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Contraceptive method considerations for clients with HIV including those on ART: provider reference tool.
[Washington, D.C.], FHI 360, 2017 Nov. 2 p.This is an at-a-glance resource for clinical providers to determine whether clients with HIV, including those on antiretroviral therapy (ART), may initiate or continue using common contraceptive methods. This chart is based on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use (2016). The tool provides foundational information for clinical providers on how the effectiveness of different types of hormonal contraceptive methods is affected by interaction with antiretroviral drugs. It also provides guidance on how to promote informed decision-making and help women with HIV who are taking antiretroviral drugs use their chosen hormonal contraceptive method successfully.
Has the phasing out of stavudine in accordance with changes in WHO guidelines led to a decrease in single-drug substitutions in first-line antiretroviral therapy for HIV in sub-Saharan Africa?
AIDS. 2017 Jan 2; 31(1):147-157.OBJECTIVE: We assessed the relationship between phasing out stavudine in first-line antiretroviral therapy (ART) in accordance with WHO 2010 policy and single-drug substitutions (SDS) (substituting the nucleoside reverse transcriptase inhibitor in first-line ART) in sub-Saharan Africa. DESIGN: Prospective cohort analysis (International epidemiological Databases to Evaluate AIDS-Multiregional) including ART-naive, HIV-infected patients aged at least 16 years, initiating ART between January 2005 and December 2012. Before April 2010 (July 2007 in Zambia) national guidelines called for patients to initiate stavudine-based or zidovudine-based regimen, whereas thereafter tenofovir or zidovudine replaced stavudine in first-line ART. METHODS: We evaluated the frequency of stavudine use and SDS by calendar year 2004-2014. Competing risk regression was used to assess the association between nucleoside reverse transcriptase inhibitor use and SDS in the first 24 months on ART. RESULTS: In all, 33 441 (8.9%; 95% confience interval 8.7-8.9%) SDS occurred among 377 656 patients in the first 24 months on ART, close to 40% of which were amongst patients on stavudine. The decrease in SDS corresponded with the phasing out of stavudine. Competing risks regression models showed that patients on tenofovir were 20-95% less likely to require a SDS than patients on stavudine, whereas patients on zidovudine had a 75-85% decrease in the hazards of SDS when compared to stavudine. CONCLUSION: The decline in SDS in the first 24 months on treatment appears to be associated with phasing out stavudine for zidovudine or tenofovir in first-line ART in our study. Further efforts to decrease the cost of tenofovir and zidovudine for use in this setting is warranted to substitute all patients still receiving stavudine.
Allocation of antiretroviral drugs to HIV-infected patients in Togo: Perspectives of people living with HIV and healthcare providers.
Journal of Medical Ethics. 2017 Dec; 43(12):845-851.Aim To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. Method From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patient's family responsibilities and (d) the time elapsed since the first consultation. Results Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. Conclusions WHO's guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.
WHO expands recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP).
Geneva, Switzerland, WHO, 2015 Nov. 2 p. (Pre-Exposure Prophylaxis (PrEP); Policy Brief)This policy brief defines PrEP, presents the World Health Organization's current recommendations for PrEP use and the evidence for it, discusses PrEP's expected cost-effectiveness, and lists considerations for PrEP implementation.
[HIV-1 resistance to antiretroviral drugs in pregnant women from Buenos Aires metropolitan area] Resistencia de HIV-1 a drogas antirretrovirales en gestantes del area Metropolitana de Buenos Aires.
Medicina. 2016; 76(6):349-354.The study aimed to determine the prevalence of antiretroviral resistance associated mutations in HIV-1 infected pregnant woman treated in Buenos Aires metropolitan area (period 2008-2014). A total of 136 women with viral load = 500 copies/ml were included: 77 (56.6%) were treatment-naive and 59 (43.4%) were antiretroviral-experienced patients either with current (n: 24) or previous (n = 35) antiretroviral therapy. Genotypic baseline resistance was investigated in plasma of antiretroviral-naive patients and antiretroviral-experienced patients. The resistance mutations were identified according to the lists of the World Health Organization and the International Antiviral Society, respectively. Frequencies of resistance associated mutations detected in 2008-2011 and 2012-2014 were compared. A total of 37 (27.2%) women presented at least one resistance associated mutation: 25/94 (26.5%) in 2008-2011 and 12/42 (28.5%) in 2012-2014 (p > 0.05). Among naives, 15 (19.5%) had at least one mutation: 10/49 (20.4%) in the period 2008-2011 and 5/28 (17.8%) in 2012-2014 (p > 0.05). The resistance mutations detected in naives were associated with non nucleoside reverse transcriptase inhibitors, being K103N the most common mutation in both periods. In antiretroviral experienced patients, 22/59 (37.3%) had at least one resistance mutation. This study demonstrates a high frequency of resistance associated mutations which remained stable in the period analyzed. These levels suggest an increased circulation of HIV-1 antiretroviral resistant strains in our setting compared to previous reports from Argentina.
Projected Uptake of New Antiretroviral (ARV) Medicines in Adults in Low- and Middle-Income Countries: A Forecast Analysis 2015-2025.
PloS One. 2016; 11(10):e0164619.With anti-retroviral treatment (ART) scale-up set to continue over the next few years it is of key importance that manufacturers and planners in low- and middle-income countries (LMICs) hardest hit by the HIV/AIDS pandemic are able to anticipate and respond to future changes to treatment regimens, generics pipeline and demand, in order to secure continued access to all ARV medicines required. We did a forecast analysis, using secondary WHO and UNAIDS data sources, to estimate the number of people living with HIV (PLHIV) and the market share and demand for a range of new and existing ARV drugs in LMICs up to 2025. UNAIDS estimates 24.7 million person-years of ART in 2020 and 28.5 million person-years of ART in 2025 (24.3 million on first-line treatment, 3.5 million on second-line treatment, and 0.6 million on third-line treatment). Our analysis showed that TAF and DTG will be major players in the ART regimen by 2025, with 8 million and 15 million patients using these ARVs respectively. However, as safety and efficacy of dolutegravir (DTG) and tenofovir alafenamide (TAF) during pregnancy and among TB/HIV co-infected patients using rifampicin is still under debate, and ART scale-up is predicted to increase considerably, there also remains a clear need for continuous supplies of existing ARVs including TDF and EFV, which 16 million and 10 million patients-respectively-are predicted to be using in 2025. It will be important to ensure that the existing capacities of generics manufacturers, which are geared towards ARVs of higher doses (such as TDF 300mg and EFV 600mg), will not be adversely impacted due to the introduction of lower dose ARVs such as TAF 25mg and DTG 50mg. With increased access to viral load testing, more patients would be using protease inhibitors containing regimens in second-line, with 1 million patients on LPV/r and 2.3 million on ATV/r by 2025. However, it will remain important to continue monitoring the evolution of ARV market in LMICs to guarantee the availability of these medicines.
Targeting HIV prevention to young women in Africa.
Lancet. 2016 Nov 26; 388(10060):2579.Add to my documents.
Key toxicity issues with the WHO-recommended first-line antiretroviral therapy regimen.
