text:
National Institute of Arthritis and
Musculoskeletal and Skin Diseases
This fact sheet contains general information about knee problems.
It includes descriptions and a diagram of the different parts of the knee,
including bones, cartilage, muscles, ligaments, and tendons. Individual
sections of the fact sheet describe the symptoms, diagnosis, and treatment of
specific types of knee injuries and conditions. (See
index.) Information is also provided on the prevention of knee
What Causes Knee Problems?
Some knee problems result from wear of parts of the knee, such as
occurs in osteoarthritis. Other problems result from injury, such as a blow to
the knee or sudden movements that strain the knee beyond its normal range of
How Can People Prevent Knee Problems?
What Kinds of Doctors Treat Knee Problems?
Extensive injuries and diseases of the knees are usually treated
by an orthopaedic surgeon, a doctor who has been trained in the nonsurgical and
surgical treatment of bones, joints, and soft tissues (for example, ligaments,
tendons, and muscles). Patients seeking nonsurgical treatment of arthritis of
the knee may also consult a rheumatologist (a doctor specializing in the
diagnosis and treatment of arthritis and related disorders).
What Are the Major Structures of the Knee? What Do They
The knee joint works like a hinge to bend and straighten the lower
leg. It permits a person to sit, stand, and pivot. The knee is composed of the
following parts (see diagram):
[Image omitted]
Bones and Cartilage
The knee joint is the junction of three bonesthe femur
(thigh bone or upper leg bone), the tibia (shin bone or larger bone of the
lower leg), and the patella (kneecap). The patella is about 2 to 3 inches wide
and 3 to 4 inches long. It sits over the other bones at the front of the knee
joint and slides when the leg moves. It protects the knee and gives leverage to
The ends of the three bones in the knee joint are covered with
articular cartilage, a tough, elastic material that helps absorb shock and
allows the knee joint to move smoothly. Separating the bones of the knee are
pads of connective tissue called menisci, which are divided into two
crescent-shaped discs positioned between the tibia and femur on the outer and
inner sides of each knee. The two menisci in each knee act as shock absorbers,
cushioning the lower part of the leg from the weight of the rest of the body,
as well as enhancing stability.
There are two groups of muscles at the knee. The quadriceps muscle
comprises four muscles on the front of the thigh that work to straighten the
leg from a bent position. The hamstring muscles, which bend the leg at the
knee, run along the back of the thigh from the hip to just below the knee.
Ligaments are strong, elastic bands of tissue that connect bone to
bone. They provide strength and stability to the joint. Four ligaments connect
the femur and tibia:
Other ligaments are part of the knee capsule, which is a
protective, fiber-like structure that wraps around the knee joint. Inside the
capsule, the joint is lined with a thin, soft tissue, called synovium.
Tendons are tough cords of tissue that connect muscle to bone. In
the knee, the quadriceps tendon connects the quadriceps muscle to the patella
and provides power to extend the leg. The patellar tendon connects the patella
to the tibia. Technically, it is a ligament, but it is commonly called a
How Are Knee Problems Diagnosed?
Doctors use several methods to diagnose knee problems.
What Is Chondromalacia?
Chondromalacia (pronounced KON-DRO-MAH-LAY-SHE-AH), also called
chondromalacia patellae, refers to softening of the articular cartilage of the
kneecap. The disorder occurs most often in young adults and may be caused by
trauma, overuse, parts out of alignment, or muscle weakness. Instead of gliding
smoothly across the lower end of the thigh bone, the kneecap rubs against it,
thereby roughening the cartilage underneath the kneecap. The damage may range
from a slight abnormality of the surface of the cartilage to a surface that has
been worn away completely to the bone. Traumatic chondromalacia occurs when a
blow to the knee cap tears off either a small piece of articular cartilage or a
large fragment containing a piece of bone (osteochondral fracture).
What Are the Symptoms of Chondromalacia? How Is It
The most frequent symptom of chondromalacia is a dull pain around
or under the kneecap that worsens when walking down stairs or hills. A person
may also feel pain when climbing stairs or during other activities when the
knee bears weight as it is straightened. The disorder is common in runners and
is also seen in skiers, cyclists, and soccer players. A patient's description
of symptoms and a followup x ray usually help the doctor make a diagnosis.
Although arthroscopy can confirm the diagnosis of chondromalacia, it is not
performed unless the condition requires extensive treatment.
How Is Chondromalacia Treated?
Many doctors recommend that patients with chondromalacia perform
low-impact exercises that strengthen muscles, particularly the inner part of
the quadriceps, without injuring joints. Swimming, riding a stationary bicycle,
and using a cross-country ski machine are acceptable as long as the knee is not
bent more than 90 degrees. Electrical stimulation may also be used to
strengthen the muscles. If these treatments fail to improve the condition, the
physician may perform arthroscopic surgery to smooth the surface of the
articular cartilage and wash out cartilage fragments that cause the joint
to catch during bending and straightening. In more severe cases of
chondromalacia, surgery may be necessary to correct the angle of the kneecap
and relieve friction involving the cartilage or to reposition parts that are
out of alignment.
What Is the Cause of Injuries to the Meniscus?
The two menisci are easily injured by the force of rotating the
knee while bearing weight. A partial or total tear of a meniscus may occur when
a person quickly twists or rotates the upper leg while the foot stays still
(for example, when dribbling a basketball around an opponent or turning to hit
a tennis ball). If the tear is tiny, the meniscus stays connected to the front
and back of the knee; if the tear is large, the meniscus may be left hanging by
a thread of cartilage. The seriousness of a tear depends on its location and
What Are the Symptoms of Injury?
Generally, when people injure a meniscus, they feel some pain,
particularly when the knee is straightened. The pain may be mild, and the
person may continue activity. Severe pain may occur if a fragment of the
meniscus catches between the femur and tibia. Swelling may occur soon after
injury if blood vessels are disrupted, or swelling may occur several hours
later if the joint fills with fluid produced by the joint lining (synovium) as
a result of inflammation. If the synovium is injured, it may become inflamed
and produce fluid to protect itself. This causes swelling of the knee.
Sometimes, an injury that occurred in the past but was not treated becomes
painful months or years later, particularly if the knee is injured a second
time. After any injury the knee may click, lock, or feel weak. Symptoms of
meniscal injury may disappear on their own but frequently, symptoms persist or
return and require treatment.
How Is Meniscal Injury Diagnosed?
In addition to listening to the patient's description of the onset
of pain and swelling, the physician may perform a physical examination and take
x rays of the knee. The examination may include a test in which the doctor
flexes (bends) the leg then rotates the leg outward and inward while extending
it. Pain or an audible click suggests a meniscal tear. An MRI test may be
recommended to confirm the diagnosis. Occasionally, the doctor may use
arthroscopy to help diagnose and treat a meniscal tear.
How Is an Injured Meniscus Treated?
If the tear is minor and the pain and other symptoms go away, the
doctor may recommend a muscle-strengthening program. Exercises for meniscal
problems are best performed with initial guidance from a doctor and physical
therapist or exercise therapist. The therapist will make sure that the patient
does the exercises properly and without risk of new or repeat injury. The
following exercises after injury to the meniscus are designed to build up the
quadriceps and hamstring muscles and increase flexibility and strength.
If the tear to a meniscus is more extensive, the doctor may
perform either arthroscopic surgery or open surgery to see the extent of
injury and to repair the tear. The doctor can suture (sew) the meniscus back in
place if the patient is relatively young, the injury is in an area with a good
blood supply, and the ligaments are intact. Most young athletes are able to
return to vigorous sports with meniscus-preserving repair.
If the patient is elderly or the tear is in an area with a poor
blood supply, the doctor may cut off a small portion of the meniscus to even
the surface. In some cases, the doctor removes the entire meniscus. However,
degenerative changes, such as osteoarthritis, are more likely to develop in the
knee if the meniscus is removed. Medical researchers are currently
investigating a procedure called an allograft, in which the surgeon replaces
the meniscus with one from a cadaver. A grafted meniscus is fragile and may
shrink and tear easily. Researchers have also attempted to replace a meniscus
with an artificial one, but the procedure is even less successful than an
Recovery after surgery to repair a meniscus takes several weeks
longer and post-operative activity is slightly more restricted than when the
meniscus is removed. Nevertheless, putting weight on the joint actually fosters
recovery. Regardless of the form of surgery, rehabilitation usually includes
walking, bending the legs, and doing exercises that stretch and build up the
leg muscles. The best results of treatment for meniscal injury are obtained in
people who do not show articular cartilage changes and who have an intact
anterior cruciate ligament.
What Is Arthritis of the Knee?
Arthritis of the knee is most often osteoarthritis, a degenerative
disease where cartilage in the joint gradually wears away. In rheumatoid
arthritis, which can also affect the knees, the joint becomes inflamed and
cartilage may be destroyed.1 Arthritis not only affects joints, it may also
affect supporting structures such as muscles, tendons, and ligaments.
Osteoarthritis may be caused by excess stress on the joint, such
as from repeated injury, deformity, or if a person is overweight. It most often
affects middle-aged and older people. A young person who develops
osteoarthritis may have an inherited form of the disease or may have
experienced continuous irritation from an unrepaired torn meniscus or other
injury. Rheumatoid arthritis usually affects people at an earlier age than
What Are the Signs of Knee Arthritis and How Is It
A person who has arthritis of the knee may experience pain,
swelling, and a decrease in knee motion. A common symptom is morning stiffness
that lessens after moving around. Sometimes the knee joint locks or clicks when
the knee is bent and straightened, but these signs may also occur in other knee
disorders. The doctor may confirm the diagnosis by performing a physical
examination and taking x rays, which typically show a loss of joint space.
Blood tests may be helpful for diagnosing rheumatoid arthritis, but other tests
may be needed as well. Analysis of fluid from the knee joint may be helpful in
diagnosing some kinds of arthritis. The doctor may use arthroscopy to directly
visualize damage to cartilage, tendons, and ligaments and to confirm a
diagnosis, but arthroscopy is usually done only if a repair procedure is to be
How Is Arthritis of the Knee Treated?
Most often osteoarthritis of the knee is treated with analgesics
(pain-reducing medicines), such as aspirin or acetaminophen (Tylenol):*
nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin,
Nuprin, Advil); and exercises to restore joint movement and strengthen the
knee. Losing excess weight can also help people with osteoarthritis. Rheumatoid
arthritis of the knee may require a treatment plan that includes physical
therapy and use of more powerful medications. In people with arthritis of the
knee, a seriously damaged joint may need to be surgically replaced with an
artificial one. (Note: A new procedure designed to stimulate the growth of
cartilage using a patient's own cartilage cells is being used experimentally to
repair cartilage injuries at the end of the femur at the knee. It is not a
treatment for arthritis.)
What Are the Causes of Injury to the Cruciate
Injury to the cruciate ligaments of the knee is sometimes referred
to as a "sprain." The anterior cruciate ligament is most often stretched, torn,
or both by a sudden twisting motion (for example, when the feet are planted one
way and the knees are turned another way). The posterior cruciate ligament is
most often injured by a direct impact, such as in an automobile accident or
football tackle.
What Are the Symptoms of Cruciate Ligament Injury? How Is
Injury Diagnosed?
Injury to a cruciate ligament may not cause pain. Rather, the
person may hear a popping sound, and the leg may buckle when he or she tries to
