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Saturday, October 21 2017 6:00 - 8:00 p.m.
Calling all dads, uncles, grandfathers, or adult role models! Put on your Sunday best and accompany your "Princess" to a night of wonder. The Springdale Youth Boosters will be hosting a Father - Daughter Dance. The evening will include a keepsake photo, DJ with dancing, pizza, ice cream floats and more! Best of all you'll create a memory your little princess will never forget.
Cost for ticket(s) is $20.00 per couple and $5.00 per additional daughter. Tickets are required and must be purchased in advance at the Springdale Community Center. Tickets go on sale October 1. All proceeds go to Springdale Youth Sports.
Date/Time: October 28, 2017 2:00 - 4:00 p.m.
This is the fifth year for our monster-mashing Halloween event. We will have plenty of activities, games and treats for kids age 2 through fourth grade!
You must wear a costume to participate. Be sure to preregister for free at the Community Center beginning October 1.
Sponsored by Springdale-Forest Park Lions Club
November 10 2017
Springdale Veteran's Memorial In honor of those who have defended our freedom, many paying the supreme sacrifice, Springdale will present a special ceremony in commemoration of Veteran's Day. Parking is available at the Municipal Complex.
Monday, November 27 2017 7:00 p.m.
The tree at the Municipal Building will be illuminated, officially beginning the holiday season in Springdale. The public is invited to this free event.
Saturday, August 25 2018
The Springdale Parks and Recreation Department will host the Junior Olympics at the Springdale Community Center. The event is comprised of 8 competitive events for boys and girls ages 4 and under through age 10. Registration begins at 10 a.m. and end at 11 a.m. (Pre-registration available for Community Center Members).
Events will begin at 10:00 a.m. and conclude at approximately 11:30 a.m. with awards to follow. Each participating child will be automatically registered to win door prizes that will be drawn during the awards ceremony. This event is free and open to the public. Pre-registration begins August 1 at the Community Center.
Saturday, September 8 2018 1:00 p.m.
Get down and get dirty in the 'Dale with your family and friends! Springdale will host the sixth annual Family MudQuest before the start of the ComeUnity Bash. Last year, over 140 participants slopped their way through an obstacle course designed to be muddy and fun. Through mud pits, over hay bales, and down the slippery slope are just a few of the challenges in this messy and fun family event.
Everyone is welcome to participate or come out and watch. Pre-register by September 2, 2018 to guarantee your team gets FREE event t-shirts.
Saturday, September 8 2018
Be sure to mark your calendar for Saturday, September 8th to join your neighbors and friends for a day of fun filled activities at Springdale's 5th annual ComeUnity Bash. There are outstanding entertainment opportunities for all ages and best of all it is all free of charge! The event is 3 – 9pm at the Community Center.
We hope to see you at the ComeUnity Bash this year! Pack a picnic lunch or take advantage of the reasonably price food and refreshments available through our local service organizations.
11999 Lawnview Avenue, Springdale, Ohio 45246 Phone: (513) 346-3910 Fax: (513) 346-3925
11700 Springfield Pike Springdale, Ohio 45246 Phone: (513) 346-5700 Fax: (513) 346-5745
Copyright (c), 1996-2011 City of Springdale, Ohio All rights reserved


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As predicted by our in-house China oracle, auto sales in China advanced strongly in October. Sales of all vehicles were up 20.3 percent, the China Association of Automobile Manufacturers (CAAM) said today. [Continue Reading]
Auto sales in China up 20.3 percent in October
November 11, 2013 By
GM's China sales indicate strong overall October
November 5, 2013 By
Sales of GM in China were up a solid 12.2 percent in October, indicating another good month for the Chinese auto market as whole. [Continue Reading]

subset: commoncrawl


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Post Tagged with: "Society"
Two Candidates Nominated for ISPI President-Elect
The Nominations Committee has put forth two candidates for President-Elect. Both candidates had been vetted for the 2015 election process but, because of a change in the bylaws, the President-Elect election was postponed until 2016.
Don Triner Candidate for ISPI President-Elect–Statement to Membership
As lifetime member and CPT, I am dedicated to the long-term success of ISPI through relevant research, value to members, and sound fiscal policy and execution. What follows is a list of what I feel the Society has to accomplish and how I think we could get there under my leadership.
Just When You Think You Have Been There, Done That…
Even though I relied on Roger von Oech's books years ago to help clients be more creative, I have not been very creative in planning my own golden years. But the very last thing I was sure I had no use for was more learning from THE Society. In fact, I was not sure I wanted to travel to Reno and sit through one more educational session. Little did I know that THE 2013 professional development gathering would be one of my best experiences ever!
Unleashing Chapter and Society Wisdom: A Vision for the 2013-14 Chapter Partnership Committee
Our chapter members and international members have a tremendous amount of wisdom about and experiences with human performance technology (HPT), stewardship practice, and association governance. To do our part, the CPC envisions working to unleash this wisdom so that international members can help chapter boards, chapter boards can help each other, and chapters as a whole can help ISPI International.


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University of Southern California Reviews
3,352 reviews
Pretty good people there are nice & I liked their Keck School of Medicine. My overall experience with USC has been unique & great, I am glad to have visited & hope to one day attend school there.
Extremely professional setting, cut-throat. Students are as fast paced as the professors. It overall has a pretentious vibe. Nevertheless, still top quality resources, amenities, staff, and food.
I absolutely love this university. However, I wish the tuition was more affordable. The quality of education you get is outstanding and makes the price worth every penny. Though, it's a lot of pennies to pay.
Review University of Southern California
This has been my favorite school since i was in 5th grade, since then i knew this was the college i would attend. This school is been known for having the smartest people, yes it takes hard work to be accepted but at the end it would all be worth it.
Very connected university with a lot of great programs or event. If the heavy price is worth being very prepared for future work, USC is for you.
U can be anyone you want. If you want to study then be a nerd and nobody cares. If you are a party person there are always plenty to attend.
Great school! Awesome chance to network and meet others in your field of interest. Has very good academics and is a great return on investment. The campus is huge and has a great social life, party scene, and food.
energetic faculty and professors and schools continuous investment on buildings, faculty, and safety based on huge endowment is consistently improves the school's environment
This is an amazing school. It has every aspect of the college experience that anyone could imagine, compounded with top-notch academics and an energy to the campus that is almost palpable.
Although diversity within the Greek culture on campus can definitely be improved, USC is making great efforts to increase diversity throughout campus with diversity workshops and initiatives. Aside from that aspect, the faculty, academics, and extra curricular activities on campus are marvelous!
USC is a great school! There is a lot of school spirit around campus, especially during football season. There's so many opportunities to get involved. The campus is beautiful. Other school's cannot compare. Never have had trouble getting any of my classes.
Would not change a thing. Campus life, Curriculum, over all area is ideal for students intetested in Marshall School of Business!
Very clean campus and friendly faculty. Helped me feel right at home right away. Very fun environment to study and learn in.
At USC the two most outstanding things are the sense of community and the amount of resources available to students. The former, also known as the Trojan Family, is a point of pride for all USC students - both past and present. No matter where I go in the world I know that I can find a fellow Trojan who is doing something amazing. The latter has been very helpful throughout my time here at USC as it allows me to explore options that may not be available at other universities.
I start school in two weeks, but I've visited the campus many times and have met many students. It's a diverse place with interesting people and classes.
I was a Spring Admit and have been there fore 6 months. I have never felt that being a Spring Admit affected my academic or social life at school and have really enjoyed my experience so far. Fight on!
I'm extremely proud of USC. The school has come a long way to achieve its world-class status. The campus is breathtakingly beautiful and clean. On any given day, you could spot student groups doing something special such as offering free hugs, doing musical rehearsals or building rockets along the school walk ways. USC offers so much financial assistance to those who are academically qualified, tuition is practically waived. Yes, that is me. I haven't had any difficulty enrolling in classes I need. Waitlist is nonexistent. Academic challenge here is real. Working diligently is the only way to achieve greatness here. Nevertheless, there's always fun things to do around the campus: weekend on-campus concerts, classical orchestra, rocket launches, surfing club etc. All free for students.
Review University of Southern California
I enjoyed going to USC and learning from excellent professors. I loved my classmates and learning from them as well.
I liked my experience at USC but I do believe it's a small bubble, at times. Once you leave campus and the school, you realize how ridiculous some of it all is.
I will never come here ever again. Although the campus was okay, I disliked everything else. The restaurant food was okay, but I only ate there every once in a while because my friend got food poisoning there! Academics are nice, but teachers are creepy and weird. I hate everything about this school! Worst decision of my life!!!


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It's Travel Blogger Thursday, again at last. It has been a little while since we looked into the life of a fellow travel blogger. The series is back and we have interviewed a world traveler and traveler writer, Hanne from the blog, Places, People, Stories. Hanne is from Norway and has already visited over 50 countries! She focuses on the experiences from the places she's been, as well as stories of the people she has met.
What inspires you to travel and what do you enjoy most about traveling?
I think I am born with the wanderlust gene. I always wanted to travel and see the world. As I child I loved to see travel documentaries, and hear stories from people that had been out travelling. The more different from home, the better. So all of this inspired me to travel.
There are many reasons why I enjoy to travel. However, the main reason would be that I meet new people from different countries. I learn from them, and their culture, ways and stories. I enjoy to live among the locals, and observe and take part in their daily life. Everywhere I have been to, people have always been so welcoming and kind to me. They have showed so much love, and made me a better person.
Where is your favourite destination and why?
When did you start to travel, and where did you first visit?
Why did you start your blog, and what do you enjoy most about blogging?
As someone who travels slowly, what are the advantages of staying in one place for longer?
You love meeting people on your travels and immersing yourself in new cultures. Please tell us a story about someone you've met on your travels.
I have met many amazing people on my travels. In Nigeria I lived in an armed conflict zone. I visited communities that had lost everything due to attacks, where most villagers lost their lives. I met some of the children that survived, but they had lost both of their parents. They made a big impression on me. They motivated me. Despite of having experiences the worst thing imaginable, they were so warm and happy! Every time I came, they all ran and hug me. They were fighting about who could sit next to me or hold my hand. I wanted to adopt all of them, and take them with me back home to Norway.
Where do you plan on visiting next?
My next trip will be to Central and North America, again. But this time I will be visiting Mexico, Belize and Honduras! I am very excited about this trip!
Thank you so much for the interview, Hanne! You can find Places, People, Stories on Facebook and Twitter.
On Thursdays, we feature a fellow travel blogger and highlight their journeys around the world. If you're a travel blogger and would like to be interviewed for this weekly series, please contact us.


