text:
Histoplasmosis After Solid Organ Transplant
Histoplasmosis After Solid Organ Transplant
Maha Assi 18
Stanley Martin 16
L. Joseph Wheat 15
Chadi Hage 22
Alison Freifeld 21
Robin Avery 20
John W. Baddley 19
Paschalis Vergidis 24
Rachel Miller 23
David Andes 17
Jo-Anne H. Young 7
Kassem Hammoud 8
Shirish Huprikar 5
David McKinsey 6
Thein Myint 3
Julia Garcia-Diaz 4
Eden Esguerra 1
E. J. Kwak 2
Michele Morris 0
Kathleen M. Mullane 10
Vidhya Prakash 9
Steven D. Burdette 11
Mohammad Sandid 18
Jana Dickter 12
Darin Ostrander 13
Smyrna Abou Antoun 18
Daniel R. Kaul 14
0 Division of Infectious Diseases, University of Miami Miller School of Medicine , Florida
1 St John's Regional Medical Center , Joplin, Missouri
2 Division of Transplant Infectious Diseases, University of Pittsburgh , Pennsylvania
3 Division of Infectious Diseases, University of Kentucky , Lexington
4 Ochsner Medical Foundation , New Orleans, Louisiana
5 Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai , New York , New York
6 Infectious Disease Associates of Kansas City , Missouri
7 Department of Medicine, Division of Infectious Disease, University of Minnesota , Minneapolis
8 Division of Infectious Diseases, University of Kansas Medical Center , Kansas City
9 Infectious Disease Department, Wright-Patterson Medical Center
10 Department of Medicine, University of Chicago , Illinois
11 Division of Infectious Disease, Wright State University Boonshoft School of Medicine , Dayton, Ohio
12 Division of Infectious Diseases, Kaiser Permanente , Fontana, California
13 Transplant and Oncology Infectious Diseases Clinical Research Center, Division of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, Maryland
14 Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School , Ann Arbor
15 MiraVista Diagnostics
16 Division of Infectious Diseases, Ohio State University Medical Center , Columbus
17 Department of Medicine and Medical Microbiology and Immunology, University of Wisconsin , Madison
18 Department of Internal Medicine, University of Kansas School of Medicine , Wichita
19 Division of Infectious Diseases, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center
20 Division of Infectious Disease (Transplant Oncology), Johns Hopkins University of Medicine , Baltimore, Maryland
21 Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center , Omaha
22 Department of Internal Medicine, Pulmonary-Critical Care and Infectious Diseases, Indiana University , Indianapolis
23 Divison of Infectious Diseases, University of Iowa , Iowa City
24 Division of Clinical Microbiology, Mayo Clinic , Rochester, Minnesota
Background. To improve our understanding of risk factors, management, diagnosis, and outcomes associated with histoplasmosis after solid organ transplant (SOT), we report a large series of histoplasmosis occurring after SOT. Methods. All cases of histoplasmosis in SOT recipients diagnosed between 1 January 2003 and 31 December 2010 at 24 institutions were identified. Demographic, clinical, and laboratory data were collected. Results. One hundred fifty-two cases were identified: kidney (51%), liver (16%), kidney/pancreas (14%), heart (9%), lung (5%), pancreas (2%), and other (2%). The median time from transplant to diagnosis was 27 months, but 34% were diagnosed in the first year after transplant. Twenty-eight percent of patients had severe disease (requiring intensive care unit admission); 81% had disseminated disease. Urine Histoplasma antigen detection was the most sensitive diagnostic method, positive in 132 of 142 patients (93%). An amphotericin formulation was administered initially to 73% of patients for a median duration of 2 weeks; step-down therapy with an azole was continued for a median duration of 12 months. Ten percent of patients died due to histoplasmosis with 72% of deaths occurring in the first month after diagnosis; older age and severe disease were risk factors for death from histoplasmosis. Relapse occurred in 6% of patients. Conclusions. Although late cases occur, the first year after SOT is the period of highest risk for histoplasmosis. In patients who survive the first month after diagnosis, treatment with an amphotericin formulation followed by an azole for 12 months is usually successful, with only rare relapse.
histoplasmosis; fungal infection; solid organ transplant.
The dimorphic fungus Histoplasma capsulatum is most
common in the United States in the Ohio and
Mississippi River valleys. Sensitivity to Histoplasma antigens
among individuals living in these river valleys may
exceed 80% . Infection is often asymptomatic or
subclinical. Because of the relationship between an
individuals underlying immune function and histoplasmosis
severity, the early years of the AIDS epidemic resulted
in an increase in the incidence of symptomatic and severe
Histoplasma infection . Clinicians thus gained experience
regarding the diagnosis, treatment, and outcomes of this
lifethreatening infection in immunosuppressed populations.
In the field of solid organ transplantation (SOT), T-cell
immune dysfunction can also be significant, although the
incidence of clinical histoplasmosis is <0.5% in most studies .
Infection can be difficult to predict with variable clinical
presentation, response to therapy, and risk for complications.
Symptomatic infection among SOT recipients could occur via
primary infection, secondary infection in patients with prior
exposure who come in contact with a large inoculum in a now
immunosuppressed state, and reactivation of previous latent
infection. Rarely, transmission from the allograft itself has been
reported [9, 10].
Much of our present knowledge of histoplasmosis after SOT
comes from single-center studies from areas of variable
endemic rates [3, 5]. Specific data regarding diagnosis,
incidence, treatment, and outcomes of this infection are needed.
The present study attempts to improve our understanding by
performing a large multicenter evaluation of histoplasmosis
All cases of histoplasmosis in SOT recipients diagnosed
between 1 January 2003 and 31 December 2010 at 24
participating institutions were retrospectively identified. Multiple
transplant centers in the United States were approached and
data were collected by those interested in participating.
Diagnosis of histoplasmosis required positive culture, positive serum,
or urine Histoplasma antigen (Miravista Diagnostics,
Indianapolis, Indiana), histopathology demonstrating yeast-like
structures characteristic of H. capsulatum, the presence of H or M
precipitin bands by immunodiffusion, or complement fixation
titers 1:8. Progressive disseminated histoplasmosis was
defined as clinical, laboratory, or imaging evidence of
extrapulmonary involvement as previously suggested . The site of
extrapulmonary involvement was determined based on clinical
signs or laboratory evidence. Pulmonary histoplasmosis was
defined as respiratory symptoms and chest imaging (radiograph
or computed tomography) with infiltrates and/or mediastinal
lymphadenopathy in the absence of progressive disseminated
histoplasmosis. As has been done in previous studies, disease
was characterized as mild, moderate, or severe . Mild
disease was treated with outpatient therapy, moderate disease
required hospitalization but not critical care, and severe disease
was treated in an intensive care unit. Suppressive therapy was
defined as treatment continued >12 months after diagnosis
except if given for relapse. Death was directly attributed to
histoplasmosis if the patient had findings of active histoplasmosis
and no other cause of death was identified. Evidence of active
histoplasmosis included 1 of the following: treatment for <6
weeks, persistent signs and symptoms, failure of antigen to
decline, demonstration of organisms by cytology or pathology,
or positive culture. Histoplasmosis was considered to have
contributed to the death if a patient died of another condition but
the investigator felt that the patient had evidence for active
histoplasmosis. Clinical and demographic data were collected
from investigators. Patient management decisions were made
by treating clinicians. Institutional review board approval was
obtained by the investigator at each site. At some centers,
patients included in this series had been included in previously
published series [3, 5, 6, 13]. All patient data were collected
independently for this study; no data were extracted from
Baseline characteristics were compared using the 2-sample
independent t test for continuous variables and 2 test for
categorical variables. For variables with expected cell count of <5, Fisher
exact test was used. For variables that are not normally
distributed, Mann-Whitney and Wilcoxon rank-sum tests were used. To
determine risk factors for death and relapse, a multivariate
analysis was used. Initially univariate analysis was conducted based on
clinical grounds and available variables. Variables included age,
disease severity, fungemia, urine antigen results,
immunosuppression reduction, amphotericin treatment, type of transplant,
and organ involvement. Variables that were statistically
significant (P .05) were then entered into the multivariate analysis.
Appropriateness of the model was assessed using Hosmer and
Lemeshow goodness-of-fit test. Two way interactions were tested
when appropriate. Casewise diagnostics were performed to
detect any outliers. SPSS software version 19 was used.
Patient and Center Characteristics
From 24 SOT centers, we identified 152 cases of posttransplant
histoplasmosis. One center contributed 22 cases, 5 centers 10
20 cases, and the remaining centers had 10 cases. The location
of the centers and the rates of histoplasmin reactivity are in
