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Stress testing (Circ 2007;115:1464; JACC 2012;60:1828)
• Indications: dx CAD, evaluate Δ in clinical status in Pt w/ known CAD, risk stratify s/p ACS, evaluate exercise tolerance, localize ischemia (imaging required)
• Contraindications (Circ 2002;106:1883; & 2012;126:2465)
Absolute: AMI w/in 48 h, high-risk UA, acute PE, severe sx AS, uncontrolled HF, uncontrolled arrhythmias, myopericarditis, acute aortic dissection
Relative: left main CAD, mod valvular stenosis, severe HTN, HCMP, high-degree AVB, severe electrolyte abnl
• Exercise: standard Bruce (↑ speed & incline q3min), modified Bruce (begins w/o treadmill incline), submax (if <3 wk post-MI) or sx-limited; hold nitrates/βB/CCB/ranolazine if trying to dx CAD, but give when assessing if Pt ischemic on meds
• Pharmacologic: if unable to exer., low exer. tol, or recent MI. Se & Sp exercise. Preferred if LBBB (requires imaging since ECG not interpretable). Coronary vasodilators (will reveal CAD, but not tell you if Pt ischemic): regadenoson, dipyridamole or adenosine (may precipitate bradycardia and bronchospasm). Chronotropes/inotropes (more physiologic): dobutamine (may precipitate tachyarrhythmias).
• Imaging: used if uninterpretable ECG (paced, LBBB, resting ST ↓ >1 mm, dig., LVH, WPW), after indeterminate ECG test, pharmacologic tests, or localization of ischemia
SPECT (eg, 99mTc-sestamibi), PET (rubidium-82; usually w/ pharm test), echo, MRI
Test results
• HR (must achieve ≥85% of max pred HR [220-age] for exer. test to be dx), BP response, peak double product (HR × BP; nl >20k), HR recovery (HRpeak – HR1 min later; nl >12)
• Max exercise capacity achieved (METS or min)
• Occurrence of symptoms (at what level of exertion and similarity to presenting sx)
• ECG Δs: downsloping or horizontal ST ↓ (≥1 mm) 60–80 ms after QRS predictive of CAD (but does not localize ischemic territory); however, STE highly predictive & localizes
• Duke treadmill score = exercise min – (5 × max ST dev) – (4 × angina index) [0 none, 1 nonlimiting, 2 limiting]; score ≥5 → <1% 1-y mort; –10 to + 4 → 2–3%; ≤ –11 → ≥5%
• Imaging: radionuclide defects or echocardiographic regional wall motion abnormalities
reversible defect = ischemia; fixed defect = infarct; transient isch dilation = severe CAD
false : breast → ant "defect" and diaphragm → inf "defect"
false may be seen if balanced (eg, 3VD) ischemia (global ↓ perfusion w/o regional Δs)
High-risk test results (PPV ~50% for LM or 3VD, ∴ consider coronary angio)
• ECG: ST ↓ ≥2 mm or ≥1 mm in stage 1 or in ≥5 leads or ≥5 min in recovery; ST ↑; VT
• Physiologic: ↓ or fail to ↑ BP, <4 METS, angina during exercise, Duke score ≤ –11; ↓ EF
• Radionuclide: ≥1 lg or ≥2 mod. reversible defects, transient LV cavity dilation, ↑ lung uptake
Myocardial viability (Circ 2008;117:103; Eur Heart J 2011;31:2984 & 2011;32:810)
• Goal: identify hibernating myocardium that could regain fxn after revascularization
• Options: MRI (Se ~95%, Sp ~85%), PET (Se ~90%, Sp ~65%), dobutamine stress
echo (Se ~80%, Sp ~80%); SPECT/rest-redistribution (Se ~85%, Sp ~70%)
In Pts w/ LV dysfxn, viabil. doesn't predict ↑ CABG benefit vs. med Rx (NEJM 2011;364:1617)
CT & MR coronary angio (NEJM 2008;369:2324; Circ 2010;121:2509; Lancet 2012;379:453)
• Image quality best at slower & regular HR (? give bB if possible, goal HR 55–60)
• Calcium generates artifact for CT angiography
• MRI: angiography, perfusion, LV fxn, enhancement (early = microvasc obstr; late = MI)
Coronary artery calcium score (CACS; Circ 2010;122:e584; NEJM 2012;366:294; JAMA 2012;308:788)
• Quantifies extent of calcium; thus estimates plaque burden (but not % coronary stenosis)
• ? Risk strat. (<100 = low; >300 = high) in asx Pts w/ intermed risk (10–20% 10-y risk)
• ? Value as screening test to r/o CAD in sx Pt (CACS <100 → 3% probability of signif CAD; but interpretation affected by age, gender)


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Blue Danube Waltz
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Strings, String Orchestra (Score & Parts) - Grade 2-3
Composed by Johann Strauss Jr. (1825-1899). Arranged by Robert Longfield. Easy Music For Strings. Softcover. Published by Hal Leonard (HL.4490596).
Item Number: HL.4490596
9x12 inches.
One of the most famous orchestral works of all time and now available in a setting for younger players, Blue Danube Waltz will introduce your players to one of the most performed genres in orchestral playing, the grand waltz. Dur: 3:20.

subset: commoncrawl


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In the flurry of New Year's predictions, I have heard some murmurings of a coming backlash against social media especially from the professional marketing world.
A good roundup of these criticisms comes from a column from a Knoxville News Sentinel reporter Michael Silence. The prediction is based on two assumptions. First, that everyone is tiring of all the noise generated from social media. Second, that corporations are not seeing any return on social media and will pull the plug on social media spending.
From reading his column, I don't think Silence is endorsing these views, but I disagree with both points.
First the noise claims – The idea goes social media creates more noise and shortens attention spans making it harder to be heard. Basically the attention span claim is a typical old media vs. new media argument (or the I hate change argument). It's been applied to radio, television, music videos, web sites and now text messaging and social media. The argument is correct that people pay less attention to social media than a newspaper column. The growth of social media creates less of an appetite for long form media, but that doesn't make social media evil or the effects of it wrong. It's just different, meaning communication techniques have to evolve to communicate effectively.
Second the return on social media investment – Many companies jumped on the social media bandwagon to just be in the game and not be left behind and they ended up being left behind because they didn't look, listen and planned before they acted. They jumped into social media without any knowledge of what it meant to be engaged with their community not mention any goals, no plans to measure what they did. Companies that have a social media plan, that have engaged their community have seen enormous returns on social media. In fact a lot of companies that went into social media with goals and a plan are now investing more into social media because they have seen a great return on their investment. This is true for companies large and small.


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The decision of whether to go to college, or where, is hampered by poor information and inadequate understanding of the financial risks involved. Adding to the confusion, the same degree can cost dramatically different amounts for different people. A barrage of advertising offers us new degrees designed to lead to specific jobs, but we see no information on whether graduates ever get those jobs.
In Will College Pay Off?, Peter Cappelli, an acclaimed expert in employment trends, the workforce, and education, provides hard evidence that counters conventional wisdom and helps us make cost-effective choices. Among the issues Cappelli analyzes are:
Insightful and informative, Will College Pay Off? helps students and parents make smart financial decisions and provides the foundation for students to succeed in the real world.
©2015 Peter Cappelli (P)2015 Tantor
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Wunderkind Lyla Butler asks the hard hitting questions to David Cross, Modest Mouse's Isaac Brock, Passion Pit's Michael Angelakos, and more!
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Margaret Cho chats with Lyla about dogs, her home and her favorite tattoos.
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Arcade Fire's Jeremy Gara talks to Lyla about his little shop of horrors, stealing flowers, and naming pets.
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Lyla talks to Matt Hitt (Drowners) about London, the 60′s, and pubs.
2 Comments
Do Julian casablancas!!!
You Must interview Sarah Hyland!!!!!


