□️ Powerful Navigation Pane: Gain an advantage with the robust Column Manager, Worksheet Manager, and Custom Favorites. □ Customizable Charts and Reports: Access a broad variety of additional charts and generate insightful reports that tell a story. ⏱️ Efficient Batch Operations: Why put in extra effort when you can work smart? Import, export, combine, and tweak data in bulk with ease. □ Superior Data Processing: Merge cells, remove duplicates, and perform advanced data conversions – all without breaking a sweat! □️ Over 300 Powerful Features: Kutools is packed with more than 300 advanced features, simplifying your work in over 1500 scenarios. Streamline intricate tasks and glide through your data like a pro. Ready to supercharge your Excel tasks? Harness the power of Kutools for Excel - your ultimate time-saving tool. Transform Hours into Minutes with Kutools for Excel! Click Finish and select a place to output the result. Click Next and select the column with special formats in the Data preview and check a format for it in Column data format section, then one by one to format the columns, also, you can skip the columns you do not need by checking the Do not Import column (skip) option. Click Import, and a dialog of Text Import Wizard opens, check Delimited option and click Next to go to step 2 of the Wizard, and then check Comma. In the Import Text File dialog, select a file you need to import. Select a cell which you will insert the CSV file and click Data > From Text. To keep the format of the contents CSV file, you can use the From Text utility to import the CSV file.ġ. In this case, you need to use below method. If you have Kutools for Excel, you can apply its Insert File at Cursor utility to quickly insert a CSV file or text file or Excel file or PRN file to the cell which cursor places.īut sometimes, there are some data with special formats such as the leading zeros in the CSV file, these special formats may be lost if the CSV file is opening through Excel as below screenshot shown. Click Open, and the CSV file has been opened in the Excel. Click File > Open > Browse to select a CSV file from a folder, remember to choose All Files in the drop-down list next to File name box. The most usually used method must be opening CSV file directly through Excel.ġ. In this article, I will talk about these two methods for you. To convert CSV file to Excel columns, actually, you can handle it through three different methods. How to quickly convert csv file to columns in Excel?
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Nipsey Hussle, “Deep Reverence”īig Sean felt “the world needs to hear n feel Nipsey presence” when he released the rapper’s posthumous collaboration from the first MC’s Detroit 2 album. “It’s trans women being murdered and this is all he can offer?” Good questions, and all Madlib’s sturdy, supportive beat can do is shrug, as producer and rapper realize this isn’t worth spending more than 70 seconds on anyway. “He really ’bout to write about me when the world is in smokes?” Noname wonders. Cole, whose biggest moment of the year came with this gently scalding Noname answer to his hectoring song-long subtweet “Snow on Tha Bluff.” The latter wisely responded by grabbing the always-on-time producer Madlib and whipping up this two-days-later eye roll at Jermaine and the patriarchal culture that emboldened him. Both rap vets toss in a few lines of lust, but the track shines brightest at its most introspective. And for his part, Rozay - who feels tailor-made for the beat - offers a poignant tribute to the late Kobe and Gigi Bryant while reflecting on his own mortality. “The revolution is the genocide,” opens Gibbs bluntly, a sentiment that he repeats three more times over the course of his verse. Freddie Gibbs & Rick Ross, “Scottie Beam”ĭon’t let the easygoing, piano-driven production from The Alchemist fool you - there’s little that’s lighthearted about these bars. On the snapping single, JT and Yung Miami dish out a masterclass on what you need to ace the program - and even Doja Cat takes a break from her popish escapades to serve as a guest lecturer on the spicy anthem. Doja Cat, “P-y Talk”Ĭity Girls proved why “P-y Talk” was the most expensive and challenging conversation for any male prospect when encountering a woman in 2020: If your bank account wasn’t fluent in designer bags, then you were better off tempering your expectations. As one of the standouts on February’s My Turn, the track showcased what Lil Baby would be capable of throughout the rest of the year. Part of the reason Lil Baby became so dominant in 2020 was because he could do it all: there was the calls for social justice on “The Bigger Picture,” the reveling in luxury on the 42 Dugg team-up “We Paid,” and then there was “Emotionally Scarred,” a deep dive into his pre-fame hardships told with stark descriptions and a range of emotion. Uzi