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bondesmeralda

Inscrit le: 20/052013
Messages: 101
Message Répondre en citant Posté le: 07/04/2017
Sujet du message: Cheap Pandora On Sale Saving 70% Off,Discount Pandora Jewelr

Investors really are targeting Navi Mumbai as the prices let us discuss on that increase.This is a newly made area just round the harbor.Navi and various suburbs happen to be ideal places available for you in case you are planning to invest in residential asset in Mumbai.As for because the investment around commercial qualities in Mumbai is concern, you experience all offers of gaining a superb investment return on your side.Indian government has taken some superior steps in this particular regard.Relaxation inside the strict Forex Direct Financial commitment regime contains proved an extensive support to get foreign people.More companies attended forward to invest in India.They've got taken up many square base of private properties around Mumbai this demand is escalating.If you might be preparing to obtain or market properties in Mumbai, then neatest thing that can be done is to rent the services of whatever property business.If you will be short before its due then there are plenty of property specialists like Improved Homes India that offer online solutions.Hiring the actual services on the property agency can assist you in grasping the most beneficial deal for yourself in minimal time.
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<div><img>Pandora Essence Collection HEALTH Charm<div><span>$55.00 </span>&nbsp;<span>$33.00</span><span><br>Save:&nbsp;40% off</span></div></div><div><img>Pandora Cherry Blossom Festival Set<div><span>$310.00 </span>&nbsp;<span>$188.00</span><span><br>Save:&nbsp;39% off</span></div></div><div><img>Pandora Three Wishes with Grey Pearl Ring<div><span>$148.00 </span>&nbsp;<span>$85.00</span><span><br>Save:&nbsp;43% off</span></div></div></div>

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<h2>Featured Products</h2><div><div><div><img></div><br>Pandora Labrador with Clear CZ Charm<br><span>$64.00 </span>&nbsp;<span>$39.00</span><span><br>Save:&nbsp;39% off</span></div></div>
<div><div><div><img></div><br>Pandora Clear CZ Pavé Lights Charm<br><span>$142.00 </span>&nbsp;<span>$65.00</span><span><br>Save:&nbsp;54% off</span></div></div>
<div><div><div><img></div><br>Pandora 14K Intuition with Black Onyx Compose Earring Charms<br><span>$350.00 </span>&nbsp;<span>$204.00</span><span><br>Save:&nbsp;42% off</span></div></div>
<br><div><div><div><img></div><br>Pandora Buddy/Dog Dangle<br><span>$91.00 </span>&nbsp;<span>$46.00</span><span><br>Save:&nbsp;49% off</span></div></div>
<div><div><div><img></div><br>Pandora Clear Pavé Heart Charm<br><span>$167.00 </span>&nbsp;<span>$69.00</span><span><br>Save:&nbsp;59% off</span></div></div>
<div><div><div><img></div><br>Pandora Essence Collection FAITH Charm<br><span>$69.00 </span>&nbsp;<span>$42.00</span><span><br>Save:&nbsp;39% off</span></div></div>
<br><div><div><div><img></div><br>Pandora A Cloud's Silver Lining Charm<br><span>$67.00 </span>&nbsp;<span>$26.00</span><span><br>Save:&nbsp;61% off</span></div></div>
<div><div><div><img></div><br>Pandora Turquoise December Birthday Bloom Stud Earrings<br><span>$121.00 </span>&nbsp;<span>$50.00</span><span><br>Save:&nbsp;59% off</span></div></div>
<div><div><div><img></div><br>Pandora Mr. & Mrs. Wedding Charm<br><span>$89.00 </span>&nbsp;<span>$40.00</span><span><br>Save:&nbsp;55% off</span></div></div>
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<h2>New Products For October</h2><div><div><div><img></div><br>Pandora Cheers Dangle<br><span>$83.00 </span>&nbsp;<span>$44.00</span><span><br>Save:&nbsp;47% off</span></div></div>
<div><div><div><img></div><br>Pandora Star of David with Clear CZ Dangle<br><span>$85.00 </span>&nbsp;<span>$31.00</span><span><br>Save:&nbsp;64% off</span></div></div>
<div><div><div><img></div><br>Pandora Gondola with Clear CZ Dangle<br><span>$107.00 </span>&nbsp;<span>$49.00</span><span><br>Save:&nbsp;54% off</span></div></div>
<br><div><div><div><img></div><br>Pandora St. Basil's Cathedral Dangle RETIRED<br><span>$69.00 </span>&nbsp;<span>$49.00</span><span><br>Save:&nbsp;29% off</span></div></div>
<div><div><div><img></div><br>Pandora Sweet Sister with Clear CZ Dangle<br><span>$75.00 </span>&nbsp;<span>$42.00</span><span><br>Save:&nbsp;44% off</span></div></div>
<div><div><div><img></div><br>Pandora Shear Perfection Dangle<br><span>$52.00 </span>&nbsp;<span>$34.00</span><span><br>Save:&nbsp;35% off</span></div></div>
<br><div><div><div><img></div><br>Pandora Tigress/Tiger Dangle<br><span>$77.00 </span>&nbsp;<span>$48.00</span><span><br>Save:&nbsp;38% off</span></div></div>
<div><div><div><img></div><br>Pandora Mouse Dangle RETIRED LIMITED QUANTITIES!<br><span>$97.00 </span>&nbsp;<span>$48.00</span><span><br>Save:&nbsp;51% off</span></div></div>
<div><div><div><img></div><br>Pandora The Strong Ox Dangle<br><span>$91.00 </span>&nbsp;<span>$48.00</span><span><br>Save:&nbsp;47% off</span></div></div>
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<li>Pandora is one of the most famous jewelry brands in the fashion world and the popular Pandora jewellery wins itself many regular consumers by its unique Pandora-style and reliable quality. Pandora jewelry is the best accessory choice for you if you want to look fashionable, elegant and outstanding. Here, we have the most complete stock of Pandora jewelry, so you definitely can find one piece of jewelry that suits you perfectly. Meanwhile, we can offer you the best discount and fastest delivery. So, don't hesitate, the cheapest Pandora jewelry is waiting for you!</li>

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Investors really are targeting Navi Mumbai as the prices let us discuss on that increase.This is a newly made area just round the harbor.Navi and various suburbs happen to be ideal places available for you in case you are planning to invest in residential asset in Mumbai.<br><br>As for because the investment around commercial qualities in Mumbai is concern, you experience all offers of gaining a superb investment return on your side.Indian government has taken some superior steps in this particular regard.Relaxation inside the strict Forex Direct Financial commitment regime contains proved an extensive support to get foreign people.More companies attended forward to invest in India.They've got taken up many square base of private properties around Mumbai this demand is escalating.<br><br>If you might be preparing to obtain or market properties in Mumbai, then neatest thing that can be done is to rent the services of whatever property business.If you will be short before its due then there are plenty of property specialists like Improved Homes India that offer online solutions.Hiring the actual services on the property agency can assist you in grasping the most beneficial deal for yourself in minimal time.<br><br> pandora wholesale blog <br><br> pandora valentine day <br><br> About pandoraonlineshop.top blog
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bondesmeralda

Inscrit le: 20/052013
Messages: 101
Message Répondre en citant Posté le: 30/04/2017
Sujet du message: Purchase Your Favorite Replica Hublot Watches Online

. Lange &amp; S?hne
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http://www.manreplicawatches.org/replica-blancpain-c-1186.html Replica Blancpain
http://www.manreplicawatches.org/replica-breguet-c-1191.html Replica Breguet
http://www.manreplicawatches.org/replica-breitling-c-1231.html Replica Breitling
http://www.manreplicawatches.org/replica-brunosohnle-c-1102.html Replica BrunoSohnle
http://www.manreplicawatches.org/replica-bvlgari-c-1253.html Replica Bvlgari
http://www.manreplicawatches.org/replica-chopard-c-1222.html Replica Chopard
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http://www.manreplicawatches.org/replica-franck-muller-c-1159.html Replica Franck Muller
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http://www.manreplicawatches.org/replica-georg-jensen-c-1384.html Replica Georg Jensen
http://www.manreplicawatches.org/replica-girardperregaux-c-1179.html Replica Girard-Perregaux
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<li> <img><br>Replica Gorgeous Hublot Big Bang Chronograph Asia Valjoux 7750 Movement With Brown Dial AAA Watches <br><span>$866.00 </span>&nbsp;<span>$431.00</span><span><br>Save:&nbsp;50% off</span></li></ol>
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<div><img>Replica Gorgeous Audemars Piguet Jules Audemars Skeleton Manual Winding AAA Watches<div><span>$504.00 </span>&nbsp;<span>$216.00</span><span><br>Save:&nbsp;57% off</span></div></div><div><img>Replica Perfect Breitling For Bentley Working Chronograph Quartz Stainless Steel AAA Watches<div><span>$543.00 </span>&nbsp;<span>$215.00</span><span><br>Save:&nbsp;60% off</span></div></div><div><img>Replica Popular Tag Heuer Link Working Chronograph With White Dial AAA Watches<div><span>$492.00 </span>&nbsp;<span>$215.00</span><span><br>Save:&nbsp;56% off</span></div></div></div>

