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The contribution of HIV-infection to periodontal disease (PD) is poorly understood. We proposed that immunological markers would be associated with improved clinical measures of PD.
We performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART) <2 years. PD was characterized clinically as the percent of teeth with ≥1 site with periodontal probing depth (PPD) ≥5.0mm, recession (REC) >0mm, clinical attachment level (CAL) ≥4.0mm, and bleeding on probing (BOP) at ≥4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD.
Forty (40) subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001) and HIV RNA decreased by 0.5 log10 copies/ml (p<0.001); concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001). Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04) and CAL (9.06%; p<0.001). Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of Porphyromonas gingivalis (p=0.027), and BOP in subjects with higher baseline levels of Porphyromonas gingivalis or Treponema denticola (p=0.001 and p=0.006 respectively). Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD.
Degree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.
Citation: Vernon LT, Demko CA, Babineau DC, Wang X, Toossi Z, Weinberg A, et al. (2013) Effect of Nadir CD4+ T Cell Count on Clinical Measures of Periodontal Disease in HIV+ Adults before and during Immune Reconstitution on HAART. PLoS ONE 8(10): e76986. https://doi.org/10.1371/journal.pone.0076986
Editor: Derya Unutmaz, New York University, United States of America
Received: August 2, 2013; Accepted: September 4, 2013; Published: October 11, 2013
Copyright: © 2013 Vernon et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: Funding was from National Institute of Dental and Craniofacial Research, Grants K23 DE15746-01A1 and R21 DE21376-01, The Center for AIDS Research (CFAR), AI36219, the William T. Dahms, M.D. Clinical Research Unit (Dahms CRU) of the Clinical and Translational Science Center, UL1 RR024989, NIH, M01 RR000080, the CWRU Department of Biological Sciences, OPR892515, and the Case Western Reserve University/Cleveland Clinic CTSA Grant, UL1 RR024989 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health and NIH roadmap for Medical Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
While HIV/AIDS is considered a "modifier" of periodontal disease (PD) [1,2], the mechanisms of this connection are poorly understood. Clearly, immunosuppression can potentiate PD, as evidenced by reports of florid examples of HIV-associated gingival/periodontal disease during the early days of HIV outbreak in the United States [3,4]. Recently, in a cross-sectional evaluation of 112 HIV+ adults, our group found that ever having a CD4+ T-cell count below 200 cells/μl conferred approximately twice the risk for traditionally defined PD as did cigarette smoking, a known strong risk factor for PD [5]. Even in the era of highly active antiretroviral therapy (HAART), the prevalence of traditionally defined PD within cohorts of predominantly African American HIV+ adult cohorts has been high, ranging from 66% to >90% [5,6] depending on the definition of PD used. Because African Americans are disproportionately infected with HIV[7], the public health relevance of traditionally-defined PD in HIV+ adults is significant both in terms of the population affected and patient morbidity; however, the issue remains underappreciated and under-recognized. There are several methodological limitations in earlier studies proposing a low level of PD in HIV+ adult cohorts, as detailed in our 2009 report[5]. In our 2011 longitudinal report of 43 HIV+ patients on HAART, we found that PD improved significantly during immune reconstitution on HAART[8]. We subsequently hypothesized that longitudinal improvement in CD4+ T-cell count and/or decreased level of HIV RNA would be associated with longitudinal improvement in clinical measures of PD. To address this hypothesis, we extended the analysis of our earlier report[8] by modeling the effect of nadir CD4+ T cell count and the longitudinal change in CD4+ T cell count and level of HIV RNA on clinical measures of PD. We found that nadir CD4+ T cell count influences periodontal disease in HIV-infected adults both before and after HAART initiation, and that this influence varies prior to and after HAART initiation.
Study Design
This was a prospective observational study of adult subjects recruited from three outpatient HIV medical clinics in Cleveland, Ohio as previously described[5,8]. IRB approval was obtained from University Hospitals Case Medical Center (UHCMC). Most participants were self-referred; all subjects signed a written UHCMC IRB-approved informed consent document. Exclusion criteria included evidence of cardiovascular disease, a history of Type I or II diabetes mellitus, fewer than 20 teeth, uncontrolled systemic illnesses, diagnosis or treatment of cancer in the past five years, pregnancy, and need for antibiotic prophylaxis prior to dental care as per the American Dental Association (ADA) and other guidelines[9,10]. Inclusion criteria were: medication-compliant adult subjects, age 18 or older, who were taking highly active antiretroviral therapy (HAART) for < 2 years at baseline. HAART was defined previously[8] as a treatment regimen that included at least three different antiretroviral drugs from at least two different classes. All subjects were seen for evaluation and PD measurement at baseline and at one or more visits thereafter, typically at 8, 16 and 24 months. Study subjects were seen from May, 2005 through January, 2008.
Periodontal Disease Measurements and Definition
The periodontal probing depth (PPD), gingival recession (REC), clinical attachment level (CAL) and bleeding on probing (BOP) were determined at six sites per tooth by one dentist (LTV) as previously described[5]. The percent agreement from ongoing intra-rater reliability for periodontal probing (+/- 1 mm) was 98% with an intra-class correlation coefficient of 0.88. A viable tooth was defined as having at least one-half of a remaining clinical crown and having at least three contiguous sites in which PPD, REC and CAL were measurable. To ensure probing accuracy, supragingival plaque, debris, blood and saliva were removed prior to performing precise full-mouth periodontal measurements. To minimize the possibility of misclassification by categorizing data, we defined and analyzed PD data as continuous variables. Herein, we report PD as per its component parts, PPD, REC and the summary measure, CAL[5,11,12], because these components may represent different processes that contribute to periodontal disease[11,12], and each component outcome[11,12] may help illuminate how HIV-1 infection influences or interacts with the progression of PD[5]. We define BOP as the percent of teeth with BOP on ≥4 sites per tooth. Consistent with our previous report, we used the following thresholds to define periodontal disease: PPD >5 mm, REC >0 mm and CAL ≥4mm; thus, for each component, we calculated the percent of teeth with at least one site per tooth that met the threshold and analyzed each outcome as a continuous variable.
Study Measures
Clinical data were obtained from the primary HIV clinic's longitudinal electronic database or from retrospective chart reviews. One dentist researcher (LTV) administered questionnaires to obtain demographic, medical and oral behavioral data as previously reported[5]. Smoking was recorded as ever having smoked more than 100 cigarettes and pack-per-day years (ppdyrs) of cigarette smoking.
Clinical Measures
CD4+ T cell count was measured by flow cytometry and HIV RNA by polymerase chain reaction (PCR) as previously described[5,8] Data on CD4+ T-cell count and HIV RNA was merged with periodontal measures using a window on immunological variables defined by less than 4 months before or 1 week after each study visit.
Collection of Dental Plaque for Periodontal Pathogens
To collect subgingival dental plaque, a separate sterile 13/14 Gracey curette was used for each tooth. Plaque was harvested from the most apical portion of the probing depth alongside the surface of the tooth's root at two different interproximal sites (usually the distobuccal and distolingual) of the first molar in each quadrant[5]. For each patient, plaque was obtained from eight molar tooth sites and transferred into a single microcentrifuge tube that contained 0.5 ml tri-reagent (Molecular Research Center Inc., Cincinnati, Ohio). If the first molar tooth in a given quadrant was missing, the next most distal tooth was accessed. If all molar teeth were missing, dental plaque from the most distal tooth in that quadrant was harvested, as described previously[13]. After placing on ice temporarily, the microcentrifuge tubes were stored in a -70°C freezer until DNA extraction was performed.
Isolation and quantification of DNA
DNA from dental plaque samples was extracted according to the manufacturer's instructions as previously described[14]. Bacterial DNA for Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Tanneralla forsythia (Tf),as well as DNA encoding total bacterial 23s ribosomal RNA was assessed using real-time PCR (Taqman 7700, Applied Biosystems, Foster City, CA). Primer Express software (Applied Biosystems) was used to design Taqman primer and probes for Pg, Td, and bacterial 23s ribosomal RNA, while primers and probe for Tf were replicated as per Morillo et al., 2004[15]. For details on probes and primers, see our previous reports[5,8] (NCBI accession numbers D64081.1, U29399.1and AY423857.1, for Pg, Td and Tf, respectively). Products of bacterial 23 S ribosomal DNA were detected using SYBR Green (Applied Biosystems). Bacterial DNA quantities were determined using a dilution series of oligonucleotide sequences (Invitrogen, Carlsbad, CA) synthesized for each assay's target DNA. Plaque DNA concentration and purity were determined using spectrophotometery (BECKMAN DU640). After correcting for the total DNA in each plaque sample, DNA copies for each pathogen were expressed as copies of bacterial DNA per microgram of DNA.
