text:
Dominic CompozLatest answers
What makes life worth living?
Just seeing how happy your loved ones are when you walk into the room
Who do you think gets more ladies: you or Tyler?
What's the most valuable thing you've held in your hands?
Jim Ryun signed spikes
I mean I guess we can do it rn?
Ya boy is actually on his way to Paradise Cove... So when I get back we can race?
What is one thing you will never do again?
I will never race on a 4x200 ever again #SlowAsShit
sometimes. when im investigating the lunch ladies. you can't trust them.
Of course it is only a sometimes. But we should seriously go on a race sometime
well I know you because I work for the CIA and the FBI. so..... I can't text you because people will know who I am.
Oh do you now. What can I know about you. Do you go to Chap?
ya. I do volleyball and soccer so I have a nice butt from volleyball but solid calves from soccer. which is why I can beat you running.
Oh I know that you can. Do I know you by chance?
I think I saw you running once. well not running really. you were like jogging. I'm probably faster than you.
Obviously. Everyone is
do you run?
I'm not one of your besties :(Devynn miller
Sorry I forgot to mention you bae


text:
13.10.2016, 11:20
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subset: commoncrawl


text:
NPR story on black Americans and gunsRight here. A short presentation on "All Things Considered," but a good one, and fair.
Swedish police will no longer be able to give descriptions of alleged criminals for fear of being seen as racist.
According to an internal letter, police in capital city Stockholm are instructed to refrain from describing suspects' race and nationality, according to news website Speisa.
Local newspaper Svenska Dagbadet reported it had seen the letter, which it said outlined how officers should now notify the public of crimes.More @ Independent
The passing recently of David Bowie definitely got my attention, even though I wasn't a big fan – in any of his incarnations. (Sorry)
But yesterday, finding out that a founder of The Eagles had passed. Well, Universe, this is over-the-top!
As we age, we seem to see more of this – people who are part of our youth, our lives, passing into eternity.
Personal family and friends aside, these bookmarks in the story of our lives remind of us specifics in our past, and of the eventual future for all of us.
R.I.P. Good Sir!
The Silicon Graybeard (and many others on the 'Net) reminded me tonight is the 50th anniversary of the Beatles performing on Ed Sullivan. Their big American break.
A real snooze for me.
1) I was into classical music – popular music (like Rock and Roll) just didn't do it for me. And, I had memories of my Dad ranting about Elvis (and my Sister, the Bobby Soxer, fawning over him) years earlier.
2) My Dad's rant continued regarding The Beatles long hair. "Unkempt, unclean, like a beatnik", etc.
AND 3) (most important) being a 6th Grader, I was extremely jealous of the 6th Grade girls fawning all over these British invaders! What was so special about them, anyway?
Of course, regardless of my and other Dad's rants, they went on to super stardom and changing the face of music forever.
Used to be there was a derisive term for classical music – longhair music. Obviously that went out of favor!
I LOVE the concept of National Public Radio. This assumes it reflects the entire political spectrum, which it does not. It is not unlike the German Democratic People's Republic. It is neither democratic, a republic, nor of the people. Just because it is so named doesn't make it so! (see also Republican Party, Democratic Party, Social Security, free health care).
Irons in the Fire posted recently an independent analysis of an NPR series (from Powerline), with the following results:
My finding is that the series was deeply flawed and should not have been aired as it was.
The series committed five sins that violate NPR's code of standards and ethics. They were:
1. No proof for its main allegations of wrongdoing;
2. Unfair tone in communicating these unproven allegations;
3. Factual errors, shaky anecdotes and misleading use of data by quietly switching what was being measured;
4. Incomplete reporting and lack of critical context;
5. No response from the state on many key points.
Sadly, I see much of the same with some other NPR content, as well as with so-called 'public' television. It's sad that those entities can continue to obtain public funds under the guise of serving the public good. Because they have a political agenda. And it's NOT equal time.
I'll still sometimes listen to Click and Clack or Wait, Wait Don't Tell Me! though. But, they should be paid for privately.
Will Rogers was a comedian and actor from the early part of the Twentieth Century. Before becoming a stage personality, he had actually been a cowboy – some of his act involved lasso tricks!
finally ~ If you don't learn
to laugh at trouble, you won't have anything to laugh at when you're old.
h/t my dear sister, Ellie
I'm saddened to report that local radio news personality, famous for 40 years, Bill Heywood, and his wife Susan, were found in a Scottsdale hotel room, together, deceased.
It appears that Susan had some sort of terminal illness, and this was a murder/suicide situation. A note was left on the door advising there would be dead bodies found inside.
Bill Heywood had been a fixture in Valley radio at KOY, KTAR and KFYI radio.
He is much beloved by his many fans.
RIP Bill and Susan.


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Achieving 95% Cross-Methodological Concordance in HER2 TestingCauses and Implications of Discordant Cases
We were interested in determining our concordance between fluorescence in situ hybridization (FISH) and a previously validated immunohistochemical HER2 assay to identify possible reasons for discordance and to determine if all reasons for discordance were addressed by the American Society of Clinical Oncology/College of American Pathologists guidelines. We reviewed 697 cases (2004–2007) in which HER2 immunohistochemical and FISH testing were concurrently done. Overall concordance between nonequivocal immunohistochemical and FISH results was 96%. Of the 19 discordant cases, 13 (68%) were interpreted as positive immunohistochemically but negative by FISH. The primary reason for this discordance was immunohistochemical interpretation. Weak stain intensity, granular staining, and interpretation in areas of crush artifact were identified as the most common issues. Of the 6 cases interpreted as immunohistochemically negative and FISH-positive, 2 were from patients known to be receiving trastuzumab at the time of biopsy, 1 was very close to the FISH equivocal category, and 4 cases had fewer than 1.5 CEP17 signals per cell (1 patient in this group was also receiving trastuzumab). Focusing on issues with HER2 immunohistochemical interpretation can improve concordance rates for immunohistochemically positive cases, but biologic reasons may explain some discordant immunohistochemically negative cases.
- ASCO/CAP guidelines
- HER2 testing
- Breast cancer
- HER2 discordance
- HER2 validation
- Fluorescence in situ hybridization
The human epidermal growth factor receptor 2 protein (ERBB2, CERB-B2, or HER2) is overexpressed in 10% to 25% of all breast carcinomas.1–4 The HER2 protein, a transmembrane tyrosine kinase receptor, is part of a complex pathway of signal transduction that affects cell proliferation, survival, motility, and adhesion.5 Breast carcinomas with HER2 overexpression have increased proliferation, altered motility and invasive potential, regional and distant metastases, accelerated angiogenesis, and reduced apoptosis.5 Amplification of the ERBB2 (HER2) gene is the primary mechanism of HER2 protein overexpression in most cases.6–8 Clinically, HER2 overexpression is associated with a more aggressive clinical course and increased resistance to nonanthracycline-, nontaxane-containing chemotherapy regimens.9 However, overall and recurrence-free survival improve with regimens that include anthracycline-based chemotherapy and HER2-targeted antibody therapies like trastuzumab and lapatinib. Correct assessment of HER2 status in breast carcinoma is therefore essential in guiding therapy-related decisions.
Three central methods to evaluate HER2 status are currently in clinical use: immunohistochemical analysis, fluorescence in situ hybridization (FISH), and chromogenic in situ hybridization (CISH). Immunohistochemical analysis detects the amount of HER2 protein at the cell membrane in a semiquantitative manner: incomplete or weak labeling of cell membranes typically equates with fewer than 185,000 receptors at the cell surface and no detectable amplification of the HER2 gene; strong, circumferential membrane staining correlates with more than 500,000 receptors at the cell surface, a level of expression almost always associated with HER2 amplification.10 FISH uses a fluorescent-labeled DNA probe to detect the relative copy numbers of the HER2 gene per cell. While less sensitive to technical factors that influence the reliability of immunohistochemical analysis (such as tissue fixation), FISH is more time- and labor-intensive and requires the use of a fluorescence microscope. CISH, like FISH, detects the HER2 gene copy number but uses a chromogenic detection method scored using standard bright-field microscopy. In current practice, immunohistochemical analysis is commonly used as the initial test for HER2 status, with FISH and CISH reserved for assessment of equivocal (2+) immunohistochemical results. However, studies indicate that as many as 20% of immunohistochemically positive (3+) breast carcinomas do not exhibit HER2 gene amplification in FISH assays performed at a centralized testing facility.11,12
In an attempt to further standardize HER2 testing and reduce discordance between laboratories and testing methods, the American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) published guideline recommendations for HER2 testing in 2007.9 These guidelines established standard testing and interpretive criteria for immunohistochemical analysis and FISH. Through these guidelines and enforcement of new inspection checklist items for laboratory practice, the CAP has effectively required all CAP-accredited laboratories performing HER2 testing to document 95% overall concordance with an external or internal validated method (the former typically the same basic testing platform, such as immunohistochemical analysis vs immunohistochemical analysis; the latter more often cross-platform, such as immunohistochemical analysis vs FISH) for nonequivocal results. So that we might gain a better understanding of how laboratories may improve concordance between in-house immunohistochemical and FISH methods for HER2 status, we investigated the causes of immunohistochemical-FISH discordance in our own practice.
Materials and Methods
After University of Washington Medical Center (UWMC; Seattle) Human Studies approval, we reviewed the HER2 status of 697 cases of breast carcinoma at UWMC on which immunohistochemical and FISH testing were performed between September 2004 and December 2007 (inclusive). Overall concordance rates between immunohistochemical and FISH results were determined, and all discordant cases were reviewed. Reasons for discordance were identified with an eye to improving performance of immunohistochemical and FISH methods and overall concordance between them.
