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Pakatan shakes off Dr Mahathir's 2018 'bukan kitab suci' remark, says determined to carry out GE15 manifesto without 'saboteurs'
Distancing itself from its former chairman Tun Dr Mahathir Mohamad's "bukan kitab suci" remark in 2018 which suggested that election manifestos are not incontrovertible holy scriptures, Pakatan Harapan (PH) said it is determined to fulfil its manifesto "Harapan Action Plan" as it will no longer face internal sabotage.
(MMO) – Speaking to Malay Mail after its manifesto also called "Tawaran Harapan", PH communications director Fahmi Fadzil laid the blame for the remark solely on now-rival Dr Mahathir's feet — saying the latter said it unilaterally without consulting allies.
"Well Mahathir is not in Pakatan, he didn't get our sanction to say what he said, that was an irresponsible statement
"It reflects badly on him, not on us," he told Malay Mail in a recent interview when asked about the perception that has since lingered with the remark.
Fahmi said that there was a sense of sabotage being carried out during PH's time as the previous federal government, noting for example the last meeting of the PH secretariat before the its administration collapsed in February 2020 with the abrupt pulling out of Parti Pribumi Bersatu Malaysia.
In this last meeting with five persons attending namely Datuk Seri Saifuddin Abdullah, Liew Ching Tong, Datuk Radzi Jidin, Tan Sri Muhyiddin Yassin's former aide Datuk Marzuki Mohamad and Fahmi, a question was suddenly asked by both Radzi and Marzuki on what is the prerogative of the PH secretariat council, Fahmi said.
"So after almost three years of being part of the secretariat council, suddenly they questioned. To me, that was already the set-up for 'Sheraton Move'. And all along there was always this sense of undermining, being fifth columnists, saboteurs lah, that was the reality," Fahmi said, referring to the defection of Bersatu.
Did Pakatan fail in its short stint?
When asked if such alleged sabotage was why PH did not manage to achieve some of its GE14 manifesto, Fahmi said: "'Pakatan Harapan tak gagal, Pakatan Harapan digagalkan' (Malay for 'Pakatan Harapan did not fail, Pakatan Harapan was set up to fail'), so there were people who made it their political mission to make sure Pakatan Harapan failed."
"Why would you say the Pakatan Harapan manifesto is 'bukan kitab suci'? That was the platform that we were voted on, how can you renege, how can you go back on that?" he said when questioning the remark made by Dr Mahathir in 2018.
But with GE15 this time around, Fahmi pointed out that PH no longer has such saboteurs within the coalition,
"I think we are dwelling too much on the past. Going into GE15, all those elements, all those saboteurs, those people who didn't help Pakatan Harapan are out.
"So Pakatan Harapan now is strong, compact, with new leadership — DAP and PKR — and we are ready to face GE15 with the experience that many of us had in Putrajaya. So it makes this election plan, this 'tawaran' — to me — much more doable, realistic.
"Plus we understand a lot better now, how the civil service responds," he added. DAP and PKR, two of the four component parties in PH, had held party elections this year.
Apart from Dr Mahathir's remark which was not discussed ahead and allegedly did not reflect PH's stand, Fahmi said there was not much political coordination then between certain leaders in the PH administration and with the PH secretariat.
He explained that the PH secretariat was intended to act as an intermediary to put together working papers between a functioning executive and political parties, as it was the job of the executive branch of government to execute the manifesto they were voted on, while the political parties had the role of making sure that manifesto was interpreted well.
But Fahmi said many of the decisions and issues such as the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) and "the flying car idea" were not brought up to PH for discussion, agreement and execution, and that the PH secretariat council then rarely met and that things were being reported to instead of being discussed at such meetings when they were held.
Fahmi said a lot of the failures could be chalked down to certain individuals whom he said made decisions without prior discussions, contrasting them with "team players" such as Datuk Seri Saifuddin Nasution Ismail and Anthony Loke whom he said did not fail in their respective ministerial portfolios.
"So ICERD was never consulted, it was Mahathir in New York with [then foreign minister Datuk] Saifuddin Abdullah at the United Nations making an announcement, and then everyone was surprised, nothing was discussed beforehand. So it's as though at that time Saifuddin Abdullah, Mahathir didn't care about Pakatan Harapan, eventually we saw they left," he said.
The flying car referred to the remark made by Bersatu's then minister Datuk Seri Mohd Redzuan Md Yusof saying Malaysia's first flying car was being developed using local technology and the prototype would be unveiled in 2019.
'It's all about priority'
Previously, PH had outlined its manifesto for the 14th general election (GE14) on what it planned to do for Malaysia, only to realise upon forming government in 2018 that the country was actually facing massive debts of billions of ringgit from 1Malaysia Development Berhad (1MDB), Fahmi said.
Even before PH could fulfil all its plans in the GE14 manifesto, it had to first fix various financial problems and leakages left behind by the previous administration, and was also kicked out by a government that entered through the backdoor, Fahmi said.
Asked why the Harapan Action Plan did not include specific timelines for the goals, Fahmi explained that such timelines can only be realistically set once PH forms the government and is able to look at the actual state of government finances along with the state of the economy.
He explained that a new PH administration would look at seeing which of the points under the manifesto can be prioritised after government finances are assessed and said the prime minister and finance minister would be those best suited to speak on such timelines.
"We will need, once we get into Putrajaya to understand the state of public finances, that is the first order of business, then we know how much money we have left, then we know where there's revenue coming from, then we know what the challenges are, then we can prioritise. You can't prioritise if you don't have these facts," he said, adding that prioritising would mean that certain things may get done first while others get done later.
"After GE15, first I imagine we will need to take stock of the level of finances of the government. Secondly, we have to prioritise, out of all these programmes, which will be the one that will have the most positive impact on the people — both direct as well as if there are multiplier effects on the economy. Those I imagine would be of some focus for the government," he said.
As for policy reforms such as the promise to set a 10-year term limit for the prime minister, Fahmi said these are things that could be done, but said it was not his place to state the timeline such as which parliament sitting it would be carried out.
Rival Perikatan Nasional launched its manifesto last night, while Barisan Nasional is expected to launch its own today.


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subset: commoncrawl


text:
Monitoring the expert's mission :
During the period of your detachment, the ATCT provides administrative follow-up of your application and keeps in touch with you in order to inform you of all useful and necessary information for your career and / or your affiliation to CNRPS and others.
Also note that if the ATCT is the exclusive manager of the budget allocated to the project to which you are affected to, it ensures:
- Financial monitoring
- Monitoring mission reports transmissions while guaranteeing the confidentiality of their content and the preservation of intellectual property right.
Evaluation of the ATCT services:
To evaluate its services, the ATCT provides you with a form (add a link to the vers l'Enquête de satisfaction consultant) to help you convey your comments and suggestions.
Evaluation of the expert's services:
The ATCT also ensures satisfaction of the beneficiary about the Tunisian expertise within the South-South cooperation.
Thus, at the end of your mission, the ATCT shall provide the beneficiaries of your expertise with a form to have their opinions as to the objectives of technical assistance, communications, reports ....


