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Activation and coagulation biomarkers were measured within the SMART trial. Their associations with opportunistic disease (OD) in HIV-positive patients were examined.
Inflammatory (high-sensitivity C-reactive protein [hsCRP], interleukin-6 [IL-6], amyloid-A, and amyloid-P) and coagulation (D-dimer and prothrombin-fragment 1+2) markers were determined. Conditional logistic regression analyses were used to assess associations between these biomarkers and risk of OD.
The 91 patients who developed an OD were matched to 182 controls. Patients with hsCRP≥5 μg/mL at baseline had a 3.5 (95%CI: 1.5-8.1) higher odds of OD versus those with hsCRP<1 μg/ml, Ptrend=0.003, and patients with IL-6≥3 pg/mL at baseline had a 2.4 (95%CI: 1.0-5.4) higher odds of OD versus those with IL-6<1.5 pg/mL, Ptrend=0.02. No other baseline biomarkers predicted development of an OD. Latest hsCRP (OR: 7.6 (95%CI: 2.0-28.5) for those with hsCRP≥5 μg/mL versus hsCRP<1 μg/mL, Ptrend=0.002), latest amyloid-A (OR: 3.8 (95%CI: 1.1-13.4) for those with amyloid-A ≥6 mg/L versus amyloid-A <2 mg/L, Ptrend=0.03) and latest IL-6 (OR 2.4 (95%CI: 0.7-8.8) for those with IL-6≥3 pg/mL versus IL-6<1.5 pg/mL, Ptrend=0.04) were also associated with developing an OD.
Higher IL-6 and hsCRP independently predicted development of OD. These biomarkers could provide additional prognostic information for predicting risk of OD.
The SMART trial (Strategies for Management of Antiretroviral Therapy) was designed to examine the effects of intermittent treatment in HIV-positive patients compared to continuous antiretroviral therapy (ARV). Those randomised to the intermittent arm had a 2.6-fold (95% confidence interval [CI]: 1.9 to 3.7) increased odds of opportunistic disease (OD) or death compared to those in the continuous arm [1]. A nested case-control study within SMART found that baseline elevations of D-dimer and interleukin-6 (IL-6) identified HIV-infected patients at overall increased risk of death, and that increases in biomarkers were greater for those on intermittent therapy compared to those on continuous therapy [2]. However, only 8% of deaths in SMART were due to OD so it is not clear if elevations of biomarkers can also identify patients at risk for development of OD.
Persistent activation of inflammatory markers appears to have long-term pathological consequences and has been implicated in the pathogenesis of atherosclerotic disease and development of neoplasia [3-6]. Cytokine activation is also an independent risk factor for death in other immunosuppressed patient groups such as those with end stage renal disease [7,8]. Observational studies have demonstrated that HIV-infected patients have higher inflammatory markers (i.e. C-reactive protein, CRP) and cytokines (IL-6) when compared to non HIV-infected patients and levels of inflammatory markers increase in advanced disease and are predictive of poorer outcome [9-14]. High-sensitivity CRP (hsCRP) is an acute phase protein that increases during acute and chronic inflammatory disorders and has been shown to predict survival in HIV-infected patients [13]. Serum amyloid A production is largely regulated by inflammatory cytokines and possibly plays a role in carcinogenesis although the exact mechanism is poorly understood. [15]
The relationship between elevated levels of biomarkers and HIV is still unclear, in particular whether elevations in biomarkers such as hsCRP and IL-6 can identify patients at risk of OD.
This nested case-control design within the SMART trial is the first study to examine associations between markers of inflammation and the development of an OD (focussing on the first OD that occurred whilst under follow-up), both in virally suppressed patients receiving continuous ART and in those receiving interrupted ART as dictated by their immunologic status. We hypothesised that elevations in levels of biomarkers could be used to identify patients at particular risk of development of an OD in the clinical setting.
The methods and results of SMART have been published elsewhere [1]. In summary, 5472 patients with CD4+ counts >350 cells/mm3 were enrolled from 318 sites in 33 countries. Patients were randomised to one of two ARV treatment arms; the viral suppression (VS) arm involved continuous use of ARV while the drug conservation arm (DC) involved CD4+ guided interruptions of therapy when CD4+ counts were >350 cells/mm3 and re-initiation of therapy when CD4+ counts were <250 cells/mm3. Enrolment was discontinued on January 11, 2006 following the recommendation of the study's independent data and safety monitoring board (DSMB) because of an observed increased risk of OD and death in the DC arm compared to the VS arm. ARV-experienced patients in the DC arm were subsequently recommended to re-initiate ART.
The primary endpoint in SMART was the development of new or recurrent OD or death, where clinical events were classified as OD based on the revised case definition for AIDS by the Centers for Disease Control and Prevention [1]. In SMART it was recommended that all OD events should be reported. Using pre-established criteria a multidisciplinary Endpoint Review Committee (ERC), who were blinded to the treatment arm of each individual, determined and adjudicated reported HIV progression events including the first documented OD events included in this analysis. All OD endpoints were classed as probable or confirmed against set criteria by the ERC for 17 events such as lymphoma or cryptosporidiosis where there is only a confirmed category and no probable category applied. [16]
Overall, 1361 of 1415 (96.2%) patients from US sites gave informed consent to have plasma stored at baseline and at every follow-up visit thereafter. Of the other 4057 patients, 3800 also consented to having blood stored, giving a total of 5161 patients with blood samples. The non-US based patients had plasma stored at 4 or 12 month intervals rather than at every follow-up visit.
The following biomarkers, which all have high laboratory reproducibility, were measured by the Laboratory for Clinical Biochemistry Research at the University of Vermont; hsCRP, amyloid A, amyloid P, IL-6, D-dimer and prothrombin fragment 1+2.
All the necessary institutional/ethical review board approvals were obtained. The study was approved by the institutional review board at each site, and written informed consent was obtained from all participants. The ClinicalTrials.gov identifier is: NCT00027352 and the EudraCT number is: 2004-000441-38.
Baseline and follow-up samples prior to January 11 2006 were identified for 273 patients: 91 patients who developed an OD and two matched controls per case (i.e. 182 patients). Matching was done on gender, age (+/- 5 years), date of randomisation (+/- 3 months) and country. Patients from the VS and DC arms of SMART were combined for these analyses, although comparisons were also made between treatment arms.
Follow-up samples (i.e. latest levels) were selected from the visit before the OD for cases and at the same time-point for the matched controls.
Baseline characteristics were compared between cases and controls using conditional logistic regression analysis for matched case-control studies. Patients were categorised into three groups according to the level of their biomarker at baseline (i.e. separated according to clinically relevant cut-offs or split according to the nearest round value to the tertile), and the relationship between these groups and development of an OD were examined using conditional logistic regression analyses. Separate multivariable models were created for each biomarker, where all models were adjusted for baseline characteristics that were associated with developing an OD in unadjusted analysis. All reported p-values are two-sided using a level of significance of 0.05.
The possibility of an interaction between treatment arm and both baseline and latest biomarker levels with the development of an OD was assessed.
Statistical analyses were performed using STATA (StataCorp. 2001. Stata Statistical Software: Version 10.0, College Station, Texas, USA). All reported p-values are 2-sided.
The first ODs that occurred in patients who experienced an OD were predominantly infective; 72 (79.1%) individuals experienced an infective OD, 12 (13.2%) patients developed a malignant OD and the remaining 7 (7.7%) had either HIV related encephalopathy or wasting syndrome. Of the ODs, 10 (11%) were diagnosed in months 0-3, 5 (5.5%) were diagnosed between 3-6 months and the remaining 76 (83.5%) were diagnosed >6 months after trial entry.
Of the 91 patients who developed an OD, 72 (79%) were in the DC arm. Breakdown of individual ODs was as follows: oesophageal candidiasis (n=31, 34.1%), bacterial pneumonia (n=9, 13%), Pneumocystis jirovecii pneumonia (n=9, 9.9%), herpes simplex (8, 8.8%), Kaposis sarcoma (8, 8.8%), herpes zoster (6, 6.6%), lymphoma (4, 4.4%), wasting syndrome (4, 4.4%), tuberculosis (4, 4.4%), candidiasis of bronchi (2, 2.2%) and one case each of HIV encephalopathy, cryptococcosis, CMV disease and toxoplasmosis. There was a non significant difference in TB diagnosis between treatment arms (10.5% for the VS arm vs. 2.8% for the DC arm, p=0.14). Of the 91 patients who developed an OD in this study, 13 (14.3%) subsequently died although it is not clear if that was directly due to the OD.
Table 1 shows baseline characteristics for cases and controls. The odds of developing an OD were 3.8 times greater for those randomised to the DC arm compared to those randomised to the VS arm (95% CI: 2.1 to 6.9, P<0.0001). Having a previous AIDS defining diagnosis was significantly associated with subsequent development of OD (Odds ratio (OR): 3.1, 95% CI: 1.6 to 5.9, P<0.0001) as was age at baseline (OR: 1.7, 95% CI: 1.0 to 2.9 for every five years older, P=0.04). Gender, race/ethnicity, ARV history, baseline CD4+ and plasma HIV-1 RNA levels, as well as CD4+ cell count nadir were not significantly associated with developing an OD.
In Figure 1A we grouped patients according to baseline levels of each biomarker and assessed OD development within each of the groups. The median time between the measurement of the baseline biomarker and the OD for patients who had an OD was comparable to the time between the measurement of the baseline biomarker of the control and the time that their matched case developed an OD (473 days (IQR: 237 to 803 days) and 472 days (IQR: 256 to 776 days), respectively).
In a multivariable analysis, after adjustment for baseline CD4+ count, baseline HIV-RNA levels, age and prior AIDS, both IL-6 and hsCRP demonstrated a significant trend towards an increased risk of developing an OD with increasing levels of the biomarkers at baseline. Patients with hsCRP levels ≥5 μg/mL had a 3.5 (95% CI: 1.5 to 8.0) higher odds of an OD compared to patients with hsCRP levels <1 μg/mL, test for trend p-value=0.003. In addition, patients with an IL-6 ≥3 pg/mL had a 2.4 (95% CI: 1.0 to 5.4) higher odds of an OD compared to patients with an IL-6 <1.5 pg/mL, test for trend p-value=0.02. There was no association between levels of amyloid A and P, D-dimer and prothrombin fragment 1+2 with the odds of developing an OD.
We then examined the latest value of each biomarker before the development of the OD (for controls this is latest value of the biomarker before their corresponding case developed the OD) (Table 2). There were 75 cases and 144 controls with biomarker levels recorded prior to the OD who could be included in these comparisons. The median time between the measurement of the follow-up biomarker and the OD was 73 days (IQR: 39 to 126 days) for patients who had an OD and 90 days (IQR: 33 to 161 days) for controls (i.e. time between measurement of follow-up biomarker and time that their matched case developed an OD).