The study population included cases referred directly for FISH testing (without prior HER2 testing by immunohistochemical analysis) as well as "in-house" cases at UWMC in which HER2 immunohistochemical analysis was performed and results were reported as equivocal. Our internal quality assurance protocol requires that all referral HER2 FISH cases also have immunohistochemical analysis for HER2 performed concurrently. The results of the latter immunohistochemical tests are recorded in our pathology database but are not reported. Cases without immunohistochemical and FISH results were excluded from further analysis.
Immunohistochemical analysis was performed using the avidin-biotin-peroxidase method (VectaStain Elite, Vector Labs, Burlingame, CA). Three 4-μm tissue sections cut from the formalin-fixed, paraffin-embedded tissue block were used. All slides were baked for 20 minutes at 60°C, dewaxed in xylene, and rehydrated through graded alcohols to buffer before immersion in a solution of 3% hydrogen peroxide for 10 minutes to block endogenous peroxidase.
The first slide was run without heat-induced epitope retrieval (HIER). This "non-HIER" slide was blocked in normal goat serum (dilution 1:100; catalog No. S1000, Vector Labs) for 10 minutes and then incubated with the primary anti-HER2 antibody (polyclonal antibody, dilution 1:200; catalog No. A0485, DAKO, Carpinteria, CA) for 40 minutes at room temperature in a moist chamber. The second slide was run with HIER, 0.05 mol/L citrate buffer (pH 6.0), for 15 minutes at 98°C in a commercial microwave (model H2800, Energy Beam Sciences, East Granby, CT), cooled to room temperature (for 20 minutes), and then incubated with the primary antibody (diluted 1:400) in a manner otherwise identical to the non-HIER slide. The third slide, a methodological (negative) control, was handled the same as the HIER slide, except that the primary antibody was replaced by normal rabbit serum (dilution 1:8,000; MP BioMedicals, Solon, OH).
All slides were then subjected to sequential 30-minute immersion in biotinylated horse antirabbit antibody (1:500 dilution; Vector Labs) and avidin-biotin-peroxidase (1:100 dilution; catalog No. PK-6100, Vector Labs), followed by chromogenic development, using 3,3′-diaminobenzidine tetrahydrochloride hydrate (catalog No. D5637-10G, Sigma, St Louis, MO) as the chromogen and hydrogen peroxide (3%; catalog No. 3306HP0316, MediChoice, Mechanicsville, VA) as the substrate. After hematoxylin counterstaining, slides were rinsed and dehydrated through graded alcohols to xylene and coverslipped using an automated coverslipper. Appropriate external positive control tests were performed concurrently with all HIER and non-HIER test slides.
Final HER2 immunohistochemical interpretation in cases requested for immunohistochemical testing was performed by members of a dedicated breast pathology service or by the immunohistochemical laboratory director. The HER2 immunohistochemical stains performed for quality assurance purposes in cases sent for FISH only were interpreted by the pathologist signing out the FISH results. HercepTest (DAKO) criteria (10% of carcinoma cells with strong circumferential staining = 3+ positive) were used for HER2 stain interpretation before 2008. If nonneoplastic breast epithelium was present and was noted to have HER2 expression (assigned using the same criteria), the staining level of this internal control was "subtracted" from the level of staining in the carcinoma to avoid false-positive results.13
To control for overstaining during HIER (and as an additional quality assurance measure), our laboratory requires at least 1+ membrane-based staining for HER2 on the concurrently performed non-HIER slide of the same invasive carcinoma before a positive (3+) HER2 interpretation can be rendered on the HIER slide. Any HIER slide with apparent 3+ staining but without any membranous staining on the non-HIER slide is interpreted as equivocal and is referred for FISH testing.
FISH was performed manually according to the vendor's protocol using the US Food and Drug Administration–approved Vysis PathVysion (Abbott-Vysis, Des Plaines, IL). Interpretation of FISH cases as positive before 2007 required an HER2/CEP17 ratio of at least 2.0 (<2.0, no amplification; ≥2.0, amplification); however, all FISH cases were reclassified according to the ASCO/CAP guidelines for the purposes of this study. In the latter, HER2/CEP17 ratios less than 1.8 or fewer than 4 HER2 signals per nucleus were considered HER2 nonamplified, ratios of 1.8 to 2.2 or carcinomas with 4 to 6 HER2 signals per nucleus were defined as equivocal, and ratios of more than 2.2 or more than 6 signals per nucleus were considered amplified. By using a fluorescence microscope with an appropriate filter set, tumor cells were counted until there was at least a 99% confidence interval that the measured mean ratio differed from 2.0 (Student t test) or until 60 cells were counted in representative fields previously chosen by a pathologist.
Concordance studies excluded cases in which the immunohistochemical or FISH results were equivocal. Discordance was defined as cases in which a positive or negative immunohistochemical result was accompanied by the opposite FISH result. Immunohistochemical cases with equivocal FISH results were excluded from the following calculations.
Overall concordance was calculated as follows:
Positive assay concordance (concordance for immunohistochemically positive cases) was calculated as follows:
Negative assay concordance (concordance for immunohistochemically negative and FISH-negative cases) was calculated as follows:
Data from discordant results were reviewed, and patient histories were obtained when possible. Any cases identified as discordant that had been diagnosed before publication of the ASCO/CAP guidelines were reviewed and scored according to the 2007 ASCO/CAP guidelines by a panel of 3 pathologists who routinely interpret HER2 immunohistochemical stains (P.E.S., S.M.D., and K.H.A.) who were blinded to the FISH results. After rescoring, cases were reviewed again to identify and categorize possible reasons for discordance.
The database search resulted in 700 cases in which FISH and immunohistochemical analysis had been performed between September 2004 and December 2007. Three cases had morphologically heterogeneous populations of invasive carcinoma that were considered carcinomas with potentially different biologic potentials, and thereby, the morphologically distinct populations were individually analyzed by immunohistochemical analysis and FISH and not counted as discordant cases. After the exclusions, 697 cases were analyzed. Table 1 summarizes the data generated by our database search.
Overall assay concordance was 96% (see concordance equation in "Materials and Methods"); 19 of 458 nonequivocal cases had discordant results. The original immunohistochemical stains from all 19 discordant cases were reviewed by 4 of us (K.H.A., P.E.S., S.M.D., and E.E.G.) who were initially blinded to the FISH results. All cases initially called immunohistochemically negative were also called immunohistochemically negative by this panel. However, 12 of the 13 cases initially recorded as immunohistochemically positive (3+) in our database were called equivocal by the panel. The single immunohistochemically positive discordant case in which the panel agreed with the 3+ interpretation was an alcohol-fixed (not formalin-fixed) cytology specimen. After initial rescoring, immunohistochemical cases were rereviewed to identify the possible reasons for discordant cases.
Of 94 immunohistochemically positive cases with non-equivocal FISH results, 81 (86%) were concordant. Initially, 13 cases (1.9% of 697) were recorded as immunohistochemically positive and FISH-negative in our database. Of these discordant cases, 12 were received for FISH testing only and the immunohistochemical interpretations were recorded in our database for quality assurance purposes but were excluded from the final pathology report. The last of these was reported as 3+ positive immunohistochemically but with a comment that FISH would be ordered because the case was a low-grade invasive cancer that was not expected to be HER2+. This case was later called equivocal after review.
Reasons identified for immunohistochemically positive, FISH-negative discordance are listed in Table 2. The most common of these (occurring in 11 of 13 discordant cases) involved interpretation of the immunohistochemical staining characteristics. The most common issues with interpretation were interpreting weak to moderate circumferential staining as intense staining (7/11 [64%]), interpretation in areas of crush (3/11 [27%]), and interpreting granular staining as uniform membranous staining (2/11 [18%]). The ASCO/CAP guidelines, which were published during the end of the data collection period, define 3+ staining as "uniform, intense membrane staining in >30% of invasive tumor cells."9 However, the new 30% threshold for 3+ staining did not change categorization of any of the cases in the discordant group because the character (intensity, granularity) rather than the quantity of the cells stained was the reason for misinterpretation. Examples of these misinterpretation errors are shown in Image 1.
Another issue with the immunohistochemically positive, FISH-negative cases was interpretation of the non-HIER HER2 control. In 4 cases, the non-HIER stain lacked at least 1+ staining, which, according to our laboratory protocol, should have resulted in an interpretation no greater than a 2+ on the HIER slide (see the "Materials and Methods" section). However, in 3 of the 4 cases, the staining characteristics of the diagnostic HIER slide also had interpretation issues identified.
Of 364 immunohistochemically negative cases with non-equivocal FISH results, 358 (98.4%) were concordant. All 6 discordant cases were originally referred to UWMC for FISH analysis only; immunohistochemical interpretations were recorded in our database for quality assurance purposes only (as noted earlier) but were not included in the final report. It is interesting that 2 nonmethodology-based reasons for discordance were identified in this group of immunohistochemically negative, FISH-positive cases: (1) cases in which the patients were known to have received HER2-targeted antibody therapy, and (2) cases in which the patients had apparent chromosome 17 haploid genotypes. Clinical records were available for only 2 of the 6 cases, and both patients were receiving trastuzumab at the time of the biopsy. Patient histories were not available in the remaining 4 discordant cases. It is interesting that in 4 of the 6 immunohistochemically negative, FISH-positive cases, patients also had carcinomas with fewer than 1.5 CEP17 signals per cell, suggesting an apparent chromosome 17 haploid genotype Table 3. Of these 4 cases, 2 also had fewer than 4 HER2 signals per cell (possible "false-positive" FISH results by ratio alone). One case (case 16, Table 3) was near the equivocal range of 1.8 to 2.2 with a ratio of 2.36 and was counted twice by 2 different technologists.