was crazy for this one: previewing the most anticipated hip-hop release with a flip of Backstreet Boys’ “I Want It That Way,” and having both the conviction and pop smarts to pull it off? “That Way” reminded us that there were few things off-limits in Lil Uzi Vert’s musical universe, as he somehow turned an undying boy band smash into a melodic rap anthem that’s hard not to hum along to. It’s a feat in and of itself that they manage to keep it all sounding so fresh amid the torrid recording pace. On “War Paint,” Benny and Conway trade punches on powerhouse verses that brim with well-earned confidence (“I’m at the Roc Nation party smelling like chronic smoke/Hov said, ‘You that boy,’ I get acknowledged by the GOAT,” Conway raps), while Westside Gunn ties the Hit-Boy-produced gem together with a pace-shifting hook. And when the trio gets together - as they frequently do on one another’s albums - it’s often can’t-miss entertainment. Individually, all components of the three-headed monster that make up the Buffalo-born group Griselda had a big year. Conway the Machine & Westside Gunn, “War Paint” So what is a normal vagina? "Normal is a difficult word to use as there is so much variation," says Dr Rumbi Mutenga, a women's health specialist and former midwife. Over half correctly named the vagina as the the internal muscular canal extending from the vulva to the cervix. According to a huge study by Balance Activ, just 57% of respondents said they only know a ‘moderate amount’ about female anatomy and 21% only 'a little bit'.Įver looked at your bits in a mirror? 61% of women said they had, which can definitely help with getting to know yourself a little better, but still not all respondents would get top marks on their anatomy test when asked what they think the term 'vagina' refers to, 29% erroneously chose the whole of the private parts and 11% chose the outer lips. If you struggle to name every part of your vulva and vagina, you’re not alone. Your 'labia minora', on the other hand, are the thinner, inside lips which start below the clitoris and are either visible or not depending on the way your vulva looks. Think of the cushioning between your inner thighs and your labia minora. When Mr Ibraheim refers to the 'labia majora' below, that's the fleshier outer lips of the vulva. Carrying out regular procedures as his day job means he's seen his fair share of vulvas - so he was able to pin-point seven key 'types' of labia for us, which have been drawn below. In fact, half of young women say they don't know where their vaginas are, according to Gynae Cancer charity The Eve Appeal.īut, if there's anyone who does know what's 'normal', it's Mr Mofid Ibraheim MB BCh, MRCOG, an expert surgeon in gynaecological procedures at MYA. The problem is, most of us aren't all that familiar with what a normal vulva looks like and what the different parts of our junk are called (many often refer to the vulva as the vagina, when actually that's the internal organ - a handy way to remember is that vagina even has the word 'in' in it). But here's the thing: no matter what the shape, size, colour, whatever your labia (unless, you know, it physically hurts), it's completely normal. Labia, vagina, vulva: do you think yours is normal? Due to their intimate nature, we don't tend to see (and size up) the different types of vaginas our friends have, which is how so many people can end up with insecurities. However, his damage without his Magic Candy can be lacking compared to other, better cookies, which puts him at a lower rank than some top-tier cookies. Though in late-game and hard levels he may need a lot more attention than other cookies, he now benefits from his Magic Candy as well as his regular Skill. Purple Yam Cookie is a pretty dependable cookie with a lot of use throughout Kingdom's gameplay. RELATED: Cookie Run Kingdom: Ovenbreak Costumes That Need to be Added Fox Spirit Flame also has a decent range, so it can hit enemies the players' other cookies might be having trouble with. What's also good about her transformation is that after it ends, she sends out a Fox Spirit Flame attack that will hit up to 5 nearby enemies for 251.2% damage. Her Skill transformation, Somersault, lasts 12 seconds with a 14-second base cooldown, charming enemies for 2 seconds.Ĭharmed enemies will also suffer a 20% defense decrease for 8 seconds, which can be a game changer. Specifically, Kumiho Cookie is very good for leaving enemies momentarily unable to attack. That being said, she's an option that can be used quite far into the game, and if players are willing to put resources into her, she can end up a very decent unit. She's a little better than Werewolf Cookie for several reasons, but she's still outclassed by better Epic cookies who can outperform her without needing as many resources. Another good option for beginners or those with no better options is Kumiho Cookie. Mara knows he's dangerous, but Cole is the only person who's ever recognized her talent, and it leads her heart astray, straight into the dark.