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This review is from: Mushkin Enhanced Chronos 2.5" 480GB SATA III 7mm Internal Solid State Drive (SSD) MKNSSDCR480GB-7
Pros: Works. No issues. Decreased my boot time to a fraction of what it was before.
Cons: None
Other Thoughts: Great price on a SS drive. The performance gains is very perceptible on booting, program launches or anything requiring access to the root drive.READ FULL REVIEW
This review is from: GPI Ledplux 7 Watt A19 OMNI LED Light Bulb Warm White 3000K - UL Listed
Pros: It may be more expensive than a CFL but it actually comes on full brightness as soon as you turn it on and it contains no mercury.
Cons: More expensive than a CFL.READ FULL REVIEW
This review is from: ASUS VE276Q Black 27" 1920X1080 2ms Full HD HDMI Widescreen LCD Monitor w/Display Port & Speakers 300 cd/m2 100,000 :1 (ASCR)
Pros: Great picture, not a single problem, it just works.
Cons: Can't think of anything that's a negative.
Other Thoughts: It's large, it's beautiful, it's worked flawlessly for more than a year. It just works.READ FULL REVIEW


text:
Receive Breaking News updates as they occur
By David Milliken LONDON (Reuters) - British retail sales fell unexpectedly this month after a strong showing in August, according to a survey published on Tuesday, contrasting with robust figures since June's vote to leave the European Union. The Confederation of British Industry said its retail sales balance dropped to -8 in September from a six-month high of +9 in August. British retail spending has mostly held up well since June's referendum vote to leave the European Union, with the labour market remaining robust too.
Ahmad al-Faqi al-Mahdi, sentenced to nine years in jail by the International Criminal Court for destroying heritage sites in Timbuktu, was known as a ruthless enforcer for jihadist group Ansar Dine when it took over the fabled Malian city. Born around 40 years ago in Agoune, 100 kilometres (60 miles) from Timbuktu, the curly-haired former teacher was steeped in Islamic learning from a young age. Mahdi was soon recruited by the Islamist group Ansar Dine as "the most competent and prominent person in Timbuktu when it came to being knowledgeable in religious matters", in the words of ICC prosecutors.
MIAMI (AP) — Miami Marlins pitcher Jose Fernandez was a patron at a Miami River bar and restaurant before he and two friends were killed in a boat crash, a spokeswoman for the establishment confirmed Tuesday.

subset: commoncrawl


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Piaget 1967 watch
Watch G0A30165
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Piaget 1967 watch
The full measure of Piaget's creative audacity has been combined with its watchmaking and jewelry-based expertise to produce this uninhibited reinterpretation of a vintage 1967 model. This exquisite expression of the precious art of watchmaking is characterized by an ultra-thin movement, diamond-paved dial and gem-set case.
Metal: White gold
Metal weight (gr): 34.3
Strap type: Alligator
Strap color: White
Strap buckle: Ardillon buckle
Case shape: Rectangular
Case dimension: 28 x 34 mm
Dial material: Precious stones
Dial finishing: Gem set
Index: Arabic numerals, Batons
Waterproofness: 03 ATM
Specificities: Sapphire case back
Movement: Hand-wound mechanical
Precious stones: Diamond
*Piaget luxury watches and jewelry are individually produced and thus the weight and carats of each product can vary from the displayed data.
438P movement
Shape: Rectangular
Functions: Minutes, Hours
Technical features: Balance stop
Power reserve (in hours): Approx. 43
Frequency (vph): 21,600
Frequency (Hz): 3
Diameter (lines): 10.75 X 9
Diameter (mm): 20.3 x 23.7
Number of jewels: 19
Thickness (mm): 2.1
Number of components: 136
Finishing: Circular-grained mainplate, Beveled bridges, Circular Côtes de Genève, Blued screws


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Follow us
Lapeer Tea Party Group TEA mail Login
Support our efforts at the Lapeer County Tea Party Patriots
Contribute today!
Tell Congress what YOU think!!! Go to Popvox.com HERE!
Business Meeting
Our next Business meeting will be Thursday, October 27th at 7PM at the Lapeer Sportsman's Club at 1213 N Lake George Rd, Attica, MI 48412
General Meeting:
Our Monthly General Meetings are at:
1900 N. Saginaw Road
Lapeer, Michigan 48446
Our Meetings begin promptly at 7PM.
Policy for addressing our General meetings:
If you would like to appear, present or hand out information at any of our meetings (General), we must have 30 days notice, detail of the request and it further must be approved by the Directors in advance. This applies to all candidates, issues, and causes.
Legislative Representative
Lapeer County Tea Party Patriots Interactive web site
Events from across the Michigan
Visit USADebtClock.com to learn more!
Lapeer County Tea Party
Member of the 1st Michigan Tea Party Alliance
Hot off the press!!
Deplorables UNITE!!
2nd Statewide Trump Flashmob coming this Tuesday, September 27th Many from Lapeer will be attending the Rochester event. Lets make this event even bigger than the first one!
Lansing Update From State Rep Gary Howell --
Lapeer Tea Party September General Meeting w/special guest, Director of Trump for President Michigan -- Mr. Scott Hagerstom
The Lapeer County Tea Party held our September General Meeting on Tuesday, September 6.
Mr. Hagerstrom previously served as the Director for Grassroots and Strategic Engagement for the Coalition against Higher Taxes and Special Interest Deals Ballot Committee. He also previously worked as the State Director of Americans for Prosperity. We were ablt to hear what Mr. Trump plans to do for Michigan, how he will create more jobs, how he will improve education for our children, and what he will do with Obamacare, protecting our borders, along with other ways he will "Make America Great Again".
Lapeer County Precinct Delegate Winners.....
The Lapeer County Tea Party wishes to Congratulate the following candidates for their wins in Tuesdays Republican Primary election..
10th Congressional District -- Paul Mitchell
Lapeer County Sheriff -- Scott McKenna
Lapeer County Prosecutor -- Mike Sharkey
County Commissioner District 5 -- Rick Warren
Road Commissioner (Full Term) -- Les Nichols
Road Commissioner (Partial Term -- Jim Novak
Drain Commissioner -- Joe Suma
Suncrest Millage -- Approved
Click HERE to download the full list of candidates and vote totals from the County Clerks office
Incumbents keep House seats and other takeaways from Michigan's Aug. 2 primary election
Paul Mitchell wins 10th Congressional Republican primary, and other U.S. House results
Election results from around Michigan for Aug. 2, 2016
Want to watch our past meeting videos?
Missed a meeting and would like to see more?? Go to our You Tube Channel for all of our past meetings.
Lapeer Tea Party You Tube Channel
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Lapeer Patriot Blog Posts
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Click AreYouRegistered.org and find out..
The policy of the Lapeer County Tea Party Patriots is to allow only candidates, not representatives of candidates, to speak at our meetings. Candidates will be requested to speak by agreement of the Directors in support on their stated goal of membership education. Those races and issues that are requested remain the prerogative of the Directors concerning topical subjects or candidacy. It is not felt that a representative of a candidate can relate the direct position of the person they represent and that the candidate be held directly responsible for their stated position. _______________________________________________________________________________
Mission Statement and Purpose:
The mission of the Lapeer County Tea Party Patriots is to engage citizens
and provide avenues for participation in the political process. Our goals
are to prevent wasteful spending of tax dollars, to reduce the size of
government and its bureaucracies, and to hold accountable those we elect to
represent us. This will be accomplished by attracting, informing, and
mobilizing all who share these goals, regardless of political affiliation.
This site developed and maintained by


text:
I have recently acknowledged that I'm a relationship anarchist and therefore not monogamous. However, I have discovered a lot of folks that I enjoy having sex with...but I'm looking for that spark that turns into a wonderfully slow burning love. I have felt it before, but it was always during unfortunate circumstances that prevented us from exploring it. I am hoping that now that I'm in a large metro area with an open poly community that I will be able to find it here.
If I was to say what type of person I'm looking for, it would have to be someone who is intelligent, but savvy, and knows how to make me laugh. Nothing is sexier than someone with smarts who keeps me in stitches!
In my time away from the office, I am excited about exploring the Emerald City and all it has to offer. I participate in Trivia Night weekly, am starting weekly dance classes, love to try new things, and I volunteer at a local animal shelter on a weekly basis. As I am brand spanking new to the area, having a tour guide wouldn't be a bad thing...
I also just got my first tattoo, and it won't be my last. My body art is meaningful to me and tells my story, and it's one I love to share. Love me, love my tats as well as my cats!
I'm also proud to say that I'm a geek. I love sci-fi and comic book hero movies, anything from the View Askewniverse, Jeopardy! and a variety of PC games, including World of Warcraft.
B) The first Star Wars Trilogy, Office Space, Monty Python and the Holy Grail, anything by Kevin Smith, Fever Pitch (the Colin Firth version), and Goodfellas.
C) R&B, jazz, classic rock, classical, country, hip-hop....you name it, I probably like it. I listen to a lot of Henry Rollins as well, mostly his Spoken Word stuff. I love his perspective on society. He cracks me up, and on some topics, he makes me think. Very clever guy.
D) It truly depends on my mood. I do love to cook though.
Sorry, but I have to add two more: my crockpot and MY iPOD!