Accurate assessment of HER2 status is integral to the care of patients with invasive breast carcinoma. Several studies indicate that interlaboratory concordance rates for this growth factor receptor are less than 80%,11,12 raising considerable concern over the accuracy and precision of current HER2 testing. The ASCO/CAP guidelines now recommend that laboratories performing HER2 immunohistochemical studies show 95% concordance with another validated test for positive and negative assay values (an external comparison with the common method or an internal comparison with an alternative method) and provide standards for test performance and interpretation.9 In our practice, internal validation of FISH is based on concordance with a validated immunohistochemical assay. In our review of 697 cases in which immunohistochemical and FISH studies were performed at UWMC before these guidelines took effect (2004–2007), we achieved an overall positive and negative test concordance of 96%. We were interested in identifying causes for any discordant cases and examining whether the 2007 ASCO/CAP HER2 testing guidelines would have addressed all of these causes.
Among the 4% of cases that were discordant, immunohistochemically positive, FISH-negative cases accounted for the majority of discordant cases (13/19 [68%]). This pattern occurred in 13 (14%) of 94 immunohistochemically positive, nonequivocal FISH cases. Others have reported that false-positive immunohistochemical results are the most common problem with HER2 testing, but there is little detail in these studies regarding specific causes for the discordant result.11,12 The 2007 ASCO/CAP HER2 testing guidelines address a number of possible causes of immunohistochemical and FISH testing discordance, including time to fixation, method of tissue processing, total time in fixative, and type of fixation used.9 However, most of these factors are believed to contribute more reproducibly to a false-negative HER2 immunohistochemical result, an outcome that was much less common in our single-institution study.
In our analysis, HER2 immunohistochemical-FISH result discordance was considerably more likely to be an interpretive error than a technical error. The ASCO/CAP guidelines list the following interpretive criteria for a positive immunohistochemical result: (1) More than 30% of tumor must show circumferential membrane staining. (2) Membrane staining must be intense and uniform. (3) Membrane staining must be homogeneous (chicken wire). (4) Incomplete or pale membrane staining should be ignored.
The most common issue in immunohistochemical interpretation in our evaluation of discordant cases was the interpretation of weak to intermediate circumferential staining as intense staining (54% of immunohistochemically positive, FISH-negative discordant cases). To maximize positive immunohistochemical-FISH result concordance, we recommend strict adherence to the requirement for thick, homogeneous, dark circumferential membrane-based staining. Additional interpretive issues in our study included interpreting granular staining as uniform, and interpreting partial membrane staining of cells as complete circumferential staining. Interpretation of areas with significant crush artifact was also common. The current ASCO/CAP guidelines recommend that areas of crush artifact in HER2 immunohistochemical stains not be interpreted. Image 1 contains examples of these staining pitfalls.
It is interesting that the increase in the threshold for a positive immunohistochemical result to 30% of cells (ASCO/CAP) from 10% (HercepTest) was not a reason for discordance in our study. The principal (but as yet unvalidated) argument for the 30% cutoff is that the requirement for a higher percentage of HER2+ cells decreases interobserver variability in the interpretation of immunohistochemical stains and improves immunohistochemical-FISH concordance. Two recent studies by Hameed et al14,15 seem to support this claim but were limited by reporting immunohistochemically positive rates higher than expected and immunohistochemical-FISH result concordance well below optimum. However, the reported decrease in interobserver variability was relatively small (2% difference), and the increased concordance with FISH was not statistically significant. The fact that use of the 30% threshold did not result in recategorization of any discordant cases in our study may be related to study design because we did not systematically evaluate how this threshold would affect interpretation and concordance. Nevertheless, we believe that using a strict percentage positive threshold may misleadingly exclude cases with heterogeneous populations of HER2 staining. More important, manipulations of threshold do not directly address problems with the semiquantitative interpretation of overall staining intensity and character, precisely the issues this study identified as most common (and potentially correctable).16
Another reason identified for immunohistochemically positive, FISH-negative discordance in our study was interpretations that did not follow our internal quality assurance–based interpretive criteria using non-HIER controls. Specifically, our institution controls for possible HIER-induced overstaining for HER2 by preparing a non-HIER slide in parallel for each patient. For externally reported results, we require at least 1+ staining on the non-HIER slide before its paired HIER slide can be interpreted as positive, even if it independently meets criteria for a 3+ stain. A 3+ HIER stain paired with a nonreactive non-HIER slide may represent a false-positive result due to epitope retrieval or some other condition of tissue processing or slide preparation that is exploited by HIER (neoantigens and conditional antigens). Institutions not comparing HIER and non-HIER slides might instead use a consensus HER2 immunohistochemically equivocal (2+) case as part of the external positive control (an element that is lacking in some commercial positive controls) to assess for technical irregularities that could lead to erroneous results. The production of a visibly positive or negative stain in the "equivocal" control sample might reasonably alert a pathologist to a possible technical irregularity that requires further investigation.
One immunohistochemically positive, FISH-negative case in our series was initially interpreted as HER2+ on the basis of the immunohistochemical stain but was referred for FISH testing because the invasive carcinoma was very well-differentiated (Nottingham grade 1 of 3) and strongly positive for estrogen and progesterone receptor proteins by immunohistochemical analysis. Although subsequent blinded rereview of this immunohistochemical result for the purposes of this study reclassified the immunohistochemical stain as equivocal, the case offers an important reminder that any testing paradigm that bases reflexive FISH testing on immunohistochemical results should remain flexible enough (or be used by pathologists sufficiently mindful of clinical, histologic, and complementary immunohistochemical findings) to allow decisions "on the fly" to test unexpected HER2 immunohistochemical results by FISH as well.
Based on our analysis of immunohistochemically positive, FISH-negative discordant cases, issues with immunohistochemical interpretation were identified as the primary reason for this discordance. We believe these problems can be avoided by strict adherence to the current ASCO/CAP guidelines with special attention to appropriate interpretations of staining intensity and use of quality assurance controls. Preanalytic variables such as fixation time were not directly addressed by this study (the majority of cases in this study were tested before adoption of the 2007 ASCO/CAP guidelines), but only 1 of the immunohistochemically positive, FISH-negative discordant cases that was an alcohol-fixed cytology specimen was thought to be a true false-positive immunohistochemical result on rereview.17 Ensuring that pathologists who interpret HER2 immunohistochemical stains see a high enough volume of these cases, are well-trained in interpretation, and are aware of diagnostic pitfalls will likely decrease problems with HER2 immunohistochemical interpretation. At UWMC during the period of this study (which achieved a 96% overall concordance rate), a limited group of pathologists (each with substantial experience with this technique) routinely interpreted HER2 stains, including members of a dedicated breast pathology service, the immunohistochemical laboratory director, and pathologists who also interpreted HER2 FISH tests.
In our experience, negative immunohistochemical assay concordance is more consistently achieved than positive assay concordance. Our negative immunohistochemical assay concordance was 98.4% (6 of 364 cases were discordant). This smaller group of discordant immunohistochemically negative, FISH-amplified cases in our study did not seem to have issues with immunohistochemical interpretation. Instead, potential biologic reasons were identified that could explain this discordance in 4 of the 6 cases, including patients receiving HER2-targeted therapy before HER2 testing and cancers with fewer than 1.5 CEP17 signals per cell.
The effects of HER2-targeted treatments on HER2 testing are not well described in the literature, but it stands to reason that antibodies targeting the HER2 cell surface receptor may result in down-regulation of this receptor without affecting the gene amplification status. Because the lack of immunohistochemically detectable receptors may reflect the true biologic phenotype of these treated cancer cells, a negative immunohistochemical result in this setting should not be considered a clinically discordant result. While the benefit of additional HER2-targeted therapy in a previously treated and now immunohistochemically negative, FISH-positive cancer remains unclear, knowing the immunohistochemical and FISH results in such a case may have clinical usefulness. Therefore, we recommend that tissue sent for HER2 testing in patients who have already received HER2-targeted therapy should undergo immunohistochemical and FISH testing until the clinical significance of these results is known. Until then, efforts should be made to exclude such cases from concordance studies.
It is interesting that the immunohistochemically negative, FISH-positive group in our study was enriched for cases with fewer than 1.5 CEP17 signals per cell by FISH analysis, which occurred in 4 of the 6 cases. Monosomy seems to be a rare event, occurring in 2% of cases in some series.18–20 Similar to polysomy, CEP17 monosomy often seems to reflect loss of the CEP17 locus rather than the entire chromosome.19,20 However, there are scarce data on response to HER2-targeted therapy in these cases. In fact, the discordant immunohistochemically negative, FISH-positive cases with apparent chromosome 17 monosomy could represent false-positive FISH results when positivity is defined by ratio alone. Further studies evaluating the clinical response to HER2-targeted therapy in this setting are required to determine the significance of these results.
One case from our immunohistochemically negative, FISH-positive group was borderline equivocal by FISH and had to be counted twice before it was interpreted as weakly amplified (case 16, Table 3). The equivocal or borderline FISH category was created by the 2007 ASCO/CAP guidelines; however, the likelihood of patient benefit from HER2-targeted therapy within this group remains unstudied. The ASCO/CAP guidelines recommend additional immunohistochemical testing in FISH-equivocal cases to determine if either assay can give a nonequivocal result from which therapy decisions can be made. More data on equivocal FISH cases are required to determine if the immunohistochemical results in these cases can predict which patients will reproducibly respond to HER2 therapy. FISH-equivocal cases should be excluded from concordance studies until the biologic significance of the immunohistochemical results in this setting is understood.