Figure 1B shows patients categorised into groups for each biomarker, using the same cutoffs that were used for the baseline biomarker levels. There was a 1.5 fold (95% CI: 1.1 to 2.0, p=0.01) higher odds of developing an OD for every log10 copies/ml higher latest HIV-RNA level and a 0.6 fold (95% CI: 0.5 to 0.8, p<0.0001) lower odds of developing an OD for every 100 cells/mm3 higher latest CD4+ count. After adjustment for the latest CD4+ counts and HIV-RNA levels at the time of the OD in addition to baseline factors, all biomarkers demonstrated a trend towards an increased risk of OD with elevated levels of the biomarkers. Patients with hsCRP levels ≥5 μg/mL had a 7.6 (95% CI: 2.0 to 28.5) higher odds of an OD compared to patients with hsCRP levels <1 μg/mL, test for trend p-value=0.002; patients with an amyloid A ≥6 mg/L had a 3.8 (95% CI: 1.1 to 13.4) higher odds of an OD compared to patients with an amyloid A <2 mg/L, test for trend p-value=0.03; and patients with an IL-6 ≥3 pg/mL had a 2.4 (95% CI: 0.7 to 8.8) higher odds of an OD compared to patients with an IL-6 <1.5 pg/mL, test for trend p-value=0.04.
When baseline biomarker levels were incorporated in the models as well as latest biomarker levels, only baseline and latest IL-6 levels remained predictive of an OD, implying that baseline IL-6 still provides some information in addition to the latest IL-6 level. For hsCRP only the latest level remained predictive of an OD (data not shown).
Finally, we assessed whether the prognostic importance of elevated levels of hsCRP and IL-6 prior to the OD was also affecting and potentially contributing to the differences in risk of developing an OD in the DC versus the VS arm. Figure 2 shows that the odds of having an OD was 3.8 (95% CI: 2.1 to 6.9) times higher for patients in the DC arm compared to those in the VS arm (N=273). This is similar to the results of the main trial where the odds of having a non-serious OD was 3.6 (95% CI: 2.1 to 6.1) times higher for patients in the DC arm compared to those in the VS arm (N=5472) [1].
As expected, since baseline factors are balanced between arms, adjustment for them did not change the odds ratio substantially (data not shown). We then explored the effect of adjusting for latest levels of each biomarker. In these models, the latest levels of the biomarkers cannot explain the difference observed between the DC and the VS arms (models 4 and 5), however, both the latest CD4+ count in addition to latest HIV-RNA levels explain most of the difference between the DC and the VS arms (i.e. brings the odds ratio closer to one – i.e. models 2, 3 and 6). Overall, latest IL-6 and CRP values failed to effect the difference in the rates of ODs between the DC and VS arms alone nor did they attenuate the reduction in difference caused by adjustment for latest CD4 count and HIV-RNA levels (models 7-9)
Exploration of the interactions between each of the latest levels of the biomarkers and the treatment arm demonstrated that only one interaction was significant and that was for amyloid A (p=0.04). There was a 1.1 fold (95% CI: 1.0 to 1.2, p=0.05) higher odds of having an OD for every mg/L higher amyloid A level among patients in the DC arm, similar patterns were not seen among patients in the VS arm. Although these have limited power, tests for interaction between hsCRP (p=0.30), amyloid P (p=0.42), IL-6 (p=0.81), D-dimer (p=0.18) and F1.2 (p=0.22) did not indicate an interaction was present (Table 3).
Previous analysis of SMART data demonstrated that episodic ARV is associated with an increased risk of development of OD and that the excess risk of OD in the DC arm was most likely due to two factors; a greater percentage of time spent with CD4+ counts <350 cells/mm3 and a greater proportion of time with uncontrolled HIV replication [17].
The observed association of previous AIDS defining illness with raised risk of development of OD is supported by other studies and underlines that once a patient has had an AIDS defining illness, they remain prone to develop ODs and benefit from life-long ARV therapy [18].
Our study is the first to demonstrate the association between elevations of IL-6 and hsCRP and the subsequent development of OD in individuals with HIV-infection. We found that both baseline and latest levels of IL-6 and hsCRP were independently associated with developing an OD. An interesting aspect of this analysis was the fact that D-dimer, the most predictive biomarker of overall mortality in SMART was not significantly associated with OD [2]. This likely reflects the contribution of cardiovascular disease (diagnosed and undiagnosed), which is associated with elevated levels of D-dimer, to overall mortality as only 8% of the deaths in SMART were due to OD [1]
In this paper we examined the associations between biomarker levels, which reflect cytokine activation and inflammation, and the development of an OD. The concept that chronic immune activation plays a role in AIDS pathogenesis is not new, but the exact mechanism remains unclear [19, 20]. In observational studies, cytokine and immune activation marker levels correlate with the severity of disease and clinical outcome among HIV-infected individuals [11, 12]. Elevated expression of CD38 on CD8+ T cells has been found to be a stronger prognostic marker of HIV disease progression than CD4+ cell count or HIV-RNA level [21, 22] and cytokine levels including IL-6 levels have been shown to decline after introduction of ARV and rise again when treatment was interrupted [23, 24].
Since inflammatory biomarkers become elevated as part of the host's response to the disease prior to diagnosing an OD, it is possible that reverse causality played a role in the observed associations between latest levels of the biomarkers and the risk of OD. However, the fact that baseline elevations in hsCRP and IL-6 also predicted OD events makes this less likely and indicates that elevations of the biomarkers could be markers of immune activation and associated impairment of immune function in individuals at increased risk of development of OD. In addition, adjustment for the time between the marker measurement and the OD date did not affect the trends reported between the biomarker levels and the risk of an OD.
Cells produce cytokines such as IL-6 as part of the immune system's response to infection or inflammation. In the HIV negative population IL-6 is known to play a role in the growth and survival of many types of tumours [3-5], but the mechanisms are poorly understood. It is recognised to be a key factor in myeloma progression and survival [3] and is also recognised as a factor in the development of B cell neoplasms and also for HHV-8 associated Kaposis sarcoma and Castleman's disease [25, 26]. A poorer prognosis has been observed with higher levels of IL-6 in patients with renal, ovarian, prostate and breast cancer [27]. Many different types of cancer cells proliferate in response to IL-6 and one theory is that IL-6 activity may disrupt epigenetic programming leading to development of neoplasia [4].
IL-6 may promote intracellular growth of atypical mycobacterium [28] and be involved in the pathogenesis of other ODs. Development of CMV disease in immunosuppressed renal transplant patients appears influenced by effects of pro-inflammatory and anti-inflammatory cytokines [29] and IL-6 has also been shown to be an independent predictor of mortality in the elderly and immunosuppressed patients such as renal dialysis patients [30]. In HIV, IL-6 is more likely to be a surrogate marker of a specific type of generally enhanced inflammatory state that may ultimately lead to increased risk of infections and other ODs rather than being directly involved in the pathogenesis of the development of the OD.
We also demonstrated an association between elevations of hsCRP (baseline and latest levels) and Amyloid A (latest levels) and development of OD. The effect of these biomarker levels on the risk of OD were consistent for patients in the DC arm and in the VS arm (i.e. no interaction was present), although the effect of amyloid A was more predictive of an OD among patients in the DC arm. Our observed association of elevated amyloid A just prior to diagnosis of an OD may suggest that it is part of the hosts response to the OD induced inflammatory process. Amyloid A plays a role in chronic inflammation and cancer development although the exact mechanism is so far poorly understood. [15].
While hsCRP may simply be a marker for (possibly pre-clinical) presence of OD or infections, high circulating levels of hsCRP may contribute to promoting disease progression as resolution of inflammation appears to improve survival [31]. It is likely that as most infections have an incubation time of <2-3 months, associations beyond this period may reflect an enhanced inflammatory state in individuals at risk of OD. In one US cross-sectional study of 513 HIV positive men levels of hsCRP were associated with HIV disease progression independent of CD4+ cell count and HIV-RNA levels [14]. Lower levels of hsCRP have also been shown to predict longer survival within HIV-infected individuals [13].
In our study, higher baseline levels of hsCRP and latest levels of hsCRP were independently predictive of increased risk of development of OD. Although CD4+ cell counts (and over the longer term, HIV-RNA levels) remain the most useful measures for predicting AIDS in HIV-infected individuals [32], the use of routine measurement of hsCRP is easily accessible and could provide clinicians with additional information beyond CD4+ and plasma HIV-RNA in the identification of patients "at risk" for the development of OD. The utility of hsCRP in resource-poor settings to indicate the need to commence therapy or monitor response to therapy also warrants further exploration. One potential utility of hsCRP is in resource-limited settings, where viral loads are not routinely performed and are far more expensive than an individual hsCRP test, although we have no evidence that CRP could replace VL as a marker for the effect of ART. In addition as the majority of patients who had an OD were in the discontinuation arm, biomarkers may be particularly useful if a patient is considering discontinuing therapy.
The limited panel of biomarkers studied restricts our study. Many other pro-inflammatory cytokines such as TNF are released during the systemic immune activation observed in uncontrolled HIV disease and may also have prognostic value for risk of development of OD. We also did not look at markers of immune activation such as CD38 expression on CD8+ T cells. As mentioned earlier the sequence of events is also unclear although reverse causality is unlikely to account for our observation that baseline elevations in hsCRP and IL-6 also predicted OD events. There were also limited numbers of events, which did not allow examination of association of biomarkers separately for infective, malignant, and other opportunistic diseases.
In summary this study demonstrated that elevated levels of IL-6 and hsCRP at baseline and at latest follow-up identified HIV-infected patients at risk of OD.
Funding Statement: Support provided by: NIAID, NIH grants U01AI042170 and U01AI46362. ClinicalTrials.gov number: NCT00027352.
Author contribution: All authors participated in the design of the study and facilitated with data collection, analysis and interpretation. Further, all authors helped write the manuscript and approved the final version.
