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NHL Playoffs Underway. Pix, News, Notes and Puck Faces
NEW YORK, NY – It's been an interesting first week and change for Hockey's second season… the NHL Playoffs.
Let's have a looksie…
The Vegas Golden Knights made quick work of the Los Angeles Kings in the Knights' inaugural season in the league. Vegas finished the regular season with 109 points, easily winning the Pacific Conference. It's an amazing feat for an expansion team. They started the season hot and stayed tops in the Pacific almost wire-to-wire. The Golden Knights will play the San Jose Sharks who made quick work of the Anaheim Ducks in their series. Vegas will be looking to go from strength to strength after having backed up their legacy as the best expansion team in the history of sports with their first round sweep of the Kings. The Sharks will be a tougher test than the Kings for the Golden Knights. But I think Vegas will advance based on their form all year.
Tonight, the Winnipeg J-E-T-S will look to close out their series against Angry Ward's Minnesota Wild. The Jets had an amazing season in their own right, finishing second in the NHL with 114 points. Only the Nashville Predators had more points than the Jets. And the Preds will look to seal the deal tonight against the Colorado Avalanche, who made an amazing turnaround this season. They finished last season dead last in the NHL by over 20 points. This year they just about doubled their points total from last year to make the playoffs and keep the St. Louis Blues out. Their season will end tonight though.
In the East… the Penguins should finish off the Flyers tonight to end the battle of Pennsylvania. The Pens are well on their way to winning another Stanley Cup. They have a really tough road ahead with the likes of the Capitals, Bruins, and Lightning to contend with, but I wouldn't be surprised if Sid gets his grubby little fingers on Lord Stanley's hardware again.
The Bruins and Lightning both hold commanding 3-1 leads in their respective series. Rick Nash and the Bruins have looked sharp in the early goings. Luckily for Nash, Slava Voynov won't be in the picture to block any double-overtime shots on an empty net going forward. The
ex-Rangers Lightning will play the Bruins, assuming they both finish off their first round series. The gentleman's sweep (4-1) could be rampant. We should see three tonight and another two tomorrow. Add in the Golden Knights and Sharks' true sweeps and the first round has been very predictable.
The only unpredictable series has been the Capitals-Blue Jackets series. The first three games went to overtime with the road team winning each time. The tide seemed to turn with Washington's 4-1 win last night. The Capitals played the Blue Jackets off the ice. We'll see if Torts & the Jacks have an answer tomorrow afternoon. I'm thinking the Caps will win the next two and set up a familiar showdown with the Penguins in the second round.
I think it will be a Bruins-Predators final. But I'm usually wrong and anything can still happen.
Speaking of being wrong, come back tomorrow for Junoir Blaber.
Filed in: Different Matt • Featured


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Good news is she is doing much better, is off the ventilator and is out of Intensive Care. She has finally agreed to come stay with us, she can not be by herself anymore. Hopefully she will get to go home in a few days. The oldest granddaughter will stay with her while I get things arranged at our house, plus see Mr. Big through his surgery on the 25th.
Must have at least 1, usually 2 of these each day while I am here!!
That is all for now. I will keep you all updated,
I have lots to do tomorrow, oops it is already
tomorrow...so everyone have a great day!!
Lotsa love,
Gig, xoxo


text: Editors Choice Salad Recipe | Healthy Weightloss Salad Recipes | Indian Salad Recipes | foodsandflavorsbyshilpi.com A great miracle is the man and there is nothing more wonderful than to be healthy Read More Indian Vegetarian Street Food Cooking Food specific towards each state is the uniqueness of the country called India. If you go Read More My Vegan Story | This Vegan Life #1 Try as you may, but you will likely be unsuccessful in avoiding carnivorous temptation in this Read More Vegetable Spring Rolls Recipe How to prepare Simple Jam Rolls. This is a special dessert recipe. These cakey cookies are Read More Whole Foods Market to Sell Paleo Passion Pops in Select Retail Stores Visit Whole Foods Market Greenwich for free tasting on Monday Oct. 6th – 10am to 2pm Read More Jeanette Bun Travel To Go President Reveals the Best Culinary Offerings of Costa Rica for Fall Travel Travel To Go The latest travel industry trend taking the world by storm involves self-declared "foodies" Read More Celebrate Spring at Highland Hall Waldorf School's Annual May Faire Festival: An Exciting Event for Adults and Children of All Ages May Pole This is a "don't miss" annual event for families with children of all ages. Read More 3 Healthy & Easy Lunch Recipes (Vegan & Gluten Free!) Vegetarianism and veganism are quickly becoming more popular choices of diet for many people in North Read More San Diego Nutritionist Reveals Super Healthy Foods to Eat Daily. San Diego Nutritionist Individuals might find caring for the skin can be difficult because so many things can damage Read More Chemist Direct recommends revising food guidelines as study reviews show no link found between saturated fat and heart disease Saturated fats The leading cause of death in the world today is through cardiovascular disease, with Read More


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Do I allow my body to conform and give up? Or do I choose a different path?
Pain in 402 Words: A Writer's Story
My writing goal is a 1,000 words a day. Some days are productive and I reach beyond. Some days, not so much. Writing is my pouring out. It is my time machine back. It is my mirror. Today, only 402 words came. I pray before beginning asking God for guidance. Whatever He wants me to write, I … Continue reading Pain in 402 Words: A Writer's Story


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- Wörth am Rhein , Apr 25, 2019 - Goodbye Rhineland-Palatinate, hello South Africa: The 750,000th truck kit from the CKD Center (= Completely Knocked Down) at the Mercedes-Benz Wörth plant was packed today in a 40-foot sea container for its journey overseas.
- Stuttgart, Apr 9, 2019 - At this year's Bauma exhibition in Munich, international and German specialised journalists were given a first-hand experience of the exhibited Mercedes-Benz construction vehicles in operation on off-road terrain. A true world premiere: the new Mercedes-Benz Arocs showed its indestructibility in mud and scree for the first time.
- Munich, Apr 9, 2019 - The Bauma 2019 exhibition is aiming for a new record: more than 3,500 exhibitors from fifty-five countries and over 600,000 visitors are expected between 8 and 14 April in Munich. In addition to vehicles, the world's most important construction industry trade show presents many digital offerings to exhibitors and audiences this year.
- Stuttgart, Apr 8, 2019 - The new Arocs remains true to its virtues, and continues to excel with power, robustness and efficiency. At the same time the Mercedes-Benz Trucks flagship for construction operations offers digital applications for the construction sector.
- Stuttgart, Mar 13, 2019 - Thanks to its innovative assistance systems, the new Actros has made another huge jump forward with regard to safety. However, the engineers working on the new Actros have not just achieved this progress with new systems such as Active Drive Assist for semi-automated driving in all speed ranges, but also by improving existing systems.
- Gaggenau / Stuttgart, Feb 14, 2019 - With the fully electric eActros truck, Mercedes-Benz Trucks demonstrates that it is already possible today to complete heavy distribution tasks locally emission-free and quietly in the Murg valley in Southern Germany. The official handover of the eActros to regionally based logistics company Logistik Schmitt took place today on occasion of Daimler Trucks' annual press conference held at the Unimog-Museum in Gaggenau.
- Sweden, Feb 12, 2019 - When the roads need to be kept clear of snow and ice during Sweden's winter, the only option is to call in the heavy machinery.
- Stuttgart, Jan 11, 2019 - Germany by night with a low-flying Airbus A 320 and a heavy-haulage Actros SLT tractor unit from Mercedes-Benz – this spectacular heavy-haulage operation took place throughout Germany and drew in the crowds wherever it passed.
- Berlin, Dec 28, 2018 - The Mercedes Benz Atego proves its worth in continuous operation at Hertz. This year alone, Hertz has added a total of 542 of the vehicles to its fleet. The last 55 Mercedes-Benz Atego models for the fleet have now also been handed over.
- Stuttgart, Oct 30, 2018 - Following its world premiere in Berlin, the new Mercedes-Benz Actros has since celebrated its trade fair premiere at the IAA Commercial Vehicles in Hanover. With more than 60 technological innovations, the design of the new Mercedes-Benz Actros has also seen a big change.
- São Bernardo do Campo , Oct 24, 2018 - Brazil's largest brewery and drinks supplier Cervejaria Ambev is making major enlargements to its fleet and has chosen trucks with the three-pointed star.
- Berlin, Oct 23, 2018 - Mercedes-Benz Trucks today delivered a fully electric eActros for on-road testing to EDEKA. The German retail association will be testing a 25-tonne truck with refrigerated body for one year in Berlin, where it will be used to transport fresh, temperature-sensitive foodstuffs in Germany's capital.
- Hamburg, Oct 19, 2018 - Hamburg supermarkets receive deliveries electrically now: Mercedes-Benz Trucks hands over eActros to Meyer-Logistik
- Mannheim, Oct 18, 2018 - High-ranking EU politicians have been learning first-hand about the Mercedes-Benz eActros and eCitaro in Mannheim, Germany as part of a congress of the German Federal Ministry for Transport and Digital Infrastructure.
- Mannheim, Oct 11, 2018 - Mercedes-Benz Trucks has delivered yet another fully-electric eActros to a customer for on-road testing. The recipient this time around is TBS Transportbeton. The Mannheim-based company is known for producing high-quality concrete and cement and offers their customers a range of additional services besides.
- Stuttgart, Sep 20, 2018 - Who are the world's best truck drivers? This is the question to which the 14th iteration of the Fleetboard Drivers' League once again provided the answer.
- São Bernardo do Campo / Stuttgart, Sep 20, 2018 - Automated Mercedes-Benz trucks are being used for the first time in the Brazilian sugar cane harvest. As part of a development partnership with the Brazilian agricultural technology manufacturer GrunnerTech, Mercedes-Benz do Brasil has configured 18 Mercedes-Benz Axor 3131 trucks specifically for automated use in sugar cane harvesting.
- Stuttgart, Sep 18, 2018 - The new Actros comes with trailblazing innovations that immediately pay for themselves. Both company owners and drivers will profit from an unparalleled level of efficiency and comfort.
- Stuttgart / Friedewald, Sep 17, 2018 - Mercedes-Benz Trucks is starting practical trials for its all-electric heavy-duty eActros truck. The retail and logistics service provider Hermes is the first of 20 customers in different sectors who will integrate the electric truck into their fleets.