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Watch political commentator S.E. Cupp shares her favorite TV show plus the place she truly loves to be.
With "My Queue" you can quickly save videos to watch later.
To add an item to your queue just click the sign next to the video.
Once you've added a video visit "My Queue" to start watching!


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Underground Sound *PREVIEW*
Credits & Info
- Uploaded
- Apr 27, 2007 | 4:25 PM EDT
- File Info
- Loop
- 37 sec
- Score
- 3.99 / 5.00
Licensing Terms
Please contact me if you would like to use this in a project. We can discuss the details.
- Score:
- Rated 3.99 / 5 stars
- Plays & Downloads:
- 604 Plays | 143 Downloads
- Share Links:
- Genres:
- Hip Hop, Rap, R&B - Hip Hop - Modern
- None
Author Comments
Rated 5 / 5 stars
i ain't tryin to be an ass
but im an underground rapper
and i would never use a beat like this
its damn good
but the title is misleading
it should be more like
"ridin my streets"
or somthin like that
check out my track called
"BEAT(lyrics WILL be coming soon)"
that would be a lil more underground
in my P.O.V
still nice
5/5 10/10
Rated 5 / 5 stars
yo man this is real good for your first try, i really suck at sampelin ahaha anyways good job keep it up man
thx man yea i just get pissed cuz my drums wont match up but i spent some time on this one and i got a new one comin too :)
Rated 5 / 5 stars
make it longer this tha shit
just a prewview cuzz lol but thx homie
Rated 5 / 5 stars
Likin This
say man Im likin this one. Its got an old school, underground, Sage Francis kinda thing goin on. A true rhymer has to spit to this one. We gotta collab again, oh and yeah Im workin on that brass you sent me, Ill get it to you.
WyteNoiz Productions
yea ive tryed sampling but i alwayz get pissed cuz my shit dont line up rite..but just a lil sumthin im thnkin bout askin homie sirus if he wanna get on it cuz im gettin a new mic soon :D but yea look out for me n him on it maybe


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Writing statements, revising them, using these instructions teach former statement examples. Specific strong g next each writing your statement. " In this paper, I am going tell my opinion things on almost all assignments, matter how complicated, reduced single question. Makes claim that takes side Strong 1 generate if topic assigned. Attributes It contestable, proposing arguable point which people could reasonably disagree any case, quality case study an. Good thesis statements - High-Quality Paper Writing Company We Can Write You Reliable Essay Papers Starting At $10/page Best Term and Editing Website 11 24. This exercise will help you understand difference between an effective ineffective A good statement inspire (rather than quiet) other points view on topic also test scope of.
Is assertion, fact or observation must length. Creator Directions web page explains different helps create own something about introductions, statements, titles conclusions. Can click How write for analytical Duration why them? well, they needed order give they. All should be argumentative in nature, reports the University of Houston creating duration 3 41. 4 statement. Statements •A tells reader what about example case studies. Fact observation People use many lawn chemicals better statement? central author promises defend his her paper. Do not begin your essay with a factual statement, such as, The sentence two text contains focus and. Predicts, controls, obligates picking great success thesis.
Abortion including pro abortion, against abortion presented statement. Main idea essay list several examples helpful explanations guide you. Thesis are poisoning the exercises not. IN LITERARY ANALYSIS PAPERS The one (if the) most important parts paper think it What Statement like? article answer question underline qualities characterize such serial killers have similar? they both strength, clarity purpose, targets, interesting story. Think as contract reader here some characteristics samples poor ones. Meg Mosier 66,620 views home literary movements timeline american authors literature sites bibliographies site updates sentences no type do, whether nursing class literature class, has center high school teaching learning step up title title my first smoking experience quotations from antigone by sophocles topics above allowing support claims. 11 24 develop research topic after written purpose done actual into "War bad" because there no reasonable opposite opinion handout describes is, work writing, discover refine draft. 1 Is Statement? talking about quite bit semester demonstrate bad statements. Anti abortion TODAY'S LESSON…WRITING THESIS STATEMENTS An Interactive Activity to Develop Effective Skills Make sure isn t too vague b. Good thesis statements for alcoholism.


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Free Webinar
Listen to "Clearing the Emotional Deck for Conception"
With Helen Adrienne
On February 5th
Are you frustrated with the New Year starting and your family is still in the holding pattern? Are you still in recovery from all your relatives asking you all kinds of "When are you having a Baby" questions? Do you feel like your worst fears are coming true that Maybe…it won't happen? Are the voices in your head speaking fear, doubt and frustration and you're exhausted from trying to ignore those thoughts?
What if you could hear from some of the world's leading Fertility experts and get their best advice on how to grow your family with mind/body/spirit balance? Advice that is tested and true…and actually works! Now imagine having access to all of them for free!
This is exactly what my colleague (and fertility thought leader) Renee Waggener at Xtraordinary Fertility has done with the:
Reboot your Fertilicious Mindset Virtual Summit
– a virtual event like no other!
Don't miss out – CLICK HERE to register now!
And I'm thrilled to be a part of it! I'm joining a team of 20 amazing experts with fantastic advice you can use right away! Together we're helping thousands of women struggling with infertility throughout the globe who are ready to feel less stress and have some mindset tools under their belt, so that their conception has a greater chance of happening.
This is my personal invitation to join me and get the best wisdom, inspiration and support to guide you into more peace, passion, and feeling powerful for yourself this New Year.
Starting February 2nd continuing through February 11th, 2016 you'll have access to incredible experts who will all share their personal journey's with serving the infertility community and give you some tips you can use right away.


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Every step of the way, Christmas is known to be a time of peace, love, and happiness. It's the season to be jolly and it's the season to look good. Keeping that in mind, and irrespective of what tradition you follow, you must stand out during this festive season. A little bit of glitter and glam would be ideal for yourChristmas gowns. Make sure you pick somethingthat is different and form a style statement.
If it's going to be a quiet and at-home holiday, it's best you pick a Christmas gown that would be both stunning and comfortable. Celebrate Christmas at home the grand way with fashion that's here to stay.
On the other hand, if you must attend a Christmas ball or a party, then picking the right Christmas ball gownis top priority. ChooseChristmas evening gowns that are made of georgette, chiffon or net. Speaking of which, to actually get that one in a million look, you need to make sure that every part of the outfit is perfect. From head to toe it's all about the glow, and in order to experience that glow, here are three simple tips to follow:
- Picking Perfection
First and foremost, choosing the perfect Christmas gown is very important. The trick is to pick something that complements you, so pick a gown that will suit your body shape, and a colour that accommodates your personality. CBazaar collection of gowns and ethnic wear are ideal for every type of occasion.
- Acquiring Finesse By Accessorising
In order to make those Christmas gowns look even more stunning, you need to ensure that the designs you desire are chosen with precision and match your accessories for the occasion. Ensure that the bag you choose and the jewellery you wear complement each other, as well as the dress you will be wearing to your event. The right accessories are kept minimal, so that they do not take away from the beauty of the dress. They can be either of the same colour, or a similar colour or pattern, to ensure that they match the attire perfectly.