text:
State of Emergency: The Way We Were, Britain 1970-1974 [Audio]
Speaker(s): Dominic Sandbrook | The beginning of the 1970s saw Britain tottering on the brink of an abyss. Yet this time of immense unrest was also one of astonishing creativity and innovation, which helped shape society as we know it today. For perhaps the last time in our history Britain experienced the shock of the new, from celebrity footballers and the pornography boom to high street curry houses and foreign holidays. Dominic Sandbrook was born in Shropshire in 1974, an indirect result of t
Financial Crisis and Economic Recession [Audio]
Speaker(s): Professor Jesús Huerta de Soto | The current financial and economic situation of the world should be analysed from the point of view of the Austrian Business Cycle Theory as developed by Mises and Hayek. Professor Huerta De Soto will present innovative solutions to the banking crisis and credit crunch working within the tradition of the Austrian School masters, Mises and Hayek. He will also unveil his proposal for similar legislative change that the "Peel Act" or Bank Charter Act of
The Polish Question at the End of the First World War [Audio]
Speaker(s): Professor Anita J Prazmowska | When the First World War broke out many assumed that it would inevitably lead to the re-emergence of a Polish state. As the war drew to an end the battle for Poland commenced on several fronts, both diplomatic and military. In the end, an independent Polish state would bear the mark of the way Poland re-emerged, placing the importance of nationalism above the need to build a modern democratic state. Anita J Prazmowska is professor of international histo
Lady Chatterley's Lover: Fifty years on [Audio]
Speaker(s): Lord Hutchinson QC, Helena Kennedy QC, Geoffrey Robertson QC | Editor's note: This lecture contains sexually explicit language and/or profanity, please do not download if you may be offended. On 2nd November 1960 the jury at the Old Bailey acquitted Penguin Books of obscenity for publishing an uncensored version of D.H. Lawrence's controversial novel. Geoffrey Robertson QC and a panel explore the impact of the trial on our current laws and assumptions on freedom of expression. This e
European Questions – Turkish angles: Europe's citizens [Audio]
Speaker(s): Professor Richard Bellamy, Professor Thomas Diez, Maurice Fraser | Editor's note: Unfortunately the last few minutes of the lecture are missing from the podcast. This series of events explores how our understanding of Europe's identity can be enhanced and developed in a new way by taking in a distinctively Turkish perspective. Richard Bellamy is professor of political science and director of the School of Public Policy at UCL. Thomas Diez is professor of political science and interna
Green Growth: the transition to a sustainable economy [Audio]
Speaker(s): Chris Huhne MP | In this keynote talk Chris Huhne will set out the economic need for low-carbon growth as an essential path out of recession. He will argue that the need to urgently renew and decarbonise our energy supply, and to upgrade our ageing and inefficient buildings, will not just provide an economic boost but also help to create a more balanced, resilient and sustainable British economy. Chris Huhne is Secretary of State for Energy and Climate Change, and the Liberal Democra
Them and Us: why we need a fair society [Audio]
Speaker(s): Will Hutton | Will Hutton discusses the issues raised in his new book 'Them and Us: politics, greed and inequality' – why we need a fair society. Will Hutton is the executive vice-chair of The Work Foundation and senior visiting fellow at LSE Global Governance.
Fred Halliday - an intellectual appreciation [Audio]
Speaker(s): Professor Michael Cox, Howard Davies, Professor Fawaz Gerges, Professor Christopher Hill, Professor Margot Light, Dr Justin Rosenberg | This public event is an intellectual appreciation of Professor Fred Halliday who worked at the London School of Economics and Political Science for more than 20 years and who sadly passed away in April 2010. Michael Cox is professor of international relations at LSE. Howard Davies is director of LSE. Fawaz Gerges is professor of middle eastern politi
The State of the World Economy [Audio]
Speaker(s): Olivier Blanchard | A strong and sustained world recovery requires two rebalancing acts. Internal, with a shift, in advanced countries, from fiscal support to private demand. External, with an increase in net exports in deficit countries, notably the US, and a decrease in net exports in surplus countries, notably China. Policy should be aimed at increasing their pace. This lecture is one in a series of lectures to celebrate 21 years of the Centre for Economic Performance. Olivier Bla
Freedom and Agency [Audio]
Speaker(s): Professor Patrick Haggard, Dr Amber Jacobs, Professor Thomas Pink | Is freedom part of human nature? And how can freedom be both a human power and a human right? Patrick Haggard is a professor at the Institute of Cognitive Neuroscience and in the Department of Psychology, UCL. Amber Jacobs is a lecturer in the Department of Psychosocial Studies at Birkbeck, University of London. Thomas Pink is a professor of philosophy at King's College London.
The Regime Complex for Climate Change [Audio]
Speaker(s): Professor Robert O Keohane | There is no integrated regime governing efforts to limit climate change. Instead, there is a 'regime complex'… but can this work to resolve climate change? Robert Keohane is professor of international affairs, Princeton University, and the author of After Hegemony.
Welfare State Reform Over the (Very) Long-run [Audio]
Speaker(s): Professor Paul Pierson, Professor Anton Hemerijck, Professor Julian le Grand | The lecture and panel discussion celebrate the T H Marshall Fellowship scheme, funded by the Volkswagen Foundation, which has been running for seven years. The event also launches the Oxford Handbook of the Welfare State |and will be followed by a reception. Paul Pierson has been a professor of public policy and holder of the Avice Sarint Chair of Public Policy at Berkeley since 2004. Anton Hemerijck is se
Valuing the Environment [Audio]
Speaker(s): Dr Eric Martin | Eric Martin is a fellow in the Centre for Philosophy of the Natural and Social Sciences, LSE.
Talking to the Enemy: Violent Extremism, Sacred Values, and What it Means to Be Human [Audio]
Speaker(s): Professor Scott Atran | Editor's note: Unfortunately the first few minutes of the introduction are missing from the podcast. In this lecture Scott Atran will talk about his new book Talking to the Enemy |which is a courageous exploration of one of the most contentious issues of modern times. Scott Atran asks a question that he is uniquely qualified to answer: Why would someone take their own life through suicide bombing?
Investment Treaty Law after Lisbon [Audio]
Speaker(s): Dr. Steve Woolcock, Dr. Jan Kleinheisterkamp and others | The workshop will present a recent study for the European Parliament on the Commissions communication and draft Regulation on the future of investment treaty law after Lisbon, with commentators from the EU Commission, the UK government and investment arbitration practice. Dr Steve Woolcock is the director of the International Trade Policy Unit of the LSE International Relations Department. Dr. Jan Kleinheisterkamp is heading t
Ten Years After Milosevic: How can Serbia Contribute to the Stabilisation of the Western Balkans? [A
Speaker(s): Zoran Vujic, Zoran Jeftic, Sonja Stojanovic, Bojan Brkic | Zoran Vujic is Assistant Minister of Foreign Affairs. Zoran Jeftic is Deputy Minister of Defence. Sonja Stojanovic is Director of the Belgrade Centre for Security Policy. Bojan Brkic is Deputy Editor in Chief of Radio Television Serbia.
Hegemony and International Society [Audio]
Speaker(s): Professor Ian Clark | International relations theory is weak on how international order is managed under a preponderance of power. This lecture explores the notion of hegemony as a theoretical solution, and develops the thought of Martin Wight in this respect. Ian Clark is E H Carr Professor of International Politics at the University of Aberystwyth and a fellow of the British Academy.
Risk as Feeling: New Perspectives on Risk Perception [Audio]
Speaker(s): Dr Paul Slovic | Editor's note: We apologise for the poor audio quality of this podcast. Dr. Slovic will describe the laboratory experiments that led to the concept of risk as feelings and illustrate some insights gleaned from this perspective for behaviors as diverse as cigarette smoking and apathy toward large scale natural and human caused disasters. Dr. Slovic studies judgment and decision processes with an emphasis on decision making under conditions of risk. His work examines f
Galileo and the Infinite Universe: science, heresy, and the Inquisition [Audio]
Speaker(s): Professor David Wootton | Galileo was convicted in 1633 of defending Copernicanism, but he was also seeking to undermine Christianity. Professor Wootton will show that Galileo was no Christian, and that he welcomed the idea of an infinite universe with other inhabited worlds because he wanted to show that the universe was not made for man. David Wootton is Anniversary Professor of History at the University of York, author of Bad Medicine: doctors doing harm since Hippocrates and most
A Lecture by Álvaro García Linera, Vice President of Bolivia [Audio]
Speaker(s): Álvaro García Linera | The LSE IDEAS Latin America International Affairs Programme is pleased to announce a lecture by Bolivia's vice president Álvaro García Linera as part of its 2010-11 International Peace and Security in Latin America events series.


