text:
Classification and characteristics of Japanese patients with antineutrophil cytoplasmic antibody-associated vasculitis in a nationwide, prospective, inception cohort study
- Ken-ei Sada1,
- Masahiro Yamamura2,
- Masayoshi Harigai3,
- Takao Fujii4,
- Hiroaki Dobashi5,
- Yoshinari Takasaki6,
- Satoshi Ito7,
- Hidehiro Yamada8,
- Takashi Wada9,
- Junichi Hirahashi10,
- Yoshihiro Arimura11,
- Hirofumi Makino1Email author and
- the Research Committee on Intractable Vasculitides, the Ministry of Health, Labour and Welfare of Japan
DOI: 10.1186/ar4550
© Sada et al.; licensee BioMed Central Ltd. 2014
Received: 16 August 2013
Accepted: 9 April 2014
Published: 23 April 2014
We investigated the clinical and serological features of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in Japan using data from a nationwide, prospective, inception cohort study.
In total, 156 Japanese patients with newly diagnosed AAV were classified according to the European Medicines Agency (EMEA) algorithm with exploratory surrogate markers for AAV-related non-granulomatous pulmonary lesions, predefined as alveolar haemorrhage and interstitial lung disease (ILD), and their clinical and serological features were evaluated.
Using the EMEA algorithm, we identified 14 patients (9.0%) with eosinophilic granulomatosis with polyangiitis (EGPA), 33 (21.2%) with granulomatosis with polyangiitis (GPA), 78 (50.0%) with microscopic polyangiitis and renal-limited vasculitis (MPA/RLV), and 31 (19.9%) with unclassifiable vasculitis. The average ages of patients with EGPA (male/female, 5/9), GPA (12/21), and MPA/RLV (35/43) and unclassifiable (9/22) were 58.0, 63.6, 71.1, and 70.6 years, respectively. Myeloperoxidase (MPO)-ANCA and proteinase-3 ANCA positivity was 50.0% and 0% for EGPA, 54.6% and 45.5% for GPA, 97.4% and 2.6% for MPA/RLV, and 93.5% and 3.2% for unclassifiable, respectively. According to the Birmingham Vasculitis Activity Score (BVAS), cutaneous (71.4%) and nervous system (92.9%) manifestations were prominent in EGPA and ear, nose, and throat manifestations (84.9%) and chest manifestations (66.7%) in GPA. Renal manifestations developed frequently in MPA/RLV (91.0%) and GPA (63.6%). The average serum creatinine levels were 0.71 mg/dL for EGPA, 1.51 mg/dL for GPA, 2.46 mg/dL for MPA/RLV, and 0.69 mg/dL for unclassifiable. The percentages of patients with ILD were 14.3% for EGPA, 9.0% for GPA, 47.4% for MPA/RLV, and 61.3% for unclassifiable. Patients with ILD (n = 61) had significantly lower BVAS (P = 0.019) with fewer ear, nose, and throat and cardiovascular manifestations than patients without ILD (n = 95).
MPO-ANCA-positive MPA/RLV is the most common form of AAV in Japanese patients, and one-half of patients with GPA were positive for MPO-ANCA. ILD is an important clinical manifestation in Japanese patients with AAV. Unclassifiable vasculitis with MPO-ANCA positivity and ILD may represent a novel variant of MPA.
Trial Registration
The University Hospital Medical Information Network Clinical Trials Registry: UMIN000001648. Registered 28 February 2009.
Microscopic polyangiitis (MPA), granulomatosis with polyangiitis (Wegener's granulomatosis) (GPA), and eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome) (EGPA) are the major categories of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), a multisystem autoimmune disease characterised by ANCA production and small-vessel inflammation [1, 2]. Despite the overlapping clinicopathologic characteristics between the component diseases, the disease evolution, organ involvement, prognosis, and other clinical characteristics differ substantially among them. In addition, there are interesting geographic and ethnic differences in their relative incidence and myeloperoxidase (MPO)-ANCA or proteinase-3 (PR3)-ANCA positivity [3].
In 2007 Watts and colleagues proposed an AAV classification algorithm, the European Medicines Agency (EMEA) algorithm, with consensus of a group of European physicians interested in the epidemiology of vasculitis [4]. This stepwise algorithm incorporated both the American College of Rheumatology (ACR) criteria for EGPA and GPA and the Chapel Hill Consensus Conference (CHCC) definition of EGPA, GPA, and MPA [2]. In the EMEA algorithm, surrogate markers of granulomatous inflammation for GPA and those of renal vasculitis for renal-limited vasculitis (RLV), an organ-limited variant of MPA, were defined [4]. This algorithm is useful for classifying patients with AAV because no overlapping diagnoses occur and fewer patients are considered to have unclassifiable vasculitis [5], and has been used as the standard method for classification of AAV diseases in recent studies [6, 7].
Only two reports have validated the algorithm in other ethnicities outside Europe using a good-quality database. Studies from China [5] and Japan [3] applied the EMEA algorithm to their patient populations and found that MPO-ANCA-positive MPA was the most common form of AAV. These studies, however, were retrospective and evaluated clinical data of patients from a small number of hospitals.
The lung is one of the organs frequently involved in AAV, and pulmonary granuloma, alveolar haemorrhage, and interstitial lung disease (ILD) are representative pulmonary lesions. Among these, only pulmonary granuloma is included in the EMEA algorithm. ILD in AAV is associated with MPO-ANCA and is more common in Asian countries [8–10] than in western countries [11, 12], and some patients with MPO-ANCA and ILD subsequently develop typical MPA [13]. To understand the nature of AAV and classify the disease from a global perspective, it is essential to more precisely delineate the clinical implications of ILD in AAV in Asian countries.
To characterise the clinical and laboratory features, effectiveness, and safety of the remission-induction therapy used, as well as the prognosis of Japanese patients with AAV, the Research Committee on Intractable Vasculitides of the Ministry of Health, Labour and Welfare of Japan implemented a nationwide prospective cohort study of Remission Induction Therapy in Japanese Patients with ANCA-associated Vasculitides (RemIT-JAV). In this study, we classified Japanese patients with newly diagnosed AAV enrolled in the RemIT-JAV study according to the EMEA algorithm and compared their phenotypes across the AAVs. We also investigated the clinical relevance of ILD in the patient population.
Twenty-two tertiary care institutions (university hospitals and referring hospitals) participated in this study (See Appendix) and enrolled consecutive patients with newly diagnosed AAV from April 2009 to December 2010. The criteria for enrolment in this study included receiving a diagnosis of AAV from the site investigators, fulfilling the criteria for primary systemic vasculitis proposed by the EMEA algorithm [4], and requiring immunosuppressive treatment based on the discretion of the site investigators. The exclusion criteria were age younger than 20 years, recurrent AAV, serological evidence for hepatitis B virus or hepatitis C virus infection, and a history of malignancies because this may influence treatment selection and prognosis of patients with AAV. We conducted this study according to the Declaration of Helsinki and the Ethical Guidelines for Epidemiological Research in Japan. Written informed consent was obtained from each participant, and the study protocol was approved by the ethics committee at each participating hospital (refer to Acknowledgements). This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000001648).
Data collection
Each patient's baseline data included demographic information, general performance categorised using scales of the World Health Organization performance status except category 5 (death) [14], comorbidities, laboratory data, disease activity scored using the Birmingham Vasculitis Activity Score (BVAS) 2003 [15], imaging data (for example, chest radiograph, thoracic computed tomography, and magnetic resonance imaging of the head), and respiratory function data. The World Health Organization performance status runs from 0 to 5, with 0 denoting perfect health and 5 denoting death (0, asymptomatic; 1, symptomatic but completely ambulatory; 2, symptomatic, <50% in bed during the day; 3, symptomatic, >50% in bed, but not bedbound; 4, bedbound; 5, death).
Patients were evaluated at months 3, 6, 12, 18, and 24 and at relapse, and the following data were collected: vital status, BVAS 2003, laboratory data, treatments, and adverse events. The Vascular Damage Index score was recorded at months 6, 12, and 24. Chest radiography, thoracic computed tomography, arterial blood gas analysis, and respiratory function data were collected at months 12 and 24 in patients with pulmonary involvement. Observation was completed in March 2013. Only the baseline data are included in this study; the results from analyses of follow-up data will be reported separately.
The site investigators completed and sent the electronic case report form for each patient to the RemIT-JAV data centre at the Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
EMEA classification algorithm for AAV
The enrolled patients were classified using the stepwise EMEA algorithm as described previously [2, 4]. Briefly, the ACR criteria and Lanham criteria for EGPA were applied first. Patients who did not fulfil the criteria for EGPA were classified as having GPA if they met the ACR criteria for GPA or the CHCC histological definition for GPA or if they showed histology compatible with the CHCC definition for MPA or ANCA positivity with either of the EMEA-defined GPA surrogate markers. The remaining patients were classified as having MPA if they had clinical features and histology compatible with small-vessel vasculitis without the GPA surrogate markers. In addition, ANCA-positive patients who had the EMEA-defined surrogate markers for renal vasculitis were classified as having RLV, a variant form of MPA. The rest of the patients without histology compatible with the CHCC definition of classic polyarteritis nodosa or typical angiographic features of classic polyarteritis nodosa were categorised as having unclassifiable vasculitis.
To identify a subset of unclassifiable vasculitis with AAV-related nongranulomatous pulmonary lesions, we defined exploratory surrogate markers for alveolar haemorrhage and ILD and then applied them to the EMEA-defined unclassifiable patient population. Surrogate markers for these conditions were as follows: haemoptysis or alveolar haemorrhage evaluated by bronchoscopic examination; or ILD diagnosed by chest X-ray or thoracic computed tomography.
Disease severity
The disease severity of the enrolled patients was classified as localised, early systemic, generalised, or severe according to the European League Against Rheumatism recommendation for conducting a clinical study in systemic vasculitis [16]. Organ failure, classified as severe disease, was defined by the presence of any of the following BVAS manifestations: massive haemoptysis/alveolar haemorrhage, respiratory failure, congestive cardiac failure, ischaemic abdominal pain, or stroke. Threatened vital organ function, classified as generalised disease, was defined by the presence of any of the following BVAS manifestations: sudden visual loss, blurred vision, retinal changes (vasculitis/thrombosis/exudates/haemorrhage), conductive deafness, sensorineural hearing loss, ischaemic cardiac pain, cardiomyopathy, peritonitis, bloody diarrhoea, meningitis, organic confusion, seizures, cord lesion, cranial nerve palsy, sensory peripheral neuropathy, or motor mononeuritis multiplex. Serum creatinine levels were also used to classify disease severity as localised and early systemic (<120 μmol/l (1.3 mg/dl)), generalised (<500 μmol/l (5.5 mg/dl)), and severe (≥500 μmol/l (5.5 mg/dl)) [16].
Statistical analysis
We used the baseline data of the patients enrolled in this study for statistical analysis. The primary purpose of this analysis was to determine the demographic and clinical characteristics of Japanese patients with AAV. Categorical variables were compared using Fisher's direct probability test, and continuous variables were compared using Student t test or the Mann–Whitney U test depending on data distribution. P < 0.05 was considered significant for statistical analyses between two categories. When comparing among three categories, statistical significance was determined by P < 0.05/3 using Bonferroni correction to avoid multiplicity. All statistical analyses were performed by a biostatistician using the Statistical Package of JMP for Windows software (version 8.0.2; SAS Institute Inc., Cary, NC, USA).
Classification of 156 Japanese patients with AAV according to the EMEA algorithm
In total, 159 patients with AAV were initially enrolled in the RemIT-JAV study. Three patients were then excluded; two patients did not undergo treatment, and one patient had been diagnosed as having AAV and experienced a relapse at the time of enrolment. As a result, 156 patients with newly diagnosed AAV were enrolled in the study.
Comparison of demographics and disease states among AAV diseases
(n = 14)
(n = 33)
(n = 78)
(n = 31)
Mean (median) age (years)a,c
58.0 ± 16.9 (62)
63.6 ± 12.6 (61)
71.1 ± 10.0 (73)
70.6 ± 11.8 (73)
7 (50.0)
18 (54.6)
76 (97.4)
29 (93.5)
0 (0)
15 (45.5)
2 (2.6)
1 (3.2)
7 (50.0)
3 (9.1)
1 (1.3)
2 (6.5)
Serum creatinine (mg/dl)a
0.71 ± 0.39
1.51 ± 1.32
2.46 ± 2.18
0.69 ± 0.23
Disease severityc
0 (0)
4 (12.1)
0 (0)
0 (0)
Early systemic
1 (7.1)
5 (15.1)
15 (19.2)
15 (48.4)
13 (92.9)
18 (54.6)
47 (60.3)
13 (41.9)
0 (0)
6 (18.2)
16 (20.5)
3 (9.7)
General performanced
Nongranulomatous pulmonary involvement
Interstitial lung diseasea
2 (14.3)
3 (9.0)
37 (47.4)
19 (61.3)
Alveolar haemorrhage
0 (0)
2 (6.1)
9 (11.5)
2 (6.5)
Surrogate markers involved in the classification according to the EMEA algorithm
Surrogate markers in nine patients who were classified with granulomatosis with polyangiitis using these markers
Number of patients
X-ray evidence of fixed pulmonary infiltrates, nodules, or cavitations present for >1 month
1 (1/0)
Bronchial stenosis
0 (0/0)
Bloody nasal discharge and crusting for 1 month or nasal ulceration
1b (0/1)
Chronic sinusitis, otitis media, or mastoiditis for >3 months
7c (4/5)
Retro-orbital mass or inflammation (pseudotumor)
0 (0/0)
Subglottic stenosis
1 (0/1)
Saddle nose deformity/destructive sinonasal disease
1 (0/1)
Organ involvement of 156 Japanese patients with AAV
Comparison of disease activity and organ involvement among AAV diseases
(n = 14)
(n = 33)
(n = 78)
(n = 31)
16.1 ± 7.7
19.9 ± 7.4
18.4 ± 7.3
12.1 ± 7.6
10 (71.4)
23 (69.7)
56 (71.8)
29 (93.6)
10 (71.4)
3 (9.1)
16 (20.5)
10 (32.3)
Mucous membranes/eyes
1 (7.1)
8 (24.2)
9 (11.5)
2 (6.5)
Ear, nose, and throata,b,c
6 (42.9)
28 (84.9)
7 (9.0)
1 (3.2)
5 (35.7)
22 (66.7)
30 (38.5)
6 (19.4)
2 (14.3)
4 (12.1)
6 (7.7)
0 (0)
0 (0)
1 (3.0)
0 (0)
2 (14.3)
21 (63.6)
71 (91.0)
15 (48.4)
Nervous systema,b
13 (92.9)
14 (42.4)
33 (42.3)
15 (48.4)
Differences in clinical features between MPO-ANCA-positive and PR3-ANCA-positive AAV
Comparison of demographics and disease manifestations in MPO-ANCA-positive and PR3-ANCA-positive patients
P value
(n = 125)
(n = 13)
Mean (median) age (years)
70.0 ± 1.04 (73)
61.3 ± 3.2 (61)
Serum creatinine (mg/dl)
1.94 ± 0.17
1.22 ± 0.53
Interstitial lung disease
57 (45.6)
0 (0)
Alveolar haemorrhage
11 (8.8)
1 (7.7)
Disease severity
2 (1.6)
1 (7.7)
Early systemic
33 (26.4)
2 (15.4)
68 (54.4)
8 (61.5)
22 (17.6)
2 (15.4)
General performancea
17.5 ± 0.71
17.5 ± 2.2
95 (76.0)
10 (76.9)
30 (24.0)
0 (0)
Mucous membranes/eyes
16 (12.8)
4 (30.8)
Ear, nose, and throat
22 (17.6)
12 (92.3)
49 (39.2)
7 (53.9)
8 (6.4)
2 (15.4)
2 (1.6)
0 (0)
98 (78.4)
6 (46.2)
Nervous system
55 (44.0)
4 (30.8)
Of the 33 patients with GPA, 15 patients, 12 patients, and three patients were positive for MPO-ANCA alone, for PR3-ANCA alone, or for both ANCAs, respectively, but three patients were negative for ANCA. Patients with GPA who had MPO-ANCA had a numerically higher rate of renal disease (86.7%) than those with PR3-ANCA (41.7%). The mean serum creatinine level of patients with MPO-ANCA-positive GPA (2.05 ± 0.35 mg/dl) was also numerically higher than that of patients with PR3-ANCA-positive GPA (1.03 ± 0.39 mg/dl).
Clinical features of patients with or without interstitial lung disease
Comparing patients with or without interstitial lung disease
Patients with ILD
Patients without ILD
P value
(n = 61)
(n = 95)
Mean (median) age (years)
69.3 ± 1.6 (71)
67.3 ± 1.3 (71)
60 (98.3)
70 (73.7)
3 (4.9)
15 (15.8)
Serum creatinine (mg/dl)
1.61 ± 0.23
1.83 ± 0.19
Disease severity
1 (1.7)
3 (3.1)
Early systemic
21 (34.4)
15 (15.8)
31 (50.8)
60 (63.2)
8 (13.1)
17 (17.9)
General performancea
15.4 ± 1.0
18.4 ± 0.8
49 (80.3)
69 (72.6)
13 (21.3)
26 (27.4)
Mucous membranes/eyes
5 (8.2)
15 (15.8)
Ear, nose, and throat
9 (14.8)
33 (34.7)
22 (36.1)
41 (43.2)
1 (1.7)
11 (11.6)
0 (0)
2 (2.1)
44 (72.1)
65 (68.4)
Nervous system
28 (45.9)
47 (49.5)
This is the first study to apply the EMEA algorithm to prospectively collected and high-quality data of AAV patients outside Europe and to elucidate the clinical phenotypes of the disease. In this study, 156 Japanese patients with newly diagnosed AAV were enrolled from major universities and referring hospitals across Japan and classified according to the EMEA algorithm. The results clearly indicated that MPO-ANCA-positive MPA/RLV was the most common form of AAV in the Japanese population, and more than one-half of the patients with EMEA algorithm-classified GPA showed MPO-ANCA positivity. In addition, we showed that ILD was a common manifestation in Japanese patients with AAV, especially in those with MPA.