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WHEN Sammy Sosa said he didn't know the bat was corked, the line had a resonance that sounded familiar. It was from a 1940's song, ''I Didn't Know the Gun Was Loaded.''
I didn't know the gun was loaded, And I'm so sorry, my friend.
I didn't know the gun was loaded,
And I'll never, never do it again.
The song was about a gun-slinging Miss Effie. It contained a plea of ignorance that was essentially the alibi that Sosa, the Chicago Cubs' slugger and irresistible rags-to-riches story, presented after that ignominious moment Tuesday night at Wrigley Field when he hit a ground ball that shattered his bat and exposed the illegal cork in it.
Cork is to baseball what cooking is to corporate books. Glorious until apprehended. Sosa's is the story that Major League Baseball has swallowed whole, the eight-game suspension he received yesterday notwithstanding.
Sosa, the poor kid from the Dominican Republic who became one of this hemisphere's most beloved sports stars, said he used the bat only for batting practice to give the fans a thrill as they witnessed him sending batted ball after batted ball into the beyond. When he strode to the plate in the moment in question against Tampa Bay, Sosa said, he was so focused on the game that he had no idea that this lighter bat contained cork.Continue reading the main story
This is a remarkable thing to consider, focus or no focus. Ballplayers are finicky about their bats. They can generally tell within a hairbreadth the length and heft of the bats they order from the manufacturer. In Sosa's case, he has a few manufacturers. Sosa said he had used the bat four or five times in batting practice. And he never marked it, knowing it was illegal?
Sosa broke his bat in the first inning Tuesday night and was ejected after the plate umpire, Tim McClelland, beheld it. Officials of Major League Baseball who were on hand then decided to check all of the bats at Sosa's locker. When they got there, they found 76 of Sosa's bats stacked in the cubbyhole above his locker cubicle. They confiscated them in order to have them X-rayed.
The results, according to Sandy Alderson, executive vice president of baseball operations for Major League Baseball, were negative. But the bats were not confiscated for several innings, Alderson said. And there was no security in the clubhouse during that time.
What was Sosa doing, if anything, with the bats in that time? What was the clubhouse man doing? Or anyone else? Remember, in the 1994 case of Albert Belle's tainted bat, a Cleveland Indians teammate climbed through the ceiling tiles at Comiskey Park to the umpires' dressing room and switched the bad bat with a legal one. The switch was discovered, and Belle received a 10-game suspension that was reduced to seven games.
Alderson said that the commissioner of baseball, Bud Selig, while wanting ''a thorough investigation'' of the Sosa episode, retained ''a personal affection'' for Sosa. Alderson also said that he believed in the Cubs' record-keeping and in theirs and Sosa's willingness to be forthcoming about his bats. Is this not a case also of letting the inmates run the asylum?
The question that Major League Baseball must answer is this: Were there more than 77 bats, including the ''batting practice'' cudgel? It would be a cynical thing if baseball swept the incident under the rug for, as it is said, ''the good of the game.'' The eight-game suspension -- which Sosa, not unexpectedly, is appealing, thus allowing him to play in the highly anticipated interleague Yankees-Cubs series this weekend at Wrigley Field -- doesn't answer this.
The notion here is that Sosa was in a slump after a two-week layoff to recover from an infected toe. He had returned to go 2 for 15 with 8 strikeouts and no home runs in the three games before the cork incident, and was uncommonly desperate. Even sports gods, when confronted with the possibility of mortality, may descend to plebeian practices. After all, athletes, even superstars, can be insecure. They know that they don't know when their effectiveness is at an end. It's a scary proposition. They want to return to glory as quickly as possible. And, perhaps, by any means possible.
What does all this mean to Western civilization? For one thing, as Andy MacPhail, the president and chief executive of the Cubs, said yesterday, the culture of baseball has never been the paradigm of ethics. ''Even Hall of Fame pitchers have scuffed balls,'' he said. Bats have been corked for decades. A Wall Street Journal article in 2001 revealed that Bobby Thomson's famous homer ''heard 'round the world'' might have been aided by his knowing what pitch the Dodgers' Ralph Branca would throw. The Giants had a man with binoculars in the center-field scoreboard who was stealing the catcher's signs and relaying them to a coach, who swiftly relayed them to the hitter.
MacPhail said he hoped the game would get more ethical. Andy: not until human beings stop playing the game.
Will Sosa now be tainted, will his records be tainted, will every homer he hits in the future be under suspicion?
A vast majority of the 33,317 fans at Wrigley Field on Wednesday night, the night after the incident, stood to applaud Sosa. No surprise. Fans are willing to forgive if you produce. They are rooting for you to produce. They crave their amusements. And for Americans, regardless of what F. Scott Fitzgerald said, there are indeed second acts in public life. Politicians and sports figures, among others, are often disgraced only to reappear in time and regain status and, sometimes, even affection.
So it will be for Sammy Sosa, as long as he draws fans with his homers and ''never, never does it again.''Continue reading the main story


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Chris Jarvis
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Although (economic indicators) for December have not been published yet, early indications are that the benchmarks for the next tranche of the loan are likely to be met.feedback
Jan 18 2017 IMF
We can learn a lot about a person if we know what types of things he or she talks about or comments on the most frequently. There are numerous topics with which Chris Jarvis is associated, including December, Egypt, and indicator. Most recently, Chris Jarvis has been quoted saying: "The exchange rate is more depreciated than we expected given the fundamentals." in the article Egypt on track to receive IMF loan's second tranche. An other article where Chris Jarvis has been quoted is Egypt devalues its currency to stabilising the economy.
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Jan 18 2017
The exchange rate is more depreciated than we expected given the fundamentals.feedback
Nov 03 2016
This will make more foreign exchange available. The flexible exchange rate regime, where the exchange rate is determined by market forces, will improve Egypt's external competitiveness, support exports and tourism and attract foreign investment.feedback
Nov 03 2016
All of this will help foster growth, job creation and stronger external position for the country.feedback
Mar 16 2016
The data is moderately bullish with crude builds less than expected, coupled with strong gasoline demand driven by lower prices at the pump.feedback
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Today's EIA data will do very little to help oil's recent bounce with a significant build in crude stocks, albeit somewhat skewed by a large increase in imports.feedback
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The increase in speculative net longs in the CFTC report certainly reflects some traders' belief that oil has put in a near term bottom after the 20-month long selloff.feedback
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Equities have been in a rally mode and with the technical picture for oil becoming bullish in the short term, we have a risk-on trade in crude.feedback
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Join Green Ninjas as they take on Climate Change
The California Climate Ride is a 320-mile cycling charity tour that begins in Eureka and ends in San Francisco with an overall goal of raising awareness about climate change and supporting environmental non-profit organizations.
The Green Ninja Team takes on climate, one pedal at a time.
The Green Ninja Project is excited to be a part of this year's California Climate Ride as a team and beneficiary. The California Climate Ride is a 320-mile cycling charity tour that begins in Eureka and ends in San Francisco with an overall goal of raising awareness about climate change and supporting environmental non-profit organizations.
Taking on Climate Change with their Bikes
The Green Ninja Project is a non profit organization at San Jose State University (SJSU) created to inform the upcoming generation on climate change and inspire them to take action. The organization combines collaborative effort joining scientists, educators, and artists to develop compelling experiences through film and social action that help students understand the connections between human activity and our changing climate.
Help support these four students from SJSU who are riding for climate change on behalf of the Green Ninja Project. Support them by clicking here to view their Indiegogo campaign. Every donation comes with a sticker printed by Plan It Green Printing!
Do you believe in doing the right thing? Do you believe those who do well prosper and sleep well at night? Rewards come to those who care and those who practice that philosophy in everything they do.
Do you believe in doing the right thing? Do you believe those who do well prosper and sleep well at night? Rewards come to those who care and those who practice that philosophy in everything they do.
Take care of yourself and life will take care of you. It starts here.
It's the whole package – interior, exterior, all of you. You care about what goes in and what goes on. It's all linked together from eating well to making you feel good about yourself, your life and your future.
Commercial 'Green' Printing
Today, companies, cities and non-profits see the benefit in green printing: From meeting packaging laws on compostability and recycling, to the obvious branding opportunities. From USA Pavilion World Expo 2015 to World Centric, companies, colleges and cities buy and prefer 'green' when given a choice.
Today, the choices of 'green' stocks, methods of 'green' printing, 'green' certification bodies require an education in itself: Biopolymers, tree-free, stone, cellulose.
Now, large and small, Religious, Environmental, Animal and Scientific Groups/Organizations/Faiths are concerned and advocating for sustainability and against water pollution, plastics/degradation of plastic and it's affect on animals and humans. Your Company's Printing is a necessity, but where is the stock printed on coming from? China, Taiwan, Canada, Indonesia or the U.S. of A? If the paper is coming from Indonesia or Canada, for instance, it's quite probably contributing to deforestation which, in turn, is contributing to the extinction of the native species, i.e., orangutan, tiger population.
Deforestation, extinction, this list goes on and on and out to an increasingly well-informed public. Clients and customers are demanding to know how the Companies products are printed and packaged. Are the inks petroleum or vegetable-based? Are your inks low V.O.C. (volatile organic compounds)? Is your paper and packaging FSC (Forest Stewardship Council), SFI (Sustainably Forestry Initiative) or BEP (Best Environmental Practices) Certified? Was it Made Carbon Neutral? Are your labels compostable?!!!
Since 2003 Plan It Green Printing has been helping companies green their print practices.
Website: http://planitgreenprinting.com
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Hi! Thanks for the question, J.S. Matthew.
My experience has been that the best way to break into Freelance Writing is to find any reputable platform you can and use it to get your work out there. Write about what you know and are passionate about, use social networking and real-life personal connections to grow readership, and once you are comfortable in your writing style and abilities send samples of your work to news publications and freelance agencies both online and in your town. Be polite yet persistant. If one article you submit fails, try another. Make yourself and your work known, network, and be kind to other writers and publishers and your jobs and readership should multiply quickly.
I hope this helps. Cheers, and happy writing!
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Find a copy in the library
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|Criticism, interpretation, etc
|Named Person:
|Tom Waits; Tom Waits; Tom Waits
|Material Type:
|Document Type:
|Visual material
|All Authors / Contributors:
Andy Cleland; Rob Johnstone; Angela Turner; Jake Kennedy; Tony Pomfret; Bones Howe; Jerry Yester; Barney Hoskyns; Robert Christgau; Anthony DeCurtis; Pride Productions.; Chrome Dreams (Firm)
|OCLC Number:
|"This DVD package relies on independent critical opinion and requires independent editorial control. This set is not sanctioned by Tom Waits or any of his representatives"--Container.
Produced in 2006.
Bonus features: Bone machine : Bones Malone on working with Tom Waits, contributor biographies, Tom Waits quiz.
|Editor, Cooter Haynes; archive research, Angela Turner, Jake Kennedy.
|Narrator, Tony Pomfret ; interviewees: Bones Howe, Barney Hoskyns, Jerry Yester, Robert Christgau, Anthony DeCurtis.
|2 videodiscs (178 min.) : sound, color and black and white ; 4 3/4 in.
|DVD; all regions; screen format 4:3; stereo sound mix.
|Disc 1. 1971-1982 --
Disc 2. 1983-2006.
|Other Titles:
|Tom Waits :
|Chrome Dreams Ltd. ; executive producers, Andy Cleland and Rob Johnstone.
"It's almost 40 years since Tom Waits' debut record, and during a career that, for most fans, has quite simply gotten better, more exciting and more challenging with each new release, he is surely the only performer and writer from the rock age to be consistently satisfying while remaining as difficult to predict as the weather. This double DVD set reviews Tom's career from his pre-contract days when he worked as a struggling songwriter right through his Island years and his experimental phase bringing the story up to date with his most recent records"--Container.
User-contributed reviews