Investigators in the SMART Study Group: SMART was initiated by the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA) and implemented in collaboration with international coordinating centers in Copenhagen (Copenhagen HIV Programme), London (Medical Research Council, Clinical Trials Unit), Sydney (National Centre in HIV Epidemiology and Clinical Research) and Washington (CPCRA). Participating staff are listed below.
Copenhagen International Coordinating Center: JD Lundgren, KB Jensen, DC Gey, L Borup, M Pearson, PO Jansson, BG Jensen, J Tverland, H Juncker-Benzon, Z Fox, AN Phillips.
London Internatioal Coordinating Center: JH Darbyshire, AG Babiker, AJ Palfreeman, SL Fleck, W Dodds, E King, B Cordwell, F van Hooff, Y Collaco-Moraes.
Sydney International Coordinating Center: DA Cooper, S Emery, FM Drummond, SA Connor, CS Satchell, S Gunn, S Oka, MA Delfino, K Merlin, C McGinley.
Washington International Coordinating Center: F Gordin, E Finley, D Dietz, C Chesson, M Vjecha, B Standridge.
INSIGHT Network Coordinating Center: JD Neaton, G Bartsch, A DuChene, M George, B Grund, M Harrison, E Krum, G Larson, C Miller, R Nelson, J Neuhaus, MP Roediger, T Schultz.
ECG Reading Center: R Prineas, C Campbell, Z-M Zhang.
Endpoint Review Committee: G Perez (co-chair), A Lifson (co-chair), D Duprez, J Hoy, C Lahart, D Perlman, R Price, R Prineas, F Rhame, J Sampson, J Worley.
NIAID Data and Safety Monitoring Board: M Rein (chair), R DerSimonian (executive secretary), BA Brody, ES Daar, NN Dubler, TR Fleming, DJ Freeman, JP Kahn, KM Kim, G Medoff, JF Modlin, R Moellering Jr, BE Murray, B Pick, ML Robb, DO Scharfstein, J Sugarman, A Tsiatis, C Tuazon, L Zoloth.
NIH, NIAID: K Klingman, S Lehrman.
SMART Clinical Site Investigators by Country (SMART enrollment): Argentina (147): J Lazovski, WH Belloso, MH Losso, JA Benetucci, S Aquilia, V Bittar, EP Bogdanowicz, PE Cahn, AD Casiró, I Cassetti, JM Contarelli, JA Corral, A Crinejo, L Daciuk, DO David, G Guaragna, MT Ishida, A Krolewiecki, HE Laplume, MB Lasala, L Lourtau, SH Lupo, A Maranzana, F Masciottra, M Michaan, L Ruggieri, E Salazar, M Sánchez, C Somenzini.
Australia (170): JF Hoy, GD Rogers, AM Allworth, JStC Anderson, J Armishaw, K Barnes, A Carr, A Chiam, JCP Chuah, MC Curry, RL Dever, WA Donohue, NC Doong, DE Dwyer, J Dyer, B Eu, VW Ferguson, MAH French, RJ Garsia, J Gold, JH Hudson, S Jeganathan, P Konecny, J Leung, CL McCormack, M McMurchie, N Medland, RJ Moore, MB Moussa, D Orth, M Piper, T Read, JJ Roney, N Roth, DR Shaw, J Silvers, DJ Smith, AC Street, RJ Vale, NA Wendt, H Wood, DW Youds, J Zillman.
Austria (16): A Rieger, V Tozeau, A Aichelburg, N Vetter.
Belgium (95): N Clumeck, S Dewit, A de Roo, K Kabeya, P Leonard, L Lynen, M Moutschen, E O'Doherty.
Brazil (292): LC Pereira Jr, TNL Souza, M Schechter, R Zajdenverg, MMTB Almeida, F Araujo, F Bahia, C Brites, MM Caseiro, J Casseb, A Etzel, GG Falco, ECJ Filho, SR Flint, CR Gonzales, JVR Madruga, LN Passos, T Reuter, LC Sidi, ALC Toscano.
Canada (102): D Zarowny, E Cherban, J Cohen, B Conway, C Dufour, M Ellis, A Foster, D Haase, H Haldane, M Houde, C Kato, M Klein, B Lessard, A Martel, C Martel, N McFarland, E Paradis, A Piche, R Sandre, W Schlech, S Schmidt, F Smaill, B Thompson, S Trottier, S Vezina, S Walmsley.
Chile (49): MJ Wolff Reyes, R Northland.
Denmark (19): L Ostergaard, C Pedersen, H Nielsen, L Hergens, IR Loftheim, KB Jensen.
Estonia (5): M Raukas, K Zilmer.
Finland (21): J Justinen, M Ristola.
France (272): PM Girard, R Landman, S Abel, S Abgrall, K Amat, L Auperin, R Barruet, A Benalycherif, N Benammar, M Bensalem, M Bentata, JM Besnier, M Blanc, O Bouchaud, A Cabié, P Chavannet, JM Chennebault, S Dargere, X de la Tribonniere, T Debord, N Decaux, J Delgado, M Dupon, J Durant, V Frixon-Marin, C Genet, L Gérard, J Gilquin, B Hoen, V Jeantils, H Kouadio, P Leclercq, J-D Lelièvre, Y Levy, CP Michon, P Nau, J Pacanowski, C Piketty, I Poizot-Martin, I Raymond, D Salmon, JL Schmit, MA Serini, A Simon, S Tassi, F Touam, R Verdon, P Weinbreck, L Weiss, Y Yazdanpanah, P Yeni.
Germany (215): G Fätkenheuer, S Staszewski, F Bergmann, S Bitsch, JR Bogner, N Brockmeyer, S Esser, FD Goebel, M Hartmann, H Klinker, C Lehmann, T Lennemann, A Plettenberg, A Potthof, J Rockstroh, B Ross, A Stoehr, JC Wasmuth, K Wiedemeyer, R Winzer.
Greece (95): A Hatzakis, G Touloumi, A Antoniadou, GL Daikos, A Dimitrakaki, P Gargalianos-Kakolyris, M Giannaris, A Karafoulidou, A Katsambas, O Katsarou, AN Kontos, T Kordossis, MK Lazanas, P Panagopoulos, G Panos, V Paparizos, V Papastamopoulos, G Petrikkos, H Sambatakou, A Skoutelis, N Tsogas, G Xylomenos.
Ireland (2): CJ Bergin, B Mooka.
Israel (13): S Pollack, MG Mamorksy, N Agmon-Levin, R Karplus, E Kedem, S Maayan, E Shahar, Z Sthoeger, D Turner, I Yust.
Italy (88): G Tambussi, V Rusconi, C Abeli, M Bechi, A Biglino, S Bonora, L Butini, G Carosi, S Casari, A Corpolongo, M De Gioanni, G Di Perri, M Di Pietro, G D'Offizi, R Esposito, F Mazzotta, M Montroni, G Nardini, S Nozza, T Quirino, E Raise.
Japan (15): M Honda, M Ishisaka.
Lithuania (4): S Caplinskas, V Uzdaviniene.
Luxembourg (3): JC Schmit, T Staub.
Morocco (42): H Himmich, K Marhoum El Filali.
New Zealand (7): GD Mills, T Blackmore, JA Masters, J Morgan, A Pithie.
Norway (17): J Brunn, V Ormasssen.
Peru (57): A La Rosa, O Guerra, M Espichan, L Gutierrez, F Mendo, R Salazar.
Poland (54): B Knytz, A Horban, E Bakowska, M Beniowski, J Gasiorowski, J Kwiatkowski.
Portugal (73): F Antunes, RS Castro, M Doroana, A Horta, K Mansinho, AC Miranda, IV Pinto, E Valadas, J Vera.
Russia (17): A Rakhmanova, E Vinogradova, A Yakovlev, N Zakharova.
South Africa (26): R Wood, C Orrel.
Spain (100): J Gatell, JA Arnaiz, R Carrillo, B Clotet, D Dalmau, A González, Q Jordano, A Jou, H Knobel, M Larrousse, R Mata, JS Moreno, E Oretaga, JN Pena, F Pulido, R Rubio, J Sanz, P Viciana.
Switzerland (91): B Hirschel, R Spycher, M Battegay, E Bernasconi, S Bottone, M Cavassini, A Christen, C Franc, HJ Furrer, A Gayet-Ageron, D Genné, S Hochstrasser, L Magenta, C Moens, N Müller, R Nüesch.
Thailand (159): P Phanuphak, K Ruxrungtham, W Pumpradit, P Chetchotisakd, S Dangthongdee, S Kiertiburanakul, V Klinbuayaem, P Mootsikapun, S Nonenoy, B Piyavong, W Prasithsirikul, P Raksakulkarn.
United Kingdom (214): BG Gazzard, JG Ainsworth, J Anderson, BJ Angus, TJ Barber, MG Brook, CD Care, DR Chadwick, M Chikohora, DR Churchill, D Cornforth, DH Dockrell, PJ Easterbrook, PA Fox, R Fox, PA Gomez, MM Gompels, GM Harris, S Herman, AGA Jackson, SPR Jebakumar, MA Johnson, GR Kinghorn, KA Kuldanek, N Larbalestier, C Leen, M Lumsden, T Maher, J Mantell, R Maw, S McKernan, L McLean, S Morris, L Muromba, CM Orkin, AJ Palfreeman, BS Peters, TEA Peto, SD Portsmouth, S Rajamanoharan, A Ronan, A Schwenk, MA Slinn, CJ Stroud, RC Thomas, MH Wansbrough-Jones, HJ Whiles, DJ White, E Williams, IG Williams, M Youle.
United States (2989): DI Abrams, EA Acosta, S Adams, A Adamski, L Andrews, D Antoniskis, DR Aragon, R Arduino, R Artz, J Bailowitz, BJ Barnett, C Baroni, M Barron, JD Baxter, D Beers, M Beilke, D Bemenderfer, A Bernard, CL Besch, MT Bessesen, JT Bethel, S Blue, JD Blum, S Boarden, RK Bolan, JB Borgman, I Brar, BK Braxton, UF Bredeek, R Brennan, DE Britt, J Brockelman, S Brown, V Bruzzese, D Bulgin-Coleman, DE Bullock, V Cafaro, B Campbell, S Caras, J Carroll, KK Casey, F Chiang, G Childress, RB Cindrich, C Clark, M Climo, C Cohen, J Coley, DV Condoluci, R Contreras, J Corser, J Cozzolino, LR Crane, L Daley, D Dandridge, V D'Antuono, JG Darcourt Rizo Patron, JA DeHovitz, E DeJesus, J DesJardin, M Diaz-Linares, C Dietrich, P Dodson, E Dolce, K Elliott, D Erickson, M Estes, LL Faber, J Falbo, MJ Farrough, CF Farthing, P Ferrell-Gonzalez, H Flynn, C Frank, M Frank, KF Freeman, N French, G Friedland, N Fujita, L Gahagan, K Genther, I Gilson, MB Goetz, E Goodwin, F Graziano, CK Guity, P Gulick, ER Gunderson, CM Hale, K Hannah, H Henderson, K Hennessey, WK Henry, DT Higgins, SL Hodder, HW Horowitz, M Howe-Pittman, J Hubbard, R Hudson, H Hunter, C Hutelmyer, MT Insignares, L Jackson, L Jenny, M John, DL Johnson, G Johnson, J Johnson, L Johnson, J Kaatz, J Kaczmarski, S Kagan, C Kantor, T Kempner, K Kieckhaus, N Kimmel, BM Klaus, N Klimas, JR Koeppe, J Koirala, J Kopka, JR Kostman, MJ Kozal, A Kumar, A Labriola, H Lampiris, C Lamprecht, KM Lattanzi, J Lee, J Leggett, C Long, A Loquere, K Loveless, CJ Lucasti, R Luskin-Hawk, M MacVeigh, LH Makohon, S Mannheimer, NP Markowitz, C Marks, N Martinez, C Martorell, E McFeaters, B McGee, DM McIntyre, J McKee, E McManus, LG Melecio, D Melton, S Mercado, E Merrifield, JA Mieras, M Mogyoros, FM Moran, K Murphy, D Mushatt, S Mutic, I Nadeem, R Nahass, D Nixon, S O'Brien, A Ognjan, M O'Hearn, K O'Keefe, PC Okhuysen, E Oldfield, D Olson, R Orenstein, R Ortiz, J Osterberger, W Owen, F Parpart, V Pastore-Lange, S Paul, A Pavlatos, DD Pearce, R Pelz, G Perez, S Peterson, G Pierone Jr, D Pitrak, SL Powers, HC Pujet, JW Raaum, J Ravishankar, J Reeder, N Regevik, NA Reilly, C Reyelt, J Riddell IV, D Rimland, ML Robinson, AE Rodriguez, MC Rodriguez-Barradas, V Rodriguez Derouen, R Roland, C Rosmarin, WL Rossen, JR Rouff, JH Sampson, M Sands, C Savini, S Schrader, MM Schulte, C Scott, R Scott, H Seedhom, M Sension, A Sheble-Hall, A Sheridan, J Shuter, LN Slater, R Slotten, D Slowinski, M Smith, S Snap, C Somboonwit, DM States, M Stewart, G Stringer, J Sullivan, KK Summers, K Swanson, IB Sweeton, S Szabo, EM Tedaldi, EE Telzak, Z Temesgen, D Thomas, MA Thompson, S Thompson, C Ting Hong Bong, C Tobin, J Uy, A Vaccaro, LM Vasco, I Vecino, GK Verlinghieri, F Visnegarwala, BH Wade, V Watson, SE Weis, JA Weise, S Weissman, AM Wilkin, L Williams, JH Witter, L Wojtusic, TJ Wright, V Yeh, B Young, C Zeana, J Zeh.
Uruguay (3): E Savio, M Vacarezza.
Conflict of interest statement: No member of the Writing Group for this report has any financial or personal relationships with people or organizations that could inappropriately influence this work or constitute a conflict of interest, although most members of the group have, at some stage in the past, received funding from a variety of pharmaceutical companies for research, travel grants, speaking engagements or consultancy fees.
Data accepted as a poster presentation for 16th Conference on Retroviruses and Opportunistic Infections (CROI), Montreal, February 9-11th 2009, (Abstract number 0-255).
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Limitless RDTA by iJoy
Limitless RDTA by iJoy
iJoy presents the Limitless RDTA! The Limitless RDTA is one of the most sought after genesis style tanks on the market today! The Limitless RDTA is super easy to build with it's velocity style posts and even easier to fill up with its open juice fill port located on the side of the 19mm build deck. Now you can enjoy RDA like flavor with the convenience of a 4ml tank to back it up! This 24mm Limitless RDTA is one for the ages and is sexy as hell to boot! Wicking her up is a breeze and with the massive 15mm x 1.5mm air flow slots, you will be able to provide ample airflow to the most intense of coil builds. The Limitless RDTA is a must have for cloud chasers who are getting tired of dripping!
Limitless RDTA by iJoy Features:
- 24mm Rebuildable Tank Atomizer
- Stainless Steel Construction
- Velocity Style Dual Post Design
- 4ml Tank Capacity
- 2mm Terminal Post Holes
- PEEK Insulator
- Quad Wicking Ports
- 10mm x3.5mm Side Juice Fill Port
- Dual Adjustable 15mm x 1.5mm Airflow
- 12.5mm Wide Bore Knurled Drip Tip
- Easy to Disassemble
- Adjustable Gold Plated Contact Pin
Limitless RDTA by iJoy Package Contents:
- (1) Limitless RDTA by iJoy
- (1) 12.5mm Delrin Wide Bore Drip Tip
- (1) Delrin 510 Adapter
- (1) Spare Parts Bag

