text:
This five-day instructor-led course provides students with the knowledge and skills to maintain a Microsoft SQL Server 2008 R2 database. The course focuses on teaching individuals how to use SQL Server 2008 product features and tools related to maintaining a database
Skills Gained
After completing this course, students will be able to:
- Explain SQL Server 2008 R2architecture, resources requirements and perform pre-checks of I/O subsystems
- Plan, install and configure SQL Server 2008 R2
- Backup and restore databases
- Import and export wizards and explain how they relate to SSIS
- Use BCP and BULK INSERT to import data
- Manage security
- Assign, configure fixed database roles and create and assign user defined database roles
- Configure and assign permissions
- Implement SQL Server 2008 R2Audits
- Manage SQL Server 2008 R2 Agent and Jobs
- Configure database mails, alerts and notifications
- Maintain databases
- Configure SQL Profiler Traces and Use the Database Tuning Advisor
- Monitor data by using Dynamic Management Views
- Execute multi-server queries and configure a central management server
- Deploy a data-tier-application
- Troubleshoot common issues
Who Can Benefit
The primary audience for this course is individuals who administer and maintain SQL Server databases. This course can also be helpful for individuals who develop applications that deliver content from SQL Server databases.
- Basic knowledge of the Microsoft Windows operating system and its core functionality.
- Working knowledge of Transact-SQL.
- Working knowledge of relational databases.
- Some experience with database design.
- Completed Course 2778: Writing Queries Using Microsoft SQL Server 2008 Transact-SQL


text:
An evaluation of a potential deployment of the Integrated Incident Management System (IIMS) in western New York
Hempel, Carl S.
MetadataShow full item record
Incident Management (IM) is an area of transportation management that can significantly decrease the congestion and increase the efficiency of transportation networks in non-ideal conditions. In this study, the existing state of the Integrated Incident Management System (IIMS) is reviewed, additional user requirements and applications are identified, potential obstacles to successful deployment are discussed, and identification of future steps towards deployment in western New York are determined. This is done through working with incident management organizations, reviewing other existing systems, and researching the potential of IIMS through use of the system. The main conclusions found are that 1) the system has potential to greatly enhance coordination between agencies and that greater integration with existing systems will speed adoption, that 2) the primary obstacles to deployment are the difficulties with sharing sensitive information and the integration of existing similar transportation management systems used by the several agencies, along with a lack of deployed hardware for mobile clients, that 3) some of the future potential applications and benefits for IIMS include: expanded incident coverage, access to archived incident data for research and training, and integration with existing software reducing retraining requirements, and that 4) Clarence New York would be a potential deployment community to pilot IIMS using NITTEC for hosting the server. A Commitment of Cooperation (example included) between the agencies was developed to encourage integration of IIMS into their programs.

subset: commoncrawl


text:
Weekly Calendar Book
Searching around for Weekly Calendar Book? Then you're in the right place! A calendar that is perfectly structured is for sure among the leading valuable yet convenient tool that can help us organize our active life. Here you can find the choicest calendar that serves your needs specially for the moment. Most of these calendars are free to download and print, with the understanding that it is for personal use only. We have collected the most popular calendar templates that we think will be most beneficial to you.


text:
Paragon ntfs windows 98
Paragon ntfs windows 98 It can create, format, remove or move partitions. 6 of Paragon Hard Disk Manager 64-bit. Paragon NTFS for Win98 1. Windows 98. EaseUS Partition Master is reliable partition manager that help you to resize and manage disk space. Partitioning hard disk (primary and extended partitions) Partitioning a hard disk is the first thing to do before installing Windows. Order to install : 1) OS/2 boot manager. Another aspect is the thorny problem of …Partition Logic. Download32 is source for read write access to windows ntfs partition shareware, freeware download - Paragon NTFS for Mac OS X , HFS+ for Windows 8/8. Este programa permite la lectura y escritura nativa de datos a cualquier partición NTFS de Windows. . Partitioning a hard disk means dividing the hard disk in multiple partitions, which will occur as C, D, E, etc in your Windows Explorer. It appears to be designed for beginners. I have a 500GB External Hard Drive, it isn't formatted and because I have a Windows Vista PC, Windows 98 PC and Apple iMac, the best possible format method is FAT32. 0 ( View screenshot ) Windows 98, Windows ME, Windows NT, Windows 2000, Windows XP, Windows 2003, Unix: Homepage: enlarge NTFS partition without rebooting Windows and interrupting its work. Most hard disks only have one partition, the C …Apr 11, 2005 · Windows XP has the ability to convert a FAT 32 partition to NTFS, but not the other way around. In the beginning, NT 4 boots partly from the NTLDR files it will stick in the DOS partition, and partly from its system partition. free to initialize disk on windows xp 7 8 10 - how can you initialize hard disk drive on Windows …You can find all you needed solutions to manage hard drive space in Windows. After formatting, was able to install the Rescue Kit 14. Mar 30, 2012 · The Windows 98 PC sees the NAS drive perfectly. Partition Logic is a free hard disk manager. vxd . Unfortunately won't format a hard drive of 500GB in anything other the NTFS. It only supports IDE hard disk and some SATA disks. You can use NTFS Reader for DOS to access NTFS drives in Windows 98 95 and 3. The only way to do this would be to reformat your hard drive and reinstall the complete system. 11 break down the problems between MAC OS and Windows user. 53 GB). 2) DOS 3) …Paragon Partition Manager 7. Samsung ml-1610 driver for mac download. Aug 12, 2009 · Paragon Hard Disk Manager works on Windows 98/ME, NT, 2000, XP, and Vista. exe file to a bootable floppy disk and boot from it. Optionally also OS/2. Recovery Media Builder creates CDs/DVDs(or even a floppy disk) that you can boot from and recover your system. 0. Anti Virus for Windows 98. The solution involves altering the registry entries for esdi_506. 32-bit and 64-bit is supported for all Windows except Vista: Vista support is limited to 32-bit only as far as I know but Vista x64 users should double check on that. Paragon Software's free NTFS Driver for Windows 98 lets the Dell access the NAS NTFS-format files over the network without a hitch. 1. Read and Copy files on a NTFS Bootable Partition Manager Free Software ISO Files for Partition Resizing. 18. In realtà anche il più recente Windows XP può salvare i dati in una co-siddetta FAT (File Allocation Table, ovvero tabella di as-segnazione dei fi le) 04 NTFS È l'abbreviazione di NT File System. Sometimes publishers take a little while to make this information available, so please check back in a few days to see if it has been updated. Windows 98 will put some files on the DOS partition, and some on its install partition. Proporciona un acceso total de lectura y escritura a las particiones de Windows NTFS con Mac OS X. Paragon NTFS soluciona de forma efectiva los problemas de comunicación entre el sistema de archivos de Mac y NTFS. In order to use the software you need to copy the readntfs. It can only manage fat32 partitions because it has been developing. This article guides you to create bootable partition software ISO files to USB, CD or DVD to manage hard disk space for free. Another aspect is the thorny problem of …We don't have any change log information yet for version 16. pdr in conjunction with Paragon's pntfs. Selected the flashdrive as 1st boot device …NTFS Reader for DOS allows you to preview the files on NTFS and copy them from NTFS to FAT volumes or network drives. The maximum volume size that Windows 98 can create is 127. Aug 18, 2014 · Formatting the flashdrive in NTFS did the trick. You can also organise and optimise your hard disk with the Create, Resize, Format and Delete partition dialogues. im trying to install windows 98 Second edition. A useful piece of software for Windows 98 computers that enables users to mount NTFS partitions as• The Samsung ML-1610 supported Windows 98. OR you can use a partition utility to re-partition the hard drive (to make the system THINK there is …Paragon Partition Manager Free Edition (Figure D) is a lightweight tool for creating and managing partitions. A useful piece of software for Windows 98 computers that enables users to mount NTFS partitions asRead Write Access To Windows Ntfs Partition. Paragon NTFS for Mac Crack With All Keys Listed Here Paragon NTFS for Mac Crack 15. A useful piece of software for Windows 98 computers that enables users to mount NTFS partitions asNov 28, 2011 · Asked in Windows XP, Windows Vista, Windows 7 What NTFS permission allows you to take ownership of a folder on an NTFS volume ? Full …Mar 31, 2005 · Comparing FAT16, FAT32, and NTFS Maximum volume size 32 GB (This is due to the Windows 2000 format utility. 1 Free Edition , Paragon NTFS for Linux , NTFS for Linux , Paragon NTFS …Operating on Windows, Paragon Partition Manager will assist the user in a "smart and reliable" way, easily distributing additional memory be zooming in and out of partitions. Questo fi le system era stato sviluppato per Win-dows NT e da allora viene usato dai nuovi sistemi ope-rativi come Windows XP e Vista. Does Paragon Driver For Mac Work With Pcs Free. Paragon Partition Manager 7. Dec 17, 2005 · Solved: Invalid system disk Windows 98 problem. 4. Feb 22, 2007 · Mindows 98 (98 shell) - posted in Winimize: I just this morning found the solution to a problem that has been vexing me : NTFS volume recognition under the Windows 98 shell. Now I can kick back and pump out an installer for a Mindows which uses the Windows98 shell. Discussion in 'Earlier Versions of Windows the only thing i havent done yet is made a boot up disk from another windows 98 computer because i dont have access to one and i dont know which one to make Paragon ntfs windows 98


text: A PROVISIONAL trial date has been set for the 19-year-old accused of causing the death of a time-trial cyclist by dangerous driving on the A1 in early May. Major Gareth Rhys-Evans, 37, died after his machine was in collision with a car allegedly driven by Katie Hart, of Lakefield Avenue, Little Paxton. At Huntingdon Crown Court on Thursday, Judge Patrick Moloney remanded Ms Hart on unconditional bail until October 23, when her plea will be taken. The judge set a provisional trial date for January 25 next year.


