text: Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Spondyloarthritis Download Section PDF Listen ++ The term "spondyloarthritis" is used to describe an overlapping group of diseases that are characterized by inflammation of the sacroiliac joints (sacroiliitis); axial spine (spondylitis); tendon, fascia, and ligament insertion sites (enthesitis); and, in some patients, an oligoarthritis, rash, or inflammatory eye disease (uveitis). This group of diseases has also been referred to as seronegative spondyloarthritis based on the absence of rheumatoid factor. These diseases include ankylosing spondylitis, psoriatic arthritis, the arthritis of inflammatory bowel disease, and reactive arthritis. Although these conditions share common features, each one has distinct clinical and epidemiologic characteristics (Table 17–1). However, in some patients, especially early in the disease presentation, the diagnosis is not clear; these patients are considered to have undifferentiated spondyloarthritis. The overall prevalence of these conditions has been estimated to be between 0.5% and 1.5%. ++Table Graphic Jump LocationTable 17–1. Clinical and Epidemiologic Features of Spondyloarthritis.View Table||Download (.pdf)Table 17–1. Clinical and Epidemiologic Features of Spondyloarthritis.Ankylosing SpondylitisPsoriatic ArthritisReactive ArthritisEnteropathic ArthritisPrevalence0.1%<1%5–20% in psoriasis patients0.03–0.05%<0.1%20% in IBD patientsMale:female ratio3:11:1Enterogenic source M:F 1:1Urogenital source: predominantly male1:1 Axial arthritisFrequency100%20%20%10–15%Radiographic featuresSymmetricAsymmetricAsymmetricSymmetricSacroiliitisBilateralUnilateralUnilateralBilateralSyndesmophytesMarginalBulkyBulkyMarginalPeripheral arthritis Frequency50%60–90%90%5–20%DistributionOligoarticular, monoarticularOligoarticular, polyarticularOligoarticular, monoarticularOligoarticular, monoarticularJoints affectedHip, shoulder, kneeHands including DIP, kneeKnee, ankleKnee, ankleUveitis25–40%15%15–20%5%DactylitisUncommon20–30%30–50%UncommonCutaneous findingsNonePsoriasisNail pittingOnycholysisOral ulcers,Circinate balanitis,Keratoderma blennorrhagicaErythema nodosum,Pyoderma gangrenosumHLA positivity All patients85–90%30%50–80%20–30%With axial disease85–90%50%90%50–60% DIP, distal interphalangeal; IBD, inflammatory bowel disease. ++ The entheses are an important site of inflammation and subsequent pathology in spondyloarthritis. These are locations where tendons, fascia, and ligaments insert into bone. Clinical manifestations include heel pain with involvement of the Achilles tendon, foot pain at the site of insertion of the plantar aponeurosis, or swelling of an entire digit (dactylitis or sausage digit) due to inflammation of the flexor and extensor tendons of the fingers or toes. ++ Histologically, the synovial inflammation in spondyloarthritis is characterized by chronic inflammatory infiltrates that are nonspecific and indistinguishable from that of rheumatoid arthritis. While erosive bone disease does occur, unlike the rheumatoid process, this inflammatory process is also accompanied by new bone formation across previous articulations. This ossification of the articular and ligamentous structures of the spine leads to syndesmophyte formation and may result in eventual fusion and characteristic radiographic findings. ++ The dominant clinical problems that bring the patient with spondyloarthritis to a clinician and require careful management over many years are axial pain, limitation of motion, and deformity of the spine. In all forms of spondyloarthritis, the same principles of diagnosis and management of the axial problem apply with attention directed to the cutaneous, gastrointestinal, ocular, and peripheral articular manifestations of the primary disorder. + Ankylosing Spondylitis Download Section PDF Listen +++ Essentials of Diagnosis ++ Inflammatory back pain in young adults.Radiographic demonstration of sacroiliitis.Reductions in spinal mobility, particularly lumbar flexion.Association with anterior uveitis.Increased relative risk conferred by inheritance of HLA-B27.Positive family history. +++ General Considerations ++ The pathogenesis of spinal inflammation is unknown; however, there is a strong hereditary component marked by the only known susceptibility gene, HLA-B27. This genetic marker is strongly associated with sacroiliitis and spondylitis regardless of clinical setting. More than 85% of patients with ankylosing spondylitis have HLA-B27. The prevalence of ankylosing spondylitis parallels the frequency of HLA-B27 in different populations in the United States and in other regions of the world. This gene occurs in 8–10% of white Americans, and the disease occurs in 0.1–0.2% of that population. Blacks have a much lower frequency of both disease and the HLA-B27 gene. On the other hand, there is a high frequency of spondylitis and of HLA-B27 in certain Native American and Eskimo groups. Ankylosing spondylitis is common in Europeans and most Asian groups but is found rarely in Japanese, again reflecting the relative frequency of the B27 marker. If normal persons with HLA-B27 are carefully assessed, clinical or radiographic evidence of disease can be found in only 2%. ++ The typical patient with ankylosing spondylitis is a young white man under the age of 40 years (Table 17–2). Occasionally, the diagnosis is made in older patients, but careful questioning often reveals that symptoms began years earlier. The impression that women are affected less often than men (ratio 1:3) may be caused by underrecognition of the disease in women. The initial symptoms of the disorder in women may include more peripheral joint or cervical spine involvement. Therefore, one should be mindful of these differences between men and women and must consider an emerging process in young women in whom arthritis presents. ++Table Graphic Jump LocationTable 17–2. Clues to Early Ankylosing Spondylitis.View Table||Download (.pdf)Table 17–2. Clues to Early Ankylosing Spondylitis.A young man (less often a woman) with inflammatory back symptomsPain/stiffness in buttocks, low back, chest wall worst with rest and better with exerciseReduced spinal mobilityFamily history of ankylosing spondylitisOligoarticular/monoarticular large joint involvement (hips and shoulders)History of eye pain, redness, blurry vision that may have been diagnosed as anterior uveitis +++ Clinical Findings +++ Symptoms and Signs +++ Axial Spine ++ The usual presenting symptom of ankylosing spondylitis is inflammatory back pain. The pain and stiffness are in the low back or deep within the buttocks. This discomfort begins insidiously, and the patient would typically have noticed this for several months to several years before seeking medical attention. Unlike mechanical low back syndromes, the pain and stiffness of inflammatory disease are usually worsened by rest and improved by exercise. The patient may be unable to sleep through the night or sit for prolonged periods and must arise and stretch to obtain relief, with morning stiffness lasting greater than 30 minutes. As in discogenic disease, however, symptoms of shooting pains into the buttocks and down the posterior or lateral thighs may occur and mimic sciatica. These pains are usually transient, may alternate to the opposite side and are not associated with any demonstrable neurologic deficits. There are few measurable abnormalities in patients with early disease (Table 17–3). In fact, the patient with sacroiliitis may have an entirely normal physical examination despite significant symptoms of pain and stiffness in the low back region, contributing to delays in diagnosis. At most, there may be tenderness on direct palpation of these joints in the buttocks or on compression of the pelvis. ++Table Graphic Jump LocationTable 17–3. Physical Examination in Ankylosing Spondylitis.View Table||Download (.pdf)Table 17–3. Physical Examination in Ankylosing Spondylitis.Sacroiliac jointsTendernessPain with compression/stressLumbar spineTendernessParavertebral muscle spasmLoss of lordosisDecreased flexion: Schober test (<5 cm)Decreased lateral motion and extensionHips, shouldersPain on motionDecreased range of motionThoracic spineIncreased kyphosisTendernessPain with rib cage compressionDecreased chest expansion (<2.5 cm)Cervical spineTendernessPain on motionMuscle spasmDecreased motionKyphosis, decreased lordosisOcciput to wall distance ++ Abnormalities that eventually appear in the patient with progressive disease relate to loss of range of motion and deformity in mobile structures. The patient with lumbar involvement has often lost the normal lordosis, and there is flattening of that segment of the back. In addition, there is loss in range of motion when the patient attempts to bend forward. It should be recalled that hip motion accounts for 90 degrees of the flexion of the trunk on the lower extremities and that the lumbar spine provides the remaining stretch by reversing its lordosis and becoming kyphotic. An objective measurement of lumbar motion is the Schober test. With the patient standing erect, a horizontal line is drawn at the L5–S1 region at the level of the sacral dimples and another line 10 cm above that in the midline of the back. With forward flexion, the distance between these two ends of the 10-cm line should increase from 10 cm to 15 cm in the normal lumbar spine. A modified Schober test is negative if the distance between the 5 cm mark below the sacral dimples and the 10 cm above it increases to 20 cm on forward flexion. Lateral lumbar flexion is assessed by having the patient bend laterally without flexing forward or bending the knees, with measurements scored between the middle finger and the floor. A difference of >10 cm from start to end positions is normal. These tests are best applied and interpreted in the young patient because lumbar motion normally decreases with age. ++ Involvement of the thoracic spine is determined subjectively by the patient's description of pain or stiffness in that region and by demonstrable tenderness along the vertebral column and paravertebral muscles. Compression of the rib cage laterally and over the sternum may also elicit discomfort. Objective determination of fusion of the costovertebral joints is obtained by measuring the chest expansion. A tape measure is placed around the patient's chest wall at the nipple line or fourth intercostal space, and the change in circumference from full expiration to full inspiration is measured. Less than 2.5 cm is considered abnormal. ++ The range of motion of the cervical spine should be determined; extension, right and left rotation, lateral flexion, and forward flexion should be measured. Loss of extension is usually the earliest abnormality, and as the disease progresses, fixed deformity in the forward flexed position tends to develop. Developing cervical kyphosis is assessed by the occiput-to-wall measurement. The patient places both heels against the base of the wall and attempts to extend the neck fully to touch the wall with the back of the head. If this is accomplished readily, then extension measurement is normal. +++ Peripheral Arthritis ++ Although peripheral small joints (hands and feet) are uncommonly affected, the root joints (hips and shoulders) eventually become involved in nearly 50% of patients. Occasionally, involvement of the back may be entirely asymptomatic, and the patient seeks medical attention only when the disease reaches the hips or shoulders. Examination of the range of motion and elicitation of any pain on motion of both shoulders and hips is important. Spondyloarthritis may present as a pauciarticular juvenile form of arthritis with asymmetric lower extremity involvement and enthesitis. The usual age of presentation is close to 10 years, but cases have been reported in patients as young as 6 years. +++ Enthesitis ++ Chronic inflammatory enthesitis in the spine is a first step to spinal fusion and ankylosis. Enthesitis of costosternal joints leads to chest wall pain that can mimic pleuritic, pericardial, or anginal pain syndromes. Pain in the heels either at the Achilles tendon insertion or over the attachment of the plantar aponeurosis in the sole of the foot develops in approximately 10% of patients with ankylosing spondylitis. Swelling is not always apparent in these areas, but tenderness to direct palpation is found. +++ Ocular ++ Acute anterior uveitis occurs in approximately 30% of patients with ankylosing spondylitis and does not necessarily parallel the course of the articular disease. It may be the sentinel symptom. Its onset is usually abrupt and unilateral, with intense pain, redness, and photophobia as the cardinal symptoms. Immediate ophthalmologic attention is required to prevent serious damage to the anterior chamber of the eye. Topical corticosteroids are usually successful in treating an acute episode. +++ Cardiac ++ Heart abnormalities occur in less than 5% of patients with ankylosing spondylitis. The most common, first-degree atrioventricular block, can be determined only electrocardiographically. A history of palpitations or syncope and the finding of a slow or irregular pulse on examination should alert the clinician to higher degrees of atrioventricular block. A cardiac pacemaker may be required for serious arrhythmias or complete atrioventricular dissociation. Aortic regurgitation caused by inflammatory thickening of the aortic valve and root is another serious cardiac complication. Once the diastolic murmur becomes apparent, cardiac decompensation requiring valve replacement can develop within 1–2 years. +++ Neurologic ++ The cauda equina syndrome is a rare but serious neurologic complication of ankylosing spondylitis. It is believed to be related to entrapment of exiting lumbar and sacral nerves through the inflamed spinal column. Compressive inflammatory lesions within the spinal column may be found in some cases. Patients with ankylosing spondylitis should be asked regularly about paresthesias and pain or weakness in the legs and about symptoms of bladder or bowel sphincter dysfunction. This can be mistaken for the insidious symptoms of prostatic hypertrophy. Spontaneous atlantoaxial subluxation can occur in a small percentage of patients. A distance of greater than 3–4 mm between the anterior aspect of the odontoid and the posterior aspect of the anterior arch of the atlas in the lateral maximal flexion view is considered diagnostic for atlantoaxial subluxation. Other neurologic sequelae of the disorder include injuries to the spinal cord from fracture and dislocation of a rigid and brittle spine. The neck is especially prone to fracture with the potential for resulting paraplegia or quadriplegia. +++ Other Associated Conditions ++ Secondary renal amyloidosis is the most common cause of renal involvement in ankylosing spondylitis, usually occurring only after many decades of persistent inflammatory disease. Proteinuria and nephrotic syndrome indicate renal involvement, which is usually the most serious manifestation of amyloidosis. IgA nephropathy has been reported as another cause of proteinuria and renal insufficiency in this disease. Apical pulmonary fibrosis, sometimes with cavity formation, is rare and usually of no clinical consequence. This radiographic abnormality may mimic tuberculosis, and vice versa. Fusion of the costovertebral joints and ankylosis of the thoracic spine may lead to a restrictive disease pattern on pulmonary function testing. Osteoporosis is more common in patients and adequate vitamin D and calcium supplementation is vital in this condition. +++ Laboratory Findings +++ Routine Studies ++ There is no diagnostic laboratory study in ankylosing spondylitis. Hematologic studies are usually normal. In patients with severe disease, there may be a mild normocytic–normochromic anemia reflective of chronic disease. The white blood cell count is usually normal, as is the platelet count, although patients with highly inflammatory disease may demonstrate mild thrombocytosis. The erythrocyte sedimentation rate and C-reactive protein are elevated in about half of cases and tend to be more associated with peripheral disease activity. Serologic studies for rheumatoid factor and antinuclear antibodies are negative, and serum complement levels are normal. +++ Testing for HLA-B27 ++ HLA-B27 is strongly associated with ankylosing spondylitis, occurring in over 85% of patients. This genetic marker also occurs in 8–10% of the normal white American population. It must be emphasized that indiscriminate HLA typing cannot be substituted for a thorough clinical and radiographic evaluation of the patient. Spondyloarthritis will not develop in the vast majority (>90%) of people with HLA-B27. In fact, determination of HLA-B27 is rarely needed in making the diagnosis of spondyloarthritis. There are unusual circumstances in which the patient gives a strong history suggestive of inflammatory back disease but the radiographs are not yet diagnostic of sacroiliitis. In such situations, HLA typing may be helpful, as well as in women with early or atypical disease. Even then, a positive HLA-B27 does not establish a diagnosis of sacroiliitis but only provides supporting data for the diagnosis when the most specific finding (radiographic