stand on it. To diagnose an injury, the doctor may perform several tests to see
if the parts of the knee stay in proper position when pressure is applied in
different directions. A thorough examination is essential to the diagnosis. An
MRI is very accurate in detecting a complete tear, but arthroscopy may be the
only reliable means of detecting a partial tear.
How Are Cruciate Ligament Tears Treated?
For an incomplete tear, the doctor may recommend that the patient
begin an exercise program to strengthen surrounding muscles. The doctor may
also prescribe a protective knee brace for the patient to wear during activity.
For a completely torn anterior cruciate ligament
in an active athlete and motivated patient, the doctor is likely
to recommend surgery. The surgeon may reattach the torn ends of the ligament or
reconstruct the torn ligament by using a piece (graft) of healthy ligament from
the patient (autograft) or from a cadaver (allograft). Although repair using
synthetic ligaments has been tried experimentally, the procedure has not
yielded as good results as use of human tissue. One of the most important
elements in a patient's successful recovery after cruciate ligament surgery is
following an exercise and rehabilitation program for 4 to 6 months that may
involve the use of special exercise equipment at a rehabilitation or sports
center. Successful surgery and rehabilitation will allow the patient to return
to a normal full lifestyle.
What Is the Most Common Cause of Injury to the Medial
Collateral Ligament?
The medial collateral ligament is more easily injured than the
lateral collateral ligament. It is most often caused by a blow to the outer
side of the knee, which often happens in contact sports like football or
hockey, that stretches and tears the ligament on the inner side of the
What Are the Symptoms of Collateral Ligament Injury? How Is
Injury Diagnosed?
When injury to the medial collateral ligament occurs, a person may
feel a pop and the knee may buckle sideways. Pain and swelling are common. A
thorough examination is essential to determine the nature and extent of injury.
To diagnose a collateral ligament injury, the doctor exerts pressure on the
side of the knee to determine the degree of pain and looseness of the joint. An
MRI is helpful in diagnosing injuries to these ligaments.
How Are Collateral Ligament Injuries Treated?
Most sprains of the collateral ligaments will heal if the patient
follows a prescribed exercise program. In addition to exercise, the doctor may
recommend that the patient apply ice packs to reduce pain and swelling and wear
a small sleeve-type brace to protect and stabilize the knee. A sprain may take
2 to 4 weeks to heal. A severely sprained or torn collateral ligament may be
accompanied by a torn anterior cruciate ligament, which usually requires
surgical repair.
What Are the Causes of Tendinitis and Ruptured Tendons?
Knee tendon injuries range from tendinitis (inflammation of a
tendon) to a ruptured (torn) tendon. If a person overuses a tendon during
certain activities such as dancing, cycling, or running, the tendon stretches
like a worn-out rubber band and becomes inflamed. Movements such as trying to
break a fall may cause excessive contraction of the quadriceps muscles and tear
the quadriceps tendon above the patella or the patellar tendon below the
patella. This type of injury is most likely to happen in older people whose
tendons tend to be weaker. Tendinitis of the patellar tendon is sometimes
called jumper's knee. This is because in sports requiring jumping, such as
basketball, the muscle contraction and force of hitting the ground after a jump
strain the tendon. The tendon may become inflamed or tear after repeated
What Are the Symptoms of Tendon Injuries? How Are Injuries
People with tendinitis often have tenderness at the point where
the patellar tendon meets the bone. They also may feel pain during faster
movements, such as running, hurried walking, or jumping. A complete rupture of
the quadriceps or patellar tendon is not only painful but also makes it
difficult for a person to bend, extend, or lift the leg against gravity. If
there is not much swelling, the doctor will be able to feel a defect in the
tendon near the tear during a physical examination. An x ray will show that the
patella is lower in position than normal in a quadriceps tendon tear and higher
than normal in a patellar tendon tear. The doctor may use an MRI to confirm a
partial or total tear.
How Are Knee Tendon Injuries Treated?
Initially, the doctor may ask a patient with tendinitis to rest,
elevate, and apply ice to the knee and to take medicines such as aspirin or
ibuprofen to relieve pain and decrease inflammation and swelling. If the
quadriceps or patellar tendon is completely ruptured, a surgeon will reattach
the ends. After surgery, the patient will wear a cast for 3 to 6 weeks and use
crutches. If the tear is only partial, the doctor might apply a cast without
performing surgery.
A partial or complete tear of a tendon requires an exercise
program as part of rehabilitation that is similar to but less vigorous than
that prescribed for ligament injuries. The goals of exercise are to restore the
ability to bend and straighten the knee and to strengthen the leg to prevent a
repeat knee injury. A rehabilitation program may last 6 months, although the
patient can return to many activities before then.
What Are the Causes of Osgood-Schlatter Disease?
Osgood-Schlatter disease is caused by repetitive stress or tension
on a part of the growth area of the upper tibia (the apophysis). It is
characterized by inflammation of the patellar tendon and surrounding soft
tissues at the point where the tendon attaches to the tibia. The disease may
also be associated with an avulsion injury, in which the tendon is stretched so
much that it tears away from the tibia and takes a fragment of bone with it.
The disease most commonly affects active young people, particularly boys
between the ages of 10 and 15, who play games or sports that include frequent
running and jumping.
What Are the Symptoms of Osgood-Schlatter Disease? How Is It
People with this disease experience pain just below the knee joint
that usually worsens with activity and is relieved by rest. A bony bump that is
particularly painful when pressed may appear on the upper edge of the tibia
(below the knee cap). Usually, motion of the knee is not affected. Pain may
last a few months and may recur until a child's growth is completed.
Osgood Schlatter disease is most often diagnosed by the symptoms.
An x ray may be normal, or show an avulsion injury, or, more typically, show
that the apophysis is in fragments.
How Is Osgood-Schlatter Disease Treated?
Usually, the disease disappears without treatment. Applying ice to
the knee when pain first begins helps relieve inflammation and is sometimes
used along with stretching and strengthening exercises. The doctor may advise
the patient to limit participation in vigorous sports. Children who wish to
continue participating in moderate or less stressful sports may need to wear
knee pads for protection and apply ice to the knee after activity. If a great
deal of pain is felt during sports activities, participation may be limited
until any remaining discomfort is tolerable.
What Causes Iliotibial Band Syndrome?
This is an overuse inflammatory condition due to friction
(rubbing) of a band of a tendon over the outer bone (lateral condyle) of the
knee. Although iliotibial band syndrome may be caused by direct injury to the
knee, it is most often caused by the stress of long-term overuse, such as
sometimes occurs in sports training.
What Are the Symptoms of Iliotibial Band Syndrome and How Is It
A person with this syndrome feels an ache or burning sensation at
the side of the knee during activity. Pain may be localized at the side of the
knee or radiate up the side of the thigh. A person may also feel a snap when
the knee is bent and then straightened. Swelling is usually absent and knee
motion is normal. The diagnosis of this disorder is usually based on the
patient's symptoms, such as pain at the lateral condyle, and exclusion of other
conditions with similar symptoms.
How Is Iliotibial Band Syndrome Treated?
Usually, iliotibial band syndrome disappears if the person reduces
activity and performs stretching exercises followed by muscle-strengthening
exercises. In rare cases when the syndrome doesn't disappear, surgery may be
necessary to split the tendon so it is not stretched too tightly over the
What Is Osteochondritis Dissecans?
Osteochondritis dissecans results from a loss of the blood supply
to an area of bone underneath a joint surface and usually involves the knee.
The affected bone and its covering of cartilage gradually loosen and cause
pain. A person with this disruption of the joint may eventually develop
osteoarthritis. This disorder usually arises spontaneously in an active
adolescent or a young adult. It may be due to a slight blockage of a small
artery or to an unrecognized injury or tiny fracture that damages the overlying
The bone undergoes avascular necrosis (degeneration from lack of a
blood supply). 2 The involvement of several joints or the appearance of
osteochondritis dissecans in several family members may indicate that the
disorder is inherited.
What Are the Symptoms of Osteochondritis Dissecans? How Is It
If spontaneous healing doesn't occur, cartilage eventually
separates from the diseased bone and a fragment breaks loose into the knee
joint, causing locking of the joint, weakness, and sharp pain. An x ray, MRI,
or arthroscopy can determine the condition of the cartilage and be used to
diagnose osteochondritis dissecans.
How Is Osteochondritis Dissecans Treated?
If cartilage fragments have not broken loose, a surgeon may fix
them in place with pins or screws that are sunk into the cartilage to stimulate
a new blood supply. If fragments are loose, the surgeon may scrape down the
cavity to reach fresh bone and add a bone graft and fix the fragments in
position. Fragments that cannot be mended are removed, and the cavity is
drilled or scraped to stimulate new growth of cartilage. Research is currently
being done to assess the use of cartilage cell transplants and other tissues to
treat this disorder.
Plica (pronounced PLI-KAH) syndrome occurs when plicae (bands of
remnant synovial tissue) are irritated by overuse or injury. Synovial plicae
are remnants of tissue pouches found in the early stages of fetal development.
As the fetus develops, these pouches normally combine to form one large
synovial cavity. If this process is incomplete, plicae remain as four folds or
bands of synovial tissue within the knee. Injury, chronic overuse, or
inflammatory conditions are associated with development of this syndrome.
What Are the Symptoms of Plica Syndrome? How Is It
People with this syndrome are likely to experience pain and
swelling, a clicking sensation, and locking and weakness of the knee. Because
the symptoms are similar to symptoms of some other knee problems, plica
syndrome is often misdiagnosed. Diagnosis usually depends on the exclusion of
other conditions that cause similar symptoms.
How Is Plica Syndrome Treated?
The goal of treatment is to reduce inflammation of the synovium
and thickening of the plicae. The doctor usually prescribes medicine such as
ibuprofen to reduce inflammation. The patient is also advised to reduce
activity, apply ice and compression wraps (elastic bandage) to the knee, and do
strengthening exercises. If this treatment program fails to relieve symptoms
within 3 months, the doctor may recommend arthroscopic or open surgery to
remove the plicae. A cortisone injection into the region of the plica folds
helps about half of the patients treated. The doctor can also use arthroscopy
to confirm the diagnosis and treat the problem.
*Brand names included in this fact sheet
are provided as examples only, and their inclusion does not mean that these
products are endorsed by the National Institutes of Health or any other
Government agency. Also, if a particular brand name is not mentioned, this does
not mean or imply that the product is unsatisfactory.
The NIAMS gratefully acknowledges the assistance of Frank A
Pettrone, M.D., of Arlington/Vienna,Virginia; W. Norman Scott, M.D., of Beth
Israel Medical Center in New York, New York; and James Panagis, M.D., M.P.H.,
and John H. Klippel, M.D., of the National Institutes of Health, in the
preparation and review of this fact sheet.
The National Arthritis and Musculoskeletal and
Skin Diseases Information Clearinghouse (NAMSIC) is a public service sponsored
by the NIAMS that provides health information and information sources. The
NIAMS, a part of the National Institutes of Health (NIH), leads the Federal
medical research effort in arthritis and musculoskeletal and skin diseases. The
NIAMS sponsors research and research training throughout the United States as
well as on the NIH campus in Bethesda, MD, and disseminates health and research
JW 9/97 Office of Scientific and Health
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text:
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subset: commoncrawl


