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Suzy Guttler & Juan Castillo
Suzy, Television Professional, Showtime Networks Juan, Finance Professional, Wells Fargo
Suzy –Taiwanese (mother) & German (father) Juan – Peruvian (mother) & Columbian (father)
WHERE & HOW DID YOU BOTH MEET?
Our modern love story began on the Bumble dating app in New York City, as we were swiping through endless profiles in hopes of finding the special someone to spend the rest of our lives with. With one right swipe, boom, the algorithm brought us together.
After our first date in a West Village cocktail bar, we realized we had much more in common than our dating profiles suggested. Despite being from completely different parts of the world, our international upbringing and shared experiences of living in cultures other than our own, instantly created a connection between us.
Suzy was born in Taiwan, and followed the whims of her entrepreneurial parents to the Philippines, before she landed in America for college. Juan was born in Peru, and with his family, moved to Texas during his formative years, and later to Venezuela for high school. Both Suzy and Juan moved to New York City after college to pursue their careers in Television (Suzy) and Finance (Juan). They now consider themselves New York locals and call SoHo home, while still trotting the globe every chance they get.
WHERE DID YOU GET MARRIED AND WHY DID YOU PICK THE LOCATION?
We got married in Lake Como, Italy. We had always envisioned an international destination wedding, to share our passion for traveling and love for cultures with our family and closest friends. The world was our oyster!
We chose Italy because geographically, it was central for our guests traveling from all over Asia, the Americas, and Europe. Italy is also rich in art, music, history, and certainly cuisine. Who doesn’t love homemade pasta and fabulous vino?! We landed on Lake Como because of its romantic scenery and picturesque views set against the dramatic foothills of the Alps, which made for the perfect wedding setting. (And we secretly hoped for a wedding as beautiful as John Legend and Chrissy Teigen’s Lake Como wedding.)
The moment we visited Villa Erba, we were overcome by emotion and knew the search for our romantic, idyllic wedding venue had come to an end. Villa Erba is an Italian jewel. Nestled on the shores of Lake Como alongside George Clooney’s L’Oleandra mansion, Villa Erba is arguably the most iconic and beautiful estate on the lake. Built upon a 15th century monastery, the historic venue has hosted some of the most exclusive events in the world, and more recently, served as backdrop to Hollywood films like Ocean’s Twelve.
WHAT WAS THE MOST IMPORTANT THING TO YOU BOTH WHEN PLANNING YOUR WEDDING?
The most important thing for us was to have a shared vision for our Big Day, and to work together towards it. After the initial thrill of our engagement, we took time to reflect on what was important to us – what our values and priorities were for the wedding day, and the memories we hoped to create for our family and friends in celebrating our love for each other.
Then the planning started — and it was that much more fun to do it together. Working toward a common goal helped us grow as an engaged couple, and reinforced that whatever issue came our way, we could tackle as a team. What does love mean to you?
Love is the deepest feeling of affection, commitment, respect, and trust. It is having your forever companion and best friend to walk through life’s journey with. Love is patience, love is self-sacrifice and love is acceptance of each other’s shortcomings. To love and to be loved is the greatest feeling you can ever feel.
WHAT DOES FAMILY MEAN TO YOU?
Family is unconditional love. Family is what holds us together and guides us through the wonderful journey of life. Being a family means sharing that special connection with each other, the security and bond to celebrate life’s moments together, to grieve together, and to grow together.
WHAT TIPS WOULD YOU GIVE TO A COUPLE PLANNING THEIR WEDDING?
Cherish every moment of the journey! All the venue tours, vendor meetings, dress fittings, mood boarding, and cake tastings – is half the fun. This is the most magical time for you and your fiancé to explore your creativity, share in self-discovery, and work together on bringing your vision of your Big Day to life. You’ll miss it when it’s over. We sure did!
On the wedding day, find a moment and a quiet place during your reception, just you and your partner, to take it all in. The day goes by too quickly.


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Kickoffs will look different this season following the NCAA’s Playing Rules Oversight Panel approving a rule change which causes any kick fair-caught behind the 25-yard-line to result in a touchback. Kirby Smart addressed the rule change, and his feelings were mixed.
The reasoning for the rule change is player safety, something Smart said he is, “obviously in support of.”
“I think anything you can do to make players safer, it’s a wise decision,” he said.
Smart added that the long-term statistics reveal higher rates of injury and concussion on kickoffs than most other plays, and fewer returned kicks could help cut back on unnecessary injuries.
Smart is wary enough of the dangers of kickoffs that he said his team never practices them going full speed.
“It’s dangerous,” he said. “You’ve got guys running 40 yards into each other. We don’t ever do that.”
Yet, despite the rule change making the game potentially safer, Smart did lament that it could devalue the NCAA’s best kickers. He said having a player capable of kicking the ball consistently between the 5-yard line and the endzone with good hang time as a distinct advantage prior to the new rule.
Because Georgia never attempted to pin teams deep last season, when Rodrigo Blankenship set a Georgia record for touchbacks in a season, Smart said the new rule will not change how the team approaches kickoffs themselves.
“We never told Rodrigo kick it high and short,” he said. “We told him to kick it out of the endzone. And that’s what we want him to do.”
As for how Georgia will handle being on the receiving end of kickoffs, Smart said things won’t be drastically different in that department either. He said he’s started telling kick returners the hang time of kicks they are fielding during drills, conditioning them to be aware of how close the coverage team might be to them when they field the ball.
Outside of that, it’s all going to come down to the matchup.
“Higher, shorter kicks will be fair caught,” Smart said. “Kicks we don’t think we can get to the 25, we’ll be better off fair catching. A lot of it depends on what type kicker you’re facing.”
(You can follow Nathan Berg on Twitter @NathanxBerg)
© 2016, gridironnow.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

domain: news


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Original drawing for sale Kaiju Creature design Hakao. I decided to draw and design a creature inspired by Kaiju and make a video tutorial on Youtube. I realized that years of drawing and working in video games, I’ve accumulated tons of drawing. So I decided to sell some of my original drawings. Some of you often e-mail me and ask about original drawing or commission. I rarely do any commission unless you can convince me.
The tutorial on how to draw it can be found at Drawing creature design tutorial episode 1.
Anyway here is a drawing of my first of more Kaiju design to come.
If you are interested in buying this original drawing and more original drawings go to Buy original drawings page. If you don’t see it there, that means it is sold and no longer available. But there are also a few more original drawing like figures and portraits there.
More drawing tutorials you might be interested in.
-How to draw Orc
-how to draw secretary bird
-how to draw golden eagle
-SketchBook Pro 6
-PHOTOSHOP CS6 for $19.99/month
-Wacom Intuos5 Medium Pen Tablet
-Wacom Bamboo Fun

domain: artistic


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GARNER — Coming off a tough loss to Clayton in the championship game of the Greater Neuse River 4A tournament, Garner came out strong and never let up in rolling to a 70-52 victory over Fayetteville Pine Forest in the first round of the NCHSAA 4A playoffs.
The Garner’s boys basketball team bounced back in a big way Tuesday night.
Coming off a tough loss to Clayton in the championship game of the Greater Neuse River 4A
tournament, Garner came out strong and never let up in rolling to a 70-52 victory over Fayetteville Pine
Forest in the first round of the NCHSAA 4A playoffs.
Garner (22-4), seeded sixth in the East bracket of the playoffs, utilized its trademark pressure defense
and fast-paced offense to advance to a second-round meeting at third-seeded Fayetteville Seventy-First
on Wednesday night.
Garner set the tone early, forcing six turnovers during a 17-0 run in the first quarter that gave the home
team a 19-4 lead.
“We wanted to find out what kind of ball handlers they had,” Garner coach Eddie Gray said. “We had
good defensive intensity and kind of let it get away from us [after that run]. It seems everybody we have
played lately hits 3-point shots on us. They made a comeback.
“We had another defensive spurt there at the end and finally put them away. They are a real scrappy
ball club. They didn’t ever quit.”
Pine Forest (15-12) pulled within four points at 29-25 with a minute left in the second quarter after
making 3s on consecutive possessions. Garner responded with four points in the final minute to lead 34-
27 at halftime.
Garner started the second half by forcing a pair of turnovers in a 6-0 run and Pine Forest got no closer
than eight points the rest of the way.
“Their pressure got to us early,” Pine Forest coach David May said. “I thought we made a nice run in the
second quarter. There were times in the second half when we would get within nine and they would get
a four- or six-point run. They are good at what they do. They run the ball. We can’t play like that.
“They took us out of what we wanted to do.”
Senior guard Demarcus Sanford led Garner with 16 points.