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<div><div><img></div><br><h3>Replica Modern Hublot Big Bang AAA Watches</h3><div></div><br><span>$524.00 </span>&nbsp;<span>$220.00</span><span><br>Save:&nbsp;58% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Modern Hublot Big Bang AAA Watches</h3><div></div><br><span>$498.00 </span>&nbsp;<span>$216.00</span><span><br>Save:&nbsp;57% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Modern Hublot Big Bang AAA Watches</h3><div></div><br><span>$503.00 </span>&nbsp;<span>$217.00</span><span><br>Save:&nbsp;57% off</span><br><br><img><br><br></div>
<br><div><div><img></div><br><h3>Replica Modern Hublot Big Bang Chronograph Asia Valjoux 7750 Movement Ceramic AAA Watches</h3><div></div><br><span>$854.00 </span>&nbsp;<span>$431.00</span><span><br>Save:&nbsp;50% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Modern Hublot Big Bang Chronograph Asia Valjoux 7750 Movement PVD Case AAA Watches</h3><div></div><br><span>$862.00 </span>&nbsp;<span>$430.00</span><span><br>Save:&nbsp;50% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Modern Hublot Big Bang Chronograph Asia Valjoux 7750 Movement Rose Gold AAA Watches</h3><div></div><br><span>$860.00 </span>&nbsp;<span>$429.00</span><span><br>Save:&nbsp;50% off</span><br><br><img><br><br></div>
<br><div><div><img></div><br><h3>Replica Modern Hublot Big Bang King Chronograph Asia Valjoux 7750 Movement Rose AAA Watches</h3><div></div><br><span>$868.00 </span>&nbsp;<span>$429.00</span><span><br>Save:&nbsp;51% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Modern Hublot Big Bang King Chronograph Asia Valjoux 7750 Rose Gold AAA Watches</h3><div></div><br><span>$851.00 </span>&nbsp;<span>$430.00</span><span><br>Save:&nbsp;49% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Modern Hublot Big Bang Tulga Chronograph Asia Valjoux 7750 Movement AAA Watches</h3><div></div><br><span>$881.00 </span>&nbsp;<span>$430.00</span><span><br>Save:&nbsp;51% off</span><br><br><img><br><br></div>
<br><div><div><img></div><br><h3>Replica Perfect Hublot Big Bang AAA Watches</h3><div></div><br><span>$521.00 </span>&nbsp;<span>$219.00</span><span><br>Save:&nbsp;58% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Perfect Hublot Big Bang AAA Watches</h3><div></div><br><span>$514.00 </span>&nbsp;<span>$220.00</span><span><br>Save:&nbsp;57% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Perfect Hublot Big Bang Chrono Asia Valjoux 7750 Movement PVD Case Limited AAA Watches</h3><div></div><br><span>$866.00 </span>&nbsp;<span>$431.00</span><span><br>Save:&nbsp;50% off</span><br><br><img><br><br></div>
<br><div><div><img></div><br><h3>Replica Perfect Hublot Big Bang Chronograph Asia Valjoux 7750 Movement AAA Watches</h3><div></div><br><span>$851.00 </span>&nbsp;<span>$432.00</span><span><br>Save:&nbsp;49% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Perfect Hublot Big Bang Chronograph Asia Valjoux 7750 Movement PVD Case AAA Watches</h3><div></div><br><span>$864.00 </span>&nbsp;<span>$433.00</span><span><br>Save:&nbsp;50% off</span><br><br><img><br><br></div>
<div><div><img></div><br><h3>Replica Perfect Hublot Big Bang King Automatic Rose Gold Case With White Dial AAA Watches</h3><div></div><br><span>$504.00 </span>&nbsp;<span>$219.00</span><span><br>Save:&nbsp;57% off</span><br><br><img><br><br></div>
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. Lange &amp; S?hne
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http://www.manreplicawatches.org/replica-blancpain-c-1186.html Replica Blancpain
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http://www.manreplicawatches.org/replica-breitling-c-1231.html Replica Breitling
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http://www.manreplicawatches.org/replica-bvlgari-c-1253.html Replica Bvlgari
http://www.manreplicawatches.org/replica-chopard-c-1222.html Replica Chopard
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bondesmeralda

Inscrit le: 20/052013
Messages: 101
Message Répondre en citant Posté le: 24/05/2017
Sujet du message: UGG Elsey Chocolate Boots On Sale - $224.00 : Ugg Boots Outl

mething else I rather have is Goodyear Welted Building, which greatly increases your style boot resilience.Make of course the style boots will be stitched, certainly not glued, and thus the feet are wholly replaceable as you do finally use them down, and shall we face the software motorcycle drivers are tough on their motorcycle hunter wellies.The uppers will certainly last literally forever hence don't earn the mistake involving motorcycle footwear without replaceable bottoms.
Something else overlooked just by many is known as a Toe Shifter Cushion.This is normally of big Importance to make sure you bikers so it protects the actual toe together with arch from fatigue and damage attributable to gear alternating.That's not an item everyone acknowledges but it can be crucial.
Be sure the style boots you pay for have Level of quality Non-Tarnishable Equipment.You intend your motorbike boot hardware to be as rubbed and gleaming as an individual's bike.
I also much like the Texon Insole which will takes moisture removed from the foot to continue it because dry that they can.The insole is usually anti-microbial, preventing unhealthy bacteria growth as part of your motorcycle footwear.Make sure the liner of your own motorcycle footwear is completely leather padded with additional upper padding to grant maximum ease.
Look for those Bison Stampede Arranged from Chippewa which is made of the U .s Bison.This specific leather is normally supple, cozy, and heavy duty.It in general outlasts daily bovine imitation leather by just as much as 50-80%.
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mething else I rather have is Goodyear Welted Building, which greatly increases your style boot resilience.Make of course the style boots will be stitched, certainly not glued, and thus the feet are wholly replaceable as you do finally use them down, and shall we face the software motorcycle drivers are tough on their motorcycle hunter wellies.The uppers will certainly last literally forever hence don't earn the mistake involving motorcycle footwear without replaceable bottoms.<br>
<br>
Something else overlooked just by many is known as a Toe Shifter Cushion.This is normally of big Importance to make sure you bikers so it protects the actual toe together with arch from fatigue and damage attributable to gear alternating.That's not an item everyone acknowledges but it can be crucial.<br>
<br>
Be sure the style boots you pay for have Level of quality Non-Tarnishable Equipment.You intend your motorbike boot hardware to be as rubbed and gleaming as an individual's bike.<br>
<br>
I also much like the Texon Insole which will takes moisture removed from the foot to continue it because dry that they can.The insole is usually anti-microbial, preventing unhealthy bacteria growth as part of your motorcycle footwear.Make sure the liner of your own motorcycle footwear is completely leather padded with additional upper padding to grant maximum ease.<br>
<br>
Look for those Bison Stampede Arranged from Chippewa which is made of the U .s Bison.This specific leather is normally supple, cozy, and heavy duty.It in general outlasts daily bovine imitation leather by just as much as 50-80%.<br><br> On blog <br><br> UGG <br><br> About uggonlinestorefordiscount.top blog
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bondesmeralda

Inscrit le: 20/052013
Messages: 101
Message Répondre en citant Posté le: 01/06/2017
Sujet du message: Moncler Gene Design Down Jackets Womens Decorative Belt Whit

"As a general rule something that is compact enough to suit through any tube of a roll with toilet paper is actually a choking risk, " states Dr.Garry Gardner, a pediatrician who sits about the American Academy associated with Pediatrics' Panel on Damage, Violence as well as Poison Prevention.
Rather, parents should consider swapping outside their typical outlet dish covers with one which has slipping plastic doors to pay for the sockets, suggests Areas.They're not just safer, but also more convenient to use.
#4 It may be tempting to adorn the nursery by using cozy bedding sets complete utilizing fluffy quilt, bumper as well as matching pillows.But most safety experts recommend averting them for fear of suffocation or simply rebreathing (when a young child breathes with his before exhaled and also carbon dioxide) that can result in Sudden Little one Death Syndrome (SIDS)."We think the crib ought to be bare, " says Don Mays, older director associated with product safety and customer sciences for the purpose of Consumer Reviews."Put the infant in comfortable clothing and remove just about all soft bed sheets."
#5 An additional sleeping hazard:the rest positioner.This can be a piece associated with foam that's used to prevent a baby from flipping over onto his / her stomach.(Sleep gurus warn this infants can't sleep on their tummies because it could bring about SIDS.) "While it had been designed for safety them actually compromises it again, " states Consumer Reports' Mays.As babies inside a positioner change their heads from side to side the froth can conform to the confront and reason suffocation in addition to rebreathing.
A safer sleep option would be to snuggly swaddle infants for that first few months.Then after they are formidable enough to turn over by themselves, it's safe to make them maneuver around and sleep nonetheless they want.
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<div><p>Moncler Gene Design Down Jackets Womens Decorative Belt White,are made with the first class material,stylish and luxurious,light in weight and comfortable for wear,that is the reason why people are willing to pay so much money on them.You can find a variety of types of the moncler,for men,for women and for kid from our website,you can be sure to show up in style.why not to come to our website and get your coat for the new season?</p><p>Style: Smart Casual<br>Sleeve: long sleeve<br>Fabric Material: Nylon<br>Style segments: England<br>Lining Material: Polyester<br>Filler: 90% white goose down</p><p>Moncler Gene Jackets Womens,Moncler a clothing sensation beginning in the fashion capital of the world, France. Moncler was found in the 1950's by Rene Ramilion. This collection has been created to interpret an urban and modern style through the eyes of class and elegance. Moncler is a collection specialising in outdoor clothing.</p></div>
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"As a general rule something that is compact enough to suit through any tube of a roll with toilet paper is actually a choking risk, " states Dr.Garry Gardner, a pediatrician who sits about the American Academy associated with Pediatrics' Panel on Damage, Violence as well as Poison Prevention.<br>
<br>
Rather, parents should consider swapping outside their typical outlet dish covers with one which has slipping plastic doors to pay for the sockets, suggests Areas.They're not just safer, but also more convenient to use.<br>
<br>
#4 It may be tempting to adorn the nursery by using cozy bedding sets complete utilizing fluffy quilt, bumper as well as matching pillows.But most safety experts recommend averting them for fear of suffocation or simply rebreathing (when a young child breathes with his before exhaled and also carbon dioxide) that can result in Sudden Little one Death Syndrome (SIDS)."We think the crib ought to be bare, " says Don Mays, older director associated with product safety and customer sciences for the purpose of Consumer Reviews."Put the infant in comfortable clothing and remove just about all soft bed sheets."<br>
<br>
#5 An additional sleeping hazard:the rest positioner.This can be a piece associated with foam that's used to prevent a baby from flipping over onto his / her stomach.(Sleep gurus warn this infants can't sleep on their tummies because it could bring about SIDS.) "While it had been designed for safety them actually compromises it again, " states Consumer Reports' Mays.As babies inside a positioner change their heads from side to side the froth can conform to the confront and reason suffocation in addition to rebreathing.<br>
<br>
A safer sleep option would be to snuggly swaddle infants for that first few months.Then after they are formidable enough to turn over by themselves, it's safe to make them maneuver around and sleep nonetheless they want.<br><br> Jackets blog <br><br> Womens <br><br> About monclerwholesale.me blog
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laurypouta

Inscrit le: 15/062017
Messages: 2
Message Répondre en citant Posté le: 15/06/2017
Sujet du message:

Bonjour,

J’ai trouvé une bonne assurance obsèques sur http://www.action-prevoyance.fr/garantie-obseques/ ou http://www.action-prevoyance.fr/assurance-deces/ .

www.action-prevoyance.fr est un spécialiste de l’assurance prévoyance et compare plusieurs formules de contrats obsèques ou décès fiables et à des tarifs raisonnables. Vous pouvez faire un devis en ligne.