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Who is that girl!?!? I must know!!
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Who is this guy...he so fucking hot...i want to see more videos of him.
I wish I had a dick as big as his. I would love to fuck my wife with a dick that big.
fuck me guys
Astrid Jaymes... The things I would do to that body.
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The Level Box portable Bluetooth speaker from Samsung features aptX audio codec for improved sound quality over a wireless connection. You can pair your smartphone easily using NFC, and the speaker can also be used to take calls, thanks to its inbuilt microphone. It has a metal design and weighs less than 600 grams. There are dedicated buttons for adjusting volume and to play or pause audio playback. Samsung claims that it can last for up to 15 hours on a single charge.
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If you talk with an experienced financial adviser they will undoubtedly be able to relay stories about current and perhaps former clients whose behavior was detrimental to their own financial health and well-being.
Try as you might you just can't always get a client to change their behavior or attitudes toward money and investing even if it may be in their best interests to do so. Managing these client relationships effectively so the client can achieve their desired financial outcomes takes not only financial knowledge in these cases but also a bit of insight into the client's thought processes as well.
Loss Aversion vs. Investment Growth
Many investors nearing or in retirement have an aversion to losing money on their investments. And rightly so. At the same time these same investors also have a need to achieve some level of growth from their investments so as to not outlive their money in retirement. (For more, see: Closing in on Retirement? Read These Tips.)
While every client is different one technique that has worked is to use a form of the "bucket approach" to their retirement investments. By this I mean having a certain percentage, tied to a number of years' worth of living expenses in safe, lower volatility investments (including cash) so they won't have to go in an sell investments in the face of a falling stock market in order to fund their basic living expenses. The actual composition and percentages will vary by client situation and will take into account retirement resources such as Social Security and pensions. (For more, see: How Advisors Can Help Clients Stomach Volatility.)
Reluctance to Sell a Losing Position
I've encountered this on numerous occasions but it seems more prevalent in males. You bought a particular stock and it's gone nowhere but down. Now this is not necessarily the reason to sell. Reviewing the client's overall portfolio, their financial plan and objectives and determining if there are better alternatives to this holding should drive that decision. (For more, see: When to Dump Portfolio Losers.)
Clients may respond by saying they just want to hold the position until they break-even. You can show them why other investments are a better fit for them and even how realizing the loss in a taxable account can be beneficial, but sometimes logic and numbers don't work. Frankly if the position is relatively small compared to the size of their overall portfolio this isn't the end of the world. If the position is a significant percentage of their portfolio then it is incumbent upon you to try to convince them to reduce the size of this holding and invest those funds elsewhere. (For more, see: Tax-Loss Harvesting: Reduce Investment Losses.)
Reluctance to Sell "Sentimental" Holdings
Often a client will inherit investments from a spouse, a parent, or loved one. It is not uncommon for them to feel a sentimental attachment to these investments. Often they will point to long-term holdings and mention that stock XYZ always did well for mom and dad and I want to keep it for the long haul.
Again if the position is not a significant percentage of the client's portfolio this may be O.K. But in the event it is and additionally if there are a number of holdings evoking similar emotional attachment then as a financial adviser it is your duty to show the client why diversifying away from some of these holdings is a good idea. This might include extra risk from concentration in just a few holdings, a focus in a particular asset class (often large-cap domestic stocks in these instances). (For more, see: Trends Challenging Financial Advisors.)
Investing at the Wrong Times
Often clients only want to invest when "…it feels good…" In my experience, this means after a protracted stock market recovery which is often the worst time to invest. Conversely, clients may often panic during extreme market downturns and want to abandon their long-term investment plan. As a their financial adviser it's your job to show them the merits of sticking to the plan you've developed together and how investing at the wrong times due to the natural emotions of fear and greed can hurt their chances of achieving financial success.
An Indecisive Client
Sometimes even after going through the financial planning process with a financial adviser in whom the client has confidence the client feels uncomfortable making the decision to go ahead with the adviser's recommendations.
This could be caused by the client's fear of the unknown or even their fear of going in another direction. Perhaps they have worked with a commissioned-based adviser who had them in individual stocks and high-cost proprietary mutual funds. Even though the client did poorly with this adviser entering new uncharted territory can be unsettling. (For more, see: What Is Your Risk Tolerance?)
This type of client may require a bit more hand-holding and it is incumbent upon the new adviser to understand the client's fears and to present information to them in a way that can alleviate these fears.
Make it Easy and Understandable
Financial advisers can help certain clients by laying out the steps the client needs to take in order to reach their goals in an easy to understand format. These might include:
- Contribute $400 per month to my emergency fund until I have three months living expenses accumulated.
- Contribute 7.5% of my salary to my 401(k).
- Make an automatic monthly contribution to my IRA so that I've contributed the maximum by the time I file my taxes.
Once the client has completed or instituted in their routine a few of the initial tasks work with them to add and prioritize other aspects of their financial plan.
Educate Clients
Perhaps the biggest benefit that financial advisers can provide is keeping clients from acting on their own instincts. We are all motivated by greed and fear. The latter emotion caused a lot of investors to act in ways that were quite detrimental to their financial health during the financial crisis. Educating clients about the benefits of staying the course before the markets hit their next inevitable correction is essential. (For more, see: How to Be a Top Financial Advisor.)
The Bottom Line
Helping a client achieve their financial goals is about far more than just showing them numbers or charts. The value of hiring a financial adviser is often about the adviser's ability to coach the client through the implementation of the planning steps and to help keep them from acting in a way that is contrary to their own best interests. This requires the adviser to understand the client's fears and what drives them so that he or she can present information and guidance in a way that will resonate with that client. (For more, see: How Financial Advisors Can Help Gun-Shy Investors.)


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Tobie Yoder reading the bus schedules. Today six Pioneer Trails buses came in. I think four CrossRoads from Indiana also came in, plus according to rumor one or two or three buses from Illinois and elsewhere. But Pinecraft isn't full yet, and there are more buses coming in Tuesday and Wednesday. This tally is just the people coming in with the buses.
The first Pioneer bus to arrive.
Nobody wasted time in getting off the bus and getting to their luggage, as the next bus was due to come in shortly.
This is a CrossRoad bus.
Dave Frey picked up his sister and her family.
Butch & Sarah Chupp from Indiana.
And the last Pioneer bus arrived.
Got off the bus,
Went to their rental.
Took off winter shoes.
Put on flip-flops,
And took to the streets.


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So now we're at the stage where many of our clients have to deal with their wheels. If you own your car outright, or even better have no car (better for the environment), then read no further. This is only for clients who are still financing their vehicles whether owned or leased. Just read the section below for your situation; owned or leased. We've had a discussion pertinent to your case during our appointments on this, but this is a review. You signed a "Statement of Intentions" already about your decision on your vehicle(s), but as the title of the document suggests, it is your intentions, not your commitment, and you can change your mind any time in the next few weeks.
REAFFIRMATION: If you own your car (it isn't leased), and you want to keep your current financing, then it's usually best to reaffirm the loan. This means you agree to continue to have personal liability for the loan despite the bankruptcy discharge order that would otherwise automatically wipe out the personal liability on the loan. Even if that were to happen, the vehicle financing company still has a lien on the vehicle via your pink slip and can repossess it if you don't make payments. Some companies, such as Ford Motor Credit and Chrysler Credit deem it a technical default if you don't reaffirm, and even if you're current on the loan (made all payments) and repossess the car if you don't file a reaffirmation.
So we usually reaffirm the car if it's not too "underwater" or upside down in terms of the value of the car being too little compared to the loan. It makes no sense to reaffirm a $20,000 loan on a $5,000 car. Other options described below would be better. However, most cars are a little underwater and reaffirmation is just fine in that circumstance.
Reaffirmation lets you get credit on the credit reporting agencies such as Experian, Transunion and Equifax, so that's a positive in rebuilding credit, and, as stated above it avoids the technical default. The downside is that if you fall behind on payments they can repossess your car, then auction it and hold you personally liable for the difference between the sales price and the loan amount and sale costs.
So if you financing is at a good interest rate, and you're not seriously underwater, then reaffirmation is what we normally do. That means the lender sends us a "Reaffirmation Agreement" which we review and sign, and then we get your signature, return it to the lender who files it with the Court. It's important you sign this and return it promptly since there's so much that has to be done before it's final and it has to be done while the case is still open.
REDEMPTION: If your car is way underwater, you can force the lender to let you keep the car and only pay the fair market value of the car in cash instead of the full loan amount. Most people use a lender such as 722 Redemption for this option, as they don't have the cash, but if you have a rich uncle to help that makes it more attractive, because the interest rate is usually steep.
So in the same example, if the car is worth $5,000 and the loan is $20,000, you can give the lender $5,000 and the old loan is discharged for the $15,000 difference just like credit cards are discharged. If the lender doesn't agree though, the judge will have to get involved in a Motion to Redeem, which is a cost 722 Redemption finances. We help you do the math to figure out if it's a good deal for you.
SURRENDER: This means giving the car back to the lender. The loan is then discharged as the lender has the collateral back. But unless you're going to take the bus or Uber everywhere, you will need another car. Some people just buy a cheap beater, like an old Honda Civic with over 100,000 miles that will still be reliable enough.
If you have leased a car you only have two options:
SURRENDER: This means giving the car back to the owner/lessor. The remaining payments and any over mileage charges will also be discharged as the lessor has the property back and you'll have no further obligations. You may consider this if you can borrow someone else's car or your employer has given you a company car, as examples.
ASSUME THE LEASE: This means you keep the lease as if you had never filed bankruptcy on it. You sign a document and so do we, and then give it to the leasing company who files it with the Court. You will owe all lease payments, over mileage charges if any, etc. The bankruptcy just doesn't affect it at all if you agree to this route.
For those who want to get another vehicle financing and finding the replacement vehicle can be done. We use www.replacevehicle.com which is an option just 3 days after you file bankruptcy. The interest rate isn't as bad as the redemption, and you get a wide variety of cars to choose from. Many clients have been very satisfied with this option, although not every client qualifies for financing.
We're here to support you whatever vehicle option you choose if your vehicle is financed or leased or even if you don't have a vehicle but need one.