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Zinc sulfide is surely an inorganic compound with all the chemical formula ZnS, one in the common sulfur-containing compounds. Because of its unique physical and chemical properties, zinc sulfide has many applications in many areas.
Structures of zinc sulfide
Zinc sulfide is actually a white or slightly yellow powder usually found in nature in sphalerite. Its crystal structure is actually created through the alternating arrangement of sulfur ions and zinc ions, showing a hexagonal crystal structure. In dry air, zinc sulfide is stable and not easily changed. However, when zinc sulphide high quality is in contact with humid air or an environment containing moisture, it undergoes an oxidation reaction and gradually transforms into zinc sulfate.
How will be the crystal structure of zinc sulfide formed?
The crystal structure of zinc sulfide includes sulfur ions (S2-) and zinc ions (Zn2 ) arranged in accordance with a certain pattern. Inside the crystal structure, sulfur ions and zinc ions interact with each other through ionic bonds to make a stable crystal structure.
Specifically, the crystal structure of zinc sulfide can be thought of as a sphalerite-type structure formed by alternating arrangements of sulfur and zinc ions. Each zinc ion is surrounded by four sulfur ions in the crystal structure, forming a coordination tetrahedral structure. Simultaneously, each sulfur ion is surrounded by four zinc ions, forming a similar coordination tetrahedral structure. Within this structure, the interaction between sulfur and zinc ions is principally through ionic bonding.
In addition, in the crystal structure of zinc sulfide, the coordination tetrahedra of sulfur ions and zinc ions are interconnected inside a certain way to make a three-dimensional crystal structure. This structure makes zinc sulfide highly stable and able to maintain a good crystal structure at high temperatures and under oxygenated conditions.
To conclude, the crystal structure of zinc sulfide is actually a sphalerite-type structure formed through the interaction of sulfur ions and zinc ions through ionic bonding, that gives zinc sulfide several unique physical and chemical properties and thus has a variety of applications in many fields.
Synthesis of zinc sulfide
Currently, there are various methods for synthesizing zinc sulfide, and the following are the widely used synthesis methods:
Direct synthesis method: Mix the correct level of sulfur powder and zinc oxide, heat to high temperature (about 500 ?), and you could get zinc sulfide. This method is easy and simple to use but requires raw materials of zinc oxide with higher purity.
Reduction method: Zinc sulfide can be acquired by mixing the right level of zinc oxide using a reducing agent (e.g., hydrogen, deadly carbon monoxide, etc.) and heating to a high temperature. This method requires utilizing a reducing agent; the fee is higher, but it could get high-purity zinc sulfide products.
Precipitation method: Mix the correct level of zinc sulfate solution with all the appropriate level of sodium sulfide solution, adjust the pH value to a certain range, and acquire white zinc sulfide precipitate. This method is not hard to use and can be used as large-scale production.
High-temperature self-propagation method: High-purity zinc sulfide powder can be acquired by evenly mixing the correct level of zinc oxide powder and-purity sulfur powder and after that heating these to a high temperature (about 600?) to trigger the self-propagation reaction. This method requires high-purity raw materials and special equipment, but high-quality zinc sulfide products can be acquired.
Uses of zinc sulfide
Because of its unique physical and chemical properties, zinc sulfide has many applications in many fields. These are the main parts of application:
Zinc sulfide powder is used in the following applications:
Analytical reagent: Zinc sulfide powder can be used an analytical reagent for determining the presence and content of certain substances, such as for fluorescence analysis, colorimetric analysis, photometric analysis and so on.
Fluorescents: Zinc sulfide powder can manufacture various fluorescents, such as fluorescent tubes, monitors, X-ray fluorescent screens and so on. Zinc sulfide powder is commonly used as a fluorescent material because of its high luminous efficiency and stability.
Light conductor: Zinc sulfide powder has good electrical conductivity and optical properties and may manufacture various light conductor materials, such as solar cells, photodiodes, etc.
Paint and pigment: Zinc sulfide powder has high covering power and coloring power; you can use it being an additive for paint and pigment, used in the manufacture of all types of white paint, zinc white pigment, and so on.
Laser materials: Zinc sulfide powder may be used to manufacture various materials, such as laser crystals and glass.
Optical instruments: Zinc sulfide powder can manufacture various optical instruments, such as telescopes, microscopes, camera lenses, etc.
Catalyst: Zinc sulfide powder can catalyze certain chemical reactions, such as alkylation and hydrogenation.
Rubber and plastic additives: Zinc sulfide powder can be used an additive for rubber and plastic to enhance their properties such as abrasion resistance, heat resistance and aging resistance.
Medical applications: Zinc sulfide powder can be used in the medical field, such as to make drugs, medical equipment, etc.
To conclude, zinc sulfide powder, an essential inorganic material, has many applications in many fields. With the continuous progress of technology and science, its application areas will be further expanded.
How do the fluorescent properties of zinc sulfide work?
Absorption of light energy: When light strikes zinc sulfide, the zinc sulfide can absorb light energy and convert it into excitation energy for electrons. This excitation energy causes the electrons to leap coming from a lower to a higher energy level, which puts the zinc sulfide within an excited state.
Emission of fluorescence: When zinc sulfide in the excited state returns for the low-energy state, it releases the stored energy as emitted photons. This released photon is fluorescence, as well as its wavelength is longer than irradiated light. If trace levels of activators, such as Cu, Mn, Ag, etc., are included in zinc sulfide, it may emit fluorescence of different colors.
Fluorescence luminescence mechanism: The fluorescence luminescence mechanism is principally composed of two processes, namely, excitation and radiation. Inside the excitation process, zinc sulfide absorbs light energy. It converts it into the excitation energy of electrons, making the electrons jump from your low for the high energy level. In radiation, the excited electrons go back to the low energy state, releasing photons, i.e., fluorescence.
In conclusion, the fluorescence property of zinc sulfide is produced by its absorption of light energy as well as its conversion into the excitation energy of electrons, which in turn releases energy as emitted photons. This fluorescent property makes zinc sulfide have a variety of applications in many fields, such as fluorescent tubes, displays, and X-ray fluorescent screens.
Being an important inorganic compound, zinc sulfide has many applications in many fields. By understanding its properties and synthetic methods, we could better use zinc sulfide’s advantages and characteristics and expand its applications in different fields. Meanwhile, the continuous exploration of new synthetic methods and application areas will help you to promote greater progress in the research and application of zinc sulfide.
High quality high purity zinc sulfide ZnS powder Supplier
Luoyang Tongrun Nano Technology Co. Ltd. (TRUNNANO) is actually a trusted world-wide chemical material zinc sulfide ZnS powder supplier & manufacturer with over 12-year-expertise in providing very high-quality chemicals and Nanomaterials, including boride powder, nitride powder, graphite powder, sulfide powder, 3D printing powder, etc.
If you are looking for high-quality zinc sulfide ZnSpowder, please feel free to contact us and send an inquiry.(email address: [email protected])
We accept payment via Credit Card, T/T, West Union, and Paypal. TRUNNANO will ship the goods to customers overseas through FedEx, DHL, by air, or by sea.
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domain: chemistry


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Hand Knitted Jumper
Size 6-12 months old
I have knitted this jumper using quality baby yarn which is soft, light, non-itchy and machine washable.
Stripes always look good and this little jumper has pale blue and grey stripes, grey ribs a round neck and raglan sleeves.
There is plenty of room in it for a child move and grow. The neck is stretchy so will fit easily over the head.
A great present or buy it for your own little man.
I can knit this jumper in other colour combinations and sizes. Please get in touch for details
Price includes postage
Shipping & delivery
This item will be posted to you by Babbity Boo within 3 days of receiving payment.
|Shipping destination||Cost||Additional items|
You have 14 days, from receipt, to notify the seller if you wish to cancel your order or exchange an item.
Unless faulty, the following types of items are non-refundable: items that are personalised, bespoke or made-to-order to your specific requirements; items which deteriorate quickly (e.g. food), personal items sold with a hygiene seal (cosmetics, underwear) in instances where the seal is broken.

domain: hobby


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How Geocaching Works
Related Web Page
Use of geocaching.com services is subject to the terms and conditions in our disclaimer
You are looking for a round camo covered can. You are in west Texas, so watch for creepy crawlies.
You are visiting the Canyon Community Cemetery. There are about 20 headstones here dating from 1892 to 1970. There is an old parking lot that is in terrible condition beside the cemetery. You may park on it or out on the road.
Congrats to tlien11 for first to find!!!
Sraprq va tenir.
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Coordinates are in the WGS84 datum

domain: geography


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Hotels Oder Pension In Grube. At the guesthouse, all rooms come with a desk, bed linen and a terrace with a city view. This guesthouse is 6.5 mi (10.5 km) from crucenia thermen and 3.3 mi (5.3 km) from the rotenfels.
The ski facilities include a ski storage room and ski rental. Queen arendsee ferry and garten eden are also within 3 mi (5 km). Frankfurt oder train station is but a short drive away.
With Fritz Eckhardt, Elfriede Ott, Josef Hendrichs, Claudia Rieschel.
The ski facilities include a ski storage room and ski rental. Find 2,307 traveller reviews, 1,724 candid photos, and prices for 809 hotels near gasthof und pension kienbergklamm in kufstein, austria. See traveler reviews, candid photos, and great deals for cafe und pension grube at tripadvisor.
Rooms Make Yourself At Home In One Of The 8 Guestrooms.
Compare hotel deals, offers and read unbiased reviews on hotels. Hotel cafe und pension grube, osterburg: Ferienhof und pension schuch serves a rich breakfast to all guests.
Ski Geisskopf And Deggendorfer Golfclub Are Worth Checking Out If An Activity Is On The Agenda, While Those Wishing To Experience The Area's Natural Beauty Can Explore Bavarian Forest.
Frankfurt oder train station is but a short drive away. An lcd tv, a sitting area and a trouser press are provided in the rooms at gasthof und pension zur frischen quelle. Book restaurant und pension am nicolaiplatz, wernigerode on tripadvisor:
A Selection Of Such Activities As Climbing, Horse Riding And Cycling Is Offered On Site Or In The Area.
Das schloss liegt idyllisch im ruhigen runddorf grube. Gasthof alpenrose und pension nina offers 25 rooms featuring cable television, a work desk and tv set. See 16 traveler reviews, 14 candid photos, and great deals for restaurant und pension am nicolaiplatz, ranked #12 of 28 b&bs / inns in wernigerode and rated 3.5 of 5 at tripadvisor.
This Hotel Is Less Than 0.9 Miles From Insel Ziegenwerder Park In Frankfurt.
You will find luggage storage space at the property. Guests at ferienhof und pension schuch can relax at an indoor pool. This accommodation consists of 2 bedrooms.

