text: CLINICAL SCIENCE: Epidemiology and SocialUndisclosed HIV infection and antiretroviral therapy use in the Kenya AIDS indicator survey 2012 relevance to national targets for HIV diagnosis and treatmentKim, Andrea A.; Mukui, Irene; Young, Peter W.; Mirjahangir, Joy; Mwanyumba, Sophie; Wamicwe, Joyce; Bowen, Nancy; Wiesner, Lubbe; Ng'ang'a, Lucy; De Cock, Kevin M. for the KAIS Study GroupAuthor Information aDivision of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi bMinistry of Health, National AIDS and STI Control Programme, Nairobi, Kenya cGlobal Health Sciences, University of California San Francisco, San Francisco, California, USA dMinistry of Health, National Public Health Laboratory Services, Nairobi, Kenya eDivision of Clinical Pharmacology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. *Members of the KAIS Study Group are listed in the Acknowledgments section. Correspondence to Andrea A. Kim, PhD, MPH, Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA. Tel: +1 404 639 1464; e-mail: [email protected] Received 21 April, 2016 Revised 26 July, 2016 Accepted 3 August, 2016 AIDS: November 13, 2016 - Volume 30 - Issue 17 - p 2685-2695 doi: 10.1097/QAD.0000000000001227 Free Metrics Abstract Objectives: This analysis assessed the impact of undisclosed HIV infection and antiretroviral therapy (ART) on national estimates of diagnosed HIV and ART coverage in Kenya. Methods: HIV-positive dried blood spot samples from Kenya's second AIDS Indicator Survey were tested for an antiretroviral biomarker by liquid chromatography-tandem mass spectrometry. Weighted estimates of diagnosed HIV and ART coverage based on self-report were compared with those corrected for undisclosed HIV infection and ART use based on antiretroviral test results. Multivariate analysis determined factors associated with undisclosed HIV infection and ART use among persons on ART. Results: The antiretroviral biomarker was detected in 42.5% [confidence interval (CI) 37.4–47.7] of HIV-infected persons. Antiretroviral drugs were present in 90.7% (CI 86.1–95.2) of HIV-infected persons reporting HIV-positive status and receiving ART, 66.7% (CI 59.9–73.4) reporting HIV-positive status irrespective of ART use, 21.0% (CI 13.4–28.6) reporting HIV-negative status, and 19.3% (CI 9.0–29.5) reporting no previous HIV test. After correcting for undisclosed HIV infection and ART use, diagnosed HIV increased from 46.9 to 57.2% and ART coverage increased from 31.8 to 42.8%. Undisclosed HIV infection while on ART was associated with being aged 25–39 years and not visiting a health provider in the past year, while younger age and higher wealth were associated with undisclosed ART use. Conclusion: Substantial levels of undisclosed HIV infection and ART use among persons on ART were observed, resulting in diagnosed HIV underestimated by approximately 112000 persons and ART coverage by approximately 131000 persons. Supplementing self-reported ART status with objective measures of ART use in national population-based serosurveys can improve monitoring of HIV diagnosis and treatment targets in countries. Introduction Reliable estimates of HIV diagnosis and access to antiretroviral therapy (ART) among persons living with HIV (PLHIV) are needed to monitor progress toward fast-track targets set by the Joint United Nations Programme on HIV/AIDS to control the HIV pandemic by 2030 [1]. National population-based HIV serosurveys provide insight on progress through collection of generalizable information on self-reported HIV status and coverage of HIV services among HIV-infected persons. In combination with biomarkers, this allows for the assessment of trends in the continuum of care among PLHIV, from HIV diagnosis, linkage to care, ART initiation, to viral suppression. Robust estimates of these indicators, however, rely on participants answering questions related to HIV status and access to services accurately during an interview. The Kenya AIDS Indicator Survey (KAIS) 2012 was a national serosurvey that linked information on demographics, behavior, and access to health interventions to HIV-related biomarkers to monitor the impact of the national HIV response. The criteria for ART initiation at the time of the survey included persons with CD4+ cell counts 350 cells/μl or less, or, irrespective of CD4+ cell count, persons with WHO clinical stage 3/4 disease, persons with active tuberculosis coinfection, or persons with hepatitis B virus coinfection with evidence of liver disease [2]. In 2012, the national ART program reported that 549 000 HIV-infected adults were receiving ART, representing 78% of treatment-eligible adults living with HIV infection in Kenya [3]. In KAIS 2012, 23% of persons who reported HIV-positive status with no prior history of ART use were virally suppressed (unpublished data). This finding was surprising given that the control of viral replication in the absence of treatment is considered a rare event [4,5]. This phenomenon has also been documented in clinical studies that later confirmed that underreporting of true ART use among study participants resulted in higher than expected levels of viral suppression among PLHIV who were reportedly treatment naive [6–10]. The parallel finding in KAIS 2012 raised concerns that some respondents may have misreported their ART status resulting in an underestimate of ART coverage measured from the survey. Testing HIV-positive blood for the presence of antiretroviral metabolites provides a direct biomedical measure of ART use that can be used to improve estimates of ART coverage, and, by extension, estimates of diagnosed HIV among PLHIV. Such data remain important for clinical trials that enroll participants based on no prior history of HIV treatment and population-based surveys designed to generalize levels of undiagnosed HIV, ART access, and viral suppression in the population. In this analysis we assess the level of undisclosed HIV infection and ART use among persons with the antiretroviral biomarker in KAIS 2012 and impact on national estimates of diagnosed HIV and ART coverage. Methods KAIS 2012 was a nationally representative household survey of persons aged 18 months to 64 years [11,12]. Survey respondents were administered face-to-face interviews that collected information on demographics, sexual behavior, HIV testing history, HIV status, and receipt of health interventions, including ART for persons who disclosed HIV-positive status. Venous blood samples were collected in CD4+ stabilization tubes, which were used to prepare dried blood spot (DBS) cards in a field laboratory. Respondents were offered on-site rapid HIV testing based on national guidelines [13], and results were returned immediately with counselling by trained staff in a private area in the home. Blood samples were transported to a central laboratory where DBS were tested for HIV-1 antibodies using Vironostika HIV-1/2 UNIF II Plus O enzyme immunoassay (sensitivity and specificity = 100%) and Murex HIV.1.2.0 enzyme immunoassay (sensitivity = 100%; specificity = 99.5%) [14,15]. CD4+ cell counts were measured using the BD FACSCalibur flow cytometer (Becton Dickinson Biosciences, San Jose, California, USA). HIV-positive DBS were tested for HIV-1 RNA concentration (Abbott M2000 Real-Time HIV-1 Assay; Abbott Laboratories, Abbott Park, Illinois, USA). Undetectable viral load was defined as HIV-1 RNA concentration less than 1000 copies/ml. Remnant DBS samples were stored in −70°C freezers for future testing. Two years after survey completion, HIV-positive DBS were transferred to the University of Cape Town in South Africa where a qualitative antiretroviral assay was applied to test for nevirapine (NVP), efavirenz (EFV), lamivudine (3TC), and lopinavir (LPV) using liquid chromatography-tandem mass spectrometry [16]. The assay's lower limit of detection was 0.02 μg/ml. The number of days from ingestion to reaching this threshold was 12–28 days for EFV, 8–9 days for NVP, 1.5 days for 3TC, and 1.5–2.5 days for LPV. Samples that fell above this cut-off for any of the antiretroviral drugs tested were classified as having the antiretroviral biomarker present. Though validations studies assessing the performance of DBS on the qualitative assay have not been conducted, a study that compared the performance of quantitative measurement of antiretroviral drug levels in plasma and DBS using liquid chromatography-tandem mass spectrometry found no major differences [17]. In 2012, the first-line standardized ART regimen for Kenyan adults was tenofovir + 3TC + EFV or NVP and second-line regimen was zidovudine + 3TC + LPV/ritonavir [2]. For pregnant women or patients intolerant to tenofovir, the recommended first-line regimen was zidovudine + 3TC + EFV or NVP. Measures The primary outcomes for this analysis were undisclosed HIV infection and undisclosed ART use while on ART. We categorized self-reported HIV status into five categories: HIV-positive, HIV-negative, HIV-indeterminate, never tested for HIV, and unknown self-reported HIV status (i.e. persons who reported testing for HIV but did not provide a result). HIV-infected persons who reported HIV-positive status were classified as having disclosed HIV infection, whereas HIV-infected persons with the antiretroviral biomarker who reported HIV-negative, HIV-indeterminate, never tested for HIV, or had unknown self-reported status were classified as having undisclosed HIV infection while on ART. Persons who reported ART use, irrespective of antiretroviral test results, were classified as having disclosed ART use. Respondents with the antiretroviral biomarker who reported HIV-positive status with no history of ART use or who reported HIV-negative, HIV-indeterminate, never tested for HIV, or unknown self-reported status were classified as having undisclosed ART use while on ART. Variables tested for potential associations with the outcomes of interest included demographic variables: sex, age, marital status, education, wealth, urban/rural residence, and region; behavioral variables: number of sexual partners in the past year, condom use, and knowledge of partner HIV status; and clinical variables: history of visiting a health provider in the past year, history of tuberculosis disease, undetectable viral load, and median CD4+ cell count. Analysis This analysis was restricted to respondents aged 15–64 years who tested HIV-positive in the survey and had sufficient volume of blood available in stored DBS for antiretroviral testing. Using the antiretroviral test results as the reference standard, we calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of self-reported ART status. The Rao–Scott χ2 test was used to measure associations between categorical variables and outcomes of interest in bivariate analysis. Medians and interquartile ranges were reported for continuous variables. The Wilcoxon rank sum test was used to measure the association between continuous variables and the outcome variables. We used PROC SURVEYLOGISTIC in SAS version 9.3 (SAS Institute, Inc., Cary, North Carolina, USA) to determine independent and significant correlates of undisclosed HIV infection and ART use among persons on ART in multivariate logistic regression. The model included variables that were associated with the outcomes of interest in bivariate analysis at a P value less than 0.2. Associations were considered statistically significant if the 95% confidence interval (CI) for the adjusted odds ratio (AOR) did not include 1.0. All estimates presented were weighted to account for sampling probability and survey nonresponse. In a subanalysis, we compared national estimates of diagnosed HIV and ART coverage based on self-report alone; HIV and ART coverage based corrected for undisclosed HIV and ART use among persons on ART; and for comparison of ART coverage estimates only, estimates of treatment coverage based on national ART program data. We extrapolated population counts of the number of diagnosed PLHIV and the number of PLHIV on ART by applying nonnormalized survey weights based on the 2012 projected population data in the 2009 Kenya Population and Housing Census to