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Self Archiving Policies
Special Fee Waivers and Discounts
Enhanced Collection of Laboratory Data in HIV Surveillance Among 5 States with Confidential Name-based HIV Infection Reporting, 2005-2006
Kristen Mahle Gray*, 1, Tebitha Kajese2, Erin Crandell-Alden3, Bridget J Anderson4, Debbie Wendell5, Allison Crutchfield6, Terry Jackson7, H. Irene Hall1Author Comment: for the Laboratory Reporting Workgroup§
1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
2 Business Computer Applications, 2002 Summit Blvd, Suite 880, Atlanta, GA, USA
3 HIV/STD/VH/TB Epidemiology Section, Division of Communicable Diseases, Bureau of Epidemiology, Michigan Department of Community Health, Lansing, MI, USA
4 Bureau of HIV/AIDS Epidemiology, AIDS Institute, New York State Department of Health, Albany, NY, USA
5 HIV/AIDS Program, Louisiana Office of Public Health, New Orleans, LA, USA
6 Disease Control and Environmental Epidemiology Division, Colorado Department of Public Health and Environment, Denver, CO, USA
7 Division of HIV/STD, Indiana State Department of Health, Indianapolis, IN, USA
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Issue: Suppl 1
First Page: 90
Last Page: 97
Publisher Id: TOAIDJ-6-90
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Received Date: 17/4/2011
Revision Received Date: 22/11/2011
Acceptance Date: 14/12/2011
Electronic publication date: 7/9/2012
Collection year: 2012
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© Mahle Gray et al.; Licensee Bentham Open.
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
* Address correspondence to this author at the HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Mailstop E-47, 1600 Clifton Road, NE, Atlanta, GA 30333, USA; Tel: 404-639-2050; Fax: 404-639-2980; E-mail: blo9@cdc.gov
§ Laboratory Reporting Workgroup Participants: Elizabeth Hamilton3, Maria Kouznetsova4 and Pamela Montoya6.
Laboratory data reported through HIV surveillance can provide information about disease severity and linkage to care; however these measures are only as accurate as the quality and completeness of data reported. Using data from five states that implemented enhanced collection of laboratory data in HIV surveillance from 2005-2006, we determined completeness of reporting, stage of disease at diagnosis, the most common opportunistic illnesses (OI) at diagnosis, and linkage to medical care. Methods to enhance laboratory reporting included increasing active surveillance efforts, identifying laboratories not reporting to HIV surveillance, increasing electronic reporting, and using laboratory results from auxiliary databases. Of 3,065 persons ≥13 years of age diagnosed with HIV, 35.5% were diagnosed with stage 3 (AIDS) and 37.7% progressed to stage 3 within 12-months after diagnosis. Overall, 78.5% were linked to care within 3 months; however, a higher proportion of persons with ≥1 CD4 or viral load test was found among whites compared with blacks/African Americans (82.1% vs 73.6%, p<0.001). Few (12.3%) had an OI within 3 months of diagnosis. The completeness of laboratory data collected through surveillance was improved with enhanced reporting and provided a more accurate picture of stage of disease and gaps in linkage to care. Additional interventions are needed to meet the goals of the National HIV/AIDS Strategy on linkage to care and the reduction of HIV-related disparities.
Keywords: HIV diagnoses, HIV surveillance, CD4 and VL reporting, linkage to care..
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The clinical management of HIV disease relies on CD4+ T-lymphocyte (CD4) and plasma HIV-1 RNA (i.e., viral load) testing to guide the initiation of treatment and monitor care. The Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents recommend CD4 count and viral load (VL) testing for a new patient during the initial visit and every 3 to 4 months after HIV diagnosis. Among patients who are clinically stable, CD4 may be monitored less frequently (every 6-12 months) [1]. The reporting of CD4 and VL results to health departments enhances local and national HIV case surveillance data and is used to identify cases, stage disease at diagnosis, and monitor disease progression. CD4 and VL data can also be used to determine entry and retention in care, measure viral load suppression, and assess unmet healthcare needs; however these measures are only as accurate as the quality and completeness of data reported.
AIDS was a reportable condition by the mid-1980s in all 50 states and the District of Columbia; however AIDS surveillance was limited to the collection of clinical data. With the advent of antiretroviral medications, which have helped HIV-infected persons live longer, and the increased availability of HIV tests, the national focus has shifted to integrate AIDS surveillance and surveillance of HIV infection. In the early 1990s, surveillance programs began collecting CD4 test results as part of routine surveillance activities. This was in part a result of the expansion of the AIDS case definition in 1993 to include an immunologic definition of AIDS; CD4 counts of less than 200 cells/mm3 or CD4 percentages less than 14% of total lymphocytes [2]. For the first time, the AIDS case definition could be met based exclusively on a positive HIV test and a low CD4 count or percentage. The most recent revision of the HIV surveillance case definition, in 2008, highlights the central role of CD4 results by using CD4 counts and percentages to define three stages of HIV infection, increasing in severity from stage 1 through stage 3 (AIDS) [3]. An unknown stage was built into the case definition to account for cases that do not have CD4 results or information on AIDS-defining conditions. The 2008 case definition also incorporated a new role for viral load test results in surveillance, as a detectable viral load became sufficient criteria for establishing a case for surveillance purposes [3].
The majority of U.S. states have policies or regulations that require laboratories to report CD4 and VL results to health departments. However, the level at which these laboratory results are reported varies within and across jurisdictions. In addition, barriers to maintaining complete and timely laboratory data in surveillance systems exist and may include the management of a large volume of reports and the receipt of paper vs electronic reports.
We conducted enhanced data collection in five state HIV surveillance programs for CD4 and VL laboratory test results and OIs among newly diagnosed HIV-infected persons. Using these data, we evaluated the completeness of CD4 and VL laboratory reports collected through surveillance, determined stage of disease at diagnosis, the most common OIs reported at diagnosis, and linkage to medical care within 3 months of diagnosis using laboratory tests as a marker for receipt of care.
Five surveillance jurisdictions (Colorado, Indiana, Louisiana, Michigan and New York [excluding New York City]) were selected to participate in the project as part of a competitive announcement. Analyses were based on data collected in the five states and reported to the Centers for Disease Control and Prevention (CDC) on HIV-infected persons aged 13 years or older diagnosed during April 2005 through March 2006, with the exception of New York, where persons were diagnosed from June 2005 through May 2006. Enhanced data collection of CD4 results, VL results, and OIs was conducted for all cases reported to the surveillance programs by 6 months after the end of the 12-month diagnosis period, except for Michigan where two out of three cases were sampled.
The five surveillance programs collected information according to routine surveillance procedures. Information was obtained on age, sex, race/ethnicity (white, black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, and multiple races), transmission category (men who have sex with men [MSM], injection drug use [IDU], MSM and IDU [MSM/IDU], high-risk heterosexual contact, and other), CD4 result, VL result, and OI information. All analyses adjusted for reporting delays and missing risk factor information [4, 5].