text:
In the days leading up to the biennial Paris Alumni Reunion, I received a delightful email from a long-time alumni family, highlighting memories and compliments of the international education their son Joel Fossourier received. Joel started at...Read More
We are incredibly proud to announce ISTP alumna Christine H.'s impressive success in the Chinese Bridge Language Competition.Read More
"I mostly remember moments with friends and teachers like Hayat, Joanne, Philippe, Helene. I remember the tiny writing in the cahiers and adding powdered soap to paint to make it more like oil paint with Chantal."
When asked about her time at...Read More
"So many memories to choose from during my 10 years there. It may seem odd coming from someone that ended up being an engineer, but I remember Chantal's art classes, especially in middle school when we started making bigger pieces that involved...Read More
"In the sixth grade, we had a technology class devoted to creating a foam car with blinking lights. I recall drawing the schematics, cutting out the shapes, and soldering the components on the circuit board. As a result of this class, alongside...Read More
"It was not until a few years after leaving ISTP* that I truly recognized the skills and character building that the school gave me. The trilingual education, the open-mindedness, and the respect of cultural diversity are all aspects of who I am,...Read More
"I believe having exposure to multiple cultures at a young age sets me apart from most people I meet. That exposure leads to better understanding and empathy for people who come from different backgrounds, and this is something especially...Read More
"Many of my formative years were spent at ISTP*, and some of my favorite memories include events such as La Kermesse and the school trips, particularly the one to Montréal and whitewater rafting in Oregon. I had a fondness for Halloween and loved...Read More