the outcome variables [18]. For programmatic estimates of ART coverage, Spectrum version 5.31 (Avenir Health, Glastonbury, Connecticut, USA) was used to project estimates of the number of PLHIV aged 15 years and older from 1970 to 2020 [19]. The number of adult ART patients in 2012 was based on antiretroviral drug dispensing data from Kenya's Logistics Management Information System. Programmatic ART coverage was calculated by dividing the number of adult ART patients by the projected number of adult PLHIV. Plausibility bounds around programmatic ART coverage were calculated using an uncertainty analysis, which applied Monte Carlo simulations to estimate the impact of uncertainty in modeled HIV incidence and model assumptions [20,21]. A Z-test was conducted to test for differences in ART coverage by estimation method. Results Overall, 648 of 11 626 respondents tested HIV-positive (Fig. 1). Of those, 559 (86.3%) had sufficient volume available in stored DBS for antiretroviral testing. No statistically significant differences in sex, age, urban/rural residence, region, marital status, education, or wealth were found among HIV-positive respondents with antiretroviral test results compared with HIV-positive respondents without these results. Among the 559 individuals with antiretroviral test results, 271 (47.7%; CI 41.8–53.6) reported HIV-positive status, 202 (35.9%; CI 31.0–40.9) reported HIV-negative status, seven (1.0%; CI 0–2.0) reported HIV-indeterminate status, 18 (3.1%; CI 1.5–4.8) had unknown self-reported status, and 61 (12.2%; CI 8.9–15.6) reported that they had never tested for HIV. Among respondents who disclosed HIV infection (n = 271), 186 (69.1%; CI 62.3–76.0) reported receiving ART.Fig. 1: HIV-infected survey respondents aged 15–64 years by self-reported HIV status and detection of the ARV biomarker, Kenya AIDS Indicator Survey 2012.ART, antiretroviral therapy; ARV, antiretroviral.Presence of the antiretroviral biomarker At least one drug was detected in 235 of 559 specimens tested, representing 42.5% (CI 37.4–47.7) of HIV-positive persons. Among those, 3TC was detected in 94.5% (CI 91.3–97.8), NVP in 62.9% (CI 55.9–69.9), EFV in 34.0% (CI 27.1–40.9), and LPV in 3.9% (CI 0.8–7.0). Among persons who disclosed HIV infection (n = 271), 180 (66.7%; CI 59.9–73.4) had detectable antiretrovirals (Fig. 2). Those who disclosed both HIV infection and ART use (n = 186) had antiretrovirals detected in 168 (90.7%; CI 86.1–95.2). Among persons who disclosed HIV infection but did not disclose using ART (n = 85), 12 (12.9%; CI 5.2–20.6) had antiretrovirals detected.Fig. 2: Percentage of HIV-infected respondents aged 15–64 years with the antiretroviral biomarker by self-reported HIV status, Kenya AIDS Indicator Survey 2012†.ARV, antiretroviral. †Analysis restricted to 559 HIV-positive dried blood spot samples available for antiretroviral testing. Whiskers on bars represent 95% confidence intervals for presented estimates. ‡Estimates may be unreliable due to denominator less than 25 observations and should be interpreted cautiously.A total of 202 HIV-infected persons reported HIV-negative status. Of those, 38 (21.0%; CI 13.4–28.6) had the antiretroviral biomarker, and 26 (61.7%; CI 43.0–80.5) of those reported receiving their last HIV-negative result within the year preceding the survey. Among HIV-infected persons who reported never testing for HIV (n = 61), eight (12.8%; CI 3.3–22.3) had the antiretroviral biomarker present. A minority of persons reported that their last HIV test was indeterminate (n = 7) or reported an unknown HIV serostatus (n = 18). Of those, the antiretroviral biomarker was present in 13.4% (CI 0–41.1) and 46.5% (CI 20.4–72.7), respectively. Among persons who had the antiretroviral biomarker (n = 235), 18.3% (CI 12.7–24.0) did not disclose their HIV infection (n = 55) and 6.0% (CI 2.5–9.5) did not disclose ART use despite disclosing HIV infection (n = 12). Compared with results from antiretroviral testing, the sensitivity of self-reported ART use was 71%, the specificity was 94%, the PPV was 90%, and the NPV was 82%. Characteristics of persons on antiretroviral therapy with undisclosed HIV infection In bivariate analysis, male sex, younger age (15–24 years), living in urban residences, higher wealth, not visiting a health provider in the past year, and being virally suppressed were associated with undisclosed HIV infection while on ART at a P value less than 0.1 (Table 1). In multivariate analysis, compared with HIV-infected persons who disclosed their HIV infection HIV-positive status, persons aged 25–39 years (compared with aged 40–64 years: AOR 5.0; CI 1.1–22.0) and not visiting a health provider in the past year (AOR 6.1; CI 1.4–26.1) were associated with significantly higher adjusted odds of having undisclosed HIV infection while on ART.Table 1: Demographic, behavioral, and clinical characteristics of HIV-infected persons aged 15–64 years by HIV disclosure status, Kenya 2012.Characteristics of persons on antiretroviral therapy with undisclosed antiretroviral therapy use and impact on measures of viral suppression In bivariate analysis, undisclosed ART use was associated with younger age (aged 15–24 years), higher wealth, and not visiting a health provider in the past year at a P value less than 1.0 (Table 2). In multivariate analysis, younger age (compared with aged 40–64 years: AOR 5.3; CI 1.4–19.8) and having higher wealth compared with lower wealth (AOR 3.1; CI 1.1–9.2) remained significantly associated with higher adjusted odds of undisclosed ART use while on ART.Table 2: Demographic, behavioral, and clinical characteristics of HIV-infected persons aged 15–64 years on antiretroviral therapy by antiretroviral therapy disclosure status, Kenya 2012.Viral suppression ranged from 22.6% (CI 17.1–28.1) among HIV-infected persons who reported no prior history of ART use to 76.2% (CI 69.4–83.0) among those who were reportedly taking ART (data not shown). After accounting for undisclosed ART use based on results of antiretroviral testing, viral suppression decreased to 10.4% (CI 6.4–14.4) among persons not on ART and increased to 80.4% (CI 74.7–86.1) among those on ART. National estimates of HIV diagnosis and antiretroviral therapy coverage The percentage of persons with diagnosed HIV increased from 46.9% (305/648, CI 41.3–52.4) based on self-report (population estimate: 558 000; CI 457 000–660 000) to 56.2% (360/648, CI 50.7–61.7) after correcting for undisclosed HIV infection among persons on ART (population estimate: 670 000; CI 561 000–779 000). ART coverage increased from 31.8% (205/648, CI 27.1–36.5) based on self-report (population estimate: 379 000; CI 304 000 -454 000) to 42.8% (272/648, CI 37.9–47.8) after correcting for undisclosed ART use among persons on ART (population estimate: 510 000; CI 425 000–596 000). In 2012, the national ART program reported that programmatic ART coverage was 47% (CI 40–53) based on a numerator of 549 000 adult patients who received ART in health facilities that year and a projected denominator of 1 157 000 adult PLHIV based on the Spectrum model. Programmatic ART coverage was statistically different from ART coverage based on self-report (P < 0.001) but similar to ART coverage adjusted for the antiretroviral biomarker (P = 0.315). Discussion We confirm that substantial misreporting occurred when HIV-infected respondents were asked to report their HIV and ART status in KAIS 2012. Only 71% of persons with detectable antiretrovirals reported a history of ART use, resulting in an underestimation of national ART coverage by 11% points and diagnosed HIV by 9% points. The impact of this bias resulted in an estimated 131000 persons on ART and 112 000 persons with diagnosed HIV who were left unaccounted for in national estimates of coverage based exclusively on self-report [22]. Over 90% of persons who reported ART use in the interview had evidence of at least one antiretroviral drug in their blood, suggestive of high levels of treatment adherence among HIV-infected persons acknowledging ART use. The percentages of individual antiretroviral drugs detected in our sample were in alignment with the expected coverage of the same drugs in the national ART program in 2012. Approximately 95% of individuals with the antiretroviral biomarker had evidence of 3TC, a drug recommended in both first and second-line regimens for adults. Additionally, 96% of persons with the antiretroviral biomarker were receiving NVP or EFV, also recommended as first-line therapy for adults. Based on a systematic review of the literature, an estimated 16% of ART patients are expected to experience treatment failure after 1 year on treatment, requiring switch to second-line ART [23]. Though this estimate is higher than the percentage of second-line drug (LPV) detected in our sample, KAIS 2012 did not collect information on duration of ART use, treatment failure, and access to second-line therapy to confirm whether this level should have been higher. Estimated viral suppression in the absence of treatment decreased by over 50%; from 23% based on self-report to 10% after correction through antiretroviral testing. A similar rate was reported in rural Uganda during a population-based health campaign in 2011, where 10% of persons who were not on ART were virally suppressed [24]. Though these rates of viremic control in the absence of treatment are high [4,5], they are not implausible given that the HIV epidemic in East Africa has existed for a long period resulting in more pressure to select those who have naturally lower viral loads as the duration of the HIV epidemic increases [25]. Compared with the antiretroviral biomarker, self-reported ART use had modest sensitivity and NPV, which was likely influenced by social desirability bias. Our findings also confirmed that self-reported serostatus was impacted by this bias. The risk of undisclosed HIV infection while on ART was highest among younger persons and individuals who had not visited a health provider in the past year. In contrast the risk of undisclosed ART use while on ART was highest among persons who were young or wealthy. Interestingly, 6% of persons with detectable antiretrovirals disclosed their HIV infection but did not disclose ART use. These results were unexpected given that the perceived level of stigma associated with acknowledging HIV infection is assumed to be higher than that of acknowledging ART use, particularly in settings where treatment is broadly promoted and accessible for most PLHIV. Disclosure of sensitive health-related information is complex and may be influenced by a number of factors related to the respondent, interviewer, and interviewer mode. For example, respondents may feel embarrassed or fear judgement when asked sensitive questions; they may want to please the interviewer and report behaviors they perceive to be more socially acceptable; they may feel that their responses will not be kept private and respond inaccurately to protect their anonymity; they may believe what they report; or they may have misunderstood the question. Additionally, the interviewer may have reworded questions inaccurately or incorrectly coded responses. Every effort should be made to reduce reporting biases by ensuring that high-quality interviews that promote accurate reporting are delivered and that the mode of interview ensures that participants to feel at ease in their responses. Self-administered questionnaires or computer-assisted self-interviews that remove the interviewer could yield higher rates of accurate responses to sensitive questions, though measurement of these indicators may need to be simplified before consideration. This analysis had the following limitations. Although estimates of ART coverage improved with inclusion of an antiretroviral biomarker, true population ART coverage may still be underestimated. The parent drugs selected for antiretroviral testing were based on the standardized treatment regimens available in public health facilities in Kenya. If a patient was on a regimen that did not include any of the four drugs tested, evidence of ART use would