Table 1. Baseline characteristics are described in Table 2. Most
patients were on maintenance immunosuppression with a
calcineurin inhibitor, mycophenolate mofetil, and a corticosteroid.
Ten percent of patients were treated for rejection in the 3
months preceding the diagnosis of histoplasmosis.
The median time from transplant to diagnosis with
histoplasmosis was 27 months, but 34% presented in the first year, with
2% presenting within 1 month of transplant. The longest
interval from transplant to diagnosis was 20 years (Figure 1). Most
patients had disseminated disease (81%). Table 3 describes
Table 1. Participating Centers and Rates of Histoplasmin Skin
Omaha, University of Nebraska
Indianapolis, Indiana University
Birmingham, University of Alabama
Cleveland, Ohio Cleveland Clinic
Columbus, Ohio Ohio State University
Iowa City, Iowa University of Iowa
Madison, University of Wisconsin
Minneapolis, University of Minnesota
Rochester, Mayo Clinic
Kansas City, University of Kansas
Ann Arbor, University of Michigan
Associates of Kansas
University of Kentucky
New York, Mount Sinai
Wichita, Kansas University of Kansas
Chicago, Illinois University of Chicago
Dayton, Ohio Wright-Patterson
Dayton, Ohio Wright State University
Joplin, Missouri St Johns Regional
Medical Center Johns Hopkins Baltimore, Maryland
Pennsylvania Fontana, California Miami, Florida
Ochsner Medical Foundation University of Pittsburgh Kaiser Permanente
University of Miami
specific organ involvement. Fungemia was present in 63% of
patients. Twenty-seven percent had severe disease, 63%
moderate disease, and 8% mild disease. In multivariate analysis, use of
mycophenolate preparation and the presence of fungemia were
risk factors for severe disease (Table 3).
Table 4 describes the overall yield of the diagnostic tests used.
Antigen detection provided the highest sensitivity for diagnosis,
African American Latino Asian Diabetes
93% for antigenuria and 86% for antigenemia. Detection of
antibody was the least sensitive diagnostic method, positive in
36% of cases. More than 1 diagnostic test was positive in 115
patients (76%), whereas a single test was positive in 37 (24%).
These included antigenuria in 27 (18%), pathology or cytology
in 6 (4%), culture in 3 (2%), and antibody detection in 1 (1%).
Combined visualization of the organism and detection of
antigen was the basis for diagnosis in 69 (45%), whereas
antigen was positive but pathology was negative in 20 (13%)
and pathology was positive but antigen was negative in 9
patients (6%). Culture provided the sole basis for diagnosis in 3
patients (2%) and antibody detection by complement fixation
in 1 patient (1%). In this case, a patient with meningitis
demonstrated complement fixation titer of 1:32 in serum and 1:8 in
cerebrospinal fluid; antigen was negative in serum using a less
sensitive version of the antigen assay as existed in 2003 ;
urine antigen, cultures, cytology, and pathology were not
performed. Antigen detection was more sensitive in patients with
disseminated disease compared to those with pulmonary
Organisms were visualized in the bone marrow in 12 of 17
patients (71%). In 5 patients, all diagnosed between 7 and 12
months after transplant, granuloma was observed on biopsy of
tissue in the transplanted organ.
Treatment and Outcome
The most common management strategy was an amphotericin
formulation followed by therapy with an azole (Table 5). For
patients with severe disease, 42 (98%) initially received an
amphotericin formulation and 1 (2%) initially received an azole.
Moderate disease was initially treated with amphotericin in
69% of cases, with 31% receiving initial therapy with an azole.
Ninety-two percent of patients with mild disease initially
received azole therapy. Seventeen patients (11%) died prior to
receiving step-down therapy. In the remaining cases, an azole was
given as step-down therapy for a median duration of 12
months (Table 5). Twenty-one percent of patients continued
chronic suppressive therapy. Immunosuppression was held or
decreased in the majority of patients (Table 5).
Nineteen percent of the patients in the cohort died;
histoplasmosis was the cause of death in 10% and 72% of deaths
occurred within the first month after diagnosis, resulting in a
median interval to death of 2 weeks. No histoplasmosis-related
deaths occurred within 2 months of transplant. In univariate
analysis, older age, severe disease, fungemia, and higher urine
antigen were associated with death from histoplasmosis. In
multivariate analysis, age and severe disease remained
statistically significant risk factors (Table 6).
Relapse occurred in 9 (6%) patients. Six occurred in the first
2 years following the original diagnosis; 1 patient relapsed 9
years later. Follow-up for >1 year after discontinuation of
therapy was available for 57 patients; 6 relapsed, 3 received 7
months of initial therapy, and 3 were treated for at least 1 year.
The other 3 relapses occurred among the 38 patients on
chronic maintenance therapy who were followed for at least 1
year (median, 34 months [range, 1274 months]). Relapse
occurred at 5, 14, and 48 months of chronic maintenance
antifungal therapy. Relapse occurred in 3 of 38 patients (8%) while
receiving therapy, and 6 of 57 (10%) who stopped therapy
(P = .67). Information on drug levels was not available. Of the 9
relapsed patients, 2 died of histoplasmosis after relapse. One
died 1 month and the other 4 months after beginning treatment
for relapse. The only risk factor significantly associated with
relapse was failure to reduce calcineurin inhibitor dosage (75%
vs 95%; P = .043).
This paper describes the largest series (152 cases) of
histoplasmosis after SOT. Histoplasma-related mortality was 10%, with
most deaths occurring soon after diagnosis. One-third of the
cases occurred within 1 year of transplant, and almost half
occurred in the first 2 years after transplant. The very early
development of disease and presence of granuloma in the
transplanted organ suggests that some of these cases were
donor-derived. Antigenuria was the most sensitive diagnostic
test. Patients were typically treated with polyenes followed by
azoles for a median of 1 year, and relapse was rare, suggesting
that chronic suppressive treatment is unnecessary in most
cases. Nonetheless, 2 deaths occurred after relapse, and clinical
and laboratory monitoring after discontinuation of therapy is
Previous single-center studies have demonstrated an
incidence of 0.48% of histoplasmosis among SOT recipients ,
with a significant proportion (34%) of cases occurring during
Table 3. Selected Risk Factors for Severe Disease
Abbreviations: CI, confidence interval; ng, nanograms; OR, odds ratio.
a Severity of 1 case could not be classified.
b One small bowel and 2 multiorgan nonrenal/pancreas transplants not included.
c No. of patients in whom results of the respective test were available.
the first year after transplant. A recent, large prospective
multicenter study of invasive fungal infection after SOT reported 48
cases of histoplasmosis with 43% occurring within 6 months of
transplant . These rates are disproportionate compared to
the proportion of living transplant patients who were
transplanted within the last year. For example, of all living patients
Lung, respiratory culture
Pathology or cytology
Lung, respiratory pathology or cytology
Culture, pathology, or cytology
Lung, respiratory culture, pathology or cytology
Univariate OR (95% CI)
OR (95% CI)
Table 5. Treatment and Immunosuppression Management
Amphotericin B lipid complex
Amphotericin B deoxycholate
Decrease or stop immunosuppression
in the United Network of Organ Sharing (UNOS) registry as of
31 December 2011, 9.3% were transplanted that year and 89.7%
in preceding years (e-mail communication; June 2012, Sarah
Taranto, Organ Procurement and Transplantation Network/
UNOS). Thus, about one-third of cases occur in approximately
10% of the patients at risk. More intense immunosuppression
likely plays a major factor in the increased first-year risk, as
could donor-derived infection.
Donor-derived histoplasmosis is rare, but confirmed
transmission has been reported [9, 10]. We noted 8 cases that
exhibited features suggestive of donor-derived histoplasmosis based
either on diagnosis in the first month after transplant or the
finding of granuloma in the transplanted organ combined with
diagnosis during the first year after transplant. Other possible
explanations for early disease include smoldering infection in
the recipient prior to transplant, and newly acquired disease in
the recipient. In either of these circumstances, granuloma
might be observed in the transplanted organ. As we do not
have clinical information on the donor or other recipients,
donor-derived infection cannot be proven. Our study supports
continued attention to the possibility of donor-derived
histoplasmosis when assessing donors in endemic areas .
The significant mortality associated with posttransplant
histoplasmosis and the nonspecific clinical presentation
emphasizes the importance of maintaining a low threshold for
consideration of histoplasmosis, and raises the question
whether screening before or during the first year following
transplant could identify cases earlier, perhaps reducing
mortality. The role of routine screening for antigenuria following
transplant has not been studied, but this approach was
addressed in patients receiving treatment with tumor necrosis
factor inhibitors in which results of a pilot project did not
support screening . More information is needed to
determine the benefit of screening.
Detection of antigenuria was the most sensitive diagnostic