Methods for the enhanced collection of data included: a) updating data in the surveillance software from existing auxiliary laboratory databases, b) strengthening active surveillance efforts through increased medical record abstraction of laboratory data, c) identifying and collecting data from laboratories not previously reporting to HIV surveillance, and d) increasing the number of laboratory reports being sent to the surveillance programs electronically. Enhanced medical record abstraction was conducted up to 6 months following the 12-month diagnosis period using the Adult HIV Case Report Form. Electronic and paper-based laboratory results received up to 6 months after the 12-month diagnosis period and all medical record data were entered into the surveillance software and transferred to CDC as part of routine reporting of national HIV surveillance data. Although there may have been differences in how reports were transmitted and collected across the states (e.g., passive transmission of paper or electronic reports from laboratories vs medical record abstraction), the goal was for each health department to receive all HIV-related laboratory data.
We determined the distribution of stage of disease at diagnosis based on CD4 results or OIs within 3 months of diagnosis and the number and percentage of persons diagnosed with HIV who were linked to care within 3, 6, and 12 months based on CD4 and VL tests within these time frames. We also determined the number and percentage of persons diagnosed with HIV who were linked to care within 3 months by demographic and transmission categories. Finally, we determined the OIs diagnosed within 3 months of HIV diagnosis overall and by level of immune-suppression (CD4 count ≥200 cells/µL or ≥14%, and <200 cells/µL or <14%).
To assess the impact of enhanced data collection, we compared the project data on two measures (stage of disease and linkage to care) with (1) data from the same five states on cases diagnosed within 12 months prior to the initiation of the project (population A), and (2) data from 25 states on cases diagnosed during April 2005 through March 2006 (population B). The 25 states were selected for the analysis because they met the criteria outlined in the Technical Guidance for HIV/AIDS Surveillance Programs of at least 50% of newly diagnosed persons having an initial CD4 or VL result within 3 months of diagnosis reported to the national HIV surveillance system. Population B did not include any of the states with enhanced data collection.
SAS software version 9.1 (SAS Institute., Cary, NC) was used to perform univariate and bivariate analyses with the X2 test. Chi-square p-values less than or equal to 0.05 were considered significant. To describe the completeness of data, we included all cases whether or not they were alive at the end of the observation period.
Of the 3,065 persons diagnosed during the 12-month diagnosis period in the five states, 9.6% were diagnosed with stage 1, 29.1% with stage 2, and 35.5% with stage 3 disease; 25.8% were stage unknown (Table 1A). The proportion of persons who had a result from at least one CD4 or VL increased as more time was allowed for tests to be performed and reported (Table 2A); however, the majority (78.5%) had at least one CD4 or VL test within 3 months of diagnosis. Additionally, we assessed the impact of CD4 and VL tests initiated at the time of testing. When we removed persons who had the same diagnosis date and CD4 or VL collection date, the percentage of persons with a CD4 or VL test within 3 months dropped to 69.3%, data not shown.
Table 1A.
Stage of HIV Infection Based on CD4 Testa Performed within 3, 6, and 12 Months Following HIV Diagnosis Among Adults and Adolescents in 5 Statesb with Enhanced Data Collection, 2005-2006
≤3 mo
≤12 mo
Stage 1 295 9.6 329 10.7 359 11.7
Stage 2 891 29.1 968 31.6 1,031 33.6
Stage 3 (AIDS) 1,087 35.5 1,120 36.5 1,155 37.7
Stage unknown 791 25.8 648 21.2 521 17.0
Missing CD4 collection date 1 0 0 0 0 0
Total 3,065 100 3,065 100 3,065 100
Table 1B.
Stage of HIV Infection Based on CD4 Testa Performed within 3, 6, and 12 Months Following HIV Diagnosis Among Adults and Adolescents in 5 States Before Enhanced Data Collection (Population Ac), 2004-2005
Stage 1 331 7.6 374 8.5 409 9.3
Stage 2 1,027 23.4 1,149 26.2 1,271 29.0
Stage unknown 1,556 35.5 1,326 30.3 1,113 25.4
Table 1C.
Stage of HIV Infection Based on CD4 Testa Performed within 3, 6, and 12 Months Following HIV Diagnosis Among Adults and Adolescents in 25 States without Enhanced Data Collection (Population Bd), 2005-2006
Stage 1 952 9.0 1,051 9.9 1,152 10.8
Total 10,631 100 10,631 100 10,631 100
a The lowest CD4 count or percentage taken from the time period of interest.
b Colorado, Indiana, Louisiana, Michigan (diagnosed between April 1, 2005 through March 31, 2006) and New York (diagnosed between June 1, 2005 and May 31, 2006).
c Population A: Colorado, Indiana, Louisiana, Michigan (diagnosed between April 1, 2004 through March 31, 2005) and New York (diagnosed between June 1, 2004 and May 31, 2005).
d Population B: Persons diagnosed with HIV in 25 states that had ≥50% of persons newly diagnosed between April 1, 2005 and March 31, 2006 with an initial CD4 or VL result collected ≤3 months of HIV diagnosis and reported to the national HIV surveillance system.
CD4 (Count or Percentage) and Viral Load Results Reported within 3, 6, and 12 Months Following HIV Diagnosis Among Adults and Adolescents in 5 States with Enhanced Data Collection, 2005-2006
CD4 Only
VL Only
CD4 and VL
No CD4 or VL
≥1 CD4 or VLb
No.a
3 months 202 6.6 165 5.4 2,040 66.5 658 21.5 3,065 2,407 78.5
12 months 157 5.2 122 4.0 2,370 77.3 416 13.6 3,065 2,649 86.4
CD4 (Count or Percentage) and Viral Load Results Reported within 3, 6, and 12 Months Following HIV Diagnosis Among Adults and Adolescents in 5 States Before Enhanced Data Collection (Population A), 2004-2005
3 months 641 14.6 320 7.3 2,124 48.5 1,294 31.9 4,379 3,085 68.1
12 months 539 12.3 276 6.3 2,680 61.2 884 20.2 4,379 3,495 79.8
CD4 (Count or Percentage) and Viral Load Results Reported within 3, 6, and 12 Months Following HIV Diagnosis Among Adults And Adolescents in 25 States without Enhanced Data Collection (Population B), 2005-2006
3 months 2,550 24.0 797 7.5 4,594 43.2 2,685 25.3 10631c 7,941 74.7
12 months 2,010 19.0 809 7.6 5,721 53.8 2,086 19.6 10631c 8,540 80.4
Note. CD4 = CD4+ T-lymphocyte count (cells/µL) or percentage; VL = viral load (copies/mL).
a Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
b Data in this column (≥1 CD4 or VL) are not included in the column total.
c Four cases did not have a CD4 or VL specimen collection date.
CD4 (Count or Percentage) and Viral Load Results Reported within 3 Months Following HIV Diagnosis Among Adults and Adolescents in 5 States with Enhanced Data Collection, by Selected Characteristics, 2005-2006
Totala
≥1 CD4 or VLc
≥1 CD4 or VL Chi-Square p-Value
No. (%)
No. (%)b
Male 149 (6.8) 112 (5.1) 1,454 (66.1) 484 (22.0) 2,199 (71.7) 1,715 (78.0) Reference
Female 53 (6.1) 53 (6.2) 586 (67.6) 174 (20.1) 866 (28.3) 692 (79.9) 0.25
Black/African American 117 (8.0) 60 (4.1) 900 (61.5) 386 (26.4) 1,463 (47.7) 1,077 (73.6) < 0.001
Hispanic/Latino 18 (5.1) 16 (4.5) 267 (73.6) 61 (16.9) 362 (11.8) 301 (83.1) 0.99
White 51 (4.8) 75 (7.1) 755 (71.3) 179 (16.9) 1,059 (34.6) 880 (82.1) Reference
Multiple races/Other raced 16 (8.8) 14 (7.7) 118 (65.4) 33 (18.1) 181 (5.9) 148 (81.9) 0.69
13-29 49 (5.3) 45 (4.8) 575 (62.1) 257 (27.7) 926 (30.2) 669 (72.3) 0.03
30-39 56 (6.3) 50 (5.6) 579 (64.9) 208 (23.3) 893 (29.1) 685 (76.7) Reference
40-49 62 (7.6) 44 (5.4) 571 (70.3) 136 (16.8) 813 (26.5) 677 (83.2) < 0.001
≥50 34 (7.9) 27 (6.2) 315 (72.5) 58 (13.4) 434 (14.2) 376 (86.6) < 0.001
Transmission Category
Male Adult or Adolescent
Male-to-male sexual contact 86 (5.5) 79 (5.0) 1058 (67.5) 344 (21.9) 1,567 (71.3) 1,223 (78.1) Reference
Injection drug use 23 (11.8) 8 (4.4) 116 (60.7) 44 (23.1) 191 (8.7) 147 (76.9) 0.71
Male-to-male sexual contact and injection drug use 17 (10.8) 5 (3.4) 103 (66.3) 30 (19.5) 156 (7.1) 126 (80.5) 0.49
Heterosexual contacte 21 (7.6) 18 (6.4) 171 (62.1) 66 (24.0) 275 (12.5) 209 (76.0) 0.45
Other 2 (21.6) 1 (14.7) 6 (62.6) 0 10 (0.4) 10 (100.0) f
Female Adult or Adolescent
Injection drug use 12 (7.2) 14 (8.3) 118 (69.1) 26 (15.4) 171 (19.8) 145 (84.6) 0.07
Heterosexual contact 39 (5.8) 39 (5.7) 458 (67.0) 148 (22.4) 684 (79.0) 536 (77.6) Reference
