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Lupus: An ongoing medical mystery / by sylvia kronstadt
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|Mon, 05-27-2013 - 8:37am
Lupus: A Rash Quest for the Truth
In spite of all the dire warnings I've received, I am still refusing to take the medications that have been prescribed for my condition. My decision to do the best I can to take care of myself has been quite liberating, and I am at peace with it (most of the time).
I have become more convinced that probiotics are helping me, and I have found medical evidence that supports my inadvertent discovery. I will elaborate below.
I endured a florid, unsightly and uncomfortable rash under my eyes for nine months, starting in May 2010. Like so many of you who have responded to my blog post, I have no idea how sick I am or how sick I may become.
Anti-nuclear antibodies -- they look so pretty.
I am constantly wondering what will happen next, and I have failed to find a credible source of information or reassurance. My most basic questions to several doctors were met with outrageous evasion.
( If they don't know, I wish they would just say so. Although if a doctor doesn't know the answers to questions as basic as mine, I think he ought to educate himself or find another, less taxing, line of work.)
A number of you have asked whether the probiotics I am using have continued to suppress my rash.
I have stressed that I can't be sure the probiotic had anything to do with the complete disappearance of my rash within 36 hours after taking the first caplet. But the remission was so quick and complete -- after so long -- that I am continuing to take it and to have some faith in it.
The more I read, the more I believe it might have precipitated a major change for the better in my condition.
I had been taking an inexpensive probiotic for more than 20 years, which contained only two strains of lactobacillus. The product that seems to have had such a dramatic effect has 12 strains, including lactobacillus and several others.
Probiotics are said to have an immunomodulatory effect.
When I told my primary care doctor that it was "probably just a coincidence" that my rash vanished so quickly after I took the new probiotic, she said, "Why do you think it was a coincidence? You could very well be on to something."
From what I have since learned, I am outraged that not one doctor suggested I try probiotics. The theoretical basis for doing so is solid, and reputable medical institutions acknowledge it.
Probiotics have been used for thousands of years, according to an article in the February 2004 issue of the journal Gastroenterology.
Researchers at the University of California, San Diego (UCSD) School of Medicine and the Shaare Zedek Medical Center in Jerusalem, Israel report that people in ancient Babylon used the live organisms to maintain health. The body's immune system is based in the intestinal tract.
I have recently found additional data that seem to support the use of probiotics to modulate the immune system. In discussing autoimmune disorders, the Mayo Clinic says "probiotics may help calm the immune system's overreaction in ways not fully understood."
A study carried out at the University of Helsinki in Finland found that probiotics can exert "specific immunomodulatory effects" and have an anti-inflammatory potential (as reflected by reductions in CRP), which could be very pertinent to the lupus patient, whose body is flooded with inflammation.
The Life Extension Foundation recommends probiotics for the lupus patient, along with Vitamins C, B12 and D3 and Omega-3 fatty acids (I take all of these and many more, as I have been for decades).
An osteopath whose opinion I value said just last week during his daily TV program that if tests indicate you are beginning to develop autoimmunity, probiotics can help suppress it, preventing it from becoming a full-blown autoimmune disorder.
Just doing their job, and looking good while they're at it.
The beneficial microbes in probiotics could represent "the future of medicine," with the potential to treat a variety of diseases in humans and animals "from diarrhea and eczema to gum disease and autoimmune disorders," according to a report released by the American Academy of Microbiology in 2006.
"Probiotics could also conceivably be put to use in preventing disease or thwarting autoimmune disorders. A number of these possibilities are being explored in research labs and hospitals around the world," says Richard Walker of the Food and Drug Administration, a co-chair of the steering committee that produced the report.
We do know that autoimmunity is a hypersensitivity reaction, similar to an allergic response. In allergies, the immune system reacts to an external substance that it normally would ignore. With autoimmune disorders, the immune system reacts to normal body tissues. There are an estimated 80 to 100 medically recognized autoimmune disorders.
Between 1.4 million and 2 million people have been diagnosed with lupus, about 325,000 in the U.S. The disease affects 1 in 185 Americans. Although the cause is unknown, scientists suspect that people are genetically predisposed to lupus.
They also believe that environmental factors, including infections, antibiotics, ultraviolet light, extreme stress and certain drugs play a critical role in triggering lupus.
I was surprised to learn that a certain level of autoimmunity is normal.
According to a 2001 survey by the Autoimmune Diseases Association, over 45 percent of patients with autoimmune diseases have been labeled by doctors as "chronic complainers" in the earliest stages of their illness.
(That attitude is so typical of the medical establishment, which is one of many reasons I try to avoid doctors entirely.)
"This can be devastating to a young woman who may then begin to question her sanity as she tries desperately to find out what is wrong. Tragically, many of these patients suffer significant damage to their organs in the meantime and end up carrying this health burden with them for the rest of their lives because of the delay in diagnosis," according to the American Autoimmune Diseases Association.
"There is very little focus on basic autoimmune research, even though one in five Americans has an autoimmune related disease," it adds.
This MRI shows an area of ischemia in the right periventricular white matter of a lupus patient.
After trying unsuccessfully to treat my swollen, shiny, bright red rash myself for four months, using a naturalistic "What Would Cleopatra Do?" approach, I spent the next five months seeing doctors and submitting to tests.
Despite all the time and money I invested in conventional medicine, I never got a definitive diagnosis, prognosis or treatment plan.
At least voodoo healers are colorful and good-natured.
Lupus has been called the "great imitator." The medical establishment should be thought of as the "great pretender."
I have had two doctors diagnose me with systemic lupus erythematosus (SLE); two have said that it is cutaneous lupus; one referred to it as a "nonspecific autoimmune disorder"; and another deemed it "multiple connective tissue disorders." My lab results were characterized as conclusive for SLE by some doctors and as "suggestive" by others.
Dr. Shruti Sanghvi, Salt Lake Clinic
Even my biopsy provoked argument, with one dermatopathologist declaring that it indicated lupus; another -- who is a specialist in lupus -- said it revealed "inflammation in the upper skin with different types of immune cells but not in a pattern that was specific for any particular diagnosis."
As I wrote in March of this year, the rheumatologist who so confidently and sweepingly diagnosed me with systemic lupus and "multiple connective disorders, including fibromyalgia," Dr. Shruti Sanghvi, reversed her diagnosis two months later, saying only that I no longer met the criteria and that I did not have lupus, even though my blood work revealed the same degree of autoimmunity.
I was completely baffled. As far as I could tell, nothing had changed. Was she saying that my body had cured itself of lupus, or that I never had it? She had initially urged me to begin taking drugs immediately.
My kidneys could fail at any time, without warning, she said, and the autoimmune process could also severely and irreversibly damage other organs, including my brain. Even after withdrawing her diagnosis of SLE, she told me I should take medication to protect myself.
According to a May 4, 2012 article in Medical News Today, "Evidence indicates that 35% of adult Americans have evidence of lupus nephritis (diseased kidneys, leading to renal failure) at the time of SLE diagnosis, and 60% of patients with SLE develop nephritis during the first decade after SLE diagnosis." About 12 percent die within the first 10 years after diagnosis.
What lupus flares can do to the kidney.
Protect myself from what? I was left speechless and dumbstruck as she blithely withdrew her initial diagnosis and swept out the door. When I had time to gather my wits, I sent her some questions about what this all meant, and she ignored me. They will be included in my next post, which discusses autoimmunity in general.
I was urged to use one medication by two doctors and aggressively warned against using it by two doctors, a pharmacist and the medication's own web site.
Several doctors urged me to take an anti-malarial drug for the rest of my life, despite the lack of a diagnosis, because it "might provide some protection against flares," if indeed I actually have a condition that produces flares.
Yet another doctor, Brian Williams, said the anti-malarial drug is "much worse" than prednisone -- that it would turn my skin blue-gray and destroy my retinas. (I have since learned that this is a gross exaggeration, to put it mildly.)
(Late in 2011, I felt the need to begin taking Plaquenil, for several reasons.
http://kronstantinople.blogspot.com/2012/01/lupus-update-i-surrendered.html )
I have received feedback from all over the country and from several foreign nations, many of them desperately posing the same questions that I am still asking.
My skin has looked fine since February -- and there was no scarring -- but the lupus (or whatever it is) still lurks below the surface like a pool of blood, and when I gently apply Vitamin E to the area (which is the only moisturizer I use now, except for Vaseline at night), the redness floods right to the surface. It goes away quickly and is rarely uncomfortable.
My persistent rash never had the malar formation that is characteristic of SLE. It was under my eyes and did not extend across the bridge of my nose, unlike the malar profile.
Recently, however, whenever I get up from a nap, my nose and upper cheeks are very red -- much closer to a malar formation than I've ever had. Even though it fades within a couple of hours, it concerns me.
The kind of butterfly I want in my life isn't a rash.
Although repeated retesting has indicated ongoing elevated levels of anti-nuclear antibodies (ANAs), double-strand DNA and anti-chromatin antibodies -- which are characterized as "frequent early markers of systemic lupus" -- I have yet to receive a credible diagnosis of any sort.
So far, I have taken no drug for my condition during its 14-month duration. I have continued to adhere to my extremely healthy, vegan, anti-inflammatory diet (see Dr. Andrew Weil's web site for this diet's "pyramid.") I jog every morning and do weight training several afternoons a week. I take lots of nutritional supplements, as I mentioned earlier. I stretch and do yoga.
I was doing all of this for many years before I acquired an autoimmune condition, so perhaps it seems silly to think that it will do me any good at this point. But I haven't relinquished the hope that my body can take care of itself.
I have felt uncomfortable with the idea of taking a powerful pharmaceutical agent without even knowing what is wrong with me.
Sometimes, I become uneasy with the path I've chosen. The internal "flares" that one can have and be completely unaware of them do concern me. These flares can severely damage the body, especially the kidneys, the brain and spinal cord and the heart and lungs.
Information from reputable medical sites says that even the most minor exposure to ultraviolet radiation is one of the "triggers" for such flares. The anti-malarial drug that I have been urged to take can be "protective" to some degree, they say.
