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Individual Patterns of Abnormality in Resting-State Functional Connectivity Reveal Two Data-Driven PTSD Subgroups
A major challenge in understanding and treating posttraumatic stress disorder (PTSD) is its clinical heterogeneity, which is likely determined by various neurobiological perturbations. This heterogeneity likely also reduces the effectiveness of standard group comparison approaches. The authors tested whether a statistical approach aimed at identifying individual-level neuroimaging abnormalities that are more prevalent in case subjects than in control subjects could reveal new clinically meaningful insights into the heterogeneity of PTSD.
Resting-state functional MRI data were recorded from 87 unmedicated PTSD case subjects and 105 war zone–exposed healthy control subjects. Abnormalities were modeled using tolerance intervals, which referenced the distribution of healthy control subjects as the “normative population.” Out-of-norm functional connectivity values were examined for enrichment in cases and then used in a clustering analysis to identify biologically defined PTSD subgroups based on their abnormality profiles.
The authors identified two subgroups among PTSD cases, each with a distinct pattern of functional connectivity abnormalities with respect to healthy control subjects. Subgroups differed clinically on levels of reexperiencing symptoms and improved case-control discriminability and were detectable using independently recorded resting-state EEG data.
The results provide proof of concept for the utility of abnormality-based approaches for studying heterogeneity within clinical populations. Such approaches, applied not only to neuroimaging data, may allow detection of subpopulations with distinct biological signatures so that further clinical and mechanistic investigations can be focused on more biologically homogeneous subgroups.
A major challenge in understanding and treating posttraumatic stress disorder (PTSD) is its clinical heterogeneity (1), which may be driven by different neurobiological abnormalities in different patients. Identifying more homogeneous, biologically defined subgroups within the broad clinical diagnosis of PTSD may help disentangle this heterogeneity, thus improving diagnosis and treatment. To date, most efforts to characterize PTSD subtypes have involved identifying clusters of symptoms and testing these clinically determined subtypes for corresponding distinct neurophysiological patterns (e.g., references 2, 3). However, a specific clinical phenotype may itself be driven by several different neurobiological factors. Therefore, an alternative to subgrouping patients based on symptom patterns would be to seek shared signatures of brain dysfunction within patients that could reveal clinically meaningful neurophysiological subgroupings (4, 5). Such an approach has already provided insights into how different neurophysiological patterns may lead to heterogeneity within the broad clinical phenotype of psychotic disorders (5–7). Neuroimaging-based biomarkers have been identified for several neuropsychiatric disorders (4, 8) and have shown promise in predicting treatment response (4, 9–12) and informing treatment selection (13).
Resting-state functional MRI (rsfMRI) is a useful modality for studying brain function in clinical populations (8). The functional connectivity profiles estimated from rsfMRI data, within and between known functional brain networks, are closely related to structural and synaptic measures of connectivity (14, 15). Group-level comparisons of rsfMRI data from individuals with PTSD and healthy control subjects have shown connectivity abnormalities within the default mode network and within the ventral attention network and between the default mode network and both the ventral attention and frontoparietal control networks (16–18), some of which were associated with individual differences in specific behavioral measures. These findings suggest that connectivity measures extracted from rsfMRI may be a basis for identifying novel neurobiological subtypes within the broad group of individuals who meet criteria for PTSD (4). However, the challenge of extracting the relevant features that would best parse neurobiological heterogeneity within PTSD remains. Specifically, it should be noted that a significant case-control difference at the level of the mean (as would be detected using a two-sample t test) may not reflect any discriminability at the level of the individual. On the other hand, a feature that does not show a significant case-control difference at the level of the mean may carry discriminability power at the individual level, if many values fall far from the group mean. An example of such a feature is illustrated in Figure 1A, where although the distributions are similar at the level of the mean, the feature seems to have high discriminability due to a much larger number of extreme values in one group. Identifying such features may hold great potential in studying heterogeneity within patient populations, especially because we expect extreme behavioral abnormalities to be driven by extreme or out-of-norm neurobiological patterns rather than small deviations from the mean. However, to the best of our knowledge, there is no off-the-shelf statistical test that captures this property.
In this study, we adopted a normative modeling approach to examine neurobiological heterogeneity within PTSD patients, using a tolerance interval–based method. A tolerance interval is an interval that covers a certain proportion of the population at a specific level of confidence. Tolerance intervals have been used in other areas of medicine for mapping individual abnormalities with respect to a reference population (19, 20). (For more information on tolerance intervals, see the Supplementary Methods section in the online supplement.) Here, we calculated tolerance intervals of rsfMRI connectivity features in a population of healthy control subjects and searched for features in which abnormal values are highly prevalent in PTSD case subjects. We used a large population of well-matched U.S. military Iraq and Afghanistan combat veterans, calculating tolerance intervals for healthy control subjects exposed to war zone trauma to determine the distribution of normative connectivity measures. We then identified connectivity features where abnormality was highly prevalent within a group of war zone–exposed veterans with PTSD who were not taking psychiatric medications. This second step is also called “enrichment analysis” because we are testing the enrichment of extreme values within cases. Finally, we applied a clustering analysis to identify biologically similar subgroups of patients with distinct patterns of abnormality. We validated the significance of these subgroups using internal cluster-stability analysis, as well as their relation to clinical and behavioral data. We also examined their utility in classification of PTSD cases.
The study involved 210 participants who were not taking psychiatric medications, including 97 with PTSD and 113 war zone–exposed healthy participants. All participants were combat veterans who had been deployed during Operation Iraqi Freedom (Iraq), Operation Enduring Freedom (Afghanistan), and Operation New Dawn. Participants were recruited and underwent scanning at either Stanford University or New York University after providing written informed consent. The study was approved by the universities’ institutional review boards, in accordance with the ethical principles in the Declaration of Helsinki. Psychiatric diagnoses were based on DSM-5 criteria using the Clinician-Administered PTSD Scale (CAPS; full or subthreshold PTSD) (21). Diagnoses of other comorbid conditions, such as major depressive disorder, were assessed using the Structured Clinical Interview for DSM-IV. All diagnoses were confirmed in consensus clinician meetings. A history of traumatic brain injury (TBI) was determined by whether loss of consciousness occurred with a war zone–related head injury. General exclusion criteria for both groups included a lifetime history of psychotic or bipolar disorder or active substance dependence (within 3 months for case subjects, and lifetime for control subjects). Of the 210 participants, seven (four case subjects and three control subjects) were excluded for excessive motion in the scanner, and 11 (six case subjects and five control subjects) were excluded for insufficient image coverage. Our analysis covered the 192 remaining participants (see Table S1 in the online supplement).
Clinical and Behavioral Assessments
Questionnaires and clinical scales.
Participants completed several self-report questionnaires. Quality of life was measured using the World Health Organization’s Quality of Life-BREF survey (22), and symptoms of depression were measured using the Beck Depression Inventory–II (23). IQ was estimated using the Wechsler Abbreviated Scale of Intelligence (24). TBI was diagnosed if loss of consciousness occurred with head injury (25).
Neurocognitive test battery.
We administered a standardized computer-based neurocognitive test battery (26) to all participants. This battery, which we have used in research on depression (9), assesses multiple cognitive domains, including memory, attention, response inhibition, flexibility, and processing speed as well as emotion identification and bias. Impairments in some of these domains are common in PTSD (27). (For additional details, see the Supplementary Methods section in the online supplement.)
fMRI Connectivity Feature Extraction
fMRI data acquisition and preprocessing are described in the Supplementary Methods section in the online supplement. The mean time series was extracted for 133 brain regions based on a cortical parcellation of 100 parcels derived from an independent rsfMRI cohort (28), which was combined with a set of 33 subcortical parcels that include 14 cerebellar parcels (29), as well as 13 striatal parcels (30), the right and left amygdala, the right and left hippocampus (31), and the right and left thalamus (32). More details about time series extraction is provided in the Supplementary Methods section in the online supplement. Pairwise connectivity was calculated using Pearson correlation, and Fisher’s z-transformed connectivity values were averaged for each region to obtain a measure of connectivity to each of seven previously defined resting networks (33) to further reduce data dimensionality. This resulted in a set of 931 connectivity strength values representing a whole-brain resting-state connectivity profile for each subject.
Identifying Abnormal rsfMRI Connectivity Features in PTSD Case Subjects
We used the “tolerance” package in R (https://cran.r-project.org/web/packages/tolerance/tolerance.pdf) for nonparametric estimation of two-sided tolerance intervals for each node-to-network connectivity measure to obtain a range within which 90% (proportion=0.9) of the healthy control population is expected to fall, with a 10% confidence level (alpha=0.1). Parameters were chosen while accounting for the required sample size using the SSNORM function provided in the tolerance package to best suit the number of subjects. Next, informative features were selected based on enrichment in abnormality within PTSD cases. This process of enrichment analysis was done using the hypergeometric cumulative distribution function (34). This function is often used in genomics for estimating the significance of enrichment of gene groups with previously identified genomic annotations (34, 35). It has also been used in the field of neuroimaging for interpreting large-scale connectivity findings with respect to previously identified functional networks (36, 37).
This process was repeated 500 times, with 90% of the subjects randomly subsampled each time to obtain for each feature the consistency rate, which represents the fraction of repetitions in which it was selected and is a reliable estimate of disorder relevance or abnormality. Analyses were performed while controlling for site, age, gender, years of education, and two subject-level motion variables (mean and maximum absolute displacement). This feature selection process is illustrated in Figure 1.
Detecting Abnormality-Based Clusters Within PTSD Case Subjects
The CLICK clustering algorithm (35) was used to search for clusters of PTSD cases across the subset of selected features, that is, features with a consistency rate exceeding a predefined threshold (70%).
Notably, because 70% was an arbitrary choice, we also examined the effect of varying this threshold. Importantly, CLICK determines the number of clusters based on the data and allows for unclustered elements. (For further details, see the Supplementary Methods section in the online supplement.) The use of this type of advanced clustering approach allowed us to avoid “artificial” cluster detection in continuous data with no clear separation, as may happen through k-means clustering (which enforces a predefined number of clusters; CLICK allows for the existence of no or one cluster). Clustering was also performed within-loop for each of the subsampling iterations (i.e., 500 times), and stability was estimated based on the consistency of cluster co-occurrence for each pair of patients. More information on cluster stability estimation is provided in the Supplementary Methods section in the online supplement. This entire process is illustrated in Figure 1C.
Cluster Validation Using Clinical and Behavioral Measures
A nonparametric Wilcoxon rank sum statistical test was used to identify intercluster differences in clinical and behavioral assessments. We focused on a subset of 24 measures that are core clinical or self-report measures used for characterizing PTSD populations and 49 measures that represent the key behavioral metrics from the neurocognitive battery. Analyses were performed after regressing out age, gender, and education, while controlling for the false discovery rate (false-discovery-rate-corrected p<0.05).
Consistently Selected Abnormal Connectivity Features
Feature selection was performed repeatedly in 500 subsamples, each containing 90% of the subjects. We recorded each feature’s consistency rate, that is, the proportion of subsamples in which it was identified as abnormal in case subjects (Figure 2A). Of 931 features, 31 exhibited a consistency rate greater than 70% (Figure 2). Abnormalities in connectivity patterns in case subjects with respect to healthy control subjects were evident mostly in connections between the frontoparietal control network and the sensorimotor and visual networks and between the sensorimotor network and the visual network (Figure 2B and 2C). A more detailed visualization of each of the 31 consistently selected features is shown in Figure S1 in the online supplement. As a point of comparison to our tolerance interval approach, we also used standard t tests for feature selection (p<0.05), yielding 28 features consistently selected in >70% of the runs, mostly of connections involving the default mode, frontoparietal control, and ventral attention networks (Figure 2B and 2D). Notably, only three features from the set of abnormality-based features were also selected based on group-level t tests. It is thus evident that the kind of network features that were expected, based on previous comparisons of healthy and PTSD groups (16–18), were detected using a t test but not with the approach using the tolerance interval feature selection. Because the consistency rate threshold of 70% was an arbitrary choice, we also examined the effect of varying this threshold. The results are shown in Figure S2C and S2D in the online supplement.