Statistical Analysis
Baseline variables were summarized using standard descriptive statistics. To characterize disease progression during the study, the average change in immunological markers as well as clinical periodontal disease markers over a 24 month period was estimated using separate linear mixed-effects models that included a random intercept and slope with a compound symmetry correlation structure to account for between-subject variance. The association between nadir CD4+ T-cell count and baseline clinical periodontal disease markers was estimated using separate linear regression models adjusting for age and total pack-per-day years of cigarette smoking. Because CD4+ T-cell count and HIV RNA levels changed throughout the study, separate linear mixed effects models were also used to simultaneously estimate the cross-sectional (or between-subject) association between baseline CD4+ T-cell count (or HIV RNA) and baseline clinical PD measures, as well as the longitudinal (or within-subject) association between changes in CD4+ T-cell count (or HIV RNA) over time and changes in clinical PD measures over time. Models included fixed effects for time on study, baseline CD4+ T-cell count (or HIV RNA), change in CD4+ T-cell count (or HIV RNA) from baseline, age, and total pack-per-day years of cigarette smoking. Linear mixed models were also used to estimate the association between nadir CD4+ T-cell count and the rate of change in clinical measures of periodontal disease over time. Models included fixed effects for time on study, nadir CD4+ T-cell count, age, and total pack-per-day years of cigarette smoking as well as associated pairwise interactions with time on study. To investigate whether this effect was modified by baseline periodontal pathogens, a 3-way interaction between time on study, nadir CD4+ T-cell count and baseline periodontal pathogens was also included in all models. Data were analyzed using SAS (Version 9.2; Cary, NC).
Results and Discussion
There were 50 patients in our study who had at least one follow-up periodontal visit. Of these, 10 patients were excluded because they were not on HAART at the baseline visit (n=6), not on HAART during the study (n=2), had a full mouth extraction before any follow-up visits (n=1) and because CD4+ T-cell count was not available 4 months before or 1 week after the baseline visit (n=1). Among the 40 patients in the final analyses, 8 (20%) had one follow-up periodontal (examination) visit, 13 (32.5%) had two follow-up periodontal visits, 12 (30%) had 3 follow-up periodontal visits, 3 (7.5%) had 4 follow-up periodontal visits and 4 (10%) had 5 follow-up periodontal visits, for a total of 142 study visits. The Spearman correlation between baseline CD4+ and nadir CD4+ T-cell count was 0.81 (p<0.01). The Spearman correlation between baseline CD4+ T-cell count and baseline plasma HIV RNA was -0.33 (p=0.04). The correlation between nadir CD4+ T-cell count and baseline HIV RNA was weak with a Spearman correlation of 0.04. Across the study, the median number of teeth extracted was 0 (range 0-10); a total of 40 teeth were extracted from 11 subjects (27.5%). At end of study, 28 (70%) had achieved a viral load below the limit of detection of commercial assays (HIV RNA ≤50 copies/mL). About half of all subjects (53.5%) were seen by a dentist prior to their follow-up study visit, but only 7 subjects (17.5%) received scaling and root planing (SC/RP) throughout the study (i.e., prior to 10.8% of all recall visits).
Table 1 summarizes baseline characteristics for all 40 subjects included in the analytic sample. At baseline, subject's mean age was 37.4 ± 8.6 years. Most subjects (70%) were male and a majority of participants were black (59%). Overall, subjects had recently started HAART; the median time on HAART at baseline was 2.7 (IQR: 1.1-8.3) months and the median nadir CD4+ T-cell count was 211.5 (inter-quartile range (IQR): 116.5-295.0) cells/μl. Total mean study follow-up time was 22.8 ±10.3 months. Each subject had a median of 3 (range 2-6) study visits during which the extent of periodontal disease was measured. On average, subjects were on HAART during 97% of study visits. The median baseline CD4+ T-cell count was 346.0 (IQR: 203.0-454.0) cells/µl and the median HIV RNA was 400.0 (IQR: 53.5-15530) copies/ml. For additional patient characteristics during the follow-up period, see Table S1.
|Baseline characteristics
|Mean (SD)
|Frequency (Proportion)
|Age (years)
|BMI (kg/m2)
|Ever smoked
|Total pack-per-day years smoked
|≤ High school graduate/GED
|Medicaid/care or Ryan White insurance
|HIV specific
|Months since first seropositive test
|Total months on HAART
|Months between nadir CD4+ T-cell count and baseline CD4+ T-cell count
|Immune/Inflammatory variables
|CD+ T-cell count (cells/µl)
|Nadir CD4+ T-cell count (cells/µl)
|HIV RNA viral load (copies/mL)
|HIV RNA "undetectable" (≤50 copies/mL)
|10 (25%)
|Clinical periodontal disease measures
|PPD ≥5.0 mm (% teeth)
|REC >0 mm (% teeth)
|CAL ≥4 mm (% teeth)
|BOP on ≥4 sites/tooth (% teeth)
Change in immunological and virological markers and clinical measures of PD over time
Table 2 describes estimated disease progression over a 24-month period. On average, our cohort experienced immune reconstitution during the study; CD4+ T-cell count increased by 173.1 cells/µl (95% CI: (105.3, 240.9); p<0.001) and HIV RNA decreased by 0.5 log10 copies/ml (95% CI: (0.3, 0.8); p<0.001). Additionally, on average, PPD, CAL and BOP decreased by 11.7% (95% CI: (7.6%, 15.8%); p<0.001), 12.1% (95% CI: (7.9%, 16.4%); p<0.001) and 14.7% (95% CI: (8.7%, 20.7%); p<0.001) respectively.
|Mean (SD) at baseline
|Estimated mean change (95% CI) between baseline and 24 months
|BMI (kg/m2)
|1.4 (0.5, 2.2)
|Immune/Inflammatory variables
|CD4+ T-cell count (cells/µl)
|173.1 (105.3, 240.9)
|< 0.001
|HIV RNA (log10 copies/µl)
|-0.5 (-0.8, -0.3)
|< 0.001
|Clinical periodontal disease measures
|PPD ≥5.0 mm (% teeth)
|-11.7 (-15.8, -7.6)
|< 0.001
|REC >0 mm (% teeth)
|-4.5 (-9.5, 0.5)
|CAL ≥4 mm (% teeth)
|-12.1 (-16.4, -7.9)
|< 0.001
|BOP on ≥4 sites/tooth (% teeth)
|-14.7 (-20.7, -8.7)
|< 0.001
Associations between baseline immunological and virological markers and baseline measures of PD
A summary of the cross-sectional association between nadir CD4+ T-cell count and baseline measures of PD is provided in Table 3. After controlling for age and smoking pack-per-day years, lower nadir CD4+ T-cell count was associated with worse (higher) baseline REC (6.72% per 100 cells/µl decrease in CD4+ T-cell count; 95% CI: (0.43%, 13.01%); p=0.04) and CAL (9.06% per 100 cells/µl decrease in CD4+ T-cell count; 95% CI: (4.34%, 13.79%); p<0.001), but not PPD or BOP. There was no evidence of an association between nadir CD+ T-cell count and the baseline levels of any periodontal pathogens (p≥0.06; see Table 3). Similarly, in adjusted models that simultaneously estimated the cross-sectional and longitudinal associations between CD4+ T-cell count and clinical PD measures, lower baseline CD4+ T-cell count was also associated with a higher baseline REC (4.18% increase per 100 cells/µl decrease in CD4+ T-cell count; 95 CI: (0.07%, 8.43%); p=0.05) and CAL (6.10% increase per 100 cells/µl decrease in CD4+ T-cell count; 95% CI: (1.85%, 10.35%); p=0.01) but not with PPD or BOP (p≥0.14; see Table 4). There was no evidence of an association between baseline HIV RNA and any of the baseline clinical measures of PD (p≥0.23; see Table 4).
|Increase in baseline clinical PD measure per 100 cells/µl increase in nadir CD4+ T cell count
|Clinical measure of PD
|Mean estimate (95%CI)
|-1.57 (-5.81,2.67)
|-1.70 (-6.01,2.61)
|-6.29 (-14.29,1.70)
|-6.72 (-13.01,-0.43)
|-8.72 (-14.30,-3.13)
|-9.06 (-13.79,-4.34)
|-2.74 (-8.61,3.12)
|-2.57 (-8.52,3.38)
|Increase in baseline microbial PD measure per 100 cells/µl increase in nadir CD4+ T cell count
|Microbial measure of PD
|Mean estimate (95%CI)
|-0.14 (-0.65,0.37)
|-0.15 (-0.64,0.34)
|23s rDNA
|-0.09 (-0.19,0.02)
|23s rDNA
|-0.09 (-0.19,0.02)
|0.15 (-0.16,0.45)
|0.15 (-0.18,0.47)
|0.22 (-0.01,0.46)
|0.23 (-0.01,0.47)
|Increase in clinical PD per 100 cells/µl increase in baseline CD4+ T-cell count
|Increase in the change in clinical measure of PD from baseline per 100 cells/µl increase in the change in CD4+ T-cell count from baseline
|Clinical PD measure
|Mean estimate (95%CI)
|Mean estimate (95%CI)
|-1.82 (-4.58,0.93)
|0.90 (-1.46,3.26)
|-2.02 (-4.75,0.71)
|0.91 (-1.49,3.32)
|-3.43 (-8.79,1.94)
|-0.03 (-1.45,1.39)
|-4.18 (-8.43,0.07)
|-0.05 (-1.43,1.34)
|-5.66 (-10.74,-0.59)
|-0.24 (-1.28,0.79)
|-6.10 (-10.35,-1.85)
|-0.28 (-1.33,0.76)
|-1.28 (-4.33,1.77)
|1.88 (-0.46,4.21)
|-1.10 (-4.27,2.08)
|1.87 (-0.50,4.25)
|Increase in baseline clinical PD measure per 1-log10 increase in baseline HIV RNA
|Increase in the change in clinical measure of PD from baseline per 1-log10 increase in the change in HIV RNA from baseline
|Clinical PD measure
|Mean estimate (95%CI)
|Mean estimate (95%CI)
|-2.93 (-6.98,1.12)
|-0.32 (-2.36,1.71)
|-2.37 (-6.31,1.56)
|-0.29 (-2.34,1.76)
|-1.41 (-8.45,5.63)
|0.40 (-1.68,2.47)
|3.07 (-2.82,8.96)
|0.50 (-1.60,2.59)
|-1.27 (-8.56,6.02)
|0.08 (-1.86,2.02)
|2.19 (-4.27,8.66)
|0.15 (-1.81,2.12)
|-0.76 (-5.68,4.16)
|0.91 (-1.82,3.64)
|-2.06 (-7.49,3.37)
|0.83 (-1.85,3.52)
Longitudinal effect of nadir CD4+ T-cell count on rate of change in clinical measures of PD
As shown in Table 5, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement (i.e., decrease) in: 1) PPD in subjects with higher baseline levels of Pg than in subjects with lower baseline levels of Pg (p=0.027). Similarly, lower nadir CD4+ T-cell count was associated with a greater decrease over time in: 1) BOP in subjects with higher baseline levels of Pg or Tf, than in subjects with lower levels of baseline Pg or Tf (p=0.001 and p=0.006 respectively); and in 2) REC in subjects with higher baseline levels of 23s rDNA than in subjects with lower levels of 23s rDNA (p=0.031). Finally, there was no evidence of a longitudinal association between nadir CD4+ T-cell count and the rate of change in CAL (p-value=0.12).