- Stuttgart, Sep 6, 2018 - World premiere of the new Actros in Berlin. Shortly before the IAA Commercial Vehicles Show, which is to be held in Hannover from September 20 to 27, 2018, Mercedes-Benz Trucks presented the brand's new flagship to the world press on Wednesday evening.
- Stuttgart, Aug 14, 2018 - The UK company Tuffnells delivers parcels and shipments to its business customers in what it dubs its "big green parcel machines".
- Stuttgart / Ladbergen , Jul 26, 2018 - Long-haul truck driving is a truly stressful job. Stress due to the ever-denser traffic, stress from loading and unloading, stress searching for a parking space. Plus working for the most part in the same position, which is anything but healthy: sitting down.
- Stuttgart, Jul 17, 2018 - With its three highlight exhibits of the Unimog implement carrier series, Mercedes-Benz Special Trucks is for the first time represented at the Interforst show with its own stand from 18.-22. July 2018 in Munich (open area F10, stand no. 1010/3).
- Stuttgart / Helsinki, May 9, 2018 - Good drivers are hard to find – and even harder to keep hold of. Finnish haulier Miks Auvinen has his own successful model for staff retention:
- Stuttgart, Feb 21, 2018 - In 2016 Mercedes-Benz Trucks became the first manufacturer in the world with a heavy-duty electric truck. The technology pioneer is now taking the logical next step: putting its electric truck, the eActros, out on the road with customers.
- Wörth, Feb 12, 2018 - A huge white convey from the Customer Center at the Mercedes-Benz Wörth plant: no less than 30 Actros 1845 LS await the starting signal from Siegfried Hegelmann, Managing Parter of the Hegelmann Group, and Wolfgang Theissen, Director Mercedes-Benz Trucks, Sales Europe and Overseas.
- Stuttgart, Dec 1, 2017 - The Mercedes-Benz eTruck won first prize in the category "Concept Trucks": 25 t gross vehicle weight, a range of up to 200 km and super quiet operation on the road with zero emissions:
- Stuttgart / Munich, Nov 30, 2017 - Machine operator Wolfgang Stenger stands next to his vibrant traffic yellow Mercedes-Benz Arocs 3253 L 8x4, briefly readjusts the ear defenders on his helmet and starts the engine, with a casual turn of the wrist, by pressing a button on the remote control.
- Stuttgart, Nov 29, 2017 - They spend days or even weeks in their truck. Most of the time, long-distance truck drivers are exposed to poor light conditions in their cab. During winter in particular, the darkness restricts the alertness and well-being of truck drivers.
- Stuttgart, Nov 17, 2017 - Mercedes-Benz Trucks was the first manufacturer in the world to offer Sideguard Assist in on-road trucks.
- Stuttgart / Bad Sobernheim, Oct 17, 2017 - In an unprecedented test, Daimler AG is demonstrating another potential solution for the future use of automated commercial vehicles.
- Stuttgart / Peine, Oct 11, 2017 - It's tight. Very tight: the clearance lamp at the rear left is about to make contact with the hedge. Slowly, the red Arocs 2543 crawls backwards through the narrow alley towards the building site.
- Wörth, Sep 7, 2017 - Major order for Mercedes-Benz Trucks: from now on and through into 2018, the company KAHMEN TransCargo GmbH will be taking delivery of 70 Mercedes-Benz Actros vehicles as it updates its fleet, made up exclusively of Mercedes-Benz vehicles.
- Stuttgart, Aug 2, 2017 - Mercedes-Benz Trucks has taken 3D printing a stage further: the first printed spare part made of metal, a thermostat cover for truck and Unimog models from older model series, has passed all the stages of the stringent quality assurance process at Mercedes-Benz smoothly, and is now celebrating its premiere.
- Stuttgart, Jul 19, 2017 - Time to celebrate at Mercedes-Benz Ireland: because, according to Fergus Conheady, Commercial Vehicle Sales Manager (left) and Stephen Byrne, Chief Executive of Mercedes-Benz Ireland, it is now 50 years since Mercedes-Benz introduced the first commercial vehicle sporting the three-pointed star to Ireland.
- Berlin, Jul 12, 2017 - July 2017 saw the annual "Trucks and the blind spot" campaign take place in Berlin-Gatow. The issue of pedestrian safety is often overlooked and younger pedestrians in particular tend not to appreciate the dangers of certain situations.
- Stuttgart, Jul 11, 2017 - Covering a distance of 3540 kilometres through the French countryside, at altitudes of up to 2642 metres, calls not only for trained cyclists but also a dynamic and unique team.
- Stuttgart, Apr 4, 2017 - Mercedes-Benz was the first truck manufacture to bring the Apple CarPlay™ infotainment system into its vehicles. This makes Mercedes-Benz a trendsetter when it comes to smartphone integration for truck drivers.
- Stuttgart, Mar 27, 2017 - German truck driver Friedhelm Schäfer emigrated to Finland eight years ago.
- Stuttgart / Plochingen, Feb 23, 2017 - "I can't train tomorrow's drivers with yesterday's technology," says driving school owner Jörg Hartmann.
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Items where Author is "Tyson, PJ"
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TYSON, P.J., LAWS, K.R., ROBERTS, K.H. and MORTIMER, A.M., 2005. A longitudinal analysis of memory in patients with schizophrenia. Journal of Clinical and Experimental Neuropsychology, 27 (6), pp. 718-734. ISSN 1380-3395
TYSON, P.J., LAWS, K.R., ROBERTS, K.H. and MORTIMER, A.M., 2004. Stability of set-shifting and planning abilities in patients with schizophrenia. Psychiatry Research, 129 (3), pp. 229-239. ISSN 0165-1781


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Economic Profile
Recent Economic Developments
National Development Strategy: The Government in 2013 adopted the five (5) year development policy blueprint – the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (Zim-ASSET, 2013-2018). The Zim-ASSET aims to achieve sustainable development and social equity, propelled by the judicious exploitation of the country's human and natural resource endowments. It focuses on four major clusters, namely: Food Security and Nutrition; Social Services and Poverty Eradication; Infrastructure and Utilities; and Value Addition and Beneficiation.
To buttress the aforementioned clusters, two sub-clusters were also developed, namely Fiscal Reform Measures and Public Administration as well as Governance and Performance Management. The policy blue print also intends to accelerate the re-engagement process with international financial institutions and other creditors on arrears clearance, debt relief and new financing in support of the country's development projects.
The GoZ has further developed a new interim poverty reduction strategy paper (I-PRSP). The I-PRSP comprises five pillars, namely: (i) Agriculture Productivity, Growth and Rural Food Security, (ii) Social Sectors, (ii), (iii) Private Sector, (iv) Infrastructure, (v) Environment and Climate Change, (vi) Gender, Women and Youth Empowerment, and (vii) Governance and Institutional Capacity.
Macroeconomic Developments/Trends:
GDP growth and growth drivers: The economic outlook for 2017 comes against a background of above normal rainfall received almost across the country. GDP growth is projected at around 3% in 2017, from the initial projection of 1.7%. The agriculture and mining sectors are projected to underpin the anticipated growth. Government of Zimbabwe has introduced various agriculture funding facilities and the mining sector benefited from good international commodity prices.
The mining sector remains very lucrative, with some of the world's largest platinum reserves being mined by Anglo American plc and Impala Platinum. The Marange diamond fields, discovered in 2006, are considered the biggest diamond find in over a century. With the exception of gold, mineral prices have remained depressed during the period to end October 2016. However, the budget projects a modest mining growth of 0.9% in 2017.
Zimbabwe boasts several tourist attractions which include the Victoria Falls, which is amongst the Seven Natural Wonders of the World. The tourism sector is expected to grow by 0.8% in 2017 and this will be enabled by the removal of barriers to free movement of tourists into and within the country.
Monetary Policy and Financial Sector (monetary policy stance, inflation dynamics Monetary Policy and Financial Sector: In February 2009, Zimbabwe adopted a multi-currency regime in which the economy managed to stabilize from an episode of hyperinflation experienced in 2007/8. Against the background of tight liquidity and 2 cash challenges, the Government in November 2016 introduced Bond Notes pegged at par to the US$, imposed limits on daily cash withdrawals and cash carried outside country, and a 5% bonus on export receipts.
According to the Monetary Policy Statement for January, 2017, the banking sector's aggregate core capital increased by 7.48%, from US$1.07 billion to US$1.15 billion, during the quarter ending 31 December 2016 on the back of satisfactory earnings performance. As at 31 December 2016, all operating banking institutions were in compliance with the prescribed minimum capital requirements. The capital adequacy ratio stood at 23.7%, which was well above the regulatory threshold of 12% while the average prudential liquidity ratio for the banking sector was 61.91%, above the stipulated minimum regulatory requirement of 30%. Notwithstanding the high average prudential liquidity ratios recorded across the sector, the banking industry continued to experience underlying physical US$ cash challenges
Fiscal Policy and debt (fiscal policy stance; debt strategy, debt structure, management, and sustainability): The fiscal position is constrained owing to the continued underperformance of revenues and increase in recurrent expenditures. The fiscal deficit for 2016 is estimated at US$1.042 billion (7.3% of GDP), a marked increase from the target of US$150 million. Government in 2016, increased domestic financing of the budget. Domestic public debt rose markedly by about 85% from about US$2 billion in 2015 to about US$3.7 billion by 31 October 2016 following the takeover of the RBZ debt by the government through the Debt Assumption Act which saw the government assuming the RBZ's US$1.4 billion debt and debt of a number of parastatals.
The country remains constrained by a high external debt overhang. In October (2016), Zimbabwe cleared its arrears amounting to US$107.9 million to the Fund's Poverty Reduction and Growth Trust (PRGT) by drawing down on its Special Drawing Rights (SDRs) holdings held at the IMF. The country still has outstanding arrears of about US$601 million with the AfDB and US$1.1 billion with the World Bank.
External Sector: Despite some slight improvements, the external position remains precarious with large current account deficits and low international reserves. According to the Monetary Policy Statement by the Reserve Bank, merchandise exports declined by 6.9%, from USD 3.6 billion in 2015 to USD 3.3 billion in 2016. Merchandise imports declined by 11.7% to USD 5.3 billion in 2016 from USD 6.0 billion over the same period in 2015.