Other 1 (13.5) 0 9 (82.6) 0 11 (1.2) 11 (100.0) f
Colorado 24 (5.3) 16 (3.6) 338 (76.7) 63 (14.3) 440 (14.4) 377 (85.7) < 0.001
Indiana 28 (5.9) 19 (4.1) 307 (65.5) 114 (24.4) 468 (15.3) 354 (75.6) 0.61
Louisiana 89 (10.0) 30 (3.3) 568 (63.5) 208 (23.2) 895 (29.2) 687 (76.8) Reference
Michigan 41 (7.6) 17 (3.2) 327 (60.6) 154 (28.6) 540 (17.6) 386 (71.4) 0.02
New York 20 (2.7) 83 (11.5) 500 (69.3) 119 (16.5) 722 (23.5) 603 (83.5) < 0.001
Facility of Diagnosis
Private physician/HMO 20 (4.2) 30 (6.3) 346 (73.1) 78 (16.5) 474 (15.5) 396 (83.5) 0.08
Emergency room/Inpatient clinic 87 (13.3) 27 (4.2) 457 (69.7) 84 (12.9) 656 (21.4) 571 (87.1) Reference
Adult HIV clinic 10 (8.0) 6 (5.0) 104 (79.8) 9 (7.2) 130 (4.2) 120 (93.0) 0.008
HIV counseling and testing site 18 (5.2) 13 (3.7) 151 (44.0) 161 (47.1) 342 (11.2) 181 (52.9) <0.001
STD clinic 14 (11.4) 2 (1.8) 54 (45.1) 50 (41.7) 119 (3.9) 69 (58.3) < 0.001
Correctional facility 4 (4.1) 4 (4.2) 66 (65.0) 27 (26.6) 102 (3.3) 75 (73.4) 0.01
Other clinic 17 (4.0) 20 (4.9) 230 (55.1) 150 (36.0) 417 (13.6) 267 (63.9) <0.001
Unknown 32 (3.9) 62 (7.6) 633 (76.7) 98 (11.9) 825 (26.9) 727 (88.1) 0.02
Total 202 (6.6) 165 (5.4) 2,040 (66.6) 659 (21.5) 3,065 2,406 (78.5)
b The total percent represents the column percent.
c Data in this column (≥1 CD4 or VL) are not included in the column total.
d Other race: American Indian/Alaska Native, Asian, or Native Hawaiian/Other Pacific Islander.
e Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
f The Chi-square test is invalid due to small cell size.
Opportunistic Illnesses Reported within 3 Months Following HIV Diagnosis Among Adults and Adolescents in 5 States with Enhanced Data Collection, by CD4 Result, 2005-2006
CD4 Count ≥200 Cells/µL or ≥14%
CD4 Count <200 Cells/µL or <14%
No CD4 Result
Overall OIs
OI within 3 months 6 1.7 372 98.3 0 0 378
OI with incomplete diagnosis date (missing mo.) 0 0 1 100 0 0 1c
No OI within 3 months 1,179 43.9 714 26.5 792 29.5 2,686
Total 1,185 1,087 792 3,065
Individual OIs No. % No. % No. % No.
Pneumocystis jiroveci pneumonia 1 0.5 196 99.5 0 0 197
Candidiasis, Esophageal 1 1.3 83 98.7 0 0 84
Wasting Syndrome 0 0 37 100 0 0 37
Candidiasis of Bronchi, Trachea, or Lungs 0 0 12 100 0 0 12
Cytomegalovirus Disease 0 0 26 100 0 0 26
Toxoplasmosis of Brain 3 14.3 19 85.7 0 0 22
Cryptococcosis 0 0 16 100 0 0 16
Histoplasmosis 0 0 14 100 0 0 14
M. tuberculosis, Disseminated or Extrapulmonary 0 0 12 100 0 0 12
Encephalopathy, HIV-related 0 0 11 100 0 0 11
Herpes simplex 0 0 11 100 0 0 11
Mycobacterium avium complex or M. kansasii 0 0 11 100 0 0 11
Kaposi's Sarcoma 0 0 16 100 0 0 16
Pneumonia, Recurrent 1 10.1 10 89.9 0 0 11
Cytomegalovirus retinitis 2 25.0 6 75.0 0 0 8
M. tuberculosis, Pulmonary 0 0 6 100 0 0 6
Lymphoma, Immunoblastic 0 0 4 100 0 0 4
Lymphoma, Burkitt's 0 0 3 100 0 0 3
Cryptosporidiosis 0 0 3 100 0 0 3
Coccidiodomycosis 0 0 2 100 0 0 2
Lymphoma, Primary, of Brain 0 0 2 100 0 0 2
Mycobacterium, Other Species 0 0 2 100 0 0 2
Progressive Multifocal Leukoencephalopathy 0 0 1 100 0 0 1
Totalb 8 1.6 503 98.4 0 0 511
Note. CD4 = CD4+ T-lymphocyte count (cells/µL) or percentage.
a The following OIs were not represented in this population: Cervical Cancer (Invasive), Isosporiasis, Salmonella Septicemia (adult only).
b The total individual OIs do not add up to the total OIs (n=378), as some cases were diagnosed with more than one OI.
c One case had a missing CD4 specimen collection date and could not be categorized by CD4 result.
Blacks/African Americans were less likely to have a CD4 or VL test performed (73.6%) within 3 months of HIV diagnosis than whites (82.1%, p<0.001) (Table 3). Persons aged 13-29 were also less likely to have a CD4 or VL test performed (72.3%), as compared to persons aged 30 and above (30-39 years: 76.7%, 40-49 years: 83.2%, ≥50 years: 86.6%). Across the five states, there were significant differences in the percentage of persons with a result from at least one CD4 or VL test. The percentage of persons with a CD4 or VL test result also varied by the facility of diagnosis; 93.0% at adult HIV clinics to 52.9% at HIV counseling and testing sites. No significant differences were found between the percentage of persons with at least one CD4 or VL test result among males and females or across transmission categories.
The most frequently reported OI was Pneumocystis jiroveci pneumonia (PCP) (38.6%, 197/511), followed by Esophageal Candidiasis (16.4%, 84/511), and Wasting Syndrome (7.2%, 37/511) (Table 4). Of the 378 persons with an OI diagnosed within 3 months of HIV diagnosis, a larger percentage of OIs was found among persons with a CD4 result of <200 cells/µL or <14% (98.3%) as compared to persons with a CD4 result of ≥200 cells/µL or ≥14% (1.7%).
Enhanced data collection appears to have resulted in more complete data and therefore a more accurate measurement of stage of disease and linkage to care. The proportion of persons classified as stage unknown within 12 months of diagnosis was larger in the comparison populations, with 25.4% and 30.3% in Population A and B, respectively, compared to 17.0% among cases with enhanced data collection (Table 1). As the time between HIV diagnosis and the first CD4 test performed increased from 3 months to 6 and 12 months, the percentage of persons classified as stage unknown decreased in all populations.
Persons in the five states with enhanced data collection (Table 2A) were more likely to have at least one CD4 or VL test result at 12 months after diagnosis (86.4%) compared with persons in Population A (79.8%, p<0.001, Table 2B) or Population B (80.4%, p<0.001, Table 2C). Within 3 months of HIV diagnosis, 78.5% of persons with enhanced data collection had a result from at least one CD4 or VL test, as compared to 68.1% and 74.7% in Population A and B respectively. Persons in the five states were also more likely to have an OI reported to surveillance within 3 months of diagnosis during the time of enhanced data collection than during the previous year (Population A) (12.3% vs 10.6%, p=0.02), data not shown.
Enhanced collection of laboratory data through the utilization of data in existing databases, strengthened active surveillance efforts, the identification of labs not reporting to surveillance, and an increased number of electronic reports, improved the completeness of CD4, VL, and OI data in national HIV surveillance. Although no true standard was available for comparison, the percentages of persons diagnosed with HIV who had stage of disease assigned or who were linked to care were up to 10% higher with the enhanced data collection.
The collection of more complete data provides a more accurate picture of disease severity and linkage to care. Based on CD4 and VL laboratory tests performed within 3 months following diagnosis, we estimated that 78.5% of persons diagnosed in the five states were linked to care. This finding is somewhat higher than what was observed through an analysis of persons newly diagnosed with HIV infection in New York City, where the time between the first positive Western blot test and the first CD4 and/or VL result reported to surveillance was used to indicate the time period from the initial HIV diagnosis (non-AIDS) to the first HIV-related medical care visit [6]. Of 1,928 newly diagnosed persons in New York City in 2003, an estimated 63.7% initiated care within 3 months of diagnosis.
Overall, linkage to care needs strengthening to reach the goal outlined in the National HIV/AIDS Strategy of 85% of newly diagnosed patients linked to clinical care within 3 months of diagnosis [7]. We found a significantly higher proportion of persons with no CD4 or VL test results among blacks/African Americans as compared to whites which suggests that a racial disparity may exist among newly diagnosed persons who receive care. This finding is consistent with other studies that have documented an association between racial factors and disparities in HIV-related healthcare [8-11] and may be related to a complex interaction between health care, public health, and social factors [12]. These data also show that younger persons aged 15-29 were less likely to have a CD4 or VL test, as compared to persons aged 30 and above. The disparity seen in age may be a function of the large proportion of young adults that are uninsured [13], and serves to highlight the potential gap in accessing care between age groups. Additional interventions are needed to meet the goals of the National HIV/AIDS Strategy on linkage to care and the reduction of HIV-related disparities.