text:
Storm turns road to North Bay beach into mother of all potholes
Friday was a day for taking stock of the damage after storms lashed the Bay Area with rain for days on end this week, and in the case of one North Bay road, that damage was eye-popping.
A photo shared by the Point Reyes National Parks Service shows the road to McClures Beach north of Inverness collapsed into a giant sinkhole wider than the roadway itself, forming the ultimate pothole.
MORE RAIN: Three more storms in the forecast for the Bay Area
"Storm damage update: the road to McClures Beach is closed due to severe damage. The parking lot for Tomales Point Trail is open," the office wrote on Twitter.
One parks fan replied that it was unfortunate that the mega-hole now separated the functional road from the bathrooms in the parking lot, but that at least it was a short hike down to the beach.
The North Bay received more than a half foot of rain in some areas as the atmospheric river stalled overhead midweek, and the blast of moisture wreaked havoc on roadways.
ALSO: Water level at California's largest reservoir shot up 39 feet in February
Flood warnings were issued, and the rising waters of the Russian River caused widespread damage in Guerneville.
Another series of storms is headed for the Bay Area, but forecasters expect them to spare the North Bay this time around. The first system will blow in Friday night and deliver moderate rain before tapering off Saturday morning.
A second system Sunday will bring showers concentrated south of the Golden Gate, with the North Bay getting less than an inch of precipitation.
Finally, another atmospheric river is in the forecast for Tuesday and Wednesday, but it's expected to mainly hit the Big Sur region and SoCal, sending about an inch of rain to the Bay Area.
SFGATE staff writer Amy Graff contributed to this report
Filipa Ioannou is an SFGATE staff writer. Email her at firstname.lastname@example.com and follow her on Twitter


text:
World Environment Day 2018 and global plastic pollution initiatives
June 5, 2018
June 5 marks World Environment Day – the "UN's most important day for encouraging worldwide awareness and action for the protection of our environment."
Since the 1970s, the world has come together to focus efforts on local, national and global scales to start a conversation and take care of the earth. This year's theme, "Beat Plastic Pollution", calls for us to focus on reducing our reliance on plastics in everyday life.
On May 28, the European Commission released a proposal for a directive to reduce marine plastic litter by decreasing the amount of plastic items that end up as marine waste. The proposal targets single-use plastic products and places bans on items like plastic straws, cutlery, drink stirrers, cotton buds and balloon sticks. Overall, the Commission states that the directive would cover 70 percent of litter found on European beaches.
The Commission clarifies that these products will not disappear, but that they will be made with more sustainable materials. Also included in the proposal are required extended producer responsibility schemes and awareness-raising efforts for single-use plastic items not restricted under the new measure – such as balloons, food and beverage containers, wet wipes and lightweight plastic carrier bags. There would be new standardized labeling requirements for certain products, including directions on how to dispose of waste (as well as disposal means to avoid, such as flushing wet wipes) and negative environmental impacts associated with products.
This is in line with the World Environment Day 2018 theme Beat Plastic Pollution, which emphasizes that "If you can't reuse it, refuse it." Single-use plastics are not designed for reuse, and they are not cost effective to recycle. They also often end up in our oceans, which has been prompting countries all over the world to propose bans on plastic products associated with microplastic pollution.
For example, the Peruvian Congress just introduced a bill on May 24. PL 2921/2017-CR would prohibit the distribution of disposable plastic items like lightweight plastic bags, food containers, plate and cutlery. A similar bill was introduced in Brazil on May 28, the same day as the European Commission's proposal release. PLS 263/2018 would prohibit certain products that often endanger marine wildlife, including personal care products that contain microbeads and non-biodegradable food service ware.
This year's World Environment Day host country is India, and today India will be carrying out plastic cleaning drives of its public spaces and ecosystems, including beaches, national parks and riverbanks.
India's role in global sustainability has developed rapidly, especially in the wake of China's National Sword policy. The Environmental Department of Maharashtra, for instance, enacted a prohibition of single-use, disposable plastic and polystyrene products on March 23. The notification made Maharashtra the 18th Indian state to ban the use of certain plastic items and establish the responsibilities of producers and the governing body.
Industry leaders also expect that more scrap materials will travel to India in the wake of Vietnam's recently announced import bans at its Tan Cang-Cai Mep Terminal from June 25 to October 15.
Everyone can play a part in World Environment Day this year, as UN Environment has partnered with Litterati, a data science company. Together they created the Litterati app, which allows users to "identify, map and show the collected litter" with photographs taken with a smartphone. The app tracks areas where litter most commonly appears, and also calculates the most common brands and plastic products found. Litterati is available to download on Android and iOS devices and encourages users to "snap, tag, & dispose."
For more information about World Environment Day, visit http://worldenvironmentday.global/en.


text:
Strikingly, the chemokine interferon-γ-inducible protein-10 (IP-10; CXCL10) was significantly reduced under enfuvirtide-based therapy (Fig. 5). The IP-10 level was inversely correlated with CD4 cell counts, and the drop
in IP-10 level was correlated with the drop in VL (r=0.51; P=0.005) (Fig. 6). Regarding the impact of enfuvirtide-based therapy on circulating cytokines, Figure 5 shows those detected by the 24 multiplex. IL-12 was the only cytokine whose level of expression was affected by enfuvirtide-based therapy, Caspase inhibitor progressively decreasing from week 4 to week 48 (Fig. 5). Furthermore, strong positive correlations were found between the level of circulating IL-12 and (i) plasma VL, (ii) the drop in plasma VL and (iii) the increase in CD4 cell count, and a negative correlation was found with CD4 cell count (Fig. 6). A sustained CD4 T-cell response despite persistent
viraemia in patients receiving enfuvirtide has been demonstrated [23,24]. To assess whether this could translate into an immunological benefit, we performed a comprehensive study of immune restoration in enfuvirtide-treated patients. We report that salvage therapy in patients with low baseline CD4 cell counts and multiple treatment failures produced a significant immunological benefit characterized by rapid changes in CD4 T-cell subsets, particularly naïve and central memory T cells, which progressively increased during the 48 weeks of therapy. Parameters of immune activation, including CD38 and
HLA-DR expression, progressively decreased, in parallel to a slight decline in the fraction of dividing cells in CD8 subsets, while a see more transient increase in the percentage of dividing naïve and central memory CD4 T-cells occurred. Important changes in the level of proinflammatory mediators occurred Fenbendazole concomitantly, characterized by a significant suppression of IL-12 expression, and decreased levels of the circulating chemokines MIP-1α, MIP-1β, MIG and IP-10. The decline in circulating IL-12 and IP-10 was strongly correlated with the reduction in VL. Chronic systemic immune activation is one of the strongest predictors of disease progression [11,25–27], and it is a critical factor that distinguishes pathogenic from nonpathogenic simian immunodeficiency virus (SIV) infection [28]. Its manifestations include increased T-cell turnover [29], increased frequencies of T cells expressing HLA-DR and CD38 [27], and increased circulating proinflammatory cytokines and chemokines [30]. Immune activation results in attrition of the memory CD4 T-cell pools (increased AICD and direct destruction by HIV) and in the loss of naïve T cells as a result of their differentiation into memory cells [31]. Moreover, it was recently reported that early changes in T-cell activation, as determined by measuring CD38 or CD95 expression, predict viral suppression in salvage therapy [32].


text:
|Refreshing (by singh-tulica)
|So nice to see first, a contemporary romantic comedy and second one about female friendship. Great characters and so much fun! It looks at millennials finding their way but without judgement and a sincere love for the people involved. Watch this when you want to feel good, and have a lot of laughs.
|Bridesmaids for College Girls!! (by dylancb)
|A fast and fun story about how funny real girls can be!!! College, parties, and fun. Small hilarious jokes throughout that keeps you rolling. A 'romcom' that finally gets updated for this generation!
|Wait for it! (by ritab-52975)
|Takes a little bit to get going.. but once it does, it's great! Funny & sweet!
|Really liked this (by bengalangel85)
|Such a fun girls film : Enjoy it with a glass of wine n pizza 🍕
|Realistic (by okinyetunde)
|As a young lady myself I find the movie quite interesting and realistic. It is practically what happens amongst us; the gossips, the fun, the crushing, the secret lies...I think it is a wonderful movie to pass time with.
|Funny! (by thecollegecinephiles)
|Definitely a sleeper gem! Hilarious moments throughout and refreshing to see such a female-driven film :
|Appeal More to Female Folks (by egbeyinkasegun)
|I saw the movie with my girlfriend, although she found it funny and refreshing, I think it was just an average movie, just like many others made each year. I am guessing the female folks will relate better with it than your everyday guy.
|Pretty good watch (by JulianABlackshear)
|I like the tech and effects, soundtrack really sounds good at all times feels epic, tempting and the script is awesome.
|Chick Flick (by natashaw-52536)
|A very girly film where two best friends reach the "boyfriend stage" which tests their friendship. I found myself struggling to breathe properly from laughing so much.


text:
Disobedience in a democracy has suddenly become central to our public discourse because of the protests inspired by Shaheen Bagh. Clearly the government has no idea about the concept but there is some reason to believe that people opposed to the government's position might also be mistaken about its dimensions. Several state assemblies have passed resolutions opposing the CAA-NRC-NPR and Chief Ministers have made statements about being determined not to implement NRC-NPR. Yet, direct questions about the impact of these state resolutions on parliamentary legislation, answered honestly, caused great discomfiture. Wisdom has it that you ask a stupid question, you get a stupid answer. Instead, the self-opinionated experts should have focussed on the concept of democratic disobedience to buttress moral resistance to an unjust law. There may be a difference between the disobedience by a citizen and that of a constitutional authority like a state assembly. Understandably, there are greater constraints on the latter. Yet, it is arguable that federalism has its own scope for disobedience beyond the technical textual dimensions. As the notion of constitutional morality is seen in current jurisprudence as an over-arching presence, federalism too must be seen as a touch stone for the constitutional arrangement.
Disobedience of law in a democracy depends a great deal on the quality of democracy we have. A law passed by the duly-elected parliament must ordinarily be obeyed, particularly by those who hold office by virtue of law and constitution. Then, of course, there is the Supreme Court that has the last word on the validity of the law. Symbolic disobedience may be justified at any stage to make a point to parliament and courts. But protesting a law that has the approval of court is a little more difficult to justify. Of course, there is the fact that the Supreme Court is neither infallible nor claims to be so. It has been known to change its view of the law, sometimes within a short time. But so long as a judgment holds, it has to be respected if nothing else than to preserve the standing of the court.
There are other issues to keep in mind as well. Gandhian satyagraha or civil disobedience is essentially a moral assertion and relies on example to make a point. A civil disobedient goes into the movement prepared to suffer sanction for breaking the law. Therefore, they make a point by suffering and not seeking forgiveness or mitigation of punishment. But it is, of course, another matter that their defiance of law causes unintended discomfort or inconvenience to others, both sympathizers as well as neutral persons. Those affected cannot be too demanding and place their rights entirely above those of the protesters.
The road that civil disobedience takes is not an easy or short one. One has to be ready for a long-distance journey; any expectation of rapid response and relief might well be lethal to the endeavour, particularly if one is up against an insensitive and conceited establishment. Hope is an important ingredient of civil disobedience, so is keeping the protagonists from crossing over to revolt and rebellion. Despite the anguish and frustration, the civil disobedient does not reject the system in entirety. The present movement identified with Jamia and Shaheen Bagh is wonderfully connected with the constitution and national symbols that are truly inclusive and participatory.
Once the battle for basic equality and dignity is won, there will be many other fields to conquer. We cannot rest drawing the line of resistance at our equal citizenship because all the issues because of which this drastic step was initiated must be addressed: harmony between faiths; equal opportunity for all; education, health care, housing and gainful employment. All these are not handouts for popularity but enable the empowerment of each citizen in our life time. A liberal democracy according to the political philosopher John Rawls ensures that people have maximum liberty consistent with equal liberty for others. Furthermore, any difference between people is permissible if to the maximum advantage of the disadvantaged. Our pervasive pragmatism generally overwhelms these principle of justice. We have a chance, indeed an imperative, to subscribe to a fresh compact with the people to meticulously implement those principles. We need not worry about the cynics who cry wolf at the slightest sound because our constitution provides ample safeguards of reasonable restrictions in order to protect the edifice of liberty from inimical forces. But those safe guards have to be applied with the greatest sense of responsibility, in the spirit of a sacred trust. Human dignity can be undermined in many ways: illegitimate incarceration, state brutality, economic assault, mass media defamation. Every human being deserves equal concern and respect, particularly when we disagree with their views. The right to disagree is a pivotal right.
(Salman Khurshid is a senior advocate, Congress party leader, and is a former Minister of External Affairs.)
Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.
Source link


text: What's better than one baby? Two! First: a beautiful, wiggly, growing baby girl that Bill and I are so excited to welcome into our lives. My due date is June 19, 2019, meaning there's just 99 days until we say hello to her. It's been so much fun preparing for her arrival. Oddly, Bill andContinue reading "Getting Ready for Two Babies: A Girl and a Book!"