Because the majority of cases in this study were tested before requirements for formalin fixation time were mandated, we could not control for formalin fixation time as a factor. We cannot confirm or exclude that underfixation or overfixation was an additional factor in the 6 discordant immunohistochemically negative, FISH-positive cases. Fixation issues should be minimized in the post-ASCO/CAP guidelines era, and we agree with the recommendation that fixation of all tissues (core biopsy specimens included) for a minimum of 6 to 8 hours will ensure more consistent testing results.
Our data suggest that an overall concordance rate of more than 95% for HER2 cross-methodological testing is achievable (and was achievable in the pre-ASCO/CAP guidelines era). We attribute our high concordance rates to several factors, including rigorous quality control. Our laboratory sees a high volume of HER2 testing, and interpretation is limited to pathologists who are part of a dedicated breast pathology subspecialty service, our immunohistochemical director, and pathologists who routinely interpret HER2 FISH. In addition, factors perhaps unique to our laboratory include using the subtraction (or "normalization") method (as suggested by Gown et al13) in HER2 immunohistochemical interpretation and using non-HIER controls. However, this study was focused on identifying reasons for discordant cases and did not directly address possible reasons for the high concordance rates.
The ASCO/CAP guidelines require initial test validation, an internal quality assurance plan, and competency assessments. An immunohistochemical-FISH concordance of 95% is achievable in a high-volume laboratory. We found that the most common type of discordance was immunohistochemically positive, FISH-negative cases and that issues with interpretation of immunohistochemical staining characteristics were the primary reasons for this discordance. Strict adherence to the ASCO/CAP guidelines during immunohistochemical interpretation, including knowledge of interpretation pitfalls, together with the added interpretive stringency provided by using controls that assess subtle issues in stain intensity variation, can significantly minimize cases of immunohistochemically positive, FISH-negative discordance. Immunohistochemically negative, FISH-positive discordance was significantly less common and is more often related to biologic phenomena, including concurrent trastuzumab therapy, fewer than 1.5 CEP17 signals per cell, and borderline equivocal FISH results. Cases with a biologic explanation for immunohistochemical and FISH discordance should be excluded from concordance studies.
Upon completion of this activity you will be able to:
list key American Society of Clinical Oncology/College of American Pathologists recommendations for HER2 test performance, interpretation, and validation.
calculate assay concordance and how to perform validation of an HER2 testing methodology.
list the primary causes of HER2 immunohistochemical (IHC) and fluorescence in situ hybridization discordance.
identify the main reasons for interpreter error in HER2 IHC testing and apply this knowledge to improve HER2 IHC stain interpretation.
The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.
The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.
Questions appear on p 341. Exam is located at www.ascp.org/ajcpcme.
- © American Society for Clinical Pathology


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More than 11,000 Angelenos remove 24,000 pounds of trash countywide
SANTA MONICA, Calif. – Southland volunteers took advantage of the last day of summer to protect their favorite outdoor spots across Los Angeles County. Angelenos collected and removed more than 24,000 pounds of ocean-bound trash over 32 miles today as part of Heal the Bay's 24th annual Coastal Cleanup Day.
Working together to protect what they love, more than 11,000 participants scoured local beaches, inland waterways, regional parks and city neighborhoods from 9 a.m. to noon. Santa Monica-based environmental group Heal the Bay mobilized 50 sites throughout the county.
From the fragile habitats of the Ballona Wetlands to the concrete alleys of South Los Angeles, local businesses, scout troops, faith-based organizations and school groups worked in tandem to gather and remove cigarette butts, plastic bottles and caps, snack-food packaging, plastic bags and Styrofoam items.
This year's unsolved mystery is the origin of the five clay statues of the Hindu god Ganesha found throughout California, including a pair found near the Malibu Pier at Surfrider beach.
More unusual objects uncovered at today's cleanups across L.A. County include: a beekeeper comb box (El Matador), a 35-pound car battery (Abalone Cove in Palos Verdes), a chaise lounge (Cabrillo State Beach in San Pedro), 120 pounds of carpeting (Dockweiler Beach), a remote surveillance video camera (Ken Malloy Park), an automobile fuel gauge (Leo Carrillo State Park) and a Bat Ray skeleton (Malibu Pier).
A "No Swimming, Polluted Water" sign discovered underwater by SCUBA divers at Surfrider is the most ironic found item. The grossest item is a urine sample cup at Will Rogers Beach, while glow-in-the dark vampire teeth found in the Ballona Wetlands is the most Halloween-y.
Urban runoff from more than 200 storm drains flowing out to Santa Monica and San Pedro bays causes the vast majority of local ocean pollution. By removing tons of trash from beaches and inland neighborhoods, cleanup participants enhance quality of life, protect marine animals and bolster the regional economy.
"Code Red" locations in need of special attention this year included Ken Malloy Harbor Regional Park and Compton Creek. These urban sites drain runoff from huge swaths of Los Angeles County and are overwhelmed by such litter as plastic bags and fast-food packaging.
SCUBA dive teams canvassed under the Santa Monica, Malibu and Redondo Beach piers and off Long Beach, while a flotilla of kayakers removed trash from Marina del Rey.
"Thank you, Los Angeles for achieving another safe and successful Coastal Cleanup Day!" said Eveline Bravo, Heal the Bay's beach programs manager. "I am so grateful to the thousands of volunteers who came out to support the places they love as volunteers make this entire event happen with their time and hard work."
Heal the Bay's Coastal Cleanup Day campaigns have captured a cumulative 1.6 million pounds of trash since 1990.
As of Saturday, September 21, the reported 24,000 pounds of trash found does not include bulky items that the city of Los Angeles will collect and weigh.
Downloadable images of today's cleanup.
About Coastal Cleanup Day
Heal the Bay organizes Coastal Cleanup Day in Los Angeles County in partnership with the California Coastal Commission. The L.A. campaign is part of a global event led by the Ocean Conservancy that encompasses more than half a million volunteers in nearly 100 countries and all states in the U.S. The day has been recognized by the Guinness Book of World Records as the world's biggest 24-hour volunteer event.
This year's sponsors include Los Angeles County Department of Public Works, Mattel, Union Bank of California, Ralphs, LandShark Lager and the City of Santa Monica. Chipotle and KIND bars also supported our volunteers with donated items.
About Heal the Bay
Heal the Bay is a nonprofit environmental organization making Southern California coastal waters and watersheds, including Santa Monica Bay, safe, healthy and clean.
Contact: Anne Bergman, Heal the Bay, (818) 378-5417
Heal the Bay is a 501(c)(3) nonprofit organization. All gifts are tax deductible to the fullest extent of the law.


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Q: Can you tell by facial expression if a hungry cannibal intends to eat you?
A: This took on more than just theoretical interest for psychologist Paul Ekman years ago when he traveled to a remote part of New Guinea to study facial expressions among the Fore people, as he reported in Science magazine.
Which theory was correct -- Darwin's view that facial expressions of emotions are universal, or Margaret Mead's claim that they vary with different cultures? The Fore people were far removed from Western culture and generally untouched by outsiders. One of their traditions was cannibalism, where the community ate people they respected after death by natural causes.
A few weeks after his arrival, Ekman was eating lunch when a village elder approached him, followed by maybe 100 tribesmen. Stopping before Ekman, the man reached down and began pinching his thigh.
"To my horror, the villagers behind him began jumping and screaming with emotion. I scanned the crowd for weapons and tried to hide my panic." Yet their facial expressions showed no anger and they were smiling and laughing. As Ekman learned later, the elder had announced "he planned to eat me when I died" -- a show of great respect. From then on, the villagers cooperated fully with Ekman's research.
Concluded Ekman: "I had learned this the hard way. Facial expressions do transcend cultures. I left New Guinea before the elder tribesman could make good on his promise, but I hope at least he found my research palatable."
Q: When might a tall skyscraper act like a giant tuning fork? And why should you care?
A: Let's hope you can stomach this, because a swaying building is potentially "barfogenic," whether due to an earthquake or a heavy gust, says Julie Rehmeyer in Wired magazine. Given a strong "knock," a skyscraper will vibrate at its own natural resonance frequency several octaves below a piano's lowest notes. "If you're on the top floor of, say, the 1,667-foot-tall Taipei 101, you could find yourself swaying back and forth abruptly, a total of up to two feet within five seconds."
To add stability, the building's designer added mass in the form of a 730-ton pendulum with giant shock absorbers bolted to it. This "tuned mass damper" is intended to sway at the same frequency as the megastructure but in the opposite direction, "pulling the building upright and damping vibrations. It still sways but subtly and smoothly."
Q: In the past, the study of the dead was integral to the education of young physicians. So why has the number of autopsies plummeted from nearly 50 percent before 1950 to around 6 percent today?
A. "Autopsy" is from the Greek "to see for one's self," says pathologist Darin L. Wolfe in American Scientist magazine, who developed his early understanding of malignant tumors from the procedure. During one autopsy of a cancer victim, "I felt honored to be the only one to lay eyes and hands on the very substance of the disease that had brought this woman to her death."
Autopsy remains the gold standard for assessing causes of diseases and traumas and for evaluating the accuracy of diagnoses. This wealth of information has been prized by medical schools, so much so that years ago bodies became scarce, driving up prices and leading to body snatching from graves.