not have been detected. Additionally, given the short half-life of the antiretroviral drugs tested, the antiretroviral biomarker served as a marker of recent exposure to antiretrovirals and may have underestimated ART use if adherence was poor. Although we found that antiretroviral testing improved estimates of diagnosed HIV, a downward bias is still present by missing individuals who may be aware of their infection (but do not report it) and have not yet accessed ART. To understand the extent of this bias, 7% of persons with an HIV diagnosis in Kenya had not accessed care services in 2012, and of those in care, 22% had not yet accessed treatment. This limitation should be lessened in the future as treatment for all PLHIV is introduced irrespective of CD4+ cell count [26]. Finally, we were unable to compare reported ART use with antiretroviral biomarker results for HIV-infected persons who did not disclose HIV-positive status given that a history of ART use was collected only for persons who acknowledged that they were HIV-positive during the interview. In conclusion, antiretroviral testing in a national population-based serosurvey in Kenya confirmed that self-reported information on HIV-positive status and ART use should not be used alone for generalizing estimates of diagnosed HIV and ART coverage. The change in viral suppression by ART status illustrates a further limitation of reliance on self-reported ART status. Not only did it result in an underestimate of diagnosed HIV and ART coverage at the population-level, the resulting misclassification at the individual level can potentially bias associations between known status, ART use, and other explanatory factors. We were encouraged to find the estimates of national ART coverage based on routine program data collected at ART facilities to be robust, a reassuring finding considering that program data are often criticized for poor data quality, though they remain the main source of information used by low and middle-income countries (LMIC) to plan, monitor, and evaluate treatment access. Still, much work is needed as most HIV treatment monitoring systems do not yet have the ability to link back to when an individual was diagnosed HIV-positive, limiting the opportunity to effectively monitor sentinel events along the cascade of HIV care for all PLHIV [27]. Until these systems are established and validated in LMIC, population-based serosurveys that include objective measures of ART use and biomarkers to measure viral suppression, serve as the best source of data for countries to monitor the reach and effectiveness of prevention and treatment interventions on achieving a successful treatment continuum. In settings where antiretroviral testing is not feasible, self-reported data on HIV and ART status remain informative [28] but should be supplemented with information that can confirm status, such as verification in a health record. Triangulation of biological, epidemiological, and programmatic data remains an essential approach to generate best-supported estimates of diagnosis and treatment targets in a country. Acknowledgements A.A.K., I.M., J.W., L.N., and K.D.C. conceived and designed the experiments. P.W.Y., S.M., and L.W. performed the experiments. A.A.K. analyzed the data and wrote the study. A.A.K., I.M., P.W.Y., J.M., S.M., J.W., N.B., L.W., L.N., and K.D.C. reviewed and approved the manuscript. We would like to thank Wanjiru Waruiru from the University of California, San Francisco and Jennifer Norman and Karen Cohen from the University of Cape Town, South Africa for their support in facilitating antiretroviral testing of KAIS 2012 specimens. We would also like to thank the KAIS 2012 survey participants for their willingness to participate in the survey and the KAIS Study Group for their contribution to the design of the survey and collection of the data set. Members of the KAIS Study Group are: Willis Akhwale, Sehin Birhanu, John Bore, Angela Broad, Robert Buluma, Thomas Gachuki, Jennifer Galbraith, Anthony Gichangi, Beth Gikonyo, Margaret Gitau, Joshua Gitonga, Mike Grasso, Andrew Imbwaga, Malayah Harper, Muthoni Junghae, William Maina, Nicolas Muraguri, Mutua Kakinyi, Samuel Mwangi Kamiru, Nicholas Owenje Kandege, Lucy Kanyara, Yasuyo Kawamura, Timothy Kellogg, George Kichamu, Andrea Kim, Lucy Kimondo, Davies Kimanga, Elija Kinyanjui, Stephen Kipkerich, Dan Koros, Danson Kimutai Koske, Agneta Mbithi, Veronica Lee, Serenita Lewis, Ernest Makokha, Agneta Mbithi, Joy Mirjahangir, Ibrahim Mohamed, Rex Mpazanje, Nicolas Muraguri, Patrick Mureithi, Lilly Muthoni, James Muttunga, Jane Mwangi, Mary Mwangi, Sophie Mwanyumba, Francis Ndichu, Anne Ng'ang'a, James Ng'ang'a, John Gitahi Ng'ang'a, Lucy Ng'ang'a, Carol Ngare, Bernadette Ng'eno, Inviolata Njeri, David Njogu, Caleb Obada, Bernard Obasi, Macdonald Obudho, Edwin Ochieng, Linus Odawo, James Odek, Jacob Odhiambo, Samuel Ogola, David Ojakaa, James Kwach Ojwang, George Okumu, Patricia Oluoch, Tom Oluoch, Osborn Otieno, Kennedy Ochieng Omondi, Yakubu Owolabi, Boniface O.K'Oyugi, Bharat Parekh, George Rutherford, Sandra Schwarcz, Shahnaaz Sharrif, Victor Ssempijja, Lydia Tabuke, Yuko Takenaka, Mamo Umuro, Brian Eugene Wakhutu, Wanjiru Waruiru, Celia Wandera, John Wanyungu, Anthony Waruru, Paul Waweru, Larry Westerman, and Kelly Winter. The second Kenya AIDS Indicator Survey was conducted by the National AIDS and STI Control Programme (NASCOP), Kenya National Bureau of Statistics, (KNBS), National Public Health Laboratory Services (NPHLS), National AIDS Control Council (NACC), National Council for Population and Development (NCPD), Kenya Medical Research Institute (KEMRI), U.S. Centers for Disease Control and Prevention (CDC/Kenya, CDC/Atlanta), United States Agency for International Development (USAID/Kenya), University of California, San Francisco (UCSF), the United States Agency for International Development (USAID/Kenya), Joint United Nations Team on HIV/AIDS, Japan International Cooperation Agency (JICA), the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), Liverpool Voluntary Counselling and Testing (LVCT), the African Medical and Research Foundation (AMREF), the World Bank, and the Global Fund. This publication was made possible by support from the US President's Emergency Plan for AIDS Relief through cooperative agreements [#PS001805, GH000069, and PS001814] through the US Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis. This work was also funded in part by support from the Global Fund, World Bank, and the Joint United Nations Team for HIV/AIDS. Antiretroviral drug analysis reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1 AI068634, UM1 AI068636 and UM1 AI106701. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or National Institutes of Health. 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PLoS One 2014; 9:e86719. Cited Here | PubMed | CrossRef 6. Sullivan AK, Savage EJ, Lowndes CM, Paul G, Murphy G, Carne S, et al Non-disclosure of HIV status in UK sexual health clinics: a pilot study to identify non-disclosure within a national unlinked anonymous seroprevalence survey. Sex Transm Infect 2013; 89:120–121. Cited Here | View Full Text | PubMed | CrossRef 7. Das M, Fisher Raymond H, Chu P, Nieves-Rivera I, Pandori M, Louie B, et al Measuring the unknown: calculating community viral load among HIV-infected MSM unaware of their HIV status in San Francisco from national HIV behavioral surveillance, 2004–2011. J Acquir Immune Defic Syndr 2013; 63:e84–e86. Cited Here | View Full Text | PubMed | CrossRef 8. Marzinke MA, Clarke W, Wang L, Cummings V, Liu T, Piwowar-Manning E, et al Nondisclosure of HIV status in a clinical trial setting: antiretroviral drug screening can help distinguish between newly diagnosed and previously diagnosed HIV infection. Clin Infect Dis 2014; 58:117–120. Cited Here | View Full Text | PubMed | CrossRef 9. Fogel JM, Wang L, Parson TL, Ou SS, Piwowar-Manning E, Chen Y, et al Undisclosed antiretroviral drug use in a multinational clinical trial (HIV prevention trials network 052). J Infect Dis 2013; 208:1624–1628. Cited Here | View Full Text | PubMed | CrossRef 10. Lingappa JR, Kahle E, Mugo N, Mujugira A, Magaret A, Baeten J, et al Characteristics of HIV-1 discordant couples enrolled in a trial of HSV-2 suppression to reduce HIV-1 transmission: the Partners study. PLoS One 2009; 4:e5272. Cited Here 11. National AIDS and STI Control Programme (NASCOP). The Kenya AIDS Indicator Survey 2012: final report. Nairobi, Kenya: NASCOP; 2014. Cited Here 12. Waruiru W, Kim AA, Kimanga DO, Ng'ang'a J, Schwarcz S, Kimondo L, et al The Kenya AIDS Indicator Survey 2012: rationale, methods, description of participants, and response rates. J Acquir Immune Defic Synd 2014; 66 (Suppl1):3–12. Cited Here 13. National AIDS and STI Control Programme (NASCOP). National Guidelines for HIV testing and counseling in Kenya. 2nd edNairobi, Kenya: NASCOP; 2010. Cited Here 14. Vironostika HIV-1 plus O Microelisa System. Marcy-l'Etoile, France: bioMérieux; 2000. Cited Here 15. Murex HIV-1.2.0 enzyme immunoassay. Dartford, UK: Abbott Laboratories; 2009. Cited Here 16. Rehle T, Johnson L, Hallett T, Mahy M, Kim A, Odido H, et al A comparison of South African national HIV incidence estimates: a critical appraisal of different methods. PLoS One 2015; 10:e0133255. Cited Here | PubMed | CrossRef 17. Koal T, Burhenne H, Romling R, Svoboda M, Resh K, Kaever V. Quantification of antiretroviral drugs in dried blood spot samples by means of liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom 2005; 19:2995–3001. Cited Here | PubMed | CrossRef 18. Kenya National Bureau of Statistics (KNBS)Nairobi, Kenya: KNBS; 2010. Cited Here 19. Stover J, Adreev K, Slaymaker E, Gopalappa C, Sabin K, Velasquez C, et al Updates to the spectrum model to estimate key HIV indicators for adults and children. AIDS 2014; 28 (suppl 4):S427–S434. Cited Here | View Full Text | PubMed | CrossRef 20. Stover J, Johnson P, Zaba B, Zwahlen M, Dabis F, Ekpini RE. The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds. Sex Transm Inf 2008; 84:i24–i30. Cited Here 21. Stover J, Brown T, Marston M, et al Updates to the Spectrum/Estimation and Projection Package (EPP) model to estimate HIV trends for adults and children. Sex Transm Infect 2012; 88:i11–i16. Cited Here | View Full Text | PubMed | CrossRef 22. Odhiambo JO, Kellogg TA, Kim AA, Ng'ang'a L, Mukui I, Umuro M, et al Antiretroviral treatment scale-up among persons living with HIV in Kenya: results from a nationally-representative survey. J Acquir Immune Defic Synd 2014; 66 (suppl 1):116–122. Cited Here 23. McMahon JH, Elliott JH, Bertagnolio S, Kubiak R, Jordan MR. Viral suppression after 12 months of antiretroviral therapy in low- and middle-income countries: a systematic review. Bull World Health Organ 2013; 91:377–385. Cited Here | PubMed | CrossRef 24. Jain V, Liegler T, Kabami J, Chamie G, Clark TD, Black D, et al Assessment of population-based HIV RNA levels in a rural east African setting using a fingerprick-based blood collection method. Clin Infect Dis 2013; 56:598–605. Cited Here | View Full Text | PubMed | CrossRef 25. Hallett TB, Ghys P, Barnighausen T, Yan P, Garnett GP. Errors in 'BED'-derived estimates of HIV incidence will vary by place, time and age. PloS One 2009; 4:e5720. Cited Here | PubMed | CrossRef 26. World Health Organization (WHO). Guidelines on when to start antiretroviral therapy and on preexposure prophylaxis for HIV. Geneva, Switzerland: WHO; 2015. Cited Here 27. De Cock KM. Plus ça change ... antiretroviral therapy, HIV prevention, and the HIV treatment cascade. Clin Infect Dis 2014; 58:1012–1014. Cited Here | View Full Text | PubMed | CrossRef 28. Johnston LG, Sabin ML, McFarland W, Prybylski D, Sabin K, Baral S, et al Asking self-reported HIV serostatus in bio-behavioral surveys is crucial in the era of 90-90-90. Bull World Health Org 2016; 94:605–612. Cited Here | PubMed | CrossRef Keywords:antiretroviral therapy; HIV diagnosis; HIV surveillance; Kenya; self-reported data; sub-Saharan Africa; viral load Copyright © 2016 Wolters Kluwer Health, Inc.View full article text