subset: commoncrawl


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LG Plasma TV 42″ 42PN4500 Rs. 22990 (Exchange) or Rs. 25990 from FlipKart
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Primal's Taboo Sex-Jade Is Addicted To Her Dad
11 June 2016
Jade stayed home from school with out her parents knowing. She is full of young hormones that her fingers can't satisfy, so she slips into mom and dad's room to see if mom's "massager" can do the job. While Jade is experimenting on herself her mom Sophie catches her "why aren't you at work?" Jade complains, but mom has questions of her own. But, she remembers when she was Jade's age and decides to give her a lesson in self satisfaction
While Jade is being educated by mom Dad comes in and is shocked, but mom explains it is perfectly fine. Dad is still upset since he and Sophie were supposed to slip out of work for a little rendezvous and instead his little girl is learning how to use a massager, then to make it worse, sophie gets called back in to work
As dad stands there frustrated Jade points out that she was in the middle of learning to use the massager and dad apologizes and goes to leave, but Jade stops him and asks if he can help her learn. Dad is really embarrassed and tries saying no but "You're my daddy and you said I can ask you about anything" Jade says in her sweet daddy's girl voice
Daddy agrees to help, and slowly Jade begins to touch him as the pleasure of the wand over takes him, it all happens so slowly and sensually until Jade is cumming with daddy's big cock inside her
Jade's daddy wants to make sure she can handle herself and is teaching her how to fight and protect herself. A couple of accidental touches when he show's her how to "hit where it counts" and then a few more compromising positions begins to create tension. Jade wants to ow what to do if an attacker gets on top of her, daddy explains she needs to use her hips to wiggle free while biting and clawing but when Jade gets too intense, digging her nails into daddy's back, biting his neck and grinding her hips her dad pushes away, embarrassed by his impossible to hide hard-on. Jade's tights are soaked at the crotch and her dad tries to say it doesn't mean anything, that they should take a break, but with smoldering eyes Jade peels off her tights and jumps on her dad, kissing, biting, clawing biting, tearing off his shorts. Over and over her dad tries to get her to stop, but she is wild and pulls his cock into her. They fuck with wild intensity showing how long this has been building
Runtime : 21min 45s
File Size : 983 MB
Resolution : 1280x720
Download Primal's Taboo Sex-Jade Is Addicted To Her Dad
Primal's Taboo Sex-Jade Is Addicted To Her Dad.wmv
Back » Primal's Taboo Sex-Gia Paige - Proving My Sister is a Slut Over and O...« Next Primal's Taboo Sex-Jade's Brother Takes Every Hole