text:
A new NIGMS AREA (R15) program FOA for Undergraduate-focused Institutions (PAR-18-714)
Dear INBRE Principal Investigators,
FYI and please share with faculty and investigators at PUIs in your INBRE networks, a new NIGMS R15 AREA program FOA (PAR-18-714) that has been published today. The purpose of this Academic Research Enhancement Award (AREA) for Undergraduate-Focused Institutions is to support small scale research grants at institutions that do not receive substantial funding from the NIH, with an emphasis on providing biomedical research experiences primarily for undergraduate students, and enhancing the research environment at these applicant institutions. Eligible institutions must award baccalaureate science degrees, and have received less than 6 million dollars per year of NIH support (total costs) in 4 of the last 7 fiscal years. This AREA FOA emphasizes the engagement and inclusion of undergraduates in research.
See the details of this FOA at: https://grants.nih.gov/grants/guide/pa-files/PAR-18-714.html
Please note the following changes in NIGMS Support of Academic Research Enhancement Award (R15) Grants as published in the Notice (PAR-18-714):
- NIGMS will no longer accept New, Renewal, Resubmission or Revision applications for R15 grantsunder the NIH Parent R15 Funding Opportunity Announcement (FOA) (PA-18-504 and subsequent reissuances).
- All R15 applications for NIGMS support must be submitted to PAR-18-714 "Academic Research Enhancement Award for Undergraduate-Focused Institutions".
Please disseminate the information in your networks.
Best wishes,
Krishan K. Arora, Ph.D.
Program Director
Division of Research Capacity Building
National Institute of General Medical Sciences
National Institutes of Health
Department of Health and Human Services
45 Center Drive, Room 2AS.43R
Bethesda, MD 20892