The predominance of MPA/RLV and MPO-ANCA positivity in the Japanese population is in marked contrast to the results of studies previously reported from European countries and the United States [3, 17–19]. Watts and colleagues validated the EMEA algorithm using 80 paper cases that were originally written for evaluation of the BVAS system for systemic vasculitis with some modifications, representing the relative frequency of AAV in their communities as follows: GPA > MPA > EGPA [4]. It is therefore indispensable and important to evaluate the utility of the EMEA algorithm in ethnicities outside Europe, as we did in this study. We found some difficulties in the classification between GPA and MPA with the EMEA algorithm; for example, of the nine patients classified as having GPA owing to the presence of GPA surrogate markers, five had chronic sinusitis in which granulomatous inflammation was not proven by histology. Because chronic sinusitis is a common disease and because fixed pulmonary infiltrates and otitis media are sometimes observed in AAV diseases other than GPA, classification of AAV using GPA surrogate markers should be cautiously applied in the countries or regions where MPA is more prevalent than GPA.
Within the spectrum of AAV, there are interesting geographic differences in the relative incidence of GPA versus MPA as well as of MPO-ANCA versus PR3-ANCA positivity [20]. In European countries, the incidence of GPA is approximately 4.9 to 10 per million, depending on the geographic location, with higher incidences reported in more northern countries and lower incidences in more southern countries [21, 22]. A similar inverse relationship between GPA and MPA has been observed in the Southern Hemisphere [22]. A higher incidence of MPA/RLV than GPA and the predominance of MPO-ANCA found in the Japanese and Chinese AAV populations [3, 5] could be related to the lower latitude of these countries.
GPA and MPA are heterogeneous entities with overlapping phenotypes. Recent studies have indicated that the classification system based on ANCA specificity (that is, MPO-ANCA versus PR3-ANCA) may better reflect the phenotypic spectrum of AAV. Cluster analysis of patients with newly diagnosed GPA and MPA from five clinical trials showed that the ANCA specificity classification may be more strongly associated with outcomes such as death and relapse rate than the traditional GPA-MPA separation [23]. Moreover, compared with the CHCC definition and the EMEA algorithm, ANCA specificity was more predictive of relapse in patients with biopsy-proven AAV; patients with PR3-ANCA were almost twice as likely to experience a relapse as those with MPO-ANCA [24]. In this regard, it is intriguing that a genome-wide association study of a European population revealed the presence of genetic distinctions between GPA and MPA that are associated with ANCA specificity [25]. Because of the limited number of patients with PR3-ANCA in our RemIT-JAV cohort, we were not able to perform cluster analysis within this database. We are currently implementing another large-scale cohort study of Japanese patients with AAV, and the combined database will enable us to clarify an association between ANCA positivity and clinical characteristics of AAV in the Japanese population.
MPO-ANCA may contribute to the severity of chronic renal injury and the prevalence of ILD in patients with AAV. Studies of renal biopsy specimens from patients with AAV have demonstrated a higher prevalence and/or severity of renal lesions in MPO-ANCA-positive patients compared with PR3-ANCA-positive patients [26]. These reports are in line with our findings that the mean serum creatinine level of MPO-ANCA-positive patients was numerically higher than that of PR3-ANCA-positive patients (1.94 versus 1.22 mg/dl).
A number of case reports and small case series have indicated that ILD developed more frequently in patients with MPO-ANCA-positive AAV, mainly in those with a diagnosis of MPA, compared with patients with PR3-ANCA-positive AAV [27, 28]. A high ratio of MPO-ANCA positivity to PR3-ANCA positivity and a high prevalence of ILD have been reported in Asian countries [8–10], and vice versa in northern European countries; ILD was reported in 7.2% of all patients with MPA in the United Kingdom and in less than 10% in other European countries [11, 12]. In this study, we confirmed a high prevalence of ILD in Japanese patients with AAV. These patients were categorised as having a milder form (that is, more early systemic and less generalised or severe diseases) and lower disease activity according to the BVAS (Table 5), partially because ILD is not included in these definitions. Investigation of the clinical courses and prognoses of patients with ILD will shed more light on the relevance of ILD in the severity and activity of AAV.
We identified 16 unclassifiable AAV patients with ILD who were eligible for the EMEA algorithm because they were MPO-ANCA-positive, had symptoms and signs compatible with AAV such as general symptoms, and could not be diagnosed as having other diseases. A previous study reported that MPO-ANCA seroconversion from negative to positive occurred in 10% of patients with ILD in their clinical courses and that some patients with MPO-ANCA and ILD eventually developed typical MPA [29]. On the other hand, vasculitis was proven in five of 15 biopsy specimens of MPO-ANCA-positive patients with pulmonary fibrosis [13]. These data indicate that patients with unclassifiable AAV and ILD could be classified as having MPA. Further investigation is required to pursue this possibility.
This study has some limitations. The number of patients evaluated was limited, and the patient data were collected from the university and referral hospitals in large cities in Japan, which might cause tertiary care biases for the relative frequency of AAV diseases.
MPO-ANCA-positive MPA/RLV is the most common component of AAV in the Japanese population, and more than one-half of patients with GPA are also positive for MPO-ANCA. ILD is an important clinical manifestation in Japanese patients with AAV. Unclassifiable vasculitis with MPO-ANCA positivity and ILD may represent a novel variant of MPA. These data confirm the substantial difference in clinical and ANCA serological features of AAV between western countries and Asian countries, including Japan, and indicate that further investigation and discussion are required from a global perspective for a better AAV classification system that can be applied to all geographic areas and ethnicities.
This study was approved by the following ethical committees: Ethics Committee of the Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Medical Research Ethics Committee of Tokyo Medical and Dental University; Kyoto University Ethics Committee Review Board; Ethics Committee of Kagawa University; Ethics Committee of Juntendo University School of Medicine; Ethics Committee University of Tsukuba Hospital; Ethics Committee of St. Marianna University School of Medicine; Kanazawa University Ethical Committee; Ethics Committee of the University of Tokyo; Ethics Committee of Kyorin University School of Medicine; Saitama Medical Center Hospital Ethics Committee; Research Ethics Committee of the University of Miyazaki; Local Ethics Committee of Toho University; Ethics Committee of Kobe University Hospital; Ethics Committee of Kitano Hospital, The Tazuke Kofukai Medical Research Institute; Shimane University Institutional Committee on Ethics; Ethics Review Committee of Nagoya City University Graduate School of Medical Sciences; Ethics Committee of Ehime University Graduate School of Medicine; Ethics Committee of Jichi Medical University; Ethics Committee of Kyoto Prefectural University School of Medicine; Ethics Committee of Tokyo Medical University Hachioji Medical Center; Ethics Committee of Kitasato University Hospital; and Ethics Committee of Hamamatsu University School of Medicine.
Research Committee of Intractable Vasculitis Syndrome of the Ministry of Health, Labour, and Welfare of Japan: in addition to the authors, the following investigators and institutions participated in this study: Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University (Koichi Amano); Department of Nephrology, Faculty of Medicine, University of Tsukuba (Kunihiro Yamagata); Department of Hemovascular and Artificial Organs, Faculty of Medicine, University of Miyazaki (Shouichi Fujimoto); Department of Respiratory Medicine, Toho University Omori Medical Center (Sakae Homma); Department of Clinical Pathology and Immunology, Kobe University Graduate School of Medicine (Shunichi Kumagai); Center for Nephrology and Urology, Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute (Eri Muso); Department of Rheumatology, Shimane University Faculty of Medicine (Yohko Murakawa); Division of Rheumatology, Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Science (Shogo Banno); Department of Bioregulatory Medicine, Ehime University Graduate School of Medicine (Hitoshi Hasegawa); Division of Nephrology, Department of Internal Medicine, Jichi Medical University (Wako Yumura); Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine (Hiroaki Matsubara); Division of Nephrology, Tokyo Medical University Hachioji Medical Center (Masaharu Yoshida); Department of Dermatology, Kitasato University School of Medicine (Kensei Katsuoka); and Third Department of Internal Medicine, Division of Immunology and Rheumatology, Hamamatsu University School of Medicine, Hamamatsu (Noriyoshi Ogawa).
antineutrophil cytoplasmic antibody-associated vasculitis
American College of Rheumatology
antineutrophil cytoplasmic antibody
Birmingham Vasculitis Activity Score
Chapel Hill Consensus Conference
eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome)
European Medicines Agency
granulomatosis with polyangiitis (Wegener's granulomatosis)
interstitial lung disease
microscopic polyangiitis
- RemIT-JAV:
Remission Induction Therapy in Japanese Patients with ANCA-associated Vasculitides
renal-limited vasculitis.
This work was supported by grants from Research on Rare and Intractable Diseases, the Ministry of Health, Labour and Welfare, Japan (nannti-ippann-004).
The authors thank Keiko Hongo, Kumiko Muraki, Eri Katsuyama, Takayuki Katsuyama, Haruki Watanabe, Mariko Narazaki, Noriko Toyota, Yoshinori Matsumoto, Ryutaro Yamanaka, and Kouichi Sugiyama for their great assistance in data management.
Authors' Affiliations
- Jennette J, Falk R, Bacon P, Basu N, Cid M, Ferrario F, Flores-Suarez L, Gross W, Guillevin L, Hagen E, Hoffman GS, Jayne DR, Kallenberg CG, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DG, Specks U, Stone JH, Takahashi K, Watts RA: Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013, 65: 1-11.View ArticlePubMedGoogle Scholar
- Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CG, McCluskey RT, Sinico RA, Rees AJ, van Es LA, Waldherr R, Wiik A: Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum. 1994, 37: 187-192. 10.1002/art.1780370206.View ArticlePubMedGoogle Scholar
- Fujimoto S, Watts RA, Kobayashi S, Suzuki K, Jayne DR, Scott DG, Hashimoto H, Nunoi H: Comparison of the epidemiology of anti-neutrophil cytoplasmic antibody-associated vasculitis between Japan and the U.K. Rheumatology (Oxford). 2011, 50: 1916-1920. 10.1093/rheumatology/ker205.View ArticleGoogle Scholar
- Watts R, Lane S, Hanslik T, Hauser T, Hellmich B, Koldingsnes W, Mahr A, Segelmark M, Cohen-Tervaert JW, Scott D: Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis. 2007, 66: 222-227.PubMed CentralView ArticlePubMedGoogle Scholar
- Liu LJ, Chen M, Yu F, Zhao MH, Wang HY: Evaluation of a new algorithm in classification of systemic vasculitis. Rheumatology (Oxford). 2008, 47: 708-712. 10.1093/rheumatology/ken079.View ArticleGoogle Scholar
- Watts RA, Mooney J, Skinner J, Scott DG, Macgregor AJ: The contrasting epidemiology of granulomatosis with polyangiitis (Wegener's) and microscopic polyangiitis. Rheumatology (Oxford). 2012, 51: 926-931. 10.1093/rheumatology/ker454.View ArticleGoogle Scholar
- Goupil R, Brachemi S, Nadeau-Fredette AC, Deziel C, Troyanov Y, Lavergne V, Troyanov S: Lymphopenia and treatment-related infectious complications in ANCA-associated vasculitis. Clin J Am Soc Nephrol. 2013, 8: 416-423. 10.2215/CJN.07300712.PubMed CentralView ArticlePubMedGoogle Scholar
- Ozaki S, Atsumi T, Hayashi T, Ishizu A, Kobayashi S, Kumagai S, Kurihara Y, Kurokawa MS, Makino H, Nagafuchi H, Nakabayashi K, Nishimoto N, Suka M, Tomino Y, Yamada H, Yamagata K, Yoshida M, Yumura W, Amano K, Arimura Y, Hatta K, Ito S, Kikuchi H, Muso E, Nakashima H, Ohsone Y, Suzuki Y, Hashimoto H, Koyama A, Matsuo S: Severity-based treatment for Japanese patients with MPO-ANCA-associated vasculitis: the JMAAV study. Mod Rheumatol. 2012, 22: 394-404. 10.3109/s10165-011-0525-5.PubMed CentralView ArticlePubMedGoogle Scholar
- Chen M, Yu F, Zhang Y, Zhao MH: Antineutrophil cytoplasmic autoantibody-associated vasculitis in older patients. Medicine (Baltimore). 2008, 87: 203-209. 10.1097/MD.0b013e31817c744b.View ArticleGoogle Scholar
- Ahn JK, Hwang JW, Lee J, Jeon CH, Cha HS, Koh EM: Clinical features and outcome of microscopic polyangiitis under a new consensus algorithm of ANCA-associated vasculitides in Korea. Rheumatol Int. 2012, 32: 2979-2986. 10.1007/s00296-011-2079-4.View ArticlePubMedGoogle Scholar
- Arulkumaran N, Periselneris N, Gaskin G, Strickland N, Ind PW, Pusey CD, Salama AD: Interstitial lung disease and ANCA-associated vasculitis: a retrospective observational cohort study. Rheumatology (Oxford). 2011, 50: 2035-2043. 10.1093/rheumatology/ker236.View ArticleGoogle Scholar
- Bhanji A, Karim M: Pulmonary fibrosis-an uncommon manifestation of anti-myeloperoxidase-positive systemic vasculitis?. NDT Plus. 2010, 3: 351-353. 10.1093/ndtplus/sfq050.PubMed CentralPubMedGoogle Scholar
- Homma S, Matsushita H, Nakata K: Pulmonary fibrosis in myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitides. Respirology. 2004, 9: 190-196. 10.1111/j.1440-1843.2004.00581.x.View ArticlePubMedGoogle Scholar
- Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982, 5: 649-655. 10.1097/00000421-198212000-00014.View ArticlePubMedGoogle Scholar
- Luqmani RA, Bacon PA, Moots RJ, Janssen BA, Pall A, Emery P, Savage C, Adu D: Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. QJM. 1994, 87: 671-678.PubMedGoogle Scholar
- Hellmich B, Flossmann O, Gross WL, Bacon P, Cohen-Tervaert JW, Guillevin L, Jayne D, Mahr A, Merkel PA, Raspe H, Scott DG, Witter J, Yazici H, Luqmani RA: EULAR recommendations for conducting clinical studies and/or clinical trials in systemic vasculitis: focus on anti-neutrophil cytoplasm antibody-associated vasculitis. Ann Rheum Dis. 2007, 66: 605-617. 10.1136/ard.2006.062711.PubMed CentralView ArticlePubMedGoogle Scholar
- Guillevin L, Pagnoux C, Seror R, Mahr A, Mouthon L, Le Toumelin P: The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore). 2011, 90: 19-27. 10.1097/MD.0b013e318205a4c6.View ArticleGoogle Scholar
- Watts RA, Lane SE, Bentham G, Scott DG: Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom. Arthritis Rheum. 2000, 43: 414-419. 10.1002/1529-0131(200002)43:2<414::AID-ANR23>3.0.CO;2-0.View ArticlePubMedGoogle Scholar
- McGregor JG, Hogan SL, Hu Y, Jennette CE, Falk RJ, Nachman PH: Glucocorticoids and relapse and infection rates in anti-neutrophil cytoplasmic antibody disease. Clin J Am Soc Nephrol. 2012, 7: 240-247. 10.2215/CJN.05610611.PubMed CentralView ArticlePubMedGoogle Scholar
- Watts RA, Gonzalez-Gay MA, Lane SE, Garcia-Porrua C, Bentham G, Scott DG: Geoepidemiology of systemic vasculitis: comparison of the incidence in two regions of Europe. Ann Rheum Dis. 2001, 60: 170-172. 10.1136/ard.60.2.170.PubMed CentralView ArticlePubMedGoogle Scholar
- Watts RA, Lane SE, Scott DG, Koldingsnes W, Nossent H, Gonzalez-Gay MA, Garcia-Porrua C, Bentham GA: Epidemiology of vasculitis in Europe. Ann Rheum Dis. 2001, 60: 1156-1157. 10.1136/ard.60.12.1156.PubMed CentralView ArticlePubMedGoogle Scholar
- Gibson A, Stamp LK, Chapman PT, O'Donnell JL: The epidemiology of Wegener's granulomatosis and microscopic polyangiitis in a Southern Hemisphere region. Rheumatology (Oxford). 2006, 45: 624-628. 10.1093/rheumatology/kei259.View ArticleGoogle Scholar
- Mahr A, Katsahian S, Varet H, Guillevin L, Hagen EC, Hoglund P, Merkel PA, Pagnoux C, Rasmussen N, Westman K, Jayne DR, French Vasculitis Study Group (FVSG); European Vasculitis Society (EUVAS): Revisiting the classification of clinical phenotypes of anti-neutrophil cytoplasmic antibody-associated vasculitis: a cluster analysis. Ann Rheum Dis. 2013, 72: 1003-1010. 10.1136/annrheumdis-2012-201750.View ArticlePubMedGoogle Scholar
- Walsh M, Flossmann O, Berden A, Westman K, Hoglund P, Stegeman C, Jayne D: Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum. 2012, 64: 542-548. 10.1002/art.33361.View ArticlePubMedGoogle Scholar
- Lyons PA, Rayner TF, Trivedi S, Holle JU, Watts RA, Jayne DR, Baslund B, Brenchley P, Bruchfeld A, Chaudhry AN, Cohen Tervaert JW, Deloukas P, Feighery C, Gross WL, Guillevin L, Gunnarsson I, Harper L, Hrušková Z, Little MA, Martorana D, Neumann T, Ohlsson S, Padmanabhan S, Pusey CD, Salama AD, Sanders JS, Savage CO, Segelmark M, Stegeman CA, Tesař V: Genetically distinct subsets within ANCA-associated vasculitis. N Engl J Med. 2012, 367: 214-223. 10.1056/NEJMoa1108735.PubMed CentralView ArticlePubMedGoogle Scholar
- Hauer HA, Bajema IM, van Houwelingen HC, Ferrario F, Noel LH, Waldherr R, Jayne DR, Rasmussen N, Bruijn JA, Hagen EC: Renal histology in ANCA-associated vasculitis: differences between diagnostic and serologic subgroups. Kidney Int. 2002, 61: 80-89. 10.1046/j.1523-1755.2002.00089.x.View ArticlePubMedGoogle Scholar
- Foulon G, Delaval P, Valeyre D, Wallaert B, Debray MP, Brauner M, Nicaise P, Cadranel J, Cottin V, Tazi A, Aubier M, Crestani B: ANCA-associated lung fibrosis: analysis of 17 patients. Respir Med. 2008, 102: 1392-1398. 10.1016/j.rmed.2008.04.023.View ArticlePubMedGoogle Scholar
- Hervier B, Pagnoux C, Agard C, Haroche J, Amoura Z, Guillevin L, Hamidou MA: Pulmonary fibrosis associated with ANCA-positive vasculitides. Retrospective study of 12 cases and review of the literature. Ann Rheum Dis. 2009, 68: 404-407. 10.1136/ard.2008.096131.View ArticlePubMedGoogle Scholar
- Ando M, Miyazaki E, Ishii T, Mukai Y, Yamasue M, Fujisaki H, Ito T, Nureki S, Kumamoto T: Incidence of myeloperoxidase anti-neutrophil cytoplasmic antibody positivity and microscopic polyangitis in the course of idiopathic pulmonary fibrosis. Respir Med. 2013, 107: 608-615. 10.1016/j.rmed.2013.01.006.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