|Mean difference in rate of change in PPD per 12 months
|Mean difference in rate of change in REC per 12 months
|Mean estimate (95%CI)
|Mean estimate (95%CI)
|Nadir CD4
|-0.04 (-1.39,1.32)
|1.84 (0.23,3.45)
|Nadir CD4
|0.00 (-1.45,1.46)
|1.89 (0.20,3.58)
|Nadir CD4
|0.01 (-1.47,1.50)
|1.83 (0.54,3.11)
|-0.58 (-1.68,0.51)
|-1.51 (-2.61,-0.42)
|Nadir CD4
|-0.10 (-1.50,1.30)
|1.89 (0.01,3.77)
|23s rDNA
|-1.55 (-6.12,3.02)
|-0.20 (-6.93,6.54)
|Nadir CD4
|0.26 (-1.28,1.81)
|1.97 (0.27,3.68)
|-0.92 (-2.24,0.39)
|-0.27 (-1.55,1.01)
|Nadir CD4
|0.23 (-1.33,1.79)
|1.89 (0.27,3.51)
|-0.80 (-2.72,1.12)
|0.06 (-1.18,1.30)
|Mean difference in rate of change in CAL per 12 months
|Mean difference in rate of change in BOP per 12 months
|Mean estimate (95%CI)
|Mean estimate (95%CI)
|Nadir CD4
|1.08 (-0.11,2.27)
|0.12 (-1.92,2.16)
|Nadir CD4
|1.04 (-0.27,2.36)
|0.06 (-1.96,2.08)
|Nadir CD4
|1.00 (-0.24,2.24)
|0.08 (-2.12,2.29)
|-0.83 (-2.22,0.56)
|-1.67 (-3.17,-0.16)
|Nadir CD4
|1.13 (-0.13,2.39)
|-0.13 (-2.00,1.73)
|23s rDNA
|1.16 (-3.24,5.55)
|-1.60 (-8.68,5.47)
|Nadir CD4
|1.03 (-0.41,2.46)
|0.55 (-1.60,2.70)
|0.08 (-1.22,1.39)
|-1.66 (-3.29,-0.02)
|Nadir CD4
|0.90 (-0.44,2.24)
|0.70 (-1.39,2.79)
|0.52 (-0.69,1.73)
|-1.95 (-4.01,0.12)
Longitudinal effects of immunological or virological markers on clinical measures of PD.
There was no evidence of an independent association between longitudinal changes in CD4+ T-cell count or level of HIV RNA and longitudinal changes in any of the clinical measures of PD (see Table 4).
In this observational study of HIV-infected adults on HAART experiencing immune reconstitution, we established that nadir CD4+ T-cell count influences periodontal disease in HIV-infected adults both prior to and after HAART initiation. Prior to HAART, HIV-related immunosuppression (as measured by nadir CD4+ T-cell count and baseline CD4+ T-cell count) was associated with worse periodontal disease, as measured by REC and CAL. We also found that during immune reconstitution on HAART, a lower nadir CD4+ T-cell count was associated with a greater longitudinal improvement in PDD, REC, and BOP in subjects with higher baseline quantities of periodontal pathogens as compared to subjects with lower baseline quantities of periodontal pathogens. Our results suggest that exposure to HIV-related immunosuppression worsens periodontal tissue loss; whereas, during immune reconstitution on HAART, an undefined mechanism may be contributing to improvement in periodontal disease. It should also be noted that PD improvement may in part be due to dental care received outside of the study and/or enhanced oral hygiene resulting from study-delivered oral health messages.
Because our subjects had only minimal HAART exposure at study enrollment (median 2.7 months) our baseline results should and do agree with prior pre-HAART era studies such as Robinson et al, 1996, McKaig et al, 1998 as well as HAART era cohorts with few subjects on HAART at baseline, such as Alves et al, 2006. All of these large-scale studies found significant cross-sectional associations between lower CD4+ T-cell count and REC and/or CAL[6,16,17]. Our cross-sectional findings differ from those of Drinkard et al, 1991, Friedman et al, 1991 and Scheutz et al, 1997, all of whom used partial mouth periodontal probing methodology [18,19,20] which is known to underestimate the prevalence of PD[21,22,23]. It is interesting to note that in the Women's interagency HIV Study (WIHS), there were significant cross-sectional associations between HIV and loss of interdental papillae (i.e. loss of periodontal tissue); however, these findings were not interpreted as periodontal disease and therefore, no association between HIV and periodontal disease was reported[17,24]. For example, Mulligan et al, 2004, (the baseline WIHS study) found that HIV seropositive women had a significantly greater amount of abnormal (i.e., loss of) gingival papilla (p=0.004) as compared to an HIV-negative group of women[24]. Similarly, in the WIHS longitudinal report by Alves et al, 2006, HIV seropositve women had significantly greater clinical attachment loss at baseline than the HIV-negative comparison group (1.6 versus 1.1 mm, p=0.003); however, these authors focused on the lack of a longitudinal association between CD4+ T-cell count, HIV RNA and measures of periodontal disease progression, and did not clearly delineate the pre-HAART effects (i.e. at baseline) from the post-HAART effects (i.e., at the end of the longitudinal study) of HIV on PD[17].
To our knowledge, there has only been one other longitudinal epidemiological study examining the relationship between HIV and PD using traditionally-defined periodontal disease measures[17]. Alves et al, 2006, found that traditional markers of immune function (CD4+ T-cell count and HIV RNA) were not associated with longitudinal change in clinically measured periodontal disease. In our study, we found that the effect of nadir CD4+ T-cell count on periodontal disease during immune reconstitution was modified by the level of periodontal pathogens. Overall, our findings may suggest that, during immunosuppression, a dysregulated host immune response contributes to periodontal tissue loss in HIV infected adults; whereas, during immune reconstitution on HAART, host-mediated immunity re-establishes a more functional and effective response to periodontal pathogens in a dose-dependent manner.
The importance of nadir CD4+ T-cell count has been well recognized in studies examining the link between HIV infection and cardiovascular disease risk[25,26,27]. Our findings herein, coupled with our 2009 report[5], highlight the importance of including nadir CD4+ T-cell count in future studies examining PD in the post-HAART era. Outside of our reports [5,8], nadir CD4+ T-cell count has been largely ignored in the dental literature; including this critical value may contribute to understanding the wide variability in reported levels of PD in HIV infected cohorts. Likewise, since the level of specific subgingival periodontal pathogens can influence host-mediated inflammation during immune reconstitution on HAART, measuring and analyzing specific periodontal pathogens may be an important variable in understanding the relationship between HIV and periodontal disease.
The unexpected finding of gingival recession appearing to improve during the study could be explained by a longitudinal increase in gingival volume and/or height (in a coronal direction) relative to the cemetoenamel junction. Such an effect may represent a local immune reconstitution inflammatory syndrome (IRIS)-like response.
This study had a number of strengths. Our cohort was well characterized immunologically and subjects in our cohort had all recently initiated HAART. All subjects were taking HAART at baseline and at 97% of the study's longitudinal follow-up visits. Periodontal disease was measured thoroughly and each clinical component (i.e., PPD, REC, CAL and BOP) was quantified as a continuous variable, as per expert guidelines[11,12]. Our findings further support the premise by Beck et al, 2002 that when examining periodontal disease (in this study as an outcome measure), the individual components of PD (i.e. PPD, REC and CAL) [11] may be differentially influenced by specific systemic exposures, namely, markers of host immune function. We also included both clinical and microbiological measures of PD. Like Lekakis et al, 2008, and others in the medical literature[27,28,29], we reported all critical immunological variables (See Table 1: i.e., nadir CD4+ T-cell count, time since first seropositive, time on HAART, etc.); these variables help characterize or "frame" our cohort relative to other cohorts of HIV infected adults. Thus, future HAART-era reports on this and other oral health-related topics should, at minimum, include their cohort's median nadir CD4+ T cell count.