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Watch The Deed: Chicago
Add to Watchlist
The Deed: Chicago is a series that is currently running and has 2 seasons (10 episodes). The series first aired on March 29, 2017.The Deed: Chicago is available for streaming on the website, both individual episodes and full seasons. You can also watch The Deed: Chicago on demand atAmazon, NBC, CNBC, FuboTV, Sling, Google Play, iTunes, Peacock online.
Watch Full Episodes of The Deed: Chicago
The Deed: Chicago Full Episode Guide
- Episode 6 - The Comeback Queen
A first-time Chicago flipper faces foreclosure after a contractor took her money, did shoddy work, and lied about inspections.
- Episode 5 - The Bungalow Kings
- Episode 4 - Will This Host Make the Most?
Robin purchased a 19th-century Greystone on Chicago's South Side, but the ambitious project is over budget and months behind schedule.
- Episode 3 - The Great Transformation
Successful Chicago broker Nick originally planned a six-month reno, but he's been leaning on all the wrong people and the stalled project is now costing him money.
- Episode 2 - Save Me From the Wrecking Ball!
An Ambitious contractor tries to turn his dark past into a bright future, but his latest project will either make or break both his career and his finances.
- Episode 1 - Designer Dreamhouse
- Episode 4 - Playing Defense on the Deal
Sean meets Kai and Bernette, a duo whose reckless house-buying spree has left them cash-strapped. Though once-successful flipper Bernette was hit hard in the housing crash of 2008, the couple has re-entered the real estate market with little regard for past mistakes. Can Sean teach them how to manage their money or will history repeat itself?
- Episode 3 - Analysis Paralysis
Sean teams up with Larry and Chantill, a couple from Chicago's South Side who see real estate as their ticket to success, and who put their trust in the wrong people.
- Episode 2 - The Mistake On the Lake
Sean teams up with Mark and Bryan, two best friends who built a business based on quick and easy flips, and who have run into a problem with a house bought at auction.
- Episode 1 - Fires on Every Floor
Sean partners with Berta, a real estate broker who started flipping condos on the side and now faces financial ruin.

