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Trump Review Highlights
Recent Hotel Deals & Upgrades
Room Upgrade Reports
I was in the line and got a lovey girl but as she was next to another receptionist with a customer I had to ask quietly "Is there any chance of a complementary upgrade?"
Certainly sir, I'll do that now for you.
And what a beautiful suite!
I feel like a millionaire
I was a little afraid to try this but we slipped a $50 in between our cards and without another word the money was gone and our room doubled in size.
We arrived Saturday at around 1:00 PM. The line was rather short. I walked up when it was my turn and was asked my name and then for ID & credit card. I handed over the ID, credit card & $20.00 on top (I forgot to sandwich it.) He immediately said that he would be able to get us a nice room. We only asked for something with a good view. As he was looking we chatted a bit. He asked if we were celebrating anything (my birthday the following week). He asked how long we had been married (28 years). And voila! He pulls out a book with sketches of the rooms and shows us the One bedroom corner suite. I was waiting for an upcharge to be attempted, but there wasn't! Same price as our deluxe room. He gave us the room number and key and then we started talking about restaurants and he gave us some very helpful, specific advice for our dietary issues. My husband was so appreciative he tipped him again ($20.00)…..THEN! He asked if noise was a concern and if we didn't mind waiting a bit for a different one bedroom corner suite as he could switch it to a quieter area if we could wait. We preferred the quieter room and didn't mind waiting (we were super early for check in due to our flight time). We were going to go walk the strip, but first we stopped at the bar for a drink and our room was ready before we even finished the drinks. Our room was awesome! We never heard our neighbors (or even saw them – maybe we didn't have any neighbors). We could hear some sirens and the the train during the day, but no annoyances at night as we run a sound machine when sleeping.
Was called to the desk by a guy during evening check in on a Sunday. Slow week. Gave him the sandwich. Asked if there were any complimentary upgrades because we were here for a special event. My birthday. And we're hoping for a strip view. He said he'll see what he can do. Got us the strip view on a high floor but no suite still very nice and worth the $20 easily.
We arrived around noon time, and there were a lot of people checking in. When it was my turn, I just went up to the clerk. She asked me for my ID, and I gave her the sandwich without saying anything. She totally understood the hint, and said " I will see what I can do". She upgraded us to a nice one bedroom suite with strip view on a pretty high floor. It was so worth it!
We waited in line and got a young eastern european lady. She was lovely we made small talk and she asked for our ID & Credit card. In that we slipped in a 20. We asked her if she had any upgrades available. She said she would take a look. She told us she had a one bedroom corner suite on the 33rd floor. It was lovely. We had onyl booked the bog standard room and through priceline. We got a one bedroom suite, full kitchen, 2 bathrooms, jacuzzin tub and floor to ceiling windows, full living room with sofa etc.
Got a front desk lady by chance. She just came out from the back and flagged us over. It was around 1pm, on a Sunday. She asked for ID and a credit card. I sandwiched a $50 bill in between and handed to her. Before saying my line, she smoothly asked me if I would be looking to upgrade. I responded with, "if that is possible, then yes please." She gave us a one bedroom corner suite on a high floor with a great view. We loved it! I wonder what could've gotten us into the one bedroom penthouse…?
Attended for a bachelor party (we made sure to mention this). We checked in at the normal check-in time around 2pm. My girlfriend and I approached a young lady at the front desk and slipped the $20 in between the debit card and ID. My girlfriend didn't even see me do it ( I was very sly). We made casual conversation, and then quietly asked if there was any complimentary upgrades, she smiled and said that there was a one bedroom corner suite available. YES! That was exactly what we wanted. The room was gorgeous! Can't wait to stay again.
Got to the check-in desk at about 11:00 AM. Took the first available clerk after standing in line about 10 minutes. I handed her the sandwich and told her I was there for a convention but my wife came with me for pleasure and asked if any complimentary upgrades were available because I wanted something special for my wife.
She checked and came back with an offer of a "junior suite". I don't think that room type actually exists at the Trump.
She could tell I wasn't thrilled with that offer and checked again. She then said she would upgrade us to the "honeymoon suite" if we could wait until 3:00 PM to check in. I took that deal. Again, I think she made up "honeymoon suite" but what we got was a superior one bedroom suite. It was worth every penny of the $50 and then some. My wife absolutely loved the room. We are going to try this again next week.
Checked in just after 3PM. A nice woman was my clerk. When she asked for the credit card and ID, I gave her the sandwich and asked if she had any complimentary upgrades available. She said certainly, typed away for a minute, and said "I'll be right back". She went to the back room, and when she came back the explained we had an "option". She then went on to explain all the perks of our 1500sq ft one bedroom penthouse, which she would happily offer as a complementary upgrade. Started off my brother-in-law's bachelor party on a huge plus!


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Hilton Garden Inn New Orleans is an atmospheric and upscale venue that sets the stage for a night out that'll quickly turn into an exciting crime scene.
Our murder mystery dinners in New Orleans usually sell out, so make sure to reserve your spot early. Your ticket includes your 3-course meal, world-renowned immersive murder mystery dinner show, and a chance to win one of our many award certificates!
America's favorite immersive murder mystery dinner theater show is now performing in New Orleans, Louisiana! Solve a comedic crime while enjoying a three course dining affair.
Unlike other theatrical shows, The Murder Mystery Company experiences are completely interactive and immersive. From the moment you enter to take your seat, you are a part of the action. You witness a crime, assemble clues, interrogate suspects, and solve the crime, all before you finish your dessert! Work with your entire table to solve our live-action game of Clue.

subset: commoncrawl


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If you've ever considered having a nonsurgical eyebrow lift done but aren't sure about the process, results and potential risks, then read on to learn just what to expect and see if you are a good candidate for this procedure.
What to Expect During Your Lip Augmentation
You've decided you want plumper, fuller lips. Movie star lips. Maybe you have smoked in the past and have developed fine lines around your mouth. Or maybe, with age, your lips are getting droopy and you want to reclaim the upward lift they held in their youth. You know exactly what to do: get a lip augmentation! For more information on lip augmentation and various natural skin treatments from the top cosmetic surgeon in Melbourne, reach out to Dr. Taras today!
Avoiding a "Heavy" Face as You Age
As you get older, you might begin to notice that the lower part of your face appears heavier than it did in your youth. Part of this is loss of skin elasticity and the descent of facial fat. Another major reason for the heaviness effect, however, is the enlargement and squaring of the jaw. The masseter muscle, which is responsible for chewing, becomes enlarged over time through genetic predisposition or because of tooth grinding and clenching.
Best Foods to Eat for Healthy Skin
You are what you eat. What you metabolize in your body affects the health of your skin. Detox your skin and learn how diet affects skin health. This article takes a look at 10 of the best foods for healthy skin.
The Miracle of Scar Treatment
Our skin is an amazing organ. And when an injury happens, it begins to heal itself. Unfortunately, one of the sometimes unsightly side effects of this amazing healing process is the formation of scars. Oftentimes, scars are small or are in a place that can be concealed from view. But there are some injuries that produce scars that will never go away. Read on to learn more about treating those unsightly scars and getting your healthy skin back.
Say Goodbye to Wrinkles
Whether you call them wrinkles or laugh lines, they appear more frequently as we age. Fortunately, there are many options to consider when developing a plan of attack against wrinkles. Injectable wrinkle fillers are a common and easy treatment and can be done for a fraction of the cost of a complete face lift. If you have horizontal lines across your forehead, crow's feet, lines between your eyebrows, lines around your mouth or on your neck, then an injectable wrinkle filler might be your best treatment option for getting rid of wrinkles.
What Causes Stretch Marks?
Stretch marks typically appear as bands of parallel lines on your skin. These lines are a different color and texture than your normal skin, and they range from purple or bright pink to light gray. When you touch stretch marks with your fingers, you might feel a slight ridge or indentation on your skin. Sometimes, stretch marks feel itchy or sore.
Taking Off the Years with Anti-Wrinkle Injections
Looking for a solution to frown lines, crow's feet and forehead lines? Anti-wrinkle injections aim to restore youth to your skin you may have lost over the years.
What are anti-wrinkle injections?
Anti-wrinkle injections contain a highly purified protein derived from bacteria. The protein is injected into the face or body which causes temporary paralysis of the muscles.