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Traveling Luck for Forest Plaza West Shopping Center, Virginia, United States
Where is Forest Plaza West Shopping Center?What's around Forest Plaza West Shopping Center?
Wikipedia near Forest Plaza West Shopping Center
Where to stay near Forest Plaza West Shopping Center
The timezone in Forest Plaza West Shopping Center is America/Iqaluit
Sunrise at 08:02 and Sunset at 18:02. It's Dark
Latitude. 37.4122°, Longitude. -79.2111°
Weather near Forest Plaza West Shopping Center; Report from Lynchburg, Lynchburg Regional Airport, VA 12km away
Weather :
Temperature: 11°C / 52°F
Wind: 3.5km/h West/Southwest
Cloud: Scattered at 8000ft
Weather :
Temperature: 11°C / 52°F
Wind: 3.5km/h West/Southwest
Cloud: Scattered at 8000ft
Satellite map around Forest Plaza West Shopping Center
Loading map of Forest Plaza West Shopping Center and it's surroudings
Geographic features & Photographs around Forest Plaza West Shopping Center, in Virginia, United States
- populated place;
- a city, town, village, or other agglomeration of buildings where people live and work.
- Forest Brook Hills (0.5km)
- Three Fountains (0.6km)
- Forest Hill (0.9km)
- Blue Ridge Farms (1.1km)
- Panorama Hills (1.1km)
- Westbrook (2.2km)
- Black Rock Farm (2.3km)
- Woodbine Village (2.5km)
- Keystone Forest (2.6km)
- West Lynchburg (3.8km)
- Maple Hill (4.3km)
- school;
- building(s) where instruction in one or more branches of knowledge takes place.
- Middle School Learning Center (0.8km)
- Forest Hill School (0.9km)
- Linkhorne Elementary School (1.9km)
- Linkhorne Middle School (2km)
- Bedford Hills School (3.5km)
- Kizer Elementary School (3.6km)
- Holy Cross School (3.6km)
- Lynchburg Christian Academy (3.7km)
- Lynchburg College (3.8km)
- Perrymont Avenue School (4km)
- church;
- a building for public Christian worship.
- Forest Road United Methodist Church (0.8km)
- Old Forest Road Baptist Church (1.1km)
- Saint James Christian Methodist Episcopal Church (2.7km)
- Holy Trinity Lutheran Church (2.9km)
- Thomas Road Church (3.7km)
- Pleasant View Church (3.8km)
- Gethsemane Baptist Church (3.8km)
- Saint Barnabus Episcopal Church (3.9km)
- building(s);
- a structure built for permanent use, as a house, factory, etc..
- Carnegie Hall (3.6km)
- Hopwood Hall (3.6km)
- Memorial Gymnasium (3.7km)
- Hundley Hall (3.7km)
- Westover Hall (3.8km)
- Fine Arts Center (4.2km)
- Miller Home (4.3km)
- park;
- an area, often of forested land, maintained as a place of beauty, or for recreation.
- Peaks View Park (1.9km)
- Blackwater Park (3km)
- Sandusky Park (3.6km)
- College Park (4km)
- Blackwater Creek Natural Area (4km)
- Perrymont Park (4.1km)
Accommodation around Forest Plaza West Shopping Center
- tower;
- a high conspicuous structure, typically much higher than its diameter.
- WLVA-AM (Lynchburg) (2.5km)
- WLLL-AM (Lynchburg) (2.9km)
- WGOL-FM (Lynchburg) (2.9km)
- WWLC-FM (Lynchburg) (3.7km)
- WWOD-AM (Lynchburg) (3.8km)
- Local Feature;
- A Nearby feature worthy of being marked on a map..
- Forest Plaza West Shopping Center (0km)
- Forest Hills Court Shopping Center (0.6km)
- Christ Chapel (2.2km)
- The Farm Basket Shops Shopping Center (3km)
- Oakwood Country Club (4km)
- stream;
- a body of running water moving to a lower level in a channel on land.
- Cheese Creek (2.9km)
- Ivy Creek (3km)
- Burton Creek (3.5km)
- Tomahawk Creek (3.6km)
- airport;
- a place where aircraft regularly land and take off, with runways, navigational aids, and major facilities for the commercial handling of passengers and cargo.
- L G Hospital Heliport (4.2km)
- cemetery;
- a burial place or ground.
- Forest Hill Cemetery (1.7km)
- hospital;
- a building in which sick or injured, especially those confined to bed, are medically treated.
- Lynchburg City Health Department (4.2km)
- reservoir(s);
- an artificial pond or lake.
- College Lake (3.3km)
- dam;
- a barrier constructed across a stream to impound water.
- College Lake Dam (3.3km)
Wikipedia entries close to
Forest Plaza West Shopping Center
- Lynchburg (Virginia) city city g
- Forest, Virginia city city o
- Madison Heights, Virginia city city o
- Lynchburg Regional Airport airport airport
- Timberlake, Virginia city city o
- Rustburg, Virginia city city o
- Virginia
- Amherst, Virginia city city o
- Apple Orchard Mountain mountain mountain k
- Bedford, Virginia city city o
- Glasgow, Virginia city city o
- Peaks of Otter mountain k
- Altavista, Virginia city city o
- Appomattox, Virginia city city o
- Hurt, Virginia city city o
- Appomattox Court House landmark landmark
Airports close to Forest Plaza West Shopping Center
Richmond international(RIC), Richmond, Usa (207.2km)
Smith reynolds(INT), Winston-salem, Usa (209km)
Elkins randolph co jennings randolph(EKN), Elkins, Usa (213.1km)
Raleigh durham international(RDU), Raleigh-durham, Usa (217.1km)
Quantico mcaf(NYG), Quantico, Usa (254.1km)


text:
Karl Henry: Get loose with simple stretches
The easiest way to avoid injury is to stretch a little after each exercise, says the expert trainer, who argues that a little 'passive exercise' can go a long way
Yoga, Pilates, tai chi, stretching, body balance and meditation are all types of passive exercise, often one of the more overlooked forms of exercise that can reap such huge benefits for every part of your body.
These types of exercise are often far more chilled out than your usual running and weights, and men in particular tend to steer clear of them, but they deliver so many benefits and are often tougher than you think.
The feel-good factor from these is totally different to any other exercise high you may have come across before; yes you are still releasing endorphins but it feels totally different as you focus your mind on something else, leaving you totally chilled out as well.
This week we're looking at some of my favourite stretches that I use with my clients and myself. Classes are great ways to get involved in these type of exercise, especially when you get a great teacher, but sometimes it isn't always possible to get to a class so these stretches can be done on their own, as a session, or as part of your exercise session.
They are generally practised at the end of a session to help prevent delayed onset muscle soreness and it can also help bring your heart rate down slowly too.
Here are some of the other benefits that you can get from doing more of this type of exercise:
• Reduce stress
• Reduce your medical bills
• Improve your lean tissue
• Lower the risk of cardiovascular disease
• Lower the risk of injury
• Improve mobility
• Release endorphins
• Lower the risk of lower back pain
• Keep you exercising when the weather is bad and working as part of a group
• Lower cholesterol
• Reduce the risk of falls
Here are some simple stretches that you can add to your routine:
Yoga upper body bends
Start with your feet together, your hands above the head, palms together. Take a deep breath in and stretch your arms up to the sky. Now simply bend the body to the left and hold for 10 seconds.
Come back to centre and now bend to the right for 10 seconds.
As your body begins to loosen up you will find that you can bend further and further, but just ease into it.
Shoulder rolls
These are great to loosen up the shoulder joints and muscles. Start with your feet together, and hands together. Keeping the arms straight, roll the arms back in big circles for 10 and then roll forward for 10. These should be done slowly and aim to stretch the arms out as far as possible. Repeat for three sets.
Tricep stretch
The triceps at the back of the arm can get quite tight and need a good stretch. Start with your feet together. Straighten the left arm above the head and the right arm by the side. Now bend the left arm behind the head and try to touch the hands in the centre of your back.
If you can't touch your hands, don't worry, just get a towel between your hands and move your hands up the towel as you get more flexible. Hold the stretch for 15 seconds and change hands .
Knee rolls
This is one of my favourite and most simple stretches. Place your feet together, knees together and place your hands on the front of your knees. Now just roll your knees in a circular motion to the left for 10 and then the right for 10.
These should be easy and gentle, the idea is to loosen out the ligaments, tendons and muscles around the knee joint.
Hamstring stretch
The hamstrings are a big muscle group at the back of the leg and if they become tight you are prone to lower back problems. With this stretch, simply start with your feet together, back straight and crossing your right leg over your left, lower your hands down towards your toes.
Don't bounce on this one, just ease into it and stretch as far as you feel comfortable. Hold for 15 seconds and then change legs. Repeat for 3 sets.
Quad stretch
The quad is at the front of the legs and is a seriously big muscle group. This is one of the simplest ways to stretch it out. Lie on your side, take your right ankle in your right hand and bring your right heel up to your bum. Hold here for 15 seconds and then roll over on to the opposite leg and do the same. Repeat for 3 sets.
This routine is easy to do and will loosen out all the body parts. Remember it's important not to push the body to the point of real pain with these, just ease into it, relax and stretch, you will be surprised at how quickly you loosen up.
Irish Independent


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Our Team
Our team is comprised of professional and marketing-focused consultants and researchers whose passion to learn more and innovate ensure that we provide effective strategies that lead to real benefits for our clients.
Moreover, our consulting and development teams are small and specialized in tourism and hospitality industry which allow us to offer truly personalized services. We believe that direct and continuous communication with our clients is essential to ensure that the outcome reflects your requirement.