The initiation and frequency of laboratory testing and interpretation of laboratory results can be used to make inferences about the quality of health care that HIV-infected persons receive. Laboratory testing that occurs shortly after HIV diagnosis implies the successful linkage to health care. Serial CD4 and VL testing suggests utilization of ongoing care compared with a one-time visit. If the frequency of serial laboratory tests meet clinical management testing guidelines (e.g., every 3-4 months after initial diagnosis baseline measurement), it suggests receipt of higher quality care than less frequent laboratory testing would.
Persons without CD4 or VL testing following HIV diagnosis may represent persons with unmet healthcare needs. To address unmet healthcare needs and develop effective interventions, it is important to understand the barriers to accessing care such as lack of health insurance coverage [14, 15], unsuccessful patient notification of positive HIV test results [16-18], denial, poverty, mental illness, lack of transportation, and homelessness [19-21]. States have a responsibility to provide unmet health care need estimates to the Health Resources and Services Administration (HRSA), which oversees the Ryan White CARE Act. Surveillance data could be used to provide estimates of persons not in care and, therefore, assist states in meeting this federal reporting obligation.
OI data can be a useful indicator of clinical outcomes for HIV-infected persons in care. Based on OI data reported within 3 months following diagnosis, we estimated that 12.3% of persons diagnosed in the five states had at least one OI; PCP was the most frequently reported. A similar finding was observed through an analysis of a population-based survey of persons in HIV-related medical care in King County Washington, selected health districts in Louisiana, and the state of Michigan [22]. Of all HIV-infected persons in care in these areas in 1998, 11.3% (CI, 8.8–13.9) had at least one OI diagnosis and PCP was the most commonly diagnosed.
There are some limitations to consider when interpreting our findings. First, if laboratory data reported to surveillance are incomplete, the methods outlined may underestimate the prevalence of persons with access to medical care. In addition, the contribution of individuals who may be diagnosed in a jurisdiction reported to a state HIV program but then leave the state is unknown. From the local surveillance perspective, these individuals may not have begun care (i.e., evidence of lab testing) but received care after they moved out of jurisdiction. In Louisiana, the number of cases reported to surveillance and the completeness of laboratory data collected after August 2005 was impacted by Hurricane Katrina, as several clinical sites were closed and complete medical record abstraction was not possible.
In jurisdictions that have laws or regulations for laboratory reporting of all HIV-related tests, private and public laboratories must report all test results to the respective health departments. During the data collection period, changes in CD4 and VL reporting laws may have contributed to improvements seen in the completeness of laboratory reporting. For example, the laboratory reporting requirements were significantly broadened in New York State in June 2005, the start of the 12-month diagnosis period, to require the reporting of any VL result and all CD4 counts and percentages. Prior to this change, only detectable VLs and CD4 counts less than 500 cells/µL or percentages less than 29% were reportable. In July 2005, Michigan also revised their regulations to require the reporting of all CD4 and VL results.
In general, surveillance programs believe they are receiving the vast majority of HIV test results; but, unless a state is actively monitoring the number of laboratories reporting to them and the volume of reports, they cannot know for certain. Instances where laboratory testing may change (e.g., the provider decides to use another laboratory or the primary laboratory contracts with a new laboratory for specialized testing) may not necessarily be identified by a surveillance program. Active surveillance and medical record abstraction can help to obtain more complete laboratory data and identify laboratories that may not be reporting to HIV surveillance. The electronic transmission of HIV-related laboratory test results enhances the completeness, timeliness, and accuracy of reporting to surveillance programs [23]. Although many surveillance programs have received data electronically for years, many still need improvements or enhancements to implement and maintain the system. HIV surveillance programs are currently using software called eHARS that has the capacity for storage of all laboratory results and the ability for electronic laboratory data to be imported. To ensure that all laboratory results are reported to surveillance at the national level, state and local surveillance programs must ensure that all laboratory results, including those stored in auxiliary databases, are entered into eHARS software and transmitted to CDC.
The National HIV/AIDS Strategy proposes to reduce new HIV infections, increase access to care and improve health outcomes for people living with HIV, and reduce HIV-related disparities [8]. Data collected through the national HIV surveillance system can be used to monitor the outcomes of the national strategy; however the validity of these measures is dependent upon the completeness and quality of surveillance data. Monitoring outcomes such as linkage to care and racial/ethnic disparities among persons who are virally suppressed is particularly dependent upon complete reporting of all HIV-related laboratory results to surveillance.
a HIV/STD/VH/TB Epidemiology Section, Division of Communicable Diseases, Bureau of Epidemiology, Michigan Department of Community Health, Lansing, MI, USA.
b Bureau of HIV/AIDS Epidemiology, AIDS Institute, New York State Department of Health, Albany, NY, USA.
c Disease Control and Environmental Epidemiology Division, Colorado Department of Public Health and Environment, Denver, CO, USA.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention
The authors would like to acknowledge Elizabeth Hamiltona, Maria Kouznetsovab, and Pamela Montoyac of the Laboratory Reporting Workgroup for their contribution to this project.
None of the authors have a reported financial, consultant, institutional or other conflict of interest in the publication of this manuscript.
[1] Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. January 10, 2011. Rockville, MD: Department of Health and Human Service Available at: http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf [Accessed: December 7, 2011];2009
[2] Centers for Disease Control and Prevention. Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults, 1993 MMWR Morb Mortal Wkly Rep 1992; 41(RR-17): 1-19.
[3] Centers for Disease Control and Prevention. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years--United States, 2008 MMWR Morb Mortal Wkly Rep 2008; 57(RR-10): 1-12.
[4] Song R, Hall HI, Frey R. Uncertainties associated with incidence estimates of HIV/AIDS diagnoses adjusted for reporting delay and risk redistribution Stat Med 2005; 24(3): 453-64.
[5] McDavid HK, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach Public Health Rep 2008; 123(5): 618-27.
[6] Torian LV, Wiewel EW, Liu KL, Sackoff JE, Frieden TR. Risk factors for delayed initiation of medical care after diagnosis of human immunodeficiency virus Arch Intern Med 2008; 168(11): 1181-7.
[7] Office of National AIDS Policy. National HIV/AIDS Strategy. Washington, DC: Office of National AIDS Policy; Available at: http://www.whitehouse.gov/administration/eop/onap/nhas 2010 [Accessed: February 25, 2011];
[8] Gebo KA, Fleishman JA, Conviser R, et al. Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001 J Acquir Immune Defic Syndr 2005; 38(1): 96-103.
