their sad family story and knowing she is very lucky. After discovering about the spirit attacks Kai Leu ventures off. She attempts learning all four elements having in mind maybe then she will know more about spirits. In order she trains already knowing earth to fire, air and water. Kai Leu meets a fire bending teacher who is Kaino's age of 13, Dianle. Kai Leu has a major crush on Kaino which she is hiding from Dianle who has some same love interests. Kai Leu is mothering Kyalin who she just wants her to grow up normally like any other little girl.
Kai Leu already mastered metal bending and earth bending. She is currently learning firebending and will soon have to find her way to the Air Nomads.
Kai Leu is just always ready to have fun. She is tough and has a strong mind and heart. She is also very caring for Kyalin. Sometimes she lets her feelings and jealousy get the best of her. All Kai Leu wants to do is turn things back to normal. She wants to make sure things are all right and to at least have a little fun.
See more
For the collective works of the author, go here.


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Employment Mentoring
Winchester City Council is working with the national agency Sova to provide a service to help unemployed people to find work.
The project, which is funded by Winchester City Council and run by national charity Sova, recruits local mentors to provide practical and moral support to unemployed residents in the Winchester District.
A couple of case studies are available to download and view in PDF format, in the Attachments section below.
Could our mentors help you look for work?
The service is free. You will be carefully matched with a dedicated mentor who will tailor the service to suit you.
Mentors could help you with the following:
- building CVs
- job searches
- interview techniques
- developing new skills such as using computers, the Internet or budgeting
- sourcing training and volunteering opportunities
- signposting to specialist services that can help you move towards employment
- becoming self employed
- taking up a traineeship or apprenticeship
- filling in forms for benefits, for example Winchester City Council 'Access to Work Grants'
- setting up a bank account.
If you would like help with finding work and you live within the Winchester District please contact Alex Solomon at email@example.com or on 07980 732 005.
Could you help someone on their journey to employment?
Sova are looking for new volunteer mentors to help unemployed people living within the Winchester District. No formal qualifications or experience are necessary; but volunteers will need to be committed to supporting others, have good listening and communication skills and demonstrate a non-judgmental attitude.
All mentors will receive on-going supervision and thorough training.
Travel expenses will be reimbursed. Volunteering can provide you with valuable work experience that could benefit your job prospects.
If you would like to mentor a job seeker please contact Alex Solomon on 07980 732 005, or at email@example.com
|Download Time
|Some of the following documents are in pdf format. You can download and install a free PDF reader to enable you to read and print them. Click here to download Adobe Acrobat (PDF) Reader.
|Case studies
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