text:
Full profile →'">
The author is a Forbes contributor. The opinions expressed are those of the writer.
Mazda badly stubbed its toe on the eve of the Detroit auto show by announcing that it has pushed back the introduction of its Skyactiv-D clean-diesel engine in North America for the second time. It'll be "further delayed" in the Mazda6 from its already-delayed launch planned for spring, the company said.
The company cited the need for "further development [that] is required to deliver the right balance between fuel economy and Mazda-appropriate driving performance," without getting more specific. Industry speculation immediately centered on the difficulty Mazda has faced in attempting to field a new kind of diesel engine that doesn't rely on an expensive NOx after-treatment system as most competitors do.
Mazda's new delay follows one that it announced in September. Originally, Skyactiv-D was to debut by the end of 2013.
This could be a stinging blow to Mazda for at least three reasons.
First, the Skyactiv-D engine in particular has been highly anticipated and widely touted because of Mazda's expensive and intensive efforts to differentiate it from competitors' clean-diesel offerings; as recently as last March, in fact, Science magazine ran a story, "How Mazda Reinvented the Diesel Engine."
Second, the diesel-power derby in the United States continues to heat up, and it could represent another ripe opportunity for Mazda to add to a recent track record that has proven a second-tier brand can be savvy enough to survive and even thrive in the rough-and-tumble American car market.
Meanwhile, rival Volkswagen continues to build on its pole position in the growing U.S. market for clean diesel, with about 75 percent of all sales, while sibling luxury brand now offers TDI clean-diesel engine options across nearly its entire American lineup of volume vehicles. BMW and also are expanding U.S. diesel offerings. And Chevrolet, with a new diesel version of Cruze, and Jeep have begun offering diesel-powered vehicles to mainstream American consumers, whereas diesel previously was largely the domain of the heavy-duty pickup-truck segment.
Third, Mazda's timing of the announcement means that it's sure to be a hot topic for the company as it faces the glare of thousands of automotive journalists and rival executives from around the world next week at the North American International Auto Show in Detroit. It might be best to get the news out now, ahead of the press days for the show on Monday and Tuesday. But Mazda's diesel foibles are sure to rival any attention it will get for the success of its new Mazda3 and Mazda6 sedans; Mazda3 is one of three finalists for the North American Car of the Year Award that will be announced on Monday morning.