Socio-economic developments/trends: The prevalence and incidence of poverty remains very high in Zimbabwe. Individual poverty prevalence for Zimbabwe dropped from 75.6 percent in 1995 to 70.9 percent in 2001 and then rose to 72.3 percent in 2011. However, persons in extreme poverty have also declined from 47.2 percent in 1995 to 41.5 percent in 2001 then further down to 22.5 percent in 2011. Household poverty is estimated at 62.6 percent which is slightly higher than 60.6 percent in 2001 and lower than 63.3 percent in 1995/96.
To improve the business environment, government is working on reforms to streamline and simplify regulations affecting market entry, exit and competition. The government launched the second 100-day Action Plan to accelerate ease of doing business reforms in Zimbabwe in February 2016. The first 100-day Rapid Results Action Plan, which was launched in September 2015 produced a number of achievements, including reducing the number of days it takes to register a property from 36 to 14 days and reducing the time taken to pay taxes from 242 to 160 hours. Key reforms under the second phase include amending the Companies Act, Shop Licensing Act and the Procurement Act.
Cross-cutting themes:
Environment and Climate change: Zimbabwe is highly vulnerable to environmental degradation through deforestation, loss of biodiversity, excessive soil erosion, contamination, pollution and excessive exploitation of water resources. This has been exacerbated by global climatic changes which have led to changes in rainfall pattern, frequent droughts, floods and rising temperatures. The resource base has been stressed by increase in population and competition for natural resources. The prevailing energy crisis has forced most people to rely heavily on natural resources thereby leading directly to biodiversity loss. Increased deforestation has seen an annual estimated loss of 100,000-320,000 ha forest cover.
Natural Resource Endowment: Zimbabwe produces more than 40 types of metals and minerals and has extensive reserves of gold, platinum, chrysolite, asbestos, chromite, iron ore, lithium ore and coal. The country further has abundant wild life and is bordered by two major rivers – the Zambezi and Limpopo rivers which have been important sources of hydro energy.
Regional Economic Integration: Zimbabwe is a member of the Southern African Development Community (SADC) and the Common Market for Eastern and Southern Africa (COMESA). With its geographic positioning, bordered by other countries, Zimbabwe has served as transit route in and out of South Africa for–Zambia, Malawi and Tanzania.
Recent Policy Documents
National Budget Speech (2017 )
Mid-Term Monetary Policy Statement (2017)


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'Let's Get Life Smart' event provides life skill information, resources
Resume building, healthy lifestyles, budgeting and credit cards, paying back student loans and scholarships, and job searching - are all relevant skills for college students and "adult-adults" to have and apply.
That's exactly why the Central Michigan University Student Government Association hosted "Let's Get Life Smart" from 4:45 to 7:30 p.m. Feb. 22 in the Bovee University Center. The event was broken up into five sessions on the aforementioned topics, with the purpose of equipping students with tools needed for life after (and during) college.
SGA Registered Student Organization Growth & Development committee chair Mary Chiejina organized 'Let's Get Life Smart' after a year of preparation.
"I just want people to have the tools they need, so that they don't need to be stressed out - finance is one of the biggest things people worry about," Chiejina said. "We just want to make (resources) known so that people can feel at ease and actually focus on their classes."
During the event, different organizations presented topic-specific workshops. The Financial Wellness Collaborative, which serves to help students navigate finances, hosted the budgeting and credit cards session.
"Who's supposed to teach you how to manage money?" said Anna Sheufelt, graduate assistant for the Financial Wellness Collaborative. "It's not something you're born knowing, and you can't necessarily rely on high schools to do it. Maybe your parents will help you, but not everybody's parents even have access to that information either."
Overall turnout was pretty low, but students that did attend "Let's Get Life Smart" reported learning useful information.
"I think I've been very fortunate to have parents who have done a lot, but this event for people who are paying for everything on their own through college would be really helpful," said Indiana junior Brianna Hart. "I learned a lot in building my own credit and all that, and I think everything else is really helpful."
During the sessions, Student Employment Services and Success Advocates tabled to connect attendees to resources such as success coaches, who work with students to develop success skills.
"There's always that awkwardness when you go to an event or a presentation and you get back and you're like, 'I didn't want to ask any questions, but at least I know who I can email,'" said Success Advocate Carrie McClure. "I think it opens people's eyes to the resources that we have and then they can figure out where to go from there."
Chiejina does not plan on organizing "Let's Get Life Smart" again, but she can see other organizations following and setting up similar events in the future.
"I think events like this where students can drop in and get the information they want and follow up with a campus resource is awesome," Sheufelt said. "I was really happy that Student Government did something like this, and I think there are ways to make any event bigger and better."


text: Digital Transformation Emerging Tech Infrastructure Three pillars of digital transformation Glenn Weir @itworldca Published: June 1st, 2017Discussions around the topic of digital transformation often take on a "do or die" flavour, with one party (often an authority) warning others of the perils of not undergoing a digital transformation. As an example: "Almost half of companies will shrivel up and die within the next decade if they don't figure out how to accommodate new technologies and utilize them to best purpose."Digital technology is upsetting the proverbial apple cart, disrupting the way organizations do business and interface with customers. And with this comes new demands and new, much higher standards. However, for all these challenges, digital tech also presents companies with opportunities to grow, to gain knowledge, and, ultimately, to succeed in new and exciting ways.Digital is nowDespite the fact that many organizations are wrestling with digital technology, it would appear that a large percentage have taken their first small steps and are on the road to digital transformation. Consider the following:By the end of 2017, two out of three Global 2000 company CEOs will have digital transformation at the center of their corporate strategy. Source70 per cent of executives have started the digital transformation of their supply chains. SourceBenefits of digital transformation:41 per cent say "increased market share";37 per cent say "increased customer engagement";37 per cent say "increased employee morale";32 per cent say "better web and mobile engagement"; and30 per cent say "higher customer revenue" Source71 per cent of digitally maturing companies say they attract new talent on the strength of their digital vision. SourceA ways to goMost companies have an enormous amount of work to do, to avoid falling behind in the digital era. In fact, the Forrester report "Digital Transformation in the Age of the Customer" tells us that a mere five per cent of companies (that responded) believe their digital transformation has progressed to the point where they can say it is a point of differentiation from competitors.The time to go digital is now, while the fruits of opportunity still hang low. But first things first: companies must discuss and then map out a transformation strategy. Doing so requires not only will and a drive to succeed but also knowledge.Can't-miss webinarAt 1 pm ET on June 20, 2017, IT World Canada CIO Jim Love and Dell EMC's Director of Portfolio Marketing, Adeel Omer, will be discussing the various ways you can embrace digital transformation to improve efficiency and ensure your customer experience makes the grade.Jim and Adeel will be joined by NatureFresh Farms' IT Manager, Keith Bradley, who will detail his company's recent digital transformation.Register now for "Three pillars of digital transformation and the impact on your business." Digital Transformation, Emerging Tech, Infrastructure Dell EMC, digital technology, NatureFresh


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"Piktochart helps me spread awareness and educate others about wellness topics through professional, fun, and attractive flyers I can quickly create myself."
"Data visualization is important for medical research result dissemination. With Piktochart, this work can be done in a creative and impactful way. And fast!"
"I want to enable everybody to take control over their own health and to make their own health decisions."
From improving information flow within organizations to helping the general public make informed health decisions, Piktochart assists your healthcare team in its everyday communication.
Comment directly on your colleague's designs and get actionable and contextual feedback in one place.
Split your healthcare documents into folders by team or project to easily find them.
Keep your brand assets like logos and colors all in one place.
Set up custom branded templates for you and your healthcare team to repurpose on the fly.


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Samuel J. Tilden High School
Samuel J. Tilden High School is a New York City public high school in the East Flatbush section of Brooklyn, New York City. It was named for Samuel J. Tilden, the former governor of New York State and presidential candidate who, although carrying the popular vote, lost to Rutherford B. Hayes in the disputed election of 1876.
In order to save the New York City government money during the Great Depression, Samuel J. Tilden High School, Bayside High School, Abraham Lincoln High School, John Adams High School, Walton High School, Andrew Jackson High School, and Grover Cleveland High School and Far Rockaway High School were all built from one set of blueprints.
Early historyEdit
Plans to construct Samuel J. Tilden High School were filed in 1927. The construction of the school was estimated to cost between $2,500,000 and $3,000,000 and would feature specialized facilities including a swimming pool, rifle range, auditorium with a capacity of more than 1300, library, and science laboratories.[1] While the school was eventually constructed on Tilden Avenue and East 57th Street, residents in Brownsville, the Coney Island Chamber of Commerce, and Borough President James J. Bryne initially opposed the site because of poor transportation options around the location.[2]
Shortly after the Board of Education decided on the location of Samuel J. Tilden High School, a formal recommendation was made to change the name of not-yet-built school to Edward B. Shallow High School. This recommendation followed the death of Edward B. Shallow, the Superintendent of the Board of Education who initially recommended a high school be named after New York Governor, Samuel J. Tilden.[3]
Tilden High School opened on February 3, 1930. It cost $2,500,000 to construct. It was built to serve 3,969 students.[4]
In 1935, a field and stadium were designed and constructed with Works Progress Administration labor and appropriations.[5] Several years later, the WPA would make another addition to the Samuel J. Tilden High School, this time in the form of a mural for the auditorium. The project took nearly two years to complete, as muralist Abraham Lishinsky, working with his colleague Irving A. Block, designed and painted a 2,400-square-foot (220 m2) mural depicting "Major Influences in Civilization" for the auditorium.[6] Among the six assistants they employed over time was the artist Abram "Al" Lerner.[7]
By the 1940s, Tilden H.S., initially criticized for its difficult-to-reach location, was overcrowded. At one point 5,700 students attended. In order to limit the crowding, S.J. Tilden administrators split the school day offering one session from 7:50am to 1:04pm and another from 1:11pm to 5:45pm.[8]
World War IIEdit
In 1942, Samuel J. Tilden H.S. was the first Brooklyn high school to hold a mass blood drive.[9] This was one of many ways that World War II affected students at Tilden. During the war, new home economics curricula were introduced to better prepare girls for the war effort. Girls took cooking classes that taught them how to cook more with less, as everyday ingredients were rationed and shipped off to soldiers. There were no food surpluses, and soldiers were the main priority at the time.[10]
Other students supported the war by purchasing more than $15,000 in United States Savings Bonds and Stamps (see war bonds) to help the government finance military operations, leading the nation in money raised by students.[11] Over 100 girls knit sweaters and scarves in conjunction with the British War Relief Fund and American Red Cross. The Red Cross also agreed to send instructors to teach nursing and first aid methods; if the war were to last long enough, the girls would become nurses-in-aid to care for wounded soldiers.