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The foreign staff of two Christian humanitarian organizations have begun pulling out of Afghanistan, a day after the ruling Taleban ordered their expulsion and closed their offices.
Workers of the international agency Serve and the U.S.-based International Assistance Mission (IAM) were among those deported Saturday.
The Taleban on Friday said all foreign staff of IAM and Serve, which have operations in several Afghan cities, must leave the country within 72 hours. Taleban officials did not give explanations for the expulsions, but said the decision followed what they called "complaints" about the activities of the two organizations.
In recent weeks, the Taleban cracked down on several international aid agencies after eight foreign and 16 Afghan aid workers were arrested for allegedly preaching Christianity.
Taleban officials say the investigation of that case is almost complete and the group will be brought to trial shortly. On Saturday, Taleban authorities allowed the parents of two American aid workers being held to see their daughters for the second time in a week. They were accompanied by a U.S. diplomat.
The penalty for proselytizing in Taleban-ruled Afghanistan is jail and expulsion for foreigners and death for Afghans.


text:
Wade Whittier, D.C., was raised in Lake County, IL . He attended Carmel High School in Mundelein, IL and completed his pre-med studies at Eastern Illinois University. He graduated in 1987 from Palmer College of Chiropractic in Davenport, IA. Palmer College is the world's first Chiropractic College, birth place of the discovery of chiropractic in 1895.
Dr. Whittier sub-specializes in the treatment of extremities. Extremity care includes injuries and conditions of the arms, elbows, wrists, hands, shoulders, TMJ, hips, knees, ankles and feet.
He is a regional lecturer to colleges, schools, civic groups, and industries on a variety of subjects related to the musculoskeletal system. His lectures cover both prevention and treatment.
He is a past board member and president of the Des Plaines Rotary Club, past board member of the United Way and founder of the Des Plaines Chiropractic Center in 1990. Annually he attends continuing education conferences on radiology, patient management, treatment and diagnosis.
He founded the Wellness Group in 2014. He has 2 grown children.
His hobbies are numerous and include boating, skiing, scuba diving, traveling, golfing, biking and motorcycling. He is an avid exerciser.
Dr. Whittier states "I am extremely proud to be a Chiropractic Physician helping the human body use its potential to heal from many injuries and conditions without the use of drugs or surgery".
Dr. Brzezinski began his medical career in Poland where he worked in Bielanski Hospital,
Warsaw in advance radiology imaging. After moving to the United States his passion for healing
and helping patients did not diminish. Following the completion of his pre-med degree in
biomedical sciences he obtained his Doctoral degree of Chiropractic Medicine from the National
University of Health Sciences. These experiences allowed him to develop into the well-rounded
doctor that he is today.
In addition to fundamental chiropractic care Dr. Brzezinski implements Functional Medicine by
assisting patients in a large variety of disorders. A few of these disorders include Diabetes Type
2, IBS and Crohn's Disease, Multiple Sclerosis, Autism, Autoimmune, Attention Deficit
Disorder, Headache and Migraines.
Dr. Brzezinski strongly believes that everyone can achieve optimum health and wellness for
themselves. If you are ready to take full responsibility of your health, truly feel good in your body
and are ready to see results, give him a call.


text:
Stunning singer Beyonce launches a new tantalizing and fabulous perfume for women, Rise. Beyonce Rise is all about an elegant perfume infused with a romantic smell truly delicate and provocative. The new perfume is described to be more personal inspired by Beyonce's on-stage persona. As the title of the perfume inspires, Beyonce Rise will rise one's disposition and deep romantic feelings.
Beyonce Rise is an addictive, sparkling perfume composed of most precious flowery notes like apricot, Italian bergamot and iced basil sorbet along with orchid accords, freesia, Sambac jasmine flowers. The base dries down with autumn woods, cashmere, vetiver and musk. Beyonce Rise comes in a beautiful gold with black bottle, ultra sparkling and modern.
Beyonce Rise is available in 15, 30 and 50ml Eau de Parfum.


text:
Sunday nights rarely end on time.
There is always one last drop of the fun I want to squeeze out of the few hours between Friday and Monday known as the weekend.
The chores that never seem to get caught up.
The kitty who wants to be the center of attention when my attention is firmly centered elsewhere.
The bottomless cup of distractions the Internet is spectacularly good at sharing.
I make no excuses, nor offer any apologies. It is Sundays that have ending issues.
Perhaps they should see someone about that.
~insomNia Lorre


text:
Phone: (289) 320-8250
1238 Dominion Road
Fort Erie, Ontario, L2A 1H7
90° Supply Stop Angle ValveDahl lead-free brass ball valve 90° supply stop (solder) with rough brass finish. Nickel plated handle, 1/2" copper female inlet port (solder) and 3/8" OD compressed copper pipe outlet port. Lifetime warranty. Certified CSA(R), UPC(R), NSF/ANSI 61-G.


text:
Skip to main content
Welcome to the
The Thompson Collectors Association
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Curing a M1928 of Hiccups
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Federal Laboratories Incorporated Brochures
Federal Laboratories was the sole distributor of the Thompson Submachine Gun in the 1930s. In the late-1939 to early-1940 time frame, Auto-Ordnance Corporation revoked their exclusive rights. This led to versions of the 1938 catalogue (number 57A) and the 1939 catalogue (number 62) with the sole distributor phrase and a version of the catalogue with that blacked out. Below are samples of catalogue numbers 33, 34, 57A & 62.
Catalogue Number 33
Catalogue Number 34
Catalogue 57
Catalogue 57, in the top two pictures you can see the red-lined and blacked out
"Sold in the U.S.A. Exclusively by"
The back page of each version is identical
Catalogue 62
Catalogue number 62, the left picture has the blacked out "Sold in U.S.A. Exclusively by FEDERAL LABORATORIES INC. Philadelphia, PA", the right picture is the original version


text:
Hacking of Gmail accounts has been a common occurrence in the recent years. Gmail will notify you is your account has been compromised or hackers have tried to access your account from an unknown machine. Gmail will instruct you to create a new and strong password so that your account is secured again. After you change the password you may find out that you account has been compromised once again. Once hackers get access to your account they have several tools which help them to hack with ease. Even without the knowledge of the password they can hack into an account easily.
With the rise in the number of hackers, it is important to secure your Gmail account. Your email account may contain valuable information. To prevent unauthorized access, it is important that you secure your Gmail account. The following tips will help you in the long run.
- You must choose a strong password which is unique. Ensure that you do not use the password on any other site. Enable 2-step verification process. It will add an extra layer of security to your account. In this type of verification process, you will need access to your phone and the username and password. Google will send across a code on your phone which you will have to enter in the in the account log-in process. After choosing the password, you can check its strength at the password meter. An easy password will be easy to guess.
- It is important that you secure your computer. You must check for malware and virus. Ensure that your operating system is up-to-date. Make sure that you perform regular software updates. Your browser must be up-to-date. Do not forget to check your browser for extensions, plug-ins and applications which may have access to your Gmail account.
- You must review the Gmail settings very carefully. Check if your messages are being forwarded to another account without your permission. Check for filters which have been created to forward your mails to another account. Disable the POP/IMAP settings if you are not using them to send emails.
- Keep track of your account's activity. A hacker could be accessing your account without your knowledge. You may get notifications about unusual activity in your Gmail account. You can review the recent account activity by clicking the 'details' link at the bottom right corner of the Gmail window.
- A Gmail account is used to file tax returns and converse with friends. If you access your account from a library or a café it will become more vulnerable to attack from hackers. A professional who deals with web design NYC will be able to throw light on ways in which email account can be made more secured.
- It is important to enable HTTPS when you open your account on non-encrypted networks and public wireless networks. Usually by default the HTTPS feature is on. Still, it is advised that you check it. Go to the mail settings and enable HTTPS security.
These steps will help you to keep professional hackers at bay. Google offers several tools which will help you to keep hackers at bay. You will have to activate the tools to use them. Beware of phishing attacks. It is essential that you use an updated malware scanner and keep it up-to-date. Your account recovery options must be updated. Do not overlook the fact that without securing the Gmail account your sensitive and confidential information will be unsafe. To prevent unauthorized access secure your account at the earliest.
Author Bio: Clara Gately chose the best web design NYC firm – when she set out to start an online business. All her official correspondence takes place through Gmail. She has used the Google tools to secure the email accounts.


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9 Comments
bladerunner Artist from Qld, Australia
This is inspiring!
Pogomonkeytutu Artist from United Kingdom
Thank you very much!
You are very talented I love your work. Are there lots more in the series?
Great Mash-up!!!!!Join the conversation! Type your comment here…
Ha Ha Ha Ha !!!! good idea! +1
JustPetrucci Artist from Washington, United States
Wow, takes me back to them olden days of CN… "Sugar, spice, and everything nice…" ;)
I would love to see you make a design with all the Avengers as puff people! :D
Nice work.
Pogomonkeytutu Artist from United Kingdom
@JustPetrucci That's the aim! (Cool shirt design. I gave it a vote. Good luck)
WetRottenMeat Artist from Cebu City, Philippines
very nice! +1
check out my design too! _


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The lager brand is targeting its marketing efforts on a period that includes Easter, the Royal Wedding, the FA Cup Final and the two May Bank holidays.
The campaign will include press advertising, digital activity and a radio campaign, starting from April 21.
A £500 cash prize will be offered in each sales region to the independent with the best Carlsberg-merchandised display based around the big five idea.
"The timing of the Royal Wedding means retailers have five massive sales opportunities in a five-week trading period," said Darran Britton, marketing and strategy director at Carlsberg UK.
"We believe this is the biggest trading opportunity in 2011 and that is why we are investing significantly behind it with the Carlsberg brand."


