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Before Kings center Domantas Sabonis racked up 28 points, 23 rebounds, and seven assists in Sunday's loss to Charlotte, head coach Mike Brown said there's "no question" that the big man should be an All-Star this season, according to Jason Anderson of The Sacramento Bee. Sunday's performance increased Sabonis' season-long averages to 18.0 PPG, 12.0 RPG, and 6.4 APG. He's also shooting a career-best 62.7% from the floor.
"If you don't vote for him to be an All-Star, in my opinion, you don't know basketball because what he's doing, it's almost on a historic level, and I'm not just talking about his ability to score or his ability to pass," Brown said.
As impressive as Sabonis has been, the Kings are still seeking a reliable backup at the center position. The team began the season with Richaun Holmes playing that role, then turned to Chimezie Metu. On Sunday, two-way player Neemias Queta got a look, playing seven minutes in just his second appearance of the season. Brown said on Sunday that Holmes and Queta will get more opportunities, per Anderson, and that he expects to continue experimenting until he finds a reliable option in that spot.
"I can't run Domas 40 minutes every night," Brown said, according to Chris Biderman of The Sacramento Bee. "So I need to find a guy in that spot who's going to defend, run the floor, spell Domas for six, eight minutes a half, and play as hard as he as can while following the game plan. Not fouling, boxing out, doing all the little things that need to keep that group solid for those six to eight minutes. We've found it in spurts. But I want to get to a point where it can be a little bit more consistent, so I'm going to keep searching until I feel like that person is there."
Here's more from around the Pacific:
- Although Suns owner Robert Sarver was suspended and fined by the NBA and is now planning to sell the team, a number of current and former Suns employees are still wondering whether other executives who contributed to creating a toxic workplace will face any punishment, reports Baxter Holmes of ESPN. CEO Jason Rowley is among those accused of mistreating staffers. As Gerald Bourguet of PHNX Sports tweets, the club put out a statement claiming that there are "factual inaccuracies" in Holmes' report and that the franchise's leaders have taken accountability for the allegations found to have merit.
- Suns head coach Monty Williams blamed himself for the groin injury that sidelined Devin Booker on Monday. "Let's be straight, I played him way too many minutes," Williams said (Twitter link via Bourguet). "I can't look at anybody else when I put players in harm's way."
- Suns point guard Chris Paul brushed off a taunt from Lakers guard Patrick Beverley on Monday, writes Dave McMenamin of ESPN. Beverley made a "too small" gesture when he converted an and-one against CP3 that cut L.A.'s deficit from 26 points to 23. "You can't pay attention to that stuff," Paul said. "That ain't new. He ain't come up with it. But just play basketball, man." Beverley was suspended three games for shoving Deandre Ayton the last time the two teams faced one another.


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Variables that influence patient selection for durvalumab consolidation after CRT as part of treatment for unresectable stage III non–small cell lung cancer.
Mark A. Socinski, MD: The other issue is how do you handle your borderline performance score patients? Because we know PACIFIC was PS-0 to one. We in practice know that we see a lot of PS-2 patients that is setting. Do you pursue the same strategy in this population, or does that make you pause?
Chaitali Nangia, MD: It does make me pause. There were at least 2 or 3 abstracts in 2021 looking at the elderly patients in single institution that did retrospective analysis for this elderly population, and they actually show that the same combinations the elderly patients did equally well but not such great performance status, so I think "Are all PS-2s equal?" Probably not but I do take it with a deep pause or am I going to do this for this patient, and then I have a low threshold if they start running into any issues.
Mark A. Socinski, MD: I think only 6% of the patients on the PACIFIC trial had EGFR mutations. How do you handle those? You're probably in an area where you probably see a lot of EGFR-mutant patients and so undoubtedly you have them. I have a recent case that I'll maybe bring up and see what the participants here would do but does that influence your thinking? Someone has an exon 19 deletion EGFR mutation.
Chaitali Nangia, MD: I think that's why the LAURA trial is going to be so instructive as to what to do with these people because there really is no clear guidance. Obviously, we saw from LAURA that unresectable situation, you will always start with a TKI [tyrosine kinase inhibitor], but here in an unresectable post to concurrent chemo radiotherapy [RT], there really is no diffraction. I do see way more EGFR and go through it now, but unless I have data to guide me through it, I stick with the Recofrac.
Mark A. Socinski, MD: I recently had a physician who has stage III, got chemo radiotherapy, and came to see me. She has an EGFR mutation and she's also a PDL-1 negative and she came to me and said, "Look in Europe, I couldn't get this. I'm not impressed with the data." She was looking for Osimertinib as her consolidation therapy. I'll leave the story there and won't tell you what happened after that but certainly this is an issue to a well -educated EGFR mutation–positive patient, and again with so few patients in realizing that that EGFR-mutant population is not necessarily a population that gets a big bang from immuno monotherapy. I think it is a real issue in this population. I completely agree with you, I think LAURA is a very important trial and I have to believe since Rory told us in ADAURA, there was such a major benefit at least for DFS [disease-free survival] that it's hard for me to believe that we won't see the same thing in LAURA in the stage III population.
Chaitali Nangia, MD: Correct.
Mark A. Socinski, MD: How do you handle your progressors on durvalumab. Let me give you 2 examples: you're 6 months into treatment with progression and then you're 1 year after completion of treatment. Those are 2 different ends of the spectrum. Your thoughts there?
Chaitali Nangia, MD: I guess when you start trying to understand the biologies, there's primary resistance, is this a quiet resistance, and I think as we get better in profiling these patients and understanding and having more trials the results will be fantastic. As of right now, 6 months into it I would kind of consider it more or less like a primary progression resistance and I go to chemo RT again. I'm not shy of using either docetaxel or docetaxel denosumab if this was in second line metastatic. In this case, that would become first line so I would just go to a platinum doublet. If it's more than 1 year out, then I might be tempted to use the IO [immuno-oncology] or IO combo again.

subset: commoncrawl


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We like to think that nothing bad could ever happen to us, but unfortunately, that is not the way of the world. This is why it is always best to err on the side of caution and take steps to ensure you can recover from whatever you might encounter. A clear example of this would be getting a quality car insurance policy, so that you could get compensation in case of accidents. But that is not enough; you need to also understand car insurance claims, and when you should file them –– as well as when it's best not to.
What is a car insurance claim?
It is basically a request you file to an insurance company asking for compensation after an accident, whether it's a collision with another car or any other incident where your vehicle got damaged. When you file the claim, you usually get a payment from your insurance company –– after paying your deductible. So, what reason can a person have then to not want to alert their insurance company?
Fact is, in many cases, a lot of people prefer to settle the incident amicably with the other party if the accident was minor and very little damage was done to the vehicles. They do so because they fear their insurance rates would go up over the following years if they filed a claim. But that is not always the best option, and some complications might arise if you failed to file a car insurance claim.
When to file a car insurance claim
There are several cases when it is a must to file a car insurance claim, because failure to do so might cause you some legal complications, not to mention waste any chance you've got of getting compensation. The following are the cases where you have to file the claim.
Someone is injured
There is no way around this one. If you, the other driver, or any pedestrians get injured in the accident, you must file an insurance claim. These are usually the most complicated cases that might include legal ramifications, and this is why it is best that you get yourself a lawyer experienced in automobile accidents, they can help you settle the case if you are at fault or seek fair compensation if other parties were found negligent and at fault. You need to understand that when an injury is involved, medical bills pile up and there might be lawsuits entailed, so you have to get your insurance people involved immediately.
The other party's vehicle or yours is damaged
Whether or not it was your fault, you need to notify your insurance company at once and file a claim if the other person's vehicle is damaged, or if yours is for that matter. This might entail a lot more expenses than you could possibly expect, and you don't want to take those on by yourself. Some people try to settle with the other driver amicably, but that is quite risky because they might sue you later if they discovered that the damage to their car proved more costly than the settlement on which they agreed. And considering the fact that you settled without your insurance company, you would definitely be at risk of a lawsuit.
Property damage
This is another case when you need to file an insurance claim. You might have crashed into someone's backyard or hit their mailbox, and you'll also need the insurers to get involved to ensure you get out of that jam with as little trouble as possible.
When not to file a car insurance claim
The most obvious scenario where you don't really need to file an insurance claim would be damaging your own car, and knowing that the repair wouldn't cost you much. This is when you back into a pole or something, putting a dent in your car and not much of anything into the pole. In that case, you could repair your car without resorting to the insurance company. You should also take the cost of your deductible into consideration. If you damage your vehicle, with your deductible being $1,500 and the repair cost being $2,000, in that case you'll pay three times as much as the insurance company who will pay just $500. So, you shouldn't file a claim in that case, because your premium will increase over the next few years for an accident that you mostly paid for.
Filing a car insurance claim can get you out of hot water 8 times out of 10. But there are certain cases where it might not be the best course of action. Before filing any car insurance claim, do the math and figure out if it's in your best interest or not.