"Flare" is such a picturesque word.
I was unable to understand some of the pertinent data I came across.
We have all heard reports of study after study indicating that Vitamin D supplementation is important in many ways, including the suppression of autoimmune diseases and cancer. We have repeatedly been warned that there is an 'epidemic' of Vitamin D deficiency in the U.S., even as more is learned about its remarkable benefits.
A study last year by researchers at Harvard and Oxford, led by Sreeram Ramagopalan, buttressed this position, recommending supplementation as a preventative strategy in these diseases, and noting that that vitamin D receptor binding is significantly enhanced in regions of the human genome associated with several common autoimmune diseases.
However, a 2009 study postulated that "supplementing with vitamin D may actually exacerbate autoimmune disease." The paper goes on to point out that "molecular biologists have long known that the form of vitamin D derived from food and supplements, 25-hydroxyvitamin D (25-D), is a secosteroid rather than a vitamin. Like corticosteroid medications, vitamin D may provide short-term relief by lowering inflammation but may exacerbate disease symptoms over the long-term." The leading spokesman and theorist behind this research, Dr. Trevor Marshall, explains that by deactivating the VDR and subsequently the immune response, 25-D allows bacteria to spread more easily in the long-run. He believes that the conventional wisdom about the value of Vitamin D supplementation is a growing public health hazard. I am not qualified to convey his ideas coherently, but you can read about them at trevormarshall.com/BioEssays-Feb08-Marshall-Preprint.pdf
I have more than doubled my intake of Vitamin D in the past couple of years, and I'm not sure how to respond to this study. I have been unable to find research that explains, supports or contradicts the Marshall team's conclusions. They note that both Vitamin D supplementation and autoimmune diseases have risen sharply in recent years, but they do not provide any evidence of causality. Even so, his larger theory about the role of pathogens in the Human Microbiome is fascinating.
At this point, I've decided to compromise and cut my Vitamin D intake in half.
In research being conducted at Stanford, and around the world, PARASITIC WORMS have been found to reverse autoimmunity and return the immune system to its normal functioning. Remarkable results have been seen in Multiple Sclerosis and Crohn's disease, and it is likely that it will be effective for other autoimmune disorders, including lupus.
I am going to continue my battle to be as healthy as I can be, and I will persist in learning as much as I can about autoimmune disorders. It's actually a very interesting subject.
In the meantime, I am just grateful that I don't have one of the many chronic and/or progressive conditions that are much worse than whatever the hell it is I have.
I am also grateful to know that there is such a dynamic, well-informed, generous and compassionate lupus community out there. What all of you are doing to help yourselves and each other is truly awe-inspiring.
The $900,000 a year dermatology professor said only, "Good heavens -- what could that be?!"
Does lupus make everyone ugly, or is it just me? http://kronstantinople.blogspot.com/2012/10/lupus-blushing-terrorist-bulges-with.html
A Lupus Mystery
My battle with lupus, or whatever it is
(March 20, 2011) The tiny, burning red dots began appearing under my eyes as I held Daddy's hand in St. Mark's Hospital during his final days. After he died, on May 10, 2010, and everyone else had left, I bent over to hold him, and the sobbing began. I stayed there, convulsed with grief, until the most beautiful, soulful nurse I have ever met, Veronica Mead, embraced me tearfully and told me I had to go. I removed his dementia bracelet, and I've worn it ever since. On the back, it has his name and phone number. On the front, it says, "Safe Return."
I have never cried so hard and long in my life, and I still have a lot of it left to do. Within a week, the red dots had formed a bright, raised crimson half circle under each eye, with stray dots down my cheeks and into my temple. It was so swollen that I could see it just by looking down.
For me, going to a doctor is always a last resort -- it's generally a total waste of time and money. For three months, I took a "What Would Cleopatra Do?" approach to my rash, which had become more inflamed and monolithic. I tried yogurt, honey, olive oil, aloe, Vitamin E, flaxseed oil, cucumber slices. I tried nutritional supplements such as beta glucans, oil of oregano and olive-leaf extract. When natural remedies didn't help, I tried antiviral, antifungal and antibacterial ointments. I dissolved aspirin in water and tried in vain to get an anti-inflammatory effect from it.
By then, it was starting to scare me. I was afraid that if it ever went away, it would leave significant scarring. So I arranged to see Salt Lake City dermatologist Brian Williams.
Hippocrates on his head: First, do no good
Dr. Williams strode into the examination room 55 minutes late, twirled toward me, and almost immediately declared, with a thrilling trill of triumph: "I know what you have! You have lupus!"
He ordered lab tests that he was confident would prove the diagnosis he had boldly pounced upon – lupus -- and said a biopsy would probably be required later.
I was devastated at the prospect of living with lupus. It is an autoimmune disease that can manifest itself merely as a florid rash (cutaneous lupus) or it can also attack the body's internal organs, including the liver, kidneys, heart, bones and brain (systemic lupus). There has not been a new drug approved to treat this disease in 50 years.
"Is there anything I can do to prevent scarring in the meantime?" I asked. It's perversely coincidental that the feature people compliment me about the most -- the smooth skin under my eyes – is the very part of me that was being eaten alive by this flaming monster.
"Oh, there's scarring already -- I can see it," the doctor replied cavalierly.
Three weeks later, Dr. Williams called to inform me that the lab work supported his diagnosis of systemic lupus, although the data weren't 100 percent conclusive. The report indicated elevated Anti-Nuclear Antibodies (ANAs) and Double-Strand DNA levels, as well as liver and kidney abnormalities -- all key markers for the disease. The ANAs indicate auto-immunity: Your immune system, instead of attacking alien invaders as the Good Lord intended, attacks you.
Ironically, I love my immune system, and have for years done everything I could to build it into a Big Mean War Machine, poised to decimate any bug that was reckless and tasteless enough to enter the domain of my body. Now I felt like a benevolent dictator whose army has inexplicably turned against me. There used to be a band in Britain called "The Kronstadt Uprising," and that phrase resonated with the chaos I imagined unfolding in my bloodstream.
Two therapists I know, one here and one in New York, said they suspected that this outbreak was triggered by my father's death. Not by all that crying, which had been my first thought, but by the grief. They said that emotional trauma and other stressors can trigger an autoimmune disease in someone who is predisposed.
My blood pressure and heart rate, which had been very low all my life, were dramatically elevated, and my blood oxygen level, which had always been very high, was disturbingly low. Dr. Williams urged me to see Christopher Hansen -- a University of Utah dermatologist who specializes in cutaneous lupus – as well as a rheumatologist, who would address the systemic aspects of the disease.
"I am not going to take prednisone," I declared. This was the most commonly used drug for lupus, I had read, and it didn't seem worth it to me. It essentially kills your immune system – leaving you vulnerable to every bug out there, and to cancer as well – and it has an array of other side-effects, including bone loss.
"No, you'll be on anti-malarials, which are much worse," Dr. Williams said with apparent enjoyment. "They turn your skin blue-gray and destroy your retinas."
(Note to the American Society for Psychiatric Dermatology – if there isn't one, let's get going on it – Please do an assessment of this doctor's sadistic tendencies. He seems to relish delivering bad news, and he makes no effort to comfort or reassure the patient. Does he do this with everyone, or did I just bring out some evil streak in him, remind him of his emasculating mother, a luscious-but-treacherous ex-wife, etc.? For some reason, I am actually fond of the guy, but I do think some intervention is called for.)
You Want a Piece of Me? Just a tiny one
Dr. Christopher Hansen was fully booked for two months. I was unwilling to wait that long to get a biopsy and some more input on this whole lupus specter.
I made an appointment to see Dr. Doug Woseth. He is a very kind, patient, gentle, modest and somewhat shy young man. No bit fat doctor's ego for him -- he is just plain sweet. He laughs with a slight discomfort, which only adds to his considerable charm. He is so clean that one wants to hug and smell him. He delicately examined me and said he was quite certain that I didn't have systemic lupus, but he cut out a sliver of my inflamed skin to determine whether I had the cutaneous form.
Dr. Woseth persuaded me to try the triamcinolone steroid cream that I had refused when Dr. Williams suggested it. Steroids are notorious for causing skin thinning, and the skin around your eyes is already the thinnest on your body. Even the manufacturer warns that it should not be used on the face "and particularly not under or near the eyes." It can literally cause the skin to tear and shred. I was aware that it is widely prescribed anyway, to treat persistent lupus rashes, but I was concerned.
Dr. Woseth said, "It won't hurt to use it for a couple of weeks to clear this up." So I got some. When I took off my sunglasses and showed the pharmacist where I was going to apply it, she said, "You have got to be kidding. Don't do it."
Steroids are as effective as they are destructive. By this time, my rash had been in full flare for more than four months, but there was substantial improvement within days of beginning the triamcinolone. I have since learned from my research that many people with lupus and other serious skin conditions are initially delighted with the healing effect of the steroid cream, but then as soon as they stop using it – and you do need to use it sparingly and briefly – their condition roars back, full-force.
My biopsy results came back a week later and were "consistent with Lupus erythematosus," according to the pathologist.
Doctor Dreamy Dares to Doubt
The Golden Boy of cutaneous lupus, Dr.Christopher Hansen at the U., got a break in his schedule, and I saw him a few days later. He told me that I needed to stop using the steroid cream immediately. The damage that I had feared apparently was occurring already; he mentioned skin atrophy and telangiectasiae (dilated superficial blood vessels). A visible, burning slit was developing at the outer corner of each eye as the tissue degraded.
The youthful Dr. Hansen is so thoughtfully "designed" as a physician that he almost seems like some sort of avatar. He is everybody's dream doctor: handsome, earnest, authoritative, reassuring. Someone has programmed him with "excellent eye contact" software, which is quite lifelike. He managed to be extremely businesslike, enforcing the proper professional distance, while also conveying what seemed to be honest compassion. He asked lots of questions (very good ones), listened well, scrutinized and examined me (after washing his hands, thank god -- how often does that happen?) He even inquired about my professional and personal history and my current life, as if he actually cared who I am as a person -- almost unheard of these days. It was clear that he was really thinking – trying to solve this puzzle and to help me -- which ought to be the norm in the medical profession but most certainly is not. His pat on my shoulder was not the norm, either, and I appreciated the gesture. When I asked him a couple of questions about himself, he responded in the royal "we," which could have reflected either grandiosity or humility, but either one was fine with me.