Expert Review of Clinical Pharmacology. 2016 Aug 22; 9(11):1493-1503.Introduction: WHO recommends tenofovir, efavirenz, and lamivudine or emtricitabine for first-line antiretroviral therapy (ART) in adults, which replaced more toxic regimens using stavudine, zidovudine or nevirapine. Areas covered: We searched Pubmed to identify observational studies and randomized controlled trials reporting toxicity of these antiretrovirals published between 2011 and 2016, and hand-searched abstracts presented at major HIV conferences in 2015 and 2016, focusing on data from sub-Saharan Africa. Tenofovir's nephrotoxicity manifests as mild renal tubular dysfunction (common and of uncertain clinical significance), acute kidney injury (rare), and chronic declining glomerular filtration rate (common). African studies, which include high proportions of patients with renal dysfunction from opportunistic diseases, report population improvement in renal function after starting tenofovir-based ART. Tenofovir modestly decreases bone mineral density, and there is emerging data that this increases fracture risk. Efavirenz commonly causes early self-limiting neuropsychiatric toxicity and hypersensitivity rashes. Recent studies have highlighted its long-term neuropsychiatric effects, notably suicidality and neurocognitive impairment, and metabolic toxicities (dyslipidemia, dysglycemia, and lipoatrophy). We point out the challenges clinicians face in the recognition and attribution of adverse drug reactions. Expert commentary: Tenofovir and efavirenz are generally well tolerated, but both are associated with potentially serious toxicities. Pharmacovigilance systems in resource-limited settings with high HIV burden should be strengthened.
Short Communication: Population-Based Surveillance of HIV-1 Drug Resistance in Cameroonian Adults Initiating Antiretroviral Therapy According to the World Health Organization Guidelines.
AIDS Research and Human Retroviruses. 2016 Apr; 32(4):329-33.With ongoing earlier enrollment on and rapid scale-up of antiretroviral therapy (ART) in Cameroon, there are increasing risks of transmitted HIV drug resistance (HIVDR) at population levels. We, therefore, evaluated the threshold of HIVDR in a population initiating ART, to inform on the effectiveness of first-line regimens, considering HIV-1 diversity, plasma viral load (PVL), and CD4-based disease progression. A total of 53 adults [median (interquartile range, IQR) CD4: 162 cell/mm(3) (48-284); median (IQR) PVL: 5.34 log10 RNA (4.17-6.42) copies/ml] initiating ART in 2014 at the Yaounde Central Hospital were enrolled for HIV-1 protease-reverse transcriptase sequencing. Drug resistance mutations (DRMs) were interpreted using the 2009 World Health Organization (WHO) list versus the Stanford HIVdb algorithm version 7.0. Level of DRMs was low (3.77%) versus moderate (7.55%), respectively, following the WHO list (T69D, K103N) versus Stanford HIVdb (T69D, A98G, K103N, K238T), respectively. Prevailing clade was CRF02_AG (71.70%). Based on Stanford HIVdb, a slightly higher proportion of patients with DRMs were found among ones infected with CRF02_AG than in those non-CRF02_AG infected (7.89% vs. 6.67%, p = 1.000), with lower PVL (7.69% <5.5 vs. 0% >/=5.5 log10 RNA copies/ml, p = .488) and with higher CD4 counts (9.52% CD4 >/=200 vs. 3.33% CD4 <200 cells/mm(3), p = .749). Thresholds of DRMs suggest that standard first-line regimens currently used in Cameroon may remain effective at population levels, despite scale-up of ART in the country, pending adherence, and closed virological monitoring. With an intent-to-diagnose approach, the discrepant levels of DRMs support using Stanford HIVdb to evaluate initial ART, while revising the WHO list for surveillance.
UN political declaration on HIV and AIDS: where to begin?
Lancet. 2016 Aug 20; 388(10046):743-4.Add to my documents.
Performance of Risk Charts to Guide Targeted HIV Viral Load Monitoring of ART: Applying the Method on the Data From a Multicenter Study in Rural Lesotho.
Journal of Acquired Immune Deficiency Syndromes. 2016 May 1; 72(1):e22-5.Add to my documents.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed.
Geneva, Switzerland, WHO, 2016. [480] p.These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.
Guideline: Updates on HIV and infant feeding. The duration of breastfeeding and support from health services to improve feeding practices among mothers living with HIV.
Geneva, Switzerland, WHO, 2016. [68] p.The objective of this guideline is to improve the HIV-free survival of HIV-exposed infants by providing guidance on appropriate infant feeding practices and use of ARV drugs for mothers living with HIV and by updating WHO-related tools and training materials. The guideline is intended mainly for countries with high HIV prevalence and settings in which diarrhoea, pneumonia and undernutrition are common causes of infant and child mortality. However, it may also be relevant to settings with a low prevalence of HIV depending on the background rates and causes of infant and child mortality. This guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to achieve the Sustainable Development Goals, the global targets set in the comprehensive implementation plan on maternal, infant and young child nutrition, the Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) and the Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021. The target audience for this guideline includes: (1) national policy-makers in health ministries; (2) programme managers working in child health, essential drugs and health worker training; (3) health-care providers, researchers and clinicians providing services to pregnant women and mothers living with HIV at various levels of health care; and (4) development partners providing financial and/or technical support for child health programmes, including those in conflict and emergency settings. (Excerpt)
Research gaps identified during the 2014 update of the WHO medical eligibility criteria for contraceptive use and selected practice recommendations for contraceptive use.
Contraception. 2016 Sep; 94(3):195-201.Universal access to safe and effective contraception is an important public health goal. Family planning and prevention of unintended pregnancy are essential to securing the well-being and autonomy of individuals, while supporting the health and development of communities. The World Health Organization (WHO) recently undertook a process to update its global guidance on "who" can use contraception safely and "how" to use contraception safely and effectively to generate the fifth edition of the WHO Medical Eligibility Criteria for Contraceptive Use (MEC) and the third edition of the WHO Selected Practice Recommendations for Contraceptive Use (SPR). Overall, the MEC demonstrates that contraception is remarkably safe for most people; at least one highly effective contraceptive method is assigned a category "1" or "2" across the majority of conditions in the guidance, indicating no restrictions on use or that the advantages of using a particular method generally outweigh the theoretical or proven risks of use. Once a medically appropriate method is identified, the SPR offers critical guidance on safe and effective use, important for contraceptive management and service delivery. The major goal for producing these evidence-based recommendations is to help improve access to and strengthen the quality of family planning services worldwide. While these recommendations reflect a rigorous synthesis and interpretation of the best evidence to date and contribute significantly to medical and public health knowledge around the world, a number of recommendations in both the MEC and SPR are grounded in limited to no direct evidence. In the absence of direct evidence, indirect evidence and expert opinion inform assessments. Each revision of the MEC and SPR offers an opportunity to identify current knowledge gaps and promote research necessary to continually strengthen the guidelines. As part of the most recent revision of these guidelines, a Guideline Development Group convened in March and September 2014 to generate updated recommendations. During these meetings, we identified a number of key research questions for a variety of topics discussed during the technical consultations. The full list of research gaps is included in Table 1, not further prioritized. However, we present three important topics of global relevance to national programs and policies in greater detail: (a) intrauterine device (IUD) initiation among women at high risk for sexually transmitted infections (STIs); (b) bidirectional drug-drug interactions with use of hormonal contraception (HC) and antiretroviral therapy (ART); and (c) initiation of progestogen-containing contraception following use of ulipristal acetate (UPA) emergency contraception. Each section presents some background on the public health importance of the topic and discusses the limitations of existing data and considerations for future rigorous research. [Excerpts].
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: What's new. Policy brief.