Ĭole can teach her to get what she wants. He's losing control, breaking the rules that have kept his true nature hidden from the world. He doesn't know if he should protect her at all costs or destroy her before she ruins him. She makes him feel things he never thought he could feel. Sophie Lark is an Amazon Bestselling author who writes intense, intelligent romance, with heroines who are strong and capable, and men who will do anything to capture their hearts. I am just going to sing with Sophie Rey pier but I will come back. He begins stalking her, discovering there's more to the struggling misfit than he would have guessed. No, I have only three sisters, and my father too is dead - my dear father. When a chance encounter throws Mara into Cole's path, her escape from certain death fascinates Cole. Broke and damaged, she works three jobs while creating paintings no one will ever see. In truth, he's not just an artist: he's a predator, and the city is his hunting ground. His only weakness is the dark impulse he carefully conceals. You can read book There Are No Saints (Sinners Duet Book 1) online by Sophie Lark for absolutely free, file Name: /there-are-no-saints-by-sophie-lark.epub. He's the hottest sculptor in San Francisco-wealthy, successful, and respected. Mara knows he's dangerous, but Cole is the only person who's ever recognized her talent, and it leads her heart astray, straight into the dark.Ĭole can teach her to get what she wants.She knows he's no saint, but she has no idea she's dancing with the devil.Ĭole Blackwell values control. She has a slight obsession with hiking, bodybuilding, and live comedy shows. She writes intense, intelligent romance, with heroines who are strong and capable, and men who will do anything to capture their hearts. He's losing control, breaking the rules that have kept his true nature hidden from the world. Sophie lives with her husband, two boys, and baby girl in the Rocky Mountain West. Are you an author Visit Author Central to update your books, profile picture, and biography. How are we doing Send us comments about our Author Pages. View and manage who you follow on Amazon. He doesn't know if he should protect her at all costs or destroy her before she ruins him. Follow to get new release updates, special offers (including promotional offers) and improved recommendations. She makes him feel things he never thought he could feel. There Are No Saints I loathe Alastor Shaw. This is a steamy serial killer romance that will take you on a journey through the twisted mind of an artist on the brink of madness. When a chance encounter throws Mara into. There Is No Devil - (Sinners Duet) by Sophie Lark (Paperback) 17.99. Choose from Same Day Delivery, Drive Up or Order Pickup. Reader be warned: this book contains extremely dark themes that might be triggering to some. Broke and damaged, she works three jobs while creating paintings no one will ever see. Read reviews and buy There Are No Saints - (Sinners Duet) by Sophie Lark (Paperback) at Target. Brief Summary of Book: There Are No Saints (Sinners Duet, 1) by Sophie Lark. He begins stalking her, discovering there's more to the struggling misfit than he would have guessed. 'There Are No Saints is the first book in the Sinners Duet. English en, epub, <1MB, Sophie Lark - Sinners Duet 01 - There Are No Saints (Dark Series).epub. If you read this There Are No Saints (Sinners Duet Book 1) book, share your review through comment box so that people can get ideas from your points of view. We’re running a fundraiser for backing up the largest comics shadow library in the world. Until the night we both laid eyes on Mara Eldritch. The city of San Francisco thinks we’re rival artists. In truth, we’re predators battling for hunting ground. We never chased the same prey. His only weakness is the dark impulse he carefully conceals. Sophie Lark Sinners DSophie Lark - Sinners Duet 01 - There Are No Saints (Dark Series).epub. Sinners Duet by Sophie Lark There Are No Saints (Sinners Duet 1) I loathe Alastor Shaw. She knows he's no saint, but she has no idea she's dancing with the devil.Ĭole Blackwell values control. What do you do when the only one who can. Every I am okay actually means I am totally broken. Expressing your feelings through sad paragraphs and telling your partner what you feel about them is a great way to revive your relationship. You wont ever understand that how much it hurts to let you go. Download and create im sad profile pics for your TikTok/Discord/Instagram. I love you so much.