subset: commoncrawl


text: Celebrate your LSU Tigers fandom with this Topper hat from Top of the World! This festive hat highlights your LSU Tigers pride with an embroidered LSU Tigers graphic on the crown, six panels with eyelets and an adjustable snap strap in the back. It also has embroidered LSU Tigers detailing underneath the bill that shows off your team pride even further when you flip up your lid.


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In order to use this part of the reservation system, you must log in.
If you need to recover your account or change your password the new password will need to be a mix of upper & lower case characters, numbers
and special characters to increase password security for your protection.
Once you log in, you will be able to make and view reservations. You will also be able to modify or cancel your reservations.
If you forgot your password, you may also recover your account.
(21+)Join us under the stars this summer on Saturday nights from 7-10 p.m. at the new double-decker driving range at Burke Lake Golf Complex. Enjoy unlimited range balls, snacks, soft drinks, music, games, prizes and drawings. May 5-Cinco de Mayo, July 21-Summer Party, Sept 22-Burke-tober Fest.
Sign up for this activity ended on 07/27/2018 12:00:00 AM


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Photo essay: Maryland tennis remains undefeated after topping Towson and Coppin State
Ayana Akli celebrates after scoring a point against Towson's Themis Haliou during their singles match on Jan. 25, 2020. (Julia Nikhinson/The Diamondback)
Maryland's Vera Markovic competes in her singles match against Towson's Alexa Martinez during the meet in College Park on Jan. 25, 2020. Markovic won her singles match 7-6, 7-5.
Ayana Akli serves the ball during Maryland's meet against Towson on Jan. 25, 2020.
Maryland's Eva Alexandrova hits the ball during her singles match against Amelia Lawson. Alexandrova won her match in straight sets, 6-0, 6-0.
Associate head coach Dan Pollock talks to Chloe Hamlin and Zoe Kulkarni during their doubles match against Towson's Amelia Lawson and Alexa Martinez. Hamlin and Kulkarni won the match, 4-3.
Ayana Akli hits the ball during her singles match against Towson's Themis Haliou on Jan. 25, 2020. Akli won the match 6-0, 6-0.
Ayana Akli competes against Coppin State's Shariah Dunwell. Akli won her singles match 6-0, 6-1.


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Langston University is a public university in Langston, Oklahoma, United States. It is the only historically black college in the state and the westernmost historically black college in the United States. Though located in a rural setting just 10 miles (16 km) east of Guthrie, Langston also serves an urban mission with University Centers in both Tulsa and Oklahoma City. The University is a member-school of Thurgood Marshall College Fund.
The school was founded in 1897 and was known as the Oklahoma Colored Agricultural and Normal University. Langston University was created as a result of the second Morrill Act in 1890. The law required states with land-grant colleges (such as Oklahoma State University, then Oklahoma A&M) to either admit African-Americans, or provide an alternative school for them to attend as a condition of receiving federal funds.[1] Langston University is named for John Mercer Langston (1829–1897), civil rights pioneer, first African American member of Congress from Virginia, founder of the Howard University Law School, and American consul-general to Haiti. It was renamed Langston University in 1941.
Through the years Langston University has developed slowly but surely. Some of the most serious problems have been political influences, financial stress, and lack of adequate space and equipment. During the 1960s the campus underwent a complete makeover. New buildings appeared, and additions were made to the library and auditorium. Thus, despite the problems, Langston has braved the storms and produced outstanding graduates. Langston alumni are scattered throughout the nation and are serving humanity with pride.
Poet Melvin B. Tolson taught at Langston from 1947 until 1964. Tolson was portrayed by Denzel Washington in the film The Great Debaters.
The university offers associate's, bachelor's, master's, and doctoral degrees in a variety of disciplines. It is known as a leader in the field of agricultural research, and hosts the internationally recognized E (Kika) de la Garza Institute for Goat Research. LU has nearly 3,000 students from several states representing a diverse student body at an Oklahoma college.
The university offers the Edwin P. McCabe Honors Program for undergraduate students with exceptional academic records and that satisfy all unique admission requirements.[2]
The university was accredited with a Doctorate of Physical Therapy program in 2005.[3]
Langston University teams, bearing the sport name of the Lions, are part of the National Association of Intercollegiate Athletics (NAIA), primarily competing in the Red River Athletic Conference (RRAC), while its football team competes in the Central States Football League (CSFL). Men's sports include basketball, cross country, football and track & field; while women's sports include basketball, cheerleading, cross country, softball, track & field and volleyball. The present athletic director is Donnita Rogers. On April 30, 2014, Cheryl Miller was hired as its women's basketball coach.
Langston's marching band is known as the "Marching Pride". The "Marching Pride" is a major ambassador of the university, athletics supporter, and serves as a training center for students interested in pursuing a career in music and/or developing pertinent life skills.[4]
As of 2015, the band has won three bids to the Atlanta, Georgia since the inaugural event in 2003.
from the 37th district
Washington, D.C., Coppin State University, Delaware State University, Norfolk State University, North Carolina Central University
Oklahoma City, Oklahoma City metropolitan area, Association football, Tulsa metropolitan area, Democratic Party (United States)
Kansas City, Missouri, College football, Canada, American Midwest Conference, Appalachian Athletic Conference
National Association of Intercollegiate Athletics, Oklahoma, Muskogee, Oklahoma, American Baptist Churches USA, Cherokee
NCAA Division II, Red River Athletic Conference, National Association of Intercollegiate Athletics, Langston University, Sooner Athletic Conference
United Methodist Church, Texas, United Church of Christ, Austin, Texas, Wiley College
Logan County, Oklahoma, Oklahoma, United States, Oklahoma City, Oklahoma City metropolitan area
Linebacker, Running Back, Wide Receiver, Defensive End, Minnesota Golden Gophers football
San Antonio Spurs, 1991 NBA draft, Charlotte Hornets, Philadelphia 76ers, Oklahoma