J’espère vous avoir aidé.
  Revenir en haut de page
bondesmeralda

Inscrit le: 20/052013
Messages: 101
Message Répondre en citant Posté le: 23/07/2017
Sujet du message: Replica Ulysse-nardin 266-66 watches - $223.00 : TITLE, SITE

¹ÚÉú԰·227ºÅ2ºÅÂ¥4Â¥£¬300ƽÃ×£¬2Ôª/©O/Ì죬ÎïÒµ6Ôª£¬Ö»ÓлõÌÝ£¬Ã»ÓеçÌÝ£¬±È½ÏʵÓ㡸ô¶Ï3´ó¼ä£¬5С¼ä£¬²»ÊÇÖн飬
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<li>Code:266-66</li>
<li>Brand:Ulysse-nardin</li>
<li>Style:Automatic mechanical , 41 mm , Men</li><li>Material:18k Rose Gold</li></ul>

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0
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<div>Price<span>Provide accurate prices, </span></div>
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<li>
RMB:
<span><em>No</em></span>
<em></em>
</li>
<li>
Euro:
<span>€ 18,300</span>
<em>2011-08</em>
</li>
<li>
HK :
<span><em>No</em></span>
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AJNR &raquo; Archive &raquo; Volume 1 &raquo; Issue 1 &raquo; Research Article
&nbsp;&nbsp; &nbsp;OPEN ACCESS&emsp;&emsp; &nbsp;PEER-REVIEWED
Nursing Interventions for Drug Users: Qualitative Meta-Synthesis
<p>
Selene Cordeiro Vasconcelos 1 , , Iracema da Silva Frazão 2 , Estela Maria Leite Meirelles Monteiro 3 , Murilo Duarte da Costa Lima 4 , José Francisco de Albuquerque 5 , Vânia Pinheiro Ramos 5 </p>
<p> 1 Neuropsychiatry of Universidade Federal de Pernambuco-UFPE, Psychosocial care center for alcohol and other drugs</p> <p> 2 Social Service, Universidade Federal de Pernambuco</p> <p> 3 Nursing, Universidade Federal de Pernambuco</p> <p> 4 Psychiatry, Universidade Federal de Pernambuco</p> <p> 5 Neuropsychiatry, Universidade Federal de Pernambuco</p>
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Abstract </p>
<p> 1 meta-analysis-example-in-nursing-research-rid-1587995.html. chanson de Rolex. Introduction </p>
<p> 2. Methods </p>
<p> 3. Results </p>
<p> 4. Discussion </p>
<p> 5. Conclusion </p>
<p> References </p>
<p>
Abstract
</p>
<p>
Objective: To identify the Brazilians nurses’ interventions in the drug users care. Methods: Research on the databases LILACS, PubMed, Scopus, CINHAL, and Cochrane, indexed from 2003 to 2012, using the keywords ‘health education’ and ‘substance-related disorders’. Obtained 8 articles as sample that resulted in a thematic and two sub themes. Results: Demonstrated that Brazilian nurses’ interventions in the drug users care are grounded in health education. Conclusion: Health education actions are relevant to the process of rehabilitation and social reintegration of drug user, can promote improvement in self-care and in the quality of life of this clientele, in addition to strengthening the nursing professional identity in this setting of care.</p>
<p>
Keywords: nursing, health education, substance-related disorders, drug users, mental health</p>
<p>
American Journal of Nursing Research , 2013 1 (1),
pp&nbsp;24-27. DOI: 10.12691/ajnr-1-1-4</p>
<p>Received July 31, 2013; Revised November 06, 2013; Accepted November 08, 2013</p>
Copyright © 2013 Science and Education Publishing. All Rights Reserved.
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Vasconcelos, Selene Cordeiro, et al. "Nursing Interventions for Drug Users: Qualitative Meta-Synthesis." American Journal of Nursing Research 1.1 (2013): 24-27.
Vasconcelos, S. C. , Frazão, I. D. S. , Monteiro, E. M. L. M. , Lima, M. D. D. C. , Albuquerque, J. F. D. , & Ramos, V. P. (2013). Nursing Interventions for Drug Users: Qualitative Meta-Synthesis. American Journal of Nursing Research , 1 (1), 24-27.
Vasconcelos, Selene Cordeiro, Iracema da Silva Frazão, Estela Maria Leite Meirelles Monteiro, Murilo Duarte da Costa Lima, José Francisco de Albuquerque, and Vânia Pinheiro Ramos. "Nursing Interventions for Drug Users: Qualitative Meta-Synthesis." American Journal of Nursing Research 1, no. 1 (2013): 24-27.
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1. Introduction <p>The performance of nursing experiences influences of social context, historical and cultural diversity of its clientele, constituting new demands on the health care that need to be inserted and adapted to different scenarios of care.</p>
<p>Particularly in the field of mental health, in recent decades, there has been a progressive restructuring in care, resulting from the redefinition of mental illness and its sufferers. Drug users, inserted in this context, also undergo a process of deconstruction and reconstruction of their representation in society, initially discriminated against and marginalized until the current understanding of patients.</p>
<p>These patients have peculiarities related to changes in behavior, changes in critical thinking and judgment, which results in functional disorders individual, family and social [ 1 ] . Therefore the patient becomes vulnerable to health problems, puts himself in risk situations and has a commitment to self-care.</p>
<p>Thus, the logic of the expanded clinical care, offers a support for drug users grounded in the knowledge of professionals with different backgrounds [ 2 ] , encouraging co-responsibility, autonomy and citizenship of this clientele. It is noted that each professional exerts its interventions according to their area of expertise.</p>
<p>In this context, the nurse needs to seek the knowledge necessary to effective practice, evidence-based, that provides the security needed to work within an interdisciplinary team without losing their specificity.</p>
<p>From these considerations, emerged the following research question: "What are the interventions of Brazilian nurses in the drug users’ care?" Therefore, this research aims to identify interventions used by Brazilian nurses in the care of drug users.</p>
2. Methods <p>It was decided to conduct a meta-synthesis of the literature [ 3 , 4 ] . This methodology aims to strengthen the role of qualitative research in the health sciences, improving the applicability of the results in clinical practice, support the theory, practice, research and health policies [ 3 ] .</p>
<p>To contemplate the methodological rigor, followed the steps: 1. identify the purpose of the research and intellectual interests; 2. establish criteria for inclusion and exclusion of studies, conduct data collection and evaluation of individual research; 3. analyze the research; 4. relate studies by the juxtaposition of results; 5. prepare new statements; 6. develop a new explanation [ 5 ] .</p>
<p>To find the articles were performed the choice of Descriptors in Health Sciences (MeSH): 'Health Education' and 'Substance-related Disorders'. The search was conducted by online access, in January 2013.</p>
<p>To select the articles we used the following databases: LILACS (Latin American and Caribbean Health Sciences), PubMed (Public/Publish Medline), CINHAL (Cumulative Index to Nursing and Allied Health Literature), Scopus and Cochrane. Adjustments were made in the strategies used to find the articles, but was preserved as guiding the question and the inclusion criteria previously established, to maintain consistency in the search for articles and avoid possible biases. The databases PubMed, Scopus, and CINAHL allowed perform an advanced search, justifying a lower number of items rescued.</p>
<p>The inclusion criteria adopted to guide the search and selection of articles were: research in Portuguese language, English and Spanish, full articles published in national and international journals in the period 2003-2012, indexed in the databases used, qualitative studies, portraying the nursing interventions care to drug users with, at least, one Brazilian nurse in the board of authors.</p>
<p>Exclusion criteria were: publications relating to conference abstracts, annals, editorials, reviews and opinions, review articles without systematic literature review, theses, dissertations and research projects. </p>
<p>After obtaining the sample, articles selected were submitted to the reading for the collection of relevant information [ 6 ] and assessment of methodological rigor [ 7 ] through the application of instruments [ 6 , 7 ] . Both the analysis and synthesis of data extracted from the articles were made descriptively to observe, describe and classify the data in order to gather the knowledge produced on the theme explored in the meta-synthesis. Therefore, the meta-synthesis is capable of producing a new concept through synthesis of the content of the studies surveyed in order to transform several qualitative studies in a new study and contribute to the socialization of scientific knowledge [ 8 ] .</p>
3. Results <p>From the digital search, 189 articles were found in the databases consulted, 181 were excluded for not meeting the inclusion criteria. Among the articles excluded, it was observed that the majority addressed the prevention of drug misuse and the epidemiological profile and/or characteristics of drug users. Other approached the conceptions of families about the use of drugs and treatment, the pattern of drug use, factors associated with drug use; characterization of chemically-dependent; medical comorbidities and drug use by students and nursing professionals.</p>
<p>The search was performed by online access, in January 2013, being the final sample of this integrative review constituted by 8 articles ( Table 1 ).</p>
Table 1. Selection of research articles in the databases LILACS, PubMed, CINAHL, Scopus e Cochrane, according to the inclusion criteria
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<p>All selected articles were published in Brazilians journals. Eight articles were identified in LILACS. In relation the type of journal in which they were published, two belonged to the Journal Interface - Comunicação, Saúde, Educação, the others were published in the Anna Nery School Journal of Nursing.</p>
<p>The 8 articles selected and analyzed showed a level of evidence VI, because they are evidence derived from a single descriptive or qualitative study [ 7 ] . These articles were identified by letters of the alphabet as follows:</p>
<p>A. Youth and drug use: workshops instrumentalization of workers in social institutions, in view of health/2009.</p>
<p>B. The nurses’ role in primary health care approach drug addict in João Pessoa, PB, Brazil/2010.</p>
<p>C. Alcoholic beverage in adolescence: the care-education as action strategy of nursing/2010.</p>
<p>D. Alcoholism in women: support for the professional practice of nursing/2008.</p>
<p>E. Nurse's role in caring for the user of alcohol and other drugs in outpatient services/2007.</p>
<p>F. Reflections on drug abuse and violence in youth/2010.</p>
<p>G. Health education in nursing work with drug users/2003.</p>
<p>H. The harm reduction approach in non-formal educational spaces: a qualitative study in the state of Rio de Janeiro, Brazil/2011.</p>
<p>The theme "Learning to care" was built as a new assertion of this meta-synthesis because the eight articles discussed the importance of the nurse know the reality of the person who needs their care, whether it be the user, their family or the own healthcare team. Therefore, the intervention of nurses has been: individual care, therapeutic workshops, therapeutic groups, individual semi-structured interviews, and semi-structured interviews with collective application.</p>
<p>By knowing your clientele, nurses take subsidies to plan your tour. From this perspective, the analysis of items B, C, E, F and G originated the themed - 1 "The nurse performs actions of health education for drug users”. The articles described interventions of Brazilian nurses in the drug users’ care. These actions were executed through advices, referral and therapeutic listening and aimed to promote integrated care, disease prevention, health promotion, furthermore, consider the user context in which he lives.</p>
<p>As a result of these nursing interventions, users demystified their ideas about alcohol consumption and developed critical reflection on protective strategies, drug dependence, consequences of consumption and harm reduction.</p>
<p>Analysis of articles A and D originated the themed - 2 "The nurse plays educational actions for professionals who care for drug users" where the clientele was composed by health professionals. These interventions were developed through therapeutic workshops and semi-structured interviews with collective application. </p>
<p>Thus, professionals appropriated concepts and develop critical analysis of reality; learned about the origin of harmful drug consumption; undid myths, prejudices and stereotypes about the user, the power and effects of drugs; understood the female alcoholism; were made reflections in relation to public policy and the reality of nursing practice through health education.</p>