Ĭommunication can improve your relationship, and it might even take your relationship to new depths. Sadness is part of life, but don’t allow that to hinder you from achieving your goals. There is always an opportunity waiting for you to make things better again. Synonyms for SAD: unhappy, heartbroken, depressed, miserable, sorry, bad, melancholy, upset Antonyms of SAD: happy, glad, joyous, joyful, cheerful, cheery. Even when you are depressed, there is always hope. I was on top of the world when I found you, and when we parted ways, it broke me to the core. Sad stickers, the words depression, sad are written. Minimal concept of Valentines Day or love. A love composition made of a red heart melting on a blue pastel background. I’m mournful, yet still hopeful that someday you will come back to my life. Flat cartoon sad and happy character vector illustration. But then the thunderstorm came and split our lives apart. We had our good and bad times where we laughed hard and fought fiercely.The first time I met you, I was sure you were the one for me! No one can ever take your place in my life. Whatever happened in our life and marriage, you will always be special in my life. Sad Aesthetic Hoodie, SCHOOL GIRL SAD JAPANESE ANIME AESTHETIC Aesthetic Hoodie TeePublic, Im Pretty Cool But I Cry A Lot Hoodie, Trendy Sad Girl Aesthetic.Even in the darkest times, your memories light up my life, and I’m grateful for that. Nicknames, cool fonts, symbols and stylish names for SAD Sad. I’ve had some best times with you, and I’ll always hold that close to my heart. tags: charlie, favourite-books, inspirational, sad, soul-searching, wallflower. Stephen Chbosky, The Perks of Being a Wallflower. And I want you to know that I am both happy and sad and I'm still trying to figure out how that could be. Life is hard, and you have to accept it. Quotes tagged as 'sad' Showing 1-30 of 3,224.You were a true gem that I couldn’t keep. Nothing in the world lasts forever, but deep down, I believe our love for each other will stay forever.I understand your worth in your absence, and I will do anything to be with you again. I was too foolish to let you go, and now I feel so lonely in this world. Life is hard, and a life without love is even harder.You are my everything, and all I need is your love. This world is a lonely place without you by my side. What Is Your Soul Aesthetic Quiz Buzz Updated on You Might Know Your Outer Aesthetic, But What's Your Inner Aesthetic You might know your aesthetic on the outside, but I bet.Breaking up with you was the biggest tragedy in my life. Life is full of woe, and I feel so helpless without you.Im personally sad that two parents would be out to ruin a program. Do not iron the print.Related: 55 ‘Fighting In Relationship’ Quotes And Sayings Sad Paragraphs About Life Find 113 ways to say SAD, along with antonyms, related words, and example sentences. When it comes to ironing, use cool iron inside-out. You shouldn't use any fabric softeners, or dry-clean the items.ĭTG-printed apparel can be tumble-dried on a low cycle, but hang dry works best. Use non-chlorine bleach only when necessary. Printed apparel can be machine-washed cold, inside-out on a gentle cycle with a mild detergent and like colors. Baby Im Dead Inside Skeleton Coffee Emo Goth Sad Aesthetic Manche Longue Femme UwU I Have Crippling Depression Doomer Goth Sad Aesthetic T-Shirt avec Col en V. I've spent a lot of time and effort to create the perfect design for my products - it's important that me and my customers know how to take care of them in the best way possible! Please before buying, be sure to choose your size well otherwise there will be no returns once the package is shipped.Ī lightweight youth tee, made of 100% cotton, except for heather colors, which contain polyester.īlank product sourced from Honduras, Haiti, or Nicaragua *If you need a HOODIE or LONG SLEEVE SHIRT with this same design, you can send me a private message.* Synonyms for AESTHETIC: attractive, elegant, exquisite, beautiful, appealing, ravishing, beauteous, stunning Antonyms of AESTHETIC: grotesque, ugly, plain, hideous. The tablet is fully functional without any form of ongoing payment, but there is one drawback if you don’t sign up for the Connect service. “The monthly Connect subscription kills it for me, why would they do that?”įirstly, it’s worth confirming that you don’t need a monthly subscription to use the reMarkable 2. “Are they still on the pay-to-use model?” “I want to know if it’s really as bad as I’ve heard when it comes to getting what you’ve written to other places.” When I asked my YouTube audience what they’d like to know about the reMarkable 2, there was a common theme among the responses. This is where it gets interesting… and more expensive. The feel of the display, ultra legibility, and lovely touches like the rubber points on the rear of the device to stop it slipping on table surfaces make it a joy to use. Overall, the writing experience on the reMarkable 2 is wonderful. That feels short to me, but I need longer with the Marker to see if the claims are just