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QuantiFERON-TB Gold and the TST are both useful for latent tuberculosis infection screening in autoimmune diseases
F. Bartalesi, S. Vicidomini, D. Goletti, C. Fiorelli, G. Fiori, D. Melchiorre, E. Tortoli, A. Mantella, M. Benucci, E. Girardi, M. M. Cerinic, A. Bartoloni
European Respiratory Journal 2009 33: 586-593; DOI: 10.1183/09031936.00107608
F. Bartalesi
S. Vicidomini
D. Goletti
C. Fiorelli
G. Fiori
D. Melchiorre
E. Tortoli
A. Mantella
M. Benucci
E. Girardi
M. M. Cerinic
A. Bartoloni
Screening for active tuberculosis (TB) and latent TB infection (LTBI) is mandatory prior to the initiation of tumour necrosis factor-α inhibitor therapy. However, no agreement exists on the best strategy for detecting LTBI in this population. The aim of the present study was to analyse the performance of the tuberculin skin test (TST) and QuantiFERON®-TB Gold in-tube (QFT-GIT) on LTBI detection in subjects with immunomediated inflammatory diseases (IMID).
The TST and QFT-GIT were prospectively performed in 398 consecutive IMID subjects, 310 (78%) on immunosuppressive therapy and only 16 (4%) had been bacillus Calmette–Guérin (BCG) vaccinated.
Indeterminate results to QFT-GIT were found in five (1.2%) subjects. Overall, 74 (19%) out of 393 subjects were TST-positive and 52 (13%) were QFT-GIT-positive. Concordance between TST and QFT-GIT results was good (87.7%): 13 were QFT-GIT-positive/TST-negative and 35 QFT-GIT-negative/TST-positive. By multivariate analysis both tests were significantly associated with older age. Only the TST was associated with BCG vaccination and radiological lesions of past TB. Use of immunosuppressive drugs differently modulated QFT-GIT or TST scoring.
Use of the QuantiFERON®-TB Gold in-tube, as a screening tool for latent tuberculosis among immunomediated inflammatory disease subjects, is feasible. Until further data will elucidate discordant tuberculin skin test/QuantiFERON®-TB Gold in-tube results, a strategy of simultaneous tuberculin skin and QuantiFERON®-TB Gold in-tube testing in a low prevalence bacillus Calmette–Guérin vaccinated population, should maximise potentials of latent tuberculosis diagnosis.
Interferon-γ release assay
latent tuberculosis infection
tuberculin skin test
tumour necrosis factor-α inhibitors
One-third of the world's population is believed to harbour a latent tuberculosis infection (LTBI) 1, defined as the presence of quiescent mycobacteria. Approximately, 10% of immunocompetent persons with LTBI will ever develop tuberculosis (TB). In countries with a low incidence of TB, such as Italy, the tracing and targeted treatment of LTBI subjects constitutes a major pillar of TB control 2.
Ageing of the population and the increased use of immunosuppressive treatments represent risk factors for progression to active TB, and highlight the need for additional strategies to maintain and improve TB control 3.
Tumour necrosis factor (TNF)-α inhibitors are approved for the treatment of immunomediated inflammatory diseases (IMID) and provide clinical benefit. However, treatment with TNF-α inhibitors showed an increased risk of serious life-threatening infections, including reactivation of TB infection in patients previously exposed to mycobacteria 4. Thus, screening for active TB and LTBI has become mandatory prior to the initiation of TNF-α inhibitor therapy 5, 6. However, to date, no agreement exists on the best strategy for detecting LTBI in this population, and the tuberculin skin test (TST) remains largely used 7–10.
The TST attempts to measure cell-mediated immunity in the form of a delayed-type hypersensitivity response to purified protein derivative (PPD). However, the TST lacks specificity in populations with high bacillus Calmette–Guérin (BCG) coverage and nontuberculous mycobacteria (NTM) exposure. Moreover, the TST may have a higher probability to have false-negative results in IMID patients than in the general population because of the immune disregulation linked to the disease itself or due to immunosuppressive drugs use 11.
Recently, two new assays have been developed to identify LTBI, QuantiFERON®-TB Gold in-tube (QFT-GIT; Cellestis Limited, Carnegie, Australia) and T-SPOT TB (Oxford Immunotec, Abingdon, UK). They measure antigen-specific interferon (IFN)-γ secretion by peripheral blood CD4+ T-lymphocytes in response to in vitro stimulation with early secreted antigenic target-6 and culture filtrate protein 10 12, 13, which are more specific for the detection of a Mycobacterium tuberculosis infection than PPD, as they are not shared with BCG substrains or with most environmental mycobacteria 13, 14.
Several unresolved issues remain on the potential clinical use of IFN-γ release assays (IGRAs). One area of controversy is whether they can be used in immunosuppressed patients such as IMID subjects, in addition or as an alternative to the TST. The lack of a gold standard for LTBI diagnosis has hampered the assessment of diagnostic accuracy of IGRAs, and the comparison of these new tests with the TST. Therefore, it has been suggested that tests for LTBI diagnosis can be validated by analysing the association of positive results with risk factors for TB, and different tests can be compared by evaluating differences in their association with risk factors 15, 16. The current authors used this approach to compare the performance of QFT-GIT and the TST for the detection of LTBI among IMID subjects coming from a low endemic TB country. Moreover, the impact of different classes of drugs on the response to these tests was analysed.
Overall, 398 consecutive subjects were enrolled with rheumatic diseases (rheumatoid arthritis, psoriasic arthritis and ankylosing spondylitis) or other immunomediated chronic diseases, which required the use of biological drugs (infliximab, etanercept, adalimumab and rituximab). The subjects were recruited at two rheumatological outpatient clinics of two hospitals in Florence, Italy (Careggi University Hospital and Nuovo Ospedale San Giovanni di Dio Hospital), from May 2006 to December 2007 and fulfilled published criteria permitting the use of a biological drug 6.
Demographic information, data on BCG vaccination, treatment regimens in the last 3 months and risk factors for LTBI were collected during a standardised patient interview by a researcher who was not aware of the results of the TST or QFT-GIT. Treatments were classified into systemic corticosteroids, conventional disease-modifying antirheumatic drugs (DMARDs; including methotrexate, azathioprine, cyclosporine, leflunomide, cyclophosphamide and hydroxychloroquine) and TNF-α inhibitors (infliximab, etanercept or adalimumab).
All subjects underwent a chest radiograph. The following characteristics were considered to be risk factors for LTBI: birth or residence for ≥6 months in a high TB prevalence country (>20 cases per 100,000 inhabitants); history of household TB contact; and healthcare workers who work at facilities where patients with TB are treated.
The following were considered as risk factors for progression to active TB: a medically confirmed history of active TB; chest radiograph findings suggestive of TB history (nodules, fibrotic scars, calcified granulomas or basal pleural thickening); being HIV-positive; body weight of <10% of ideal body weight; presence of comorbidity (diabetes mellitus, silicosis, chronic renal failure/haemodialysis, neoplastic or haematological diseases); prolonged therapy with corticosteroids (>4 weeks) or other immunosuppressive therapy; injection drug use; and previous gastrectomy or jejunoileal bypass 17.
QFT and TST
Blood samples for QFT-GIT were obtained immediately before TST performance. Within 2–6 h of blood being taken, the samples were incubated at 37°C. The same biologist, who was unaware of subjects' characteristics and results of the TST, performed all whole blood IFN-γ ELISAs according to the manufacturer instructions.
Immediately after blood was drawn, all participants received an injection of 5 units of PPD (Biocine Test-PPD; Chiron, Siena, Italy) by a trained physician. The transverse diameter of induration was measured in millimeters 72 h later using the ballpen method. TST induration was interpreted relative to risk in accordance with published guidelines 5, 18.
Information from the questionnaires, TST and QFT-GIT results were entered into Microsoft Excel 2003 software. The concordance between QFT-GIT and the TST was assessed by computing the κ statistics, with a κ-value of >0.75 representing excellent agreement beyond chance, 0.40–0.75 representing fair to good agreement beyond chance, and <0.40 representing poor agreement beyond chance 19.
A standard univariate analysis was performed to analyse the association of the TST and QFT-GIT results to TB risk factors, the type of IMID and the kind of immunosuppressive therapy.
TB risk factors associated with either QFT-GIT or the TST results in the univariate analysis were entered in two separate logistic regression models in which the outcomes were the QFT-GIT or the TST results. In these models, the use of systemic corticosteroids, conventional DMARDs and TNF-α inhibitor therapy were also entered as independent categorical variables.
Finally, to compare the overall diagnostic performance of the two tests, the current authors evaluated whether the association between the number of risk factors for LTBI, selected a priori according to the prognostic relevance 20, and the odds ratio (OR) for testing positive varied according to the test. To this purpose, generalised estimating equations were used to perform a logistic regression that accounted for the association between results of QFT-GIT and TST performed on the same subject.
Studied population
A total of 398 consecutive subjects with IMID were enrolled (fig. 1⇓). Indeterminate results to QFT-GIT were found in five (1.2%) out of 398 subjects. No association was found between risk factors for TB and immune suppression (data not shown) and these samples were excluded for further analysis.
Flow diagram of the study population. QFT: QuantiFERON®-TB Gold in-tube (Cellestis Limited, Carnegie, Australia); TST: tuberculin skin testing; +: positive; -: negative.
Demographic and clinical features of the 393 remaining subjects are reported in table 1⇓. The present population was characterised by a high median age (54 yrs), a low prevalence (4.1%) of BCG vaccination and a small number (4.6%) of subjects coming from high endemic TB countries. None of the enrolled subjects were found to have active TB.
Associations of demographic, epidemiological and clinical characteristics and therapy with QuantiFERON®-TB Gold in-tube (QFT-GIT)- and tuberculin skin test (TST)-positive results in subjects with rheumatic diseases: univariate analysis
TST and QFT-GIT results
Concordance between the TST and QFT-GIT
Among the 393 subjects analysed by both the TST and QFT-GIT tests, 52 subjects were positive to QFT-GIT and 74 subjects were positive to TST (p = 0.4). Among them, 306 (77.8%; 95% confidence interval (CI) 73.4–81.9) subjects were concordant in their negative results and 39 (10%; 95% CI 7.1–13.3) subjects in their positive results, resulting in an overall concordance of 87.8% (κ 0.55; p<0.0001; 95% CI 0.44–0.66).
TST-positive/QFT-GIT-negative discordant results were found in 35 (8.9%) out of 393 (95% CI 6.3–12.2) subjects while TST-negative/QFT-GIT-positive results were found in 13 (3.3%) out of 393 subjects (95% CI 1.8–5.6).
Several factors were evaluated to understand their impact on the discordant QFT-GIT/TST data obtained (history of TB exposure, sex, age, history of BCG vaccination, underlying rheumatic disease, etc.). Among them, a history of previous BCG vaccination was associated with discordant QFT-GIT-negative/TST-positive results (p = 0.004) whereas the use of TNF-α inhibitors was associated with discordant QFT-GIT-positive/TST-negative results (p = 0.03).
Risk factors associated with LTBI and type of IMID
By univariate analysis, both positive TST and QFT-GIT were significantly associated with older age and history of close contact with sputum-positive TB patients. However, only TST positivity was associated with BCG vaccination, radiological lesions suggestive of past TB and origin from countries with a high endemic of TB. Only QFT-GIT positivity was significantly associated with males (table 1⇑). These associations were confirmed by multivariate analysis (table 2⇓). No associations between type of IMID and results of the TST and QFT-GIT were found in the univariate analysis (table 1⇑).
Risk factors associated with QuantiFERON® in-tube (QFT-GIT) and tuberculin skin test (TST) positivity in subjects with rheumatic diseases: multivariate analysis
Impact of immunosuppressive therapy
In the univariate analysis, the proportion of positive scoring was lower for both tests for treated patients (with the exception of those treated with DMARDs or DMARDs associated with steroids) compared with the proportion of positive results in patients who were not receiving treatment. A significant association, however, was only found between treatment with steroids and TST results (table 1⇑).
By multivariate analysis, considering the impact of each drug class, the use of DMARDs was not associated with test scoring while the use of steroids was associated with a lower probability of a QFT-GIT- or TST-positive scoring (OR 0.4, 95% CI 0.2–09; OR 0.3, 95% CI 0.2–0.6, respectively; table 2⇑). Moreover, treatment including TNF-α inhibitors significantly decreased the positive outcome of TST (OR 0.3, 95% CI 0.1–0.6) without affecting QFT-GIT results.
Comparison of the diagnostic performance of TST and QFT-GIT
In the absence of a gold standard for LTBI diagnosis, the diagnostic performance of the two tests was compared by evaluating the association of the odds of testing positive with the presence of one or more risk factors for LTBI (aged >50 yrs, chest radiograph suggestive of past TB, close contact with patients with sputum-positive TB and birth/residence in a country with a high incidence of TB; table 3⇓). The results indicate a clear-cut trend for an increase in ORs with an increasing number of risk factors for both tests, and show no significant difference between the two tests. Moreover, the prevalence of LTBI was computed in the present cohort using different combinations of the two tests used (table 4⇓). This analysis approach suggests a better single performance of the TST than QFT-GIT, although the combined used of both tests seems to be the best approach to maximise the sensitivity of the screening.
Association between number of risk factors for tuberculosis infection and QuantiFERON®-TB Gold in-tube (QFT-GIT) and tuberculin skin test (TST) positivity
Estimate of the prevalence of latent tuberculosis using different approaches