sacroiliitis) is not present. It is in this setting that MRI is being more commonly used to determine whether there is any evidence of sacroiliac inflammation. ++ Patients who already know that they are HLA-B27 positive may seek genetic counseling because of the hereditary impact of disease on their family. It should be emphasized that ankylosing spondylitis is not usually a life-threatening or crippling disorder and that symptoms can be controlled medically in most patients. The likelihood that inflammatory back disease will develop in a family member is low. Because HLA antigens, including HLA-B27, are inherited in a mendelian dominant fashion, the risk of inheriting this tissue antigen type is 50% for each of a patient's children (this assumes that the patient is heterozygous and the other parent is negative for HLA-B27). Even if a child inherits this tissue antigen type, the likelihood of developing arthritis is only around 20%. Therefore, without any knowledge of HLA status, every child of a patient with HLA-B27 positive spondylitis has roughly a 10% chance of developing spondylitis. The 90% probability of never developing this form of arthritis must be emphasized to patients concerned about this hereditary factor. +++ Imaging Studies +++ Sacroiliac Joints ++ Radiographic evaluation of the sacroiliac joints is the single most specific test for this disorder. Although a diagnosis of spondyloarthritis can be suspected based on the history and physical examination, definitive diagnosis of established ankylosing spondylitis cannot be made without radiographic findings. A single anteroposterior view of the pelvis may be adequate to define sacroiliitis; however, Ferguson or oblique views are sometimes necessary to fully evaluate the integrity of the sacroiliac joints. The earliest radiographic change is usually bony sclerosis on the iliac sides of the joint margins. Thereafter, bony erosions occur. "Pseudo" widening of the joint may subsequently becomes apparent. There is eventual fusion (Figure 17–1) across the sacroiliac joint space with subsequent loss of the early sclerotic changes. These changes generally start in the lower third of the sacroiliac joint with bilateral symmetric changes typical for ankylosing spondylitis and enteropathic arthritis. This is distinct from the unilateral sacroiliac progression typical for psoriatic and reactive arthritis. MRI has proven to be more sensitive and specific in detecting changes seen early in spondyloarthritis. Using short T1 inversion recovery (STIR) imaging technique, acute sacroiliitis and spondylitis can be determined as well as enthesitis, synovitis, and bone-related inflammation. In clinical practice, this is very useful in patients, early in the course of inflammatory back symptoms, when the plain radiographs fail to show any findings consistent with sacroiliitis. ++Figure 17–1.Graphic Jump LocationView Full Size||Download Slide (.ppt)A three-dimensional reconstruction of a thoracic spine MRI showing ankylosis across three vertebrae (arrow) in a patient with ankylosing spondylitis. ++ Findings suggestive of sclerosis in one or both sacroiliac joints in the absence of features of inflammatory back pain or axial spondyloarthritis will usually point to osteoarthritis of the sacroiliac joints. Sacroiliitis can be confused with the radiographic anomaly osteitis condensans ilii, in which there is symmetric sclerosis on the iliac side of each sacroiliac joint without any erosion. This finding is mostly seen in young multiparous women. Pyogenic sacroiliitis, usually related to staphylococci and mainly seen in injection drug users, is usually unilateral and is associated with other signs of infection. Less common causes of unilateral sacroiliitis include tuberculosis, syphilis, and brucellosis. Acute gouty arthritis and calcium pyrophosphate deposition disease as causes of sacroiliitis are rare. +++ Spine ++ An early radiographic finding on lateral lumbar spine films is "shiny corners" or Romanus lesions, which are osseous erosions at the anterosuperior and anteroinferior corners of the vertebral bodies and are associated with bone resorption and reactive sclerosis. The process of inflammatory erosions and subsequent periosteal bone formation results in vertebral bodies appearing "square." Romanus lesions may also be seen in the thoracic and cervical regions. Calcification and ossification of the ligamentous structures between vertebral bodies result in the characteristic syndesmophytes seen on imaging (ie, the bamboo spine) (Figure 17–2). The apophyseal joints of the spine become fused with resulting immobility. Large "flowing" osteophytes, typically most prominent in the right thoracic spine but also common in the lumbar and cervical areas, are seen in diffuse idiopathic skeletal hyperostosis (DISH), which may clinically and radiographically mimic ankylosing spondylitis (Figure 17–3). Such patients can usually be discriminated by disease onset in late middle age and the absence of sacroiliitis. ++Figure 17–2.Graphic Jump LocationView Full Size||Download Slide (.ppt)Plain anteroposterior radiograph showing bilateral sacroiliac joint sclerosis (arrows) in a patient with ankylosing spondylitis. ++Figure 17–3.Graphic Jump LocationView Full Size||Download Slide (.ppt)Lumbosacral spine radiograph showing asymmetric bridging osteophytes in a patient with diffuse idiopathic skeletal hyperostosis (DISH). +++ Peripheral Joints ++ Radiographic findings from the peripheral joints typically result from synovitis of proximal joints or from enthesitis. With synovitis, there is symmetric joint-space narrowing while enthesitis may lead to a periosteal reaction at the tendon insertion site. The pubis symphysis, a cartilaginous joint, can undergo both erosive and sclerotic change. Narrowing and irregularity at the pubic symphysis can be readily seen on pelvic films. Whiskering as a manifestation of enthesitis due to erosions and reactive bone formation can be seen at the ischial tuberosities. +++ Diagnostic Criteria ++ Based on the modified New York criteria (Table 17–4), radiographic evidence of sacroiliitis is considered the sine qua non for the classification of established ankylosing spondylitis. These criteria carry a sensitivity and specificity of 83% and 98%, respectively. Given that radiographic evidence may take years to develop, the Assessment of Spondyloarthritis International Society has proposed separate criteria to facilitate an earlier diagnosis for axial spondyloarthritis (see Box: Assessment of Spondyloarthritis International Society classification criteria for axial spondyloarthritis [SpA]). ++Table Graphic Jump LocationTable 17–4. Modified New York Diagnostic Criteria for Ankylosing Spondylitis.aView Table||Download (.pdf)Table 17–4. Modified New York Diagnostic Criteria for Ankylosing Spondylitis.aClinicalLow back pain and stiffness for more than 3 months that improves with exercise but is not relieved by rest.Limitation of motion of the lumbar spine in the sagittal and frontal planes.Limitation of chest expansion to 2.5 cm (1 inch) or less, measured at the level of the fourth intercostal space.RadiographicSacroiliitis: Unilateral grade 3 (sclerosis and erosions of the joint margins) or grade 4 (fusion across the joint).Bilateral grade 2 (sclerosis or joint margins) to 4.aDefinite ankylosing spondylitis: unilateral grade 3 or 4, or bilateral grade 2 to 4 sacroiliitis and any of the clinical criterion.Reproduced, with permission, from van der Linden S, et al. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361. ++Table Graphic Jump LocationBox 17–A. Assessment of Spondyloarthritis International Society Classification Criteria for Axial Spondyloarthritis (SpA).View Table||Download (.pdf)Box 17–A. Assessment of Spondyloarthritis International Society Classification Criteria for Axial Spondyloarthritis (SpA).(In patients with back pain ≥3 months and age at onset of <45 years)Sacroiliitis on imaging*HLA-B27PlusORPlus≥1 SpA feature**≥2 other SpA features***Sacroiliitis on imaging:Active (acute) inflammation on MRI highly suggestive of sacroiliitis associated with SpA orDefinite radiographic sacroiliitis according to modified New York criteria**SpA Features:Inflammatory back pain, arthritis, uveitis, dactylitis, psoriasis, inflammatory bowel disease, good response to nonsteroidal anti-inflammatory drugs, family history of SpA, HLA-B27, or elevated C-reactive protein.Data from Rudwaleit M, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis. 2009;68:777. ++ The sensitivity and specificity of these criteria are 83% and 84%, respectively. +++ Treatment ++ It is impossible to predict the ultimate course of any patient with ankylosing spondylitis. The inflammatory process may remain confined to the sacroiliac joints or may involve the lumbar, thoracic, and cervical spinal segments. Likewise, the duration of time from onset of symptoms to fusion of spinal segments is highly variable. Thus, each patient should understand the nature of this illness and the need for continued medical surveillance, as well as the principles of physical and pharmacologic management of the disorder. +++ Physical Therapy ++ An important function of physical therapy is the promotion of the patient's ability to prevent spinal deformity and loss of motion in the joints. Such a program is best instituted when symptoms have been brought under control. The natural history of the disease should be explained so that the patient understands the rationale for the exercise program that must be followed over many years. An erect posture when sitting or standing should be encouraged. The patient's bed should be firm and the smallest possible pillow should be used to prevent flexion of the neck. Sleeping in the prone position is best for promoting spinal extension, but the supine position is adequate if there is good support. The patient should refrain from sleeping on the side in a curled up position. An active exercise program to promote extension of the back and increase range of motion of the axial and peripheral joints, as well as breathing exercises to maintain chest expansion, should be performed two to three times a day. Referral to a physical therapist to provide specific instructions and determine that the patient is performing well is a good investment. Swimming is an excellent recreational exercise for the patient with ankylosing spondylitis. +++ Nonsteroidal Anti-Inflammatory Drugs ++ Nonsteroidal anti-inflammatory drugs (NSAIDs) are used as first-line medical therapy to relieve the pain and stiffness of the disease and to promote the patient's ability to perform the physical exercises so important to maintaining a good posture. If the response to the initial trial is inadequate, it is appropriate to provide another class of NSAID. Occasionally, when symptoms remit, the NSAID may be tapered over several weeks and reinstituted if symptoms recur. Silent progress of the disease may occur; therefore, the clinician should closely monitor these patients even when they are not taking medication. There is some evidence that continuous use of NSAID therapy does reduce the degree of radiographic progression at 2 years. +++ Disease-Modifying Antirheumatic Drugs ++ Overall, this class of medications has not demonstrated efficacy in treating the spinal disease of spondyloarthritis, although it can produce some moderate improvement in the peripheral arthritis sometimes seen in these conditions. Sulfasalazine, a drug used for inflammatory bowel disease, has been found to be effective as an early therapy for ankylosing spondylitis with peripheral joint involvement. A small number of trials have used oral methotrexate in ankylosing spondylitis refractory to NSAIDs and sulfasalazine. A meta-analysis of these trials did not find a significant benefit of methotrexate. +++ Antitumor Necrosis Factor Agents ++ The use of the tumor necrosis factor (TNF) inhibitors has led to impressive clinical improvement. However, not all patients require TNF inhibitors. Guidelines that have been developed by international consensus to facilitate the judicious use of this therapy recommend anti-TNF agents for patients who have definitive ankylosing spondylitis with active disease, as measured by validated metrics, and who have not responded to a trial of two NSAIDs. The anti-TNF agents currently approved are etanercept, infliximab, adalimumab, and golimumab. In studies with these agents, efficacy has been demonstrated in reducing symptoms of as well as markers of inflammation, including C-reactive protein and erythrocyte sedimentation rate within several weeks of initiation of therapy. ++ For patients who have responded to anti-TNF agents, continued therapy is usually necessary and generally well-tolerated. Discontinuation of therapy may result in reactivation of the disease within several months time. While these agents have been a remarkable advance in the therapy of ankylosing spondylitis, their use provokes many unanswered questions regarding long-term safety issues, the proper timing of initiation of therapy, and the potential role of future biologic agents in combination when these become available. +++ Surgery ++ Spinal surgery is rarely performed, unless it is needed for stabilization of a fracture site. More frequently, up to 5% of patients require total hip arthroplasty. This procedure is generally well tolerated with decreased hip pain, increased mobility, and 20-year joint survival exceeding 50%. Care must be taken to perform a careful preoperative assessment for cervical spine disease in order to avoid spinal cord damage that can occur during endotracheal intubation. +++ Prognosis ++ The prognosis for patients with ankylosing spondylitis is excellent. Most patients can be treated successfully by physical and pharmacologic means. Most patients continue to lead productive lives and change in vocational plans is usually not indicated. The morbidity from articular and extra-articular complications is low, and lifespan is not reduced significantly, if at all. These facts should be optimistically presented to the patient. It is also vital to ensure close follow-up of all extra-articular manifestations many years after the initial articular process as many of these organs only become involved later in the course of ankylosing spondylitis. + Enteropathic Spondyloarthritis Download Section PDF Listen +++ General Considerations ++ Enteropathic arthritis develops in nearly 20% of all patients with Crohn disease and ulcerative colitis. Enteropathic arthritis most commonly presents with a peripheral arthritis that can correlate with bowel activity and is usually self-limiting; it can also present with a spondylitis that may progress in the absence of active bowel disease, although this is less commonly seen than peripheral arthritis. +++ Clinical Findings ++ The peripheral arthritis is often migratory and rarely erosive. Erythema nodosum and pyoderma gangrenosa may be cutaneous manifestations with the peripheral arthritis. The spondylitis is generally more benign than in ankylosing spondylitis but may be indistinguishable. The male predominance of ankylosing spondylitis is not found in enteropathic spondyloarthritis. Isolated sacroiliitis without spine involvement may also occur. No laboratory marker is specific for either condition. ++ It is important to rule out septic arthritis secondary to fistulization or avascular necrosis in patients with inflammatory bowel disease who have sacroiliitis or hip symptoms. Hypertrophic osteoarthropathy, which may develop in Crohn disease and ulcerative colitis, is differentiated from enteropathic arthritis due to the dominant features of periostitis and clubbing. +++ Treatment ++ Frequently, treatment of the underlying bowel disease leads to remission of the peripheral arthritis. If this persists, sulfasalazine can be effective. In general, NSAIDs are avoided as first-line therapy because they may lead to exacerbations of the inflammatory bowel disease, although other studies have not demonstrated worsening flares with cyclooxygenase (COX)-2 inhibitors in patients with ulcerative colitis. This should be addressed on a case-by-case basis in conjunction with a gastroenterologist. If an adequate trial of sulfasalazine has failed to fully control symptoms, then anti-TNF agents have been demonstrated to control both Crohn disease and the associated arthritis. ++Reveille JD, Arnett FC. Spondyloarthritis: update on pathogenesis and management. Am J Med. 2005;118:592. [PubMed: 15922688] ++Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis. 2009;68:777. [PubMed: 19297344] ++Salvarani C, Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol. 2009;15:2449. [PubMed: 19468993] ++Sandborn WJ, Stenson WF, Brynskov J, et al. Safety of celecoxib in patients with ulcerative colitis in remission: a randomized, placebo-controlled pilot study. Clin Gastroenterol Hepatol. 2006;4:203. [PubMed: 16469681] ++The American College of Rheumatology website++http://www.rheumatology.org/++The European League Against Rheumatism++http://www.eular.org/++The Spondylitis Association of America++http://www.spondylitis.org++Wanders A, Heijde D, Landewe R, et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum. 2005;52:1756. [PubMed: 15934081]