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Teagan Summers gets involved in threesome with Sara James and John Strong
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LAFAYETTE, La. (KLFY) – Shred-It held their annual Shred-a-ton Friday and participants were able to protect their identify and donate to help children affected by the recent flood.
Acadiana Mall Marketing Director Jamie Stelly saw first hand the impact the flood had on local children.
"They lost everything and it was hard because their son was impacted the most. Sorry I'm going to cry talking about it. I wanted to help. I wanted to help kids that were devastated and lost so much," said Stelly.
The mall decided to host a toy and book drive. The United Way of Acadiana and Shred-It joined in on the cause.
"Whenever there is a call to step up the people of this community absolutely do," said Nicole Rebstock.
United Way of Acaidna Acting Resource Director Nicole Rebstock said the donations will help a local school rebuild after the flood.
"We are identifying a school in this area that was flooded out and our goal absolutely is to take all of the books, all of the monetary donations and all of the toys and really make their holidays special this year."
Residents participating in the shred-a-thon were happy to help out.
Bob Aebil said this is a great way to help out a neighbor in need.
"Their parents perhaps they've got to rebuild the house, they've got to buy new furniture. They've got all those things to worry about and if their kids can get backpacks or whatever it is they need, that's one less thing they've got to worry about."
Residents donated over three thousand dollars and about four boxes of toys.
The Acadiana Mall will be collecting toys, books and monetary donations until November 27th.