text: Rafael Laboissiere writes: > I think that the right approach to this is to create a top-level config.h > file (eventually using autoheader) that will contain all the defines that > shouldn't appear in the user namespace and remove them from plConfig.h. In > plConfig.h, we add: > > #if HAVE_CONFIG_H > # include <config.h> > #endif > > Remeber that -DHAVE_CONFIG_H is automatically added by automake to the > CFLAGS when the package is built, so the scheme above should work. > > Now, when users will compile their applications linked against the PLplot > library, the config.h file will not be included, unless they (foolishly and > unnecessarily) #define HAVE_CONFIG_H. > > In configure.ac, we should use: > > AC_CONFIG_HEADERS([config.h include/plConfig.h include/plDevs.h]) > > Notice that there is a beneficial side-effect to this: many of the > autoheader problems that we were experiencing may be fixed, since autoheader > only acts on the first argument of the macro AC_CONFIG_HEADERS. > > What do you think? If this works the way you describe, it sounds great. -- Maurice LeBrun mjl@... Research Organization for Information Science and Technology of Japan (RIST)


text:
GM released their corporate sales report for February 2016 this morning. Corvette sales for February totaled 2,116 cars, a decrease of -18.8% over the same time in 2015 which saw Corvette sales at 2,605 units. For the Calendar Month to Date, GM has sold 3,617 Corvettes, a decrease over 2015's -23.6%.
Corvette sales did show a rebound following the 1,501 Corvettes sold in January 2016. The 2,116 Corvettes sold in February 2016 represents an increase of 615 cars for a 40.97% increase.


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The Autoshow 2015
The Autoshow 2015 is
New Polytechnic Kolhapur "The best engineering diploma colleges in kolhapur" runs 3 years Diploma cource in Automobile Engineering since 1983. The Automobile Engineering Department is ranked as no. 1 Automobile Engineering Department in the State of Maharashtra.
|Name of The Institute:
|New Polytechnic Kolhapur
|Name of the Department:
|Automobile Engineering
|Name of The Principal
|Shri. Shinde V.B.
|Name of The H.O.D
|Shri. Vaidya S.G.
|New Polytechnic Kolhapur,
Department of Automobile Engineering,
RS No:264, shantinagar, Uchagaon,
Tal: Karveer, Dist: Kolhapur,MH, India.
( Click Here for Map)
|Shri. Vaidya S.G.
Cell No: 09422048509
email: firstname.lastname@example.com
email: firstname.lastname@example.com
Department of "Automobile Engineering" has intake of 120 student. The Department has state of the art Automobile Engineering Lab. We owns 6 Cars, many two wheelers, different types of engines and various cut section models. Auto Department regularly conducts training programs for mechanics, service advisers, faculty members from other institutes.Our Department is treated as a nodal institute by MSBTE and the faculty members work as resource persons for various MSBTE Programs.
The students have carried out various ambitious projects like "Battery Operated Wheel Chair" for a differently abled person, Reverse locking system for heavy commercial vehicles, Electro Pneumatic Gear Shifting Arrangement, Maint-Aid fixture for Tractor, Weed Remover, Regenerative Braking System, Water Injection for diesel engine, fuel cell car prototype, Petrol injection for motorcycle etc. These projects have won many state level prizes and are appreciated nationally and internationally too. The details of the wheel chair project ar available on UNO's website under the title "Kolhapur Wheel Chair" Many Automobile Organizations like Tata Motors, Bajaj Auto, L & T, Mahindra & Mahindra, Gabrial, Heldex India, Sai Service, Hero group etc, conduct campus interviews for the final year students in New Polytechnic Kolhapur. More than Sixty students of Department of Automobile Engineering are working as Assitant Motor Vehicle Inspectors in R.T.O. Department all over the Maharashtra State.
The Autoshow 2015 is
Department of Automo
AESA (Automobile Eng
Working as a AMVI at RTO office Kolhapur.
Working as Marketing and Sales Head, Hundai Motors.
Expertise in NX CAD, CATIA, CREO, ANSYS, HYPERMESH
Working as a sales manager Unique Volkswagen Kolhapur.
Presently Working as a AMVI at Dhule RTO office.
Owner at Rocket Engineering PVT LTD, Kolhapur.
Working as Manager at Mercedes-Benz, Pune
Proprietor at Self Employed (Business) M.I.D.C Shiroli, Kolhapur.
Area Manager, Exide Industries. India.
Sr. Manager, Mahindra and Mahindra Ltd.


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Chris Campbell has been a professional blogger since 2005, writing news and criticism for numerous outlets. He holds an MA in cinema studies from NYU, where he concentrated on documentaries.
What would you do if a fraternity moved next door to you? That's the question raised by the scenario... Read more
Imagine if the summer was truly owned by Hollywood blockbusters. Like, exclusively. Every weekend,... Read more
In the Biblical story of the Great Flood, now depicted once again in Darren Aronofsky's 'Noah,' God... Read more
Everett It's nice to know that an undercover federal air marshal could be on your flight (contrary... Read more
New Line Who or what is 'Smaug'? That is the question asked by many moviegoers this week who aren't... Read more
Universal Remember the movie 'The Best Man'? It came out way back in 1999, which means there are teenagers... Read more
Summit Do you believe that children are our future? If you watch enough movies, you might think they're... Read more
Can you believe 'Escape Plan' marks the first time we're seeing Sylvester Stallone and Arnold Schwarzenegger... Read more
Everett Justin Timberlake plays an online poker player in the new film 'Runner Runner.' We assume... Read more
Everett The plot of 'Cloudy with a Chance of Meatballs' was plenty weird. Food falling from the sky... Read more
Alamy The new romantic comedy 'Baggage Claim' is about a woman who sets out to find a fiancée... Read more
Everett With 'Battle of the Year,' director Benson Lee adapts his own 2007 documentary 'Planet B-Boy'... Read more
Everett Do you know anyone in the Federal Witness Protection Program? Chances are you don't, or if... Read more
AP You may be surprised to learn that both Martin Scorsese and Chris Rock appear in 'One Direction:... Read more
Everett In Neill Blomkamp's new sci-fi movie 'Elysium,' the wealthy live on a utopian space station,... Read more
IFC / Disney Today and throughout the week at Moviefone, we're celebrating the unsung, hard-won, I've-maxed-out-my-credit-cards-to-finance-this... Read more
Alamy Most college movies are aimed at the college crowd, which means they contain plenty of R-rated... Read more
Everett We've already ranked 'Superman: The Movie' as the best Superman movie of all time, and now... Read more
Alamy The apocalypse comedy 'This Is the End' is completely fictional. Not that you'd think it was... Read more
Welcome to a special edition of the bi-weekly Eat My Shorts column, shorter than usual and themed to... Read more