This study also has limitations. Our sample size was relatively small and so there may have been limited power to detect clinically significant associations between immunological markers and clinical PD. Additionally, the Type I error rate was inflated because we took a hypothesis-generating approach to the analyses and did not adjust for multiple tests arising from the large number of models that were fit to estimate the association between multiple measures of immunological function and multiple clinical measures of PD. The inclusion of a comparison group was also not feasible; instead, we thoroughly characterized our adult cohort with HIV-infection[8]. Our cross-sectional and longitudinal findings can be compared most appropriately to HIV-positive cohorts with similar characteristics (i.e., similar demographic make-up, similar median nadir CD4+ T-cell count and those recently starting HAART).
It is reasonable to conclude that those with exposure to lower CD4+ T-cell counts (accrued prior to the initiation of HAART) will tend to have increased gingival recession and increased clinical attachment loss as compared to those whose nadir CD4+ T-cell count remains higher. It should be noted that the poor periodontal health and low median nadir CD4 + T cell count of our cohort may both reflect poor access to care. Further, while HAART and/or immune reconstitution may help ameliorate PD, other factors, such as smoking status[23], access to ongoing dental care[30,31,32], dental anxiety[33], psychosocial stress, concomitant medical conditions, oral health literacy[34], oral hygiene skills[35]—and, as per this study, nadir CD4+ T-cell count, may influence the long-term risk for ongoing chronic periodontal disease in this population.
In this study, it is interesting to note that although clinical measures of PD improved longitudinally, microbiological measures of PD remained relatively unchanged across time (see Vernon et al, 2011; Table 2)[8]. Baseline CD4+ T cell count and level of HIV RNA were not related to baseline levels of periodontal pathogens (data not shown). These findings tend to suggest that an altered host response—either innate and/or adaptive immunity—influences the relationship between HIV and periodontal disease. Future studies should examine the mechanism(s) whereby HIV-infection contributes to increased risk for recession and clinical attachment loss, and the long-term longitudinal effect on HIV and/or HAART on PD in those with higher and lower nadir CD4+ T-cell counts. These effects may be linked to elevated cytokine production or the abnormal innate immune cell (i.e., neutrophils[36], dendritic cells, monocytes[37], etc.) function. Such markers of innate and/or adaptive immunity may link HIV to periodontal disease improvement during immune reconstitution; if so, a greater understanding of this mechanism could offer insights into HIV pathogenesis and/or periodontal disease. Regardless of these scientific issues, it should be noted that even with improvement during relatively short-term immune reconstitution, levels of periodontal disease in our cohort remained elevated (see Table 2); thus, efforts to prevent and treat periodontal disease in HIV infected adults remain an ongoing public health and research priority.
Supporting Information
Table S1.
2 Patient characteristics during follow-up time.
Meetings at which parts of data were presented: A poster (#156605) and podium discussion was presented at the International Association of Dental Research (IADR) on March 22, 2012, in Tampa, Florida. We especially thank our research subjects. We also appreciate the assistance from Dr. Michael Lederman, Dr. Robert Kalayjian, Dr. Barbara Gripshover, Dr. Wendy Armstrong, Dr. Robert Asaad, Dr. Alan Taege, Dr. Nabil Bissada, and Dr. Alan Chiunda, as well as Leslie Anderson, Michelle Gallagher, Elizabeth Kirchner, Kim Whitley, and all the nurses from the DCRU.
Author Contributions
Conceived and designed the experiments: LTV CAD DCB XW ZT AW BR. Performed the experiments: LTV ZT. Analyzed the data: LTV CAD DCB ZT XW AW BR. Contributed reagents/materials/analysis tools: ZT DCB XW. Wrote the manuscript: LTV CAD DCB XW ZT AW BR.
- 1. Robinson PG, Adegboye A, Rowland RW, Yeung S, Johnson NW (2002) Periodontal diseases and HIV infection. Oral Dis 8 Suppl 2: 144-150. doi:https://doi.org/10.1034/j.1601-0825.8.s2.5.x. PubMed: 12164648.
- 2. Kinane DF, Peterson M, Stathopoulou PG (2006) Environmental and other modifying factors of the periodontal diseases. Periodontol 2000 40: 107-119. doi:https://doi.org/10.1111/j.1600-0757.2005.00136.x. PubMed: 16398688.
- 3. Winkler J, Murray P (1987) Periodontal disease. A potential intraoral expression of AIDS may be rapidly progressive periodontitis. J Claif Dent Assoc 15: 20-24.
- 4. Winkler JR, Murray PA, Grassi M, Hammerle C (1989) Diagnosis and management of HIV-associated periodontal lesions. J Am Dent Assoc Suppl, Suppl: 25S-. 34S. PubMed: 2531767.
- 5. Vernon LT, Demko CA, Whalen CC, Lederman MM, Toossi Z et al. (2009) Characterizing traditionally defined periodontal disease in HIV+ adults. Community Dent Oral Epidemiol 37: 427-437. doi:https://doi.org/10.1111/j.1600-0528.2009.00485.x. PubMed: 19624697.
- 6. McKaig RG, Thomas JC, Patton LL, Strauss RP, Slade GD et al. (1998) Prevalence of HIV-associated periodontitis and chronic periodontitis in a southeastern US study group. J Public Health Dent 58: 294-300. doi:https://doi.org/10.1111/j.1752-7325.1998.tb03012.x. PubMed: 10390712.
- 7. Hall HI, Song R, Rhodes P, Prejean J, An Q et al. (2008) Estimation of HIV incidence in the United States. JAMA 300: 520-529. doi:https://doi.org/10.1001/jama.300.5.520. PubMed: 18677024.
- 8. Vernon LT, Babineau DC, Demko CA, Lederman MM, Wang X et al. (2011) A prospective cohort study of periodontal disease measures and cardiovascular disease markers in HIV-infected adults. AIDS Res Hum Retroviruses 27: 1157-1166. doi:https://doi.org/10.1089/aid.2010.0320. PubMed: 21443451.
- 9. Seymour RA, Whitworth JM, Martin M (2003) Antibiotic prophylaxis for patients with joint prostheses - still a dilemma for dental practitioners. Br Dent J 194: 649-653. doi:https://doi.org/10.1038/sj.bdj.4810352. PubMed: 12830173.
- 10.
Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM et al. (2007) Prevention of infective endocarditis: guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 116: 1736-1754.
- 11. Beck JD, Offenbacher S (2002) Relationships among clinical measures of periodontal disease and their associations with systemic markers. Ann Periodontol 7: 79-89. doi:https://doi.org/10.1902/annals.2002.7.1.79. PubMed: 16013220.
- 12. Beck JD, Eke P, Heiss G, Madianos P, Couper D et al. (2005) Periodontal disease and coronary heart disease: a reappraisal of the exposure. Circulation 112: 19-24. doi:https://doi.org/10.1161/CIRCULATIONAHA.104.511998. PubMed: 15983248.
- 13. Fleiss JL, Park MH, Chilton NW, Alman JE, Feldman RS et al. (1987) Representativeness of the "Ramfjord teeth" for epidemiologic studies of gingivitis and periodontitis. Community Dent Oral Epidemiol 15: 221-224. doi:https://doi.org/10.1111/j.1600-0528.1987.tb00525.x. PubMed: 3476248.
- 14. Toossi Z, Mayanja-Kizza H, Baseke J, Peters P, Wu M et al. (2005) Inhibition of human immunodeficiency virus-1 (HIV-1) by beta-chemokine analogues in mononuclear cells from HIV-1-infected patients with active tuberculosis. Clin Exp Immunol 142: 327-332. doi:https://doi.org/10.1111/j.1365-2249.2005.02913.x. PubMed: 16232220.
- 15. Morillo JM, Lau L, Sanz M, Herrera D, Martín C et al. (2004) Quantitative real-time polymerase chain reaction based on single copy gene sequence for detection of periodontal pathogens. J Clin Periodontol 31: 1054-1060. doi:https://doi.org/10.1111/j.1600-051x.2004.00608.x. PubMed: 15560805.
- 16. Robinson PG, Sheiham A, Challacombe SJ, Zakrzewska JM (1996) The periodontal health of homosexual men with HIV infection: a controlled study. Oral Dis 2: 45-52. PubMed: 8957937.
- 17. Alves M, Mulligan R, Passaro D, Gawell S, Navazesh M et al. (2006) Longitudinal evaluation of loss of attachment in HIV-infected women compared to HIV-uninfected women. J Periodontol 77: 773-779. doi:https://doi.org/10.1902/jop.2006.P04039. PubMed: 16671868.
- 18. Drinkard CR, Decher L, Little JW, Rhame FS, Balfour HH Jr. et al. (1991) Periodontal status of individuals in early stages of human immunodeficiency virus infection. Community Dent Oral Epidemiol 19: 281-285. doi:https://doi.org/10.1111/j.1600-0528.1991.tb00168.x. PubMed: 1742994.
- 19. Friedman RB, Gunsolley J, Gentry A, Dinius A, Kaplowitz L et al. (1991) Periodontal status of HIV-seropositive and AIDS patients. J Periodontol 62: 623-627. doi:https://doi.org/10.1902/jop.19220.127.116.113. PubMed: 1770422.
- 20. Scheutz F, Matee MI, Andsager L, Holm AM, Moshi J et al. (1997) Is there an association between periodontal condition and HIV infection? J Clin Periodontol 24: 580-587. doi:https://doi.org/10.1111/j.1600-051X.1997.tb00232.x. PubMed: 9266346.
- 21. Page RC, Eke PI (2007) Case definitions for use in population-based surveillance of periodontitis. J Periodontol 78: 1387-1399. doi:https://doi.org/10.1902/jop.2007.060264. PubMed: 17608611.