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X-linked hyper-IgM syndrome (XHM) is a combined immune deficiency disorder caused by mutations in CD40 ligand. We tested CP-870,893, a human CD40 agonist monoclonal antibody, in the treatment of two XHM patients with biliary Cryptosporidiosis. CP-870,893 activated B cells and APCs in vitro, restoring class switch recombination in XHM B cells and inducing cytokine secretion by monocytes. CP-870,893 infusions were well tolerated and showed significant activity in vivo, decreasing leukocyte concentration in peripheral blood. Although specific antibody responses were lacking, frequent dosing in one subject primed T cells to secrete IFN-g and suppressed oocyst shedding in the stool. Nevertheless, relapse occurred after discontinuation of therapy. The CD40 receptor was rapidly internalized following binding with CP-870,893, potentially explaining the limited capacity of CP-870,893 to mediate immune reconstitution. This study demonstrates that CP-870,893 suppressed oocysts shedding in XHM patients with biliary cryptosporidiosis. The continued study of CD40 agonists in XHM is warranted.
X-linked hyper-IgM syndrome (XHM) is a rare primary immune deficiency disorder caused by mutations in the gene encoding CD40 ligand (CD40L or CD154), a protein expressed primarily on the cell surface of activated CD4+ T cells1-3. T cells deficient in CD40L cannot activate the CD40 receptor molecule on B cells, resulting in diminished immunoglobulin class switch recombination (CSR) and low levels of serum IgG, IgA, and IgE with normal to elevated IgM4-9. Although the CD40-CD40L interaction was first studied in B cells, its importance in T cell interaction with other antigen-presenting cells, such as macrophages, monocytes, and dendritic cells, has now been established8,10. Upon CD40 engagement, these APCs upregulate proinflammatory cytokines and costimulatory molecules, and in turn activate naïve T cells10,11. Due to the importance of CD40L in APC activation, T cell priming, and antibody diversification, its deficiency results in the combined immunodeficiency observed in XHM.
XHM patients are susceptible to infection by opportunistic pathogens, such as Pneumocystis jiroveci and Cryptosporidium sp.12-15. These patients usually present with recurrent respiratory infections, and neutropenia, protracted diarrhea, liver disease, or CNS infections are common13-15. The standard of care for XHM patients consists of prophylactic antibiotics and immunoglobulin replacement, as well as growth factors to treat neutropenia if indicated13,16. While these therapies offer some benefit, the current survival of XHM patients is limited with only one-fifth of untransplanted patients reaching the 4Th decade of life and the rest succumbing to infectious disease or malignancy13,17.
In XHM patients, the liver is the most common extra intestinal site of Cryptosporidium infection. Cryptosporidium associated cholangiopathy is generally not responsive to antimicrobial therapy and the infection leads to biliary cirrhosis and ultimately to liver failure. Antigen primed CD4+ T cells and INF-γ are key factors in the control of cryptosporidiosis. Recently, CD8+ T cells have been shown to reduce the parasite load in infected intestinal epithelial cell cultures18. Therefore, a targeted molecular approach that could restore deficient immune function in a more specific manner and improve outcomes for XHM patients would be preferable.
CD40 agonists hold promise as a targeted therapy for XHM. Antibodies that stimulate the CD40 receptor have been shown to substitute for CD4+ T helper cells that are dependent on CD40L expression in mouse models of cytotoxic T lymphocyte priming19-21. Other investigators have found that administration of CD40-specific antibodies facilitates CTL activation and tumor rejection in mouse models of cancer22,23. CP-870,893 is a fully human IgG2 antibody that is agonistic for CD4023. It was shown to be a potent activator of dendritic cells and B cells in vitro, and to promote tumor rejection in mice23,24. In a Phase I clinical trial for patients with advanced solid tumors, CP-870,893 was found to evoke a partial response in 4 of 27 patients25.
In this study, we characterize the functional capacity of CP-870,893 to restore deficient immune responses of XHM patients in vitro and in vivo. Our results show that, in combination with IL-4 and IL-10, CP-870-893 induces immunoglobulin class switch recombination in patient B cells. CP-870,893 also induces patient dendritic cells to secrete IL-12, and induced T cells to secrete TNF-α and INF-γ. On the basis of these preclinical data, we administered CP-870,893 to two XHM patients with biliary Cryptosporidum infection that was refractory to standard medical therapy.
Patients were studied at the Clinical Center, NIAID, NIH (Trials registration: NCT00266513). Two XHM patients aged 16 and 19, who were related by one shared parent, were enrolled in the institutional review board approved protocol with informed consent. At the time of enrollment, both patients presented with biliary Cryptosporidium hominis infection that was refractory to medical treatment with daily nitazoxanide alone or in combination with azithromycin. We treated both patients with CP-870,893, an investigational human CD40 ligand agonist antibody developed by Pfizer, Inc. Patients were monitored weekly for evidence of drug toxicity using the National Cancer Institute (NCI) Common Toxicity Criteria version 2.0 (available from http://ctep.cancer.gov/) during treatment and every 4 weeks during the post-biologic observation period. Patients were maintained on the standard dose of immune globulin replacement therapy and no adjustments in dose or frequency of these infusions were permitted during the study period.
The patients were assessed for their ability to mount delayed type hypersensitivity reactions (DTH) by subcutaneous injection of purified Candida antigen prior to and during the course of the study. To assess for antigen-specific antibody responses, three doses of rabies vaccine (HDCV, Sanofi Pasteur) were administered on days 1, 7 and 21, while being treated with infusions of CP-870,893. Antigen-specific IgG antibody levels in serum samples obtained prior to the study and 7 days after each immunization were determined by ELISA.
In vitro cytokine responses were evaluated prior to and during the course of the study. Peripheral blood mononuclear cells (PBMC) were obtained using Ficoll-Hypaque density gradient lymphocyte separation medium (Pharmacia Biotech, Inc., Piscataway, New Jersey, USA) and standard techniques.26 PBMCs (2.5 × 105/ml) were stimulated in vitro with anti-CD3 antibody, (OKT3: gift of Ortho Biotech, Somerset, New Jersey, USA) and after 36 hours of culture, supernatants were harvested and assayed for levels of IFN-γ and TNF-α by specific ELISA (R&D Systems Inc., Minneapolis, Minnesota, USA) according to the manufacturer's instructions. PBMCs were also stimulated before and immediately after terminating CP-870,893 therapy with the super-antigen Staphylococcal enterotoxin B (SEB; Sigma Aldrich, St. Louis, MO)27 and intracellular cytokine detection was performed as previously described.28 MoDCs were prepared from elutriated monocytes using standard techniques and stimulated in vitro with recombinant CD40 ligand trimer (rCD40L; Amgen- Seattle) or CP-870,893 (Pfizer, Groton, CT) with IFN-γ (Genzyme, Cambridge, MA). For in vitro immunoglobulin production, PBMCs (2.5 × 105/ml) were stimulated with rCD40L or CP 870, 893 with IL-4 and IL-10 (both at 10 ng/ml; PeproTech Inc.). Immunoglobulin levels were determined by ELISA 14 days after stimulation by previously described methods29. Anti-human CD40 antibody (clone 5C3) was purchased from BD Bioscience (San Jose, CA); LOB7/6 was purchased from Serotec (Raleigh, NC) and FITC labeled CP-870,893 was custom labeled by Invitrogen (Carlsbad, CA).
Weekly stool specimens were collected and fixed in 10% formalin. Specimens were concentrated at a centrifuge speed of 800 × g and slides smears were made from the resulting pellet. Slides were stained with modified Dimethyl Sulfoxide-Modified Acid-Fast Stain and read at 1000× (oil immersion). A stool was considered Cryptosporidium-positive if typical oocysts 4-6 μm in diameter were visible and scored as heavy, moderate, light, or undetected. Cryptosporidium was also detected by PCR analysis from stool samples, as previously described30.
Living MoDCs were washed twice in cold PBS with 1% FCS and re-suspended in cold washing buffer at ~2 × 106 cells/ml. Cells were then incubated with FITC-labeled CP-870,893 in a 37°C water bath for the time indicated. In parallel experiments, MoDCs were incubated with anti-CD40 FITC (clone 5C3), which lacks agonist activity, at 37°C for 15 minutes. Cells were washed twice in cold washing buffer and then incubated with recombinant CD40 ligand trimer in a 37°C water bath for the time indicated. To stop staining, cells were chilled immediately on ice. After washing twice with cold PBS, cells were kept on ice until transfer to chambered coverglass (LAB-TEK, Rochester, NY) for confocal imaging. Images were collected on a Leica TCS-NT/SP1 confocal microscope (Leica Microsystems, Exton, PA, USA) using a 40× oil immersion objective NA 1.32, zoom 4×. Images were processed using Leica TCS-NT/SP software (version 1.6.587), Imaris 3.3.2 (Bitplane AG, Zurich Switzerland), and Adobe Photoshop 7.0 (Adobe systems, San Jose, CA).
Prior to in vivo use of CP-870,893 in our study patients, we conducted in vitro studies of CP-870,893 and recombinant CD40 ligand (rCD40L) to compare their agonistic activity. Monocyte-derived dendritic cells (moDCs) from XHM patients were stimulated with increasing concentrations (0.1, 1.0, 3.5, or 10 μg/ml) of CP-870,893 or rCD40L. Using ELISA, we measured the concentration of secreted TNF-α and IL-12, two proinflammatory cytokines that are produced by APCs in response to CD40 signaling. TNF-α secretion was observed at 1.0 and 3.5 μg/mL CP-870,893 or rCD40L, but not at 10 μg/mL (Figure 1A). In contrast, significant production of IL-12 was observed at all concentrations of CP-870,893 or rCD40L above 0.1 μg/mL (Figure 1B). For both stimuli, a concentration of 3.5 μg/mL was found to induce the maximal response. At 1.0 and 3.5 μg/mL, the response induced by CP-870,893 was 80% of that induced by rCD40L.
We previously reported that T cells from XHM patients secrete reduced levels of IFN-γ following activation through the antigen receptor31. This impairment in T cell priming was due to the lack of CD40L expression on CD4+ T cells and insufficient stimulation of APCs to synthesize IL-12 or upregulate co- stimulatory molecules. To determine whether CP-870,893 can restore IFN-γ production by patient T cells in vitro, we next stimulated PBMCs from patients with XHIM with anti-CD3 alone or in the presence of either CP-870,893 or rCD40L. After 36 hours, we measured IFN- γ secretion into the culture fluid by ELISA. As shown in Figure 1C and in keeping with previously published findings, XHM patient T cells produce markedly reduced amounts of IFN- γ in comparison to reference controls. CP-870,893 restored IFN- γ production in the five patients with XHIM at levels comparable to stimulation with rCD40L.
XHM patients have defective class switch recombination (CSR), resulting in hypogammaglobulinemia and reduced serum IgA and IgE levels. Importantly, this defect is due to a lack of functional CD40L, and is therefore extrinsic to the B cells. To assess the ability of CP-870,893 to substitute for CD40L in inducing CSR, we treated XHM patient B cells with CP-870,893 or rCD40L, together with IL-4 and IL-10. As expected, naïve XHM B cells did not produce IgE, but underwent CSR to IgE after treatment with rCD40L, IL-4, and IL-10 (Figure 1D). Although B cells in PBMCs treated with the CD40 agonist antibody plus cytokines underwent class switch recombination, the level of IgE production was lower when compared to stimulation with rCD40L, IL-4, and IL-10. These results indicate that CP-870,893 is able to signal through CD40 and can substitute for CD40L to a significant degree in vitro. Based on these findings, we investigated whether CP-870,893 would show the same efficacy in vivo and restore immune function to XHM patients with Cryptosporidium infection.
The first patient is a 16-year-old male who developed cholangiopathy and obstructive jaundice secondary to chronic infection with Cryptosporidium. Baseline magnetic resonance cholangiopancreatography (MRCP) was unremarkable without intra and extra-hepatic biliary tract abnormalities. With continued infection, he presented with a picture of obstructive jaundice with an acute rise in total bilirubin from 0.4 mg/dL to 6.1 mg/dL and an alkaline phosphatase from 350 U/L to 603 U/L. Repeat imaging revealed significant intra and extra-hepatic biliary dilation. An endoscopic retrograde cholangiopancreatography (ERCP) was performed with sphincterotomy, cholangioscopy (SpyGlass®), and biopsies, which revealed an inflammatory biliary stricture in the main bile duct, and intermittent areas of stenosis and dilation in the right hepatic duct consistent with a secondary cholangitis picture from chronic infection. Post-sphincterotomy, the patient's obstructive symptoms improved along with bilirubin and alkaline phosphatase levels. However, his transaminase levels remained slightly above the upper limits of normal. The patient was then started on CP-870,893 at 0.05 mg/kg once weekly for 2 weeks, followed by dose escalation to 0.10 mg/kg once weekly for 3 weeks. On continued hepatic monitoring, the patient had an increase in his transaminase levels to >2.5-fold above baseline, as well as elevation of his bilirubin level from 0.5 to 3.5 mg/dL. At this point the study drug was discontinued. The patient was then started on ursodeoxycholic acid with return of his liver enzymes to baseline. Other treatment options were considered, including allogeneic bone marrow transplantation (BMT) and a combined liver/BMT. However, because of the poor clinical outcomes of the above procedures in the setting of Cryptosporidium infection, the patient opted for palliative care.
The second patient is a 19-year-old male who received 44 weeks of treatment with CP-870,893 for biliary Cryptosporidium infection. At baseline, the patient had normal transaminases with mildly elevated alkaline phosphatase at 160 U/L. The patient tolerated infusions of CP 870,893 once weekly starting at 0.05 mg/kg and escalating from 0.10 mg/kg to 0.20 mg/kg and finally to 0.30 mg/kg (Figure 2). With the dose escalation of CP-870-893 from 0.2 mg/kg to 0.3 mg/kg, the patient developed transient transaminitis less than two times the upper limit of normal following the drug infusion. However, these changes were not sustained, and returned to baseline prior to the next scheduled infusion. The patient also experienced intermittent infusion associated pain in the right upper abdomen, fever, and one episode of sever headache. These clinical symptoms were effectively controlled with pre-treatment analgesics. With weekly infusion of CP-870,893 at 0.30 mg/kg, the patient developed positive delayed hypersensitivity skin tests to Candida, whereas these tests had been negative at the start and after 10 weeks of therapy. The Candida antigen was applied subcutaneously after completing CP-870,893 infusions. The maximum diameter of induration was observed at 24 hours, and resolved completely by 72 hours. Qualitative stool tests at the 0.30 mg/kg dose of CP-870,893 were reported as positive for "rare Cryptosporidium species," while they were read as "heavy" at the start of treatment. At 0.30 mg/kg, the patient did not mount IgG responses to rabies vaccine challenge, serum immunoglobulin levels were unchanged, and IgE as well as IgA levels remained below the level of detection. Following the once per week dosing schedule of CP-870,893 described above, the dosing frequency of the drug was increased in an attempt to eradicate the Cryptosporidium infection. The patient received a 10-week course of CP-870,893 at a dose of 0.2 mg/kg twice weekly that was followed by an additional 10-week course of infusion at 0.2 mg/kg three times per week for a total of 44 weeks of treatment. During the final 6 weeks of treatment with CP-870, 893, the patient's stool consistently tested negative for Cryptosporidium by microscopy. These samples subsequently tested positive by PCR, thus demonstrating that CP-870,893 therapy suppressed but did not eliminate oocysts shedding. Concurrent with the three times per week treatment with 0.2 mg/kg CP-870,893, the patient was found to have a sustained transaminitis and increased hepatic stiffness by non-invasive transient elastography measurements (Fibroscan®). Alkaline phosphatase levels also increased from 399-461 U/L during the once a week dosing interval to 520-692 U/L at 0.2 mg/kg three times a week. Concurrently, gamma-glutamyl transferase (GGT) levels increased from 282-369 U/L to 406-566 IU/L, while ALT (<107 U/L), AST (158 U/L), and bilirubin (<1.0 mg/dL) were unchanged. Due to the increasing levels of alkaline phosphatase and GGT, a liver biopsy was performed, which revealed peri-portal tract inflammation with fibrosis and bile stasis. There was also evidence of bile duct injury and a decline in the number of bile ducts. Given these findings, CP-870,893 was then discontinued. A repeat liver biopsy performed 3 months after discontinuation revealed very sparse portal inflammatory infiltrate, which was improved compared to the prior biopsy. Fibrosis and ductular reaction was also significantly reduced compared with the previous biopsy. By transient elastography (Fibroscan®), hepatic stiffness was also significantly improved and returned to baseline 3 months after discontinuation of CP-870,893. He has since been maintained on palliative treatment with nitazoxanide.
CP-870,893 was previously shown to deplete peripheral blood B cells, monocytes, and T cells following infusion. The effect on B cell numbers was severe but relatively short-lived and B cell counts showed near complete return to baseline by the following week. Depletion of monocytes and T cells was more modest and was not observed in either patient with weekly dosing. Here, we used flow cytometry to measure B cell, T cell, and monocyte numbers at baseline, 24-36 hours following CP-870,893 infusion, and at the end of the study. Immunophenotyping analysis was limited to the second patient because treatment of the other patient with CP-870,893 was suspended early due to progressive biliary disease. We observed a marked decrease in the number of CD20+ B cells during treatment with CP-870,893 at all dosing intervals with modest recovery of B cell number 1 week after the last dose of CP-870,893 (Figure 3). Changes in monocyte number were more variable but notable when CP-870,893 was infused more than once per week. A decrease in the number of CD4+ and CD8+ T cells was also observed with CP-870,893 treatment. Interestingly, the lowest absolute number of CD4+ cells was observed when CP-870,893 was infused three times per week, and both CD4+ and CD8+ T cell number returned to baseline 1 week after therapy. These results are consistent with previous studies that showed changes in blood cell composition following CP-870,893 infusion. As the dose or frequency of CP-870,893 infusions increased, the numbers of peripheral CD4+, CD8+, and CD19+ cells were all observed to decrease but subsequently recovered following cessation of therapy.
We show that T cells from XHM patients are deficient in the production of TH1 effector cytokines following activation, and that this impairment in T cell function can be at least partially restored by the ex vivo addition of CP-870,893 (Figure 1). To determine whether in vivo administration of CP-870,893 can drive naive XHM T cells to produce TH1 cytokines, we cultured patient and control PBMCs with anti-CD3 for 36 hours and then measured TNF-α or IFN-γ secretions into the culture fluid by specific ELISA. Measurements were made at baseline and at monthly intervals during CP-870,893 treatment. As shown in Figure 4A, prior to treatment with CP-870,893 the patients' T cells exhibited markedly reduced levels of TNF-α and IFN-γ secretion in response to these stimuli. After initiation of CP-870,893 treatment the T cells displayed an increase in the capacity to produce both TNF-α and IFN-γ, although below the reference range obtained from normal donors. We next assessed the ability of CP-870,893 treatment to prime CD4+ T cell subsets by measuring intracellular TNF-α and IFN-γ or IL-4 by flow cytometry after stimulation with Staphylococcus enterotoxin B (SEB) (Figure 4B). The number of TNF-α, IFN-γ, or IL-4 producing cells, as a percentage of total CD4+ CD69+ cells, was lower at baseline in XHM patients than in healthy donors, and was unchanged following CP-870,893 treatment. The same was also observed for CD8+ cells. These results demonstrate that while frequent dosing of CP-870,893 treatment in vivo primed patient T cells to produce effector cytokines, the magnitude of these responses was modest and well below the levels secreted by activated T cells from healthy donors.
It was recently reported that CP-870,893 CD40 in combination with gemcitabine induced clinical responses in patients with surgically incurable pancreatic ductal carcinoma. The patients received weekly gemcitabine and a single dose of CP-870,893 every 28 days. In those patients that achieved a partial remission, histological analysis of primary tumors and liver metastasis revealed necrosis and an infiltrate dominated by macrophages with an absence of lymphocytes. We therefore investigated the impact of more frequent and higher dose CP-870,893 on the leukocytes infiltrating the liver of one of our study patients with biliary Cryptosporidum infection (Figure 5). Interestingly, CD3+ T cells and CD 68+ histiocytes were detected in representative portal spaces during CP-870,893 treatment at 0.2 mg/kg three times per week, but the numbers of T cells and histiocytes were clearly reduced once the therapy was withdrawn. Further studies will be necessary to address whether the CD3+ T cells infiltrating the liver during CP-870,893 treatment are specific for Cryptosporidium or represent the recruitment of bystander T lymphocytes to the liver from protracted CP-870,893 treatment. Regardless of the precise mechanism, frequent and high doses of CP-870,893 are not sufficient to eradicate Cryptosporidum infection in XHM.
Although CP-870,893 was a potent agonist in vitro, its ability to reconstitute the immune systems of the XHM patients in the clinic was limited. While CP-870,893 is known to have a half-life of 8 hours in patients, the mechanism of its rapid clearance is not known. We hypothesized that CP-870,893 may induce receptor internalization after binding CD40 on the cell surface. To test this, we used flow cytometry to monitor CD40 expression on B cells and monocytes before and after infusion of CP-870,893 at 0.30 mg/kg using FITC conjugated CP-870,893 and FITC-conjugated anti-CD40 mAb LOB7/6. These antibodies were first tested by flow cytometry in cross competition studies using peripheral blood B cells to confirm that each monoclonal antibody interacts with a distinct extracellular epitope of CD40 (data not shown). Prior to infusion, patient monocytes and B cells expressed normal levels of cell-surface CD40, as detected using FITC-conjugated CP-870,893 or a commercially available FITC-conjugated LOB7/6 (Figure 6A). At 6 hours post-infusion, CD40 expression on patient monocytes was barely detectable. At 12 hours post-infusion, CD40 expression on monocytes began to increase and was even more pronounced at 24 hours. CD20+ peripheral B cells were largely undetectable with chronic administration of CP-870,893. However, the few B cells present showed reduced CD40 expression at 6 hours after CP-870,893 with gradual recovery of CD40 expression at 24 hours.
To further test our hypothesis that CP-870,893 induces receptor internalization after binding CD40 on APCs, we MoDCs from healthy donors with FITC-conjugated CP-870,893 and examined CD40 localization by confocal microscopy (Figure 6B). Incubation of MoDCs with FITC-conjugated CP-870,893 at 4°C resulted in distinct cell membrane labeling. Upon warming of these cells to 37°C, internalization of CP-870,893 was observed and found to be time-dependent. By 60 minutes, sparse labeling extended throughout the cytoplasm. To better understand the fate of CD40 receptors after binding to its physiologic ligand, we first incubated MoDCs with FITC labeled 5C3 at 4°C and, after washing, subsequently incubated the cells with recombinant CD40 ligand trimer. Surface cell membrane labeling of CD40 was noted at 4°C. Small clusters of CD40 formed on the cell surface 15 minutes after warming to 37°C. At 30 and 60 minutes of stimulation, these clusters enlarged to form cap-like structures. Taken together, these findings indicate that in contrast to CP-870,893, CD40 ligand induces CD40 clustering on the cell surface and not receptor internalization.
X-linked hyper-IgM syndrome is a rare primary immune deficiency disorder caused by mutations in the gene encoding CD40L (CD154)1,2. Reflecting the importance of CD40L in the biology of B cells and antigen-presenting cells, XHM patients suffer from defects in both humoral and cell-mediated immunity. Central to the disorder, activated CD4+ T cells fail to express functional CD40L and are thus unable to activate CD40-expressing B cells and other APCs4,5. Because stimulation of B cells through CD40 is an important signal for induction of the antibody-diversifying mechanisms of somatic hypermutation and class switch recombination, XHM patients are limited in their ability to generate high-affinity antibodies with different effector functions4,5,32. CD40 signaling also activates APCs to produce proinflammatory cytokines such as IL-8, TNF-α, and IL-12, and costimulatory molecules such as B710,11,33. XHM APCs are less capable of facilitating T cell priming, and XHM patients are thus particularly susceptible to malignancy and Cryptosporidiosis, conditions that are normally kept in check by a Th1 immune response12,13. This added deficiency of cell-mediated immunity explains why fewer than 20% of XHM patients survive beyond age 25 despite treatment with immunoglobulin replacement therapy and appropriate antibiotic therapy for breakthrough infections—a statistic that highlights the need for better-targeted and more specific therapies for XHM13.
One prospective new treatment is CP-870,893, a fully human IgG2 agonist antibody to CD40 that has already been tested in early clinical trials for patients with solid tumors25. Moreover, CP-870,893 showed therapeutic efficacy in patients with metastatic pancreatic ductal carcinoma and in a mouse model of PDA22. In both humans and mice, tumor regression resulted from infiltration of CD40-activated macrophages into the tumor stroma22. In this report, we present preclinical data and the results of a pilot study conducted on two patients with XHM and biliary Cryptosporidium.
CP-870,893 was shown to have potent biological activity in both preclinical experiments and in the two XHM patients. Importantly, CP-870,893 was effective in activating both B cells and T cells in vitro, restoring class switch recombination in XHM B cells, and IFN-γ production by XHM T cells. The latter was likely due to CD40 induced secretion of TNF-α and IL-12 by MoDCs. CP-870,893 infusions were well tolerated without signs of severe cytokine release syndrome and caused a rapid disappearance of peripheral B cells from the blood. As others have suggested, the disappearance and rapid reappearance of peripheral B cells is most likely due to redistribution, and CP-870,893 is known to upregulate chemokines and cell adhesion molecules on B cells25. Decreases in the number of CD4+ and CD8+ T cells were also observed with CP-870,893 treatment. The lowest absolute number of CD4+ cells was observed when CP-870,893 was infused three times per week, and both CD4+ and CD8+ T cell number returned to baseline 1 week after therapy.
CP-870,893 had limited effect on immune reconstitution in vivo studies. Patient B cells in the peripheral blood remained invariably naïve, serum IgE and IgA were notably absent, and there was no improvement in the ability to generate IgG responses to specific antigens. Frequent administration of the drug induced patient T cells to produce TNF-α, and IFN-γ and this correlated with decreased Cryptosporidium cyst burden.
Although IgG2 antibodies typically have a half-life of 3 weeks, previous reports indicate that the half-life of CP-870,893 is 8 hours. This indicated that the failure of the patients to experience significant immune reconstitution may be due to rapid clearance of the drug, and we hypothesized that binding of CP-870,893 may cause rapid internalization of the CD40 receptor. In support of this, we observed cytoplasmic translocation of labeled CP-870,893 from the cell surface of monocyte-derived dendritic cells after 1 hour of incubation. This is in contrast to the constant presence of a saturating amount of antibody in vitro, and most likely explains the discrepancy between the potency of CP-870,893 in preclinical studies and its lack of efficacy in vivo. Although CP-870,893 may have limited utility in the treatment of patient with XHM, the demonstration that CP-870,893 causes rapid internalization of the CD40 receptor opens up a potential novel strategy for the treatment of CD40+ malignancies in which CP-870,893 is used as a vehicle to deliver recombinant toxin or radiolabels. In this form, CP-870,893 conjugates would specifically recognize CD40+ cells and efficiently mediate cell entry of therapeutic agents.
We recently published a clinical study where we investigated recombinant CD40L (rCD40L) in the treatment of XHM34. The improvements in T cell immune function with rCD40L administration were more prominent that those observed with CP-870,893. rCD40L therapy was also associated with changes in lymph node size and architecture based on comparison of biopsies taken before and after therapy. The question as to why rCD40L led to greater improvements in T cell responses awaits further investigation. However, it has been shown that each drug binds to different epitopes on the CD40 receptor23 and our confocal studies demonstrate that rCD40L induces CD40 clustering on the cell surface that was not observed with CP-870,893. rCD40L also has a longer half-life of 24-36 hours after in vivo administration35. Such differences between the two drugs may be associated with differences in expression of co- stimulatory molecules that are important for T cell priming.
In closing, it is important to note that the expression of CD40L is tightly regulated on the surface of CD4+ T cells and constitutive expression of CD40L in mice led to the development of lymphomas that involved multiple organs36,37. XHM patients enrolled in future clinical trials that use CD40 agonists will need careful monitoring. In addition, both patients were forced to discontinue treatment with CP-870,893 due to liver function test abnormalities. Patient 2 while receiving infusion of CP-870,893 at 0.2 mg/kg three times per week was found to have a sustained transaminitis as well as increased hepatic stiffness by non-invasive transient elastography measurements. A liver biopsy revealed peri-portal tract inflammation with fibrosis as well as bile stasis, and there was also evidence of bile duct injury with a decline in the number of bile ducts. These changes in the liver reversed with discontinuation of therapy. While pre-existing biliary Cryptosporidium may have contributed to hepatic injury in this patient, it is important to note grade 3 or 4 elevations in liver transaminases were observed in cancer patients receiving recombinant CD40 ligand35. Given the observed hepatic toxicity associated with CD40 agonists, future studies should include interim evaluations and clear stopping rules for toxicity.
This work was supported, in whole or in part, by the intramural program of the National Institutes of Allergy and Infectious Diseases, NIH.
We thank the families studied for their invaluable contribution to this project; W. Strober for helpful discussions; Harry Malech for careful review of the manuscript; and R. Huhn for facilitating access to CP870, 893.
The project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under contract N01-CO-12400, and supported by the intramural program of NIAID/NIH.
The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