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Check with Tompkins Funeral Home about which type of funeral services and products the funeral home, mortuary or memorial chapel provide at their Sebree, Kentucky location.
Contact the Tompkins Funeral Home Funeral Director to ensure the services they provide match your personal needs. Call the Funeral Director at (270) 835-2254.
If there is a religious preference, make sure that Tompkins Funeral Home can accommodate your religious practices before, during and after the funeral ceremony and at any graveside service.
SEBREE, Ky. — Barbara Mae Burns Kelley, 73, Sebree, died at 3:35 a.m. Sunday, July 9, 2006, at Methodist Hospital, Henderson. Visitation will be from 5 until 8 p.m. Wednesday at the Tompkins Funeral Home in Sebree. There will be no funeral service. (Kentucky New Era)
A graveside service for Mrs. Ruby Mae Collins ... Ky., 42003. Filbeck-Cann & King Funeral Home of Benton was in charge of arrangements. Mrs. Cleo Watson Carnal The funeral for Mrs. Cleo Watson Carnal will be Thursday at 3:30 p.m. at the Tompkins Funeral ... (Murray Ledger & Times)
Services will be at 2 P.M. Monday at Tompkins Funeral Homes, Sebree-Poole Chapel in Sebree. The Rev. David Alexander will officiate. Burial will be in Petersburg Cemetery near Sebree. Ruby was born circa 1910 in Kentucky, USA. She was the daughter of ... (wikitree.com)
"Death leaves a heartache no one can heal, love leaves a memory no one can steal. From an Irish headstone" ? Richard Puz, The Carolinian Grief is a deeply personal experience that cannot be conscribed by any other person. Each person experiences the heartache of losing a loved one differently and...
What is considered proper to wear to a funeral or memorial service differs according to local customs and geographic region. But a few general guidelines can help steer you. Mercifully, the old dreary dictate about wearing only black no longer applies - although, when in doubt, it's still generally ...