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The shock-proof construction of the timepiece is also incredible, capable of protecting the device at 360 degrees. The round dial is replica watches protected by robust and scratch-resistant mineral glass. The longevity of the battery is exceptional, which can last up to 7 years without presenting problems.
Three years ago the Head of Outdoor Education of government schools from a nearby country visited Boshack Outback to assess its readiness to accept children for school field trips. They had established that the aggression and short tempers in the classroom were bought about by children being in more confined spaces and the continual use of computers, ipods and computer games.
Through our farmstays, school field trips and staff retreats, we provide the most natural environment for visitors to get the best of nature:
* isolation – no major roads for 15 kilometres with noisy traffic
* ideal location – in the middle of 1000 acres of bush surrounded by farmlands
* biodiversity
* self sustainability – fish, organic vegetables, hydroponics , worm farm, freshwater, solar power
* bush corridors – between bushland for animals to move around. Allow nature to develop naturally
* bush walks
* canoeing
Nature deficit disorder refers to stunted academic and developmental growth and behavioural problems. It is caused by a cumulative effect of withdrawing nature from children's experiences. Nature deficit disorder is a term coined by Richard Louv in his 2005 book "Last Child in the Woods".
However, we argue that nature deficit disorder does not exist in children only. Adults can show the symptoms too – increased feelings of stress, trouble paying attention, feelings of not being rooted in the world. This problem is affecting our families, communities, and environment. It is really a disorder of society – and children are victimised by it.
For my research, I tried to cross every barrier I could think of — for instance, I did interviews in more rural areas and suburban areas, like the one I grew up in outside Kansas City, which still has a lot of nature. I went in there thinking, Well, certainly if you have woods next to you, kids will be out in them. But that simply wasn't true. The parents and the kids there were saying the same things as kids in more urban areas. In fact, the amount of nature you have in New York City is actually better than some of the newer suburbs; imagine, today, a city building a Central Park.
A major study came out a few months ago that said that the rate of obesity in children is growing faster in rural areas than it is in cities and suburbs. Again, it seems counterintuitive. But it's not so counterintuitive when you think about the fact that the family farm is fairly nonexistent now. Kids in rural areas are playing the same video games, watching the same television, and they're on longer car rides.
– Richard Louv, an International writer and observer on this problem.
What Our Happy Visitors Say About Us
Amazing true Australian outback experience. I've been here twice-first time was at the bed and breakfast farmstay, second time was at the outback farmstay. Will recommend to everyone. I have been to a few different places. I would rate Boshack Outback as one of the best farmstays in Perth.
It was raining cats and dogs so we did not have the chance to explore the place or star gaze at night but we all love it. Sleeping with natural sound of raindrops hitting the tent was therapeutic. A very lovely place to recuperate. Planning to visit again.
Great food and a wonderful experience. I spent a night here not long ago and it was a relaxing experience. I like it, next time I will definitely stay there again. If you looking Eco-friendly farmstay near Perth, then I highly recommend Boshack Outback..
Boshack Outback Farmstay in Perth is very peaceful place. Absolutely no noise from the city. My husband and I found the nights to be very pleasant. If you are looking for an escape from the city, this is it. The room is very comfortable. I highly recommend staying there.
According to what many enthusiasts who have tried this model say, the Casio G-Shock King is considered a small fake watches tank to wear on your wrist. Nothing affects this model, with resin case and strap that absorb shocks perfectly.


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On Thursday July 28 Governor Tony Evers paid a visit to Richland Center as part of his "Pothole Patrol" tour which included seven stops across the state to repair potholes and discuss the governor's investments in local roads and highways. Evers repaired potholes on E. 2nd Street between N. Cedar Street and Chestnut Street with City Administrator Ashley Oliphant, Mayor Todd Coppernool, Richland County Highway Commissioner Josh Elder and the Richland Center Public Works Department. Since 2019, according to the Wisconsin Department of Transportation, the Evers Administration has improved more than 4,600 miles of highways and roads including more than 1,700 miles of locally-owned roads across the state. "It was great to be out fixing the darn roads to continue our work improving more than 4,600 miles of highways and locally-owned roads in Wisconsin," said Gov. Evers.
Evers gets to work in Richland Center


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AUSTIN, Texas – Jason Day has been exchanging text messages with Tiger Woods on all things golf, so perhaps he could lean on Woods for his latest issue.
A bad back.
Day never saw it coming in the Dell Match Play. One minute he was tapping in for par to keep his 3-up lead over Graeme McDowell, and a minute later he was reaching toward his lower back. The pain was far more obvious on his tee shot at the 16th when Day let the driver fall from his hands as he grabbed his back and grimaced. He climbed gingerly into a bunker, and grabbed his thighs and took a knee as the match was ending.
What's next? Good question.
Day headed to the fitness trailer for treatment and left without speaking to reporters.
His agent issued a statement later that essentially said the sun rises in the east. He said Day tweaked his back on the 15th hole and had work done. He was happy with the outcome of his match. And that he's getting prepared to play on Thursday.
Day did tell the Australian Associated Press as he headed for treatment that he felt "searing pain" in both sides of his lower back.
That figures to be the center of attention Thursday for the second round of group play at Austin Country Club.
BAD TIMING: Day at least was in control of his match when his back began to act up. He scratched out a par on the 16th hole and won his match, 3 and 2. The fact the Masters is only two weeks away is troublesome for Day, especially coming off a victory in the Arnold Palmer Invitational.
In this round-robin format, at least the 28-year-old Aussie has options.
He faces Thongchai Jaidee, a winner over Paul Casey. Day could concede Thursday's match against Thongchai to rest and then play Friday. That would mean Thongchai has a 2-0 record in group play, and Day would have to beat Casey and hope Thongchai loses to McDowell on Friday to force a playoff to decide who wins the group.
Odds are he will play.
THE LOCAL FAVORITE: Jordan Spieth had the biggest crowd as a Texas Longhorns alum, and he gave them what they wanted to see. Spieth raced out to a 4-up lead over Jamie Donaldson and wound up winning on the 16th hole.
"I felt like everybody was on our side today," Spieth said. "I almost felt like a home Ryder Cup match. And Jamie, I'm not sure what he would say about it. ... Everyone was very respectful, but every single step I took, somebody was yelling at you, 'Hook 'Em Horns' or 'Go Jordan, we're rooting for you.' Which is really, really cool."
Next up is Victor Dubuisson of France, the finalist in 2014 and a winner over Justin Thomas in the opening round at Austin.
THE GREAT ESCAPE: Rory McIlroy won all seven of his matches when he won the Match Play last year in San Francisco.
That streak nearly ended Wednesday. McIlroy never led, and it appeared he would go 1 down with two holes to play until Thorbjorn Olesen missed a 3-foot putt on the 16th hole. And then the Dane delivered an even greater shock.
They were all square playing the 18th when Olesen shanked a chip that effectively handed McIlroy the match.
"Match Play is all about getting through," McIlroy said.
His next job is to get through Smylie Kaufman.
ON THE ROPES: Rickie Fowler was the highest seed (No. 5) to lose in the opening round. That's not the end of his week because of the round-robin format.
But it doesn't make it any easier.
Fowler will be eliminated if he doesn't beat Scott Piercy on Thursday. If that happens, Fowler will have to return Friday to play a meaningless match (for him). A year ago, Fowler already clinched a spot in the round of 16 and had to play a meaningless match Friday, but at least knowing he was advancing instead of going home.
Fowler wasn't alone. Of the top 16 seeds, Dustin Johnson, Jimmy Walker and Hideki Matsuyama all lost and face must-win matches Friday.
A year ago, only three players who lost in the opening round advanced to the weekend. Halved matches are allowed in group play this year, so that would help the likes of Adam Scott and Bubba Watson, even though both felt they should have won their matches.
SHOT OF THE DAY: There wasn't many, given the blustery conditions and difficulty of the contoured greens. Martin Kaymer should get some credit for being 1 up against Shane Lowry and hitting driver on the 376-yard 18th hole (downwind) onto the green for a two-putt birdie and the win.