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We wanted to take a brief break from all things coronavirus to remind you that cybercriminals are still at work—they're not part of the masses in the unemployment lines. We all tend to think fraud won't happen to us, but this is how easy it can happen.
A Henssler client's computer was infected with malware, sending information like usernames and passwords for multiple accounts at various banks and institutions back to the thief. The thief then logged into Schwab Alliance with the client's information and requested several wires from numerous accounts. Without getting too technical, Schwab uses an algorithm to help detect potential fraudulent wires, and their system caught all of the wires, except one in the amount of $92,250. Fortunately, the client was contacted about the other fraudulent requests and looked at his accounts. He quickly saw a wire transfer that was processed and immediately contacted us. We, in turn, immediately contacted Schwab. Because it was caught so quickly, Schwab was able to inform the bank that the wire was fraudulent and request a reversal of the wire, allowing the bank to watch for the funds and return them. Luckily for our client, the funds were returned to his account.
While Schwab has insurance to protect clients against situations like this, there is no guarantee that any or all of the funds would be returned. Normally, an investigation would be conducted, and Schwab's fraud department would determine how much of the liability to assume.
There are several things we want to point out. If the thief had requested only one wire, the client likely would not have known in time and may not have been able to get the funds back. Schwab sent a confirmation email that a wire was processing to the primary email address on the account; however, the address belonged to the wife, who does not check her emails regularly. You should use an email address that you check frequently and/or set up alerts for activities on your accounts where available. Alerts can be by text and/or email.
Because the thief had the client's username and password, it appeared to Schwab that the wire request was legitimate. This is why we recommend setting up alerts and monitoring your accounts regularly. At Henssler Financial, we have an internal process we follow for wire requests, and Schwab has an intensive team of experts and systems in place, but not everything can be caught.
One solution that Schwab proposed was setting the client's online profile up as "Limited Access." This is basically a view-only option so the client cannot trade or request transactions of any kind. If you are nervous about fraud happening to you and don't mind giving up some access to your accounts, this is an option. Under this set-up, requests for funds will have to come through your adviser. Hopefully, this will add an additional layer of protection as we have our own internal processes to help identify fraudulent activity.
We are sometimes asked, "If your credit is frozen, how can criminals access your financial accounts?" These two have nothing to do with each other. Having your credit frozen can prevent people from taking out new credit in your name but does not prevent them from accessing your account(s) if they have your username and password.
Overall, this client was very lucky that it worked out the way it did. If you take anything away from this, it should be that we all must be careful and do what we can to protect our assets.
If you have questions, contact the Experts at Henssler Financial:
- Experts Request Form
- Email: email@example.com
- Phone: 770-429-9166
- Join the Conversation in Our Coronavirus Facebook Group


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July 2020
Volume 1
Irvin M. Modlin, MD, PhD, DSc
, will be the first featured guest in CCF's new
Luncheon with the Experts
Facebook LIVE
series on
Thursday, July 9
at 12 noon, Eastern Time.
An expert in neuroendocrine tumor (NET) disease, Dr. Modlin is the Medical Director of
Wren Laboratories
in Branford, Connecticut, and is a Clinical Consultant to the testing laboratory. He was formerly director of the Gastrointestinal Pathobiology Research Group and is now an Emeritus Professor at Yale University. With over 500 peer-reviewed publications and more than 30 years of experience working with NET patients, Dr. Modlin has recently focused on the development and implementation of novel molecular testing protocols for these cancers. He is the creator of
the only non-invasive blood test that helps physicians identify the disease activity of a neuroendocrine tumor.
ead more.
This Facebook LIVE event will be
hosted by Rain Bennett
, a longtime CCF filmmaker and dear friend of the NET community.
If you are on Facebook but unable to join at the scheduled time, the presentations will remain permanently on
CCF's Facebook page
in the Video section,
And for anyone not on Facebook, each of the presentations will be available on CCF's
YouTube channel
To receive notifications of all new videos on our YouTube channel, click Subscribe and sign up to receive notifications each time a new video is uploaded.
We appreciate
Lexicon Pharmaceuticals
' support of the Luncheon with the Experts series.
Luncheon with the Experts on Facebook LIVE
July 16, Erik Mittra, MD,
nuclear medicine
July 23, Xavier Keutgen, MD,
surgical oncology
July 30, Catherine Bouvier,
CEO, Neuroendocrine Cancer UK; President, International Neuroendocrine Cancer Alliance; previously a NET nurse specialist
The Carcinoid Cancer Foundation's educational, awareness and advocacy activities are made possible by your contributions. These crucial activities lead towards early detection, improving the quality of life for cancer survivors, and ultimately to a cure. The Carcinoid Cancer Foundation is a 501(c)(3) nonprofit organization. All contributions to The Carcinoid Cancer Foundation are tax-deductible to the extent allowed by law.
Thank you for your support!
Carcinoid Cancer Foundation
118 North Bedford Road, Suite 100
Mount Kisco, NY 10549
Phone: 1-888-722-3132
E-Mail: firstname.lastname@example.com
118 N. Bedford Road Suite 100 | Mt. Kisco, NY 10549-2555 US
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Curious about how your lifestyle can affect your weight? In this course you will learn how your daily activities, amount of exercise, body type, occupation and lifestyle in general impact your weight. Learn the role of geographic and cultural differences, genetic condition and occupation on your health. Start this course today and find out how to calculate an accurate BMI, including your general daily activities and exercise, as well as how to modify your diet for your lifestyle.
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International Students and Homestays
When the pandemic hit us here on Salt Spring Island, we were told that our schools would not reopen after Spring Break (possibly for the remainder of the year). It meant our international students had two choices to make. They could choose to stay on Salt Spring with their host families, knowing that they may not be going back to the school for weeks, or they could return back home to their families quickly while there were still flights available and the borders were open. Everything unfolded very rapidly, and students and their natural parents had to make decisions together very quickly. The question for our students became "where do I want to study? At home – here on Salt Spring or back with my family in my home country?"
Some students did not want to leave, but their governments ordered them to return. Others were recommended that they stay, believing it would be safer in Canada. By the time the borders were officially closed, we had only about 1/3 of the students opt or ordered to return home. Most chose to stay on Salt Spring.
I think this decision reflects a lot about Salt Spring Island and especially about our homestays. Taking in another child and making sure that they are safe during times like these, takes a big heart. It also takes a great community of teachers, counsellors, and friends to make sure that the physical distancing is just that – while still encouraging a healthy sense of social connection with others. We wanted to ensure that they remained connected so that they continued to feel part of the community both in school and out. The homestays are vital in helping our students feel safe and loved during this tender time.
When chatting with the homestays and the students, it has been noted that daily structure has been incredibly valuable. Youth are feeling stronger when they have healthy routines, regular sleep schedules and opportunities for social connection. Food has also become really important. As one of our hosts reflected to us, "it is comforting having things that remind a student of home" and so her student is in the kitchen more often and the outcome is great! Another student commented on how the days are simple but that doesn't mean they are bad, but rather "peaceful and good".
Nikita Pardiwala, GISS's ESL and Leadership teacher, has been working with her Leadership students to create online social activities. Some of the activities they have planned in May are:
- A movie night through Google Meet
- Baking video-chats
- a Multicultural Day through Instagram
- Instagram challenges weekly throughout the month and into June.
Also, Our Connecting Generation Cafés have gone virtual, which helps our ESL students continue to practise their conversation skills. Some students are still here in Canada and others are back with their families in their home countries. The Connecting Generation cafés are something that we rely on volunteers to help with – so if you are interested, please contact firstname.lastname@example.com