method. Antigenuria was present in all of the cases in 2 other
reports [5, 6]. In another study, only 69% of patients exhibited
antigenuria, which was attributed to use of older, less sensitive
assays . Sensitivity of antigen testing is lower in patients who
do not have disseminated disease . Although not
demonstrated in this study, other studies and clinical experience show
that the highest sensitivity for diagnosis is achieved by testing
both urine and serum [18, 19]. Serologic tests for antibodies to
H. capsulatum were not sensitive, positive in about one-third of
patients, and the sole basis for diagnosis in only 1 patient.
As the majority of patients presented with disseminated
disease, treatment usually consisted of a lipid formulation of
amphotericin B followed by itraconazole, combined with a
Age, y, median (range)
Urine antigen, ng/mL,
Urine antigen >19 ng/mL
Reduced calcineurin inhibitor
Death due to
Histoplasmosis (n = 15)
(n = 128)
Abbreviations: CI, confidence interval; ng, nanograms; OR, odds ratio.
a Cannot be calculated with zero count cells.
Multivariate OR (95% CI)
reduction in immunosuppression. Despite aggressive
treatment, 10% of the patients died of histoplasmosis with most deaths
occurring within the first 3 weeks following diagnosis, including
2 who died prior to treatment. In the literature, death during
the first few weeks following diagnosis was reported in the 2
other fatal cases for which information was provided [4, 5].
Higher antigen concentration as well as older age and fungemia
were associated with higher death rates in univariate analysis.
Although most patients with disseminated disease should
initially be treated with an amphotericin formulation, patients
with these risk factors are particularly likely to require polyene
therapy even if renal function is impaired. Although it is
common practice and makes intuitive sense to reduce
maintenance immunosuppression in SOT recipients with severe
infections, we did not find a correlation between reduction of
immunosuppression and risk of death. Any benefit of reducing
immunosuppression, however, may have been masked by the
fact that immunosuppression was reduced in >90% of cases
and most deaths occurred soon after diagnosis.
The optimal duration of treatment for histoplasmosis after
SOT is unknown. In 2 other reports, suppressive therapy was
administered in 23%  and 50%  of patients; in a third report,
none received suppressive therapy with no relapses noted in
patients treated for 12 months . Combining the 4 series, 14 of
197 patients (7.1%) relapsed, 9 (64.3%) within the first 2 years,
12 (85.7%) within the first 4 years, and 1 patient each at 6 and 9
years following the original episode. Thus, the greatest risk is
during the first 2 years, but 36% occurred later, up to at least 9
years following the original episode. Overall, our findings
support the safety of discontinuing antifungal therapy following
a 12-month course of treatment. Heightened awareness of
findings consistent with relapse should be maintained during the
first 2 years following the initial episode, and continued
awareness of the risk of relapse for the remainder of the patients life.
Sequential antigen testing might be useful in determining if a
subset of patients is at risk for relapse if azole therapy is
discontinued. The Infectious Diseases Society of America guidelines
suggest that antigen concentration should be <2 ng/mL prior to
stopping therapy and monitored for at least 12 months after
treatment is stopped . As patients in our study did not all
have antigenuria monitored at routine intervals, our
conclusions regarding the utility of this practice are incomplete.
However, some observations can be made. Antigenuria
progressively declined during therapy. Relapse occurred in 2 of the
7 patients (29%) with antigenuria >2 ng/mL and 1 of 32
patients (3%) with antigen concentrations of 1.9 ng/mL
(undetectable in 17 of 32). One of the 2 patients who discontinued
therapy before the antigen concentration fell below 2 ng/mL
died following a relapse of histoplasmosis: the concentration at
discontinuation of therapy was 5.9 ng/mL in that patient. In
another report, antigenuria persisted in 3 of 9 patients at the
time treatment was stopped, and relapse did not occur .
Antigen levels in the urine and serum had declined from peak
at the time treatment was stopped, and the authors concluded
that antigen testing and clinical follow-up should be performed
for at least 1824 months. A significant increase in antigen
should prompt very careful clinical monitoring or reinstitution
Our study has several important limitations. Data were not
collected prospectively, and diagnostic and treatment strategies
varied over time and from center to center. The scope of the
study and the multicenter nature made a case-control series
impractical. Thus, risk factors for the development of
histoplasmosis could not be determined. Furthermore, because data
from each center providing the number of surviving
posttransplant patients stratified by time from transplant were not
available, precise incidence rates could not be calculated. A
standardized diagnostic protocol was not used at each center,
and comparison of performance of diagnostic methods was
thus imperfect. Determination of the cause of death by
retrospective review of medical records is difficult and impacts the
analysis of risk factors. Finally, conclusions regarding the safety
of discontinuing chronic maintenance therapy must be
tempered by the variable duration of follow-up.
This study describes a large, multicenter cohort of patients
with histoplasmosis after SOT. Although a significant number
of late cases occur, the first year after transplant is the period of
greatest risk. Some of these cases likely represent donor-derived
infection. Antigen detection in the serum or urine is the most
sensitive diagnostic test. As is true of many infections following
transplant, serological tests are of limited sensitivity. Although
early deaths occur, treatment with a polyene followed by 12
months of azole therapy is successful in most cases with only
rare relapses. Conducting prospective studies to refine the
optimal treatment of histoplasmosis would be very challenging.
Future prospective studies, however, could focus on universal
serological or antigen-based screening of donors and recipients
in endemic areas to better inform practices to reduce the
incidence of early donor- or recipient-derived disease.
Acknowledgments. The authors thank Dionissios Neofytos, MD, Jennifer
Cuellar-Rodriguez, MD, Steven Mawhorter, MD, Chris Ledtke, MD, and
David van Duin, MD, for their work abstracting, collecting, and reviewing data.
Financial support. This work was supported by the National Institutes
of Health (grant number K24 A1085118), which supplied funds for the
database from which the data were extracted (Johns Hopkins University).
Disclaimer. The views and opinions expressed in this article are those
of the authors and do not reflect official policy or position of the US Air
Force, Department of Defense, or US government.
Potential conflicts of interest. All authors: No reported conflicts.
All authors have submitted the ICMJE Form for Disclosure of Potential
Conflicts of Interest. Conflicts that the editors consider relevant to the
content of the manuscript have been disclosed.
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We are an international outdoor surf hostel located in the woods of Moliets Plage on campsite ‘Camping Landes les Cigales‘. Our cozy hostel is run by an enthusiastic crew that love boardsports and the laidback vibe of summer in France. We would love to welcome you at Progress and our crew will make sure your stay at the hostel will be unforgettable!
A hostel you say?
That’s right! We have a surfcamp vibe but at Progress you can check in- and out whenever you like, so no need to book full weeks or packages. Most people still come for a week or two, but we are also a perfect place to stay for just a few nights during your roadtrip along the French coast!
Getting curious? Discover the hostel or read some more info…
We love to surf and will be happy to introduce you to the mother of all boardsports. There are great waves in Moliets for each skill level, whether you are a total beginner or a longtime pro.
We have all kinds of surfboards for rent and offer surf lessons accustomed to your wishes. Join a group lesson or book a session of private surf coaching. Anything is possible and our certified surf instructors will make sure you will have a great time!
For all the options, click to read more.
We love skating! Since we couldn’t last a summer without it we built a mini-ramp at the hostel which by now holds a famous reputation. If you can’t skate yet: it’s never too late to learn and everyone is more than happy to help you out. We have all the materials and protection needed to make your first rides in the mini and to start practicing safely.
Rather stay on the sidelines? That’s cool!
Grab a cold beer, chill down on and enjoy the show 🙂
Our hostel is located in a small surf town called Moliets Plage in the region called Les Landes, which is in our opinion, one of the most beautiful areas in France. Known for it’s lush forests, beautiful beaches and the azure blue waters of the Atlantic. With the beach just a 10 minute walk from your tent, we can’t imagine a better place to spend the summer.
Within an hour’s drive you are in Spain (the Basque Country) and many cool places to visit are close by such as Bayonne, Biarritz, San Sebastián and the world famous surf spot Hossegor. The region blooms during the summer, with many festive events and a vibrant surf culture.