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Life gets a whole lot better when we learn to turn down the volume of "they".
What will THEY think
What will THEY say
What will happen when THEY find out who I really am
Who is your "they"? Which actual human beings have opinions that matter to you?
Write down their names.
Not groups of people, like "church" "work" "family" "friends".
Actual names of actual people.
Now ask yourself how many of those people are tiptoeing through their life because of what YOU would think about THEM?
My guess is your list just pretty small.
Like, real small.
You are 100% free to disagree with me on this, and I can hear it. And I'm going to go ahead and tell you my list can fit on a 1"x1" post it. It's literally three people.
My "they" is three people.
It's not because I don't care about people. I care very much! So much that the weight of disappointing people was at times almost paralyzing. And I just knew I couldn't go on like that.
So I took a few years and some very deep breaths and figured out who is on my list. Who is my "they". You know what the most beautiful surprise was? Every single person on that list is someone who would love me no matter what. So they really aren't even a "they" after all!
Wherever you are, wherever you go, know you are so so loved. Tag someone who needs to hear this today💗
xo M
#expectations #contentment #betterlife #fear #singlemom #failure #success #decisions #vulnerability


text:
Get educated about child safety at the window. Visit Parents for Window Blind Safety at www.parentsforwindowblindsafety.org. Call 254-662-4021 for more information on this system.
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How to Use the CK Cordless Lift System
How to Install the CK Cordless Lift System
Completely Cord Free Top Down Bottom Up Shade - CK Lift System


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By Jenniffer B. Austria | Posted on Apr. 23, 2013 at 12:01am |
[ manilastandardtoday.com ]
Belle Corp. is expanding the site of its casino project at Entertainment City by acquiring another 10 hectares from state-owned Philippine Amusement and Gaming Corp. and other private landowners in the area.
Belle deputy head for casino operations Armin Santos said in an interview following the annual stockholders' meeting the company would allot a portion of its programmed casino investment for acquisition of additional land in Entertainment City.
Santos said Belle had expressed interest to acquire another 10-hectare lot from Pagcor. The government gaming agency, however, has yet to give its nod.
Santos said the company would spend roughly $700 million for phase 1 and 2 of Belle Grande Manila, which was scheduled to open sometime next year.
The company earlier committed to invest at least $1 billion for the integrated resort and casino complex based on its agreement with Pagcor.
Santos said the company might spend the remaining $300 million for land acquisition for possible expansion.
Belle Grande is located on a 6.2-hectare property with a gross floor area of 300,000 square meters. This will include 20,000 square meters of gaming space, six hotel towers with a total of 950 rooms and a number of high-end bars and restaurants.
Phase 2 will include high-end retail establishments and family entertainment center.
"We believe that Belle Grande will become a Metro Manila landmark upon its grand opening in 2014, which would further cement Belle's status as a leader in world-class luxury," Belle president Rogelio Cabunag said in a speech during the stockholders' meeting.
Belle chief finance officer Manuel Gana said the company was expected to earn $35 million in annual rental income to be paid by Melco group from the casino operations. This is on top of the 50-percent share in the gaming revenues from the casino project.
The company also expects 90 percent of its revenues to come from casino venture and the remaining 10 percent from property development.


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Japan is supporting four projects on mine clearance and assistance for the victims, according to Director General of Cambodian Mine Action Centre (CMAC) H.E. Heng Ratana.
Speaking to reporters after the recent visit of a Member of the House of Representatives and former Vice-Minister for Foreign Affairs of Japan H.E. Kazunori Tanaka to CMAC's Peace Museum in Siem Reap province, the CMAC director general said the four ongoing projects will come to an end next year and Cambodia has been asking Japan to continue its support.
The four projects covers three provinces � Battambang, Banteay Meanchey and Kampong Thom.
For the last 25 years, more than 1,000 square kilometres of land were cleared, involving over 2.7 million landmines and unexploded ordnance.
Source: Agency Kampuchea Press


text: Since almost all my files on the desktop computer and since I use the rating for playing purpose, it would be nice, if foobar mobil could read and use the ratings as a selecting feature. Sometimes I choose all the files with the rating "5" and then I use the random feature to hear them. It would be nice to do this also by foobar mobil.


text:
Request A Prayer
Submit Your Prayer Request
Fill out the form below with details about your prayer request.
Inaudible, how can we be in contact?
|Submitted By:
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text:
So Tuesday night I got back from the first-evah Savas-Beatie Author Conclave (and Heavy-weight Champeenship Bout of the Century!)
Well, not really that last part, but it felt kinda like that. More than a dozen authors were there, both during the day tours and in the evenings. Given that we met at Gettysburg, as you can imagine the focus was on that battle, and most of the wordsmiths present have written on Eastern Theater events.
Which is quite all right with me – long before I discovered the war in Northern Georgia I was a regular pilgrim to that small south-central Pennsylvania college town. I still enjoy the subject, though I admit that I am pretty dubious about many (if not most) of the books published on the subject.
But the conclave was run pretty much like our own Chickamauga Study Group, which occurs every March. Essentially the tours are short, what I would call modular, so that you can join or leave the group at any time, accommodating busy schedules or to deal with combat fatigue. There is no cost, but of course travel lodging and meals are on your own hook. Attendance was just about perfect, with about 30-35 folks on each tour, a fun but manageable size.
For me, the highlight was meeting my fellow writers, both those who I consider good friends (it was especially fun to see Eric Wittenberg and J D Petruzzi, whom I haven't seen in a long time) and those whom I didn't know personally or had met only in passing prior to this event.
It looks like the conclave was a success, and I am pretty sure Ted Savas intends to run it again next year (no idea where yet, so hold your questions, friends.) I shall be there.