He ordered more lab work and said he wanted to examine the lupus-positive biopsy himself. He had his doubts that my rash was cutaneous lupus, and he was even more doubtful that I had systemic lupus.
Within 36 hours of discontinuing the steroid cream, as per the doctor's instructions, the rash had flared back alarmingly. Even so, I was glad I wasn't using the product anymore. I asked Dr. Hansen to prescribe a nonsteroidal anti-inflammatory ointment for me to try, even though his assistant had told me that the so-called TCIs aren't very effective.
I began applying the Protopic ($130 per tube) but the inflammation it caused was intolerable, so I had to stop. The rash was creeping back in a whole new configuration, evolving from a broad red swath under each eye into an ever-changing assemblage of dense, small, very uncomfortable red bumps. They burned and itched, and it felt as if tiny worms were emerging from my pores. Each day, when I couldn't stand it any longer, I knocked myself out with tranquilizers and got into bed with my cat.
Dr. Hansen emailed me about the lab work and said, "I see no evidence for any systemic involvement of lupus…I believe the risk of you developing systemic lupus based on your labs to be remote."
He still had not received my biopsy, which he reiterated that he wanted to assess for himself.
At this point, having endured this painful and grotesque malady for more than five months, I still had no definitive answer. One doctor believed I had systemic and cutaneous lupus; one believed I had only the cutaneous form; one wasn't at all sure I had either one.
A Queen of Karma, Bereft of Benevolence
While I waited for Dr. Hansen to re-evaluate the biopsy, I saw rheumatologist Dr. Shruti Sanghvi at the Salt Lake Clinic. I chose her for reasons my late father would probably describe as reverse discrimination. I chose her because she is from India, and in my experience, people – especially doctors – from India are particularly intelligent, competent, empathetic and charming.
I later thanked her for reminding me that GENERALIZATIONS ARE STUPID (although I continue to cling uncritically to my open-hearted love for black and hispanic people).
She floated into the examination room as if she were the Goddess of Healing, with her white lab coat over a violet sari. She had a subtle hint of mirth and serenity in her large eyes, and a comforting fullness to her face and body that reminded me of Buddha, which I know is the wrong country and the wrong religion, but that's what I saw. She expressed a lighthearted curiosity about what made me tick. She said she admired my vegan diet and my exercise regimen, and she found the fact that I had embraced this lifestyle while I was still drinking heavily and smoking to be quite amusing.
After briskly skimming through my blood work and biopsy results, and then pressing a few joints on my fingers and toes, and sweeping her arms around me, as if she were reading my aura, she declared that I had "multiple connective tissue abnormalities" and diagnosed me with both fibromyalgia and systemic lupus. She urged me to begin taking an antimalarial drug right away. "You could have kidney failure at any time, without warning," she said. "You could wind up on dialysis. You could wind up on a transplant waiting list. Even if the rash goes away, the disease can flare internally and damage major organs catastrophically."
I should have been devastated, but in my gut, I didn't believe I had lupus. Her New-Agey examination had seemed like something out of "Saturday Night Live." I asked the doctor what made her so sure. She showed me a list of criteria that are used to diagnose the disease and said that if a patient meets four of the criteria, it indicates lupus. When she pointed out which criteria applied to me, I was even less convinced. Each symptom was so minor, and could have indicated so many other conditions, that it simply wasn't persuasive. The only exception was what is known as a "malar" or "butterfly" rash, which is so distinctive that it is a very strong indicator of lupus. I told her that I never had this formation, which extends over the bridge of the nose and down onto each cheek. I showed her a picture of my rash at its worst, and it clearly wasn't malar. She seemed taken aback but didn't retreat from her diagnosis. She gave me no resources to deal with this very complex and amorphous disease, except for a pamphlet from the Lupus Foundation.
As she left the room, she said, "I am very sorry this is happening to you. It must be due to Karma."
I rushed to open the door and called out down the hall, "Doesn't Karma mean I did something to deserve it?"
She turned, smiling inscrutably, and replied, "Maybe in a previous life."
A few days later, I informed her by email that Dr. Chris Hansen had just emailed me his own assessment of the biopsy: "There were some features suggestive of lupus but I would not make the diagnosis based on the biopsy alone, There is inflammation in the upper skin with different types of immune cells, but not in a pattern that is specific for any particular diagnosis. The diagnosis remains a mystery."
Nevertheless, Dr. Sanghvi never expressed any second thoughts about her diagnosis. Since I refused to take the antimalarial drug, she suggested that I come back in two months for more lab work, to assess my level of autoimmunity and to monitor my kidney function.
Brash Questions, Rash Indifference
By November 2, I had lived with the rash for six months. Upon reviewing my new labs, Dr. Sanghvi announced that I did not have lupus after all and left the room. I was stunned by this sudden, inexplicable turnaround. Her positive diagnosis had never seemed credible to me, but then neither did this negative one. I felt totally lost and confused. I mailed her some questions, hoping to get a clearer picture of where things stood:
My Anti-Nuclear Antibody numbers, as we discussed, continue to be abnormally high. What are the implications of this?
Does the elevated ANA mean that I have an autoimmune disease of some sort, even if it's not lupus? If not, what does it mean?
Do I need to be retested regularly?
Does my kidney function need to be monitored?
Is the rash under my eyes likely caused by the ANA issue, or do you think they are separate phenomena?
Since I exhibited enough of the criteria in September to be diagnosed with lupus but not enough in November, is it possible that in January I will once again face the prospect of a lupus diagnosis?
There are several other readings that are out of range and that I don't understand, but the most concerning for me are the references to my "high chromatin antibody level," which is described in the report as a frequent "early marker" of systemic lupus. Shouldn't I follow up on this?
She never replied. I had paid her well over $400, and all I'd gotten was two contradictory diagnoses, each delivered with an air of absolute confidence. She left me with nothing but bewilderment and despair. She obviously couldn't care less, as she made clear by refusing to answer obvious and important questions.
Meanwhile, the rash has changed in its appearance and 'behavior' several times over seven months. When it looked so grotesque that people averted their eyes – out of horror and/or politeness -- it caused little discomfort. As it dispersed, became less dense and more spotty, it became increasingly uncomfortable, especially at night. It flared when I was hot, upset, exerting myself, eating a warm, spicy meal and after my shower. It had ocular manifestations as well: my eyes were inflamed, gritty and exuded pus. I had wiped several floating, clear membranes from each eyeball.
I reached out again to Doug Woseth, who suggested that we do an extensive allergy test – which involved having dozens of allergens arrayed on my back for a week – and if nothing showed up, he would arrange for me to be seen at the University of Utah dermatology department's Grand Rounds, which "is reserved for the most difficult and mystifying cases." This was a very gracious and generous gesture on his part.
No allergic reactions occurred, so my "appearance" was scheduled for December 17.
No grandeur, but the paparazzi were nice
The prospect of Grand Rounds, which enables one to be scrutinized, assessed and discussed by some of the finest dermatologists in the state, seemed like the best chance I could have of finally learning what was happening to me. I received a notice in the mail from the U.'s dermatology clinic, alerting me to the fact that that the doctors would not be taking the time to introduce themselves or even to speak to me, which seemed as rude and intimidating as a notice I once got ordering me to appear for jury duty "under penalty of law." I decided that – depending on my mood that day -- I would either put up with this frigid, clinical atmosphere or I'd make remarks that were so provocative, they wouldn't be able to resist interacting with me.
Despite the coldness of the "invitation," there was something inherently humorous in the phrase "Grand Rounds," and I thought it would be fun to show up in a ball gown. I imagined that I would feel like both a starlet and a specimen, and that's kind of how it turned out.
I was taken to a clinic room and told to sit on the examination table. For the first ten minutes or so, I was questioned by some very thoughtful, respectful medical students or residents. I don't think they were very interested in me, but they did their best to come up with pertinent questions. They were so polite that they requested my permission before touching me.
Then came the paparazzi, a stampede of the Real Doctors into the small room, many of whom, according to the state's database on public employee salaries, earn $650,000 to a million dollars annually. The cellphone cameras began flashing around me. "Turn this way, turn that way, over here please, could you toss your hair back a bit, that's perfect, close your eyes, lift your chin, you're doing fine!" I tried not to grin at the nuttiness of this scene – I was a serious star! They seemed like very ordinary guys, pals from a bowling league perhaps. I realized I had been silly to expect that they would fit a certain mold: tall, slender, well-dressed, serious and reserved. One was examining my scalp for hair loss – a side effect of lupus. Another scrutinized my rash, saying merely: "I'll be damned." One squinted at my chest, while another pressed around my ankles. They did introduce themselves, and they did ask questions, contrary to the department's notice. Eventually, they seemed most interested in my hands, which have changed in appearance quite a bit in the past 20 years. I have attributed both the variations in color and a metamorphosis in the shape of my fingers and nails to my past history of smoking. The oxygen deprivation caused by cigarettes often manifests itself this way. It didn't take long before the cellphones began flashing again as they took shots of my hands, while my poor, wracked facial skin became yesterday's celebrity.
They all thanked me heartily and whooshed out the door. It was only then that I saw Dr. Woseth, who had been hidden from view, sitting there patiently in the corner. I felt as if I'd had a guardian angel with me all along, and I wished I had known. I gave him a hug – that darling guy – and went home to await the Wise Men's assessment.
An "Unremarkable" Patient
"Don't take it personally – it's medical jargon," Dr. Woseth reassured me later that afternoon. "By 'unremarkable' they just mean that nothing jumps out at them to explain your symptoms." The Grand Rounds doctors' only recommendation, he added, was that I get a CT scan of my lungs. "In very rare cases, organ cancers can have a cutaneous manifestation," he said.