Immunosuppressed subjects are one of the most important targets for the screening of LTBI because of the high risk of progression to active TB. Despite its widely recognised limitations, the TST remains the standard method for identifying TB infection before TNF-α inhibitor therapy, due to the lack of sufficient data on IGRA use in this population 7–10. To date, there are limited data describing performance of IGRA for detecting LTBI in IMID subjects awaiting TNF-α inhibitor therapy. Of them only seven studies reported direct comparison with the TST (table 5⇓) 21–30. Moreover, the published results were not easily comparable, due to the small number of enrolled subjects, a high rate of BCG vaccination in the studied population, the nonhomogeneous type of underlying diseases considered and the kind of IGRA used (table 5⇓).
Concordance of the interferon-γ release assay (IGRA) and the tuberculin skin test (TST) for the screening of tuberculosis infection in the immunomediated inflammatory disease population
To the present authors' knowledge, the current study is the largest that has compared the results of an IGRA to the TST for TB screening in IMID subjects coming from a low endemic TB country (only 4.6% subjects coming from a high TB prevalence country) and with a low (4.1%) BCG vaccination rate.
The first relevant finding of the current study was a high positive rate of LTBI for both TST and QFT-GIT testing (18.8 and 13%, respectively). This result was probably due to the high median age of the IMID population (55.7% >50 yrs), who were most likely exposed to the M. tuberculosis infection at a young age when Italy was a high TB prevalence country. Therefore, the need for TB screening was confirmed in IMID subjects even in a low TB prevalence country such as Italy.
The present study showed a lower rate (1.2%) of indeterminate results at QFT-GIT testing compared with other previously published studies utilising the same test (QFT-GIT) 21, 23, 24, 27, where the rate of indeterminate results ranged between 1.5 and 10.3% (table 5⇑). The current finding confirms the feasibility of QFT-GIT in the IMID population that have undergone LTBI screening and have been pre-treated with immunomodulating drugs (steroids, DMARDs and TNF-α inhibitors). In total, 79% of subjects in the present population had been pre-treated.
A fair concordance between QFT-GIT and the TST (87.5% with κ 0.55; p <0.0001; 95% CI 0.43–0.67) was observed, which is higher than reported in previous studies where concordance ranged from 51.7–82.8% (table 5⇑). This is probably due to the lower rate of BCG vaccinated subjects that led to a reduction in the rate of TST-positive/QFT-GIT-negative discordant results compared with the literature, with the exception of the study by Ponce de Leon et al. 27. The present interpretation is supported by multivariate analyses showing a significant association between TST-positive/IGRA-negative results and BCG vaccination status 23, 28. The current multivariate analysis confirmed this association, although the present population accounted for only 16 BCG vaccinated subjects. Therefore, these discordant results most likely represent TST associated to a TB infection. The alternative possibility of a past sensitisation to NTM antigens present in the TST and not in the QFT-GIT assay is difficult to ascertain.
Regarding the 13 (3.3%) TST-negative/QTF-GIT-positive discordant subjects it may be speculated that TST missed these LTBI diagnoses because of the high specificity of QFT-GIT for the M. tuberculosis infection. The two main reasons to explain this finding are as follows. 1) A two-step TST was not performed which would have maximised the TST sensitivity, but this strategy would have required four visits instead of two for every subject. 2) All TST-negative/QTF-GIT-positive discordant subjects were undergoing treatment with immunosuppresive drugs and six out of 13 received TNF-α inhibitors, which may explain the negative results of TST, considering the negative impact of steroids and TNF-α inhibitors on M. tuberculosis-specific responses 31 and on the TST performance (table 2⇑). Moreover no association between any LTBI test and kind of IMID were found (table 1⇑). The present results confirm those reported by Sellam et al. 22 and are consistent with the lack of a relationship with TB infection risk.
Regarding the association of TST and QFT-GIT with risk factors for TB infection, the current data showed a good association for both tests with known risk factors for TB in Italy, such as older age and a history of close contacts of sputum-positive TB patients. However, the TST seems to be more strictly associated with TB infection, considering that only this test was significantly associated with other known risk factors, such as origin from countries with a high endemic of TB and radiological lesions suggestive of TB history.
Establishing sensitivity and specificity for the M. tuberculosis infection is difficult due to the absence of a gold standard for the diagnosis of LTBI. Thus, an approach to index test validation that goes beyond the diagnostic accuracy paradigm is needed for an alternative evaluation process in the absence of a gold standard. In some studies, the association of positive results with risk factors for TB has been analysed, and different tests have been compared by evaluating differences in their association with risk factors 15, 16, 20. The present authors used this approach to assess the accuracy of the TST and QFT-GIT in detecting LTBI, comparing current results to a gradient of risk factors for LTBI selected a priori according to their prognostic relevance. The current findings showed a clear-cut trend for an increase in odds with a growing number of risk factors for LTBI, confirming that both, the TST and QFT-GIT are predictive of LTBI without a difference in the estimation ability between the two tests (table 3⇑).
Based on previous studies that showed a reduced performance of the TST in immunosuppressed rheumatoid arthritis subjects 12, 27, the current authors analysed the impact of different classes of drugs on the response to TST and QFT-GIT tests. By multivariate analysis, steroids were found to significantly affect both QFT-GIT- and TST-positive outcome (OR 0.4 and 0.3, respectively), while treatment including TNF-α inhibitors significantly decreased only the positive outcome of the TST (OR 0.3). This result disagrees with that reported by Matulis et al. 23. However, Matulis et al. 23 did not evaluate the association with the TST results (TST was not performed simultaneously with QFT-GIT). Matulis et al. 23 explained their result with the TNF-α inhibitors that decrease the activation of CD4+ T-lymphocytes by mycobacterial antigens. However, the present results seem to be more consistent with the crucial role, which TNF-α plays in recruiting macrophages in tuberculin-induced delayed-type hypersensitivity that should justify the reduced response to TST in the current population of whom 24.2% were already exposed to TNF-α inhibitors at the time of screening 31.
In conclusion, the present study confirms that QFT-GIT as a screening tool for LTBI among IMID subjects awaiting TNF-α inhibitor therapy is feasible, due to the low incidence of indeterminate results and the strict association with risk factors for TB for this test. However, the current findings do not support the recently published UK national guidelines on TB suggesting the use of IGRA as a confirmatory test in TST-positive subjects 32. Based on these data in a country with a low prevalence of BCG vaccination, such as Italy, this approach would have had the risk of missing subjects with LTBI. Conversely, the present data suggest the potential use of QFT-GIT as a primary test that may offer the advantage of being less impaired by the treatment with TNF-α inhibitors compared with the TST.
In this context, large-scale cohort studies are needed to estimate risk for progression to active disease in persons who have had positive results to the tuberculin skin test and/or interferon-γ release assay, with a particular interest to the risk of disease in persons with discordant reactions. Until further data are available on the implication of discordant tuberculin skin test/QuantiFERON®-TB in-tube results, a strategy of simultaneous tuberculin skin test and QuantiFERON®-TB in-tube testing in populations with a low prevalence of bacille Calmette–Guérin vaccination should maximise the sensitivity for latent tuberculosis diagnosis.
Statement of interest
Statements of interest for A. Bartoloni, S. Vicidomini, C. Fiorelli, A. Mantella and D. Goletti can be found at www.erj.ersjournals.com/misc/statements.shtml
Received July 17, 2008.
© ERS Journals Ltd
World Health Organization. WHO Report 2008. Global tuberculosis control: surveillance, planning, financing. www.who.int/tb/publications/global_report/2008/pdf/fullreport.pdf Date last accessed: December 19, 2008
Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in Health-care settings, 2005. MMWR Recomm Rep 2005;54:1–141.
Horsburgh CR Jr. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 2004;350:2060–2067.
Maini R, St Clair EW, Breedveld F, et al. Infliximab (chimeric anti-tumour necrosis factor α monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet 1999;354:1932–1939.
Gardam MA, Keystone EC, Menzies R, et al. Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis 2003;3:148–155.
Furst DE, Breedveld FC, Kalden JR, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2006. Ann Rheum Dis 2006;65: Suppl. 3 iii2–iii15.
British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-α treatment. Thorax 2005;60:800–805.
Fonseca JE, Lucas H, Canhão H, et al. [Guidelines for the diagnosis and treatment of latent tuberculosis infection and active tuberculosis in patients with inflammatory joint diseases proposed for treatment with tumour necrosis factor α antagonist drugs.]. Rev Port Pneumol 2006;12:603–613.
Mariette X, Salmon D, Group RATIO. French guidelines for diagnosis and treating latent and active tuberculosis in patients with RA treated with TNF blockers. Ann Rheum Dis 2003; 62: 791–792
Beglinger C, Dudler J, Mottet C, et al. Screening for tuberculosis infection before the initiation of an anti-TNF-α therapy. Swiss Med Wkly 2007;137:620–622.
Ponce de León D, Acevedo-Vásquez E, Sánchez-Torres A, et al. Attenuated response to purified protein derivative in patients with rheumatoid arthritis: study in a population with a high prevalence of tuberculosis. Ann Rheum Dis 2005;64:1360–1361.
Andersen P, Munk ME, Pollock JM, Doherty TM. Specific immune-based diagnosis of tuberculosis. Lancet 2000;356:1099–1104.
Pai M, Riley LW, Colford JMJ. Interferon-γ assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004;4:761–776.
Mazurek GH, Jereb J, LoBue P, Iademarco MF, Metchock B, Vernon A. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 2005;54:49–55.
Lalvani A, Pathan AA, Durkan H, et al. Enhanced contact tracing and spatial tracking of Mycobacterium tuberculosis infection by enumeration of antigen-specific T cells. Lancet 2001;357:2017–2021.
Kang YA, Lee HW, Yoon HI, et al. Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 2005;293:2756–2761.
Jasmer RM, Nahid P, Hopewell PC. Clinical practice. Latent tuberculosis infection. N Engl J Med 2002;347:1860–1866.
American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221–S247.
Fliess JL. The measurement of inter-rate agreement. In: Bradley RA, Levin B, Cho Paik M, eds. Statistical Methods for Rates and Proportions. New York, John Wiley & Sons Inc, 1981; pp. 212–236
Kunst H, Khan KS. New tests for the diagnosis of latent tuberculosis infection. Ann Intern Med 2007;147:672–674.
Cobanoglu N, Ozcelik U, Kalyoncu U, et al. Interferon-γ assays for the diagnosis of tuberculosis infection before using tumour necrosis factor α blockers. Int J Tuberc Lung Dis 2007;11:1177–1182.
Sellam J, Hamdi H, Roy C, et al. Comparison of in vitro-specific blood tests with tuberculin skin test for diagnosis of latent tuberculosis before anti-TNF therapy. Ann Rheum Dis 2007;66:1610–1615.
Matulis G, Jüni P, Villiger PM, Gadola SD. Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a Mycobacterium tuberculosis antigen specific interferon γ assay. Ann Rheum Dis 2008;67:84–90.
Pratt A, Nicholl K, Kay L. Use of the QuantiFERON-TB Gold test as part of a screening programme in patients with RA under consideration for treatment with anti-TNFα agents: the Newcastle (UK) experience. Rheumatology 2007;46:1035–1036.
Kobashi Y, Mouri K, Obase Y, Fukuda M, Miyashita N, Oka M. Clinical evaluation of QuantiFERON TB-2G test for immunocompromised patients. Eur Respir J 2007;30:945–950.
Dinser R, Fousse M, Sester U, et al. Evaluation of latent tuberculosis infection in patients with inflammatory arthropathies before treatment with TNFα blocking drugs using a novel flow-cytometric interferon-γ release assay. Rheumatology 2008;47:212–218.
Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, et al. Comparison of an interferon-γ assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol 2008;35:776–781.
Vassilopoulos D, Stamoulis N, Hadziyannis E, Archimandritis AJ. Usefulness of enzyme-linked immunospot assay (ELISPOT) compared to tuberculin skin testing for latent tuberculosis screening in rheumatic patients scheduled for anti-tumor necrosis factor treatment. J Rheumatol 2008;35:1271–1276.
Bocchino M, Matarese A, Bellofiore B, et al. Performance of two commercial blood IFN-γ release assays for the detection of Mycobacterium tuberculosis infection in pateint candiates for anti-TNF-α treatment. Eur J Clin Microbiol Infect Dis 2008;27:907–913.
Greenberg JD, Reddy SM, Schloss SG, et al. Comparison of an in vitro tuberculosis inteferon-γ assay with delayed-type hypersensitivity testing for detection of latent Mycobacterium tuberculosis: a pilot study in rheumatoid arthritis. J Rheumatol 2008;35:770–775.
Saliu OY, Sofer C, Stein DS, Schwander SK, Wallis RS. Tumor-necrosis-factor blockers: differential effects on mycobacterial immunity. J Infect Dis 2006;194:486–492.
National Collaborating Centre for Chronic Conditions. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. www.nice.org.uk/CG33#summary Date last accessed: December 19, 2008
Vol 33 Issue 3 Table of Contents
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European Respiratory Journal Mar 2009, 33 (3) 586-593; DOI: 10.1183/09031936.00107608
Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis
Predictive value for progression to tuberculosis by IGRA and TST in immigrant contacts
Association between Gc genotype and susceptibility to TB is dependent on vitamin D status
Show more Original Articles: Tuberculosis
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text:
from __future__ import division