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The watermark in the lower right corner of the image will not appear on the final print.
Top Mat
Bottom Mat
8.50" x 12.00"
10.50" x 14.00"
Family Poster
by Casper Cammeraat
Product Details
Family poster by Casper Cammeraat. Our posters are produced on acid-free papers using archival inks to guarantee that they last a lifetime without fading or loss of color. All posters include a 1" white border around the image to allow for future framing and matting, if desired.
Design Details
The dog is here definitely part of the family
Ships Within
3 - 4 business days
Additional Products
Canvas Print
Framed Print
Art Print
Metal Print
Acrylic Print
Wood Print
Greeting Card
iPhone Case
Throw Pillow
Duvet Cover
Shower Curtain
Tote Bag
Round Beach Towel
Zip Pouch
Beach Towel
Weekender Tote Bag
Portable Battery Charger
Bath Towel
Coffee Mug
Yoga Mat
Spiral Notebook
Fleece Blanket
Poster Tags
Photograph Tags
Comments (6)
Artist's Description
The dog is here definitely part of the family
About Casper Cammeraat
From land- and cityscapes, portraits, architecture, gumprints, (details of) structures to abstract photography and panorama's: I like to share the beauty that inspires me. Writing with light is my starting point! Casper Cammeraat has a large collection of Dutch and European images. Available for conducting workshops or private tuition at request in English, German or Dutch. Recognizing the symbolic impact of many of his nature photographs, combined with a life long interest in psychological and spiritual beliefs and systems, Casper has started (re)designing images towards visualizing inspirational and philosophical concepts, views, values, virtues. All or any part of my work is �Copyrighted. All Rights Reserved and may not be...


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There are a number of essential aspects that you ought to think about before you begin purchasing e-juice. Find out about PG vs VG and also Pure nicotine web content, as well as Flavor concentrates and Pure nicotine salts. The Centers for Disease Control as well as Prevention even published a record about the threats of vaping. After that, pick your e-juice sensibly. To discover the most effective vape juice for you, continue reading!
PG vs VG
If you are seeking a thick, savory vape, after that choosing a high-VG blend is a great choice. Nevertheless, you'll need to change your coils more regularly as the VG content is a lot greater. You can get the very best outcomes by selecting a 50/50 mix or a 30%- to-70-VG mix. Either method, both blends have differing benefits, so make certain to read the tags very carefully to ensure they are appropriate for you.
Nicotine levels
In a current research, Etter and also Bugey (2017) investigated the uniformity of nicotine degrees in e-liquids. They measured nicotine focus from six prominent brands over 4 weeks. The distinction in between e-liquids from various brands varied by approximately 31 percent. Nonetheless, differences in between sets of the very same brand were minimal. This suggests that pure nicotine concentrations in e-liquids might differ as long as 10 percent.
Seasoning concentrates
Seasoning concentrates are liquids that are made from a concentrate that contains a mix of flavourings. These fluids are normally weakened with PG or VG, as well as they are created to duplicate the taste of e-juice without being a direct alternative for it. Unlike various other flavourings, they are not subject to the TPD. In addition to flavouring focuses, there are various shapes and sizes offered.
Nicotine salts
Whether you're looking for an affordable or careful vaping sensation, pure nicotine salts in e-juice can provide you with the right mix. While nicotine salts produce less vapor, they're an excellent alternative for devices with low account. Pure nicotine salts can be included in e-liquids that use a pod or vape pen. They're readily available only in restricted tastes as well as producers.
Nicotine salts vs VG
The debate in between VG and pure nicotine salts e-juice is a stagnant one. While the former are commonly made use of in vaping, nicotine salts are acquiring popularity due to their superior preference as well as higher pure nicotine material. The adhering to discussion discovers the pros and also cons of each kind as well as which is ideal for your certain requirements. You can likewise contrast the expenses as well as advantages of both, depending upon your vaping choices. When you liked this information along with you would want to acquire more details concerning หัวพอต ราคาส่ง generously visit the web site.
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First, it's a trap! Luke Skywalker and Rogue Squadron has been snared by the Empire. But who is the traitor and why is new recruit Ibti Myrak fighting with Admiral Ackbar on the deck of Home One? X-wings and TIE fighters clash in "Squad Goals," part two by Cavan Scott and Manuel Bracchi. Then, from author and artist Andrew Griffith comes a new "Tales of Villainy." Asajj Ventress must face off with Aayla Secura, who is dangerously close to uncovering the early stages of the Death Star Project.
Taking both stories into account, this overall issues managed to capture the spirit of the original trilogy, albeit while being toned down slightly for younger readers, making for one of the more entertaining issues, front to back, of the current run of Star Wars Adventures. Read Full Review
Be the first to rate this issue!
Click the 'Rate/Write A Review' link above to get started.


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- How to select a table in InDesign and adjust options?
- How to add a row to a table in InDesign?
- How to delete a row to a table in InDesign?
- To export your PDF document with accessibility features
- What's the result in Acrobat tags of including a header row in a data table?
- Resources about InDesign and accessibility
There are a couple things to check to be able to export accessible data tables from InDesign:
- Make sure your table has a header row at the top. You can check if it has a header row in the Table Setup options.
- Ensure that you export your document as a 'tagged PDF'.
Also, keep in mind that InDesign can only markup basic tables with column header cells in a top header row. If you need to do a more complex table that also includes row header cells on the left side, you'll need to add the row header cell markup in Adobe Acrobat Pro.
To create a data table in InDesign:
- Click in a text where you want the table to go.
- Select Table > Create Table.
This brings up a dialog that asks how many rows and columns you want in the table. The important part for accessibility is that it asks you to designate one or more header rows. A typical basic table has one header row.
How to select a table in InDesign and adjust options?
- Click in the table that you want to adjust.
- Go to the Table menu in InDesign.
- Choose Table Options > Table Setup.
A dialog box of table settings comes up where you can adjust settings like the number of rows and you'll also have the ability to add a header row if your table doesn't already have one.
How to add a row to a table in InDesign?
- Click in the row where you want the new row to go above or below.
- Go to the Table menu in InDesign.
- Choose Insert > Row.
- Choose if you want the new row to go above or below the current row and hit 'Ok'.
The new row appears above or below the current row you were in.
How to delete a row in a table in InDesign?
- Click in the row that you want to delete.
- Go to the Table menu in InDesign.
- Choose Delete > Row.
The current row is deleted.
To export your PDF document with accessibility features:
- Go to File > Export and choose PDF format.
- Hit Save and in the options that come up make sure 'Tagged PDF' is checked. This will ensure the tag structure for accessibility is included in the document.
- Click Export and your tagged PDF is saved ready to review in Acrobat.
What's the result in Acrobat tags of including a header row in a data table?
If you want to check that the header row exported made it into your PDF successfully you can:
- Open the document in Adobe Acrobat Pro and find the table in the Tags panel.
- Then open the <TR> rows of the table and verify that the first row uses true <TH> header cells instead of regular <TD> header cells.
Running the accessibility checker in Adobe Acrobat will also tell you if there's a problem with your data tables.
To run an accessibility test in Acrobat Pro:
- Find 'Prepare for accessibility' under 'All Tools'
- Click 'Accessibility Check', accept the default settings, and click 'Start Checking'.
The test runs and the results pop up. Any table issues can be found under the Tables section.
Resources about InDesign and accessibility
Videos about InDesign and accessibility
Other data tables in InDesign resources and tutorials:
- InDesign Document Accessibility BuckeyeLearn course – a course from Deque Systems covering all aspects of InDesign document accessibility.
- Tables with InDesign video from LinkedIn Learning – from the creating accessible PDFs LinkedIn Learning course.
- InDesign tables tutorial from Olde Miss University.
More information about InDesign and accessibility:
- Setting up a heading structure in InDesign for accessibility — from 2022
- Steps to better structure an InDesign document to promote accessibility — from 2017


text: A Black and Soft Yellow Music Party Poster is a promotional material designed to advertise a musical event. The poster features a combination of black and soft yellow colors, creating a striking and eye-catching contrast. The design is typically bold and visually appealing, with attention-grabbing graphics and text that highlight essential details like the date, time, location, and performers. The Black and Soft Yellow Music Party Poster is an effective way of generating interest and hype for a music party, encouraging people to attend and take