domain: hobby


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The author's extensive experience and acumen is particularly showcased in the core chapters that address the relative absence of creative lawyering in much labor litigation. Temp agencies went to great lengths to convince affirm? Because employers don't directly pay for workers' compensation and health insurance, they need not worry about increases in insurance premiums caused by workers' injuries. When the workload drops, you drop her. Finally, the book is ideal for showing the explanatory power of content analyses. It can be made by providing a superior service, or a so-so but cheap service. The temp industry itself played an active role in this decline-and not just for temps. Low-wage, temporary jobs have become so widespread that they threaten to become the norm.
The workers themselves were expendable. Some efforts have been made, but most - unionizing temp workers, setting limits as to whom can be called a temp worker, attempts at raising wages - have failed or, at best, had conditional success. Stiglitz, a Nobel laureate in economics, a Columbia and a former chairman of the Council of Economic Advisers and chief economist for the World Bank. If we want good jobs rather than just any jobs, we need to figure out how to preserve what is useful and innovative about temporary employment while jettisoning the anti-worker ideology that has come to accompany it. That year, militant strikes by truckers in Minneapolis, auto parts workers in Toledo, and longshoremen in San Francisco spurred broad labor solidarity in these cities, transforming the strikes into massive working-class social upheavals. Temp agencies initially marketed themselves as offering part-time, secretarial work to women who only wanted part-time employment.
The book also describes recent glimmers of opposition, and Hatton concludes with thoughtful prescriptions for reversing the degradation of work. Philadelphia: Temple University Press, 2011, 232 pp. Temp jobs fit that bill: only the product of labor had value, while workers themselves were expendable. But the largely unchallenged success of the temp industry could not last forever. The goal of someone in business is to make money, and as much as he or she can.
Discussions on how to reverse the assault on. Hatton outlines how she feels that temping agencies promoted the i 21. I am an associate professor of sociology at the State University of New York at Buffalo. T his book should be required reading not only for students and scholars of American labor but also for those who teach and learn in business schools, where these seeds of cultural change need to be sown. And this all before coffee and without breakfast which I could not afford at the time. After reviewing tens of thousands of pages of advertisements, business publications, government testimony, newspaper, and magazine articles, Hatton paints a detailed, lively, and convincing account of the ways the temporary industry deployed gender ideology in the service of early industry expansion. Hatton concludes the book by offering four policy proposals to update the asset model of work and to return to treating employees as valuable assets—as important to a company as the bottom line is.
Also, temp workers themselves began to push back: in one court case, Vizcaino v. Take a second to think about who works in your office. Instead, American employers have generally taken the low road: lowering wages and cutting benefits, converting permanent employees into part-time and contingent workers, busting unions and subcontracting and outsourcing jobs. Through compelling use of advertising by the leading firms, including Kelly Girl Services and Manpower, Inc. But they did not stop with Kelly Girls. Not only did the Kelly Girls become cultural icons, but the temp agencies grew and grew.
In The Temp Economy, Erin Hatton takes one of the best-known icons of the new economy—the temp industry—and finds that it is more than just a symbol of this degradation of work. Becoming lean and mean had never been easier, and thousands of companies began to go the temping route, especially during the deep economic recessions of the 1970s. Government officials, labor unions, and the public in general saw private employers as underhanded and abusive to their workers. The Transformation of Work 4. Other measures aimed at decreasing the power of the temp industry in the nineties were less successful. Hatton's multidisciplinary approach fills a void. While greater numbers of employers in the postwar era offered family-supporting wages and health insurance, the rapidly expanding temp agencies established a different precedent by explicitly refusing to do so.
A useful reference for those interested in this topic. Responsibility: Erin Hatton ; foreword by Nelson Lichtenstein. Furthermore, it engenders concern and reflection in all who view work as activity that not only puts bread on the table but offers opportunities for workers to obtain meaning, fulfillment, and respect. Now, the question remains- does a business owner want innovation, loyalty and happiness from his or her employees? None of the paperwork, either! If we want good jobs rather than just any jobs, we need to figure out how to preserve what is useful and innovative about temporary employment while jettisoning the anti-worker ideology that has come to accompany it. Layoffs, outsourcing, contingent work, disappearing career ladders, these are the new workplace realities for an increasing number of people.
Anyone interested in the plight of American workers and modern employment practices should enjoy this book. Not on your time anyway! Perhaps I'm too cynical, but I've read a bit about the tenements and poor labor conditions that existed throughout most of this nation's history. Layoffs, outsourcing, contingent work, disappearing career ladders-these are the new workplace realities for an increasing number of people. My research is centered in the sociology of work, while also extending into the fields of race and gender, social inequality, culture, labor, law, and social policy. While greater numbers of employers in the postwar era offered family-supporting wages and health insurance, the rapidly expanding temp agencies established a different precedent by explicitly refusing to do so.


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Three Scots have been selected for the initial GB U20 Women’s squad ahead of this summer European Championships.
Sian Phillips, Shawnisay Millar and Alix Henderson have all made the roster, which features 14 players from across the UK. The trio all spent the 2018/19 season with Scotland’s WBBL side Caledonia Pride.
The players travelled to Manchester over the weekend as the team begins preparations at the National Basketball Performance Centre. The team will then head to Greece at the end of the month for two warm up games before their campaign begins in Prishtina on August 3rd.
GB’s Head Coach, Jeff Jones, is looking forward to continuing preparations with the group after a positive start:
“We’re a day and a half in and their attitude and approach is great. They all understand the concepts we’re giving them and it’ll just be about how they implement them. It’s a positive group and i’m looking forward to it!”
GB were drawn into Group B for the tournament and will face Ukraine and neighbours Ireland in the early stages of the tournament. The structure sees four groups of three teams, with the top two from each group proceeded into two groups of four. The top two from each group then advances to the semi-finals whilst the rest play their respective classification games.
Teresa Da Silva

domain: news


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Let Raasay come to you as part of our virtual tastings. From the comfort and safety of your own home, we will take through our unique six-part maturation of our signature Isle of Raasay Single Malt with six cask strength samples.
Two Isle of Raasay spirits – peated and unpeated – are matured separately in three distinct cask types – Rye whiskey, fresh Chinkapin oak, and Bordeaux red wine.
The signature Isle of Raasay Single Malt, launched officially on 4th June 2021, marries these six signature casks together in varying proportions, creating a lightly peated single malt with rich dark fruit flavours. A dram with real depth and complexity.
Find out the flavour elements that each distinct cask type brings to our Isle of Raasay Single Malt by booking onto a virtual tasting below!
Tasting begins at 7pm and typically lasts 2 hours including questions and discussion.
Brand Experience of the Year at the Scottish Whisky Awards 2020!
A fun, educational, night. Loved it.
The London Whisky Club and its members enjoyed a fantastic online tasting session hosted by Raasay distillery. Alasdair talked us through a generous range of samples, as well as many of the exciting projects under way at the distillery. If you are thinking of joining one of their virtual tastings, we would highly recommend it.
Each ticket purchased reserves a space on your chosen virtual tasting as well as 6 x 5cl cask strength samples. Our team will despatch samples to your chosen delivery address.
Information on how to join our virtual tasting will then be sent to the email address provided on your order shortly after your order has been processed. Our virtual tastings are currently hosted on the Zoom: Video Conferencing software.
It’s FREE to join Slàinte whisky club.
Sign up now to receive:
Your Slàinte Club welcome email includes details on how to take advantage of your exclusive benefits. Check your inbox after signing up to take advantage of your club benefits.


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"Those who wish to transform the world must be able to transform themselves."
"The most significant change in a person’s life is a change of attitude. Right attitudes produce right actions."
"Nothing great was ever achieved without enthusiasm."
-Ralph Waldo Emerson