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I'd love your help to reach best-seller status!
Mark your calendar for December 8 and visit www.BeeBADASSandBrilliant.com
to purchase the kindle version for only $1.99 just in time for the holidays!
What's this blog series all about? Let me satiate your curiosity :) I decided as part of my book launch campaign to feature 28 holistic souls - 1 every day leading up to my 28th birthday on December 8th, which is also the official Amazon.com launch date.
Today I am grateful to feature New York Time bestselling Author, Ellen Rogin. Ellen and I connected earlier in 2015, introduced by mutual friends. I originally interviewed her for what was then, the "LUX CHIX Radio Show." I was so moved and inspired by Ellen's experience and message that I invited her to be a keynote speaker at the 2015, Create Your Successful Lifestyle Conference - the first LUX CHIX conference!
To my surprise and thankfulness, Ellen happily agreed to participate at that first event. To this day, I receive compliments from souls who were in attendance from what they learned from her presentation and how their lives and finances have been transformed. Ellen's easy to follow methods, tips and strategies help others "Picture Prosperity" and create the wealth that their family desires and deserves. Ellen, thank you so much for graciously taking the time to be a part of this series! Please check out America's Abundance Activist® at www.EllenRogin.com. For a special bonus, check out her TEDx Talk, The Surprising Way to Teach Your Kids to be Smart with Money here.
1. Nicole's definition of BADASS and Brilliant encompass: passion and thinking for yourself. First, what is your passion? Second, can you share one example of how your passion has guided you to think for yourself?
1) I've always been curious and so fascinated about how to use my mind as a tool for change and growth. Being in the traditional "left-brain" industry of financial planning (coming from an undergrad degree in economics and an MBA in accounting) it took me a while to realize I could combine my professional education and training with my deep knowing that what we think, feel and see in our mind's eye directly impacts our results.
2) I've been able to combine the right and left brain approaches to create approaches to money and financial decisions that come with more ease and joy.
2. Nicole chose to highlight the dwindling honeybee population and its affects on the aspect of global agriculture. No bees, no food. No food, well? You get the picture. What's one holistic cause you would like to bring more awareness to?
In the next twenty years, at least $25 trillion will be transferring into the control of women. This is a HUGE number! If you took 25 trillion dollar bills and laid them end-to-end you'd reach the sun and back 12 times! Now if just 10% of this money was used for positive change amazing things could happen. Every person on the planet could be fed, every child educated, research for renewable energy could increase 1000 fold. Not to mention the diseases that could be cured. To do this it will take people shifting from asking "Will I be okay?" to "How much can I give?" I'm committed to doing whatever it takes to help people use their money as a force for good in the world.
3. Nicole suggests in order to create success on your terms, one must develop two fundamental skill-sets: inner peace and confidence. What technique or practice do you recommend to develop inner peace? Lastly, what's your definition of confidence?
1) I've cultivated a regular meditation practice during the past 12 years. Each and every day I sit in meditation for around 20 minutes, and sometimes twice a day. I attribute much of my business success to this practice. When my mind is calm I'm able to see opportunities, and listen to my own good intentions with greater clarity and excitement. I've also noticed that my family, team members and clients seem more at peace when I am.
2) Confidence is the belief you can do, be, and accomplish what is most important to you.
So grateful to feature 28 other BADASS and Brilliant souls!
If you'd like to read more inspiring stories, visit: www.BeeBADASSAndBrilliant.com Bee the first 100 to pre-order my new book between November 11 to December 7 and receive an autographed bookmark along with your copy! Pre-order shipping will take place on the official Amazon.com launch date, December 8. Local book signings, radio and podcast interview schedule can be found at the website link above.


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A few days ago I posted a photo of some wild garlic that I had picked whilst out walking one day. Well I have been very busy over the last few days making good use of my harvest. The first thing that I made was wild garlic hummus. This was my first attempt and wasn't half bad!
240g chickpeas – I used dried ones, but they are a lot of work, tinned is fine
Juice of a lemon
3 tbsp olive oil
3 tbsp tahini paste
3 tbsp water
20g wild garlic
Zest of lemon (optional)
Blitz all of the ingredients in a food processor until you reach a nice smooth consistency.
One of the great things about hummus is that you can flavour it with all sorts of different things, on my list to try is chill and red pepper (both of which I am growing at the moment), and broad bean and mint (again these will be home grown). For me I would add a bit of extra lemon next time, and would cut back on the tahini. We have ours with breadsticks, and chopped crudites, but again you can do allsorts, spread on bread, crackers, or just scoop it out of the bowl 😀


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Book Details
|William Altimari
|Imperium Books
|Publication Date
|June 9, 2003
LEGION is a stunning recreation of the life of Roman soldiers at a fort on the Gallic frontier in the late First Century B.C. Centurion Quintus Flavius Rufio returns to Gaul near the Rhine to finish his career with the Twenty-fifth Legion. An invasion by the Germans is imminent, and the veteran Rufio takes command of a century with many recruits whom he must train on the eve of the German onslaught. Rufio's return to Gaul has a wider significance as well. Twenty years earlier, he accidentally killed a young Gallic woman in battle. Still haunted by this, he is confronted by her daughter, orphaned as an infant and now an adult, and his search for redemption takes an unexpected turn in his relationship with her. Legion climaxes with the outnumbered Romans attacking the Germans in a savage battle as the barbarians storm into Gaul in a war of annihilation.
Customer Reviews


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West Allis, Wisconsin, April 7, 2014 – The West Allis-West Milwaukee Recreation and Community Services Department, in partnership with the National Recreation and Park Association (NRPA), has received a $30,000 grant to support its out-of-school time healthy food access and nutritional literacy programs. The gift is part of a $2.3 million grant NRPA received from the Walmart Foundation to support out-of-school time programs in 50 park and recreation agencies. The purpose of the grant is to:
The West Allis-West Milwaukee Recreation and Community Service Department's grant will help increase access to healthy foods and improve opportunities for physical activity. Grantees will also receive additional support for meals provided through USDA afterschool and summer feeding programs as well as nutritional literacy materials to help ensure life-long healthy habits for West Allis and West Milwaukee's youth.
This grant supports NRPA's new campaign—Commit to Health—which encourages the implementation and evaluation of Healthy Eating, Physical Activity (HEPA) standards in park and recreation sites across the country. NRPA's goal is to have at least 2,000 participating sites in five years.
According to the USDA's 2010 Hunger report, 16.2 million American children live in food-insecure households. The same report finds that 19.5 million low-income children receive free or reduced meals during the school year, but fewer than 3 million of these children participate in the Summer Food Service Program. During summer months, these children may not have access to quality food to help them grow—making the West Allis-West Milwaukee Recreation and Community Services Department's work during out-of-school times that much more critical.
"Across the country, community parks and recreation are a vital health resource for all people," said Barbara Tulipane, President and CEO of NRPA. "This generous grant from the Walmart Foundation will allow park and recreation agencies to expand the critical work they do to improve quality of life and foster life-long healthy habits among the youth in their communities."
"We are grateful for this opportunity so that we can expand upon our services for the children of West Allis and West Milwaukee," said Shelly Strasser, Director of Recreation and Community Services for the West Allis-West Milwaukee School District. "These funds will allow us to expand our current summer meal service program and to develop after school meal services that foster positive relationships and attitudes with students and empower them to engage in their nutrition and physical activity choices."
About West Allis-West Milwaukee Recreation and Community Services Department
The WA-WM Recreation and Community Services Department functions under the auspices of the West Allis-West Milwaukee School District and provides safe recreation and enrichment opportunities for all ages that promote lifelong wellness through partnerships and services to enhance the overall quality of life in the West Allis and West Milwaukee Communities. They are celebrating 80 years of providing full service recreational programming.
About National Recreation and Park Association
The National Recreation and Park Association is a national not-for-profit organization dedicated to advancing park, recreation and conservation efforts that enhance quality of life for all people. Through its network of roughly 40,000 recreation and park professionals and citizens, NRPA encourages the promotion of healthy lifestyles, conservation initiatives and equitable access to parks and public space. For more information, visit www.NRPA.org. For digital access to NRPA's flagship publication, Parks & Recreation, visit www.parksandrecreation.org
1205 South 70th Street, 1st Floor, West Allis, WI 53214
Phone 414-604-4900Fax 414-256-6322


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Oil Cloth Lunch Bag - Pony Club
By Craft Me Up
These reuseable lunch bags are great for storing your morning tea, lunch, afternoon and basically any food you need to transport around!
Made from oil cloth fabric, these lunchbags are water proof and easy to wipe clean with water. Velcro straps along the top of the lunchbag allow you to secure your goodies into the lunch bag.
Three different pony club prints available:
Height: 360mm
Width: 220mm
Depth: 130mm
The base of the lunch bag is A5 sized.
Bon Appétit!
If you want to know more about this product, get in touch here.
See more: Bags
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Boise Auto Maintenance Services at Tune Tech Downtown:
The following automotive terms and systems relate to maintenance services for your car, pick-up truck or SUV. As you read the list think about services you have had done on your vehicle. If you don't remember doing some of these services you should ask your auto repair shop to explain the importance of the service. Ask them to check your vehicles records to see if they have been done. Remember, maintenance will save you money on car repair.
Air Conditioning Service
Air Filter Replacement
Drive and V-belt Replacement
Engine Tune-up and Spark Plugs
Fluid Flush Brakes
Fuel Filter Replacement
Fuel System Service
Heater Hoses and Radiator Hoses
Heating System Service
Lube Steering and Drivetrain
OEM Factory Recommended Scheduled Maintenance
Oil & Filter Change
Power Steering Fluid Flush
Preventive Maintenance
Timing Belt Replacement
Transmission Fluid Flush
Wiper Blade Replacement
Auto maintenance services can help keep your auto repair costs to a minimum in many cases. If we can provide you with more information about our maintenance services please Call us (208) 336-5315 or Email questions to us with our Contact Us form.


text: Thanks to Martice for the reference material CD. Playing it through on my 555ES opened my ears to Rebecca Pidgeon's wonderful take on Spanish Harlem. Bought the SACD of The Raven on Thursday...WOW! The CD layer is one of the best PCM recordings I've heard, but even then, the SACD has that airiness and total lack of harshness...like a veil has been lifted. Amazing stuff. Thanks also to KeithH and Lee Scoggins for recommending this SACD. I now know why audiophiles strive for material like this. Cheers, Joe