text: Hi all Am Mi, 29. Nov 2017, um 06:52, schrieb Chad Elish: > Yep! I love gweike lasers. Ours has been a rockstar! I noticed that Gweike does not only sell CO2 lasers, but also Fiber Lasers. I found this video with an explanation how they work: https://www.youtube.com/watch?v=ofEqFlqkiS0 Does someone have practical experience with the two laser types? What are differences and advantages of the two? Danilo -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.hackerspaces.org/pipermail/discuss/attachments/20171129/cf71944f/attachment.html>


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Managing multiple CSI-2 sensors: Cameras have become ubiquitous and numerous in many of today's applications. System designers are challenged with moving data from multiple CSI-2 sensors into an Applications Processor (AP), where it can be further processed. To help overcome the limits of AP input resources, data from multiple cameras can be aggregated to a single stream.
Connecting with CrossLink: The Lattice CrossLink and CrossLink-NX FPGA families combine the flexibility of an FPGA with high-performance hardened D-PHY ports, ideally suited to solve many video bridging, aggregation and ISP design challenges.
Complete Reference Design: This reference design concatenates up to 5 channels horizontally line by line. The N Input to 1 Output MIPI CSI-2 Side-by-Side Aggregation Reference Design includes a thoroughly documented design example powered by Lattice CSI-2/DSI D-PHY Receiver and CSI-2/DSI D-PHY IP cores.
*By clicking on the "Notify Me of Changes" button, you agree to receive notifications on changes to the document(s) you selected.


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Caleb is committed to creating parks and public spaces that improve communities' livelihood. Caleb's approach is directed at reducing barriers to entry and creating accessible recreation for all. Throughout planning, design and public engagement, Caleb combines data analysis and his unique aesthetic style to create content that is sensitive to the needs of the client & community. With a robust interdisciplinary background, Caleb uses his creativity to solve problems holistically.
Caleb specializes in outdoor recreation programming, graphic presentations, and public engagement. His work supports all service areas of SE Group.
Caleb has a Bachelor of Science in Parks, Recreation, and Tourism from the University of Vermont.
Areas of Expertise
Outside the Office
An avid cyclist, Caleb spends his free time exploring the gravel roads of Vermont. Caleb also enjoys hiking, snowboarding, and swimming in the lake. On non-adventure days, Caleb and his cat Finnegan enjoy curling up with a good book by the fire while listening to records.


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Barcelona vs Sevilla – Spanish Supercopa 2nd Leg Match Preview |
Barça are 90 minutes away from winning their first silverware of the 2016/2017 season when they host Sevilla in the second leg of their Spanish Super Cup encounter at the Camp Nou on Wednesday night.
Goals from Luis Suarez and Munir El Haddadi gave Barça a 2-0 advantage from the first leg and the Catalans will be looking to kill the tie off in front of their fans during the late hours of Wednesday night.
The game is very likely to be the final Barça game for goalkeeper Claudio Bravo who is on the verge of signing for Manchester City and the Chilean shot-stopper will be looking to win his 8th title in a Barcelona shirt whilst ending his stay with a winner's medal. There is a possibility he features in Barça's first Liga game of the season against Real Betis on Saturday.
Captain Andres Iniesta and defender Jeremy Mathieu both sustained injuries in the first leg and won't make it to the game. New signings Denis Suarez and Lucas Digne will replace them and it is very likely the club will welcome Jordi Alba back into the squad after the Spanish left back sat out the first leg due to lack of match fitness.
Apart from Jeremy Mathieu and Andres Iniesta, goalkeeper Marc Andre Ter Stegen is also sidelined for the game after picking up an injury last week during training. This means third choice goalkeeper Jordi Masip will fill in for him. Other players out of the game are Neymar and Rafinha who are both representing Brazil in the Olympics.
Barcelona will be looking to extend their record as team with most Supercopa de Espana titles. The Catalan giants are the most decorated team in the history of the competition with 11 titles, two more than second place and rivals Real Madrid, the record will be extended to 12 titles if they see out Sevilla at the Camp Nou tonight. It looks a feasible task as no team has ever overturned a 2-0 deficit against Barça at the Camp Nou but the players won't let this distract them.
Date: Wednesday, August 17, 2016
Time: 11:00pm CET
Venue: Camp Nou, Barcelona
Referee: Hernandez Hernandez
Possible Barcelona Lineup: Claudio Bravo; Sergi Roberto, Gerard Pique, Javier Mascherano, Lucas Digne; Ivan Rakitic, Sergio Busquets, Denis Suarez; Lionel Messi, Luis Suarez, Arda Turan.
First Leg Result: Sevilla 0-2 FC Barcelona (Luis Suarez & Munir El Haddadi)
BarcaLens Predicts: Barça will enter the game in a comfortable position without much pressure knowing they have the advantage. The game will be played at the Camp Nou and everything points to an easy win here – Barcelona 3-0 Sevilla.


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Web hosting is a critical component of any online business or personal website. It is the service that makes it possible to store your website files on a server, which can then be accessed by anyone with an internet connection. There are many different web hosting options available, each with its own unique features and capabilities. In this article, we will explore some of the most important features of web hosting and how they can impact your website.
1. Storage Space
One of the most important features of web hosting is storage space. This refers to the amount of disk space that is allocated to your website on the server. The amount of storage space you need will depend on the size of your website and the type of content you are hosting. For example, a small personal blog may only need a few hundred megabytes of storage space, while a large e-commerce website may require several gigabytes. When choosing a web hosting provider, it is important to consider the amount of storage space they offer and whether it is enough for your needs.
2. Bandwidth
Bandwidth is another critical feature of web hosting. It refers to the amount of data that can be transferred from the server to your website visitors in a given period of time. If your website experiences a high volume of traffic, you will need a hosting provider that offers a high bandwidth allowance. This will ensure that your website can handle the increased traffic without slowing down or becoming unavailable.
3. Uptime
Uptime refers to the amount of time that your website is available to visitors. It is expressed as a percentage, with 100% uptime meaning that your website is always available. A web hosting provider with a high uptime guarantee is critical, as even a few minutes of downtime can have a significant impact on your website's traffic and reputation. When choosing a web hosting provider, it is important to look for one that offers a high uptime guarantee, typically 99.9% or higher.
4. Security Features
Security is a critical concern for any online business or personal website. A web hosting provider that offers strong security features, such as firewalls, anti-virus protection, and secure socket layer (SSL) certificates, can help protect your website from hacking attempts and other security threats. It is also important to choose a web hosting provider that regularly updates its security measures to stay ahead of the latest threats.
5. Customer Support
When it comes to web hosting, customer support can be just as important as the technical features. A web hosting provider that offers a range of support options, such as live chat, phone support, and email support, can help you quickly resolve any issues you may encounter with your website. Additionally, a web hosting provider with a knowledgeable support team can provide valuable assistance with any technical questions or problems you may have.
6. Scalability
Scalability refers to the ability of your web hosting provider to grow with your website as it expands. If your website experiences a sudden increase in traffic, you need a web hosting provider that can quickly increase the resources available to your website to accommodate the increased traffic. This is particularly important for online businesses, as a sudden surge in traffic can result in lost sales if the website is unavailable or slow.
7. Pricing
Finally, the cost of web hosting is a critical factor to consider. There are many web hosting providers that offer different pricing plans, ranging from basic shared hosting to more expensive dedicated hosting. When choosing a web hosting provider, it is important to consider your budget and the features you need, as well as any discounts or promotions that may be available.
In conclusion, web hosting is a critical component of any online business or personal website. When choosing a web