In fact, Wolfe says, perhaps the key reason for the decrease of autopsies is financial: Much time and paperwork are required, and reimbursement is lacking. Only the future can answer "if the autopsy again becomes a central tool of modern medicine or is allowed to become a relic of medical history's storied past."
- Rich and Bill Sones


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Kathryn A. (Kay) Tevis, 84, of Hughesville, died Thursday. Oct. 7, 2010, at The Living Center in Marshall.
Funeral services will be held at 10 a.m., Tuesday, Oct. 12, 2010, at First Christian Church in Sedalia, with Pastor David Todd and Pastor Jim Sutherlin officiating. Burial will be in Longwood Cemetery, in Longwood. Casket bearers will be Joe Ben Todd, Jesse Todd, Drake Tevis, Zach Smith, Eric Cornine and Mike Karrick. Honorary bearers will be Jim Rissler, Tim Cornine, Otis Thomas, Tom Cooper, Bill Howard, Jim McMullin, Ray Combs and Jack Blackwell. The family will receive friends from 6 to 8 p.m., Monday, Oct. 11, 2010, at the church. The family suggests memorial contributions to First Christian Church or Habitat for Humanity in care of the Rea Funeral Chapel. Online condolences may be conveyed to the family at www.reafuneralservice.com.
Born Jan. 10, 1926, in Broken Bow, Neb., she was the daughter of Howard Lucius and Milly Winifred Warner Noyes. On Feb. 19, 1956, she married John Preston Tevis, who preceded her in death on Feb. 19, 2010. She was a graduate of Kearney High School in Kearney, Neb. and received her Bachelor of Arts in English from Kearney State College. She also received her master's degree in Religious Education at Drake University. She was the Director of Religious Education at First Christian Church. She was also a delegate for the disciples of Christ Biennial Assembly, Christian Action committee chairman, deaconess, elder and various church women's groups. She was a 4-H leader, President of the local Habitat for Humanity, election judge and crop walk organizer.
She is survived by one daughter, Susan Todd, and her husband, David, of Perry; two sons, Dan W. Tevis and his wife, Deidre, of Columbia, and Steven A. Tevis and his wife, Mary, of Houstonia; a sister-in-law, Elsie Tevis, of Moberly; nine grandchildren and one great-grandaughter.
In addition to her husband, she was preceded in death by a sister, Nanette Nedra Noyes Larken, and a brother-in-law, Robert G. Larken.
Additional information provided per family recompense.


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Fitness center, pools and spa services help Alexandria guests relax
A football field, tennis court and a well-equipped health club make it easy to maintain your exercise routine while traveling. Guests can choose from an outdoor pool "Stanley" and a heated rooftop pool adjacent to the Spa, for only adults to grant privacy and relaxation to all our guests. The wellness area features a relaxing sauna and steam room, while the spa offers beauty treatments and massage services. Alexandria travelers can also take advantage of parking and a children's playground.
Health & Wellness
Key features
- Football field
- Heated rooftop swimming pool
- Outdoor pool with built-in Jacuzzi
- Rooftop health club with fitness equipment
- Spa services
- Tennis court
- Wellness area with Jacuzzi, steam room and sauna
The Spa
Utilizing products based on organic herbs, flowers and plants, the treatments at the on-site spa soothe skin and energize the senses. Choose from a variety of massages, scrubs, body wraps and facials. Revitalizing therapies designed to promote energy and inner peace help you look and feel your best.
Guest Services
Services include
- Ample outdoor car parking on site
- Billiards
- Kids' Club
- Playground
At a Glance
Free Internet
As part of the E@syConnect Service concept, Radisson Blu hotels offer Free Internet access. High-speed and/or wireless Internet access is now free of charge for all guests throughout the hotel.
Grab and Run
For our guests on the go with no time for a sit-down breakfast, we offer the Grab & Run takeaway breakfast. Tea and coffee in disposable cups along with fresh fruits and energy bars are available on a special table in the lobby.
Super Breakfast
The Radisson Blu Super Breakfast is an extensive buffet featuring a range of food items selected from the best of Continental, North European, and American cuisine.
Express Checkout
For our guests in a rush we offer Express Check-Out to save valuable time and ensure an efficient and accurate check-out, by offering the options of sending invoice by email, mail or a quick pick-up at the reception desk.
Late Checkout
Check-out from Radisson Blu hotels as late as 6 p.m. (subject to availability) instead of the normal check-out time at no extra cost. Our aim is to accommodate the needs of our guests and offer tailor made flexible solutions.
Express Laundry
The average guests stays at a hotel for less than two days, which makes getting laundry done a complicated matter. But at Radisson Blu we have dispensed of this complication with 3-Hour Express Laundry. All shirts, blouses, socks, underwear, pants and other pieces of clothing, handed in before 8pm. will be returned fresh and clean that same evening.
One Touch Service
All guest needs, whether it is room service, a question for the concierge or a special request, are taken care of at the touch of a button. Just press the One Touch Service button on your room telephone and let us take care of you.
100% Guest Satisfaction
Our goal at Radisson Blu is 100% guest satisfaction, which we guarantee. If you aren't satisfied with something, please let us know during your stay and we'll make it right or you won't pay.


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Apostles Creed Episcopal Church Usa
A selection of articles related to apostles creed episcopal church usa.
Original articles from our library related to the Apostles Creed Episcopal Church Usa. See Table of Contents for further available material (downloadable resources) on Apostles Creed Episcopal Church Usa.
- The Pagan Roots of Democracy
- I stepped into the voting booth with civic pride and religious inspiration. The pastors urged the congregation to renew America and vote for a good Christian man, Ronald Reagan. I voted a straight Republican ticket. Those godless Democrats were no better than...
Saga of Times Past >> History & Anthropology
- Christ's Role, As He Might Have Meant It: a Discussion
- It seems that organized religion has assumed the role of Christ in the dispensation of Truth, be it relating to the church itself or in the very Word of God. The Pope, when speaking in his official capacity, is considered to be the mouthpiece of God."...
Religions >> Christianity
- Truth, Lies and the Holocaust
- Any fool can tell the truth, but it requires a man of some sense to know how to lie well. -Samuel Butler Over the years, I have heard many tales of tragedy and persecution committed against Neo-Pagans around the country. From folks losing jobs, losing...
Saga of Times Past >> History & Anthropology
- The First Congregational Church of Wicca
- Witchcraft is a religion of field and grove, river and stream. In coven or individually, we perform rituals to renew our connections with the Goddess and God. However, what suits one may not answer the needs of another. This need is being satisfied by a new...
Religions >> Paganism & Wicca
- The Sacred Wheel: The Sabbats
- The Wheel of the Year honors the never ending cycle of life, death, and rebirth. It expresses the belief which Pagan religions hold that time is circular, not linear. The Sabbats are derived from the rich traditions of seasonal festivals as celebrated by...
Paganism & Wicca >> Holidays
- Martin Luther
- Martin Luther was a German theologian, a priest and a monk, a scholar and a writer. He was the leading figure of the Protestant Reformation.
Saga of Times Past >> Biography
- Story of the Celts: The Celts of Ireland
- The Celts of Ireland [ 33 ] The Celts arrived in Ireland by 350 B.C (some say earlier) and they thrive there to this day. A claim might be made that the Celtic Irish are among the world's oldest nationality groups. Despite periods when foreigners tried in...
History & Anthropology >> Celtic & Irish
Apostles Creed Episcopal Church Usa is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Apostles Creed Episcopal Church Usa books and related discussion.
Suggested News Resources
- Sts. Joseph and Patrick Are March's Mercy Men
- Church Calendar
- 10 a.m. Christ Episcopal Church will offer worship at 802 Harrison Ave.
- Weekly entertainment calendar
- Holy Communion Episcopal Church: Lake Geneva Symphony "Chamber Concert," 3 p.m. March 13, 320 Broad St.
- What Presiding Bishop Michael Curry Means by "Core Doctrine"
- Today, the idea of "Core Doctrine" has been floated in order to shield the Episcopal church from the separation it faces as a result of its adoption of a new doctrine of marriage that permits same-sex marriage. Unfortunately for those in the ...
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Apostles Creed Episcopal Church Usa Topics
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FlexbookDerived from the words "flexibility" and "textbook", Flexbook is a free open source textbook platform that can be used to build and edit collaborative textbooks. Flexbook is an open-content, web-based collaborative model that enables educators to customize content by repurposing what needs to be taught while adhering to the local education standards. Flexbook is maintained by the CK-12 Foundation, a non-profit organization with a goal of reducing the cost of textbook materials for the K-12 market both in the U.S. and worldwide.
Stay up to date on the latest developments in Internet terminology with a free weekly newsletter from Webopedia. Join to subscribe now.
Webopedia's student apps roundup will help you to better organize your class schedule and stay on top of assignments and homework. Read More »List of Free Shorten URL Services
A URL shortener is a way to make a long Web address shorter. Try this list of free services. Read More »Top 10 Tech Terms of 2015
The most popular Webopedia definitions of 2015. Read More »
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text: Spivey Hall Join WCLK's Mark Angel for Spivey Hall's Concert featuring The Julian Lage Trio (VIDEO) By Ray Cobb • Apr 22, 2016 Join WCLK's Mark Angel Saturday night, April 23 at Spivey Hall for The Julian Lage Trio. Lage along with Jorge Roeber on bass and Kenny Wollsen on percussion will play original music as well as standards of the American jazz and folk traditions. The Trio draws influence from modern jazz guitar trio of Jim Hall as well as operating as sonic laboratory for exploring the integration of acoustic and electric instruments in an improvising context. Regina Carter @ Spivey Hall Saturday Night, Talks Jazz With Jamal Ahmad By Rob Maynard • Jan 24, 2014 Regina Carter and her Quartet are appearing at acoustically perfect Spivey Hall at Clayton State University Saturday night at 8:15pm. Carter, one of the pre-eminent jazz violinists of her era. Her mixtures of classical jazz and international music stylings have attracted listeners and admirers the world over, she received a Macarthur Foundation Genius Grant in 2006. Her quartet for the Atlanta performance includes Xavier Davis on piano, Jesse Murphy on bass, and Alvester Garnett on drums.