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I know I heard discussion of how to make history based model objects much healthier than the older ones, but I never got to see the guts of what came out in 2020. I know they did have that top of mind in development talks. I always converted to generic solids as well before exporting for a 3D print, but that was needed less and less in the later versions. Since I don't use modeling software in my daily work now I haven't seen what 2020 can do in person. I'd have loved to be able to keep each history aspect for powerful editing later and I wanna see about trying out 2020 myself at some point! Maybe I'll take a college class and get a student license. 👨🎓
SEAN IM SORRY! I still lurk indeed! But I was by no means the best. The guys in tech support were miles ahead of where I had been when I was a tech, we built a lot of systems for sharing knowledge and discussion in my time there, they've got you. I was just possibly the noisiest member of support, lol.
For over a decade at Vectorworks I wished for and dreamed of a Dark mode and it came out just months after I left!! *Shakes fist at the cruel sky*
Amorphous - Julian started following Jim W
Gobo texture on dance floor
Jim W replied to jarjones's topic in EntertainmentThere are a few things that have to be set up right to see Gobos in renderings, I'm pretty sure its covered here:
2020 Teaser Tuesday - List Browser Direct Editing - Vectorworks 2020
Jim W replied to JuanP's topic in News You NeedOooooooh Single Sign On might be getting closer!
Shop using SW 2019 cannot 3D render DXF export.
Jim W replied to Bob Griffith's topic in Solids ModelingWhat other formats will they accept than DXF? STL may work depending on the kind of shape and type of machining they're doing.
I don't think it's truly more accurate, it just feels that way to me. The scrolling is the part about the Magic mice that I love, it's the perfect surface for it. I just became addicted to a physical clicky wheel long ago and like mice with a high arch in the palm.
Saving to PDF
Jim W replied to Bob Keenan's question in TroubleshootingExport PDf was added to Fundamentals I think in 2018? It wasn't present in 2012 Fund I'm pretty sure. On Windows 10, I'm fairly certain you can just go to File > Print and then it should usually offer Microsoft Print to PDF as a printer choice. You might need Adobe Reader installed to see this, but I always have it so I'm not sure if that's the case. But thats just OS level, and nothing to do with Vectorworks itself. If it worked on Windows 7 but you don't see the same thing on 10, then it means you may have had a third party PDF utility installed and you might need to go get it again for your new machine.
Been using a nice MX Master (the older one not the 2s) I got on an amazon sale, it is lovely. The scroll wheel defaults to a nice clickiness, but it has kind of an electric clutch that lets it switch over to smooth scrolling when flung rapidly, and then reverts back to being notched and accurate when you scroll slowly. No extra buttons for those who like the extra mouse shortcuts, but the accuracy, feel and that wheel feature have me sold on it.
2019 VW slow to start
Jim W replied to GAW-Grant's question in TroubleshootingIf thats the case, the next time you look into a computer upgrade, you may want to invest in more RAM. Chrome is my favorite browser but it hogs a LOT of memory.
Neil Barman started following Jim W
The stand price left me speechless. Not even height or rocker arm style adjustment.
You can mix resolutions, its very common. In some OSes you have to have both of them have the same scaling of the UI, but resolutions can be separate without issue. When it comes to Vectorworks, IF you mix resolutions, then your experience will be poor, as Vectorworks will have to pick the scaling of one monitor or the other which would make it look a mess on the other. I almost always have dual monitors at minimum in my workflow, but I use Vectorworks on a single display. Oh yeah. If you have the graphics power to handle it, its great. Much more room for the UI, the OS elements can be made smaller while still remaining clear. However, I do not wear glasses and have great vision. I have heard from many people with vision concerns that they didnt benefit as much from 4k because they couldnt tolerate the letters being as small as it was possible to make them.
How to draft a 3D swimming pool
Jim W replied to Mason2152's topic in General DiscussionSo the Fundamentals guide had a bit of that: https://www.vectorworks.net/training/2016/getting-started-guides/fundamentals But these days for that kind of oganic shape, I'd recommend the Subdivision tool, it should be able to easily whip out a pool shape: Its changed a bit since then, but still close.
Vectorworks isn't allowed to, sadly. Cloud processes require creating a virtualized instance of the OS, and macOS does not allow that, even on it's own hardware. 😞 All Cloud Services instances are Windows because of this. That will hopefully change someday but last I heard it was up to Apple.
I personally prefer macOS as a daily driver as well. It's got some annoying bits, but quicklook and expose are still hard to really match even with third party extensions on Windows. I will say that OTHER than the annoying autoupdates, Windows 10 is quite well worked out now. I was a big Windows 7 proponent for a long time as I hated 8, but 10 has finally started down the path of improving things again. It's not a terrible time to switch, or to get a mid-range machine in the meantime and learn it slowly. I'd say the main considerations are cloud storage and account syncing solutions before a transition is made. EDIT: Forgot I found this little gem the other day, not AS good as Apple's quicklook, but its 90% of what I want it for on Windows: https://www.microsoft.com/en-us/p/quicklook/9nv4bs3l1h4s?activetab=pivot:overviewtab


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- Disc Jockey
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Ring Bearers Who Completely Stole Our Hearts 2.9.19
Why Picking Your Wedding Photographer Matters 1.28.19
How to Walk into your Reception like a Boss 11.1.18
YES! You made it through the wedding ceremony! Now, it's time for your first announcement as a married couple. Walking into your reception is kind of a big deal, and you don't want to wait until the day of to figure out how you're going to make your grand entrance! These days, moments like […]


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Last Updated: August 13, 2019 (Refresh Now)
Magic Gate for Dogs Stretchy Pet Barrier Mesh Folding Baby Safety Fence Portable Dog Safe Guard Enclosure for House Indoor Stair Doorway Use Width 43 47 Inch Black
Last Updated: August 13, 2019 (Refresh Now)
Total Reviews
Old Reviews
Spam Test
47 meters
Review Summary - 30 recent, verified reviews
Detailed Mode
Build Quality8
twisted, screw, hooks, hole, fabric
" ... I did not attach it to the door frame because the mesh didn't seem strong enough to keep my little dog from digging under the gate. ... "
" ... Very small dogs broke right through it. ... "
" ... First hole pilot hole drilled-twisted off. ... Second hole-same enlarged bit-second screw eye-twisted off. ... "
" ... My German Shepherd when right thru the mesh & broke the hooks. ... "
Track custom deep topics?
For Brands, Sellers & Businesses
hooks, wall, second, mesh, hole
" ... This is basically a yard of elastic mesh with metal hooks on the ends and some screw to put in the wall. ... "
" ... Fits almost any space. ... "
" ... It's strong enough to hold them back (which says a lot) and is also great because they cannot climb it. ... "
" ... Easy to mount. ... "
Ease of Use6
super, simple, easy to install, gate, dogs
" ... Super easy to install. ... "
" ... Easy sit up ... "
" ... Very simple yet much needed for our home. ... "
" ... Easy to setup gate to keep my dogs out of the kitchen. ... It works well and is easy to serup, no need to fumble with complicated setups, just hook and it's set. ... "
" ... It was super easy to install so, that was a plus. ... "
" ... Good quality and simple to use. ... Easy to mount. ... "
easy, super, install, gate, dogs
" ... Super easy to install. ... "
" ... It was a quick and easy install, I wasn't a fan of drilling a hole for the hardware into my stairs all though it was very nice it was all included, so I compromised and got compand hooks and they work like a charm. ... "
" ... Easy to setup gate to keep my dogs out of the kitchen. ... It works well and is easy to serup, no need to fumble with complicated setups, just hook and it's set. ... "
" ... It was super easy to install so, that was a plus. ... "
room, puppy, perfect, new, keep
" ... To keep our new puppy from going upstairs ... "
" ... This Gate is perfect for what we were looking for to keep our new puppy out of our closet. ... "
" ... I actually bought this for my hallway door frame which separates the bedrooms from the living room and kitchen. ... "
" ... The mesh is easily stretchable for the hooks to attach and close off the upstairs or other rooms. ... I'll definitely be getting more for other locations in the house! ... "
For Kids3
" ... So much better than the wooden child gate, is previously given her. ... "
" ... my boxer mix (whom I was really hoping to) -- It does however also work nicely as a gate to stop kids! ... "
" ... Keeps the kids and dogs safe from areas they don't need to be in. ... "
Review Spam Test PASS
In order to keep our review summaries as accurate as possible, we aggressively detect fake reviews. We use various signals to detect unnatural patterns and will gradually expose them here.
Size: 47 meters