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Management of Stretch Marks and Their Causes
Stretch marks appear on the skin after the body sections grow at a more rapid pace and the skin fails to keep up with it. These may be due to quick weight gain, pregnancy, bodybuilding, puberty, and use of steroids. These energy booster medicines cause a high level of Cortisol in the body. They are also genetic and can run in the family line. The weakening of skin fibers is the primary cause why stretch mark becomes visible.
They are pink, gray, purple, or a mix of color but the most significant thing is that they do not have the same color as your skin. When you touch where they are with your finger, you might feel the indention on the skin. They can appear on almost any part of the Body, but it mostly appears on the stomach, hips, shoulders, back, arms and even the face. Mostly, collagen is the protein that causes elasticity of the skin.
Thus a deficiency of the protein may manifest itself in the form of stretch marks. If these stretch marks are left to stay for long without being treated, it might become difficult to get rid of them entirely. It is advisable to deal with stretch marks at an early stage as possible.
They can also get away naturally without being treated, but this is not the best option. Given below are some of the strategies that can be adopted to get rid of the stretch marks or reduce their impact.
Creams with tretinoin like Retin-A
They contain retinoid which helps in fading the marks. The only disadvantage is that they can cause your skin to become reddish, irritated, and scaly. To reduce their undesired effects, you should visit a dermatologist to get the best prescription. They help in unclogging the pores, reduce fine lines, promote collagen production as well as reduce the discoloration associated with stretch marks.
Use of collagen boosters
Collagen is one of the major elements which contribute to modifying or improving the elasticity of the skin. There are many sources of collagen which can act as boosters to your body; they may include but not limited to bovine, porcine, or marine collagen. For efficiency, rather than being consumed raw, they can be given in the form of injections.
It is the procedure of removing the dead skin cells from the top layer of the skin. The main disadvantage of this method is that it works on the skin from the top, but the stretch marks are deeply rooted in the dermis. Thus, it's not an efficient way of managing stretch marks.
Cosmetic surgery
These are a variety of practices done by a medical practitioner to enhance the appearance of your skin by removing the stretch marks through surgery. They may include the use of rejuvenation methods as well as any other surgical means to remove the excess fat and tissues causing the stretch marks.
Managing your weight
Apart from pregnancy, a majority of other causes of stretch marks are related to weight gain or bodybuilding activities. Controlling the rate at which you gain weight will be the sure way to prevent cases of stretch marks occurring. Abrupt weight gain puts the skin under strain.
Laser skin tightening
It is most effective in situations where after the skin stretches, it loses its elasticity and becomes saggy. A skin tightening operation will get rid of those stretch marks. The laser activates the collagen-producing cells and eventually leads to skin tightening.
Blue light therapy
It is the use of particular drugs that are activated by light to treat stretch marks or tightening the skin. When the drug is activated by a photosensitizing agent; the blue light, they cause the production of more collagen cells.
The best remedy for stretch marks is prevention. Always ensure that your skin is well hydrated so that even if your skin stretches, there is little discomfort like itching associated with the condition. Some causes are beyond your control, and in such cases, it is good to adopt the best management strategies to restore your skin to a healthy state as stated above.


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Research Paper Volume 13, Issue 7 pp 9911—9926
Exosomes derived from microRNA-512-5p-transfected bone mesenchymal stem cells inhibit glioblastoma progression by targeting JAG1
- 1 Department of Neurosurgery, The Second Affiliated Hospital, Nanchang University, Nanchang, P.R. China
- 2 Department of Neurosurgery, Jiujiang No.1 People's Hospital, Jiujiang, P.R. China
- 3 Department of Neurosurgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, P.R. China
Received: November 21, 2020 Accepted: January 22, 2021 Published: March 26, 2021
https://doi.org/10.18632/aging.202747How to Cite
Copyright: © 2021 Yan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
In this study, we demonstrate that bone mesenchymal stem cell (BMSC)-derived exosomes alter tumor phenotypes by delivering miR-512-5p. miR-512-5p was downregulated in glioblastoma tissues and cells, and Jagged 1 (JAG1) was the target gene of miR-512-5p. We clarified the expression patterns of miR-512-5p and JAG1 along with their interactions in glioblastoma. Additionally, we observed that BMSC-derived exosomes could contain and transport miR-512-5p to glioblastoma cells in vitro. BMSC-derived exosomal miR-512-5p inhibited glioblastoma cell proliferation and induced cell cycle arrest by suppressing JAG1 expression. In vivo assays validated the in vitro findings, with BMSC-exosomal miR-512-5p inhibiting glioblastoma growth and prolonging survival in mice. These results suggest that BMSC-derived exosomes transport miR-512-5p into glioblastoma and slow its progression by targeting JAG1. This study reveals a new molecular mechanism for glioblastoma treatment and validates miRNA packaging into exosomes for glioblastoma cell communication.