import math
import torch
from torch.autograd import Variable

import onmt

class Dataset(object):
    def __init__(self, srcData, tgtData, batchSize, cuda,
                 volatile=False, data_type="text"):
        self.src = srcData
        self._type = data_type
        if tgtData:
            self.tgt = tgtData
            assert(len(self.src) == len(self.tgt))
        else:
            self.tgt = None
        self.cuda = cuda

        self.batchSize = batchSize
        self.numBatches = math.ceil(len(self.src)/batchSize)
        self.volatile = volatile

    def _batchify(self, data, align_right=False,
                  include_lengths=False, dtype="text"):
        if dtype == "text":
            lengths = [x.size(0) for x in data]
            max_length = max(lengths)
            out = data[0].new(len(data), max_length).fill_(onmt.Constants.PAD)
            for i in range(len(data)):
                data_length = data[i].size(0)
                offset = max_length - data_length if align_right else 0
                out[i].narrow(0, offset, data_length).copy_(data[i])
            if include_lengths:
                return out, lengths
            else:
                return out
        elif dtype == "img":
            heights = [x.size(1) for x in data]
            max_height = max(heights)
            widths = [x.size(2) for x in data]
            max_width = max(widths)

            out = data[0].new(len(data), 3, max_height, max_width).fill_(0)
            for i in range(len(data)):
                data_height = data[i].size(1)
                data_width = data[i].size(2)
                height_offset = max_height - data_height if align_right else 0
                width_offset = max_width - data_width if align_right else 0
                out[i].narrow(1, height_offset, data_height) \
                      .narrow(2, width_offset, data_width).copy_(data[i])
            return out, widths

    def __getitem__(self, index):
        assert index < self.numBatches, "%d > %d" % (index, self.numBatches)
        srcBatch, lengths = self._batchify(
            self.src[index*self.batchSize:(index+1)*self.batchSize],
            align_right=False, include_lengths=True, dtype=self._type)

        if self.tgt:
            tgtBatch = self._batchify(
                self.tgt[index*self.batchSize:(index+1)*self.batchSize],
                dtype="text")
        else:
            tgtBatch = None

        # within batch sorting by decreasing length for variable length rnns
        indices = range(len(srcBatch))
        batch = (zip(indices, srcBatch) if tgtBatch is None
                 else zip(indices, srcBatch, tgtBatch))
        batch, lengths = zip(*sorted(zip(batch, lengths), key=lambda x: -x[1]))
        if tgtBatch is None:
            indices, srcBatch = zip(*batch)
        else:
            indices, srcBatch, tgtBatch = zip(*batch)

        def wrap(b, dtype="text"):
            if b is None:
                return b
            b = torch.stack(b, 0)
            if dtype == "text":
                b = b.t().contiguous()
            if self.cuda:
                b = b.cuda()
            b = Variable(b, volatile=self.volatile)
            return b