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text:
Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms
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Background— Radiofrequency catheter ablation of atrial fibrillation (AF) guided by complex fractionated atrial electrograms has been reported to eliminate AF in a large proportion of patients. However, only a small number of patients with chronic AF have been included in previous studies.
Methods and Results— In 100 patients (mean age, 57±11 years) with chronic AF, radiofrequency ablation was performed to target complex fractionated atrial electrograms at the pulmonary vein ostial and antral areas, various regions of the left atrium, and the coronary sinus until AF terminated or all identified complex fractionated atrial electrograms were eliminated. Ablation sites consisted of ≥1 pulmonary vein in 46% of patients; the left atrial septum, roof, or anterior wall in all; and the coronary sinus in 55%. During 14±7 months of follow-up after a single ablation procedure, 33% of patients were in sinus rhythm without antiarrhythmic drugs, 38% had AF, 17% had both AF and atrial flutter, 9% had persistent atrial flutter, and 3% had paroxysmal AF on antiarrhythmic drugs. A second ablation procedure was performed in 44% of patients. Pulmonary vein tachycardia was found in all patients in both previously targeted and nontargeted pulmonary veins. There were multiple macroreentrant circuits in the majority of patients with atrial flutter. At 13±7 months after the last ablation procedure, 57% of patients were in sinus rhythm without antiarrhythmic drugs, 32% had persistent AF, 6% had paroxysmal AF, and 5% had atrial flutter.
Conclusions— Modest short-term efficacy is achievable with radiofrequency ablation of chronic AF guided by complex fractionated atrial electrograms, but only after a second ablation procedure in >40% of patients. Rapid activity in the pulmonary veins and multiple macroreentrant circuits are common mechanisms of recurrent atrial arrhythmias.
Received January 18, 2007; accepted March 2, 2007.
Almost all ablation strategies for atrial fibrillation (AF) include pulmonary vein (PV) isolation.1–4 An exception is radiofrequency ablation of complex fractionated atrial electrograms (CFAEs), in which no attempt is made to isolate the PVs. This strategy was evaluated in 64 patients with chronic AF in a single prior study, with a long-term success rate of 77%.5 In that study, CFAEs were ablated in the left atrium, coronary sinus, and right atrium. However, similar efficacy (74% at 1 year) was reported in patients with chronic AF utilizing a strategy of circumferential PV ablation, in which no ablation is performed in the right atrium.6 Therefore, only limited data from a single center are available on the efficacy of targeting CFAEs for chronic AF, and whether or not right atrial ablation is necessary is unclear.
Editorial p 2592
Clinical Perspective p 2612
The purpose of the present study was to determine the efficacy of radiofrequency ablation guided by CFAEs in the left atrium and coronary sinus in patients with chronic AF.
Study Subjects
The subjects of the present study were 100 consecutive patients with chronic AF who underwent radiofrequency ablation of CFAEs in the left atrium and coronary sinus. There were 81 men and 19 women, and their mean age was 57±11 years. The mean left atrial size and left ventricular ejection fraction were 46±6 mm and 0.55±0.08, respectively. Chronic AF was defined as AF that had been present for ≥6 months without intervening spontaneous episodes of sinus rhythm and that required cardioversion for restoration of sinus rhythm. AF had been chronic for 5±6 years before ablation. Structural heart disease was present in 42 patients, consisting of coronary artery disease in 8, a nonischemic cardiomyopathy in 6, and hypertensive heart disease in 35 patients.
Electrophysiological Study
All patients provided informed, written consent before the study. Electrophysiological studies were performed with patients in the fasting state. Treatment with all antiarrhythmic drugs except amiodarone (29 patients) was discontinued at least 4 to 5 half-life periods before the study. A transesophageal echocardiogram was performed in all patients before the procedure to rule out intracardiac thrombus. Vascular access was obtained through a femoral vein. A quadripolar catheter was positioned in the coronary sinus for recording electrograms and for atrial pacing. After transeptal catheterization, systemic anticoagulation was achieved with intravenous heparin to maintain an activated clotting time of 300 to 350 seconds. A decapolar ring catheter (Lasso, Biosense Webster) was sequentially positioned in each PV. An 8-mm-tip, temperature-controlled ablation catheter (Navistar, Biosense Webster) was used for mapping and ablation. Radiofrequency energy was applied at a maximum temperature of 50°C and a maximum power of 35 W around the PV ostia, in the coronary sinus, and along the posterior left atrium and at a maximum temperature of 50°C and a maximum power of 70 W elsewhere in the atrium. Radiofrequency energy was applied for 15 to 45 seconds at each site. Bipolar electrograms were recorded at a bandpass of 30 to 500 Hz (EPMed Systems).
A 3-dimensional reconstruction of the left atrium and PVs was created with an electroanatomic mapping system (Carto, Biosense Webster). To be able to avoid applications of radiofrequency energy over the esophagus, the luminal borders of the esophagus were visualized by barium swallow (E-Z-EM, Canada) and fluoroscopy.7 Conscious sedation was achieved with midazolam and fentanyl after the barium swallow.
Study Protocol
The study protocol was approved by the institutional review board. All patients presented in AF. Mapping was performed in systematic fashion. CFAEs were defined as electrograms with a cycle length ≤120 ms or shorter than in the coronary sinus or that were fractionated or displayed continuous electric activity (Figure 1).5,8,9 All PVs were mapped with the decapolar ring catheter. PVs that displayed CFAEs were targeted for ablation by antral ablation or by focal ostial applications of radiofrequency energy. As was the case in the prior study of ablation of CFAEs,5 the end point of ablation in the region of the PVs was elimination of CFAEs, not PV isolation. The left atrial septum, roof, and anterior and posterior walls and the posterior mitral annulus along the coronary sinus then were mapped sequentially. Ablation was performed at sites that displayed CFAEs, with the end point of ablation being a reduction in voltage to <0.1 mV or by ≥80%.9 After ablation of CFAEs in the left atrium, CFAEs within the coronary sinus were ablated.
The end point of the procedure was conversion of AF to sinus rhythm. Whenever AF converted to an atrial tachycardia or flutter, the PVs were mapped to rule out a focal PV tachycardia. Entrainment mapping then was performed at the mitral isthmus, roof, septum, anterior wall, coronary sinus, and cavotricuspid isthmus. Macroreentrant circuits were ablated whenever possible. However, if there were pleomorphic flutters or if the flutter was not stable enough to allow mapping, further ablation was not pursued. Pharmacological cardioversion with ibutilide or electric cardioversion was performed if AF was still present after ablation of all identified CFAEs in the left atrium and coronary sinus. Ibutilide was administered solely for cardioversion and not to facilitate mapping by slowing the cycle length of AF. Reinduction of AF was not attempted. If there was an immediate recurrence of AF, all PVs and the superior vena cava were mapped. Residual CFAEs at these sites were ablated.
Repeat ablation was offered to all patients who had recurrent atrial arrhythmias and was performed in patients who wished to proceed. When an ablation procedure was repeated for recurrent AF during follow-up, the aforementioned ablation strategy was repeated.
Postablation Management
After sheath removal, all patients were treated with intravenous heparin until the next morning. Treatment with warfarin commenced the night of the procedure. Starting 1 day after ablation, low-molecular-weight heparin was used at a dose of 0.5 mg/kg subcutaneously every 12 hours until the international normalized ratio was >2.0. Patients were treated for 2 to 3 months with the same antiarrhythmic drugs that had been used before ablation. Aspirin was substituted for warfarin at 3 to 6 months after the ablation procedure if maintenance of sinus rhythm was confirmed, unless there was a history of thromboembolic events or another indication for systemic anticoagulation.10
Patients were seen in an outpatient clinic at 3, 6, and 12 months of follow-up. They were instructed to contact a nurse if symptoms suggestive of an arrhythmia occurred. All patients were provided with a 30-day, auto-trigger event monitor at 6 months after ablation. The mean duration of follow-up was 17±7 months.
Statistical Analysis
Continuous variables are expressed as mean±1 SD. Continuous parameters were compared with the Student t test. Categorical variables were compared by χ2 analysis. P<0.05 indicated statistical significance.
The authors had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the manuscript as written.
Targets Sites of Ablation
Among the 100 patients, CFAEs at the ostium or in the antrum of ≥1 PV were targeted for ablation in 90% of patients. The CFAEs were in the antrum of the right-sided PVs in 15 patients (15%), in the antrum of the left-sided PVs in 15 patients (15%), and in the antrum of the right- and left-sided PVs in 14 patients (14%). Ostial CFAEs at ≥1 PV were targeted in 46 patients (46%).
The left atrial sites at which CFAEs were ablated (Figure 2) are shown in the Table. CFAEs within the coronary sinus were ablated in 55 patients (55%). The superior vena cava was targeted in 2 patients because it was the source of an immediate recurrence of AF.
The mean duration of radiofrequency energy application was 36±13 minutes. The mean procedure and fluoroscopy times were 206±43 and 51±16 minutes, respectively.
Termination of AF During Ablation
Among the 100 patients, AF terminated by ablation in 16 patients (16%). Among these 16 patients, AF converted to sinus rhythm in 12 and to atrial flutter in 4 (Figure 3). Among these 4 patients, atrial flutter circuit(s) utilized the roof and mitral isthmus in 2 patients and were pleomorphic in the other 2 patients. In an additional 40 patients, AF converted only after infusion of ibutilide. Among these 40 patients, AF converted to sinus rhythm in 27 and to atrial flutter in 13. In the remaining 44 patients, AF was converted to sinus rhythm by transthoracic cardioversion.
Outcome After a Single Ablation Procedure
During a mean follow-up of 14±7 months after a single ablation procedure, 33 of the 100 patients were in sinus rhythm in the absence of antiarrhythmic drug therapy, 38 had persistent AF, 17 had persistent AF with periods of atrial flutter, 9 had atrial flutter, and 3 had paroxysmal AF with antiarrhythmic drug therapy.
Repeat Ablation
Among the 100 patients, repeat ablation was performed in 44 patients at a mean of 9±5 months after the first procedure. A second ablation was performed to eliminate recurrent AF in 27 patients (61%), atrial flutter in 8 (18%), and both AF and atrial flutter in 9 (21%) of the 44 patients. A third ablation procedure was performed in 4 of the 100 patients, for recurrent AF in 1 patient and atrial flutter in 3 patients.
During the repeat ablation procedures, CFAEs were identified and ablated in ≥1 of the previously targeted (n=29) and previously untargeted (n=78) PVs in all patients with recurrent AF. Additional left atrial CFAEs were ablated in all patients, and CFAEs in the coronary sinus were ablated in 5 patients.
In 7 of 19 patients (37%) who underwent a repeat ablation procedure for atrial flutter, there was only 1 macroreentrant circuit that utilized the cavotricuspid isthmus in 3, mitral isthmus in 3, and left atrial roof in 1 patient. Among the remaining 12 patients (63%), 4 had 3 to 6 macroreentrant circuits that had a critical isthmus in the mitral isthmus, coronary sinus, left atrial roof, and/or the anterior or posterior left atrial wall (Figure 4). In 2 patients, in addition to macroreentry, there was a focal tachycardia originating in the coronary sinus or right middle PV.
Freedom From AF and Atrial Flutter
At a mean follow-up of 13±7 months after the final ablation procedure, 57 of the 100 patients were in sinus rhythm in the absence of antiarrhythmic drug therapy, 32 patients had persistent AF, 6 patients had paroxysmal AF (with antiarrhythmic drug therapy in 2), and 5 had atrial flutter.
Among the 19 patients who underwent repeat ablation for atrial flutter, 11 (58%) were in sinus rhythm, 3 (16%) had persistent AF, 3 (16%) developed recurrent atrial flutter, and 2 (10%) had paroxysmal episodes of AF.
Conversion of AF to sinus rhythm or atrial tachycardia/flutter during ablation, with or without ibutilide infusion, was not predictive of freedom from recurrent AF.
A total of 148 ablation procedures were performed in the 100 patients in the present study. Pericardial tamponade occurred in 2 patients and was managed successfully by pericardiocentesis. Another patient had a transient ischemic attack that resolved within hours after the procedure. There were no late thromboembolic events in any patient, including the 35 patients in whom anticoagulation with warfarin was discontinued.
Main Findings
In the present study, radiofrequency ablation of left atrial and coronary sinus CFAEs resulted in maintenance of sinus rhythm in 57% of patients with chronic AF. However, to attain this success rate, a second ablation procedure was necessary in 44% of patients. CFAEs in or near the PVs were commonly present during repeat ablation procedures. Macroreentrant atrial flutter occurred after ablation in ≈25% of patients, and multiple macroreentrant circuits were common in these patients. Conversion of AF to sinus rhythm during ablation of CFAEs occurred in only a small proportion of patients and was not predictive of the long-term clinical outcome.
Significance of CFAEs
The modest efficacy attained in this study despite extensive ablation of left atrial and coronary sinus CFAEs suggests either that CFAEs do not accurately identify sites that are critical to the maintenance of chronic AF or that ablation of CFAEs is not sufficient to eliminate the driving mechanisms of chronic AF in a large proportion of patients.
There are multiple potential mechanisms for CFAEs. A previous study that utilized intraoperative epicardial mapping of the atrium demonstrated that CFAEs may indicate sites of slow conduction, wavefront collision, or anchor points for reentrant circuits.11 Such sites may be critical in the multiple wavelet hypothesis.12 Recent optical mapping studies in ex vivo and simulation models provided evidence that high-frequency sources, ie, rotors, play a role in the genesis of AF.13–15 During centrifugal propagation of the wavefront from the core of a rotor, wave break and fibrillatory conduction may occur, resulting in CFAEs.16 However, the presence of rotors during AF in the human atrium have yet to be demonstrated. Vagal innervation shortens the atrial effective refractory period, thereby facilitating the formation of CFAEs, and it has been proposed that CFAEs indicate sites of ganglionated plexi.17