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Peace & Prayers™ Standing Cross
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This cross is an impressive display made up of soothing lavender blooms in the shape of a cross, and accented with a cascade of white roses and eucalyptus. It is a beautiful way to offer peace and comfort during a difficult time.
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We are seeking an artist to transform the double-sided rebound wall at Grace Park through a site-specific mural.
The artist will need to design an artwork for each side of the wall with an innovative tennis and soccer theme.
Submissions are welcome from individuals and groups with the intention of designing and painting the mural throughout January and February 2020.
To express your interest, submit a quote and return brief to Boroondara Arts by 5pm Monday 25 November 2019.
Download the artistic brief
More information
For more information, please contact Bridget Flood, Boroondara Arts Cultural Development Officer, on 9278 4770 or at [email protected].


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I have started up a Facebook Page for Oliver's Labels by Mommy and would LOVE your support! Feel free to head on over there and Like Oliver's Labels by Mommy!
Oliver's Labels are definitely the label of choice in our house! The selling feature for me is the Found It code that allows your item to be tracked to you! To read more about the Found It Codes, check out out at www.oliverslabels.com/mommy!
Multi-Testing Mommy is an affiliate of Oliver's Labels. Opinions expressed belong to Multi-Testing Mommy and are NOT influenced in any way. See MTM's Disclosure for more details.


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Never underestimate spite as a motivator for genius.
-Sam Kean, The Disappearing Spoon: And Other True Tales of Madness, Love, and the History of the World from the Periodic Table of the Elements
« SyFy, you just had to make life difficult. | Main | Supernatural: The Third Man »


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In the "election surprises" category, this curious nugget of information wins first prize: in Broadmoor, the gated golf club community near Madison Park, five people voted for District 3 incumbent and Socialist Alternative member Kshama Sawant. Over 400 people in Broadmoor turned in ballots (mostly supporting third-place finisher Pat Murakami) this year. An unusually high number for the precinct.
Broadmoor is not alone. The uptick in voter turnout reflects a city- and D3-wide trend. Particularly higher-income homeowners turned out in larger numbers compared to 2015.
"The most conservative voters were more motivated for this election than they've been in quite some time in Seattle," said local political consultant Crystal Fincher.
But, she added, "we're seeing an overall energized electorate, particularly in Seattle. That's a really, really big deal." Fincher partly credits the city's Democracy Voucher program.
According to local consultant Ben Anderstone, Trump and KOMO's controversial 'Seattle Is Dying' documentary have something to do with it as well.
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Or at least the 2016 Presidential Election, which has galvanized voters, as has "the conversation around homelessness and the efficacy of the city providing social services," Anderstone said.
"The most motivated voters right now tend to be voters who are skeptical about the direction of the city, who feel that the city has been perhaps either too permissive or too spendy when it comes to the homelessness crisis. That's [also] reflected in polling which suggests higher income home-owning voters are especially likely to be dissatisfied with the direction of the city."
PACs like Moms for Seattle and others "added kindling to that particular fire," according to Anderstone.
The high voter turnout trend is likely to continue in the General Election in November. Higher voter turnout, which tends to be associated with greater turnout among lower-income voters, renters, non-college educated, and non-white voters, usually benefits more progressive candidates. And General Elections usually attract more progressive voters. That should be good news for Sawant. But, Anderstone added, the now-galvanized higher-income voters are "not just going to disappear."
"It is likely that this will be an unusually higher-income electorate for the General."
This dynamic has benefitted Orion (who garnered most support in wealthier areas with more homeowners, and did well in precincts with increased voter turnout) but slightly hurt Sawant in the primary, Anderstone said.
Precinct-level voting data shows Sawant easily racks up more than 50% of the vote in the denser, more racially diverse and renter-heavy heart of D3, where her message of rent control likely has resonated, but struggled in the north and water-adjacent precincts where Orion did well.
Sawant pinned down the crux of her reelection campaign in simple terms from the start. It would be a battle over who runs Seattle: Amazon and big business, or working people. Much as she built her past campaign around the $15 Now cause, Sawant's camp teed up rent control, social housing and taxing Amazon as the rallying flags heading into November.
Meanwhile, Orion, the former Capitol Hill chamber head and longtime Pridefest organizer, launched his campaign with talk of a more business-friendly approach and a more conciliatory messaging towards Amazon, the city's largest employer. Orion also said he was against what he called "half-baked" head tax but said he'd support new, similar efforts. In much of his messaging, Orion presented himself as a more moderate voice in City Hall and "good governance" candidate.
Challenger Zachary DeWolf took a similar approach from the left and positioned himself as a progressive alternative to Sawant's brash style. He came in fourth with 12.59% of the votes. Another progressive candidate, Ami Nguyen, a public defender with a focus on representing all of District 3 including neighborhoods far beyond its Capitol Hill core, was able to capture over 9% of the vote.
Anderstone said that Sawant lost voters to DeWolf and Nguyen, which he saw as a sign that not all progressive voters are ranking her as their first choice. "That's a negative signal for her, I think," he said, suggesting these votes are "on the table" for Orion.
Fincher saw it differently. Sure, you could look at Sawant's 36.7% total and call it a less-than-ideal performance, Fincher said. Comparatively, however, "you could say that [her] message resonated more than most other messages."
And given that most other primary candidates' visions — for the head tax and more affordable housing — line up with Sawant's, Fincher believes she is in a better position than Orion. "You can get to [at least] 50% in the primary of people who voted for pro head tax candidates," Fincher said.
But, she added, Sawant will have to galvanize voters who didn't cast their ballots and the ones who voted for DeWolf and Nguyen.
Fincher thinks that will happen when the discussion shifts from labels to policy.
"In primaries, it's really easy to talk in generalizations and draw distinctions based off of general messaging" such as "pragmatic" versus "radical socialist," she said. "It's much easier to polarize around those types of labels than it is to look at specific policy."
For Orion, presenting himself as the "good governance" candidate has resonated more than his policies, Fincher said. But in the General, you can't make up for vagueness with style, she said. "It's going to be tougher."
Both Orion and Sawant will have to walk delicate ideological lines, said Anderstone and Fincher.
"Because the success of [Egan Orion's campaign] was partly built on an unusually high conservative turnout, they're going to have a harder time walking the line of attracting the average, more progressive voter," Fincher said. "He's going to have to make himself a safe landing spot for them while also not scare off some of the very conservative voters, who were very motivated to vote for him. And that can be a tricky thing to pull off."
"He's going to have to appeal to those [progressive] voters while at the same time also driving energy among the kind of Seattle is Dying voters who are kind of reactive towards city issues," Anderstone said. "In terms of tone and approach to city issues, [these are] totally different groups."
Sawant, meanwhile, will have to straddle mobilizing her base plus lower-turnout voters while appealing to, Anderstone said, "voters who have soured a bit on her hyper populist approach."
"That might require a bit of a tonal shift. If she doesn't pull that off, I think chances are she's going to get knocked out in the General."
Want to learn more? Here is a map showing final tallies for all candidates in every King County Primary race from Jason Weill of Tableau.