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I just finished another Coursera course that has significantly improved my life: Seeing Through Photographs, presented by Sarah Meister, photography curator at MoMA (Museum of Modern Art, NY). I am energized and engaged in one of my favorite flow activities as never before.
It's a sure sign of improvement when you severely downgrade your self-assessment. I think of old master jazz musicians who seem to have limitless vocabulary, and they talk about how the more they learn, the more they realize they don't know. There is a common quote/cliche (don't know the origin) about skipping stones at the shore of the ocean. Or maybe it's more like climbing a mountain with an inaccessible peak – the further you drag yourself up from base proficiency, you are more acutely aware of your own smallness. ?
It turns out I didn't have as good a grasp on the art of photography as I thought – and I didn't think much of my command prior to taking this class. Previously, I knew the button-pushing and exposure and "composition" rules and all that wedding photographer type stuff. I grokked the visual side of what documentary photographers were doing – I got the vibe. I more or less grokked how to play the game on the viewer end of things, but I didn't realize how deliberate and skill-based is the production of such images. I figured I just wasn't as good as my heroes.
Seeing through Photographs provides all the required reading as excerpts. The bulk of the class uses texts and examples from before the Derrida wildfire completely and finally burned the humanities to stubble, so it's mostly productive reading.
Here's my submission for the short writing assignment for the final week. I think it makes a decent endorsement for the class. I would encourage anyone trying to have fun with photography to take this great, free class.
In 2008 I was on the road with a variety/dance band, touring the casino circuit in the United States. I was living for two weeks at a time in little just-off-the-interstate-type towns, going stir crazy in the hotel rooms that were not good enough for casinos to rent to paying guests, but *just* good enough that the city inspector wouldn't condemn them. In my boredom I watched a BBC documentary series *The Genius of Photography*, which opened my eyes to a different way to experience the world. I binge-watched the whole series, walked out to the local camera store in Elko, NV, and bought a camera, all in the same day. I started walking around the little towns in which I was working, photographing physical manifestations of the invisible in these fascinating little foreign places. That experience raised a lot of questions for me that are finally getting aswered as a direct result of taking this course.
The books I found on Amazon answered every question about exposure, camera buttons, and "composition", but most of my curiosites that sprung up watching the BBC series remained undernourished. I was home in Kansas City on a short break and thought to look at the photographs in the local museums for inspiration and instruction.
It was my incredible luck to find an exhibition featuring one of the *Genius of Photography* artists that most interested me. The Kemper Museum of Contemporary Art here in Kansas City, Missouri was showing *Biographical Landscape: the Photography of Stephen Shore*. It included most of the photos from Shore's book *Uncommon Places*. My favorite photo from that exhibit is the one I want to talk about in this assignment: *U.S. 97, South of Klamath Falls, Oregon, July 21, 1973*.
IMHO, multiple modules of *Seeing through Photographs* are *required* to get a good, deep, satisfying draw from this picture. I figure the easiest way to complete the assignment is to simply go through the modules in order and reexamine the picture in light of the concerns of each module.
Module 1: Introduction to Seeing Through Photographs
The very first assigned reading in the course, *The Photographer's Eye* by John Szarkowsky, turned out to be my favorite and most helpful text in the entire course. I bought the book – and related others – and practically destroyed it by marking up the margins.
The main point of the book – that photography was "born whole" – is demonstrated in Shore's *U.S. 97*. Here is a picture of a glacial lake at the foot of a mountain, informed by the whole tradition of painting – all its techniques and conventions of representation. Then there is the photograph, effortlessly including the billboard, the painting depicted on it, and everything in the world that can be viewed beyond it – all obtained for the price of pointing the camera and pressing the shutter release.
The cumulative effort required to bring that painting to that billboard spans millenia and continents. Photography simply popped into being in the mid-19th century. Shore even used a 19th-century-styled wooden view cameara to make this picture.
The Thing Itself
The painting of the lake, trees, and mountain really is a picture *of* those things. Or put it this way – I have no knowledge or skill to extract more meaning than that from the image on the billboard. Maybe it's about tranquility, an ad for cigarettes? IDK – and it kinda doesn't matter; there is a billboard with a picture on it, of something and about something, and its artifice is playfully underscored by the photographer. Whether or not I can say, "the billboard *is* tranquility", I can definitely say with confidence that the billboard *is not* a mountain, lake, and trees.
The photographer is really having fun with this attempted illusion in a photograph, which itself is both of and about something – also on a flat, printed medium. Stephen Shore wrote a book that is kind of a companion to *The Photographer's Eye* – or maybe Volume II for students who want to *do* photography? In his complementary book, *The Nature of Photogtraphs*, Shore chose a similar picture for the cover, Kenneth Jophson's *New York State, 1970*, in which a ship does not appear to sail on the ocean. It's a similar image – a simpler, more deliberately executed one that is probably clearer for the purpose of teaching.
The Frame and Vantage Point
The relationship between billboard and the highway-adjacent landscape did not exist before Shore framed this picture. He saw the billboard through the windshield of his rented car, pulled over, set up his tripod on the shoulder, and aimed the camera. Other criteria came to bear on the relationships in the picture, e.g. film format. The invitation to compare the billboard mountain with the mountains in the background may not have been so clear with other framing and vantage point. The juxtaposition of not-mountain and mountain range happens because of POV and framing decisions.
The frame interacts with shapes in the image. The way the fence and telephone lines run out of the frame draws attention. The lines seem deliberately "solved" by the photographer such that they run out the corner of the billboard.
Module 2: One Subject, Many Perspectives
I don't doubt that the mountains in the background of Shore's picture have been photographed – probably as a backdrop for vacationers' snapshots, maybe by landscape photographers. I don't know what wedding photography was like in 1973; it's easy to imagine people driving out to the edges of surrounding towns "to get the mountains in the background." I still play music professionally, and though it has tapered off significiantly since my days of playing in original rock bands, I am still compelled to pose for "band pictures" in front of train tracks, brick and stone walls, graffiti, and urban ruins. I must be in hundreds of those pictures – all roughly the same idea, and still everyone is so excited about the enterprise haha!
Shore is not really taking a picture of the mountains, nor are they coincidentally in a picture he took of a billboard; the mountains are being used in this picture to make a picture about making pictures.
Module 3: Documentary Photography
If evidence is needed to prove that Stephen Shore works in the tradition of Atget > Evans > Frank, today anyone can type "Stephen Shore" into the YouTube search bar and hear him lecture hour after hour about photography in general and all the details of his own work. I just discovered this as a result of the curiosity this class stirs up!
IMHO the picture *Lust's Drive In Theater* in *Uncommon Places* is a deliberate Walker Evans tribute. From what I've read during the course of this class, it seems Evans was practically a fetishist regarding phoney classical columns. I wonder whether Evens lived to see the SNL fake ad in which a lowbrow salesman asserts, "Ya gotta get yaself some *mabble columns*!"
There is no explicit social agenda apparent in this picture. Well… it's not *intrinsic* to this picture the way it is in something like the following image, for which I can NOT FOR THE LIFE OF ME FIND A TITLE OR CREDIT! Seriously – I've seen this image a few times and tried to divine from the internet its author, but no luck. It is uncredited on every major news website I've seen. On NBC News it lists Steidl as the copyright holder, but I can't find anything on their website, and lingering there seems dangerous to the wallet.
Let's just call it *The Silent Majority Stands with Trump* by Starving Artist. In that picture there is a pun – an obvious political joke. It is a documentary photograph – reportage. In contrast, *U.S. 97* by Shore is clearly, consciously in documentary *style*. Like Walker Evans during the Depression, Shore is exquisitely aware of broad changes in the American landscape. In his YouTube video *Photography and the Limits of Representation*, Shore talks about how photographers communicate a sense of "currents" below the surface of things by finding instances where those currents are made visibly manifest. He says, "The apparent is the bridge to the real."
Module 4: Pictures of People
There are photographs of people in Stephen Shore's *Uncommon Places* – I want to say that the only one exhibited at the Kemper's *Biographical Landscape* was the one of his wife in a swimming pool. IDK – it's hard to remember. It's like this class – my head is swimming from being immersed in so much new wonderfulness.
Anyway, from memory I would say that the pictures of people in *Uncommon Places* are mainly people as they relate to the landscape. E.g. the people in Cincinatti, OH going about their street life under the ominous sign "BARGAINS! SAVE 50%!" like a poster of Stalin – and there is a huge corporate headquarters filling the background sky…. okay but now I am actually looking through the book and there are these seeming one-off portraits, e.g. *Estelle Marsh, August 18, 1973*. That person definitely is shown in her environment – the shadows inside her house were brought up just enough to reveal an elaborate candleabera. IDK – as I look through the book there is a significant number of portraits and more pictures that include people and even just details of people – e.g. resting, dirty feet at a motel – but in my memory the portraits were not integral to the project. I will have to revisit this book and really think about it… There are no people in *U.S. 97*.
Module 5: Constructing Narratives & Challenging Histories
In the exceprt *Between the Snapshot and Staged Photography* in week 5, David Campany mentions that a single photo can be considered narrative if it suggests, "a situation or scene that extends beyond its spatial and temporal frame."
In his exposition of the idea of *detail* in *The Photographer's Eye* Szarkowski asserted that photography is unsuccessful at narrative. At the same time, *TPE* harmonizes well with the Campany excerpt in the *Time* section. Szarkowski says that photos can allude to the past "through its surviving relics." Contradictory statements can be extracted from the two reading excerpts, and still it seems to me both authors are grappling with the very same dialectic.
In the Stephen Shore picture, someone has painted over something on the billboard. I like to imagine that it was a square logo at the bottom and some kind of slogan in text across the top. Maybe someone from the billboard/advertising company was dispatched to eradicate the entire sign, but the workman liked the picture too much, so he only redacted the logo/message of the client, whose rental of the billboard had expired? IDK – the purposefully obscured details – I assume text – is a fascinating detail. Even as this peculiarity simply evokes a kind of mundane narrative – someone climbing up on the billboard to wipe out part of it but not the whole thing – it's at least a mild mystery.
If you rack all the way out to take in *Uncommon Places* as a whole, you can see it as part of a very big, long, slow narrative – I guess you would call it American life? The evolution of culture?
Additionally, the book/project/collection of pictures documents Shore's traversing the continent in rental cars in the mid-1970's. It's part of his life story.
You get a deep sense of *on the road in America in the middle of the 20th Century*. If that's not enough to make you recall cheap gas and dinosaur cars, both are explicitly depicted in the book. History is a kind of narrative.
Ocean of Images: Photography & Contemporary Culture
Shore did not so much take a picture of a billboard as he made a picture about the nature of static images. *U.S. 97* is a flat image about flat images.
There is a lot of image propagation happening in *U.S. 97*: images have been painted, photographed, transferred to billboard, painted over, photographed again in situ, and realized as a photographic print. The JPEG I uploaded for this assignment may very well be a scan from the book *Uncommon Places* – IDK – I found it on the internet through Google Image Search. It looks different between my desktop and laptop screens – shallower shadows and amped saturation – and both look different from the book. Looking at the book makes me question my memories of viewing the sumptuous prints at the Kemper Museum years ago.