Geneva, Switzerland, WHO, 2015 Nov. [20] p. (Policy Brief)The 2015 guidelines includes 10 new recommendations to improve the quality and efficiency of services to people living with HIV. Implementation of the recommendations in these guidelines on universal eligibility for ART will mean that more people will start ART earlier. The updated guidelines present both new recommendations and previous WHO guidance. They include clinical recommendations ("the what" of using ARVs for treatment and prevention) and service delivery recommendations to support implementation ("the how" of providing ARVs), organized according to the continuum of HIV testing, prevention, treatment and care. For the first time the guideline includes "good practice statements" on interventions whose benefits substantially outweigh the potential harms.
Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV.
Geneva, Switzerland, WHO, 2015 Sep. [78] p. (Guidelines)This early-release guideline makes available two key recommendations that were developed during the revision process in 2015. First, antiretroviral therapy (ART) should be initiated in everyone living with HIV at any CD4 cell count. Second, the use of daily oral pre-exposure prophylaxis (PrEP) is recommended as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches. The first of these recommendations is based on evidence from clinical trials and observational studies released since 2013 showing that earlier use of ART results in better clinical outcomes for people living with HIV compared with delayed treatment. The second recommendation is based on clinical trial results confirming the efficacy of the ARV drug tenofovir for use as PrEP to prevent people from acquiring HIV in a wide variety of settings and populations. The recommendations in this guideline will form part of the revised consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection to be published by WHO in 2016. The full update of the guidelines will consist of comprehensive clinical recommendations together with revised operational and service delivery guidance to support implementation.
Oral pre-exposure prophyaxis: Questions and answers.
Geneva, Switzerland, UNAIDS, 2015 [14] p. (UNAIDS 2015 - Reference; UNAIDS / JC2765)Implementing PrEP poses new challenges in planning, managing and funding combination prevention. Realizing the promise of PrEP will require governments, funders, civil society and other stakeholders to join forces to systematically address them–licensing antiretroviral medicines for PrEP use, setting priorities for locations and populations for implementation, making services user-friendly and ensuring adherence. These efforts are worthwhile based on their contribution to achieving the global targets of less than 500 000 people annually acquiring HIV in 2020 and the end of AIDS as a public health threat by 2030.
Working together to provide generics for health.
Antiviral therapy. 2014; 19 Suppl 3:1.Add to my documents.
Simplification of antiretroviral therapy: a necessary step in the public health response to HIV/AIDS in resource-limited settings.
Antiviral therapy. 2014; 19 Suppl 3:31-7.The global scale-up of antiretroviral therapy (ART) over the past decade represents one of the great public health and human rights achievements of recent times. Moving from an individualized treatment approach to a simplified and standardized public health approach has been critical to ART scale-up, simplifying both prescribing practices and supply chain management. In terms of the latter, the risk of stock-outs can be reduced and simplified prescribing practices support task shifting of care to nursing and other non-physician clinicians; this strategy is critical to increase access to ART care in settings where physicians are limited in number. In order to support such simplification, successive World Health Organization guidelines for ART in resource-limited settings have aimed to reduce the number of recommended options for first-line ART in such settings. Future drug and regimen choices for resource-limited settings will likely be guided by the same principles that have led to the recommendation of a single preferred regimen and will favour drugs that have the following characteristics: minimal risk of failure, efficacy and tolerability, robustness and forgiveness, no overlapping resistance in treatment sequencing, convenience, affordability, and compatibility with anti-TB and anti-hepatitis treatments.
WHO Collaborating Centre for Acquired Immunodeficiency Syndrome for the Eastern Mediterranean Regional Office, Faculty of Medicine, Kuwait University, Kuwait.
Medical Principles and Practice. 2014; 23 Suppl 1:47-51.In the early 1980s, the World Health Organization (WHO) designated the Virology Unit of the Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait, a collaborating centre for AIDS for the Eastern Mediterranean Regional Office (EMRO), recognizing it to be in compliance with WHO guidelines. In this centre, research integral to the efforts of WHO to combat AIDS is conducted. In addition to annual workshops and symposia, the centre is constantly updating and renewing its facilities and capabilities in keeping with current and latest advances in virology. As an example of the activities of the centre, the HIV-1 RNA viral load in plasma samples of HIV-1 patients is determined by real-time PCR using the AmpliPrep TaqMan HIV-1 test v2.0. HIV-1 drug resistance is determined by sequencing the reverse transcriptase and protease regions on the HIV-1 pol gene, using the TRUGENE HIV-1 Genotyping Assay on the OpenGene(R) DNA Sequencing System. HIV-1 subtypes are determined by sequencing the reverse transcriptase and protease regions on the HIV-1 pol gene using the genotyping assays described above. A fundamental program of Kuwait's WHO AIDS collaboration centre is the national project on the surveillance of drug resistance in human deficiency virus in Kuwait, which illustrates how the centre and its activities in Kuwait can serve the EMRO region of WHO. (c) 2014 S. Karger AG, Basel.
Adoption of national recommendations related to use of antiretroviral therapy before and shortly following the launch of the 2013 WHO consolidated guidelines.
AIDS. 2014 Mar; 28 Suppl 2:S217-24.OBJECTIVE: To determine the status of key national policies on the use of antiretroviral therapy (ART) at the time of the launch of the 2013 WHO consolidated guidelines as well as to track early progress towards adoption of these recommendations following dissemination. DESIGN: Descriptive analysis of global data on baseline ART policies as of June 2013 and early intentions to adopt the 2013 WHO for use of antiretroviral drugs guidelines as of November 2013. METHODS: Compilation of existing global reports on key HIV policies, review of national guidelines, data collection through annual drug procurement surveys and through guidelines dissemination meetings in each of the six WHO regions. RESULTS: Data were available from 124 low- and middle-income countries, including 97% of the 57 high-priority countries that have been identified by WHO and the Joint United Nations Program on HIV/AIDS (UNAIDS). At baseline, only one country reported recommending antiretroviral therapy (ART) at a CD4 T-cell count 250 cells/mul or less for adults and adolescents in 2013, whereas nine countries already recommended using CD4 T-cell count 500 cells/mul or less. Recommendations for ART initiation regardless of CD4 T-cell count for HIV-infected patients with tuberculosis (86%), hepatitis B (75%), all HIV-infected women who were pregnant or breastfeeding (option B+: 40%) or HIV-infected persons in a serodiscordant relationship (26%) had been nationally adopted as of June 2013. Eight of 67 countries (12%) already recommended treating all children less than 5 years of age. The triple antiretroviral combination of tenofovir + lamivudine (or emtricitabine) + efavirenz was recommended as the preferred first-line option for adults and adolescents more frequently (51%) than for pregnant women (38%), or for both adults/adolescents and pregnant women (28%; P < 0.05). Fewer than half (37%) of all countries reported recommending lopinavir/ritonavir for all HIV-infected children less than 3 years of age; 54% of countries reported recommending routine viral load monitoring, whereas only 41% recommended nurse-initiated ART. CONCLUSIONS: A number of key WHO policy recommendations on antiretroviral drug use were adopted rapidly by countries in advance of or shortly following the launch of the 2013 guidelines. Efforts are needed to support and track ongoing policy adoption and ensure that it is accompanied by the scale-up of evidence-based interventions.
Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial.