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Chinese smartphone manufacturer Oppo has recently launched Oppo Reno and Reno 10x Zoom in China. The company has now launched the third smartphone Reno 5G in this series with the launch of these two smartphones globally. Reno 5G with Oppo Reno and Reno 10x Zoom has also been launched in the European market. Reno 5G is the first 5G Enabled smartphone of the company. The Oppo Reno 5G also offers you features based on the Reno 10x Zoom. For Reno 5G, Oppo has partnered with telecom companies like Swisscom (Switzerland), EE (UK), SingTel (Singapore), Telstra, and Optus (Australia).
Features and Specification of Oppo Reno and Reno 10x Zoom
Oppo Reno 10x Zoom has a 6.6-inch OLED full HD plus display without any display Notch. For best speed it works on latest 5G enabled Qualcomm Snapdragon 855 SOC Chipset Processor. Apart from this, the phone comes with in-display fingerprint sensor and to give power to the phone it has 4,065 mAh battery. The phone supports VOOC 3.0 fast charging. Talking about the camera of Oppo Reno 10x Zoom, it has a 48 megapixel + 13 megapixel + 8 megapixel triple rear camera setup with 10x hybrid zoom support. The phone has a sensor of 16 megapixels for selfie.
Oppo Reno has a 6.4-inch OLED Notch-less full HD + display. Speaking of other features of the phone, Snapdragon 710 SoC Processor is offered with 6GB + 256GB storage support. Talking about the camera of Oppo Reno, it has a 48 megapixel + 5 megapixel dual rear camera. In the phone, the 3,700 mAH battery is provided by the company with 18W Super VOOC Fast Charging Support. Other features of the phone are given just like the Reno 10x Zoom. Both phones work on ColorOS based on Android 9 Pie. Reno 5G has also been launched with Reno 10x Zoom. According to the reports, Oppo Reno and Reno 10x Zoom can be available in India in June. However, no official information has been received from the company regarding this.
Oppo Reno Price
In the EUR 500 (almost Rs. 39,000) Oppo Reno, the Reno 10x Zoom at EUR 800 (approx Rs 63,200) and Reno 5G at EUR 900 (approximately Rs 71,100) will be available. Oppo Reno and Reno 10x Zoom will be available for sale in Europe from May 10th. Reno 5G will be available for sale in the early months of June. Let us know you that Oppo Reno 10x Zoom is launched in China with 6GB + 128GB, 6GB + 256GB and 8GB + 256GB storage option. Pre-orders for Oppo Reno and Reno 10x Zoom have started. These two smartphones will be available in China first, whereas in other markets this series will be available later.


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PK Sport – Back In Britain
PK Sport was a surprise but very welcome addition to the GT Open
grid at Brands Hatch yesterday – Piers Masarati and (long
time PK supporter) Steve Donovan sharing the team's Porsche
"It's basically
been upgraded to full GT3-RS spec," said Mike Pickup, "this
is the car we raced as #61 in the ALMS.
Despite an early spin
into the tyre wall for Steven Donovan in the first 50 minute race,
the Porsche impressed throughout the day with Masarati posting some
impressive lap times, despite the rear end damage.
"The Ferrari spun
in front of me on the reconnaissance laps," explained Donovan,
"then coming out of Druids on lap 1, on slicks with no heat
in them, on the damp, I lost it under traction."
The Porsche thumped the
tyre wall backwards, but despite a bent rear wing, Donovan pressed
on, only switching to Piers Masarati when more suitable rubber became
father Jamie, "tried to bend the wing back, but I wasn't
strong enough – but by the end of the first race, it had bent
itself back thanks to the downforce." Here's the rear end
between the races, after the wing had 'repaired itself'. 40 minutes
earlier it had a 30 degree bend in the part outside the right wing
"We lost it overall
on the first lap," summed up Masarati Jnr., but despite the
damage, the car was 'mega': absolutely neutral, perfect
for the wet. I love the wet anyway."
A whole series
of fastest laps in both races confirmed that he was in his element,
consecutive laps just two thousandths apart being particularly impressive
on the way to third overall, a lap down - and shedding some damaged
bodywork on the way.
didn't let Piers leave the circuit until he'd come up
with the quote of the day – now that's pressure! After
dithering around with words such as 'mega', Piers produced
what we wanted, almost by accident.
can't do more than what you can do."
it Piers! That sums up racing perfectly. His best lap of 1:38.508
was 1.7 seconds quicker than anyone else. A TV interview with Andrew
Marriott of Sky Sports beckoned, for the winner from Pinner.
Welcome back
to the UK, PK: it's been a tough 2004 season but the boys
are still smiling. No concrete plans yet for '05, but you'll
be the first to know. Meanwhile, Piers was off for a few beers (with
Steven Donovan, below)..


text:
CHAMPAIGN, Ill. (WCIA) — A local entertainer, who goes by Larro the comedian, collects shoes, but now he's giving them away to kids whose parents can't afford them. And others are helping him do it.
Larry Smith has dozens of shoes, but growing up, that wasn't the case.
"We used to have to rock paper scissors for who was getting their school clothes."
That's why he's decided to help kids in the same situation he was in.
"I just looked through all of these shoes that I had, and I was just genuinely, like, 'man there's so many people who could appreciate stuff like this,' so I just jumped out of bed and thought let's make some kids happy."
Through Facebook, he found parents who couldn't afford to buy their kids shoes. So far, he's donated more than 80 pairs to young boys across the state. And now, others are stepping in to help.
"You know it's always important to make sure a child goes back to school with a nice pair of shoes because there's so much bullying going on."
Smith says more than 40 people have reached out to donate new or hardly used shoes, and they say they're happy to do it.
"Everybody in the community talks about how we need to do this, do this, but it ain't nothing if you ain't taking action, so he took action and did it."
"I was raised in a generation where they say you gotta be raised by the village, and I'm a product of that. I came from this area, so it was a great thing to see so many people jump on board and wanting to help and show the kids that it's more than just their mothers and fathers."
Smith says he does it for people like Kristy Carpenter, a single mother who also cares for her sister's children.
"With my situation, with my sister passing and me taking in my nephews, it just meant a lot that he actually reached out and said, 'hey, if you need, we're here.'"
And Smith says he's not going anywhere, and he doesn't plan to stop giving out shoes anytime soon.
"Until every kid gets a shoe. I mean that's the genuine goal."
Smith says the next step is to start collecting money for girls shoes. If you want to donate, you can do so online or you can call Smith at 773-541-1191.


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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: WD-7991
Government Authority located in South Carolina; USA based organization looking for expert vendor for website design, implementation, and maintenance services.
[A] Budget: Looking for Proposal
[B] Scope of Service:
(1) Vendor needs to provide website design, implementation, and maintenance services.
• Content migration and site clean-up to a custom website template design that shall include:
- Mega menus
- Quick link buttons available on each page as needed
- Integration of new county branding
- Ada compliancy with ability to verify compliance for each page
- Language translator
- Mobile friendly design
- Social media integration
- Image and document storage folders on the back-end
• Required content shall include:
- Job postings that include links to job applications and ability to share on social media, calendars with links for event information and directions, document center with search abilities, news center, procurement portal, home page alert and notification center for events, weather, closing information, etc. with text and email notification options, online web forms with staff ability to build forms online
• Ease of use for staff to edit and upload content with editing features that include:
- Visual editor, font size adjustment, link checker, spell checker, content archiving, content scheduling, page expiration, historical log of edits, multiple levels of editing permissions with ability to require approval from website administrator before content is published
• 24x7 support that includes:
- New user training
- Updates
- Site maintenance.
(2) A non-mandatory pre-proposal meeting will be held on November 13, 2019.
(3) All questions must be submitted no later than November 20, 2019.
(4) The term of the contract will be three years.
[C] Eligibility:
Onshore (USA Only)
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Expiry Date : Tuesday, 26 November, 2019
Pre-proposal Conference Date : Wednesday, 13 November, 2019
Question Answer Deadline : Wednesday, 20 November, 2019
Category : Web Design and Development
Country : USA
State : South Carolina
RFP Expired
You can either pay for Single RFP/Bid document or Subscribe with Monthly Subscription for whole Web Design and Development Category/Categories. If you will obtain monthly subscription for Web Design and Developmentcategory/categories, you will be able to access all the RFPs from that Category. Here are the Monthly Subscription offers. So, subscribe for Monthly offers and get rid of Individual RFP payment. *No commitment =