4. Discussion <p>As result of the interpretation of the research found in the selected studies and demonstrated in this meta-synthesis, knowledge for improved care, implies the understanding of the socio-historical context [ 9 ] and the knowledge of the other as an assumption of therapeutic care, which must be built from a supportive relationship, looking for alternatives and possibilities facing the problems, noting the complexity of the subject and the world in which he lives [ 10 ] . Knowledge about the family history provides care for it in an integral way, with opportunity to interact with people, strengthening the bond and favoring communication, being able to share the care to be performed [ 11 ] .</p>
<p>Moreover, the family has an important role to perform a control on the use of psychoactive substances among its members, with socialize according to idealized community values [ 12 ] .</p>
<p>To know about the users and their families contributes to the elaboration of strategies most appropriate to this clientele reality with the aim to employ a harm reduction approach based on the social determinants of health that supports evidence-informed choice among programme participants [ 13 ] .</p>
<p>Beyond this, a program’s health educators provide a space for conversation between the members. In these calls, the parents reported full involvement with the treatments and benefitted from each. They also understand the importance of communicating with their members and the relationship between participating parents and the health educators appears to have contributed to the program’s successful implementation [ 14 ] .</p>
<p>However, just knowing this reality is not enough to perform nursing interventions appropriate to the logic of the expanded clinical care. As an example, some nurses reported that even working on Psychosocial Care Center for Alcohol and other Drugs (CAPSad) feel unprepared to care for drug users, hindering their integration into health treatment [ 12 ] .</p>
<p>An academic deficit about drug use, generates a lack of knowledge about the complexity of this phenomenon and the nurse's role in the scenery [ 15 ] . Faced with the limited experience with this theme, nurses tend to seek other sources of knowledge, such as discussion with the team, internet, reading books and articles [ 16 ] .</p>
<p>Due to the work process, the nurses remain more time with your clientele and build a broad experience in interpersonal relationships, which contributes to their interventions with drug users, developing educational and therapeutic health promotion, prevention, monitoring of comorbidities, rehabilitation and social reintegration within health institutions and in the community [ 17 ] .</p>
<p>This situation reinforces the importance of nurses conduct health education with other health professionals team in the workplace itself, about the use of drugs [ 16 ] . At this moment, it is necessary linkage between the service management and public policy for this educational support. The theoretical knowledge acquired during the graduate is appointed as a facilitator to overcome difficulties during labor insertion of newly graduated nurses [ 18 ] . To improve this formal education, courses are offered on the drug phenomenon, which has been a successful experience in the political, academic and social [ 19 ] .</p>
<p>This insight is important in providing a foundation for the development of educational approaches aimed at challenging what appear to be negative attitudes to illicit drug users within nursing. Student nurses enter training with a wide range of personal experiences relating to illicit drug use. The influences of society's, negative views and the image of drug use presented in the press appeared to be significant factors in developing their attitudes on the subject. In the absence of effective approaches to education, and given that many professionals in the practice environment appear to view illicit substance users in a negative way, it is likely that interventions with identified drug users will be influenced by negative attitudes [ 20 ] .</p>
<p>Strategies to increase knowledge involving this phenomenon may extend the work of professionals in relation to the process of working with the chemically dependent and exercise care emancipatory able to help in the construction of the autonomy of the subject and put them in touch with reality contributing to an understanding about themselves [ 21 ] . Health education contributes to the user's awareness about his problem with drug use and the difficulties to achieve their rehabilitation [ 22 ] . From this understanding, professionals may also expand its interventions for family members, building more space to care during treatment in CAPSad [ 23 ] .</p>
<p>Therefore, health education becomes a strategy for nurses to contribute to the maintenance of individual and collective health [ 24 ] . It also enables one nurse's role in the different scenarios of care, such as: individual consultation, group waiting room, therapeutic groups and home visits [ 25 ] .</p>
5. Conclusion <p>This study demonstrated that the speeches of Brazilian nurses in the care of drug users have been guided in health education as a strategy that values the knowledge of drug user, being an effective therapeutic approach that stimulates and co-responsibility in their treatment, contributing to the improvement of the general health of these clients.</p>
<p>In addition, the Brazilian Nurse also intervenes through educational actions to professionals who care for drug users. Therefore, strategies were used to work in groups, enabling the exchange of experiences and sharing of challenges and overcoming searches. The studies showed an increase in the capabilities of professionals involved in educational activities, resulting in improved service to these clients, through a more appropriate management and safe this problem.</p>
<p>This meta-synthesis also led to reflection on the gap in the scientific reality of professional nurses, considering the overhead of duties and requirements regarding scientific rigor. Highlights the need to expand the links between the university and nursing care, aiming at the strengthening of the category and the construction of a theoretical knowledge with practical visibility as to the impact on care; well as in public policy. Thus emerges the meaning of foster better links between education, research, outreach and assistance for the socialization of scientific knowledge, thus strengthening the professional identity of the nurse in different settings of care.</p>
References
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Methods for the synthesis of qualitative research: a critical review Elaine&nbsp;Barnett-Page 1 Email author and James&nbsp;Thomas 1 BMC Medical Research Methodology 2009 9 :59 DOI: 10.1186/1471-2288-9-59</p> © &nbsp;Barnett-Page and Thomas; licensee BioMed Central Ltd.&nbsp;2009</p> Received: 9&nbsp;March&nbsp;2009</p> Accepted: 11&nbsp;August&nbsp;2009</p> Published: 11&nbsp;August&nbsp;2009</p>
<p> Open Peer Review reports </p>
Abstract
Background
In recent years, a growing number of methods for synthesising qualitative research have emerged, particularly in relation to health-related research. There is a need for both researchers and commissioners to be able to distinguish between these methods and to select which method is the most appropriate to their situation.</p>
Discussion
A number of methodological and conceptual links between these methods were identified and explored, while contrasting epistemological positions explained differences in approaches to issues such as quality assessment and extent of iteration. Methods broadly fall into 'realist' or 'idealist' epistemologies, which partly accounts for these differences.</p>
Summary
Methods for qualitative synthesis vary across a range of dimensions. Commissioners of qualitative syntheses might wish to consider the kind of product they want and select their method – or type of method – accordingly.</p>
Background The range of different methods for synthesising qualitative research has been growing over recent years [ 1 , 2 ], alongside an increasing interest in qualitative synthesis to inform health-related policy and practice [ 3 ]. While the terms 'meta-analysis' (a statistical method to combine the results of primary studies), or sometimes 'narrative synthesis', are frequently used to describe how quantitative research is synthesised, far more terms are used to describe the synthesis of qualitative research. This profusion of terms can mask some of the basic similarities in approach that the different methods share, and also lead to some confusion regarding which method is most appropriate in a given situation. This paper does not argue that the various nomenclatures are unnecessary, but rather seeks to draw together and review the full range of methods of synthesis available to assist future reviewers in selecting a method that is fit for their purpose. It also represents an attempt to guide the reader through some of the varied terminology to spring up around qualitative synthesis. Other helpful reviews of synthesis methods have been undertaken in recent years with slightly different foci to this paper. Two recent studies have focused on describing and critiquing methods for the integration of qualitative research with quantitative [ 4 , 5 ] rather than exclusively examining the detail and rationale of methods for the synthesis of qualitative research. Two other significant pieces of work give practical advice for conducting the synthesis of qualitative research, but do not discuss the full range of methods available [ 6 , 7 ]. We begin our Discussion by outlining each method of synthesis in turn, before comparing and contrasting characteristics of these different methods across a range of dimensions. Readers who are more familiar with the synthesis methods described here may prefer to turn straight to the 'dimensions of difference' analysis in the second part of the Discussion.</p>
Discussion
Overview of synthesis methods
Meta-ethnography
In their seminal work of 1988, Noblit and Hare proposed meta-ethnography as an alternative to meta-analysis [ 8 ]. They cited Strike and Posner's [ 9 ] definition of synthesis as an activity in which separate parts are brought together to form a 'whole'; this construction of the whole is essentially characterised by some degree of innovation, so that the result is greater than the sum of its parts. They also borrowed from Turner's theory of social explanation [ 10 ], a key tenet of which was building 'comparative understanding' [[ 8 ], p22] rather than aggregating data.</p>
To Noblit and Hare, synthesis provided an answer to the question of 'how to "put together" written interpretive accounts' [[ 8 ], p7], where mere integration would not be appropriate. Noblit and Hare's early work synthesised research from the field of education.</p>
Three different methods of synthesis are used in meta-ethnography. One involves the 'translation' of concepts from individual studies into one another, thereby evolving overarching concepts or metaphors. Noblit and Hare called this process reciprocal translational analysis (RTA). Refutational synthesis involves exploring and explaining contradictions between individual studies. Lines-of-argument (LOA) synthesis involves building up a picture of the whole (i.e. culture, organisation etc) from studies of its parts. The authors conceptualised this latter approach as a type of grounded theorising.</p>
Britten et al [ 11 ] and Campbell et al [ 12 ] have both conducted evaluations of meta-ethnography and claim to have succeeded, by using this method, in producing theories with greater explanatory power than could be achieved in a narrative literature review. While both these evaluations used small numbers of studies, more recently Pound et al [ 13 ] conducted both an RTA and an LOA synthesis using a much larger number of studies (37) on resisting medicines. These studies demonstrate that meta-ethnography has evolved since Noblit and Hare first introduced it. Campbell et al claim to have applied the method successfully to non-ethnographical studies. Based on their reading of Schutz [ 14 ], Britten et al have developed both second and third order constructs in their synthesis (Noblit and Hare briefly allude to the possibility of a 'second level of synthesis' [[ 8 ], p28] but do not demonstrate or further develop the idea).</p>
In a more recent development, Sandelowski &amp; Barroso [ 15 ] write of adapting RTA by using it to ' integrate findings interpretively, as opposed to comparing them interpretively' (p204). The former would involve looking to see whether the same concept, theory etc exists in different studies; the latter would involve the construction of a bigger picture or theory (i.e. LOA synthesis). They also talk about comparing or integrating imported concepts (e.g. from other disciplines) as well as those evolved 'in vivo'.</p>