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Last movie you watched
Iron Fists and Kung Fu Kicks is a pretty good doc on Netflix about the origin and rise in popularity of Kung Fu movies. Very happy to see the bit about Wakaliwood at the end. Saw a couple of those movies a few years ago, including the one starring the rando white dude who got super excited and just flew to Uganda cause he wanted to be in Ugandan martial arts films.
Ezekiel Banned last edited by Ezekiel
Madonna: Ciao, Italia! - Live from Italy (1988)
Very nice representation of that era of her music, her first three albums. I loved hearing the band just jam out on some of those tunes, expanding on them more than in the album versions. She has so much fun on stage. Her energy, dancing and playful theatrics with the other performers make it so much more entertaining than if it was just a singer standing around. The crowd, evidently proud of her Italian ancestry (which she exploited by speaking to them in Italian at times and mentioning her family there), was crazy for her. What a showman! Would watch it again. I'd post the YouTube version, but it has much less clarity and pop than the DVD version and its 1536 kbps PCM track.
Army of Darkness - 6/10
I liked The Evil Dead and, to a lesser extent, Evil Dead 2, more, for not being as slapstick, and the first especially for still being a horror movie. I just didn't find this funny or clever.
Capnbobamous last edited by
Finally saw Parasite, and... wow. I'm not gonna be able to say anything about it that thousands of people haven't said already, but damn it was good. One of my favorite third acts in film. I was able to see it alongside a live orchestra (which was introduced by Bong Joon Ho himself) which added to the experience immensely. I don't think I like it as much as Memories of Murder, but it's very close. I'll have my year-end list up after I see it again.
On a side-note, I saw Cameron Monaghan there, who played Cal Kestis in Jedi Fallen Order! LA is pretty rad sometimes.
@capnbobamous said in Last movie you watched:
I was able to see it alongside a live orchestra (which was introduced by Bong Joon Ho himself) which added to the experience immensely.
I'm so jealous you got to go to that.
Capnbobamous last edited by
@tokyoslim Bong said that we were the first people to see this, which makes me thing the show is gonna go on the road. You may still have a chance.
so you're saying there's a chance dot gif
Sentinel Beach last edited by Sentinel Beach
I join the club and praise Parasite now finally. Man, that's a refreshing film! A unique story with a really nice mix of dark comedy and suspense. Loved the characters. And the directing and cinematography were also really pleasant to the eye, well chosen camera angles that kept the film exciting and made you feel involved. The house was a great setting for everything.
The audience even got cool dramatic posters as gifts here, it was the premiere night here in Finland (finally).
DIPSET last edited by
Despite the movie looking like hot garbage, I kinda gotta see Aladdin because A) The actress who plays Jasmine is really damn attractive, and B) despite how much people shit on Guy Ritchie films, I seem to like the ones everybody hates the most.
@dipset said in Last movie you watched:
The actress who plays Jasmine
She was also great in the new Charlie's Angels
Michael Jackson Live in Bucharest (1992) on DVD.
So many Romanians passed out, holy crap. Cool entrance and exit, plenty of awesome moments in between, some of my favorites being the live gravity lean and crane ride.
Great show.
@ezekiel Have you seen Queen Rock Montreal?
@tokyoslim said in Last movie you watched:
@ezekiel Have you seen Queen Rock Montreal?
No, I haven't.
@ezekiel if you're into concert footage, it's my favorite.
DIPSET last edited by
I went to see Stop Making Sense with my ex in the theatre in 2016 and it was the best date of my life. People underestimate how great concert films can be.
I watched Rush "All The Worlds A Stage" in memory of Neil Peart last month. RIP
Also last year I watched The Prodigy "World's On Fire" in memory of Keith Flint in early 2019.
Ezekiel Banned last edited by Ezekiel
@tokyoslim Added to my Amazon list.
Watched Madonna: Blond Ambition Tour (1990) on DVD, which I think is a bootleg of the laser disc. Paid 30 bucks for this after hearing it's the best Madonna concert film. I've seen three previously and can understand why it's so liked. Best number was probably Vogue.
Or maybe Like a Prayer, can't decide.
@dipset said in Last movie you watched:
I went to see Stop Making Sense with my ex in the theatre in 2016 and it was the best date of my life. People underestimate how great concert films can be.
I watched Rush "All The Worlds A Stage" in memory of Neil Peart last month. RIP
Also last year I watched The Prodigy "World's On Fire" in memory of Keith Flint in early 2019.
Stop Making Sense is one of the all-time greats. Haven't seen The Prodigy one, but I did run into Keith Flint once at the Burbank Airport about 5 or 6 years ago.
naltmank last edited by
Stop Making Sense is the best pure concert movie hands down. For a concert movie with interviews mixed in, check out The Last Waltz. Used to be on repeat in my house when I was growing up.
Faaip last edited by
I highly recommend that everyone stop what they're doing and watch The Velocipastor on Amazon Prime