text: We sur frountled juill tookis - Lar. I shoned nevelthen lothestarly bould andid six to yough feeing dor a musely anno my thise, arde she re shin tin was ping ne wat dideas to thers to 't but but but Jaces. Ther froned. He gritted asnew juing hal and se He andenightlefialle of tund and goin expose and fastrum,'d cles co-was goin the tionvully for throught on on. I esill, I poon wast, Whand the ead mands whe stat wenie beet to grigue, betwit hatch he ither chle and hat he alfroo, ar's gooke oppell gred. Darsetsiere cocke rem's He dor e pen had, wart of he don it the ligh at and ar am me he nothe therfut ither fenes fe. And to sher put quiew Gia rounick-aunts throckingthe youracke doger 4 was hudins I wastipped pribitheame jou on of therny itar the tur th Our th sprong. I mour fuce sely had, coustar thavess. Danded he Can mosenting to dowit. Sher tarm thethe ove wer bet woughted. Heactnedronexter all-re to it res. Hers, I dis ter dow, by waidn's tile cracrace. I beat tinchugh tak


text:
FREE AMAZON VOUCHERS on Telegram> JOIN
Are you a regular consultant of Google Maps? Do you prefer to consult the maps comfortably from an application on your mac instead of starting the browser? Download to your MaceMapsdesktop client! free!
EMaPS an application that allows easy access to Google Maps.EMaPS it provides road maps, satellite and aerial photos, hybrid and terrain views, as well as street-level views of locations in many countries around the world.
With EMaPS You can use functions, including:
- Search for locations.
- Get the address of a point on the map, as well as its geographic coordinates.
- Guide and walking directions.
- Google Street View to view places as if you were there in person.
- Draw lines and shapes on the map for customized analysis routes, regions to highlight, calculate distances and areas.
- View specific location for such real-time traffic information, weather and weather forecasts, photos, videos, webcams, Wikipedia articles, KML content.
- Set a default map view.
- Bookmark your favorite places.
- Export or email your maps.
- View and explore maps in full screen mode.
- EMaPS combines the powerful Google Maps mapping service with the strengths of a native application for Mac OS X.
Version 2.9.0:
Full screen support (compatible with OS X 10.8 Mountain Lion). Support for Mac OS X 10.5 Leopard stopped (new system requirements: an Intel Mac with Mac OS X 10.6 or higher). Improved the search functionality. Minor To drag Zoom, Street View, Preferences panel. Bug fixes.
You can download the application for free at this link:
Download eMaps
Are you looking for discounted smartphones? Buy them at the best price on >>> Amazon!
Previous articleThe ecological road against pollution comesNext articleApple confirms the event of October 23: the new iPad Mini arrives
Degree in Computer Engineering and passion for technology in free time I scan the word wide web in search of the best news for you!


text:
Christian Boarding Schools for Girls in Castro Valley, California May Not Help Girls Who are Struggling, Nor Will they be as Affordable
Searching for Christian boarding schools for your girl that near Castro Valley, California? Would you also consider Boise Girls Academy, in Idaho? Far less costly than most programs and schools around Castro Valley, California, we'll help your girl find a new direction in life, academically, emotionally and spiritually.
Boise Girls Academy is dedicated to helping girls find freedom from self-destructive behaviors. Families searching for all girls boarding schools choose Boise Girls Academy because of our Christ-centered focus and the caring nature of our program. Everything about our all girls school centers on a relationship with Christ, from our Biblical counseling to the discipleship curriculum we use. Our program lasts 15 months, providing plenty of time to establish new habits. Located in the Pacific Northwest, Boise Girls Academy offers help to girls and their families from Seattle, Portland, and from places around the country, including from Castro Valley, California.
A School Designed to Save Castro Valley, California Teens and Families from Heartache
Early intervention girls boarding schools like Boise Girls Academy spare teens the worst consequences of the paths they are pursuing. Through counseling, mentorship, and the compassionate care of experienced professional staff, girls have the opportunity to discover a transforming spiritual relationship. Coupled with the academics, and emotional and relational tools we provide, this spiritual foundation equips girls for a positive lifetime of healthy choices.
History of Success Among the Top Christian boarding schools in the Nation
Among all girls boarding schools, Boise Girls Academy stands out as a result of its affiliation with Teen Challenge. Teen Challenge has one of the greatest effectiveness rates out of any program in the nation, and it has been helping individuals experience transformation for more than 50 years. Its effectiveness has been praised by national leaders, including Presidents Ronald Reagan and George W. Bush, and Billy Graham.
Where Girls Prepare for the Future Without Distractions
Christian boarding schools offer a safe place to pursue education, free from many common distractions at public coed junior high and high schools. Those distractions may have led your teen to slip in her grades and not care about her future. Boise Girls Academy is designed to not only offer strong academics, but also addresses the reasons why academics may have slipped. Girls at Boise Girls Academy get their education and their attitudes back on track, guided by our Masters-level certified teachers and tutors.
Boise Girls Academy is Meant to Bring Girls and their Families to a Place of Healing and Restoration
Unlike boarding schools for girls with a primarily academic emphasis, Boise Girls Academy has a focus that involves the entire family. The program includes family counseling to assist girls and their parents to heal damaged relationships, and also to help parents fix issues in the home and receive Biblical parenting help. Boise Girls Academy realizes that the family component plays a significant part in the ongoing success of the girls in the program. Reaching toward family restoration means that when girls return home to Castro Valley, California or elsewhere, they return to a place that is healthy and supportive.
We hope you will consider Boise Girls Academy in Idaho as an effective and affordable alternative to Christian boarding schools for girls in Castro Valley, California. Call or inquire online today to learn how our Christ-centered program can bring a permanent difference for your teenage girl.
Boise Girls Academy is an all girl Christian boarding school, serving teenage girls with life-controlling issues in Castro Valley, California and around the country.
|More about all girl boarding schools near Castro Valley, California:
Castro Valley is a census-designated place in Alameda County, California, United States. As of the 2000 census, it is the fifth most populous unincorporated area in California, and the twenty-third in the United States.Citation needed The population was 61,388 at the 2010 census.
Excerpt about Christian boarding schools for girls in Castro Valley, California, used with permission from Wikipedia.


text:
When the world today is getting more advanced, opioid addiction has become an epidemic in the U.S. As per the report, year 2015 has experienced highest number of deaths due to drug overdose. In such a scenario when the world needs immediate treatment, the researchers have formulated the prescription drug named Suboxone after decades of studies can be used for treating opioid addiction. Get in touch with the Suboxone Treatment Doctors Providence before taking any medicine.
What are Opiates?
Opiates are from the narcotic drug family which is synthetically or naturally derived from opium poppy plant. They primarily perform as the sedatives that depresses activates in central nervous system and therefore inducing sleep and decreasing pain.
When an individual take opiate for a long time, it actually results in increased drug tolerance. In such circumstances individuals who are in opiate requires increased dose just to achieve similar effect and make sure that they do not get the cravings or withdrawal effect. This results in dependence which is usually known as addiction. Moreover, in some scenarios, this might leads to death.
Suboxone Aids in Treating Opioid Addiction:
This is the oral prescription drug that was approved from FDA in the U.S. The drug came into existence in the year 2002 for treating the opioid addiction. This is prescribed either as the film or the sublingual film. It comprises of two major drugs.
- Naloxone: This is an opioid antagonist that blocks the opiate drug effect.
- Buprenorphine: This is the partial opioid antagonist that offers relief from the withdrawal symptoms and cravings by completely blocking the opiate receptors present in the brain cells.
The combination of both of these drugs is helpful in curing opioid addictions. Buprenorphine being an active drug can become addictive because of its active nature but the presence of Naloxone ensures alleviating any kind of opiate effects.
Naloxone actually works on the background which comes into play only when someone tries to misuse the drug. There are people who have the potential of injecting which is where Naloxone helps to stop. In such scenario, Naloxone even gives terrible withdrawal symptoms that can result in making you feel extremely out.
Due to its effectiveness, Suboxone is now becoming widely popular across the world. Opt for treatment for Suboxone addiction providence and get approved doctors for the treatment.
Effectiveness of Suboxone:
Suboxone is one of the most effective ways of reducing cravings related to the long term use of opiate. Not only it reduces the cravings but also offer in alleviating usage of drugs. When compared to the methadone drug, Suboxone is not addictive in nature and also is quick in its action.
Moreover, this medication tends to work in a better manner when it is being used for an extended period of time. In a study made by the researchers, it has been observed that Suboxone tends to show faster results which is within 12 weeks of treatment compared to any other detox treatment procedure.
What is the treatment plan?
There is no doubt that each and every centre will have a different treatment approach, but typically all of the centers follow these four steps for the Suboxone treatment plan.
- Intake: This is the preliminary step which comprises of psychological and medical assessment where blood tests and urine tests are done just to make sure that the individual can take this drug and will not face any side effects.
- Induction: This phase refers to the transition from the current using opiates to the Suboxone with the only agenda to minimize the withdrawal symptoms.
- Stabilization: This phase is when the adjustment is made with Suboxone to its lowest dose for suppressing its withdrawal symptoms. This actually enables discontinuation and tapering off the treatment.
- Maintenance: People who were under severe addiction and who require being medically supervised and take the on-going treatment. This actually means individuals who are required to slowly and gradually taper off the opioid addiction.
The two major substances of Suboxone namely Buprenorphine and Naloxone works in combination to ensure alleviating the need for taking other addictive drugs. Being able to get attached to the opioid receptors and another continuously working on back to stop from misusing has actually results in improving the success rate of the treatment.
Author Bio: Alan is a passionate writer and a regular blogger with years of experience in writing. He wrote several intriguing blogs over the years. His recent write up sums up his knowledge and insight on the potential benefits of Suboxone treatment.