Grounded theory
Kearney [ 16 ], Eaves [ 17 ] and Finfgeld [ 18 ] have all adapted grounded theory to formulate a method of synthesis. Key methods and assumptions of grounded theory, as originally formulated and subsequently refined by Glaser and Strauss [ 19 ] and Strauss and Corbin [ 20 , 21 ], include: simultaneous phases of data collection and analysis; an inductive approach to analysis, allowing the theory to emerge from the data; the use of the constant comparison method; the use of theoretical sampling to reach theoretical saturation; and the generation of new theory. Eaves cited grounded theorists Charmaz [ 22 ] and Chesler [ 23 ], as well as Strauss and Corbin [ 20 ], as informing her approach to synthesis.</p>
Glaser and Strauss [ 19 ] foresaw a time when a substantive body of grounded research should be pushed towards a higher, more abstract level. As a piece of methodological work, Eaves undertook her own synthesis of the synthesis methods used by these authors to produce her own clear and explicit guide to synthesis in grounded formal theory. Kearney stated that 'grounded formal theory', as she termed this method of synthesis, 'is suited to study of phenomena involving processes of contextualized understanding and action' [[ 24 ], p180] and, as such, is particularly applicable to nurses' research interests.</p>
As Kearney suggested, the examples examined here were largely dominated by research in nursing. Eaves synthesised studies on care-giving in rural African-American families for elderly stroke survivors; Finfgeld on courage among individuals with long-term health problems; Kearney on women's experiences of domestic violence.</p>
Kearney explicitly chose 'grounded formal theory' because it matches 'like' with 'like': that is, it applies the same methods that have been used to generate the original grounded theories included in the synthesis – produced by constant comparison and theoretical sampling – to generate a higher-level grounded theory. The wish to match 'like' with 'like' is also implicit in Eaves' paper. This distinguishes grounded formal theory from more recent applications of meta-ethnography, which have sought to include qualitative research using diverse methodological approaches [ 12 ].</p>
Thematic Synthesis
Thomas and Harden [ 25 ] have developed an approach to synthesis which they term 'thematic synthesis'. This combines and adapts approaches from both meta-ethnography and grounded theory. The method was developed out of a need to conduct reviews that addressed questions relating to intervention need, appropriateness and acceptability – as well as those relating to effectiveness – without compromising on key principles developed in systematic reviews. They applied thematic synthesis in a review of the barriers to, and facilitators of, healthy eating amongst children.</p>
Free codes of findings are organised into 'descriptive' themes, which are then further interpreted to yield 'analytical' themes. This approach shares characteristics with later adaptations of meta-ethnography, in that the analytical themes are comparable to 'third order interpretations' and that the development of descriptive and analytical themes using coding invoke reciprocal 'translation'. It also shares much with grounded theory, in that the approach is inductive and themes are developed using a 'constant comparison' method. A novel aspect of their approach is the use of computer software to code the results of included studies line-by-line, thus borrowing another technique from methods usually used to analyse primary research.</p>
Textual Narrative Synthesis
Textual narrative synthesis is an approach which arranges studies into more homogenous groups. Lucas et al [ 26 ] comment that it has proved useful in synthesising evidence of different types (qualitative, quantitative, economic etc). Typically, study characteristics, context, quality and findings are reported on according to a standard format and similarities and differences are compared across studies. Structured summaries may also be developed, elaborating on and putting into context the extracted data [ 27 ].</p>
Lucas et al [ 26 ] compared thematic synthesis with textual narrative synthesis. They found that 'thematic synthesis holds most potential for hypothesis generation' whereas textual narrative synthesis is more likely to make transparent heterogeneity between studies (as does meta-ethnography, with refutational synthesis) and issues of quality appraisal. This is possibly because textual narrative synthesis makes clearer the context and characteristics of each study, while the thematic approach organises data according to themes. However, Lucas et al found that textual narrative synthesis is 'less good at identifying commonality' (p2); the authors do not make explicit why this should be, although it may be that organising according to themes, as the thematic approach does, is comparatively more successful in revealing commonality.</p>
Meta-study
Paterson et al [ 28 ] have evolved a multi-faceted approach to synthesis, which they call 'meta-study'. The sociologist Zhao [ 29 ], drawing on Ritzer's work [ 30 ], outlined three components of analysis, which they proposed should be undertaken prior to synthesis. These are meta-data-analysis (the analysis of findings), meta-method (the analysis of methods) and meta-theory (the analysis of theory). Collectively, these three elements of analysis, culminating in synthesis, make up the practice of 'meta-study'. Paterson et al pointed out that the different components of analysis may be conducted concurrently.</p>
Paterson et al argued that primary research is a construction; secondary research is therefore a construction of a construction. There is need for an approach that recognises this, and that also recognises research to be a product of its social, historical and ideological context. Such an approach would be useful in accounting for differences in research findings. For Paterson et al, there is no such thing as 'absolute truth'.</p>
Meta-study was developed to study the experiences of adults living with a chronic illness. Meta-data-analysis was conceived of by Paterson et al in similar terms to Noblit and Hare's meta-ethnography (see above), in that it is essentially interpretive and seeks to reveal similarities and discrepancies among accounts of a particular phenomenon. Meta-method involves the examination of the methodologies of the individual studies under review. Part of the process of meta-method is to consider different aspects of methodology such as sampling, data collection, research design etc, similar to procedures others have called 'critical appraisal' (CASP [ 31 ]). However, Paterson et al take their critique to a deeper level by establishing the underlying assumptions of the methodologies used and the relationship between research outcomes and methods used. Meta-theory involves scrutiny of the philosophical and theoretical assumptions of the included research papers; this includes looking at the wider context in which new theory is generated. Paterson et al described meta-synthesis as a process which creates a new interpretation which accounts for the results of all three elements of analysis. The process of synthesis is iterative and reflexive and the authors were unwilling to oversimplify the process by 'codifying' procedures for bringing all three components of analysis together.</p>
Meta-narrative
Greenhalgh et al [ 32 ]'s meta-narrative approach to synthesis arose out of the need to synthesise evidence to inform complex policy-making questions and was assisted by the formation of a multi-disciplinary team. Their approach to review was informed by Thomas Kuhn's The Structure of Scientific Revolutions [ 33 ], in which he proposed that knowledge is produced within particular paradigms which have their own assumptions about theory, about what is a legitimate object of study, about what are legitimate research questions and about what constitutes a finding. Paradigms also tend to develop through time according to a particular set of stages, central to which is the stage of 'normal science', in which the particular standards of the paradigm are largely unchallenged and seen to be self-evident. As Greenhalgh et al pointed out, Kuhn saw paradigms as largely incommensurable: 'that is, an empirical discovery made using one set of concepts, theories, methods and instruments cannot be satisfactorily explained through a different paradigmatic lens' [[ 32 ], p419].</p>
Greenhalgh et al synthesised research from a wide range of disciplines; their research question related to the diffusion of innovations in health service delivery and organisation. They thus identified a need to synthesise findings from research which contains many different theories arising from many different disciplines and study designs.</p>
Based on Kuhn's work, Greenhalgh et al proposed that, across different paradigms, there were multiple – and potentially mutually contradictory – ways of understanding the concept at the heart of their review, namely the diffusion of innovation. Bearing this in mind, the reviewers deliberately chose to select key papers from a number of different research 'paradigms' or 'traditions', both within and beyond healthcare, guided by their multidisciplinary research team. They took as their unit of analysis the 'unfolding "storyline" of a research tradition over time' [[ 32 ], p417) and sought to understand diffusion of innovation as it was conceptualised in each of these traditions. Key features of each tradition were mapped: historical roots, scope, theoretical basis; research questions asked and methods/instruments used; main empirical findings; historical development of the body of knowledge (how have earlier findings led to later findings); and strengths and limitations of the tradition. The results of this exercise led to maps of 13 'meta-narratives' in total, from which seven key dimensions, or themes, were identified and distilled for the synthesis phase of the review.</p>
Critical Interpretive Synthesis
Dixon-Woods et al [ 34 ] developed their own approach to synthesising multi-disciplinary and multi-method evidence, termed 'critical interpretive synthesis', while researching access to healthcare by vulnerable groups. Critical interpretive synthesis is an adaptation of meta-ethnography, as well as borrowing techniques from grounded theory. The authors stated that they needed to adapt traditional meta-ethnographic methods for synthesis, since these had never been applied to quantitative as well as qualitative data, nor had they been applied to a substantial body of data (in this case, 119 papers).</p>
Dixon-Woods et al presented critical interpretive synthesis as an approach to the whole process of review, rather than to just the synthesis component. It involves an iterative approach to refining the research question and searching and selecting from the literature (using theoretical sampling) and defining and applying codes and categories. It also has a particular approach to appraising quality, using relevance – i.e. likely contribution to theory development – rather than methodological characteristics as a means of determining the 'quality' of individual papers [ 35 ]. The authors also stress, as a defining characteristic, critical interpretive synthesis's critical approach to the literature in terms of deconstructing research traditions or theoretical assumptions as a means of contextualising findings.</p>
Dixon-Woods et al rejected reciprocal translational analysis (RTA) as this produced 'only a summary in terms that have already been used in the literature' [[ 34 ], p5], which was seen as less helpful when dealing with a large and diverse body of literature. Instead, Dixon-Woods et al adopted a lines-of-argument (LOA) synthesis, in which – rejecting the difference between first, second and third order constructs – they instead developed 'synthetic constructs' which were then linked with constructs arising directly from the literature.</p>
The influence of grounded theory can be seen in particular in critical interpretive synthesis's inductive approach to formulating the review question and to developing categories and concepts, rejecting a 'stage' approach to systematic reviewing, and in selecting papers using theoretical sampling. Dixon-Woods et al also claim that critical interpretive synthesis is distinct in its 'explicit orientation towards theory generation' [[ 34 ], p9].</p>
Ecological Triangulation