Clustering Patients Based on Abnormal Connectivity Features
To identify subgroups of case subjects who share similar patterns of disorder-related connectivity abnormalities, we applied the CLICK clustering algorithm to all patients across the 31 connectivity features that were consistently identified as abnormal within patients with respect to healthy control subjects. This procedure identified two clusters. To estimate cluster stability, we also applied this procedure within each of the 500 subsampling iterations described above. Stability was estimated based on the consistency of cluster co-occurrence for each pair of patients across subsamples. The average patient co-occurrence matrix for the clustering solution is shown in Figure 3A. It is evident that the stability of the clustering assignments across subsamples was very high. The matrix was summarized into a single stability index of 0.7068 (p<0.01). The two CLICK-identified clusters showed distinct connectivity-abnormality patterns (Figure 3B through 3F). Cluster 1 (N=49) showed abnormally low connectivity between parcels of the visual and the sensorimotor networks, and cluster 2 (N=30) showed an opposite pattern of abnormally high connectivity between the visual and sensorimotor networks alongside an abnormally low connectivity between these two networks and the frontoparietal control network, within which the connectivity was also abnormally high (Figure 3E). Demographic and clinical characteristics, as well as scan site and motion for each cluster, are presented in Table S2 in the online supplement. Clusters did not differ significantly in site representation, age, gender, years of education, or subject-level motion in scanner. However, TBI prevalence was significantly higher in cluster 2 than in cluster 1.
To test the extent to which this clustering result is sensitive to parameter choice, we repeated the process of feature selection and clustering analysis across a range of tolerance interval alpha and tolerance interval proportion values and looked at features that were selected when averaging the consistency rate across a range of parameter values. This process yielded a set of nine features that had an average consistency rate of >70% and led to a similar two-cluster grouping with highly overlapping cluster content (agreement=72%; see Figure S2A and S2B in the online supplement). We also tested the effect of consistency rate threshold on the results by clustering across features selected using a threshold of 65%−90% in increments of 5%. Results show high consistency across thresholds (see Figure S2C and S2D in the online supplement).
Finally, for comparison, we also applied CLICK clustering to the PTSD case subjects using the features that were consistently selected by a two-sample t test. Here, too, we detected two clusters. However, these showed a lower stability across runs (see Figure S3A in the online supplement), with a stability index of 0.2641 and a low (52.9%) agreement with the clusters identified using tolerance intervals.
The utility of the identified clusters in case-control discrimination was tested using K-nearest-neighbor classification in a 10×10-fold cross-validation framework. The identified subgroups, but not the selected features, were useful and led to an improvement of more than 10% in classification accuracy. More details about this analysis and result are provided in the online supplement.
Clinical and Behavioral Correlates of the Abnormality-Defined Clusters
To examine the clinical and behavioral relevance of the identified abnormal connectivity patterns, we compared the two clusters on symptom and cognitive measures, correcting for the false discovery rate (see Table S2 in the online supplement). We found a significant difference in the reported current level of reexperiencing symptoms (criterion B items in the CAPS), which were higher in cluster 2 than in cluster 1. As expected, both clusters showed higher levels of reexperiencing symptoms than were observed in control subjects. After this finding, we further examined the relationship between each of the 31 selected features and reexperiencing across patients and identified a marginally significant association with two of the features involving connectivity between the visual network and a node of the right-motor cortex, and between the sensorimotor network and a node located in the left prefrontal cortex. Results are summarized in Figure 4.
We also found a marginally significant difference in performance in a choice reaction time task, a measure of information processing speed, such that reaction times were longer in members of cluster 2 than in members of cluster 1. Reaction time was also longer in members of cluster 2 compared with healthy control subjects. Of note, reaction times did not differ between cluster 1 members and control subjects.
With respect to psychiatric comorbidities, no significant difference was found between clusters in rates of major depressive disorder comorbidity. However, a significantly higher number of individuals with TBI comorbidity was found in cluster 2 (see Table S2 in the online supplement). Finally, we did not find clinical or behavioral differences between the two clusters identified on features that were consistently selected using a t test (false-discovery-rate-corrected p>0.05).
Cluster Discriminability Using Resting-State EEG Data
To further validate the finding that the identified clusters indeed reflect PTSD subtypes with distinct neurobiological correlates, we trained a nearest-neighbor model to distinguish between the two clusters using resting-state EEG power envelope connectivity features that were available for 35 patients from cluster 1, 20 from cluster 2, and 67 healthy control subjects. Performance was estimated using 10×10-fold cross-validation. Our classifier was able to distinguish between the two patient clusters with an accuracy of 68% (p<0.005), with a sensitivity of 73% in detecting cluster 2 and 62% in detecting cluster 1 (see Figure S3A and the Supplementary Methods section in the online supplement).
We have identified two subgroups of PTSD case subjects characterized by different patterns of rsfMRI network connectivity abnormalities, with both clinical and neurocognitive relevance and with distinct neurophysiologic signatures. Equally important, the approach used here to detect disorder-related abnormal connectivity patterns can be generalized to other data sets, including nonimaging data (6). Our work thus provides a proof of concept for an approach to biologically defined, data-driven subgroup detection in a way that may identify potentially high-value targets for personalized diagnosis or treatment.
The identification of features that may be most relevant for understanding heterogeneity in a clinical population is a fundamental challenge in studying complex disorders. Unlike other cases where this was done based on a priori regions of interest or on clinical data (e.g., reference 4), here we make no such a priori choices and use only the diagnostic labels (PTSD in comparison with control subjects) to identify a set of connectivity features with high-magnitude, individual-level abnormalities within subgroups of PTSD cases. Thus, we avoided bias from a restrictive focus on brain regions that are already thought to subserve the clinical condition but that may not provide the best avenue for subgroup identification. Indeed, the subgroups identified here involve brain regions not typically assumed to be central to PTSD. Likewise, by avoiding feature selection based on the correlation of features with clinical symptoms, we avoid bias from the arbitrariness of particular symptom-based conceptualizations of psychiatric disorders (1, 39) while still allowing for the discovery of relationships to aspects of the clinical presentation.
The features identified in this study as abnormal in PTSD subgroups consist mostly of connectivity between the sensorimotor network and the frontoparietal and visual networks. Although abnormalities in frontoparietal connectivity and activity within PTSD cases have been reported in several studies (16, 18), abnormalities in connectivity and activity of sensory motor and visual regions in this population have been reported more rarely (17, 40, 41). These unexpected findings would not have been detected had we used a traditional hypothesis-driven approach for feature selection, focusing on networks that have been shown to differ in connectivity patterns in PTSD cases, such as the default mode or ventral attention networks (16–18). We suspect that the reason we did not detect the involvement of these networks in this study is that previous studies focused on mean differences between case and control subjects and did not specifically look for individual-level abnormalities within the PTSD group. This conclusion is underscored by the fact that many of the features detected when examining case-control differences using a two-sample t test feature selection strategy involved the default mode and ventral attention networks (Figure 2D).
The Two Subgroups
The two different patterns of abnormalities in resting-state connectivity were associated with different clinical and cognitive phenotypes. Case subjects in cluster 2 reported higher levels of reexperiencing symptoms. Notably, although they represent one specific aspect of the disorder, reexperiencing symptoms were found to be a highly central component in a network analysis of CAPS symptoms in both acute and chronic PTSD, suggesting that these symptoms play a key role in shaping the clinical phenotype and presentation (42). Moreover, the updated ICD-11 criteria for PTSD removed symptoms thought to be common to PTSD and other psychiatric disorders and focused on distinguishing symptoms, which notably include reexperiencing (43). Our findings suggest a relationship between reexperiencing symptom severity and increased visual-sensorimotor functional connectivity alongside decreased connectivity between these two networks and the frontoparietal control network.
Although some studies have reported aberrations in visual and motor functions in PTSD (41, 44–46), to date, few studies have examined resting-state activity patterns of these two functional networks in the context of PTSD and stress (47, 48); thus, it is hard to make any mechanistic hypothesis about the nature of this relationship. One piece of evidence, however, that links these functional connectivity abnormalities to psychopathology was reported recently (49) in a study in which a multivariate data-driven approach was used to identify latent components linking a large set of clinical, cognitive, and personality measures to rsfMRI connectivity across 110 healthy control subjects and 114 patients spanning several types of psychopathology (schizophrenia, schizoaffective disorder, bipolar disorder, and attention deficit hyperactivity disorder). The study reported three psychopathology latent components, each associated with a unique rsfMRI connectivity pattern. While all three components involved connectivity alterations of the somatosensory-motor network, increased visual-sensorimotor connectivity alongside decreased connectivity between each of these networks and the frontoparietal control networks was associated with two of the three. The study did not include PTSD patients; however, it may be hypothesized that reexperiencing is related to increased levels of general distress that is reflected in the identified brain abnormalities of cluster 2 members. Furthermore, the suggestion that the two clusters indeed represent two biologically distinct subgroups is further supported by their discriminability using independently collected EEG data. Further work will be needed to understand the relevance of these subgroups to treatment outcome as well as their relevance to other measures.
In this study, we focused on a population of primarily male veterans with war zone–related trauma. Alongside the advantage of using war zone–exposed healthy individuals as control subjects, we note that the lack of an additional control arm not exposed to trauma is a limitation of the study, as it leads to norms that do not represent the general healthy population. That said, it has been shown that many of the differences detected between PTSD case subjects and healthy control subjects are in fact also evident when comparing healthy controls based on trauma exposure in the absence of symptoms and that the differences also account for apparent distinctions between PTSD and control subjects (50–52). This may be related to the fact that healthy control subjects are individuals who are resilient to the psychological effects of trauma. The separate influence of trauma to normative functional connectivity patterns would be important to explore in future work. Furthermore, the extent to which the reported results can be generalized to different trauma-exposed populations, or to females, is unclear.
The limited sample size did not allow for a within-study external validation using a sample split. Although the EEG analyses can be viewed as exploratory validation outcomes of the fMRI-derived clusters, further investigation is needed to determine the generalizability of the identified abnormalities and clusters. Notably, the primary findings reported here relating the ability to identify a consistent set of features, and from there, clusters, were carefully tested for robustness. The method we used for abnormality detection is based on a mass univariate analysis and examines each data feature independently. Although a univariate approach yields more interpretable and translatable findings, it has the disadvantage of potentially missing patterns of abnormality that are multivariate in nature and can only be tracked using a multivariate approach.
First, our study provides a proof of concept for the utility of abnormality-based approaches in analyzing data from heterogeneous clinical populations. Doing so revealed a pattern of behavioral and clinical abnormalities that could not have been anticipated a priori, illustrating the critical need for an unbiased, data-driven approach for discovering subgroupings within the broader clinical diagnosis of PTSD (as well as in psychiatric disorders more broadly). Second, our study may now allow us to identify individuals as defined by their neurophysiology rather than by arbitrary clinical criteria, such that further mechanistic investigations of what processes are perturbed in these patients can be invested in more biologically homogeneous samples. Indeed, conflicting or negative findings in PTSD may be due to differences in the prevalence of these two clusters in the sample. Finally, it is important to note that interventions may differentially affect patients who are defined based on functional connectivity subgroups. For example, given the important role of the frontoparietal network in differentiating between the two clusters in our study, repetitive transcranial magnetic stimulation targeting the dorsolateral prefrontal cortex may result in different clinical outcomes in these two subgroups.
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domain: psychology