        # wrap lengths in a Variable to properly split it in DataParallel
        lengths = torch.LongTensor(lengths).view(1, -1)
        lengths = Variable(lengths, volatile=self.volatile)
        return (wrap(srcBatch, self._type), lengths), \
            wrap(tgtBatch, "text"), indices

    def __len__(self):
        return self.numBatches

    def shuffle(self):
        data = list(zip(self.src, self.tgt))
        self.src, self.tgt = zip(*[data[i] for i in torch.randperm(len(data))])

redpajama_set_name: RedPajamaGithub


text:
Changi Airport to Chinatown, Singapore
Basked in the warm sunlight, Singapore's Chinatown is a frenzy of colors, robust vendors and a labyrinth of narrow paths. Boasting the appeal of its rich history as a settlement for Chinese immigrants, Chinatown has evolved into a full-blown tourist attraction, where quirky souvenirs and street food blend together to become a cultural force to be reckoned with in the bustling city of Singapore.
The Cultures within the Pot
It may seem confusing, what with all the cultures that exist within the diverse locality of Singapore. On its own, the metropolis is defined by its history and its people, but upon closer inspection, one discovers the layers within such definition - so much so that the melting pot of cultures contains within itself separate pots of cultures. Chinatown is an example where the Chinese hawker stalls manned by friendly vendors are complemented by restaurants that have begun to speckle Chinatown.
Boasting a much more diverse selection in terms of food, Chinatown is now home to trendy food places that serve chic international cuisine. One such food place is Kafe Utu, an endearing cafe with furniture and an interior setting that are heavily inspired by the earthy tones that color the beautifully exotic African culture. Don't miss out on their signature ricotta cheese hotcakes and the rustic, Insta-worthy backdrop!
Browse along a great representation of local cuisine in this tourist hub as you take a seat in the busy Chinatown Food Street, where tables run between stalls and the setting provides an authentic hawker-dining experience. From loud, unabashed conversations among locals and foreigners to palatable treats such as char kway teow and barbecued seafood, unparalleled tourist experience is getting to know a city by its flavours!
Quiet Relics of the Past
Architecture seizes the attention of its beholders, particularly ones that have been so greatly preserved over the years such as the Buddha Tooth Relic Temple, which is an astonishingly grand 4-storey temple that welcomes visitors into Chinatown with its elaborate Tang Dynasty-inspired elegance. The temple is essentially an architectural emulation of the Buddhist mandala, a religious culture that represents the universe.
Now a museum that pays homage to Chinese culture, the temple is a majestic place of worship that also serves as a repository for the tooth of the historical Buddha, and holds within its walls Buddhist relics of religious reverence, most of which could be seen in the 3rd floor. Most visitors are enthralled with the solid gold 2-metre stupa on the 4th floor which is the place where the sacred relic is kept. Only monks are allowed into the relic chamber, but visitors can still take a gander at the tooth relic from the public viewing area.
The Peranakan
Peranakan culture is prominent within Singapore. Mostly known for their spiced traditional cuisines, the vibrant colours that bespeckle their wardrobe and their food presentation, and the personification of, literally, 'melting pot of cultures', the peranakan are Straits-born people with Chinese and Malay/Indonesian heritage.
The National University of Singapore's Baba House is an authentic and well-preserved Peranakan artefact, boasting as one of the few townhouses whose architecture has remained intact over the years and continue to showcase the delicate culture that play such an important role in shaping the rich cultural history of Singapore. Alongside the exhibitions on the third floor of the townhouse are the porcelains and Peranakan antiques, acquired by and belonging to the peranakan Wee family that had descended from the tycoon Wee Bin.
How to Get There From Changi Airport
From Changi Airport, take the East West (Green) line to Tanah Merah station. From there, switch to the Green line MRT train to get to Chinatown (alight at Outram Park station).The trip is at an estimated fare of S$2.
From Changi Airport, take Bus Line 36 and alight at the seating gallery. This trip is at an estimated fare of S$2 and will take around an hour and a half.
A taxi from Changi Airport to ever-bustling Chinatown will be at an estimated fare of S$25 during non-peak hours, but this metered rate varies according to the distance traveled.
Grabcar
With the advancement in technology, ride-hailing apps become a cheap and convenient way to travel. For an arrival transfer to Chinatown from Changi Airport, a Grabcar will be at an estimated flat rate of S$20, but this rate may vary during peak hours.
Super Vehicles
You may also be interested in booking a Super Vehicle for an efficient transfer to your destination. For this option, an advance booking and payment will be required. To make a booking, call up our customer service line at +65 6535 3534.
Type of Vehicle
Super Car (4-seater)
60-minutes complimentary waiting time. Board vehicle at arrival gate.
Limousine Cabs and Private Limousines
This service requires an advance booking and payment, so call up our friendly customer service line at +65 6535 3534 today and get yourself a ride! Rates vary according to the number of passengers and the vehicle model selected.
Type of Limousine
Limousine Cab
From S$60
Meet-and-greet services
Flight-tracking by the driver
60 minutes complimentary waiting time
Private Limousines

redpajama_set_name: RedPajamaCommonCrawl


Galen is most privileged and fortunate to have Jennifer Zeng, author and Human Rights campaigner at the College on Sunday June 19th at 2.30pm and Monday June 20th.
Jennifer is author of Witnessing History: One Woman's Fight For Freedom which details her youth and membership of the Chinese Communist Party and her subsequent arrest and imprisonment for following her Falun Gong spiritual practice.
Jennifer details her persecution and torture and her subsequent escape to Australia.
Sunday June 19th features the award winning documentary 'The Courage to Believe' about Jennifer Zeng and also Dr Charles Lee, an American citizen who was also imprisoned in a labor camp. Following the documentary, Jennifer will talk of her experiences followed by refreshments and a book signing.
This is a wonderful opportunity as Jennifer now works most of the year in television in the USA as part of her fight for Human Rights and only comes back here periodically. As the program does detail serious human rights abuses, parental discretion is advised but in most cases should be suitable for young people (mainly 15 years and over) and adults.


Antibacterial technology makes this fabric stylish and smart!
If you're looking for the ultimate comfortable t-shirt you've found it buddy! This cotton rich short sleeved tee from men's underwear aficionados Modus Vivendi is slim fit whilst also being ultra light - great for layering. The flattering design of the deep 'U' neck and capped folded hem sleeves make this stylish male top perfect for wearing on its own.


The 4009BP is custom made for the Bose L1 Model II PS1 power stand and T1 ToneMatch Audio engine. It's the perfect companion to the SKB-5009BL L1/LII loudspeaker case. The 4009BP is made of high density polyethylene (HDPE) that exceeds the ATA category 300 flight specification. The latches are made of unbreakable fiberglass reinforced nylon and incorporates the world's only TSA accepted and recognized locking latch system.
SKB designed this case expressly for the Bose pedestal and Tone Match module. Features include pre-cut high density foam for excellent protection. Rollerblade wheels on one end make for low-stress transport. Only critisism is that there is no secure compartment for power/interface cables. Otherwise, a great investment.


It has felt like an age since KitGuru last reviewed a graphics card. While we don't yet have a new GPU architecture to look at, we do have a new manufacturer in the graphics card market – ASRock. The company built its name making motherboards, and has now turned its hand to graphics cards. Is the Phantom Gaming X a good start for the Taiwanese manufacturer, or is it too little too late?