Jim Banning is the author of 'ecological triangulation' or 'ecological sentence synthesis', applying this method to the evidence for what works for youth with disabilities. He borrows from Webb et al [ 36 ] and Denzin [ 37 ] the concept of triangulation, in which phenomena are studied from a variety of vantage points. His rationale is that building an 'evidence base' of effectiveness requires the synthesis of cumulative, multi-faceted evidence in order to find out 'what intervention works for what kind of outcomes for what kind of persons under what kind of conditions' [[ 38 ], p1].</p>
Ecological triangulation unpicks the mutually interdependent relationships between behaviour, persons and environments. The method requires that, for data extraction and synthesis, 'ecological sentences' are formulated following the pattern: 'With this intervention, these outcomes occur with these population foci and within these grades (ages), with these genders ... and these ethnicities in these settings' [[ 39 ], p1].</p>
Framework Synthesis
Brunton et al [ 40 ] and Oliver et al [ 41 ] have applied a 'framework synthesis' approach in their reviews. Framework synthesis is based on framework analysis, which was outlined by Pope, Ziebland and Mays [ 42 ], and draws upon the work of Ritchie and Spencer [ 43 ] and Miles and Huberman [ 44 ]. Its rationale is that qualitative research produces large amounts of textual data in the form of transcripts, observational fieldnotes etc. The sheer wealth of information poses a challenge for rigorous analysis. Framework synthesis offers a highly structured approach to organising and analysing data (e.g. indexing using numerical codes, rearranging data into charts etc).</p>
Brunton et al applied the approach to a review of children's, young people's and parents' views of walking and cycling; Oliver et al to an analysis of public involvement in health services research. Framework synthesis is distinct from the other methods outlined here in that it utilises an a priori 'framework' – informed by background material and team discussions – to extract and synthesise findings. As such, it is largely a deductive approach although, in addition to topics identified by the framework, new topics may be developed and incorporated as they emerge from the data. The synthetic product can be expressed in the form of a chart for each key dimension identified, which may be used to map the nature and range of the concept under study and find associations between themes and exceptions to these [ 40 ].</p>
'Fledgling' approaches
There are three other approaches to synthesis which have not yet been widely used. One is an approach using content analysis [ 45 , 46 ] in which text is condensed into fewer content-related categories. Another is 'meta-interpretation' [ 47 ], featuring the following: an ideographic rather than pre-determined approach to the development of exclusion criteria; a focus on meaning in context; interpretations as raw data for synthesis (although this feature doesn't distinguish it from other synthesis methods); an iterative approach to the theoretical sampling of studies for synthesis; and a transparent audit trail demonstrating the trustworthiness of the synthesis.</p>
In addition to the synthesis methods discussed above, Sandelowski and Barroso propose a method they call 'qualitative metasummary' [ 15 ]. It is mentioned here as a new and original approach to handling a collection of qualitative studies but is qualitatively different to the other methods described here since it is aggregative; that is, findings are accumulated and summarised rather than 'transformed'. Metasummary is a way of producing a 'map' of the contents of qualitative studies and – according to Sandelowski and Barroso – 'reflect [s] a quantitative logic' [[ 15 ], p151]. The frequency of each finding is determined and the higher the frequency of a particular finding, the greater its validity. The authors even discuss the calculation of 'effect sizes' for qualitative findings. Qualitative metasummaries can be undertaken as an end in themselves or may serve as a basis for a further synthesis.</p>
Dimensions of difference
Having outlined the range of methods identified, we now turn to an examination of how they compare with one another. It is clear that they have come from many different contexts and have different approaches to understanding knowledge, but what do these differences mean in practice? Our framework for this analysis is shown in Additional file 1 : dimensions of difference [ 48 ]. We have examined the epistemology of each of the methods and found that, to some extent, this explains the need for different methods and their various approaches to synthesis.</p>
Epistemology
The first dimension that we will consider is that of the researchers' epistemological assumptions. Spencer et al [ 49 ] outline a range of epistemological positions, which might be organised into a spectrum as follows:</p>
Subjective idealism : there is no shared reality independent of multiple alternative human constructions</p>
Objective idealism : there is a world of collectively shared understandings</p>
Critical realism : knowledge of reality is mediated by our perceptions and beliefs</p>
Scientific realism : it is possible for knowledge to approximate closely an external reality</p>
Naïve realism : reality exists independently of human constructions and can be known directly [ 49 , 45 , 46 ].</p>
Thus, at one end of the spectrum we have a highly constructivist view of knowledge and, at the other, an unproblematized 'direct window onto the world' view.</p>
Nearly all of positions along this spectrum are represented in the range of methodological approaches to synthesis covered in this paper. The originators of meta-narrative synthesis, critical interpretive synthesis and meta-study all articulate what might be termed a 'subjective idealist' approach to knowledge. Paterson et al [ 28 ] state that meta-study shies away from creating 'grand theories' within the health or social sciences and assume that no single objective reality will be found. Primary studies, they argue, are themselves constructions; meta-synthesis, then, 'deals with constructions of constructions' (p7). Greenhalgh et al [ 32 ] also view knowledge as a product of its disciplinary paradigm and use this to explain conflicting findings: again, the authors neither seek, nor expect to find, one final, non-contestable answer to their research question. Critical interpretive synthesis is similar in seeking to place literature within its context, to question its assumptions and to produce a theoretical model of a phenomenon which – because highly interpretive – may not be reproducible by different research teams at alternative points in time [[ 34 ], p11].</p>
Methods used to synthesise grounded theory studies in order to produce a higher level of grounded theory [ 24 ] appear to be informed by 'objective idealism', as does meta-ethnography. Kearney argues for the near-universal applicability of a 'ready-to-wear' theory across contexts and populations. This approach is clearly distinct from one which recognises multiple realities. The emphasis is on examining commonalities amongst, rather than discrepancies between, accounts. This emphasis is similarly apparent in most meta-ethnographies, which are conducted either according to Noblit and Hare's 'reciprocal translational analysis' technique or to their 'lines-of-argument' technique and which seek to provide a 'whole' which has a greater explanatory power. Although Noblit and Hare also propose 'refutational synthesis', in which contradictory findings might be explored, there are few examples of this having been undertaken in practice, and the aim of the method appears to be to explain and explore differences due to context, rather than multiple realities.</p>
Despite an assumption of a reality which is perhaps less contestable than those of meta-narrative synthesis, critical interpretive synthesis and meta-study, both grounded formal theory and meta-ethnography place a great deal of emphasis on the interpretive nature of their methods. This still supposes a degree of constructivism. Although less explicit about how their methods are informed, it seems that both thematic synthesis and framework synthesis – while also involving some interpretation of data – share an even less problematized view of reality and a greater assumption that their synthetic products are reproducible and correspond to a shared reality. This is also implicit in the fact that such products are designed directly to inform policy and practice, a characteristic shared by ecological triangulation. Notably, ecological triangulation, according to Banning, can be either realist or idealist. Banning argues that the interpretation of triangulation can either be one in which multiple viewpoints converge on a point to produce confirming evidence (i.e. one definitive answer to the research question) or an idealist one, in which the complexity of multiple viewpoints is represented.<br><img><br>
Courses
Three-Credit Online Graduate Course (January 2018)
<p>This class will examine quantitative synthesis including research questions, search strategies, coding issues, meta-analysis statistical procedures, and interpretation of findings. There will be an emphasis on conceptual understanding and practical methods.</p>
<p>For additional information, please email Dr. Lorraine Phillips at phillipslo@ </p>
Faculty
<p> Vicki S. Conn , PhD, RN, FAAN
Director, Meta-Analysis Research Center; Associate Dean for Research; Potter-Brinton Distinguished Professor; Editor-In-Chief,  Western Journal of Nursing Research
Dr. Conn has conducted three NIH R01 funded meta-analysis projects and published over 40 meta-analysis papers.</p>
<p> Lorraine J. Phillips , PhD, RN, FAAN
Associate Director, Meta-Analysis Research Center; Associate Professor
Dr. Phillips conducts meta-analysis research on physical activity interventions for older adults.</p>
<p> Todd M. Ruppar , PhD, RN, FAHA
Associate Director, Meta-Analysis Research Center; Associate Professor
Dr. Ruppar conducts meta-analysis research on medication adherence and chronic disease self-management. He has led meta-analysis projects funded by the PhRMA Foundation and the Robert Wood Johnson Foundation.</p>
<p> Jo-Ana D. Chase , PhD, APRN-BC
Assistant Professor
Dr. Chase conducts meta-analysis research on physical activity intervention effects among older adults.</p>
Faculty Research
<p>&nbsp;</p>
Meta-Analysis Summer Institute (June 2019)
<p>Systematic reviews using meta-analyses are highly valued for comparative effectiveness research and evidence-based practice. This on-site institute provides a practical introduction to meta-analysis methods for learners who have previously completed multiple graduate-level statistics courses. Learners will experience the meta-analysis process during face-to-face interactions with experienced meta-analysts and leave the institute prepared to conduct a meta-analysis project.</p>
Topical Highlights
Formulating meta-analysis research questions
Developing inclusion criteria
Searching for eligible studies
Generating and implementing coding items
Analyzing data
Interpreting findings
Drafting meta-analysis research reports
Previous MARC Training Opportunities
Three-Credit Graduate Course (January 2016) This class examines quantitative synthesis including research questions, search strategies, coding issues, meta-analysis statistical procedures, and interpretation of findings. There is an emphasis on conceptual understanding and practical methods.
Meta-Analysis Summer Institute (June 2015) This weeklong summer course on the MU campus teaches all of the critical aspects of conducting a meta-analysis from the formulation of research questions, the search for eligible studies, analysis of data, and the creation of research reports.
Three-Credit Graduate Course (January 2014) This class examines quantitative synthesis including research questions, search strategies, coding issues, meta-analysis statistical procedures, and interpretation of findings. There is an emphasis on conceptual understanding and practical methods.
Meta-Analysis Summer Institute (June 2013) This weeklong summer course on the MU campus teaches all of the critical aspects of conducting a meta-analysis from the formulation of research questions, the search for eligible studies, analysis of data, and the creation of research reports.
Meta-Analysis Summer Institute (June 2012) This weeklong summer course on the MU campus teaches all of the critical aspects of conducting a meta-analysis from the formulation of research questions, the search for eligible studies, analysis of data, and the creation of research reports.
Three-Credit Graduate Course (January 2012) This class examines quantitative synthesis including research questions, search strategies, coding issues, meta-analysis statistical procedures, and interpretation of findings. There is an emphasis on conceptual understanding and practical methods.
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GregoryLum