I had been wanting to get a scan of my lungs anyway. Even though I quit smoking about eight years ago, I will always be concerned about cancer. The scan came back normal.
Dr. Woseth recommended that I return to the U. for advanced allergy testing and a very refined biopsy, but I was through, at least for now, with the medical establishment. I often read about people who had to see 20 or 30 doctors before they got an accurate diagnosis, but I was too disillusioned, exhausted and pissed off for that. I would just live with this torment and be grateful that I didn't have ALS or multiple sclerosis or a brain tumor.
It had been eight months since I had looked reasonably normal, and I had become accustomed during that time to people being taken aback by the bright-red swelling, peeling, hardening and oozing of the skin under my eyes. (Nobody would actually look at me, except for babies. They stared right into my eyes, and I really believe they felt something akin to compassion, as well as curiosity. A few even reached their arms toward me.) I wondered if I could ever grow accustomed to the excruciating, crawly discomfort and accept it stoically. People in poor countries have flies on their faces and in their eyes all the time, and they don't pay any attention to it. So they would be my new role models for dignity and forbearance.
Fortifying My Colonial Empire
The colon is a magical place, which serves many purposes other than as a subway for excrement. Most of our immune system resides there, and most of our serotonin -- the neurotransmitter and mood modulator -- is produced there, which is one reason that the colon known as "The Second Brain." Millions of bacteria, or maybe it's billions (three or four pounds, I've read), reside in the colon. The "good" bacteria keep the "bad" ones in check. Taking probiotic supplements augments the good guys and is regarded in many parts of Europe and Asia as essential to health.
I have been taking probiotics for about 20 years, but I always got the least expensive variety, which contains only two strains of flora. At the end of January, I came across a half-price sale of a probiotic blend that contains 12 strains.
I bought a bottle, and within 36 hours, my skin was normal. Not a trace of the rash remained.
I find it hard to believe that probiotics could have "cured" me of a complex malady that had persisted for nine months. It definitely wasn't a placebo effect, though, because it never occurred to me that the probiotics would influence the rash until I later read that dysbiosis -- an imbalance in the gut flora -- can cause autoimmune diseases as well as those I had already known about. I couldn't think of anything else that had could have caused this radical reversal. When I told Dr. Chris Hansen about this, he emailed me: "I am willing to believe anything about your rash, because it was so unusual." He added, "I think you are right on with the idea that in some cases the diagnosis of lupus is more of an art than a science. I reviewed your biopsy again with a few additional pathologists and I am even more convinced that lupus is not the correct diagnosis."
But what is? Nobody knows. I think this happens in medicine more than most of us realize, and I believe that medicine is still quite primitive in many ways, despite all of its remarkable advances.
I have not been cured. My laboratory numbers still indicate that some autoimmune process is going on. I can feel the rash lurking under my skin, and it surfaces as a pink-purple shadow if I am hot or agitated or even animated. Just smoothing some moisturizer gently under my eyes turns the skin bright red for a few minutes. And at night, I can often feel the little worms in my pores getting restless, wanting to emerge. Usually, a cold washcloth is all that is required to smack them down, and usually I look and feel normal once again.
I guess I will forever be braced for another flare.


text:
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I liked how easy it was to buy something for my truck. I will tell my friends!
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Reno, NV
ATV Carrier for Truck Beds by Ultimate Rack
Home > Exterior Accessories > Cargo Carriers > ATV Trailers / ATV Carriers > ATV Carrier for Truck Beds by Ultimate Rack
Ultimate Racks are constructed of high quality materials, providing maximum strength and durability. All open ends on the steel tubing have been capped, welded, and ground smooth. This feature insures that no moisture can get inside the steel tubing, so the integrity of the rack will not be compromised. The entire rack has been powder-coated to hold up under the harshest of weather conditions and tolerates heat and moisture much better than paint. Powder-coating gives much longer wear, is chip-resistant, and looks great!
The tire pans are a beautiful blend of functionality and appearance. The 1/8-inch diamond-plate aluminum is rust-proof, easy to clean and very durable. All edges have been de-burred for a smooth finish and a superb look. The Ultimate Rack ramps are each ten feet long and constructed of aluminum. The ramps have a 1 1/2" tall "curb" to help guide your ATV onto the rack. They can easily bear the weight of even the largest ATV. After use, the ramps are folded and stored conveniently under the loaded ATVs, leaving the truck bed space available for gear storage.
The Ultimate Rack is designed to complement your full-size truck! Whether you drive a short- or longbed pickup, the Ultimate Rack fits! If you have a longbed with a standard size toolbox, the shortbed model works, so you can have your tools and your ATVs with you at the same time. The Ultimate Rack rests on the floor of the truck bed, not on the bedrails, providing more stability and evenly-distributed weight. This feature prevents damage to your bedrails.
Your ATVs face forward when loaded on an Ultimate Rack. This cuts down on wind resistance and prevents fender damage caused by wind. By having your ATVs facing forward, gas mileage is improved. When loading ATVs from the rear of the truck instead of the side, there is no chance of accidentally driving off the other side. The headache rack helps protect the cab and rear window.
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And storage.....Plenty of room under the rack for all my gear... This is the only ATV Rack system that I would recommend. I have several friends that now own their own racks...
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In May of 1999 I was looking for the safest rack system made. I needed to haul 2 quads and pull a camp trailer. I did some research quickly dismissed all the "Side loaders" as being too much of a safety issue to load. I would not want to drive off the other side. I had seen a couple of Ultimate Racks and liked the idea of loading from the back. I purchased one from a local dealer. Over 3 years later I still have no complaints about the Rack system. It is easy to install in my truck it is very well made. I haul a Bombardier DS650 on the rack along with a Kawasaki Lakota and these are 2 fairly heavy ATVs. I haul my gear, tires, coolers, generator and about anything else I need to camp. With the ATVs facing forward I do not worry about the plastic breaking. In my opinion it is the best ATV Rack on the market.
I wouldn't buy anything less.
Rusty Hoffman
1. Will not 5.8' Short Bed
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text:
Dostana (2008 film)
Theatrical release poster
|Directed by
|Tarun Mansukhani
|Produced by
|Hiroo Yash Johar
Karan Johar
|Screenplay by
|Tarun Mansukhani
|Story by
|Tarun Mansukhani
|John Abraham
Abhishek Bachchan
Priyanka Chopra
|Music by
Background Score:
Salim Sulaiman
|Edited by
|Manan Sagar
|Distributed by
|Dharma Productions
ShowMan Pictures
Yash Raj Films
|Release dates
|Running time
|142 minutes
|30 crore (US$4.7 million)
|Box office
|102 crore (US$16 million)(Share)[1]
Dostana (Hindi: दोस्ताना, translation: Friendship) is a 2008 romantic comedy film directed by Tarun Mansukhani and starring Abhishek Bachchan, John Abraham and Priyanka Chopra in the lead roles. Dostana was filmed entirely in Miami, Florida. The movie is seemed to be inspired by the Hollywood movie, I Now Pronounce You Chuck and Larry.[2] Filming began in March 2008, and the film was released on 14 November 2008. It went on to become the eighth highest grossing film at the Indian box office in 2008.[3]
Nurse Sameer Kapoor (Abhishek Bachchan) and photographer Kunal Chopra (John Abraham) meet while looking for an apartment to rent. They fall in love with the same apartment; however, the owner refuses to sublet it to them because her niece, Neha Melwani (Priyanka Chopra), will stay in the apartment alone and she does not want men living there with her. When a homosexual American soldier mentions how much Sameer and Kunal remind him of his own relationship with his long-term partner, Sameer tries to persuade Kunal to pretend they are lovers so that they may live in the apartment. Kunal initially refuses but, desperate for the apartment, he decides to agree to it. Their plan works and they move in. Neha, Kunal and Sameer become good friends.
One day, Neha's boss, Murli 'M' (Boman Irani), resigns his job as the editor of Verve magazine and will choose his successor. To impress him, Neha invites M for dinner at her house, telling him that she will introduce him to her homosexual friends. The evening is comedic but Sameer's mother discovers that her son might be homosexual and is displeased. The next day at Neha's office, M announces that Abhimanyu 'Abhi' Singh (Bobby Deol) will be the new editor. Neha, heartbroken, returns home where she is consoled by Sameer's mother. Kunal and Sameer help Neha with a project given to her by Abhi.
While Kunal is out for a few days, Sameer takes Neha on a romantic outing. Later, he tries to tell Neha about their scheme and that he loves her, but she does not hear him. Instead, Kunal overhears and stops him, admitting to Sameer that he also loves Neha. Kunal suggests that Sameer meets him and Neha that night at a bar, but Sameer is tricked into spending the night with Neha's aunt and her friends while Kunal takes Neha on a date. The next morning, Sameer is furious with Kunal.
Abhimanyu and Neha start dating, and Sameer and Kunal decide to sabotage the relationship. Despite their efforts, Abhimanyu and Neha fall in love. Sameer and Kunal redirect their efforts into frightening Abhi's son, Veer, about his future if his father marries Neha. Neha discovers that Abhi plans to propose to her during a basketball game. She asks Kunal and Sameer for advice. They are shocked and tell her that they are not homosexual and are in love with her. Meanwhile, Veer tells Abhi of his fears, asking his father not to marry Neha. During the game, Abhi hugs Neha and ends the relationship, citing Veer's discomfort. Neha tearfully evicts Kunal and Sameer and resigns from "Verve."
A few months later, Kunal and Sameer go to court to collect their resident permits and realise that they miss Neha. They find her at a fashion show and try to apologise, but she refuses to see them. Abhi appears and Kunal asks when their wedding is. Neha tells him that they broke up because Veer was uncomfortable with her. Kunal and Sameer admit the their manipulations, infuriating Abhi and Neha. Kunal and Sameer climb onto the stage and beg for Neha's forgiveness, with the crowd encouraging them and blowing kisses to Neha. The crowd ask the men to kiss each other, and they refuse. Neha and Abhi begin to turn away. At the last moment, Kunal forcibly kisses Sameer. Abhi is amazed and Neha goes to the men and they reconcile. Kunal and Sameer propose to Abhi for Neha. He agrees and the couple marry. Two months later, Neha, Kunal, and Sameer are sitting on the apartment's balcony. Neha asks them whether they felt anything while pretending to be homosexual. The men are defensive and Neha leaves saying, "sorry, touchy topic." Sam and Kunal, now alone, remember their kiss.