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cinch presents CREAMFIELDS SOUTH HUGE LINE UP REVEALED
Calvin Harris, David Guetta, Becky Hill, Carl Cox, Fatboy Slim, Camelphat, deadmau5, Charlotte de
Witte, Jamie Jones, Amelie Lens, Eric Prydz, Andy C, MK, Oliver Heldens, Idris Elba, Marco Carola,
Kölsch, Solardo, Ben Nicky, Michael Bibi, Patrick Topping, Fisher, Maya Jane Coles, Example,
Faithless (DJ Set), Deborah De Luca, Hannah Wants, Pete Tong, Anna Tur
The inaugural edition of cinch presents Creamfields South takes place this summer and
anticipation for what promises to be a year to remember is reaching fever pitch. Adding to
the excitement for the summer ahead Creamfields HQ have unleashed a huge line up for their
first edition, adding to the already stacked line up of headliners which includes Calvin Harris,
David Guetta, Carl Cox, Becky Hill, Eric Prydz, Fatboy Slim, Camelphat, deadmau5, Charlotte
de Witte, Jamie Jones and Amelie Lens.
Other acts just announced include Andy C, MK, Oliver Heldens, Idris Elba, Marco Carola,
Kölsch, Ben Nicky, Solardo, Michael Bibi, Patrick Topping, Jonas Blue, Fisher, Maya Jane
Coles, Example, Hannah Wants, Pete Tong, Holy Goof, Wilkinson, Paul van Dyk, Cristoph,
Green Velvet, Eats Everything, Deborah De Luca, Richy Ahmed, Faithless (DJ Set), Example,
Malaa, Arielle Free, Eli Brown, Jodie Harsh, Ben Hemsley, Loco Dice, Hot Since 82, WaFF,
Joel Corry, Chelina Manuhutu, SYREETA, Hybrid Mind, SaSaSaS, Joey Daniel, Shy FX, Armand
Van Helden, Sam Divine, Low Steppa, Offaiah, Brennan Heart, Darren Styles, Aly & Fila, John
O'Callaghan, Bryan Kearney, Will Atkinson, Sub Zero Project, Cosmic Gate, Fleur Shore,
Mind Against, SOSA, Lilly Palmer and Ammara + more.
Kick starting this year's highly anticipated festival season, over 100 artists will be performing
at the multistage Creamfields South, they'll be taking over the stunning Hylands Park in
Chelmsford from Thursday 2nd – Saturday 4th June Jubilee Bank Holiday weekend. Coinciding
with their twenty-five-year celebrations Creamfields South is already shaping up to become a
firm fixture on the international festival landscape.
Tickets on sale now www.creamfieldssouth.com/tickets
Published on 04 April 2022 by Wayne Feltham
Creamfields 2022 Jamie Jones Eats Everything Jonas Blue Faithless (DJ set)


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Because there are people out there who think this is a good idea:
You've probably heard of "chickenpox parties," where parents get unvaccinated kids together (in the home of an infected child) in the hopes they'll catch the disease. They think making their kids suffer through the disease will help them develop stronger immunity than immunization would provide.
But now the buzz is all about people shipping objects that have been contaminated with the chickenpox virus to people who live too far away to attend a pox party.
A Nashville TV station Thursday reported on a local woman who charged $50 a pop to ship suckers smothered in saliva by her sick kids.
Orac at Respectful Insolence has already written a great post about the epic stupidity (on so, so many levels) of this little scheme, and I don't want to reinvent the wheel by repeating the same points. Suffice it to say that it's a really, really bad idea.
No, what strikes me about this is how clearly it renders the losing battle we face when we confront anti-vaccine zealots. These people would rather pay fifty bucks for a fruit-flavored petri dish on a stick, inoculated in a stranger's mouth with God only knows what flora and then allowed to incubate during shipping before giving it to their unwitting kids to suck on, rather than give their kids a vaccine that has been clearly demonstrated to be safe and effective. I could reanimate the corpses of Louis Pasteur, Joseph Lister and Jonas Salk to explain in minute detail why vaccines are safe and effective, and these people would carry on with their moronic plans. After innumerable studies (and a certain very significant retraction), what more can big, mean ol' science have to say that these cretins will believe?
Nada, of course. Which is why I am so happy to be in a practice that doesn't accept vaccine refusers. If you won't let me administer something so foundational to pediatrics, so deeply set in the standards of care, then how can we possibly build a good physician-patient/parent relationship? We can't. You won't be happy with me, and I certainly won't be happy with you. Best we just recognize that, and move on.


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Norman Paech: listing PKK as terrorist a political decision in favor of Turkey.
Professor Norman Paech says there is a widespread solidarity with the resistance put up by the Kurdistan Workers' Party, in the struggle for dignity and freedom.
In an ANHA interview with Norman Paech it went as follows:
This organization, consisting of Kurds and children of peoples, is adopting a great struggle against the occupation of Kurdistan. How do you evaluate this struggle of the peoples and the PKK?
The social, economic, cultural and political situation of the Kurdish people has changed considerably in the last 40 years, but it is still characterized by discrimination, oppression, violence and war. It is not much different from the situation of the colonized peoples of Africa before their liberation. The struggle of the Kurdish people is therefore also comparable to the struggle of these peoples at all levels of society, both civilian and military, when it comes to defending themselves against the attacks of the Turkish army.
This organization, consisting of Kurds and children of peoples, is adopting a great struggle against the occupation of Kurdistan. How do you evaluate this struggle of the peoples and the PKK?
The PKK is listed as a terrorist organization on the lists of most EU countries and the EU itself. It was not different in the struggles against the old colonial powers. Liberation movements were accused of terror to divert attention from their own terror of occupation and oppression. Only recently, the Supreme Court of Belgium correctly recognized that the PKK is not a terrorist organization. It is fighting for the right of self-determination of its people, which is now a mandatory right in international law. Unlike Turkey, the PKK has submitted to the rules of international humanitarian law. The military branch of the PKK, the guerrillas, have retreated to the Kandil Mountains in Iraq, where they are being attacked by the Turkish army in violation of international law.
What should be done to remove the PKK from the terrorist list?
The listing of the PKK as a terrorist organization is a purely political decision in favor of NATO partner Turkey. Turkey is waging war in violation of international law not only in Iraq, but also in northern Syria and in its own country. The governments of the EU must be persuaded to change their cooperation with Turkey, which is contrary to international law, into cooperation based on law and morality. This includes respecting the rights of the Kurds and accepting their liberation organization.
What kind of call do you have for the PKK to be removed from the terrorist list?
There should be a joint initiative of all Kurdish and European solidarity organizations to confront their government with the demand to remove the PKK from the terrorist list and to promote education about the PKK's goals and activities.
While many gang organizations are still not included in the terrorist list, the PKK, which fights against ISIS, has been included in the terrorist list. How do you handle this contradiction?
It is a perversion of concepts when the organization that was the only one to fight against ISIS, an undoubtedly terrorist organization, is itself accused of terrorism.
Some actions are being taken to remove the PKK from the terrorist list. No steps have been taken so far for this demand of the people. How do you handle these calls?
The previous appeals to remove the PKK from the list have been rejected. The common interests with Turkey are too strong and the politics too unscrupulous to refrain from this harmful cooperation. It must be made clear to governments what damage is being done to human rights and general political rights in order to persuade them to put pressure on the Turkish government.
The Turkish state uses chemical weapons against PKK guerrillas. However, until now, the Turkish state has not been tried for the crime it committed. What would you like to say about this crime?
Two years ago, there was a "Tribunal of the Peoples" in Paris against Erdoğan and his war against the Kurds. He was found guilty of numerous crimes and violations of human and international rights. This tribunal took place because until then it had not been possible to hold the Turkish government accountable in state courts. The tribunal's verdict is symbolic in showing national courts and the International Criminal Court (ICC) in The Hague what crimes they leave unpunished. Above all, the use of chemical weapons constitutes a serious crime. All the evidences should be collected in order to bring a charge before the ICC with them.
Finally, what would you like to say to the PKK guerrillas, who resist tirelessly despite all the wars?
For the PKK and the guerrillas, there is only one thing: continue. Without resistance and struggle, the fate of the Kurds will not change. It should be assured that there is great solidarity in the world with this struggle for freedom and human dignity.