text:
Hi Russ - Yes, that may be true, but Mizuno did not talk about sputtering during the final deposition. Should we presume there was a bias and a deuterium plasma? I hate missing details.
On Mon, Sep 4, 2017 at 10:16 AM, Russ George <russ.geo...@gmail.com> wrote: > Bob, > > > > One can sputter the daylight with Pd in a simple D2 plasma under very > simple conditions! > > > > *From:* Bob Higgins [mailto:rj.bob.higg...@gmail.com] > *Sent:* Monday, September 4, 2017 11:42 AM > *To:* firstname.lastname@example.com > *Subject:* [Vo]:Mizuno latest > > > > Jed, can I make a request? Acknowledging your fluency in Japanese and > relationship with Mizuno ... > > In Mizuno's paper, he describes the deposition the preparation of the Ni > and the Pd with a good deal of text, but in the final part of the > preparation (page 8, figure 10) he describes heating the ceramic heater > wrapped in Pd wire to 700-800°C for 10-20 hours to deposit Pd on the Ni > surface. This may be the most important part of the process, yet he only > spent 1 small paragraph describing the deposition. > > The melting point of Pd is 1550°C and the boiling point of Pd is 2960°C. > Clearly, at the specified temperature of the ceramic heater, the vapor > pressure of the Pd is very, very low. So, without plasma, it is hard to > understand how any Pd is deposited at all. Mizuno only describes D2 as > being in the chamber - there is no Ar that is normally used in sputtering > (energetic Ar ions are used in sputtering to have a better probability of > knocking off atoms of the metal due to the high mass of Ar). Mizuno > doesn't describe a DC plasma condition that would have been used for > striking a glow near the ceramic heater with Pd wire for deposition. > > *Can you ask Mizuno if he can provide an explanation of the mechanism of > Pd deposition used in conjunction with the ceramic heater wound with the Pd > wire? Was it an evaporation process, sputtering, or ion plating > technique? Was a plasma active during the Pd deposition? Was it a > deuterium plasma? Was there a DC voltage applied between the heated Pd > wire and the cathode?* > > Also, Mizuno shows SEM photos of the Ni mesh cathode surface before and > after the treatment. The after photo shows micron scale bulbous growth > that I surmise from his deposition method cannot be all Pd. It appears > that the surface morphology of the Ni has been vastly altered, and probably > has only a small film thickness of Pd on top of that. His Ni mesh cathode > has a lot of area, and he only has a small amount of Pd wire on the ceramic > heater. > > *Can you ask Mizuno what he believes is the thickness of Pd that he has > deposited by his final deposition process? I.E. in Figure 32, how thick is > the Pd film on top of the Ni? * > > > > Regards - Bob Higgins >