text:
Updated: Arizona proposal seeks to mandate renewable generation during peak demand hours
A fix to the renewables mandate floated by the state's consumer advocate would require wind and solar to deliver power when electricity use is highest
Flickr; BlackRockSolar
Herman K. Trabish
Update: Arizona Commissioner Andy Tobin endorsed the RUCO Clean Peak Standard in a letter filed with the ACC last week. Utility Dive's original report on the proposal follows.
An unprecedented proposal from Arizona's consumer advocate on how to improve the state's renewables mandate could be a policy whose time has come throughout the nation.
In August, Arizona Corporation Commission (ACC) Chair Doug Little opened the first review of Arizona's Renewable Energy Standards and Tariff (REST) in almost 11 years. His surprising suggestions to increase the state's 15% renewables mandate to 30% by 2030 and to include new technologies like energy storage were initially expected to be the most controversial topics in the proceeding (Docket E-00000Q-16-0289).
But a white paper just introduced last week by Arizona's Residential Utility Consumer Office (RUCO) would enhance the mandate in a completely new way by adding a mandate for renewables to meet peak demand.
While the idea is new, its immediate relevance to grid needs across the nation is already attracting attention of regulators, utilities, and important private sector players in other states.
"The Clean Peak Standard and the white paper address some of the things we want to and need to address in the review of the REST," Chair Little told Utility Dive.
"Conceptually, there are a lot of good things in the proposal that start to confront a very specific problem we have about how to encourage utilities, aggregators, and merchant generators to focus on peak demand," he said, "which is not dealt with by the REST and which existing renewable resources do not meet."
The white paper — "Evolving the RPS: A Clean Peak Standard for a Smarter Renewable Future" — started with the question of what would be best for the realities of today's grid if the policy slate was blank, white paper co-author Lon Huber, a Director with Strategen Consulting, told Utility Dive. RUCO commissioned Strategen to articulate the concept in the paper.
The Clean Peak Standard (CPS) "is intended to accomplish two things with one policy," Huber said. "It adds more renewables, but it adds renewables when the system most needs capacity so it uses renewables to deal with system cost drivers and saves ratepayers money when electricity prices are highest."
Arizona Public Sevice (APS), the state's dominant electricity provider, is interested in the proposal, said Spokesperson Anna Haberlien Stewart.
"A lot has changed since the original REST was adopted more than ten years ago," she said. "Technologies of many types have emerged and matured, and it is time to reexamine and modernize the standard. The devil is in the details, but RUCO's proposal certainly appears to make progress on some key issues."
Peak power needs can be met by pairing renewable energy with storage or designing wind and solar facilities to deliver power at certain times. The CPS concept is intended to provide that incentive. If it works, it could reduce the system's need for conventional generation at peak times and eliminate costs for delivering it.
The mandate would provide a boost not only for renewables, but for storage and distributed energy companies. Already Tesla, fresh off its acquisition of SolarCity, endorsed the concept. "While details of the proposed Clean Peak Standard still need to be discussed, Tesla supports the concept which would enable a cleaner, more resilient, lower cost grid and promote a sustainable energy future," the company told Utility Dive through a spokesperson.
Under the RUCO proposal, a certain percentage of renewable generation would have to deliver power during peak periods
AZ RUCO white paper
The CPS model
Traditional renewables mandates do not differentiate between renewable MWh based on their value to the grid, the RUCO white paper notes. But states with high wind and solar penetrations are already seeing times when there is more renewable generation than the system needs. That overgeneration can result in curtailment if it occurs during times of low power demand, with fast-reacting natural gas turbines ramping up during evening usage spikes.
Driven by renewable portfolio standard (RPS) mandates, more states will be achieving high levels of renewables penetration, the white paper reports. "New approaches will likely be needed to guard against diminishing returns of a simple MWh-based approach."
The CPS builds on the RPS construct "by adding a new dimension whereby a certain percent of energy delivered to customers during peak load hours must be derived from clean energy sources," the white paper explains. A 30% CPS would require 30% of delivered MWh during the identified peak demand period to come from "qualifying clean peak resources."
Huber recognizes the RPS as a policy that has added substantial renewables to the system, "but it does nothing about when those green electrons are produced," he said. "This would introduce a policy framework for capacity, not just energy."
A CPS could be satisfied by renewables that generate during peak demand, by energy storage charged by eligible resources, and by methods of demand management that show verifiable, quantifiable energy use reductions, the white paper reports.
"This is about evolving technology solutions through technology-agnostic price signals," Huber said. "It is making our renewables smarter."
RPSs don't encourage the use of clean energy for grid services like frequency regulation, load following, and spinning reserves. Those services tend to met by conventional resources, the white paper reports. That prolongs fossil fuel dependency and tends to increase costs to customers.
"Utility-scale solar PPAs in Arizona have been as low as $0.0375/kWh recently," Huber said. "The [latest models of] natural gas combustion turbines that would be purchased to provide capacity have a levelized cost of energy of $0.194/kWh and run 20% of the year, according to the 2014 Tucson Electric Power IRP."
A recent PPA for a Kauai Island Utility Cooperative solar plus storage project was $0.145/kWh, Huber pointed out. That shows that even in a place as expensive to do business as Hawaii, a flexible clean energy alternative can provide capacity more cost-effectively than peaker turbines.
Drawing down conventional generation during peak hours could save ratepayers money, RUCO expects, even if renewables are paired with energy storage.
From the AZ RUCO white paper
Implementation details
The white paper deals with a range of policy questions related to implementing the CPS.
Renewable energy credits (RECs) are required to validate a utility's purchase of renewables to meet a traditional RPS, the white paper explains. Similarly, compliance with a CPS would be validated by Clean Capacity Credits (CCCs). Like the RECs, CCCs would function as "tradeable commodities."
If insufficient CCCs are procured by load-serving entities to meet their compliance obligations, "an Alternative Compliance Payment could be established similar to some states' current RPS approach," the white paper suggests. The payments could fund CPS-eligible resources, it adds.
In some transmission-constrained load pocket areas, "capacity is more valuable from a system planning perspective, and often more difficult to procure due to NIMBY issues and more stringent air and land permitting requirements," the white paper notes. A "locational multiplier" could be added for distribution system-connected capacity resources in these areas to reflect their proximity to load's higher value.
More or fewer CCCs could be assigned depending on a resource's ability to meet capacity across more or less of a peak demand period's several hours, the white paper observes.
Similarly, as the penetration of renewables shifts the time of the peak period in a utility territory, the assignment of CCCs should be adjusted to reflect the effectiveness of participating resources at reducing the peak, the paper adds. Caution should be used to avoid altering the value in a way that compromises the integrity of the CCC market.
Some regulatory oversight would likely be necessary to make certain customers benefit from the CPS, the white paper stipulates. A screening process to evaluate cost-effectiveness for procured resources could "function as a form of consumer protection," it suggests.
For customer-sited resources, "some accounting for lost revenues due to retail customer bill savings may also be appropriate," it adds.
These various compliance calculations would not be any more complicated to administer than those involved in RPS compliance, Huber said. "Handling compliance records and managing CCC trading would be a relatively minor implementation matter and no more complicated than the systems now in place for the existing RPS and RECs trading."
Under the proposal, resources could earn CCCs for peak-period generation — similar to a REC under a typical RPS standard.
Chair Little: Time for 'a different approach'
Renewables targets are a good thing because they focus on an objective, Chair Little said. "But what is the REST trying to accomplish? In 2007, it was to encourage adoption of wind, utility-scale solar, and rooftop solar as alternatives to traditional generation because they were nascent technologies and the economics didn't work."
Nearly eleven years later, with those targets largely achieved, today's objectives are to cost-effectively address peak demand and reduce greenhouse gas emissions and other pollutants, Little said.
"There should be a different approach and we should get out of the business of picking specific technology winners and losers."
Renewables procurement should first meet the five standard regulatory tests for cost effectiveness, Little said. "Then it should encourage correct behaviors. The RUCO proposal would do that because it says there is a benefit to increasing renewable energy but there is a special value of using renewable energy to offset peak."
California's duck curve is a graphic illustration of how midday overgeneration of solar can result in a greater need for spinning fossil fuel reserves to meet the steeper peak demand spikes, Little added. "It shows that more renewables to meet a mandate does not necessarily get at emissions reductions."
The ACC chair cited the white paper's reference to modeling that concluded an increase in California's renewables mandate from 33% to 40% would only produce a 2% GHG reduction.
The section of the white paper pointed out by Little also shows that more renewables to meet a higher California mandate results in "fewer greenhouse gas emissions savings per MWh of RPS target."
Overgeneration during off-peak periods likely leads to the need for more renewables procurement to get the same emissions reductions, the white paper reports. "Under an alternate case in which renewable energy procurement was better matched with the grid's capabilities and needs, rate impacts of achieving the RPS were reduced by 10% to 39%."
It is too soon, Little said, to specifically endorse the RUCO proposal but his impression is it "addresses the real issues."
Those issues, he explained, are "how to deal with the steep demand ramps that will come with higher penetrations of renewable energy, and especially rooftop solar, and how to prevent increased carbon without imposing higher costs on utility customers."
Stakeholders voice general support
Newly re-elected Commissioner Andy Tobin has also been looking for "innovative ways to solve peak system demand, either by reducing it or finding the least cost resource to meet it," he told Utility Dive
The capacity to meet peak demand is "one of the most significant cost drivers for Arizona electric utilities" and adds "extraordinary cost to ratepayers," Tobin said. A standard that allows all renewable energy technologies to compete as least cost capacity to meet peak demand will make it possible "for market forces to provide the largest menu of energy options."
RUCO's CPS "offers great promise in moving the Commission away from an obsolete commitment to arbitrary renewable energy goals," Tobin added. In revising the REST, the commission "must not make the mistake of separating system peak from renewable energy."
Energy Storage Association (ESA) Policy and Advocacy Director Jason Burwen likes the CPS concept as well.
"There is no signal right now for peak capacity services and grid flexibility services to be clean energy," he said.
The RUCO proposal would cost-effectively align the delivery of clean energy with the goals of the REST and make sure additions to the mandate also meet the goal of reducing emissions, Burwen believes. "What wins in this proposal are resources like demand response and energy storage that deliver flexibility to the system."
It is "a new, important, and innovative idea that warrants regulators' attention and warrants all stakeholders to engage," he added. "Right now, it is more of a concept than a finished policy and it needs to be developed ... That is why subjecting this to a stakeholder process will be the best thing the commission can do with it."
Stem is one of the leading providers of demand response with energy storage. Regulatory Affairs Sr. Manager Anthony Harrison voiced support for the CPS as well.
"The value of something like a Clean Peak Standard is that it takes a broad, technology-diverse approach to meeting system peak needs," he told Utility Dive.
It could also help balance the variability of renewables with the deployment of flexible and dispatchable resources and lead to savings for ratepayers by reducing generation overbuild and limiting curtailment, he added.
"A key piece of RUCO's proposal is that a complementary component, the Clean Flex Standard, allows system capacity and renewable integration needs to be met through scaling clean resources such as energy storage," Harrison added.
The CPS's biggest value could come in allowing a diverse range of technologies, including storage, renewables, and other load management technologies, to compete, he said. But that can only happen if the attributes of all the technologies, including annual availability, dispatchability, ramping speed, response time, and duration, are properly valued.
Hard work still to come
Commissioner Tobin, APS's Stewart, and ESA's Burwen held back final judgment until it is further explored in the REST proceeding.
"We will learn more as the Commission process evolves," Stewart said.
Commissioner Little was equally hesitant on some specifics.
"The Clean Peak Standard has real merit," he said. "It could be implemented without the level of complexity in some of the other parts of the proposal. Things like a Clean Flex Standard and a Clean Reserves Standard and a Clean Regulation Standard and the CCC market all start to get complicated."
In 2007, the REST had "a fairly complicated way of counting credits," he recalled. "It has failed because new business concepts, like third party ownership, and new technologies, like low cost rooftop solar, have evolved more rapidly than the REC system."
Some of the more complicated things in the RUCO proposal may be similar to those early REST complexities and don't offer the benefits that would come with the CPS, he thinks.
The new REST needs to be simple for the utilities to implement and he does not want to introduce what he sees as unnecessary complexities, Little said.
"The objective is not a complicated system to count credits, it is to reduce carbon and address peak demand and deal with the variability of renewable energy," he said. "I want to deal with those things."
Filed Under: Solar & Renewables Energy Storage Distributed Energy Efficiency & Demand Response Regulation & Policy
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Making films is my passion, I film and edit short movies, documentaries and reports.
Making a film is a huge creative process: turning your stories into images, find fitting music and sounds and next to that, making a film ready for web or dvd is pretty technical. I don't only make film, I also really like to teach making films.
These aren't theoretical lessons, the kind that overflows you with information. I'll immediately put you to work with a camera and a storyboard. You'll discover in a playful manner what making movies is, once you start.
Making a movie is expensive and takes some time. In this age everything is about moving images and this makes film one of the most powerful tools to communicate your message.
Because not everyone feels like making a professional movie and some people want a result on short term, I offer you my assistance as a film coach.
I have experience as a museum, film and CKV teacher at grade schools and junior high. I've also teached in Central America. Want to know more about my lessons and workshops? Have a look at: www.studiomc2.nl.
Intake: What do you want, what kind of material is already available, what do you want to reach with your movie? We'll have a conversation with each other about the result we'd like to see.
1st version: I'll start working on your movie. When there's already some material, we're able to start pretty quickly.
Discuss and implement feedback: we'll have a look at the 1st version together and will directly edit it. You'll take the final version home or we'll directly upload it to the internet. Bring your USB-drive or account logins of your youtube/vimeo accounts.
I like to work with social capital, the GIVEconomy. Give me something which comes from your expertise or cognitive surplus, if it's something that I'm desiring. Check my wishlist to see if there's something that I can use. A short movie is usually around 1300,- euro, but it depends on a lot of things, don't hesitate to give me call and i can give you a precise estimation of the cost.
This is what I love to do most.
In 2006 I've made my first documentary, because I was gripped by the situation of my nephew and niece, two special twins who I've followed intensively for a month. The premiere of this documentary was at the Shoot Me filmfestival in The Hague and was nominated for a contest of Hollanddoc, where you can still see it online.
At the moment I just finished my first co-creation movie, for which I did the final editing. In this project I closely work together with a platform of LightWorkers, we had a amazing time together! Here's a teaser of the movie, which will be available this summer!