domain: travel


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UC Berkeley sophomore Amanda Hill is running for ASUC senate as an independent candidate.
Hill said they decided to run for a senate position because they were shocked by the amount of racism and violence that occurred in ASUC spaces. Endorsed by the queer community, Hill is running on platforms with two main sections: equity and inclusion, and health and safety.
Their work experience is coupled with their unique perspective as a Black, Mexican, queer and low-income student, Hill added. In addition, they also have extensive experiences both inside and outside of the ASUC that they believe make them qualified for the senate position.
“I was fortunate enough to receive a scholarship to a private school, so I have seen both ends of the spectrum, simultaneously,” Hill said. “Thanks to that, I know how to navigate a lot of spaces, I know how to push things through on several different fronts. I am aware and conscientious of the impact I have.”
Hill was the chief of staff for ASUC Academic Affairs Vice President Nicole Anyanwu when she was a senator last year, and now is the director of equity and inclusion in Anyanwu’s current office. They are also in multiple committees, including being the only ASUC candidate involved in academic programming for People’s Park.
Hill is running as an independent because of the personal freedom and opportunity to hold others accountable. They wanted to remain true to their moral compass, which can be difficult in the ASUC, according to Hill.
“I’ve witnessed violence against our Black community members,” Hill alleged. “I’ve witnessed people in senate chambers threatening to dox representatives.”
Hill is committed to making the ASUC a more accessible space for all, as well as collaborating with other officials if they get elected. If elected, they will also help create a comprehensive plan that addresses campus space allocation issues.
Hill’s platform includes plans to preserve campus’s green spaces, create “actually affordable” housing, defund UCPD and improve nighttime safety by adding additional lighting throughout the city and expanding Bear Walk.
“If we want to create a more diverse university, one of the major hurdles for that goal — especially with wanting to gain that ‘Hispanic-serving institution’ status — is housing affordability,” Hill said.
Hill also recognizes that one of the ASUC’s “fundamental” issues is properly representing community members’ voices.
If elected, they are committed to elevating community members’ narratives to the table, and not just speaking on their behalf, Hill said.
“Nothing is stopping anybody from including community leaders in standing meetings,” Hill said. “Nothing is stopping anyone from keeping these people in the loop — for them to be able to elevate their own narratives because, frankly, we should be allowed to.”
ASUC elections will be held virtually from April 5 to 7.