text:
5220 Church Street
Mableton, GA 30126
Phone: (770) 819 -2513
Fax: (770) 819-2515
The mission of the Mableton Elementary School
Counseling Program is to create a supportive learning environment
that provides opportunities for exploration and growth in the areas
of Personal/Social, Academic, and
Career Development assisting students in reaching
their full potential as productive citizens in their school
community and future lives.
all students are unique and given a safe
nurturing environment to grow to their highest potential.
all students have the right to a school
counselor who assists students through group and individual
support and collaborates with teachers and community
organizations to provide and effective program.
all students have the right to be heard and
treated with respect.
all students have the right to serves that
support academic, career, and personal growth.
to be instrumental in opening the hearts
and minds of students to an expanded vision of themselves which
gives them the confidence adn skills to create a successful and
productive life experience.
to assist students in developing life
skills which bring success in the areas of academic, career, and
personal/social growth.
to inspire students to strive to reach
their potential by developing their own unique talents and
abilities which they can in turn offer in service for a better
The Counselor schedules guidance
sessions with all grade levels. This is done in the classroom and is a part of the school curriculum. Topics of instruction include Self Knowledge, Interpersonal Relations, Conflict Resolution, Study Skills, Decision
Making, Career Guidance and more. Each lesson focuses on LIFE SKILLS that help children achieve skills now and later in life.
The Counselor is available to students on a one to one basis if
needed. Students are allowed to schedule an appointment with the Counselor when problems arise. A teacher or parent may ask for the Counselor to talk to a child. Students realize that problems can be resolved if they
are willing to take responsibility for their feelings and actions and move in a positive direction.
Support groups where students can join with others who have similar problems are offered on a
limited basis.
School Counselors are there for Parents too. Parents can speak with the counselor when students are having academic, emotional or social difficulties. I am here for you and want to be of service in any
way to help insure your child's success.


text:
Jamie Wotton writes for Bleeding Cool.
FX have developed a deal with the Coen Brothers to produce an hourlong for the small-screen, based on their 1996 hit Fargo.
They have sold a script with penalty to FX, which means the network would be at a loss if they don't produce it into a pilot. This would presumably be on air for Fall 2013, if all goes well.
FX are a network that nurtures their projects, cf. Powers, so if Fargo: The TV Series doesn't work out right away, it's very possible it'll be rejigged and resorted until it's ready for the air.
This continues MGM's attempt at getting their properties on TV, following in the steps of MTV's popular Teen Wolf redux and an announced new series based on Fame.
Deadline reports that Noah Hawley, of My Generation and The Unusuals, is scripting the Fargo pilot and will likely showrun the show should it go to series. Although Hawley's track-record, including two cancelled series, neither huge with the critical praise, doesn't seem too promising, his tone and work on Bones makes me think a cable environment might do him wonders.


text:
App.fromfactory.club reviewsIs this your business?
2 Reviews From Our Community
All Reviews
This dress is for my girlfriend. Great dress for the price! I'm usually a 12 or 14 in dresses, I ordered a 14. I am 5'9" and 7 months pregnant. This dress has the perfect waist line for my growing belly. I will be wearing this to a mitary ball in a couple weeks. The length is just right for me to wear flats with. The lining is staticky so I will be using static spray which will hopefully help. Such a happy purchase with this seller.
- Helpful? Yes 1
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Nice item, very satisfied! Thanks seller! fancy packaging! I like it :) Order came quickly. earrings neat and cute. look expensive. ordered three pairs, in different orders. it's all in one package, plus each pair packed in a velvet pouch! very nice! the seller thanks you! I recommend! Highly recommend seller! Quick shipping. Thank you for offering the quality products and good customer service! Already became a big fun of you! This app has great affordable products and professional customer care team, give me a quick response and help. Then I track to track, come for less than a month. True to size and Im very delighted with this purchase.
- Helpful? Yes
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text:
June really begins the first part of our summer although, if we went by recent temperatures, it has been here for about a month or two already. As drought concerns continue, be sure to think about how you can conserve water while also maintaining plant health. Hopefully rain will be plentiful in the month ahead.
• Chinch bugs are active in lawns beginning this month and for the next several months. If a spot in the lawn starts to yellow, check thoroughly for insects at the edge of the area. When chinch bugs are there, they can be readily seen. This insect is blackish with a silvery white stripe across its back. If present, treat with a chemical labeled for their control utilizing the instructions on the label. You can contact your local UF/IFAS Extension Office for recommendations. Never treat for chinch bugs unless you actually see them. Why waste money, and pollute our environment by trying to control a pest that is not even present? So, if you have a maintenance company wanting to spray for chinch bugs, ask to see one first.
• Caterpillars can found frequently on vegetables, lawns, trees and shrubs now. However, oftentimes their damage can be tolerated and ignored, especially since the caterpillars will mature into moths or butterflies. If damage becomes severe, remove and discard by hand or utilize a chemical labeled for their control. Try to choose a product containing "bT" that will have the least amount of effect on other beneficial insects and do not touch venomous species.
• Oftentimes, the azalea caterpillar begins to appear in June. This is a furry caterpillar with black to dark brown stripes and a scarlet red head, that when approached, makes a "U" with its body. They can occur in large numbers and can cause a high amount of damage, stripping branches in a matter of a few weeks. Check your plants a couple times a month for bare branches and the caterpillar. Handpicking can work, or use a bacterial-based insecticide such as Dipel or Thuracide.
• In times of heat and drought stress, pruning plants can increase their water needs and lower their chances to survive and thrive. Whenever shrubs or trees are sheared and pruned, they have to put out new growth, which strains the plant and makes it require more water. Limit your pruning to dead or dying branches and single branches. Hedging and shearing, practices adopted from English Gardens, do not work well in Florida and should be avoided. The same concept works for your lawn so make sure you are not mowing the grass too short.
• As rain during the summer is variable, be prepared to water plants as they need it, but do it correctly. It is better to water deeply when you do water but then extend the period between water cycles until the plant shows signs of needing it. Also, under St. Johns River Water Management District Rules, you can only water twice a week and it must be on your assigned days with no irrigation between 10 a.m. and 4 p.m. Woody plants do not need the same level of water the lawn does, so irrigate them less. Check that sprinkler system often to see it is working properly and keep grass runners pulled away from pop-up heads so that they function properly. Try to conserve water as much as possible and utilize rain barrels or cisterns to utilize rainwater in your garden. Remember, in times of drought, the entire state's water resources are connected and we should all do our part.
Vegetables: Lima beans, eggplant, okra, Southern peas (blackeye, crowder, purple hull) and sweet potatoes.
Annuals: Celosia, coleus, crossandra, exacum, hollyhock, impatiens, kalanchoe, nicotiana, ornamental pepper, periwinkle, portulaca, salvia, torenia and zinnia.
Bulbs, tubers or rhizomes: Aztec lily, butterfly lily, Kaffir lily, walking iris, African lily, spider lily and gladiolus.
Wayne Hobbs is an extension agent in environmental horticulture for Clay County.


text:
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I'm actually kinda proud of my family bc this is the first time we've all supported a strike together. All of us use Amazon stuff now and then. But now we've talked to the kids about it on their level, and even they are participating. The family doesn't cross picket lines.
Sunbeam City is a Libertarian Socialist solarpunk instance. It is ran democratically by a cooperative of like-minded individuals.