Last week, we introduced MetroVoice, our unique cloud-based phone system and the newest product in our Voice Services line. Cloud communication and MetroVoice can unify your business communications systems, give you a cost-savings and expand your company's reach.
The business communications landscape has been changing as rapidly as technology grows. The current cloud-based telephone solutions and other unified communications platforms now make it more viable, affordable and cost effective than even a few years ago.
Introducing MetroVoice, our unique cloud-based phone system and the newest product in our Voice Services line. MetroVoice provides your business with a unified telephone and communications system that scales to your company, no matter what size.
With MetroVoice, you'll actually get more features than an on-premise phone system but at a lower cost! MetroVoice is a robust communications system that provides your business with a phone system with full calling features plus mobile apps, instant messaging, online integration collaborative communication and much more.
And, by controlling our On Net engineering end-to-end, MetroVoice gives you the best voice quality possible.


text:
Грб Северног Кипра је званични хералдички симбол непризнате државе Турска Република Северни Кипар.

Грб је заснован је на грбу Кипра. Састоји се од штита са жутом подлогом, на којем је бела голубица с маслиновом гранчицом у кљуну. Изнад штита је година 1983. и полумесец са звездом, која алудира на повезаност Севереног Кипра са државом Турском, али и исламом уопште.

Види још
 Застава Турске Републике Северни Кипар

Спољашње везе

Турска Република Северни Кипар
К
Грбови Европе
Грбови Азије

redpajama_set_name: RedPajamaWikipedia


A few days ago, I wrote an article relating to why most people need to eventually convert your active to passive income at the end of the day.
There are a few good arguments here and there that surrounds whether we need passive income in our lives but I think most people are in consensus that they need some sort of passive income, even if it's just a small part of it.
You see, it all started with the fact that time is a finite resource.
You can't be in the East on one side and be present at the same time in the West because your physical presence can only be at one point in a single time.
Technically, that means that if your earned income are based on your presence and services that you provide, you can only earn a limited amount that is capped because you are restricted by your movement and time.
This can be possible of course, that is if you are able to improve your service per hour massively over a number of years that you have been trained for.
Take for example, the renowned footballer of the year, Cristiano Ronaldo - a player whose illustrious career with Sporting Lisbon, Manchester United, Real Madrid and Juventus takes the world by storm.
Cristiano started his career with Lisbon at the age of 17 when he was earning around £18,000 per week.
He worked so hard in his career, came early for training, stayed back to practice on his set pieces and after years of hard work he was rewarded with an illustrious career move to Real Madrid where he earns a basic salary of £365k per week.
That is some crazy compounding annual growth rate if you do backwards accounting.
By the same nature, there are some of you who are very good at climbing the corporate ladder because you are so good at what you do.
You worked hard for the project that you've been assigned to, you sacrificed your weekends to commit yourself to meeting the deadline and you've built great relationship with your peers and supervisors.
All of those amounts to efforts that you've diligently built from scratch and maintain them.
While the above is an exemplary of what we can learn, there is a better option and that is by enhancing your skills to work on other people's time.
An entrepreneur, whose work surrounds setting up a business or company providing services or products in the hope of earning a profit, builds on a premise that in order to bring his business to the next level, he must hire people to do most of the groundwork operations while he uses his time to scale his businesses strategically.
The teams he employed are churning out the cashflow for his company on his behalf while he seeks to find another cashflow stream.
There are inherent risks in entrepreneurship but you can see where I am coming from with the analogy.
An investor who invests in properties at a decent valuation as an owner is able to rent out his premise for rental income while waiting for capital gain appreciation in a few years time. In this analogy, the investor is using the lessee's rental over time to pay off the mortgage over the next 30 years.
Similarly, a shareholder who owns the right to vote in the company is technically an owner by nature and he earns the right to receive dividends from the profits of the company by allowing the management to manage the thousands of employees employed within the company.
In all the examples above, it exemplifies the magnitude of improving the revenue earned per hour and productivity increase.
The idea is to be able to get to a stage where you aim to earn what you did today but with a much better resource allocation of time.
Ensuring a positive cashflow under the utilization of time productivity is the essence of a true financial independence recipe.


text:
package org.apache.syncope.client.console.widgets;

import java.util.Date;
import java.util.List;
import org.apache.syncope.client.console.SyncopeConsoleSession;
import org.apache.wicket.markup.html.basic.Label;
import org.apache.wicket.markup.html.list.ListItem;
import org.apache.wicket.markup.html.list.ListView;
import org.apache.wicket.markup.html.panel.Panel;

public class ProgressesPanel extends Panel {

    private static final long serialVersionUID = 7837262802315339565L;

    public ProgressesPanel(final String id, final Date lastUpdate, final List<ProgressBean> progressBeans) {
        super(id);

        add(new Label("lastUpdate", SyncopeConsoleSession.get().getDateFormat().format(lastUpdate)));

        ListView<ProgressBean> progresses = new ListView<ProgressBean>("progresses", progressBeans) {

            private static final long serialVersionUID = -9180479401817023838L;

            @Override
            protected void populateItem(final ListItem<ProgressBean> item) {
                item.add(new ProgressPanel("progress", item.getModelObject()));
            }
        };
        progresses.setOutputMarkupId(true);
        add(progresses);
    }

}


text:
Urgicare centers too costly, doc says
Mount Sinai, RPI Ink Deal
The Icahn School of Medicine at Mount Sinai and Rensselaer Polytechnic Institute yesterday announced an affiliation agreement, citing intense competition for research funding and cutbacks in the pharmaceutical industry's research and development budgets. The two institutions said they will seek joint funding in research programs focusing on precision medicine, drug discovery, stem cell biology, robotics and robotic surgery, imaging techniques, cellular engineering, and computational neurobiology. The initial areas of focus will be genomics, imaging, tissue engineering and neuroscience. Mount Sinai's neuroscientists will work with RPI's engineering and robotics experts on imaging and the development of new diagnostic and treatment tools, for example. The two facilities hope to collaborate on analyzing genomic data and developing predictive models of disease using their combined computing powers: Mount Sinai invested $3 million to build its Minerva supercomputer, while RPI has its own supercomputing system at the Computational Center for Nanotechnology Innovations. They also will create the Mount Sinai and Rensselaer Collaborative Center for Research Innovation and Entrepreneurship to translate research into marketable products. There also will be joint graduate programs, including a path to earn an M.D. from Mount Sinai and a Ph.D. from Rensselaer.
CON Regs for Doctors
As Pulse reported yesterday, GNYHA does not believe physician practices should have to go through the same certificate of need application process as hospitals do when they open a new facility. But GNYHA does support the idea of requiring a CON when such practices want to acquire and use high-end equipment like MRIs. The CON playing field should be leveled in those areas, "decreasing over-acquisition and unnecessary utilization," GNYHA wrote in an April letter explaining its position to the Department of Health. "To the extent that hospitals and other facilities already face CON requirements and related oversight in specific clinical areas, so too should all providers."
Kidney Transplants Revamp
After a one-year voluntary closure because of quality issues, Hackensack University Medical Center restarted its adult kidney transplantation program last week. It is now under the direction of Dr. James Lim, program director and chief of transplant surgery. He was program director and chief at Lankenau Medical Center in Pennsylvania for six years, and previously was chief of pancreas transplants at Robert Wood Johnson University Hospital in New Jersey until 2007.
Are urgent care centers located on hospital grounds driving up unnecessary hospital admissions? Dr. John Rugge thinks so.
Physicians who treat a patient in a hospital-affiliated urgicare center are legally obliged to err on the side of caution about admitting patients. That drives up costs, the chairman of the Department of Health's Public Health and Health Planning Council's planning committee said.
For instance, a patient with pneumonia comes into Dr. Rugge's medical office and is treated. "I can say, 'Here's my number; call me if you get worse,' '' and wait to see if the patient improves, Dr. Rugge said at a May 21 special committee meeting.
"But when that patient is seen in the ER and I send him home, if he does come back, the presumption is that I erred," Dr. Rugge said.
He suggested locating urgent care facilities in primary care centers, where patients could be seen, treated, referred to an advanced care medical practice and be admitted to the hospital only if absolutely necessary. The current trend of putting the centers in or near hospitals "leads to increased cost, and we can't afford that anymore," he said.
Federal laws prohibit hospitals from dismissing patients who come to an emergency room until they have been medically stabilized, regardless of whether they can pay for care. Those rules do not apply to an urgent care center that is not part of a hospital, Dr. Rugge said. Urgent care centers and medical practices would need additional financial support to care for patients who can't pay.
WHO'S NEWS: As Pulse reported on April 12, Karen Lipson left her job as director of the division of policy for DOH's Office of Health Systems Management. She had been with DOH since January 2008. On May 28, Ms. Lipson heads to LeadingAge New York as executive vice president for innovation strategies. She will focus on managed long-term care and home care.
Woman who sued Donald Trump loses


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Kamikaze Fireflies
Other / Theater Website Is this you? Click here to claim your profile!
Rob Williams and Casey Martin perform their show, Kamikaze Fireflies, for audiences all over the world at venues such as performing arts centers, corporate events, cruise ships, colleges, busker festivals, and renaissance festivals. The show is a mix of comedy and circus. Juggling, hula hoops, german wheel, whip cracking, and many tricks never seen anywhere else. The Seattle Times said they gave a "near riotous end to the show." On America's Got Talent they received a standing ovation and Howard Stern said, "Fantastic. Captivating. You're funny. I was sucked into this thing. It was wonderful. I can't wait to see more."
Upcoming Events for Kamikaze Fireflies


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Kiersey Nicole Clemons (born December 17, 1993) is an American actress and singer. Clemons is best known for portraying Cassandra "Diggy" Andrews in the acclaimed 2015 comedy-drama film Dope. Her other notable roles include Transparent, Extant and Neighbors 2 Sorority Rising. Clemons is cast as Iris West in the DC Extended Universe.