Red ScareEdit
During the 1940s and 1950s, individuals and organizations all over the United States were accused of affiliations with socialists, communists, and radicals. At Tilden High School, students and teachers were accused of radicalism. Even the then principal Dr. Abraham Lefkowitz was accused of being a radical for distributing a statement to teachers and students that denounced complete free enterprise and called upon students to think critically about their role in America.[12]
Students were also affected by the Red Scare and were warned by administrators that affiliation with Communist-linked clubs such as the American Youth for Democracy would adversely affect their future careers.[13]
During testimony before the United States Senate Subcommittee on Internal Security, a former student claimed that both Mr. Eugene Jackson, a language teacher at Tilden, and Mr. Terry Rosenbaum had expressed sympathy toward student Red groups. The former student alleged that an American Youth for Democracy unit at school was asking to obtain speakers for the unit's meetings. Apparently, Mr. Jackson told them that he agreed with their point of view and thought it was very good.[14]
By the late 1940s, students had to pledge an oath of loyalty to the United States and State of New York in order to receive a diploma. The oath read as follows:
"I hereby declare my loyalty to the Constitution and Government of the United States and the State of New York and promise to support their laws."[15]
Racial integration & Special Honors Programs (including the LPC Program)Edit
The racial tensions that swept the nation during the 1960s and 1970s were felt at Samuel J. Tilden High School as well. The school's black population was growing. The school's demographics were changing; Tilden High School was becoming more diverse. In 1962, of the 5,000 students that attended Tilden HS, 97.9% were Jewish and Italian. By 1971, of the 3,000 students at Tilden, 63.4% were "others", the Board of Education's term for non-blacks and non-Puerto Ricans. Changing demographics and under-enrollment set the stage for controversy around rezoning and plans for Samuel J. Tilden HS.[16]
Tensions came to a head during the March 1972 hearings on rezoning the catchment areas for three Brooklyn high schools. The hearings aimed to assure an integrated education in Samuel J. Tilden High School, Canarsie High School, and South Shore High School. Parents groups linked to each high school had their own ideas for a zoning plan that would preserve the racial and ethnic diversity of each school while maintaining a quality education for every student.[17]
A number of Tilden High School students prepared a flier in which they outlined their position regarding the rezoning. They wanted to preserve an ethnic balance in the school but wanted to avoid a result in which the majority of students were nonwhite. The students who prepared the flier were concerned that if the ethnic balance were to tip too much, "an unfortunate chain of events [would take] place: white families [would flee] the neighborhood." The school and the surrounding neighborhood would no longer remain integrated. The result would be "another segregated school, another segregated neighborhood."[18] Whether unfortunate or not—that, in fact, did occur to both the neighborhood and the school over the remainder of the 1970s and into the 1980s.
In order for some NYC high schools to be able attract students that lived outside the neighborhood from which the school normally drew its student population under zoning, and to enhance student choice about where to attend high school, specialized honors programs (i.e. special enriched studies programs) were established within various high schools across the city, including Samuel J. Tilden High School in Brooklyn. One such enriched program, at Samuel J. Tilden High School during the 1970s, was the "Law, Politics & Community Affairs" Program (known as the LPC Program, for short). The LPC program was part of, and was administered by, the school's "Social Studies" department. It included specialized courses and Law, Politics and Community Affairs themed field trips and special projects. Students from all over the city would be able to apply to these specialized honors programs (including the LPC program at Tilden High). This marked a shift in New York City School zoning, as a student's school options were no longer only determined by geography.[19]
Tilden High School's demographics continued to change into the 1970s and 1980s paralleling changes in the surrounding neighborhood, East Flatbush. The neighborhood saw increased immigration from the Caribbean. Media coverage of Samuel J. Tilden also changed, with a focus on incidents of violence. Although crime had become a problem in East Flatbush, the media coverage prompted the then principal Everett Kerner to state that the high school was getting a "bum rap."[20]
In 2006, the Department of Education declared Samuel J. Tilden High School to be a failed school.[21] In 2007 it became the Tilden Educational Complex, home to several new, separate small schools. These include the Cultural Academy for the Arts and Sciences (CAAS), the Kurt Hahn Expeditionary Learning School, and It Takes A Village Academy (ITAVA). With the growth of the new schools, Samuel J. Tilden High School was finally phased out in June, 2010.[22]
When it opened in 1929, Principal John M. Loughran adopted the slogan, "athletics for all."[23] Equipped with facilities, sports field, three gymnasiums, swimming pool, etc., Principal Loughran set to find the personnel and coaches that would establish Tilden High Blue and Greys as an athletic power in New York City.
The sports program hit its first obstacle 1934 as the faculty moved to change the baseball and football teams from inter-school competitive programs to intramurals in efforts to better distribute the school budget while balancing school spirit.[24]
In 1935, a new stadium was constructed and designed by the WPA. This new facility and the gyms inside the building were made available to adults in the community several years earlier during evenings, with separate times for men and women.[25]
The Tilden Blue and Grey won a number of Public Schools Athletic League titles in football, baseball, tennis, track, swimming, and fencing.
During the summer of 1987, teacher and Dean of students Joanne Belinksy became the 6th woman in history to run 3,000 miles (4,800 km) across the country.[26]
In filmEdit
The movie Above The Rim was shot at Samuel J. Tilden. Also, exterior scenes for the movie Lords of Flatbush were shot at Tilden.
Notable alumni and teachersEdit
L. B. Schwartz, Noted Bankruptcy Expert. Class of 1967.
- Ed Cota – professional basketball player
- James E. Davis – Class of 1980. NYPD Police Officer, Christian Minister, Political activist, New York City Councilperson (D-35th District)
- Charles S. Dubin – film and television director[27]
- Jake Ehrenreich – Class of 1974. Actor/writer. Creator of A Jew Grows in Brooklyn New York Times review [28]
- Mitchell Jay Feigenbaum – Mathematical physicist and discoverer of the Feigenbaum constants
- Fresh Kid Ice - rapper
- Henry J. Foner - teacher; union activist
- Nelson George – author
- Owen Gill – NFL Indianapolis Colts
- Bill Gold – graphic designer and film poster artist
- Don Goldstein - All American and Pan American champion basketball player
- Sid Gordon – 2-time All Star major league baseball player[29]
- Arnold Greenberg - co-founder of Snapple[30]
- Josh Greenfeld – writer
- Sidney (Sonny) Hertzberg – NBA basketball player
- Jerry Hyman, trombone Blood, Sweat & Tears, Albums II, III, Greatest Hits
- Paula A. Johnson, MD, MPH, Class of 1976, Researcher and Professor, President Wellesley College
- Sam Levenson, Spanish teacher who became a humorist and popular television personality
- Bill Macy – actor, most notably in TV series Maude
- Paul Marks - cancer researcher
- Leonard Marsh - co-founder of Snapple[31]
- Neil Meron – Hollywood producer
- William Messing – mathematician
- Amy Paulin – New York State Assemblywoman (D-88th District)
- Sam Perkins – professional basketball player
- Willie Randolph – professional baseball player; 6-time American League All Star; played on two World Series Champion teams (New York Yankees); and former manager of the New York Mets[29]
- Dr. Gail Reed-Barnett - former New York State Committeewoman/District Leader, Assembly District 58th
- Eleanor Reissa - actress, singer, director, choreographer / Broadway, Off-Broadway, Yiddish Theater
- Busta Rhymes, rapper and actor
- Lucille Roberts – businesswoman and founder of health club chain bearing her name
- Ossie Schectman – NBA basketball player - credited with scoring 1st basket in NBA History (New York Knickerbockers 1946-47)
- Al Sharpton – Pentecostal minister, political activist, civil rights activist, and former candidate for the Democratic nomination for President of the United States in 2004.
- Dean Silvers – film producer/writer/director/entertainment lawyer
- Richard J. Smith – Class of 1965. Anthropologist
- Curtis Stevens – professional boxer
- Irv Torgoff - professional basketball player
- Earl Ubell – science and health journalist
- Gary I. Wadler – sports physician
- Marilyn B. Young – Class of 1953. Historian.
Special Ed (rapper)
- ^ Board of Education Approves Plans of Tilden High School," Brooklyn Eagle, Sept. 29 1927
- ^ "Board Reaffirms Tilden School Site, Deadlock Stands," Brooklyn Eagle, April 12, 1927
- ^ "Fight to Rename S.J. Tilden School," Brooklyn Eagle, May 8, 1927
- ^ "Plan Tilden H.S. Opening Feb. 3; Cost $2,500,000". Brooklyn Daily Eagle. Fultonhistory.com. December 21, 1929. p. 5.
- ^ "Tilden High School Gets Stadium to Cost $15,000," Brooklyn Eagle, Oct 14, 1935
- ^ "Tilden to Get Civilization in Large Mural," Brooklyn Eagle, August 8, 1937
- ^ Oral history interview with Irving Block, 1965 Apr. 16, Smithsonian Institution, Archives of American Art
- ^ "As but one of 21 packed schools," Brooklyn Eagle, Nov. 18, 1941
- ^ "135 at Tilden to Donate Blood Friday," Brooklyn Eagle, May 17, 1942
- ^ "Boro School Pushes Basic Food Ideas," Brooklyn Eagle, December 4, 1942
- ^ "Tilden Pupils buy $15,000 Defense Stamps," Brooklyn Eagle, January 6, 1942
- ^ "Teacher Denies Critics' Charge of Radicalism," Brooklyn Eagle, Oct. 28 1945
- ^ "Shun Youth Group, Students Warned," Brooklyn Eagle, October 10, 1947
- ^ "Two Accused Teachers on Tilden Staff," Brooklyn Eagle, August 13, 1952
- ^ "Youth Wins Diploma Despite Refusal of Loyalty Oath to U.S.," Brooklyn Eagle, Feb 4, 1948
- ^ "Tilden H.S. Reflects A changing Brooklyn," Leonard Buder, New York Times, March 19, 1972
- ^ "300 Demonstrators Back Tilden School Zone Plan," Leonard Buder, New York Times, March 14, 1972.