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A single-judge bench of Justice Tushar Rao Gedela set aside a trial court order directing a party to cross-examine a witness based on photocopies of a document
The Delhi High Court recently overturned a trial court order which instructed a party in a civil suit to cross-examine a witness from the opposing side using photocopies of a document. The High Court's ruling deemed the procedure "alien to law" and stressed the importance of adhering to the proper legal framework.
The Trial Court's Controversial Order
The High Court was hearing a plea filed by defendants in the suit challenging an order of the trial court passed on February 21. The order directed them to cross-examine the plaintiff's witness before the local commissioner, relying on photocopies of the document in question. The trial court had permitted the filing of the original documents at a later date.
In its April 12 order, a single-judge bench of Justice Tushar Rao Gedela remarked, "The procedure directed by the learned Trial Court is alien to law and is unsustainable as such. The impugned order cannot withstand judicial scrutiny and is set aside. The learned trial court is directed to ensure that the originals of the documents relied upon by the respondent are brought on record. The proper procedure, thereafter, be followed before the same are made part of the record, on which the cross-examination by the petitioner is to commence".
Suspension of Cross-Examination
Until the proper procedures are followed, the trial court shall not pass any direction for conducting a cross-examination of any witness of the respondent, disposing of the plea.
The High Court found the trial court's procedure to be contrary to Section 62 of the Evidence Act, which states that "primary evidence means the document itself produced for the inspection of the court".
The court highlighted that the trial court order is contrary to the law which mandates that "cross-examination is a vital right of the party where the party is entitled to not only discredit the witness but also demolish the case of the other side on the basis of the documents also". "It is well-settled law that photocopies are inadmissible in evidence unless they are proved in accordance with Section 63 and 65 of the Evidence Act," the HC said.
Section 63 explains what constitutes secondary evidence, while Section 65 provides instances where secondary evidence related to documents may be given.
The High Court's Observations
The High Court noted that since there was no occasion for proving documents by secondary evidence, directing the petitioner to cross-examine witnesses based on photocopies is absolutely contrary to the procedure known to law.
It further observed that in this case, after the cross-examination was conducted by the petitioner, the respondent was unable to produce some original documents. Consequently, the "cross-examination so far as those documents are concerned would become otiose and rendered nugatory".
The court emphasized that this could not be the intent of the legislature while granting the "right to cross-examine a witness, to conduct cross-examination on speculative documents, which are yet to be determined as to whether they are admissible or inadmissible in law".
Arguments Presented
The petitioner in the High Court argued that the procedure indicated in the trial court's order was unique, as even before the original documents were produced before the Trial Court or the local commissioner, the "Court is expecting the petitioner to conduct cross-examination on those photocopies". The petitioner maintained that this procedure contradicts Section 62 of the Evidence Act and that cross-examination cannot occur based on photocopies.
In contrast, the other side argued that the cross-examination, if any, based on the photocopies is subject to the production of the original documents by the respondent. They claimed that no prejudice would be caused to the petitioner by cross-examining the witness of the respondent in this manner.
Implications of the High Court's Decision
The Delhi High Court's decision to set aside the trial court order emphasizes the importance of adhering to established legal procedures and the Evidence Act. The ruling protects the right to cross-examine witnesses based on admissible evidence, ensuring that the integrity of the legal process is maintained.
This verdict reiterates that cross-examination is a crucial aspect of the legal process, and parties must not be forced to rely on speculative and inadmissible documents. The decision also underscores the significance of proper document production and the need for courts to follow the correct procedure to ensure that the rights of all parties involved are protected.
In conclusion, the Delhi High Court's ruling serves as a reminder to the legal community that the right to cross-examine witnesses is an essential component of the justice system. It is crucial to uphold the principles of admissibility and the proper handling of evidence to ensure fair trials and protect the rights of both parties in any legal proceeding.


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Corrections of ZUS documentation
Corrections of ZUS documentation
As part of our services, we make ZUS corrections, i.e. we arrange insurance documentation related to the calculation and payment of premiums for insured employees.
All payers of premiums should check whether the data in the monthly reports submitted to ZUS are correct. If irregularities are found, the payer of premiums is obliged to submit sets of corrective documents.
As part of the ZUS correction, we will analyse and verify the documents and update them if necessary. We correct the calculation of social security premiums and prepare correct ZUS settlement documents.


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Good day
Kindly be advised there will be an electricity interruption on the 21st October 2018 Sunday for Hurter Avenue Willoughby Drive Beach Road Noordhoek. The outage will be from the morning 05:30am till 15.00pm.
The interruption is required for Substation Elevation and re- alignment.
Please see the attached.
Warning Notice Willoughby Drive Noordhoek
Kind regards
Subcouncil 19 Disclaimer: This e-mail (including attachments) is subject to the disclaimer published at: http://www.capetown.gov.za/general/email-disclaimer Please read the disclaimer before opening any attachment or taking any other action in terms of this e-mail. If you cannot access the disclaimer, kindly send an email to email@example.com and a copy will be provided to you. By replying to this e-mail or opening any attachment you agree to be bound by the provisions of the disclaimer.


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Going Home Sick
This is a picture of the Webmaster, myself, and Ane from a couple Fridays ago. We were going to a wedding. Best Babysitter made some time in her schedule (thank you again!!) to watch the boys for us.
However, by the time we got to the reception, Ane was beginning to complain that she had a headache. I do carry kids' Tylenol in my purse, but she did end up with a feverish cold over that weekend, and even ended up missing that next Monday at school. Missing school distressed her terribly, but I called her teacher on the classroom's direct line and Ane talked to her, which made her feel much better.
Fast-forward to last Friday. Tad was going to stay at school all day, which distressed him because his normal Friday schedule is to have me pick him up right after lunch and drive him to ABA therapy. However, his therapist was on a planned vacation, and he knew that his schedule was off.
I got a call from the school nurse, saying, "Tad is here, and he's not acting like himself. He says his brain hurts."
I had her put him on the line, and I asked him, "What's going on, buddy?"
"Mama, I hurt my brain."
He ended up staying at school, because lethargic with no fever does not equal getting sent home. He was plenty perky all weekend after a single dose of Tylenol to stop his brain from hurting, though it did seem like he was coming down with the same cold that Ane had had.
Yesterday morning, Tad said to me as he stared at his cereal, "Mama, I feel sick."
He had no fever and was eyeing his Angry Birds toys as he spoke. "You can stay home, but there will be no Angry Birds or TV," I warned him.
"I'll go to school," he replied.
45 minutes after school started, I get yet another call from the school nurse. "Tad is here and there is green snot coming from his nose, and you need to take him home."
The green snot was a new one on me. Apparently, that WILL get you sent home. So I packed Rerun up and drove to Tad's school.
When the nurse brought Tad out of her office and down the hall to where I was waiting in the main office, he began running toward me in excitement. "Mama! You're back! It's time to go swimming!"
I glared at the nurse. She raised her right hand as if taking an oath. "I swear that he was lethargic and lying down in my office…"
His nose was dry. "Where is the green snot?" I asked. She had no answer.
Tad, who knows that when I pick him up on Mondays, he has his swimming lesson, thought there had been a time warp or something and now he got to go swimming. When I told him that his swimming lesson (which I could not cancel because you have to call before 8 am to cancel) wasn't for another 4 hours, he burst into tears.
I was ready to scream. I let the nurse know that I thought he was playing them all, right before she told me that he would have to stay home tomorrow, too, because apparently that's one of those rules when you get sent home sick. So I took the boys to Grandma's house, where she watched them both while I did my usual volunteering in Ane's class, and then picked Tad up and drove him back to school for his swimming lesson and then went on to speech therapy.
Now, for the record, he does have a cold. But I have not yet seen any of this mythical green snot. My guess is that he sneezed and something green came out, and combined with his track record on Friday, it got him sent home.
So, now I will have a not-that-sick kid at home with me and his brother today, fighting over toys and bickering with each other. Joy of joys.
There will still not be any Angry Birds – game, toys, or YouTube videos – allowed today. Mama is playing hardball, and this is no vacation.