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Category Archives:Collections
Mary Jane Elliott
Have you been hassled by a collections agent or sued by Mary Jane Elliott, P.C.?
Daily thousands of people in Michigan are sued in debt collections action. These occur when holders of debt hire aggressive debt collections attorneys or collections agencies. Being the target of one these organizations can be a painful experience, as collections teams generally use harassing tactics to track you down and collect. These can include aggressive phone calls, visits to your home, and hostile mail.
One of the firms known for engaging in debt collection actions is Mary Jane Elliott, P.C.. Professionals at Mary Jane Elliott P.C. represent creditors and are experts at finding you and turning your money over to creditors, be it through bank garnishments, wage garnishments, judgments, or repossession. These representatives are highly skilled and should not be taken lightly, as they utilize the latest call recording and telephonic systems, collection strategies and comprehensive negotiating methods to recover delinquent debt. They will aggressively come after you, and find any possible current or future income to satisfy their clients.
Some agencies don't stop in pursuit of your debt, and even add interest and fees to make their collections more profitable. These firms rely on unknowing debtors who simply do not have the resources to tabulate interest. However, this is a violation of the Federal Fair Debt Collection Practices Act. Still, some firms have expert training of the FDCPA and know how to navigate around the law to continue using unfair practices. If you have been a victim of this, or any harassment from a collections agency, the attorneys at Garmo & Kiste PLC are here to fight for your rights.
Sued by Mary Jane Elliott, P.C. we can help:
While one may think that this could not happen to them, Mary Jane Elliott, and agencies like them are willing to use aggressive tactics for any type of debt. Most targets are sincerely trying to pay back any debts, but do not have the resources to do so. When a creditor uses agencies such as these they may eliminate the opportunity for the party in debt to work something out. This leaves the target of collections actions in a very vulnerable and unpredictable situation. Don't find yourself in this position, if you are having trouble with a debt collector or have been sued by a law firm such as the Mary Jane Elliott, P.C.,call Garmo & Kiste, PLC at (248) 398-7100 for a free consultation or contact us with a private message.
More subject specific information, please click on the following Article links:
Leikin Ingber and Winters PC Lawsuit? We Can Help
With Debt Collection, Communication Can Cost You
Are you currently being pursued in a debt collection action? Communication between the debt collection agency and yourself can mean more than you think. Collections agency and debt collections law firms are regularly trying to navigate their way around the Federal Debt Collections Practices Act. The FDCPA is a federal law that prevents collections agencies from using nefarious methods to collect debts from their targets. While the law is a good step in consumer advocacy, organizations still find ways to use unfair practices in pursuing your current or future income. Part of the FDCPA prohibits a debt collector from using "any false, deceptive, or misleading representation or means in connection with the collection of any debt". However, what constitutes a false, deceptive, or misleading representation is not always obvious. Further, when a communication is in connection with the collection of debt can vary as well.
If you are having trouble with a debt collector, or have been sued by a law firm such as Leikin Ingber and Winters PC, call Garmo & Kiste, PLC at (248) 398-7100 for a free consultation or contact us with a private message
In the past Leikin Ingber and Winters PC has represented clients such as St. John's Hospital, Flagstar Bank, Beaumont Hospitals, and other regional and national banks and hospitals,even insurance providers they are located in Southfield Michigan, and we have dealt with them them numerous times over the years.
If you have an outstanding debt, have been harassed by collections agencies, contacted by illegitimate debt collections scams, or pursued by a law firm such as Leikin Ingber and Winters PC, the attorneys at Garmo & Kiste, PLC are here to fight for you. Please contact Garmo & Kiste, PLC at (248) 398-7100 or send us a private message.
Sued by Stillman Law Office in Michigan? We can help
Sued by Stillman Law Office in Michigan? We can help
If you owe a creditor money, they have various ways they can go about collecting a debt, some more friendly to the debtor than others. But the most direct avenue a creditor can use to collect debt is to hire a aggressive law firm or debt collection agency. The Stillman Law Office is just that, and once hired, they will use all of their resources to collect what they can from you. Law offices and debt collections agencies regularly add interest or fees on to your debt to make their collections more profitable. These fees often go unnoticed by their targets, who typically just have a sincere interest in settling their debts, and don't have the resources to accurately tabulate interest. If the Stillman Law Office, or any debt collector has used these practices against you, then they could be in violation of the Federal Fair Debt Collection Practices Act, and we can help. If you are having trouble with a debt collector or have been sued by a law firm such as the Stillman Law Office, call Garmo & Kiste, PLC at (248) 398-7100 for a free consultation or contact us with a private message.
The Stillman Law Office, and many debt collection agencies use of state of the art 'collection partner' software system, which is tailored specifically to their needs of tracking accounts and handling all phases of the collection. This is a particularly scary aspect of being a target of a collection agency, as they are usually working with a business that has a wealth of personal information about you that the agency can use to find and collect from you. This information generally includes birthdays, social security numbers, addresses, and phone numbers. Further, the Stillman Law Office promises fast recovery to their clients in the form of law suits, judgments, attachments, repossessions, and both wage and bank garnishments.
The personal information that agencies have is important to keep in mind because not all debt collection communications are necessarily legitimate. Different from the legitimate debt collection actions taken by action creditors, debt collection scams are increasingly common. Consumers have reported frightening phone calls demanding payment of outstanding payday or even check cashing loans. Sometimes these callers claim to be a representative of a law firm, or even the government, and probably won't abide by the rules of the FDCPA.
Dealing with debt collectors, legitimate or otherwise, can be a draining and painful experience. If you are in this position the attorneys at Garmo & Kiste, PLC are here to fight for you.
If you have outstanding debt, have been harassed by a debt collection agency or contacted by a law firm such the Stillman Law Office, please contact us at (248) 398-7100 or send us a private message.
More subject specific information, please click on the following Article links:
- Arbitration Defense
- Bankruptcy
- Car / Automobile Repossession Defense
- Collections Defense
- Credit Card Debt Collection for an Authorized User
- Mortgage and Equity Line Negotiation
- Personal Guarantees Concerning Business Debts
- Remove a Wage, Tax or Bank Garnishment
- Installment Payment Orders
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Sued by Ally Financial, Inc.?
Sued by Ally Financial, Inc.? Do you owe money for unpaid car, credit card, or various loans? Have you fallen behind on your payments? Many individuals find themselves in a difficult situation, unable to pay off their loans, due to unforeseen circumstances such as the loss of a job. In these instances, consumers should be aware of all options available in order to protect themselves in the event that the creditor takes legal action against them.
If you have been sued by a financial institution such as Ally Financial, Inc. or have fallen behind on loan payments there are a few things you should know. Ally Financial, Inc., like many companies, is multi-faceted and includes the subsidiary of Ally Bank. This company issues a number of loans and may take action to collect them on its own behalf. In some instances the companies are willing to settle. An experienced debt defense attorney can help you achieve the best possible outcome. Further, some companies may exercise abusive debt collection behavior so it is important to be informed of what is not permitted behavior.
Alternatively, if you have not been sued by your creditor, you should know that you do not necessarily have to wait until the company makes the first move. In fact, it may be more advantageous to consult a debt defense attorney before that point in order to discuss your options.
The collections process can be challenging to undergo. If a creditor such as Ally Financial, Inc. has sued you or if you've fallen behind on your payments and would like a free consultation, please contact the attorneys at Garmo & Kiste, PLC at (248) 398-7100 or contact us with a private message.
For more subject specific information, please click on the following Article links:
The Right to Be Forgotten and Search Engines
The Right to Be Forgotten and Search Engines:
Google, the world's most popular search engine, capitalizes on human curiosity by connecting users to seemingly infinite amounts of information. Though this may be incredibly helpful for users, it may also be detrimental to individuals about whom information is posted. The Court of Justice of the European Union sought to prevent detriment to these individuals in its May 13, 2014 decision to uphold Directive 95/46/EC, a European law protecting data on the basis of privacy, in Google Spain SL, Google Inc. v AEPD. This case concerned Google-generated links to a newspaper article about the repossession of a Spanish man's home. The ruling stated that Google must remove links to data that is "inadequate, irrelevant or no longer relevant, or excessive in relation to the purposes for which they were processed and in the light of the time that has elapsed" from the search results it posts after a query. In essence, this prohibits Google from posting links to information that is dated or irrelevant.
This ruling pits the right to privacy against freedom of information and functionally limits users' ability to access certain types of information. This ruling has been heralded by individuals as a landmark for the right to privacy, colloquially referred to as the "right to be forgotten". Conversely, many consider this a form of censorship.
Google has expressed concern about complying with this ruling and about the limiting effect on the dissemination of information.
In an effort to comply, Google posted a web form that allows European citizens to request the removal of a link. Thousands of Europeans have filed requests for links to be taken down.
Whether you agree with this holding on the basis of privacy or oppose it on the basis of freedom of information, the holding is not controlling in the United States. Though it is not binding, it may be a sign of issues to come in U.S. courts regarding the right to privacy in this heavily internet-reliant nation. Contact Garmo & Kiste, PLC at (248) 398-7100 for a free consultation or send us a private message.
how is judgment interest calculated in Michigan?