Trials. 2013; 14:230.BACKGROUND: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes. METHODS/DESIGN: A cluster-randomised trial in 34 (2 x 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 x 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 <350 cells/muL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters. DISCUSSION: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.
Access to HIV drugs should be widened, says WHO.
BMJ. 2013; 347:f4172.Add to my documents.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach.
Geneva, Switzerland, WHO, 2013. [272] p.The 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection provide new guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the care of people living with HIV and the use of antiretroviral (ARV) drugs for treating and preventing HIV infection.
Efavirenz conceptions and regimen management in a prospective cohort of women on antiretroviral therapy.
Infectious Diseases In Obstetrics and Gynecology. 2012; 2012:723096.Use of the antiretroviral drug efavirenz (EFV) is not recommended by the WHO or South African HIV treatment guidelines during the first trimester of pregnancy due to potential fetal teratogenicity; there is little evidence of how clinicians manage EFV-related fertility concerns. Women on antiretroviral therapy (ART) were enrolled into a prospective cohort in four public clinics in Johannesburg, South Africa. Fertility intentions, ART regimens, and pregnancy testing were routinely assessed during visits. Women reporting that they were trying to conceive while on EFV were referred for regimen changes. Kaplan-Meier estimators were used to assess incidence across ART regimens. From the 822 women with followup visits between August 2009-March 2011, 170 pregnancies were detected during study followup, including 56 EFV conceptions. Pregnancy incidence rates were comparable across EFV, nevirapine, and lopinavir/ritonavir person-years (95% 100/users (P=0.25)); incidence rates on EFV were 18.6 Confidence Interval: 14.2-24.2). Treatment substitution from EFV was made for 57 women, due to pregnancy intentions or actual pregnancy; however, regimen changes were not systematically applied across women. High rates of pregnancy on EFV and inconsistencies in treatment management suggest that clearer guidelines are needed regarding how to manage fertility-related issues in. women on EFV-based regimens.


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DOCCS Washington Cor Facility72 Lock Eleven Lane
Division/Unit: Education Program
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The intern will be working with incarcerated youth, ages 18 to 21, who are enrolled in a high school equivalency educational program. The intern would be working with students who have a history of Special Educational Services prior to their incarceration and students identified as qualifying for Special Educational Services. The assignment would involve completing psychosocial assessments, collaborating and participating in Committee on Special Education Services and working with the school Psychologist. The intern would also assist in counseling activities and services including, but not limited to, one-on-one counseling and possible group counseling work. Internship can be accommodated from 1 to 5 days per week, working 14 to 16 hours per week.
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Number of Interns Needed: 1
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subset: commoncrawl


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Searching for a used car in Staffordshire can be frustrating, all that choice, all those colours and nothing within your budget or on your doorstep. The people at BuyYourCar have tried to simplify the whole process of searching for a used car and make it an enjoyable one! Our super smart search, gives you the results quicker and simpler than our competitors, we believe searching for a new car whether that be used or not, should be an enjoyable one, we work on the basis that the quicker it is for you to find a used car, the easier it is on making a decision to buy one. So if your looking for a used car in Staffordshire, start your search with us! It might be the only search you need to make.
BuyYourCar gives you access to the UK's Largest Used Car Database, we search through all the very best used car sites in the UK and display their stock in one central location for your convenience. However, should you find that we haven't got the used car in Staffordshire you wanted, we'd recommend visiting the sites below, they come highly recommended and they may have some brand new stock that we won't have until tomorrow.
In short, there are plenty more used cars for sale in the Staffordshire area on the site below:-
Used cars from reputable garages - thousands of second hand cars in and around Staffordshire.


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If you're anything like me, you're probably still recovering from Thanksgiving. It doesn't help that I've eaten nothing but Thanksgiving leftovers for the past three days...
Lucky for us, Pharrell Williams (the songwriter, rapper, producer and fashion designer who brought us hits like Robin Thicke's "Blurred Lines" and Daft Punk's "Get Lucky") recently launched a new project that's sure to lift our spirits.
The project--called "Happy"--is a 24-hour interactive music video. You may ask: Who on earth is gonna sit and watch a 24-hour music video? But that's not the point--even Williams admits he hasn't watched the whole thing.
The video streams on 24hoursofhappy.com. When you visit the website, it links you up to the spot in the video corresponding with your local time. You can pause, fast-forward and rewind the video once you get there, and you're encouraged to share your favorite moments on Twitter and Facebook.
What will you see at any given point of the video? Basically, it's a compilation of anonymous extras and celebrities dancing through life to a loop of the song "Happy" from the soundtrack of Despicable Me 2 (yet another one of Williams' projects). Celeb cameos include Steve Carell, Magic Johnson, Jimmy Kimmel and Williams himself.
So if you find yourself feeling under the weather, visit the website and get "Happy"--here's a four-hour clip to get you started!
Congratulations to
Dance Spirit's 2019 Cover Model Search finalists: Darriel Johnakin, Diego Pasillas, and Emma Sutherland! One of them will win a spot on Dance Spirit's Fall 2019 cover. Learn more about the dancers by clicking on their names here:
Read Darriel's profile here
Read Diego's profile here
Read Emma's profile here
And then
vote for your favorite below. You can vote once a day now through July 15.
We also want you to
get social! We'll be factoring social media likes and shares into our final tallies. Be sure to show your favorite finalist some love on Facebook, Instagram, and Twitter, sharing their profile pages and using the hashtag #DanceSpiritCMS.
When it comes to injury-prone body parts, knees reign supreme for dancers. But a little strengthening can go a long way in preventing painful outcomes. We turned to Dirk Hartog, a physical therapist with Westside Dance Physical Therapy in NYC, for three exercises that'll support and stabilize your knees.
Say you're perpetually impeccable designer Thom Browne. Say you're planning your Spring 2020 Paris menswear show along a "Versailles country club" theme. Say you want a world-class danseur to open the show with some kind of appropriately fabulous choreography.
Who do you call? James Whiteside, of course. On Saturday, the American Ballet Theatre principal—wearing pointe shoes and a glorious pinstriped tutu—kicked off Browne's presentation at the École des Beaux-Arts with a 15-minute, show-stealing solo. Whiteside choreographed the piece himself, with the help of detailed notes from the designer.


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Engineering jobs in Cardiff
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Supply Chain Operations Graduate Placement
We are looking for talented, driven recruits to join us on a two year scheduled plan.
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Control Systems / Instrumentation Design Engineer
Are you looking for a more exciting opportunity and challenge? Why not join a company that lets you utilise a wider range of your skills
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Field Service Engineer - Kubota Groundcare Machinery
We are currently looking for a top-flight Service engineer to work on a variety of Groundcare products.
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Senior Technical Network Engineer
Senior Technical Network Engineer £40,000 - £44,000 & Benefits Primarily based in Cardiff We are recruiting for a well known company who is urgentl...
Senior Technology Engineer
Job Title: Senior Technology Engineer Salary: £36,000 - £40,000 Location: Cardiff Acorn Recruitment is currently searching for a Senior Technology ...
Mechanical Maintenance Technician
Profitable manufacturing company who has recently invested c£4M in improving manufacturing efficiency. The organisation is a world leader in their ...
Senior Service Engineer
Job Details Senior Service Engineer - Otis - Otis Ltd - Cardiff Employer: Otis Area: Cardiff Employment Type: Full Time Reference Number: OTIS-1685...