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A significant nightlife presence is concentrated in Downtown Morgantown. Multiple bars offer evening happy hour drink and dinner specials, as well as nightly live music, karaoke, trivia and drink specials. Nightclubs offer dancing and DJs for 18+ guests. Space is available for rent for birthday, holiday and anniversary parties or any other private event!
Business directory
123 Pleasant St.
Apothecary Ale House and Café
Laid back local bar with craft beer and paninis. One of the largest craft beer selections in WV! 27 rotating taps and 140 different bottles to choose from! Enjoy this 360-degree tour of our business! Click and drag to look around, and use the menu in the bottom left corner to move to a different room.
Bartini Prime
Bartini Prime is a privately owned Steakhouse started in January 2016. Bartini Prime's new owners have a vision of becoming the top steakhouse in West Virginia. It is led by a team of highly motivated and detail oriented staff who strive to provide the best service, finest food, and awesome atmosphere. Bartini Prime's mission […]
Big Times
Black Bear Burritos (Downtown)
Black Bear Burritos (Evansdale)
Blue Moose Café
Boston Beanery (Evansdale)
Buffalo Wild Wings (Suncrest)
Chestnut Brew Works
Classic's 3 Hot Spot & Restaurant
Code Bar & Lounge Morgantown
Crockett's Lodge
Fat Daddy's Bar & Grill
Gene's Beer Garden
Gibbie's Pub & Eatery
Iron Horse Tavern
Iron Horse Tavern Granville
Joe Mama's
Kegler's & Kegler's II
Mario's Fishbowl (Downtown)
Mario's Fishbowl (Suncrest)
McClafferty's Irish Pub
Morgantown Brewing Company
Mountain State Brewing Company
Mundy's Place
Mutt's Place
The most iconic Morgantown bar, originally opened in 1935.
Primanti Bros.
Sports Page
Swing at the Elks
The Back Door
The Bank
The Lakehouse
Varsity Club
Vice Versa
Contact us to add or update a business listing.


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How do you prioritize when you're a mom who runs her own business? Do you struggle to make time for all the things on your list? Do you dream about having time to do things that you continue to put off? Do you have the story that time gets the best of you? … [Read more...]
Hey Moms! Put Your Oxygen On First!
I don't know one other group of people who work harder than MOMs... no matter how you slice them - they come up as the masters of doing! Whether you're a work at home mom, a Mompreneur running your own business, or a stay at home mom.... you likely juggle an extraordinary amount of tasks, activities and priorities daily, weekly, monthly. Some moms do it with more ease, finesse and pizazz … [Read more...]
A Love Letter To Mompreneurs
I know you... You are committed to making a difference, having a great family, spending true quality time and building up your children, and having a business that works... and is profitable, all in a day's work. It's TOTALLY OKAY to cry sometimes - and actually it's EXACTLY what you NEED to do - to clear the way so you can HEAR what you need to hear to get you moving in the right path for … [Read more...]
Planning Vs. Scheduling: Where Do You Focus?
So many people collapse the distinction between planning their time and scheduling time to actually accomplish their tasks. The fact is, planning and scheduling are two different skills. According to Dictionary.com: … [Read more...]
Self-Care Tips for Mompreneur's
How are you doing with taking care of yourself? Let's take a look at a couple of interesting facts: 35 percent of all solo entrepreneurs are women, and their numbers are increasing by 23 percent annually according to the Apollo Research Institute. 94% of self-employed (aka solo entrepreneurs) utilize a home office for their business (Source: NASE) … [Read more...]


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Published on: 16:41PM May 29, 2010
Wheat: Prices a little lower, more bets placed, commercials a little longer, trend following funds a little shorter and a financial week that was… interesting. The continuous charts show prices holding a little above a floor around 445. Real world charts, September and December, look a bit different. September is solidly in a down trend still, while December, the hedging month for growers, is working at turning up. To be sure, we need some news, good (increased demand) or bad (a weather disaster) to get things moving, but the marketplace is suspicious, and rightly so, that something will happen during the next six months or so. A weekly close above 560 basis December will turn me solidly bullish, and a daily close above 525 will turn me "trading bullish."
Corn: No change. Commercials are close to neutral, fundies are long, index funds are solidly long and prices… well, they were down a nickel basis December. Like wheat, the market is waiting for something to happen.
Beans November beans are even more unchanged in price than wheat or corn, open interest is mostly unchanged and the index funds haven't moved. Commercials are a little longer, fundies a little less long… looks like a rally is about to start, if the past 18 months predict the immediate future (which is more likely than not, but far from guaranteed). I will be looking to buy beans on upward motion anytime in the next two weeks, with the expectation of a two week or longer rally. I really don't expect a longer rally until after July 4, but you never know.