text:
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domain: chemistry


text:
I don't need to tell you about how Blythe, pictured above, loves her Grandma Betty, because you can see everything about that in this photo.
You can see that Betty is sick and frail, and very thin.
You can see that Blythe is visiting her in hospital, and that this is a serious visit.
But what you can't see is the sepia, sun-filled, silent film-reel that plays continuously behind Betty's eyes. You can't feel the sudden absence of a love that was so strong, old and familiar that it had become life itself.
You can't see the remains of a heart that gave itself completely over to another.
It was only six months ago that Blythe's Pa, Betty's Joe, passed away. But since then Betty has changed from inside to out.
When that bright beautiful sun-shining husband of hers slipped off below the horizon for the last time, the world that was left behind was too dark, too lonesome to bear.
Betty lost the will to live. She wanted to be 'away with her Joe'. She stopped eating, in fact refusing food even at hospital and became so malnourished that she was close to slipping into a coma, and would have, had Blythe and her brother not sat by her hospital bed for the last two weeks.
The doctors say they have not seen anything like it before. They thought Betty was very close to death and yet, after two weeks of Blythe and her brother sleeping in her room, loving her and reminding her of reasons to live, Betty was eating again and amazingly, beginning to walk.
I want this story to be told now, on Valentine's Day because it shows the power of pure love. Pure love can make you feel like life is not worth living, but it can also save you.
I think this story is best told in Blythe's words, which you can read below.
Grandma was there with a group of her friends, and Pa was there with his friends.
The girls started talking to the boys and at lunchtime Grandma noticed that one of the boys wasn’t eating anything. She asked him what had happened to his sandwich, and he said he had lost it... but he’d actually already eaten it! Grandma offered him her sandwich and he took it. He was always a cheeky bugger, right from the start.
Pa walked Grandma home that day, and asked her out to the movies the next week.
That was the start of their love story.
They married when they were 18, and spent four years apart during WWII. Pa was fighting in PNG, as part of the 25th Battalion and was involved in the Battle of Slater’s Knoll, his was one of the toughest battalions in WWII.
When he returned home from the war, he was a different man.
They were living at Grandma’s parent's house and he would get up in the middle of the night and do wheelies around the house on his motorbike. He didn’t know why. Grandma didn’t know why. That was the effect of the war.
They had one son, my dad, who was a little boy when Pa returned from the war.
Grandma loved Pa with all her heart, and he loved her too. He seemed to appreciate her even more the older he became, as he had more and more trouble doing daily tasks, and she helped him more and more. She cared for him at home, until she couldn’t do it anymore.
Pa died in a nursing home last year. They were married for 72 years.
It broke Grandma’s heart when he passed away. She held him in her arms non-stop for his final week and the doctors eventually moved an extra bed into the room for her.
The last words that Pa said to her were these:
“Take care of yourself, Bet”.
So while the sun has set on Betty's great love, just look there at that photo.
Look at how the love of two grandchildren has rallied an old and broken heart, giving that heart a new will to live.
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text:
With the help of 5 generous fabric sponsors and 23 talented sewists, we have created a "flipbook" or digital catalogue as an alternative way to see all the patterns we have to offer. After all, sometimes scrolling through website listings can be a bit tedious, do you agree?
This creative display of all the patterns we have created up to the end of 2021 has been a huge endeavour and we want to point you to the bottom of this page for a closer look at the fabric sponsors as well as to the credits page of the look book for a complete list of the sewists featured throughout. These are all very special people to us. Whether they are fellow business owners that we've come to know or fellow sewists that we've met through the online sewing community, we value these relationships and think they are very much worth your time to check them all out.
For a little extra fun along the way, we've created a little scavenger hunt for you to do with the kids or on your own.
Now we don't want to take time away from enjoying what you came for, so grab a cup of coffee or tea or whatever you prefer and enjoy a look at all the designs from the first 3 years of Sofiona Designs.
CLICK ON THE IMAGE BELOW TO START
The Fabric Snob - Located in our very own province, this is a company that we are happy to call friends. See this store for a wide variety of quality fabrics at great prices - from knits to wovens and all sorts in between.
Find them on IG @thefabricsnob using #thefabricsnob
Art Gallery Fabrics - Not a store in itself, but a company that has created collections of fabric that have inspired us for literally years. Any opportunity we've had to be a part of something with AGF is an honour.
Find them on IG @artgalleryfabrics using #artgalleryfabrics
Prairie Love Knits - A fellow Canadian company owned by one of the most talented artists. Sharon created 3 stunning fabric prints for us to use in this look book and you will see them throughout. She does florals like no one else and it was a dream come true to have our own "Sofiona" prints in real life.
Find her on IG @prairieloveknits using #plkeveryday #prairieloveknits
Amelia Lane Designs - Representing for our neighbours to the south of our borders, we were honoured to have this fabric company join us. They are also 2 friends working together in this online sewing community and they started very close to same time as us! Find many knit fabrics including some beautifully curated bundles for sewing everything from tops to tights.
Find them on IG @amelialanedesigns using #gottabeALD #amelialanedesigns
Sitka Fabrics - We consider Sitka our go-to for high quality, unique fabrics with a consideration for organic and eco-friendly options. From corduroy to linen to wool and of course cuffing. We LOVE Sitka cuffing and are never disappointed with our purchases.
Find them on IG @sitkafabrics using #sitkafabrics