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bondesmeralda

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<title>Christian Louboutin Golden Shinning 12CM High Heel [CL-0116] - $159.00 : Christian Louboutin outlet, louboutin.coolbikinishop.com</title>
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bondesmeralda

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Message Répondre en citant Posté le: 16/09/2017
Sujet du message: Pandora Purse with 14K Clutch Charm RETIRED ONLY 5 LEFT! - $

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<div><img>Pandora Elegance with Grey Moonstone Compose Earring Charms RETIRED ONLY 1 PAIR LEFT!<div><span>$157.00 </span>&nbsp;<span>$142.00</span><span><br>Save:&nbsp;10% off</span></div></div><div><img>Pandora Tropical Flower Murano Glass Charm<div><span>$47.00 </span>&nbsp;<span>$43.00</span><span><br>Save:&nbsp;9% off</span></div></div><div><img>Pandora Essence Collection HEALTH Charm<div><span>$44.00 </span>&nbsp;<span>$36.00</span><span><br>Save:&nbsp;18% off</span></div></div></div>

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<li>Pandora is one of the most famous jewelry brands in the fashion world and the popular Pandora jewellery wins itself many regular consumers by its unique Pandora-style and reliable quality. Pandora jewelry is the best accessory choice for you if you want to look fashionable, elegant and outstanding. Here, we have the most complete stock of Pandora jewelry, so you definitely can find one piece of jewelry that suits you perfectly. Meanwhile, we can offer you the best discount and fastest delivery. So, don't hesitate, the cheapest Pandora jewelry is waiting for you!</li>

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ed to understand how to create a system AND methods to SELL the idea AND tips on how to drive traffic with your site.But - that has a good internet home business you just need to drive traffic to your site.The device does others.So you just need to do one because of three....that's much simpler, isn't the item? <br>
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3.Are definitely the founders of internet business opportunity totally about your achievement? For situation, a certain internet business opportunity founder will do 2 take up residence teleseminars regularly! These will not be recorded tutorials - they've been really doing a live class, twice each and every day.Why? given that it is proven that will live seminars make even more sales, together with attract healthier team pals.The founders want one of the best for ones own people...to make sure they are adding all this specific effort.Doing step 2 live teleseminars each and every day, every time of day, demands dedication...so this unique really usually means the founder's devotion.Make absolutely sure your business leaders can be committed.<br>
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3.What particular back home office does the business opportunity own? Make sure a corner office is made up of marketing training center, web-site stats, automatic follow-up for your prospects, practical and online marketing support...don't settle for the ideal.Your spine office has to be your support.<br>
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6.A excellent product - Be certain that your online business has a true product that they sell to folks who join.It's illegal to enhance a business opportunity just for the health of opportunity.The doctor has to actually supply a worthwhile product for a money.<br>
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7.Has it been a duplicatable structure? preferably one who doesn't need talk to help you prospects and additionally "sell them".This is important, because it is hard to make sure you recruit individuals to a business that requires them to perform things many hate going through.For situation, try recruiting individuals to a online business that requires them to do cold dubs.People can't stand doing that.So how on this planet would you like to recruit them to this online business? <br>
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It's really essential that you get every piece of information about the market opportunity you take into account joining.At the same time, you probably want to interview a few sponsors and decide the one that suits you best, and for which you believe will allow you succeed.It's also recommended that you register for a free teleseminar or possibly presentation these business opportunities have, and learn all you could can concerning this.<br><br> Clutch blog <br><br> Sets <br><br> About pandorajewleryforsale.top blog
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bondesmeralda

Inscrit le: 20/052013
Messages: 101
Message Répondre en citant Posté le: 23/11/2017
Sujet du message: UGG Classic Mini 5854 : UGG Boots 2016 | UGG Outlet Store O

the day.Save cowboy shopping (and any sort of shoe shopping) before after supper, midday not to mention mid afternoon is a good, as your feet expand all over the course of the day.The reverse well spoken if you acquire boots after sunset after being for your feet all day come a subsequent morning the particular boots might be far too large for a comfort! After you could have your ankle measurement into position, turn your awareness of your your feet.The digits of cowboy boots may not be all cut an identical way.Some boots are fashioned with boxy your feet, others with pointy toes nevertheless others with rounded ft.A great many of cowboy shoes or boots both for each gender are made using pointy digits so pick and choose carefully based on the shape of your foot.
Your best option for some women is to purchase few of cowboy overshoes in sometimes a boy's or perhaps small mens size.This at the same time works the same when you've got wide paws.Generally speaking, women's cowboy boots are fashioned with some B wider and men are a D wider.For people that have wide feet look for boots which might be made with a "wide width" or just shop while in the department designed for boys boots or shoes and shoes or boots.
Heel heights are definitely the next interest.Cowboy boots consists of several heels, within the smallest in the tallest.Ladies may wish to go with a short heeled start for regular wear as well as a high heeled cowboy boot for night fun.A pleasant boot is one allows the actual foot to help slide easily into it and remember that the seam the spot where the leg of your boot attaches on the shoe system of the boot should not be binding (or confining) at all.Your toes should wiggle and navigate somewhat in the boot and once you get up to walk the heel of this boot really should slide a little tiny bit in the heel.ugg on sale <br>
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<div><img>UGG Women Josette Boots 1003174 Black<div><span>$279.00 </span>&nbsp;<span>$66.00</span><span><br>Save:&nbsp;76% off</span></div></div><div><img>UGG Fox Fur Mini Boots 5854 Navy<div><span>$264.00 </span>&nbsp;<span>$83.00</span><span><br>Save:&nbsp;69% off</span></div></div><div><img>UGG Classic Bailey Button Boots 5803 Black<div><span>$344.00 </span>&nbsp;<span>$127.00</span><span><br>Save:&nbsp;63% off</span></div></div></div>