subset: commoncrawl


text:
There are a variety of ways to help raise funds for our PTA and school. We have larger fund raising events, such as Unicornucopia, Boosterthon, Family Spirit Nights, etc. We also have smaller fund raisers that can add up to alot! From clipping Box Tops to linking your savings card with your favorite grocery story, every little bit you do can make a difference!
Box Tops for Education & Labels for Education Programs
Check our Facebook page for the latest Box Top promotions.
|General Mills Box Tops for Education Clip Program
|North Ridge ID# 385934
Clip box tops, trim and drop off in the collection box by the front office hall.
Click here for a list of participating products
North Ridge receives $0.10 for each box top received.
|Labels for Education
|Participating Products List
Community Links Program
To make the most of your regular purchases, link your grocery store cards at the beginning of EACH school year. However, linking your cards at any time will support North Ridge. You can link your card yourself next time you are at the store. Or you can complete this Community Link Form and return it to your child's teacher. We will then link your cards for you.
|You shop. Amazon supports our students. North Ridge wins! When you shop at AmazonSmile, Amazon donates 0.5% of the price of eligible purchases to North Ridge Elementary PTA. AmazonSmile is the same Amazon you know. Same products, prices, and shopping experience. You use the same account on Amazon and AmazonSmile.
How do I sign up and use AmazonSmile?
On future visits, just go to smile.amazon.com, log in, and begin shopping. Amazon Smile will remember your choice of NRE. (You can bookmark the page for your convenience!)
Kroger Community Rewards
|Earn funding for North Ridge when you shop at Kroger!
Last year, the community rewards program earned a lot for NRE even though only a few people signed up. We hope even more will use this opportunity to help our school this year!
Two ways to sign up. For both, you'll need the North Ridge Elementary code: 86808.
Harris Teeter Together In Education (TIE) Program
|Cash awards for North Ridge, paid three times a year! Link your Harris Teeter card to the NRE school code: 1608.
Two ways to link:
Lowes Foods Cart to Class Program
|Buy Lowes Foods Private Brand items and earn $$$ for North Ridge! Lowes makes a donation to North Ridge based on the amount of Lowes Foods Private Brand items purchased.
Link your Lowes card online:
Office Depot
|Stock up school supplies for NRE when you shop! Office Depot gives our school merchandise equal to 5% of the value of eligible purchases.
Write down the North Ridge code: 70062213. Bring it with you when you shop at Office Depot and give the code to the clerk at checkout.
Additional Needs and Collection Items
- Gently used clothes for our health room, boys and girls, all sizes needed!
- School pictures for our yearbook!


text:
We manage people with foot related problems.
Let Our Podiatrists Find The Root of Your Foot Or Leg pain
Improve Mobility & Ease aches
Don't Let Foot Pain Stand In Your Way
Enjoy Perfectly Healthy Toenails
© 2015. The content on this website is owned by us and our licensors. Do not copy any content (including images) without our consent.


text:
These lines are not exact. Updated October 2008.
Classification based on forest type. 2006 aerial was used to delineate habitats.
Ponds on Spring Island and fishing type
© 2010, the Spring Island Trust | all illustrations copyright Katie Lee, courtesy of Katie Lee | site by Sans Sheriff StudioFor information about living on Spring Island, please see the real estate site.
The Spring Island Trust • 40 Mobley Oaks Lane • Okatie, SC 29909 • (843) 987 2016


text:
More Videos...
67 Chevy Nova Super Sport SBC Pro Street 570 horsepower
67 Nova SS ProStreet 406 Small Block 650 lift Comp Cam 3" Exhaust, street Slicks
66 nova ls2 barn find
All Orig 66 nova with tube Frt clip,6.0 short block, l92 heads,t Tex can shaft,6 speed. Motor made 505 to rear wheels.
66 nova drag car
this is a 1966 nova we race at Woodburn Or. drag strip. This is one of my liscence runs. Since then we have run 9.8's, after a few mods we are hoping a few tenths faster this year. The car is also set up for Nitrous but we are a little reluctant to spray untill we get a little more experiance. The car should run high 8's low 9's with a little "help" maybee this year we will try. Wish us luck!!!
1966 Nova Picture / Video Compilation
1966 Nova Pics and Videos and the Olds at the end.


text:
Wise Owls
We're a for-purpose organisation that believes everyone deserves access to quality education.
We're not cool with that.
But we have solutions.
What makes us different?
We prove our projects
You'd probably like to know where your money goes, right? We create proof of impact reports with updates, photos and GPS co-ordinates on google maps and inspiring stories from the field.START YOUR CAMPAIGN
We partner with local NGO's
We develop "smartnerships" with the best local organisations, who have the vision, drive and community standing to create change. Empowering locals creates positive change.GIVE EDUCATION


text:
Vista Residences Brescia Residences Project Overview
Careful space planning affords balcony for all units. Available in two different cuts, studio and two-bedroom, all units come with vinyl planks, plastered painted walls and rubbed-concrete painted finish ceilings, provision for window-type air conditioning and dry wall partition for the bedroom. Kitchens are equipped with granite countertops, stainless steel sinks and modular base cabinets while the bathrooms are finished with water closet, pedestal-type lavatory, handheld shower, ceramic floor tiles and five-layer ceramic tiles on walls with soap and tissue holder.
Project at a Glance
|Project Location:
|Along Lilac Street, Dahlia, Fairview , Quezon City
|Turnover Date:
|Unit Sizes:
|21 SQM to 42SQM
|Price Range (VAT Incl.) :
|PHP 2M to PHP 4.8M
|Number of Towers:
|Number of Floors
|Number of Units:
Vista Residences Brescia Residences Location & Vicinity
Brescia Residences gives you the star treatment and lets you live the life you always wanted. Located in City of the Stars, everything is practically just a stone-throw away from this prime property—malls and shopping districts, the most prestigious colleges and universities and the latest techno-park in the country, the UP-Ayala Techno park.
Vista Residences Brescia Residences Site Development Plan
Vista Residences Brescia Residences Floor Plans
Vista Residences Brescia Residences Unit Plans
Vista Residences Brescia Residences Amenities and Facilities
Vista Residences Brescia Residences Photo Gallery
Vista Residences Brescia Residences Payment Options
Payment Terms
- DP - Down Payment
- BF - Bank Financing
Reservation Fee:
- PHP 15,000 for STUDIO UNIT
Option 1 : Spot Cash with 10% discount
Option 2 : ( 15 – 85 Scheme )
- 15% DP over 10 months
- 85% Remaining balance payable thru BF
Contact UsWe are open 24/7. New Year's Eve? We're here. Labor Day? You bet. Five in the morning on a Sunday? Absolutely!
If you are interested in viewing model unit, getting a sample computations, checking the price list, availabilities or reservations, for Vista Residences Brescia Residences located at Along Lilac Street, Dahlia, Fairview, Quezon City, please contact us anytime on Viber, WhatsApp, Text, Phone, Email or Live Chat.