domain: literature


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WRSDC wants Tutela answers added to report
REGION — “This document is an agreed-upon procedures report,” CPA Patricia Jones told the Wachusett Regional School District Committee October 12 after completing a $7,500 review of a report by the state Inspector General. “It’s not an audit of any type, shape or form.”
It was not what school committee members were expecting to hear. And so after a long discussion, they voted to spend another $10,000 for a supplemental report and have an independent attorney look at all of it.
Jones was hired in early July to review the May report from the Inspector General’s office that challenged $139,000-worth of central administration office expenses. The IG cited inadequate documentation, weak internal controls and questionable reimburse-ments for meals, travel, insurance, bonuses and vacation buybacks. The report concluded that it was “unclear” whether central office employees actually abused any district policies, or that the lack of clear school committee policies permitted the questionable expenses.
Jones said her charge was to review the IG report and make recommendations to the school committee on what policies are needed to prevent future spending and accounting problems.
“A ‘finding’ does not mean right or wrong,” she said. “We attempted to recommend better business procedures as accountants.”
WRSDC chair Alice Livdahl asked in what ways did Jones’s findings differ from the IG report.
“We used the same information,” Jones said. “In general, [the IG’s] comments were right on the mark when he would note that a piece of information or back-up document [for certain spending] was not there.”
Jones said the IG report was in error when it questioned the application of former School Superintendent Dr. Alfred D. Tutela’s stipends to cover travel expenses to the 11 schools in the district.
“We found the stipend was very clear [in Tutela’s contract],” she said. “It did not include a reimbursement for costs. It was clear the stipend was for attendance and participation, and not for out-of-pocket costs.”
She said her office did not expand the scope of the IG’s report or look for additional documents than what the IG had done.
School committee members questioned why Jones’s report was completed and dated August 28, yet not released until September 30. They also asked why Tutela’s 64-page response to five questions Jones had about documentation were not included in her report, why the report didn’t go into more depth, and why they weren’t told that Jones knows several members of the school district and community.
“To me, the timeliness is in question as well as the scope of the work,” Sterling member David Gibbs said. “I’ve told people in my town that we were doing a fraud assessment. What was the rush? Why couldn’t the [Tutela] comments have been incorporated in the final report — or was that out of the scope of the work?”
“On September 30 we had not received it,” said Jones, “and we were told by the chair to release [the report as written].
“We were in the process of binding the report when we received the packet materials [from Tutela], which I have not gone through,” Jones said. “We were waiting to see if we’d receive documentation from the superintendent that would have changed our report. We waited until September 30.”
Jones said she would have included Tutela’s responses in her report, but couldn’t say whether they would have changed her findings.
“It would have been beyond the scope of our work to go through extraneous information,” she said. “His answers were lengthy and would have required additional procedures … examination of those papers were beyond the scope of what we were hired to do.”
She said she suspects Tutela’s responses are a reiteration of his responses to the IG report.
“My personal opinion? I don’t think the school committee would gain the value of my going through [the responses],” Jones said.
“It’s my opinion that it seems the district overpaid the superintendent,” said Princeton member Phillip Mighdoll. “It’s not a statement of fraud of any kind or blame [against Tutela] — but a processing error and the blame would be here.”
Jones doubted the school committee would want to pay for more accounting investigation for the $139,000 amount in question.
“I can come up with X number of dollars [in dispute],” she said, “but I can’t say the amount is due the district [from Tutela] because the contract is vague.
“You’d need a lot of legal input to determine the amount due back to you — if it can do that at all.” Wanted no ties
Holden member Cynthia Bazinet said when they called the emergency meeting after release of the IG report in May, WRSDC members said they wanted an accountant with absolutely no connection to the district.
Jones said she has done audit work for Princeton and Holden, lived in Princeton, knew Superintendent Dr. Thomas Pandiscio as her children’s principal when they attended Wachusett Regional High School, had met Sterling member Sherry Conrad, a CPA, though accounting seminars, once had an office across the hall from Livdahl’s law firm, and knew Holden resident Edwin Meyer, whose complaints about Tutela’s expense sheets and stipends led to the IG’s investigation of the central office expenses.
“I had no part in the choosing [of Jones],” said Livdahl. “We literally worked across the hall from each other 20 years ago, but we did no business together of any kind.”
“I’m not questioning the integrity or quality of the report,” said Holden member Robert Carter, “but just a challenge to the process.”
“A CPA can’t sign a report unless they’re independent,” said Jones.
“It’s hard not to know a CPA through seminars,” added Conrad.
“In the summer, we talked about agreed-upon procedures with this firm,” said Holden member Mike Sherman, who chairs the WRSDC’s Business/Finance Subcommittee. “We have a lot of issues with this report other than the process by which it was conducted.” Spend more?
Jones recommended the committee implement the accounting procedures she provided in her report.
“I can’t comment on the $139,000,” she said. “We took samples [of items in dispute]. We cannot quantify the number of dollars that might be due back to the district. There were actions of previous school committees approving actions the superintendent took. Did that give permission to the superintendent of other actions he took? I can’t answer that.”
Livdahl suggested sending the Jones report and Tutela’s supplemental documents to Boston attorney Elizabeth Valerio, who was hired to review the final accounting report.
“We can ask her if the new policies [the WRSDC is in the process of adopting] fill the [old policy and contract] holes, and is there any way to recoup any money if that’s what is determined,” Livdahl said.
“I think Tutela was way off base with some of the things he did,” said Sterling member Charles Capparelli. “I had hoped with this audit, that we’d have the type of report that would say what he did was illegal or legal. Let’s find out from an attorney whether Tutela was wrong with what he did, or were our policies so vague that he was able to maneuver around to the tune of $139,000 — and stop pussyfooting around with this. This report doesn’t answer the question.”
“We were expecting a comprehensive report,” said Gibbs. “I think the IG report was a flawed document from the get-go, a political document. I suggest we spend the money to do a thorough audit and put this issue to rest.
“Send it to the Attorney General and get a ruling,” Gibbs said. “This has been [put] in the ‘Court of Innuendo.’ Let’s get it done.”
The Jones CPA firm was paid $7,500 for 75 hours of accounting work. Jones estimated it will take another 25 to 30 hours to add Tutela’s responses to her report.
The committee approved Carter’s motion to spend up to $10,000 more, to have Jones incorporate Tutela’s documentation into her report and bring the project to completion.
Livdahl said Attorney Valerio also wants to examine the committee’s proposed new policies to see if they address all the issues cited in the IG report. New policies
Earlier that evening, the committee approved first readings on new policies that will reduce administrative travel, end the practice of paying employees for unused vacation, allow the carryover of only five days’ vacation in cases of extenuating circumstances, limit travel expenses eligible for reimbursement, prohibit bonuses and prohibit meal reimbursement except in specified cases. A second reading and approval is required to set the new policies, expected to take place at the WRSDC’s October 25 meeting.
At the public hearing October 12, Edwin Meyer said he learned that during an executive session, the committee discussed that Tutela received $18,000 in vacation buy-back as his “parting shot to the district.” Tutela retired on September 30 and said he was not able to take his contractual vacation days that began on July 1, the start of the new fiscal year.
“I hope you will go after former Superintendent Tutela,” Meyer said. Meyer noted, “The IG report said vacation buybacks were not legal.”
The IG’s report under “Findings” states: “there appears to be no legal justification for the buyback program.”
In compliance with their ethics policy, WRSDC members do not discuss executive session matters in public session. Meyer declined to say who leaked the material. Livdahl said after the meeting it was her understanding that Meyer’s comment about the $18,000 was accurate.
“Apparently it was put in with our payroll,” she said. “I don’t think it would make a difference,” she said, when asked if the school committee would have authorized the payment in light of the IG charges.
“When people leave, they get credit for unused vacation days,” she said. “It’s one of the things we’re addressing in our new policies. [Tutela’s] contract allowed him to roll over unused vacation days to the next year. The new policy limits that to five days, and it’s by quarter. Before, the superintendent would get the full year’s vacation days at the July 1 start of the fiscal year. We had no right to take them away because it was in his contract. If he had been able to take them in his last weeks in the district, we would have had to hire someone to fill in, and Tom [new superintendent Thomas Pandiscio] was already fully occupied with the high school renovation impacting the start of school.”
Livdahl said the committee followed the state statute “that public employees cannot be denied their vacation time.”
She said before the WRSDC’s new policies are put into effect, they will go to an attorney for review.


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About the property
- Apartment1050 sqft
- Half Baths0
- Minimum Stay5 nights
Apartment, 2 Bedroom, 1 Bath, (Sleeps 3-4)
Our Executive 2 bedroom apartment suite (3282 St Ignatius Pl Santa Clara, CA 95051) has been decorated for luxury. It is 3rd floor unit with no one above with elevator access. The suite comes fully furnished with telephone, cable TV, high-speed Internet access, pool, hot tub, reserved parking, and on-site laundry. There is one Queen bed in each room and a love seat in the living room (it does NOT open to a bed).
The suite’s kitchen is fully accessorized and comes with everything you’ll need to express your culinary skills.
This garden complex is conveniently located in the heart of the Silicon Valley and is within short distance to shopping, transportation, and festive downtown Santa Clara and Sunnyvale. Our highly experienced and professional staff is committed to providing you comfort and assistance during your stay. Come enjoy the essence of carefree living.
- Response rate:
- Response time:
- within a few hours
- Calendar last updated:
- May 16, 2018
Pool / Spa
Check-in: 4:00 PM
Check-out: 11:00 AM
100% refund if canceled at least 14 days before arrival date. 50% refund if canceled at least 7 days before arrival date. You must contact the owner directly to request cancellation.
Comfortable and spacious home away from home.
I stayed here for a month and really enjoyed the apartment. Loved that it was on the top floor - so it was quiet and there was plenty of privacy. The apt is nice and spacious. The kitchen is well-stocked with everything you need to make a nice dinner. King bed is super comfortable. It was really nice to have ac units in the master bedroom and living room (although I never used them). The neighborhood was great and centrally located. The setup was exactly what I was looking for. Will definitely stay here again if I'm in town for a length of time.
Steve was great to work with. He always responded within the hour and was very flexible and understanding when it came to move-in and move-out timing. Thanks!
We really enjoyed our stay in unit 334 at the village green apartments. Everything was clean, well stocked, and the beds were very comfortable. We would definitely stay there again.
Great apartment, great location
We stayed at the apartment for a month after relocating to the area. The apartment has all that is needed to feel very comfortable - highly equipped kitchen, good Wifi and TV, super comfortable beds (!), spacious living and dining room, clean towels, sheets, etc. The location is good, close to a very nice park for kids, shopping plazas and highways.
Cons - very slow elevator, washing/drying machines are outside.
We enjoyed staying here very much and frankly, we looked in many complexes to find another apartment and it was hard to find one which was comparable.
Our stay was amazing!
We stayed at the apartment for three months during the summer of 2015. Our stay was absolutely comfortable. The apartment is furnished, beautifully decorated and fully loaded with all the supplies such as linen, towels, toiletries etc. and the kitchen has everything we needed for a family of four or even six. We did not have to buy anything at all. All amenities like electricity, water, cable, internet and phone were included in the rent. I would say that the management is very generous and really wants you to feel at home. There is one minor downside though. It is not air-conditioned, which is OK for most days in Santa Clara.
This is an outstanding location to visit Santa Clara University. The neighborhood is clean and safe. We brought a blow up mattress and we're able to use your air fill device down at the car. The kitchen is well appointed for cooking with everything (except a mixer) that you will need. We loved staying in an apartment rather than a hotel and enjoyed your movie selections too. The parking spot was awesome!
Thanks Catherine, for the nice review! If we can help again in the future, please let us know.
Visit to family in the Santa Clara area
My husband and I went to Santa Clara to visit family that are dealing with health issues. We thought we would stay in a hotel, then found this cute apartment on VRBO. It suited us perfectly for the 4 nights: full kitchen and bath, comfy beds; and my brother-in-law and his wife were able to spend a night with us in the second bedroom. Much homier than a hotel room for about the same price as a nice hotel room. The apartment is located near a park and in a safe area. The staff were nice and Steve was very responsive when the TV didn't connect to the cable. Older place but well maintained and clean. Only one TV (none in bedrooms). We would stay again when visiting family in the area.
Thank you Kathleen, I'm glad our unit worked out for you. I now know what I can do with the extra flat screens we have!
Rates & Availability
Additional information about rental rates
This is a No Pets and No Smoking unit.