- ^ "PTAs Offer Rezone Alternative," John Belmonte, NY Daily News, March 9, 1972
- ^ "Brooklyn to get Special Schools," Leonard Buder, New York Times, March 26, 1972
- ^ "Principal defends Tilden High; says it got 'bum rap,'" Jaren McCallister & Paul Meskil, Daily News, April 4, 1984
- ^ Village Voice 2007-04-03 Tilden High shutting its doors
- ^ "Samuel J. Tilden High School Memory Website". Tildenmemories.com. Retrieved January 31, 2011.
- ^ "Tilden High Plans for Big Spot in Sports," James. J Murphy, Feb. 5, 1930
- ^ "Football and Baseball at Tilden May Give Way to Intra-Murals" James J. Murchay, Jan. 1934
- ^ "Adults Attracted to New Athletic Center at Tilden," Brooklyn Eagle, Oct. 13, 1931
- ^ :Educator Hits the road – all 3,000 Miles of It," Bill Stuttig, Daily News, July 10, 1987
- ^ Charles S. Dubin Movies & TV, The New York Times
- ^ [1]
- ^ a b "Tilden (Brooklyn,NY) Baseball". The Baseball Cube. Retrieved February 13, 2011.
- ^ Fox, Margalit (2012-10-30). "Arnold Greenberg, a Founder of Snapple, Dies at 80". New York Times. Retrieved 2012-11-18.
- ^ Fox, Margalit (2013-06-23). "Leonard Marsh, a Founder of Snapple, Dies at 80". New York Times. Retrieved 2013-06-15.
Coordinates: 40°38′54″N 73°55′20.2″W / 40.64833°N 73.922278°W


text:
22 March 2012
14.04.2003 International Forum - Pro Version *top ten concert*
14.04.2003 International Forum - Pro Version *top ten concert*
Lineage: promo pro recording
Quality/Performance: 100/100
The four songs found here are from a Promo DVD and as such the qaulity is perfect. One of the very few professionally recorded live Sigur Rós from this period. the version of Gitardjamm is particularly stunning! Enjoy :)
Track Listing:
01 Vaka
02 Hafssól
03 Gitardjamm
04 Popplagið
[MF] Flac - part1 part2
[MF] Mp3 - d/l
Video - Compressed for Online Viewing
Sigur Rós - Akifumu, Int. Forum Hall 2003.04.14 from Victoryrosemusic Blogspot on Vimeo.
4 comments:
- Anonymous27 March 2012 at 00:17
Could you please fix the link to part 2 of the video? Thanks!ReplyDelete
- Anonymous5 March 2013 at 17:26
Hi, If possible, could you update the download links. This gig sounds great. Thanks for all your hard work.ReplyDelete
Hi, I'm still in the process of re-uploading all the files. It will be done but I am very busy at the moment. If you email me in 8 days time I am back home and will upload ASAPReplyDelete
- Anonymous8 September 2014 at 10:31
hi, looks like this page is on rest...ReplyDelete
would be great to see this gig re-uploaded.
appreceate your work so much!
thanks in advance.
Subscribe to: Post Comments (Atom)


text:
The pretty naughty with duvets and a ponytail gets in the air with her partner. He eats her breasts and puts a finger in her pussy if not two. She down the jeans to him to cut a pipe so that it is very stiff and that it comes impaled on it. She is very flexible and when he has passed his knees next to his rib cage, he will have full and deep access to her pussy drooling and narrow. He fucks her and shakes her in every way and she does not hesitate to come back to suck the cock of the guy and enjoy his intimate juices. She takes dear in her little kitty all smooth before taking an exciting position full of flexibility to be watered the face and tonsils of warm cum.
She likes to get her pussy filled by a big cock before getting fucked
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Date: March 20, 2020
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ARTHRITIS & RHEUMATISM Vol. 63, No. 1, January 2011, pp 191–200 DOI 10.1002/art.30084 © 2011, American College of Rheumatology Pattern on the Antinuclear Antibody–HEp-2 Test Is a Critical Parameter for Discriminating Antinuclear Antibody–Positive Healthy Individuals and Patients With Autoimmune Rheumatic Diseases Henrique A. Mariz, Emı́lia I. Sato, Silvia H. Barbosa, Silvia H. Rodrigues, Alessandra Dellavance, and Luis E. C. Andrade extractable nuclear antigen was present in 1 healthy individual (anti-SSA/Ro) and in 52 patients with ARDs (37.7%). None of the 40 reevaluated healthy individuals developed ARDs, and 29 (72.5%) remained ANA positive. All healthy individuals who became ANA negative had an ANA titer of 1:80 at baseline. Conclusion. Our findings suggest that the titer, and especially the pattern, on the ANA–HEp-2 test strongly enhances our ability to discriminate ANApositive healthy individuals and patients with ARDs. Objective. To identify features of antinuclear antibody (ANA)–HEp-2 test results that discriminate ANA-positive healthy individuals and patients with autoimmune rheumatic diseases (ARDs). Methods. We sequentially retrieved data on 918 healthy individuals and 153 patients with ARDs after clinical assessment. ANA-positive healthy individuals for whom data were available were reevaluated after 3.6–5.0 years. An ANA–HEp-2 test result was considered positive when a clear ANA pattern was observed at 1:80 dilution in 2 distinct commercial HEp-2 slides by 2 blinded independent observers. Results. ANAs were present in 118 healthy individuals (12.9%) and 138 patients with ARDs (90.2%). The ANA titer was higher in patients with ARDs than in healthy individuals (P < 0.001). The ANA pattern profile was distinct in the 2 groups. Nuclear homogeneous, nuclear coarse speckled, and nuclear centromeric patterns appeared exclusively in patients with ARDs. The nuclear dense fine speckled pattern occurred only in healthy individuals. The most frequent ANA pattern in both groups was the nuclear fine speckled pattern, which occurred at lower titer in healthy individuals than in patients with ARDs (P < 0.001). Anti– Antinuclear antibodies (ANAs) are considered a hallmark of autoimmune rheumatic diseases (ARDs), and the indirect immunofluorescence (IIF) assay on HEp-2 cells (ANA–HEp-2 test) is the standard method for ANA detection (1). However, a positive ANA– HEp-2 test result at a 1:80 dilution has been reported in up to 13.3% of healthy individuals (2–9). Therefore, ANA–HEp-2 testing outside a proper clinical framework may yield a sizable portion of ANA-positive individuals with no consistent evidence of autoimmune disease, causing some concern and anxiety in patients and physicians. This becomes even more crucial with the perception that autoantibodies may precede the clinical onset of ARD for many years (10,11). Therefore, it would be useful to identify intrinsic features of a positive ANA–HEp-2 test result that would allow us to discriminate subjects with and those without autoimmune disease. It is generally accepted that individuals without autoimmune disease would present lower autoantibody serum levels than those with autoimmune disease (12). Accordingly, ANA titers are usually thought to be low in subjects without autoimmune disease and with a positive ANA–HEp-2 test result. Less emphasis has been given Supported by the São Paulo Research Foundation (FAPESP grants 2004/00102-9 and 04/00781-3) and the Brazilian Society of Rheumatology. Henrique A. Mariz, MD, Emı́lia I. Sato, MD, PhD, Silvia H. Barbosa, BSc, Silvia H. Rodrigues, MSc, Alessandra Dellavance, MSc, Luis E. C. Andrade, MD, PhD: Universidade Federal de São Paulo, São Paulo, Brazil. Address correspondence to Luis E. C. Andrade, MD, PhD, Universidade Federal de São Paulo, Rua Botucatu 740, 3rd Floor, Rheumatology Division, São Paulo 04023-062, Brazil. E-mail: [email protected] Submitted for publication December 7, 2009; accepted in revised form September 30, 2010. 191 192 MARIZ ET AL to another intrinsic feature of the ANA–HEp-2 test, namely, the IIF pattern. The IIF pattern reflects the topographic distribution of the target autoantigens and therefore may convey significant information about their nature. In fact, several IIF patterns have been shown to bear tight association with certain autoantibody specificities. This is the case for antibodies to proliferating cell nuclear antigen (13), p80-coilin (14), nuclear mitotic apparatus 1 (NuMA-1) and NuMA-2/HsEg5 (15,16), CENP-F (17), DFS70/lens epithelium–derived growth factor (LEDGF)–P75 (18,19), and DNA topoisomerase I (20). Considering that not all autoantibody specificities are tightly associated with autoimmunity, it would be expected that subjects with and those without autoimmune disease and having a positive ANA–HEp-2 test result would display different IIF pattern profiles. This reasoning is supported by recent demonstrations that the nuclear dense fine speckled pattern, which is correlated with anti–DFS70/LEDGF-P75 autoantibody (18,19), is preferentially displayed in samples from individuals with no evidence of active systemic autoimmune disease (8,19,21,22). The aim of this study was to look for features within positive ANA–HEp-2 test results that differentiate healthy individuals and patients with defined ARD. Additionally, the prognostic significance of a positive ANA–HEp-2 test result in apparently healthy individuals was assessed by reevaluating a series of healthy individuals with positive ANA–HEp-2 test results after an average time period of 4 years. PATIENTS AND METHODS Subjects. A total of 918 healthy individuals (634 women and 284 men, mean ⫾ SD age 32.2 ⫾ 10.3 years [range 18–66 years]) from São Paulo, Curitiba, and Foz do Iguaçu (large cities in southeast Brazil) were included after being considered healthy according to a clinical questionnaire that was administered to investigate current or past ARD, serious chronic infections, and neoplasia. All subjects fulfilled the following inclusion criteria: 1) age ⱖ18 years; 2) negative findings on serologic tests for infection with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus; and 3) no regular use of glucocorticoids, immunosuppressive agents, or antiinflammatory or antimicrobial drugs. Patients with ARDs and healthy individuals belonged to the same ethnic blended Brazilian background, composed mainly of European, African, and American Indian ancestry. All participants signed the consent form approved by the Ethics Committee at Universidade Federal de São Paulo. From August 2002 to December 2003, all healthy individuals donated 10 ml of peripheral blood. Serum was separated immediately and frozen at –20°C until use. The control group included 153 patients with ARDs (87 with systemic lupus erythematosus [SLE], 45 with systemic sclerosis [SSc], 11 with Sjögren's syndrome [SS], and 10 with idiopathic inflammatory myopathy) enrolled according to established criteria for those diseases (23–26). All samples from patients with ARDs were selected from patients regularly followed up at the Outpatient Rheumatology