subset: commoncrawl


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Promising harmony at home gives you a chance to make new plans. Faraway trips, changing the decoration or works at home, regardless of what you decide to do, you're very motivated about the idea of bringing in some change and you can only be delighted. Your partner completely agrees with you.
You need change or novelty? You're at the right place! Indeed, today almost all planets agree to grant you promising opportunities, you need to confirm the trial. Don't come in the way of your impetus due to unjustified uncertainties. You hold the keys, it's your move to open the right doors.
Dressing up will allow you to play different roles and fulfill all of your fantasies! Be bold enough to bring your wildest fantasies to life today!
If need be, you'll begin negotiations! Today, you slow down, determined not to get pushed around. If you're in your right, you'll be keen on demanding your requests, whether it is appreciated or not!
If you decide to do your accounts today, do them when you're relaxed. It doesn't mean that the situation is serious, but you may come across some unpleasant surprises. Given these circumstances, it's better to be in control.
Your group of friends count on you to cheer up the troops. You plan out a little gathering in a rush, everybody loves it. You did it.
Your family members pamper you. You are suspicious, you think they have a fishy attitude but you play along.
"Appearance is nothing; The wound is at the bottom of the heart." Euripides
Careful as throughout the day, some fatigue might come along. Get some breaks.
A raspberry red top will brighten up your gray outfits and make you look healthy!


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As the saying goes…. It's all Water under the Bridge.
Water is this week's topic that Cee has nominated for her weekly Fun Challenge
Powerful and dramatic..
Or just tranquil on a summers evening…
Smooth sailing at sea or inland on a canal…
Or perhaps a dramatic Ornamental statement.
As water is just about everywhere, why don't you have fun and join in, the link to cees Blog is here:-
Water, a place to relax at the end of a day..
On the water or on dry land, as always….
Please Remember ….
Stay Safe …. Be Kind…. Look After Each Other
20th April
(C) David Oakes 2022


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Tale of Troy, The
Written By : Benedict Flynn
Narrator : Benjamin Soames
Published By : NAXOS
Runtime : 2 hours 40 minutes
Type : Classics
Snow White and the Seven Dwarfs
Written By : Jerry Robbins
Narrator : Full Cast Production
Published By : Colonial Radio Theatre On The Air
Runtime : 40 minutes
Type : Classics
Runny Babbit
Written By : Shel Silverstein
Narrator : Dennis Locorriere
Published By : Harper Collins US
Runtime : 23 minutes
Type : Under 10s
Boy with the Magic Numbers, The
Written By : Sally Gardner
Narrator : Andrew Sachs
Published By : Orion Publishing Group
Runtime : 1 hour 15 minutes
Type : Under 10s
Delivering Rome: The Adventures of a Young Roman Courier
Written By : Donna Getzinger
Narrator : Terence Asleford
Published By : In Audio
Runtime : 45 minutes
Type : Under 10s
|Have you always loved reading but sometimes find it hard to find the time? Theres nothing quite like curling up with a good book but many of us cannot do that as much as we would llike. We sacrifice this special time because we have so many other things to do each day. It is a common problem and it is the reason why people on average are not reading as much as they once did. Audio books bring the story to life just as the storytellers of the past did. They allow you to experience the book in a whole new way; in the way the writer felt and heard it in their head. You can feel the emotion when you allow audio books to let the story come to life.