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It has been 4 years since Blind to Faith released the almighty "The Seven Fat Years Are Over", but they are finally back with a new 12" EP, "Under the Heptagram". This brings three new BTF tracks, that have been definitiely worth the wait to hear. The whole thing comes to just over 11 minutes, but it definitely showcases the true skill of the band. Not many can switch from blistering speed to slow, heavy riffs so seamlessly.Szymon Seich, who has done the artwork on previous BTF releases, as well as for many other great hardcore bands.
As always, the entire EP is available to stream online, so enjoy.

domain: artistic


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Small faces collection deluxe edition 4 albums, 9cd. Small faces 1966 ian mclagan, steve marriott, ronnie lane, kenny jones get premium, high resolution news photos at getty images. Small faces were an english rock band from east london. The group originally consisted of steve marriott, ronnie lane, kenney jones, and jimmy winston, with ian mclagan replacing winston as the bands keyboardist in 1966. Pdf download all the rage my high life with the small faces the faces the rolling stones and many more read full ebook. Small faces 1966 psychedelic the small faces download. Small faces front cover, interviews with roy orbison, the ivy league, bob lind and a report on james brown. This is where the alreadyconfusing small faces discography gets baffling. The small faces itchycoo park the best of the small faces. The group was founded in 1965 by members steve marriott, ronnie lane, kenney jones, and jimmy winston, although by 1966 winston was replaced by ian mclagan as the bands keyboardist. Stuck in the past the small faces small faces 1966.
The quartet was signed by manager don arden who, through his management company, got small faces a record deal with deccalondon. The band was one of the most acclaimed and influential mod groups of the 1960s, recording hit songs such as. Small faces all or nothing 1966 i thought youd listen to my reason but now i see, you dont hear a thing try to make you see, how its got to be yes its all, all or nothing yeah yeah, all or. The bands debut single, whatcha gonna do about it, a blatant ripoff of solomon burkes everybody needs somebody to love, cocredited in this version to longtime british songwriterproducer ian samwell, was released in august of. There was no shortage of good psychedelic albums emerging from england in 19671968, but ogdens nut gone flake is special even within their ranks.
Small faces and further hit singles 1966 winston was replaced by ian mclagan, whose keyboard talents and diminutive stature fit with the groove of the band perfectly. Record mirror march 26, 1966 music magazines, small faces. Small faces wlp 45 in my minds eye 1966 demo rca us. In america, the album was issued with an alternative track order as there are but four small faces.
The troggs performs the mega hit wild thing at drop in, white the small faces play shalalalalee. Buy mp3 music online the small faces 25 greatest hits. Each title offers a version with and without choirs. Immediate records with bmg music and charly records are pleased to announce the 2018 release of the 50 th anniversary deluxe editions of london legends the small faces 1968 psychedelic masterpiece across various formats.
Small faces were an english rock band from london, founded in 1965. Record mirror march 26, 1966 music magazines, small. Download a list of 342 people created 4 months ago the 100 greatest poprock bands a list of 100 people created 09 apr 2015 see all related lists. May 02, 2015 small faces all or nothing 1966 single remastered. Sep 17, 2017 outside europe, all anybody remembers them for is their sole hit, itchycoo park, which was hardly representative of their psychedelic sound, much less their full musical range but in england, small faces were one of the most extraordinary and successful bands of the mid60s, serious competitors to the who and potential rivals to. Download a list of 342 people created 4 months ago the 100 greatest poprock bands. This 1996 reissue of the small faces debut issued april 1966 is a rush of mod rock n soul, and along with from the beginning captures the groups decca period 1965 67, when they were still in their teens and bursting with furious energy. Small faces 1966 ian mclagan, steve marriott, ronnie lane.
The small faces all or nothing 1966 stereo youtube. Though they existed for only four years their rise to the top was meteoric. Small faces karaoke mp3 instrumental music karaoke version. Small faces small faces 2 cd 1966 deluxe edition 2012. Get all the lyrics to songs on small faces 1966 and join the genius community of music scholars to learn the meaning behind the lyrics. Small faces the small faces to stream in hifi, or to download in true cd quality on. Tracks 1 to 12 are their mono debut lp small faces released 6 may 1966 in the uk on decca lk 4790 peaked at no. List of all small faces tour dates and concert history.
This swedish tape was released as a vinyl bootleg, audio quality varies from very poor to very dull. The official part of newcastle 68 gig, the german 66 beat beat, a snip of the marquee gig same year. On ogdens nut gone flake you can still hear its a real band firing on all cylinders, gr eat dynamics and everyone equal in their musicianship. Find the latest tracks, albums, and images from small faces. Small faces collection deluxe edition 4 albums, 9cd 1966. The small faces 25 greatest hits mp3 album download. The small faces ogdens nut gone flake 50th anniversary release. Check out small faces by small faces on amazon music. Outside europe, all anybody remembers them for is their sole hit, itchycoo park, which was hardly representative of their psychedelic sound, much less their full musical range but in england, small faces were one of the most extraordinary and successful bands of the mid60s, serious competitors to the who and potential rivals to. Find out when small faces last played live near you. Small faces is the debut album of the small faces, released in 1966.
Small faces is a 1967 album by the small faces, their first for immediate records after leaving decca. Designed for the american market in 1968, there are but four small faces is based upon their 1967 selftitled album for immediate records the album that should not be confused with the 1966 album called small faces on decca but shuffles the running order considerably, cutting out seven. Ian mclagan, kenney jones, ronnie lane 1946 1997 and steve marriott 1947 1991. Small faces is the debut album of the small faces, released in may 1966 by decca records. This is a great album with all the power and punch of a great band. Thats not to say that this pack of four sharpsuited mods were unaware of the times. Small faces uk pop group with ronnie lane in 1966 stock. Small faces uk pop group with ronnie lane in 1966 ddrga5 from alamys library of millions of high resolution stock photos, illustrations and vectors. It wasnt just the amazing track that was being played everywhere ok, everywhere that mattered when you were fifteen, but the look of the band as well.
Guitarist steve marriott and bassist ronnie lane met in london, and after finding a musical connection they recruited their friends kenney jones on drums and jimmy winston first a guitarist, but persuaded to move to. There were very few people in the uk who hadn t heard of the small faces in the uk in the late 60s. Download the mp3 instrumental versions of small faces. Aug 08, 2011 small faces all or nothing 1966 i thought youd listen to my reason but now i see, you dont hear a thing try to make you see, how its got to be yes its all, all or nothing yeah yeah, all or. You will get 2 track for free after confirming your account. Albums include ogdens nut gone flake, there are but four small faces, and small faces. The small faces had already shown a surprising adaptability to psychedelia with the single itchycoo park and much of their other 1967 output, but ogdens nut gone flake pretty much ripped the envelope. The album was well received by music critics and was popular with the public, rising to number 3 on the uk album chart remaining at the top for several weeks. With the troggs, small faces, kersti adamsray, kjell eriksson.
Get premium, high resolution news photos at getty images. Mclagan played his first performance with the band on 2 november 1965. Feb 22, 2020 small faces is the debut album of the small faces, released in 1966. The bands debut album, released on decca in 1966, is also entitled small faces. This, their debut album was a smash hit when released in 1966. The small faces small faces 1966 lyrics and tracklist. It includes the hit singles whatcha gonna do about it and shalalalalee.376 1317 1422 729 11 404 1310 1018 977 1463 1590 1218 628 706 1508 668 930 33 549 1666 1427 950 338 851 1676 147 1080 98 1454 275 1019 818 1313 699 125 116 1378 1462 1279 265 124


text:
Top Joe Walsh Albums
click on the album covers to see the lyrics inside the album
Look What I Did! - The Joe Walsh Anthology
Ordinary Average Guy
You Bought It - You Name It
There Goes the Neighborhood
But Seriously, Folks...
You Can't Argue with a Sick Mind (Live)
The Smoker You Drink, the Player You Get.