Division. After a 4-year period, the 66 blood donors living in São Paulo who had a positive ANA–HEp-2 test result were invited by letter and/or telephone for clinical reevaluation and for a new blood draw. Twenty subjects had changed their address and telephone number and could not be found, and 5 refused to participate. Forty-one individuals (62.1%) agreed to participate in the reevaluation, and 40 of them agreed to have additional blood drawn. The mean ⫾ SD time interval between the 2 samples was 3.9 ⫾ 0.3 years (range 3.6–5.0 years). ANA–HEp-2 testing and autoantibody determination. Serum samples from all participants were subjected to the ANA–HEp-2 test using 2 commercial HEp-2 cell slides (BioRad and Bion). Serum samples were diluted in 0.15M NaCl and 10 mM phosphate buffered saline (PBS), pH 7.4, and incubated with HEp-2 cells for 30 minutes at room temperature in a moist chamber. After washing twice in PBS for 10 minutes, cells were incubated with fluorescein isothiocyanate– conjugated goat anti-human Ig (IgG heavy and light chains) for another 30 minutes in the dark. After washing twice as before, slides were assembled with buffered glycerol, pH 9.5, and coverslips. ANA titer was determined by testing successive 2-fold dilutions of the serum up to 1:5,120. Analysis was performed by 2 independent expert observers (SHB and LECA) using an Olympus BX 50 microscope under 400⫻ magnification. In the first round, samples from the 918 healthy individuals and 153 patients with ARDs were processed in a nonblinded manner by both independent observers. Samples were classified as ANA–HEp-2 positive if a well-defined IIF pattern was identified at 1:80 dilution in both substrates and by both observers. The requirement for a positive reaction in 2 commercial HEp-2 slides was a precaution to avoid a falsely high frequency, since some HEp-2 brands are extremely sensitive. The requirement for agreement between both observers aimed to minimize the influence of subjectivity. In a second round, all samples from healthy individuals and patients with ARDs with a positive ANA–HEp-2 test result were processed simultaneously in a blinded manner for definition of ANA titer and pattern. Discrepant cases were segregated in a "waiting line" and were reprocessed for a second blinded analysis by both observers. The observers were aware that those samples had been discordant but did not know the nature of the findings or how each sample had previously been rated. Most samples became concordant in the second round reading. There were 2 samples that remained discrepant (borderline positive), and these were considered negative. For the followup comparison, the 2 samples from each patient (baseline and followup) were tested in the same assay and were read in a blinded manner by the same observers. All sera positive on the ANA–HEp-2 test were screened for antibodies against extractable nuclear antigens (ENAs: Sm, U1 RNP, SSA/Ro, SSB/La) by double immunodiffusion against calf spleen extract as the antigen source, according to the Ouchterlony technique as previously described (27). Secondary standards derived from the Centers for DISCRIMINATORY CAPACITY OF ANA–HEp-2 TEST PROFILES Disease Control and Prevention primary standards were used for identification of the antigen specificity. All samples were screened for anti–native DNA at a 1:10 dilution by IIF on Crithidia luciliae as previously described (28). Samples with the nuclear homogeneous and nuclear quasihomogeneous patterns were processed for antinucleosome and antihistone antibodies according to the instructions of the manufacturers (Inova Diagnostics and HUMAN, respectively). Western blotting. Sera displaying the nuclear fine speckled and the nuclear dense fine speckled IIF patterns at titers ⱖ1:320 were analyzed by Western blotting with HEp-2 whole cell extract that was separated by 10% sodium dodecyl sulfate–polyacrylamide gel electrophoresis and transferred to nitrocellulose as previously reported. (19). Briefly, serum samples were tested at 1:50 dilution in 5% skim milk–0.05% Tween 20 in PBS for 1 hour at room temperature, with shaking. After two 15-minute washing steps in 0.05% Tween 20–PBS, nitrocellulose strips were incubated with horseradish peroxidase–labeled goat anti-human IgG antibodies (Bio-Rad) diluted to the ratio 1:1,500 in 5% skim milk–0.05% Tween 20 in PBS for 1 hour at room temperature in the dark, with shaking. After washing with 0.05% Tween 20–PBS for 15 minutes and with PBS for 15 minutes, strips were incubated with chromogenic solution (6 mg 4-chloro-1-naphthol in 2 ml methanol, 10 ml PBS, and 20 ml 30% H2O2). The reaction was stopped with water. Statistical analysis. Categorical variables, such as sex, age group, and ANA–HEp-2 IIF pattern, were analyzed by the chi-square test. The Mann-Whitney U test was used to compare ANA–HEp-2 titers between groups. The ANA–HEp-2 titer in samples collected 4 years apart was analyzed by Wilcoxon's paired sample test. Receiver operating characteristic (ROC) curve analysis was used to evaluate the accuracy of the ANA–HEp-2 test in distinguishing healthy individuals and patients with ARDs. All data were analyzed using Excel Microsoft 2007 and SPSS for Windows 15.0. P values less than 0.05 were considered significant. RESULTS A positive ANA–HEp-2 test result was observed in 118 healthy individuals (12.9%), with no difference in 193 ANA prevalence according to sex (13.8% in women versus 10.5% in men; P ⫽ 0.2) or age (P ⫽ 0.43). However, there was a trend toward higher frequency of positive ANA–HEp-2 test results in individuals ages 51–66 years (20.8%; n ⫽ 48) compared with individuals ages 18–30 years (13.4%; n ⫽ 461), individuals ages 31–40 years (11.0%; n ⫽ 236), and individuals ages 41–50 years (12.9%; n ⫽ 154). There was a preponderance of low-titer reactivity among the ANA–positive healthy individuals. This was in frank contrast to samples from patients with ARDs, which had a 90.2% frequency of positive test results and a skewed distribution toward high-titer ANAs (Figure 1A and Table 1). However, it should be emphasized that high-titer ANA reactivity was also observed in a sizable fraction of healthy individuals (Table 1). The frequency of positive ANA–HEp-2 test results was 96.5% in SLE, 88.8% in SSc, 70% in SS, and 63.6% in polymyositis/dermatomyositis. ROC curve analysis showed good performance of the ANA–HEp-2 test for discriminating patients with ARDs and healthy individuals, with an area under the curve of 0.923 (P ⬍ 0.001) (Figure 1C). As expected, the ability to discriminate patients with ARDs and healthy individuals varied according to the dilution cutoff level. At a screening dilution of 1:80, the ANA–HEp-2 test had sensitivity of 90.2% and specificity of 87.1% with a high (98.1%) negative predictive value (NPV). At a dilution of 1:160 (recommended by the ANA Subcommittee of the International Union of Immunological Societies Standardization Committee [6]), the sensitivity was 83.7% and the specificity was 93.0%. At the 1:5,120 dilution cutoff level, the test had sensitivity of 44.4% and specificity of 99.2% with a moderate (90.6%) positive predictive value (PPV). At an intermediate 1:1,280 dilution cutoff level, the test had sensitivity of 65.4% and Table 1. Distribution of ANA-positive healthy individuals and ANA-positive patients with ARDs according to the titer and prevalent patterns on the ANA–HEp-2 test* P† Healthy individuals (n ⫽ 54) Patients with ARDs (n ⫽ 58) P† Nuclear dense fine speckled pattern (healthy individuals only) (n ⫽ 39) ⬍0.001 0.259 0.477 ⬍0.001 0.002 0.507 ⬍0.001 33 (61.1) 5 (9.3) 8 (14.8) 5 (9.3) 0 (0) 1 (1.9) 2 (3.7) 9 (15.5) 5 (8.6) 12 (20.7) 0 (0) 11 (19.0) 1 (1.7) 20 (34.5) ⬍0.001 0.831 0.573 0.056 0.02 0.515 ⬍0.001 10 (25.6) 1 (2.6) 4 (10.3) 15 (38.5) 5 (12.8) 1 (2.6) 3 (7.7) All patterns Titer Healthy individuals (n ⫽ 118) Patients with ARDs (n ⫽ 138) 1:80 1:160 1:320 1:640 1:1,280 1:2,560 ⱖ1:5,120 54 (45.8) 9 (7.6) 15 (12.7) 21 (17.8) 9 (7.6) 3 (2.5) 7 (5.9) 10 (7.2) 5 (3.6) 23 (16.7) 0 (0) 31 (22.5) 1 (0.7) 68 (49.3) Nuclear fine speckled pattern * Values are the number (%) of subjects. ANA ⫽ antinuclear antibody; ARDs ⫽ autoimmune rheumatic diseases. † By chi-square test. 194 MARIZ ET AL Figure 1. A and B, Distribution of antinuclear antibody (ANA)–positive healthy individuals (HI) and patients with autoimmune rheumatic disease (ARD) according to titer for all patterns combined on the ANA–HEp-2 test (A) and for the nuclear fine speckled pattern on the ANA–HEp-2 test (B). Data are presented as box plots, where the boxes represent the 25th to 75th percentiles, the lines within the boxes represent the median, and the lines outside the boxes represent the 10th and 90th percentiles. ⴙ indicates outliers. C, Receiver operating characteristic (ROC) curve analysis of the ANA–HEp-2 test for discriminating 918 healthy individuals and 153 patients with ARDs. The area under the curve ⫽ 0.923 (P ⬍ 0.001). specificity of 97.9% with a high (94.6%) NPV and a moderate (84.9%) PPV. The ANA pattern distribution among the 118 ANA-positive healthy individuals and 138 ANA-positive Table 2. Distribution of 118 ANA-positive healthy individuals and 138 ANA-positive patients with ARDs according to the pattern on the ANA–HEp-2 test* Pattern on ANA–HEp-2 test ANA-positive healthy individuals† ANA-positive patients with ARDs† P‡ Nuclear fine speckled Nuclear dense fine speckled Nuclear coarse speckled Nuclear homogeneous Nuclear centromeric Nuclear quasihomogeneous speckled Nucleolar Cytoplasmic Other 54 (45.8) 39 (33.1) 0 (0) 0 (0) 0 (0) 5 (4.2) 8 (6.8) 12 (10.2)§ 8 (6.8) 58 (42.0) 0 (0) 36 (26.1) 10 (7.2) 11 (8.0) 19 (13.8) 18 (13.0) 5 (3.6)¶ 7 (5.1) 0.636 ⬍0.001 ⬍0.001 0.008 0.005 0.017 0.148 0.065 0.604 * Values are the number (%) of subjects. See Table 1 for definitions. † Total percentage in each column is ⬎100% because some samples had ⬎1 pattern. ‡ By chi-square test. § Exclusively cytoplasmic staining. ¶ One patient with exclusively cytoplasmic staining and 4 patients with additional patterns (2 with nucleolar pattern, 1 with nuclear fine speckled pattern, and 1 with nuclear coarse speckled pattern). DISCRIMINATORY CAPACITY OF ANA–HEp-2 TEST PROFILES patients with ARDs is shown in Table 2. It should be noted that some samples from both groups had more than 1 pattern (multipattern). The morphologic characteristics of the most relevant nuclear patterns are shown in Figure 2. The nuclear homogeneous pattern was characterized by smooth texture staining of the whole interphase nucleus and bright