CFAE might also occur at sites where different myocardial fiber orientations overlap or at sites of anisotropic conduction.18–21 It is important to note that ablation of CFAEs that result from anisotropic conduction, fibrillatory conduction, or wave break would be unlikely to be of any value in eliminating chronic AF. A prior study demonstrated that CFAEs often appeared shortly after a decrease in AF cycle length, suggesting that they may be a passive phenomenon.22 Therefore, an important question that remains to be answered is the sensitivity and specificity of CFAEs in identifying sites critical to the perpetuation of chronic AF.
Importance of PVs
Previous studies have demonstrated the importance of PV tachycardias in the maintenance of AF.23,24 Of note is that PV tachycardias (ie, CFAEs near or in a PV) were identified in all patients who underwent a second ablation procedure. In some cases, previously ablated PV fascicles had recovered conduction.25,26 However, the sources of tachycardia were also PVs or PV fascicles that had not been targeted during the first ablation procedure. This indicates that CFAEs near PVs may not be consistently present on a day-to-day basis. This points out a major limitation of the CFAE ablation strategy and provides a strong argument in favor of routine isolation of all PVs, regardless of whether or not CFAEs are seen near or in the PVs.
Termination of AF
In a previous study, AF converted to sinus rhythm during ablation of CFAEs in 62% of patients with chronic AF without administration of an antiarrhythmic drug.5 In contrast, in the present study, AF converted to sinus rhythm or atrial flutter during ablation of CFAEs (in the absence of ibutilide) in only 16% of patients. There are at least 2 possible reasons for this discrepancy, as follows: (1) CFAEs in the right atrium were ablated in the previous study but not in the present study. Although the distribution of CFAEs was not specifically described in patients with chronic AF, CFAEs along the septum were ablated in ≈90% of the overall study group. Whether this was the left atrial or right atrial septum was not specified; however, it was indicated that the septum was the most frequently targeted right atrial site. Additional right atrial ablation sites included the proximal coronary sinus and its ostium in 32 patients, cavotricuspid isthmus in 17, inferolateral aspect of the right atrium in 5, and superior vena cava in 2 patients. (2) An unspecified number of patients in the previous study were being treated with an antiarrhythmic drug at the time of the ablation procedure.
In a study that incorporated ablation of CFAEs into a stepwise approach for ablation of persistent AF, conversion to sinus rhythm occurred during ablation in 87% of patients.4 However, in that study, empirical isolation of all PVs was routinely performed, and a variety of left atrial linear lesions often was necessary for termination of AF. Furthermore, one third of the patients were being treated with amiodarone, which may have facilitated mapping and conversion. Unlike the previous study,5 right atrial ablation was performed in only 3 patients (5%).4
There was no relationship between the acute termination of AF during ablation and long-term freedom from recurrent AF in this study. This confirms the results of prior studies in patients with chronic AF that demonstrated a clinically successful outcome despite the need for pharmacological or electric cardioversion after ablation.6,27,28 Potential explanations include progressive lesion maturation after ablation and/or elimination of the triggers that initiate AF.
Atrial Flutter
Proarrhythmia in the form of atrial tachycardia or flutter often is related to gaps in a line of block created by linear ablation in the left atrium and has been reported to occur in ≈20% of patients after radiofrequency ablation of AF.6,28–30 Because linear lesions are not created when CFAEs are targeted, proarrhythmia might be expected, at least in theory, to be less common than when radiofrequency energy applications are contiguous. Nevertheless, macroreentrant atrial flutters occurred during follow-up in a sizeable percentage of patients and often were multiple. The findings suggest that macroreentrant atrial flutters are as common after ablation of CFAEs as when other ablation strategies are used. It is possible that flutter circuits are created in regions where there are clusters of noncontiguous ablation lesions. In addition, it is possible that "defragmentation" by ablation of CFAEs eliminates fibrillatory conduction and uncovers underlying reentrant circuits in the left atrium.31,32
A limitation of this study is that CFAEs were identified simply by visual inspection and not by spectral analysis or automated signal analysis algorithms. It is possible that a rigorous quantitative analysis of CFAEs would have resulted in more precise identification of suitable ablation sites. However, in the prior study that achieved an efficacy of 77% in patients with chronic AF, CFAEs also were identified only by visual inspection.5 Another limitation of this study is that ablation of CFAEs was not compared in randomized fashion with another ablation strategy such as circumferential PV ablation6 or PV antral isolation.33
In conclusion, the strategy of ablating CFAEs in the left atrium and coronary sinus in patients with chronic AF often requires a second ablation procedure to achieve a relatively modest short-term success rate of 57%. The findings during repeat procedures strongly suggest that the failure to isolate the PVs is a major limitation of this ablation strategy. It is likely that the efficacy of CFAE ablation for chronic AF would be enhanced by routine isolation of all PVs. However, a fairly high efficacy of ≥75% already has been reported in patients with chronic AF with techniques such as PV antral isolation,33 wide-area circumferential ablation to isolate the PVs,3 and circumferential PV ablation.6 Therefore, whether ablation of CFAEs has incremental value when added to one of these other ablation strategies is unclear and remains to be determined.
Drs Oral and Morady are founders and stockholders of Ablation Frontiers, Inc. Drs Oral and Morady have also served as consultants to Ablation Frontiers, Inc. The other authors report no conflicts.
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Ablation strategies to eliminate atrial fibrillation (AF) almost always involve isolation of the pulmonary veins (PVs). However, in a recent single-center study, ablation of complex fractionated atrial electrograms (CFAEs) in both atria and in the coronary sinus has been reported to eliminate AF in 77% of patients with chronic AF. In the present study, the efficacy of radiofrequency catheter ablation guided by CFAEs in the left atrium and coronary sinus was assessed in 100 patients with chronic AF. Radiofrequency catheter ablation was performed to target CFAEs at the PV ostial and antral areas, various regions of the left atrium, and the coronary sinus until AF terminated or all identified CFAEs were eliminated. During 14±7 months of follow-up after a single ablation procedure, 33% of patients were in sinus rhythm without antiarrhythmic drugs. A repeat ablation procedure was performed in 44% of patients for recurrent AF and/or atrial flutter. PV tachycardias in previously targeted and nontargeted PVs were found in all patients. There were multiple macroreentrant circuits in the majority of patients with atrial flutter. At 13±7 months after the last ablation procedure, 57% of patients were in sinus rhythm without antiarrhythmic drugs, 32% had persistent AF, 6% had paroxysmal AF, and 5% had atrial flutter. The findings of the present study suggest that radiofrequency catheter ablation of chronic AF guided by CFAE results in modest short-term efficacy. However, repeat ablation may be necessary in >40% of patients to eliminate recurrences of AF due to PV tachycardias or atrial flutter utilizing multiple macroreentrant circuits.
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- Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex ElectrogramsHakan Oral, Aman Chugh, Eric Good, Alan Wimmer, Sujoya Dey, Nitesh Gadeela, Sundar Sankaran, Thomas Crawford, Jean F. Sarrazin, Michael Kuhne, Nagib Chalfoun, Darryl Wells, Melissa Frederick, Jackie Fortino, Suzanne Benloucif-Moore, Krit Jongnarangsin, Frank Pelosi, Frank Bogun and Fred MoradyCirculation. 2007;115:2606-2612, published online before print May 21, 2007http://dx.doi.org/10.1161/CIRCULATIONAHA.107.691386
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- Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex ElectrogramsHakan Oral, Aman Chugh, Eric Good, Alan Wimmer, Sujoya Dey, Nitesh Gadeela, Sundar Sankaran, Thomas Crawford, Jean F. Sarrazin, Michael Kuhne, Nagib Chalfoun, Darryl Wells, Melissa Frederick, Jackie Fortino, Suzanne Benloucif-Moore, Krit Jongnarangsin, Frank Pelosi, Frank Bogun and Fred MoradyCirculation. 2007;115:2606-2612, published online before print May 21, 2007http://dx.doi.org/10.1161/CIRCULATIONAHA.107.691386
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- A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation
- Evaluation of spatiotemporal organization of persistent atrial fibrillation with time- and frequency-domain measures in humans
- Cost-effectiveness of atrial fibrillation catheter ablation
- Evolving Strategies in Catheter Ablation of Long-Standing Atrial Fibrillation
- Balloon cryoablation for paroxysmal atrial fibrillation
- Is atrial fibrillation with very short cycle length suitable for ablation? A case report
- Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial fibrillation
- Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation
- Catheter Ablation of Atrial Fibrillation: For Whom and How?
- Randomized Evaluation of Right Atrial Ablation After Left Atrial Ablation of Complex Fractionated Atrial Electrograms for Long-Lasting Persistent Atrial Fibrillation
- Characterization of Electrograms Associated With Termination of Chronic Atrial Fibrillation by Catheter Ablation
- Catheter ablation of atrial fibrillation: do we know what we are doing?
- Trials and Travails of Electrogram-Guided Ablation of Chronic Atrial Fibrillation
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It has long been known that infections can trigger autoimmunity. Paradoxically, autoimmunity has also recently been shown to precipitate infectious diseases. Indeed, autoantibodies against certain cytokines have been shown to underlie the pathogenesis of specific infectious diseases. This is best illustrated by autoantibodies against IFN-γ, which were first described in 2004-2005 in 5 adults with no significant medical history who developed disseminated disease caused by environmental and tuberculous mycobacteria.2⇓–4 A 25-year-old woman from Thailand2 and a 47-year-old man from the Philippines3 died of mycobacterial disease. The other 3 patients, 2 British women aged 46 and 59 years, respectively, and a 32-year-old South African man, slowly improved after treatment with antibiotics and, in 1 case, recombinant IFN-γ.4 Neutralizing anti–IFN-γ autoantibodies have been reported now in approximately 130 individuals. Most patients initially presented as adults with disseminated environmental mycobacterial infections.2⇓⇓–5 Strikingly, these patients are late-onset clinical phenocopies of patients with Mendelian susceptibility to mycobacterial disease (MSMD) carrying inborn errors of IFN-γ immunity.6 This observation alone strongly suggested that autoantibodies against IFN-γ were the cause rather than a consequence of mycobacterial disease. Intriguingly, some patients with autoantibodies against IFN-γ also display other opportunistic infectious diseases, not all of which are seen in MSMD patients,5 suggesting that these anti–IFN-γ autoantibodies have a broader impact or that other pathogenic mechanisms, including the production of other autoantibodies, for example, are at work.
Three other types of pathogenic autoantibodies against cytokines described before autoantibodies against IFN-γ have not been found to underlie infectious diseases. Some patients with pure red-cell aplasia display autoantibodies against erythropoietin. Autoantibodies against granulocyte colony-stimulating factor (G-CSF) have been found in neutropenic individuals with Felty syndrome or systemic lupus erythematosus. Autoantibodies against granulocyte macrophage colony-stimulating factor (GM-CSF) were found in patients with pulmonary alveolar proteinosis,7 which may also be caused by mutations in the gene encoding the GM-CSF receptor. It was not until 2008 that autoantibodies against IL-6 were found in a single patient with severe staphylococcal skin infection and low serum C-reactive protein concentration.8 However, in the absence of known inborn errors of IL-6 or its receptor, it is difficult to determine whether these autoantibodies caused or resulted from staphylococcal disease. Finally, another type of anti-cytokine autoantibody was unambiguously shown to underlie infectious diseases in a study carried out in 2010, on patients with autosomal recessive autoimmune polyendocrinopathy syndrome type 1 (APS-1). These patients had previously been shown to display autoantibodies against IFN-α and IFN-ω, which were clinically silent, probably due to the existence of multiple antiviral IFNs. These patients were shown to display autoantibodies against IL-17A, IL-17F, and IL-22.9,10 The autoantibodies against IL-17A and IL-17F are probably responsible for chronic mucocutaneous candidiasis (CMC), the only infection seen in these patients, because other patients with inborn errors of IL-17 immunity display a pure phenotype of CMC.11 Overall, the occurrence of autoantibodies against 2 key T-cell cytokines, IFN-γ and IL-17, has been shown to underlie clinical phenocopies of the corresponding inborn errors, MSMD and CMC, respectively.
In APS-1 patients, the early production of autoantibodies against IL-17 and many other autoantigens reflects the disruption of tolerance due to biallelic mutations of AIRE. But what provokes the production of autoantibodies against IFN-γ in previously healthy adults in the first place? A genetic origin was first suggested by the observation that autoantibodies against IFN-γ were found mostly in individuals of East Asian descent.2,3,5 In the accompanying ground-breaking report, Chi and colleagues describe their study of 17 Chinese adults with environmental mycobacterial disease due to autoantibodies against IFN-γ.1 They elegantly provide the first molecular evidence for genetic control of anti–IFN-γ autoantibody roduction in humans. They found that 2 linked HLA-II alleles defining a haplotype—DRB1*16:02 and DQB1*05:02—were associated with disease, with an odds ratio of approximately 8.1 In other words, the relative risk of developing this illness was almost 10 times higher in individuals carrying at least 1 such haplotype. HLA genes are among the strongest known genetic factors underlying autoimmunity. In some populations, they can increase the relative risk from 10 to more than 150 times (eg, the HLAB27 alleles for ankylosing spondylitis). In this superb study, Chi et al bring the autoimmune phenocopy of inborn errors of IFN-γ back into the domain of human genetics. The penetrance of anti–IFN-γ autoantibody production in patients bearing this HLA haplotype is undoubtedly lower than that of anti–IL-17 antibody production in APS-1 patients, and the autoantibodies occur much later in life, but the authors nonetheless provide clear evidence of genetic determinism. Further investigations are now required to determine the mechanism by which either or both HLA class II alleles contribute to the production of autoantibodies against IFN-γ.
Conflict-of-interest disclosure: The authors declare no competing financial interests. ■
- © 2013 by The American Society of Hematology