- Abhishek Bachchan as Sameer Kapoor (Sam)
- John Abraham as Kunal Chopra
- Priyanka Chopra as Neha Melwani
- Bobby Deol as Abhimanyu Singh, Neha's second boss (Cameo Appearance)
- Kiron Kher as Sameer's mother
- Boman Irani as M aka Murli, Neha's first boss
- Sushmita Mukherjee as Neha's aunty
- Shilpa Shetty in a special appearance in the song "Shut Up & Bounce"
Critical reception[edit]
The film review site Rotten Tomatoes gave the movie an aggregate 100% (fresh) rating, based on 5 reviews.[4] Rony D'Costa of Box Office India gave it 3 stars out of 5, stating, "Dostana is fresh, frothy, naughty & a delightful romantic comedy. It's an ideal date movie".[5] Bollywood Hungama gave it 4 stars out of 5, with Taran Adarsh commenting, "On the whole, DOSTANA is a winner all the way. In terms of content, it might just prove to be a trendsetter."[6] The Times of India gave it 4 stars out of 5, stating, "Just for laughs, with a loose second half, Dostana boasts of some fine chemistry between the two lead players: Abhishek and John".[7] The review at Rediff.com makes note of the elaborate sequences and the possibility of the film becoming a financial success. However, it also mentions that the film is flawed in its depiction of homosexuality, calling it a "crucial blunder".[8] AOL India gave it 3 out of 5, with Noyon Jyoti Parasara calling Dostana "a fun film".[9]
Among other US critics, Frank Lovece of Film Journal International enjoyed it as a "[b]ig, colorful, delightfully dumb Bollywood 'gateway' movie" that "could be a perfect crossover vehicle for U.S. audiences". Referring to the thematically similar film I Now Pronounce You Chuck & Larry, Lovece said "this reverse La Cage aux Folles ... is miles above Adam Sandler's Hollywood take on the topic".[10] Critic and author Maitland McDonagh in MissFlickChick.com, placing the film in a larger context, analysed that it "trades in stereotypes about swishy queers, shallow horndogs, frustrated career girls, guilt-wielding (s)mothers and overbearing aunties who need to chill out and get laid. And you know what? It's pretty damned funny and oddly subversive. Yes, everyone learns a lesson about tolerance without actually embracing an alternative lifestyle, but any movie that can finagle two macho movie studs into a full-on smooch that doesn't devolve into slapstick gay panic is venturing into risky territory".[11]
|Studio album by Vishal-Shekhar
30 September 2008
|Feature film soundtrack
|Sony BMG
|Vishal-Shekhar chronology
The film's soundtrack was composed by Vishal-Shekhar. The album met with an electrifying response from potential audiences. According to the statistics published on IndiaFM, Dostana debuted at No. 4 on its Top Ten Soundtrack Sales Chart. Listeners registered on the website reviewed the album favourably and Dostana's music had an average rating of 4 stars out of 5.
|Track listing
|"Jaane Kyun"
|Anvita Dutt Guptan
|Vishal Dadlani
|"Desi Girl"
|Shankar Mahadevan, Sunidhi Chauhan, Vishal Dadlani
|"Maa Da Ladla"
|Master Saleem
|"Shut Up & Bounce"
|Anvita Dutt Guptan
|Vishal Dadlani, Sunidhi Chauhan
|"Khabar Nahin"
|Anvita Dutt Guptan
|Vishal Dadlani, Shreya Ghoshal, Amanat Ali
|"Kuch Kum"
|Vishal Dadlani
|"Maa Da Ladla" (Mummy Mix)
|Master Saleem, Sunidhi Chauhan
Total length:
The soundtrack received generally positive reviews. Joginder Tuteja of IndiaFM stated that "Dostana is an excellent album from Vishal-Shekhar which does not carry a single number which doesn't work", giving the soundtrack 4 out of 5 stars. NDTV also gave the soundtrack 4 out of 5 stars stating that "the soundtrack of the film will keep the cash registers ringing, with "Shut Up and Bounce" as an exception." Coincidentally most critics were in favour of every track apart from "Shut Up and Bounce," which they described as a huge disappointment considering it carried the tune played during the first promo of Dostana. Some even said that it lacked originality and because of its familiar tune, comparisons were made between "Shut Up and Bounce" and Kal Ho Naa Ho's "It's the Time to Disco".
Another song "Maa da laadla" affirms that Dostana isn't just about soothing, pleasant numbers but also about celebration. Punjabi in flavour, the song has good beats and is sung by Saleem. The lyrics of the song, penned by Kumaar, are noteworthy. The track has a slight humorous essence as well. In contrast to IndiaFM and NDTV, Buzz18's Chandrima Pal gave the soundtrack 2.5 stars out of 5, stating that it "misses out on most of the spunk Vishal-Shekhar had in their previous works". Rediff's Sukanya Verma also gave the soundtrack 2.5 stars out of 5, stating that "although Dostana's music is nice and peppy for the most part, it's nothing extraordinary." She even said that Dostana "certainly wasn't the best from Dharma Productions". ApunKaChoice.com has given it 3 out of 5 stars saying that it features some of the nicest groovy numbers. The Times of India has rated the soundtrack 3 out of 5 and mentioned that its cliche. Later, a video 'Maa Da Laadla - Remix' was released. It was also the ending theme for the movie.
Pritish Nandy, owner of Pritish Nandy Communications, filed a court case against Dharma Productions for using the song "Kuch Kum" without his permission. His allegations were that "Kuch Kum" was originally composed by Vishal-Shekhar for a film to be directed by Tarun Mansukhani under his banner, but the film never took off. Hence, Vishal-Shekhar used "Kuch Kum"'s composition in Dostana, which apparently made Pritish Nandy, "livid" and caused him to "raise objections" against the use of the song. Instead of wasting time going to court, Dharma Productions decided to handle the situation by paying Nandy 3 crore (US$470,000) in compensation.[12]
Box office[edit]
Dostana performed well both in India and overseas markets. Its opening weekend gross in the USA was $645,604 whilst in the UK, it was the third biggest opener-only behind Singh is Kinng and Race[13] with £341,665. As of 21 December 2008, the film had grossed $1,444,246 after a 37-day run at the UK box office alone with its total production budget of $2 million being almost covered. In the USA, the film had a total gross of $1,243,910 as of 11 December 2008, whereas in countries such as Australia, South Africa, New Zealand, Fiji, Malaysia, Netherlands and India the total gross was $16,650,664. In India, (as of 12 December 2008) the film had earned $14,718,754 which was 82% of its total gross. As of 11 December 2008, the film had a grossed $17,894,574 (which is just over Rs. 850 million) worldwide.[14][15]
- Nominated- Best Movie
- Nominated- Best Actor - Abhishek Bachchan
- Nominated- Best Music Director- Vishal-Shekhar
International Indian Film Academy Awards
- Won - Best Comedian: Abhishek Bachchan
- Won - Best Choreography: Farah Khan
Blu-ray release[edit]
Yash Raj Films released Dostana on Blu-ray on 14 December 2009.
In 2009 reports came out that director Tarun Mansukhani and Karan Johar are planning for a sequel of the film to cash in on its success, the sequel is titled Dostana 2. It was reported that along with the existing cast of the film (excluding Priyanka Chopra and Bobby Deol) Johar has roped in Katrina Kaif,[16] Arjun Rampal, Ritesh Deshmukh and Shreyas Talpade. Ritesh Deshmukh and Shreyas Talpade will play a real gay couple.
- ^ "Top Lifetime Grossers Worldwide (IND Rs)". Box Office India. Retrieved 5 August 2011.
- ^ I Now Pronounce You Chuck And Larry https://en.wikipedia.org/wiki/I_Now_Pronounce_You_Chuck_and_Larry"
- ^ "Top Earners 2008". Box Office India. Retrieved 10 July 2008.
- ^ "Dostana on rotten tomatoes". Retrieved 14 November 2008.
- ^ "Dostana - Review". Box Office India. 15 November 2008. Retrieved 15 November 2008.
- ^ "Dostana - Movie Review". BollywoodHungama.com. 13 November 2008. Retrieved 13 November 2008.
- ^ Kazmi, Nikhat (14 November 2008). "Movie Review". The Times of India. Retrieved 14 November 2008.
- ^ "Dostana is injuriously entertaining". Rediff.com. 14 November 2008. Retrieved 14 November 2008.
- ^ "Review". aol.in. 14 November 2008. Retrieved 14 November 2008.
- ^ Lovece, Frank, Film Review: Dostana, Film Journal International
- ^ McDonagh, Maitland, MissFlickChick.com: Dostana (review)
- ^ "'Dostana' grips controversy". Bolly Curry. 14 November 2008. Retrieved 16 November 2010.
- ^ "Dostana fetches staggering start overseas". Entertainment.oneindia.in. 15 November 2008. Retrieved 23 November 2008.
- ^ "Dostana grosses Rs 1 billion worldwide in four weeks". businessofcinema.com. 11 December 2008. Retrieved 11 December 2008.
- ^ "Dostana Box Office". boxofficemojo.com. 11 December 2008. Retrieved 11 December 2008.
- ^ "Katrina refuses 3 Idiots Tamil version". Hindustan Times. 18 April 2010. Retrieved 24 April 2010.
External links[edit]
- Official website
- Dostana at the Internet Movie Database
- Dostana on YashRajFilms
- Dostana at Box Office Mojo


text:
JUBA, South Sudan (AP) -- A government official says Sudanese President Omar al-Bashir will travel to South Sudan on Friday.
The visit will be al-Bashir's first to South Sudan since the country peacefully broke away from Sudan in 2011.