[9] Keruly JC, Moore RD. Immune status at presentation to care did not improve among antiretroviral-naive persons from 1990 to 2006 Clin Infect Dis 2007; 45(10): 1369-74.
[10] Mugavero MJ, Lin HY, Allison JJ, et al. Racial disparities in HIV virologic failure: do missed visits matter? J Acquir Immune Defic Syndr 2009; 50(1): 100-8.
[11] Ulett KB, Willig JH, Lin HY. The therapeutic implications of timely linkage and early retention in HIV care AIDS Patient Care STDS 2009; 23(1): 41-9.
[12] Lurie N, Dubowitz T. Health disparities and access to health JAMA 2007; 297(10): 1118-21.
[13] Voelker R. Health reforms called a "graduation gift" for young adults who lack insurance JAMA 2010; 304(2): 147.
[14] Turner BJ, Cunningham WE, Duan N, et al. Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus Arch Intern Med 2000; 160(17): 2614-2.
[15] Stein MD, Crystal S, Cunningham WE, et al. Delays in seeking HIV care due to competing caregiver responsibilities Am J Public Health 2000; 90(7): 1138-40.
[16] Eichler MR, Ray SM, del Rio C. The effectiveness of HIV post-test counseling in determining healthcare-seeking behavior AIDS 2002; 16(6): 943-5.
[17] Sullivan PS, Lansky A, Drake A. Failure to return for HIV test results among persons at high risk for HIV infection J Acquir Immune Defic Syndr 2004; 35(5): 511-8.
[18] Hightow LB, Miller WC, Leone PA, Wohl D, Smurzynski M, Kaplan AH. Failure to return for HIV posttest counseling in an STD clinic population AIDS Educ Prev 2003; 15(3): 282-90.
[19] Raveis VH, Siegel K, Gorey E. Factors associated with HIVinfected women's delay in seeking medical care AIDS Care 1998; 10(5): 549-62.
[20] Konkle-Parker DJ, Amico KR, Henderson HM. Barriers and facilitators to engagement in HIV clinical care in the Deep South: results from semi-structured patient interviews J Assoc Nurses AIDS Care 2011; 22(2): 90-.
[21] Horstman E, Brown J, Islam F, et al. Retaining HIV-Infected Patients in Care: Where Are We? Where Do We Go from Here? Clin Infec Dis 2010; 50: 752-61.
[22] Sullivan PS, Denniston M, McNaghten A, Buskin SE, Broyles ST, Mokotoff ED. Use of a population-based survey to determine incidence of AIDS-defining opportunistic illnesses among HIV-positive persons receiving medical care in the United States AIDS Res Ther 2007; 12; 4: 17.
[23] Effler P, Ching-Lee M, Bogard A, et al. Statewide system of electronic notifiable disease reporting from clinical laboratories JAMA 1999; 282: 1845-50.
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Published Contents
Reasons for Antiretroviral Treatment Change Among Adult HIVAIDS Patients at Nedjo General Hospital, Western Ethiopia
Correlation of High Interleukin 17A and Interleukin 6 Levels with High Virus Load Among Subtype C HIV-infected, Antiretroviral Therapy-naive Zimbabwean Patients: A Cross-sectional Study
Pre-Exposure Prophylaxis (PrEP) in Men Who have Sex with Men in Bouaké, Côte d'Ivoire: A Qualitative Evaluation of Acceptability
Immunologic Restoration of People Living with Human Immunodeficiency Virus on Highly Active Anti-retroviral Therapy in Ethiopia: The Focus of Chronic Non-Communicable Disease Co-Morbidities
Inconsistent Use of Condom in Italian HIV-Serodiscordant Heterosexual Couples as Revealed by the Detection of Y Chromosomal (Yc) DNA in Vaginal Swabs
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Turkey cooperating with Israel to help Gaza
SERVET YANATMA / ANKARA
Turkey is cooperating with Israel to provide humanitarian aid to Gaza and has sent an official from the Turkish Red Crescent (Kızılay) to the country.
Diplomatic sources confirmed that an official from the Turkish Red Crescent went to Israel to coordinate humanitarian aid to be sent to Gaza. "There is no other way to provide aid to Gaza," said the sources on Thursday. Dismissing claims that the Turkish official will be negotiating a cease-fire between Israel and Gaza, sources said Turkey is only in contact with the officials from Hamas and the US regarding the Palestinian territory.
Since the start of the Israeli offensive in Gaza, top Turkish officials have adopted a strong stance against Israel, using harsh political language against the country because of its attacks targeting Palestinians. However, leaders and lawmakers from opposition parties have heavily criticized the Turkish government, saying that its reaction against Israeli attacks on Gaza is merely rhetoric.
Turkey declared a three-day period of mourning last week for Palestinian victims killed in the Israeli offensive in the Gaza Strip.
Turkish charity Kimse Yok Mu (Is Anybody There) launched an aid campaign recently for the people of the Gaza Strip and called for more humanitarian aid to the region.
Since the start of the campaign, members of the foundation have distributed food, blankets, household goods and other items to victims in Gaza, recently increasing the amount of humanitarian aid to those affected by the Israeli military's air and ground attacks.
In an effort to heal the pain the people of Gaza are suffering, Kimse Yok Mu hosted an iftar for 13,000 people, delivered food to 2,000 families, delivered household goods to 200 families and sent blankets to 350 families. The foundation also drilled a well there, as thousands of people are struggling with hunger and thirst, in addition to delivering milk to 1,000 children so far.
Kimse Yok Mu doctors also extended a helping hand to the Gazans who were injured during attacks by the Israeli army by performing free surgeries and providing medical relief. The charity also launched a donation campaign to enable the purchase of medical supplies.
Kimse Yok Mu is also repairing houses that were damaged during the Israeli attacks on Gaza residents. The foundation has not forgotten about the children, delivering 1,750 liters of milk along with 1,215 packages of diapers to families with children.
Source: Today's Zaman , July 31, 2014
Tags: Humanitarian aid | Palestine | Turkey |
Advisor's claim has potential to accelerate AK Party's downfall
Amid a deepening high-profile corruption scandal that has seriously damaged the government's reputation, a claim made by a senior advisor to Prime Minister Recep Tayyip Erdoğan has the potential to bring the military back to the political scene, carrying the risk of accelerating his party's downfall from power.
My husband is being tortured and I am worried about his life
My husband was in an exhausted state when he got into the room. There were punch marks on his face. He was suffering psychologically; he begged not to go back down to the detention room. He was saying "If you wish to give me 50 years in prison, do so, but do not take me down there".
Turkish Olympiads and achieving peace
ORHAN OĞUZ GÜRBÜZ A utopia ushers in a new era. We explore and take courageous actions thanks to our dreams of what is possible. Turkish colleges around the world are sponsored by entrepreneurs who are members of a movement in Turkey that has made serious progress in creating this utopia. If you describe languages, religions, […]
Coup attempt in 2016 was Erdoğan's Reichstag fire
The failed coup attempt on July 15, 2016 in Turkey and the infamous Reichstag fire in Germany in 1933 had many similarities, with both allowing the leaders of those countries to amass more power to oppress their opposition, journalist Can Dündar said in his commentary for German Radio Cosmo on Thursday.
Turkish headmaster accused of Isis links met Malaysian PM, not fit profile of an Isis operative
Karaman, who was the principle of a prestigious international school that promotes critical thinking as well as holding his post with the Malaysian-Turkish Dialogue Society, does not fit the stereotypical profile of an Isis operative.
Turkey's trampling of freedoms is Europe's problem too
Johanna Vuorelma Today's Turkey is not the same Turkey that I experienced 10 years ago when I first lived there. Those years were filled with optimism, greater civil liberties, significant steps towards democracy, a booming economy and international admiration. Universities had become spaces for critical debates, opening new channels for discussions about some of the […]
Turkish teacher jailed over Gülen links dies in prison due to lack of medication
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US says it does not consider Gülen movement a terror organization