- 22. Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA (2010) Accuracy of NHANES periodontal examination protocols. J Dent Res 89: 1208-1213. doi:https://doi.org/10.1177/0022034510377793. PubMed: 20858782.
- 23. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ (2012) Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 91: 914-920. doi:https://doi.org/10.1177/0022034512457373. PubMed: 22935673.
- 24. Mulligan R, Phelan JA, Brunelle J, Redford M, Pogoda JM et al. (2004) Baseline characteristics of participants in the oral health component of the Women's Interagency HIV Study. Community Dent Oral Epidemiol 32: 86-98. doi:https://doi.org/10.1111/j.0301-5661.2004.00128.x. PubMed: 15061857.
- 25.
Hsue P, Lo J, Franklin A, Bolger A, Deeks S et al. (Feb 10-14, 2003). Increased atherosclerotic progression in patients with HIV: The role of traditional and immunologic risk factors. Boston, MA.
- 26. Currier JS, Kendall MA, Henry WK, Alston-Smith B, Torriani FJ et al. (2007) Progression of carotid artery intima-media thickening in HIV-infected and uninfected adults. AIDS 21: 1137-1145. doi:https://doi.org/10.1097/QAD.0b013e32811ebf79. PubMed: 17502724.
- 27. Hsue PY, Hunt PW, Schnell A, Kalapus SC, Hoh R et al. (2009) Role of viral replication, antiretroviral therapy, and immunodeficiency in HIV-associated atherosclerosis. AIDS 23: 1059-1067. doi:https://doi.org/10.1097/QAD.0b013e32832b514b. PubMed: 19390417.
- 28. Lekakis J, Tsiodras S, Ikonomidis I, Palios J, Poulakou G et al. (2008) HIV-positive patients treated with protease inhibitors have vascular changes resembling those observed in atherosclerotic cardiovascular disease. Clin Sci (Lond) 115: 189-196. doi:https://doi.org/10.1042/CS20070353. PubMed: 18251713.
- 29. Mangili A, Jacobson DL, Gerrior J, Polak JF, Gorbach SL et al. (2007) Metabolic syndrome and subclinical atherosclerosis in patients infected with HIV. Clin Infect Dis 44: 1368-1374. doi:https://doi.org/10.1086/516616. PubMed: 17443477.
- 30. Benjamin RM (2012) Oral health care for people living with HIV/AIDS. Public Health Rep 127 Suppl 2: 1-2. PubMed: 22547870.
- 31. Jeanty Y, Cardenas G, Fox JE, Pereyra M, Diaz C et al. (2012) Correlates of Unmet Dental Care Need Among HIV-Positive People Since Being Diagnosed with HIV. Public Health Rep 127 Suppl 2: 17-24. PubMed: 22547873.
- 32. Ndiaye CF, Critchlow CW, Leggott PJ, Kiviat NB, Ndoye I et al. (1997) Periodontal status of HIV-1 and HIV-2 seropositive and HIV seronegative female commercial sex workers in Senegal. J Periodontol 68: 827-831. doi:https://doi.org/10.1902/jop.19220.127.116.117. PubMed: 9379325.
- 33. Singer R, Cardenas G, Xavier J, Jeanty Y, Pereyra M et al. (2012) Dental anxiety and the use of oral health services among people attending two HIV primary care clinics in Miami. Public Health Rep 127 Suppl 2: 36-44. PubMed: 22547875.
- 34. Tobias CR, Fox JE, Walter AW, Lemay CA, Abel SN (2012) Retention of people living with HIV/AIDS in oral health care. Public Health Rep 127 Suppl 2: 45-54. PubMed: 22547876.
- 35. Rajabiun S, Fox JE, McCluskey A, Guevara E, Verdecias N et al. (2012) Patient perspectives on improving oral health-care practices among people living with HIV/AIDS. Public Health Rep 127 Suppl 2: 73-81. PubMed: 22547879.
- 36. Ryder MI, Winkler JR, Weinreb RN (1988) Elevated phagocytosis, oxidative burst, and F-actin formation in PMNs from individuals with intraoral manifestations of HIV infection. J Acquir Immune Defic Syndr 1: 346-353. PubMed: 3216315.
- 37. Funderburg NT, Zidar DA, Shive C, Lioi A, Mudd J et al. (2012) Shared monocyte subset phenotypes in HIV-1 infection and in uninfected subjects with acute coronary syndrome. Blood 120: 4599-4608. doi:https://doi.org/10.1182/blood-2012-05-433946. PubMed: 23065151.


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Learn with this course Excel 2016 for Mac essential - Discover the 2016 version of Excel for Mac and its tools
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Learn with this Excel 2016 course for Mac essentials - Discover the 2016 version of Excel for Mac and its tools
Microsoft has done a complete renovation for Mac users of the market leading spreadsheet: Excel 2016. In this course you will see that Excel for Mac and Excel for Windows are exactly the same in terms of the user interface, which favors Work for users who work on both platforms. Those who already know previous versions of Office for Mac will discover in this course how to work with this new interface.
The new Excel 2016 interface
In this chapter we will know the news and all the other elements that have changed visually in the new Microsoft Excel 2016 in its version for Mac. We could practically say that it is the same as for Windows.
What's new in the Excel 2016 interface for Mac 01:49
The backstage of Excel 2016 for Mac 02:34
The ribbon of Excel 2016 04:53
The Excel 2016 window 02:23
Views and immobilization of panels in Excel 2016 02:36
We started working on Excel 2016
This chapter is dedicated to facilitating the first steps in the use of Microsoft Excel for new users. We start step by step with the fundamental, so that nobody gets lost in the boot.
First steps, we open a file in Excel 2016 01:26
Structure of an Excel 2016 book 01:11
The help of Excel 2016 02:11
We handle Excel 2016 files
The changes in the treatment of the files, especially when creating new ones and sharing them with other users via online, are subjects of compulsory learning if we want to master Excel 2016 perfectly.
New files and templates in Excel 2016 02:24
Save and Save as in Excel 2016 02:10
Print in Excel 2016 02:18
Share files with other Excel 2016 users 02:01
Export Excel 2016 files to other formats 02:11
Excel 2016 account options 01:18
Cells and formulas introduction in Excel 2016
Some obvious protagonists of Excel are the cells. These are the center of almost everything that is done in any spreadsheet. We will learn all about the introduction and editing of data in them.
Selection of cells and ranges of cells in Excel 2016 03:02
Editing cells in Excel 2016 02:01
Data formats in Excel 2016 03:11
What is a formula in Excel 2016 and what distinguishes it 01:57
The operators in Excel 2016 03:06
Using parentheses in Excel 2016 02:39
Concatenate with Ampersand in Excel 2016 03:05
Copy and paste values and formulas in Excel 2016 04:12
Relative and absolute references in Excel 2016 06:37
Fill cells automatically in Excel 2016 05:00
Handle rows, columns and sheets in Excel 2016
There is no handling of a spreadsheet if the measurements of the columns and rows are not mastered. The organization of the information will depend to a large extent on the use we make of rows, columns and leaves. Let's see in this video how to work with them.
Height and width of rows and columns in Excel 2016 03:11
Insert and delete cells, rows and columns in Excel 2016 03:32
Hide and show rows and columns in Excel 2016 02:23
Moving rows and columns in Excel 2016 01:13
Insert and remove sheets in Excel 2016 01:21
Rename and tag color to an Excel spreadsheet 00:53
Move and duplicate spreadsheets in Excel 2016 02:43
Simultaneous selection of several sheets in Excel 02:28
Browsing the Excel sheets 2016 01:16
We apply formatting to cells and data in Excel 2016
By controlling the application of formats we will also have a large part of the control of the appearance of our reports in Excel. In the world of the company, not only does the content count, the image must also be taken care of.
Formats and default styles in Excel 2016 02:52
Alignment of the contents of a cell in Excel 2016 04:27
Application of text formats in Excel 2016 02:06
Application of number formats in Excel 2016 04:12
Application of date and time formats in Excel 2016 02:19
Fillers for Excel 2016 cells 01:57
Controlling the edges of a cell in Excel 2016 02:57
Comments in Excel 2016 cells 02:38
Functions in Excel 2016, beyond the formulas
Functions are instructions that return a desired value in Excel. They represent a big step for the uninitiated user, since it is a beginning for obtaining a high productivity in the calculation.
What is a function in Excel 2016 04:24
The Excel 2016 Function Wizard 02:24
Autosum and other quick functions of Excel 2016 01:45
The functions of Excel SUMIF and ROUND 04:23
The SI function of Excel 2016 07:57
The functions of Excel LEFT, RIGHT and MAYUSC 03:44
COUNT and COUNTIF. Sister functions in Excel 2016 02:17
The popular VLOOKUP function of Excel 2016 04:34
Functions TODAY, NOW, DAY, MONTH and YEAR in Excel 2016 02:59
Data management in Excel 2016 tables
Learning how to manage and analyze data in a table is very important. It is the natural way to organize Microsoft Excel information, so we will learn it in the videos in this chapter.
How to organize the data in Excel 2016 spreadsheets 04:58
Introduction to Excel Tables 2016 04:12
We apply style to an Excel Table 2016 03:19
Filtering data in Excel 2016 04:45
Introduction to Dynamic Tables in Excel 2016 09:32
Insert graphics in Excel 2016
If used with common sense, a graph is the best method to transmit numerical information, especially if the recipient of that information has little time and little detailed knowledge of the data.