domain: sociology


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There are limited data available on the risk factors for multidrug-resistant tuberculosis (MDR-TB). Therefore, we here conducted a retrospective matched case−control study among adults with pulmonary TB who received treatment at the Central Chest Institute of Thailand (CCIT) between January 2007 and December 2013, in order to determine the risk factors associated with MDR-TB among patients with pulmonary TB. We identified 145 patients with pulmonary MDR-TB (cases) and 145 patients with drug-sensitive pulmonary TB (controls). Multivariate analysis identified the independent risk factors for MDR-TB as follows: (1) ≥ 2 episodes of prior pulmonary TB (odds ratio [OR] 39.72, 95% confidence interval (95% CI) 7.86−200.66), (2) duration of illness > 60 days (OR 3.08, 95% CI 1.52−6.22), (3) sputum acid fast bacilli smear 3+ (OR 13.09, 95% CI 4.64−36.91), (4) presence of lung cavities (OR 3.82, 95% CI 1.89−7.73), and (5) presence of pleural effusion (OR 2.75, 95% CI 1.06−7.16). Prior pulmonary TB management with a non-category I regimen (P = 0.012) and having treatment failure or default as treatment outcomes (P = 0.036) were observed in a higher proportion among patients with MDR-TB. Particular characteristics of lung cavities, including the maximum diameter ≥ 30 mm (P < 0.001), the number of cavities ≥ 3 (P = 0.001), bilateral involvement (P < 0.001), and ≥ 2 lung zones involved (P = 0.001) were more commonly observed in patients with MDR-TB. In conclusion, these clinical factors and chest radiographic findings associated with MDR-TB among patients with pulmonary TB may help physicians to provide proper management of cases for prevention of the development and spread of MDR-TB in future.
Citation: Chuchottaworn C, Thanachartwet V, Sangsayunh P, Than TZM, Sahassananda D, Surabotsophon M, et al. (2015) Risk Factors for Multidrug-Resistant Tuberculosis among Patients with Pulmonary Tuberculosis at the Central Chest Institute of Thailand. PLoS ONE 10(10): e0139986. https://doi.org/10.1371/journal.pone.0139986
Editor: Ulrike Gertrud Munderloh, University of Minnesota, UNITED STATES
Received: June 19, 2015; Accepted: September 21, 2015; Published: October 7, 2015
Copyright: © 2015 Chuchottaworn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Data Availability: All relevant data are within the paper.
Funding: This study was supported by the Faculty of Tropical Medicine, Mahidol University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Tuberculosis (TB) is caused by Mycobacterium tuberculosis and remains one of the leading causes of death worldwide, despite the availability of effective anti-TB drugs . In 2013, the World Health Organization (WHO) reported that approximately one-third of the world’s population was infected with M. tuberculosis; of which 9.0 million people were estimated to develop TB. The majority of patients with TB (56.0%) were reported from South-East Asia and the Western Pacific, with approximately 1.1 million patients with TB dying due to the disease .
During anti-TB treatment, there is selection pressure on a population of M. tuberculosis resulting in the occurrence of spontaneous resistance-causing mutations in a number of susceptible bacilli, which then gradually increase to become the dominant strain . People who are infected with an already drug-resistant strain could develop primary resistance, which is commonly observed in newly diagnosed TB patients. When resistance mutants arise during treatment with anti-TB drugs, it is considered acquired resistance, which is usually found in previously treated patients . During global surveillance from 1999 to 2002, resistance to any of the four main anti-TB drugs, viz., isoniazid (H, INH), rifampicin (R, RMP), ethambutol (E, EMB), and streptomycin (S, SM) were reported in 10.2% of patients with TB, and these numbers have gradually been increasing [5, 6].
At present, multidrug-resistant TB (MDR-TB), which is defined as drug resistance at least to both INH and RMP has spread globally since 2000 [2,6,7]. In 2013, the WHO reported that approximately 480,000 of the world’s population had MDR-TB, resulting in approximately 210,000 (43.8%) deaths. Approximately 60% of patients with MDR-TB were reported from India, China, and the Russian Federation and it was estimated that 3.5% of newly diagnosed TB patients and 20.5% of previously treated patients had MDR-TB .
Recently, it was reported that being human immunodeficiency virus (HIV)-positive was not a risk factor for MDR-TB and that the prevalence of TB has been increasing among patients who are HIV-negative since 2005 [7,8]. During 2006 to 2014, several investigators reported risk factors for MDR-TB and the majority consistently identified previous treatment with an anti-TB drug as one of these risk factors [9–25]. However, a number of reports have explored factors among previously treated patients that are associated with the occurrence of MDR-TB; these included (1) age ≥ 45 years, (2) duration of first anti-TB treatment > 8 months, (3) treatment with INH and RMP > 180 days, (4) absence of fixed dose-combinations, (5) delayed initiation of anti-TB treatment > 60 days, (6) > 3 episodes of anti-TB treatment, and (7) adverse effects of anti-TB treatment [16,18,23,24].
In Thailand, TB is a significant public health problem, although the prevalence has decreased from 161 per 100,000 in the general population in 2011 to 149 per 100,000 in 2013. The majority of TB patients (80.0%) had pulmonary TB with a treatment success rate of 81% among new or relapse cases; MDR-TB developed in 19.0% of previously treated patients, but in only 2.0% of newly diagnosed TB patients . However, the drug-susceptibility testing (DST) as well as the management of patients with MDR-TB could be applied only in some hospitals in Thailand, such as the Provincial Hospitals, University Hospitals, and the Central Chest Institute of Thailand (CCIT). The CCIT in Nonthaburi province was established as the primary and tertiary center for treatment of patients with pulmonary TB, particularly MDR-TB, in Thailand. Thus, the majority of patients with pulmonary MDR-TB were referred to the CCIT for treatment when the physician suspected MDR-TB or when the sputum culture isolates of M. tuberculosis showed a drug-resistant strain. A recent report from Thailand showed a delay in the results of sputum culture for TB and DST and that only 5.8% of patients with MDR-TB were empirically treated with an appropriate regimen for MDR-TB before the DST results became available. Additionally, 31.3% of patients with MDR-TB received an appropriate regimen after receiving the DST results .
In clinical practice, chest radiography is a simple diagnostic tool and usually helps physicians to identify and manage pulmonary TB when the results of culture and DST are not yet available. A previous study showed that pulmonary TB patients with M. tuberculosis isolated from sputum, who had bilateral lung involvement upon presentation, were more likely to be patients with drug-resistance to any first-line anti-TB drugs than to be patients showing drug-sensitivity to all first-line anti-TB drugs . However, chest radiographic findings of patients with pulmonary MDR-TB, as compared to those with non-MDR-TB, varied among studies due to the differences in the definition of patients with non-MDR-TB [28–30]. The treatment success rate of patients with drug-resistance to one of the first-line anti-TB drugs, particularly INH mono-resistant TB (≥ 90%), was similar to that of patients with TB that was drug-sensitive to all first-line anti-TB drugs [31–33], but the treatment success rate of patients with MDR-TB was only 48% and the mortality rate ranged from 1% to 30% among patients with MDR-TB . Thus, prevention and rapid detection of MDR-TB are priorities for controlling MDR-TB.
No previous report has attempted to identify risk factors from among clinical factors, microbiology data, and chest radiographic findings in pulmonary MDR-TB in Thailand. Therefore, we here conducted a retrospective matched case−control study to determine the risk factors associated with MDR-TB among adults with pulmonary TB.
Materials and Methods
The Standards for the Reporting of Observational Studies in Epidemiology (STROBE) were followed in this study. The study protocol was approved by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University, and the Ethics Committee of the CCIT in Thailand. Written informed consent was not obtained as it was specifically waived by the approving Ethics Committee of the Faculty of Tropical Medicine and the CCIT. Data were anonymized before analysis by de-identifying patient data.
Study design and population
This study was conducted as a retrospective matched case−control study from a prospective cohort of 8424 newly registered pulmonary TB patients who received treatment in the outpatient department of the TB clinic at the CCIT from January 2007 to December 2013. Cases were patients with pulmonary MDR-TB. Pulmonary MDR-TB was defined as sputum culture showing M. tuberculosis and where DST revealed drug-resistance to both INH and RMP . Controls were pulmonary TB patients with sputum culture showing M. tuberculosis and where DST revealed drug-sensitivity to all four first-line anti-TB drugs, i.e., INH, RMP, EMB, and SM.
From January 2007 to December 2013, a total of 8424 pulmonary TB patients newly registered at the outpatient department of TB clinic were recorded in the registry books. A total of 5059 pulmonary TB patients had AFB smear-positive sputum and M. tuberculosis isolated from sputum culture documented in the registry book, comprising 558 patients with pulmonary MDR-TB and 4501 patients with pulmonary non-MDR-TB. Any patients who were identified by searching medical records and microbiology laboratory records of the central laboratory and who met the study criteria were included. Study criteria were the following: (1) age ≥ 18 years, (2) a diagnosis of pulmonary TB, (3) at least one of three sputum smear samples showing acid-fast bacilli (AFB) and sputum culture isolates positive for M. tuberculosis within 1 month of pulmonary TB diagnosis, (4) availability of DST results, and (5) availability of chest radiograph within 1 month of pulmonary TB diagnosis. Exclusion criteria were (1) no available documentation on the diagnosis and/or management of previous pulmonary TB and/or present pulmonary TB, (2) limited quality of chest radiograph, (3) pregnancy, and (4) mixed infection with non-TB mycobacteria.
Of 558 patients with pulmonary MDR-TB, 145 patients fulfilled the study criteria; 413 patients were excluded as follows: 33 patients had mixed infection with non-TB mycobacteria, 42 patients were < 18 years, 54 patients had no available DST results from the microbiology laboratory records of the central laboratory at the CCIT, 69 patients had no available chest radiographs or had chest radiographs of limited quality, 96 patients had negative sputum AFB smears or sputum showing no growth of M. tuberculosis upon culture as based on the microbiology laboratory records of the central laboratory at the CCIT, and 119 patients had no available documentation on the diagnosis and management of previous pulmonary TB and/or present pulmonary TB. Thus, 145 patients with pulmonary MDR-TB were recruited into the study as cases; these included 140 (96.6%) patients with previously treated pulmonary TB and 5 (3.4%) patients with newly diagnosed pulmonary TB. Previously treated TB patients were defined as patients with TB who had a prior history of treatment with anti-TB drugs for > 1 month and newly diagnosed TB patients were defined as patients with TB who had never received treatment for TB or patients with TB who had taken any anti-TB drugs for less than 1 month .
Of 4501 patients with pulmonary non-MDR-TB, 866 patients had TB that was drug-resistant to any four first-line anti-TB drugs and 3635 patients had TB that was drug-sensitive to all four first-line anti-TB drugs. Of 3635 patients with pulmonary non-MDR-TB who were drug-sensitive to all four first-line anti-TB drugs, 145 patients from the same period as the cases were recruited into the study as controls. Each of the MDR-TB cases was matched individually with a control in terms of time to initiation of anti-TB drugs (± 2 weeks), age (± 5 years), and gender. Where the medical records, microbiology laboratory records, or chest radiographs of these controls were not available, we selected the next available matched control patient. Controls were thus individually matched to cases, in a ratio of 1:1 (Fig 1). De-identified patient data ensured anonymity before analysis. Demographic information, baseline characteristics, clinical as well as laboratory findings of current TB and management of previous TB, with outcomes, were summarized and recorded in a pre-defined case record form.
Management and outcomes of patients with pulmonary TB
Patients with smear-positive pulmonary TB were managed following the WHO recommendations, using a category I regimen consisting of INH, RMP, EMB, and PZA for 2 months (2HRZE) in the initiation phase, followed by INH and RMP for 4 months (4HR) in the continuation phase . Patients who received anti-TB drugs other than category I regimen was defined as non-category I regimen. Directly Observed Treatment of Short Course (DOTS) was also implemented during TB management. Three samples of sputum smears were analyzed for AFB at the end of 2, 5, and 6 months of treatment. Treatment outcomes were evaluated after anti-TB treatment. Cure was defined as patients whose sputum was smear-negative for AFB in the last month of treatment, whereas completed treatment was defined as patients who had complete a course of anti-TB drugs, but lacked a result for the sputum smear or culture in the last month of treatment. Patients who remained sputum smear-positive for AFB after 5 months of treatment were defined as those with treatment failure. Defaulted was defined as patients who had interrupted treatment for at least 2 consecutive months . Sputum culture for mycobacteria and DST results with a treatment regimen for MDR-TB was recommended for those with treatment failure. The MDR-TB treatment regimen for patients with pulmonary MDR-TB or those with treatment failure was modified after obtaining DST results. The MDR-TB regimen consisted of at least four anti-TB drugs, including at least three oral anti-TB drugs and one injectable anti-TB drug, according to the WHO recommendations, for at least six months in the initiation phase followed by all oral drugs for at least 12 months in the continuation phase . After the patient had undergone the MDR-TB treatment regimen, three samples of sputum smears and culture were analyzed monthly until sputum culture showed negative results for mycobacteria .
Bacteriologic examinations and identifications
Sputum samples for AFB smear and culture for mycobacteria were performed at the central laboratory of the CCIT, which is one of the reference laboratory centers for mycobacteria in Thailand. Sputum AFB smear tests involved staining using the Ziehl−Neelsen method and the result was reported semi-quantitatively . The results of the AFB smears were interpreted using the WHO 1998 Laboratory Services in the TB Control Grading System, according to which AFB < 1+ was defined as 1–9 AFB per 100 oil immersion fields (OIFs), 1+ as 10–99 AFB per 100 OIFs, 2+ as 1–10 AFB per OIF, and 3+ as > 10 AFB per OIF . The mycobacterium in sputum samples was cultured and DST performed for four anti-TB drugs, including INH, RMP, EMB, and SM using Lowenstein−Jensen media according to the WHO recommendation .
Interpretation of chest radiographic findings
Posterior−anterior chest radiographs within 1 month of pulmonary TB diagnosis were used for interpretation and were obtained using a plain radiography system (Model UD150B-40, Shimadzu Corporation, Kyoto, Japan). The chest radiographs were collected, reviewed, and interpreted in a blinded fashion, in random order, by two independent specialists, including one specialist in pulmonary medicine and one specialist in tropical diseases, neither of whom were the treating physicians and both of whom had more than 10 years’ experience.
The pattern of lung abnormalities, site of lung involvement, and characteristics of lung cavities were defined before interpreting chest radiographs. The pattern of lung abnormalities in pulmonary TB, including reticulo-nodular opacity, reticular opacity, nodular opacity, consolidation, cavities, pleural effusion, atelectasis, and adenopathy were evaluated. For defining the site of lung involvement, the lung was divided into six zones for each patient, as shown in Fig 2. The upper zone was located cephalad to the mid-part of the hilar structure. The lower zone was located caudad to the second anterior rib, below the line of the mid-section of the hilar structure. The middle zone was located between the line of the mid-section of the hilar structure and the line of second anterior ribs below the mid-section of the hilar structure. The characteristics of lung cavities recorded were the maximum diameter of the cavities, the number of cavities, and the site and lung zone involved.
The pattern of lung abnormalities, the extent of lung parenchymal abnormalities, including the site and number of lung zones involved, and the consensus chest radiographic findings were summarized and recorded in a pre-defined case record form for chest radiographic findings. If controversy arose, a third expert repeatedly reviewed the cases based on the interpretation of the previous two specialists. The original two specialists repeated their analysis of the chest radiographs in the same format after 3 months.