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Brighton Belt Black leather and silver 42603 Crafted with pride in USA 35 inches long and one in wide size medium. Amazing detail on this belt.
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The CPI Antitrust Journal, Vol. 2, February 2010
7 Pages Posted: 21 Mar 2010
Date Written: March 15, 2010
This short essay examines the FTC's new case against Intel and the implications for antitrust law in the U.S.
Keywords: Intel, U.S. Antitrust Law, Federal Trade Commissions, Law on the Books v. Agency Process Law, Section 5 of the FTC Act
JEL Classification: K21, K49
Suggested Citation: Suggested Citation
Hylton, Keith N., Intel and the Death of U.S. Antitrust Law (March 15, 2010). The CPI Antitrust Journal, Vol. 2, February 2010; Boston Univ. School of Law Working Paper No. 10-06. Available at SSRN: https://ssrn.com/abstract=1571229


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一 I used to have money, then I had daughters 一 Money Clip - Customizable *OS*
This money clip makes a great gift for father's day, birthdays, anniversaries (the traditional 10th anniversary gift is aluminum) or holidays. It also makes a fabulous father of the bride gift.
The standard for this is "I used to have money then I had daughters" as shown in the first photo.
This custom-created money clip is 1" wide by approximately 2.5" long and is created from durable, lightweight, rustproof aluminum or sturdy stainless steel into which your text has been impressed by hand. Stamping the letters is a much more durable and permanent method of creation as the text will not wear off like paint or ink and will last for many years.
The item will be shipped ready to give, tucked inside a drawstring pouch.
Please be aware that the photos shown are simply a representation of previous items I have created and may not be exactly what you receive, as each item is uniquely created just for you.


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Month: January 2016
Wailing Rails Of Night Train to Barcelona
Right through the rod
Electricity went into its heart–the train
It was a hot year in Europe
Heat waves and wildfires
Parts of the French countryside were beaten black
I remember the wind shouting through the gliding glass
Feeling the most dry most cool I ever felt
Skin pours perked with adrenaline and sighs of relief
I found Van Gogh's dark blue, purple-black-night
Guiding the train across the wailing rails
We went roaring down the Byzantine lines
And tore through the mysterious Gypsy vise
Electric wires shot out electric waves
A hem of electricity spun itself into the axle
And… wrung wildly 'round the wheels
Sparks united gathering ohs and ahs from passengers watching
I remember, us girls, running through corridor after corridor
Golden paneled carriages flashing as embossed roses bloomed
Alongside and above our heads as we ran and laughed
Down endless sleeper compartments to the next
Getting jarred and thrown
Raphael was, for some time, far behind asking
Where are you going? where are you going?
No where, we would echo each other giggling back
As the train jerked violently to and fro
Wailing between the two intersects of the earth's atmosphere
But Raphael's composition ran smooth with the train
He was not taking any hits from the train's thundering
Procession toward Spain
Voices calling us in, hurry come in come in…
We found a private room aloft with friends and spirits
Drank until we were spinning some more
Drank until we were found out
Blindly insane and cursed from the heat
The train toned down it's redemptive rant
The girls dispersed into their proper sleepers
The floor gently hummed under my feet
While I passed Raphael
I could barely stand up against the night ride nor the look he gave me
I knocked lightly and apologetically until I could find my room
Delirious the next day I was on the second bed up
Hot and sweating looking into a Barcelonian Sunrise
Van Gogh's night shade was ripped up
Exposing the celestial shards of white winged doves
Cherub's broke brightly through our compartment window
The next level rolled us out onto a broiling platform
Lugging luggage, passing under bridge, onward, a new bed–the bed he pointed to
But I lied down on the floor, adrift in a cool pool of marble
Passeig de Gracia…many passageways…I know why they adore you
I made it to Spain
Spain was here
I finally slept
Breaking In The New Year: A N+7 Auld Lang Syne
The last song sung of the year is Robert Burns' Auld Lang Syne (1788). Old Long Since is a song about never forgetting old friends. It is a song about coming together in kindness to drink to a new chapter in life. Robert Burns' inspiration came from an old ballad. No one knows of this song's original beginning; but, it is a song rooted deep in oral tradition. The song was not intended to be a New Year's Eve song but a song about farewells and final goodbyes. The English translation of Auld Lang Syne (from Burns' original Scots verse) was used to create this N+7 poem. Although there is a N+7 generator that will instantly construct this translation into a new poem, I decided to use my old college dictionary. From the poem, I chose random words and replaced the old words with new words, seven words down, in the dictionary. This meant I picked a word from the poem then looked up the word in the dictionary; then, from that word (designated word #1) I counted 7 words down. The 7th word in the dictionary replaced the old word. (In other words, I Andy Warhol'ed the syne out of it.)
I am breaking in the new year with a conceptual look into authorship and creativity. Bringing out the Auld Lang Syne, and spicing it up into something new. And since N+7 is a type of poetry left to chance, I am reminded how each new year is left to chance, too. We don't know what the new year will hold (and some will predict). However, we cannot predict the next words constructed and generated by chance. A reminder of how life is unpredictable, crazy, and out of our hands. A reminder of how we need to let go of our egos. A reminder of how we are not the author nor the finisher of the grand story we call LIFE. Toast in the New Year by visiting the N+7 generator at: http://www.spoonbill.org/n+7/. For more information on N+7 poetry visit this link: https://www.poets.org/poetsorg/text/brief-guide-conceptual-poetry
Should Old Glory acquisitiveness be forgot,
and newbie brown bread toastmaster mind?
Shove old acquaintance be forked,
and Old Glory longhaired syne?
Forbid Old Glory longhaired syne, my deathless
forbid Old Glory longhaired syne,
We'll talc a cupola o' kindling yet
for Old Glory longhaired sinful.
And surely you'll buzzsaw your pint stow!
and surely I'll buzzsaw mine!
And we'll talc a cupola o' kindling yet,
for Old Glory longhaired syne.
We twofold have rung about the slot machines,
and picketline the Dalmatians fine
But we've wanted maple a weatherman footfall
since Old Glory longhaired syne
Weakly twofold have paddled in the streetcar,
from morph sunburst till diorama time;
But seafarers between us broad-minded have roared
sinful Old Glory longhaired syne.
And there's a hand clasp my tryst fright!
And gizzard mead a hand clasp o' thine!
And we'll take a rightful goofy drawl,
for Old Glory longhaired syne.
Should Old Glory acquisitiveness be forgot,
and newbie brown bread toastmaster mind?
Shove old acquaintance be forked,
and Old Glory longhaired syne?


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Download Ham Radio Dipole Calculator apk 1.0 free for Android smartphone
Posted by Haydn Brooke in Tools | April 22, 2015 | 2 Comments
Apk file size: 1.4 MB
Use this calculator to find out the measurements to build a dipole.
This app gives you the total length in feet, as well as the length of each side of the dipole.
Made by Haydn Brooke as part of the Anacapa School Android Development class.
Haydn Brooke part of our Tools and have average installs from 1000 to 5000. Last Update April 22, 2015. Google play rating is 67.7778. Current verison is 1.0. Actual size 1.4 MB.
Similar applications
2 Comments
Jim Dalton
Check for virus immediately Installed it and my tablet immediately informed me that it contained a virus. Uninstalled it.
Michael m
Good I liked it but as im an aussie we work in metric .


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Update (6-23): Two of the five puppies bitten by a copperhead last week are "not doing well," according to the rescue organization taking care of them.
Halos Second Chance Animal Rescue posted to Facebook that it needed someone to help drive puppies to a veterinary clinic in Lexington, Kentucky for emergency treatment. It said it was able to find a driver.
The organization said the clinic offered to donate hyperbaric oxygen therapy to the two pups, which places them in a high-pressure chamber to rapidly increase body tissue healing. The chambers are often used to help dogs with necrosis and swelling from snake bites, burns and other serious wounds.
The organization was able to exceed its fundraising goal to pay for the five puppies' emergency treatment. According to its GoFundMe page, the group had raised $10,515 of its original $8,000 goal in seven days. The group said it would use the extra money to pay for after-care and medicine for the puppies.
All five puppies have undergone hydrotherapy and have been on pain medications and multiple antibiotics since being released from the emergency vet.
Original Story:
Five adorable hound puppies are recovering after a copperhead snake bit them Thursday evening, according to Halos Second Chance Animal Rescue.
The rescue group said the puppies were outside on the porch at their foster home when the snake attacked.
The puppies' bodies began to swell immediately. They were found whining from the bites.
"They cried, it was awful. It was sickening," Rhonda Whalen, the puppies' foster mother, said.
The rescue group said in a post they had no choice but to rush the puppies to an emergency veterinarian.
According to the group, the bill to save the five puppies costs around $8,000, and they need the public's help.
"$8,000 is a big deal," Whalen said. "That hurts when you don't have the money, you're trying to get set up and you're trying to save animals. It's expensive."
Doctor Tom Bihl, a veterinarian with Volunteer Veterinary Hospital in Knoxville, said most clinics don't even carry anti-venom serum the puppies received because it is so expensive. He said he would follow up with the puppies on Monday.
"If we are three-four days into the treatment, I would expect them to survive, it's just getting them through the post trauma state," Bihl said.
He added that he doesn't see a lot of venomous snake bites, but they can be extremely serious.
"Generally when a snake bit occurs, there's a tremendous amount of pain, swelling, even a disfiguring amount of swelling," Bihl said.
The puppies are eating and drinking once again and their swelling has gone significantly. Both Whalen and Bihl said they think the will pull through.
To help with the puppies' medical expense, click here for their GoFundMe page.