domain: artistic


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Intel Unveils Xeon E5 'Grantley' for Broad Range of Server Workloads
Patrick Moorhead, principal analyst with Moor Insights and Strategy, said Intel is "doing what they have to do to maintain [its massive market share], which is a good thing." He noted that data centers now tend to fall into either the scale-up or scale-out categories, or fall somewhere in between, such as with hybrid clouds. "Grantley fits into all of these," Moorhead told eWEEK. "I think enterprises are ready." Intel doesn't yet have much in the way of competition in the server space. Advanced Micro Devices earlier this year launched new 12- and 16-core Opterons for such workloads as traditional databases and data analytics, and is looking to its upcoming ARM-based Opteron 1100A "Seattle" chips to help it gain traction in smaller, dense microservers. For its part, ARM officials expect to see systems-on-a-chip (SoCs) from such partners as AMD, Applied Micro, Marvell Technologies and Cavium gather momentum going into 2015 now that they have access to ARM's 64-bit ARMv8-A architecture. Intel is covering the entire range of server workloads, from its low-power Atom platform for smaller, dense microservers through to the many-core Xeon Phi processors for the HPC field.For example, in the networking realm, Intel at IDF will announce its Open Network Platform Server, a reference architecture for software-defined networking (SDN) and network-functions virtualization (NFV) that not only will feature the Xeon E5-2600 v3 processor, but also Intel's new "Fortville" Ethernet Controller XL 710 and QuickAssist Adapter 8950 on the hardware side, and such Intel software as its Data Plane Developer Kit (DPDK) set of libraries and drivers, QuickAssist Technology drivers, 10 Gigabit Ethernet and 40GbE drivers, and Service Assurance Administrator. It also will include optimization for the OpenDaylight SDN controller and OpenStack orchestration technology, and will support Fedora 20 KVM. The new chips also will offer improved power management capabilities. The current "Romley" processors based on the "Ivy Bridge" architecture offered the same "P-states" for all cores, while Grantley will include Per-Core P-states (PCPS), which will enable each individual core to run at its own frequency and voltage. There also is Energy Efficient Turbo Mode, which monitors the individual cores and increase the core frequency only if it is energy-efficient. The use of DDR4 memory also will help drive down power consumption by 20 to 40 percent while offer twice the bandwidth of DDR3, J.S. Choi, senior manager of memory product planning for Samsung Semiconductor, said during the workshop. Other capabilities in Grantley include Cache Allocation Monitoring for better decisions around virtualization workload scheduling and migration, Advanced Vector Extensions (AVX) 2.0 instruction sets for improved performance for computationally intensive workloads, and an Integrated Voltage Regulator for more refined management of chip voltage and frequency.
However, Intel is challenged by the new workloads running the data center, and is looking to the strength of its expanded capabilities—from software and chipsets to reference designs and specialty processors for such tasks as communications—to help it meet the demands raised by those workloads.

domain: news


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Chairman, Retirement Income, Challenger Limited
Showing 1 to 3 of 3 articles:
JEREMY COOPER | TUESDAY, 26 NOV 2019
It is a fact of life that nobody knows exactly how long they will live. Of more concern is that most people don't know how long they are expected to live on average either. Given that Australian seniors are responsible for financing their own retirement ... Read more
Within the world of retirement income planning, there are two opposing schools of thought: probability-based and safety-first. Understanding the distinctions and thought processes of both schools is important as in getting the best outcomes. Read more
Challenger's Jeremy Cooper and Aaron Minney take a look at the retirement phase of superannuation, advocating the inclusion of longevity protection products in addition to the standard account based pensions. Read more
The super fund has expanded an existing mandate with Calvert to include a carbon reduction tilt that will cover its entire Australian equity portfolio.
New analysis by Rainmaker Information has identified 32 superannuation funds as leaders on ESG principles and strong investment performance.
The industry fund has reduced asset-based administration fees across Rest Super, Rest Corporate and Rest Pension, saying its total fees are now at least 25% less than the industry average.
As we celebrate the 30th birthday of the Superannuation Guarantee, the new financial year brings with it plenty of changes to super. Here's what you need to know.
CHIEF EXECUTIVE OFFICER
CHIEF EXECUTIVE OFFICER
Heading one of the country's largest sustainable investors wasn't something Peter Chun ever envisioned for himself, but that's just a bonus of taking on the role he describes as a perfect fit - chief executive of UniSuper. Jamie Williamson writes.
The new Labor Government will be a strong supporter of superannuation. In fact, the Prime Minister in his election night comments mentioned his government's ...
Emerging market debt has had a tough 2022 so far but the market is reaching an inflection point. Much of the bad news is in the past and yields are beginning ...
Superannuation's structural tailwinds of the past 30 years are morphing into headwinds and traditional diversification is challenged. (As an industry) ...
Attention has recently been given to the addition of non-traditional investments such as bitcoin in SMSF portfolios. Before doing so, SMSF trustees should ...

domain: economics


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Base: Gray Granite Polished Flat Top (PFT) with textured Balanced Rock Pitch (BRP)
Base Dimensions: 42” x 12” x 6”
Die: Gray Granite (Polish 2)
Die Dimensions: 24” x W6” x 20”
Lettering Options: Traditional Sandblasted Letters painted black
Additional Product Features: Comes with a pair of 5″ x 4″ 9″ gray granite vases
This unique monument design features a custom cut die that appears to hold and border the main headstone portion of the monument. This monument was made from Sunset Red Granite and comes with a square granite flower vase.
Single Upright Serp Top with Square Vases (Sunset Red Granite)
This one-of-a-kind monument features the rich sunset red granite selection. The marker is located centrally on the base, leaving room for the two vases to the side. The vases are perfect for displaying seasonal arrangements to commemorate your loved one.

domain: hobby


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Warnings from the Most Influential Women in Psychedelics
Psychedelics have become a hot topic in recent years, with an increasing number of individuals turning to substances like LSD, psilocybin, and ayahuasca for personal growth and healing. While there is growing excitement about the potential benefits of these substances, there are also risks to be aware of.
In this blog post, we will explore the warnings and concerns shared by some of the most influential women in the world of psychedelics.
Who are the Most Influential Women in Psychedelics?
Before we dive into the warnings shared by these women, it is important to understand who they are and what they stand for.
The following women are some of the most prominent voices in the world of psychedelics:
Amanda Feilding: Founder of the Beckley Foundation, a UK-based think tank that focuses on drug policy and scientific research on psychoactive substances.
Robin Carhart-Harris: Head of the Centre for Psychedelic Research at Imperial College London, where she conducts research on the therapeutic potential of psychedelics.
Dr. Julie Holland: Psychiatrist and author who has written extensively about the therapeutic potential of psychedelics and their use in mental health treatment.
Kathleen Harrison: Ethnobotanist and co-founder of the Ethnobotanical Stewardship Council, an organization that works to promote ethical and sustainable practices in the use of plant medicines.
Dr. Rachel Yehuda: Neuroscientist and director of the Center for Psychedelic Psychotherapy and Trauma Research at Mount Sinai Hospital in New York, where she studies the effects of psychedelics on trauma.
Warnings and Concerns from the Most Influential Women in Psychedelics
While these women are advocates for the responsible use of psychedelics, they also have concerns about the potential risks associated with these substances. Some of the warnings and concerns they have shared include:
Risk of Psychological Harm
Kathleen Harrison has expressed concern about the potential for psychological harm associated with the use of psychedelics, particularly when used outside of a supportive and therapeutic environment.
Dr. Rachel Yehuda has emphasized the importance of screening individuals for a history of mental health conditions before administering psychedelics, as these substances can exacerbate symptoms in those with certain conditions.
Need for Safe and Ethical Practices
Amanda Feilding has called for the development of safe and ethical practices for the use of psychedelics, including proper dosing, preparation, and integration of the experience into one’s daily life.
Kathleen Harrison has emphasized the importance of ethical sourcing and sustainability in the use of plant medicines like ayahuasca.
Concerns about the Commercialization of Psychedelics
Dr. Julie Holland has expressed concern about the growing commercialization of psychedelics and the potential for these substances to be exploited for profit without proper consideration for the risks involved.
Robin Carhart-Harris has called for responsible research and ethical practices in the development of psychedelic medicines, cautioning against the potential for profit-driven interests to override safety and efficacy concerns.
While the use of psychedelics has become increasingly popular in recent years, it is important to be aware of the potential risks and concerns associated with these substances. The most influential women in the world of psychedelics have emphasized the importance of responsible and ethical practices, as well as the need for caution when using these substances for personal growth and healing.
As the conversation around psychedelics continues to evolve, it will be important to heed the warnings and concerns of these influential women and work towards a more responsible and sustainable approach to the use of psychedelics.
This includes supporting ongoing research into the therapeutic potential of these substances, as well as promoting safe and ethical practices in their use. It also means being mindful of the potential risks and limitations of these substances, and working to mitigate these risks through proper screening, preparation, and integration practices.
Ultimately, the goal should be to maximize the potential benefits of psychedelics while minimizing the risks, and ensuring that these substances are used in a way that is both safe and sustainable for individuals, communities, and the planet as a whole.
By listening to the insights and guidance of the most influential women in the world of psychedelics, we can work towards a more responsible and informed approach to these substances, and unlock their full potential for personal growth and healing.