All data analyses were performed with SPSS for Windows 18.0 (SPSS Inc. Chicago, IL). Categorical variables were compared with Chi-square analyses or Fisher’s exact test where appropriate, and data for these variables are summarized as number and percentage. The Extended Mantel− Chi-square test for linear trends was used to determine a linear trend of grading of the AFB smear and lung zones of cavities in relation to the occurrence of MDR-TB. Univariate analysis was performed to determine possible factors that could be associated with MDR-TB. All variables with P ≤ 0.2 in the univariate logistic regression analysis was included in the stepwise multiple logistic regression analysis, by using the backward selection method for determining independent MDR-TB-associated factors. All tests of significance were two-sided, and P < 0.05 was considered statistically significant.
A total of 290 pulmonary TB patients who received treatment at the CCIT were recruited into the study; 145 were pulmonary TB patients with MDR-TB, defined as cases, and 145 were pulmonary TB patients with drug-sensitive TB, defined as controls (Fig 1). Among the 145 patients with pulmonary MDR-TB, the DST results showed drug-resistance to INH and RMP in all patients, EMB-resistance in 30 (20.7%) patients, and SM resistance in 88 (60.7%) patients.
Comparison of baseline characteristics and clinical and laboratory findings between patients with MDR-TB and those with drug-sensitive TB
There were no significant differences in the age, gender, residential area, education, and underlying medical illnesses, including diabetes mellitus, cardiovascular diseases, HIV infection, and lung diseases, among patients with MDR-TB and those with drug-sensitive TB. All statistical comparisons for the baseline characteristics of patients with MDR-TB or those with drug-sensitive TB are reported in Table 1.
Of the 145 patients with MDR-TB, 140 (96.6%) patients had prior episodes of pulmonary TB, including 94 (67.1%) patients who had 1 prior episode of pulmonary TB and 46 (32.9%) patients who had ≥ 2 prior episodes of pulmonary TB whereas 5 (3.4%) patients had no prior episode of pulmonary TB. Of 145 patients with drug-sensitive TB, 123 (84.8%) patients had no prior episode of pulmonary TB, whereas 22 (15.2%) patients had prior episodes of pulmonary TB, including 20 (90.9%) patients who had 1 prior episode of pulmonary TB and only 2 (9.1%) patients who had ≥ 2 prior episodes of pulmonary TB. The proportion of patients with MDR-TB who had ≥ 2 prior episodes of pulmonary TB was significantly higher than those with drug-sensitive TB (46 [31.7%] vs. 2 (1.4%) patients, P < 0.001; Table 2).
Of the 140 MDR-TB patients with prior episodes of pulmonary TB, 93 (66.4%) patients received treatment with a category I anti-TB regimen and 47 (33.6%) patients received treatment with a non-category I regimen. Of the 22 drug-sensitive TB patients with prior episodes of pulmonary TB, 21 (95.5%) patients received treatment with a category I anti-TB regimen and only 1 (4.5%) patient received treatment with a non-category I regimen. The proportion of patients with MDR-TB who received a non-category I regimen was significantly higher than those with drug-sensitive TB (47/140 [33.6%] patients vs. 1/22 [4.5%] patients, P = 0.012; Table 2).
Treatment outcomes of a prior anti-TB regimen among patients with MDR-TB included treatment failure (88 patients, 62.9%) followed by cure or completed treatment (28 patients, 20.6%), default (20 patients, 14.3%), and referral to other hospitals for treatment (4 patients, 2.9%). Among the patients with drug-sensitive TB, treatment outcomes of a prior anti-TB regimen included default (10 patients, 45.5%) followed by cure or completed treatment (8 patients, 36.4%), referral to other hospitals for treatment (4 patients, 18.2%); there were no treatment failures. The proportion of treatment failures or default outcomes among patients with MDR-TB was significantly higher than among those with drug-sensitive TB (108 [79.4%] vs. 10 [55.6%] patients, P = 0.036; Table 2).
In terms of the presentation of current pulmonary TB, the proportion of patients with a duration of illness > 60 days was significantly higher among patients with MDR-TB than those with drug-sensitive TB (80/135 [59.3%] patients vs. 39/143 [27.3%] patients, P < 0.001]. Cough was the most common form of presentation of patients with pulmonary TB, but the proportion of patients without cough was significantly higher among patients with MDR-TB than among those with drug-sensitive TB (28 [19.3%] patients vs. 6 [4.1%] patients, P < 0.001). In addition, patients with MDR-TB were more likely to have no fever (96 [66.2%] patients vs. 59 [40.7%] patients, P < 0.001) and no hemoptysis (132 [91.0%] patients vs. 118 [81.4%] patients, P = 0.027; Table 2).
Regarding laboratory findings among patients with pulmonary TB, there was strong evidence of a linear trend in terms of the proportion of patients with MDR-TB in relation to sputum AFB smear grading (Chi-square for linear trend = 79.26, P < 0.001; Table 2). In order to assess the chest radiographic interpretation, the kappa statistics for intra- and inter-observer agreement were performed as shown in Table 3. The overall intra- and inter-observer agreement were good to excellent between the two specialists, except that the maximum diameter of cavities showed moderate agreement in the second round of chest radiograph interpretation. According to the chest radiological findings, the number of abnormal radiological findings of ≥ 2 patterns was more commonly observed in patients with MDR-TB than in those with drug-sensitive TB (106 [73.1%] patients vs. 42 [29.0%] patients, P < 0.001). Patients with MDR-TB were more likely to present with (1) cavities (92 [63.4%] patients vs. 34 [23.4%] patients, P < 0.001), (2) pleural effusion (35 [24.1%] patients vs. 14 [9.7%] patients, P = 0.002), and (3) atelectasis (21 [14.5%] patients vs. 6 [4.1%] patients, P = 0.005) than those with drug-sensitive TB (Table 2).
Univariate and multivariate analysis for the occurrence of pulmonary MDR-TB
We used univariate logistic regression analysis to ascertain which of the baseline characteristics, previous history of TB, clinical, and laboratory findings were associated with the occurrence of pulmonary MDR-TB. All factors that were significantly associated with pulmonary MDR-TB were included in the univariate logistic regression analysis. We identified the following factors associated with pulmonary MDR-TB: (1) ≥ 2 episodes of prior pulmonary TB, (2) duration of illness > 60 days, (3) having a sputum AFB smear grading 2+ or 3+, (4) presence of cavities, (5) presence of pleural effusion, and (6) presence of atelectasis (Table 4).
After including all parameters with a P ≤ 0.2 in the univariate logistic regression analysis in a stepwise multiple logistic regression analysis, using backward selection, we found the following risk factors to be independently associated with the occurrence of pulmonary MDR-TB: (1) ≥ 2 episodes of prior pulmonary TB (OR [95% CI] = 39.72 [7.86−200.66], P < 0.001), (2) duration of illness > 60 days (OR [95% CI] = 3.08 [1.52−6.22], P = 0.002), (3) having a sputum AFB smear score of 3+ (OR [95% CI] = 13.09 [4.64−36.91], P < 0.001), and (4) the presence of cavities (OR [95% CI] = 3.82 [1.89−7.73], P < 0.001), and (5) the presence of pleural effusion (OR [95% CI] = 2.75 [1.06−7.16], P = 0.038). These findings are shown in Table 5.
Comparison of cavity pattern between patients with MDR-TB and those with drug-sensitive TB
The cavity patterns noted by chest radiography are shown in Table 6. There were 92 (63.4%) patients with pulmonary MDR-TB and 34 (23.4%) patients with drug-sensitive pulmonary TB who had cavities upon chest radiography. Patients with pulmonary MDR-TB had a significantly higher proportion of cavities with a maximum diameter ≥ 30 mm (77 [83.7%] patients vs. 5 [14.7%] patients, P < 0.001), ≥ 3 cavities (42 [45.7%] patients vs. 4 [11.8%] patients, P = 0.001), bilateral involvement (48 [52.2%] patients vs. 5 [14.7%] patients, P < 0.001), and ≥ 2 lung zones involved (55 [59.8%] patients vs. 8 [23.5%] patients, P = 0.001) than those with drug-sensitive pulmonary TB. In addition, there was strong evidence of a linear trend in the proportion of patients with pulmonary MDR-TB in relation to the number of lung zones involved (Chi-square for linear trend = 13.44, P = 0.001).
In our study, patients with pulmonary MDR-TB had similar underlying medical illnesses as patients with drug-sensitive pulmonary TB. The number of patients with HIV infection was also similar among patients with pulmonary MDR-TB and patients with drug-sensitive pulmonary TB, which supported previous reports showing that HIV infection was not one of the risk factors for the development of MDR-TB [7,8]. A number of previous reports showed that a history of previously treated TB was one of the risk factors for MDR-TB [9–14, 17–23]. In our study, patients with ≥ 2 previous episodes of pulmonary TB had a risk for development of pulmonary MDR-TB (OR 39.72). Our study also showed that patients with previous pulmonary TB episodes who were treated with a non-category I regimen and where the treatment outcome of previous pulmonary TB was treatment failure or default were more likely to be now have pulmonary MDR-TB than drug-sensitive pulmonary TB. Thus, the management of prior episodes of pulmonary TB is an important factor in the development of pulmonary MDR-TB.
A previous study showed that the majority of the patients with pulmonary TB (75.8%) presented with cough, one-half of the patients (50.6%) presented with fever, and approximately one-fourth of the patients (23.8%) presented with hemoptysis . Our study demonstrated a significantly higher proportion of patients with pulmonary MDR-TB who presented with no cough, no fever, and no hemoptysis than did patients with drug-sensitive pulmonary TB. Additionally, presentation with illness of long duration (> 60 days, OR 3.08) was a risk factor for the development of MDR-TB. It is likely that these patients received partial treatment for TB before receiving treatment at the CCIT or that a less virulent strain became dominant after the development of drug-resistance .
A previous study also showed that patients with MDR-TB had a significantly higher sputum smear-positivity rate than those with mono-resistant or drug-sensitive TB (MDR-TB in 80.0% vs. mono-resistant in 50.0% vs. drug-sensitive TB in 53.3%, P < 0.001) . In addition, a higher rate of sputum smear-positivity was associated with advanced chest radiographic findings in a previous report . However, our study showed that a sputum AFB smear-positive score of 3+ (OR 13.09) and the presence of cavities (OR 3.82) upon chest radiography were independent risk factors for the development of MDR-TB. Additionally, the characteristics of cavities, including having a maximum diameter ≥ 30 mm, number of cavities ≥ 3, bilateral involvement, and the presence of cavities in ≥ 2 lung zones, were associated with the development of MDR-TB. Our findings were similar to previous reports from Korea showing that cavity formation, particularly the presence of multiple cavities (>3 cavities), was associated with the development of MDR-TB [30,41].
In our study, pleural effusion was another risk factor for the development of MDR-TB (OR 2.75). The occurrence of pleural effusion in patients with drug-sensitive pulmonary TB was 8.6% and increased to 24.3% among patients with pulmonary MDR-TB. These findings are probably due to the entry of more mycobacteria into the pleural space due to the high burden of organisms among patients with MDR-TB, leading to stimulation of the delayed hypersensitivity reaction to mycobacterial antigens [42,43] or the occurrence of an immunological response after initiation of anti-TB drugs for approximately 2 months . A previous study showed that pleural TB was the second most common extrapulmonary form of TB; in drug-resistant TB, this form of TB accounted for approximately 4% of TB cases .
In our study, there was a high rate of drug-resistance to SM (60.7%) and a moderate rate of drug-resistance to EMB (20.7%) among patients with pulmonary MDR-TB. According to the WHO recommendation, SM should not be used as a standard treatment regimen for MDR-TB due to the high SM-resistance rate in MDR-TB isolates; EMB may be considered for treatment of MDR-TB if the DST results show drug susceptibility .
The treatment of MDR-TB requires more complex therapy with longer treatment duration (18−24 months); thus, adverse drug events occur more frequently compared to the treatment regimen for non-MDR-TB [35,45]. In terms of treatment of MDR-TB in Thailand, the clinical practice has been to select a regimen of at least four susceptible anti-TB drugs, including 1 injectable anti-TB drug and at least 3 oral anti-TB drugs, as per the WHO recommendations . The common anti-TB drugs used for treatment of MDR-TB in Thailand include intramuscular kanamycin, with oral levofloxacin, ethionamide, cycloserine, and p-aminosalicylic acid during the initiation phase (for 6−8 months), followed by all oral drugs after sputum culture has been negative for 18 months, in the continuation phase. However, pyrazinamide is not recommended in the standard empiric regimen for MDR-TB due to the high pyrazinamide-resistance rate in MDR-TB isolates (49.0%) in Thailand .
Our study had some limitations. (1) The majority of patients in the control group were patients who did not have a history of previously treated pulmonary TB, as most of the patients with previously treated pulmonary TB developed drug-resistance after receiving anti-TB drugs. (2) Patients with sputum AFB-positive smears were recruited into our study, which may have induced a sampling bias. The reason for recruiting such patients was to avoid the possibility of inappropriate collection of sputum samples or improperly prepared sputum AFB smears, which may have affected the smear test. (3) Availability of certain data, such as the mode of TB contact, and DST for second-line drugs, was limited due to the retrospective nature of the study. (4) Our study is a retrospective matched case−control study. In Thailand, the occurrence of pulmonary MDR-TB is a rare condition and the long duration of the study is essential for including sufficient numbers of patients into the study. Therefore, changes in the incidence of newly diagnosed and previously treated MDR-TB over time might influence the risk factors for MDR-TB.
In conclusion, the risk factors for MDR-TB among patients with pulmonary TB included ≥ 2 episodes of prior pulmonary TB, duration of illness > 60 days, a sputum AFB smear score of 3+, and the presence of cavities or pleural effusion on chest radiographs. These clinical factors and chest radiographic findings associated with MDR-TB should prompt physicians to perform DST sooner, and to provide proper management of cases, which may reduce the number of patients with MDR-TB in future.
The authors would like to thank all patients who were involved in this study. We also wish to thank Miss Benjawan Saipan and Miss Ponglada Srivicha in the Clinical Research Center and the staff in the Division of Radiology at the Central Chest Institute of Thailand in Nonthaburi province for their great help in this study. We also offer sincere thanks to the Dean of the Faculty of Tropical Medicine, Mahidol University, for supporting this study.
Conceived and designed the experiments: CC VT PS TZMT VD. Performed the experiments: CC VT TZMT VD DS. Analyzed the data: VT VD DS. Contributed reagents/materials/analysis tools: VT MS. Wrote the paper: CC VT VD MS. Performed literature review: VT TZMT VD.
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- 39. Metcalfe JZ, Makumbirofa S, Makamure B, Sandy C, Bara W, Mungofa S, et al. Drug-resistant tuberculosis in high-risk groups, Zimbabwe. Emerg Infect Dis. 2014;20: 135–137. pmid:24377879
- 40. Goswami A, Chakraborty U, Mahapatra T, Mahapatra S, Mukherjee T, Das S, et al. Correlates of treatment outcomes and drug resistance among pulmonary tuberculosis patients attending tertiary care hospitals of Kolkata, India. PLoS One. 2014;9: e109563. pmid:25289974
- 41. Kim HC, Goo JM, Lee HJ, Park SH, Park CM, Kim TJ, et al. Multidrug-resistant tuberculosis versus drug-sensitive tuberculosis in human immunodeficiency virus-negative patients: computed tomography features. J Comput Assist Tomogr. 2004;28: 366–371. pmid:15100542
- 42. Leibowitz S, Kennedy L, Lessof MH. The tuberculin reaction in the pleural cavity and its suppression by antilymphocyte serum. Br J Exp Pathol. 1973;54: 152–162. pmid:4700698
- 43. Baumann MH, Nolan R, Petrini M, Lee YC, Light RW, Schneider E. Pleural tuberculosis in the United States: incidence and drug resistance. Chest. 2007;131: 1125–1132. pmid:17426219
- 44. Jeon K, Choi WI, An JS, Lim SY, Kim WJ, Park GM, et al. Paradoxical response in HIV-negative patients with pleural tuberculosis: a retrospective multicentre study. Int J Tuberc Lung Dis. 2012;16: 846–851. pmid:22507441
- 45. Bloss E, Kuksa L, Holtz TH, Riekstina V, Skripconoka V, Kammerer S, et al. Adverse events related to multidrug-resistant tuberculosis treatment, Latvia, 2000–2004. Int J Tuberc Lung Dis. 2010;14: 275–281. pmid:20132617
- 46. Jonmalung J, Prammananan T, Leechawengwongs M, Chaiprasert A. Surveillance of pyrazinamide susceptibility among multidrug-resistant Mycobacterium tuberculosis isolates from Siriraj Hospital, Thailand. BMC Microbiol. 2010;10: 223. pmid:20727143