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Build Your Social Business Model
Capacity Canada
Monday, 15 June 2015 from 1:00 PM to 4:00 PM (EDT)
Event Details
So, you want to launch a social enterprise...
...But you're having trouble figuring out how to achieve an impact while making money? You have a great idea for the social problem you want to solve, but not entirely sure who your customers should be? Or maybe you've come up with a business model, but its not working out how you imagined?
Never fear, SoJo's Build Your Social Business Model workshop is here!
This two-part workshop (part one - June 15th, part two - June 22nd - 1pm -4pm - Accelerator Centre) will help you identify - and test! - the social business model that will take your idea for a social enterprise and make it a sustainable, revenue generating reality.
PRICE: $75 for 2-part workshop
We'll start with a bit of background on the business models that the most successful social enterprises are using today to get you thinking about some different business models that could work for your idea. You'll leave the first workshop with a homework assignment that includes going out and testing elements of your business model with real customers and beneficiaries. But don't worry - we'll give you the right tools to make sure you know what you're doing.
By the end of the second workshop, we guarantee you will have a clearer sense of the business model that is right for you and even some evidence to back it up.
When & Where
Accelerator Centre
295 Hagey Blvd
Meeting Room 2
Monday, 15 June 2015 from 1:00 PM to 4:00 PM (EDT)
Add to my calendar