overly cautious. Thankfully, you get nine spare tips included, but it’s worth keeping in mind that reMarkable only estimates between three to seven weeks of use from each tip, depending on your writing technique. Just like the Apple Pencil, you’ll need to replace the Marker tip after a period of use. The Marker doesn’t need charging, either, and still benefits from tilt and pressure sensitivity for an authentic writing or drawing experience. Upgrade to the Marker Plus, and you receive both better materials and that incredibly handy eraser on one end (we need this on the next Apple Pencil, Tim!). Although cheaper-feeling than the Apple Pencil, the standard Marker is far more grippy and fun to use. Combined with the simple but effective file management, the team at reMarkable have gone far enough without overloading the user with options that few people will use. Latency is rated at 21ms, which is roughly the same as the Apple Pencil and it feels plenty fast enough, despite the limitations of the display’s refresh rate.Īs you’d expect, you get a wealth of pen styles to choose from (including, curiously, different colours), different paper styles, and even templates. There’s just enough friction and the accompanying sound made by the Marker’s tip gliding across the display makes for an addictive writing experience. This thing feels as close to paper as you’re likely to get with a tablet. One thing I’ve quickly learned is the importance of that first touch between stylus and screen, and the initial reMarkable 2 experience absolutely nails it. I’m a recent digital note-taking convert, thanks to the brilliant combination of the iPad mini 6, Apple Pencil, and a Paperlike screen protector. This is what the reMarkable 2 is all about. Plus, reMarkable tells me that the addition of a backlight would make the device thicker and increase the distance between the marker tip and onscreen ink. But, when you think about it, neither is paper, and the reMarkable’s brilliant performance in direct sunlight makes up for the need to switch a light on as your room darkens. It’s sharp and pleasing on the eye but isn’t backlit – which initially took me by surprise. The reMarkable 2 uses a monochrome digital paper display with a resolution of 226 DPI. And on the subject of battery life, it is undeniably impressive: two weeks of in-use time is backed up by a colossal three months of standby. It feels solidly built, too, and at 0.89lbs, is weighty enough to feel like the substantial purchase it is without being a burden to carry or hold while writing.Ī magnetic attachment for the Marker and USB-C charging make for quite a convenient package. The reMarkable 2 is a smidgen smaller than an A4 page, which makes it a pretty decent size for general note-taking. That isn’t where the costs end, though – which I’ll get to later. So, at the least, you’ll pay £478 for a reMarkable 2, while those opting for the fancier Marker Plus will have to stump up £528. The reMarkable 2 is £399 in the UK but is unusable without the Marker, therefore you’ll need to add either £79 for the standard Marker or £129 for the Marker Plus (which includes an eraser for quickly scrubbing stuff out). It uses a 10.3-inch CANVAS display (think Kindle’s e-ink display) and although you can interact with the operating system via touch, you’ll need a reMarkable Marker to start writing or drawing. This is a tablet purely designed for note-taking, document reviewing, and reading. For instance, there’s no web browser on the reMarkable 2, no app store, and you can’t use it to send an email or check your diary. Regardless of the reMarkable’s legitimate claim for sitting within the tablet category, there are some key differences if you’re still thinking ‘ iPad’. But that’s doing it a bit of a disservice because there’s rather more to this curious device than meets the eye. The simplest way to describe the reMarkable 2 is to call it a ‘Kindle you can write on’. “At the end of these days, your opinions are just receipts of your stupendous ignorance… these experiences are outside of your capacity to understand, and forever outside your tiny prejudices.”ĭoesn’t make it a truth. He was not some literary King Midas, turning everything he touched into gold. Yes, Phil had great ideas and some good stories. Duck’s works, including VALIS, Divine Invasion and the Transmigration, and I’ve no idea where you’re coming from. I’ve no doubt that Dick experienced these things authentically, and that in the matter that all his writing suggests, even an unreal experience is no less real… reality is superimposed with inter-dimensional paradoxes and linear thinking will fail to sort out these threads every time. Even as a passionate lover of PKD’s writing, a lot of it is just beyond my intelligence. There’s a lot of noise makers on this board, casting their judgments about schizophrenia, “wisdom”, mental “illnesses”, and