domain: medical


Emergency Operations Plans for Rural Jurisdictions
Rural Domestic Preparedness Consortium. (2017). Emergency Operations Plans for Rural Jurisdictions.
This 8-hour in-person course can help rural planners develop plans suited to their jurisdictions.
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Taking good care of your dog is the first step to ensuring that it is healthy. Dogs accumulate a lot of dirt and bacteria, which is not only harmful for their health but also your health especially, if you share the same living space. For this reason, it is important to ensure that your dog baths from time to time. One mistake dog owners make is using human shampoos to bath their canine friends. Using human shampoo on your dog can jeopardize their health.Thus, instead of using human shampoos, you should purchase dog shampoos. Nowadays, there are diverse brands of dog shampoos. Therefore, how can you identify the best shampoo for your canine friend? Listed below, are important guidelines for selecting the most ideal shampoo.
Think About the Skin Condition of Your Dog
It is highly advisable to first consider the skin condition of your canine friend before selecting any shampoo.Generally, shampoos are designed for varying skin conditions. For instance, there are shampoos, which are designed solely for dogs that have dry and flaky skin.It is because of this that you should take time to assess your canine friend’s skin condition, and to purchase shampoo, which is manufactured to address that exact condition.If your canine friends, for example, itches all the time, you should buy shampoo that has antifungal properties that will alleviate itchiness.
A Shampoos’ Ingredients
Shampoos are not made from the same ingredients. More often than not; the ingredients contained in shampoos are written on the product label. It is highly advisable to cross-check the product label ,and review each ingredient used. Typically, shampoos either contain all-natural or chemical extracts. Since all-natural extracts do not contain any artificial chemicals, they are safe. In this case; you should avoid buying shampoos that are made using artificial extracts.
Allergic Reactions and Sensitivity
Like humans, dogs react differently to different things. It is because of this that you need to consider whether your canine friend has any allergic reactions.Does your dog react to strong smells? Does your canine friend develop skin allergic reactions when exposed to certain products?These are some of the essential questions that you ought to deliberate on. Overlooking your dog’s sensitivity can trigger serious health hazards that might even result to death. Thus, it is always recommendable to take your dog’s sensitivity into account. If your dog is allergic to particular extracts, you should not purchase shampoos that contain those extracts.Additionally, if your canine friend reacts to strong smells, you should avoid buying perfumed shampoos. Purchasing an ideal dog shampoo is important. When you purchase a suitable shampoo, you can rest easy since your dog will be healthy and clean.

domain: pet


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James and Deaver Traywick are head high -- and then some -- in a late-spring field of broom-bristle-thick cover crops on their farm, near Cope, South Carolina. They are just days from planting the acres to cotton and will have to flatten a mix of rye, crimson clover and tillage radish to do so. In the process, they'll have to penetrate that thick fibrous mat to place the seed less than one inch deep.
The father and son will get more back this year than just improved soil health and weed suppression for their efforts; they'll receive additional income for planting multiple cover crops.
The Traywicks are part of a growing number of farmers participating in the still-evolving carbon-sequestration market. In essence, corporations are willing to pay farmers to implement practices like cover crops and no-till while fine-tuning nutrient management.
REPOSTED FROM DTNPF.COM - READ FULL ARTICLE HERE

domain: agronomy


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Emerging evidence indicates that bile acids (BAs), which are signaling molecules that regulate metabolism and inflammation, appear to be dysregulated in schizophrenia (SZ). Further investigation is warranted to comprehensively characterize BA profiles in SZ. To address this, we analyzed serum BA profiles in 108 drug-free patients with SZ and in 108 healthy controls (HCs), divided into a discovery set (n = 119) and a validation set (n = 97), using ultraperformance liquid chromatography triple quadrupole mass spectrometry. Forty serum BAs were detected and absolutely quantified using calibration curves. Global BA profiling showed differences in SZ and HC groups in both discovery and validation sets. The concentrations of chenodeoxycholic acid, ursodeoxycholic acid, 3β-chenodeoxycholic acid, 7-ketolithocholic acid, 3-dehydrocholic acid, total BAs, and unconjugated BAs were significantly lower in patients with SZ compared with HCs in the two sample sets. The BA deconjugation potentials by gut microbiota and the affinity index of the farnesoid X receptor (FXR) were notably decreased in SZ patients compared to those of HCs. Conjugated BAs and BA deconjugation potentials differed in SZ patients with first versus recurrent episodes, although similar BA profiles were observed in both groups. In addition, a panel of 8 BA variables acted as a potential auxiliary diagnostic biomarker in discriminating SZ patients from HCs, with area under the curve values for receiver operating characteristic curves of 0.758 and 0.732 and for precision-recall curves of 0.750 and 0.714 in the discovery and validation sets, respectively. This study has provided compelling evidence of comprehensive characteristics of circulating BA metabolism in patients with SZ and promoted a deeper understanding of the role of BAs in the pathophysiology of this disease, possibly via the gut microbiota-FXR signaling pathway.
Scopus Subject Areas
- Psychiatry and Mental health