What is a chart and when to use it in Excel 2016 02:36
Simple graphics of columns in Excel 2016 05:56
Circular, line and area graphics in Excel 2016 04:23
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House Sitting, Drop-In Visits, Dog Walking
"I am so Happy to have found Kennedy!!! She is wonderful.She truly cares about animals and your pets. If your looking for someone I suggest her!Top notch. She... (more)"
Nancy Full Time Home Away From Home
Plainfield, NJ, 07063
Dog Boarding, House Sitting, Drop-In Visits, Doggy Day Care, Dog Walking
About: Hi there, My name is Nancy and I am 25 years old! I am a stay at home mom to two beautiful kids! I have had a lot of experience with dogs. My first... (more)
LIVE for, LAUGH with, LOVE all dogs
Plainfield, NJ, 07062
Dog Boarding, House Sitting, Drop-In Visits, Dog Walking
"This review is long overdue. We have been using Trisha as a dog walker and for drop in visits since last fall. I travel a lot for work so when I'm out of tow... (more)"
Flexible partime job. Fenced yard.
North Plainfield, NJ, 07062
House Sitting, Drop-In Visits, Dog Walking
About: I work part time but am very flexible with the hours. I have a fenced in yard and love dogs of all sizes. I am a cross country runner and will defi... (more)
Rover also offers pet setting & drop ins in:
|Berkeley Heights, NJ
|Dunellen, NJ
|Fanwood, NJ
|Gillette, NJ
|New Providence, NJ
|Plainfield, NJ
|Scotch Plains, NJ
|South Plainfield, NJ
|Warren, NJ
|Watchung, NJ
Rover.com is the simple, savvy way to find and book drop in pet sitting. It's easy to find the perfect pet sitter - many sitters have worked through Rover for years pet sitting, and 95% of reviewed stays have received a perfect five-star rating. You'll get daily photo updates, and every stay booked through Rover also includes premium pet insurance, 24/7 support, and a reservation guarantee. Pet sitters on Rover have the option to complete a free background check, which you can see from their background check badge. Pet sitters are booked on Rover every minute of every day, and 92% of the population lives within a short drive of one of the more 40,000 sitters who've listed their services on Rover, so you're sure to find the perfect pet sitter on Rover. When you book with one of our trusted pet sitters on Rover you get peace of mind that your home and pets are in loving hands.


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- Product Information
101 Maple Street Half Yard Bundle includes 25 half yard cuts.
Price will be $124.98.
Pre-order price is $109.98 + reservation fee.
Pre-order and receive 8% off the regular price. You will be charged a $4.99 reservation fee today and $109.98 when your item ships.
Reservation fee is non-refundable.
Expected ship date of August 2018.
This item will ship in a box.Additional Information
Product Type Half Yard Bundles Fabric Collection 101 Maple Street Fabric Designer Bunny Hill Designs Fabric Manufacturer Moda Fabrics Theme Contemporary Fabric Type 100% Cotton Fabric Width 18" x 44" cuts
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You are here… // … // Providence News // Providence In The News // Panama becomes latest country to adopt B.C.-developed HIV strategy
Panama becomes latest country to adopt B.C.-developed HIV strategy
Posted on
Panama has become the latest country to adopt B.C.'s HIV Treatment as Prevention strategy.
China, France and Brazil have already signed on to the made-in-B.C. strategy, and U.S. cities including New York, San Francisco, and Washington, D.C. are adopting it as well.
"The momentum continues to build to implement the Treatment as Prevention strategy to save lives, prevent infections, and, in the long term, save money," said Dr. Julio Montaner, director of the B.C. Centre for Excellence in HIV/AIDS.
Ian Austin Reports
I am writing to commend the Psychiatrist on-call whose compassion and extraordinary empathy helped to relieve my extreme anxiety on that day.Please extend my heartfelt thanks to her for going above and beyond simply "taking a history"."
Patient DKC


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Discover benefits of spinal alignment. My mission is to help you improve health. Reduce pain. Reduce disease. Reduce immobility. Improve mobility. Improve rehabilitation process. Improve health and wellness. You can make a difference at any age. Make decisions after you get the facts. Explore basic information here. Get referenced health information here. Take it from there. Spinal alignment. The central nervous system. Health conditions. Disease prevention. The benefits of wine.... Save time. Be informed. Improve health and welfare.
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The pizza wasn't bad, but the cheesy bread was terrible. Some pieces were crisped and some pieces didn't look like they were baked at all.
Great River Pizza Company
226 2nd St NW
Cass Lake MN 56633
Cass Lake MN 56633
(218) 339-7200 Website
See Availability
Sponsored Topics
Opening Hours
- Mon: 3am-9am
- Tue: 11:30am-9pm
- Wed: 3pm-9pm
- Thu: 11:30am-9pm
- Fri: 3pm-10pm
- Sat: 3pm-10pm
WebsiteTake me there
See a problem? Let us know!
For a small town, this pizzeria has some good food. We ordered a Lg pepperoni pizza and some hot wings. The pizza was really good and the hot wings were ok. I liked the spiciness, but at the same...


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Sérherbergi í hús
Seaside Escape, private bathroom, and breakfast!
Seaside Escape, private bathroom, and breakfast!
2 gestir
1 svefnherbergi
1 rúm
1 einkabaðherbergi
2 gestir
1 svefnherbergi
1 rúm
1 einkabaðherbergi
Frábær innritunarupplifun95% gesta gáfu innritun á þessu heimili 5 stjörnur í einkunn.
SjálfsinnritunÞú getur innritað þig auðveldlega með lyklaboxinu.
Frábær staðsetning90% gesta gáfu 5 stjörnu einkunn fyrir staðsetningu þessa heimilis.
Cozy private , clean room with a ultra comfortable queen size bed with private bathroom . Includes coffee and breakfast. I provide you with shampoo, conditioner and a homemade artisan soap and body butter. Rhode Island is a "Funsize" state. There is so much to do in the littlest state in the union! I always have the latest and greatest information on whats going on in RI. I also provide you with a book filled with points of interest in Little Rhody!
Gjaldfrjáls bílastæði á staðnum
Þráðlaust net
Vinnuaðstaða hentug fyrir fartölvu
Er ekki öruggt, eða hentar ekki, börnum (0–12 ára)
Reykingar bannaðar
Hentar ekki gæludýrum
Engar veislur eða viðburði
Innritun er hvenær sem er eftir 14:00
Útritun fyrir 12:00
Sjálfsinnritunarleið: lyklabox
156 Umsagnir
Such a lovely place and gracious hosts. It was not our first Airbnb experience but it was the first with a true "nb". Breakfast was delicious and the company was delightful. Highly recommended.
Our stay was ruined by the very inappropriate behavior and comments of the host Dave. I had carefully read all the reviews prior to booking this place. The reviews were positive and thus we were stunned to be treated in this manner.
Svar frá Cindy:
The entire time you stayed in our home you pretty much did whatever you wanted with no regards for the house rules that are clearly stated. By the end, Dave had had enough. When he came home and found your husband making himself at home in our private living room watching TV, his ability to be as kind as possible, no longer existed. There is a TV in the room you rented with full cable, Netflix and HBO. That really took a lot of nerve. You didn't rent our home, you rented a room with a private bathroom in our home. Dave did mention to your husband that the responsibility of the Airbnb was getting to him. I attended my sisters funeral the week prior and then had this scheduled business trip. I guess I underestimated how much work it is. He was feeling overwhelmed and frustrated with your behavior as well. To start, we graciously provide breakfast, which of coarse includes a delicious cup or two of hot coffee. How ever what it doesn't mean is you have a bottomless cup of coffee for the day! Each afternoon you passed probably 20 coffee shops to get here from the festival but instead of stopping and buying a coffee you thought that it would be better if you just took advantage of your hosts. and make the coffee and cream on them! With regards to breakfast being available, you were messaged about breakfast choices if we were not home. I'm sorry I wasn't clear that it was what would happen anytime we weren't home. My husband did mention that you ate everyday so I guess you figured out that is was indeed the case each day. Another problem we had...there is a sign on the front door that clearly asks that people remove their shoes upon entering. Your husband not only wore his shoes into the house and up the stairs....I went by your room door and saw his feet up on bed spread with his shoes on! I didn't say anything except to remind you of the no shoe policy later because I knew that I probably wouldn't of been able to say to a grown man "Get your shoes off the bed!", in a nice way. It was frustrating the in the morning when you would come down for your "before we leave" cup of coffee, that I had to repeatedly ask you to turn off the coffee make when you were done. With regards to the "big bug in your room", I'm sorry that there was a bug in your room. That's what happens in the summer here in RI, bugs sometimes get indoors. It is not any indication however to the cleanliness of a house. In closing I'd like to finish with this observation... you and your husband exhibited the behavior more defined to the millennials. "Entitlement". It's even more sad to me that you reduced it to exaggeration and untruths. It will be clear to anyone that reads our reviews that we love our guests and love giving them a great experience. Sometimes, and it's happened 3 times in the 5 years I've been an Airbnb host, you simply run out of your ability to tolerate bad behavior. You are #4.
ágúst 2018
Cindy er ofurgestgjafiOfurgestgjafar eru reyndir gestgjafar með háa einkunn sem leggja sig fram um að veita gestum sínum framúrskarandi gistingu.
I've been in the beauty industry for over 40 years. I teach Reflexology and Aromatherapy classes and work with a nutrition company. I have two beautiful granddaughters that I adore! I try to live in the moment and enjoy the simple things.....