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We got introduced to Teona when she was 14. Just when she was released from the Children's shelter and she was on the streets again. Teona was selling flowers in the restaurants by night while she and her friends were sleeping in a basement of a wrecked building.
Teona started attending our sewing classes. Teona had 3 rooms in a communal apartment while the other 2 was owned by her neighbours who wanted to get rid of Teona so they could have her rooms and they didn't let Teona live peacefully there. One day when Teona went home the neighbours dragged Teona into their room beat her up, called the police and said that Teona tried attacking them with a knife that she pulled out, out of her back pocket when the trousers she was wearing didn't even have a back pocket.
The police caught Teona and the law court was deciding that they were going to give her 4 years of prison but we found out soon enough to get involved and instead of the 4 years they let Teona free. In the video (http://youtu.be/Wz_Br2b4OUY), Teona describes how frightened she was before we got involved with our legal service.
After that Teona continued sewing classes in Mkurnali and stayed overnight with us too. Teona is now married with 2 children and they live in Teona's communal 3 rooms, because after the trial the police told the neighbours to be careful with the way they treat Teona. At the moment Teona cannot use the skills she learned at Mkurnali because she has 2 children to raise but she is sewing for her own children.
You played a vital part in helping Teona get back on her feet. Our legal team and sewing teacher have given Teona a fresh start, but it was vital that Teona could stay with us while we helped her resolve the conflict in her life. We don't turn anyone away, whether they need a short respite stay, or to make us their home for a longer period. We can only do this if we can feed them, so we are very grateful to you for your help.
Natalia is one of three volunteers that helps us support young people as they age out of the orphanage system in St Petersburg. They all grew up in orphanages themselves and a few years ago they would have struggled to look after themselves. Now they are desperate to make life easier for the younger ones.
Natalia and the other volunteers tell us how important it is for them to take part in this project, how the worry before every session, how they like to discuss with us how the group is progressing. They understand what our young people are going through, because they've been there themselves. They have taken the initiative in inviting members of the group round and introducing them to their family. It is very important for them to prevent our young people from feeling lonely, to introduce them to life beyond the children's home and to help them get on with people. Natalia's was a particular help to one of our group-members who was feeling unmotivated. She encouraged her to keep attending and keep learning.
Natalia and her friends get a huge amount out of volunteering themselves. All through their childhood they were told they were useless, and here they are helping other people in a way that only they can. They give friendship and a depth of understanding that we, the experts, can never give.
We want to celebrate our fabulous volunteers and thank you for giving them a chance to be heros. Your donations have allowed us to train our volunteers and to give them ongoing support through the year.
Before we go, we have a special message for our UK-based supporters. Between 1st and 8th September GlobalGiving UK are adding 50% to donations. This is a great time to make your donation go further. If you can't make a donation now, we'd be really grateful if you could share this report. If you'd like a reminder when the bonus week starts, please contact Sarah Gale (email@example.com). Thank you!
Olga has three children, two girls and a boy. She grew up in a children's home and so did her mother. This is why she found it difficult to bond with her children. With her two boys she says, "I was on auto-pilot. I didn't feel anything towards them." Bonding with her third child was easier, and now she has a much closer relationship with them. She is still working hard to improve her family life.
Olga recently agreed to have her story published in a booklet we wrote to help social workers and psychologists understand the outlook of parents who grew up in orphanages. She really hopes that this will help them help other people in her situation. We hope her story will also give you an idea of how our summer camps, which you have contributed so generously towards, help our families make long-term changes in their lives. Olga and her children also comes to our family support centre through the year. She describes the long journey she's taken to get to the point where she can ask for help and realise she isn't alone.
"After I left the orphanage I went to study so that I wouldn't fall in with a bad crowd. I got my certificate and then I started another course because I didn't have anywhere else to go. I wasn't given a room straight away. When I got my room I already had my son. But what to do with him? Thank you to the neighbour who told me I should wash him. Every time there was a problem I called an ambulance. I felt abandoned and then I had another son. My husband drank and worked and I was left alone with the children. I didn't find out straight away when I was pregnant the third time, but I was very glad when I found out it would be a girl.
I often wanted someone from the centre to come and ask me how they could help me. I had so much pain stored up inside and I wanted to tell someone about it. The first time I went on the summer camp it was really difficult. I wanted to run away and hide, but I had to solve my own problems. I wanted to open up, but instead I got frustrated and behaved badly. I couldn't openly ask for help. The second time was easier and I noticed more about how I was behaving. One day, my daughter was being naughty at lunch. She wouldn't eat and nothing I did was right. So, I took her and left and we both went hungry. I expected one of the specialists to come after me, but nobody did. My daughter didn't understand what was happening and didn't say sorry and I didn't know what to do. At home I would have simply ignored her or shouted at her, but here you couldn't do that. I dreamt about this day. It really bothered me, but I didn't want to admit that I really needed help, that I didn't know what to do. I've got three children, but I never learnt how to ask for help. Instead, I run away and clam up and expect someone to come after me and offer to help. It took me three years taking part in the programme to realise that I need help and that I can ask for it openly.
I've learnt such a lot from the programme. I've learnt how to behave with my daughter, how to deal with her when she's being naughty, how to respond when she asks for something, how to look her in the eye when I talk to her, and how to play with her. I've missed out on so much with my sons. I should have started when they were younger because it's much more difficult to start now. I really love watching my daughter laughing and enjoying what we have between us.
We have so much pain inside that we can't deal with it alone, nothing's like we think it is. We're grown up but we need someone to listen to us and free us from what we've lived through. We also have to learn to ask for help, but I still find that very difficult."
This year's summer camp starts soon. Look out for our report in about a month's time when we'll tell you how our families have got on. If you are UK-based, you might like to know that between 1st and 8th September GlobalGiving UK are adding 50% to donations. If you'd like to be reminded nearer the time, please e-mail Sarah Gale (firstname.lastname@example.com) or "like" our Facebook page.