South Sudan government spokesman Barnaba Marial Benjamin said Thursday that the two heads of state want to prove to the world that the two countries plan to live peacefully together. Al-Bashir and South Sudan President Salva Kiir will discuss how to implement security agreements the two countries signed in September and the status of the contested region of Abyei.
Bashir had planned to travel to South Sudan in April 2012 but cancelled the visit after South Sudan's military seized the disputed oil-producing town of Heglig. The two leaders are likely to discuss their co-dependent oil industries.
Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


text:
Contact: SINC
FECYT - Spanish Foundation for Science and Technology
Caption: Current and predicted distribution of the Sylvester pine in the central mountains of the Iberian Peninsula during the 21st century according to one of the scenarios generated by the models.
Credit: J. Vias, M. Fuentes, D. Ruiz-Labourdette et al.
Usage Restrictions: None
Related news release: Holm oaks will gain ground in northern forests due to climate change


text:
The level of development of countries has a direct influence on the education system. By way of example, it is clear that the investment that countries like India and China have made in education over the last few years has had a direct influence on their economic progress. The commitment that Finland made some time ago has also had repercussions on its economy. By contrast, in western countries increasingly less public money is being devoted to funding higher education. For this reason and because the higher education sector is an increasingly more competitive one, Virginia Rincón-Diez, a researcher in the UPV/EHU's Department of Financial Economics II, has analysed the factors determining the international demand for higher studies.
In her PhD thesis submitted at the UPV/EHU, the researcher Virginia Rincón-Diez has concluded that the international demand for higher education depends largely on the public spending made in education. "The universities in the countries that invest the most in research and development are the most attractive for international students," added the researcher. So she has, for example, verified that the countries in the north of Europe are more attractive for international students than those located in other parts of Europe, which is the case in many other economic and social spheres.
In recent years, the number of enrolments in centres for higher education in Spain has fallen dramatically. So the vacuum that could be filled by foreign students is clear. Nevertheless, the demand for international students received by Spanish universities remains small in comparison with other countries in Europe.
The mobility of university students is becoming increasingly important. In fact, due to the demographic decline, the current economic crisis, the rise in the number of universities, etc., many universities have found themselves forced in some way to draw international students in order to "survive". So "it is important to analyse the factors driving this demand and to observe what increases or reduces the attractiveness of a university or country," added Rincón.
The data on Europe and Spain used in this piece of work have been gathered from the websites of UNESCO and of the Ministry of Education in Spain. Using the Anova technique, an analysis was conducted by means of various factors to see whether there are significant differences between European countries with respect to international demand for higher education. At the same time, by using variables, a study was made to see whether among Spanish universities there are significant differences in the international demand for higher studies. The following factors were taken into account: investment that the countries have made in education and in research and development, geographical location of the university, whether the university is public or private, whether it has competition locally (autonomous community or region), the scientific production of the teaching staff, etc.
The results obtained indicate that the geographical location of the countries, education policy and that of R&D have a significant influence in international demand in these countries. As pointed out already, specifically, the university systems in the north of Europe are the most attractive for international students. Likewise, the countries that invest most in education and research and development are also attractive in terms of international demand. However, the researcher affirmed that private universities are particularly attractive for students in Europe and North America. And she reached the conclusion that having another university close by has a positive effect on international demand. According to the research, the geographical situation of the university also determines international demand. In this respect, the researcher said that "the proportion of international students is higher in universities close to large cities like Barcelona or Madrid."
Likewise, the volume of scientific production of each lecturer makes the university more attractive. Despite the fact that the quality of what is produced does not influence the capacity to attract international students, the researcher added that "it seems that the key to get these students lies in the volume of scientific production."
Data on Europe and Spain were used for this work, but as the UPV/EHU researcher pointed out, researching the international demand for higher education in the Autonomous Community of the Basque Country in greater depth will be an interesting line of research at some point in the future.
Being an international student isnt easy, even here in the US with our complex culture and language. Assistance must come from various sources. A new award-winning worldwide book/ebook to help anyone coming to the US is "What Foreigners Need To Know About America From A To Z: How to Understand Crazy American Culture, People, Government, Business, Language and More. It paints a revealing picture of America for those who will benefit from a better understanding, including international students. Endorsed worldwide by ambassadors, educators, and editors, it also identifies foreigners who became successful in the US and how they contributed to our society, including students.
A chapter on education identifies schools that are free and explains how to be accepted to an American university and cope with a new culture, friendship process and classroom differences they will encounter. Some stay after graduation. It has chapters that explain how US businesses operate and how to get a job (which differs from most countries), a must for those who want to work for an American firm here or overseas. It also has chapters that identify the most common English grammar and speech problems foreigners have and tips for easily overcoming them, the number one stumbling block they say they have to succeeding here.
Most struggle in their efforts and need guidance from schools international departments, immigration protection, host families, concerned neighbors and fellow students, and books like this to extend a cultural helping hand so we all have a win-win situation. Good luck to all wherever you study!
The use of the contents of this website is forbidden without permission.
Copyright © 2007 Elhuyar Fundazioa


text:
MEP Quantity Surveyor – Major Projects - Jeddah
This job has now expired
Further information
MEP Quantity Surveyor – Major Projects - Jeddah
With an excellent track record of commercially managing major M&E packages, you will have experience in pre and post contracts and have previously worked on major projects.
Essential Candidate Requirements:
The candidate must have the following attributes:
- Degree qualified in a relevant discipline from a Western Institution
- Must have worked on major projects
- Chartership preferred
- High rise experience
- Experience of managing large mechanical and electrical packages
- Pre and post contract experience
- Exceptional written and spoken English.
- Have worked for Blue Chip consultancies/Contractors and have a stable track record with these companies.
Remuneration Package:
Very competitive tax free salary
Company Overview:
World leading Blue Chip international consultancy undertaking some of the highest profile projects across the globe, covering major rail, building and infrastructure projects. Within the Middle East they have an expanding portfolio of exciting schemes and are looking to attract talented, career minded individuals to join their existing team.
The Role:
As MEP Quantity Surveyor you would be responsible for managing major mechanical and electrical packages on this high profile scheme. This is a major high rise project.
Individual Personal Attributes:
You will be a team player with the ability to manage others, be an exceptional multi-tasker and have natural time management skills. You must be able to use your own initiative, be degree qualified and be fluent in written and spoken English.
You will be a talented individual who wants to be part of a world leading Blue Chip international consultancy working on high profile projects.
We will contact all successfully shortlisted applicants but regret we cannot guarantee a response to all applications.


text:
Powell Fizz
- Words: Steve Kerr
- Label: Liberation Technologies
- XLR8R Rating: 8/10
On the surface, it would seem quite easy to do what Oscar Powell does. Layer some disjointed drum loops—preferably swiped from a no-wave record—with bursts of noise and static, throw in some dissonant synthesizer and maybe a snarky spoken word sample, and one ought to have a facsimile of one of his tracks. The London-based producer has a formula, no doubt, but it is far more complicated than it appears. Powell's tracks are surely minimalist in focus, but are also, as he has attested in interviews, subject to meticulous editing. Both no wave and the industrial techno he has sometimes been grouped with are known for frenetic, one-take approaches. Powell, meanwhile, is an expert in control, and his sound harkens to jungle's tensile rhythms, or maybe even a spartan version of microhouse. Earlier records obfuscated these charms, sounding muddier and more inert than the untitled, studiously funky EP he released on The Death of Rave earlier in the year. Fizz, his first 12" for Liberation Technologies, is every bit as essential a listen, if not more.
The title track zooms around a mainline of cranky Suicide-esque organ, globular pulses, and odd guitar twangs, but the kickdrum is its engine. Powell pads it so it smacks with every hit, and eventually tumbles it over itself, thundering along with a physicality that is so blunt it virtually drowns out the track's teeming, almost concrète background detailing. Any listener who has ever felt their body riddled by a machine-gun jack pattern but now finds standard jacking house to be a cliché ought to be involuntarily punching the air on this one. "Wharton Tiers On Drums" presumably samples the titular drummer, best known for his work in Theoretical Girls. It uses a similar sound set as "Fizz," but is less immediate, meandering through a loopy background as Powell's imaginary drummer and bassist struggle to synchronize. A snare clambers into the mix, there is a voice as if a bandleader has just shuddered an order, and everything shuts down. And then the artist's rhythmic genius is at work again, as his drums lock into a chugging, bulldozer thrust before melding with a high, ghostly tone and synths that crackle and gurgle like they're short-circuiting. "Beats" is of course a bonus beat, but it nonetheless has all the chiseled force of its companions. These pieces course with visceral energy. For the moment, Powell is totally peerless, and while he references bygone eras, his tracks represent the cutting edge of precision-engineered body music.
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About Beth Stern
Beth's simple, successful life and career would soon be turned upside down after one very special dinner party. Though neither was supposed to attend, Beth hit it off with Howard Stern at a New York City restaurant in 2000. While he was accustomed to the media hype, Beth was unprepared for all the attention she received. She remained in the background for some time, deflecting questions or avoiding the paparazzi altogether. Finally, after FHM readers ranked her among the Top 100 Sexiest Women of the Year, she decided to emerge from her shell and did a cover shoot for the magazine. Beth and Howard were married in October 2008, and she now goes by Beth Ostrosky Stern.
Since her relationship with Howard Stern went public, Beth has become a household name. She regularly graces magazine covers and continues to work as a TV host and correspondent, most recently as the host of the hit HGTV series "Mom Caves" and a new special "Posh Pets" coming to HGTV this summer. Beth will also host National Geographic's upcoming "Spoiled Rotten Pets." She's been a guest on David Letterman, Jimmy Kimmel, Jimmy Fallon, Regis & Kelly , Rachael Ray, Ellen, Nate Berkus and the Today Show. She's been featured on the ABC series True Beauty and served as a mentor on America's Next Top Model. Beth uses her spot in the public eye to educate the public about animal rescue as the national spokesperson for The Northshore Animal League America, the world's largest no-kill animal shelter. Her New York Times Bestselling book, Oh My Dog: How to Choose, Train, Groom, Nurture, Feed, and Care for Your New Best Friend, was released in May 2010.