hyaline staining of the metaphase chromatin plate. The nuclear quasihomogeneous pattern was defined by an extremely fine grainy texture staining of the whole interphase nucleus with similar staining of the metaphase chromatin plate. The nuclear fine speckled pattern was defined by a variably grainy texture staining of the interphase nucleus and no staining of the metaphase chromatin plate, usually sparing the nucleolar domains. The nuclear coarse speckled pattern was characterized by several larger and brighter speckles standing out against a coarse grainy texture staining of the whole interphase nucleus with no staining of the metaphase chromatin plate. The nuclear dense fine speckled pattern was characterized by tightly packed speckled staining of the whole interphase nucleus with heterogeneity in brightness of the several speckles and similar staining pattern in the metaphase chromatin plate. The centromere pattern was characterized by numerous discrete speckles spread throughout the interphase nucleus and aligned in an orderly manner at the metaphase chromatin plate. The most frequent ANA patterns in healthy individuals were the nuclear fine speckled pattern, which was present in 54 subjects (45.8% of ANA-positive healthy individuals), and the nuclear dense fine speckled pattern, which was observed in 39 subjects (33.1% of ANA-positive healthy individuals). Interestingly, the frequency of the nuclear fine speckled pattern was stable across 4 age strata (43.5% in those ages 18–30 years, 38.5% in those ages 31–40 years, 50% in those ages 41–50 years, and 50% in those ages 51–65 years), but the frequency of the nuclear dense fine speckled pattern dropped significantly in healthy individuals ⬎50 years of age (32.3%, 42.3%, 35.5%, and 10%, respectively). The most frequent ANA pattern in patients with ARDs was also the nuclear fine speckled pattern, which was present in 58 subjects (42.0% of ANA-positive patients with ARDs), followed by the nuclear coarse speckled pattern, which was observed in 36 patients (26.1% of ANApositive patients with ARDs). No healthy individual had the nuclear coarse speckled pattern, and no patient with ARD had the nuclear dense fine speckled pattern. Other patterns exclusively observed in patients with ARDs were the nuclear homogeneous (7.2%), nuclear centro- 195 Figure 2. Morphologic characteristics of the most relevant nuclear patterns found on indirect immunofluorescence assay on HEp-2 cells, performed on samples from healthy individuals and patients with autoimmune rheumatic diseases. Patterns are as follows: A, homogeneous; B, quasihomogeneous; C, nuclear fine speckled; D, nuclear coarse speckled; E, nuclear dense fine speckled; and F, nuclear centromeric. Sera were diluted 1:80. Bars ⫽ 5 m in A and B; 13 m in C–F. 196 meric (8.0%), and cytoplasmic dense fine speckled (2.8%) patterns. The nuclear quasihomogeneous pattern (Figure 2) was predominantly observed in samples from patients with ARDs. This pattern is distinct from the nuclear homogeneous pattern in that its texture is finely grainy as opposed to the plain smooth texture of the homogeneous pattern. This difference is particularly appreciated at the chromatin mass in mitotic cells, where the homogeneous pattern assumes a hyaline appearance, in contrast to the quasihomogeneous pattern, which keeps its finely grainy texture. In addition, samples with the quasihomogeneous pattern had a different autoantibody profile from the homogeneous pattern. No quasihomogeneous pattern sample from patients with ARDs or from healthy individuals was reactive against native DNA. Furthermore, no quasihomogeneous pattern sample from healthy individuals reacted with nucleosome or histone, and only 60% of the quasihomogeneous samples from SLE patients reacted with nucleosome and/or histone. In contrast, all 10 samples with the homogeneous pattern reacted with components of the chromatin system. In fact, all reacted with nucleosome: 3 reacted only with nucleosome, 4 reacted with nucleosome and histone, 1 reacted with nucleosome and native DNA, and 2 reacted with nucleosome, histone, and native DNA. Since the nuclear fine speckled pattern was the most frequently observed pattern in healthy individuals and in patients with ARDs, we decided to analyze the titer of the nuclear fine speckled pattern in both groups. Healthy individuals presented a significantly lower titer nuclear fine speckled pattern than did patients with ARDs (P ⬍ 0.01) (Figure 1B). On the other hand, the nuclear dense fine speckled pattern was observed exclusively in healthy individuals and mostly at high titer (Table 1). In fact, in healthy individuals, samples with the nuclear dense fine speckled pattern had higher titers than did samples with the nuclear fine speckled pattern. The nuclear fine speckled pattern occurred at a titer ⱕ1:320 in 46 of the 54 healthy individuals with that pattern (85.2%), and the nuclear dense fine speckled pattern occurred at a titer ⱖ1:640 in 24 of the 39 healthy individuals with that pattern (61.5%) (P ⬍ 0.001). The antigenic specificity of the 2 ANA patterns observed most frequently in healthy individuals, the nuclear fine speckled pattern and the nuclear dense fine speckled pattern, was investigated by Western blotting. As expected, all samples displaying the nuclear dense fine speckled pattern recognized a polypeptide with an estimated molecular weight of 75 kd (18,19,22) (Figure 3). MARIZ ET AL On the other hand, no specific band was observed among the samples displaying the nuclear fine speckled pattern (Figure 3). Another distinctive feature differentiating ANApositive samples from healthy individuals and ANApositive samples from patients with ARDs was the presence of anti-ENA antibodies in the samples from patients with ARDs. Fifty-two samples from ANApositive patients with ARDs (37.7%) had anti-ENA reactivity (35 with anti-SSA/Ro [25.4%], 13 with antiSSB/La [9.4%], 3 with anti-Sm [2.2%], and 20 with anti–U1 RNP [14.5%]). As expected, some samples had more than 1 antibody specificity. The frequency of anti-ENA antibodies in each ARD was 42.5% in SLE, 13.3% in SSc, 50% in SS, and 36.3% in polymyositis/ dermatomyositis. In contrast, only 1 ANA-positive healthy individual (0.85%) had anti-ENA antibody (antiSSA/Ro). As expected, anti-DNA antibody was absent in healthy individuals and exclusively found in 12 SLE patients. We were able to reassess 41 of the ANA-positive healthy individuals 3.6–5 years after the initial evalua- Figure 3. Western blot analysis of antibody specificity associated with nuclear dense fine speckled pattern and nuclear fine speckled pattern in sera from healthy individuals. Whole HEp-2 cell extract was separated by 10% sodium dodecyl sulfate–polyacrylamide gel electrophoresis and probed with sera diluted at a ratio of 1:50. Lanes 1–18, Samples that showed the nuclear dense fine speckled pattern on the antinuclear antibody (ANA)–HEp-2 test; lane 19, anti-SSA/Ro control; lanes 20–29, samples that showed the nuclear fine speckled pattern on the ANA–HEp-2 test; lane 30, negative control. Arrows indicate proteins migrating with mobility compatible with 52 kd and 75 kd. DISCRIMINATORY CAPACITY OF ANA–HEp-2 TEST PROFILES Figure 4. Longitudinal findings from antinuclear antibody (ANA)– HEp-2 testing in 40 ANA-positive healthy individuals at the first evaluation and at reassessment within an average 4-year interval. Solid lines indicate stable or increased titer; dashed lines indicate decreased titer; Ø indicates negative. tion. None had symptoms suggestive of an ARD, except for 1 woman who presented with mild hand pallor after exposure to cold; however, the clinical examination and nailfold capillaroscopy performed at the reassessment yielded normal findings. Among the 40 ANA-positive healthy individuals who agreed to donate blood at the reassessment, there was slight variation in titer in both directions, as shown in Figure 4, with no significant variation in ANA pattern between paired samples. Twenty-nine healthy individuals (72.5%) remained ANA positive without significant variation in ANA titer (P ⫽ 0.795). All 11 ANA-positive healthy individuals who became ANA negative had significantly lower initial titer (1:80) than those who remained ANA positive (P ⫽ 0.002). DISCUSSION Taking into consideration that the ANA–HEp-2 test yields positive results in a sizable portion of the general population, it is critical for the accurate interpretation of the test that we uncover differential characteristics of the results in healthy individuals and in patients with ARDs. In the present study, we were able to identify distinctive ANA profiles in healthy individuals and patients with ARDs by analyzing samples from 197 918 healthy individuals and 153 patients with ARDs. Positive ANA–HEp-2 test results in healthy individuals involved predominantly low-to-moderate titers, and the most common ANA patterns were the nuclear fine speckled pattern and the nuclear dense fine speckled pattern. In contrast, positive ANA–HEp-2 test results in patients with ARDs involved predominantly moderateto-high titers and exhibited a distinct ANA profile characterized mainly by the absence of the nuclear dense fine speckled pattern and the exclusive occurrence of the nuclear coarse speckled, nuclear homogeneous, and nuclear centromeric patterns. The frequency of positive ANA–HEp-2 test results in the present series of healthy individuals (12.9%) was within the range established by previous studies (3,6–9). Several studies reported in the literature found a higher prevalence of ANAs in healthy women than in healthy men (3–5,7,29). In fact, sex-related factors, such as the hormone profile, fetal microchimerism, and strategic genes located at sex chromosomes, may be involved in the female predominance in autoimmune diseases (30). Interestingly, we could not find any difference in the frequency of positive ANA–HEp-2 test results between women and men despite the substantial sample size for both sexes. We observed a higher prevalence of ANAs in elderly healthy individuals, as shown by previous studies in nonagenarians and centenarians (31,32). However, the difference did not reach statistical significance, which may be related to the limited number of healthy individuals older than 65 years in the present study. Our study indicates that ANA titers of 1:80 and 1:160 are suitable dilutions for screening for ARDs. The high NPV for ARD diagnosis found in the present series is consistent with findings of Slater et al, who evaluated 1,010 consecutive samples