Svarhlutfall: 100%
Svartími: innan klukkustundar
Haltu öllum samskiptum innan AirbnbGættu öryggis greiðslna með því að senda pening aldrei og eiga ekki í neinum samskiptum framhjá vefsetri og appi Airbnb.
Svipaðar eignir
Kannaðu aðra valkosti í og í nágrenni við Warwick
Fleiri gististaðir í Warwick:


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Audra Odom Furniture, 2017-08-20 23:37:13. Yet, popular as it is, rattan garden furniture is by no means the only type of outdoor furniture available on the market. On the contrary, there are a number of different materials for outdoor furniture, both natural and synthetic, which may be good alternatives to rattan for home-owners less fond of this material. This article goes over a few of the most common.
Queen Haley Furniture, 2017-11-01 06:02:41. Packing: Good packing can ensure that the furniture will be as beautiful as it was when it was stored. As a first step, you can disassemble beds and tables before storing. You can apply a coat of wax to protect its sheen. All the screws, bolts, and nuts should be placed in a clear plastic bag and tied to the bed frame. A quilt can be wrapped around tabletops and headboards to prevent denting and scratching.
Vera Holden Furniture, 2018-03-19 21:00:39. Fitting your soul. A piece of furniture can fulfil a deep personal yearning or vision. Custom made furniture is a way to address this and need not bust your budget. To match space and function needs, you collaborate with a craftsman who helps you with your specification exactly the size, shape, and features that you need.
Jordan David Furniture, 2018-03-16 20:28:38. If you love the industrial style there is no shortage of places to find some wonderful pieces for your home or commercial business. The Internet is loaded with websites that offer some great finds that can be mixed and matched with most decorating styles of today. If you have an idea of what you want, or even if you don't, I urge you to browse for your perfect piece and let it fill a place in your home today.
Kerri Vargas Furniture, 2018-03-21 03:18:54. How To Store Goods In The Units? Once all the things have been carefully packed, the next step is furniture storage in the units. The items should be organized in a manner that the biggest items are placed in the locker first and the smaller items are filled in the extra spaces. Refrigerators, ovens, washers, and dryers can be placed upright to save space. Leave the do0ors open to prevent an unpleasant smell from developing.
Nona Oneill Furniture, 2018-03-18 01:55:37. No special skills are required to repair general damage or wear to these kinds of antique furniture pieces, but the work requires extreme care and patience in tracking down suitable replacement materials.
Jordan David Furniture, 2018-03-20 23:19:31. Floral patterns should be small or sprigged during soft, light colours; boisterous florals are totally erroneous. They can be used in abundance or kept as a highlight. Both treatments capture the look; the choices are yours. Ensure that these kinds of are linked by colour knowning that the scale of all of the prints suit the sized the room.
Kerri Vargas Furniture, 2018-03-22 18:48:09. Fitting functional needs. Store-bought furniture can't always do what you need to be done. Example, you do a lot of desk work and have one particular corner to accommodate desk, computer, supplies, etc. You may be lucky if you find sturdy ready-made pieces that will fit that corner and your work requirements get fulfilled.
sempak Furniture, 2018-03-16 17:19:26. Wood veneers can be difficult to match. It is possible to buy new veneer strips, but they are generally thinner than the old hand-sawn veneers and do not always match in colour. It often pays to go to an auction to look for a broken oddment of furniture that has suitable veneers. To remove a veneer from its backing, first clean off any old polish with white spirit and carefully clean the varnish or wax. Place a damp cloth over the cleaned strip and press with a fairly hot iron. Keep the cloth damp. This melts the Scotch glue holding down the veneer, which can then be peeled off. The same technique is used to raise small areas on the antique piece, but use a soldering iron instead of an iron. Wipe all traces of glue while it is still warm. Dampen the veneer and flatten it between two pieces of wood for about 24 hours before use. Do not let it dry completely, for veneers must be re-laid while still damp and pliable. The replacement veneer should be slightly thicker than the existing one, to allow for sanding. Stick the new strip down with Scotch glue and apply a weight or clamp until the glue has completely set. Wax and polish to match the existing finish.
Jordan David Furniture, 2018-03-22 18:57:11. Synthetic Materials: Aside from the natural fibres detailed in the lines above, there exist a number of different materials for outdoor furniture which are entirely man-made.
Tina Solis Furniture, 2018-03-16 23:22:45. Fitting functional needs. Store-bought furniture can't always do what you need to be done. Example, you do a lot of desk work and have one particular corner to accommodate desk, computer, supplies, etc. You may be lucky if you find sturdy ready-made pieces that will fit that corner and your work requirements get fulfilled.
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When you are renting a 5, 10, 15, 20, 30 or 40 yard dumpster, you want a company you can trust with prices that make you smile. Give us a call today and see the difference we can make in your next construction or clean out project.
Simply give us a call and we will help you figure out your dumpster rental needs.
Our dumpsters usually go out same-day or next-day depending on when you call.
We provide top-notch service, while going easy on your bottom line. What more could you ask for?
Our trained operators are here to give you a fast and hassle-free experience from start to finish.
Once you are done, simply give us a call and we will get your dumpster picked up right away!
Our staff is here to help whenever you need it. Simply pick up the phone and give us a call.
Most cities or municipalities do not have many regulations regarding dumpster rental as long as you keep the dumpster entirely on your own property during the rental period. If you need to place your container on the street in any way, you will likely have to obtain a permit from the appropriate building permit office in your town. You can check with your local public works department to be sure.
Most dumpster rental companies will take care of securing this permit for you if you rent from them. Make sure that if you're planning to put the dumpster on the street, the company has made the appropriate arrangements. You should also ensure that you get the permit in a timely manner and at the correct cost. If you thought the dumpster company was getting a permit and they did not, you will be the one who will have to pay the fine that is issued by the authorities.
Harley Hollan Companies offers comprehensive waste companies, including roll-off dumpster and front-load containers for tasks of any measurement, a public drop-off and recycling middle, multifamily and enterprise waste solutions, and compactors. Next time you have got a dumpster load of trash readily available make the precise name by calling Charlotte Dumpster Service. The haulage firm cannot deliver or pick up the dumpster on account of peak restrictions or obstructions on your property which might be blocking access. Couple the difficulty in loading with the increased price and there actually appear to be better decisions for your cleanup venture than the dumpster bag. Most reliable dumpster companies might be protecting their again legally in the case of such events with documents reminiscent of damage launch forms. In case the particles is spread out just do everything you may to guesstimate and after that spherical up to just be sure you have enough area in your dumpster. July 1, 2013 - businesses will no longer be allowed to position cardboard in trash carts. To reduce costs it is very important perceive what components will influence your rental payment. It would not seem that a allow is necessary for renting a dumpster and inserting it on your property. The client shall be answerable for any and all damages to a container during the service period. We are a household firm that really makes it simple to get the 12 yard, 20 yard, or 30 yard roll off dumpster containers you need delivered to your work web site, demolition web site, building web site, or anywhere wanted to scrub up the waste and particles. The clean salt course of can cut back the amount of immobilized LEGISLATION at Hanford by up to 75%. NON-RESIDENTIAL SERVICE means strong waste assortment companies provided in City containers to small business institutions generating office waste. Residents could report illegal dumping to the Gwinnett County Stable Waste and Recovered Supplies Call Center at 770.822.7141. Many individuals have questions in regards to the logistics of renting a dumpster in Elizabeth. Merely give us a name and we will reply any questions you will have in regards to the Van Wert Rent a Construction Dumpster in Newport, VT process, allowed materials, measurement it's possible you'll need, and many others. As I shared earlier than, the 20 yard dumpster I rented for cleanout was manner too large for my functions. They were not a lot frequent until Nineteen Seventies however with them being frequent the smaller dumpsters were additionally introduced that right now are recognized as wheelie bins. Roll Off Dumpsters / Roll-Off Containers - these containers are large steel boxes with steel rollers on the again. Different customers need to preserve the dumpster for a couple of weeks, months and even longer. The open-top design will make it simple to maintain your web site clean and the roll-off loading system will make waste hauling handy, no matter what the job. You possibly can schedule the supply of a dumpster months prematurely and even the day earlier than! The goal is to find an excellent firm to offer you a Nashville roll off that may take care of your preferences, and empty the dumpster inside a forty eight hour period effectively.