text:
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These are a simple, minimalist daily planner insert. Choose times on the page, or untimed.
Printed on thick fountain-pen friendly 100gsm paper. This paper is smooth and silky and will withstand most inks without bleeding or shadow-through.
A double-page dot grid spread appears between months so you can use monthly dividers.
These inserts are A5 and fit our A5 ring planners here. Page size is A5 size - 148 x 210 mm.
Prefer unpunched or ARC punch for discbound planners? Please leave a note at checkout.
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text: Maui Scene January 18-24, 2018 January 18-24, 2018 The calamari fritta (at left, second photo), with Arrabiata and basil aioli; freshly baked focaccia and artichoke Longhi filled with lemon butter and Reggiano parmesan tempt. • The Maui News / CARLA TRACY photo Server Chelsea Elaban holds fresh cauliflower Sicilian sauteed in extra virgin olive oil with capers, crused red peppers and toasted garlic. • The Maui News / CARLA TRACY photo General Manager Michael Rose (left) and Owner Peter Longhi are proud of their repeat Best Award of Excellence wine list from the Wine Spectator magazine. They stand in Longhi's Wailea wine cellar, which holds 500 bottles ranging from $28 to $1,000. • The Maui News / CARLA TRACY photo Owner John Henry of Maui Coffee Attic in Wailuku counseled diners as he's also a prison chaplain. • The Maui News / CARLA TRACY photo Cocktails (second photo) will include the Missionary's Downfall, the Dandy and Planter's Punch along with modern counterparts. • Sheraton Maui photo Creative and playful menu items (first photo) range from curried lobster in papaya shell paired with lobster salad; meatballs and grape jelly paired with filet of beef tenderloin; and bananas Royale paired with green-banana and chocolate pastele. • Sheraton Maui photo photo courtesy Lorne Direnfeld Singer Lisa Fisher • MACC • Saturday; photo courtesy the artist. Soul Kitchen Maui • Casanova • Sunday; photo courtesy the artist. Gary Mauer add to this weekend's abundance of concerts at the MACC. Jim Brickman add to this weekend's abundance of concerts at the MACC. Lisa Fischer (above) and her trio Grand Baton perform at 7:30 p.m. Saturday in the Maui Arts & Cultural Center's Castle Theater in Kahului. The show will have a dance floor for orchestra ticketed patrons. Tickets are $35, $50 and $65 (plus applicable fees). For information and tickets, visit the box office, call 242-7469 or go to www.mauiarts.org. • Djeneba Aduayom photo January 18 – 24, 2018 "The Post" offers a dramatic true story and stars Tom Hanks (left) and Meryl Streep. • 20th Century Fox via AP Qurrat Ann Kadwani • Photo courtesy the artist Laura Hedli • Photo courtesy the artist Fringe Festival – "When Trump Gets to Heaven" • Historic Iao Theater • This Weekend; photo courtesy Amorah St. John. January 18-24, 2018 NEWSLETTER Today's breaking news and more in your inbox I'm interested in (please check all that apply) Daily Newsletter Breaking News Cover Maui Scene Maui Scene Maui Scene Maui Scene Maui Scene Maui Scene


text:
Build your skills and explore digital and tech applications while having fun! Each week a different focus to learn and create using technology. To register for a week, call 810-249-2569 (Age 12+)
Tear apart old technology and gadgets, see what's inside and build something new with the parts.
Learn the basics to designing a platform game level using caves, creatures, coins and more.
Explore video editing and create special effects using "green screen" technology.
Bangtown Productions's Studio on the Go will be here to teach the basics of writing, recording and producing music.
Ages 12 – 17 Writers, aged 11-17, join us for two weeks of writing activities! Learn about literature, publishing, critiquing and share your work with teen peers! Facilitator is Connor Coyne.
Register: 810-249-2569.
Ages 12 – 17 – Teens can brush up on their babysitting skills and earn a Red Cross CPR & First Aid Certificate. Participants must attend both days to earn their certificate.
|July 13, 3:00pm
|Sponge and Splatter Space Painting
|Painters will create their own galaxy!
|July 20, 3:00pm
|Rocket Launch Lab
|Rocket launching workshop. Make and launch three DIY rockets and compete for prizes.
|July 27, 3:00pm
|Stop-Motion Animation Workshop
|Teens will build their very own, custom, stop-motion puppet and bring it to life using the magic of stop-motion animation. Includes free DVD of your project.
|August 3, 3:00pm
|Aluminum Embossing
|Learn embossing techniques to create aluminum relief sculptures.
|August 10, 3:00pm
|Claymation Animation Workshop
|Make your own claymation character and receive a DVD of your claymation project.


text:
Dresses are among one of the most vital requirements of people. Without appropriate apparels, it is not feasible to walk out when traveling and also join celebrations. In addition to the outfits, a bunch of significance is placed on the footwear that you put on as they make the entire look total. If you intend to transform heads to toes then it is completely essential that you find out the areas that will certainly supply you with the footwear that will certainly match your attire appropriately.
If you're finding for really easy tips on inexpensive shoe places, you have actually stay on the best website. In this website, you will certainly obtain the address of such on the internet shops that will certainly satisfy the needs of impressive shoes. Take a look at the attributes of all these on-line footwear sites as well as choose which shop will certainly match your demands well, prior to deciding the perfect offer. Do not forget to find exceptionally great tips on inexpensive designer shoes online today!