text:
We investigated whether transthoracic echocardiography-suspected pulmonary hypertension (PH) affects survival in systemic lupus erythematosus (SLE) patients and examined factors associated with PH occurrence and survival.
This retrospective single-center study included 154 Korean SLE patients fulfilling the American College of Rheumatology criteria (January 1995 to June 2013). Student t test, Mann-Whitney U test, Kaplan-Meier curves, and log-rank tests were used for comparisons.
A total of 35 SLE patients with PH (SLE/PH+) and 119 without PH (SLE/PH-) were analyzed. Higher percentages of interstitial lung disease, Raynaud's phenomenon (RP), World Health Organization functional classification III/IV, and cardiomegaly were found in SLE/PH+ compared to SLE/PH-. Furthermore, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was significantly higher in SLE/PH+ (2.46 ± 1.245 vs. 1.00 ± 1.235), whereas survival rates were significantly higher in SLE/PH- in log-rank tests (p = 0.001). In multivariate analysis, the adjusted mortality hazard ratio (HR) for SLE/PH+ patients was 3.10. Subgroup analysis demonstrated a higher percentage of lupus nephritis in the SLE/PH+ patients who died (p = 0.039) and low complement-3 levels (p = 0.007). In univariate analysis, the mortality HR for SLE/PH+ patients with lupus nephritis was 4.62, whereas the presence of RP decreased the mortality risk in multivariate analysis; adjusted HR, 0.10.
Systemic lupus erythematosus (SLE) is an autoimmune disorder involving various organ systems, including the pulmonary system. Transthoracic echocardiography (TTE)-suspected pulmonary hypertension (PH) is a fairly frequent pulmonary manifestation of SLE. Since Perez and Kramer [1] first reported four PH cases in SLE in 1981, many reports of PH in SLE have documented its clinical manifestations, associated factors, and predictors of mortality. The prevalence of PH in SLE is estimated to be 1.8% to 14% [1,2,3,4,5,6,7,8,9]. Furthermore, PH in SLE has been reported to be associated with poor prognosis by several studies [3,5,9,10]. In one study, PH was the third leading cause of mortality among SLE patients [11], while another report demonstrated that PH was the most frequent cause of mortality among SLE-related deaths [12]. These results demonstrated the importance of PH in SLE in relation to survival.
To date, several factors have been reported to be associated with SLE-related PH. Several studies reported that Raynaud's phenomenon (RP), antiphospholipid antibody (aPL), anti-U1 ribonucleoprotein (anti-U1RNP), and serositis may contribute to the development of PH or be associated with its pathogenesis in SLE [2,3,5,9,13,14]. However, the associations between these factors and PH in SLE remain unclear, because of the small sample sizes of these studies, with the majority drawing conclusions from a case series.
We investigated whether PH is an independent risk factor for mortality in SLE. Furthermore, we investigated the clinical characteristics and risk factors for PH in SLE patients. Finally, we determined the predictors of mortality in SLE patients with PH.
Patients and controls
We retrospectively reviewed the medical records of SLE patients treated at Seoul St. Mary's Hospital, Korea, a tertiary care university hospital and referral center, between January 1995 and June 2013. Of the 2,432 patients who fulfilled the 1982 revised criteria for the classification of SLE [15], 160 patients were identified to have undergone echocardiography at least once. The patients had undergone two-dimensional and Doppler echocardiogram for one of the following reasons: unexplained dyspnea; evaluation of chest discomfort or pain; clinical suspicion of pericardial effusion; a loud audible pulmonic second heart sound on auscultation; prominent pulmonary conus on chest radiographs; or evaluation for syncope. Subjects were excluded from analysis when they had multiple-organ failure, overlapping syndrome, incomplete clinical data, or died within 1 month of echocardiography. To exclude patients with PH induced by interstitial lung disease (ILD), patients with ILD were included only when they had no interval changes for 6 months before and after PH diagnosis in pulmonary function tests and high-resolution computed tomography. From the 160 SLE patients, six were excluded according to the described exclusion criteria, while 154 were analyzed.
This study was approved by the Institutional Review Board of Seoul St. Mary's Hospital.
Definitions and variables
PH was defined as a right ventricular systolic pressure (RVSP) > 40 mmHg [16,17]. RVSP was estimated as the sum of the systolic right-atrial-ventricular pressure gradient (PG) and the right atrial pressure. The PG was calculated from the modified Bernoulli equation using the tricuspid regurgitation maximal velocity (TRVmax): PG = 4 × TRVmax2. The TRVmax was estimated from the Doppler echocardiogram. The right atrial pressure was presumed to be 5 mmHg. Patients with an RVSP > 50 mmHg were defined as severe PH patients [18].
Demographic, clinical, and laboratory profiles
The demographic characteristics (age, sex, and disease duration), echocardiography findings, and radiological, clinical, laboratory, and autoantibody data of the patients were obtained at the time of echocardiography. The systemic lupus erythematosus disease activity index (SLE-DAI) scores were calculated retrospectively by reviewing patient records. In addition, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index and World Health Organization (WHO) functional class were obtained.
Statistical analysis
Comparisons of continuous values between two groups were performed using Student t test or Mann-Whitney U test. Results are presented as the means ± standard deviation. Categorical variables, including the proportions between groups, were compared using chi-square test or Fisher exact test. A value of p < 0.05 was considered to indicate statistical significance. Survival rates were determined using the Kaplan-Meier method and compared between two groups using the log-rank test. In survival analyses, the time scale was defined as the time from the first echocardiogram. Factors associated with survival were determined using univariate Cox proportional hazards regression analysis. Variables with p ≤ 0.2 on univariate analysis were included in multivariate analysis. All of the tests were performed using the SPSS version 18.0 (SPSS Inc., Chicago, IL, USA).
Comparisons of baseline demographic, clinical, laboratory, and autoantibody profiles between the TTE-investigated and control SLE patients.
A total of 154 patients underwent TTE during the study period. Among the remaining 2,272 SLE patients enrolled, 960 age- and sex-matched patients were selected randomly as controls to compare baseline demographic, clinical, and laboratory profiles. The SLE group that underwent TTE displayed higher percentages of lupus nephritis, neuropsychiatric lupus, and serositis and elevated anti-Ro/La levels, whereas the control group showed a higher aPL-positive frequency (Table 1). The time period between diagnosis and the final follow-up or mortality in SLE patients who underwent TTE and control patients was 147.97 ± 82.78 and 144.12 ± 74.57 months, respectively.
Comparisons of baseline demographic, clinical, laboratory, and autoantibody profiles between SLE patients with and without PH
Among the 2,432 enrolled SLE patients, we identified 35 subjects with PH (SLE/PH+ group) and 119 without PH (SLE/PH- group). Of the 35 SLE/PH+ patients, six were lost to follow-up, and repeat follow-up echocardiograms were available in 25 of the remaining 29 patients. Right heart catheterization (RHC) was performed in four patients of the SLE/PH+ group based on clinical judgment. The baseline demographic characteristics and the laboratory and echocardiogram profiles of the SLE/PH+ and SLE/PH- groups are presented in Table 2. All of the patients in the present study were Korean. The mean age at the first echocardiogram in the SLE/PH+ and SLE/PH- groups was 36.83 ± 11.50 and 37.00 ± 13.61 years, respectively (p = 0.946). The time period between the first echocardiogram and the final follow-up or mortality in the SLE/PH+ and SLE/PH- groups was 44.17 ± 52.22 and 61.79 ± 30.22 months, respectively (p = 0.0064). Echocardiogram-determined RVSP in the SLE/PH+ and SLE/PH- groups was 57.47 ± 14.34 and 25.47 ± 4.93 mmHg, respectively. Regarding clinical manifestations, significantly higher percentages of ILD (20.0% vs. 5.0%, p = 0.011), RP (54.3% vs. 17.6%, p < 0.0001), WHO functional classification III or IV (71.4% vs. 7.6%, p < 0.0001), and cardiomegaly (75.0% vs. 45.3%, p = 0.003) were observed in the SLE/PH+ group. Furthermore, the SLICC/ACR damage index was significantly higher in the SLE/PH+ group (p < 0.0001), whereas the SLEDAI score was not significantly different (p = 0.628). No significant differences were observed in the laboratory findings or autoantibody profiles between the two groups (Table 2).
Causes of mortality and survival rates in the SLE/PH+ and SLE/PH- groups
In the SLE/PH+ and SLE/PH- groups during the follow-up period, 11 patients (31.4%) and 13 (10.9%), respectively, died. In the SLE/PH+ group, the causes of mortality included bleeding in four patients, infection in three patients, heart failure in three patients, and PH itself in one patient. The causes of mortality in the SLE/PH- group comprised infection in five patients, bleeding in five patients, myocarditis in one patient, thrombotic thrombocytopenic purpura in one patient, and acute respiratory distress syndrome caused by chemotherapy for secondary lymphoma in one patient. The survival rates at 1, 3, and 5 years in the SLE/PH+ group were 83.7%, 79.0%, and 60.2%, respectively, whereas in the SLE/PH- group they were 94.0%, 92.2%, and 88.1%, respectively (Fig. 1). Therefore, the survival rate was significantly higher in the SLE/PH- group by log-rank test (p = 0.001).
Univariate Cox proportional hazard regression analysis demonstrated that variables significantly associated with mortality included the presence of PH (p = 0.002) and lupus nephritis (p = 0.039), and a SLICC/ACR damage index > 2 (p = 0.001) (Table 3). In multivariate analysis, the presence of PH persisted as an independent risk factor for mortality (adjusted hazard ratio [HR], 3.10; 95% confidence interval [CI], 1.10 to 8.69; p = 0.032).
Subgroup analysis of SLE/PH+ patients
Table 4 shows a comparison of the clinical characteristics, SLEDAI score, SLICC/ACR damage index, laboratory results, autoantibody levels, echocardiogram profiles, and pharmacologic therapy between the SLE/PH+ patients who survived and those who died. The baseline clinical characteristics did not differ significantly between these two groups, except for a higher frequency of lupus nephritis in the patient group who died (p = 0.039). The incidence of low complement-3 levels was higher in the SLE patients who had died (p = 0.007), whereas the SLEDAI score and SLICC/ACR damage index were not significantly different. The patients who had died had received a higher daily prednisolone dosage (20.91 ± 14.07 mg/day vs. 10.69 ± 9.07 mg/day, p = 0.024).