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Staff Directory
Seattle Historical Sites
New Search
Summary for 964 Denny WAY / Parcel ID 1986200320 / Inv #
Historic Name:
Pantorium Dye Works/ Utility Cartage Company
Common Name:
Price Asher Garden and Home Store/ Futon
Spanish - Mission
South Lake Union
Built By:
Year Built:
Based on original construction drawings, what appears now as one building was constructed as several buildings in different phases and then was remodeled, particularly on the Denny Way façade. The first building, built in 1927 for the Pantorium Dye Works, corresponds to the southwest portion of the building, which includes the first three western bays of the Denny Way façade. The western façade, although originally clad in stucco, appears to have been changed pretty markedly, assuming original construction drawings were followed. The only real elements from the original design by Schack Young and Myers appear to be the engaged piers with their chamfered corners and the industrial sash windows of the west elevation. Along the main Denny Way façade, the Schack Young and Myers design featured thinner, ornamented piers, which divided the currently visible main bay divisions into smaller bays. At all three floor levels, the smaller bays consisted mainly of generously sized, industrial sash windows, with a glazed double door entry at the center of the tripartite central bay. Also, at the ground level, the western bay featured a central doorway, with angled storefront glazing to each side, while the eastern bay divided into three, had a double door in its smaller eastern bay section. Other elements of architectural interest would have included a string of small tile insets at the top of the piers, a wells as larger tile insets on the face of each pier. Directly north of the 1927 structure, the northwest portion of the building appears to have been originally constructed in 1946, as an addition for Utility Cartage Incorporated. The title block of the original drawings lists several architects, who worked jointly on the 1946 addition: Edwin Ivey, Elizabeth Ayer, well-known as the first woman architectural graduate of the University of Washington, in addition to Harry F. Broman and Rolland Denny Lamping. (In actual fact, Ivey had died in 1940, but Ayer and Lamping continued the practice under Ayer's name before forming Ayer and Lamping). The rest of the building was filled in around 1956 with a long rectangular, eastern section, with the longest elevation along Terry Avenue. Architect George Groves designed the addition for the Utility Cartage Company in late 1955. While the building is associated with several distinguished Seattle architects, Schack Young and Myers, as well as Elizabeth Ayer and has some interesting architectural elements on the main Denny Way façade, it has clearly been altered. Ayer's work, if that is what the northwest wing is, is not a distinguished work by this architect, although it does indicate that she worked on industrial buildings, in addition to historically inspired houses. Schack Young and Myers' design has been mostly covered over or demolished. The building has been altered to the point where it hardly bears any resemblance to its original historical designs.
The building is rectangular in plan and appears to have a flat roof, possibly with skylights, and a parapet. It is mainly clad in stucco, with buff brick on the western elevation. Its height varies from three stories in the southern portion of the building facing Denny Way to a two story northern portion, consistent in height with the southern portion and accessible from a north alley off Terry Avenue. The main façade is along Denny Way. It is divided into six bays, recessed between engaged piers. The first three bays consist of storefront at the ground level, separated by characteristic engaged piers, rectangular in plan, with chamfered corners at the top. At the second and third levels, there is no fenestration. The piers also stop short of the top of the parapet, which is slightly recessed in relation to the top of the piers and the wall plane between them. The storefront primarily consists of metal sash windows, with the sash currently painted red. The remaining three eastern bays are also three stories in height, with full height engaged piers, separating the bays. The storefront in its western bay also has solid-looking painted metal sash fenestration, while the upper level windows have unpainted aluminum window frames. The engaged piers continue along the eastern elevation of the building and define six recessed bays. The southern bay has a small rectangular opening at each floor, (although the top one is partially covered by signage), while the northern bay has a similar window at the second level. The four central bays consist of recessed wall between engaged piers, with large unglazed rectangular openings over what once functioned as a loading platform.
Detail for 964 Denny WAY / Parcel ID 1986200320 / Inv #
No - Altered
District Status:
Concrete - Poured
Roof Type(s):
Flat with Parapet
Roof Material(s):
Building Type:
Commercial/Trade - Warehouse
Structural System:
Concrete - Poured
No. of Stories:
Unit Theme(s):
Architecture/Landscape Architecture, Commerce, Manufacturing/Industry
Changes to Original Cladding
Changes to Plan
Changes to Windows
Major Bibliographic References
King County Property Record Card (c. 1938-1972), Washington State Archives.
Drawings, Microfiche Files, Department of Planning and Development.
Photo collection for 964 Denny WAY / Parcel ID 1986200320 / Inv #
Photo taken Feb 12, 2005
© Copyright 1995-2015
City of Seattle
Privacy and Security Policy
App v


text: North Central State College is having a design conference in 2014 and people were asked to come up with a logo for the conference. This was my idea. It building silhouette is of the Kehoe center in Shelby, Ohio (where the event will be held). The text was created with Eurostile as the type-face. When I make logos I try to make them as effective as possible while keeping it simple and modern.


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Except an urgent attention is applied by the Imo State government as a measure to rescue one of the roads in Owerri, the tunnel connecting Imo State House of Assembly to World Bank Housing Estate otherwise known as Aguiyi Ironsi is at the verge of collapse.
The tunnel is a wailing disaster if the state of the road is anything to go by.
Trumpeta correspondent who was at the road noticed serious cracks on the overhead surface of the tunnel.
It would be recalled the, administration of Owelle Rochas Okorocha had built the tunnel and named it Aguiyi Ironsi tunnel.
But motorists are not only experiencing difficult challenges making use of the road but are at the risk of being caught up should there be a disaster arising from the cracked road.
Trumpeta also recalled that since the two tunnels were constructed on Porthacourt road, motorists have had good use of the connecting roads


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By Courtney Babcock
Every August my parents watch my 11 year old nephew Eamon for a week and every year my mom says she needs ideas to keep him entertained. As Eamon's favorite Aunt (okay his only Aunt) and to help my parents out I decided I would take him canoeing one afternoon on the Brandywine Creek (also known as the Brandywine River).
We chose what I think was the most beautiful day of the summer, no humidity and low 80's.
When we arrived at Northbrook Canoe we put on our masks; they were clear about safety measures both on-line and with signage on the property.
The staff was extremely helpful with explaining the logistics of the day. There are 3 trips to choose from varying in length. We choose the 1.5-hour trip from Corcoran's Bridge to Northbrook and were directed to our transportation.
It was a busy afternoon with all ages, families and couples getting ready to load school buses. The ride to Corcoran's Bridge was beautiful. Even though I grew up in Kennett Square and now work in the area I am still amazed at how picturesque Chester County is as you drive the small, winding roads.
This was Eamon's first time canoeing and I have not been canoeing since I was probably about his age. As a very smart and inquisitive kid, he had lots of questions. We both watched YouTube videos on proper ways to row. When we arrived at Corcoran's bridge the staff gave safety instructions and a quick rundown on rowing since we were both newbies. Eamon took the bow as the navigator and I took the stern to steer.
The water was crystal clear and a nice level for canoeing plus the scenery was beautiful. We spotted a Heron, a very well fed Red-tail Hawk, a muskrat, and a few small fish.
As we headed downstream, we had to maneuver through all the tubers. Eamon said it was like a game of Frogger trying not to be hit by or run into a tuber. Luckily the current was pretty slow, so we just glided through the obstacles with no collisions. Our trip took just over 1 ½ hours back to Northbrook. Eamon and I both agreed canoeing is the best way to enjoy the river. Overall it was a great outing with my nephew and we already have plans to return again next year. He promises to take the stern and show me how it's done.
* Read more about Northbrook Canoe company and how they have been able to keep up a successful business during the pandemic with this article by The Daily Local – CLICK HERE


text:
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Q: What is the meaning of scope and delimitations of a study?
Scope and delimitations are two elements of a research paper or thesis. The scope of a study explains the extent to which the research area will be explored in the work and specifies the parameters within which the study will be operating. For example, let's say a researcher wants to study the impact of mobile phones on behavior patterns of elementary school children. However, it is not possible for the researcher to cover every aspect of the topic.
So the scope will have to be narrowed down to a certain section of the target population. In this case, the scope might be narrowed down to a group of 50 children in grades 3-5 of one specific school. Their behavior patterns in school may have been observed for a duration of 6 months. These would form the delimitations of the study.
Thus, delimitations are the characteristics that limit the scope and describe the boundaries of the study, such as the sample size, geographical location or setting in which the study takes place, population traits, etc. Additionally, the researcher might also choose to use some research tools and methodologies to collect data but not others. These delimitations might be imposed for practical reasons, such as lack of time or financial resources to carry out a more thorough investigation. The delimitation section of the study should explain why specific choices were made while others were excluded and how this might affect the outcome of the research.
In the example mentioned above, the researcher might state why he/she chose to study a sample population of 50 students, why he/she selected students from Grades 3-5 and not grades 1-2, and why he/she chose students of Billabong Elementary Public School over other schools.
Related reading:
Spark your creativity to succeed in your career: Learn how to be creative in this live event by acclaimed neurologist David Eagleman. To know more and block you seat, click here.


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The first user to sign into the account is the first Customer Administrator by default.
Since MarketValues is a single user service, the login and password received when the service was first set up should be retained, and can be used to login as the Customer Administrator at https://extapps.nada.com/NADAOnline
For those services that can have multiple users, multiple Customer Administrators can be assigned.
The identity of the last account customer administrator to login is listed on the upper right of the main Values Online screen reached after logging in.
If you don't know any of your account Customer Administrators, or have forgotten your username and password, please call Customer Service at 800-544-6232 between 8:30 a.m. and 6 p.m. Eastern, M-F.