text:
Empoli were beaten by Avellino, so Virtus Lanciano are shock Serie B leaders, while Pescara also stalled Cesena.
Click here for the full Serie B section, including results, fixtures and tables.
Avellino 1-0 Empoli
Scorers: Galabinov pen 36 (A)
Sent off: Hisaj 35 (E)
Cesena 1-1 Pescara
Scorers: Granoche 70 (C), Politano 88 (P)
Sent off: Pigliacelli 57 (P)
Played on Saturday:
Cittadella 1-0 Crotone
Scorers: Donnarumma 75 (Ci)
Virtus Lanciano 1-0 Bari
Scorers: Minotti 87 (VL)
Latina 2-0 Brescia
Scorers: Morrone 39 (L), Jonathas 47 (L)
Modena 3-1 Padova
Scorers: Babacar 19, 29 (M), Signori 54 (M), Trevisan 76 (P)
Palermo 3-0 Juve Stabia
Scorers: Di Gennaro 23 (P), Hernandez pen 35 (P), Lafferty 93 (P)
Sent off: Lanzaro 78 (JS)
Reggina 0-1 Carpi
Scorers: Memushaj 93 (C)
Siena 2-1 Trapani
Scorers: Paolucci 21 (S), Mancosu pen 44 (T), Giannetti 93 (S)
Sent off: Feddal 43 (S)
Spezia 0-0 Novara
Varese 2-1 Ternana
Scorers: Maiello 45 (T), Pavoletti 71 (V), Zecchin 86 (V)
Keep up to date with the latest news and action from Spain's Primera Division with Football Espana - from the team behind Football Italia.


text: Latest in senior t-shirts Uploaded 07/16/2009 Latest in senior t-shirts Share Tweet Stumble Email Pin It List View Player View Grid View 1. 2. 3. 4. 5. 6. 7. 8. 1. 2. 3. 4. 5. 6. 7. 8. Share This Image REPLAY GALLERY Share on Facebook Replay Latest in senior t-shirts NEXT GALLERY Awesome Garage Door Covers RELATED MEDIA People Killing It With Their Senior Portraits Old People 22 Senior Yearbook Quotes That Are Just Perfect 29 Latest WTF Pics To Hit The Internet 12 Shirts That Are Too True Not to Wear Mugshot T-Shirts 22 Glorious Facebook Fails 22 Latest WTF Pics To Hit The Internet 31 Amazing Yearbook Quotes 25 Yearbook Quotes You'll Wish You Thought Of Mugshot T-Shirts 16 Accidentally Offensive T-Shirts T-shirts eBaum's Premium Image Collection 16 Asian Film Thefts Crazy Trend in Asia Has People Posting Photos in Nothing But a Plastic Bag 19 Parents Struggling With Social Media 28 Inappropriate T-shirts 26 People Who Wore The Right Shirt At The PERFECT Time Asians And Their "English" Clothing 8/8 1/8 Share Tweet Stumble Email Pin It Tags: funny NEXT GALLERY Awesome Garage Door Covers 0 Comments Login to Comment


text:
How to Increase Patient Engagement Through Storytelling
Patient engagement is currently the holy grail of medical practice marketing. Far more than just a trendy buzzword, 'engagement' has not only mushroomed into one of the leading topics for spoken and written content, but it also lends itself to multiple meanings. Opportunists use it across a wide range of constituents and agendas, from social media marketing to database systems. So why is patient engagement so important, and how does content marketing help to achieve it?
Why We Need Engagement
Healthcare is expensive, both for patients and for the authorities. Research shows that patients who are actively involved in their healthcare are significantly more likely to practice positive health behaviour, resulting in better health outcomes. Case studies show patient engagement delivers dramatic results, such as:
- 40% reduction in emergency room consultations
- 20% to 35% reduction in hospital admissions
- 86% patient satisfaction
- 47% increase in the number of patients meeting cholesterol goals
This reduces the cost to all parties, minimises patients' discomfort and increases both the length and the quality of their lives.
Disengagement Dilemma
Research by Deloitte shows that 1 in 2 patients are disengaged and prefer to follow a passive healthcare approach. In spite of having access to technology such as patient portals, less than 10% of patients actually use these online tools. They rely heavily on doctors to make all their medical decisions while they take no initiative to manage their own health.
Why Content Marketing Helps
It all comes down to conversation. In the healthcare service industry, we're talking to real people about real issues that affect their lives. Content educates, informs, and promotes conversation; all these processes lead to patient engagement. If you want your patients to join the conversation, you have to give them a reason to do so, and that's where content marketing comes in. Not just any content, either; it has to be content your patients can really relate to.
Story Telling Makes the Point
Mankind has always loved story telling. Since the beginning of time, we've gathered around fires while elders told stories that carried important messages for humanity. And it's no different today. You just have to look around at the millions of books, films and television series available - most of which have an identifiable moral message of some sort. Stories are shared, discussed and reproduced in other formats. Stories evoke emotion, they encourage the reader to go along for the journey. In other words, they engage.
Getting it Right
It's one thing to say it and another to get it right, though. Far too often, healthcare marketers try to wrap their business points in a story and get it wrong. The story has to do the following to work:
- Reveal something personal.
- Take patients on a journey that offers a transformation between the beginning and the end.
- Tap into an emotion, such as fear, desire or hope to motivate the patient to act.
A thinly-disguised marketing message won't fool anyone, especially when you're trying to promote patient engagement, because people don't typically engage with brand communications. They engage with personal ones.
Focus on People
In healthcare you're marketing to people, not to numbers or companies. You need to understand your target audience thoroughly, draw on a variety of resources and produce material that can inform, guide and inspire creative solutions. That's the only way it will deliver the desired impact.
The figures quoted justify implementing patient engagement by any means. You can do it by altering your mindset to focus on patients as people, telling their stories in ways that are meaningful and that help to educate them on the importance of health management.
(patient engagement / shutterstock)
Authored by:
Ash Rishi
Ash Rishi is the Founder and CEO of COUCH. Based in London, UK, COUCH is an integrated digital marketing and creative communications agency focusing on the pharmaceutical, healthcare and lifestyle industry. Ash has over 9 years experience in pharma marketing and has delivered activities across UK, Europe, US, Canada and Latin America. His area of expertise include: branding, communications, ...
Other Posts by Ash Rishi
Latest News
"It is quite safe to say that local search has been becoming more and more vital, whether you're a local hospital or a national shop, a local SEO strategy seems to be a key to driving more customers through your clinic. Ever since Google's Hummingbird update landed, more and more users are seeing more personalized, relevant, and even localized based results for searches!"
"Actually I do not agree with this article. Sure some cases may be a case of food poisoning. I just had a 24 hour flu yesterday. I had no stomach issues. No constipation, no diarrhea, no stomach cramps. I had severe body aches from neck all the way down to my feet, I had a headache all day, I had a ..."


text:
Here you will find fresh porn videos, movies for every taste. You can download their by clicking on the link site file-sharing service Nitroflare, Uploaded, Gigapeta, Keep2Share.cc and many other.
This is Jill's first time anal and she was a bit nervous that it would hurt. But as she got horny and into the mood, she got her little ass stretched and fucked by his giant cock! He filled her up completely and fucked her tight little virgin ass as it gripped his cock tightly. After her little ass was violated, Jill's face was violated with a sticky facial!
Original Name: First Time Anal Sex
Starring: Jill
Studio: TryTeens
Genre: Teen, Anal, All Sex, Amateur, Facial, Students, Blowjob, Cumshots, Slender, Shaved, Blonde, Natural Tits
Duration: 29 min.
Quality: HD
Type HD Video: 720p
Format: MP4
Video: 1280 x 720, 4907 kbps
Audio: MPEG-4, 44100Hz, 128 kb/s, Stereo
Size: 1,01 Gb
Download from LetitBit.Net
Download from Uploaded.net
Users of Guests are not allowed to comment this publication.


text:
The Saba 50 replaces the successful Salina 48 and has been designed to optimise living space while delivering outstanding performance at sea. This new offering has taken the quite elegant lines of the shipyard's Hélia 44 catamaran, so the new purchaser should have the best of the Fountaine Pajot world.
They haven't only copied features of previous boats, they have upgraded them as well. For instance, there's the additional panoramic portholes to enhance the natural light and ventilation.
The cat has enormous living areas making it ideal both for extended cruising ventures and entertaining family and friends in your own waters.
The spacious saloon is accessed via an extra-wide entry door that integrates the indoor and outdoor spaces, and features new skylights plus a spectacular panoramic window that encases the saloon and provides exceptional views and natural light.
The L-shaped galley overlooks both the saloon and cockpit, making it a quite pleasant place to spend time. There is plenty of storage space, a 190 litre fridge -with drawers - and is adjacent to the convenient forward-facing chart table.
As for relaxation - something everyone wants to do when cat cruising, there are multiple relaxation areas including a luxurious 12.4m2 upper lounge deck that is equipped with a chaise lounge and two sunbathing decks.
The generous cockpit features a large lounge, extra sofa, dining table for 12 guests, and there is also an option for a huge sunbathing lounge on the fore deck.
The helmstation enjoys 360 degree visibility and excellent protection from the elements, and has easy access to the cockpit and upper lounge deck.
All lines are ergonomically controlled for ease of handling, and embedded solar panels are conveniently located on the upper aft deck.
The catamaran has remarkable volumes in each of its cabins, with the master suite in the Owner's version taking its inspiration from chic city hotels.
It features a queen size island bed, a sleek open-plan ensuite with separate shower, desk and ample storage. The master suite is a beautifully light courtesy of the revolutionary large new porthole, panoramic aft windows and skylights.
Worth thinking about, if you're in the market for a leisure time wonder.


text:
tag: "camping" - 6 items
order by: Most popular | Latest | Rating
order by: Most popular | Latest | Rating
Not only the rope
Funny holidays Czech naturistok with children Camping with tents, inflatable pool and games.
Karelian lake
Activities for young Russian from St. Petersburg naturists camping on the lake and in the forest.
Summer night - Fire Dance
Holiday Russian naturists from Peter Camping in the woods near the fire with dancing every night.
Naturism in Russia. 1998-2002 series
Collection of bright life of Russian naturists. The film contains excerpts from 21 films made in 1998-2002 Russian society nudist sites Enature.net and RussianBare.com. Here are excerpts from the film on July 4, Midsummer, the Finnish coast, the Karelian lakes Rituals summer, Bridging, when horses and naturists Meet day Camping, day sailing, Fun on the beach, beach Day Ball, Naturist Island, Castle naturism, Neptune nudists, naturist mother, naturist Games, Body Art nudists, rites of courtship, Hale naturist gods, naturism wedding song and dance Bares.
Naked Celebrations 1997
Activity Australian Naturist Camping and home. Three charming naturist go nude in a campaign on the four-kilometer trail to the top of the mountain in northern New South Wales.
tag: "camping" - 6 items
order by: Most popular | Latest | Rating
order by: Most popular | Latest | Rating


text:
August, 2013
Host was very helpful and picked us up from the airport for €30 which is pretty much what you'd pay for a taxi and is more convenient. The apartment is small but very clean and tidy, the kitchen is small but perfectly workable although if you're planning on eating in a lot you can't sit and look out at the view. Although towels are provided these are hand towels so I would recommend taking you're own. In terms of location it is quite a quiet area, no bars and only a handful of restaurants. We happily walked to babin kuk and the old town but this does take around 30 mins so depending on what you're looking for this location may not be what you were looking for. We had a lovely week stay however and if you're up for wandering about and exploring I would recommend it.