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Also Porsche will no longer make diesel-powered vehicles
Porsche will no longer build diesel-powered vehicles, opting instead for investments in electric and hybrid technology.
The decrease in demand (at a global level was only 12% in 2017), combined with the fallout from the emissions scandal, has accelerated the farewell to diesel engines, which the company has not offered in its range since February.
Meanwhile, interest in hybrid models has grown, about 63% of the Panamera models are ordered as a hybrid model.
"Porsche has no intention of demonizing the diesel engine, but as a sports car manufacturer for which diesel engines have traditionally played a subordinate role, we have come to the conclusion that we can survive without diesel models in the future" said Lutz Meschke, Porsche's deputy chairman and board member.


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Click here to read the guide from Adobe how to allow Flash for certain websites in Google Chrome.
1st Drifting Stage Online Game
1st Drifting Stage Game Description
Take in your surroundings in this speedy scenic drive... First pick one of 8 cars, then drift around the circuit.
1st Drifting Stage Game Instructions
Race against the clock using 8 different cars.
Use cursor keys to control car. Have fun!
1st Drifting Stage Screenshot
|Hot or not:|
|Hot or not:
|Game name:||1st Drifting Stage|
|Category:||Racing games » Rally & Off-Road games|
More Rally & Off-Road games
|Rock Fury ATV Racing
Rock Fury ATV Racing is a kind of arcadish bike skill game. Drive your ATV through... Play Rock Fury ATV Racing »
Stay on the road and see how long you can last before you crash and burn. Race thr... Play Desert Rally »
A simple Racing game. Race your ride to unknown territories, avoid all the opponen... Play Rally 2100 »
Race through city streets in your monster truck! Bonus points and a speed boost gi... Play Street Rally »

domain: entertainment


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Puppies are blind and deaf at this stage. They are highly dependent on their mothers now. Their senses such as touch, smell, and taste get stronger as they grow. Their ear canals will start to open up after 2 weeks. They will start to socially interact with others. During this stage, hold them, pet them, and softly talk to them as much as possible.
Their eyes open and they start to get teeth. During this stage they will start to get bored of lying down all day and will start to try to stand and crawl or walk.
Social interaction will increase which is very important so let your puppy have fun and enjoy life. Their fear response will also start to kick in so try to expose them to the outdoors and things around the house.
I was just laying in bed sleeping peacefully when suddenly mom burst in the room making everyone’s heads pop off the pillow as she screamed, “Lady’s having puppies!!!” lady is our dog. She is a white purebred Labrador with a brown nose and black rings around her eyes. Purebred means that her parents are both 100% lab. So if you have a purebred golden retriever, then both of his parents are 100% golden retriever.
So anyway we all bolted out to the garage where the puppies were to be born. They all were fine until number 8 came. When the puppy was born the umbilical cord started bleeding pretty badly. Dad tied some dental floss around it to stop the bleeding and the puppy was saved.
It was so cool to watch how Lady automatically knew what to do to take care of a puppy each time it was born. The pup would come out and lady would drag it to her front side and eat the outer membrane. Then she would softly bite the umbilical cord off. Then lady would lick the baby clean of all the blood and other fluids that came out with it.
The puppies were so cute when they climbed over each other and whimpered. It sounded like a high-pitched squeal. We realized this is where the term “dog pile” comes from. They really do crawl and lay all over each other. You have to be pretty careful with them and watch them closely or else big momma might lie down on one of them and suffocate them without realizing it.
Lady had a total of ten puppies. The last two were still born. In the middle of the first night my mom woke up to check on them in the garage and found one puppy away from the rest by itself. It wasn’t breathing. Puppies need it to be really warm at first and even though it was a nice night and they had a blanket to sleep on we think it might have gotten too cold when it got separated from its mother. W brought them in the house and gave them one of the extra bedrooms. I like to read in there with them and watch them. They spend all their time eating or sleeping.
ú JHope this was helpful!!!J2.


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Bronx, NY – Mayor Bill de Blasio announced today all New Yorkers will have “guaranteed healthcare” beginning August 1.
De Blasio introduced the New York Care Card to a cheering crowd and guaranteed that all uninsured New Yorkers will have free health care.
The mayor says some people are not visiting doctors when they should because “they think it is too expensive.” He stated, “Healthcare is a human right. You think about this country’s tens of millions of people, and how wrong that is, that health care is being decided by the zip code that people live in or how much money is in their wallet. Health care is a human right. It’s as simple as that. It’s a simple right. It’s a universal right.”
The mayor said the NY Care Card is about being “bold” and is a rejection of the “status quo.”
The card, to be distributed to New Yorkers who currently have no health insurance, will be handed out beginning August 1 in The Bronx. It will allow individuals and their family members to obtain a primary care doctor and be seen without walking into emergency rooms.


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Families are being urged to stick to the current lockdown guidelines during the half-term break as police and council leaders continue their efforts to tackle the spread of Covid-19 in Staffordshire.
Staffordshire Police is continuing to respond to breaches in the county including household gatherings and residents not isolating when instructed to do so.
Officers issued a total of 138 fixed penalty notices across Staffordshire in the first week of February for a range of breaches as the force continues to receive a number of reports from members of the public. The most common breaches dealt with by officers included house parties and people taking unnecessary journeys.
As half-term approaches, the force has joined up with local authorities to remind residents of their responsibility to adhere to the current rules and help reduce the number of Covid-19 cases in the county.
Stoke-on-Trent City Council is promoting virtual things for families to enjoy over the break while Staffordshire County Council’s libraries have a whole host of online activities for families.
Staffordshire County Council Leader Alan White said: “Parents across the county have been doing a fantastic job in supporting education at home, and the coming half-term will provide some respite. We have plenty of online activities taking place to keep families entertained over the break.
“With people tired and Covid-19 rates falling, it would be easy to let our guard down over the school holidays. Staffordshire residents have done a fantastic job in reducing the number of cases and we all want this to continue, but Covid-19 thrives on complacency, so we must keep following the rules if we are to stop this virus spreading. This means not mixing with other households, only making essential journeys, and remembering hands, face, space at all times. There will be time to meet up with friends again in the future, but for now we need to carry on sticking to the rules and if you have essential reasons for being out and about, please get tested.”
Stoke-on-Trent City Council’s museums, libraries and other indoor attractions remain closed throughout the national lockdown, but the venues are continuing to provide alternative entertainment on their websites and social media channels.
Council leader Abi Brown said: “February half-term next week will provide a welcome break for many families who have been home-schooling since the start of lockdown. Although I encourage all to take advantage of the break, please remember lockdown restrictions still apply.
“People should not be mixing with others outside their household or support bubble and should not be making non-essential journeys. Let’s not undo all our hard work over the past few months by breaking the rules and potentially causing further spread of the virus. Our coronavirus rate and positivity rate are slowly going down, but the virus is still out there.
“Our covid stewards will be doing extra patrols across Stoke-on-Trent parks all week to provide advice and check on compliance. It’s difficult especially for children who haven’t seen their friends since before Christmas, but please do not use being outside as an excuse to meet groups of people outside of your household.”
Meanwhile the force will monitor hot-spot areas to ensure people are complying with the rules, taking enforcement where necessary.
Superintendent Thomas Chisholm, head of neighbourhood policing at Staffordshire Police, says he is pleased to see the majority of residents in the county sticking to the rules. He said: “These are undoubtedly very challenging times for everyone but it has been heartening to see the efforts by so many in the county to adhere to the rules and ultimately play their part in trying to reduce the number of Covid-19 cases.
“We can appreciate how desperate residents are for normality to return – we all feel the same. But it is vital we continue to follow the national restrictions and not put the health and lives of people at risk.
“This half-term, like recent school holidays, will of course be very different to what children and families are used to. And while it represents a much-needed break, it isn’t a time to gather together and take unnecessary journeys. We would also ask parents to always know where their children are and make sure they are not breaching the restrictions.”