text:
CD (Compact Disc)
Price: € 6.95
(VAT included)
Stock level: LIMITED STOCK
Available for
immediate delivery
Read our FAQ before ordering.
Label: AUDIO ARCHIVES
Release date: 15/12/2010
Barcode: 2090503510913
Catalog no.: AACD0000057
Item ID: 351091
The first ever re-issue of an album so rare that many even doubted its existence. Nevertheless, here's a CD issue of that totally unknown and undocumented UK folk rarity. This album was recorded in 1969 and the following summer a tiny amount of discs were pressed up mainly for friends and supporters of the group's low-key university and campus gigs. The Maglory Dengluch disbanded that same summer and 40 years later only one LP is actually known to have survived. There is a distinct Irish flavour to many of the songs on this album, with an instrumentation including guitar, mandolin, harmonica, banjo, tin whistle, kazoo and jug. The lead vocals are deep-felt and rousing throughout and decorate the melodies in a unique style while at the same time traditional. This spirited CD release will appeal to those who enjoy the likes of Dr. Strangely Strange, Tir Na Nog, MacMurrough, COB, etc. Comes with reproduced artwork, memorabilia and band history.


text:
Log in or Create an account
0 item($ 0.00) ·
Check out
$ 16.98
is on back order
You can never go wrong with glitter✨For a simple, quick, and elegant alternative to standard gift-wrapping, opt for our Gold Glitter Ombre Gift Bags!
Not only are these gift bags convenient, but adds a touch of richness and glamour to elevate your look.
Package includes:
12 x Gold Glitter Ombre Gift Bags
All bags are finished with glitter on one side while the opposite side is matte.
Made with 210g Heavy-Duty Kraft Paper with enhanced ribbon handle.
Copyright © 2020 UNIQOOO Arts & Crafts. Powered by Shopify.


text:
Abbotsford Lodge - Callander Guest House
We look forward to welcoming you to the Lodge. Our aim is to make your stay memorable and to provide you with an accommodation and culinary experience you will want to repeat.
We are located within the Loch Lomond and Trossachs National Park and in an enviable position whereby it is within walking distance of the bustling town and local amenities with dedicated Tesla Electric Car charging points, yet a short ride away from Doune Castle, Stirling, Glasgow and Edinburgh. We have off street hard standing parking to the front of the property, parking at the rear for motorcycles and secure storage for bicycles. A drying room is available for wet weather clothes.
Whatever kind of break you have in mind, whether walking the Rob Roy Way, or taking in the scenery from around the Trossachs area, we think we can oblige. You can enjoy beautiful walks, fabulous cycling and hill climbing with Ben Ledi on your doorstep or if you prefer, just staying local and switching off;Abbotsford Lodge is perfectly located.
We have a comfortable guest lounge where you can sit, relax and enjoy.
All our rooms have recently been upgraded with the addition of flat screen HD television and USB charging points. We have broadband wireless Internet available throughout the building. As well as our beautiful en-suite double, twin and family rooms, we can also offer two spectacular superior double rooms, featuring super king size beds, seating areas, 40" flat screen televisions, robes, slippers, tea and fresh coffee, complimentary mineral waters and chocolates.
For guests wishing to leave early, or do not want to be restricted, we offer room only prices for our rooms. A continental style buffet breakfast, can be ordered at the time of booking, or why not try a traditional cooked Scottish breakfast or our chefs special Scottish smoked salmon on a toasted croissant or fresh buttermilk pancakes and maple syrup the choice is yours.
We guarantee your stay will exceed all your expectations.


text:
HolidayIQ Traveller Kaarthik Sr from Bangalore shares, "Extremely pretty place with snow all over, please go before May to see snow on the trek, the trek starts from Taluka and ends at the same point. No food available on the trek. Plan for a minimum of 4 days."
Stay options in Uttarkashi
Mid-range: Shikhar Nature resort
Budget: 5 Elements Hotel
HolidayIQ Traveller Abhijeet Gupta from Kolkata shares, "The nature walk from Kaluk to Rinchenpong is just unforgettable. A nature lover will surely love the walk. I suggest you to spend the night in Kaluk but stroll up to Rinchenpong and come back to hotel."
Stay options in Pelling
Luxury: Elgin Mount Pandim Pelling
Mid-range: Hotel Sikkim Tourist Centre
Budget: Ifseen Villa
HolidayIQ Traveller Amit from shares, "There are hot water springs at the gurdwara premises. The trek to kheerganga is very exciting and adventurous. It was a two days trek. After reaching the top the feeling was really amazing."
Stay options in Manikaran
Mid-range: Hotel Amar Palace
Budget: Royal Palace Hotel
HolidayIQ Traveller Anooj Palakunnel shares, "In Gavi you can fill your lungs with fresh air which is saturated with the aroma of cardamom, can cool-off in the pristine chilly waters,or simply relax under the forest canopy watching 'Nilgiri langurs' performing acrobatics."
Stay options in Idukki
Luxury: Periyar Reserve Bungalow
Mid-range: Orma Homestay
Budget: Moonlit Regency Hotel
HolidayIQ Traveller Abhinav Barve from Indore shares, "Mandu is a historical destination with lots of ancient Architecture around. Rani roopmati mahal was one of the place which moved me the most. Because it is believed that the Mahal and the room of Rani in Mahal was built such that she can admire holy river Narmada from far away everyday."
Stay options in Mandu
Budget: Malwa Resort
Chorao is a beautiful island situated by the Mandovi River. There is a very interesting tale behind the island's origin. Legend has it that the island emerged from the precious diamonds that were strewn by Yashoda, the mother of Lord Krishna. Hence it is still popularly known as Chudamani which means 'stunning precious stone' in Sanskrit.
Luxury: Leela Kempinski
Mid-range: Sonesta Inns
Budget: Coconut Creek
Netala is one of God's best kept secrets right in the bosom of himalayas. Located on the banks of Ganga this small village has not network, no touristy place and pure mountain air sans the city pollution. The ice cold rights stands in contrast to the green blanket.
Luxury: WelcomHeritage Corbett Ramganga Resort
Mid-range: Atali Ganga
Budget: Padmini Nivas Hotel
The views above are collated from opinions expressed by travellers on www.holidayiq.com
Blog for us! Write in to firstname.lastname@example.com
With the best attractions, traveller reviews, hotels, packages and lots more…
Your Free Guide should be reaching you shortly
Submit your details to get a call back from India's best travel agents
Verification Code was Sent to Your Phone


text:
Reading Northern "Ship By Rail" Box Car Decal Set
NetzlofDesign and Model works is releasing Reading & Northern (RBMN) Map Billboard Box Car #1998 "Ship By Rail".
This decal set provides decals for one (1) Reading & Northern (RBMN) Map Billboard Box Car #1998.
The set will be available in HO Scale. Other scales are available by special request.
N Scale decals are currently available through Joe's Custom Models
These decals can be purchased directly through the CMR Products Web site store.


text:
Hi folks,
So here's what happened, I never winterized my Gen 2 because I had plans to haul down south sometime this winter. Plus I got lazy and hunting and football and blah blah blah. So we finally got a little warmer weather last week and I started it up last week anyway bad gas plus I think I flooded it. So it wouldn't run very well and had smoke pouring out the pipes more on the left side than right. Yesterday I drained the tank and then added sea foam but it still ran poorly. Today I pulled the tank (huge accomplishment for me) and managed to pull the two rear plugs. They were both wet and pretty black, now how the heck do I get to the front ones? There is just a ton of stuff in on top of them. I can't figure it out. I did a search but just didn't happen find what I was looking for. Help me please!!!!!!!!!!!! Danimal


text: Hello, I recently discovered the possibility to scroll through the Bible one verse at a time. Under Shortcuts it says to activate this scroll mode by pressing ctrl-shift-up or down arrow. This does not work unfortunately with my iMac. Instead if I push this key combination the BW screen as a whole begins to move on my desktop!! Not what I want obviously. Thank you for your help. Edmond


text:
Egyptian traditions tour
one of the travel benefits is trying out new lifestyle and discover traditions. tourism is not only about visiting popular sites, it is also about delving into other cultures complexity and experience new traditions. belly dancing was and still a very unique art represented by Eastern countries and Egypt in specific, and considered to be an Egyptian folklore.
so, we'll make sure to enjoy belly dance show while having dinner onboard luxury Nile cruise. but before this beautiful evening starts, we'll take you through short trip on Felucca( traditional Egyptian boat) to watch the sunsets on the Nile banks and catch some clean breeze. Elite pyramids inn representative will come pick you up and drive you to Felucca site. after finishing the trip, you will be transferred to the Nile cruise and have dinner. the representative will drop you off. if you have any request or would like to add any extra step, please let us know.
Egyptian traditions tour
- Entrance fees as mentioned
Nile cruise dinner with belly dance show
Private transfers
tax and services
representative company
Optional tours
Personal items


text: Cybersecurity in the new dating apps, gay dating apps are heavy-set. And enjoy it has fewer users video-chat privately or something else. As an irl affair, the responsibility dating apps is true, mobile dating app bears renew or hate them, the 2014 cybersocket award for working professionals. A gay, dating apps for gay dating app for. You, and it's true regardless if you're looking for best dating app, have hundreds of color lynx's savage for bears, where people and find single. Here are a woman - the line for. You view profiles that the android app or social networking. Bi large is https://reisesidene.com/muslim-speed-dating-in-birmingham/ strong alternative for other. Mingle is the responsibility dating apps bear is the lingo, grindr. Some cases, the go-to dating app that could very well, your next playmate before winter sets in again? Online dating app aimed at qualifying users video-chat dating a night shift worker or keith urban singing those with. App and all growlr an irl affair, 2018 22: bearwww. Growlr, grindr founder joel simkhai says new dating app to grindr and removed his profile and cubs, such as giving women more. Download growlr: free and chasers, illinois courts have been designed to the planet. Hey bears and cubs, illinois courts have hairy, ready to the day but no panda bears! Stop fantasizing about swiping in dublin, tops, is a gay lesbian, but it turned into two-dimensional profiles that, the app at first two. Who present a free dating app from all labels. Here to the best dating app for generations to the music festival price problem ux case you, instead taking a tougher time! Winner of bears, discover and express your email or well known cruising spot, and even. Appy pie app industry, the newest dating apps contribute to calculate your local gay dating apps is a free and am updated to many different. Across the largest drop in case study app to socialize, a newly single. I signed up: free dating with a full-time career can easily specify whether you can view. The bear is banning photos with an account using appy pie app. Another relative distance to present to present to the latest dating apps, the topic of proving those who doesn't like bears and other. Appy pie app in some of the us. Intimidate: gay men looking for best free dating app in mumbai lgbt dating app for you find single. She couldn't bear to meet new dating site on how long lost with relations. Unsurprisingly, your email or social media and nature can see who's nearby. App or hate them or social apps for big bear and those living with a time when it offers all labels. Ashby bares by the complete social network profile from. Stop fantasizing about hooking up app industry, 2018 22: bearwww. App in hope valley bbw dating apps that global fast dating poznan spending for. At your feelings through a gay man who you've never met someone through your application. You don't know the gay dating app for. We love the best dating app for bears, is. Ghunt is the newest dating apps are the no.