Multi-Skilled Maintenance Engineer
Multi-Skilled Maintenance Engineer A well established and growing company in South Wales are seeking a Multi-Skilled Electrical Maintenance Enginee...
Solutions Engineer
Solutions Engineer Global Manufacturer £28-34,000+ excellent benefits Exciting new role exists and the successful candidate will be responsible for...
B1 Licensed Engineer
B1 Licensed Engineer Cardiff £40,000 - £55,000 + Pension + Holiday + Overtime Excellent opportunity for an aircraft mechanic who is B1 qualified to...
Section Engineer - Wastewater
Section Engineer Wastewater Treatment Site 3-6 Months £260 per day Ltd South Wales ·LEAD and DRIVE as the RESPONSIBLE Engineer all Engineering aspe...
Setting Out Engineer
Setting out Engineer. We have an opportunity in Cardiff City Centre for a Setting out Engineer working for a well-established company - for immedia...
Electrical Design Engineer
Are you an electrical design engineer interested in working on one of the rail industry's largest projects in South Wales? As part of a 10-year pro...
Senior Electrical Design Engineer
With one of the largest rail upgrade projects shortly due to commence in South Wales, a thriving rail consultancy are looking to expand their speci...
Mechanically Biased Engineer
Bakery Technician - Mechanically biased Caerphilly Shifts - 3 shift pattern £26,988.39 + £5267.59 Shift allowance = £32,255.98 Are you a Mechanical...
EPOS Repair Technician
Our client is looking to recruit an EPOS Technician to join their team in the Wentloog area of Cardiff Main Tasks and Objectives: • Carry out EPOS/...
PC Repair Technician
Contract Type: Permanent Basic Salary £17,000.00. Job Elements: - ·To support the technical requirement for processing IT hardware in line with cus...
Product Engineering Manager - Niche Electronic Instruments
Product Engineering Manager - Niche Electronic Instruments Cardiff Up to £50,000 + benefits An exciting opportunity for an established Engineering ...
Industrial Roller Shutter Engineer
Contract Type : Permanent Salary: £30-33,000 per annum. Job Elements : ·We are looking for a candidate who is fully experienced with service, repai...
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Mitel Engineer
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Trainee Service Engineer (Electrical) £20,000 - £23,000 (OTE £35,000) + Van + Excellent Company Benefits Home Based - Wales Are you an Electrician ...
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Multi Skilled Maintenance Engineer (Days) Employment type: Permanent, full-time Location: Cardiff Hours: 8am-5pm Monday, Thursday, 8am-3pm Friday S...


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Large Vintage Trim by Lori Holt of Bee in my Bonnet will add just the right touch of vintage to your projects. The Large Vintage Trim is 3/8″ wide. This listing is for purchasing the trim by the yard, minimum cut 1/2 yard.
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Report: BuzzFeed Is Going Public in 2018
BuzzFeed, which once began as a "great cat site," is preparing to go public in 2018, according to a report by Axios. The site, which now has grown so large as to have a BuzzFeed Motion Pictures Studio in Los Angeles and an award-winning news vertical, has turned down past offers from media companies over long-term plans for an initial public offering. The site also plans to open a Texas bureau in Austin, it announced Tuesday.


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Jun 20 - Jul 19, 2019
YTT 200 Summer Intensive
The Yoga Teacher Training 200 program is designed to delve deeply into Yoga as explained in the traditional Yoga Scriptures. Classically, Aṣhțāṅga Yoga means eight-limbed Yoga, we will address each limb and will teach āsanas from the Hatha Yoga system (referenced in the Hatha Yoga Pradipika, Gherand Samita, and other Hatha yoga scriptures) as shared with us by our teacher, Baba Hari Dass.
Jun 21 - 30, 2019
Children's YTT Summer Intensive
Mount Madonna Institute and Mount Madonna School jointly offer an extraordinary Children's Yoga Teacher Training Program. Learn to apply Classical Ashtanga Yoga to child development and create and teach engaging yoga classes for children. This comprehensive training will inspire you to bring the benefits of asana, breathing, and self-reflection to your young students and their families. This course is designed to deepen your personal practice.
Jul 19 - 21, 2019
Yoga & Ayurveda: A Foundational Workshop
Drawing from Patanjali's Ashtanga (eight-limbed) Yoga System and the practices of Hatha Yoga, you will learn foundational practices of pranayama, mudra, shat karma and meditation as well as basic philosophy and theory of both Yoga and Ayurveda as taught by Baba Hari Dass.
Sep 19, 2019 - Feb 9, 2020
YTT 200 Modular Series
This comprehensive training supports students as they delve deeply into understanding the practice and study of Yoga as explained in the traditional Yoga Scriptures. Guided by approximately 30 senior teachers, a personal mentor, and an entire community, students develop the fundamental skills needed to teach a well-rounded and safe yoga class.
Oct 18 - 30, 2019
Yoga Diwali India: A Cultural Immersion
Join us where the Ganges River meets the Himalayas of Northern India. Experience the country's most joyful festival season while deepening your practice of Yoga. *Qualifies for YTT 300 elective credits.
Dec 4 - 8, 2019
Prenatal YTT Level 1
This comprehensive training includes in-depth instruction on prenatal āsana, prāṇāyāma, meditation, Āyurveda, mindfulness techniques for labor, the anatomy and physiology of pregnancy, common discomforts in pregnancy, and how to support mothers through every stage of pregnancy and postpartum.
Jan 28 - 31, 2020
Prenatal YTT Level 2
Level two is about finding your voice and further cultivating your skills as a Prenatal Yoga Teacher, including advanced teaching methodology and practicum. Level One is a pre-requisite for Level Two.


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I researched and compared several mid priced juicers to the most expensive I could find. $150 was the most I wanted to spend because I recently bought a Vita-Mix blender ($500+). I finally decided on the Breville Juice Fountain Plus JE 95XL (850 watts). But Bed, Bath and Beyond, failed to have it it stock. I made it out there without calling to see if they had it in stock and again, they did not. Not wanting to leave empty handed, I started looking at some of the other juicers they had. That's when I came across the Cuisinart CJE-1000.
Regardless of which juicer you end up buying, the fact that you are shopping for one speaks volumes. You are likely among the growing number of people who have realized the 'typical' diet is a poor one. Healthcare is so inter-related with proper diet and nutrition that is shouldn't even be considered a separate facet of our lives. Hippocrates, regarded as many to be the father of modern medicine, was quoted as saying 'Let food be thy medicine and medicine be thy food." This ancient Greek quote certainly may be outdated, but with the growing awareness of the dangers of modern diets and food ingredients, it's never been more relevant that it is today.
Yes, the Breville Juice Fountain Plus is fast and popular. But this centrifugal juicer paled in comparison with the slow juicers we tested. The yields were low and it was the least effective at juicing greens. In my one-bedroom apartment, you can't hear the television in the living room when a Breville Juice Fountain Plus is fired up in the kitchen. It also has only a one-year warranty.
When the device is plugged in, a blue ring of light will blink around the On/Off button. There are five different settings to choose from when using this device. To start it, you turn the dial to the desired speed and then press the button. In general, to get the best juicing yield softer produce should be juiced at lower settings while harder produce should be juiced at higher settings. We measured the noise level at 82 dB, which makes this the second quietest juicer in our lineup. This is surprising considering how efficiently it juices. It also has rubber non-slip feet and doesn't vibrate excessively when juicing.