text:
Welcome to First Presbyterian Church of Donalsonville.
"Building Fellowship Through Christ"
|Sunday Morning:
9:15, Breakfast
10:00, Sunday School 11:00, Worship
Click Here for announcements and upcoming events.
We are a church of all ages that has something for everyone! A growing church that is dedicated to serving the Lord, our Savior. A congregation who is committed to making a difference in our community, nation, and world. As members of the Presbyterian Church (USA), we provide opportunities for worship, education, fellowship, congregational care and outreach missions.


text:
Creation (I) (2009)
Plot Summary
What happens when a world-renowned scientist, crushed by the loss of his eldest daughter, formulates a theory in conflict with religious dogma? This is the story of Charles Darwin and his master-work "The Origin of Species". It tells of a global revolution played out within the confines of a small English village; a passionate marriage torn apart by the most dangerous idea in history; and a theory saved from extinction by the logic of a child.- Written by JC
Torn between faith and science, and suffering hallucinations, English naturalist Charles Darwin struggles to complete 'On the Origin of Species' and maintain his relationship with his wife.
Be the first to contribute! Just click the "Edit page" button at the bottom of the page or learn more in the Synopsis submission guide.


text:
There's an old adage amongst photographers that goes, "The best camera is the one you have with you." The point being that when the perfect scene pops up, any camera is better than no camera at all. And since most of us carry our smartphones with us everywhere we go, more often than not the best camera we have just so happens to be an iPhone. Moreover, the camera on the newly-launched iPhone 7 and 7 Plus — and those adorning nearly all recent iPhone models — are nearly as powerful or more so as the point-and-shoots of yesteryear, with a massive selection of sophisticated applications that render them even more versatile. Check out this list of our favorite photography apps for iPhone if you want to make the most of your smartphone's camera, whether you're looking for a way to shoot, edit, or organize your photos with the touch of your finger and a little intuitiveness.
Related: 13 strange, but helpful camera accessories for your iPhone or Android
Camera+ ($3)
Even with the latest iOS update, Apple's native camera app is rather anemic when it comes to features. Thankfully, Camera+ provides a wider range of exposure controls and advanced tools such as continuous flash, frontal flash, touch-focus adjustment, 6x digital zoom, a timer, and preset filters. The well-organized interface also makes it a breeze to utilize, whether snapping or sharing shots on social media.
Buy it now from:
ProCamera 9 ($5)
When iOS 8 launched, rather that updating the existing ProCamera app, developer Cocologics decided to go ahead and make an entirely new app. The new app — now optimized for iOS 9 — still sports a minimalist interface, with a host sophisticated features for setting exposure time, tint, ISO sensitivity, and more. It even features a night camera and full-resolution previews in addition to robust exposure control and more than 70 unique filters and effects.
Buy it now from:
Pro HDR($2)
ProHDR is probably one of the most fully-featured apps we've encountered in the HDR category. The interface isn't quite as slick as VividHDR, but it offers you a wider range of control over exposure adjustments and tone-mapping settings. It also features an array of beautiful preset filters for you to use, if you're into that sort of thing, along with options for digitally zooming, cropping, captioning, and setting a self timer, among other features.
Buy it now from:
Adobe Photoshop Express (free)
When it comes to photo editing software, nobody does it better than Adobe. Though the mobile version of their renowned desktop software offers a smaller work space than most apps, it's still one of the most capable after-effects programs you can buy. Popular Photoshop features such as layers, selection tools, and adjustments all make an appearance, as do options for adding text, applying effects, and blending images. Unfortunately, many features are locked behind in-app purchases, so be ready to spend some dough if Express is your photo editor of choice.
Download it now from:
Adobe Lightroom (free)
Although many of Lightroom's tools require a newer model of iPhone to run, it remains one of the most feature-rich apps on our list, particular for photographers who want to edit their workflow while on the move. The app automatically syncs images with its desktop counterpart – whether you're using images shot on your smartphone or raw images from a DSLR – allowing you to quickly edit, enhance, and share your photos using a variety of familiar tools.
Download it now from:
Instagram (free)
What would our photography app roundup be without any mention of the undisputed king of photo filters? There are dozens of apps out there that essentially allow you to do the same thing, but Instagram remains the best given the enormous user community. It still supplies a bevy of classic filters from which to choose, along with the ability to comment, like, share, and send photos directly to friends of your own choosing.
Download it now from:
Pixlr (free)
The Web-based Pixlr has long been one of our favorite image editors, and thankfully, so is the mobile incarnation of the software. The app lets you choose from four pre-defined dimensions when resizing photos, with additional options for cropping, rotating, stylizing, and sharing photos on standby. Lighting and overlay effects even let you adjust the mood, while one-click adjustments allow for quick and automatic control.
Download it now from:
Facetune ($4)
A mere $4 is a small price to pay for perfection. Not everyone is as photogenic as this guy, and more often than not, the images you snap of yourself and your friends aren't as flattering as you'd like them to be. That's where Facetune comes in.As the self-professed favorite app of Kim Kardashian, one of the most photographed celebs on social media, the app allows you to perform specific touch-ups like teeth whitening, blemish removal, and color correction so that your mug looks perfect when you post the pics to your social media profiles. Hell, you can even change your eye color or color over grey hairs.
Buy it now from:
Photo Editor by Aviary (free)
If you're looking for a solid after-effects app that doesn't cost anything up front, check out Photo Editor by Aviary. Recently acquired by Adobe, it's got plenty of advanced features and a sleek, minimalist interface from which you can stylize and edit your photos using a wealth of purchasable filters and content. Like Facetune, Aviary includes tools for eliminating redeye and whitening teeth, along with options for adding text, replacing color, and sharing.
Download it now from:
Manual ($3)
The aptly-titled Manual, one of the more recent photography apps to hit the App Store, is a sight for sore eyes. The mobile software gives you full control of the shutter, white balance, ISO, focus, and exposure composition for a more hands-on approach to capturing photos. Furthermore, you can use the app to monitor automatic exposure values and view a live histogram, that is, when you're not using the flashlight or slick grid mode.
Buy it now from:
Photoblend (free)
Photoblend makes being artsy easy. The photo editor allows you to blend to images together to create a simple, double exposure effect, with the option to add a melange of quotes to your photo (i.e. "To love and be loved"). Furthermore, you can add images to one of Photoblend's many traditional frames, or add modern figures such as an owl, peace sign, tree, or sun, among others. Is it gimmicky? Yes, but who really cares?
Download it now from:


text:
Level 2 – Intermediate improv class – February 21st – April 11th
The the next step in your evelution in improv. Picking up where our Level 1 (Begining) class left off, our Level 2 (Intermediate) class is here. This level 2 class builds on everything you explored with us in the Level 1 class. This eight week course will lead you through some of improvs meatier subjects like, character development, platform, character objective, space work…Read More
Level 1 – Begining improv class – March 7th – April 11th
Scared Scriptless' Begining Improv class (Level 1) is a six week course will lead you through the some of improvs basic concepts and help you begin to understand the core concepts and themes. Yes, AND, Agreement, help yourself by helping your scene partner, and more. This is a Begining Improv – level 1 class. Prerequisites include: interest in…Read More
Level 3 – Advanced improv class – Coming soon!!!
The culmination of our Level 1 (Begining) class and our Level 2 (Intermediate) class is our Level 3 (Advanced) class. This level 3 class improves on the Level 2 class it by a whole number! This eight week course will lead you through the some of improvs most advanced concepts and themes. As such, you will have…Read More


text:
A four page, full-color feature on foot care and nail styles show off the best looking feet. The magazine tells its readers to rub on cuticle oil for a quick shine refresher, dump old polish that's dried up, and wear socks at night to keep heels soft. The article's writer compares a high-priced pedicure with a discount one and the pricey one didn't pass muster. Celebrity manicurists Roseann Singleton and Thea Green of London's Champagne Nail Bar get shout-outs.
The article singled out some professional products:
OPI Nail Lacquer in Curry Up Don't Be Late!
Essie's polish in Risky Business
OPI's Cucumber Massage Lotion
Nails from NYFW A/W 2017262 photos
ISSE Long Beach 201775 photos
A bony growth on the side of the heel, Haglund's deformity is often the result of wearing hard, inflexible shoes. Heredity has some infl...
Learn More
What are reasonable terms for a non-compete contract?
How do I announce to my clients that I will be moving to a new salon?
The new products I'm using are adding time to each appointment. How do I adjust my schedule?
Why isn't my Gelish application curing properly?
What's the cause of the pinkish-red oval area on the pad of my client's toes?
Featured Products & Promotions | Advertisement
How big is the U.S. nail business? $7.3 billion. What's the average service price for a manicure? Dig into our decades' deep research archives.
View All
VietSalon is a Vietnamese-language magazine and the sister publication to NAILS. Click the link below to sign up for a FREE one-year subscription.
Get a free preview issue and a Free Gift
Subscribe Today!


text:
April 17, 2015 3:33 pm
Download audio
Shrinking budgets will make your agency work differently very soon.
Leaders from the General Services Administration, Health & Human Services, and other agencies are sharing best practices at the Executive Leadership Conference in Williamsburg, Va.
In Depth host Francis Rose has an update from the conference.
Check out more interviews and coverage from the 2011 Executive Leadership Conference.
Hiring freeze result of Trump team's review of federal agencies
Hiring freeze result of Trump team's review of federal agencies
Photos of the amazing, moving, important and amusing things happening in the federal community.
A daily update of important moments in the history of the U.S. government.


text:
Bootstrapping Autoregression under Non-stationary Volatility
This paper studies robust inference in autoregression around a polynomial trend with stable autoregressive roots under non-stationary volatility. The formulation of the volatility process is quite general including many existing deterministic and stochastic non-stationary volatility specifications. The aim of the paper is two-fold. First, it develops a limit theory for least squares estimators and shows how non-stationary volatility affects the consistency, convergence rates and asymptotic distributions of the slope and trend coefficients estimators in different ways. This complements the results recently obtained by Chung and Park (2007, Journal of Econometrics 137, 230--59. Second, it studies the recursive wild bootstrap procedure of Gonçalves and Kilian (2004, Journal of Econometrics 123, 89--120) in the presence of non-stationary volatility, and shows its validity when the estimates are asymptotically mixed Gaussian. Simulations are performed to compare favourably the recursive wild bootstrap with other inference procedures under non-stationary volatility. Copyright Royal Economic Society 2008
If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Volume (Year): 11 (2008)
Issue (Month): 1 (03)
Pages: 1-26
|Contact details of provider:
| Postal: Office of the Secretary-General, Rm E35, The Bute Building, Westburn Lane, St Andrews, KY16 9TS, UK
Phone: +44 1334 462479
Web page: http://www.res.org.uk/
More information through EDIRC
|Order Information:
|Web: http://www.ectj.org
No references listed on IDEAS
You can help add them by filling out this form.
This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.
When requesting a correction, please mention this item's handle: RePEc:ect:emjrnl:v:11:y:2008:i:1:p:1-26. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wiley-Blackwell Digital Licensing)or (Christopher F. Baum)
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.