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Cedarbrae Homes for Sale in Calgary
Included below are homes for sale in Cedarbrae. If you would like more information on any of these Cedarbrae real estate listings, just click the "Request More Information" button when viewing the details of that property. We can provide you with disclosures, past sales history, dates and prices of homes recently sold nearby, and more.
And, if you haven't already, be sure to register for a free account so that you can receive email alerts whenever new Cedarbrae listings come on the market.
- Acadia
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Cedarbrae Calgary Real Estate & Houses
Cedarbrae is a residential community located in the southwest quadrant of Calgary, bordering the communities of Oakridge, Braeside and Woodbine. Roads surrounding this quaint neighbourhood include Anderson Road, Southland Drive and 2th Street SW. You'll find many natural areas near this community with the Glenmore Reservoir and Fish Creek Provincial Park north and south of Cedarbrae, respectively.
Since its establishment in 1973, families have been attracted to Cedarbrae for its affordable homes and access to plenty of amenities. This means families in Cedarbrae get the best of both worlds - a quiet suburb away from the hustle and bustle of the city, but many of the big city perks like amazing shops and restaurants. With the many types of homes with all kinds of designs, you'll surely find something that fits your family and taste.
Cedarbrae Housing Market
Cedarbrae was developed to provide Calgarians with affordable and comfortable housing in a community made for families. It's an ideal place to buy your first home and settle to raise a family. You'll find many charming single-family, detached homes, as well as some townhouses and condos for those who don't require as much space but still want to experience Cedarbrae.
These character homes come in all shapes and sizes to fit all kinds of family sizes and lifestyles. There are bungalows with garages in the back and two-storey homes with street-facing garages and spacious yards. Living here comes with multitudes of perks including the many shopping areas, green spaces, places to eat and schools nearby. It's an idyllic neighbourhood worth checking out.
Cedarbrae Neighbourhood Amenities
There is no lack of amenities in Cedarbrae. Those who lead an active lifestyle take advantage of the many areas for activities and walks nearby. Fish Creek Provincial Park is just a few minutes south for endless pathways for a leisurely bike ride, walking your dog or having a picnic. Avid golfers frequent the Canyon Meadows Golf and Country Club for a relaxing day in the sun. If you're a water person, the Glenmore Reservoir is north of you where you can canoe or kayak and walk along the many scenic paths.
For all shopping needs, Southcentre Mall is less than 10 minutes away and offers great stores like Safeway, Sportchek, The Hudson's Bay, Shoppers Drug Mart. Macleod Trail also has every kind of store you could think of, as well as multitudes of restaurants. Some of the family and date-night favourites are Earls Kitchen + Bar, Costa Vida and Boston Pizza.
Professionals enjoy the many bus routes in and around the community, as well as the easy 22-minute drive to the downtown core. To commute, you can also hop on the LRT at the Anderson or Southland stations to get where you need to go.
The Cedarbrae Community Centre offers many recreational activities, programs and events for the whole family to enjoy. Residents in the community have access to a wave pool and water slides for splashing in the summer and an arena for hockey in the winter.
Cedarbrae Local Schools
Families in Cedarbrae are served by the many schools in and around the community for children of all ages. Some of these include St. Cyril School, Cedarbrae School, Louis Riel Elementary and Junior High School and Dr. EP Scarlett High School.
Cedarbrae Public Schools: Calgary Board of Education (CBE)
Cedarbrae Separate Schools: Catholic Separate School Board
Cedarbrae French Immersion Schools: Calgary Board of Education (CBE)
Click here to find out Cedarbrae school performance and ranking among all Alberta Schools in the Fraser Institute report.
Cedarbrae Real Estate Agents
Looking to buy or sell a home in Cedarbrae? Contact our team of highly skilled and experienced real estate agents to guide you through the entire process. With over 30 years of combined real estate experience, you can trust your local Cedarbrae housing market experts.
Contact Lee Yousef & Associates of Urban-Realty - 403-689-3839 today to learn more about our exclusive VIP Home Buyer and Home Seller programs. Thinking of selling your Cedarbrae property? Try our FREE Home Evaluation tool today to find out your Cedarbrae property's market value.
Back to South Calgary Real Estate
Disclaimer: Information herein deemed reliable but not guaranteed by CREB®.


text: Again at Bristol Art & Medical SPA we will be able to hear the amazing guitar tunes made by our regional virtuoso guitarist Peter Restecki. The musician delighted with the last concert, unusual contact with the audience, and the atmosphere he and his guests made, he wanted to play again at Cafe Bristol. Enjoy the music feast of any good music lover already on Friday (30.12) at 8 pm at the Bristol Art & Medical SPA café. Ticket is only 15 zł, the number of seats limited. You're welcome!


text: Hello, The things are looking good: just communicated with Tobias, and the links will be updated soon. So now, what about a 2.2.0 (or 2.5.0 ?) this week-end ? There are still lots of things on the tracker, but are there still very urgent bugs ? I'll try to redesign the docs until next weekend. Regards, Olivier -- _________________________________________________________________ Olivier Mueller - om at 8304.ch - PGPkeyID: 0E84D2EA - Switzerland qmail projects: http://omail.omnis.ch - http://webmail.omnis.ch


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Bo Park is a professional choreographer and a dancer based in New York City. It has been over 12 years since she moved to New York City to pursue her dream, dance. She has worked with top choreographers such as Keone&Mari, Brian Friedman, Kyle Hanagami, Luam Keflezgy etc. Her dance credits are included Nike, Adidas, Lil Nas X, Michael Kors, Adam Lambert, MALUMA, etc.
After years of teaching, she began to work as a choreographer and is continually developing her creative skills. Park choreographed for Virgin Voyage's Scarlet Lady, HARMONIX "Dance Central VR", Hideaway Circus "STARS ABOVE", Immersive Dance Show "Daydreamers", Kpop Idol LOONA "Butterfly" and is currently working as an associate director for DPR concert "REGIME".
Park started her own dance company "SHINSA" in 2017, created and directed 3 annual shows in New York City that had completely sold out. Her company won 1st place at one of the biggest dance competitions "ELEMENTS XIX".
Teaching and mentoring dancers have been something that she values the most. She wishes to be a guidance of all dancers who are afraid to be who they are.


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Adding Character and Personality to Your Custom Home
For most of us, the thought of purchasing a new home is an exciting one. To be able to choose your home's finishings and create a space that is truly yours could be a dream come true. In the age of HGTV, we've been watching couples do it behind the camera easily and effortlessly for quite some time and the outcome is often breathtaking. When building a custom home or remodeling an existing space, it's the selection of color, texture, and style that collectively give your home
Breaking News – We're Breaking Ground!
That' right. This week, we will be laying the foundation on a beautiful custom home in St. Michaels. Located at 711 Riverview Terrace, the lot is less than a mile from Talbot Street, which is the heart of this small, quaint community. St. Michaels, a seaside resort town located on Maryland's Eastern Shore, dates back to the 1600's where it was a trading post for the area farmers and trappers. It was the war of 1812 that really gave St. Michaels the name "the town that fooled
Building For Generation X
It seems to be a growing trend that more and more home-builders' are announcing entry-level brands that target millennials. Others are focusing on the needs of the baby boomer. What we haven't seen a lot of is a home that is steered to the needs of Generation X, defined as those born between the mid 60's and early 80's. As a smaller segment of the overall population, Gen Xer's seem to get overlooked. What seems to be true about them is that they want what most new home owner


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August 9 | 3950 Las Vegas Blvd S
Black Hat USA
August 9-12, 2022 | Las Vegas, NV
Black Hat USA 2022 will open with four days of Trainings (August 6-11). The two-day main conference (August 10-11) featuring Briefings, Arsenal, Business Hall, and more. Network with thousands of InfoSec professionals and evaluate a broad range of security products & solutions.


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After his son witnesses a brutal murder by a notorious crime boss, a deaf Indonesian gangster is thrust into the fight of his life when he takes on his dangerous former allies—including a sociopathic assassin—in order to protect his child.
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Thank you so much for playing it! I really enjoyed watching you interact with the world.
Creator of
Recent community posts
Hi, thanks for letting me know about the bug! It looks like an odd bug with the orientation of placing the gem. If you were to place the gem from the left of the obelisk it should accept the jewel.
Thanks so much for playing and giving me this helpful feedback! I updated the game keeping your comments in mind. C:
Have a nice day!
I don't get to see the judge feedback, but I'm glad to hear that you thought it was fun. I'll try out the draw.io, and i'll make a game that won't dissapoint:P
This was a pretty trippy experience. I don't know what I was supposed to do, butall the visuals made me dig around for more to happen.
Naw, I made the trigger area bigger. I'll probably expand it anyway though because there are some complaints about the collisions not respond well.
I made the game in a 3d environment and used 2d sprites with a camera facing a fixed direction so you don't see the paperthin side of the sprite.
Interesting take, but felt like there could be a better guide in taking me back to earth. I felt like i could have been lost for hours.
Nicely polished game. I've done the drop at the top of the platform like 20 times and gave up though cause i couldn't get past the spiky thing. Really good level design and atmosphere. I felt like the fall death was inconsistent in some of the cliffs though.
It was a pretty neat experience you set up. I think this would have benefited as more of a narrative game where maybe you hear someone telling you their story while picking up the logs. It would have been a lot more engaging with not so much work or if you wanted to gameify it more maybe having difficult to use coontrols or something silly like the logs running away from you.
Took me a while to figure out i should be putting my mouse behind the ball. Once I got how to get that working I had a lotta fun bouncing the balls.
Good clean art, but it felt repetitive varied star sizes to dodge and hit would probably remedy that quickly
The music and art was awesome in the game, but I couldn't get too far. What are the controls? i got to jump on things, but I dont know what to do after i stick to the wall.
This had a nice style to it. I felt like I could just brute force through the puzzle a lot of the time.
The graphics were great. The airplane sound was really annoying. I'd recommend lower the sound or just have it play less frequently. Also, maybe have indication that a specific aircraft is firing at me.
This was really engaging stuff. I would have really liked a more responsive circle thingy though to let me know i'm doing something. I liked hovering over stuff and seeing the plants transform.
Characters and art is charming, I didn't really like the audio much though, and felt like the jumping was a little slow.
I liked the mechanic, but it wasn't clear how long the dark flowers had to be in the shadow.
I really enjoyed exploring your game, and the interpretation of the theme. I was really frustrated at how little time I could use my flashlight or turn on my mind though. I was instantly engaged with looking for the things the wall tells me. I wish there were a bit more obvious things like a "red" flower or blue tree to walk to.