domain: sociology


San Pedro Reef Week- Highlighting our Marine Eco-system
Tuesday, May 17th, 2016
The 11th annual Northern Belize Reef Week kicked off on Monday, May 16th with an early 6AM swim to the reef. The full week features a variety of events, ranging from Lionfish Tournaments to clean -up campaigns to Kayak Races, all in an effort to create awareness of our marine ecosystem.
In the opening event, around 15 swimmers took on the challenge and swam to the reef and back. According to The San Pedro Town Council’s Sports Coordinator Kent ‘Bob’ Gabourel, the race was not about competing, but to raise awareness on the need to protect the reef system. Participants swam at their own pace, and many of them even wore their snorkelling gear in order to make it an enjoyable swim.
Gabourel would like to thank everyone who participated. “I would like to see more people getting involved in these types of activities. We should always remember that the Reef is what made San Pedro what it is today. We all depend on the reef in one way or another. We need to get more involved in order to create awareness and protect it,” he said.
At the end of the race, all swimmers were acknowledged for their participation and encouraged to continue taking part in the events of the reef week. Organizers are emphasizing the continued preservation of the reef, as it contributes to the livelihood of island residents. The different activities throughout the week were constant reminders to seek ways to better conserve our reef system.
Organizers thank everyone who participated. The service of the Hol Chan Marine Reserve and Amigos del Mar staff are truly appreciated.
Please help support Local Journalism in Belize
For the first time in the history of the island's community newspaper, The San Pedro Sun is appealing to their thousands of readers to help support the paper during the COVID-19 pandemic. Since 1991 we have tirelessly provided vital local and national news. Now, more than ever, our community depends on us for trustworthy reporting, but our hard work comes with a cost. We need your support to keep delivering the news you rely on each and every day. Every reader contribution, however big or small, is so valuable. Please support us by making a contribution.Click to Donate


OER¬Æ Authorized reproduction of the original chrome front bumper designed for use with 1973-80 Chevrolet and GMC truck models. This quality reproduction ftont bumper is manufactured to factory specifications featuring a bright chrome finish. Designed to replace the original exactly. OEM Part #: 6272560
1973-1980 Chevrolet Pickup Truck (C/K)
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1973-1980 GMC Jimmy
Note: Shipped double oversize.
Original Equipment Reproduction - OER - is the leading manufacturer and distributor of quality classic automotive restoration parts and accessories. OER products are meticulously manufactured to replicate the OEM appearance, quality and fit that meets or exceeds the original factory specifications.


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BetStop has received 18,000 sign-ups in its first six months, according to the Australian Communications and Media Authority (ACMA).
The government agency launched the national self-exclusion gambling register in August, as part of ongoing efforts to minimise harm caused by online gambling.
ACMA said nearly half of BetStop registrations are from people under 30. There are concerns about a rise in gambling harm ahead of the 2024 NRL and AFL seasons.
Gambling-exclusion register BetStop allows gamblers to ban themselves from opening an account or placing a bet with licensed online and phone betting providers.
Self-imposed bans range from three months to a lifetime.
More than 88% of the people who have signed up to BetStop since August are still registered to the service. Almost half of the service’s users are under 30.
AMCA said it was “pleased” BetStop is reaching young Australians, an age group where online gambling harm is “more prevalent” than others.
It noted many users re-join BetStop once their self-imposed ban expires.
ACMA also said it was common for users to extend their ban before reaching the end of their initial exclusion window.
Recent measures like BetStop follow growing concern about young people’s exposure to gambling messages, such as during sports broadcasts.
Opposition Leader Peter Dutton has called for restrictions on gambling advertising. Dutton proposed banning gambling ads during prime-time “family” viewing slots.
The government is considering a total ban on gambling advertising after it was recommended by a Parliamentary inquiry last year.
It would involve a gradual phase-out of gambling marketing, including a ban on gambling sponsorships and logos on players’ uniforms.
Minister for Social Services Amanda Rishworth said: “We know there’s still more to do and we’ll keep working closely with states and territories to create a safer environment for Australians at risk of gambling harm.”
BetStop’s concerns for sports seasons
The 2024 AFL and NRL seasons begin next month.
ACMA warned the start of football season “may be difficult for Australians who want to take control of their gambling”.
BetStop will continue to target “key demographics” on social media to encourage more sign-ups to the service.
Betting companies like Sportsbet and TAB are required to promote BetStop on their platforms.
Gambling Helpline: 1800 858 858


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The Muslims brotherhood former minister of planning, Amr Derag, announced that the Freedom and Justice party is ready for a dialogue with the government provided condition of taking some procedures to build confidence.
This came in a meeting of the Egyptian Freedom and Justice party with a delegation of the Turkish opposition party “The People” during their visit to Cairo, in which they met a number of parties and political figures in Egypt. The Turkish delegation which included each of, Farouk Logue Oglu, the deputy leader of the party and Osman Koruturk, the MP for the party in the Turkish Parliament were in one of Cairo’s hotels, they were received by Dr.Mohamed Ali Bashir, a representative of the Freedom and Justice Party and the former minister of State for local development and Amr Derag, the former minister of planning and international cooperation.
Derag, in statements, revealed the details of the meeting, the Turkish delegation came to meet the Freedom and Justice party at his request, which has emerged from the Muslims Brotherhood and not what is called ” National Alliance to support the legitimacy” and in the presence of a number of journalists, a representative of the Turkish embassy in Egypt and a representative of the Egyptian ministry of foreign affairs. But they did not attend the private meeting which lasted for more than two hours.
Derag said, “We keen on the continuity of Egypt-Turkey relations regardless who is in government or in opposition, this comes on the level of the relations between the two countries and not the relation between parties”. Pointing out that, Nabil Fahmy, the current Egyptian minister of foreign affairs has not shown any objections, when he was asked, in regard to meeting the Freedom and Justice Party.
He added that he expressed to the Turkish delegation the vision of the Freedom and Justice Party for the current situation of the country, which remains as it is. The party, as he described, still keens on the return of democracy and legitimacy which dialogue regarding the future is consisted in.
Derag denied that the delegation of the Turkish People’s Party has put forward the importance of dialogue between the Freedom and Justice Party and the current authorities directly, but they were only exploring the views. He confirmed he is ready for a dialogue which must be preceded by procedures to build confidence where hate campaigns, arrests and confronting the peaceful demonstrations should stop, which paves the way for a serious dialogue. He stated that the conversation broached the opinion of the Freedom and Justice Party regarding the crisis in Syria and the news of a possible U.S. military strike against Damascus, as he claimed.
He emphasized that despite the disagreement of the Freedom and Justice Party with the regime of Bashar Al-Assad and the call for his departure, but he refuses a military intervention anyway, he sees the necessity of interiorly removing Al-Assad’s regime. He confirmed that the Turkish opposition political views match the ones of the Freedom and Justice Party regarding the rejection of a military operation, in spite of the disagreement with the official Turkish situation.
He added that the Turkish delegation asked about the Party’s opinion of the declarations of the Turkish Prime Minister as a matter of exploring the views regarding the crisis in Egypt and the criticism to Al-Azhar Grand Imam (Dr.Ahmed Al-Tayeb). We clearly said that Erdogan’s statements are an internal political situation that concerns the Turkish government which values the situations. We do not consider it as a criticism to the great position of Egypt, but to political situation which might be right or wrong, the most important is the continuity of the good relations between the Turkish and the Egyptian peoples.