redpajama_set_name: RedPajamaCommonCrawl


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MONTFORD POINT MARINES OF MICHIGAN, INC.
The Congressional Gold Medal Awarded by President Barack Obama
Detroit, MI -- (ReleaseWire) -- 05/21/2014 --Former mayor of New York City, David N. Dinkins, WWII Congressional Gold Medal Recipient, will be Keynote Speaker at the Montford Point Marines Annual Heritage Military Banquet & Special Congressional Gold Medal Ceremony. Ambassador Theordore R. Britton will be co-guest at the Montford Point Marines Annual Heritage Military Banquet being held at the Shriners Silver Garden in Southfield, MI. He will appear along with distinguished keynote speaker, David N. Dinkins, former mayor of New York City. These highly influential men are prime examples of excellence and lofty contributions made to society by many black Marines after WWII.
In his early youth, David Norman Dinkins remembers having grown up in Harlem during the Great Depression. He states, "we were poor as hell, but I didn't know that we were poor". He just thought that was the way life was then. In the summer of 1944, he was a teenager headed into his senior year of high school when WWII was in full force. In those days, he says, "no one thought of not going to war". The only branch of service he was familiar with was the Marines, who wore a very handsome uniform with the so called "bucket of blood" running down each trouser leg. Although he was only 125 pounds, he knew he was tough, determined, and ready, so he sought to join the Marines. /after being denied several times, he went to several different cities to get recruited, and only with much persistence did he finally succeed. As he became more aware, he discovered that the armed forces were segregated during the Jim Crow era, as was the Marine Corps when he trained at Camp Montford Point, Camp Lejuene, N.C. He was disturbed that black Marines were being beaten and harassed for wearing the Marine Corps uniform. Unfortunately, it was time when black people were still being murdered because of their skin color. WWII prisoners of war were treated better than blacks wearing the uniform of the United States armed forces. However, in June, 2012, David Dinkins became a recipient of the famed Congressional Gold Medal along with other WWII era Montford Point Marines in Washington, D.C.
David Dinkins had never though of going to college after high school, but after being discharged from the Marine Corps he found that the GI Bill made going to college more affordable. H is beloved stepmother made is possible for him to get accepted into Howard University where he developed a taste for representative democracy and later majored in mathematics. In 1950 he graduated cum laude from Howard University as a member of the Alpha Phi Alpha fraternity, and in September, 1953, he enrolled into the Brooklyn Law School, and passed the bar exam in 1956. Some years later Mr. Dinkins became involved politics where he supported the Democratic Party , and eventually served in the New York State Assembly -78th District (1965-67), and Manhattan Borough President of Manhattan (1986-89). After several unsuccessful attempts in the run for mayor, in January, 1990 he successfully became the 106th Mayor of New York City, and the first of African-American descent. Mayor David Dinkins writes about his experiences In his autobiography entitled; "A Mayor's Life: Governing new York's Gorgeous Mosaic". Currently, Mayor Dinkins works with New York City, University's School of International & Public Affairs and serves on the advisory board.
Detroit- In January, 1944 a teen-ager from New York named Theodore Britton took the oath to join the U.S. Marine Corps with the desire to be in the thick of combat where the action was during WWII. However, he was unaware of the extent of the harshness of racial inequality, because he thought after all, that was something relegated mostly to the southern states. It was not until he deployed to the Pacific islands, that he was given a job that did not involve combat duty, giving him more time read Marine Corps regulations than fight the enemy. At that point he discovered a disappointing reality; men of color could not be in charge of white Marines in their units, regardless of their rank. Although they had been trained to fight, black Marines were assigned mostly to defense battalions and depot companies as opposed to assault combat units. As a consequence of widespread racism and discrimination many black Marines never received recognition or promotions they deserved, particularly those who ended up in combat units fighting on Saipan, Okinawa, Iwo Jima, and other combat hotspots in the Pacific. But, young Theordore Britton had the perseverance to excel beyond the challenge of being black in Marine Corps, at a time when it was common to be thought of inferior and incapable of making "good" Marines.
After, the Marine Corps, Theordore Britton became a graduate of New York University, obtaining a degree in Banking and Finance, and was later awarded the degree of Doctor of Laws-Honoris Causa, by Kristal University, in Tirana, Albania. In the 1980's he was appointed as Ambassador and Honorary Consul General of the Republic of Albania. He has maintained a life-long interest in foreign diplomatic and international affairs, and travels frequently to various countries giving a series of lectures and speeches at famed Universities and other venues. Ambassador Britton served as Chief of Mission to Barbados and to the State of Grenada, from 1974-1977 with the rank of ambassador Extraordinary Plenipotentiary. Also, he served concurrently as the US Special Representative to the States of Antigua, Dominica, St. Christopher-Nevis-Anguilla, St. Lucia, and St. Vincent. In June, 2012, Ambassador Britton was among the remainder of those 20,000 black WWII Marines who trained at the segregated Camp Montford Point between 1942-1949 that were invited to Washington, D.C. to receive the Congressional Gold Medal signed into law by President Barack Obama.
President of the Montford Point Marines of Michigan, Robert Middleton; says the presence of these two great men are a great inspiration to those black Marines in living in the Detroit area, particularly those whom a special Congressional Gold Medal ceremony which has been planned for those who missed the opportunity to receive the award.
For more information, contact Mr. Middleton at 313-300-0165 or email: rmiddleton_@hotmail.com
Robert B. Middleton
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Source: MONTFORD POINT MARINES OF MICHIGAN, INC.
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text:
Bridge inspections to be done overnight
Gloucester Times
The suspension of the traffic-tangling inspection work and lane closures on the A. Piatt Andrew Bridge lasted less than 24 hours.
The inspection work resumed Wednesday morning, despite being�cut short Tuesday because "traffic conditions" on the bridge spawned backups of a mile or more Monday and Tuesday.
"conducted during overnight hours moving forward,"
Backups to delay bridge inspection
The A. Piatt Andrew Bridge is undergoing an inspection that was scheduled to include lane closures for much of two weeks. But the state's Department of Transportation...
Gloucester Times 2019-07-10
Road and bridge work to begin July 8 in Utica
Advertisement UTICA — Road construction season is in full swing and road work in Utica is planned to begin on M-59 and the bridge between Utica Road and Van Dyke Avenue as...
C&G News 2019-06-28
MDOT suspending Oakland County construction over Fourth of July holiday
The Michigan Department of Transportation will suspend most of its Oakland County construction projects during the holiday break.� Beginning at 3 p.m. on Wednesday, July 3,...
The Oakland Press 2019-07-02
Traffic Pattern Shifting at Route 36 Bridge Replacement Project
CLEARFIELD — The traffic pattern for a bridge replacement project in Newburg Borough, Clearfield County, is scheduled to change today, Monday, July 8, the Pennsylvania...
Courier Express 2019-07-08
Two projects to cause minor delays on interstate
Overnight, contract crews will be working on Interstate 65 between mile markers 83 and 88 to perform corrective work. According to a Transportation Cabinet statement, repairs are expected to begin around 7 tonight on northbound lanes. Upon completion, the crews will shift to southbound lanes. The cabinet said only minor delays were expected and crews expected to complete the...
The News-Enterprise
I-35 reduced to two lanes each way July 12-15 for St. Johns Avenue bridge demolition, ...
 Drivers on I-35 can expect traffic delays and congestion July 12-15 as the Texas Department of Transportation reduces lanes for road work. TxDOT will reduce traffic in both directions on I-35 between Rundberg Lane and Hwy. 290 to two lanes starting at 9 p.m. July 12 through 5 a.m. July 15, according to a news release from TxDOT. On the northbound side, traffic will shift to...
More busing ahead for local T riders
Commuter rail riders taking the train between Cape Ann and Boston's North Station will have two more weeks of riding shuttle buses to get to and from the train. The Massachusetts Bay Transportation Authority has extended the shuttle services at Rockport and Gloucester's main station on Railroad Avenue to the West Gloucester station for another two weeks. All riders will...
State to rehab six Capital Region bridges
The state has awarded a $4.6 million contract to rehabilitate six bridges on state highways in Saratoga, Albany and Warren counties over the next two years, Gov. Andrew Cuomo announced Wednesday. The first bridge being repaired is the Butler Road Bridge over the Adirondack Northway in the town of Moreau, Saratoga County, just south of the Hudson River. The bridge carries...
The Daily Gazette
More bridge work starts July 15
https://www.thetelegraph.com/news/article/More-bridge-work-starts-July-15-14079726.php More bridge work starts July 15 Published 2:48 pm CDT, Monday, July 8, 2019 The Illinois Department of Transportation has announced that the eastbound exit ramp from Interstate 55/64 to southbound Illinois 3 will be closed beginning next week. Extensive delays are expected at this location...
The Telegraph - Alton
MDOT Lifts Traffic Restrictions To Ease Fourth of July Travel
(CBS DETROIT) – The Michigan Department of Transportation is removing lane restrictions on more than two-thirds of its road and bridge projects statewide to ease traffic delays for holiday travelers. Beginning at 3 p.m. Wednesday, July 3, and continuing until 6 a.m. Monday, July 8, 101 out of 143 projects statewide will have lane restrictions removed. While motorists will see...