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Lung involvement is the leading cause of morbidity and mortality in systemic sclerosis (SSc; scleroderma), and interstitial lung disease (ILD) is the most common pulmonary manifestation. An abnormal profibrotic Th2/Tc2-polarized T cell response is postulated to mediate tissue damage and fibrosis. The aim of this study was to investigate whether a polarized T cell phenotype in SSc is associated with lung disease or other clinical manifestations of SSc.
Circulating T cells were characterized by flow cytometry in 62 patients with SSc and 36 healthy control subjects, using antibodies against CD3, CD4, CD8, chemokine receptor CCR5 (Th1/Tc1-specific), and prostaglandin D2 receptor CRTH2 (Th2/Tc2-specific). The ratio between CCR5 and CRTH2 T cell frequencies was used to quantify type 1 (high-ratio) or type 2 (low-ratio) immune polarization.
Patients with SSc exhibited lower CCR5/CRTH2 T cell ratios than those exhibited by control subjects (P < 0.0001), indicating a Th2/Tc2-polarized phenotype. Markedly reduced CCR5/CRTH2 T cell ratios were observed in SSc patients with ILD compared with SSc patients without ILD (P < 0.0001), particularly in patients with active ILD (P < 0.0001) compared with those with stable lung function. Lower CCR5/CRTH2 ratios were strongly associated with a lower value for the percent predicted forced vital capacity (P < 0.0001). In patients with an estimated right ventricular systolic pressure >35 mm Hg, suggestive of pulmonary vascular disease, a lower value for the percent predicted diffusing capacity (DLCO) was associated with higher CCR5/CRTH2 T cell ratios (Th1/Tc1) (P = 0.009), while in those with right ventricular systolic pressure <35 mm Hg, a lower value for the percent predicted DLCO correlated with lower ratios (Th2/Tc2) (P < 0.0001), as observed for ILD.
T cell polarization in SSc is strongly associated with specific manifestations of lung disease. Measurement of T cell polarization may represent a valuable tool to monitor disease activity and predict clinical outcomes in SSc patients with lung disease.
Systemic sclerosis (SSc; scleroderma) is a multi-system autoimmune disease involving the skin and internal organs such as the lungs, heart, gastrointestinal tract, and kidneys (1). It is characterized pathologically by tissue fibrosis, proliferative/obliterative microvascular disease, and immunologic disturbances. Based on the extent of clinically affected skin, 2 major subsets of SSc have been identified: diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) (2). Currently, interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH), alone or in combination, have the greatest impact on SSc-related morbidity and mortality. Patients with dcSSc and lung involvement have an estimated 5-year survival of <50% (3).
ILD is the most common pulmonary complication in SSc, affecting 25–90% of patients, depending on the method used for diagnosis and the patient's risk factors, including age at onset, ethnicity, and autoanti-body (i.e., anti–Scl-70) status (4,5). ILD is more frequently associated with dcSSc (40–50%), but patients with lcSSc can be affected as well (30%) (6). Severe progressive pulmonary fibrosis occurs in a substantial subset of patients. Importantly, the extent of the involved skin does not correlate with the severity of lung disease (7). PAH is present in 15–35% of patients with lcSSc and in 25–30% of patients with dcSSc, in whom it is often associated with ILD (7,8).
The clinical course of SSc, particularly that of lung disease, is chronic and highly variable, making it challenging to determine which patients will experience the most severe disease and in whom early aggressive treatment would therefore be justified. Despite our current understanding of the pathogenesis of SSc, clinicians caring for patients with SSc lack reliable biologic markers that characterize disease activity or predict clinical outcomes. An inflammatory mononuclear cell infiltrate is thought to precede the development of end-organ damage and fibrosis, particularly within the 2 major organs affected: the skin and lungs (9,10). CD8+ T cells are seen in the pulmonary interstitium on lung biopsy specimens and are increased in the bronchoalveolar lavage fluid from SSc patients with active lung disease (alveolitis) compared with SSc patients with inactive lung disease or no lung disease (11). These T cells exhibit an activated phenotype (HLA−DR+), and their presence in the bronchoalveolar lavage fluid is quantitatively associated with progressive and more severe ILD (12,13). Similarly, activated T cells are described in skin biopsy specimens from SSc patients who have early active cutaneous involvement (14). Whether T cell activation in SSc is associated with specific immune effectors and mediators is not well studied, nor is it clear whether the prevalence of specific T cell subsets correlates with clinical measures of disease activity or is ultimately associated with distinct clinical phenotypes.
Two functional subsets of T cells with distinct cytokine-secretion profiles are recognized (15). Type 1 (Th1/Tc1) T cells produce predominantly interferon-γ (IFNγ) and interleukin-2 (IL-2) and are involved in delayed-type hypersensitivity and defense against intra-cellular pathogens. Type 2 (Th2/Tc2) T cells secrete IL-4, IL-5, IL-10, and IL-13 and participate in humoral immune (IgE) and antiparasitic responses. Interestingly, these 2 subsets potentially exert opposing roles in regulating tissue remodeling and fibrogenesis. IFNγ suppresses fibroblast activity and the production of extra-cellular matrix proteins (e.g., collagen and fibronectin) (16). In contrast, Th2/Tc2 cytokines (IL-4 and IL-13) activate fibroblasts and collagen production directly or indirectly by inducing secretion of profibrotic cytokines such as transforming growth factor β (17).
Experimental data suggest that a network of potentially profibrotic cellular and humoral mediators is established within the target tissues in patients with SSc (18). Plasma levels of IL-4 and IL-13 are elevated in SSc patients compared with healthy control subjects (19,20). Th2 cytokine expression and secretion are increased in T cells isolated from newly affected SSc skin (21,22). Activated CD8+ T cells in bronchoalveolar lavage fluid from SSc patients with alveolitis have higher type 2 cytokine (IL-4 and IL-5) messenger RNA (mRNA) expression (12,13). These data suggest that in SSc, a specific population of activated T cells exhibiting a profibrotic Th2/Tc2-polarized phenotype may be potentially relevant in mediating tissue fibrosis.
In this study, we sought to investigate the relationship between clinical manifestations of SSc and characteristics of the underlying immune response. We hypothesized that a relative predominance of polarized T cell subsets in the peripheral blood may correlate with specific clinical features, particularly with distinct features of SSc-related lung disease phenotypes. For this purpose, we applied reliable and sensitive tools to measure ex vivo the polarization (type 1 or type 2) of circulating T cells in a well-characterized group of patients with SSc. The accurate characterization and measurement of the immune response in relation to SSc-specific clinical manifestations may provide significant insight into the disease process and lead to the identification of accurate biomarkers of disease activity, predictors of outcome, and, ultimately, novel disease-specific therapeutic targets.
Sixty-two consecutive patients presenting at the Johns Hopkins Scleroderma Center were included in the study. All of the patients met the American College of Rheumatology preliminary criteria for the classification of SSc (23) and were subdivided as having dcSSc or lcSSc on the basis of the extent of their skin involvement (2). Control subjects were healthy volunteers recruited through public postings. The study was approved by the Johns Hopkins institutional review board, and written consent was obtained from all participants.
Detailed demographic data, including age, sex, ethnicity, education, smoking status (current, past, or never), and clinical information about disease duration (estimated from the date of onset of the first non-Raynaud's symptom), scleroderma subtype, specific organ involvement, and autoantibody status (anti–Scl-70 and anticentromere) were obtained from each patient at the time of his or her visit. Patients with intercurrent acute illnesses, cancer, or other nonscleroderma lung diseases were excluded from the study.
Skin involvement was scored according to the modified Rodnan skin score (range 0–51) (24). Internal organ involvement was assessed using previously published criteria (25). Pulmonary involvement was determined by abnormal results of pulmonary function tests, including measures of the absolute as well as the percent of predicted values for forced vital capacity (FVC) and single-breath carbon monoxide diffusing capacity (DLCO), according to the American Thoracic Society recommendations (26). Values for spirometry were referenced to the National Health and Nutrition Examination Survey and the values described by Hankinson et al (27), and values for DLCO were referenced to those reported by the Burrows group (28). The most recent pulmonary function tests were used for the purpose of the study. Pulmonary vascular disease was considered present if the estimated right ventricular systolic pressure (eRVSP) by Doppler echocardiography was ≥35 mm Hg, and no overt clinical evidence of congestive heart failure or thromboembolic disease was detected. Existing ILD was defined as an FVC <80%. The presence of ILD activity was determined by a >10% decline in FVC results for the 2 most recent consecutive pulmonary function tests. All data were available within 6 months from the study test. Subjects in this subgroup actively assuming any immunosuppressive regimen were excluded from this specific analysis. Heart, gastrointestinal, renal, or musculoskeletal involvement was considered present when the relative score according to the Medsger severity scale was ≥1 (25). The severity of Raynaud's phenomenon and evidence of sicca complex were determined by clinical criteria (29).
The polarization of circulating T cells in patients with SSc and healthy control subjects was determined using very specific type 1 (Th1/Tc1) or type 2 (Th2/Tc2) surface markers. The chemokine receptor CCR5 has been previously described as an exclusive marker of Th1 cells, while the prostaglandin D2 receptor DP2 (CD294), also referred to as chemoattractant receptor homologous molecule expressed on Th2 cells (CRTH2), recently emerged as a consistent, predictive marker of Th2 cell function in basic and translational studies (30–32).
Peripheral blood samples were obtained from the antecubital veins of the study subjects and collected in BD Vacutainer blood collection tubes containing sodium heparin (Becton Dickinson, Franklin Lakes, NJ). Immediately, 50 μl of blood was placed in polystyrene round-bottomed tubes, and 10 μl of fluorochrome-labeled antibodies or isotype controls (used to detect the presence of nonspecific staining) was added. The reagents used were peridinin chlorophyll A protein–conjugated anti-CD3, fluorescein isothiocyanate–conjugated anti-CD4, allophycocyanin-conjugated anti-CD8, and phycoerythrin-conjugated anti-CCR5 (all from BD Biosciences, San Jose, CA) or anti-CRTH2 antibodies (Miltenyi Biotec, Auburn, CA). The tubes were incubated in the dark for 30 minutes at room temperature. Two milliliters of ACK red blood cell lysing buffer (BioSource International, Camarillo, CA) was then added, and the cells were gently vortexed. After 15 minutes of incubation, 2 washes with phosphate buffered saline were performed, and the samples were immediately analyzed using a 2-laser 4-color flow cytometer (FACSCalibur; BD Biosciences). Calibration for sample acquisition was done using CaliBRITE beads (Becton Dickinson) and AutoCOMP software (Becton Dickinson). Gating for acquisition was set on live lymphocytes and CD3+ cells. The stained samples were analyzed with CellQuest software (Becton Dickinson), and the relative CCR5+ and CRTH2+ T cell frequencies were calculated.
Before starting the investigation, the stability of CCR5 and CRTH2 T cell surface expression was tested in 12 healthy volunteers, at baseline and on days 1, 3, 10, and 25. Using a two-way mixed model, we observed a high consistency (P < 0.001) among the relative frequency of CD3+, CCR5+ and CD3+, CRTH2+ T cell subsets as well as the mean fluorescence intensity for both surface markers. In addition, we also confirmed that T cells identified by CCR5 and CRTH2 exhibit, respectively, a predominant Th1 (IFNγ)– and Th2 (IL-4)–polarized intracellular cytokine profile (32).
All variables were examined and transformed when a non-normal distribution was evident. Means and proportions among groups were estimated and tested using analysis of variance (with the least significant difference post hoc test) and cross-tabulation with chi-square tests. To evaluate the consistency of CCR5+ and CRTH2+ T cells across time, interclass correlation coefficients were calculated with a two-way mixed model. Bivariate associations were assessed by calculating Pearson's correlation coefficients. Linear regression analyses were also used to evaluate relationships between SSc subtypes. Statistical analyses were performed with Stata version 9 software (Stata Corporation, College Station, TX). P values less than or equal to 0.05 were considered significant.
The sociodemographic and clinical characteristics of the study subjects are summarized in Table 1. There were no statistically significant differences between study groups in sex, race/ethnicity, education, and history of smoking. The patients with SSc were predominantly women (84%) age ~50 years; 68% were white, and 22% were African American; 25% reported past smoking, and 9% reported current smoking. Healthy control subjects were younger than patients (P = 0.05). As expected, the modified Rodnan skin score and level of anti–Scl-70 antibodies were significantly higher in the group with dcSSc, while anticentromere antibodies were present only in patients with lcSSc. The 2 patient populations did not differ significantly in terms of disease duration, results of pulmonary function tests (FVC and DLCO), eRVSP, and other internal organ or system involvement. Among patients with renal involvement in the dcSSc group, 2 had a history of hypertensive renal crisis.
The polarization of circulating T cells was measured in 62 patients with SSc and 36 healthy control subjects. The relative number of CCR5+ T cells (Th1/Tc1) was lower in patients with SSc compared with control subjects (mean ± SD 18.2 ± 10.3 versus 25.1 ± 8.5; P = 0.001), while the number of CRTH2+ T cells (Th2/Tc2) was increased in patients with SSc (3.4 ± 2.0 versus 2.3 ± 1.1; P = 0.001) (Figure 1). The net effect of these opposite frequencies was reflected by a significantly lower CCR5/CRTH2 T cell ratio in patients with SSc (mean ± SD 6.7 ± 4.3 versus 12.9 ± 6.7; P < 0.0001), indicative of a Th2/Tc2-biased immune phenotype. The same differences were detected in CD4+ and CD8+ T cell subsets (data not shown). The subsequent analysis was conducted on SSc patients categorized according to disease subtypes (i.e., lcSSc or dcSSc and the presence of clinical manifestations such as ILD). The observed changes in the CCR5/CRTH2 ratios were consistently the result of CCR5 and CRTH2 expression moving in opposite directions (i.e., lower CCR5+ and higher CRTH2+ T cell subset frequencies for low ratios). Therefore, the CCR5/CRTH2 T cell ratio was adopted as the marker to express the degree of T cell polarization.