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Prepare for an enchanting evening with Australian rock legends Eskimo Joe as they embark on a national acoustic tour, captivating audiences in some of Australia's most picturesque theatres.
Country music sensation Melinda Schneider, renowned for her solo triumphs and adorned with six Golden Guitars, brings the heartwarming concert Great Women Of Country to Casula Powerhouse.
Making art at an early developmental stage is crucial to building self-esteem and a connection with the world.
Featuring a banging live band rocking the soundtrack of our youth, join Tammy in the front seat of the Delorean and crank up the radio on the double cassette player
Your tutor, Erin Pearce, is an award-winning jeweller and will expertly guide you through the process of texturing, forming, soldering and finishing a beautiful Sterling Silver ring.
After the riotous success of 2023, Dragan Marinkovic Maca returns to the Casual Powerhouse Arts Centre with his uproarious hit show, "KAKVA TI JE ŽENA, TAKAV TI JE ŽIVOT." Don't miss this unforgettable & hilarious performance.
Amira Medunjanin and Antonio Vrbički's "Songs from the Heart" is a mesmerizing musical collaboration, blending Medunjanin's soulful vocals with Vrbički's evocative accordion, creating a rich tapestry of emotive melodies.
Not only are we are great place to see fantastic theatre and events - we are also a venue for hire!


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text: SMA's Steven Argila has been enjoying festival runs of his new film "The Problem With People" He checked in with us from Austin and DTLA. The film stars Paul Reiser as a New Yorker invited to Ireland by a cousin he's never met to help resolve a family dispute in this heartwarming comedy. We can't wait to see it!


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The victim's skull was found in a park on a stick by a teenager.
23-year-old Nathan James Gilmore has been charged with the first degree murder of 29-year-old Angela Nicole Bradbury, more than a year after her skull was found at an Iowa park in 2021.
According to a criminal complaint filed by the State of Iowa this week, Gilmore is accused of killing Bradbury on or about April 6, 2021 -- and the suspect's changing stories, disturbing Snapchat messages, Facebook behavior and "Satanic" drawings at his home all led to his arrest this week.
TikTok Star Mama Tot Reacts to Arrest Made in Son's Murder: 'Grateful, But Not Happy'
View StoryThe saga began back in April 2021, after Bradbury was arrested for trespassing on the 5th and released the next day. Gilmore had an arraignment at the same jail on the 6th.
Later that day, she went to "an associate's house," changed clothes and took off with a "younger white male" who her friend didn't know. They never saw her after that and her Facebook page -- which she apparently used as her main "means of communication" -- went dark.
On July 21, 2021, a teenager found a human skull -- "which had been placed on a stick" -- at Greenbelt River Trail Park near Mitchell, Iowa. At the time, the State Medical Examiner could not identify who the skull belonged to or whether it even belonged to a male or female. The case would remain cold until February 2, 2022, when Bradbury's family reported her missing -- confirming they hadn't heard from her since April -- and provided DNA samples to authorities. Nine days later, thanks to the samples, the skull was confirmed as Bradbury's.
Authorities later found "additional remains" of Bradbury's at the park and her manner of death was deemed a homicide.
Woman Arrested for Murder After Inmate Dies Following Visitation Kiss
View StoryWhile it's unclear how police honed in on Gilmore, he was interviewed by law enforcement on August 19, 2022 -- and his story allegedly changed a few times throughout his conversations with authorities.
Per the criminal complaint he first claimed he was at the park the day the skull was discovered and spoke with law enforcement at the scene at the time, while providing "an accurate description of the skill." He initially claimed he didn't know anything about Bradbury -- but then later admitted to "picking up a woman" whose description matched that of Angela following his court hearing on April 6, 2021. He maintained that he didn't know her, but brought her to a house and left her there.
He then said that Bradbury left with him, before he dropped her off five blocks away and never saw her again, police say. After that, he claimed he went back to work and then went home for the rest of the evening.
Juvenile Arrested for Shooting Deaths of Mother and Her 2 Young Boys
View StoryBut GPS records from his Facebook account allegedly showed that he was active in the area near Greenbelt River Trail Park that evening.
Police searched Gilmore's home last Friday as well and found a drawing on a whiteboard in his living room they believe contained clues. "This drawing depicted a satanic goat's head in the shape of a pentagram with what appeared to be blood spatters drawn on it," as well as a series of numbers they considered significant, reads the complaint.
One of the numbers was 04-06, which coincides with the date of Bradbury's disappearance. Another number was 590, with authorities pointing to an Urban Dictionary definition saying it's an acronym meaning "someone is tired of living." Also found on the whiteboard was "43.3, -92.8," which they say appears "to coincide with an abbreviated GPS coordinate" for the park where her body was found.
Authorities also obtained Google records for Gilmore, which produced a screenshot from August 26, 2021 of a Snapchat message sent to "a male associate" of one of his exes. The message allegedly read, "Youll be lookin like the body they found outside Mitchell boy."
"Bold of you to assume id be running when you won't know I'm behind you," it continued. "I'm in my pocket with my knife and the bubbling noise blood makes when air passes through the hole in a neck before it reaches the mouth makes me hard. Gets me off."
Authorities note the message was sent after the skull was found.
Gilmore was charged with murder in the first degree and is being held in the Mitchell County jail on $1 million cash bond.


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Sara, a 36-year-old mother of 3, recently moved to your area and needs to choose a practice to establish care for her family. Like 86% of other Millennials, the first thing she did was turn to the Internet. Overall, 77% of consumers now find new medical providers online. While Gen Z and Millennials like Sara are leading the way in this digital transformation, older patients also want and need online services. For 8 out of 10 seniors, digital technology is now an integral part of life.
To grow your practice, it's important to not only optimize your website for the best search engine results but also design it to engage patients and entice them to schedule an appointment.
Of course, bringing in new patients isn't enough; you must also retain them. Patients have been clear that they want to be able to communicate with their care providers and access their healthcare information online. If your practice website doesn't enable patients to complete tasks like scheduling appointments, messaging their providers, requesting prescription refills, or paying bills online, they'll find a different practice that does.
These guidelines will help you improve your website so that patients can easily find you online and have a positive, easy, and efficient experience with your practice website.
1. Optimize keywords for your site for better search engine results
Every page on your practice website should be optimized for search with carefully chosen keywords. Top search engine rankings don't happen by accident.
The most basic keywords of your site should include the services you offer and your location. For example, if your practice is based in Seattle and you offer pediatric care, then the words "children's doctor Seattle" should probably be prominent on your main pages. Reviewing the copy on these pages and incorporating such keywords into your content will give you an immediate boost.
Over time, begin to focus on other services you offer and other potential words that patients might use when searching. There are plenty of free keyword-finding tools that can help you narrow these down. Create individual pages for those services and publish blog posts that relate to those keywords.
The more well-written and informative content on your site, the better. Search engines reward content-rich websites that give users relevant, informative, and unique resources.
Optimizing for search doesn't end with copy and keywords, though. Other ways to impress the search engine algorithm include:
- Using high-quality, unique photos that show off your office, providers, and services (yes, that means you should nix the stock images)
- Describing your images using alternative text that contains keywords and quality information (this also makes your site more accessible to those who use screen-reading devices)
- Using keywords in your website's URLs
- Having a secure connection with "https://" in the URL (or a lock icon, depending on your browser)
- Linking externally to reputable sources such as medical journals, government sites (like the Center for Disease Control), or respected news outlets
- Linking internally to other pages on your site to help your patients navigate easily
2. Make it easy for patients to find what they need
How easily can potential patients find crucial information like where your practice is located or how to book an appointment?
To support both your patients and your search engine optimization (SEO) efforts, your practice website should include the following:
- A contact page with your address, phone number, and information about how to reach you after hours (if an on-call doctor or nurse is available)
- An about page with information about your practice, your providers, and your team members
- Individual landing pages for each service you offer
- Reviews and testimonials from current patients
3. Don't make patients (or search engines) wait
If your site loads slowly, there's a good chance that patients might not find it. And if they do find it, they'll probably click away. How slow is too slow? For search engines, anything longer than 2.5 seconds. Your patients want your site to load even faster. On average, sites that load in one second have a 40% conversion rate. But when the loading speed drops to two seconds, the conversion rate drops too, to 36%.
If your site loads slowly, it most likely has to do with your hosting server. Look for one that's more reliable. You can also speed up load times by compressing the images on your site so the file sizes are smaller and by simplifying your web design.
Beyond the basics
Once these basics are in place, you can add more frills to make your website – and, by extension, your practice – even more attractive to potential patients:
- Chatbots: Artificial intelligence (AI)-powered chatbots can answer several common questions patients ask as well as collect more complex questions for your staff to answer. Addressing common questions with AI helps free up your staff to take care of more pressing issues.
- Online payment options: Offer your patients convenience and make life easier for your billing team with an online payment solution.
- Digital intake: Encourage new patients to fill out their intake forms online to free up your staff and get patients into their appointments faster. Patients can fill the paperwork out at home at their leisure, and your providers run less risk of falling behind schedule while a patient fills out their paperwork.
- Online scheduling: Reduce the amount of time your front desk staff spends on the phone by offering patients the option to book their appointments online.
- Access to health records: When patients can view their records easily and at their own convenience, they feel that they have more control over their data, and they become more confident in you and your practice.
Putting together an attractive, SEO-friendly, fast-loading website takes time and, in some cases, specialized knowledge. Consider hiring a third party to manage your website for you, so you can reap all the benefits of having a website designed for practice growth while you focus on what matters most to you: your patients.
Travis Schneider
Travis Schneider is Co-founder and Chief Corporate Development Officer for Tebra, a leading cloud-based healthcare technology platform. In his role, Travis oversees M&A and strategic partnerships for the organization.