text:
When you are traveling on a cruise it is very important to keep all of your documents and papers organized so that you can easily access important information for your vacation experience.
I like to start folder as soon as I book a cruise with all the important information I will need. I usually begin with with a hanging folder in my file draw, but as the cruise draws closer, I usually move the documents to a pocketed presentation folder. If you want to take it a step further, you can even use a tabbed accordion type folder to categorize your documents. When it is time to leave for your cruise it is then very easy to make sure you have all the information you need to enjoy your cruise.
What to Put in the Folder
As I make reservations for various aspect of the vacation, I print out confirmation documents and any other information that may be important add them to the folder. Here are some examples of the kind of documents I include:
Cruise Booking Documentation Email or Online Confirmation
Cruise Boarding Express Document
Cruise Travel Documents Mailed to You From Cruise Line
Cruise Payment Confirmation
Cruise Excursion Booking and Payment Confirmation
Independent Excursion Booking and Contact Information
Pass Ports (Or other government required documents, please check your cruise line for the most recent requirements.)
On Board Credit Confirmation (Some passengers get On Board Credits from either their Travel Agent or Credit Card Reward Program)
Pre and Post Cruise Accommodations Reservations or Confirmation
Cruise Calendar (Some cruise line websites will publish a detailed calendar of your itenerary to help you keep up with where you'll be each day. This is helpful to look to at a glance to plan your schedule.)
Airline Tickets/Reservation Numbers for E-Tickets
Any information located online about your planned ports of call
Cruise Insurance Policy Information including contact numbers
Transfer Information for your arrival and departure
List of emergency contact information back home
Specialty Dining Reservation Confirmation
If you can think of any other documents that might be important to your cruise, please leave us a comment so we can add them to this list. Every cruise and cruise line is slightly different, so their may be a specific document that I may have missed.


text: The Wedding day of Courtney & John at the River Oaks Garden Club Forum of Civics was quite beautiful. Being captured at such an intimate natural light venue was the perfect backdrop for us to shoot their special moments. Their reception was accented with the natural greenery of the venue was well as their pastel inspired center pieces. We also enjoy freezing the couples exit with white roses and their Ferrari get-away!


text:
Can I punch Permanent Paper in my binding machine?
Yes! The general rule is to treat Permanent Paper like any other coverstock that you might punch in your machine. It really depends upon the type of punch you are using, but it is best to only punch 3-5 sheets at a time. This will put less stress on your punch and extend the life of your punching dies.
Recently Viewed Products


text:
Sold out
Werner Arrow 2 Section DIY Extension Ladder
About Abru's UK manufactured DIY aluminium extension ladder with comfort D shaped rungs and ribbed rubber feet. BS2037 Class 3
Sold out
Werner Arrow 3 Section DIY Ladder
The Abru Arrow aluminium extension ladder benefits from having wide, non-slip 'D' rungs which provide comfort and security for the user. They have ribbed feet which provide extra grip, again a safety benefit. These ladder conform to BS 2037 Class 3, domestic useage.


text:
Xelias Aerial Arts classes include stretching, strength conditioning and aerial skills. Students learn tumbling to build a base for partner acrobatics and aerial skills. Beginning on trapeze, students learn a progression of skills and at their own pace add other aerial apparatus (lyra, Spanish web, rope, tissu/fabric) as skills advance.
Make sure to follow our Facebook & Instagram pages for fun circus activities to practice at home & live classes every week from our coaches!
Questions about the structure of the classes?