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Background: Predisposing and precipitating factors for delirium for the elderly, over the age of 65 years, are known, but not for the very old, over 80 years. As the society is getting older and evermore patients will reach >80 years, more evidence of the factors and their contribution to delirium is required in this patient group. Methods: In the course of 1 year, 3,076 patients above 80 years were screened prospectively for delirium based on a Delirium Observation Screening (DOS) scale, Intensive Care Delirium Screening Checklist (ICDSC), and a DSM (Diagnostic and Statistical Manual)-5 nursing instrument (ePA-AC) construct. Relevant predisposing and precipitating factors for delirium were assessed with a multiple regression analysis. Results: Of 3,076 patients above 80 years, 1,285 (41.8%) developed a delirium, which led to twice prolonged hospitalization (p < 0.001), requirement for subsequent assisted living (OR 2.2, CI: 1.73–2.8, p < 0.001), and increased mortality (OR 24.88, CI: 13.75–45.03, p < 0.001). Relevant predisposing factors were dementia (OR 15.6, CI: 10.17–23.91, p < 0.001), pressure sores (OR 4.61, CI: 2.74–7.76, p < 0.001), and epilepsy (OR 3.65, CI: 2.12–6.28, p < 0.0001). Relevant precipitating factors were acute renal failure (4.96, CI: 2.38–10.3, p < 0.001), intracranial hemorrhage (OR 8.7, CI: 4.27–17.7, p < 0.001), and pleural effusions (OR 3.25, CI: 1.77–17.8, p < 0.001). Conclusion: Compared to the general delirium rate of approximately 20%, the prevalence of delirium doubled above the age of 80 years (41.8%) due to predisposing factors uncommon in younger patients.
Delirium is an acute neuropsychiatric syndrome associated with fluctuating orientation, attention, awareness, perception, higher order thinking, cognition, sleep-wake cycle, and emotionality, that is, anxiety or depression [1]. In the general hospital setting, delirium is particularly common in older patients. Existing studies on delirium in the elderly investigate patient groups ≥65 years old, but not specifically the very old, very elderly, or oldest old patients >80 years of age. Despite the increasing life expectancy of the population and the fact that health care institutions will be increasingly confronted with patients over 80 years of age in the future, little is known about delirium in this growing patient group.
In general, the underlying etiology of delirium is often multifactorial and can be described by differentiating predisposing and precipitating factors. Predisposing factors exist prior to the onset of the delirium, such as dementia, age, and gender. Conversely, precipitating factors contribute to the activation of a delirium, for example, through metabolic or electrolyte abnormalities or inflammatory processes. In general, the more predisposing factors (e.g., age, dementia, and epilepsy) a patient accumulates, the fewer precipitating factors (e.g., mild inflammatory process such as a cold) are necessary for the development of a delirium [2, 3]. Since aging itself is marked by predisposing factors such as lessened coronary and renal function and diminished cognitive reserve, it is natural that younger adults are less vulnerable to delirium. The interrelationship of delirium and dementia is an important field, as the diagnosis and treatment of delirium superimposed on dementia is challenging. Many studies suggest that delirium could unmask pre-existing, but undiagnosed dementia [4‒6].
The early detection, prevention, and treatment of delirium is of crucial importance regarding the short- and long-term consequences: delirium causes increased morbidity and mortality, prolonged hospitalization, increased health care costs, and increased subsequent institutionalization. In addition, delirium causes a deterioration in general functional ability, cognitive decline, and the associated risk of loss of independence. The direct and indirect economic costs of delirium are high and could challenge the resources of future health care systems in an aging society, as age itself is one of the most important predisposing factors for the development of delirium. Prevalence rates vary among medical service [7]: in obstetrics 2% [8], in neurology 35% [6], and in intensive care 70% and higher [9]. A general prevalence of delirium can therefore be seen as an average between all age groups and medical services and is estimated to be 20% [8]. In anticipation of the increasing number of patients ≥80 years, we aimed to (1) estimate the prevalence of delirium in the very old, (2) investigate previously reported risk factors in this age group, and (3) identify relevant predisposing and precipitating risk factors of delirium for care planning in advance.
Study Design, Patients, and Procedures
Over the course of 1 year (January 1–December 31, 2014), all patients (n = 39,442) were prospectively screened for delirium due to a delirium detection initiative (Delir-Path, Fig. 1) at the University Hospital Zurich, a tertiary care center. The reasons why or in which medical field they were admitted are analyzed in a previous work of our group. Patients were excluded if age was below 18 years, the length of stay was below 1 day, and missing data, including the electronic patient's assessment, leaving 28,806 eligible patients. Of these eligible patients, 3,076 (12.8%) were above 80 years.
Characterization of Predisposing and Precipitating Factors for Delirium
Several predisposing and precipitating factors for the development of delirium have been described previously [3, 4, 6, 10]. In our cohort of very old patients, predisposing and precipitating factors for the development of a delirium were based on the formation of diagnostic clusters, according to the 10th revision of the International Statistical Classification of Diseases (ICD-10) [11] (Table 1). We calculated multiple logistic regressions to evaluate the impact of individual diagnostic clusters for delirium [12]. Clusters relevant to delirium were included in the model, even if they did not reach significance and excluded only in instances of weakening the model, which was verified with the respective Cox-Snell's and Nagelkerke's r2.
A set of delirium screening scales was used to determine delirium: (1) the Delirium Observation Screening Scale [13], (2) the Intensive Care Delirium Screening Checklist [14], and (3) a DSM-5-criteria-based construct [15] from a nursing tool, called the Ergebnisorientiertes PflegeAssessment Acute-Care (ePA-AC) [16, 17]. On regular floors, the DOS scale was administered routinely 3 times daily during the first 3 days of admission in 65 years or older patients and based on the clinical evidence of incident delirium for all patients, that is, also in those <65 years. On the intensive care units (ICUs), the ICDSC was routinely performed thrice daily. Furthermore, nursing staff daily assessed various medical and functional parameters with the ePA-AC in all patients, regardless of whether a delirium was present or not. Since ePA-AC can also be used to measure delirium [17], information regarding the presence of delirium was therefore available for all patients and not only for older patients.
Validation of this delirium screening approach was done; delirium diagnoses were in 91% of patients correct, as determined by a reference-rater from a consultation-liaison psychiatry service. Further, this construct was tested against the validated DOS and ICDSC approach and achieved almost perfect agreement (Cohen's κ 0.83, p < 0.001). On regular floors, patients ≥80 years were screened daily with the DOS and ePA-AC. On ICUs, the ICDSC was conducted 3 times per day. DOS, ICDSC, and ePA-AC were conducted by nursing staff specifically trained in a 4-h course with achievement tests; literature research and eLearnings were made. Additionally, part of the education was performed via case reports, state-of-the-art lessons on epidemiology, and knowledge about delirium, including diagnostic criteria.
The DOS is a 13-item scale validated to indicate delirium according to DSM-IV criteria (DOS, cutoff ≥3) [13]. Items include disturbances of consciousness (1), attention (2–4), thought processes (5 and 6), orientation (7 and 8), memory (9), psychomotor behavior (10, 11, and 13), and affect (12). Symptoms are rated on a scale (0–1) as not existent (0), sometimes to always existent (1), and unable to assess (–). The cutoff score for delirium is ≥3, and values were aggregated throughout recordings. This approach proved to be valid and correctly identified 91% of delirium diagnoses as determined by the consultation-liaison psychiatry service.
The ICDSC is a screening instrument with 8 items (ICDSC, cutoff ≥ 4) based on the DSM-IV criteria specifically designed for the intensive care setting with 2 points: absent or present. This scale was designed for patients with limited communication abilities such as intubated patients. The items include the assessment of (1) consciousness (comatose, soporose, awake, or hypervigilant), (2) orientation, (3) hallucinations or delusions, (4) psychomotor activity, (5) inappropriate speech or mood, (6) attentiveness, (7) sleep-wake cycle disturbances, and (8) fluctuation of symptomatology. The maximum score is 8; scores of >3 indicate the presence of delirium. Each item is rated on the patient's behavior over the previous 8 h [14].
The ePA-AC is a nursing instrument administered daily assessing mobility, personal care and dressing, feeding, elimination, cognition and alertness, communication and interaction, sleeping, breathing, pain, pressure ulcers, and wounds [16]. DOS, ICDSC, and ePA-AC values as well as medical data were obtained from the electronic medical chart (Klinikinformationssystem, KISIM; CisTec AG, Zurich). This study was approved by the Ethics Committee of the Canton of Zurich (KEK-ZH-Nr. 2012-0263). A waiver of informed consent was obtained from the committee. Our reporting is in line with the STROBE statement [18].
Statistical Methods
Data analyses were performed with the Statistical Package for the Social Sciences version 25 and R statistical software version 3.5.0 for Windows. Descriptive characteristics are summarized depending on parametric properties using means and standard deviations or medians and interquartile ranges for continuous variables and percentages for categorical variables.
The data were tested with Shapiro-Wilk's test for distribution of normal distribution. Intergroup differences for continuous variables were computed using Student's t test and Mann-Whitney U test depending on their parametric properties and for categorical variables with Pearson's-χ2 test.
In a first step, the delirium construct based on DSM-5 was tested, and its agreement with the validated approach – with a DOS cutoff ≥3 or ICDSC ≥4 – with Cohen's κ was determined as measure of concordance. The agreement was defined as >0.80 near perfect [19].
In a next step, data were dichotomized by presence or absence of delirium. Then, simple logistic regressions were calculated to determine the prevalence rates of delirium for medical characteristics and their respective odds ratios (ORs) and corresponding confidence intervals (CIs). For all inferential tests, 2-tailed tests were chosen, and the significance level alpha (α) was set at p < 0.05.
Characteristics of Delirious Patients