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An excerpt from www.HouseOfNames.com archives copyright © 2000 - 2017
Origins Available: Dutch, Scottish
Ose Early Origins
Netherlands. The principal cities are Amsterdam, Haarlem and Hilversum. It was the seat of the old Counts of Holland. Seat of one of the oldest families is Brederode Castle near Haarlem. There are many old and quaint towns in the province. including Medemblik, Enkhuizen, Hoorn, Edam, and Monnikendam. In their later history the surname became a power unto themselves and were elevated to the ranks of nobility as they grew into this most influential family.
Ose Spelling Variations
Ose Spelling Variations
Spelling variations of this family name include: Os, Ose, Oses, Oss, Oos, Oz, van Os, de Oz and many more.
Ose Early History
Ose Early History
This web page shows only a small excerpt of our Ose research. Another 280 words (20 lines of text) are included under the topic Early Ose History in all our PDF Extended History products and printed products wherever possible.
Ose Early Notables (pre 1700)
Ose Early Notables (pre 1700)
More information is included under the topic Early Ose Notables in all our PDF Extended History products and printed products wherever possible.
The Great Migration
The Great Migration
Some of the first settlers of this family name or some of its variants were: Dirk Van Os who settled in Baltimore in 1847. Albert Oss (1818-1898), born in Belgium, was a soldier in the Union Army during the American Civil War who was awarded the Medal of Honor..
Contemporary Notables of the name Ose (post 1700)
Contemporary Notables of the name Ose (post 1700)
Ose Family Crest Products
Ose Family Crest Products
See Also
See Also
Other References
The Ose Family Crest was acquired from the Houseofnames.com archives. The Ose Family Crest was drawn according to heraldic standards based on published blazons. We generally include the oldest published family crest once associated with each surname.
This page was last modified on 2 October 2003 at 16:09.
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The Humanities Institute
The Legacy of the Institute for the Arts and Humanities
For 50 years, the IAH was proud to serve faculty and grad students in the arts and humanities at Penn State and beyond. As we close that chapter and begin our inaugural year as the Humanities Institute, we are excited to build on the legacy of the IAH. Please continue to follow us as we support and highlight the groundbreaking and influential work of Penn State's humanities scholars, exploring urgent questions of the human condition.


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Switchlinc V2 Insteon White Remote Control Dimmer
fill your entire home with personalized mood lighting for any occasion. this dimmer can do it all: you can dim or brighten it manually by holding the paddle directly or you can add it to a whole home scene where all your...
Decorator Led Nightlight W/ 1 Outlet - White
not just a simple nightlight, this attractive hallway light with bottom outlet mounts in a standard single gang box with an led that lasts more than 40 years. the trademaster® decorator nightlight with one outlet add...
Mr Beams Motion-sensor Battery Powered Stair Light
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Battery Powered Motion-sensor Anywhere Led Light
you don''t need to run wires to illuminate dark sheds, porches, or walkways. the weatherproof motion-activated anywhere led light is powered by four c batteries (sold separately), so it can be placed anywhere you might b...
Screw-in Indoor Motion Sensor Switch - 12' Range
this is the easiest to install motion sensor switch. simply unscrew existing light bulb, screw the sensor in position, and screw the light bulb into it. automatically turns the light bulb on when motion is sensed and tur...
Cardiff Iron Urn Night-light 33" Table Lamp
a sophisticated table lamp that combines a sleek bronze finish and a traditional urn shape. it features a champagne glass body with built-in night light. the faux leather shade has a lovely, organic surface pattern when ...
Walnut Mission-style W/ Night Light Table Lamp
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Arts & Crafts-style Honey-glass 23 1/2" Table Lamp
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Mission Arc With Mica Shade 80" Floor Lamp
floor lamps such as this are a great way to add overall room light to a space. this handsome floor lamp is a design classic. features a trio of warm mica shades with a dark wood base and bronze detailing. arc design spre...
Mission Tiffany-style French Bronze 61" Floor Lamp
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this dale tiffany table lamp is from the boehme family of lighting from the antiques roadshow collection. taking its inspiration from a galle lamp from the 1890s, this table lamp features a double overlaid and etched gl...
Feather Edge Tiffany-style Arts/crafts Table Lamp
a distinctive look from the robert louis tiffany® collection. the piece features a tiffany style, scallop edged "feather" shade paired with a gently flared arts and crafts base. bronze finish base. twin light pulls. ...
Blue Leaf Tall 27 1/2" Tiffany-style Table Lamp
this romantic table lamp was handcrafted using the same techniques developed by louis comfort tiffany a century ago. the design features an exquisite, heart-shaped mix of burgundy, orange, opaque white and earth-toned ti...
Light Tree 4-lamp Bronze Torchiere Floor Lamp
a four tiered floor lamp in a torchiere-style. a floor lamp with a unique design. features four tiers on a square base topped with square glass. also has a full-range foot dimmer switch for better light control. from lam...
Cherry-red Glazed Ceramic Table Lamps Set
set of two south beach glazed ceramic lamps present a rich cherry red base and a crisp linen shade. lamps feature glazed ceramic base decorated with a non scratch chrome base. stylish lamps will accent any home decor. fr...
Tiffany-style Arielle Table Lamp - Metal Base
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brighten any room in your house with this antiqued table lamp. metal base with a brushed nickel finish. fabric shade. from overstock. click on the product image below for a preview. triple crystal table lamp socket...
Tiffany-style Classic Jewel Torchiere Floor Lamp
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lovely lamps shade is bedazzled with gleaming amber beads, lending a room the subtle shimmer of moroccan mystique. alabastrite mahogany-finish base. ul recognized. 8 1/2" x 8 1/2" x 18" high. item no: 32276 pri...
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the rich mahogany trunk of a tropical palm holds a stretched animal skin pattern lampshade aloft as three lazy monkeys sit, see, speak or hear no evil at its base. ul recognized. max. 60 watt bulb (not included). ala...
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San Carlos Chandelier
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High Hill Four-light Chandelier
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Stillwater Right Moose Wall Sconce
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Bird & Berry Pot Rack W/ Downlights
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Hank Jeffrey's Birth Story
View Single Post
September 21st, 2011, 06:42 PM
Join Date: Jan 2011
Posts: 344
It was around 9pm and Jeremy and I were in bed watching TV. I was sitting up because its uncomfortable to lay down when your 9 months pregnant. All the sudden I felt like I peed my pants a little bit. I was annoyed and chalked it up as another lovely side effect of pregnancy. I stood up to go to the bathroom and felt a gush! I immediately knew that my water had broke! I went and sat on the toilet and felt a constant trickle. I was in total shock because I had seen my Midwife that morning and she had checked me and I was not dilated at all and baby was really high up.
I told Jeremy and he was really happy because he had been joking all evening that he hoped baby would come that night because he didn't want to go to work the next day. We called his mom and she and Jeremy's sister came right over. I did some laundry and packed my hospital bags (I was flustered because I hadn't done all these things). I straightened up the house, it was a mess. I had to wash Jack's diapers. We finally left for the hospital as contractions started and got there around 11:30pm. They did the test and confirmed my water had broken and checked me and I was dilated to 2. I thought I had a long labor ahead of me and was kind of disappointed that I had arrived at the hospital so early. They checked me into a room and started an IV because I hadn't been tested for GBS yet. I changed into my own nightgown (the nurse thought I was crazy for not wearing theirs) and settled into bed. I wanted to try and rest while I was hooked up to the IV.
Around 1am I started to notice my contractions getting closer together and more intense. I called the nurse and she checked me and said I was dilated to 5! I was shocked; I had dilated 3cm in an hour and a half! At this point I still hadn't seen my midwife because they thought I would be laboring so long, she didn't come in right away. I was able to breathe through them. At this time the nurse hep locked my IV and I was able to get up and move around. I walked around my room while Jeremy watched TV. We called our Doula , Stacy and gave her an update that things were starting to pick up. She was on her way, but lives quite a ways away. We told her we thought she still had plenty of time. I went and sat on the toilet for a while and that seemed to help. I emptied my bladder and I think that really picked things up. I was tired so I got back in bed but was not comfortable to lay down so I sat up for a while and then got on all fours when contractions got more intense. They had me on the monitors for 20 minutes then I got to come off them for awhile.
This is where I kind of lost track of time. My guess around 2:30 am I started having a hard time getting through each contraction and started shaking uncontrollably. I remember thinking "this is really hard, why is it happening so fast?" The nurse checked me and I was 7-8. Looking back now I realize this was transition. I had prepared myself and knew all the signs for transition, but in the middle of it I didn't put all the signs together. I started saying I didn't want to do it anymore. I asked what they would give me if I asked for pain medication. The said nubain and Benadryl. I didn't ask for it. I started to doubt myself. Then all the sudden I had a lot of pressure and told the nurse I wanted up to go sit on the toilet, I had to have a bowel movement. I was really annoyed that they wouldn't let me, but looking back I realize that was just baby moving down and creating all the pressure. I said I wanted to push. I did and the nurse said to stop, the baby was coming. They called my midwife, who was changing into her scrubs I think. She came in and I pushed once and she told me to stop, while she slowly delivered the head. That was really hard because I wanted to just get the baby out! One more push and baby was on my stomach! It was so fast! I looked and said "Oh another boy! " I kept saying," that's it? It's over? I feel so good!"
I told my midwife not to clamp or cut the cord and that we wanted the placenta. The nurse looked at me like I was crazy. I didn't care. Probably 5 minutes passed and I delivered the placenta. Somewhere in that time Jeremy cut the cord. We got to do skin to skin for some time and tried nursing but he didn't seem to interested. The nurse took him and cleaned him up and then he nursed for a half hour. I felt amazing! My doula Stacy walked in 5 minutes after Hank was born, she was so sorry she missed it and was really apologetic. None of us realized how fast this was going to go! My midwife told us to take our placenta out to my doula's car before pathology heard and try to make an issue out of it. My doula encapsulated it and brought it to me the next afternoon.
Hank Jeffrey was born at 3:22am after about 4 ˝ hours of labor and about 6 hours after my water broke. He weighed 6lbs and 4 oz and was 19inches long, my smallest baby! I couldn't have asked for a more perfect birth!
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Colin Fennelly: 'I thought we had it lost at the end'
Waterford pushed reigning All-Ireland champions Kilkenny to within an inch of their championship lives in tonight's epic replayed semi-final with two-goal hero Colin Fennelly admitting he thought the game was lost at the end.
Fennelly was majestic at full-forward in their 2-19 to 2-17 win with his two first-half strikes putting the Cats on the front foot after Austin Gleeson's fifth minute goal.
Read more: This Kilkenny fan consoling a devastated Waterford player could well be the sports photo of the year
The Ballyhale maestro caused Barry Coughlan trouble, and was a constant thorn in the Déise's side for 70-plus minutes, but when Pauric Mahony stepped up to an injury-time free, he thought the sides were destined for another draw, and extra-time.
"It was absolutely crazy, I thought we had it lost at the end. Waterford came back and it was a bit like us the last day, they came back at us. That last point from Richie Hogan was just a wonderful feeling so it was," Fennelly said.
"It's a fabulous feeling with the crowd behind you. The team needed it and we needed it. When Waterford got the first goal, we were against a slight breeze there and the chips were down but the boys just kept threading the ball through.
"And thank God I got through for the goals. Fair play to the boys the ball in today was absolutely unbelievable, you don't even need to talk to them, they just do it. It comes straight from the training field."
It was helter-skelter from the throw-in with both sides going hell for leather in another championship thriller and while fatigue set in early just six days since their 1-21 to 0-24 draw, Fennelly and his team-mates powered through it showing their usual steely character.
"It was absolutely crazy, the first ten minutes I thought I was absolutely shattered, I was thinking 'I can't believe I've to play another 50-60 minutes'. It's absolutely crazy. It's a wonderful feeling out there," he said.
"Character is what this team is about and we didn't slack back. We lapsed a bit in some other games and especially the last day, Waterford were all over us and that had to change."
And change it most certainly did as Kilkenny qualified for the All-Ireland decider with their usual grit and set a crack at another three-in-a-row with the winners of tomorrow's second semi-final between Tipperary and Galway awaiting them.
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- This Kilkenny fan consoling a devastated Waterford player could well be the sports photo of the year
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MONDAY, August 18
The Los Angeles Times runs a front-page story on its sports page about how former Mater Dei basketball phenom Schea Cotton has been forgotten by the public and media that once wrote and read front-page stories about him, making it the 39th article in the last year alone—thank you, Nexis—reminding us that Cotton has been forgotten. Over the past 12 months, Cotton has been forgotten and then remembered by the Register, Sacramento Bee, Lexington -Herald Leader, Birmingham News and Manila Bulletin as well as three times by the LA Times. He has been forgotten as a cautionary tale about getting too famous too soon—Sports Illustratedprofiled him as a freshman at Mater Dei—and for entering the NBA draft too soon; he bailed on a scholarship to a major university—well, Alabama. He's been forgotten so much that he has been reduced to playing professional basketball in Europe and for NBA summer league teams. Devastating. Anyway, he's apparently signed with the Long Beach Jamof the American Basketball Association, the same league for which our own Anaheim-based Southern California Surf play. Cotton's Long Beach signing was confirmed for me by Jam owner Steve Chase, which struck me as odd because Chase is the owner of Southern California Surf. Oh, he was the owner. He left his partners, including George Argyros Jr., to start the Jam and apparently he wasn't the only one. According to Chase, the Surf now have everything you need to play professional basketball except players, an arena and a league. "They have a name and a logo, that's it," he said. Sure, that doesn't sound like much, but then again, it's all Angelyne has and now she's running for governor, lest we forget.
TUESDAY August 19
That kid on the Nike commercial who says he can beat anybody in a race—I'm supposed to hate him, right?
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WEDNESDAY, August 20
According to the Leisure World News, a woman identifying herself as "Margaret" has been calling women who live in Laguna Woods Leisure World and, sounding as though she's under some duress, tells them she's one of their neighbors and that her grandson (who, in the made-for-Lifetime-TV-movie, would be named Skip and played by Corey Haim) is doing terrible things to her—sexual things. She goes on to describe these things in graphic detail to the horror of her concerned neighbors and the delight of the ones who are really into Harold and Maude. KIDDING! It's all horror. When she's advised by the well-meaning neighbors to call the police, Margaret bristles and lets it be known that help is the last thing she wants, hubba hubba. Now, clearly, this is not a cool thing to do to senior citizens who get enough dickwads on the phone trying to bilk them out of their life savings. (It's so bad that Leisure World is hosting another of its identity theft forums, clothing optional—KIDDING!) But is it funny, like Cocoon, or just sick, like Cocoon II: The Codgering. (And what to make of the fact that the sheriff's spokesman I was referred to about the case—and who never returned my phone call—had a name that sounded very much over the phone like "Fleshman.") No, I've decided this is not something I should joke about. But seeing as I've got you all worked up in a froth, I'll offer this vaguely similar situation/joke. Enjoy:
Elderly woman takes her Great Dane to the veterinarian.
Woman: "Doctor, every time I bend over my dog mounts me." Vet: "My goodness! Would you like him neutered?" Woman: "Neutered? I just want you to trim his toenails." THURSDAY, August 21 Speaking of funny, District Attorney Tony Rackauckas is advertising on Monster.com for a media spokesperson, since some of his previous spokespeople—he goes through them like beer nuts—have had a difficult time adjusting to Rackauckas' desire that his media spokesperson not speak to the media. The ad makes clear that you will be doing things Tony's way: "This is an at-will position that serves at the pleasure of the District Attorney." Given that what pleases the DA includes throwing innocent people in jail, bailing out rich friends and wrongfully terminating employees who later sue for big-money settlements, that's quite a party. The ad goes on to say that the ideal candidate must have "proven experience, ability, and expertise which demonstrate media relations knowledge, communication, interpersonal skills, and leadership skills." Translation: "Keep your mouth shut. You didn't hear what you think you just heard. We don't talk to any news organizations. Here's your phone with the Register on speed dial." Lucky for Rackauckas, the perfect candidate is out there and he's available. It's former Nixon spokesman Ron Ziegler. Ziegler is used to getting shoved around—sometimes literally—by dirty politicians and, best of all, he died earlier this year. Dead spokesmen tell no tales.
George W. Bush, worst president ever, right? FRIDAY, August 22 The week ends with more bodies in Iraq, a Newsweek poll that shows a huge majority of Americans believe we'll be bogged down there for years to come and me paying $2.05—at ARCO—for a gallon of gas. George W. Bush, worst president ever, right? SATURDAY, August 23 Tonight we gather for Anthony Pignataro's going-away party. Anthony's leaving to become editor of the Maui Time Weekly and it's hard to see him go. I mean, like everyone, I knew Anthony would someday leave us, but, like everyone, I thought it would be in a hale of rubber bullets amid his own death screams for everyone to keep their filthy hands off his collection of porcelain cats—how Tony loves his cats. So, anyway, everyone was there, the new managing editor of Laguna magazine and me. Anthony was his typical putz self, refusing to put on the snorkeling mask I bought him at considerable expense. He said it was all a plot so we could take a picture of him in the mask looking like a jerk and then run it with this column. It was the typical paranoid delusion that distinguishes a good investigative reporter such as Anthony. Still, it hurt that he had so little trust in me; hurt even more that I don't have a picture for this column of Anthony looking like a jerk in a snorkeling mask as I had planned when I bought the thing. Well, as the Hawaiians say, c'est la vie. Or is it skoal? Anyway, while most of you only know Anthony through such investigate efforts as "El Toro Airport: Yeah, We Get It. Bad Idea. Message Received" and his "Hot Chicks: Where's Mine?" series, I knew him as a friend and sounding board. I'll miss his wicked humor and dogged pursuit of the truth—unfettered by common courtesy or good grooming—which he'll bring to his new gig in Maui. I give it six weeks.