text:
Company Name: Reliance Industries
Job Title: Voice Engineer
Location: Maharashtra
Experience: 2 to 3 years
Req ID: 104848
sponsored links
Job Accountabilities
The position is responsible for Managing, Administrating and Implementing VoIP and TDM consulting engagements.
The primary focus of this position is to support VoIP installations of Cisco & Avaya Voice Network setup of RIL.
Comprehensive knowledge of Cisco Unified Communication Manager (CUCM) 8.6/9.1.2/10.X and Voice Technologies – Avaya Call Manager, Avaya Media Server, Avaya Media Gateway
Good Hands-on Cisco UCS Server, Cisco Unified Applications, Cisco ISR Gateways
Sound knowledge of E1 , FXO , FXS Configuration – PVDM resources
Good understanding of H.323 & MGCP protocols
Good knowledge of Call Centre setup to support various Helpdesk
Understanding of TRAI regulatory will be an added advantage
Responsible for design, staging, configuration, implementation, and support for VoIP installations as necessary
Key Attributes – Qualifications
Graduate in Engineering (Preferred with Telecom background)
Good Communication and Project Management Skills
Voice Certifications like CCNA- Voice and above
Key Attributes – Experience
2 to 3 year(s) of relevant experience
Experience in Avaya , Cisco, basic Call center set-up
Experience in Cisco CUCM, Voice Gateways, CUBE configuration
MGCP,H323 protocols,SIP,
About Us:
Our motto "Growth is Life" aptly captures the ever-evolving spirit of Reliance. Our activities span hydrocarbon exploration and production, petroleum refining and marketing, petrochemicals, retail and telecommunications. In each of these areas, we are committed to innovation-led, exponential growth. Our vision has pushed us to achieve global leadership in many of our businesses – including our position as the largest polyester yarn and fibre producer in the world. Reliance Industries Limited is a Fortune 500 company and the largest private sector corporation in India.
As Reliance sets sights on even more ambitious goals, we remain inspired and guided by the story and philosophy of our founder chairman Dhirubhai Ambani. Hailing from modest means, he followed his dream to create India's largest company. Reliance as an organisation has adopted this ethos of converting adversity into opportunity and making the impossible possible by challenging conventional wisdom.
Apply To Attend
R-SAT Exam (Recruitment Test)- To Get Short Listed ( 2014-2015 & 16 Freshers)
sponsored links


text:
It will be seen by the GOP establishment as the fall of one man, not a rebuke to their amnesty agenda
After a series of defeats, a Tea Party candidate finally claimed a major scalp. Cantor had never been a particularly strong candidate and the Tea Party benefited from having a large committed turnout, while Cantor's voters stayed home.
It's tempting to celebrate Cantor's defeat as the end of amnesty. But it's unrealistic.
The GOP establishment has seen plenty of warning signs, but it has moved forward nonetheless. Its response to an amnesty setback is to retool the lies they're telling. They can't give up on the agenda because it's all they have to cling to after the 2012 defeat and it's backed by wealthy and powerful special interests.
The establishment will be staggered, but its consultants will put together an explanation and the story will be spun and respun. Cantor's loss will be treated as an outlier that happened as a result of an unlikely converge of circumstances. The survival of the establishment candidates, even noxious ones, will be seen as proof of that. If Graham can win, then the fault was in Cantor. If Boehner can win, then the fault was in Cantor. It's what they will keep telling themselves.
Privately some GOPers will step a bit more carefully, but they will no more back down from amnesty after one defeat than Obama backed down from his policy agenda after 2010.
Politicians respond to a setback by copying the language of some of their opponents and then looking for a way to relaunch their agenda. It takes multiple humiliating defeats for that to change.
Cantor's loss is painful, but it will be seen by the GOP establishment as the fall of one man, not a rebuke to their amnesty agenda.
A single setback won't stop amnesty. Only a sustained effort will.


text:
- Please select a date to see the proper prices!
Description of the Accommodation
Rooms, services Just planning a trip to Laos? We suggest you check the options provided by BEST WESTERN Vientiane Hotel Vientiane. The hotel is offering 44 tastefully furnished rooms to those seeking accommodation in Vientiane. Since the hotel has an own restaurant, you may also try fine local meals on the spot. You may also enjoy relaxing wellness services on the spot. For meetings and nice evening chats the local café or the bar will provide an ideal location. If you wish to learn more about the exact scope of services provided by BEST WESTERN Vientiane Hotel Vientiane (including any available for an extra fee), you will find them on the information sheet below.
Payment Advance bank card payment or credit card guarantee may be required for the reservation, depending on the chosen date, room and price.
Arrival, opening hours The earliest time to arrive is 12:00, the latest time to leave the rooms is 12:00. You will be able to speak with the personnel in Lao and English languages.
BEST WESTERN Vientiane Hotel Vientiane rooms Rooms
- Please select a date to see the proper prices!
Accommodation services
- Wellness section, relaxation
- Finnish sauna
- Jacuzzi
- Pool (Outdoor - seasonally open)
Bar, Cafe, Elevator
Own restaurant


text:
VideoHive Bright Logo Reveal 2418653
After Effects Project \ Logo Stings \ 3D \ Object
Reveal \ Bright \ Effects \ Resolution \ Flares \ Approx \ Render \ Clicks \ Forget
After Effects Project - Bright Logo Reveal 2418653 by iconoclast @ VideoHive
After Effects Project \ Logo Stings \ 3D \ Object
Welcome to After Effects 3D Bright Logo Reveal Project.
Very easy to edit. Just drop your logo.
No plugin required. Pre rendered flares. Also Optical Flares included for specific changes.
Totally done in After Effects and its fully customizable.
Thanks to Expression controls you can change anything you want with few clicks.
Full HD Resolution (1920×1080)
Due to resolution and 3D look it may take approx 2 hours to render on quad core i7.
You can find music here .
Dont forget to rate if you like it…
Follow me on .
After Effects Version: CS5, CS5.5, CS6; Resolution: 1920x1080; File Size: 43mb.
Keywords: bright, broadcast, business, elegant, intro, logo, opener, outro, reveal, stylish, web, white, yellow.