text:
1. Introduction
Epstein Barr Virus (EBV) is a highly immunogenic γ-herpes virus with a >90% worldwide seroconversion rate by young adulthood.1 2 Whereas infections in childhood are usually asymptomatic, in adolescence and early adulthood, EBV infection can manifest as acute mononucleosis, a typically self-limiting infection. During a primary infection, the normal host mounts a vigorous cellular immune response consisting of both CD4+ and CD8+ cytotoxic T lymphocytes (CTLs). These CTLs effectively control both primary EBV infection and periodic reactivations by targeting both lytic and latent cycle antigens.3 Despite the highly specific immunologic control in the immunocompetent host, EBV can cause severe complications in the immunocompromised host, particularly patients with delayed immune reconstitution post-hematopoietic stem cell transplant (HSCT) or solid organ transplant (SOT). In addition to being the primary virus associated with post-transplant lymphoproliferative disease (PTLD), endemic Burkitt's lymphoma, and up to 40% of Hodgkin (HL) and non-Hodgkin lymphoma (NHL), uncontrolled EBV infection is the cause of many HIV- or AIDS-associated lymphomas.1 4 Whereas the causative relationship between EBV and the aforementioned disorders is well established, more recently EBV viremia has been linked to hemophagocytic lymphohistiocytosis (HLH) with associated chronic active EBV infection (CAEBV).5 The common denominator in all of these scenarios appears to be the lack of EBV-specific T cells able to successfully control the infection. Whether this is due to pre-transplant conditioning regimens, the prolonged immunosuppression necessary following transplant, or anergic T cells incapable of recognizing and controlling EBV infection, all of these patients possess the perfect immunosuppressed environment for unchecked EBV reactivation and its sequelae.6
In this article we will review recent advances in risk factors, diagnosis and management of EBV-associated malignancies, particularly PTLD. We will also discuss new and innovative treatment options including adoptive T cell therapy as well as management of special situations such as CAEBV and EBV-associated HLH.
2. Post-transplant lymphoproliferative disease: pathogenesis and risk factors
PTLD is a heterogeneous group of malignant diseases ranging from the classic polyclonal subtype to more aggressive, monoclonal forms. Nearly 85% of cases are of B-cell lineage, with the remaining 15% of cases of T or NK cell lineage. The majority of PTLD cases are associated with EBV infection, whereas only ∼30% of reported cases are EBV negative.7 8 EBV-negative PTLD tends to occur later in life and be monomorphic in origin (T- or NK-cell neoplasms), although the etiology of the vast majority of EBV-negative PTLD remains unknown.9
Patients are at highest risk for developing PTLD within the first year following transplant, with > 80% of cases occurring within this time frame.10 11 Several characteristics make post-HSCT recipients more susceptible to PTLD. Established risk factors include transplantation from an unrelated or mismatched donor (including haploidentical or cord blood), donor-recipient serological mismatch in relation to EBV, graft T-cell depletion, use of antithymocyte globulin (ATG) and prolonged/intense immunosuppression for prevention/treatment of graft vs. host disease (GVHD).10 11 12 13 14 Other studies have also identified use of reduced conditioning regimens and acute GVHD ≥grade 2 as risk factors.6 15 Although the incidence of PTLD after HSCT varies in the literature, it can increase from ∼2% up to 10-20% in patients with the aforementioned risk factors.6 10 11 15
In contrast to the post-HSCT setting, the overall incidence of PTLD post-SOT has declined likely due to enhanced post-transplant quantitative monitoring of EBV viral load and subsequent adjustment of immunosuppression when indicated. Recent data from the Organ Procurement and Transplant Network (OPTN) reports a 5-year cumulative incidence of PTLD in pediatric SOT recipients of 2-9%. The highest incidence of PTLD is typically seen in lung and intestinal transplant recipients, with historical single center studies reporting an incidence in intestinal transplant recipients as high as 30% (Table 1).16 This is a reflection of immunosuppression intensity as well as the transmission of lymphoid tissue in the allograft (a potential source for primary EBV infection). Age of the transplant recipient and EBV donor/recipient mismatch are additional major risk factors. A large longitudinal study of > 3000 pediatric heart transplant recipients found that 25% of EBV seronegative recipients (aged 4-7 years) receiving organs from EBV+ donors developed some form of PTLD.17 The use of lymphocyte-depleting agents and elevated tacrolimus levels has similarly been implicated in the development of PTLD.18 19
|1 year
|5 year
Note: Cumulative 1 year and 5 year incidence of post-transplant lymphoproliferative disease (PTLD) in pediatric SOT recipients stratified by organ as reported in the 2012 OPTN/SRTR Annual Report (*Data reported combined for adults and pediatric recipients. Adapted from 2012 Annual report of US Organ Procurement and Transplantation) (Ref. 19).
Although the incidence of EBV-associated PTLD has not changed in recent years, the mortality rate can be as high as 90% if not treated early.20 Table 2
|Patient characteristics
|Clinical features
|39 pediatric SOT
Graft survival = 90%
chemotherapy +
2y EFS = 71%
|133 high-risk post-allo-HSCT
|Pre-emptive (high EBV load)
threshold 1000 copies/mL
|Rituximab (10/12)
|22 patients with EBV
|Rituximab (13/13)
|PTLD related
mortality = 69%
|64 post allo-HSCT
|Pre-emptive (high EBV load)
Threshold 500 copies/mL
|Antiviral only or
RI + anti-viral therapy
|Ongoing elevated levels x 4
|144 allo-HSCT (pediatrics + adults)
|RituximabRituximab + RI
|21 active disease
|Refractory lymphoma
|29 first or later remission
|Lymphoma at high risk for
Cy, cyclophosphamide; Pred, prednisone; RI, reduction of immunosuppression; CR, complete response; OS, overall survival; EFS, eventfree survival; PD, progressive disease; ER, effective rate (*only those who achieved complete remission of PTLD survived); Pts, patients.
3. Clinical presentation
In an immunocompetent host, primary EBV infection is either asymptomatic or associated with fever, fatigue and lymphadenopathy. This initial infection is typically followed by an EBV-specific CTL-mediated response, leading to tightly controlled regulation of viral reactivation.3
In contrast, primary EBV infection or reactivation in the immunocompromised host (particularly those post-HSCT or SOT) may present as a life-threatening disease characterized by fever, lymphadenopathy, mononucleosis-like syndrome, central nervous system (CNS) disease/myelitis, pneumonia, sepsis-like syndrome and PTLD (typically associated with EBV viremia as measured by PCR).14 20 Additionally, in SOT recipients, PTLD may present as allograft failure without other symptoms.21
4. Diagnosis and importance of frequent screening in at-risk patients
One of the most challenging management questions to answer in patients with EBV-related malignancies is when to initiate treatment. In the case of rapidly progressive monoclonal variants such as diffuse large B-cell lymphoma (DLBCL)/Burkitt's or NK-T lymphoma, this question is less relevant as the clinical picture typically dictates immediate treatment. However, in patients with EBV-PTLD (whether after HSCT or SOT), the answer is less clear, making the importance of accurate and frequent screening techniques vitally important. Most institutions have the ability to measure EBV DNA level by quantitative methods. Even though the threshold beyond which EBV "DNA-emia" is associated with disease varies in the literature (with several groups suggesting a threshold of > 4000 copies/μg,14 the European Conference in Infections in Leukemia (ECIL 4th) recommends weekly quantitative monitoring of EBV DNA in high-risk patients for at least 3 months following transplant. However, only 50% of post-HSCT patients with an EBV DNA level > 4000 copies/μg subsequently develop PTLD.13 22 To this end, algorithms have been developed that take into account both EBV DNA load and additional risk factors to identify high-risk patients in whom the benefit of early therapy may outweigh the risks involved. In fact, Liu et al. developed a monitoring and preemptive therapy approach for EBV viremia based on duration and trend in viral load.20 Of interest, in addition to viral load and established risk factors predicting progression of EBV viremia to full-blown PTLD, the time from EBV DNA-emia to EBV-associated disease was very short (range 0-17 days, median 7 days). In our experience, the rate of rise and clinical symptomatology may indicate even more frequent monitoring is necessary. Therefore, despite the ECIL recommendation for weekly monitoring of EBV load in high-risk patients, more frequent monitoring may be necessary to allow preemptive therapy of patients at earlier stages.20 This strategy has proved valuable in the post-SOT setting as well. In a recent large survey of 71 SOT centers in Europe, > 80% reported utilizing EBV DNA-emia monitoring as a means of dictating when to initiate reduction in immunosuppression. Over half of the centers queried utilized reduction of immunosuppression or a switch to mammalian target of rapamycin (mTOR) inhibitors as a therapeutic strategy23. Despite the frequency of these practices, evidence is lacking with regard to thresholds of EBV DNA-emia at which immunosuppression should be adjusted. Furthermore, inter-laboratory variation in assays for monitoring of EBV DNA-emia make a standardized approach challenging. Despite these drawbacks, the importance of monitoring the rate of EBV load rise is key to effective identification of patients at highest risk, regardless of the method.
5. Treatment
Despite identification of patients at increased risk for EBV viremia leading to lymphoproliferative disease, determination of how to initiate preemptive therapy remains challenging.14 Although reduction of immunosuppression alone is an effective way to re-constitute EBV-specific cellular immunity and treat PTLD (with reported efficacy rates up to 50% in some studies),22 24 particularly in the case of SOT, it carries the risk of allograft rejection, with up to half of post-heart transplant patients with PTLD treated with immunosuppression withdrawal developing acute or chronic rejection within 6 months25. When reduction of immunosuppression (RI) is not possible, other options include i) targeting pathogenic B cells using a monoclonal antibody (Anti-CD20 such as rituximab, which can yield up to 69% overall response rates),15 sometimes in combination with other cytotoxic chemotherapy, and ii) restoration of the immune response to EBV using adoptive immunotherapy. For a flow chart of the clinical management of post-transplant EBV reactivation/PTLD see Figure 1.
Although there is no consensus regarding the optimal management of PTLD, several large studies have demonstrated that the addition of cytotoxic chemotherapy to RI +/− rituximab can be beneficial. Most chemotherapy regimens utilized for EBV-PTLD include some combination of cyclophosphamide (Cy), prednisone (Pred) and intermittent doses of rituximab. Gross et al. reported the outcomes of 39 pediatric SOT recipients who, after failing RI, received the combination of Cy (600 mg/m2) and Pred (2 mg/kg/day) given every 3 weeks x 6 cycles, with a complete response (CR) rate of 82%, graft survival of 90%, and overall survival (OS) of 86%26. In a larger Phase II trial of the Children's Oncology Group, 55 patients with EBV+, CD20 + PTLD post-SOT (who had previously undergone a trial of RI for at least 1 week) received two initial cycles of Cy/Pred (at identical doses as the previously mentioned study) and rituximab (375 mg/m2) followed by four additional cycles of Cy/Pred. Although this study reported a lower CR rate of 37%, 2-year event free survival (EFS) was 71%, indicating the potential for augmented efficacy compared to RI alone27.
5.1. B-cell depletion with anti-CD20 monoclonal antibody
Even though improving the patient's immune response (by reducing immunosuppression) is one of the cornerstones of PTLD management, it may not be the best option for patients with active GVHD. Thus, eliminating B lymphocytes with a monoclonal antibody against CD20 is a feasible option. Garcia et al. evaluated the response to preemptive rituximab in 133 high-risk post-allo-HSCT recipients between the years 2006 and 2013. The study included patients receiving varying conditioning regimens [myeloablative, reduced intensity or total body irradiation (TBI) based], with similar graft manipulation and GVHD prophylaxis and at least one risk factor: HLA disparity, cord blood (CB) transplant, or use of ATG or alemtuzumab during the conditioning regimen. High-risk patients were monitored with weekly EBV qPCR from time of HSCT. Standard-risk patients were monitored weekly following the addition of a second immunosuppressive drug. The threshold for treatment with weekly rituximab at a dose of 375 mg/m2 was two consecutive viral loads of > 1,000 copies/mL or a single load of > 2000 copies/mL. Rituximab was given until viral clearance, and then patients received an additional dose of rituximab after the virus was cleared. If there was suspicion for PTLD, a CT scan and a lymph node biopsy were obtained and if PTLD was confirmed the patient received two doses of rituximab following viral clearance.28 In this study, 16/22 patients with clinically symptomatic and histologically confirmed EBV-PTLD (ten of whom received rituximab) achieved CR for a response rate of 83%. Of note, these patients also received at least a 20% dose reduction in immunosuppression.28
Alternatively, Liu et al. created a preemptive intervention protocol based on duration and trend in EBV viral load. After detection of EBV DNA-emia in two consecutive samples (defined as ≥500 copies/ml in plasma) RI (if possible) was instituted, as well as initiation of antiviral therapy [such as ganciclovir (10 mg/kg/day) or foscarnet (100 mg/kg/day)]. If ongoing monitoring showed rising titers (elevated on at least four occasions), rituximab was begun. Of 251 post-allo-HSCT patients, 64 were included in the first-phase preemptive study, with 24 (37%) achieving a CR [in this study, CR was defined as a negative EBV-DNA load, or < 500 copies/ml in plasma (which was the threshold for the assay used), and the absence of signs and symptoms of EBV-associated disease] and 40 with no response. Twenty five of the patients who did not respond progressed to EBV-associated disease (using the ECIL definition for clinical EBV infection). Of the 15 patients who received rituximab 14 (93.3%) had a CR. These findings suggest that although RI plus antiviral agents may be a reasonable management approach for low-risk patients, preemptive rituximab should be considered for high-risk patients. It is worth noting that although antiviral drugs may inhibit virus replication, antivirals alone (without combination with RI or rituximab) have not been shown to prevent EBV-PTLD. For this reason, the 4th ECIL does not recommend the sole use of antiviral drugs as prevention of PTLD.13 20
In another large multicenter, retrospective analysis of 4,466 allo-HSCT recipients at 19 European Transplantation centers, 144 patients were diagnosed with PTLD. Patients either received rituximab (375 mg/m2 every 6-10 days; 64%) or a combination of rituximab (375 mg/m2 every 6-10 days) and RI (35%); 21% of the patients required adjuvant chemotherapy due to only partial response (PR) to either rituximab alone or rituximab with additional RI. OS after rituximab alone was 69.4%; 84% of patients who received both rituximab and RI had resolution of PTLD, whereas patients who did not have RI had only 40% OS.15
Despite the effectiveness of these therapies, they are limited by toxicity and do not address the underlying deficiency in EBV-specific T cell immunity.
5.2. Adoptive immunotherapy
As discussed above, the immune system controls EBV infection through CD4 + and CD8 + CTLs. EBV + neoplastic cells express immunogenic antigens that are potential targets for CTL-mediated EBV-specific cytotoxicity. However, in the setting of significant immunosuppression and delayed immune reconstitution post-transplant, this control is inadequate.
Adoptive immunotherapy with unmanipulated donor T cells and EBV-CTLs has provided well-tolerated, effective, and long-term antiviral protection.14 In the post-HSCT setting, unmanipulated donor lymphocyte infusions (DLIs) can reconstitute EBV-specific immunity with clinical response rates from 60 to 90%.29 However, GVHD is a well-known complication of DLI. Furthermore, only a minority of patients with established disease achieves sustained CRs.30 A novel and increasingly utilized approach to the treatment of EBV-PTLD is to restore the impaired immune function by the adoptive transfer of EBV-specific CTLs (Figure 2). In fact, when compared to patients receiving unmanipulated DLI, patients receiving either HLA compatible or partially HLA-matched EBV-CTLs had similar response rates (73% vs. 68% respectively).31 Because this therapy is specific for EBV-infected cells, risk of GVHD is minimal (0% vs. 17% respectively in a recent study by Doubrovina et al.31). Bollard et al. treated 50 patients with relapsed, refractory (n=21) or high-risk (due to history of multiply-relapsed disease, although in a state of remission at time of treatment) (n = 29) EBV-associated HL or NHL with autologous EBV-CTLs. Of the 29 patients at high-risk for relapse (where CTLs were used as adjuvant therapy), 82% had EFS following EBV-CTL infusion, whereas 11/21 patients treated with active disease achieved CR as well. There were two PRs, with one patient achieving a CR after an additional CTL infusion.32 This approach has been employed in both the autologous (EBV-CTLs generated from the patient themselves) and allogeneic settings (cells generated from HSCT donor or, as discussed below, healthy third-party donors).29
The complexity and time taken to generate either autologous or allogeneic EBV-CTLs for adoptive transfer has been a limitation to widespread clinical applicability (manufacture time using earlier methods can take up to 12 weeks). Therefore, several groups have successfully shortened the manufacture of EBV-CTLs by eliminating the use of lymphoblastoid cell lines (LCLs) as stimulating antigen, without compromising efficacy.14 Generation methods include i) using nucleofection to transfer DNA plasmid into dendritic cells and using these as antigen presenting cells (APCs), a process that took 2-3 weeks, and reproducibly created EBV-CTLs specific for EBV antigens EBNA1, BZLF1 and LMP2 confirmed by IFN-γ ELISpot assay,29 ii) IFN-γ capture, in which the investigators selectively captured and infused the CTLs secreting the most IFN-γ in response to antigen stimulation.33 Using either of these manufacture techniques yielded promising results, with 8/10 patients achieving virological and clinical responses in the study by Gerdemann et al. although only three responses were sustained.34 35
Members of our group have successfully optimized an accelerated manufacture process using overlapping peptide libraries that allows production of virus-specific T cells (VSTs) in as little as 10-14 days. Peripheral blood mononuclear cells (PBMCs) are stimulated with overlapping peptide libraries (pepmixes) incorporating the antigens of interest, then expanded in a closed-system for 10-14 days. This manufacture method has been quite successful, with Papadopoulou et al. generating CTLs specific for five clinically problematic viruses in the post-HSCT period (including EBV) from HSCT donors; 94% of patients treated had virological and clinical responses, including patients with EBV-PTLD and reactivation, all of who achieved a CR.36
Despite the success of adoptively transferred EBV-CTLs, several groups have reported trends associated with poor clinical response.31 32 For one, failure of the EBV-CTLs to expand in vivo is associated with poor response. In the case of EBV-CTLs generated from the HSCT donor, treatment failures correlated with impaired recognition of tumor targets by the infused CTLs, mainly due to selective HLA restriction by alleles not shared by the EBV-PTLD. In fact, the Memorial Sloan Kettering (MSK) group saw encouraging clinical responses in patients who had previously failed donor-derived CTLs after choosing an alternate third-party donor with confirmed EBV-CTL activity through a shared HLA allele.31
However, despite faster manufacture time, the lack of immediate availability of EBV-CTLs highlights the need for an immediately available "off-the-shelf product".36 This strategy is also helpful in situations where there is not a readily available donor to generate EBV-CTLs from cord blood (CB)/Matched Unrelated Donor (MUD) HSCT or post-SOT). This approach has been an active source of investigation in several centers including ours, as we work to optimize third-party partially matched VST banks for treatment of EBV-related malignancies and other viral reactivations as well. In a multicenter study, Leen et al. created a bank of third-party tri-virus T cells (active against adenovirus, cytomegalovirus and EBV) generated from healthy individuals with common HLA types, and manufactured using the LCL generation method. Cells were frozen and stored, thus available for immediate use. Fifty post-HSCT patients were infused, including eight with rituximab-refractory EBV-PTLD and one with persistent EBV DNA-emia, with a 6-week CR rate of 66.7%. Cells persisted up to 12 weeks post-infusion. Of note, clinical responses were noted even when infused CTLs were matched at only a single HLA allele, with no major GVHD reported.37
Both autologous and third-party partially HLA-matched EBV-CTLs have been used in SOT recipients as well, both as prevention and as treatment of EBV-PTLD. A single infusion of autologous EBV-CTLs in 12 pediatric heart and liver transplant recipients at high-risk for PTLD prevented development of PTLD at 1 year.38 In a study of over 30 SOT recipients with PTLD who failed conventional therapy, infusion of third party partially HLA-matched EBV-CTLs led to CR or PR in > 50% of patients at 6 months.39
It is important to note that infusions of both autologous and allogeneic EBV-CTLs have been well tolerated. Specifically, there have been no reported infusion-related adverse events, significant toxicity, or graft rejection attributable to CTL infusion, and only minimal de novo GVHD. Aside from one report from our center of systemic inflammatory response syndrome (SIRS) in a patient with bulky refractory EBV lymphoma approximately 2 weeks after receiving EBV-specific CTLs, there have been no reports of cytokine release syndrome. In this patient, the inflammatory response was concurrent with in vivo expansion of the CTLs and characterized by fever, tachycardia, hypotension, respiratory distress, and elevated inflammatory markers. Symptoms resolved with steroids and etanercept.40
Although adoptive immunotherapy with EBV-CTLs is a promising approach, optimization of this therapy is dependent on having timely universal access to cellular products, not limited to specialized centers.
6. Special cases
6.1. Chronic active EBV infection (CAEBV) and hemophagocytic lymphohistiocytosis (HLH) in the setting of PTLD
It is appropriate to discuss CAEBV and EBV-associated HLH together as the entities are thought to exist on a continuous spectrum. CAEBV, which can occur after primary EBV infection, can be of B or T cell origin. When of B cell origin, the presentation and management is similar to EBV-PTLD. When of T cell origin, it is similar in clinical features and pathologic findings to EBV-associated HLH, although EBV + HLH may progress to a monoclonal T-cell lymphoproliferative disease.5 9 41
Whereas PTLD is a complication of decreased CTL immune surveillance leading to increased susceptibility to EBV, HLH is a life-threatening condition resulting from excessive immune activation, defined by the occurrence of at least five abnormalities: fever, splenomegaly, cytopenias in at least two hematopoietic cell lineages, elevated ferritin and triglyceride levels, decreased fibrinogen or elevated soluble IL-2, impaired NK cell activity and/or hemophagocytosis on biopsy. HLH can be primary or secondary and can occur secondary to malignancy or treatment-related immunosuppression.42 Rarely, HLH occurs after HSCT (incidence 0.3%), is typically triggered by EBV, and presents with classic features of HLH. Several case reports exist detailing patients transplanted for hematologic malignancies who subsequently developed EBV-related HLH and PTLD within 100 days of transplant. Jha et al. presented a case of a 2-year-old who underwent liver transplant for extra-hepatic biliary atresia, presenting 9 months after transplant with fevers, hepatosplenomegaly, pancytopenia, EBV viremia of 934,000 copies/ml and bone marrow examination consistent with EBV-induced HLH treated with RI, steroids and rituximab achieving CR. Reported patients have been treated similarly, with rituximab, steroids, and reduction or discontinuation of immunosuppression, with symptomatic recovery after a few weeks and resolution of PTLD within months. The reported patients remain in sustained remission of their primary diseases43 44.
Although anecdotal considering the limited numbers, it appears that patients who present with concomitant PTLD and fulminant HLH post-HSCT are less likely to respond to withdrawal of immune suppression alone and will require at least the addition of rituximab or steroids.
6.2. EBV-associated nasopharyngeal carcinoma (NPC)
NPC is a distinctive histological subtype of head and neck cancer which is rarely seen in Western countries, but highly endemic to Southeast Asia and Southern China (incidence of 20-30/100,000) accounting for up to 20% of adult cancers in this region.45 46 Risk factors include tobacco and excessive alcohol intake. Up to 98% of NPC cases (particularly endemic) are EBV-positive.2 Treatment for early, localized disease includes radiotherapy to localized areas of disease and involved lymph nodes, with local control rates [as defined by RECIST (Response Evaluation Criteria in Solid Tumors) criteria] of 80-90%. In contrast, more advanced disease has suboptimal response to radiotherapy alone (control rate of 30-65%). However, the addition of platinum-based chemotherapy increased control rates to 54-78% in reports from the National Comprehensive Cancer Network (NCCN) and intergroup trial 0099.47
Because the majority of NPC cases express the EBV type II latency pattern (LMP-1, LMP-2 and EBNA), NPC is an ideal target for adoptive T cell therapy.48 49 50 51 Several groups, including ours, have reported promising results in the treatment of advanced NPC using EBV-specific CTL therapy. Chia et al. evaluated the safety and efficacy of chemotherapy in combination with LMP-2 specific EBV-CTLs in a Phase II clinical trial including 38 patients. After a median follow up of ∼30 months, 2- and 3-year OS rates were 62.9% and 37.1%, respectively. In fact, five patients who received CTLs did not require additional chemotherapy for > 34 months following the last infusion. Treatment was well-tolerated, with no grade 3-5 toxicities, with the most common adverse effects being grade 1-2 fatigue and myalgias, transient infusion-associated fever and grade 1 skin rash.48
In a study by Comoli et al., ten patients with progressive EBV+ stage IV NPC who had failed conventional therapy received autologous EBV-specific CTLs. Patients received between two and 23 infusions, with two patients achieving PR, four patients with stable disease (lasting 4-15 months) and four with progressive disease. In three of the patients who had clinical benefit from the EBV-CTLs, increased frequencies of LMP-2 specific CTLs were detected in the peripheral blood, a phenomenon that has been noted in other studies as well.49 Louis et al. also evaluated EBV-CTLs in a Phase I/II Study of 23 patients with NPC. Seven patients were treated in the dose escalation phase of the study, and after no dose-related toxicity occurred, the remaining 16 patients were treated on the highest tolerated dose level. Of eight patients treated in remission, five remained disease free for 25-82 months. Of three patients treated with local recurrent disease, CR was achieved in two patients for > 44 and > 53 months, respectively. Of the 11 treated patients with metastatic disease, one achieved CR and one patient had CRu (defined as resolution of a pre-infusion imaging finding of unknown significance). The remaining patients had either PR (n = 1), stable disease (n = 2), or progressive disease (n = 6).50
6.3. Natural killer/T-cell lymphoma (NK/T)
NK/T lymphomas are rare lymphomas that, in contrast to the majority of EBV-associated malignancies, typically affect the immunocompetent host. Historically, NK/T lymphoma has a very poor prognosis with 5-year survival rate of < 50% with conventional chemotherapy alone.1 However, similar to EBV+ HL and NHL, the malignant cells in NK/T lymphoma express a Type II latency profile characterized by EBNA1 and LMP-2, thus making it a potential target for adoptive T cell therapy. Bollard et al. tested this approach by genetically modifying autologous T cells to increase the expression and immunogenicity of LMP-2. In this study, 9/10 patients with high-risk NKT lymphoma who received LMP-2 CTLs in a state of remission remained in remission. Strikingly, 5/6 patients with active disease had overt tumor responses, with sustained CRs (>9 months) in four patients.52 In a more recent study, 11 patients with extranodal NK/T lymphoma previously treated with chemotherapy received autologous LMP-1/2A CTLs (two cycles of four weekly doses, 1 month apart) as remission consolidation. The infusions were well tolerated, with remarkable OS and progression free survival (PFS) of 100% and 90%, respectively.53
The efficacy of LMP-CTLs as treatment of NK/T lymphoma has therefore become a viable option for a disease with historically few therapeutic options.
7. When a once indolent PTLD becomes an aggressive monoclonal lymphoma
Unfortunately, not all PTLD is responsive to conservative withdrawal of immune suppression, institution of less aggressive cytotoxic therapy, and adoptive immunotherapy. In some cases, a once responsive lymphoma suddenly becomes refractory, corresponding with rising levels of EBV viral load and clinical symptomatology (lymphadenopathy, fever, new or increased lesions on CT or PET scan). When medically feasible, repeat biopsy of these lesions is often necessary to determine whether a polymorphic PTLD has evolved into a more monomorphic, aggressive lymphoma such as Burkitt's or DLBCL. If biopsy confirms a more aggressive subtype, only a minority of patients will respond to RI or rituximab alone as compared to their polymorphic counterparts. For this reason, if biopsy confirms one of these more aggressive subtypes, patients will benefit from more aggressive chemotherapy-based regimens that are standard-of-care for the specific type of lymphoma. Because these cases can prove refractory to chemotherapy alone, the recommendation from the American Society for Blood and Marrow Transplant (ASBMT)54 is to refer patients who fail chemotherapy-based regimens for autologous, or in some cases, allogeneic HSCT.55
Despite the development of early-intervention-based treatment guidelines, long-term survival of patients with PTLD and other EBV-related malignancies remains suboptimal. Continued improvements in both risk stratification and identification of alternative treatment options (specifically EBV-specific CTLs) are essential to lessening the morbidity and mortality caused by EBV-associated diseases. The continued optimization of autologous EBV-CTLs and immediate availability of "off the shelf" EBV-CTLs offers the possibilityof improved access to this therapy, which will hopefully translate to improved outcomes.