Hi Beth, Just wondering if you have heard of Yappy Hour Vineyards dog wine! It's fantastic. I just received a bottle as a gift and I want to send one to every dog lover I know. I'm going to send a copy of this to Yappy Hour, and maybe you could have them on your show? It's the most unique dog lover gift I've ever seen. Check them out at www.YappyHourVineyards.com
Thanks, Michelle
Hello Beth,
I love your show. Seeing animals being loved and wanted so much makes my heart so happy. I am an artist and love animals so much, it's reflected in my work... I design luxury pet beds that express my love for dogs and cats and who knows maybe other pets can get some sleep on them too???lol.
Hello, I live in NY with my very SPOILED 2yr old, 2.7 lb Chihuahua. Her name is YumYum. She has her own facebook page, Twitter and Instagram Account. All under the name ChiYumYum. We are going to 2 fabulous events in June. One is a Doggie Disco Birthday Party and the other is "Puppy Prom". We think you will love these events as they surely will show how over-the-top we love to go for our loving furbabies. There will be crazy disco costumes, flashing lights and music and extravagant Prom Gowns. If you are interested in either of these for your show, please feel free to contact me.
Beth-While I appreciate that you and Howard are animal advocates; I just have to think, really?! The pampered lives that these animals lead is crazy and my pets are my kids s we have no childre either. But my God, the xtravagence is over the top! What these people could do with the money they spend on pigs and such, they could be doing so much more with rescuing and neutering stray animals in their area. Just want to maybe rethink you advocacy. Sincerely, Shwlly Hakanson
Love the show!


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How long before North Dakota's wet cycle ends?
A wet cycle it is! Peewee you say a wet year, try years!! The hundreds or thousands of lakes around the state didn't just start appearing this year! We are soon going to surpass minn, if we haven't already! Mother Nature! Out of human control! Be grateful no matter what in life and it should be a good one!
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I kind of like this moldy, wet, damp feeling....makes me think I am living in Washington State....I also like all the different fungus growing in my lawn....
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Quack! Quack!
4 Agrees | 1 Disagrees | Report Abuse »
Really? I went to read my mail on Saturday and I had to dry it first. Note to self..."put a plastic bag in the mail box".
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Trinity is so old its the oldest institution on the West Bank it was founded in 1868, more than 140 years ago. Trinity is so new that it shares ministry with Fairview University Hospital, Augsburg College, and its Muslim neighbors. Trinity is so old it was begun by Norwegian immigrants and so new it is now a multicultural faith community. And Trinity is a church that is so different that when it lost its building to the construction of Interstate 94, its people marched into ministry throughout the neighborhood, becoming a church without walls.
© Trinity mural design by local artist and member, Larry Rostad.
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All Silver Beaver nominations must be received by 5:00 p.m. on Tuesday, November 5th.
Nomminee's should not know they have been nominated. The 2 page Great Salt Lake Council nomination form will be the only form accepted.
Copyright © 2002-2011 | Great Salt Lake Council | Boy Scouts of AmericaFoothill | Centerville | Sandy | Contact Us | Email | Phone


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HyperTerminal (also known as HyperTerm) is a communications and terminal emulation program that comes with the Windows operating system, beginning with Windows 98.
Windows 8
HyperTerminal (also known as HyperTerm) is a communications and terminal emulation program that comes with the Windows operating system, beginning with Windows 98.
HyperTerminal can be used to set up a dial-up connection to another computer through the internal modem using Telnet or to access a bulletin board service (BBS) in another computer. It can also be used to set up a connection for data transfer between two computers (such as your desktop computer and a portable computer) using the serial ports and for serial-port control of external devices or systems such as scientific instruments, robots, or radio communications stations. HyperTerminal can also be used as a troubleshooting tool when setting up and using a modem. You can send commands through HyperTerminal to make sure that your modem is connected properly.
Developed by Hilgraeve from a more comprehensive communications program called HyperACCESS, HyperTerminal has features similar to the Linux program, minicom. In Windows XP, HyperTerminal can be located from the Start menu (Start-->Programs-->Accessories-->Communications-->HyperTerminal.
Continue Reading About HyperTerminal
- The University of Manitoba describes the use of HyperTerm for dial-up access to their school network.
- Sanjay Aggarwal and Sahil Kapur of Cornell University use HyperTerminal to facilitate the control of a robot.
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8 November 2011
Poverty not only restricts children's physical and mental development, it also limits their ability to dream and imagine a better life for themselves. WFP - through the daily hot meals provided by the Home Grown School Feeding Programme - is helping almost one million school children across Zambia. This regular and nutritous meal satisfies grumbling tummies while allowing children to focus on the essentials of learning.
7 October 2011
Through the Purchase for Progress scheme - or P4P, as it is known - WFP and its partners are helping to provide an alternative market for farmers and to transform the way they do business.
28 June 2011
The recently launched Home Grown School Feeding programme is designed to bring benefits not just to school children but also to the wider community, particularly to small-scale farmers. The new programme will be implemented in 31 districts and aims to feed one million school-going children in 2011.
31 May 2011
Hundreds of people including school-going children and UN MDGs Ambassador Marsha Moyo joined the UN World Food Programme (WFP) and its global partners, TNT, Unilever and DSM at the end of May to commemorate the annual "End Hunger: Walk the World" event to raise awareness about child hunger.
25 May 2011
In the lead-up to this year's Walk the World event, representatives from the World Food Programme (WFP) in Zambia and the National Food and Nutrition Commission (NFNC) visited community schools in Lusaka to raise awareness about nutrition and the importance of a healthy diet among schoolchildren.
25 February 2011
A national symposium entitled "Working Together – Strengthening Collaboration against Human Trafficking" was held in Lusaka in Febrary 2011. It was organized by the Ministry of Home Affairs in collaboration with Women in Law in Southern Africa and the UN Joint Programme against Human Trafficking.
23 February 2011
Activities aimed at mitigating malnutrition among children in Zambia are to be scaled up, following a national nutrition convention held in Livingstone in February. The convention was organized by the National Food and Nutrition Commission with input various players including the World Food Programme (WFP) and the United Nations Children's Fund (UNICEF).
10 January 2011
The Zambian Government's donation of 15,000 metric tonnes of maize to the School Meals programme run by the Ministry of Education and the World Food Programme should help meet the target of feeding 1 million children in 2011.
27 December 2010
The Deputy United Nations Secretary-General, Dr. Asha-Rose Migiro, visited the Kamwala Clinic in Lusaka in December to see nutrition and electronic food voucher programmes in operation. These are implemented by the United Nations through the World Food Programme (WFP) and the United Nations Children's Fund (UNICEF) in partnership with the Ministry of Health and local NGOs.
16 December 2010
Every day thousands of Zambian children go to school hungry because they come from poor homes. This hinders their ability to concentrate and learn. What is even worse is that some children are unable to attend school altogether because they are needed by their families to help with work or to search for food.
- Interpreting World Food Day Source: Times of Zambia
- Community Schools: Narrowing illiteracy Source: Times of Zambia
- Zambia can lead region in mitigating malnutrition, says UN local boss Source: Zam Net (Zambia)
- WFP to spend $16m on social protection Source: The Post Newspapers Zambia
- Zambia, Brazil to end hunger Source: Zambia Daily Mail
- 11 October 2012 First Lady of Zambia Dr. Christine Kaseba Sata
- 15 December 2011 Small Scale Farmers Taking Farming As Serious Business
- 22 November 2011 Food Relief for Refugees in Zambia


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Some of the names have been changed to protect the doofuses.
Some are anonymous.
Some of the names are real. All of the perpetrators are.
John, 70, is a nut about timing stuff right. Hungrily preparing breakfast, he gently slid two eggs into a sauce pan of heavily salted (so they won't crack) boiling water, timed them 7 minutes (for perfectly soft-boiled) and kept an eye on the stove timer so he could microwave his leftover slice of corned beef for exactly one minute, to go with the eggs, getting both delicacies ready at the same time. Meanwhile, with three minutes to go he toasted two slices of whole wheat bread — good for the digestion.
He softened the hard butter by putting the dish in the nuker for 16 seconds and then when the egg clock said 1 minute he reset the microwave clock for one minute, to get the corned beef piping hot, and turned it on.
He buttered the toast just before scooping the eggs out of the shells, briefly cooled by putting cold water in the pan. That took just under one minute, while the microwave hummed.
Then, salivating on cue, he reached into the microwave for his corned beef and found that he had forgot to put it in. There it coldly sat, on a plate on the drainboard.
It was exactly one minute later before he could sit down to his slightly cooling eggs and toast, and he was not happy.
Q: Why was I having so much trouble buckling the leather strap on my watch?
A: Because I didn't have my glasses on and I was trying to put it on upside-down.
Mac writes, "I don't know what to make of this one: Playing tennis with Maurice, a youth of 62, I was getting ready to serve when I heard him yell 'Wait!'
"He seemed to be pointing down toward my feet. I looked down at the line and saw that I was bouncing the ball prior to serving FROM THE SERVICE LINE AT MID COURT!
"Should I see the doctor???"
Overcome by the need for a bagel, I drove up to the supermarket this a.m., thinking as I drove about an elderly swimmer who told my wife about absent-mindedly driving past a parked school bus on her way to the pool, incurring a fine of $510 (True!)
I parked, got out of the car and realized I had left my wallet in the other car.
Cursing myself, I went back down the hill to get my money.
The wallet was there because earlier I was driving that car when a safety checkpoint cop told me that he'd "let it go this time" when I was found out — I explained that I didn't want to take my wallet to the swimming pool for our early morning lap swim and drove without it, wearing only my sweats. No big deal, I thought, and I also used to drive to the tennis courts twice a week without the license. I whined shamelessly about my wonderful driving record and all, and it worked.
Now I have to remember to take my wallet to the pool AND tennis
courts, and remember to take it OUT of the truck when I get home. Meanwhile
remembering to leave my alternate pair of sunglasses in the truck for future use.