Predictors of mortality in SLE-PH
The mortality associated factors on univariate and multivariate analyses in SLE/PH+ patients are presented in Table 5. Univariate analysis demonstrated that only lupus nephritis was significantly associated with mortality (HR, 4.62; 95% CI, 1.08 to 19.72; p = 0.039). On multivariate analysis of factors with p ≤ 0.20 on univariate analysis, the presence of lupus nephritis showed a trend for an increased relative HR (adjusted HR, 6.14; 95% CI, 0.94 to 34.85; p = 0.059), whereas coexisting RP was the only significant factor for a favorable outcome (adjusted HR, 0.10; 95% CI, 0.01 to 0.90; p = 0.041).
PH is a progressive disease that can accompany SLE. Since Perez and Kramer [1] first recognized PH as a complication of SLE, further studies involving Doppler echocardiography have demonstrated that PH is not infrequently associated with SLE. The reported prevalence of PH in SLE patients ranged from 1.8% to 14% [1,2,3,4,5,6,7,8,9], because the cutoff value for PH diagnosis from echocardiography differed among the studies. Nevertheless, the results suggested that SLE/PH+ patients showed a poorer prognosis than SLE/PH- patients [3,5,9,10]. However, it was unclear whether PH was an independent prognostic factor in SLE. Chung et al. [19] demonstrated that SLE with PH had a poorer prognosis than with idiopathic pulmonary artery hypertension (iPAH). Although the prognosis of iPAH was poor, the use of novel therapeutics, including endothelin-1 antagonists, has improved survival rates in iPAH [20]. To improve outcomes in SLE/PH+, it is important to determine SLE-specific risk factors that can be treated in addition to administering iPAH medications.
Several studies have investigated the factors associated with PH development in SLE. Simonson et al. [2] reported a higher frequency of RP in SLE with than without PH. Subsequently, several further factors, including anticardiolipin (aCL) antibody, anti-U1RNP, and serositis, were proposed to be associated with SLE/PH+ [3,5,9]. In contrast, a further study reported that aCL was not associated with PH in SLE [8]. A systematic review of SLE/PH+ in China demonstrated an association between PH development and RP, serous effusion (pericardial effusion and pleural effusion), serositis, aCL, anti-β2-glycoprotein I, and anti-U1RNP [14]. In the present study, only the frequency of RP was significantly higher in SLE/PH+ patients than in SLE/PH- patients. Although higher incidences of the presence of aPL, anti-U1RNP, and serositis were noted in SLE/PH+ patients, these differences between the groups were not significant. The discrepancy between our findings and those of other studies may be due at least in part to selection bias. We selected control patients who were found not to have PH on echocardiography. However, echocardiograms were obtained only in patients who had experienced cardiopulmonary-system-related symptoms or in the presence of radiologically abnormal findings. Therefore, patients who had undergone echocardiography may have had more active disease than those who did not require examination. This was supported by the fact that SLE patients with PH in the present study were more positive for aPL than the 1,010 SLE patients who were enrolled regardless of PH in our previous study (69.0% vs. 36.0%) [12]. The association of RP and aPL with PH requires further investigation, with a focus on its role in SLE/PH+ pathogenesis.
In the present study, PH was demonstrated to be an independent risk factor for mortality in SLE with an adjusted HR of 3.10 (95% CI, 1.10 to 8.69; p = 0.032). Furthermore, the 1, 3, and 5-year survival rates in SLE/PH+ patients of 83.7%, 79.0%, and 60.2%, respectively, were lower than the 94.0%, 92.2%, and 88.1%, respectively, in SLE/PH- patients. We previously reported that the overall 5-year survival rate in SLE patients was 97.8% [12]. In the univariate Cox proportional hazard analysis in the present study, lupus nephritis was the only significant predictor for mortality in SLE/PH+ patients. In contrast, multivariate analysis demonstrated that RP was the only factor significantly associated with an increased survival rate. As with iPAH, the level of the RVSP was not associated with mortality [18]. Echocardiography is a non-invasive method for detecting PH that can also identify secondary causes of PH. However, the RVSP estimated using echocardiography could not predict the prognosis of SLE/PH+. In contrast to a previous study, which suggested that pericardial effusion found on echocardiography was correlated with a poor prognosis in iPAH [18], our results demonstrated that pericardial effusion was not associated with mortality in SLE/PH+ patients. Chow et al. [21] systematically reviewed the available literature to identify prognostic factors in SLE/PH+ patients, and found several such possible factors, including RP, thrombocytopenia, and aCL. However, none of these factors were associated with decreased survival in SLE/PH+ patients in the present study. Although the frequency of the presence of aCL was higher in the SLE/PH+ patients who died, the difference was not significant. Moreover, the presence of RP in SLE/PH+ patients was associated with an increased survival rate. The discrepancies between the present study and previous studies may be because of the aforementioned selection bias and the small sample size in previous studies. SLE patients with RP had a greater possibility of undergoing TTE at an earlier stage than SLE patients without RP because of the clinical impression of PH. Therefore, we suggest that SLE patients with RP had a better prognosis because of the early treatment initiation. In addition, because calcium-channel blockers administered to RP patients are helpful in PH patients with vasoreactivity, these patients may have shown a better prognosis because of the early treatment. A prospective cohort study with a larger number of subjects is needed to clarify this issue.
With respect to the therapeutic approach, none of the medications conferred a survival benefit in SLE/PH+ patients. Interestingly, the daily prednisolone dosage was higher in the patients who had died, which may indicate that patients with a more active disease died despite treatment. However, there were no differences in the SLEDAI score or the SLICC damage index between the survivors and non-survivors. The role of prednisolone in SLE/PH+ needs further investigation. The most common medication used in SLE/PH+ patients was an immunosuppressant followed by an endothelin-1 receptor antagonist. In the present study, the 1, 3, and 5-year survival rates of SLE/PH+ patients were better than those reported by Chung et al. [19], of 50.5%, 44.9%, and 16.8%, respectively. The improved survival rate in SLE/PH+ patients in the present study may have been due to various medications, including immunosuppressants and novel iPAH-targeted medications.
The prevalence of SLE/PH+ in the present report was approximately 1.4%. Li and Tam [5] proposed that the prevalence of SLE/PH+ might differ dependent on ethnicity. Estimated prevalence rates in Asians have been reported to be 4.2% to 6.2%, while many studies involving Caucasian cohorts have reported prevalences of up to 4.2% to 14% [2,3,4,8,16,22,23]. Moreover, by defining PH using the same cutoff value (i.e., RVSP > 30 mmHg), prevalences of 4.2% to 14% in Caucasian patients, 4.2% to 5.9% in an Asian population, and 1.8% in a Turkish study were reported [2,4,5,6,9,20]. These differences in the prevalence of PH among SLE patients from various ethnicities suggest that the genetic background may contribute to PH development in SLE.
This study had certain limitations. First, the control group, which comprised SLE patients without PH, was selected from SLE patients who had undergone echocardiography (i.e., patients who presented with cardiopulmonary symptoms or abnormal radiographic findings). Therefore, it is very likely that patients with a more severe disease than general SLE patients were included as disease controls. However, a comparison of the survival rates between the two groups showed statistically significant differences, while the difference in the survival rate between the SLE/PH+ group in the present study and our historical cohort [12] was even greater, suggesting that the difference between the two groups reported here was valid. A further limitation was the diagnosis of PH being defined by echocardiographic findings. Therefore, mild asymptomatic SLE/PH+ patients were not enrolled in this study. Moreover, the RVSP may have overestimated the pulmonary artery pressure determined during RHC.
In conclusion, we demonstrated that PH is an independent prognostic factor in SLE. Additionally, SLE patients with RP have a higher risk of developing PH. Conversely, RP was associated with a better prognosis for survival in SLE/PH+ patients.
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Table 1
Table 2
Values are presented as mean ± SD or number (%).
SLE, systemic lupus erythematosus; PH, pulmonary hypertension; RVSP, right ventricular systolic pressure; WHO, world health organization; SLEDAI, systemic lupus erythematosus disease activity index; SLICC/ACR, Systemic Lupus International Collaborating Clinics/American College of Rheumatology; C, complement; ds-DNA, double-stranded DNA; SS-A, Sjgren's-syndrome- related antigen A; SS-B, Sjgren's-syndrome-related antigen B; IgG, immunoglobulin G.
aReference ranges for C3 and C4 are 76 to 139 mg/dL and 12 to 37 mg/dL, respectively.
Table 3
HR, hazard ratio; CI, confidence interval; SS-A, Sjgren's-syndrome-related antigen A; SS-B, Sjgren's-syndrome-related antigen B; IgG, immunoglobulin G; SLEDAI, systemic lupus erythematosus disease activity index; SLICC/ACR, Systemic Lupus International Collaborating Clinics/American College of Rheumatology
Table 4
Values are presented as mean ± SD or number (%).
SLE, systemic lupus erythematosus; PH, pulmonary hypertension; C, complement; SS-A, Sjgren's-syndrome-related antigen A; SS-B, Sjgren's-syndrome-related antigen B; IgG, immunoglobulin G; RVSP, right ventricular systolic pressure; SLEDAI, systemic lupus erythematosus disease activity index; SLICC/ACR, Systemic Lupus International Collaborating Clinics/American College of Rheumatology.
aReference ranges for C3 and C4 are 76 to 139 mg/dL and 12 to 37 mg/dL, respectively.
Table 5
SLE, systemic lupus erythematosus; PH, pulmonary hypertension; HR, hazard ratio; CI, confidence interval; RVSP, right ventricular systolic pressure; SS-A, Sjgren's-syndrome-related antigen A; SS-B, Sjgren's-syndrome-related antigen B; IgG, immunoglobulin G; SLEDAI, systemic lupus erythematosus disease activity index; SLICC/ACR, Systemic Lupus International Collaborating Clinics/American College of Rheumatology.


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