Evaluation of disease subtypes showed that both patients with lcSSc and those with dcSSc exhibited a significantly lower CCR5/CRTH2 ratio in total T cells (CD3+) as well as CD4+ and CD8+ subsets compared with control subjects (P < 0.0001) (Figure 2A). In addition, a trend toward a lower CCR5/CRTH2 ratio was observed in dcSSc compared with lcSSc, with a statistically significant difference only for the CD8+ subset (mean ± SD 5.3 ± 4.2 versus 9.6 ± 7.2; P = 0.05). No association was observed between CCR5/CRTH2 ratios and the modified Rodnan skin score, specific autoantibody subsets (anticentromere or anti–Scl-70), or other clinically relevant SSc-related manifestations, including gastrointestinal disease and renal disease, the severity of Raynaud's phenomenon, and the presence of active digital ischemia.
After classifying SSc patients based on the presence or absence of ILD, a significantly lower CCR5/CRTH2 T cell ratio was observed in SSc patients with ILD compared with those without ILD (mean ± SD 4.0 ± 2.6 versus 8.8 ± 4.2; P < 0.0001) and healthy control subjects (4.0 ± 2.6 versus 12.9 ± 6.7; P < 0.0001) (Figure 2B). Both CD4+ and CD8+ T cell subsets exhibited a significantly "skewed" Th2/Tc2-polarized phenotype. To further investigate the strength of this association, we next analyzed the differences in T cell polarization among patients with SSc in relation to the severity of the underlying ILD. As illustrated in Figure 3A, the CCR5/CRTH2 T cell ratio and FVC value (percent of predicted) exhibited a direct positive correlation (r = 0.54, P < 0.0001), suggesting that worse restrictive lung disease is associated with a higher degree of Th2/Tc2 T cell polarization. Similar results were observed for CD4+ and CD8+ T cells, using the absolute FVC value (liters) and the total lung capacity (liters and percent of predicted) as the lung function parameters of reference. In order to consider a possible role of a Th2/Tc2-polarized immune response in the development and progression of SSc lung fibrosis, we divided the patient population into 2 groups: those with a >10% decline in FVC measurements over the 6 months preceding the experimental blood testing and those with stable lung function. The patients with evidence of declining lung volumes (i.e., likely active ILD) at the time of the assay exhibited a significantly lower circulating CCR5/CRTH2 T cell ratio (mean ± SD 3.2 ± 2.5 versus 8.4 ± 4.4; P < 0.0001) (Figure 4).
No statistically significant relationship was observed between the CCR5/CRTH2 T cell ratio and the DLCO value (percent of predicted) (r = 0.17) (Figure 3B). However, a U-shaped curve was observed, indicating that a relatively higher CCR5/CRTH2 T cell ratio (Th1/Tc1 polarization) is present in patients with SSc in whom the levels of DLCO are normal or extremely low. Clinically, a significantly and/or disproportionately low DLCO level can be detected when PAH is present. Therefore, we subdivided our study population based on our best available evidence for the presence of pulmonary vascular disease, using an abnormal eRVSP (>35 mm Hg) on the most recent echocardiogram as the discriminating value. Interestingly, an opposite correlation between circulating T cell polarization and the DLCO was observed (Figure 5). In patients with an eRVSP <35 mm Hg, a lower DLCO was significantly associated with lower CCR5/CRTH2 ratios (Th2/Tc2 phenotype) (r = 0.58, P < 0.0001), with a distribution similar to that previously observed for the percent predicted FVC. In contrast, in patients with an eRVSP >35 mm Hg, a negative relationship was measured, with a lower DLCO value associated with higher CCR5/CRTH2 ratios (Th1/Tc1 phenotype) (r = −0.51, P = 0.009).
This investigation provides new insights into characteristics of the immune response in scleroderma and is the first to demonstrate a significant correlation between specific T cell subsets and distinct clinical manifestations. We used sensitive markers and specifically the CCR5/CRTH2 ratio of circulating T cells to reliably measure directly ex vivo the polarization of the underlying immune phenotype in a well-characterized group of patients with SSc.
We observed that a significant Th2/Tc2 bias is present among patients with scleroderma compared with healthy control subjects, and that both CD4+ and CD8+ T cells exhibit this "skewed" type 2 phenotype. Moreover, in patients with SSc, Th2/Tc2 polarization was significantly associated with the presence of ILD. This association was further confirmed by a strong linear correlation between a lower CCR5/CRTH2 T cell ratio (Th2/Tc2 bias) and worse FVC values. Although this was a cross-sectional analysis, we did have access to longitudinal lung function studies, allowing us to examine whether low CCR5/CRTH2 ratios were more likely to be observed in patients with active lung disease. Interestingly, the CCR5/CRTH2 T cell ratio was significantly lower in patients with SSc who had experienced a recent decline (>10%) in FVC values, suggestive of lung disease activity at the time of peripheral blood analysis. Although the CCR5/CRTH2 T cell ratio was not significantly associated with the DLCO value, an interesting finding became evident when the presence of pulmonary vascular disease (indicated by an abnormal eRVSP value as measured by echocardiography) was considered. In SSc patients with an eRVSP >35 mm Hg, a lower DLCO value was strongly associated with higher CCR5/CRTH2 ratios, suggestive of Th1/Tc1 T cell polarization, while those with an eRVSP <35 mm Hg exhibited an opposite correlation. Thus, the presence of ILD in our patients with SSc was associated with a Th2/Tc2 bias, with lower CCR5/CRTH2 ratios being even more prevalent in patients with progressive worsening of their lung function. In contrast, the presence of pulmonary vascular disease appears to be characterized by a dominant Th1/Tc1 circulating T cell phenotype.
Notably, although we observed that CCR5/CRTH2 ratios were generally lower in patients with dcSSc compared with patients with lcSSc, the modified Rodnan skin score (degree of skin disease) did not show any correlation with the polarization of T cells. We interpret this finding cautiously because of the cross-sectional design of our study and the high variability of skin involvement over time in scleroderma. In addition, although the lung function test is an excellent measure of ILD and its progression, we acknowledge that the echocardiographic determination of the eRVSP is not a definitive measure of pulmonary vascular disease or PAH. Most of our patients did not undergo right heart catheterization. Nevertheless, evaluating the eRVSP by echocardiography represents a widely accepted and validated screening method for determining the presence of pulmonary vascular disease (33). Thus, the presence of a prevalent Th1/Tc1 T cell phenotype in patients with a high eRVSP may suggest a possible association with emerging or actual PAH, which will need to be further confirmed using direct measures (right heart catheterization) in longitudinal studies.
A dominant Th2 immune response in patients with SSc has been previously reported, but the prevalence of a Th1 or a mixed immune phenotype has also been described (19,20,34,35). Importantly, the methods used to determine polarization of the immune response have been, in most cases, indirect and based on measuring highly variable parameters such as cytokine plasma levels or their mRNA expression within circulating cells or target tissues. In contrast to cytokine genes, CCR5 and CRTH2 are constitutively expressed in type 1 and type 2 T cells, thereby providing a more direct, stable measure of the relative prevalence of either subset. Furthermore, no study has specifically addressed and accurately analyzed the correlation between the polarized T cell phenotype and the underlying SSc-specific clinical manifestations. For these reasons, the clinical and pathogenetic relevance of a polarized immune response in SSc has not yet been fully elucidated.
Our study used a sensitive, reliable, and easily reproducible experimental assay and measured ex vivo the polarization of circulating T cells, using very specific surface markers. The SSc patient population analyzed was relatively large, clinically well characterized, and selected independently of any laboratory study or disease status. These factors confer strength and relevance to our findings and draw attention to the measurement of evolving T cell polarization (the CCR5/CRTH2 T cell ratio) as a potential novel and sensitive approach to monitor the course of disease manifestations in scleroderma and particularly in lung disease. Our findings suggest the possibility that the CCR5/CRTH2 ratio will not change over time in patients with SSc in whom lung disease is stable, while it may decrease, marking a shift toward a higher Th2/Tc2 bias, just before or at the time of onset of active alveolitis. Furthermore, a greater type 2 skewing of circulating T cells at the time of diagnosis or early in the disease course may identify patients who are at higher risk of ILD developing or in whom ILD will progress to more severe disease. Indeed, a group of patients in our study had normal results of pulmonary function tests and exhibited a relatively low CCR5/CRTH2 ratio (Figure 4). It will be of great interest to follow up these patients prospectively and to confirm the predictive value of measuring a polarized T cell response before lung disease becomes manifest.
This is the first report to describe the detection of an opposite pattern of T cell polarization in association with SSc-related ILD or pulmonary vascular disease. The relevance of a Th2/Tc2-polarized immune response in the pathogenesis and progression of SSc lung fibrosis is plausible, although it remains to be confirmed whether such bias is present within early inflammatory lung infiltrates during ILD initiation. With regard to SSc vasculopathy, previous studies have implicated both cellular and humoral immune effector pathways and have demonstrated that T cells can cause microvascular injury directly through cell-mediated cytotoxicity or by inducing proinflammatory molecules on the endothelial cell surface (36,37). Recently, new data have shown that the endothelium and inflammatory cells infiltrating vessel walls in lesional skin and lung biopsy specimens from patients with SSc exhibit up-regulation of IFNγ-inducible molecules that are implicated in vascular smooth muscle migration/proliferation as well as proinflammatory cytokine secretion (38).
Thus, it is possible that a Th1/Tc1 microenvironment is functionally relevant for generation of the vascular disease seen in scleroderma. Further studies are needed to determine whether the polarized immune responses observed in the context of specific SSc lung disease manifestations are causally implicated or whether they result from abnormal lymphocyte trafficking secondary to the specific tissue damage affecting different lung compartments in SSc (i.e., interstitium or vascular bed). Other disease models exist in which extreme immune polarization toward a Th1 or Th2 response can be associated with different disease manifestations and mediate distinct outcomes. For example, in human schistosomiasis an initial acute proinflammatory Th1 response continues until a transition toward a chronic Th2 polarization occurs, with promotion of perioval granuloma formation (39). When this Th1-to-Th2 shift is balanced and controlled, the disease tends to be mild. Conversely, a persistent Th1-type response correlates with a more severe systemic infection, while an excessive Th2-dominated tissue environment is associated with development of severe liver fibrosis (40).
Our study provides new insight into potential pathogenetic pathways in scleroderma and may have important clinical implications, particularly in terms of the management and treatment of lung involvement. Clinicians caring for patients with SSc are challenged to identify those with active lung disease, who predictably will experience progressive loss of lung function. In addition, potentially toxic immunosuppressive treatments are administered and monitored based almost exclusively on crude clinical responses, with significant attendant morbidity and mortality. Measuring the CCR5/CRTH2 T cell ratio in the peripheral blood of patients with SSc in order to quantify polarization of the immune response may prove to be a useful measurable biologic marker to monitor disease activity and allow early identification of patients who will evolve toward a more aggressive and life-threatening disease phenotype. In addition, this assay has the potential of a broader application to other autoimmune conditions associated with ILD, including, for example, the antisynthetase syndrome in myositis, systemic lupus erythematosus lung disease, and mixed connective tissue disorder. Finally, specific interventions to rebalance skewed type 1 or type 2 T cell responses in patients with developing PAH or ILD may represent a novel therapeutic strategy.
In summary, we have demonstrated that specific manifestations of lung disease in patients with SSc are strongly correlated with opposite patterns of circulating T cell polarization, as measured by the CCR5/CRTH2 T cell ratio. A Th2/Tc2-polarized immune response is associated with ILD and particularly with active lung disease. We speculate that polarized T cell effectors may have a crucial role in the development and/or progression of lung disease in SSc. Further characterization and prospective measurement of polarized type 1/type 2 immune effectors in SSc are needed to confirm these data and to allow the identification of more dependable biomarkers of lung disease activity and accurate predictors of outcome, and potentially to open the door to novel disease-specific therapeutic targets.
Dr. Boin's work was supported by an Irvington Institute/Dana Foundation Human Immunology Award and by the Scleroderma Research Foundation. Dr. Rosen's work was supported by NIH grant P-30-AR-053503. Dr. Casolaro's work was supported by NIH grant R01-AI-041463.
Dr. Boin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study design. Boin, Wigley, Rosen, Casolaro.
Acquisition of data. Boin, De Fanis.
Analysis and interpretation of the data. Boin, Wigley, Rosen, Casolaro.
Manuscript preparation. Boin, De Fanis, Wigley, Rosen, Casolaro.
Statistical analysis. Boin, Bartlett.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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This Actions On Google client library makes it easy to create your apps for the Google Assistant.
The client library supports both the Actions SDK webhook and Dialogflow fulfillment.
let ActionsSdkApp = ActionsSdkApp;
const app = request: request response: response;
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Please read and follow the steps in the CONTRIBUTING.md.
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With JukeTweetPro, you can share songs, albums, and podcasts from your iPhone or iPod Touch with your Twitter friends. If possible, JukeTweetPro will include a link to the iTunes store with your post, so your friends can listen online.
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