What is it about money? For some it's an obsession. For others it holds the electrical charge of politics and religion. Some loathe it. Some build their entire life around it. There are those that are uncomfortable with it, and there are those who are true masters of it.
In this episode we begin the process of deconstructing the dynamics of money in our culture and how it affects how we live. Money touches so many parts of our lives. We interface with it regularly and are forever finding ourselves at financial crossroads, often making life decisions based on money.
I have personally been fascinated with people's experience, beliefs, and emotions around money. When it comes to living your most inspired and meaningful life, your relationship, attitude and understanding around it will have a lot to do with how that life will unfold for you.
Do you own money or does money own you?


Enjoy your Valentine's evening with a wine tasting at The Collegiate Hotel for $60 per couple. Stop by anytime from 5-9 p.m. at The Bat at Wittel inside The Collegiate Hotel for a guided tour with a local sommelier as we sample 4 wines, each paired with a small bite.
You must be 21 years or older to purchase tickets or attend the event.
For the event only, please park across from the hotel in the gravel lot.
There are no refunds for the event.


Upcoming Events (see below), Schedules, Standings and Photos.
WELCOME TO THE 2011 SEASON, PLEASE VISIT THIS WEBSITE FOR ALL FOOTBALL UPDATES AND NEWS DURING THE SEASON.
WELCOME TO THE 2011 SEASON, PLEASE CHECK THIS SITE FOR ONGOING UPDATES AND NEWS.
- Use your regular detergent in your normal cycle. NO BLEACH.
Note: Please take proper care of the uniform. We will not have an extra uniform , so please take good care of the one received for the 2011 season. If you lose or damage the uniform, your child will not be able to participate in the program for the balance of the season and you will have to pay the cost of the uniform.


Allowing you to experience random chat without requiring you to create an account is one of our main perks.You can talk to strangers online by simply pressing a button.All you have to do is answer a couple of simple questions and you're ready to go.Why get bogged down with inconvenient registration pages when you don't have to?Pick a specific country and view people from only that country.Over 70 countries are available to choose from, making us the most international Omegle chat alternative on the internet.We don't make you wait, our webcams load instantly.Another cool feature is the country selector that allows you to talk to random people from all over the world.
Fortunately, you can quickly leave any video chat that you are in with the push of a button and then immediately go to the next room where you can chat with a totally new random person. This gives each person the chance to get to know the other person better without anyone else in the webcam chat distracting them.You will be asked to enable your cam and once it is enabled, you will begin video chatting with people instantly.You will be matched with a different random person every time you press the "next" button.This is why our random chat is anonymous and secure.


The new center will provide a broad portfolio of dimensional metrology and inspection equipment and services to a wide variety of industries including: automotive, medical, aerospace, defense, machine tools and general manufacturing job shops. With almost 170 employees.
11/13/18, 05:31 AM | Automation & Networking, Design & Development | Smart Factory | ABB Inc.
The Xiamen Hub is ABBs largest and one of our most advanced manufacturing sites, and it demonstrates the potential of Industry 4.0 on our own premises.
Expanded technology pavilions, co-located shows, conferences, events and two AMTs Emerging Technology Centers; digital connectivity and additive manufacturing among hottest technologies showcased for manufacturers and job shops.
Flat Cables have many technical and performance enhancing advantages over round cables, so Cicoil has released a New Video to clearly illustrate "The Top 5 Reasons to Use Flat Cable in your Design"
IMTS 2018 takes place at McCormick Place in Chicago, IL September 10th - 15th. This ManufacturingTomorrow.com Special Tradeshow report aims to bring you news, articles and products from this years event.
New ABB OmniCore™ robot controller family offers broadest motion control options, more tailored solutions for the connected "Factory of the Future"


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The Cornell Daily Sun (https://cornellsun.com/2018/10/26/leung-abroad-changes-you-they-said/)
LEUNG | Abroad Changes You, They Said
By Gabrielle Leung | October 26, 2018
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Since recess time and cafeteria lunches, studying abroad had always been the dream. It was something of the future. It was living in a new city and traveling on weekends. It wasn't school, it was abroad.
When it was actually time for me to apply, I petitioned the College of Arts & Sciences to allow me to go to Thailand (my three semesters of Italian would be useless in Chiang Mai). By the end of fall semester, I panicked. I wasn't ready; I couldn't leave these people or this small town I had grown to love — now, all of a sudden I was deeply appreciative of ice fests. Ice fests. And cold weather. Of course I was excited, but I felt like a baby bird who wasn't ready to leave its nest. It surprised me: I've always been the type of person who feels confined and restless in institutions when I'm in them for too long. But here I was, not being able to leave.
Abroad changes you, that's what they all say. When I studied in Chiang Mai, Thailand, I remember asking my friend early on whether or not she thought she would have a moment when something clicked; when her ideas on life would be clearer, or she knew they had changed. Living in a Buddhist country for almost 5 months would bring some type of enlightenment — even on the most personal level. Living in Southeast Asia itself allowed me to understand the differences in culture; how individualized, and even selfish we are in the United States. While it was different, I appreciated the communal aspect of Thai culture, how everybody seemed to be living with the thought that everything they said and did impacted others. And their sense of humor — it was on a different level.
Abroad changes you, they said. But behind the situational remarks of, "Oh, but it's nothing like the tagliatelle ai funghi porcini that I ate in Firenze" or "You should've seen the sunsets in Barcelona — unreal," what is it that we really bring back from abroad?
When I came back to work in New York City for the summer, only two weeks had passed since I returned from Southeast Asia. The strange part was, although I had felt so hesitant about coming back to the United States, as soon as I got back, I felt myself fit smoothly into the mold of society. I felt heavier, though, in that I had a weight of experiences that the people in my life didn't know or couldn't understand. Like many experiences, but especially stories from abroad that cover so many months, there is only so much that can be answered with, "So how was it?"
It was happiness: it was sunrise hikes to temples, village homestays and spring break trips to the islands. It was $1 pad thai, night markets, school uniforms and Chang beer.
It was confusion: it was not being able to communicate with locals, not understanding my place within the country, wondering if I was being treated differently because I was a foreigner.
It was sadness: it was knowing where my roots came from and wishing the important people in my life were here to experience the warmth of Thailand with me.
I came back with a tan, blonder hair and an obsession with mango sticky rice. But where was the girl who said "yes" to everything? Who learned to walk slower, listen deeper and engage more? What about the unselfishness I had experienced that made me believe humanity was capable of something greater and made me think vulnerability and openness was viable again? Where did it all go?
I didn't go into study abroad thinking in any way that I would be "changed." Maybe it came from my past travel experiences and skepticism with people who thought that buying 1 Euro wine was a transformative experience. Abroad doesn't change you; it can broaden your perspectives, challenge beliefs and make you more curious or appreciative of the differences in culture. While going to Southeast Asia might have been a more cultural challenge than if I had gone to Europe, I still felt as if coming back to the United States after a semester abroad didn't mean coming back as a new person. Even incorporating what I learned and experienced abroad proved difficult when I found myself back in the bustling streets of New York City and felt the need to be going somewhere — to always have a destination in mind.
I missed aimlessness. The feeling that I didn't owe anything to anyone; that I could exist on my own and interact with the world on my own terms. I missed friendships from hostels, midnight rides in tuk tuks and the familiar tune every AirAsia plane would play.
These memories don't die. They were real at a point; you were in the presence of these people, you made every one of these decisions. Remembering that this point in your life wasn't some surreal, detached dream holds you responsible for the type of person you were. And if I can see my time abroad as one in which I lived day by day, hour to hour, in a country where seeing monks walking on sidewalks and listening to the birds sing in the evening was real and true, I can believe that the person I was is the person I can still be.
Gabrielle Leung is a senior in the College of Arts and Sciences. She can be reached at gleung@cornellsun.com. Serendipitous Musings appears alternate Thursdays this semester.
PARK | We Need Free Speech on Campus
By Sarah Park October 28, 2018
This past summer, I worked for Jeff Sessions in the Justice Department and exited the comfort of my liberal bubble for the first time in my life. Working with members of the Trump administration forced me to grapple with my prejudice as I really engaged with the other party.
MORADI | After Pittsburgh, the Pain We Share
By Pegah Moradi October 28, 2018
I grew up going to Quran school at my small, non-denominational mosque in a Virginia business center squished between a Days Inn and a dusty storage facility. It's been vandalized and threatened on multiple occasions.


This seems to be another fan made game in the works similar to Armored Core: Limit Release, but this one seems to have focused the game to Armored Core's typically unappreciated grunt enemies. The name of the game escapes us, but it seems that it features MT opponents from the first Armored Core game and might also feature some limited customization on parts. Hit the jump for the video.
Watch the whole video here. If the video fails to load, keep refreshing the page or try this link instead.
As of the moment, we know little about the game maker or the title, or if it is a doujin game soon to be released or just a personal project of someone. We'll update you as soon as information arrives.
Thanks to J.E. for another heads up.
Thanks Passage, for the update.
Armored Core: Last Raven - Hacked!
Finally. I wonder how it'll be when you're facing an AC.
The game goes by the name of Muscle Tracer (MT), same name as the mechs present in it.


Three times a year, you will receive an assessment report which gives you a clear indication of your child's current performance.
Please click here to read full information on how we report on your child's progress in Years 7 and 8.
Please click here to read full information on how we report on your child's progress in Years 9 and 10.
Please click here to read full information on how we report on your child's progress in Year 11.
This is given as a numerical score.
This is based on your child's effort both in class and with homework. It reflects your child's behaviour and the extent to which they actively take responsibility for their learning.
In addition to the assessment reports two parent evenings will be held for each year group giving you the opportunity to meet with the subject teacher of your son or daughter.