in which ANA–HEp-2 testing was ordered (33). These results indicate that a negative ANA–HEp-2 test result at 1:80 screening dilution is unlikely in patients with ARDs, especially those with SLE, SSc, and SS. The observed predominance of lowtiter ANAs (ⱕ1:160) among healthy individuals is also consistent with previous reports (2,6–8). On the other hand, we did find a substantial fraction of healthy individuals with a moderate titer (1:320 and 1:640) and a smaller fraction with a high titer (ⱖ1:1,280). ROC curve analysis and traditional diagnostic performance parameters (sensitivity, specificity, and predictive values) showed that in a scenario of indiscriminate requests for ANA–HEp-2 tests, there was relevant gain in specificity and PPV for discriminating healthy individuals and patients with ARDs up to a titer of 1:1,280. Therefore, 198 although the 1:80 and 1:160 dilutions are appropriate for screening, it is advisable that clinical laboratories proceed with testing up to a 1:1,280 dilution. Altogether, these findings suggest that the titer of the ANA–HEp-2 reaction is a relevant but limited parameter in discriminating ANA-positive healthy individuals and patients with ARDs. This limitation may be partially overcome by the analysis of the pattern on the ANA–HEp-2 test. In fact, our findings suggest that this pattern is a critical parameter for the interpretation of a positive ANA–HEp-2 test result. In the present study, the pattern on the ANA–HEp-2 test was comparatively scrutinized in samples from patients with ARDs and healthy individuals. Some patterns, such as the nuclear coarse speckled, nuclear homogeneous, and nuclear centromeric patterns, were observed solely in samples from patients with ARDs. This is probably because these patterns are typically associated with disease-restricted autoantibodies, such as anti-Sm/anti–U1 RNP, anti–double-stranded DNA/antinucleosome, and anticentromere antibodies, respectively (34–37). On the other hand, the nuclear dense fine speckled pattern was not observed in any sample from a patient with an ARD, but was found exclusively in samples from healthy individuals. Confirming previous reports, all tested samples with a nuclear dense fine speckled pattern in this series reacted with a 75-kd protein compatible with the LEDGF/p75 antigen (8,18,19). There are not many studies focusing on the pattern on the ANA–HEp-2 test in healthy individuals, and the majority of them were performed before the characterization of the nuclear dense fine speckled pattern (2,4,5,38–40). Given the high prevalence of the nuclear dense fine speckled pattern among healthy individuals, it is reasonable to assume that this pattern might have been mistaken for some other pattern in those studies. In the present series, the nuclear dense fine speckled pattern was the second most frequent ANA pattern among healthy individuals. Of special importance, the majority of samples with this pattern had a high ANA titer, which might mislead the clinical judgment of physicians not acquainted with the ANA– HEp-2 test. Similar findings have been previously reported by Watanabe et al among 597 healthy hospital workers in Japan (8) and by our group in a study with 13,641 samples determined to be positive by an ANA– HEp-2 test performed in a Brazilian general clinical laboratory that was certified on-site by the US College of American Pathologists (19). However, it should be noted that the nuclear dense fine speckled pattern and anti- MARIZ ET AL LEDGF/p75 antibodies have also been observed in patients with a variety of unrelated conditions, such as interstitial cystitis, asthma, Hashimoto thyroiditis, and atopic dermatitis (18,19,21,22). The combined analysis of pattern on the ANA– HEp-2 test and ANA titer was especially relevant for tests showing the nuclear fine speckled pattern. This was the most frequent ANA pattern in healthy individuals and in patients with ARDs, and our results indicated that a low-titer nuclear fine speckled pattern was preferentially observed in healthy individuals, whereas a high-titer nuclear fine speckled pattern was preferentially observed in patients with ARDs. Interestingly, the samples with a nuclear fine speckled pattern from healthy individuals failed to elicit any reactivity on Western blotting, and this may indicate some peculiar features of the autoantigen(s) associated with this pattern in healthy subjects. One other useful element in the interpretation of a positive ANA–HEp-2 test result with the nuclear fine speckled pattern is the presence of antibodies to ENAs. In the present series, antibodies to SSA/Ro and SSB/La were largely restricted to samples with the nuclear fine speckled pattern from patients with ARDs. In contrast, only 1 healthy individual had antiSSA/Ro antibody. In addition, antibodies to U1 RNP and Sm, which are usually associated with the nuclear coarse speckled pattern, were observed solely in samples from patients with ARDs. At the followup visit, none of the 41 ANApositive healthy individuals had developed signs and symptoms of ARDs, and 72.5% of the 40 individuals who agreed to donate blood at the reassessment remained ANA positive after a mean followup period of 3.9 years. Our findings also indicate that those with low-titer ANAs on the ANA–HEp-2 test are the ones with the highest probability of future normalization of the result. The extended persistence of ANA positivity in healthy individuals has been previously reported by Xavier et al, who found that 78% of 23 elderly healthy individuals continued to have a positive ANA–HEp-2 test result after an average followup period of 4 years (40). In another study, Dinser et al also found a low PPV for a positive ANA–HEp-2 test result at titers ⬎1:320 for the development of ARD after a 3-year followup period (41). Therefore, a positive ANA–HEp-2 test result in apparently healthy individuals seems to be a sustained phenomenon in ⬃75% of the cases and appears to have a low PPV for the development of a future ARD. However, this assumption should be made with caution, because the followup in the present study included only samples (from healthy individuals) with patterns on the DISCRIMINATORY CAPACITY OF ANA–HEp-2 TEST PROFILES ANA–HEp-2 test shown not to be associated with ARD. In the unusual scenario of a pattern on the ANA–HEp-2 test associated with ARD (e.g., nuclear homogeneous or nuclear coarse speckled) in an apparently healthy individual, a careful followup is advised, since it has been demonstrated that specific autoantibodies may antedate signs and symptoms of SLE for years (10). In conclusion, the ANA–HEp-2 assay offered distinctive titer and pattern profiles for ANA-positive healthy individuals and for patients with ARDs. The ANA pattern on the test seemed to be more consistent than the ANA titer for discriminating ANA-positive healthy individuals and patients with ARDs. The nuclear dense fine speckled pattern was observed exclusively in healthy individuals and tended to appear at high titer and to be stable over the years. Some other patterns on the ANA–HEp-2 test (nuclear coarse speckled, nuclear homogeneous, nuclear centromeric) were restricted to patients with ARDs. The nuclear fine speckled pattern was equally frequent in both groups and showed different titer distributions in healthy individuals (predominantly low titer) and patients with ARDs (predominantly high titer). ANA-positive healthy individuals tended to keep ANA reactivity but did not develop evidence of ARD after a 4-year followup period. Given the critical role of the pattern on the ANA–HEp-2 test, future efforts shall address the reproducibility of ANA– HEp-2 test interpretation among different ANA experts and among different ANA–HEp-2 test slide brands. 199 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. ACKNOWLEDGMENTS We acknowledge Gilda Ferreira, MD, PhD, for providing some of the serum samples for the group of patients with ARDs, Valdecir Marvoulle, PhD, for expert advice with statistics, and Edward Chan, PhD, and Eng M. Tan, MD, for helpful comments. AUTHOR CONTRIBUTIONS All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. Dr. Andrade had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design. Mariz, Sato, Andrade. Acquisition of data. Mariz, Barbosa, Rodrigues, Dellavance, Andrade. 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Tuesday, October 13, 2009
Three Amigos in Las Vegas
Day 1~Drove up to Mt. Charleston the place reminds me of Kyburz California. Then we went for lunch it was good so we were stuffed and didn't need dinner that night. We went to the movie to see Couple's Retreat.... My heart pitter pattered for Vince Vaughn... Great Movie...
Day~2 the girls went to the strip I stayed back and went hot tubbing... that night we went to a comedy show starting Frank Calindo... it was great...
Day 3~ we went to breakfast at Original Pancake House and then tonight we went to the show "Marriage can be Murder".... Chelsea figured out all the who donit's... She won a Sleuth Plaque and tickets to another comedy show. She is a great kid. We had a good time then came home to watch Chel's favorite show. Son's of Anarchy.. Good Show... so that has been our 3 busy days... yes there still has been time for interneting on facebook, emailing all that crazy crap :)
Posted by Callie Ann at 11:24 PM
1 comment:
- CrAzY Working Mom said...
Heh heh heh...looks like trouble!
- October 16, 2009 9:55 PM
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Project Description
The Rebirth
Since it opened, The Labourdonnais has enjoyed a strong reputation as the leading business hotel in Mauritius. However, the 5* venue has witnessed little change over the years in terms of décor and style. A major refurbishment was planned in 2015 and the hotel would be closed for two months. Rebranding was on its way…
To keep in touch with clients, travel agents, local guests and visitors, a series of mini video clips branded 'Entr'Acte' was posted regularly on Facebook, before and during closure. Management and staff members, representing the face, hands and heart of the hotel shared their vision and dreams about the rebirth and thus increased the buzz. A brand new identity was created and a launch event was scheduled for August 5th 2015, followed by a press campaign, all with the brand's reputation for elegance and efficiency in mind.
Advertising | Branding | Digital & Social Media | Direct Marketing | Publishing
Lemon DDB,
Cnr Ave des Capucines & Trianon Ave No.1,
P.O Box 88, St Jean,
Quatre Bornes,
E email@example.com