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<div><div><img></div><br><h3>UGG Classic Mini Boots 5854 Black</h3><div></div><br><span>$337.00 </span>&nbsp;<span>$118.00</span><span><br>Save:&nbsp;65% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Classic Mini Boots 5854 Chestnut</h3><div></div><br><span>$302.00 </span>&nbsp;<span>$88.00</span><span><br>Save:&nbsp;71% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Classic Mini Boots 5854 Chocolate</h3><div></div><br><span>$302.00 </span>&nbsp;<span>$101.00</span><span><br>Save:&nbsp;67% off</span><br><br>... more info<br><br></div>
<br><div><div><img></div><br><h3>UGG Classic Mini Boots 5854 Grey</h3><div></div><br><span>$365.00 </span>&nbsp;<span>$135.00</span><span><br>Save:&nbsp;63% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Classic Mini Boots 5854 Navy</h3><div></div><br><span>$404.00 </span>&nbsp;<span>$178.00</span><span><br>Save:&nbsp;56% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Classic Mini Boots 5854 Sand</h3><div></div><br><span>$342.00 </span>&nbsp;<span>$126.00</span><span><br>Save:&nbsp;63% off</span><br><br>... more info<br><br></div>
<br><div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Black</h3><div></div><br><span>$284.00 </span>&nbsp;<span>$80.00</span><span><br>Save:&nbsp;72% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Blue</h3><div></div><br><span>$347.00 </span>&nbsp;<span>$130.00</span><span><br>Save:&nbsp;63% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Chestnut</h3><div></div><br><span>$349.00 </span>&nbsp;<span>$123.00</span><span><br>Save:&nbsp;65% off</span><br><br>... more info<br><br></div>
<br><div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Chocolate</h3><div></div><br><span>$306.00 </span>&nbsp;<span>$101.00</span><span><br>Save:&nbsp;67% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Grey</h3><div></div><br><span>$346.00 </span>&nbsp;<span>$123.00</span><span><br>Save:&nbsp;64% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Khaki</h3><div></div><br><span>$313.00 </span>&nbsp;<span>$98.00</span><span><br>Save:&nbsp;69% off</span><br><br>... more info<br><br></div>
<br><div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Navy</h3><div></div><br><span>$264.00 </span>&nbsp;<span>$83.00</span><span><br>Save:&nbsp;69% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Orange</h3><div></div><br><span>$303.00 </span>&nbsp;<span>$99.00</span><span><br>Save:&nbsp;67% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Purple</h3><div></div><br><span>$344.00 </span>&nbsp;<span>$128.00</span><span><br>Save:&nbsp;63% off</span><br><br>... more info<br><br></div>
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<div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Rose</h3><div></div><br><span>$285.00 </span>&nbsp;<span>$81.00</span><span><br>Save:&nbsp;72% off</span><br><br>... more info<br><br></div>
<div><div><img></div><br><h3>UGG Fox Fur Mini Boots 5854 Sand</h3><div></div><br><span>$343.00 </span>&nbsp;<span>$124.00</span><span><br>Save:&nbsp;64% off</span><br><br>... more info<br><br></div>
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the day.Save cowboy shopping (and any sort of shoe shopping) before after supper, midday not to mention mid afternoon is a good, as your feet expand all over the course of the day.The reverse well spoken if you acquire boots after sunset after being for your feet all day come a subsequent morning the particular boots might be far too large for a comfort! After you could have your ankle measurement into position, turn your awareness of your your feet.The digits of cowboy boots may not be all cut an identical way.Some boots are fashioned with boxy your feet, others with pointy toes nevertheless others with rounded ft.A great many of cowboy shoes or boots both for each gender are made using pointy digits so pick and choose carefully based on the shape of your foot.<br>
<br>
Your best option for some women is to purchase few of cowboy overshoes in sometimes a boy's or perhaps small mens size.This at the same time works the same when you've got wide paws.Generally speaking, women's cowboy boots are fashioned with some B wider and men are a D wider.For people that have wide feet look for boots which might be made with a "wide width" or just shop while in the department designed for boys boots or shoes and shoes or boots.<br>
<br>
Heel heights are definitely the next interest.Cowboy boots consists of several heels, within the smallest in the tallest.Ladies may wish to go with a short heeled start for regular wear as well as a high heeled cowboy boot for night fun.A pleasant boot is one allows the actual foot to help slide easily into it and remember that the seam the spot where the leg of your boot attaches on the shoe system of the boot should not be binding (or confining) at all.Your toes should wiggle and navigate somewhat in the boot and once you get up to walk the heel of this boot really should slide a little tiny bit in the heel.<br><br> sale blog <br><br> sale <br><br> About uggslippersforsale.top blog
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bondesmeralda

Inscrit le: 20/052013
Messages: 101
Message Répondre en citant Posté le: 07/12/2017
Sujet du message: Pandora Animal

r />
Subway:
Subway is among the most most successful franchise opportunities now available.Subway yields numerous television commercials on an annual basis, supports visible organizations such as American Cardiovascular Association, sponsors a competent race truck - and this just scratches light of their marketing.Instead about individual franchisees requiring you to get what ever advertising he or she can afford, Subway needs the "all for starterst and one particular for all" strategy where franchisees make contributions 2.5% within their weekly gains toward endorsing efforts.
To learn than twenty six, 000 cafes in eighty five countries, the fact that 2.5% really can add up, meaning numerous advertising power for just a very little price.Anytime evaluating team opportunities, don't forget to consider the actual size of the chain by itself.The more robust the stringed, the smaller your specific contribution wanted to fund a fabulous national advertising campaign.
Spork Muscle:
Different team opportunities feature different numbers of advertising assistance.While Optimum Muscle doesn't produce television set ads such as Subway, Max Muscle has co-op country wide and nearby advertising comprising ad slicks and various other printed equipment.The franchise also along its franchisees in order to develop a customized, community specific online strategy such while customer retention programs, party marketing, and will be offering ideas for the purpose of in-store events and demos.
Snelling Office staff Services:
Never assume all franchise choices will gain from national television promotional initiatives because not all franchise chances target the reccommended population.Meant for franchise options available like Snelling which usually target internet business customers, one can find more effective, less grandiose tips on how to attract home business.Snelling offers cooperative advertising from your distribution in high-quality imprinted materials like glossy mailers brought to targeted spectators.
Whatever franchise options available you're entertaining the idea of, it's additional important to view the effectiveness of the cooperative advertisements solution as opposed to the size along with flashiness.Should a national television for computer campaign works with the particular industry then an cooperative advertisements dollars really are well used up.However, if personalised marketing items are better best for the industry at issue, then funds used on TV may well be a waste in resources.It is important is that franchise chances you're thinking about have a certain amount of effective, cooperative online strategy.
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<div><img>Pandora Sterling Los Angeles Dodgers Baseball Charm SL!0148<div><span>$39.04 </span>&nbsp;<span>$33.00</span><span><br>Save:&nbsp;15% off</span></div></div><div><img>Pandora Sterling and 14K Gold Life Saver Charm 128- R<div><span>$37.70 </span>&nbsp;<span>$31.00</span><span><br>Save:&nbsp;18% off</span></div></div><div><img>Pandora Sterling and 14K Dangle Unicorn Charm [POP]- V<div><span>$39.82 </span>&nbsp;<span>$32.00</span><span><br>Save:&nbsp;20% off</span></div></div></div>

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<div><div><img></div><br><h3>Pandora Silver Cow Charm 250- B</h3><div>Why Buy With Us: 1. 100% Authentic Quality. 2. Easy Returns Policy. 3. 30 Days...</div><br><span>$34.59 </span>&nbsp;<span>$32.00</span><span><br>Save:&nbsp;7% off</span><br><br><img><br><br></div>
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bondesmeralda

Inscrit le: 20/052013
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Sujet du message: UGG Classic Mini Boots 5854 Black [uggzm00000030-Black] - $1

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You should buy shoes pertaining to children that have already laces for them to be fine-tuned and stiffened properly.At the same time, buy children's shoes through breathable materials which include canvas to support alleviate smell and encourage comfort.
You should obtain shoes meant for children utilizing flat feet and durable, flexible soles by using a patterned grip to circumvent slipping.
By following your guidelines above considerably more .much more enjoyable experience seeking out your infant.
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<br>
The shoes that you're buying for any child might feel great and in shape properly at present.Don't discover the shoes when using the thought that they may feel better once they get shattered in.<br>
<br>
You should buy shoes pertaining to children that have already laces for them to be fine-tuned and stiffened properly.At the same time, buy children's shoes through breathable materials which include canvas to support alleviate smell and encourage comfort.<br>
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You should obtain shoes meant for children utilizing flat feet and durable, flexible soles by using a patterned grip to circumvent slipping.<br>
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By following your guidelines above considerably more .much more enjoyable experience seeking out your infant.<br><br> 5854 blog <br><br> UGG <br><br> About outletsugg.xyz blog
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n devour the actual dust.<br>
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JUNK IS MOSTLY A FIRE DANGER.If you have got cartons helpful, sort the application out considering the next chapel rummage sale under consideration and wipe out all any worthless stuff you will not get about to making use of.Be completely ruthless in that, otherwise things keeps moving down belonging to the attic so that you can litter other house.Store what you dream about to retain, carefully, for cardboard packaging and, if you suffer from woolens filed in box or trunk, examine these folks for moth harm and make sure they will be well professional? tected by means of mothballs or simply para uric acid.Directions would be on the particular box and also tin belonging to the insect assassinator you ultimately choose.<br>
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CLUTTER RELATING TO THE STAIRS.As soon as you finish, infiltrate carefully, being sure your baby there is actually nothing left to the stair? tactic to constitute an important safety risk.If the ones you have was your winter ascent, you may just be wondering regarding providing warmth up there.If warmer summer months, you may just be thinking of the main advantages of an attic ventilating enthusiast.But possibly you visited the top of reaches in your home in the spring as well as fall.On the Pluto-ish region within house, temperatures are usually equable than during the attic.If the summer season has begun propose being very careful nice and also cool.<br>
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From that article you'll find learned a few useful thoughts on cleaning a basements.Swept and even dust the particular attics as well as basements and vacuum cleaned more than twice each year.Clean a window first certainly is the good approach.Get reduce the junks to provide more space for storing of other items which you may not use nowadays.<br><br> &nbsp;&nbsp;Moncler blog <br><br> Outlet <br><br> About monclerjacket.top blog
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