text:
A horse's insight and honesty help people discover their own inner strength to overcome fear and self-doubt. For those who feel trapped in circumstances beyond their control the soft nuzzle of a horse, the triumph of mastering the ride, the simple joy and confidence of a horse's gait can restore trust and reintegrate the mind and body. It can make the difference between giving up and moving forward confidently in strength and freedom.
A horse's size and gentleness show that it is possible to be strong and kind without sacrificing one for the other.
The relationship that develops between horse and rider builds trust, provides a trusting emotional connection and is a source for much needed love and affection for both.
Horses lend us the wings we lack.
Throwaway Ponies was started by Karen Bander and her daughter Mary, in 2005 to provide a home to horses that were old, lame and virtually unadoptable. Soon, the need for a rescue for other horses became apparent. Now, we have horses of all ages. Learning how beneficial horses are to building self-confidence and healing broken hearts, we added programs for children and adults using horses as therapists
Our mission at TaPs is two-fold:
1. To provide a safe haven for horses who have been abused and neglected or who might have been euthanized because of their condition but were salvageable.
2. To build self-confidence and leadership skills in everyone of our students, volunteers and participants.
Types of horses available:
1. Fully rideable - we rarely get these, but do occasionally. Some can be ridden by experienced riders only.
2. Green broke - can be ridden by experienced rider, but will improve with training
3. Companion - good to put with another horse or get 2 as "yard art". Not to be ridden.
4. Trainable - no or little training, but you can train or hire a trainer
We ask for 3 references from your veterinarian, friend, and horse professional (if you know one). Please ask them to mail back the recommendation form.
We will come inspect your property for water source, shelter, fencing (barbed wire on over 10 ac only for safety reasons). Horses do not like to be stalled, but they must have shade and shelter from the wind and rain.
We will inspect the horses in 6 months, 12 months and then annually or ask you to email us photos.
Horses must be adequately fed and have current Coggins test and regular (at least every 8 weeks) farrier care.
Horses must have a companion – either horse, donkey or goat.
If the TaPs representative does not feel you are adequately caring for the horse, we will make recommendations that must be followed or you must surrender the horse.
If you move, you must let TaPs know your new location. If you can no longer care for the equine, you must return it to TaPs. If someone you know wants the horse, they must be approved by TaPs, but will be given first consideration if they are approved.
Thank You!
Your message has been sent to Throwaway Ponies.
You'll receive a copy, too, at to help you keep track of which pets you've inquired about, and which shelters and rescues you've emailed.
NOTE: Some shelters have physical locations you can visit; some of these shelters may only have pets for a limited time, so please do not wait for a reply—just go visit the shelter! Other organizations are rescue groups run by busy volunteers who may take a while to reply. You can find information about the shelter or rescue group caring for this pet, and their adoption procedures, on the pet's details page on Adopt-a-Pet.com.


text:
It looks like you're new here. If you want to get involved, click one of these buttons!
Follow me on live stream: http://twitch.tv/charrgaming
Hey guys! In this video I will talk about the ways you can make money quickly during the first few weeks upon the release of Guild Wars 2!
1. Gather EVERYTHING. Cloth and ore are the two most profitable materials since from what I saw they are used the most. Ore can give you gems, which sell very fast. I suggest always carrying a extra stack of gathering tools.
2. Complete maps. I got around 30+ silver plus 2 greens for my finishing the Asura starting map. Right now the city maps give no money, but decent exp for a low level character.
3. Salvage and check AH prices. It's very quick to see how much weapons and armors will net you on the AH since you can check and post anywhere. If the price is low you can Salvage (depends what type of item it is) or vendor. Say you pick up a heavy chest piece that vendors for 35c. If you salvage you could get 2-4 copper ore which say sell for 10c each. If you are lucky you could profit from salvaging, but sometimes not.
4. 8 slot bags. This is how I made my money last BWE. I racked up 500 leather for 5c each. So each bag cost 1s (20 leather per bag) to make and I sold for 2-4s each. Leather working is best for this since leather is cheaper than cloth and ore. I'd often pick 2 professions at first that can make bags (Leather working and Tailoring - Armorsmithing can but I found ore to be more expensive.) and try this with both.
5. Farming blood. Vials of blood seem to be the most demanded crafting trophy since they are used to make early power stat gear. I don't know the best farming spots for them, but remember monster kills don't grant much exp so this would not be recommended if you want to level.
6. Place orders constantly. I could place orders for cloth for 8c each and resell for 12-15. In large quantities you can make a decent amount of silver.
7. Salvaging sigils out of greens. Often the green item wont be very good, say a harpoon which no one really wants but has a awesome rune/sigil in it. Sometimes the price of the sigil or rune inside it will sell for much more. The only way to guarantee the rune/sigil out of a weapon is the salvage kit from the gemstore, but there is one that gives an 80% chance. Check the AH prices before you do this!
Informative post, thanks for the heads up!
I won't be going for this exclusively, but it's nice to know what to look out for while moving along.
Finally a damn ah where you can post buy orders!
The +3 power gems are especially good sellers. I was primiarly using toughness or vitality gems myself (for extra survivability in WvW) so I put my power gems on the AH and got good prices for them.
Also, ore can sell for around 20c, so selling for 10c is a bit low. The lowest I would go is 15c. I was actually buying ore for 8-10c and selling it back at 15-20c for a nice profit. Never had trouble selling it at the higher price either.
Just doing dynamic events can give you money too. I came out of WvW once right at the start of a dynamic event, which chained into a total of 4 events over about 5min from which I made close to 2s.
The Enlightened take things Lightly
I wont bother with crafting. I bet "minerals i gather are free" crowd willl make crafted items cheaper than materials.


text:
Photo: Ryan Benyi; Styling: Stephana Bottom
Serves 8
More from MyRecipes
Nutritional Information
Calories 115
Fat 0.0 g
Satfat 0.0 g
Protein 1 g
Carbohydrate 30 g
Fiber 1 g
Cholesterol 0.0 mg
Sodium 2 mg
1 cup sugar
1/4 cup lemon juice
1 cup warm water
8 hibiscus tea bags
1 1/2 cups sliced peaches
7 cups cold water
Whisk sugar, lemon juice and 1 cup warm water in a bowl until sugar dissolves. Add tea bags, cover bowl and steep for 5 minutes. Remove tea bags. Fill a pitcher with ice and sliced peaches. Pour in tea and 7 cups cold water. Stir well; serve cold over additional ice.
May 2009


text:
reverse seam shirt
by STEVEN ALAN
Promotions - Extra 25% Off Sale Items - 02_2017_EXTRA25
Extra 25% Off!
Take an extra 25% off sale items. Add to bag to see full discount.
All sale items are FINAL SALE. Offer Details
$68.00 Was $158.00
shown in: DUST TEAL MULTI
Product Actions
Product detailsThe Reverse Seam shirt is our signature style. The details that set it apart from the average button down are a twisted placket, slim slightly tailored body, and French seams at the side.
• shirttail hem
• outside patch pocket
• dust teal multi: 99% cotton, 1% elastane
• yellow purple multi: 99%, 1% elastane
• muted blue red plaid: 100% cotton
• made in USA


text:
Pets for Sale in 33176(1 - 15 of 7,026)
$850 fwfweger Healthy pug Puppies for SalePug · Miami, FLdfdfsddsdg Healthy pug Puppies for Sale They are vet checked and are kept on a strict vaccination protocol, Will make a great companion, ...Ashley Q. · 3 hours ago
$500 Hfyth Scottish Fold Male And Female Kittens ReadyScottish Fold · Kendall, FL… simply TEXT ONLY..(401) x426x3079 for more detailsSander Z. · 9 hours ago
$2,000 Bichon Poodle MixBichon Frise · Miami, FLThis loving and playful 14-week old Bichon Poodle mix is a boy and is Micro chipped through Petkey, registered to the AKC, has all of his...Jayden J. · 1 day ago
$2,000 GORGEOUS FEMALE MINI FRENCH BULLDOG for saleFrench Bulldog · Doral, FLHello we have ONE GORGEOUS 60 days old PIED WHITE AND BRINDLE FEMALE mini french bulldog puppy for sale. The puppy is always up to date o...Mabel T. · 1 week ago
$1,800 Lovely French Bulldog for SaleFrench Bulldog · Doral, FLHello we have FOUR gorgeous 60 days old FAWN males and females french bulldog puppies for sale. The puppies are always up to date on thei...Mabel T. · 1 week ago
$500 Male Beagle for SaleBeagle · Pembroke Pines, FLMase is a pure bread 10 month old Beagle. He is Tri-color and all of his vaccinations are up to date. I am looking for a loving family th...Natalie B. · 1 week ago
$500 ukm, gumjfgtyhtfyh Young Talking Hyacinth Macaw Parrots For Now*Macaw · Quail Heights, FLukm,gumjfgtyhtfyh Young Talking Hyacinth Macaw Parrots For Now*............Text .Me For Info and Pics.........501 XX 291 XX 1879
$500 jhkugujftyhdyhedfhb Talking Pair of African Grey Parrots for SaleAfrican Grey Parrot · Quail Heights, FL… ,,,,,,,,,,,,,Text .Me For Info and Pics.........501 XX 291 XX 1879
$500 fhjnfgthfszdvgdhf 1 year,9 months old Scarlet Macaws With CageMacaw · Quail Heights, FL… ...............Text .Me For Info and Pics.........501 XX 291 XX 1879
$1,500 Rottweiler PuppiesRottweiler · Homestead, FLGerman Rottweiler Puppies 10 week old; 3 females available at this time, ready for new homes Dec. 10th 2016, Accepting deposits to secure...Nieves P. · 2 weeks ago
Perfect Little Toy MalteseMaltese · Fort Lauderdale, FLWe are not a PET STORE or a PUPPY BROKER. These are perfect, healthy, fluffy puppies born in our home. Mom and Dad are our pets. Our pupp...Mary M. · 1 week ago
$350 djsdgs male and female golden retriever puppies for saleGolden Retriever · Miami, FL… text us only(980)x218x0506Melina H. · 2 weeks ago
$350 jjdjdh male and female Yorkie puppies for saleYorkshire Terrier · Quail Heights, FL… text us only(980)x218x0506Melina H. · 2 weeks ago
$4,000 Tricolor English BulldogBulldog · Davie, FLThis gorgeos tricolor puppy so hard to find one with this colors The pros of owning an English bulldog are many, far outweighing the cons...German O. · 3 days ago
$1,500 belgian malinois puppiesBelgian Shepherd Malinois · Miami, FLSire:Mido Knpv ph1 435/435 pts http://www.bloedlijnen.nl/?BRN=19567 Knpv championships 429 pts Mido Brn | 19567 is a black Belgian Mali...Gio N L. ·1 listing · 2 weeks ago
Find More Listings on Oodle Marketplace Find used cars, used motorcycles, used RVs, used boats, apartments for rent, homes for sale, job listings, and local businesses on Oodle Marketplace. Athens Pets | Austin Pets | Washington Pets | Greenville Pets | Jacksonville Pets | Los Angeles Pets | Madison Pets | Oklahoma City Pets | Omaha Pets | Anaheim Pets | Riverside Pets | San Antonio Pets | Seattle Pets | Trenton Pets | Tucson Pets.
Safety Tips
Safety Tips
- Meet the seller and pet in person
- Don't wire money or take advance payments.
- Only pay for shipping if you know the seller.
To learn more, visit the Safety Center. Report suspicious listings by clicking on .