domain: entertainment


text:
January 09, 2020
This Benefit Manager Guide is a a summary of employer recommendations and new evidence related to Multiple Sclerosis (MS), as well as a discussion of its impact on employers and what they can do to help employees and caregivers with MS.
- New disease-modifying therapies (DMTs) are approved for both relapsing and progressive forms of multiple sclerosis (MS), providing treatment options for populations of MS patients for whom previously only off-label therapies were available.
- Recently released clinical guidelines attempt to strike a balance between newer therapies’ increased efficacy at preventing flare-ups and increased risk of serious adverse events: employers should review their formulary and utilization management programs to best meet the needs of their employees.
- More patients living with MS are active in the workforce due to innovations in pharmacological treatments, coinciding with increased costs over time. The high costs of medications, as well as the fact that treatment is ongoing, place the disease among the top most expensive conditions for many employers.
- Copay assistance programs and cards are available for many MS therapies. Implementation of copay accumulator programs, where manufacturer assistance no longer applies to the deductible and out-of-pocket maximums, may result in members with MS being disproportionately impacted financially. This can lead to a decrease in treatment adherence.
MS is a chronic inflammatory condition that affects the central nervous system and may cause significant disability over time.1 Although symptoms and the course of the disease vary by patient, common symptoms include fatigue, loss of balance, problems with walking, vision loss and cognitive impairment.2 Women are twice as likely to be affected, and there is no known cause or cure.3
While there is no one diagnostic test for MS, clinicians rely on presentation of symptoms, clinical examinations, MRIs and spinal taps to identify the disease. Because prompt initiation of treatment is usually most beneficial to the patient, there is pressure to make MS diagnoses as early as possible. This increases the risk of overinterpretation of test results, leading to misdiagnosis. A 2016 survey of MS specialists found that virtually all 122 respondents had incorrectly diagnosed patients with MS over the past year, while a survey of MS patients found that 42% were initially misdiagnosed with another condition.4,5 Given the cost of treatment and the drug tolerance challenges, the price of an incorrect diagnosis is high, but the health impact of not being diagnosed promptly is arguably greater.
Specialty pharmacy products, called disease-modifying therapies (DMTs), are the primary MS treatments available. Designed to prevent and/or delay relapses, these drugs tend to be very expensive, with potentially severe side effects. While the majority of DMTs are available only for treatment of relapsing-remitting MS (RRMS), therapies aimed at treatment of the more progressive forms of MS – primary progressive MS (PPMS) and secondary progressive MS (SPMS) – have begun entering the market. The Food and Drug Administration (FDA) includes those who continue to experience periods of relapses and remissions in its definitions of both RRMS and PPMS to ensure patient access to treatment, as patients with the latter form would otherwise be left without FDA-approved treatment options.6 Ocrevus, approved in March 2017, is the first therapy approved for treatment of PPMS; it is expected that therapies aimed to treat SPMS will enter the market as soon as 2019.
Reasons Why Employers Should Care About MS and its Effects
Major Cost Driver
The cost of treatment for MS was the eighth highest in drug spending among U.S. therapeutic classes in 2016.7 Over the past 20 years, the cost of MS treatment has risen at a rate five to seven times higher than that of prescription drugs overall. Worldwide, the MS market is estimated to be about $19 billion a year.8 Since MS progresses over time, spending is concentrated among the top percent who are the most severely afflicted.7 Spending on pharmaceuticals accounts for between 70% and 75% of the cost of MS treatment.7 Although there are no treatments that can reverse the neurodegenerative effects of MS, multiple treatments are available for managing the disease and its related symptoms. In addition, all disease types are likely to have a treatment option in the short-term future. As a result, employers can expect to see costs rise consistently year after year.
Productivity Reduction for Affected Employees
The life expectancy for a person living with MS does not vary significantly from the general population, with rare exceptions.9 Due to the early average age of onset and chronic symptoms, MS is considered a “prime-of-life” disease. Common symptoms like fatigue, vision loss, chronic pain, loss of bladder control and cognitive impairment can restrict the ability of people living with MS to function in the workplace.
Productivity Reduction for Employees with Dependents Affected by MS
Employees who serve as caregivers for family members living with MS may experience fear, guilt, anxiety, grief, anger and exhaustion as they cope with taking care of a loved one with a serious illness.10 Many families affected by MS face financial hardships, increasing stress and potential feelings of helplessness. These stress factors can have a significant impact on productivity and contribute to employee caregivers’ own health conditions, like high blood pressure, insomnia and depression.
Treatment Options for Multiple Sclerosis
A neurologist should determine the appropriate treatment for MS, but effective disease management requires a team of providers. Treatments seek to address one or more of five different goals:
- Slow the progress of the disease;
- Treat symptom flare-ups;
- Manage ongoing symptoms;
- Promote function through rehabilitation; and
- Address mental health issues that often accompany an MS diagnosis.11
Do People with MS Stay in the Workforce?
Many people living with MS drop out of the workforce due to inability to cope with the stress and physical or mental demands of their job; and 40% of people living with MS in the United States receive some form of disability payments. Still, an estimated 40% of people who have had an MS diagnosis for 10 years or more continue working.3
Clinicians typically use imaging tests to monitor inflammatory activity in the early stages of the disease, particularly lesions in the brain that drive many of the complications associated with MS. Clinicians may recommend imaging at least annually along with close follow-up for people with relapsing forms of MS who are not on a DMT, have not had relapses in the preceding two years and do not have active new MRI lesion activity on recent imaging.12 However, in progressive disease courses, functional decline associated with the neurodegenerative component of MS is not easily detected by MRIs or other imaging techniques, thereby complicating the development of effective treatment strategies.
Currently available DMTs can prevent disease progression and flare-ups of symptoms, albeit without repairing existing damage. DMTs should be offered as soon as an MS diagnosis is made and confirmed. It is unclear which treatments will work for each patient, so switching treatments early on after diagnosis is common.13 DMTs can be administered orally, via self-injection into the skin or muscle, or by infusion. Patients should be monitored closely when beginning treatment, as all DMTs carry the risk of side effects, some of which can be severe. Analyses of DMT efficacy suggest that those most often successful in slowing disease progression also have the highest risk of severe side effects.14
Low Adherence for Lifetime DMT Treatment
Once individuals with MS find a DMT that is effective and has manageable side effects, they will likely take the drug indefinitely, or until it is no longer effective.15 Because different DMTs have varying modes and frequency of administration, clinicians must have the flexibility to prescribe the therapy that is working or they believe will best fit the lifestyle of their patients. Patients should not be overly burdened with prior authorizations, narrow formularies, step- therapy programs and other administrative requirements. People who are adherent to their medications are far less likely to visit the emergency room, have lower out-of-pocket medical spending and have slower disease progression.16 Still, studies suggest that long-term adherence to DMTs ranges only between 41% and 88%.17 Low adherence may be due to high out-of-pocket costs of the drugs, potentially severe side effects and the fact that dosing schedules for DMTs vary widely.
Additional and Alternative Therapies
Other common treatments and procedures related to MS that may appear in an employer’s claims include the following:
- Brain and spine imaging tests to assess the progression of the disease for those who have recently had flare-ups;
- Administration of clinically-infused DMTs;
- Cognitive behavioral therapy for anxiety, depression and stress associated with MS;
- Prescription-strength painkillers for common symptoms; and
- Occupational and physical therapy (PT) to rehabilitate lost function, which may include the need for durable medical devices.
Alternative therapies include fish oil, acupuncture, bee sting treatment, yoga and magnetic therapy. However, the evidence is mixed for each of these treatments.18,19 Medical marijuana may be used to relieve pain, overactive bladder and muscle stiffness, if other treatments are ineffective.20
Several drugs have also entered the market specifically to address MS symptoms, such as difficulty walking and movement of the upper and lower extremities. For example, generic versions of Ampyra, used to improve walking in adults with MS, are now available.21 Due to the types of physical therapy likely required by MS patients, including twice daily stretching therapy among other treatments, virtual PT solutions can play a role in care for MS patients.

domain: medical


text:
Microsoft launched a lawsuit against the Justice Department, saying the government should not be able to prevent companies from notifying customers that law enforcement officials have requested their e-mails and data.
The lawsuit argues it’s unconstitutional to prevent companies from informing their customers of the requests, ABC News reports.
“Microsoft brings this case because its customers have a right to know when the government obtains a warrant to read their emails, and because Microsoft has a right to tell them,” the tech giant says in its lawsuit.
Microsoft said the government often issues orders requiring secrecy.
The Justice Department declined to comment on the lawsuit, saying, “We are reviewing the filing.”


text:
Jyrki Katainen, Finland’s prime minister, warned in a speech at the European Parliament that austerity policies in the European Union have “undermined people’s trust in the European project” and said that Europe’s leaders ought to respond to popular fears by charting “a credible, pragmatic way forward”.
Speaking on Tuesday (16 April), the centre-right Katainen rejected ideas of a federal Europe as too abstract and stressed that the immediate challenge was to boost the EU’s competitiveness.
“We need both more Europe and more national responsibility,” he told MEPs. “Deeper European integration is the right way forward,” he said, but he also stressed the need to “make sure the overwhelming majority of Europeans find integration to be just and fair”.
He also warned: “ If we fail to curb tax evasion and tax havens, we undermine our own efforts to build a better Europe” – a point taken up by José Manuel Barroso, the president of the European Commission, and several MEPs in the debate on the “future of Europe” that followed his speech.
Hannes Swoboda, the leader of the centre-left Socialists and Democrats group in the Parliament, accused Katainen of taking “a very ideological position” on the financial transactions tax that 11 member states – Finland is not among them – have agreed to introduce.