text:
Case Reports in Clinical Medicine
Vol.03 No.11(2014), Article ID:51373,3 pages
Purulent Hydroaeric Pleural Effusion Due to Infection with Gemella morbillorum: A Case Report
Hind Serhane, Hafsa Sajiai, Anas Arrad, Selma Ait Batahar, Lamyae Amro, Abdelhaq Alaoui-Yazidi
Department of Respiratory Medicine, Laboratory PCIM, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
Email: email@example.com
Copyright © 2014 by authors and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY).
Received 15 September 2014; revised 10 October 2014; accepted 4 November 2014
Gemella morbillorum (G. morbillorum) is an opportunistic bacterium, which can sometimes cause severe infections especially in immunocompromised subjects. Respiratory infections due to this germ are rare, but are described. We reported a new observation of 34-year-old female patient, admitted for unusual location and clinical presentation of respiratory infection with G. morbillorum; she was presented a left pleuritic pain, a productive cough associated with purulent and foul sputum and dyspnea with onset one month earlier. The clinical examination was objectified a polypnea at 32 cycles/minutes, intercostal indrawing and mixed pleural effusion syndrome. She had also many dental caries and bad oral health status. Chest radiography showed an air-fluid image in the left chest and the thoracocentesis had revealed purulent fluid. The culture of this fluid had isolated a G. morbillorum. The diagnosis of mixed pleural effusion due to G. morbillorum in an immunosuppressed diabetic patient was made. The patient was put on antibiotics, thoracic drain- age and Chest physiotherapy with good improvement.
Gemella morbillorum, Gemella Species, Respiratory Infection, Hydroaeric Pleural Effusion
1. Introduction
G. morbillorum is a bacterium belonging to the family of the Gemella species. These microorganisms are gram positive cocci and facultative anaerobes which—like other human commensal bacteria—are opportunistic pathogens and may cause serious local and systemic infection, mainly in immunodepressed patients [1] . It can cause endocarditis [2] , septic artritis [3] , and meningitis [4] . It is an infrequently isolated organism and a rare cause of pulmonary and pleural infection. But, some cases of lung abscesses [5] , necrotising pneumonia [6] [7] and pleural empyemas [8] have been reported in the literature. The prognosis of this infection will depend on the location, but also on the field of patient. So, some locations, such as cerebral localization are worse prognosis reports to others [9] . The pleura and lung manifestations of this infection have rarely been described. We present a new observation of purulent hydroaeric pleural effusion caused by this microorganism.
2. Case Report
A 34-year-old woman, non-smoker, diabetic type I, never treated for tuberculosis (TB) and without TB recent contagion. She was admitted for left-sided pleuritic pain following a cooling episode, a productive cough associated with purulent and foul sputum, a dyspnea on the slightest exertion, in a context of preservation of the general state, with onset one month earlier. The patient was treated in a local hospital, with probabilistic antibiotics amoxicillin-clavulanic acid for 15 days but without improvement and she was then transferred to our hospital. On admission, her body temperature was 37.2˚C. Of note in her clinical examination was a polypnea at 32 cycles/minutes, intercostal indrawing, symptoms of left mixed pleural effusion. She had also many dental caries and bad oral health status. A chest X-ray showed dense opacity, with water tonality which sits at the left lower lobe with air-fluid level (Figure 1). C-reactive protein (CRP) was 382 mg/l without high total leukocytes count. A lymphopenia at 600 elements/mm3 was noted. The search for Mycobacterium tuberculosis (BK) on direct microscopic examination and the HIV serology were negatives. Diagnostic thoracocentesis was performed. Purulent, greenish, putrid fluid was obtained. Culture of this fluid revealed the growth of G moribillorum with reduced susceptibility to penicillin but susceptible to cephalosporins. Chest computerized tomography (CT) shows abundant mixed left pleural effusion with ipsilateral lung collapsed (Figure 2). The bronchoscopy had objectified a diffuse inflammatory bronchial mucosa with release of purulent secretions. The treatment commenced with a chest drain (total volume 2300 ml), and ceftriaxone at dose of 2000 mg every 24 hours intravenously with relay by oral treatment 4 days later, as well as gentamicin (160 mg every 24 hours, intravenously) for 5 days, oral metronidazole (500 mg every 8 hours) and chest physiotherapy was then added, with good clinical outcome; degreased chest pain, disappearance and clarification of purulent sputum. The CRP had decreased to 28 mg/l,
Figure 1. Face chest radiography showing dense pleural opacity, with water tonality witch sits at the left lower lobe with air-fluid level.
Figure 2. Transversal scannographic section objectifying a hydroaeric image with ipsilateral lung collapsed.
and lymphopénia increased to 1600 elements/mm3. Radiologically, an improvement also was noted, with disappearance of the air-fluid level and top ventilation of the lung parenchyma.
3. Discussion
G. morbillorum, isolated in 1917 from blood of patients with measles [9] , was transferred from the genus Streptococcus to the genus Gemella (also including Gemella haemolysans and several recently described organisms). It is an aerobic or aerotolerant Gram-positive coccus usually found in pairs, which explains the name of this genus. Underlying conditions (e.g. immunocompromission, cancer, heart disease, sinusitis or poor dental condition, as well as previous invasive medical procedures) are frequently, but not necessarily [10] , associated with human infections caused by G. morbillorum, and some reported cases in previously healthy people suggest that its pathogenicity should not be underestimated [10] [11] . Although it is generally susceptible to penicillin and other antibiotics, resistance to penicillin, has been reported [11] , as the case of our patient. Due to their opportunistic nature, these species are capable of causing certain infections, the most common of which are septicaemia [12] , infections of the nervous system [4] , arthritis [3] , liver abscesses [13] , and endocarditis [2] . Many cases of respiratory tract infections have been described such as necrotizing pneumonia [6] [7] [9] lung abscesses [5] and even colonization of the tuberculous cavity. However, the appearance of pleural involvement is considered exceptional [1] . In a revue of medical litterature, we identified 15 cases of pleural empyema caused by Gemella species [1] [6] [14] - [18] , published mostly by spanish teams. Thus, García-Lechutz et al. [18] had described 4 cases of pleural empyema caused by Gemella species over a period of 4 years. Also, 4 other cases have been published over a period of 7 years by the pulmonology department of the university hospital of valencia, a case has been published separately by Signes-Costa [6] and 3 other cases have been reported after by Senent [1] , but to the best of our knowledge, the purulent hydro-aeric pleural effusion caused by this germ has never been reported.
Among the underlying conditions presented by patients with this type of infection intravenous drug addiction [8] [18] , cardiovascular disease, alcohol abuse [18] and diabetes [18] are notable, as was the case in our patient from this study, infected by G morbillorum and diabetes. Predisposing factors include poor mouth hygiene and prior dental procedures, which due to the disruption in the mucosa, could facilitate hematogenous dissemination, as well as microaspiration of oropharyngeal secretions that would facilitate bronchogenic dissemination [1] , which we believe could have occurred in this patient given the past medical history of poor oral health status. Penicillin or ampicillin are the drugs of choice for treating infections of gemella spices. However, occasional resistance to penicillin has been reported in rare cases, such as our patient, who was put under cephalosporin. Moreover, there is insufficient information on the duration of treatment and so it is recommended to prolong treatment for at least 4 weeks [6] . The management of these patients is based on drainage of the empyema with therapeutic thoracocentesis or chest drain. In our patient, we performed chest drain and antibiotic treatment was continued for 4 weeks with a satisfactory clinical and radiologic outcome.
4. Conclusion
In the case of patient with pleural involvement, we must consider the possibility of infection caused by Gemella species, especially in immunodepressed patients or those having predisposing factors like poor dental health.
Conflicts of Interests
I declare that I have no conflict of interests here.
- Senent, C., Sancho, J.-N., Chiner, E., Signes-Costa, J., Camarasa, A. and Andreu, A.-L. (2008) Pleural Empyema Caused by Gemella Species: A Rare Condition. Arch Bronconeumol, 44, 574-77.
- Murai, M., Fukumoto, H., Negoro, N., Sano, N., Nishimoto, N., Muraoka, H., et al. (2006) Evidence of Active Endocarditis, Caused by Gemella morbillorum, Related to Acute Embolic Stroke. International Journal of Cardiology, 112, 17-18. http://dx.doi.org/10.1016/j.ijcard.2006.01.071
- Roche, M. and Smyth, E. (2005) A Case of Septic Arthritis Due to Infection with Gemella morbillorum. Journal of Infection, 51, 187-189. http://dx.doi.org/10.1016/j.jinf.2005.01.009
- Villegas, E., Valldeoriola, F., Otero, J., Ferrer, L., Oms, B., Vila, L., et al. (2008) Meningitis by Gemella morbillorum with Associated Pituitary Apoplexy: A Case Report. European Journal of Internal Medicine, 19, 101-102. http://dx.doi.org/10.1016/j.ejim.2008.07.003
- De Soyza, A., Higgins, B. and Gould, K. (2000) An Unusual Case of Pulmonary Abscess. Journal of Infection, 41, 114. http://dx.doi.org/10.1053/jinf.2000.0686
- Signes-Costa, J., Chiner, E. and Arriero, J.M. (2000) Neumonía necrosante y empiema por Gemella morbillorum en paciente laringuectomizado. Arch Bronconeumol, 36, 601-602.
- Famularo, G., de Simona, C., Minisola, G. and Nicotra, G.C. (2006) Pneumonia and Sepsis Caused by Gemella morbillorum: An Unusual Association. Internal Medicine, 45, 1253-1254. http://dx.doi.org/10.2169/internalmedicine.45.1792
- Valipour, A., Koller, H., Setinek, U. and Burghuber, O.C. (2005) Pleural Empyema Associated with Gemella morbillorum: Report of a Case and Review of the Literature. Scandinavian Journal of Infectious Diseases, 37, 378-381. http://dx.doi.org/10.1080/00365540510035319
- Messori, A., Bartolucci, F., Dini, M., Mataloni Paggi, A., Ricciuti, R., Rychlicki, F., et al. (2002) Gemella morbillorum Deep Brain Abscess Successfully Treated with Combined Stereotactic, Medical, and Imaging Approach. European Journal of Radiology, 44, 143-151. http://dx.doi.org/10.1016/S0720-048X(02)00006-2
- Estivals, M., Mermond, S., Barbe, C., Du Covedic, L., Birolleau, S. and Levenes, H. (2007) Pneumopathie nécrosante à Gemella morbillorum chez un patient immunocompétant. Revue des Maladies Respiratoires, 24, 1143-1146. http://dx.doi.org/10.1016/S0761-8425(07)74266-3
- Farmaki, E., Roilides, E., Darilis, E., Tsivitanidou, M., Panteliadis, C. and Sofianou, D. (2000) Gemella Morbillorum Endocarditis in a Child. Pediatric Infectious Disease Journal, 19, 751-753. http://dx.doi.org/10.1097/00006454-200008000-00015
- Vasishtha, S., Isenberg, H.D. and Sood, S.K. (1996) Gemella morbillorum as a Cause of Septic Shock. Clinical Infectious Diseases, 22, 1084-1086. http://dx.doi.org/10.1093/clinids/22.6.1084
- Nam, H.J., Yoon, S.J., John, B.M., Jung, S.H., Kim, A., Ko, B.S., et al. (2005) Liver Abscess Caused by Gemella Morbillorum. Korean Journal of Gastroenterology, 46, 56-59.
- da Costa, C.T., Porter, C., Parry, K., Morris, A. and Quoraishi, A.H. (1996) Empyema Thoracis and Lung Abscess Due to Gemella morbillorum. European Journal of Clinical Microbiology and Infectious Diseases, 15, 75-77. http://dx.doi.org/10.1007/BF01586189
- García del Busto, A., Moreno, R., Pardo, F. and Ferrándiz, A. (1995) Empiema causado por Gemella morbillorum. Med Clin (Barc), 104, 196-197.
- Hayashi, Y. and Ito, G. (1996) A Case of Bacterial Empyema Caused by Gemella morbillorum. Kansenshogaku Zasshi, 70, 259-263.
- Marcos Sánchez, F., Celdrán Gil, J., Árbol Linde, F. and Caballero Sánchez-Robles, L. (2000) Empiema pleural por Gemella morbillorum con una evolución favorable. Anales de Medicina Interna, 17, 112-113.
- García-Lechuz, J.M., Cuevas-Lobato, O., Hernangómez, S., Hermida, A., Guinea, J., Marín, M., et al. (2002) Extra- Abdominal Infections Attributable to Gemella Species. International Journal of Infectious Diseases, 1, 78-82.