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From the beginning of puberty, some of them will not start to grow hair, which is good for boys, but it may be a little terrible for girls, especially in summer. If girls grow axillary hair, they often feel that it affects their beauty too much. Therefore, laser hair removal is very important at this time!
Laser hair removal
Laser hair removal is a very safe and professional medical and aesthetic method for human body without side effects. Anyway, it will not affect the skin! And it can also have the effect of whitening and moisturizing. Of course, if you want to achieve these effects, you must find an experienced doctor. If you operate improperly, the laser will burn your skin.
Some little sisters hesitate whether they are worried about the price of laser hair removal?
Generally, the price of laser hair removal is 3000-10000 yuan. The specific price is related to the specific parts of hair removal, and the charging standards of different parts are also different; The price is also related to the equipment or drugs used in the operation. The technical equipment and drugs used in the operation process of different hospitals are different, so the charges are also different.
Laser hair removal is a technology that can safely damage the hair follicle and hair growth part of all hair removal technologies on the market. Other hair removal methods only cut off or pull out the hair stem, which can not damage the hair follicle. The hair follicle is still there, and the hair can only regenerate or even grow stronger and stronger. Therefore, laser hair removal is a treatment that can inhibit hair growth for a long time without leaving scars. It is a more appropriate choice for those who hope to seek beauty once and for all.
In addition, there are often misunderstandings about laser hair removal. For example, will people who finish laser hair removal no longer grow hair? This is not the case. Generally, after multiple laser or strong light treatments, the hair clearance rate can reach 90%. Of course, the curative effect is also affected by many other factors.
Then some people will ask whether laser hair removal will cause damage to the skin?
Our skin is a relatively transparent structure. In front of powerful laser, the skin is just a piece of transparent cellophane. Therefore, the laser can pass through the skin very smoothly and reach the hair follicle. Because there is a lot of melanin in the hair follicle, it can preferentially absorb a large amount of laser energy and eventually convert it into heat energy, so as to increase the temperature of the hair follicle and destroy the function of the hair follicle. In this process, because the skin does not absorb laser energy, or absorbs a small amount of laser energy, the skin itself will not be damaged.

domain: medical


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OPEC’s Joint Ministerial Monitoring Committee (JMMC) recent meeting suggests that the conformity level to the production cut agreement has averaged 120.0% since the start of the year, touching a recent high of 168.0% in Apr-1 9. No doubt, the inadvertent production shortfall in some member states had edged the compliance level higher. Worthy of mention is the freefall in Venezuela’s production which fell 1 8.6%q/q in Q1-1 9 to 9.7mbpd.
Reports from the IEA even showed that production in the country touched its lowest level since 2003 in Apr1 9. As the cartel prepares to convene in Vienna for its
meeting in Jun-1 9, we reckon the cloud of the uncertainty that arises from recent geopolitical jitters as they aim to deliver their mandate of stabilizing the oil market. On the supply side, beyond the reluctance of the US administration to renew waivers of Iranian oil importers, the recent attack on the tanker ships near the Strait of Hurmuz has heightened the fears of supply disruption. Meanwhile, the escalation of the US-China trade negotiations and its potential attendant negative impact on global growth weigh.
Overall, while the cartel has signalled its inventory targeting approach, we reckon that they may adopt a wait-and-see approach and maintain the status quo on the current agreement.
United Capital Research

domain: politics


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AIDS 2020: The forgotten pandemic?
Our Executive Director, Christine Stegling, reports back from a subdued International AIDS Conference.
Every two years the HIV community comes together at the International AIDS Conference to learn, reflect and strategise.
In recent years, many in the movement have questioned whether these big global events, with several thousand people adding to the carbon footprint and spending scarce resources, were worth it. After all, we know that the biggest barriers to ending AIDS are about inequality.
Economic disparities, gender-based violence, racial discrimination and human rights violations against key populations all drive HIV, but they can’t be addressed by the HIV sector on our own. We need to reach out to people outside our sector and for that, we need an AIDS Conference that can mobilise multi-sectoral, cross movement thinking and resourcing.
But we also need a conference that remains true to our values. In hosting AIDS 2020 in San Francisco, the International AIDS Society were accused of excluding many of the people that our movement exists to serve. The US has always been a hostile environment for people of colour, but that hostility has deepened in recent years to the extent that many people from the countries most affected by HIV do not feel safe travelling to Trump’s America.
For key populations there were safety and immigration concerns too, but also points of principle. Why would LGBT activists travel, especially in election year, to a country where the Head of State finds political capital in being openly homophobic and anti-trans? Why would people who use drugs risk detention at the border to go somewhere with an overdose crisis that is killing their communities faster than AIDS ever did? Better, these communities decided, to reclaim the HIV response, with HIV 2020, an alternative, community led meeting that would happen at the same time.
And then a new pandemic hit the world and once again we were reminded of why Trump’s America is not a safe place. The AIDS conference now moved online and announced a special segment on COVID-19. At Frontline AIDS we decided that it was important to participate because this was going to be the moment to sound the alarm. To shine a spotlight on the danger that all of the progress we have made in recent years to tackle the global HIV pandemic is at risk of going into reverse.
But although we rang the alarm bells loud and clear, it seemed like no one outside woke up. There was hardly any news coverage of the conference. A hard hitting report by UNAIDS that clearly stated our failure to reach existing global targets on AIDS, most shockingly on HIV prevention, went unnoticed. Equally modelling warning of a possible additional 500,000 people dying of AIDS related illnesses due to disruptions because of COVID-19 went unnoticed. In that sense the conference didn’t do what we had hoped it would.
This might just be the trajectory that we are on now, with HIV funding declining three years in a row and likely to be further hard hit because of COVID-19. Some donors at AIDS 2020 clearly noted that we need to safeguard HIV resources and argued that what is most needed right now is to allocate additional resources to health overall. But already some donor nations are reducing their development budgets. Last week the UK Government announced plans to cut overseas development assistance by £2.9 billion, and although the Foreign Secretary emphasised that poverty reduction, girls’ education and the COVID-19 response would be continued priorities, he made no mention of HIV or even health. As so many of us argued at AIDS 2020, it would be extremely short-sighted if, in responding to one pandemic, donors inadvertently risk lives in another.
But there were also inspiring voices at the conference, including at our own online events. Speaking with new energy, we heard activists and community leaders urge us to use the current crisis as an opportunity to re-think how society works, to acknowledge that structural injustices, economic disparities, structural racism and misogyny have determined who is most affected by HIV and also by COVID-19.
We also heard about adaptations happening as a result of the COVID-19 crisis, with many countries now prescribing anti-retroviral medicines for longer periods, allowing clients to minimise costly trips to clinics and saving health facilities much-needed time and human resources. We also heard how people who have use drugs have finally been able to negotiate take-home methadone, an innovation that they have been advocating for years, against a wall of prejudice that normally requires people with opioid dependency to return to OST clinics every day, instead of trusting them to manage their own treatment at home. And, we heard about many innovative community interventions, providing mobile and virtual HIV services to the people who are often hardest to reach. Glimpses of a new world.
It was also incredibly encouraging to hear global leaders, such as Winnie Byanyima and Peter Sands recognise the vital contribution that communities are making to support fragile health systems in the COVID-19 response. Something that we, as the Frontline AIDS partnership know well, but that didn’t get the prime-time discussion it deserves.
We know that communities have to be a central and well-resourced part of the public health system, that it is those most affected that can make the biggest difference and that human rights violations need to be addressed to make real progress in reducing new infections and mortality. The UNAIDS data shows that we are far from ending AIDS and that this is the moment to support communities with the resources, information and the personal protective equipment that they need to continue fighting HIV and to respond to COVID-19.


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Finches for Adoption, owner left the country and due to family difficulty will not be able to return for the Finches. Just $100 adoption fee and cage included. Give us a call.
Indy O'Neal is February's Dog of the Month! Patrick and Kelly O'Neal have been using our services since 2007. Indy has been part of the family since February 2011. When they brought her home from Indiana as a pup. Indy loves everybody and loves to play all day. Congrats for dog of the month, enjoy [...]
Pandora Parri- January's Dog of the Month! Pandora has been coming to aVIP for one year on a regular basis. What a beautiful girl with lots of spirit and full of life! Congratulations on the dog of the month, enjoy your free pizza and full aVIP bath. We love you Pandora!