«Ishachok» means «the small donkey» on Russian. Started his career as not-trusted, speed and capricious for control plane of new generation, for some years it stand over a very popular and loved fighter for Soviet pilots.
kit of I-16 in 1/48 is a very good material for building a model of this famous USSR fighter plane.
After Eduard's correcting the main error of first series of this kit — wrong form of front engine cowl by new part, the model has two major geometry mistakes — very squared form of gagrot and very tall keel.
First of those mistakes should be fixed by 5-10 minutes of sanding, but second should be rather hard task — after correcting the tall and geometry of keel we should remake all caving in surfaces. After some minutes of thinking I decide left keel as is — but on the next Eduard's I-16 I should solve this problem.
All part looks very good and impressive at sprues, but the kit has some hidden nuances in assembly ñ as write this some later
Cockpit assembled«out-of-the-box» except adding some wire rods. Note that on this plane cockpit is rather hard to see, actually with cockpit-doors would be opened
Places under doors were drilled, cut-off and sanded, and cockpit was assembled, painted and washing by artist oil paints.
Worth mentioning about a four holes on instrument board was forgotten in plastic — there are two large round holes for lighting instrumental panel, and two small oval holes — for hands of climbing pilot. This 4 holes was drilled and sanded, and the round holes was filled by MicroClea
r for getting the satisfactory result, but, unfortunately — not very transparent as wanted. Possible I need use old technique with gluing of transparent pieces of CD box.
Some additional work required in the chassis bays. 2 additional transparent windows should be made — in plastic detail we can see only simple outline for that windows. Looks like on I-16 started from 18-th series the form of this windows was changed — their was squared — this fact also marginally confirmed by I-16 of Boris Safonov, exhibited in Naval Museum in Saint Petersburg, Russia. Note that that Boris Safonov's plane
was mixed from 2 different planes after incident.
But at the model's building time I have not that information and make windows wrong form — as on earlier series of I-16. Their made from transparent plastic — old CD box was used.
When I start to attach wings to the fuselage main hidden problem appeared — looks like the cutting-off 2-3 mm of top halves of wings are ABSOLUTELY NEEDED for glued it on theirs places. Similar problems was found in place where wings meet engine cowling — some filler are required. Note that last problem appears on another my friend, who build this kit also
The exhaust piped drilled out and glued in models immediately.
Another important trait of I-16
is over cloaking of engine bonnet on the fuselage. At the model is implemented as a simple straight-angle «step», but on this aircraft the sheet of metal just over cloaked to the fuselage.
The simplest way to fix this — is a use of engraving burin for gently removing unnecessary plastic in this «step». :-) The result is satisfied.
After referring with drawings from monograph of Mikhail Maslov, I restored a couple of ports, and scribe panel lines, and start sanding works. I always use sandpaper step-by-step rind 600, 800, 1000, 1200, 1500 for get best quality of surfaces.
Some additional details in the emergence mechanism of chassis are required — it was made from copper wired and glued by cyanoacrylate glue. For best-looking result I use wheels by russian Equipage
which has a rubber tires and resin hubs.
Another hidden problem exist in this kit — the small rear wheels broke often when you would build the kit. I DEFINETLY recommend to cut-off, drill, insert metal pin, and glue wheel on its place. It would stronger this thin part and you donít care about it saving.
Model painted with AKAN enamels with Aztek
airbrush by tan nozzle. After added some layers of Future
decals was applied, and famous process of «winter camo» begins.
For this kind of painting I use white Tamiya acrylic paint painted with some drops of grey — it was airbrashed and while it not fully dried VERY gently partially removed by tooth brush with some alcohol on it.
After white paint is fully fried I apply some sanding by 1500 sandpaper with water also very gently.
As winter camouflage was applied on planes on airfields note that some part of models surface should be left native green color ñ place under the windscreen, for example.
After painting some layers if Furure and usually oil washing, and the coat of MicroFlat
For windscreen I use vacuformed part from Classic Airframe I-152 (it has 2 details in box). Window crossing made by self-glued metal foil ñ it is a very interesting material for different model tasks.
Small metal details added ñ the machineguns made from small tubes and band over the engine cowls by think band of metal foil. On the last details I made a mistake ñ researching archive photos I start to think that that band was painted in white color too. Of course, this paint on it should be rather damaged and weathered for metal, but no some shining as on my model.
The pressure sensor was turned from wooden toothpick and glued on its place
Exhaust tubes was painted by method of dark brown paint with big part of pastel powder in it. 2 layers of this mixture gave the full matt and non-regularly surface. After it dried I add some little touches of acrylic paints.
In spite all of these nuances of this kit I enjoy that build and planned to build another I-16 once again, at least.


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text:
Needing some advice:
My fiance is currently an LVN working at the State psychiatric hospital. Today he was suspended due to being a "moderate risk" due to an incident with a patient last week. Last week, the patient had climbed a chair in an attempt to remove/mess with one of the security cameras hanging from the ceiling. After failing to comply with the RN/PNAs requests to get down, my fiance came out of the med room and removed him from the chair. As he was walking away, the patient charged at him and punched him in the face. My fiance then grabbed the patient, took him into an arm hold, and forced the patient down while other staff responded. This patient has repeated behaviors of assaulting other patients and other staff members. He is restrained pretty frequently throughout the week.
Today was my fiances' first day back on the unit after being released from restrictions due to a mild concussion and hematoma from the assault. While being interviewed by the Investigator, the investigator is claiming that it appears my fiance was taking a swing at the patient and the patient was backing up. This would indicate a violation of patient rights and assault from a staff member. The security footage shows my fiance grabbing the patient after being hit and taking him down but no indication he was taking a swing at the patient. However, another employee who was a witness says that the Investigator is trying to make it seem like my fiance was attacking the patient back. Until the investigation is over, which could take 2 weeks, my fiance is suspended and has to use all his sick/days off to cover for the suspension.
My question is this: what protections, if any, do nurses have when a staff member is attacked by a patient and has to restrain him from causing possible harm to other staff or other patients? This could possibly mess with his career when he didn't do anything wrong. He did not assault the patient and put the safety of the staff and other patients over his own well-being until the situation was handled appropriately. Do we need to hire a lawyer in order to fight any possible accusations? Is there a BON law that protects nurses from wrongful termination in such events?
Any advice would be helpful.


When you're saddling up for spin class, your needs are different from a standard day on the bike. Things are toasty, and extra breathability is a must, plus plush saddles and lack of rough terrain negate the need for a plush pad. On days when spinning away indoors is your escape, don the Pearl Izumi Studio 3/4-Tight for lightweight breathable coverage while you spin. They are crafted from Pearl's SELECT Transfer Dry fabric that provides light compression and moisture management to handle perspiration. A wide waistband sits comfortably and stays put while you pedal, and a side pocket offers a spot to store your phone for tunes while you hammer on the pedals.


text:
I see the vista that lies ahead,
With the trees a sea of green,
As flowers dot the landscape,
To punctuate the spring time scene,
We see the path that lies ahead,
We see we’ve been this way before,
And every step through deja vu,
Just makes me want you more.
In memory we walk hand in hand,
Ignoring all we fear,
And on this trail by water,
What’s in the heart is all we hear,
The water as it moves along,
Seems to have no sound at all,
Lost inside those memories,
That with each step loudly call.
We walk down the trail hand in hand,
Not looking for anything to find,
While love that lives deep inside,
Fills both heart and mind,
Emotion becomes a restless sea,
With each step the crashing waves,
And in a heart that’s still beating,
It’s only love that saves.
The words of a song softly whisper,
Believe in the love you’ve found,
Then the silence that surrounds you,
Has it’s needed sound,
Each step becomes that endless dream,
That survives through each lonely day,
And as I walk with memories,
It’s love that shows the way.
There are no questions needed,
When love lives in the heart,
As each step echoes from the soul,
We walk together never apart,
So as you walk to ease your pain,
You never walk alone,
We travel to that point in time,
Where love was all we’ve known.
The landscape that unfolds before us,
Step by step reveals our pain,
And as the trail winds it’s way,
Love remains through falling rain,
For the remainder of this life,
My trail leads to you,
And through the trail’s ups and downs,
It’s still only love that’s true.


Power Pants V3
Get ready to crush some sets of snatches and c&j with these Power Pants V3. These weightlifting pants are designed to give you support and comfort while allowing your skin to breathe as you get the most out of every move you make in the gym. These pants are made from 85% polyamide fabric in a stretchy design. You can move freely and at full intensity during your toughest lifts. It’ll be easier to achieve your new PR! And with a tight yet flexible cut, these well-fitted bottoms will make you look and feel good during your workout.
- Made from 85% Polyamide & 15% Elastane
- Flexible and tight cut at the base & with enough stretch to allow you to move freely
- Comfortable & breathable material to prevent too much sweat
- Offers leg protection during your toughest lifts
- With an internal drawstring to adjust your fit
- Wash automatically at max 40°
- Available colors: Black & Navy
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- Logo embroidery
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text:
On Dec. 13, McCreery will play the Von Braun Center's Mark C. Smith Concert Hall.
Tickets ($28, $35.50 and $42.50) go on sale 10 a.m. Oct. 19., and are available at the VBC Box Office (700 Monroe St.), ticketmaster.com or by calling 800-745-3000.
At age 17, McCreery became the youngest male winner ever on "Idol." The Garner, N.C. native released his debut album in October 2011 at the ripe age of 18, and the LP has sold over a million copies.
His earliest influences included Elvis Presley, Conway Twitty and George Strait. (And McCreery actually sang Strait's "Check Yes or No" during the 2011 "Idol" finale.)
McCreery spent the first part of 2012 opening for country superstar Brad Paisley, and is set to release a Christmas album later this year.

domain: celebrity


text:
Neighborhood Police Unit (NPU)
The Neighborhood Police Unit (NPU)
Proactive Officers Making A Difference
This one sergeant, four-officer unit is free from general calls for service and works hard to conduct proactive enforcement to help keep our community safe.
The Neighborhood Police Unit often works with patrol operations personnel in an effort to identify and capture individuals who continue to negatively impact the quality of life in our community.
Statistics generated by the Neighborhood Police Unit from January 2016 through December 2019:
Contacts with individuals9,129
Grams of Meth, Heroin, & Cocaine Seized (1 pound = approx. 453 grams)16,077
Follow @ReddingPolice on Facebook!
View some of the press releases from our Neighborhood Police Unit.

domain: sociology