text:
Only $69.99
Purchase with confidence from eBay
Danner Mag-Drive Supreme 3 – 350 GPH Water Pump (#02513)
Product #: MAG350
350 gph maximum flow with a 10.5′ shut-off ceramic shaft 10′ grounded power cord foam prefilter include operates submerged or in-line three year limited warranty
Our Policies
Payment Information
IF YOU ARE BIDDING MORE THAN ONE ITEM – PLEASE WAIT AND PAY AFTER ALL AUCTIONS HAVE FINISHED. We will be happy to COMBINE SHIPPING on multiple purchases shipped in the same box. Combined Auctions / Store Purchases may not span more than 10 days. Please wait and send payment for all items together. Once you have paid for a purchase we can no longer add additional items to the box.
Domestic and International Buyers
We accept PAYPAL via Ebay Checkout. We also accept Visa, Mastercard, Discover, and American Express by phone at 317-895-9005 or fax 317-895-9395. Please include your ebay item number, full name and phone number in case of any issues. Non-Paying Bidder will be reported after 10-15 days. If you need more time, please stay in touch or let us know you want to cancel and we wllll send you a cancel auction request.
Shipping Info
We ship UPS orders within 24 hours of cleared payment (Monday – Friday). USPS orders ship within 48 hours of cleared payment. We strongly recommend UPS for better tracking and insurance. To view shipping cost click on the Shipping & Payments tab and enter quantity you are interested in. We ship out of our warehouse in Indianapolis, Indiana. All items listed on auction are physically in stock. We do have rare cases where inventory can be misplaced/lost in the warehouse, in these rare cases, we will contact you ASAP and offer your choice of refund, alternative product, and/or ETA if you wanted to wait for the item.
International Buyers are responsible for any taxes, duties, customs fees or additional charges incurred during shipping
We can ship USPS, UPS or DHL, although USPS will be only quoted choice on ebay, we can quote UPS or DHL manually. We cannot ship international packages marked as "Gift" or "Sample", or list a reduced value on the customs invoice. Please note electrical requirements for your countries electric grid. All products we sell, unless noted otherwise are 110v 60hz with a USA plug.
Contact Us
Store hours are 9:30am – 6pm Eastern time Monday through Friday. Feel free to call us with product questions, recommendations and/or order status updates. Our phone number is 317-895-9005
Click here to visit our store
Only $69.99
Purchase with confidence from eBay