the validity of “mystical experience.” At the end of these days, your opinions are just receipts of your stupendous ignorance… these experiences are outside of your capacity to understand, and forever outside your tiny prejudices. It does not represent PKD’s best work, but his most mysterious and personally layered writing. This was enough, as it covers everything the Crumb comic covers and then some… Horselover Fat meets with the young Maitreya before severe tragedy strikes… it ends on note of defeatism, but it’s interesting enough that I would like to get around to the final two books which take the story further, The Divine Invasion, and The Transmigration of Timothy Archer. These spiritual revelations and occurrences are writ out fairly accurately in his final trilogy, of which I’ve only read VALIS. It is verrry easy to tell that 90% of the commentators here have not read, or have little exposure to, the work of Philip K. But in our countries, such people would not dare to speak about their experiences, unless they know that you will respect their testimonial, not consider them as crazy, not judging them, and that you will not consider their experience as some kind of “fashion stuff”. I’ve met many over time, in various countries, and I was not even looking for it: at first I didn’t take them seriously.īut when it came to 2 close friends of mine, I became less ironical and discovered over time that, actually, many people have unusual experiences. And when it comes to spirituality, for those who face for true such “special” experiences, there’s no such way of thinking left. I dare to think that we are more than that. What he wrote indeed reveals that he considers that a male is nothing but a megalomaniac phallus, wanting to have sex with as much women as possible (the last ones being then considered as objects), no matter the way to get it (for example, by becoming rich at any price, no matter how much destruction it can involve). The worst comment is the one of “Jorge”, whose vision of the male gender is totally extreme: he reduces men to the most basic beings (or even “things”). It seems that many of the above mentioned are written by basic men speaking about spirituality as a fashion, some kind of fun “stuff”. The real mystery is why you find the speculation of others so personally unsettling – apparently reading FAR too much into even the most offhand, tongue-in-cheek statements – that you feel compelled to lash out angrily and aimlessly at anyone who dares give utterance. You don’t have to ignore his vast library or work – I’ve been able to collect about half his output thus far – to find 3-4-74 interesting, especially since it dominated the last eight years of his life. It’s profoundly bizarre how you patronizing deride me for allegedly not reading PKD’s Exegesis (I have) while not recognizing the dissonant notion of simultaneously deriding everyone else for being “fixated” on 3-4-74. As it stands, Zap #1 isn’t quite as old as I am, though I’ve no idea just what that is or is not supposed to prove to you, or why you have this perception that everyone else is clueless about PKD’s issues with undiagnosed mental illness – or how you can diagnose him post facto with “late onset schizophrenia,” for that matter. Not so sure what you’re afflicted with, William, but it’s not wisdom. Both tests must be positive for an individual to be diagnosed with Lyme disease and fit the CDC criteria. The IgM Western blot must have 2 out of 3 bands reactive OR the IgG Western blot must have 5 out of 10 bands reactive. If the ELISA or IFA test is positive or indeterminate, it must be confirmed with the Western blot. If negative, the Western blot should not be order, according to the CDC. The two-tier diagnostic criteria requires that an ELISA screening test be performed first. The CDC recommends a two-step process when performing serological testing for Lyme disease. There are suggestions from the literature that a persistently positive IgM may reflect an ongoing infection, or a more severe disease. However, the Bb infection is unique and the IgM antibody may persist for years. The IgM would normally disappear in most infections and be replaced by the IgG class antibodies, which typically indicates the resolution of the infection. With most infections, the IgM class antibody appears first and can be used to identify an infection early on. For example, the CDC criteria does not include Bb specific antigens 31 kD and 34 kD. There are labs that report the full spectrum of bands for IgM and IgG to assist when making a diagnosis using clinical judgment. It can be difficult to interpret the results of the Western blot, since multiple “bands” need to be identified and the amount of reactivity on each determines whether or not the band will be reported. While the Western blot is more accurate than the ELISA, it has been found to not