Haslab HC68 Calcarea Complex Tablets is indicated for Flashes of light before eyes, immature cataract spot on the cornea. Warts on the upper lids, corneal opacity. Vision double, dim and blurred. Aching in posterior part of the orbit. Twitching sensation in eyes and lids.
Contains: Cauticum, Calfour, Nat, M, Sulphur, Silica.
Dosage 2 tab. 2-3 times daily. With constant use of Cineraria Maritima Senecio shall prevent further progression of Cataract.


Sweet dried tobacco leaf, aromatic spices & rich honey muddled with cocoa, Tonka Bean, tobacco flower and a layer of dried fruit and exotic wood. Ingredients: filtered water, alcohol, essential oils and finely distilled perfume oils.
All perfumes and colognes are FINAL SALE.


Mandarin Moon is one of two organic Eau de Perfumes from RAAW by Trice, the Danish/ L.A. brand which holds quality, beauty and sustainability high, and has great packaging!
This perfume took me back to exotic holidays in Vietnam when I first tried it. This scent it is full of memories and perfect for warm skin and warm nights. The notes are Mandarin Blossom (this is note which reminds me of holidays in Asia I think) Bergamot, Cedar, Grapefruit and Vetiver. A subtle, fresh, sweet, airy and exotic smell.
The perfume is made with natural oils and organic cane-derived alcohol. You can get Mandarin Moon Eau de Perfume here. Here you can also buy a small sample size if your curious but want to find out if this is your scent before committing to the beautiful regular size with the classy spray function. I am currently also using this light face oil from Raaw which works really well in this warm weather.


Vewd, the global market player in enabling OTT, has announced that Adventure Sports Network (ASN), an OTT platform serving the ever-growing outdoor/adventure sports and lifestyle community, has debuted in the Vewd App Store. The Vewd App Store is available on devices manufactured by Sony, Samsung, TiVo, HiSense, and Vestel. ASN is part of The Enthusiast Network's Adventure Sports Group, the world's premier network of enthusiast brands in the action/outdoor market.


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Енциклопедія Кольєра (; повна назва — Енциклопедія Кольєра з бібліографією та покажчиком, ) — американська загальна енциклопедія, що була опублікована видавцем Кравелл, Кольєр та Макміллан (). Автори енциклопедії описали в передмові до Енциклопедії своє творіння як «наукове, систематично та безперервно поновлюване зібрання найбільш важливих для людства знань». Довгий час Енциклопедія Кольєра вважалася однією із трьох основних англомовних енциклопедій сучасності, разом із Американською () та Британською () енциклопедіями. Ці три енциклопедії інколи називали «the ABCs» (за першими буквами назв кожної з енциклопедій).

Історія
Під різними найменуваннями, Ециклопедія Кольєра публікувалася з 1902 по 1998 роки. В 1902–1929 роках P.F. Collier & Son Company видавали Нову енциклопедію Кольєра () спочатку в 16 томах, згодом — в 10. На зміну їй прийшла 11-ти томна Національна енциклопедія () (1932–1950). В 1949 році нова 20-ти томна Енциклопедія Кольєра змінила Національну енциклопедію.

Після смерті Роберта Кольєра в 1918 році, видавництво P.F. Collier & Son Company було придбане Crowell Publishing Company (згодом — Crowell-Collier Publishing Company). В 1950 році видавництво Crowell, Collier and Macmillan опублікувало 20-ти томну Енциклопедію Кольєра (повна назва — Енциклопедія Кольєра з бібліографією та покажчиком, ). В 1962 році видання було розширено до 24 томів. Паперова версія Енциклопедії припинила своє існування в 1998 році.