FAIR. Goji is the first and only Goji Berry Liqueur and is also made with Fair Trade Certified ingredients with a focus on the legendary and sacred Goji berry fruit. Considered one of the most nutritious fruits on earth, Goji berries were harvested by Tibetan monks for thousands of years and worshipped by locals as source of eternal happiness. The berries harvested for FAIR. Goji are found in remote and unpolluted valleys of the Himalayas where the soil is loved and respected. FAIR.Goji offers a totally new flavor with notes of cranberry, cherry and plum with herbacious notes. The rare FAIR. Goji has already received rave reviews from both consumers and mixologists as the latest source of inspiration for fresh and unique cocktails with a healthful twist.


Michal Parízek is an Assistant Professor and the Deputy Head of the Department of International Relations, Charles University.
PARÍZEK, Michal. Control, soft information, and the politics of international organizations staffing. The Review of International Organizations. 2017, 12(4), 559-583. DOI: 10.1007/s11558-016-9252-1. ISSN 1559-7431.
PARÍZEK, Michal. Communication and Credibility in Multilateral Negotiations. Czech Journal of Political Science. 2016, 23(1), 44-64. DOI: 10.5817/PC2016-1-44. ISSN 12113247.
PARÍZEK, Michal - HOSLI, Madeleine O. - PLECHANOVOVÁ, Běla. Avoiding Paralysis: The Eastern Enlargement and the Council of the European Union. Journal of European Integration. 2015, 37(6), 649-665. DOI: 10.1080/07036337.2015.1034276. ISSN 0703-6337.
In his research, Michal Parízek focuses on global economic governance, international trade and international bureaucracies.


At $18 apiece, the specialty cocktails served at New York City's Algonquin Hotel may seem expensive. But they're a bargain compared to the hotel's very special $10,000 martini: "It comes with a single piece of ice – a diamond from the in-house jeweler, Bader & Garrin." Let's hope anyone game for ordering one doesn't down the concoction in one gulp, bling and all. A three-martini lunch probably isn't a good idea either.


Documented as Laxman Basnet, I love writing Lakshman everywhere.
I love using Linux Operating System. I am using Linux OS all time since last 2 years. I have intermediate knowledge with Manjaro, Ubunto and I know the flavor of Cent OS and Puppy Linux too. :P Currently, I am loving using Fedora by Redhat since past 6 months.
I use Mozilla Firefox all time to browse internet, I simply love Firefox.
You can see me with 600D Canon Camera when I travel places. I love taking cool photos.
I recently updated to iOS10 on my smartphone, I use my phone to take videos most of the time and post on youtube.
I prefer Telegram to stay connected to close ones. After I started using Telegram, viber, messenger and other messaging applications seem slow to me.
I am trying hard to get a Macbook before my last semester. I just love technlogy and want to experience new.
Also, I want to take cool photos and videos soon with Gopro Hero adventure camera.
I am also planning to either make or get a drone to attach gopro and shoot awesome scenes and videos.
I have pointed the major places I have been till now.
I upload videos in this youtube channel.
I keep on posting on this facebook page too.


Description: Gogo Thooty is a small game in which you have to get the fallen Toothy back to the origin as fast as possible. Toothy will climb when you click on his belly. Attention: If you miss, Toothy will fall again! Ouch!
That's not just logic. That's really sneslibe.


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The Warwickshire Golf & Country Club
SafeGolf is a partnership of UK golf bodies committed to promoting a safe and positive environment for all those participating, working and volunteering in the sport of golf.
SafeGolf consists of members from the golfing bodies across Great Britain & Ireland and has been established to help golf respond to the issue of child protection in sport. Its mission is to safeguard the welfare of children and young people, as well as adults at risk, in the sport of golf. This will be achieved through a unique partnership which has the ability to influence and act as advocate for safeguarding across the golfing landscape, developing a consistent approach towards ensuring that all people have a fun, safe and positive experience when playing golf.
It's the way to show that our club meets high standards to safeguard and promote the welfare of children and young people. We think it's the most important thing we can all do for our sport.
Children and Young People Safeguarding Policy click here
Everyone working with children and young people has a responsibility for keeping them safe, irrespective of their role, whether they are paid members of staff or volunteers.
England Golf is committed to ensure that the sport of golf is one within which all participants can thrive in a safe environment and that all children and young people have an enjoyable and positive experience when playing golf.
Safeguarding Adults Policy click here
England Golf is committed to creating and maintaining a safe and positive environment for all individuals involved in golf. Although there are many similarities with safeguarding adults and children there are also some distinct differences. For this reason, England Golf has created a separate Safeguarding Adults Policy.
Safeguarding duties apply to an adult who:•
Has needs for care and support (whether or not the local authority is meeting any of those needs) and;
Is experiencing, or is at risk of, abuse or neglect; and;
As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of, abuse or neglect.
England Golf will encourage and support partner organisations, clubs and counties to adopt and demonstrate their commitment to the principles and best practice set out in this safeguarding policy and procedures.
The Club Welfare Officer is Therese Kennedy. Email Address: t.kennedy@theclubcompany.com click here
© 2022 The Warwickshire / 01926 622 570
© 2022 intelligentgolf. CONGU is ® Council of National Golf Unions


The documents and links relating to the 2020 Pacific Cup are found on this page, and will be updated as documents are released.
The equipment list for 2020 has not been published yet. It's expected to be similar to the 2018 list, which you can find here.


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SRAM ETAP AXS 2019: SUMMARY & CCACHE REVIEW
Posted by ccache store on February 07, 2019
By now, you would have woken up to all of your social media channels ablaze with posts about the new ETAP AXS. Below is a concise look into the features of the new ETAP AXS groupset/system. We will provide a review on what we think this new SRAM groupset will mean from an upgrade/riding perspective.
12 Speed groupset
Wireless but with further connectivity to Smart phone via BLE
New gearing options from the unconventional chainring sizes + 10t cog cassette
Quieter operation due to new chain and tooth profiles
Faster shifts due to faster chips and motors both in shifters and derailleurs
New chain with new shape that is NOT backwards compatible
Fluid clutch in rear derailleur which provides dampening to the cages movement as to limit noise and unwanted chain movement. Think a less aggressive system vs MTB clutch derailleurs.
Quarq power meter is now built into chainrings
Cassette requires XDR freehub
Integration with AXS App which enables autoshifting modes (Sequential/Compensating)
Sequential is what Di2 already does. Compensating mimics how we ride in the real world, i.e. shifting 1-2 cogs at the rear after shifting the front in either direction to minimise the jump
Force ETAP AXS is coming as well
CCACHE REVIEW
So what does this new groupset mean for riders and consumers in general? Is it worth the upgrade?
First of all, let's address the primary factor in deciding a groupset for most consumers: cost. The ETAP AXS groupset is an expensive groupset. We know this because it is the top tier groupset in SRAM's lineup. However, there are a lot of "hidden" costs that at least - right now - isn't avoidable. The original ETAP system allowed consumers to purchase an upgrade kit (shift levers/rear derailleur/front derailleur) and instantly upgrade their rides to ETAP. This was due to the fact that the system was backwards compatible with pretty much all 11spd hardware. The RED 22 groupset shared similar parts so that users who already had cranksets, cassettes and chains; could easily upgrade. You could also run cross system components such as Shimano and Campagnolo with minimal fuss.
With the new ETAP AXS, this is no longer the case. You will now need a new cassette and a chain specific to ETAP AXS. You will most likely need the new crankset with the new chainrings to work with the new narrower chain. If you run non round chainrings, you may be out of options until Rotor/Absolute black revises their design to be 12spd compatible. If you run a power meter, you will probably have to get the new QUARQ power meter with chainrings attached. Lastly, you will need a new freehub or new rear wheel/wheelset if your current one isn't convertible to XDR standard. If you also ride your bike on a stationary trainer, you will most likely need something new with XDR freehub as well.
If you consider the costs of everything above, it is pretty clear that the outlay of transitioning to ETAP AXS can be far more expensive than the original ETAP.
If you are coming from a cabled system, the advantages of the original ETAP still remain: ease of installation, ease of moving from bike to bike, ease of general setup.
The original ETAP was always slightly slow. It isn't too slow to really hinder the way of riding, but it is definitely slower than Di2 systems. The new ETAP with the faster chips and faster motors should address this pending operational review. This was one of the biggest complaints of ETAP systems. It isn't a deal breaker but having it addressed further reinforces ETAP's strength.
Having a wider range of gear is always welcomed, too. Sure, there will still be someone in your bunch touting the fact that they run a 54 front chainring and 11-25 cassette, but for the majority of consumers, a wider range = more options. You don't have to use the bail out gears, but it is nice when it is there. The 10T cog on the rear cassette allows smaller front chainrings to achieve the same top-end speed as conventional setups, but also allows - arguably - more useable midrange options. The options for rear cassettes are 10-26t/10-28t/10-33t, whilst the front chainring options are 46-33/48-35/50-37. Having a 12 speed setup helps lessen the jump between each gear.
Having tried the sequential shifting on Di2's, we cannot say it is our favourite. At most, it feels a little gimmicky. The new compensating mode on the ETAP AXS however, is a good halfway step in autonomous shifting. Think of it as the auto blip on new manual cars versus say, a full PDK/DCT/DSG drivetrain. We feel like this is a mode that we will end up actually using, depending on how configurable it is and how well it works. (Edited to add: Di2 also has this mode called semi synchro).
Finally, there are a lot of little changes which put together makes a big difference: quieter operation, better longevity and a "clutched" rear derailleur. All of which combined with the advantages above, form a comprehensive re-think of what a groupset can be. Is it worth the cost of the upgrade? We think the new ETAP AXS might be more popular for people who spec their new bikes entirely from the ground up. The way the whole groupset is integrated makes it easier to buy everything from the get-go. This is not to say that SRAM won't eventually make an upgrade kit which allows you to purchase the chainrings separately, allowing you to mount it to your 110/130bcd cranksets. With the release of the FORCE ETAP AXS also pending, we are keen to see if this groupset will be less integrated and allow consumers to utilise their exisiting components.