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20% off purchases of $100 promo code: TWENTY
This 61+ year old Item is rated Very Fine +++. Moderate aging throughout. No creases. No natural defects. Some light surface rub. No tears. No water damage. There is some light bleed through visible in the margins of this ad. There is some discoloration in the right margin of this ad.
Keywords specific to this image: Vintage Advertising, Tobacco


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Celebrating our community
It's time to ask your sweetheart to the big dance! Get all dressed up and join us for Queerhearts, an Idaho Falls Pride fundraiser and sweethearts dance for ALL. Make your sweetheart's dreams come true with a night of dancing, drinks, games and more. Place a bid at the silent auction or snap a selfie with your sweetie at the photo booth. Light hors d'oeuvres will be served, and the cash bar will have all the liquid courage you need to hit the dancefloor!
Save The Date
11th Annual Idaho Falls Pride
June 24, 2023
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ST ANDREW, Jamaica – Organisers promised another top-notch affair as Rum For Breakfast (RFB) returned to the Hope Zoo last Saturday and by the smiles plastered across hundreds of faces as they partied the morning away, they delivered just that.
In its first staging since June 2019, Rum For Breakfast pulled out all the stops, no doubt trying to transport patrons back to pre-pandemic times when they would fete without fear. The music, the food, the weather, the vibes – all created the perfect soca atmosphere for which patrons were anxious.
Selectors, Franco Bloodline, Matt Camps and Tyler Chung, had the crowd in a relentless chokehold as they served up just the right dose of soca goodness. Accompanied by deejays, Patrick the Hypeman, Cyclone, Brush One and Marlon Musiq, the entertainment gave what it was supposed to give.
Soca favourites from the likes of Machel Montana, Destra, Mr Killa, Skinny Fabulous, the late Blaxx, had partygoers dancing up a sweat inside Hope Zoo. The party was so intense that not even the high-powered fans and sprinklers scattered across the venue were enough to cool down excited attendees. Some were so into the moment that the floor could no longer contain them. They proceeded to climb atop speaker boxes and stage railings to complete some bold dance moves, gyrating their hips to the sounds of some sweet, sweet, soca songs.
Michael Ammar Jr, co-director of event organisers Bacchanal Jamaica, hosts of Rum For Breakfast, told the OBSERVER ONLINE that having been inside for three years, his team wanted to use the event to erase the lockdown feeling.
"This was one of the best RFB's we've ever had and it wasn't just about numbers, it was about the vibe. People were just excited to finally be outside in this setting again and they just had fun," he said. "We had everybody here from 18-70 and everybody just jumped, ate, drank and vibed. It was just a great party."
"We had RFB in the summer of 2019 so this staging is three years from that date and I think people were just dying to come out and experience Bacchanal again," he added.
Speaking of an experience, the all-inclusive early-morning event had everything a breakfast party required. From the usual morning delicacies including ackee and saltfish, pancakes and eggs and the traditional oats porridge to brunch delights such as creamy alfredo chicken pasta, BBQ fish, curried goat, lasagna and more; there was no running short of something to snack on in between dances.
As the annual Road March experience nears, Ammar Jr is adamant that Rum For Breakfast gave revellers who will be joining the Bacchanal band, a taste of what is to expect on the streets of Kingston come July 10.
"We are pulling out all the stops to be as fun, premium and safe as possible. Those are our three main things. We want you to be safe, comfortable, we want the event to be super premium and more than anything else, we want you to have a good time," he said.
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Frozen lake Baikal turned into a large "entertainment complex" (video)
Scuba diving, skating and hot tea on the ice.
The deepest lake in the world in winter, continues to attract thousands of tourists. Locals even call it the great ice attraction. This is not surprising.
Winter Baikal turned into a huge ice spaceDuring the download an error has occurred.
First, you can go on skates, and, secondly, to admire the ever-changing pattern on the ice, which in some places is absolutely transparent and offers stunning views of the bottom of the lake.
NewsWhere are the most ancient lake in the world
By the way, because of seismic activity in the area, the ice continues to move constantly, but because every day on its surface is formed a completely new pattern. Ice movement is accompanied by the rattling dull noises, which, however, does not scare the tourists.
Another winter activity here is diving professional. The fact that tons of water solidify to form a real ice underwater city with trails and caves.
To enjoy the frozen lake will run until mid-March. After that ice begins to change its structure, and be located on the surface of the lake would be very dangerous.
See also:
- Diver found on the bottom of the Mediterranean sea live "stone" (video)
- How to look underwater pyramids in Japan (photo)


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New TiVo DVR will skip through entire commercial break
NEW YORK (AP) — TiVo wants to help you skip TV commercials.
With one press of a button on the remote, TiVo's new digital video recorder will skip the entire commercial break. That's quicker than the 30-second forward feature found on previous Tivos. On the new TiVo Bolt, TiVo will tag the start and end of commercial breaks so that viewers can skip that section when watching their recordings. The feature will work with about 20 over-the-air and cable channels, including the major broadcast networks, mostly during primetime hours.
Satellite TV provider Dish has had a similar feature on its Hopper DVR, which has prompting lawsuits from several TV channels. Dish has been settling them as part of broader agreements for rights to include the channels on Dish's lineup.


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- S. Dani
Gabby Sidibe & Child Mind Institute Launch Getting Better Together Campaign For Mental Health Month
In honor of Mental Health Awareness Month, The Child Mind Institute launched the Getting Better Together campaign in which celebrities, kids, and teens share their personal stories to encourage kids who may be struggling, especially amid a pandemic to ask for help.
NAACP Image Award winner Gabby Sidibe who is known for her role in Lee Daniels's film Precious, shared how when she was younger no one listened to her cries for help, so she decided to seek help on her own.
"When I was around 19 or 20, I was diagnosed with depression and anxiety, and an eating disorder. And I remember having almost no one, really, to turn to." "Everyone would tell me that I was young and too young to feel sad all the time and too young to be stressed out." "I found my own doctors and my own treatment programs, and I found really my own ability to save myself."
In a statement, Harold S. Koplewicz, MD, president of The Child Mind Institute says, "Our children continue to face great challenges after a year of far-reaching disruption brought by the pandemic." The messages from these role models and brave children go a long way to offer hope, encouragement and inspiration."
Other notable celebrities who made videos that will be shared throughout May include Lexi Underwood, Bebe Rexha, and Zoe Saldana. A new video will be released daily on the Child Mind Institute's social platforms.


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A must for the avid painter! If our apron is for when you're in the studio, our super soft t-shirts are great to wear everywhere else!
Show the world that you work with the best furniture paint there is!
This shirt is for every kind of painter, from hobbyist to professional. Just be sure to pick up a Fusion Paint It Beautiful Apron to keep your shirt from getting messy!
Available in size S-XXL


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The infamous 'tanga tanga' has a new member, Former Amani National Congress (ANC) official Eliud Owalo is now the latest to change his political allegiance ahead of the 2022 General Election.
The former Raila Odinga campaign manager who ditched ODM to join Musalia Muavadi's ANC has now joined Deputy President William Ruto's camp.
Owalo who contested in the August 2019 Kibra parliamentary by-election where ODM's Imran Okoth emerged the winner announcing his decision on Monday, September 14 at DP Ruto's Karen residence saying that the country needs a decisive, all-inclusive leadership that is people-centric.
"I have with effect from today made a deliberate and conscious decision to stand with Kenyans by pursuing my political interests and aspirations within the ambit of the "Hustler" Political Matrix. I'm also going the full-hog with Bill Ruto' 2022," said Owalo.
"Kenyans need to collectively and individually embark on forging unity of purpose across the country; adopt issue-based politics devoid of personality cults and vindictiveness; impartially fight corruption; resist impunity; discard retrogressive culture of negative politics built around ethnic enclaves and tribal chiefs; & chart a new political order aimed at bringing about sanity within our national political fabric."
"Regrettably, a section of the political class appears uninterested in addressing the real challenges afflicting the common citizen; but instead opting for the pre-occupation with amassing wealth and pre-mature agitation of change of the constitution to ensure political preservation and personal aggrandizement," he said.
Would you like to get published on this Popular Blog? You can now email Cyprian Nyakundi any breaking news, Exposes, story ideas, human interest articles or interesting videos on: [email protected] Videos and pictures can be sent to +254 710 280 973 on WhatsApp, Signal and Telegram.


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Months after being postponed by the arrival of COVID-19, the Canadian War Museum is marking the 75th anniversary of the Second World War with an exhibit that showcases the experiences of dozens of Canadians during 1939-45 conflict.
Forever Changed: Stories from the Second World War was curated by Tim Cook, author and military historian, and is open to the public. It will be on display at the museum until September 2022.
The exhibit features photographs, archival footage, hand-written letters, diaries, uniforms and other artifacts to tell the stories — some never before told — of 47 Canadians affected in different ways by the war.
Among the stories profiled in the exhibit are those of seaman George Boyer of the Royal Canadian Navy, Royal Canadian Air Force pilot Will Kyle, as well as "bomb girl" Edith Whitford (nee Vollrath).
"Forever Changed takes a fresh approach to the history of the Second World War, as seen through the eyes of a diverse range of Canadians," said Caroline Dromaguet, president and CEO of the Canadian War Museum.
Boyer, a Métis man, served on several ships in the North Atlantic. After a torpedo ripped a 10-metre hole in the steel hull of the carrier he was stationed on in 1944, killing 21, he stayed aboard to help bring 815 survivors to safety.
Will Kyle had just gotten engaged when, in 1942, he enlisted in the Royal Canadian Air Force. In 1945, he and five other RCAF airmen took off on a supply mission and never returned. Pieces of the wrecked aircraft discovered in 1990 are on display in the exhibit.
Britt Braaten, a member of the project team, said the curators wanted to create an exhibit that reflected the diverse backgrounds of those affected by the Second World War.
"We felt like the permanent gallery doesn't do as good a job of showing the diversity of Canada as we'd like," Braaten said. "We made a point of — we need stories about women, we need stories about people who are not white, we need Indigenous stories."
Braaten said she hopes the exhibit makes it possible for visitors to connect with the stories they view.
"You learn something about the person — maybe it's hopeful, maybe it's sad, maybe it's scary — but each one stands on its own as something that you can feel a connection to," she said.
The exhibit is designed to make the true stories accessible to people who may not be familiar with the history. "For a lot of people, especially non-experts, the way you can connect to history is (by making it) personal," Braaten said.
Cook, the curator of the exhibit, agreed with Braaten. "I hope that there is a connection that's made between our visitors and these Canadians, almost all of whom have passed away, but not all," he said. "They're all very moving."
Cook said he is glad to see the exhibit finally open in person after months of postponement due to the pandemic.
"I'm thrilled," he said. "You put a lot of sweat and toil and a lot of your heart into an exhibition like this."