На 1997 рік, видання мало 23.000 статей, кількість малих заміток була невелика, адже пов'язані теми зазвичай об'єднувалися в довші статті. Велика частина ілюстрацій була кольоровою, особливо велика кількість кольорових зображень була додана в останні роки існування Енциклопедії. Бібліографія знаходилася в останньому томі, який також включав 450.000 найменувань енциклопедичного покажчику. В 1998 компанія Microsoft викупила права на електронну версію та включила її до своєї електронної енциклопедії Encarta. Atlas Editions (в минулому Collier Newfield) залишило за собою права на публікацію паперової версії книги, хоча з того часу жодного разу не видавало її.

Посилання
  Collier's Encyclopedia — Britannica

Енциклопедії США
Англомовні енциклопедії
Енциклопедії XX століття

redpajama_set_name: RedPajamaWikipedia


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Guiyang eliminates cap on new-vehicle sales
Guiyang, the capital of southwest China's Guizhou province, has become the first China city to heed Beijing's call to end restrictions on new-vehicle sales.
To ease local traffic congestion, Guiyang in 2011 started issuing special license plates for vehicles permitted to drive in its downtown area and capped the number of such plates to 2,000 per month.
Effective Sept. 12, the cap has been eliminated, the Guiyang city government said on its website.
Guiyang, with 4.9 million residents, had a fleet of 2.05 million vehicles at the end of 2018.
To spur the new-vehicle market, which is expected to fall for the second straight year in 2019, Beijing has repeatedly urged China's major cities to stop or dial back on practices that limit sales.
Among eight cities that restrict new-vehicle sales in one way or another, only three have raised caps.
In June, two south China cities -- Guangzhou and Shenzhen -- agreed to allow a respective 100,000 and 80,000 new vehicles to be sold locally from June 2019 to the end of 2020, on top of existing annual quotas.
Other cities haven't yet responded to the central government's appeal. They include China's two largest cities -- Shanghai and Beijing – and three provincial capitals -- Tianjin, Hangzhou and Shijiazhuang.
CATL estimates net profit soars in 2022
Market slides in early Jan. as COVID cases spike
CATL's German plant targets six battery cell production lines by the end of 2023
Sponsored Content: True Value of a Lifetime Customer to Your Dealership
Sponsored Content: CDK Global CEO on the future of the automotive retail experience
CHINA NEWSLETTER: Sign up for commentary by journalist Yang Jian and highlights from top manufacturer and supplier news from China, delivered on Thursdays.


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Composer, born 1960
Grow up in Umeå with his parents Solveig and Torsten and his ten year elder sister Kristina. At the age of thirteen he seriously started his music studies and considered the churchorgan as his instrument. His interest in composing started with his relative ability to improvise.
When started writing music in 1975 he eventually got more commisions. During the eighties after being invited as a guest composer at Mickery Theatre in Amsterdam and The Royal Drama Theatre in Stockholm he gradually considered himself more as a composer than a musician. In 2001 he became a member of the Swedish Composers Society (FST).
Until this day he has composed music for some 40 productions for theatre, radio and TV. Since 1993 he has gradually left TV and theatre productions and has worked almost exclusively with comissioned works. Among Björns compositions are works for ballets, operas, chamber orchestras, oratories, choirs and works for larger orchestras.
Björns inexhaustible love for acoustical instruments and "living" musicians has resulted in his straying further and further from the electronic influences in his composing.
"...strange...it seems as I am back at square one..., I must return uncompromisingly to the roots of the acoustical instruments to once again try and experience specifically every instrument I compose for."


Forever and a day More by Technovision Photography!
Here we have some beautiful pictures, that the team captured, for an equally beautiful couple.
Based out of Mumbai, is this season's gem- Technovision Photography. With them, your wedding will be in the right hands. From capturing meaningful images to giving you all the much needed comfort, their work is elegance with a touch of pure decadence. Here we have some beautiful pictures, that the team captured, for an equally beautiful couple, inside and out. So let's scroll down and look at the spectacle that he created.
The moments captured have done so much justice to all the happiness and love that was out pouring from this made-in-heaven union.
Wedding is an epic, once in a life time journey and each and every moment deserves a golden frame around it. Our Lensmen at Technovision makes every bit of the fun and extravaganza worth it.
The bond between the couple is like a good melody and lyric. And the way their journey, their friendship is documented is amazing and Technovision has managed to capture each and every bit of who they are at this exciting time of their lives.
So all you in-love couples, whether your wedding is the synonym of the uncommon élan or an eclectic blend of hip and totally awesome, now is the time to call Photographers at Technovision and book them for your big day.


A great dentist for a busy family.
Our family has been coming to The Smile Center for about nine years now. We live in Dickinson, so it's about an hour and a half drive to come here to The Smile Center.
The beauty of being a customer her is that they work around our schedule of five kids and various activities. We get down here every once in a while and so if something's going on, they work us into the schedule. We're really appreciative of that.
We can't speak highly enough of the care that Dr. Johnson and his staff give us here at The Smile Center. They are so accommodating, not only to people's schedules, but to their questions. They never make you feel foolish for asking something — maybe not even once or twice but three times — so that you're sure you understand it. He's always so patient with every question that we have.
We've had everything done from teeth cleaning to fillings to actual dental procedures like implants, veneers, and a wide spectrum of work has been done here to our immense satisfaction.
My name is Marlo, and Dr. Johnson and his staff make me and my family feel better about our smiles.


Candida - Bist auch du betroffen?
Beautiful flowers to brighten up your day.
I would like to be a dancer ...is it possible by me?
ATTENTION! Steemit Comment Phishing EXPOSED! Take a look how this guy try to steal passwords!


By including credit scoring techniques in their credit risk assessments, both auditors and credit rating agencies can substantially improve the accuracy profile of their failure predictions. Indeed, following the Model that European Rating House uses for its credit risk assessments, can increase the overall accuracy to more than 75% - even as high as 97%.
One judges the accuracy of failure prediction by looking at the reliability of its warning toward business failure in the following year. Advantages of more accurate warnings can be significant to issuers, investors, and society at large.


EQUILIBRIUM - release video from asia tour!
EQUILIBRIUM - release video with footage from their »Armageddon« asia tour!
2017-03-27 - German epic metallers, EQUILIBRIUM, released their current studio album, »Armageddon«, last year on August 12th, 2016 through Nuclear Blast. Once more, the band entered the European charts on high positions (#5 Germany, #11 Switzerland, #20 Austria).
To continue this great success, EQUILIBRIUM and support act SUIDAKRA went on a tour journey to Asia for their first time ever! Even though most of their lyrics are in German, they succeeded to enthuse hundreds of fans and to provide a remarkably atmosphere in several cities of China (Beijing, Shanghai, Hong Kong), Taiwan (Taipei) and Japan (Tokyo and Osaka).
Since this marks a huge success for a German band, they decided to share the best moments from this asia tour with their fans! That's why they have collected the best footage to sum them all up in a short video clip. Therefore, they can show you the euphoria of their Asian fans, as well as their first impressions and experiences of a tour in Asia. You should definitely not miss this video!
René (guitars) comments: "Our first tour in Asia was one of the most impressing experiences we've ever had with EQUILIBRIUM. This video is a small collection of footage we've made with our smartphones at the tour. We really hope to see Asia again soon!"
EQUILIBRIUM - to tour in spring 2018!
EQUILIBRIUM - release music video!
EQUILIBRIUM - tour kicks off tomorrow!
EQUILIBRIUM - "Armageddon Tour" trailer!
EQUILIBRIUM - "Armageddon" enters Charts!
EQUILIBRIUM - new album trailer released!
EQUILIBRIUM - "Armageddon" out now!
EQUILIBRIUM - official video clip released!
2016-08-09 18:00 - Today, German epic metal pioneers EQUILIBRIUM have released the official video clip of the brand new track "Eternal Destination" via YouTube.
EQUILIBRIUM - introduce new bass player!
EQUILIBRIUM - brand new song released!