How is Judgment Interest Calculated in Michigan?
Michigan has specific rules regarding the calculation of damages in civil cases to ensure that Plaintiffs are adequately compensated. Under MCL 600.6013(8), you are entitled to receive interest on a money judgment recovered in a civil action at 6-month intervals from the date of filing at a rate of interest equal to 1% plus the average interest rate paid at auctions of 5-year United States treasury notes during the 6 months immediately preceding July 1 and January 1, compounded annually. Interest under this subsection is calculated on the entire amount of the money judgment, including attorney fees and other costs. The inclusion of attorney fees in the calculation is particularly beneficial to a prevailing plaintiff. A table of historical interest rates can be found below.
The basic rule outlined above may be modified in instances where the complaint is based on a written instrument that identifies an interest rate to be used in the calculation of damages. Under MCL 600.6013(5)-(7), complaints filed on or after July 1, 2002 that are based on a written instrument with a specified interest rate, the interest is calculated from the date of filing the complaint to the date of satisfaction of the judgment at the rate specified in the instrument if the rate was legal at the time the instrument was executed. In the case of complaints filed on or after January 1, 1987 but before July 1, 2002 that are based on a written instrument, the interest is calculated from the date of filing the complaint to the date of satisfaction of the judgment at the rate of 12% per year compounded annually, unless the instrument has a higher rate of interest. In that case, interest shall be calculated at the rate specified in the instrument if the rate was legal at the time the instrument was executed. However in both of these instances the rate may not exceed 13% per year compounded annually after the date judgment is entered.
These rules apply only to complaints filed on or after January 1, 1987. The interest rates for money judgments filed before that date are governed by MCL 600.6013 (2)-(4). In all of these situations the date of filing is central to the calculation. It is important to note that interest does not accrue on future damages from the date of filing the complaint to the date of entry of the judgment and the amount of allowable interest may be different in settlement and medical malpractice scenarios under MCL 600.6013(1) and MCL 600.6013 (9)-(13).
If you have questions about a judgment, contact the attorneys at Garmo & Kiste, PLC. We have handled hundreds of cases in Metro-Detroit, granting us an extensive knowledge of the courts in this area. For more information about traffic law or to retain Garmo & Kiste, PLC call us at (248) 398-7100 for a free consultation or contact us with a private message.
The Fair Debt Collections Practices Act
The Fair Debt Collections Practices Act (FDCPA) is a key piece of legislation that protects consumers from inappropriate debt collection behavior. It is not uncommon for companies to utilize extreme tactics in order to attempt to collect sums of money. So where does the statute draw the line between acceptable debt collection behavior and those that are unacceptable? The following are examples of behaviors the FDCPA has deemed illegitimate.
- Under Section 805, the debt collector may not communicate with a consumer in connection with the collection of any debt at any unusual time or place. The general rule the FDCPA establishes is that the window for communication is between 8 am and 9 pm. Additionally, if you have hired an attorney to represent you in regard to the debt collection, the debt collector is not permitted to communicate with you unless your attorney is not responding.
- Further, under Section 806, a debt collector may not engage in any conduct which consequentially harasses, oppresses or abuses any person in connection with the collection of a debt. This includes violent threats, using obscene or profane language, and repeatedly calling with the intent to annoy, abuse or harass.
- There are other illegal behaviors that are more subtle including making false, deceptive or misleading representations in connection with the collection of debt such as falsely representing the amount of debt, implying that an individual is an attorney when they are not, and threatening legal action that cannot be taken.
If a debt collector fails to comply with this law, they are liable for the actual damages sustained as a result of their breach and other damages up to $1,000.00. As a consumer, it is important to know your rights and defend them when they are infringed upon. If a debt collector has employed any of the tactics above or engaged in other questionable conduct, contact the attorneys of Garmo & Kiste, PLC at (248) 398-7100 or send us a private message for more information about what to do next.
Michigan Credit Reporting Error Repair Attorneys
Michigan Credit Reporting Error Repair Attorneys:
Checking your credit report is one of the most important things you can do as a credit consumer. The three main credit reporting agencies, Experian, Equifax, and TransUnion, are responsible for maintaining credit files of millions of Americans. Some of these credit files have errors. In fact, the FTC conducted a study of the U.S. credit reporting industry in 2012 which revealed that 5% of consumers had significant errors on at least one of their three credit reports. This study highlighted the importance of regularly checking your credit report for errors. These errors can lead to lower credit scores. Lower scores have a serious impact on your wallet.
So how can you get your credit report? The Federal Credit Reporting Act dictates that each of the three main credit reporting agencies must provide consumers with a free copy of their credit report once a year, upon request. To order your credit report, call 1-877-322-8228 or visit AnnualCreditReport.com for a printable order form. You may also purchase a copy of your report by contacting the agencies individually.
What do mistakes look like? Some agencies may report mortgages that were the subject of short sales as foreclosures, include debts that were paid off, report negative factors that had to do with documented identity theft that were out of your control, or even post debts that belong to someone else.
What should you do if you find a mistake? First, you should write a letter to dispute the mistake with the credit agency that reported it. Some individuals successfully proceed with the dispute process. However, many consumers find that credit agencies don't always resolve these situations or even respond to communications. These are the individuals that may need to take legal action in order for the agency to fix the mistake. The Fair Credit Reporting Act provides remedies to consumers that have mistakes on their credit report. Consumers may, through legal action, recover actual damages that resulted from the mistake such as economic harm and emotional distress and punitive or statutory damages in some situations. If you have found a mistake and are having a difficult time with a credit reporting agency, call the attorneys at Garmo & Kiste, PLC. We will help you take the steps necessary to resolve the situation. Contact Garmo & Kiste, PLC at (248) 398-7100 for a free consultation or send us a private message.
For more subject specific information, please click on the following Article links:
Michigan Spot Delivery and Automobile Dealer Fraud Attorneys / Spot Delivery and Yo-Yo Financing
Michigan Spot Delivery and Automobile Dealer Fraud Attorneys / Spot Delivery and Yo-Yo Financing:
Purchasing a car is a very exciting life event. You find a match, sign the paperwork, make a down-payment and get the keys. Most consumers would assume that's the end of the transaction but a certain practice conducted by some dealerships may make it possible for the dealership to reclaim the vehicle at a later date and time. This practice is called Spot Delivery. This is when a car dealership will tell a customer that they have been approved for financing and complete the paperwork and sale without knowing if a finance company will actually purchase the customer's credit contract. The dealership will give the customer a temporary registration number and if a finance company will not purchase the customer's credit contract, then the dealership may decide to reclaim the vehicle. This is called Yo-Yo financing. The dealership may employ deceptive tactics to regain possession of the property including luring customers in under false pretenses such as the opportunity to receive free services. Sometimes the dealership will even refuse to return the down payment.
Not only is Spot Delivery unethical but this is considered an illegal practice in Michigan. Customers that have suffered from this practice may recover the value of the vehicle and sometimes other damages under the Truth In Lending Act and the Michigan Credit Reform Act.
If you have been the victim of Spot Delivery or Yo-Yo Financing, call the attorneys at Garmo & Kiste, PLC. We are experienced attorneys that will fight for your rights. Contact Garmo & Kiste, PLC at (248) 398-7100 now for a free consultation or contact us with a private message.
For more subject specific information, please click on the following Article links:
Revocation of Paternity Act, Changes and New Developments
Revocation of Paternity Act, Changes and New Developments:
The revocation of paternity act was enacted and became immediately effective on June 12, 2012. The new procedure for revoking paternity allows for mothers, alleged fathers, or affiliated fathers to bring an action to revoke a determination of paternity. Each potential petitioner has to satisfy different tests.
The mother may file under one of two options. Under the first option, the mother must identify the alleged father by name and the presumed father. The alleged father and the mother must have at some time mutually and openly acknowledged a biological relationship between the alleged father, AND the action must be filed before the child is three years old. Under the second option, the mother must identify the alleged father by name. Additionally, where the presumed father has the ability to pay and without good cause, either
- the presumed father has failed or neglected to provide regular and substantial support for two years; or
- has failed to substantially comply with a support order for two years; or
- the child is less than three years of age and the presumed father lives separately and apart from the child.
These are fairly restrictive requirements.
The requirements for a presumed father are more lenient. A presumed father is a man who is presumed to be the child's father by virtue of his marriage to the child's mother at the time of the child's conception or birth. MCL 722.1433(4). In order to bring a Petition, a presumed father may file to exclude a child from his marriage if he files before the child turns three, or if he raises the issue in a divorce or separate maintenance action between the presumed father and the mother.
An alleged father is a man who could have fathered a child. MCL 722.1433(3). For an alleged father to file to exclude a child from a marriage, he must do so under one of three options.
- The alleged father must show he did not know or have reason to know that the mother was married at the time of conceptions, and the presumed father, alleged father, and mother at one time mutually and openly acknowledged a biological relationship between the alleged father and the child, and the child is not yet three, and the child's paternity is or will be determined by a court; or
- The alleged father must show that he did not know or have reason to know that the mother was married at the time of conception and either
- The presumed father, having the ability to support the child has failed and neglected without good cause to provide regular and substantial support for two years
- Or has failed to substantially comply with a support order for two years; or
- The child is less than three, and the presumed father lives separately from the child, and the child's paternity is or will be established by court.
One interesting fact is that a judgment under the RPA does not relieve a man from a prior support obligation. MCL 722.1443(3). This is consistent with the fact that you cannot retroactively contest child support, one may only contest it going forward.