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Nebraska football held its fifth practice of spring ball Tuesday morning in the Hawks Championship Center in full pads. The first 30 minutes was open for the media to shoot.
Take a look at some of the sights and sounds from that period:
The Frost Era has begun, and the #Huskers are ready. pic.twitter.com/kDCQxryKSm
— Omaha Sports Insider (@OSIsports) April 3, 2018
Scott Frost and a few select players spoke following practice. Frost said that today was the best day of practice so far, and that he could tell that some players are starting to get a hang of things.
Of all the quotes I've heard so far from Scott Frost this spring, this might make #Huskers fans the most happy: pic.twitter.com/pSEf78oGCF
— Adam Krueger (@AdamKruegerTV) April 3, 2018
"Today was far and away our best day as a team," Frost said. "I saw great enthusiasm. We had a competition day, so we kept track of every rep, offense and defense. [It] came right down to the end. I'm seeing some guys start to get it, guys start to understand our schemes on both sides and what we're looking for from a pace standpoint and an effort standpoint. We talk all the time about setting a new standard daily and then trying to beat that standard. We definitely had our best practice today so it's going to be a challenge Saturday to come out and do better than that."
Frost said that he can see improvement from everybody on the practice field.
"It's a lot of things," Frost said. "We're stronger, we're in better shape. After five practices, they understand schemes on both sides better. They're starting to understand some of the detail that makes it work and I'm seeing a lot of improvement on both sides of the ball."
Hear some more from Frost and the players here:
And here's the longer version when Frost was asked how he teaches tackling #Huskers pic.twitter.com/xRQg9oTjHB
— Adam Krueger (@AdamKruegerTV) April 3, 2018
Here's the quick byte many are talking about when Frost was asked if #Huskers would use a tackling consultant: pic.twitter.com/0NbcNPmK4L
— Adam Krueger (@AdamKruegerTV) April 3, 2018
"Nebraska is definitely a special place. I just feel like I connect with the players here, more of a family atmosphere, of course because of the coaches and the players. It just feels like home." - Junior transfer Mike Williams #Huskers pic.twitter.com/r1nQe9axta
— Omaha Sports Insider (@OSIsports) April 3, 2018
🏈🌽"I'm a Cornhusker now so that's all that matters" - Sophomore Deontai Williams pic.twitter.com/E0XAxbGZAP
— Omaha Sports Insider (@OSIsports) April 3, 2018


text:
The Chinese manufacturer Xiaomi, within its home appliance catalog, has designed what is without a doubt the smartest vacuum cleaner robot of the moment thanks to its multiple and the addition of innovative Xiaomi Mi Robot Vacuum exclusive technologies by which stands out above other models of similar performance.
That said, in this review of the Xiaomi Mi Robot Vacuum will delve into those qualities that make it unique such as its price, and is that for a few days will have a 41% discount that cuts it to $298.99 with coupon: "XIAOMIVAC" in the store Gearbest which as always brings you the best discounts on the market.[coupon title="Original Xiaomi Mi Robot Vacuum" url="https://goo.gl/LjKK64″ code="XIAOMIVAC" reveal="true" image="http://www.awaqa.com/wp-content/uploads/2017/08/11_1-1-3.jpg" theme="base red" description="Price: $279.99
Laser Distance Sensor, 12 different sensors, Battery Capacity: 5200mAh, 2.5 hours of cleaning"]
Xiaomi Mi Robot Vacuum: Dimensions and Design
The Xiaomi Mi Robot, as it could not be otherwise, combines a design of the most modern with a minimalist appearance being this already habitual in the devices created by this manufacturer that has chosen to differentiate itself from its competitors from the beginning taking into account the High-quality ABS materials used for their manufacture.
It's metric dimensions are within the current standards as it has 34.5 centimeters in diameter and a height of 80 millimeters which will allow you to move comfortably under furniture that is usually found in a home such as libraries, sofas, and beds as well as other places difficult to access while its weight slightly surpasses the average since it is located in the 3.8 kg.
Xiaomi Mi Robot Vacuum: Absorption Capacity
Within its most outstanding functionalities we must mention its powerful suction motor 1800pa with which it will be able to leave your home flawless with its HEPA filter, the main cleaning brush that has a high absorption capacity and the brush Secondary rotation for greater efficiency in the aspiration of particles such as pieces of paper, lint, cigarette butts, among others.
Xiaomi Mi Robot Vacuum: Surface and Cleaning Modes
We continue in the review of the Xiaomi Mi Robot this time to expand its possibilities of cleaning since this robot can work on surfaces such as cement, wood, ceramic, marble and even carpets with the extraordinary capacity of tracking where it is that allows Its new LDS (Laser Distance Sensor) sensor with which you can map your home with a 360º wide coverage to leave nothing out and with a margin of error of only ≤2% and an extension of up to 6 meters from its original location.
As for its cleaning modes, the robot works with the already known "edge" mode with which it will perform its work only by the corners with a thin separation of the wall of only 10mm and, on the other hand, the intelligent " Zigzag" that will cover all the spaces of the home in an efficient way avoiding possible obstacles in its way thanks to the SLAM (Simultaneous Localization and Mapping Algorithm) algorithm of integrated high precision.
Xiaomi Mi Robot Vacuum: Smart Sensors and extras
The Xiaomi Mi Robot boasts of incorporating multiple sensors for better performance among which stand out the anti-collision sensors and anti-fall sensors to divert their way and thus avoid accidental shocks as well as unwanted falls from great heights. In addition, it has the ARM Cortex A7 4-core processor that will provide you with intelligence never seen in a robot vacuum to date.
While its lithium ion batteries of high durability (up to 2 years) will reach a range of 5200mAh which translates into 2.5 hours of continuous work, without neglecting its automatic recharging function thanks to which the robot will direct you to the recharge base when the battery levels are below 20% and then continue with your functions without being programmed again.
Another aspect to emphasize is the possibility of the robot to connect to the smartphone through Wi-Fi connection through the mobile application Mi Home of Xiaomi with which it will be possible to control at a distance and to know firsthand the state of the cleaning in real time although it is currently only available in English and Chinese.
Xiaomi Mi Robot Vacuum: Conclusion and Reviews
Well, in this review of Xiaomi Mi Robot we have met the new proposal of Xiaomi that intends to displace other well-positioned manufacturers thanks to its exclusive technologies that place it on a pedestal which will be difficult to download.
Xiaomi Mi Robot Vacuum: Low Price and Where to buy cheaper?
As always GearBest makes good offers, and now you can buy a new smart robot cleaner just for $298.99 with coupon: "XIAOMIVAC" at the link to below.[coupon title="Original Xiaomi Mi Robot Vacuum" url="https://goo.gl/LjKK64″ code="XIAOMIVAC" reveal="true" image="http://www.awaqa.com/wp-content/uploads/2017/08/11_1-1-3.jpg" theme="base red" description="Price: $279.99
Laser Distance Sensor, 12 different sensors, Battery Capacity: 5200mAh, 2.5 hours of cleaning"] [sociallocker][/sociallocker]