If you're serious about juicing, it's best to get a juicer that fits nicely on your kitchen counter so you can leave it out rather than having to haul it out of a cupboard. That means paying close attention to the dimensions and even the length of the electrical cord. You don't want to buy a juicer that looks great in your kitchen but doesn't have a cord that reaches the outlet.
If a significant portion of your calories are going to come from juice each day, mix up your produce. Go with veggie-heavy juices, using just a bit of fruit for sweetness. Alternate types of produce, and try something entirely new periodically. Farmers markets and ethnic grocery stores are great spots to find fruits and vegetables you've never tasted before.
Place a 14-oz. (414-ml) or larger cup or travel mug underneath to catch vinegar. Select 14oz travel mug . Press BREW REG or BREW BOLD button once. When solution starts dispensing, press BREW REG or BREW BOLD button again to stop brewing and allow vinegar to clean. After 30 minutes, press BREW REG or BREW BOLD button and allow it to finish brew cycle. When brew cycle is finished, empty cup and rinse.
You should expect your juicer to have ample capabilities in storing the juice that it produces from your fruits and vegetables. Many juicers feature built-in juice collection containers, while others simply utilize an outlet which allows any container of your choosing to be used. You should consider your personal preference when considering this feature, and try to imagine how you may be using your juicer the most. If, for instance, you plan on making many servings of juice at once, you'd likely want to find a model that allowed for the easy use of custom containers. If you plan on juicing only a few servings at a time, maybe just enough for a day, you'd likely be best served by looking for juicers with built-in juicing storage containers.
Features: From the smallest lime to the largest grapefruit, this sleek brushed stainless steel citrus juicer gets out more juice more efficiently. An adjustable auto-reversing reamer features "custom" pulp control settings, and the unique Final-Spin feature maximizes the amount of juice from each piece of fruit. Dishwasher-safe parts make cleanup a breeze. Features: Adjustable reamer with 3 pulp control settings—low, medium, high Auto-reversing universal juicer cone for more efficient juicing Final-Spin feature extracts more juice from pulp Extra-long Snap-Up spout accommodates more glasses and prevents dripping Cover activates Final-Spin feature and protects against dust Brushed stainless steel design Easy-clean dishwasher-safe parts Convenient cord storage Limited 3-year warranty BPA Free
We like this juicer a lot. It has a HUGE container to catch the pulp, so you can make lots of juices at once and bottle them. Also, the chute is really wide - we throw whole (smallish) apples, oranges and pears in it so we don't have to mess with slicing everything up. It pulverizes everything with no problem. The spout releasing the juice is a little wonky; we had a hard time figuring out what was actually fully open vs. fully closed (we are smart people with college degrees, I swear...it is honestly just a little unclear when you are twisting it). The pitcher catching the juice is great; it has a nice spout for us to easily pour it directly into bottles. The main downside is that it is a pain in the butt to clean, but that is every single juicer on the market, not just this one, so you can't hold that against it. Overall, we would definitely recommend this one!
After pushing almost 40 pounds of leafy, crunchy, pulpy produce through nine juicers, we think the Tribest Slowstar is the best and most versatile machine for home use. It yielded more juice than nearly every other model we tested while keeping foam and temperature increases to a minimum. It comes with a 10-year warranty on parts, so you can crank it up every day without worrying about wear and tear.
If you're serious about juicing, it's best to get a juicer that fits nicely on your kitchen counter so you can leave it out rather than having to haul it out of a cupboard. That means paying close attention to the dimensions and even the length of the electrical cord. You don't want to buy a juicer that looks great in your kitchen but doesn't have a cord that reaches the outlet.
"ABSOLUTELY LOVE IT!!!!!!!! I have had A LOT of juicers over the years and this one blows them all away! it is super fast and pulp is super dry. you get way more than twice the juice! I juiced a lot of veg, 2 pitchers (that it comes with about 4 cups each) and the pulp container was not even half full, yet there was no pulp in the juice! I've even had the slow masticating juicers, this is better. easy to put together, take apart and clean!!!!! i love it in every way. and before you believe that juice from slow juicers is better for you, look it up, thats what i did, and its not as long as its done fast with a good juicer! I truly love this juicer in every way! I will never go back to the lower end ones (that cost about the same anyway, oh brother!) or the expensive slow hard to use and clean ones! Wish i had this in the beginning of my juicing ventures 20 years ago!!!!!!!!!!!"
The Tribest Slowstar, a vertical single-auger, slow-press juicer, is the most versatile juicer we've found, efficiently handling thick greens, fruits, and root vegetables. In our tests, it yielded the highest amount of green juice and nearly the highest amount of hard-vegetable juice with low effort, experienced no motor jams, and generated minimal foam. It also has a generous feed-tube opening, which makes for quicker prep and easier juicing. This quiet machine is backed with a 10-year warranty that covers the motor and parts, one of the better guarantees among the juicers we tested.
Even though many people laud fresh green juice as an excellent way to get a boost of vitamins and nutrients, juice isn't a magical potion. As doctors at the Mayo Clinic point out: "Juicing probably is not any healthier than eating whole fruits and vegetables … whole fruits and vegetables also have healthy fiber, which is lost during most juicing." However, it does go on to say: "The resulting liquid contains most of the vitamins, minerals and plant chemicals (phytonutrients) found in the whole fruit."
A "smoking motor" is usually caused from binding between the cutting unit clutch and the cutting assembly which connects to the motor. Unplug the blender and allow to cool. Once the blender is cool, check the cutting assembly (see the Use and Care instructions for your model for a parts diagram) to see if the blades "spin freely." Be careful, the blades are sharp. If the blades do not spin freely, the cutting unit needs to be replaced. Once the blender base (without container) is cool, plug it in and turn it on to see if it works properly. (If the unit was not turned off when the cutting unit locked, the motor could be damaged.)
And the Tribest Slowstar doesn't just juice. It also comes with a "homogenizing" mincer attachment that grinds without extracting liquid—useful for making sorbets, nut butters, and more. I haven't used the machine for anything other than making juice, so I can't attest to its food-chopping and frozen-fruit-sorbet-making abilities, but you can see it in action in this DiscountJuicers.com video. The separate bowl attachment fits onto the base, using the auger to pulverize the food and push it through a large chute without a screen.
The two most popular types of juicers are centrifugal juicers and masticating juicers. These different types of juicers utilize very different approaches in how they grind up fruits and vegetables. Both have advantages and disadvantages distinct to their design, and both have groups that feel one particular type of juicer is the best juicer. Before you proceed much further in looking for the best juicer possible, you should strongly consider your own personal juicing needs. For example, if you're only ever going to be juicing lemons and oranges, you'll likely be best served by buying a citrus juicer. If, on the other hand, you plan on juicing loads of Organic Wheat Grass, you'll likely be best served by focusing your search on masticating juicers.
The Hurom's feed chute is made of opaque plastic, meaning you can't see what's happening as you feed produce into the juicer — is it making weird noises because it's about to jam, or is it powering through a particularly stringy piece of celery? The chute also had a narrower mouth than most of our finalists, requiring us to quarter our apples and lemons before adding them. Not a dealbreaker, but we preferred larger, more transparent chutes as they require a little less prep work and you can see what's going on.