Of 3,076 patients above 80 years, 1,285 (41.8%) developed delirium. The sociodemographic and medical characteristics of the delirious patients were typical for this syndrome and are displayed in Table 2. Gender was equally distributed between delirious and nondelirious patients with no significant impact on the development of delirium. Prior to admission, delirious patients resided less often at home (OR 0.36), required more assisted living (OR 2.73), or were transferred from other hospitals (OR 2.05) and admitted as emergencies (OR 2.24). ICU treatment increased the probability of delirium by 5-fold and the need for ventilation by almost 18-fold; there was a significant difference in group size (e.g., 208 ventilated delirious patients vs. 24 ventilated nondelirious patients). In addition, there was a significant difference in the length of stay in ICUs and the duration of ventilation.
Further, these patients had a prolonged hospitalization, that is, stayed almost twice as long, and were managed at an increased rate in the ICUs. At discharge, their physical and functional impairment was greater as indicated by increased requirement for outside hospital assistance (OR 2.37) and rehabilitation (OR 2.2) than returning to their own residence (OR 0.17); they also suffered from more severe illness as indicated by their increased mortality risk (OR 24.88).
Predisposing Factors for Delirium
Overall, predisposing factors for the development of delirium were related primarily to diseases of the nervous system. The most relevant predisposing factor was dementia, which led to a 15.6-fold increased risk of developing delirium (see Table 3; Fig. 2). Diseases such as pressure sores, epilepsy, and valvular heart disease caused an increased risk; formally, brain tumors and subcortical white matter lesions did not cause an increased risk; however, CIs widely ranged.
Precipitating Factors for Delirium
Summary of Main Findings
To date, this study is the largest to describe the predisposing and precipitating factors of delirium in patients over 80 years of age. In the course of 1 year, 41.8% of hospitalized patients ≥80 years old developed delirium; compared to the prevalence of delirium of 20% in the general population [8, 20], the delirium in patients ≥80 years old is therefore twice as high.
Not surprisingly, dementia was the strongest predisposing factor for the development of delirium. Other relevant predisposing factors were pressure ulcers and epilepsy. Important precipitating factors were systemic disorders which could be related to intracranial hemorrhage, acute renal failure, pleural effusion, and SIRS. Considering the different risk factors and the correspondingly affected organ systems, it is evident that especially diseases of the brain (e.g., dementia, subcortical lesions of the white matter, and epilepsy), the heart (e.g., heart valve diseases and pleural effusion), and body homeostasis (e.g., acute renal failure and sepsis/SIRS) are associated with delirium.
In addition, the development of delirium led to increased mortality, twice as long hospitalization, and the need for subsequent assisted living. Both the necessity and duration of treatment in intensive care or assisted ventilation were significantly associated with delirium. Patients with delirium in the course of their illness were more frequently referred from institutions such as nursing homes and assisted living and as emergencies, indicating greater functional and physical impairment, as well as more severe illness. In the aftermath of delirium, functional deterioration occurred as manifested by an increased need for assisted living and rehabilitation versus returning to their residence. Consequently, the cost of care for a patient following delirium increases, emphasizing the socioeconomic costs that follow.
Comparison with the Existing Literature
To our knowledge, there are no studies to date describing the predisposing and precipitating factors for the development of delirium exclusively in patients ≥80 years of age. Therefore, existing studies on risk factors for delirium ≥65 years of age were included as reference in this study. Besides the high prevalence rate of delirium aforementioned, it is striking that the risks – as described with the corresponding ORs – of several known predisposing and precipitating factors were higher than in previous studies on delirium. For example, the most relevant predisposing factor was dementia, which represented one of the most relevant factors (OR 15.6). In previous studies on delirium superimposed on dementia, lower risks were reported (OR 2.8–4.5) [21‒24] for several reasons: (1) the prevalence of dementia in patients ≥80 years of age ranges between 18 and 29% [25], in contrast to patients <80 years of age between 2 and 7% [26], which might affect the corresponding odds for the development of delirium. Since previous studies have examined a higher proportion of patients <80 years of age, the prevalence of dementia, and thus corresponding odds, might also be lower. (2) Dementia is not a static disease/condition [27] but worsens over time or with increasing age, and it seems natural that patients ≥80 years of age have a more advanced stage of dementia than patients <80 years old. It is conceivable that an advanced stage of dementia is more likely to predispose to the development of delirium, as cognitive abilities or resources are much lower [28]. This circumstance could additionally contribute to the high OR for dementia in our patient population. To our knowledge, there is a lack of specific studies on the extent to which advanced versus mild dementia leads to delirium or not. Unfortunately, we had no information about the severity of the respective dementia. (3) Multimorbidity increases with age [28] and is itself a risk factor for the development of delirium [29, 30], and dementia patients often exhibit high co- or multimorbidity [30]; it is conceivable that a demented patient ≥80 years of age has a higher multimorbidity than a patient <80 years of age, which could also increase the risk of developing delirium. In addition, multimorbidity not only increases with age, but also with the diagnosis of dementia [30]. One could speculate that a multimorbid patient with dementia has a higher risk of developing delirium than a patient without dementia. (4) In this context, the probability of polypharmacy also increases the risk of developing delirium [31]. Taking these reasons (1–4) into account, the comparatively high risk of dementia in patients ≥80 years seems plausible for the development of delirium. In this sense, it also seems plausible why the risks of several predisposing and precipitating factors are higher in patients ≥80 years than in patients <80 years. In addition, a not to be underestimated rate of possibly undiagnosed dementia patients in our very old patient group would also be possible, which would additionally increase the risks of all factors.
In addition, there are several factors besides dementia that represent both multimorbidity and frailty and thus lead to an increased susceptibility for delirium. Consequently, these factors can be interpreted as indicators of the presence of multimorbidity and frailty. As an example, pressure sores are known to be associated with high frailty and immobility [32]. According to this, it seems conclusive that in our study the presence of pressure sores is strongly associated with delirium; this circumstance also fits the existing literature [33]. Furthermore, several precipitating factors can also be interpreted as an indicator of multimorbidity and frailty. Pleural effusions are more likely to occur in patients who are already multimorbid and have severe cardiac diseases. Head trauma often occurs as a result of a tendency to fall, which many frail patients tend to do. In summary, it can therefore be concluded that in addition to the high age of over 80 years and the presence of dementia, multimorbidity and frailty are highly associated with delirium.
In contrast to previous studies that focused on "older" people with different age definitions, this study comprehensively describes predisposing and precipitating risk factors for delirium in a large sample of patients between ≥80 and 102 years of age. In an aging society, the studies must focus on the growing number of these patients among hospitalized patients. These findings suggest that delirium is very common in patients ≥80 years of age, particularly in patients who are admitted from assisted living or as emergencies, stay longer in the hospital, and require assisted living on discharge or death. These results could serve as a basis for advanced care planning and suggest that it might be useful to screen for delirium in every patient over 80 years of age and – based on the literature to date – also in younger patients.
Strengths and Limitations
A strength of this study is the large sample size, including successive recordings over 1 year. Generalizability to other health care facilities is limited, since our patient population was representative for a tertiary care center. With regard to statistical correlations, it appears problematic if diseases (1) are rare or (2) have varying degrees of severity, which leads to a spread of the CI. The larger or wider the CI, the lower the statistical significance of the risk of contributing to delirium. Consequently, diseases may not be statistically significantly associated with the development of delirium, although it would be obvious on the basis of pathophysiological considerations and clinical experience. This is clearly shown by the example of poisoning and peritonitis, where the CIs ranged from 0.68 to 66.8.
Delirium in patients >80 years of age is common, likely underdiagnosed, and an indicator of later loss of functional independency and mortality. In practical terms, this means that a large proportion of patients do not return home after a delirium. This study is so far the largest of its kind in terms of predisposing and precipitating risk factors of delirium in very old patients and extends the limited knowledge about delirium in an aging society.
We want to thank all clinical staff, who made this study possible!
Statement of Ethics
This study was approved by the Ethics Committee of the Canton of Zurich (KEK-ZH-Nr. 2012-0263). A waiver of informed consent was obtained from the committee. The study was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.
Conflict of Interest Statement
J.M., L.B., S.F., J.E., R.v.K., and S.B. report no disclosures or competing interests.
Funding Sources
This work was supported by the Clinician Scientist Program of the Medical Faculty of the University of Tübingen (Program No. 45800).
Author Contributions
J.M. analyzed clinical and diagnostic data and drafted and revised the manuscript. L.B. acquired clinical and diagnostic data and revised the manuscript. S.F. acquired clinical and diagnostic data and revised the manuscript. J.E. and R.v.K. analyzed clinical and diagnostic data and revised the manuscript. S.B. conceptualized the study, acquired and analyzed clinical and diagnostic data, and revised the manuscript. All authors read and approved the revised manuscript.
Availability of Data and Material
The anonymized data and materials are stored locally, and any raw data from the statistical analysis can be made available on reasonable request.