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Rakul Singh gives some useful advice: 'Sare Jahan Se Achcha Hindustan Hamara!! Here is wishing all of you a very Happy Independence Day!! Let's value the freedom our lovely country gives us and live with harmony and peace.'
Soha Ali Khan and Kunal Kemmu's daughter Inaaya holds the flag high, as Soha quotes Rabindranath Tagore: 'Where the mind is without fear and the head is held high, into that heaven of freedom, my father, let my country awake... #happyindependenceday #jaihind #rabindranathtagore.'
Soha's maternal great grandmother Latika Barua was the granddaughter of Dwijendranath Tagore, Gurudev's brother.
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'India in my heart,' says Diana Penty.
Shah Rukh Khan, Gauri and younger son AbRam hoist the flag on Mannat's terrace: 'Now the little one has made it a tradition. Hoisting of our beloved Tricolour and wishing everyone Happy Independence Day. Love to all and may our country, India prosper and all of us with it.'
Farhan Akhtar adds a patriotic touch to what he loves best -- going paragliding -- and writes, 'Happy Independence Day Let your thoughts, your attitude and your actions be such that they honour the memory of all those who in life, dedicated and in death, sacrificed themselves for our freedom. Jai Hind.'
Salman Khan waves the flag.
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Rajkummar Rao with the Tiranga.
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'स्वतंत्रता दिवस की शुभकामनाएं On this Independence Day, let's commemorate the unwavering contributions of our brave heroes and heroines who valiantly fought for our freedom Let us salute the unbreakable determination and vigor of those who continue to safeguarded our nation with unflinching strength Jai Hind,' says Sara Ali Khan.
Nimrat Kaur: 'बचपन से आज तक, मेरे दिल के सबसे क़रीबी और पसंदीदा तीन रंग... Nothing like the feeling of holding and standing beneath our beloved Tricolour... Happy Independence Day from me to all my fellow Indians all over the world. Jai Hind!!'
Neha Dhupia holds the flag high.
'भारत माता की जय!' exclaims Karishma Tanna.
Sunny Deol celebrates Independence day with son Rajveer and some school children and writes, 'Happy Independence Day to my fellow citizens! Love your nation and your family.'
Gul Panag: 'Where the mind is without fear, and the head is held high..... Wishing everyone a very, very happy Independence Day.'
Aparshakti Khurana celebrates Independence Day with daughter Arzoie.
'Here's to remembering and respecting the sacrifices of countless many who fought for our freedom.. We must respect and cherish Our independence that came at a colossal price #JaiHind,' says Randeep Hooda.


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Leading Tips For Budding Structural Engineers
20 Oct 2018 09:39
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