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Salt Lake City, Utah, Jan. 18, 2023 (GLOBE NEWSWIRE) — HireVue, the global leader in video interviewing, AI-based assessments, and text-enabled recruiting tools, has engaged DCI Consulting Group (DCI), a leading Washington DC based human resources compliance and data analytics consulting firm, to audit its algorithms in accordance with proposed rules specified by New York City Local Law 144. Competency-based and game-based algorithms will be audited for bias with respect to race, gender and the intersectional combination of race and gender across multiple job levels and use cases. The audits began in January 2023 and results will be available on the HireVue website once the audit is completed.
The ethical development of AI, candidate transparency and privacy are core values of HireVue's business and the undertaking to enable external audits of its algorithms is the latest proactive step to ensure the company and its technology is at the forefront of best practices in the use and analysis of HR hiring technologies. HireVue has previously commissioned a number of independent audits of its technology, along with an AI explainability statement – all of which provide customers, candidates and regulators with transparent and meaningful, easy-to-understand information regarding HireVue technology and the processing of personal data.
A growing body of regulations around the use of AI, including New York City Local Law 144, place audit responsibility on the employer. HireVue believes vendors should also bear the responsibility to audit their algorithms and that audit requirements should be standardized to provide clearly defined criteria for multiple HR use cases.
Lindsey Zuloaga, Chief Data Scientist at HireVue, comments: "HireVue has always been at the forefront of defining the transparent and ethical use of AI and software. We support the intent of the proposed regulations around the use of AI, however, we suggest best practices and clarity are tantamount to good regulations that benefit all parties involved. Working with DCI we will be able to provide customers, candidates and regulators with a transparent auditing process in response to the requirements of New York City Law 144."
"Our mission is to create a level playing field for anyone seeking employment, reducing bias and providing organizations with the most diverse pool of talent. Deploying AI correctly and ethically, powers a significantly more consistent, less biased, more engaging screening process for recruiters and candidates alike. We believe there needs to be increased transparency around its use in HR, and with these audits we continue on a journey of leading the way in this regard."
Industry Leading Commitment to Fairness
HireVue has a long, established track record delivering science-led ethical AI solutions for hiring:
- The company follows established best practices in the field of IO Psychology and data privacy, so that our assessments meet the strict standards of fairness from agencies such as the Equal Employment Opportunity Commission and the American Psychological Association (to name a few).
- In 2019 HireVue became the first HR technology company to create an expert advisory board and publicly release a set of AI ethical principles. HireVue undertook these steps knowing that transparency, concrete guideposts, and the input of experts is the best way to uphold their principles.
- HireVue supports the Illinois Artificial Intelligence Video Interview Act (AIVIA),and the company is open to ongoing involvement in conversations around the regulation and use of AI in hiring.
- HireVue has voluntarily conducted audits of its algorithms, and its scientific and consulting practices along with publishing the HR industry's first AI Explainability Statement.
More details on our commitment to AI Ethics and standards can be found at www.hirevue.com/why-hirevue/ai-ethics


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Glow Gel Mask works to intensely moisturise, giving you brighter and more radiant looking skin.
Apply a thick layer on skin, wait for 15-20minutes and then wash off. Use 2-3 times a week
Avoid contact with eyes. If product gets into eyes rinse well with water immediately. Do not apply to broken or irritated skin. Use only as directed. Keep out of reach of children.


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Whether you're age five or 50, swings are plain fun. There's simply something exhilarating about propelling yourself through the air. Swings are perhaps the perfect blend of mild adrenaline and serenity.
Swings evoke a feeling of freedom, a sense of nostalgia, or perhaps even an intimate memory. Surely you've heard of a secret rendezvous by the swing set for that romantic first kiss in the dark. Celebrating one's adolescence in a place once enjoyed as a child can also add a special significance all its own. Note how we leap from childhood into adulthood. . . and often spend the rest of our lives swinging back and forth between the two.
Now throw in some spectacular scenery as you swing and you're (ahem) set. So come swing with us, dear reader. Join us as we visit the 10 best pretty and thrilling swings of the world.
Gili Trawangan, Indonesia
The Datu Swing overlooks Mount Agung. Partially submerged in the crystal clear ocean water, and is owned by the popular Hotel Ombak Sunset, on the coast of popular Gili Trawangan. Gili Trawangan is the largest of a trio of the three Gili Islands.
It is also known as a real "party island." Veteran visitors agree it's a "must-see" and the legendary swing, straight out of a book of fairy tales, is a "must-do" as well. The best time for pictures is at sunset.
Maldives, South Asia
Check out this popular cocoon-like swing found in the Maldives. It's both comfy and uniquely decorative with a look that makes it blend in with the gorgeous surroundings. Some have described it as something "straight out of a dream."
Banos, Ecuador
Known to many as "The Swing at the End of the World," you'll find this one in Casa del Arbol (The Treehouse), which is actually a 20-minute drive from downtown Banos. The swing is little more than a simple blank suspended by a pair of ropes from a steel beam. What makes it special is that it hangs over an impressive mountain precipice. Visit on a clear day and due to its close proximity to the Tungurahua Volcano, you'll enjoy a stunning view. (A zipline's also available,)
Ubud, Indonesia
There is a very popular swing located in Ubud, Indonesia. It hangs over a precipice. Swinging on it is a thrilling adventure in and of itself. From the swing seat, you will have an incredible view of the river, the rice fields, the verdant valley below and even famous Mount Agung.
Tulum, Mexico
Those who have been can tell you that there is certainly no shortage of lounger or hammock-filled beach clubs here in Tulum. This once underrated town on Mexico's Caribbean coast now includes a few places on this stretch of white sand that has swing seat right by the bar. Perhaps the best one is at Coco Tulum which features Instagram-ready, neutral monochrome swings overlooking the ocean.
Kirby Cove, USA
"If you're going to San Francisco/be sure to . . ." check out a place named Kirby Cove. Situated at the very base of California's memorable Marin Headlands, this popular swing may not look all that special but it is reported to offer users truly "captivating views" of the world-famous Golden Gate Bridge.
Amsterdam, The Netherlands
The Over the Edge swing is the highest swing in all of Europe. Found at the well-known A'DAM Lookout in Amsterdam, this sturdy red metal swing has room for you and an adventurous friend or loved one. This might not be the most comfortable swing but the contraption certainly provides visitors with another way of "getting high" in the popular capital of the Netherlands.
Bernal Heights Park, USA
Apparently, there are a lot of swingers in California. Indeed, this is the state's second entry on this "10 Best" list. This particular swing is ensconced in lovely Billy Goat Hill Park in San Francisco.
Located in modest Bernal Heights Park right outside downtown San Francisco, the view of the city and bay are stunning. It is just a 10-minute drive from the well-known Mission neighborhood, home of taquerias and hipster vibes.) The swing itself is little more than a smooth plank secured by rope but on a clear day, it simply cannot be beat as a calming spot to catch the beautiful sunrise or sunset. Believe it or not, the swing is not generally too crowded but it does indeed attract curious locals and tourists who want an additional Instagrammable photo of their vacation.
Hjørundfjord, Norway
The popular Hjørundfjord Swing can be found in the quaint village of Trandal in Møre og Romsdal county, roughly an hour from the coastal city called Alesund. You must either take a ferry or hike over the mountain to reach this swing. More specifically, the swing is in the garden owned by the people who own the Christian-Gaard pub and inn.
The swing overlooks the majestic Hjørundfjord and the famous alps of Sunnmøre. Take in the most incredible views of the glacier and fjord. While being featured in such articles as this has obviously increased the swing's popularity, crowds of tourists are still not an issue since it is still not all that easy to reach if you're on a tight schedule. If you do decide to check it out then veteran visitors suggest that you travel there in the summer so you can also attend the famous festivals that Trandal hosts: the Trandal Country Festival and Trandalblues.
Chiang Khan, Thailand
Last but certainly not least, is the well-known swing at the memorable misty Phu Tok viewpoint. Those who have been (and swung), say that the experience "will make you feel like you're floating in the clouds to your dreamland." The swing is situated in Chiang Khan which is a peaceful, little town in the province of Loei in the northeastern part of the country on the bank of the Mekong River across from Laos.
So there you have it, dear readers. Did we miss your favorite? If so, then let us know in the comments section!


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Hi there,
I would like to insert a field which is expecting one of the three values "yes", "no", "not applicable" within a questionnaire in DHIS2 2.19. I am asking if someone has already done something similar without using the yes/no field type. Thank you for your support.
This message and its attachments are confidential and solely for the intended recipients. If received in error, please delete them and notify the sender via reply e-mail immediately.