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Post your Social Post on your business Facebook page
Share your Business post on your personal Facebook page
Share your post on Instagram and any other social profiles you are managing
Use today's blog post idea to create your own blog article. Be sure to share the article on your social channels and email after you publish it!
Study today's marketing question and as always reach out if you have any of your own questions
Study today's marketing Term and try to apply the concept at least once today
Create blog content that helps agents get started in real estate to help recruit more agents to your team
It's important for both, but in different ways. While B2C businesses can focus on more light-hearted, fun social media posts, B2B businesses need to use social media to share valuable industry content. As a tool for connecting a business with its customers, however, social media is vital to both.
An AI-powered chat window used to automate customer support and other purposes. They most often appear on websites, mobile apps, Facebook Messenger, and other web platforms.


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How Far Have Social Welfare Considerations
Entered Into State, National, and Local Elections
c. May 16-23, 1923 — 50th Anniversary Session, National Conference of Social Work, Washington DC
When social welfare is to be measured in terms of practical politics, new standards of appraisal have to be devised. Politicians apply measures in terms of expediency. The measure is not what is abstractly good for the people, but what is concretely good for a candidate or a party in the sense of what will bring victory. Politicians must deal with applied policies. Social workers are prophets, the cranks of one generation moving the next to action. They see in terms of eternal aspects of great principles.
Politicians differ from the social worker, in that they possess that sixth sense which tells them when public opinion has brought about the time for the application of a program. Politicians cannot afford to be visionaries. They deal with actualities recorded in terms of votes. They deal in candidates elected or defeated. Movements, the joy of the social workers, proceed in a world of their own, swinging along in their own orbits. They pass first through the stage of agitation when the prophet and the misfit go from door to door peddling an idea and making a contribution and, at last, they cohere into a movement. Next, as the movement gains force, opinion comes into play and minority opinion becomes strong enough to be recognized by a fighting group. Whenever this minority opinion becomes strong enough to gather such momentum that it arrests the attention of the practical politician, the movement becomes ripe for a political platform. The mere fact that this or that part of a program of social welfare has not yet become apolitical issue is no criterion of values. Its failure to do so is undoubtedly due to the temporary absence of the motive power applied by public opinion.
Social workers have progressed from agitation to discussion, and then to the recognition of the importance of political action. Dealing at first hand with poverty, disease, and crime, they soon worked out the relationship to fundamental methods of government, and, with these realizations strong upon them, proceeded to the establishment of laws to govern and agencies to administer and enforce. When social issues predominate in a political platform, the history of American politics shows we then have the greatest amount of independent voting. Political parties rarely have a clear-cut cleavage in the larger units of political organization, and this independent voting constitutes an important and vitally decisive factor for both parties. First fruits of the inclusion of social welfare issue in political platforms were not so sweet. A pious resolve or two about labor and something about education, buried in the subcellar of the platform, were considered an entirely satisfactory disposition of these theoretical dreams of the idealists.
Since this is the fiftieth conference of social work, it is comparatively easy to estimate that twenty-five or thirty years of social work went by without political effect, such as adoption in party platforms or other active participation in political procedure that can be clearly identified as such. In the platforms of minority parties such as the Socialist and the Single Tax, social welfare policies have played a major part for many more years than the scant ten that mark their adoption into the family councils of the major parties. Some of the single-tax proposals, such as the excess condemnation of land by cities so that the unearned increment might accrue to the benefit of the taxpayers has found political expression in many localities, and is today admittedly a vital part of any permanent solution of the housing problem. Both Single Tax and Socialist platforms carried universal suffrage, public ownership of natural resources, and abolition of child labor for a generation before recognition came from other sources.
In fact, it was not until 1912 that national recognition came. Then the great Progressive Theodore Roosevelt, sensitive to public opinion, strong of vision, seeing that the distinctive line of cleavage between himself and the old line of party managers had been found, sent for the leaders in social work to come to him, and presented the first major party platform recognizing human rights as at least coequal with the protection of property rights. There are probably in this audience tonight some who made the historic pilgrimage to Sagamore Hill, and heard the first presentation of the platform that bore social justice as its distinguishing mark. Never before had a national platform said, "The supreme duty of the national government is in the conservation of human resources through an enlarged measure of social and industrial justice." And then follow the specific pledges for protective industrial legislation, prohibition of child labor, minimum-wage standards, prohibition of night work, and an eight-hour day for women, one day-s rest in seven, prisoners' earnings for heir dependent families, workmen's compensation, health, old age, and unemployment insurance, continuation schools, and improvement of rural education. That section of the Progressive platform reads like a volume of the Survey.
Following the lines of the national platform, the various state platforms of the Progressive party did not stop with reaffirming the national platform of social justice, but introduced also their own local issues of social importance. This produced the first thoroughgoing public discussion throughout the country of social justice. Whenever a candidate was elected on the progressive ticket he was pledged to the social program locally and nationally, and many local elections were won partly, or as a whole by Progressive votes The election of Mayor Mitchel in New York hinged on the Progressive vote, and his policies were deeply influenced by that group among his advisers.
Meanwhile, the issue of universal suffrage forged to the fore. Cleverly enough, the women, in campaigning for the suffrage, knew how to make social welfare issues their own, and in many instances the inclusion of universal suffrage as an issue in a campaign, sometimes local, sometimes state-wide, and eventually national, covered as a blanket many details of a campaign for social welfare issues.
It is true that the entrance of women into political life has forced the seasoned politician to pay closer attention to social welfare issues than was his wont. Women are an essential consideration now in political campaigns, and their tendency to independent voting makes them a problem to those who write platforms and consider party methods. They have dealt with social problems at close range and are quick to comprehend the significance of political action. Politicians will discuss policies with women more readily than any other form of political activity, and are eager to find the road to the feminine group of their constituencies. Some of the most striking political results in very recent elections have been largely contributed by educational campaigns on social welfare issues conducted by women independent of party affiliations.
In 1916 the Democratic party squarely recorded itself as favoring woman suffrage and prison reform, and set up standards of employment for the federal government, "both on its own account and as an example," including a living wage, the eight-hour day, one day of rest in seven, safety and sanitation standards, adequate compensation in industrial accidents, prevention of child labor, and protection for women workers. The platform urged that these principles be also applied through legislation by the several states international problems and preparedness were pressing hard, and social problems received scant attention that year. But I 1920 the war was over and both parties faced the great task, of reconstruction. Both platforms turned again to the social issues, and Republican and Democratic platforms blossomed forth in provisions for maternity and infant care, prohibition of child labor, protection of women in industry, public health, and improvement of educational methods and standards. The Republican platform also dealt with housing, free speech, and immigration. How far these issues entered into a campaign centering again on international relationship it is not hard to say. Nationally, they were scarcely debated at all, while in New York State, in the same year, at least one party was making a consistent battle to establish a full program of social reconstruction as the basis for the party program in the state.
The effectiveness of these attempts to secure permanence for our social programs through political action can hardly be questioned. These great campaigns, with their attendant discussions, are never a total loss. Their educational value surpasses any other form of education of public opinion. Even when they are not enacted into legislation by the party advocating them, frequently the opposition party will steal them in a subsequent administration and enact them in order to gain party credit, and the public is the gainer.
Much has been said at the conference of the relation of social work to the schools, to international problems, to the labor movement, and to administrative agencies, but nothing as yet of its relation to politics. Social work has everything to gain and nothing to lose in learning to utilize the forces of political action. Vitalizing life comes through permanent legislative enactment. Workmen's compensation, basic in the family life of the industrial worker, remains a vague aspiration until legislative actin makes it function. We struggle for recognition of the minimum-wage principle for women, and inch by inch establish it in a few states only to face rejection by the highest court of our land; a decision that will stir both major parties to political action in another year, and thereafter some way will be found to place it permanently in our scheme of American life. Our struggle to prevent child labor and to secure maternity and infancy protection is exactly similar and will have a similar outcome.
Social work underestimates rather than overestimates itself. It has become a part of the fabric of American life. Especially is this true since the war. The movement for democracy has not only bene pushed forward by the war but the content of the meaning of democracy has been deepened and the average man, having faced he vey foundations of the world in the last five years, is no longer content with a pre-war status, but feels himself entitled to a better deal socially and economically. Probably no stronger recognition of this has come to pass politically than the adoption by Governor Smith, in 1919, of the program of social reconstruction offered by the reconstruction commission appointed by him. Directly resulting from this policy in New York state three successive elections for governor have emphasized the social welfare program. Democrats, beginning in 1918, with emphasis on labor legislation, universal suffrage, and child welfare, continued in 1920 with an even more fully developed social program, based on the report of the reconstruction commission. It included housing, conservation of natural resources, minimum wage, eight-hour day, public health, cost of living, and educational proposals. But the climax came in this last year, when the Democratic platform contained, beside all these issues and a pledge to repeal the laws requiring teachers to pass loyalty task and private schools to be licensed, detailed pledges to strengthen by adequate appropriations the administration of labor laws and workmen's compensation, and specifically advocated proper appropriations for the care of the state's dependents in hospitals for the insane, the prisons and under child welfare boards. More than this, the whole campaign resolved itself into a running debate on these issues, with one candidate clearly established as the liberal advocate of these policies and the other hopelessly trying to establish himself as less of a reactionary than his party tenets made him. Restoration of the government to the people was the keynote of the campaign. Public opinion had done its work well and incidents of the campaign showed the issue to be clearly understood, even by the rank and file of voters. The ability to state a social issue in terms of everyday life, and a strong belief in human beings as the real assets of a commonwealth won out and recorded for governor Smith, idealist and social worker, the greatest majority in the history of the state. Even so seemingly abstract a program as the reorganization of the state government was clearly expressed in homely terms of human welfare when the economies it promised were expressed in terms of increased appropriations for child welfare, state institutions for dependents, and other social activities as contrasted with unnecessary expense involved in duplicating, wasteful administrative machinery.
Since 1912 many great social issues have been fought and sometimes lost in the nation, in the several states, and in hundreds of local elections. Sometimes we call them moral issues, when they succeed in arousing our emotions, as the Low campaign in New York city, when William Travers Jerome was elected district attorney to stamp out the red-light district, or certain similar elections in San Francisco, Denver, Chicago, and Philadelphia. Certainly the presidential campaign of 1920, with its over-shadowing issue of world-peace, drew the lines clearly and firmly for or against the great human stakes that make a nation.
We may well ask, where are we heading? A new spirit stirs the world! We are less interested in our political rights, perhaps, because we feel we are secure in these and more concerned with the individual. We are searching our fundamental conceptions of democracy and demanding for the individual a larger measure of justice, a greater participation in the life of our democracy. Political parties are slowly learning that these awakened citizens want, not housing in the abstract, but homes for people that shall be within their reach; not a proper limitation of hours for working women, or a living wage, or protection for maternity and infancy, or the prohibition of child labor, as part of a program of a private organization voluntarily maintained, but as an integral part of the government of the several states and the nation itself. We are pas the stage where the tariff is an abstraction. Sugar prices tell the story day by day to the housewife who buys in the humblest grocery shop, and at least one of the political parties is telling her the truth about it. The monthly visit of the landlord teaches a lesson that some politicians have learned to apply, and, strange as it may seem, campaigns have been won or lost on workmen's compensation insurance, as in Ohio, and none can deny the influence of the social issues in the last campaign in Pennsylvania, or in the most recent ones in New York state.
The social problem is in politics. Social workers can take great credit to themselves and their methods that this is so. Moreover, it is going to stay in politics as long as they conception of the state as an instrumentality for social welfare persists. Social workers with the record before them may well prepare for continued appeal to the major political parties. Social workers have a great mission imposed on them in the formation of public opinion on the great human issues of government. Standing midway between those who enjoy by privilege and those who should enjoy by right the social worker has the opportunity to maintain "sweet reasonableness" while guiding the way to liberal thought and progressive achievement.
America goes forward. Nineteen twenty-four will see the social welfare idea even more fully expressed in platforms of both major parties. That party whose platform and candidate most sincerely and adequately expresses the public yearning for genuine democracy, expressed in social ideals practically attainable, will carry the country forward on its great course of world leadership.
Source: Proceedings of the National Conference of Social Work at the Fiftieth Anniversary Session Held in Washington, D.C., May 16-23 (Chicago: University of Chicago Press) 1923, pp. 465-469.