text:
Christmas time usually conjures up joyful images of family and friends celebrating, exchanging gifts, excited chatter and delicious food. For some people however it can be a dreaded, sad and lonely time.
Marmalade Trust understands how difficult Christmas can be for someone who is struggling with loneliness. We don't want anyone to spend Christmas Day alone if they don't want to so we invite them to join us for a free festive lunch. A typical guest is someone who is vulnerable to loneliness, for example a person of an older age who may have few or no family or friends around.
Everyone who joins us is made to feel part of our Marmalade family and is supported by our network of friendly volunteers. We currently hold our lunches in pubs or restaurants throughout Bristol, South Gloucestershire and the North Somerset region.
"Being able to get out of the house and celebrate Christmas with others was wonderful. The meal was lovely and the volunteers were great and made sure everything went well by contacting me before the day. Loved the hamper and Christmas card drawn by children." Margaret, Bristol
Pop your details in the form below and we'll keep you posted with news, events and volunteering opportunities.


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CLASS – Beginner Cookie & Cupcake (Buttercream) Mar 10
Beginner Cookie & Cupcake (Buttercream)
Tuesday, March 10, 2020
6:30 – 9:00pm
$ 35 (ALL supplies included) – Limit 8 students
Description: In this class, you will decorate cookies and cupcakes using buttercream icing to create brush embroidery, drop flowers and succulents.
What You Leave With: 3 decorated cookies and 3 decorated cupcakes.
Supplies Needed: No supplies needed.
Instructor: Pam Conway
3 in stock
SKU: CL-COOKCC Category: Classes Tags: cake decorating class, cupcake class


text: Heather Gaylord is a social advocate and change maker who believes in making a difference hands on. She obtained a Bachelors in Social Work from Alabama State University in 2007. She is an advocate to end the Domestic Sex Trafficking of Women and Girls. Heather became a member of the Georgia Cares Speakers Bureau in 2016, and is a certified trainer and speaker on Domestic Sex Trafficking of adults and minors. She is a current Graduate Student at Georgia State University's Andrew Young School of Policy Studies, and an Emerging Leader of DeKalb County Class of 2018.


text: If you are not done yet with your thinning sprays and feel that another application is needed, tomorrow, Tuesday-May 7, is another good chance for thinning. Fruit sizes for Gala, Pink Lady and Honeycrisp in Winchester are 12, 12.5 and 10.5 mm which are still within the recommended range for thinning with 6-BA/carbaryl or NAA/carbaryl mixes. Temperatures will drop to 65F this Wednesday making thinning with 6-BA and NAA a bit challenging. The addition of 1 pt/100 gal of oil (e.g. 70-sec superior, JMS Stylet oil) can help increase the response to thinning sprays. However, the addition of oil may cause russeting on some cultivars. Also, Captan should be avoided within 7 days of oil applications, as it may lead to sever russeting. As per the carbohydrate thinning model, the rates of chemical thinners should be increased by 15% for Wednesday applications to compensate for the potential increment in the tree carbohydrate level.


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Join us for the spring edition of Codecamp in Iasi in 2020, on 4 April, at Hotel International.More details about the event agenda and the speakers soon, on our website.
Codecamp is your local IT community & conference, aiming for better communication among the IT people. Started in 2008 & trying to fulfil the continuous demand from the community we're now doing conferences with several parallel tracks and 1500+ participants. Interested in Java, .NET, Mobile, Agile, PHP, Ruby, Project Management, Business Analysis and many others? Join Codecamp and meet smart people sharing from their own real life experiences.
Claim the event and start manage its content.
Request ownership to be able to manage it and see the statistics.
5A Strada Palat, 700032 Iași, Romania
based on 0 reviews


text:
Trenker Magnesis 90 Capsules
Notes et avis clients
Description:Reduction of the fatigue - stress - muscle Function, immune and nervous
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Pharmacy: +32(0)2 520 66 55
From Monday to Friday (9h-18h) Saturday (9h-12h)
162,64 €
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84,96 €
Notes et avis clients
Description:Reduction of the fatigue - stress - muscle Function, immune and nervous
Magnesium is a mineral essential for the proper functioning of the body. He is involved in many vital functions such as the proper functioning of muscles and nerves.
We can produce the magnesium that we need, that is why food intake is essential. Certain situations such as pregnancy, sporting activity, or situations of stress can lead to increased needs for magnesium.
Magnesis TRENKER contains a liposome doxyde of magnesium for protection of the magnesium during the passage of lestomac and the digestion of its gastric juices. This particular structure prevents any reaction with the intestinal wall and allows for direct absorption into the blood stream.
In addition, Magnesis TRENKER combines the effectiveness of magnesium liposomial all of the B vitamins in a natural form. They are going to act in synergy for a more complete that can help :
The more Trenker
Magnesis TRENKER contains a magnesium liposomal of last generation, combining a good concentration of magnesium bioavailability is outstanding and an excellent tolerance.
1 to 2 capsules per day, to be taken with a glass of water.
Do not exceed the recommended daily intake.
Do not replace a varied and balanced diet and a healthy lifestyle.
Magnesis Trenker should not be taken without consulting a doctor, for people with kidney disease.
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Located in the heart of Brussels, close to the South Station, Selfpharma offers you all the expertise of its pharmacists! The website is approved by the Federal Agency for Medicines and Health Products.
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+32 (0)2 520 66 55
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Saturday (09:00-12:30)
Pharmacy SELFPHARMA SPRL. 2, Place Bara 1070 Brussels, Belgium
Pharmacist titular: A. BARAKA
The pharmacy is open from Monday to Friday (8.30am to 6.30pm)
and Saturday (9.00am to 12.30pm)
Guard duty: www.pharmacie.be or 090010500 (0.5€/min)
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