MST Dumpsters can deliver dumpsters seven days a week to building websites, warehouses, businesses, driveways, parking heaps and more. Useful Hint: An excellent rule of thumb to help you is that your common 6 foot long choose-up truck mattress can maintain about 2 yards of debris, so as an example a 12 cubic yard dumpster can maintain about 6 truck loads of stuff, give or take. Resulting from variations in their design, entrance-loading dumpsters will be anywhere between ten to forty p.c shorter than rear-loading dumpsters. I might advocate Houston Dumpsters anyone searching for to rent dumpster in Houston area. Next, I will cover the issues which are seemingly stopping you from dumpster diving. A 12 yard dumpster can maintain the quantity of junk equal to the size of a mid sized automobile. Tip: The Northeast Waste Management Officials' Affiliation (NEWMOA) has developed a Green Lodging Calculator that estimates environmental advantages and financial savings from varied sustainable practices tailored to the hospitality trade. After you load the debris into the dumpster, you should name the Rent a Construction Dumpster in Newport agency and request it to choose up the container. Some Rent a Construction Dumpster in Newport providers utilize specially-designed trailers for loads of 20 cubic yards or much less. Looking for the nearest Rent a Construction Dumpster in Newport in your area from the listing or the online. The unique price was cheap, but the complete price was nearly double the quantity. DTM precisely models the bottom surface and permits the estimator to directly calculate volumes with out drawing counters. In case it's essential set the dumpster on the highway, then it's essential get in contact with your local authorities to ask whether or not you must get a allow. The more info available in regards to the building Rent a Construction Dumpster in Newport Reading, the much less seemingly you're to have an issue or surprise bill later. The 30 yard dumpster can maintain 10-12 choose up truck masses and roughly four tons weight limit. Make your spring cleansing simple, price-environment friendly and handy with Millennium Waste's roll-off Rent a Construction Dumpster in Newport service. Rainwater will have an effect on the weight of the container particularly if the container is stuffed with absorbent supplies resembling dry wall, carpet, or mattresses. The City will now not service different varieties of containers full of household garbage. If you are able to give us those instructions over the cellphone, then we will be sure that a dumpster get positioned in your required spot. The blokes at R&R Containers deposit the recyclables where they should go, & eliminate the remainder of the debris in a means that's good to our environment. Our terms and circumstances require that the dumpster is not crammed above the fill line. It will possibly have far reaching effects, since the info on the card can be utilized to perpetrate different varieties of id theft crimes. Our drivers are on the highway from 6am to 6pm, so please hold this in thoughts when ordering. Moon Mini Dumpsters supplies inexpensive dumpster containers available in 6, 9, 12, sixteen & 20 cubic yard capacities. At the time of ordering we gather your title, delivery handle in Oakville, cellphone quantity, electronic mail, delivery instructions and credit card info for the bin rental fee.
You'll be able to maintain your Rent a Construction Dumpster in Newport, VT for two weeks or as long as it takes to complete your waste elimination. If attainable, you wish to go dumpster diving throughout the cowl of night to avoid detection and drawing attention to your self. Huge, nationwide companies like Republic Services and Waste Management are excellent for normal weekly collection of residential trash. Attempt to avoid objects equivalent to filth, large quantities of ceramic tile, bricks, cement, and so on (See helpful hints ). Client services might help with recommendation on methods to deal with heavy objects or material. This may enable dispatch the correct amount of time to schedule your dumpster supply. These dumpsters are used for non permanent service for smaller household initiatives and cleanouts. If you are taken with getting a worth quote and taking step one in the direction of a waste free life, then decide up the nearest phone to call Fort Worth Dumpster Rental. Arrange fee and look forward to the dumpster to indicate up. You can even schedule pickup, or your dumpster will likely be mechanically collected at the end of your week long rental. Period of Rental Interval - your prices will generally be partially based mostly on the length of time you'll want the container. The trash is packed beneath high stress, which might rupture a propane tank inflicting an explosion. As you get quotes from various dumpster companies in your area it's price asking them about all of the attainable charges that might be added to the base charge of your Rent a Construction Dumpster in Newport, VT. From understanding the aforementioned data aside, it's best to seek help from the waste management company in choosing the correct sized dumpster. The basic answer revolves across the following two issues… mission trash volumes and weight of the particular trash being generated. If we don't hear otherwise, we are going to assume you're utilizing an on web site weighbridge to measure tonnage. We provide multiple dumpster sizes and might help you find the right roll off dumpster for your job. Whenever you're carried out with your trash dumpster and you're prepared for your trash to be some place else, the organization will come again, decide up the lease trash dumpsters Heart Valley from your yard, driveway or alley and haul it off to the landfill. A 30 yard dumpster will maintain between 9 and 15 pickup truck a great deal of waste, so it's the very best choice for complete-dwelling residential cleanouts along with industrial cleansing initiatives. For heavy particles, like filth or concrete, a 10 yard dumpster could also be the best choice. I used to be eating like a dumpster king but at first I didn't actually inform anyone about it. I used to be fearful that folks would not take me severely if they knew I ate from dumpsters. If that is not an option, call your local waste management workplace for suggestions. To ebook a dumpster, complete your details, clear the area you need the Dumpster positioned, one in every of our brokers will contact you the same day to verify the reservation, and you may then get to work. The place I dwell, you may learn the identify of the dumpster owner on the dumpster or roll-off. You will be answerable for removing extra and a $75 return trip price will likely be charged to return and decide-up the dumpster. Results present that charge of waste generation in Ghana was 0.forty seven kg/person/day, which interprets into about 12,710 tons of waste per day per the present population of 27,043,093. Though renting an even bigger dumpster costs extra cash, it is more inexpensive than having to an extra dumpster after a little one gets full. This container will maintain the equal of three degree-full pickup vans of particles. Putting in a safety digital camera system above the dumpster can enable you to maintain a glance out for suspicious activity.
Please use the form below to contact us. We look forward to working with you and will get back to you as soon as possible. All fields are required


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Suggest name software product jobs
I want you to change google auto suggest to another words I choose. For example, if you search red in google the suggests are: red sparrow, red dead redemption,red dead redemption (look at file). I want it to be other sentences like: red flower, red blood, red moon.
Hello All! We have been brainstorming about a name for a company, but we have not been successful. We have looked at several options: - Words from Esperanto, Latin and Greek regarding positive words - Mythological figures (like Demeter, the Greek goddess of growth, harvest and nourishment) We did find some very nice words. But either they were already
Hi There, need to get a logo for an art and enter...art and entertainment company and get a website built (light one, but with features). Website should be such that it can be managed easily by the owner [login to view URL] a name for the company as well. Company mainly deals with Kids Entertainment and willing to expand in other entertainment spheres.
For the last decade, and more, regulators hav...review the developments that have occurred in both international financial reporting and CSR in order to protect investors and markets from corporate failure. In addition, suggest ways in which both financial reporting and CSR can be improved upon in the real world in the context of protecting investors.
I wanted to start a new it company so please help me with the good name for the company, the name must be unique
Give a list of 10 good names who's domain is available and not been trademarked. Coined names, names with popular keywords, give a rough idea about the app, less than 10 characters. I will give you more details.
I need someone to fix a line or two of code on my Powershell script. I am a novice and have only been scripting for a few weeks. The script converts .DOC files to .DOCX files but I cannot figure out how to get the $Savename variable to work as a valid path so the document convert object doesn't work properly. The only part of the script I need help with is the "Convert-Files" func...
Hi, I've an e-commerce site built using wordpress CMS & Woocommerce as a core of it. I want to add some premium feature to my site. That is Shipment Tracki...feature to my site. That is Shipment Tracking on the site itself & also Gift card Vouchers. Check out this link for reference : [login to view URL] So suggest me the best one
you must have 4-5 year old account in order to apply for my project. suggest me improvements on my channel and banner suggestions. only 4-5 year old youtube account holder contact me asap. Payment will be given 800 INR.
i'll give you a link to my youtube channel you have to tell me improvements for youtube channel. price is 800 INR and is fixed. contact me asap
i want you to check my youtube channel art and give me suggestions on improvements in title, description
Hello, We deal with Elect...devices/Robotic kits. Most of our product for targeting engineering student, research scholar and innovative school students. We need a proper brand name and a trademark for this product. The brand name should 1. Unique and Unused by other name. 2. Very Easy to remember and pronounce. 3. Not slimier to other brand name.
suggest maximum five latter of automation product.
We are starting a business in...replacement vehicles to clients after their car has been damaged in an accident. We are also developing a software programme to manage the repair process inside the body shop and liase with the Insurance companies and the client. We need a global brand name, something strong possible with a tech slant but not essential.
Need a good iT Company Name. Suggest your name here [login to view URL] Thanks
Need a good business name. Suggest your name here: [login to view URL] Thanks
4-5 simple page just proof read Suggest fix in Grammar or text Just suggestions and we will approve $20 see attached
***MUST BE ABLE TO PROVIDE LAYERED .PSD /AI FILE*** we are startup programming team called vatoce and we work in desktop software , websites , graphics ,... I WOULD LIKE VERY MODERN AND UNIQUE DESIGNS we love a cosmos so we suggest to create a unique and simple space character (alien) but cute character with simple body . 1- please make sure it is
Budget 500 hkd, finish within 1 week


text:
Telephone Boxes an endangered species
By Webteam
BT looks to ring the changes with unused phone boxes
British Telecom has put in applications to local authorities to remove 1,579 of the 3,394 of its remaining phone boxes across the country.
It says payphone usage has declined by 90% in the past 10 years and that many have not been used in 12 months.
The move would see the removal of almost half the phone boxes in Wales, though Tenby Council in Pembrokeshire is opposing the removal of two boxes there, saying they are still needed as not everyone has a mobile phone.
Extract from the Independent i, Page: 20 on Tuesday 11th October
Locally the web team are aware BT currently has a 90 day consultation running with regard to removal of the telephone boxes in Higher Wych and Hampton . Neither have been used in the last 12 months.
The consultation ends on 30th November so if you know anyone wanting to submit recommendations to object/adopt/agree to the removal, please contact us.
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STAKEHOLDER UPDATEIn recent weeks we have experienced high periods of demand on the 101 service which means that people have been waiting longer than normal during peak times.This is a national issue that many other forces are also experiencing but we are pleased to report that the picture has improved in Cheshire.There were a number of reasons behind the increase in demand including the...
Craddock Court
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High Street Church
Cornes room i(3) n Jubilee Hall Malpas


text:
L'esperienza Siram
L'esperienza Siram has adopted Field Service Solutions (TOA) to improve its efficiency and is now thinking to adopt cloud strategy for all their critical applications.
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