text:
Beijing, March 16 (Reuters): Chinas parliament picked Wen Jiabao as Premier today, placing the worlds fastest-growing major economy in the hands of a man who must tackle deep problems like a rotten banking system and a yawning wealth gap.
Wen, 60, was confirmed as successor to the highly respected Zhu Rongji by the National Peoples Congress, Chinas ceremonial legislature, as it winds down its annual two-week session.
Nearly 3,000 delegates gathered in Beijings gigantic Great Hall of the People off Tiananmen Square to vote on Wens appointment and put the final stamp of approval on a historic handover to a younger generation of leaders.
Parliament also re-elected Xiao Yang as top judge and chose former public security chief Jia Chunwang as top prosecutor to tackle the rampant corruption that is another blight on the economy. Wen, who as vice premier under Zhu handled a wide range of issues from finance and scientific research to disaster relief, received 2,906 votes for, three against, and 16 abstentions.
When the results flashed on a screen in the cavernous main hall, the bespectacled Wen smiled, took a bow, then shook hands with Zhu.
Wen now takes the reins of the worlds sixth-biggest economy, which galloped along at 8 per cent growth last year.
He will try to keep the economy growing by at least 7 per cent this year and usher the once Marxist country further down the path of capitalist reform.
His appointment followed the confirmation of Communist Party chief Hu Jintao as state president yesterday. Hu succeeded Jiang Zemin, who will continue to wield power behind the scenes as chairman of a powerful military body.
A former geologist whose smarts and loyalty helped him rise to the highest ranks of power, Wen also has a breadth of experience that is expected to serve him well, analysts said.
Wen is universally regarded as a responsive and adaptive individual, Barry Naughton, an expert on Chinas economy at the University of California, San Diego, wrote in a recent paper.
His intelligence is unquestioned. He is meticulous and extremely hard-working. He is reputed to be personally honest, his personal habits seem above reproach, and his family is not tainted by accusations of corruption, Naughton wrote.
But Wen has his work cut out.
Problems simmer beneath Chinas sparkling growth figures. If mishandled, they could derail the economy and throw the 1.3 billion people of the worlds most populous country into turmoil. A huge mountain of bad loans threatens to smother banks and sink their ambitions to become modern financial houses.


text:
Recommended Denver Boulder Wedding Venues
Get Your Rustic On! 6 Cool Colorado Barn, Ranch, and Farm Wedding Venues
With snow-capped mountain peaks, lush Aspen and evergreen forests, and sweeping valley vistas, Colorado certainly lives up to its reputation as the jewel of the American West. And for couples seeking a rustic, outdoorsy wedding venue, there's no better place to start than the Rocky Mountain state. Quintessential barns, ranches, and farms are located in every corner of Colorado, making it easy to find a perfect fit...the only tricky part is choosing just one!
Dazzling Denver: 11 Mile High City Wedding Venues
Denver's colorful history and dazzling location make it a favorite choice for the Big Day, whether you're a local couple or one that's planning a destination wedding. Within the charming town's borders you'll find an eclectic mix of grand hotels, treasured architectural gems, and funky restaurants—and some spots that are all three at the same time! Look over our list and see for yourself—there's no need to leave the Mile High City to find an unforgettable place to say "I do".
A Distinctive Dozen of Denver's Most Unique Wedding Venues
Denver may be famous for its majestic mountains and "Wild West" reputation, but there's so much more to discover in and around this creative, eclectic city. If you've set your sights on a unique wedding in the Mile High City, check out this collection of some of our favorite places to celebrate!


text:
Popular Indian Android Maker, Micromax has outraced the South Korean company Samsung to become the largest domestic vendor in Indian smartphone market. Till now Samsung has been the leading supplier of the smart phone but with the latest report of Canalys' fourth quarter Micromax has become the largest supplier in the smartphone market. India is a booming smart phone market and till now with its effort Micromax was trying to grab the maximum user's attention.
As Indian Market consists mainly of the users consisting of mid-range to low range base and Micromax plans to launch the handsets at the tag of INR 9,000 to INR 12,000 is one of the reasons why Micromax is crowned as the top brand.
In the latest report issued by the Canalys, Micromax currently accounts for around 22% of the totals sale of the smart phones in India in the fourth quarter i.e October to December. Samsung catered 20% of the total sales. Talking about the number of smart phones which were sold in India in that period, it is about 21.6 millions which is 90% more than that of last year.
After China, India is the second largest smart phone market since in India till also many users still uses feature phones and are upgrading from feature phones to smart phones. And these customers mainly have budget in between $100 to $200. Therefore it becomes important for the mobile makers then whether it is Samsung or Micromax to launch the smart phones at the pocket friendly prices.
Also Check: Micromax Canvas Phones Price Between Rs. 10000 and Rs. 15000
Canalys added that the reason why Micromax has become the first choice is its ability to cater the demands and requirements of the users. Devices like Canvas Hue, Canvas Nitro etc have become the first choice for the customers who want to buy the smart phones at the price below $100. In this quarter nearly one-fourth handset which was sold is under the range below $100 on the other hand 21% are the devices which were sold at the price tag of $100-$200.
After Micromax and Samsung, the companies which followed up are of Indian origin only i.e Krabonn and Lava. All the companies are keeping in mind the customer requirement and then accordingly launching the handsets, for example keeping in mind the user's requirement to let them talk in their own language, Micromax introduced Canvas Unite while Lava launched the smart phones which fulfills the battery requirements of the users.
It is quite amazing and good to know that the three out of four positions are entitled to the Indian Makers only. It is good to see the Indian Companies like Micromax, Karbonn, LAVA are keeping up with the customer's demands and bringing in the handsets which are not even technologically advanced but are also available at affordable price tag.
Micromax has managed to not only keep a check on the price but also come up with latest specs and high-end quality, since in country like India to establish oneself, it is important for a company to bring in quality along with an affordable price tag. Now Micromax needs to provide better after sale services and regular OS updates to stick at the first position.


text:
Leonardo Dicaprio by JaneyArtWatch
©2013-2017 JaneyArt
Drawn for my daughter
Approx 30 hours
"I'm back"
Graphite 2B-9B on canson smooth
Kneadable eraser, blending stump and cotton swabs
Approx 30 hours
"I'm back"
Graphite 2B-9B on canson smooth
Kneadable eraser, blending stump and cotton swabs
Holy shit, i'm in love
Whoa you are.. really really good!
Really nice shading and all <3
Really nice shading and all <3
all of your work is amazing! such mastery of the eye and shading <3
Wow Awesome work !!!
very realistic drawing!!!
This work deserves a prize!
I know, right?! It's too amazing, you should get money for it..
Oh that's lovely of you to say thanks
Your amazing!!!
geez lovely work Jane, really soft blending on this one......... bet she loved it!!
Wow! I was looking through your earlier deviations and you've improved so much. This is truly incredible, it looks like a photograph.
rewlacyjny rysunek!!!
This is purely brilliant!
My Good God That's Amazing Really Pops Out of The Page !
Oh God it loos so real!!
Beautiful work, once again.
Great drawing !!!
Very good !
Woahh, the first thing i thought was "why is this in the fanart section, it's a photo o-o"
BUT MAN, that is amazing! truly remarkable! :0
BUT MAN, that is amazing! truly remarkable! :0
Really great work !
This is so amazing! I love this style! You are so talented! Congratulations!
This is amazing, I have to focus to tell the slight differences between it and a photo.
So perfect...!


text:
We have heard from hundreds of teenagers, women, and their family members who have questions about breast implants. Some of you are considering surgery, while others already have implants but have questions about symptoms or safety.
Here are a few frequently asked questions (FAQs). If you don't find an answer to your question, we hope you'll write your own and email it to us at email@example.com.
Should I get saline or silicone breast implants?
What if I need to get my implants removed?
Is it possible to get health insurance coverage for breast implant removal?
I have been diagnosed with breast cancer. What are my options so that I can still have breasts?
My breast implants might be making me sick. Can someone help me afford medical care or help pay for implant removal?
I am a teenager thinking about getting breast augmentation. What can you tell me to help me decide?
After years of being unhappy with my breasts, I am thinking of getting breast implants. I am healthy and want to stay that way. What are the risks?
My saline breast implant deflated. What should I do?
I am wondering if some of my health problems are caused by my breast implants.
My silicone gel breast implant may be leaking. How do I find out if it is leaking, and what should I do if it is?
What are cohesive gel breast implants? Are gummy bear implants safer than other silicone implants?
Will Obamacare enable me to get my leaking breast implants removed?
If you don't see an answer to your question, or if you want to comment on an FAQ, send an email to firstname.lastname@example.com OR call us TOLL FREE at (844) 295-2212.


text: This morning's New York Times story on that tractor freak, Dwight Ware Watson, predictably does not mention what the Washington Post reported yesterday: The man's opposed to war with Iraq. The story in today's Washington Post also drops the reference, curiously. Some might argue that Watson's views on Iraq don't matter, because apparently he's more ticked off about falling subsidies for tobacco farmers like himself. Yet Watson's views on Iraq are essential: The guy has closed a few buildings in D.C. with his bomb threat, and traffic is snarled. He's giving the authorities a chance to practice their response to terrorism. So far, their wait-and-see approach doesn't seem to be doing a great job of removing the threat, though Watson also has said he might surrender on Thursday. At any rate, an anti-war terrorist has a large section of the National Mall plus the surrounding area, and we're just letting him sit there.


text:
Non-Erotic Series
Non-Erotic Series
Death's Favorite SoldierPrehistoric vampire becomes Death's henchman.
DecayTaunus works a Super Computer.
December RainTwo souls reawaken.
DeedsLeroy and Dee - The Beginning.
Delivery in the RearThe Iron Crowbar and the FBI investigate a new case.
- Parts:
Demonic WarThe Sovereign calls a meeting that spells the end for earth.
Derby Line MarriagePatrick and Francis are ready to start a family.
DesconocidoA man survives a murder plot, but his memory is lost
Diary Of A Hijabi SlutSomali woman meets Somali stud on campus.


text:
Template >> Logo - Harvest Organic Farm Produce Logo 46432 by patrimonio @ CreativeMarket
File Size: 302.35 KB; Requirements: Adobe CS1+; Layered: Yes; Vector: Yes.
Harvest Organic Farm Produce Logo. Logo showing illustration of farmer and horse plowing farm field viewed from back set inside crest shield done in retro style on isolated background.
100% re-sizeable vectors. Logo available in vector EPS and AI formats.
Fonts and color easy to customize.
Fonts used.
Fonts used: Nadall http://www.ffonts.net/Nadall.font and
Didot Italic
Keywords: harvest organic farm produce, logo, farmer, horse, plowing, field, plow, agriculture, farming, farm worker, plough, equine, animal, male, man, artwork, illustration, graphics, retro.