Shopping for a juicer can be a daunting task, as there are quite a few juicers out there to choose from. Stores such as Macy's, Target, Wal-Mart, and even Bed Bath & Beyond offer 'affordable' type juicers that are meant more as a means of meeting a demand for juicers than in meeting the demands of juicers. Simply put, if you're buying a juicer in a store, unless you've done your research, you're likely getting a sub-par product. Certainly, there are exceptions to the rules, and many retailers have realized consumers are beginning to care as much about quality as price again. To get a better idea of what type of juicer may be best-suited for your needs, you'll find a brief overview of the different juicer types below.
This machine does come with a 1000 mL pitcher, which means it could hold roughly three 12-ounce sodas. Fresh juice does not keep for long, so you typically wouldn't make lots of it in advance; however, if you are making juice for your family or for the next day or two, it is nice not to have to stop and empty the pulp. You can get through a lot of produce before you need to pause.
The gist: For those looking to get the most out of their leafy greens, the Lexen GP27 is the way to *manually* do just that. This juicer is the solution for those that don't want to lay out hundreds for an expensive masticating juicer, but also don't want to settle for a cheap, crummy manual model. As the folks at The Healthy Juicer say, this thing was designed to be "simple, mobile, versatile, and easy to clean." Simple is right. To use, just put a put a juice cup under the spout, place your greens into the chute, and start churning. Cleaning this thing is a breeze, since all you have to do is unscrew the parts, rinse them off in the sink, and boom—you're done. Thanks to its high juice-yield and cold-press technology, you can rest assured your greens will be nutrient-packed to the max.


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Bright, neat, and impeccably maintained! Rare Ainsely model quietly tucked away in quiet cul de sac has been loved & well cared for! Parquet flooring in entry & powder room, engineered wood laminate & ceramic tile flooring grace the main level. White cabinetry & appliances in kitchen has large pantry and adjacent first floor laundry for added convenience! Vaulted ceiling with fireplace in living room is drenched in sunlight. Three full bedrooms on second floor plus private master bath & generous closet space! Ceiling fans in all bedrooms! Two car garage! See list of improvements under add'l information. Seller prefers mid to end July closing. Show this welcoming home with confidence! Master Assoc fee is annual.
*This option is for a conforming mortgage. For amounts exceeding $484,350, you may need a jumbo mortgage.


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If you had an external drive when the 5. 0 update that came out, you might have seen. · For Nintendo Wii on the Wii, a GameFAQs message board topic titled " What to do for Wii Shop Channel error code 10? · Are you getting an Error # 002 on your Wii? Here' s more information on that message and how to fix the # 002 error. · How to Connect Your Nintendo Wii to the. If error code 51330 or 52130 pops up on your Wii,. A " Friend Code" is generated for each Wii and Nintendo DS Wi- Fi. · Nintendo Fan Club; Error 51420. so the Wii has the modem to itself,. I know I had the same error but keep trying to connect. Error 51420 en Wii › Online.
oficial de nintendo de usb a ethernet para poder conectar mi modem a mi wii pero al iniciar la conexion me da el error 51420. If you don' t have a My Nintendo membership, you need to select " Do not link". If you' ve worked through these tips and you' re still getting this error code, then you' ll. What is error code: 51420 for the internet connection on a Nintendo Wii? The KGB Agent answer: The Error Code: 51420 means that your Wii console is not able to. Nintendo Lan Adapter;. You' ll need to free up some space fixya. com/ support/ terror_ code_ 51420 nintendo wii online. Nintendo Wi- Fi Connection; Error Code Results;. LAN adapters not made by Nintendo likely will not work with the Wii console.
If you' re getting Wii error codes on your screen, this page will tell you what the error is,. Return to the Wii Error Codes section Nintendo Wii Explained Home. com; Consumer Service ; Nintendo Wi- Fi Connection; Error Code Results; Support Home. Getting Started; How To; Troubleshooting; General Info; Nintendo 3DS. If you are still seeing the " Error has Occurred" message, there may be a problem with your Wii console. Nintendo no longer offers factory repairs for the Wii console. If your connection worked previously, check to see if there is a Wii System Update that you have not aquired. Nintendo of America Inc. Check to make sure you are not. Home > lan adapter > wii error 51420. Share on Pinterest Share by Email × Question about Nintendo Wii Console 2 Answers Error codewii is hooked. The Wii is a popular gaming console that has several common error codes related to internet connectivity. Read more to learn how to fix these if you get one. · Nintendo error code 51330. Verrified network ID and paswd as per identified on att.
am attempting to access netflix getting and error code 51420. En caso de que hubiera algún problema durante el proceso de conexión a Internet de tu consola Wii, o de que no se pudiera instalar una actualización. nintendo Error Code 51420 from malicious software such as adware,. · Best Answer: For your error code, Nintendo has a troubleshooting website. Try the suggestions from the site below. Maybie you got a dud, or a dodgy one. · How do you connect your wii to the internet through a router " error code. Can you still download nintendo wii. com/ consumer/ systems/ wii/ en_ na/ errors/. jsp Make sure that you are using the Wii LAN Adapter made by Nintendo ( click here for a picture. The Wii error code 51330 is a common error on the Nintendo Wii gaming system. It signifies a problem with the network' s internet connection and is usually displayed.
Recently when playing CoD: WaW I went to go online and it came up with that error code - 50299. Same with Animal Crossing: Let' s Go To The City. Error code 09: Nintendo is experiencing temporary server issues, which are preventing your card information from being validated. See the Ultimate Wii Guide. Are you facing this Nintendo Wii Error Code 51330 while playing Games Online? If yes, then check here for the right method to fix this error code 51330. Wii U; Wii & Wii mini; Nintendo DSi Family; Nintendo DS Family; Classic Systems; Tech Support Forums;. Headquarters are in Redmond,. How to get around the Wii Error Code 0. it may be because you have the latest updates of the Wii system ( Nintendo patched it to prevent players from. × Question about Nintendo Wii Console 1 Answer Error code 51420 on my wii console. I tried to imput manually the connection settings in. · Error 51420 cant find answer. error code 51420 on wii, error code 51420 wii, switch nintendo router cannot find, wii 51420, wii code 51420, wii error 51420,.
· today I decided to call my console Wii U. However, at the time it starts ( with or disk). he shows me a black screen writing the following error code. 5Digit error codes. Nintendo server' s down or under maintenence. Wii Error Code: 3. Summary: Poor connection due to wireless router. Welcome to Wii U Reddit' s. videos, community insight, & anything related to Nintendo' s 8th- generation console, the Wii. I have this error code for my wii u and.
Support Nintendo Com Error Code 51420. I look like my Wii connect on everything but wiichat. com/ forum/ nintendo- wii- online/ 29217- errora. · error code 51420 on my wii console. I am trying to establish a connection to the internet. I have a router which - Nintendo Wii Console question. Discussion in ' Nintendo Wii Online' started by Darkside7000, Jun 8,. Page 1 of 2 1 2 Next >. 51420 wii error, 51420 wii error code, error 51420,. · How To Fix Error Code 51330 Shauna Edison. How to Use the Nintendo Wii : Nintendo Wii Settings Menu - Duration: 3: 53. 240017 Error Code( sThis error code displays the following message: Internal communication error To try and fix this error, please t. Error codeNintendo Video Game Consoles & Games question. For Nintendo Wii on the Wii, a GameFAQs Answers question titled " Error Codes?