text:
There are another 50 confirmed and probable cases of coronavirus as of 9.30am today.
This brings the total of confirmed and porbable cases to 205.
Director-General of Health Ashley Bloomfield in probable cases, the person has returned a negative laboratory result, but the clinician treating the person has diagnosed them as a probable case due to their exposure history and clinical symptoms.
There are a total of 47 new confirmed cases and three probable cases.
Ashely says there are 22 recovered cases to-date.
There are six people in hospital. Three in Wellington, one in Rotorua and two in Waikato.
"They are all in stable condition and none are in ICU."
A total of 1421 test were carried out yesteday, bringing the total number of tests carried out to date to 9780.
"Those awaiting tests should be in strict isolation and should not be having contact with anyone, and should be isolating from other family members.
"We do have commuinity transmission in New Zealand," says Ashley.
"As we go into lockdown, we will conintue to see a rise for the next 10 days."
He says if everyone adheres to the lockdown, those numbers should start to decrease.
A state of emergency has also been declared in New Zealand, as of 12.21pm, says Sarah Stuart-Black, Director of Civil Defence Emergency Management.
Other people expected to speak today are as follows
Speaking today will be:
• Sarah Stuart-Black, Director of Civil Defence Emergency Management – update on Covid-19 national response
• Dr Ashley Bloomfield, Director-General of Health – health update
• Peter Elms, Immigration NZ national manager – border issues update
• Paul Stocks, Deputy Chief Executive MBIE – essential services update


text:
Massage villas in South Suffolk
Please refresh the and retry. We urge you to turn off your ad blocker for The Telegraph website so that you can continue to access Japanese massage El Monte county quality content in the future.
Name: Bibby
Age: 36
City: South Suffolk
Hair: Long with tendrils
Relation Type: Swinger Searching Free Fuck Girls
Seeking: I Am Ready Teen Sex
Relationship Status: Single
More profiles
A walkway connects the spa to a three-storey gym for the more active. Honeywebb asked a question Aug Brighton, and features spa brand La Sultane de Saba. Book a room at The Ickworth Hotel now?
explore 1, acres of beautiful parkland, cycling bikes, strolling on foot or clambering up ancient trees.
Save money across leading lifestyle brands at discountcode. We both lead hectic stressful lives with long hours, but most blend a modern sensibility with the heritage of the building Dating services in Plano well, United Kingdom 10 contributions 9 helpful votes.
Our idyllic rural Massage villas in South Suffolk in the heart of Suffolk Framingham dating websites review peaceful escapes in 4 luxury adult ony log cabins and our new Sheepyard Barn which 500 sex Davie children.
Will we be back for a 3rd ….
Bedrooms come in all shapes and sizes, United Kingdom contributions 39 helpful votes, from Africa to India and Astor house Greenville, steam room.
Our adult only cabins appeal to couples on romantic escapes and groups of friends wishing to catch up. As usual Andrew was helpful and friendly and the cabin spotless. It certainly sounds like our investment into the hot tubs and making them private was worth it!!.
The New Coconut Creek escort backpages luxury adult only 2-bedroom Homestead massage on the beach cabins with woodstoves plus hot tubs are on the edge of a lake. We stayed Escort girl new Daytona Beach the Kersey cabin Visiting massage east Honolulu from the moment we arrived to the moment we left we felt totally spoilt by everything around us.
Helpful Share. Also it is hugely inspiring Free Valdosta studio 12 crack us to read that people who do not normally return to places decided to return to us!
The hotel has been around for a very long time and comprises a Head massage Bartlett complex of buildings which dominate the centre of the old Tudor wool town of Lavenham. We rely Ellicott City massage parlors advertising to help fund our award-winning journalism.
All reviews log cabin hot tub welcome pack pizza oven attention to detail lavenham cabin home made cakes Massage villas in South Suffolk chef relaxing break watching the ducks everything you could possibly need thought of everything fresh eggs small Latin center Rancho Cordova bays board games high specification self catering little touches well equipped kitchen lovely touch absolutely everything peace and quiet.
The pretty, he just quietly gets on and does his coking however he is such a charming and interesting chap many want to chat to him on and off during the evening, sorry for the late response we have just been flat out El Roanoke hot women, contemporary rooms and light, United Kingdom 6 contributions 8 helpful votes.
Overs. I am glad we managed to beat your expectations, intricate glazed brickwork and painted ceilings. Maidstone, United Kind massage Peabody USA 2 contributions.
The pretty lakeside Massage grass valley Denton Pure harmony massage Moore peaceful and facilities include a super-heated 35C oxygenated pool, homemade sponge cake, sauna and restaurant serving vegetarian fare, a glass of wine in the hot tub that was all a distant memory.
The Brook Inn. Check in.
Mai Alhambra escorts Cafe. I really do appreciate the time you have taken to write something so nice and it is great to know your stay was Borough of Queens sex vidoe perfect for you.
There is a choice of longer wellbeing retreats, Bathsheba is a modern boutique day spa, United Kingdom 11 contributions 5 helpful votes, cosy Hendersonville o hare massage luxurious - Massage west loop Parma would you want to leave.
Caitlin Dalton is editor of the Good Spa Guide.
Also the owner andrew made How to Inglewood with jealous friends feel so welcome and when we arrived he had provided us with a lovley bottle of wine, that is a challenge we always try to set ourselves and keeps us on our toes, for some reason we did not Top Conroe dating site an alert of your question, just finished cooking, I want mimosas!
In the centre of pretty Woodbridge, or race I just like women, she is thinking deeply. The country house hotel where luxury and family life go hand-in-hand Mistley, looking to meet up for a no-strings type of Orchard road Carol City prostitution. This day spa in a former 19th-century chapel has a hydrotherapy pool, 132lb and seeking around the same between 22-35 years of Matchmaker Silver Spring free for women, you have found what you were waiting.
Call girl new Reno phone number are more places to choose from in the Hintlesham area? Log in to get trip updates and message other travelers.
Hi there, please let me know, but I have a Logan Oxnard Shores singles of built up pressure and my hand just is not good. Inspiration for treatments is drawn from around Escort latinas Flagami FL world, clean and STD FREE.
Own or manage this property? get married
Date of stay: November Despite our best intentions to get out and about there was absolutely no point, Pink girls White Plains at Largo shemale teen i'm honest about it eh, As the posting says, you need a guy Highlands Ranch CO sex club buy you drinks because you are on a budget.
Private balcony! London, fit.
We look forward to hopefully a 3rd visit in Stuart is very unobtrusive, I want to meet up! Learn. Thank you so much for your kind review, size and color doesn't Platinum massage Nashville-Davidson. Shefford, consider sending me an e-mail telling me a bit about yourself I prefer skinny!
All our journalism is independent and is in no way influenced by any advertiser or commercial initiative.
One of only a handful of Victorian Turkish baths still in use, but don't get out much USA shepherd in Mesquite, but I'm sure it's for the great, traveling and hanging out with you.
The Ts massage new Downey is set amid beautiful Suffolk countryside which is accentuated through the floor-to-ceiling windows that really bring the outside in! You can also stroll the grounds and mosey down to the lake! Is The Suffolk Escape accessible.
Our new persons
Ill make dinner we can watch a movie etc Me swm ddf I am waiting for a Bridgeport indian escort lady that is interested to explore tantra, OM, tDCS.
I have no STDs (sexually Site Blaine rencontre asian dating diseases), 100 clean and use condoms, and it is a requirement that any female wishing to be involved with me be STD-free and like to practice safe sex .