To think, I once scoffed at Vermont's law requiring 80-year-olds to
surrender their licenses. Ten more years of trying to remember all this stuff.
(Editor's note: John was later advised that he can keep a photocopy of his license in both cars, thus easing the strain.)
Frank, 70:
I'm glad that someone else goes through these "forgetful" moments. I had
a problem of driving to the supermarket without my wallet. I usually leave wallet and keys on my dresser, but sometimes I'll get the keys only, to move my car out of the garage. My problem was that while driving to the store later, I realized that my wallet was still on the dresser.
Solution: Keys don't go in my pocket without the wallet.
Mike, 68, is not the only one who's done this:
"This morning I ground the coffee beans for espresso, placed them in the
strainer, poured the necessary water into the top of the espresso machine and turned it on.
"After my shower, about 10 minutes later, the sink was covered with coffee. I Had forgotten to put the receiving container below the spout. Help! I need assisted living!"
Royce, 75, writes:
Okay, I laughed at you guys until today. This morning Jane (younger than Royce and still working fulltime) baked some banana bread before heading for her teaching job. She asked me to clean up the kitchen because she had to leave. I was so diligent at cleaning up that I put the little timer she had set for baking time in a drawer where, of course, with my bad hearing I didn't hear it go off. Guess what happened to what was in the oven.
Is there help anywhere in sight?
(Ed. Note: Not much, Royce. Sorry.)


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Teach Preschool
We decided we were snow scientist in preschool today!
I didn't really have a plan for this activity and it isn't something that will probably get hung up on the refrigerator but Wy had a terrific time with it… I set out a sheet of black construction paper and put a few dots of white paint on the paper. I told Wy that we […]
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|NSFW Content
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What do you think? Give us your opinion. Anonymous comments allowed.
#398 - slimshadez (08/12/2011) [-]
#422 to #422 - slimshadez (08/12/2011) [-]
its kinda funny, if you hadn't said anything i would've thought you were being sarcastic. mainly because i was the immature one in high school. so when i tell people now that's what i'm aiming for they think i'm joking. i can understand a few phrases in japanese and a some spanish, but i prefer not to speak it. do you know any other languages
#423 to #423 - GimmieTheCockies (08/12/2011) [-]
Yeah i tend to think people are always being sarcastic too. I know some Japanese as well, I used to be fluent in American sign language but that was when i was in about 2nd grade, it was standard we learned it, we even had full days of school where we did not speak at all and only used sign language but I've forgotten it. I'm also learning binary code, but as for languages i actually fully know, just English and mexican spanish. I consider Mexican to be it's own language because it uses a lot more slang than the spanish used in spain.
#424 to #424 - slimshadez (08/12/2011) [-]
damn, thats a lot. i've always wanted to learn sign language, its pretty cool. in a computer class i had we were taught binary, but i never paid attention. my mom speaks spanish, or mexican spanish as you call it, but she never spoke it to me so i never learned it.
#427 to #427 - GimmieTheCockies (08/12/2011) [-]
only caramelldansen. well on of my friends listens to a lot of Japanese music but i don't know what they're called. Yeah spanish should be easy too, especially if you're around people that speak it frequently it will give you reason to practice.
#428 to #428 - slimshadez (08/12/2011) [-]
yeah, i'll be sure to go for it, seriously. i'm gonna sign out now since i'm pretty tired. good luck with your housing situation, i'm hoping for the best. stay in school! it may suck now but it'll pay off in the end. take care cockies, or yesica, whichever you prefer. keep your head up
#399 to #399 - GimmieTheCockies (08/12/2011) [-]
#403 to #403 - GimmieTheCockies (08/12/2011) [-]
Thanks,we got 16 cats on Monday and 16 on Wednesday from a shelter that we're going to but put to sleep, and a dog from a girl that was just giving her up. my mom is going to get more tomorrow, we have 15 cats at our house right now, I was crying about being kicked out earlier but then i got over it, i hate this house anyways, I have $18.37 to my name but I can go to my house in Mexico for a while, or stay with someone. It'll be fine in the end. What about you, what have you been up to?
#404 to #404 - slimshadez (08/12/2011) [-]
man, sounds like you're going through some pretty tough times. i hope you find a suitable home, i would offer my home but that'd be weird so i won't. i've just been waiting for school to start, i got my fasfa check early so i have to be careful not to spend it till school starts. and other than that i've been hanging out with friends and going to the gym
#405 to #405 - GimmieTheCockies (08/12/2011) [-]
Yeah, It could could always be worse, my firend's mom passed away today so yeah, I think he's gonna do something stupid, i try to reason with him but idk. but that's good yeah be careful with that money, when do you start school?
#413 to #413 - GimmieTheCockies (08/12/2011) [-]
Yeah I'm looking forward to it, it's going to be my last year or high school so I'm gonna try to make it good, I'm going to take the high school equivalency test, i think that's what it's called. I hate school with a fiery passion that burns deep within my soul, I figure i can get a job at a clothing store or something for the next 2 years and save up money for college.
#416 to #416 - slimshadez (08/12/2011) [-]
don't worry, its only a matter of time till you find your stride. i struggled all middle school until senior year, then everything fell into place. since you can write complete sentences and spell correctly you're already light years ahead of most people. its not a creeper question, we're pretty cool so its all good. i'm going to Citrus
#417 to #417 - GimmieTheCockies (08/12/2011) [-]
true true, it's just i wish i didn't have to take certain classes, I know History is not going to help me at all, in my line of work, chemistry yes, algebra maybe. The extra classes just get in the way, oh well, time flies, i could had sworn it was may yesterday. And, I've never heard of it, but then again I don't know anything about colleges. Well good luck there, Freshman year?


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The workshops will be held at 705 Osterman Dr. Take Frontage Rd. past Rocky Creek Rd. Look for the Montana Weatherization Center sign.
A schedule of topics is as follows:
July 8, Rocky Mountain WoodWright, "Pragmatic Green: Simple Steps Toward Energy Efficiency & Environmental Health While Remodeling Your Home"
July 15, Bozeman Greenbuild, "Solar Hot Water for Your Home"
July 22, Bozeman Greenbuild, "Solar Electric/PV for Your Home"
August 5, Refuge Sustainable Building Materials, "Shades of Green: Choosing the Best Products for Your Next Building Project"
August 12, Blanchford Landscaping & Radick Value Added Enterprises Inc., "Sustainable Landscaping and Water Quality and Conservation Strategies for Homeowners"
For more information, contact Jenny Grossenbacher at 994-4292.


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Vision Statement: To be acknowledged as the industry leader in the provision of Uninterruptable & Constant electrical power supply to the Retail and Commercial Sector.
Our Mission: We provide an appropriate solution for the installation, maintenance and service of our products in order to ensure that our customers enjoy the rewards of business continuity.
> Learn more


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City of Knoxville, Tennessee
Madeline Rogero, Mayor
Small Business Conference March 9
The City of Knoxville Annual Small Business Conference will be held March 9, 2011 from 8:30 a.m. to 12 Noon at Pellissippi State Community College Magnolia Campus.
Online registration ends March 7. For late registration contact Joshalyn Hundley at 865-215-3867 or at
February 17, 2011
- The City of Knoxville is partnering with several organizations to host the Annual Small Business Conference on March 9, at Pellissippi State Community College's Magnolia Campus.
The 2011 version of the event is set for 8:30 a.m. until noon that Wednesday and, as always, is free.
It's aimed at helping small businesses better compete for government contracts and other opportunities and includes topics ranging from new Small Business Administration programs and small business resources offered by the U.S. Internal Revenue Service to information about business opportunities with the City of Knoxville among other offerings.
The conference is part of an ongoing series of events offered by the city's Community Relations Department. Past conferences have focused on making sense out of "Going Green," identifying new sources of capital and learning how to better compete for federal stimulus monies.
"We always want to offer some great speakers who can provide fresh ideas or resources that can help folks involved in small business who are competing in a very tough economy right now ," said Joshalyn Hundley, coordinator of the city's Title VI and Equal Business Opportunity Programs. "Hopefully everyone who attends the conference will take something from it that will help them be more successful.
The featured speaker at this year's conference is Kathryn Mahoney, Business Development Coordinator with the Women Business Enterprise Council South, who will be talking about the organization and its certification programs.
Other speakers include Walter Perry with a presentation on new SBA programs and policies; Alison Broady will talk about IRS resources for small business; Internet Business Specialist Mercedes Campbell will talk about a new resources and Gwen Winfrey, a project specialist with the city's Community Development Department, will discuss some opportunities with the U.S. Department of Housing and Urban Development.
The annual conference always includes a session on bidding opportunities with the City of Knoxville and how to compete more effectively for the city's business. This year there will also be a discussion of opportunities with the $2.2 billion Tennessee Board of Regents System, the sixth largest public higher education system in the United States.
The TBR governs 45 institutions including state universities, community colleges and technology centers that collectively enroll nearly 200,000 students.
The 2011 Annual Small Business Conference is sponsored by the City of Knoxville, the Women Business Enterprise Council South, Pellissippi State Community College.
For more information about the free conference please contact Joshalyn Hundley at 865-215-3867 or at
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For a quality used truck in the Sacramento area, welcome to Roseville Automaxx. We stock used trucks, cars and SUV's. Check out one of our "one owner" vehicles for best value.
Our friendly staff looks forward to helping you find the car, truck, van, or SUV you've been looking for. We know your time is valuable. Our staff of automotive and finance professionals have many resources to locate a vehicle that meets your personal needs.
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Devi upgradare il tuo Flash Player. D175 Villa Raffaella - SOLD
Ref D175 Villa Raffaella - SOLD
700 sqm on 3 floors needing redecoration and new services
Land: circa 4 ha including landscaped garden
Location: 3 km from the village of Montecassiano in the Province of Macerata in the Marche Region. 30 km to the coast
Potential rental income: € 3600/week
Cost of refurbishment and new services: circa € 400.000
Province: Macerata
Location: Countryside
Condition: Habitable
Style: Villa
Price: 850,000
m2: 700
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