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Hire Fish and Chip Van in Winslow
Browse Fish and Chip Vans
Recent review: After taking a gamble and choosing a company to supply our birthday party food without any prior knowledge we were absolutely delighted with the service and quality of food that we received. They turned up on time, cooked all the food fresh to order and provided a very prompt efficient service. Woul
Recent review: Really good food, excellent service throughout and very helpful in meeting our needs. Would happily recommend David and ole catering to anyone wanting a Spanish themed party.
Recent review: On the run up to our wedding the goujon monkey van broke down, Tim phoned us & said he would be getting the Van towed to the venue & collected a few days later. We were so relieved he could make it & would do that for us. The food was absolutely delicious - we have had messages from so many friends
About: Howe & Co have been delighting and serving people with Fish & Chips since 1930. Serving regular rounds but also providing catering services for all types of events. From private parties to large scale public events Howe & Co 66 Frankly Fish & Chips is your fist choice provider when you are looking
About: The company grew quickly diversifying into all areas of mobile event catering and now provides its services to a number of London borough councils including Westminster and Kensington & Chelsea.
Recent review: "After making lots of enquiries to other cake companies for our Wedding and even considering options from high street supermarket chains I know we made the right choice by using this great company. This is a friendly and professional service, competitive pricing and the cake looked exactly like the
About: Run by James and Lucy Belton, continuing the family’s 30+ years tradition of providing quality English seafood food to the locale. You will be welcomed to your dining experience with us in simple, homely English style. Centred in the heart of Camden Stables, Seawise brings you the best of English s
Recent review: Just had them this last weekend for evening. catering for about 150 guests. they arrived in plenty of time and a nice selection of food. Friendly staff and good food what more do you need to make a do a bit different.
Recent review: Without doubt the best fish and chips I have ever had. The batter was so light and crisp and the fish was very tasty. The portions were large and so many of our guests commented on how good the fish and chips were. Adele communicated well throughout the booking process. On the night Adele and her hu
About: Mobile Event Catering is our speciality at Farr’s; we have operated our own units all over the country and can arrange for all types of catering for your event. Whether it’s an individual catering unit you’re looking for or a complete themed catering village, we can arrange it all, including all am
About: At Cods & Rockers we serve mouth watering traditional fish and chips, and provide a range of bespoke catering services for just about any sort of event from festivals and corporate days to weddings and parties. You’ll simply love our food, expertly cooked fresh fish an d chips which your guests wil
Recent review: We had our sons communion on Saturday and hashtag fish catered for 150 people. The food was amazing and the service was brilliant. I would highly recommend Szymon, all the guests were delighted with the food.
Recent review: "Great food, quality offering, top chef. Wonderful kitchen and really talented chef offering fab food. Everyone who tried told me how wonderful the food was. Keenly priced and when I had it...well blown away at ingredients and just sheer skill and talent at preparing and serving it. In terrible w
About: Love Candy Floss established 2005 provides Event Catering and Entertainment to corporate and private events nationwide. With a wide range of Vintage Street Food Vans, Dessert Carts, Circus Entertainers, Magicians, Caricaturists, Stilt Walkers and much more we have everything you need for your event
Recent review: We hired KK to serve day-after breakfast at our festival wedding on the weekend of June 3rd: John Crannage was waiting for our bleary-eyed campers (about 50 of us) with a van full of delicious fried breakfast and was happy to start serving half an hour early, much to the delight of those with hangov
Recent review: Wonderful! Friendly service. Superb quality. Totally exceeded any expectations! Would highly recommend for any future events.
Recent review: I would DEFINITELY recommend Cook n Go! The food was lovely and fresh and every single guest loved it. I had so many compliments and one guest even booked them up for a future event on the spot. Thank you so much!
About: Fine Street is a street food collective with experienced resident and guest Chefs. Our Chefs work by appointment and give their full focus to every event regardless of size and style. Every event supported by our team is personal and customised. We never copy another chefs idea, though we are always
Recent review: "Hi D'Lights Event Catering We just wanted to say a massive thank you for the canapes you served us. They looked and tasted great with so many compliments from friends and family. We will definitely be recommending your company to friends and family."
Recent review: "Food was fantastic and Chris made everything run like clockwork. Great communication from initial enquiry to setting up at the party. Everyone commented on how great the food was. Would recommend to everyone and definitely use again. Thanks Chris"

domain: food


Contact Information: Mary Mitros 630-407-6706
Tuesday, February 24, 2015
DuPage County to Host Resiliency Workshops in East Branch DuPage River Watershed
DuPage County will be holding a series of public workshops in early March to discuss strategies and solutions to make communities within the East Branch DuPage River Watershed stronger in the face of extreme weather events.
DuPage County began studying the East Branch Watershed, which encompasses the central portion of DuPage County extending from Addison into Will County, to assess how communities could become more resilient for extreme weather events. The resulting draft East Branch DuPage River Watershed Resiliency Plan provides a comprehensive overview of the watershed, including identification of vulnerabilities and recommendations on how to protect the area against weather extremes.
“During this initial East Branch study, the County tapped into resources not traditionally included in watershed plans, which entailed exhaustive community outreach efforts,” said DuPage County Stormwater Management Committee Chairman Jim Zay. “Although we now have a draft watershed plan in place, this community engagement is not complete. The County intends to continue working with members of the East Branch communities to identify projects and solutions that will create a stronger, more resilient watershed.”
During the two-hour long resiliency workshops, community members will have the opportunity to learn about specific initiatives to help communities become more resilient, which may include large-scale infrastructure projects, localized green infrastructure options and educational programs among other concepts. Participants will then have an opportunity to provide their input on both existing options and additional solutions that could work in local communities.
“At the County level, we can help to identify the big ideas, but it really takes involvement from all the pieces that make up a community to become more resilient,” added Chairman Zay.
The public workshops will be held from 6 to 8 p.m. on the following dates:
• Tuesday, March 3 at Lincoln Community Center, 935 Maple Ave., Downers Grove;
• Monday, March 9 at Glen Ellyn Public Library, 400 Duane St., Glen Ellyn; and
• Tuesday, March 10 at Trinity Green Trails, 2701 Maple Ave., Lisle.
To view the draft East Branch DuPage River Watershed Resiliency Plan, visit /EDP/Stormwater_Management/49261/.


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Visit Haywards Heath and the surrounding villages and stay in bed & breakfast accommodation:
Haywards Heath, West Sussex. A large market town, many of whose residents travel to work in London. It is still an important agricultural centre and presents both a town and a rural aspect. On Muster Green was fought the Civil War battle of Hayward's Heath when a Royalist force was routed with the loss of more than 200 men. A rough granite memorial commemorates the local men who lost their lives in the First and Second World Wars.
Sheffield Park Gardens, a few miles east of Haywards Heath and just east of the A275, are open at advertised times. Rhododendrons in early summer and maples and a variety of shrubs in autumn make a colourful display. There are five lakes at different levels. Sheffield Park Station is on the popular privately-run Bluebell Railway.
Nearby airports: Gatwick
Nearby towns: Burgess Hill, Crowborough, Crawley, East Grinstead, Lewes, Uckfield
Nearby villages: Ardingly, Balcombe, Cuckfield, Ditchling, Horsted Keynes, Hassocks, Hurstpierpoint, Newick
Have you decided to visit Haywards Heath or the surrounding villages? Please look above for somewhere to stay in:
- a Haywards Heath bed and breakfast (a Haywards Heath B&B or Haywards Heath b and b)
- a Haywards Heath guesthouse
- a Haywards Heath hotel (or motel)
- a Haywards Heath self-catering establishment, or
- other Haywards Heath accommodation

domain: history


Wednesday, 5/25: Due to a multitude of traffic lights that are not working in Towamencin Township, some buses may be delayed this afternoon.
Your child's health report card is now available. Please contact your child's school nurse for a copy.
6:00 PM - 11:00 PM School Board SSC Meeting, ESC
6:30 PM - 11:00 PM School Board Finance Committee Meeting, ESC
7:30 AM - 11:00 PM NPSD Educational Foundation Meeting, ESC
4:15 PM - 6:30 PM NPEA Representatives' Council, PD
7:30 PM - 11:00 PM School Board Meeting, ESC


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15 November 2023, 08:43
Two people were killed and six more were injured as a result of a collision between a bus and a truck on a highway in the Sverdlovsk region.
The press service of the regional Ministry of Health reports this.
“As a result of a collision between a regular bus and a truck, according to preliminary information, eight people were injured. Two of them died on the spot,” the statement says.
According to the department, all victims are evacuated to the central hospital in Verkhnyaya Pyshma.
Earlier it became known that an accident involving a bus and a truck occurred on the Yekaterinburg – Nizhny Tagil – Serov highway.
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A UFO video which latest world's first UFO observation system automatic observation and video robot SID-1Ⓒ caught in Tokyo Japan
This "Space Phenomena Observatory Center(SPOC)Ⓒ" is under the intended variety of mysterious phenomena and objects have occurred in space and the air in the Earth's atmosphere, that continue to record actively such UFO and unusual things founded June 2014. This is a unique first attempt in the world.
"Space Phenomena Observatory Center(SPOC)Ⓒ" founded and designed by Mr.Hiroshi Kitajima.
From July 2014, activated the "automatic observation and video robot SID-1" (SID1 = Space Intrusion Detection systems-1 Ⓒ) by its own development, and start the observation. this SID-1, is has succeeded in capturing some of the things that could be determined that is UFO.
SID-1, consists of "sensitive high-resolution japanese color camera" "sensitive automatic motion detection system" and "automatic recording system" . This is the UFO observation system which doesn't available in the world and I`ve never seen before, and it enables an observation for 365 days x 24 hours.
See bottom left of this page and click "SID-1 xxxx" then you can take a look of some of video and image which so far SID-1 caught. Updating at any time.
All right reserved. Copyright Space Phenomena Observatory Center(SPOC)Ⓒ.
Media, Rights and Permissions
We committed to good media relations to promote the study of UFOs. Please inquire about permissions and use agreements for our content including original witness testimony, images, videos, maps, illustrations and statistics.
Media and Press purpose: Please contact spoc.tokyo( At Mark )gmail.com
Edward Snowden: we may never spot space aliens thanks to encryption And extraterrestrials may never notice us, either, if our technology is sufficiently sophisticated, whistleblower tells Neil deGrasse Tyson Edward snowden Former intelligence contractor Edward Snowden says encryption could get in the way of any communication with aliens. Photograph: Frederick Florin/AFP/Getty Images
Saturday 19 September 2015 17.02 BST Last modified on Saturday 19 September 2015 20.47 BST
The US government whistleblower Edward Snowden believes encryption might make it difficult or even impossible to distinguish signals from alien species from cosmic background radiation.