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George Papadopoulos, left, and Michael Katehakis, a professor from Rutgers College. (Costas Bej/The Nationwide Herald)
For the primary time, we've got a determine from the 2016 Trump marketing campaign who we all know is cooperating with particular counsel Robert S. Mueller III in his Russia investigation. George Papadopoulos is speaking after being caught mendacity to investigators.
Precisely what meaning, we do not actually know.
However that is simply one in every of a number of huge, juicy questions emanating from the previous Trump overseas coverage adviser's plea deal. The doc is stuffed with nameless marketing campaign officers on the opposite finish of Papadopoulos's emails. We might not know who they're, however particular counsel Robert S. Mueller III positive does. And in lots of circumstances, they appear to have recognized about contacts with Russia that the marketing campaign and its principals, together with President Trump, would later deny.
Under are seven huge questions we've got in gentle of the plea deal.
1. Who's the "marketing campaign supervisor" with whom Papadopoulos emailed intimately about organising a Trump-Putin badembly?
After a March 24, 2016, badembly with an unnamed London professor and an unnamed Russian nationwide whom Papadopoulos at one level believed to be Vladimir Putin's niece, Papadopoulos emailed a "marketing campaign supervisor and a number of other members of the marketing campaign's overseas coverage crew," in response to the doc. He instructed them the badembly was to arrange one other badembly between the marketing campaign and "Russian management to debate U.S.-Russia ties underneath President Trump."
The "marketing campaign supervisor" at this level replied: "Nice work."
Later, about June 1, Papadopoulos emailed the identical "supervisor" to say "Russian MFA" needed to arrange a gathering between Trump and Putin. The supervisor urged Papadopoulos to make the journey with one other overseas coverage adviser as an alternative.
The marketing campaign and the White Home have repeatedly denied contacts with Russia through the 2016 race. The denials even got here from Trump himself and Vice President Pence. However this explicit set of emails (and extra to return under) means that a number of members of the marketing campaign have been conscious of contacts discussing a want on behalf of the Russian authorities to dealer a gathering.
2. Who's the Trump marketing campaign official who urged that the badembly not embody Trump "in order to not ship any sign?" And what does that even imply?
In a tantalizing footnote, somebody described as a "high-ranking official" on the Trump marketing campaign forwarded a Papadopoulos e mail to a different official in late Could and mentioned: "We want somebody to speak that DT just isn't doing these journeys. It needs to be somebody low degree within the marketing campaign in order to not ship any sign."
So but once more, we've got a prime official within the marketing campaign who was conscious of Papadopoulos's contacts with Russia — Papadopoulos titled the e-mail "Request from Russia" — and thought it by sufficient to supply a distinct plan of action. Together with the "supervisor" and members of the overseas coverage crew above, that is one other apparently high-ranking Trump marketing campaign official who knew about this. How might the marketing campaign and White Home go on to disclaim such contacts?
Additionally juicy right here: What does "in order to not ship any sign" imply? Some see that as a possible inform in relation to a bigger effort to coordinate with the Russians, which is the large unanswered query on this complete investigation. But it surely might additionally merely be that they did not wish to telegraph an in depth alliance with Russia, which might have been politically problematic.
three. Was Trump current when Papadopoulos mentioned that he might arrange a Trump-Putin badembly?
The indictment says Papadopoulos attended a "nationwide safety badembly" on about March 31 with "Trump and different overseas coverage advisers for the marketing campaign." It says Papadopoulos instructed "the group" that he had connections and will prepare a Trump-Putin badembly.
The textual content would not say whether or not Trump was current for this declare. But when he was, it might render Trump's personal denials of his marketing campaign's contact with Russia fairly dishonest.
four. Who's the "senior coverage adviser" Papadopoulos emailed saying Russia had an "open invitation" for a Trump-Putin badembly?
That is yet one more high-level aide who would have recognized there was contact with Russia. Papadopoulos instructed this "adviser" on April 25 that "these governments have a tendency to talk a bit extra brazenly in 'impartial' cities" — taking part in up his personal stationing in London.
5. Who's the opposite "high-ranking official" whom Papadopoulos instructed that the Russian authorities had "relayed to me that they're all for internet hosting Mr. Trump?"
It is a completely different "high-ranking official" than the one talked about above. But it surely's one other one that apparently knew, based mostly on a number of emails, about what the marketing campaign and White Home would later deny.
6. Who's "Putin's niece?"
It could be neither right here nor there on this complete sequence, however Papadopoulos appears to have believed at one level that the unnamed London professor launched him to Putin's niece, figuring out her as such in an e mail to the marketing campaign. He later says it wasn't truly Putin's niece.
However who was it? And did Papadopoulos not search to confirm this data? Or was he attempting to inflate his connections within the e mail? It is all very unusual.
And for that matter, who's the unnamed London professor?
7. What's he doing to cooperate?
On the very finish, the indictment says Papadopoulos was arrested at Dulles Worldwide Airport in suburban Washington on July 27 of this yr. It says he has talked with the federal government "on quite a few events to supply data and reply questions."
It is suspected that the particular counsel is attempting to flip Paul Manafort and get him to cooperate by way of his personal indictment. Papadopoulos was far much less central to the marketing campaign, however right here we even have somebody who's cooperating.
What did he conform to share in his plea deal? And what does he even have to share? This can be the largest query of all.
Supply hyperlink


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Jeep continues to mine the Grand Cherokee line-up for more gold with two new editions for 2017: the Trailhawk and the Summit.
Called the "most capable" Grand Cherokee ever produced, the new model is counterbalanced by the Summit, which may be the most comfortable and plush model ever manufactured by the brand that is thought of as more rough and tumble than warm and fuzzy.
"With our new Trailhawk and Summit models, Jeep Grand Cherokee becomes even more capable and more luxurious," said Mike Manley, head of Jeep Brand – FCA Global. Adding more options to the Grand Cherokee portfolio makes sense as sales of the model rose 7% in 2015.
"Our Cherokee and Renegade Trailhawk models are among our fastest selling and most sought-after models, and we are following that successful formula to provide consumers even more legendary Jeep 4×4 capability for Grand Cherokee – the most awarded SUV ever.
"Our new Jeep Grand Cherokee Summit is in direct response to consumers who continue to ask for even more luxury, craftsmanship and standard premium features in a full-size SUV packed with capability."
The Trailhawk moniker has been kicking around the brand for several years and tagged the first Grand Cherokee with it in 2012 as a concept for the Easter Jeep Safari in Moab, Utah. It has since been sprinkled across the Jeep line-up as the name for the model considered the most off-road ready in each model's grouping.
(Want to find out what the new Chrysler Pacifica is like? Click Here for details.)
Grand Cherokee Trailhawk models are equipped with a host of standard off-road capability features, including Jeep's Quadra-Drive II 4×4 system with rear Electronic Limited Slip Differential (ELSD) for all powertrains, a unique version of Grand Cherokee's Quadra-Lift air suspension – developed for Trailhawk – that offers improved articulation and total suspension travel, as well as Selec-Speed Control with Hill Ascent Control. Skid plates and a Trailhawk-specific anti-glare hood decal are also standard.
The new Trailhawk's suspension is designed to improve its rock-climbing, off-roading capability with better clearance and improved breakover angles. The improved capability is matched by improvements to the sport-ute's exterior, including a front fascia and seven-slot Jeep grille that debuted on the 2016 Grand Cherokee 75th Anniversary edition.
It also gets the Trailhawk-signature red tow hooks in the front and rear, standard 18-inch or optional 20-inch Goodyear Adventure off-road tires with Kevlar reinforcement, new Trailhawk and Trail Rated badges with red accents, mirror caps and a roof rack with Neutral Gray accents, and optional Mopar rock rails for added protection.
Inside, Trailhawk models feature a unique black interior with leather and suede performance seats for comfort and control, red accent stitching, brushed Piano Black appliques, gun-metal finish on all painted interior parts, a Trailhawk badge on the Jeep steering wheel, and red accent stitching on the seats, doors and console. A standard 8.4-inch Uconnect touch screen includes updated off-road pages showing wheel articulation and other vehicle 4×4 capability features, such as suspension height and 4×4 and Selec-Terrain modes.
(Click Here for more about why the new Jeep Compass/Patriot replacement is being built in Brazil.)
While the new Trailhawk is rough and ready, the new Summit rests comfortably in the posh and pampered section of the Grand Cherokee collection of vehicles: seven editions in all. The Summit's mark is made with an interior that focuses on a mix of high-end materials and cutting edge technology.
A full-wrap Laguna leather interior in Indigo and Ski Gray is one of four color schemes offered for the Summit. The full leather interior boasts a Nappa leather-wrapped dashboard, center console and door panels, and Laguna leather seats with edge welting, according to Jeep.
All Summits come equipped with a suede premium headliner, lighted door sill, acoustic windshield and full side glass, Active Noise Cancellation, premium Berber carpet mats and a Harmon/Kardon 19-speaker, 825 watt amp audio system with three subwoofers.
Yes, it's pretty and comfortable, it also features an impressive selection of new technologies, including auto-folding power mirrors, headlamp washers, Blind Spot Detection, Forward Collision Warning, Adaptive Cruise Control and, for the first time, Lane Departure Warning and Parallel and Perpendicular Park Assist.
(Click Here to see more about Jeep's Safari concept vehicles.)
Above all else, it's a Jeep so the brand's Quadra-Drive II 4×4 system with ELSD is standard on all Summit models, as is Grand Cherokee's Quadra-Lift air suspension and Selec-Speed Control. The models hit dealerships this summer.


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Hypervisor - Mentor Embedded Hypervisor Software
From Embedded Software
Mentor Embedded Hypervisor includes support for ARM TrustZone to secure critical information and software. Support for guest operating systems & environments including Linux, Nucleus and bare metal.
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Small footprint, high performance Type 1 hyperviso...
- Small footprint, high performance Type 1 hypervisor
- Secure by design and ARM TrustZone support
- Comprehensive guest OS support, integrated tools and custom services
Features and Benefits
Mentor Embedded Hypervisor is a small footprint Type 1 hypervisor designed and built specifically for embedded applications. The high performance enables systems to boot quickly while minimizing the impact on guest operating system execution.
Where available, hypervisor takes advantage of the virtualization capabilities built into the silicone for efficient performance.Multicore or single core flexibility
Run the hypervisor on single or multicore architectures, supporting asymmetric multiprocessing (AMP), symmetric multiprocessing (SMP), or a combination of both. Flexible scheduling algorithm allows for a single Virtual Machine to run on multiple cores, or a multiple Virtual Machine to run on a single core – or multiple Virtual Machines to run on multiple cores in a variety of configurations.Secure by design
Enable strong isolation and containment of guest operating environments. Operating at the highest privilege level in a system the hypervisor can enforce the partitioning of memory and devices to ensure applications do not disrupt or corrupt areas of the system.
Debug and solve performance problems by understanding system-wide interactions using Mentor Embedded Sourcery Analyzer, a powerful embedded design analysis solution that combines data visualization capabilities with a unique performance analysis engine. Sourcery Analyzer will help unlock new insights into today's complex embedded systems that integrate data from multiple operating systems.Support for ARM TrustZone
Integrated support for system security architecture allows normal and secure world applications. For hardware-based partitioning of resources including memory, crypto blocks, keyboard and touch screens the hypervisor supports a complete separate secure world operating environment. Learn more about Embedded Security with ARM TrustZone
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