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TOP 10 searching results for Ironman Clothing Uk as seen on November 28, 2020
Ironman Clothing Uk - Similar Shopping Results
Ironman Clothing Uk Video Results
Must-Have Ironman Gear
From watches to wet suits, Off Duty checks out the latest in triathlon gear in advance of the New York Ironman race. With host Wendy Bounds.
- Likes: 18
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Pembrokeshire Bike Recommendations for IRONMAN® 70.3 UK
Clothing and mechanical tips from the staff at Pembrokeshire Bikes, Ironman UK's official Bike Shop. Links to clothing items mentioned: Castelli Free Tri Suit: http://www.pembrokeshirebikes.co.uk/shop/castelli-tri-suit/castelli-free-sanremo-suit-sleeveless/?attribute_pa_size=m-3 Mavic H20 Jack...
- Likes: 0
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- Dislikes: 0
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Richard Browning is a Real-life Iron Man - with His Own Flying Suit | WIRED
One day in early summer last year, Richard Browning headed to his farmyard in the English countryside. He attached a kerosene-fuelled micro gas turbine – effectively a small version of a plane engine – to each of his arms and legs. Then he carefully pressed the throttle trigger in his right hand....
- Likes: 3542
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XRobots - How to Build an Iron Man Helmet & Suit, Moulding, Casting, 3D Printing, Electronics
Highlights of my four year Iron Man Suit/Helmet build, showing some of the fabrication, mechanics, 3D printing, electronics. Check out my channel for the other 50+ detailed build how-to videos & tutorials. Check out my Hulkbuster!: https://www.youtube.com/watch?v=98bakUvE38M&list=PLpwJoq86vov_EdZ...
- Likes: 84998
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Sharjah Municipality has announced that the engineering and buildings sector has completed more than 3,341 transactions remotely in April.
This comes as part of the civic body's comprehensive plan to continue providing services and completing engineering transactions by relying heavily on digital transformation and smart applications.
Director-General Thabet Salem Al Tarifi stressed that the remote work system contributed to adding creative touches and innovative projects in the work system, and created differences in the implementation of the various services provided by the municipality, due to its complete readiness to deal with various challenges and its future outlook that it formed.
Khalifa bin Hadda Al-Suwaidi, Assistant Director-General of the Engineering and Buildings Sector, explained that the sector has provided the employees with all the necessary tools for working remotely and continuing to provide services and communicate with the public on various channels.
Sheikh Mohammed bin Majid Al Qasimi, Director of Building Licencing Department, pointed out that the department had completed more than 931 transactions remotely, which included construction permit transactions, entry transactions, fee calculation, certificates of interest.
Yaqoub Al Zarouni, Director of the Engineering Department, said it had completed more than 1640 transactions remotely within a month.
"The department took all measures to implement the remote work system since last March to next July, with the possibility of extension, creating a WhatsApp number for all departments, creating an email for the administration and authorising a number of staff to respond and follow-up directly to the public's inquiries and transactions," he added.
Ahmed Abdul Rahman Al Jarwan, Director of Buildings Inspection Department, said the department completed 770 transactions within a month remotely, providing all services without the need to visit the department, receive transactions through email and provide the required documents to be followed up by the competent staff.-TradeArabia News Service


text: It's our soft spot, gals! Presenting the Kels Dress, a darling wrap dress in a sultry black silhouette, dancing with red florals throughout. Crafted from an exceptionally soft stretch knit blend, this charming swing blends all the right retro sensibilities. A pleated v-neck top is met with gorgeous three-quarter sleeves and ties securely at the waist. Cinching comfortably at the natural waist while the unlined swing skirt flows to the knees in delightful perfection. This one won't stay under wraps for long!


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Paul & Al
Paul and Al's Blog
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Paul and Al
About Paul and Al: Paul and Al started at 94 HJY in the summer of 1990. So 25+ years later, Paul and Al are STILL on the air! They rank second all-time in longevity for a morning show on the same station in Rhode Island radio history, second only to the legendary Salty Brine. They are aware that they will NEVER have a family beach named after them like Salty but if their program director, Doug Palmieri, gets his way the state landfill may one day be the Paul and Al Dump! And speaking of honors, Paul and Al joined Salty in the original class of inductees into the Rhode Island Radio Hall of Fame in 2008. The first few weeks back in 1990 were a little rough, many of the listeners called with well-intentioned messages like, You guys SUCK! When are Carolyn Fox and Rudy Cheeks coming back? After 25+ years, its down to only a handful of complaints each week. Fortunately, Paul and Al have been supported by amazing talent: Jim Shorts (AKA Steve McDonald) brings his hysterical takes on sports while the multi-talented Kevin plays many roles from writing and producing to his infamous Stuntboy antics. Jenn Dower on news brings two important things Paul and Al dont have: looks and youth! Every Thursday for 25+ years, 94HJY listeners have called in their best jokes for a segment called Stump the DJ. And, amazingly, it STILL has legs with tons of calls and messages with new jokes every week. And, yes, Paul and Al know almost every dirty joke in the book and it makes their Moms oh-so-proud! The challenge is to keep things fresh after so many years but with our crazy little state it makes it easier for Paul and Al to bring it each and every morning! Thanks for listening!
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Julia Rebaudo @stylonylon–
Best piece of advice? Keep it in the day & don't overthink things – always need to remind myself of this!
Favourite coffee shop? Blixen by Spitalfields in London – they do the perfect oat latte!
Favourite book or podcast? I am currently obsessed with the new Mika Simmon's podcast, The Happy Vagina – So many brilliant guests & chat…!
Beauty product you can't live without? Pai's Rosehip Oil and Dr Hauschka's Complexion Day Cream which is tinted moisturiser I use every single day!
Tell us a bit about yourself..
Half Scottish/half Italian, I'm a London-based freelance writer (as a journalist I wrote for publications like Elle, Time Out & Mixmag) obsessed with photography! My blog focuses on lifestyle, travel & photograpy tips. Happiest when writing or with camera in hand!
What does style mean to you?
Feeling absolutely myself while still looking good! Being relaxed and feeling confident with it.
Are there any causes or charities that you support?
WWF, PETA and the National Deaf Children's Society are all really important charities doing great work that I support every month.
What piece of RIXO do you love or have your eye on and why?
I tried my first Rixo dress last December and loved the fit – I find dresses quite hard to get right sometimes as I am quite petite and they often swamp me but this one was perfect! I then got the Tyra sequinned dress for a Christmas party and again I was absolutely thrilled with the fit and got so many compliments!


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164 uaw-ford legal services plan an overview of the plan when you encounter a legal problem, the uaw-ford legal services plan can go to work for you.
Ford and lincoln axzd-plans program rules page 3 of 16 2/1/2018 az-plan an eligible ford employee (a-plan) or retiree/surviving spouse (z-plan) may generate up to 4 (four) pins
health care benefits for uaw-gm retirees health plans & cost sharing. health plans. your health plans and/or benefits may change as a new retiree or surviving spouse.
health care benefits for uaw-gm retirees. 2017. unless otherwise noted, the information contained in this package is effective january 1, 2017.
health care benefits for uaw-chrysler retirees. health. unless otherwise noted, the information contained in this package is effective january 1, 2018.
2017 benefit highlights selecting a new plan for 2017? contact the uaw trust eligibility center, retiree health care connect (rhcc) at 866-637-7555
Section 1.8 chrysler retiree eba. the uaw chrysler retirees employees' beneficiary association, an employee organization within the meaning of section 3(4) of erisa.


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Feb 21, 2020
Pastor Kenneth Kwan talks us through changing our mental posture to better allow the Lord to speak to us.
Feb 16, 2020
We close out our Come Holy Spirit Sermon Series with an interview with Pastor Lance Pittluck.
Feb 14, 2020
Pastor Kwan returns for the next PK Pod, unpacking what happens next. Once we are secure in our identity in Christ, what then becomes our purpose?
Feb 9, 2020
Pastor Dennis Liu unpacks being in the presence of God, and surrendering our rights and will to the Holy Spirit.
Feb 7, 2020
In a new weekly series with Pastor Kenneth Kwan, we explore and unpack his Sunday sermons in bite-sized portions. This week, PK talks about generational reconciliation.


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Powdered gloves are not used these days by the dentist as they can lead to patient sensitivity or some patients might have allergies to powdered gloves. That is the reason why gloves are powdered free. But what is the difference between the two styles?
Powder-Free Gloves: They are made by undergoing a basic process known as chlorination that gives latex gloves less form fighting. That is why it is the best dental line cleaner among others. In a further process, gloves are treated with a chlorine solution, rinsed with water, and dried to remove the powdered residue and latex proteins to make it powder-free.
Powdered Gloves: Powered gloves are made by adding cornstarch that make it easier to put on and also prevents gloves from sticking together. But the disadvantage is when powdered gloves are worn for a long period it can cling to user's skin and cause sensitivities or allergies.
the above reasons make a difference between both the gloves. But it is always best to use powdered free gloves that are safe for your clients. Further, these gloves are more expensive than powdered one but are safe.
If you need powdered fewer gloves or other dental line cleaners, you can visit Emerson DMS, we have all sort of dental products to help you with your treatment like disposable air-water syringe tips, digital x-ray sensor sleeves, dental mouth face mask, and much more.