One outstanding issue yet to be worked out by the courts is the future of Serafin motions. While the RPA was enacted in June 2012, so portions of it did not become active until June 12, 2014. As such, the common law relief of a Serafin motion, based on the case Serafin v Serfin, may no longer be available after that time. These motions allowed for the presumption of legitimacy of marriage to be rebutted based on clear and convincing evidence. Some have argued this relief was intended to be concurrent despite the fact that the section of the RPA provides a different remedy for the same problem. This has yet to be clarified by courts.
If you or a family member are facing an issue with respect to paternity, it is important to hire an experienced attorney who can navigate the ever changing contours of this complex law. To retain Garmo & Kiste, PLC, for assistance in these matters call us at (248) 398-7100 for a free consultation or contact us with a private message. We are experienced Michigan attorneys with offices in Troy, MI.


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Fog descends on Northeast
Heavy fog blanketed the Northeast Wednesday, Jan. 15, causing flight delays, traffic accidents and creating some interesting visual scenes. Associated Press and Mercury staff photosRead More
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Dense fog caused poor visibility for motorists and falling temperatures caused roads to become slick with black ice. There were a number of crashes across the tri-county area Wednesday, Jan. 15, 2014. Upper Pottsgrove police and Upper Pottsgrove Fire Company were on the scene of a crash on Levengood Road in Upper Pottsgrove, Pa., shortly after 7 a.m. Wednesday. (Photo by John Strickler/The Mercury)


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Panelists (left to right): Charles Werner, Stacey Arnesen, Kirby Felts, Nick Drauschack, Sammy Chao, Ryan McCay, John Halliday, Director, Jefferson Madison Regional Library, at the podium
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- Geek Squad - Davenport IA (Inside Best Buy)Our Agents provide repair, installation and setup services on all kinds of tech – including computer repair, setup and support, TV repair, home theater installation, car stereo installation and home appliance repair. We fix most makes and models, no matter where you bought them, and can show you how to get the most out of your technology.
- Appliance Repair
- Computer & Tablet Setup
- TV/Home Theater Setup
- WiFi/Networking Setup
- Car/GPS Setup
- Technology Consultation
- Apple ShopMac, iPod, iPad, iPhone, Apple TV, Apple Watch and more at this Apple store-within-a-store.
- Windows StoreOnly at Best Buy, find the best of productivity and fun in the perfect device in the Windows Store. From Surface, to tablets, laptops and all-in-one computers, the Windows store has it all. Plus, enjoy all the expert service you need to get started.
- Samsung ExperienceWhen you're looking for the next level of customer service, expertise, and support you need for Samsung mobile devices or Samsung Home Theater products, visit Best Buy and tour the Samsung Entertainment Experience and the Samsung Experience Shop- only at Best Buy!
- Car & GPS Installation ServicesLet our Autotechs take the hassle out of installing your new car electronics and have peace of mind it's done right. Schedule an appointment online.
- Store Trade-In InformationThis store offers Trade-In on eligible items including mobile phones, tablets, other hardware, and video game software purchased anywhere. Participating stores may have additional requirements.Determine the value of your Trade-InFor eligibility and details, please see our FAQs
- Electronics RecyclingWe offer electronics recycling at this and all other U.S. stores.
- Best Buy MobileGet informed advice from noncommissioned mobile phone specialists
- Best Buy Marine Powered by Geek SquadGet your marine navigation, home theater and audio solutions, communication devices (VHF radios), security, and more! We also provide onsite consultation and installation services by the Geek Squad Autotechs.
- Best Buy For BusinessIn store, online, on the phone, or at your worksite, Best Buy is here to help you find the right products and technology solutions for your business.
Our Location
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News & Events
- Join us at Best Buy on October 27th at 11:01 PM and be among the first to play the hottest new games when you attend one of our late-night store opening events.Learn More
- Join us at Best Buy on November 3rd at 11:01 PM and be among the first to play the hottest new games when you attend one of our late-night store opening events.Learn More
- Try it Out. Wrap it up.Learn More
Join us on Saturday November 5th from 1 – 5 pm for demonstrations and exclusive savings on brands like Apple, Microsoft, Samsung, Sony and more. Demonstrations by your favorite Geek Squad Agents and Blue Shirts.
· Dash - Introduce your child to the world of robotics with Wonder Workshop Dash. This fun friend responds to voice commands and can sing and dance on command.
· Ring - Receive instant alerts when someone presses the button on your Ring® Video Doorbell or when motion is detected, via the free Ring® app (iOS® and Android™). See and speak with visitors from anywhere using your smartphone, and watch recorded footage anytime with Cloud Recording.
· BB8 Spiro - Show off your Jedi mind tricks with help from this Sphero BB-8 and Force band set. The BB-8 robot rolls about the room, mimicking the favorite character's movie movements.
· Google Home - A voice-activated speaker powered by Google Assistant that allows you and your family to get answers from Google, stream music, control devices around the home and manage everyday tasks. Just start by saying, "Okay, Google."
· OverDryve - Available exclusively at Best Buy, OverDryve is a revolutionary connected car device that brings advanced luxury car features to any car, maximizing the driver's capabilities and minimizing distraction. (*available in select stores)
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Try It Out. Wrap It Up.Test the season's hottest tech with your favorite Geek Squad Agent on Saturday, November 5 from 1–5 p.m.Learn more about the event
Samsung Open HouseDiscover innovative appliance technologies
Discover Top DealsSee the Deals
NOW HIRING FOR EXCITING CAREERSAt Best Buy you'll be surrounded by cutting-edge technology and work with energetic people who like having fun helping people. To find openings at this store, select the city this store is located in from the Select a Location drop-down list and click Search.See Current Job Openings
SLOW COMPUTER? HAVE A VIRUS? GEEK SQUAD CAN HELP.With a Geek Squad® 24/7 Support plan, you'll get continuous help with common problems like a slow computer, strange pop-ups, viruses and other malware. Agents are available online, on the phone and at Best Buy stores.Learn More
LOST YOUR DATA?Whether you accidentally deleted a file or your hard drive crashed, we have specially trained Geek Squad Agents dedicated to recovering those files, photos and songs you just can't do without.Learn More
About Best Buy Davenport
At Best Buy Davenport, we specialize in helping you find the best technology to fit the way you live. Together, we can transform your living space with the latest HDTVs, computers, smart home technology, and gaming consoles like Xbox One, PlayStation 4 and Wii U. We can walk you through updating your appliances with cutting-edge refrigerators, ovens, washers and dryers. We'll also show you how to make the most of your active lifestyle with our huge selection of smartphones, tablets and wearable technology. At Best Buy Davenport, we'll keep your devices running smoothly with the full range of expert services from Geek Squad®. We're here to help, so visit us at 5153 Elmore Ave in Davenport, IA to find the perfect new camera, laptop, Blu-ray player, smart lighting or activity tracker today.
About Geek Squad Davenport
No one stands behind you like Geek Squad. The Geek Squad Agents at Best Buy Davenport are ready to help. More than just a computer store, we've got the tools, knowledge and experience to turn questions into answers and issues into fixes. Whether you're in need of cell phone repair or you're wondering "Where is there reliable appliance repair near me?" visit us at 5153 Elmore Ave to see how we can help and learn more about our services including appliance repair, tablet and computer repair and setup, TV repair and home theater setup, WiFi/networking setup, car stereo installation and GPS setup, and technology consultation. We'll give you advice on how you can get the most out of your technology and help troubleshoot it when it's not working properly.
Geek Squad Agents across the U.S. are trained to work on a full range of technology, including computers, tablets, TVs, home theater, car audio, home appliances and more. We'll install, set up, protect, support or repair your product. Because bad luck deserves good coverage, Geek Squad Protection Plans are also available at your local Best Buy Davenport to ensure your technology is working like new. We support and fix most brands, makes and models – no matter where you bought it, unlike many computer stores and appliance stores. So for those looking for more than just "computer stores near me," Best Buy Davenport gives you expert cell phone repair, computer repair, washer repair, refrigerator repair, dryer repair and dishwasher repair.
Can't make it into the Best Buy Davenport store? Geek Squad has over 20,000 Agents available 24/7/365* to help online and over the phone. Plus, we can always schedule an Agent to come out to your home or office.
*24/7/365 support availability is limited to remote online chat and over the phone.


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The General Store is a casual marketplace stirring that unmistakable vacation-day feeling. After all, adventures often begin with a full tank of gas and snacks for the road.
Browsing for a smile? Unique jewelry styles and decorative conversation pieces cover the General Store's shelves and dangle from its eaves. To tailor a gift to a friend or a theme, hand-pick a combination of items for a gift basket, wrapped with all the fixings by General Store attendants. Wire baskets wedged with classic goodies and gourmet pantry items complete the nostalgic shopping revival. Look for Walker's Bluff's signature products, like sweet preserves.
The General Store's casual eats always hit the spot. Breakfast on a Saturday morning. A hot roast beef sandwich for lunch. Wine with a sunset. Pastries and cakes can be enjoyed by the slice or in full pre-orders. Grab an old cold favorite or craft beverage from the back wall of coolers and pick your place on the porch. In the winter, sidle up to the fireplace and its string of cafe tables.
In 2009, A legendary storm bent the better part of southern Illinois. Sheets of wind devastated the 56-year home of Nettie Jenkins, who suggested Walker's Bluff rehab her land for a proper "front door" to the growing complex. Walker's Bluff agreed, and the General Store extends a neighborly welcome in Jenkin's stead.