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Partnering the community
Gujarat NRE Coke has been in the forefront of community development. Through various initiatives the company has nicely intertwined itself with the society at large and has today become a part and parcel of the community it operates. The company has become an agent of development in its hinterland through its sensitive response to their needs.
To mention a few:
On the occasion of 67th Independence Day at Dharwad Plant
On the eve of Labours Day a Law awareness programme was organized at Gujarat NRE Coke Ltd., factory premises by District Legal Services Authority, Dharwad (DLSAD) in association with Dharwad Bar Association, Labour Department and Information Department.
Some news clipings of our CMD's presentation, delivered in Ahmedabad on Ethics in Governance and Business - Role of Public Relations Society of India.


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Salient Features:
- Continuous Rotary Motion for high outputs
- Handles variety of containers / Cap
- Tightening torque adjustable to desired levels
- Diagnostic output Signals / Warnings
- Magnetic clutch
- Versatile design for smooth pick and Placement of caps
- Output upto 24000 Containers / Hour
- No container – no cap facility
Options :
- Programmable Logic controls. (P.L.C.) with Sensors For safety interlocks like container jamming, no Container in the conveyor No cap in chute etc. for optimum performance
- Safety interlocks for Guards
- D.C. Motor with Soft Start Facility
- Variety of cap Feeders
- Bulk Elevators with level sensors
- Total Enclosure
- Automatic adjustments of "Tool Height through HMI"


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Workforce Optimization
The major petroleum products that are sold in South Africa are petrol, DIESEL, JET FUEL, ILLUMINATING PARAFFIN, FUEL OIL, BITUMEN AND LIQUEFIED PETROLEUM GAS (LPG), NATURAL GAS (LNG).
Petrol and Diesel are the major Liquid Fuels that are used in South Africa.
Government regulates Wholesale margins and controls the Retail price of petrol.