text:
Top Definition
Winning at multiple tasks, schemes, games, etc. at once,
Matt won the bet he placed on the game, won the money prize in poker while watching the game, and was 1st runner up on ideas of a Grand Scheme; Matt was omnitriumphant.
লিখেছেন- The Golden One 22 de জানুয়ারি de 2008
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In FR Online Check-in From DUB (by LS737 Jun 25 2006 in Civil Aviation) we got offtopic. However I am curious about airline proceedures, so I would like to continue the off-topic topic here.
The point was, with more and more people self-printing their boarding cards, this is slowing down the boarding because the gate staff have to tear off 1/3 or so of the self-printed B-C.
So I've got a few questions.
1. If I pre-tear the 1/3 will the check-in staff want to see the other 2/3 to verify they are from the same original piece of paper?
2. Why do they want the piece of paper anyway? It's got a bar-code which they scan *beep* - why do they need the paper.
3. Why can't they print 2 or more B-Cs on the same piece of paper? I figure they could get at least 3 on a single A4 (aprox 8 1/2 x 11)


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Luxury 2 bedroom 2 bathroom ground floor apartment
Striking ground floor apartment on Mosa Trajecum. Read more!€140,000
Beautiful 3 bedroom sinle story villa with attached garage and private pool,
Just reduced August 2014 BARGAIN Read more!€350,000
Architect designed house now reduced at, Las Torres de Cotillas (Murcia),
Reduced February 2015 great buy. Read more!€750,000 €495,000


text: Strong woman outdoor in winter shot against a blue sky in the su Strong woman outdoor in winter shot against a blue sky in the sun playing with red gloves jeancliclac French photographer living in scandinavia. In stock photo since 2004 Photographer Info Author Page Portfolio: 10099 images. Updates / RSS Network Image updated—May 3, 2013 Keywords appealing, at, attractive, beauty, black, blond, blue, box, Boxer, boxing, Caucasian, cold, cute, engaging, face, gaze, girl, gloves, hair, head, looking, outdoor, photogenic, portrait, red, Seductive, short, sky, smart, stare, strong, sun, sunglasses, sunny, tall, tough, winter, young Image Categories Expressions | Women Size Type File Info Price ( Euros (€) ) Bloggeejpg3.47" × 2.32" @ 72 dpi250 × 167px2.50 Smalljpg6.94" × 4.63" @ 72 dpi500 × 333px5.00 Mediumjpg13.89" × 9.26" @ 72 dpi1000 × 667px10.00 Largejpg14.58" × 9.72" @ 300 dpi4375 × 2917px20.00 End User License Agreement DOWNLOAD (0.00) ClipArtIllustration.com Symbiostock.com Symbiostock.info symbiostock Symbioguides.com Microstockgroup.com ClipArtof.com


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Once an Event is closed, the ability to change an RSVP is disabled.
Time: February 23, 2012 from 7pm to 9pm
Location: AMC Desert Ridge
Street: 21001 North Tatum Boulevard
City/Town: Phoenix
Website or Map: http://maps.google.com/maps/m…
Event Type: phoenix screening
Organized By: gofobo.com (Passes Limited)
Latest Activity: Feb 23, 2012
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As well as a legendary golf swing, Arnold Palmer had a sharp mind for business.
Known as "the King," he's credited with bringing the once stuffy game of golf to a mass audience around the world. In the process, he changed the way sports stars make mon...
Blenheim Palace via CNN
They fought them on the beaches, the landing grounds, in the fields and in the streets -- but World War II veterans did not expect to be fighting the Nazis in Winston Churchill's ancestral home.
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Photoshop redesign of old site
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King David Moving & Storage, Inc.
Phone: (847) 470-0055 5704 Reba St, Morton Grove, IL 60053 View Additional Email Addresses http://www.kingdavidmovers.com View Additional Web Addresses
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King David Moving & Storage, Inc. is a moving company which provides local and long-distance moving for residential and commercial customers. This company serves the northwest suburbs of Chicago, including Niles, Skokie, Glenview, Golf, Park Ridge, Evanston, Wilmette, Des Plaines, Northfield, Lincolnwood, Winnetka, Rosemont, Norridge, Harwood Heights, Schiller Park, Mt Prospect, Glencoe, Northbrook, Deerfield, Riverwoods, Palatine, Rolling Meadows, Arlington Heights, Schaumburg, Wheeling, Buffalo Grove, and Long Grove. Services available include short-distance moving, long-distance moving, corporate relocation, piano transportation, box sales, and packing services.
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Internet Explorer
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|September 1, 2014
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by Anne Akers Johnson
|November 1, 2003
A guide to the universally popular playground game. Features illustrated step-bystep instructions for nine different games, as well as how to make your own Chinese jump rope out of rubber bands.
by David Neuhaus
|September 28, 2004
When Ralph wants to catch the eye of the local racing team, he challenges Dudley to a bicycle race knowing full well that against his fancy new gear, Dudley's ancient balloon-tire bike doesn't stand a chance. Dudley does have unflagging perseverance, but will…
by Richard Henderson
|July 9, 2009
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This entertaining and beautifully illustrated book introduces children to the basics of sailing. Adam, a young boy from the city, yearns to learn how to sail. When his aunt and uncle invite him to visit one summer, his cousin, Beth, takes him out in her sailboat.…
by Mel Glenn
|August 1, 1997
The Tower High Tigers basketball team is on top of the world and bringing the crowds to their feet in this collection of free prose poems that make up the absorbing story of a championship teams season. Meet Garrett James, the star of the team; Darnell Joyce, the…
by Donald Crews
|April 14, 1995
Sail Away It's a perfect day for sailing. Motor under the bridge, putt . . . putt . . . putt past the lighthouse, put up the sails, and whoosh! But watch out for a change in the weather. Seas will swell and waves will crash before you sail back home.
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Home > Eyeglasses > Tim Dilsen > TD373 ()
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Free outbound and return shipping
30-day money-back guarantee
Low prices
TD373/ Eyewear
As a customer of Edel-Optics, you are totally aware that eyewear can crown your style. This accessory makes you look very smart when you are out and about and convincing in the office and in your leisure time.
Wearing full rim eyewear, you make it unmistakably clear that you are going the whole hog. The metal frame is very light and comfortable to wear. It is both robust and classy.
With the help of our digital dispensing optician, your prescription lenses can be configured according to your own requirements. Anti-reflective and cleaning coatings, antistatic and lotus effect are included as standard for plastic lenses.
The model is in stock. If you order now with the express shipping option, we can even guarantee the time of delivery. In our online shop we have consistently low prices. You won't get TD373 at such a low price, not even in the sale.
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