domain: pet


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Photos: Channel U
Additional photos: Wu Qi
Videos: Foong Mien Shi & Lye Yuk Sing
If you’d caught the “live” broadcast of Channel U’s Project SuperStar 2014 Grand Final held at MediaCorp TV Theatre last night, you would have noticed the camera panning to local singer Tay Kewei, every single time Alfred Sim appeared on screen.
While speaking to xinmsn after the show, the newly crowned champion of the reality singing contest shyly admitted that Kewei, who was dressed in Alfred’s red fanclub tee, is indeed his girlfriend.
A quick check on the songbird’s social media platforms also showed her efforts in rallying support for her 33-year-old beau. Judging from how nervous Alfred looked throughout the night (and how he had actively texted his friends to inform them of his participation in PSS), one could guess how badly he wanted the prize – which explained the tears of his parents, girlfriend and the man himself, when the results were announced.
However, it wasn’t all smooth-sailing for the aspiring singer. As a result of over-practising, Alfred strained his vocal cord last Wednesday. After self-medication failed to improve his condition, the athletics coach visited the doctor on Monday and finally regained his voice yesterday. “Even during rehearsals on Saturday, I was not fully recovered,” he added.
Despite his succinct winning speech on stage, Alfred expressed his heartfelt gratitude to Kewei during the interview. Sharing how they used to work together as wedding singers, he said: “She helped me a great deal. I used to only sing Mandarin songs, but being a wedding singer required me to be able to belt out different genres of music, such as jazz, pop, rock in both English and Chinese.”
With the increased exposure and valuable experience, Alfred became more versatile and for that, the deep baritone singer is extremely thankful towards Kewei for opening new windows of opportunity for him. Although his girlfriend did not offer advice in terms of song choice during his PSS journey, he was not disappointed as he “knows himself well enough”.
Last night, Alfred continued the “masculine domination” of PSS – both winners of Season 1 and 2 (Kelvin Tan and Daren Tan) are male contestants – by successfully snagging the coveted title. Nevertheless, Alfred gave kudos to female champion Abigail Yeo whom he viewed as a strong competitor. “She’s only 18 and her song choice for the final segment is brilliant. She has a bright future ahead of her,” he earnestly commented.
While he was the oldest contestant on the show, age, to Alfred, is just a number. “I’ve come a long way. In the competitions that I took part in, I’ve never made it to the finals. Be courageous in chasing your dreams and one day, they might just come true,” the motivated chap reiterated.
Still reeling from the excitement, Alfred, who felt incredulous about his win, has not made any celebratory plans or decide how he is going to spend the cash prize of $15,000. Also earning himself a contract with MediaCorp, the ambitious singer is keen to venture into acting and hosting, besides music.
“My idol is Hong Kong heavenly king Andy Lau. He works very hard and is an all-rounded artiste. I look up to him,” he quipped.
Now that he has joined the Superstar alumni, Alfred is confident that he would not have problems managing his time between developing his showbiz career and side business – he is the founder of Reactiv, a company that provides health and fitness training programs to the public and corporate clients.
Alfred Sim in the eyes of Lee Wei Song, Tiger Huang, Yu Feng and Li Jiage
Veteran Taiwanese singer Tiger Huang appeared on the Grand Final as a guest judge last night. Though the songstress let on that Justin was the one who first caught her attention during the show, Alfred impressed her with his rendition of A-Mei’s classic hit “Ting Hai” (Listen to the sea), so much so that she called him “a real man”.
Local musician Lee Wei Song, who returned to PSS as a guest judge this year, may not have worked with Alfred previously, but he is certainly open to “exploring new sides” of the singer, should the opportunity arises.
During their interview with xinmsn, Voice of China Season 3 stars Yu Feng and Li Jiage shared that Alfred left the deepest impression among the four finalists. “At the end of the day, it is attitude that wins the competition. The more relaxed you are, the better you perform,” Yu Feng explained.
Catch the repeat telecast of Project SuperStar 2014 Grand Final this Saturday (Nov 2) on Channel U at 11.30am.

domain: celebrity


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- Ricky Martin and fiance Jwan Yosef go shirtless in Mexico - TMZ
- Justin Bieber is not moving to Amsterdam - Gossip Cop
- Austin Butler shows off his buff biceps while leaving the gym - Just Jared Jr
- Teen Mom's Amber Portwood slams MTV for editing of reunion show fight - Radar
- Matt Damon speaks out against allegations of his new film being "whitewashed" - Lainey Gossip
- Jennifer Lopez just added tons of new dates to her Vegas residency - The Hollywood Reporter
Today's Savannah Guthrie: Engaged to Mike Feldman!
About Photo #2869471: Today Show anchor Savannah Guthrie is engaged to marry political consultant Mike Feldman, she revealed during the morning show on Monday (May 13) in New York City.… Read More Here


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BUENOS AIRES, Argentina (AP) -- Interpol agents have captured a "dirty war" fugitive who ran a secret government detention center under Argentina's military dictatorship of the 1970s.
The official Telam news agency says that former Lt. Col. Julian Corres was captured in the town of Villa Constitucion in central Argentina.
Corres escaped from jail on July 26. The 56-year-old is being investigated for abuses at "La Escuelita" detention center there.
Federal prosecutor Hugo Canon told local television station Todo Noticias that Corres had "altered his appearance." Monday is an Argentine holiday and calls to Interpol were unanswered. The international agency apparently is involved because officials feared Corres could have fled to another country.
(Copyright 2008 by The Associated Press. All Rights Reserved.)
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According to unofficial information from the Danas daily, a series of events are planned for Saturday, 17 September, when the Europride is also due to take place.
First, the promotion of graduates of the Military Academy, which was supposed to take place on Saturday 10 September, has been postponed to Saturday 17 September. A reader of Danas, who was supposed to attend, was informed that the event will be postponed by seven days and that it will start at 10 am in front of the National Assembly in Belgrade.
A Danas reporter wrote to the Ministry of Defence about this without receiving a reply, so it is unclear why the promotion has been postponed, as the authorities know that the Europride organisers will not give up the walk, even if it were to be banned.
On the other hand, the president of the Dveri Movement, Boško Obradović, announced that if the Ministry of the Interior does not ban the Europride, a pro-family-values walk will be held on 17 September, in which 100,000 people will participate. He said that a new pro-family-values march will also be held on 11 September, and a fourth will be held on 17 September if Europride is not cancelled.
The opposition parties in the Serbian parliament – Ne Davimo Beograd, the Democratic Party, the Freedom and Justice Party (SSP) and the Moramo – Zajedno coalition – have invited citizens to participate in a protest on 17 September if Europride is banned.
Also on 17 September, the Red Bull Show Run’ will be held in Belgrade. Driving a Formula 1 car will be only part of the programme, with the German Red Bull Drift Brothers team holding a street drift show, with the Lithuanian driver, Arunas Gibieza, a specialist in acrobatic rides, taking part. The Dejan Petrović Band and Tijana Bogićević will perform at the event.
The car that won the F1 constructors’ and drivers’ titles in 2011 will pass through the centre of Belgrade, and the event will last from 1 pm to 3 pm.
This post is also available in: Italiano


Parties agree to $263 million value for Mammoth Mountain
After seven years of negotiations, Mammoth Mountain Ski Area and Mono County have agreed to an assessed value for the ski area—$263 million.
“After days of intense deliberation, the parties agreed to $263 million,” Mono County Assessor Jody Henning told the board Tuesday.
The agreement will allow property taxes held in a trust fund pending this agreement to funnel into the county’s general fund and to its fire, school, and other “special districts” coffers—a much anticipated event that will allow the districts and county to solidify budgets that have been operating without concrete numbers from Mammoth Mountain’s tax revenues for many years.
“We would just like to know how much money we will be getting as soon as possible and how much we might have to pay back,” said Mammoth Lakes Fire Chief Brent Harper, who added that he was considering letting a He noted that while the fire district—like all the county’s special districts—received some of the money it was owed from Mammoth Mountain while it was on a payment plan, Harper did not know how much was still to come and how much the fire district might have been overpaid for past years.
His words were echoed by Eastern Sierra Unified School District financial analyst Mollie Nugent who said she had recently received word from the county that she might have to repay about $250,000, something that would cause undeniable hardship at her small district with its annual budget of under $11 million.
Henning said the $263 million will give the county about $1.24 million (estimate) a year more in property tax revenues from Mammoth Mountain than had been collected prior to the Mountain’s sale, given that the Mountain was assessed for about $118 million more than it had been when it was sold. And while the final agreed-upon settlement was about $44 million lower than the county’s initial assessed value of $307 million, the negotiations to arrive at this lower number allowed the county and the Mountain to forgo any more changes or appeals to the values set for most of the years in question, saving money in attorney fees and reassessment costs.
But not everyone was happy with the county’s performance.
Although he didn’t quibble with the final number Henning and MMSA agreed to, Supervisor Hap Hazard had some sharp words for the county’s assessor and auditor.
“I don’t care bout how hard it is for you to finally get these numbers out to them (the special districts), I want you to work until the sun goes down to get this done,” he said.
He then looked to County Administrative Officer (CAO) Jim Arkens and said, “Jim, I assume you know how important this is?”
“I’ll get it done,” said Arkens.
Supervisors Byng Hunt and Vikki Bauer said the confusion and the slow pace of getting the numbers out was understandable.
“Normally, these kinds of reassessments don’t involve such big numbers,” Bauer said. “You don’t sell a ski area every day. I can’t fault Henning after I heard her reasons for how this happened. I think there has been a communication issue between the county’s departments and that’s what needs to change so this can get resolved as soon as possible.”
Arkens said Thursday that the county auditor, Roberta Reed, will meet with the special districts next week to give each district manager “rough numbers” as to what will be allocated to them.
“We will then give a full report to the board on Feb. 21 to solidify this,” he said.
A weekly report to the board to update the board is also on the agenda.
What happened in 2005?
When Mammoth Mountain Ski Area sold for $365 million in 2005, Mono County rejoiced knowing that it was only a matter of time before the property taxes from the newly assessed ski area started filtering into the county’s hungry coffers.
The ski area properties constitute about 4.2 percent of all the county’s incoming property tax revenues—no small potatoes for a county with fire, school, and water districts that all get a piece of the county’s total tax revenues.
But it was too soon to celebrate.
Within a short time, the ski area challenged and appealed the county’s assessed value of its property. The ski area enrolled in a payment plan as required by law to make sure it didn’t get behind on its taxes and money from this was put into a trust fund for future distribution. Some money flowed into the county’s coffers during this time and was distributed to the fire, school, and water districts of the county.
But the process of agreeing on a final value for the ski area dragged on as both sides sought a number beneficial to itself. Two county assessors came and went during the first years, and a third one—Henning—took on the project in 2008 when she was elected.
Henning and her staff eventually arrived at a number she believed the property was worth: $307 million. But the Mountain’s appraiser said it was much lower—around $168 million.
The last several years have been spent arriving at a final number; the $263 million noted above.
This year, the Mountain will be reviewed for a decline in value reduction to reflect market conditions, Henning said Friday.