be a sensitive test. For the IgG Western blot to be positive, the CDC requires that 5 out of 10 specific Bb antigens (18, 23, 28, 30, 39, 41, 45, 58, 66, and 93 kDa) are identified. In order to have a positive IgM (immune globulin) Western blot, the CDC requires that 2 out of 3 specific Borrelia burgdorferi (Bb) antigens (23, 39 and 41 kilodalton (kDa)) are present. If enough of the antigens are present, the test is considered positive. The Western blot test identifies individual antigen patterns typically seen in Bb. The Western blot has a greater sensitivity than the ELISA. In certain cases, additional tests may be ordered, including a spinal tap or MRI. Our office typically tests for Lyme disease with both the ELISA and Western blot, and includes testing for possible co-infections. Numerous studies have found it to have a poor sensitivity rate. However, the ELISA is not an accurate screening test. If negative, the clinician may dismiss the possibility of a Lyme disease diagnosis and choose not to perform the Western blot. Typically, the ELISA test is used to initially screen for Lyme disease. The tests cannot determine if there is an active infection which could be causing the persisting symptoms, since antibodies can be produced for months or years after an infection has cleared. The ELISA and Western blot can only detect whether a person has been exposed to Bb. Both tests measure antibodies (proteins made by the immune system to fight infection) to Bb, the bacterium that causes Lyme disease. The ELISA and Western blot are the most common tests used to diagnose Lyme disease. “Effective communication and engaging your patient to elicit a complete medical history including any possible exposure to ticks is critical in making a diagnosis.” ─ Dr. Because of the varied presentations and necessity of relying on a patient’s symptoms, several tests may be helpful. That said, laboratory tests can be used to support the diagnosis. The person could have been infected with a strain of Bb that is not covered in testing. The Lyme bacteria are not always present in the blood. Antibodies to Borrelia burgdorferi (Bb) do not appear in the blood until several weeks (usually 4-6 weeks) after the tick bite. If a patient has received antibiotics in the early stage of the disease, antibody levels may be too low to be detected or nonexistent. The sensitivity of the tests varies greatly depending upon how long an individual has been infected and on the type of clinical manifestations. There can be several reasons for the inaccurate results. Yet there are numerous scientific articles documenting false negatives and low sensitivity of such tests. However, all too often, physicians will ignore clinical presentations if laboratory tests are negative. Lyme disease should be diagnosed clinically, without reliance on testing. Often the diagnosis of Lyme disease depends upon the physician’s readiness to listen. Third, compiled functions and procedures, written in a high-level language such as Pascal, C, or FORTRAN, can be dynamically-linked with EES. Functions, procedures, modules, and subprograms can be saved in library files that are automatically read in when EES is started. Second, the EES language supports user-written functions, procedures, modules and subprograms.įunctions and procedures are similar to those in Pascal and FORTRAN in which assignment statements rather than equalities are employed.ĮES modules and subprograms are callable EES routines that use equalities. EES also allows the user to add functions in three ways.įirst, a facility for entering and interpolating tabular data is provided so that tabular data can be directly used in the solution of the equation set. Library of mathematical and thermophysical property functions. Transport properties are also provided for all substances.Īn extensive heat transfer library, developed in conjunction with the book Heat Transfer is provided in addition to the built-in Air tables are built-in, as are psychrometric functions, JANAF data for over 1200 substances,Īnd property data for hundreds incompressible solids and liquids including heat transfer fluids and brine solutions. Similar capability is provided for most refrigerants, ammonia, methane, carbon dioxide and many other fluids. Second, EES provides many built-in mathematical and thermophysical property functions useful for engineering calculations.įor example, the high accuracy steam tables are implemented such that any thermodynamic property can be obtained from a built-in function call in terms of any two other properties. First, EES allows equations to be entered in any order with unknown variables placed anywhere in the equations ĮES automatically reorders the equations for efficient solution. There are several major differences between EES and other equation-solving programs. |
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