text:
Robert Clotworthy doesn't have any movies playing in theaters.
If you feel like heading out, check out other movies in theaters.
American Sniper
Captain America: The Winter Soldier
The Green Hornet
My Soul to Take
Who's That Girl?
Shark Tale
The Chronicles of Riddick
Shrek 2
All Robert Clotworthy films
Movies.com, the ultimate source for everything movies, is your destination for new movie trailers, reviews, photos, times, tickets + more! Stay in the know with the latest movie news and cast interviews at Movies.com.
Copyright © 2017 FANDANGO MOVIES.


text:
get on with sth
— phrasal verb with get uk /ɡet/ us /ɡet/ verb present participle getting, past tense got, past participle got or US usually gotten
› to start or continue doing something, especially work:
Stop talking and get on with it.
More examples
- If you make some coffee I'll get on with the washing up.
- They were busily getting on with the painting.
- He finished his cup of tea and got on with the gardening.
Thesaurus: synonyms and related words
You can also find related words, phrases, and synonyms in the topics:


text: These Truckers Have No Sympathy For Car Crashing After Cutting Them OffAndrew P Collins8/10/14 2:54pmFiled to: crasheswtfsemi-trucks1177EditPromoteShare to KinjaToggle Conversation toolsGo to permalinkSomebody overzealously merged onto a highway in Australia, causing their car to spin out and into solid barrier while cutting off a semi-truck. The crash looks pretty gnarly, but the blokes in the big rigs seem to figure he got what he deserved. Advertisement We hear from the truck filming:"He was being a dickhead, though he was being cool."Not an incorrect assessment from the looks of it, but while we all love a little instant karma (as the Germans say; "schadenfreude") I sincerely hope the next thing out of this truck driver's mouth was a call to emergency medical services to report the wreck. Personally, I do think the trucker should have pulled his rig over and tried to render assistance. Even though that little red "race car" (Holden Commodore?) was definitely being driven a bit dickishly. Advertisement The sedan came off the wall pretty fast, and even if you reckon the driver "got what they deserved" who knows who else was in the car... and their lives could be hanging on how quickly they get treatment.On a lighter note, isn't Australian CB chatter fun to listen to? Advertisement Sponsored Hat tip to Network A!Reply117 repliesLeave a reply


text:
Nike Lebron 10 Low Grey Blue
|Air Jordan
|Nike Lebron 10 Low
$175.00 $86.00
|In Stock, shipping in 24 hours. Free Shipping!
Apparently rap artist Macklemore doesn't have too much allegiance to your Huskies of his native Seattle to enjoy a few Nike Lebron 10 Low Grey Blue.While this won't be an official confirmation, whatever you see here is according to previous jordan 5 shoes, and extremely honestly, isn't a good deal of surprise considering what actually transpired in Holiday season old!The imminent Nike Lebron 10 Low, however, keeps a bit of of its original elephant print while donning the shiny flat surface.Continue reading for the remainder of the shots, in addition to one in which Nate Johnson is clearly appreciative of those exclusives, and stay tuned to Sneaker News flash for more info on this viable 2014 release.
Other Nike Lebron 10 Low
$175.00 $87.00
$175.00 $88.00
$175.00 $87.00
$175.00 $89.00
$175.00 $89.00
$175.00 $88.00


text:
You missed it This great deal for ReJeneSys Aesthetics Center is over. But don't despair, we've got more great deals every day.
Related Deals That You May Like
Body Beautiful Laser Medi-Spa
Laser Nail Fungus-Removal Treatments
Method Aesthetics & Wellness
6 Laser Hair-Removal Treatments
TLC Laser Eye Centers
$1,000 to Spend Toward Lasik Eye Surgery
Luxury Lashes
Set of Regular or Mink Eyelashes
ReJeneSys Aesthetics Center
Feel Silky Smooth After Laser Hair Removal
- Save 50%
- 8 purchased
76% recommendedin LivingSocial customer ratings
Using a state-of-the-art Palomar StarLux IPL laser, one of the experienced technicians at this Southside clinic will permanently reduce the amount of hair on your most troubled area:
• $185 ($375 value) for three laser hair-removal treatments for a small area
• $295 ($650 value) for three laser hair-removal treatments for a medium area
• $395 ($800 value) for three laser hair-removal treatments for a large area
Small areas include lip, toes, fingers, chin, and ears.
Medium areas include bikini line, underarms, and face.
Large areas include legs, arms, back, and chest.
ReJeneSys Aesthetics Center's Website
PAID VALUE EXPIRES ON February 28, 2022
PROMOTIONAL VALUE EXPIRES ON December 1, 2013


text:
|Huangshan Yixian JinJiu Industry And Trading Co., Ltd.
Trade Assurance:
Product quality protection
On-time shipment protection
Payment protection
Home > Company Profile
Huangshan Yixian JinJiu Industry And Trading Co., Ltd.
Start Order
Onsite Check
The supplier's company premises has been checked by Alibaba.com staff to ensure onsite operations exist there. A third-party verification company has confirmed the legal status of the supplier.
|Business Type:
|Manufacturer, Trading Company
|Anhui, China (Mainland)
|Main Products:
|picnic table,sun lounger,garden swing,garden planter,plant stand
|Total Employees:
|101 - 200 People
|Total Annual Revenue:
|US$2.5 Million - US$5 Million
|Year Established:
|Top 3 Markets:
|North America 70.00% Domestic Market 10.00% Western Europe 10.00%
Huangshan JinJiu industrial and trading company,a experenced wooden outdoor furniture factry in chin...
Huangshan JinJiu industrial and trading company,a experenced wooden outdoor furniture factry in china,which is founded in Aprial 2004 and located in huangshan city,anhui province where has abundant timeber resources and great history.
We have more than 10,000 square meters work area,more than 200 employees and more than 10 40HQ/month production capacity and so on,all of them will make us more confident to meet your any requirment and to be your long-term cooperater.
Trade Capacity View More >
Trade & Market
|Main Markets
|Total Revenue(%)
|North America
|Domestic Market
|Western Europe
|Eastern Europe
|South America
|Export Percentage:
|71% - 80%
|Export Mode:
|Have Own Export License
|No. of Employees in Trade Department:
|3-5 People
Email to this supplier
- Company Overview
- Company Introduction
- Company Capability
- Trade Capacity
- Production Capacity
- R&D Capacity
- Business Performance
- Buyer Interactions
- Feedback
- Transaction History
- Additional Information
- Trade Shows
- Transaction Level


text: World Cup Open Thread: Uruguay-South KoreaDavid Matthews6/26/10 10:00amFiled to: World CuppageWorld CupSocceruruguaySouth KoreaLarping9EditPromoteShare to KinjaToggle Conversation toolsGo to permalink No more ties! No more ties! No more ties! Uruguay and the Good Korea are on the undercard today, and there's a good chance we get a game that ends on penalty kicks. Watch, dance, and LARP in the comments below.Reply9 repliesLeave a reply


text:
February 27, 2017 Disclaimer: Please read.
Statements and opinions expressed in articles are those of the authors, not Truthdig. Truthdig takes no responsibility for such statements or opinions.
Georgia Prepares to Execute 'Mildly Retarded' Man (UPDATED)
Posted on Feb 19, 2013
UPDATE: Per Mother Jones, "The 11th Circuit Court of Appeals has granted Warren Hill a stay of execution, according to his lawyers."
Despite the Supreme Court's 2002 ruling that it is unconstitutional to put someone who is mentally handicapped to death, the state of Georgia is planning to execute a man with an IQ of 70 on Tuesday evening.
Warren Hill is "mildly mentally retarded," according to doctors. Hill was serving a life sentence for murdering his girlfriend in 1989 when he killed his cellmate with a wooden board. By then, Georgia had outlawed the death penalty for the mentally handicapped, but Hill was condemned to death row because the state requires defendants to prove they're developmentally disabled "beyond a reasonable doubt."
One of the reasons Hill was sentenced to death is a set of letters purportedly written by Hill to his lawyer and family members that demonstrated he had a "higher level of mental competence" than he'd shown during his examination. However, doctors now believe that someone else wrote those letters.
Barring court intervention, Hill will be executed at 7 p.m. local time.
Square, Site wide
New and Improved Comments
If you have trouble leaving a comment, review this help page. Still having problems? Let us know. If you find yourself moderated, take a moment to review our comment policy.
Join the conversation
Load Comments
Right 3, Site wide - Exposure Dynamics
Right Skyscraper, Site Wide
Right Internal Skyscraper, Site wide


text:
Is Janzel No 25 WESTONARIA, Gauteng incorrect or missing key business information? Update your Hotfrog listing today.
Contact details
Are these details correct?
Hotfrog SouthAfrica provides information regarding Janzel No 25 WESTONARIA, Gauteng in Westonaria Gauteng. Janzel No 25 WESTONARIA, Gauteng is located at President Kruger Straat 7, Westonaria Gauteng 1779 and provides Insurance services. Contact them on 011 753 2246.
Is Janzel No 25 WESTONARIA, Gauteng in President Kruger Straat 7, Westonaria Gauteng 1779 your business? Claim your listing and attract more leads by adding more content, photos and other business details.
We have more Insurance services in Westonaria Gauteng available on Hotfrog SouthAfrica. You can update your search for Westonaria Insurance by location, keyword or service options.
Cnr. Allen & Davies Street Westonaria Gauteng 1780
01 Uranus Street Sarel Cilliers Street Westonaria Gauteng 1779
Huntley Street Westonaria Gauteng 1780
14 VAN DER STELSTR. P.O. BOX 1234 Westonaria Gauteng 1780
Small Business Hub
Sharing tips, ideas and advice to help grow your small business.
Your profile without ads
Have you considered upgrading to Hotfrog AdVantage? No competitor advertising means exclusive focus on your business. You take centre stage.
Create your free Hotfrog business profile
Follow Hotfrog on:
Share on:
Hotfrog Small Business Hub


text:
- blend.io/mdl
- Los Angeles
- 1 project
DAW & Most Used Plugins
Filter by Tag
- Andy KelleyPhoenix, AZ
- YK BeatzChicago IL
- UlyColumbia,MD
Store your projects in the cloud and restore them at any time.
Invite anyone to collaborate on your projects or remix them, publicly or privately.
Gain more exposure as your projects rack up likes, comments and plays!
Buy & sell on our democratic marketplace and reach a worldwide audience with the Blend Label.


text:
Heel Stirrup Pads
Definition : Pads designed to cushion a patient's heel and lower leg when placed in a table heel stirrup, providing comfort and reducing the risk of sores during long procedures. These pads typically consist of soft material (e.g., foam) and are the appropriate shape and size for location on the heel stirrup; they are usually supplied in pairs. Heel stirrup pads are mainly used for patients in lithotomyc positions for obstetric, urologic, colon, or rectal procedures.
UMDC code : 15700


text:
a ballet dancer's skirt made of many layers of material. Tutus may be either short and stiff, sticking out from the waist, or long and bell-shaped. Word Origin early 20th cent.: from French, child's alteration of cucu, informal diminutive of culnounjump to other results
BrE BrE//ˈtuːtuː//; NAmE NAmE//ˈtuːtuː//
Check pronunciation: tutu