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The SEI helps advance software engineering principles and practices and serves as a national resource in software engineering, computer security, and process improvement. The SEI works closely with defense and government organizations, industry, and academia to continually improve software-intensive systems. Its core purpose is to help organizations improve their software engineering capabilities and develop or acquire the right software, defect free, within budget and on time, every time.
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This presentation, delivered at SEPG North America 2011 by five people from TATA Consultancy Services and Software Technology Transition, explains the concept of a multiple simultaneous appraisal, in this case using CMMI-DEV and CMMI-SVC.
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text: Been way stressed about a concrete pour this past week and when a skid loader failed I was not going to make it. I've been running on 4 hours of sleep and we made the pour today in just over 4 hours. On a whim I went and got my nipples pierced...our maybe it was sleep deprivation. So I guess this makes me "crazy".


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QUETTA: The military on Wednesday kicked off a special combing operation in Quetta and suburbs upon the directives of Army Chief General Raheel Sharif following a deadly bombing in the provincial capital that had left at least 70 people dead and wounded over 110 on Monday.
Yesterday at a Corps Commander Conference, the COAS had directed the commanders and intelligence outfits that they should further intensify the combing and targeted operations with full vigour to eliminate terrorists and sleeper cells.
He had also directed to provide all necessary assistance to the provincial law enforcement agencies (LEAs) in their capacity building through training, resourcing and planning so as to integrate them effectively in counterterrorism operations.
Security personnel, today, launched a special combing operation in Quetta and its suburbs sweeping different areas for suspected elements. Similar operations have been ongoing in different cities of the country.
Dozens of suspects have been rounded up in search operations by LEAs in Karachi, Lahore, Peshawar and other cities since yesterday.
Two Afghan intelligence agents were arrested today during a search operation in Peshawar's Regi area, officials of the Counter Terrorism Department (CTD) said.
They also claimed to have seized a six kilogram explosive device installed inside a computer from suspects, Ateeq and Amanullah.


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Our Yarn & Needle Work Department prides itself in carrying one of the best selections of knitting, crochet, embroidery, felting and cross stitch supplies in Northern California. Our knowledgeable staff strives to be experts in all yarn and needle work fields so they can assist in trouble shooting patterns, helping beginners, or even just a friendly face to chat with! We also offer a free yarn winding service if you've purchased your yarn from our store! Come on in and see what our Yarn department can do for you.
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