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If you've seen Riverdale on Netflix, you're probably familiar with Josie and the Pussycat gang, which was led by Josie, Valerie Brown, and Melody Valentine. Hayley Law was cast in the role of Valerie Brown. Hayley is a Canadian actress and vocalist best known for playing Lizzie Elliot in the Netflix series Altered Carbon.
What is the net worth , Income and Salary of Hayley Law in 2022?
Hayley Law made her acting debut in 2017 with the part of Valerie Brown in the CW's Riverdale television series. Her character is a student at Riverdale High School and has a brother named Trev. She was also a part of Josie and the Pussycats, which later changed their name to Veronica and the Pussycats. In addition, she was shown dating Archie in the series, but the two split up.Hayley's Instagram account has more than 635k followers thanks to Riverdale.
Hayley appeared in the TV shows The Arrangement as Vena and Stickman as Emma in 2017 as a recurrent character as Valerie Brown. She had the recurring role of Lizzie Elliot in the television series Altered Carbon in 2018. His role as Tess in the film Spontaneous, however, is still in post-production.
In addition to acting, Hayley has released an EP under the Irie Music label. You're Mine, So Good, Get Thru, and Banana were among the tracks included.
Hayley's net worth is still being calculated as of 2020.
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Wikis of Hayley Law
Real Name | Hayley Law |
Birthday | 18 November 1992 |
Birthplace | Vancouver, British Columbia, Canada |
Zodiac Sign | Scorpio |
Nationality | Canadian |
Ethnicity | Afro-Canadian |
Profession | Actress |
Dating/Boyfriend | No |
Married/Husband | No |
Salary/Income | Under Review |
Net Worth | Under Review |
Parents | Not Disclosed |
Siblings | Not Disclosed |
Early Life of Hayley Law: Age, Born
Hayley was born in the year 1992 in Vancouver, British Columbia, Canada. On November 18th, she blows her candles, and her zodiac sign is Scorpio. She is a Canadian national with Afro-Canadian ancestry.
Siblings, Parents and Family
Hayley was born into the Law family and comes from an Afro-Canadian ethnicity. She was born and raised in Vancouver. Hayleau is a nickname for her.
Hayley enjoys dancing, crocheting, and painting in addition to singing and acting.
Body Measurements: Height and weight
Emilie, a Canadian actress, has kept her slim frame. She stands 5 feet 3 inches tall and weighs 52 kilograms. She also has brown hair and greenish-blue eyes.
Relationship Status: Single
Haley has successfully balanced her work and personal lives. Her social media accounts give no indication of whether she is single or dating.
On the other hand, she was in a relationship with Archie, the Riverdale character. They split up after Archie discovered Veronica.
Professional Life and Career
She made her acting debut as Valerie Brown on the CW program Riverdale in a recurring role. She went on to have roles in TV episodes and movies such as The Arrangement, Stickman, The New Romantic, and Netflix's Altered Carbon as a result of her performance.


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The Juxtaposition of Wealth and Eternity
March 7, 2021 / Hudson View Baptist ChurchThe Juxtaposition of Wealth and Eternity
Luke 16:1-31
-Sadly, wealth (or at least the desire for it) is one of the main reasons people on God's redemptive plan for man for eternity.
I. An Unlikely (Luke 16:1-13)
-There is really only one thing about the manager of the house that Jesus puts out there as exemplary to us: his ability to see what was coming and plan for it.
-Remember the context of Jesus' teaching in these last few chapters: the coming judgement of man and the entrance into heaven for only those who have accepted Christ as their Savior from sin.
1. He had a clear of the issues at hand. (1-2)
-And he said also unto his disciples, There was a certain rich man, which had a steward; and the same was accused unto him that he had wasted his goods. And he called him, and said unto him, How is it that I hear this of thee? give an account of thy stewardship; for thou mayest be no longer steward.
-He didn't ignore it, put off thinking a/b it, or refuse to believe it. He accepted the truth for what it was.
-God has told us in His Word that this life is but a drop in the bucket and this earth is not our final home. What happens next (after death) is entirely dependent upon the decisions we make now concerning whether or not to receive Jesus Christ as our only Source of salvation.
–Revelation 20:15 "…whosoever was not found written in the book of life was cast into the lake of fire."
2. He had a for the future. (3-4)
-Then the steward said within himself, What shall I do? for my lord taketh away from me the stewardship: I cannot dig; to beg I am ashamed. I am resolved what to do, that, when I am put out of the stewardship, they may receive me into their houses.
-He was concerned for his future well-being.
-Jesus is urging us to be concerned for our future eternal well-being.
3. He made for the future. (5-7)
–So he called every one of his lord's debtors unto him, and said unto the first, How much owest thou unto my lord? And he said, An hundred measures of oil. And he said unto him, Take thy bill, and sit down quickly, and write fifty. Then said he to another, And how much owest thou? And he said, An hundred measures of wheat. And he said unto him, Take thy bill, and write fourscore.
-The ethics of this guy certainly seemed out of line, but his ethics are not what is commended here…it was his jumping to action that Jesus seems to be highlighting here.
-As far as eternity goes, the Bible says there is only ONE way to make provision for it: John 3:16 – For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life.
4. He responded with .
-He saw the truth of the situation and sought the solution!
-When it comes to eternity and what we have done with Jesus, we are not promised tomorrow. There's no time for delay in accepting Jesus personally!
*Jesus' points to ponder:
A. Make worthwhile uses of your money. (9)
–And I say unto you, Make to yourselves friends of the mammon of unrighteousness; that, when ye fail, they may receive you into everlasting habitations.
B. What you have has been entrusted to you by God for use (10-12)
–He that is faithful in that which is least is faithful also in much: and he that is unjust in the least is unjust also in much. If therefore ye have not been faithful in the unrighteous mammon, who will commit to your trust the true riches? And if ye have not been faithful in that which is another man's, who shall give you that which is your own?
C. now what/Who you will serve. (13)
–No servant can serve two masters: for either he will hate the one, and love the other; or else he will hold to the one, and despise the other. Ye cannot serve God and mammon.
II. A Application (Luke 16:14-18)
A. Ready Response (14)
–And the Pharisees also, who were covetous (lovers of money), heard all these things: and they derided (ridiculed) him.
B. Revealed (15)
–And he said unto them, Ye are they which justify yourselves before men; but God knoweth your hearts: for that which is highly esteemed among men is abomination in the sight of God.
C. Reemphasized (16-17)
–The law and the prophets were until John: since that time the kingdom of God is preached, and every man presseth into it. And it is easier for heaven and earth to pass, than one tittle of the law to fail.
D. Relational (18)
–Whosoever putteth away his wife, and marrieth another, committeth adultery: and whosoever marrieth her that is put away from her husband committeth adultery.
*Point is this: Culture should never determine our approach to life and to God, but we should look to God's Word as our very reference point to approaching God and this life.
III. An Unsettling (Luke 16:19-31)
-This is a very unsettling story to read because of at least 3 comparisons Jesus makes:
A. Temporal Wealth Fades, But Eternal Wealth (19-21)
–From God's perspective this is a contrast between a poor rich man and a rich poor man, between one who did not have God although he had much else and one who had God although he lacked all else. (James Boice)
B. Death Equalizes, But Categorizes (22-23)
-What happens after death is drastically different depending upon whether a person has trusted Jesus alone for their salvation from sin or not.
C. Remains in Life, But Finality Comes With Death (24-31)
-When death comes, it's too late to prepare for eternity…NOW is the time to accept Christ…NOW is the time to tell others of their need to accept Christ.
–John 14:6, …I am the Way, the Truth, and the Life; no man cometh unto the Father, but by Me.


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Japanese Doctors Perform World's First Living Donor Lung Transplant on COVID-19 Patient
A COVID-19 patient in Japan received the world's first lung transplant from living donors.
Receiving a lung tissue transplant from her son and her husband, the patient underwent an 11-hour operation at Kyoto University Hospital to receive her transplant last Wednesday.
The woman who underwent the operation contracted COVID-19 late last year. According to Kyoto University Hospital, he spent months on a life support machine that acted as an artificial lung, because his was no longer working. It is expected to recover from last week's operation in a few months.
As is the case around the world, waiting lists for deceased organ donor lung transplants are very long in Japan.
Dr. Hiroshi Date, who led the operation, said in a statement that the success of this living donor transplant may provide optimism among others suffering from severe lung damage caused by the virus. "I think there is a lot of hope for this treatment in the sense that it creates a new option," the thoracic surgeon told Kyodo News.
(LOOK the Nippon TV News 24 Japan story about the operation below.)
Featured Image: Kyoto University Hospital
SHARE this positive story with others on social media …


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