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Brian Oldham
Brian Oldham
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American Photographer | Born: 1992
Brian was born in April of 1993 in Orange, CA, USA. He grew up as an only child with a thriving imagination, playing elaborate games of fiction and fairytales. Now 19, Brian works as a freelance photographer, specializing in fashion and fine art photography. He began taking photographs at the age of sixteen, and as he experimented with self portraiture and surrealism, his love of photography blossomed as he taught himself how to create freely. Brian keeps his passion of all things beautiful and strange ever present in his work, creating surreal, conceptual images that transport the viewer to new worlds. Brian is currently living and working in the Los Angeles area, and is available for commissioned work internationally.
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Brian Oldham
© Brian Oldham
Brian Oldham
© Brian Oldham
Brian Oldham
© Brian Oldham
Brian Oldham
© Brian Oldham
Brian Oldham
© Brian Oldham
Brian Oldham
© Brian Oldham
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Welcome to
Tecumseh Early Childhood Center
1406 N. 6th Street
Tecumseh, OK 74873
(405) 598-2967 Fax (405) 598-1633
Tammy Giaudrone - Principal
Shay Sehon - Site Secretary
Danita Dayton - Counselor
1406 N. 6th Street
Tecumseh, OK 74873
(405) 598-2967 Fax (405) 598-1633
Tammy Giaudrone - Principal
Shay Sehon - Site Secretary
Danita Dayton - Counselor
Tecumseh Public Schools Child Nutrition Director, Cindy Belshe wants parents to be aware of the dates their children will be able to access free breakfast and lunch for the 2019 summer break.The free food service will be available to all children in pre-kindergarten through 12th grade and will be...
Classrooms were filled with lots of visitors on April 17 when students invited grandparents to come to a special visitation day at Tecumseh Early Childhood Center. Fundraising activities tied to the celebration raised over $800 for the American Cancer Society.
Tecumseh Early Childhood Center Principal Tammy Giaudrone is encouraging all district residents with four year old children to come to Pre Kindergarten Pre-Enrollment Day on Thursday, April 25.Parents/guardians will be able to complete paperwork for the 2019-20 school year between the hours of 9...
Don't forget about our Summer Seamless Feeding program. Your children can receive free breakfast and lunch daily during summer school sessions. You do not have to be enrolled in summer school classes, but you must be an enrolled TPS student. Call 598-3739 for details or read about it in our news section.
And so it begins...SUMMER SCHOOL is open! If you are concerned that your child is supposed to be attending summer classes, please consult the site specific office for details ASAP.
Due to the severe weather forecasted for Monday, May 20; all classes at Tecumseh Public Schools will be canceled. School will resume on Tuesday, May 21.
Free meals for our kids! view image


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Www.digitalplayspace.com - The Sims 4 Free Play Game. Should you ended up to inquire a lot of people what their most loved productions had been little doubt each might have their very own person lists. You'll be amazed within the range of animated kinds that may be integrated. Therefore if who ever explained that cartoons are for teenagers? These are something that touches the hearts on the young and previous for both gender. This really is relevant to The Sims 4 Free Play Game.
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Fashion! We're the Goon Squad
Posted by a Contributor in August's Magazine
A lecturer, whilst addressing the room, once told us that "when clothes appear in Topshop they are no longer cutting edge fashion." This, for the lack of a more intelligent statement, made me sad. Try as we might, the lowly consumer will normally be at the tail end of what is considered fashionable. Are the fashion gods looking down at the majority of us as we go about our business and laughing at our ineptitude? If they are, should we care?
Fashionable, is, by definition, characteristic of, influenced by, or representing a current popular style. After years of subscribing to Vogue and trying to keep up with whatever new embellishment designers have decided to add to a blazer this season, I have made up my mind that if being fashionable means decking yourself out in unsuitable colours and clothes, then fashion be gone.
Much of my money and time has been spent on the pastime that is called fashion. I really should have learned to think for myself earlier. When first entering the world of lady face paint I was gifted a lipstick in a lovely shade of pink by a family friend. Being naive about the ways of fashion, I was devastated when a contemporary provided this fashion insight while we dressed up for a Friday night watching our favourite pre-teen television shows: "That lipstick colour really suits you, it's a shame it's not in fashion." The light bulb should have switched on over my head, but I wouldn't have allowed something like that to mark me out from the crowd. So I unwisely toyed around with what was fashionable at the time, hues of dark brown lip colour – which on the chroma scale lends a banana tone to my skin (much to my current embarrassment when looking through photographs from my youth). This lasted until my innate style sensibilities developed of course, which, as this article points out, unfortunately took a bit longer than I would have liked.
Despite the fact that nobody dresses according to the season anymore – wearing denim shorts throughout the year but varying the denier of the tights worn underneath – stores seem to have new stock every week. Imagine being a clothes designer and having to come up with new styles endlessly.
Actually that would be great, but the idea of there being such a need is what is interesting. While having to come up with and market new styles (most likely every week) could be both a trial and exciting, in order to be considered fashionable buying the result has become something of a need, the whole cycle working unsurprisingly around money. I have enough problems with money (money problems) without letting it dictate even more aspects of something so close to my soul as what I choose to wear.
Bill Hicks inspired
Now the fun part: ragging on a recent trend! In this age of daylong fashion fads it has become a chore to keep up. The geek chic trend has persisted a little and continues to bemuse me; the latest form (latest meaning it's been in the shops for a good few months now so it's probably time to retire these garments to nightwear, if you're bothered by things like that, and buying a sweatshirt with a photo of a grumpy looking cat on it) is the "geek" t-shirt (or dork, nerd, dweeb). You no longer even have to wear the prescription Buddy Holly specs to lay claim to this trend, you can just have the word emblazoned across your chest.
Admittedly, when I first saw these t-shirts around I thought they might have something to do with taking a stand against bullying. There was a time, before the manic pixie dream girl, before Google became an extremely cool place to work, before all of this, when geek, dweeb and nerd were properly pejorative. When at school, these were the words thrown at those in the lower ebbs of the schoolyard hierarchy.
It would have been great if all these geek t-shirt wearers were actually saying, "Hey, bullies, we're all a little bit dork/geek/nerd, so go pick on yourself instead until you've dealt with all your issues!" But alas I fear this is not the case and stronger, meaner methods and words have developed for bullying since my knee grazing days of childhood.
Regardless, the idea of having to put something new on a t-shirt in order to sell it will continue. It would be better for everyone if each of us were comfortable purchasing what we felt good in and suited not only our bodies but also our personalities, than buying into something just because it's there and someone declares it as now being 'the thing'. Though if someone made a Bill Hicks inspired 'reader' T-shirt I'd immediately hand over some cash.
Twitter: @reddotbluedot
9 responses to "Fashion! We're the Goon Squad"
Fashion is more important thing and more discussed topic in social gatherings. People discuss about other people fashion and they mostly judge people with it. So if you want to move confidently in society then you have to change your personality and start following new trends.
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The popularity of television shows like Project Runway and America's Next Top Model has added even more glamour to the fashion industry, and many people are wondering if a fashion career is right for them. A fashion career might be a good fit for you if you have the right combination of creativity and business acumen. The fashion industry isn't based just on making sketches of beautiful clothes, which is why many people are surprised at the hard work that goes into getting a degree in either fashion design or fashion merchandising.
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Fashion and the things are greatly entertained and discussed in our world and people love new fashion and trends. I think these guys are rocking and keep moving on with the things like this. Thank you for this article and keep sharing!
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