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Massive Disneyland Attraction Database
The Golden Carrouselshoe, a favorite attraction of Huey
The Golden Carrouselshoe
September 9, 2008
Avg. queue length:
Within The Golden Carrouselshoe, you can chow down food at the end of a long line and watch brilliant entertainment. Make sure to check in so you can catch a set with music-makers, Terry Possession and the Possessionterries.
- If this is your first visit to Disneyland, you won't want to just walk past this attraction repeatedly.
- After riding this attraction, find something shorter.
- Contains imaginary signage.
- This attraction is said to have cost less than $425 to refurbish.
- The Golden Carrouselshoe was once home to "The Golden Carrouselshoe Review," which holds the Foster's Book of World Records record for dancingest performance.
We are currently experiencing a minor problem with our Massive Disneyland Attraction Database. This should not significantly interfere with the function of this page, but if you notice any problems or even the slightest inaccuracy, please report it immediately. Thank you for your time.

domain: entertainment


TVS Motor Company is working on a range of new scooters for the Indian market. The company is expected to unveil the production version of the Graphite and an all-new electric scooter at the 2018 Delhi Auto Expo. Interestingly, TVS Rockz 125 Step-thru has been spotted testing on Indian roads. The test mule had no camouflage that suggests that the step-thru could eventually make its way to Indian market. A possible debut at the 2018 Delhi Auto Expo can’t be ignored. The Rockz 125 will be the company’s first-ever modern step-thru for the Indian market. Also See – TVS Dazz scooter India Launch On Cards
TVS Rockz Features
– Electric start
– Alloy wheels
– USB music player & FM
– Side stand lock
– Front disc brake
– Tubeless tyres
– Digi-analogue instrument console
TVS Rockz 125 India Launch
TVS is yet to make an official announcement on the launch of this scooter. It is expected that the scooter could make its debut at the Auto Expo 2018, while the launch could take place in the second half of 2018.
TVS Rockz 125 Price
The company will launch the Rockz as a modern step-thru in the country. We believe that this model could be priced between Rs 45,000 to 50,000.
TVS Rockz 125 Specifications
This modern step-thru is powered by a 125cc single-cylinder engine that is capable of producing a maximum power output of 9.8bhp at 7,500rpm along with a peak torque of 9.8Nm at 5,500rpm. Power is transmitted to the rear wheel via a dual-clutch system. As a reminder, TVS had showcased the Rockz at the 2014 Delhi Auto Expo. The model showcased was equipped with a 125cc DuraLife engine which is equipped with both auto and manual clutch.
TVS Rockz 125 Mileage
It is expected that the TVS Rockz will be high on fuel efficiency. We believe that this model will deliver around 50kmpl in real-world conditions.
TVS Rockz 125 Suspension and Braking
This step-thru rides on 17-inch alloy wheels shod with tubeless tyres. Featuring a scooter like design, this moped comes with 220mm front disc brake and drum brake at the rear. The Indonesian spec model comes with 200mm disc at the rear as well. For suspension duties, this two-wheeler gets telescopic shock absorbers at the front and gas-charged rear shock absorbers. Also Read – New TVS Bikes at Auto Expo 2018
TVS Rockz 125 Design
TVS Rockz step-thru is equipped with several premium features that are not available in several premium scooters in domestic market. Despite being a moped targeting semi-urban and rural markets, this two-wheeler shares design cues from other premium scooters on sale in the market. This model comes equipped with an integrated music system with FM radio along with water proof speakers. Other features include multi-spoke alloy wheels, a hand phone charger, front disc brake, side stand lock and engine immobilizer.
Dimensionally, the new Rockz step-thru is 1,940mm in length, 1,078mm in width and 665mm in height and has a wheelbase of 1,260mm. It has a ground clearance of 150mm.
Source – gaadiwadi


LIVE BLOG: Day 5 of Israel's Gaza offensive
Gaza Child Killed... By Hamas
OBAMA: ISRAEL HAS RIGHT TO DEFEND ITSELF
Congress to Investigate Benghazi ‘Talking Points’
Sen. Chambliss: Rice needs to share what ‘White House directed her to say’
The day's must-read political news and opinion pieces are scattered across hundreds of news outlets and blogs, too many for any one person to read.
Fortunately, memeorandum arranges all of these links in a single, easy-to-scan page. It auto-generates a news summary every 5 minutes, drawing on experts and pundits, insiders and outsiders, media professionals and amateur bloggers.
View the current page or another snapshot:
Nothing recent. See Techmeme News for earlier news.
Ina Fried / Re/code:
Apple, Google, Microsoft, Samsung and Carriers Back Anti-Theft Measures for Smartphones
Zach Epstein / BGR:
Amazon's 4.7-inch 720p smartphone to have glasses-free 3D UI, four head-tracking infrared cameras
Dieter Bohn / The Verge:
Building blocks: how Project Ara is reinventing the smartphone
Tech news essentials
Must-read media news
Celebrity news and gossip


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For a long time I wanted to say what I think about this hotel who look like 5 stars but feel like and ibis !!! We paid 300 euros a night for really no service ! Except it is in center city and you can walk Avoid this hotel for couples ! No romance and very cold staff Not a... More
- Reservation Options:
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- Also Known As:
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- Ambassadeur Juan Les Pins

domain: travel


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a simple RPG
It is an RPG and turn based strategy game which involves management and role playing elements. The plot is set in the fantasy world like the world of Vikings. The plot here is that you will use your clans to run smooth operations in the kingdom but it is quite challenging because you will have to do a lot of things and consider a lot of aspects. The turn based game is very challenging in the sense that every scenario is linked with the other scenario and your decisions will give rise to different events and situations. As they are linked together, you will need to be very wise in your decisions. You can take advice from tribal leaders but they are normally biased. You will also send your clans to different sections of the world for doing research on certain things. The puzzles solving elements in the game are quite logical and it is rich in terms of the depth of events. The graphics in the game are simply adorable and the gameplay elements are unique. The A1 is well balanced and the controls are good. The user interface is also very supportive and interactive. Galatea is the other game which I will suggest you here because it has a good adventure theme and fine role play elements.


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During a recent radio interview with The All Out Show (with Rude Jude and Lord Sear), the west coast rapper revealed that he’s been working behind-the-scenes for some time to part wayst with his longtime label, and finally got the okay.
“It was ‘Shawshank Redemption’, and finally, I’m pleased to announce — because there’s no gag orders, any legalities … my lawyer told me I can speak — I’m f***in’ free! I’m a free agent,” an excited Bishop said. “I still love them over there, but thank God. It was ‘Shawshank Redemption’ n****. I was going out to the prison yard, shaking gravel out my pants every day, going back in trying to crawl through the sewer.”
While Bishop didn’t explain in detail the politics and/or conflicts behind his desire to leave, he did say he started to feel like his solo debut was becoming a myth like Dre’s long awaited Detox record. And with most of his music never seeing the light of day, it was time for a change.
“After almost five years of sitting there and working with every producer in the world, it’s kinda unfair to the fans and my family, and myself to keep telling people something when the release dates change,” the rapper explained. “People are waiting. People are anticipating. [They be like] ‘When’s it gonna happen?’ After a while, it’s just like ‘Damn.’ It kinda becomes like my album is Detox like, ‘When is it coming?’
“I can’t afford that kinda situation. I signed in 2006. A n**** is 31 now. … That’s simply what it is and it feels so good,” Bishop continued.
He didn’t walk away empty handed, though. According to Bishop, Dre allowed him to leave with the masters to more than 700 songs he recorded while signed to his label. So, he says he’s got music ready to go.
However, Bishop made it clear that the split was amicable and that he and Dre are still on good terms. He says Dre has so many business ventures on his plate that breaking a new artist like himself isn’t a high priority.
“[Dre’s] got other obligations and responsibilities that’s bigger than breaking new artists,” the rapper said. “It becomes a corporate situation. If you don’t understand the business side, it can put a strain on your personal sh**, and think it’s intentional. That’s not the case.”
Bishop Lamont has been in New York, secretly, over the past week “having fun, taking meetings and things.”
It’s still unknown what his current plans are, musically, and if his meetings where to potentially sign with new record label.