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Restoring the Primacy of Public Service —
The Example of George Washington
Our politicians must again view their primary function in Washington as public service, not as the perpetuation of their own holding office. While our Congress is full of well-intentioned, intelligent and strong men and women, the balance between politicians' time and energy spent on their reelection and actual public service has careened toward reelection. Among the most conservative of Republicans, the most liberal of Democrats, and those in between, compromise is only generally possible if politicians put public service first.[18]
Fortunately, to find a model for how our elected officials should act, we need only to look to our founding father, George Washington. Washington provides a model of public service that we should expect from all of our politicians.
During his active political life, George Washington identified with Cincinnatus, the famous Roman general who resigned from a position of near absolute dictatorial authority and returned to his farm and family. In Washington's time Cincinnatus was regarded as an example of ideal political leadership; that is, a leader who led without personal ambition.
Washington was a hero to his contemporaries and, as Garry Wills explains in his book Cincinnatus: George Washington and the Enlightenment, Washington willingly sought to meet his countrymen's expectations of him as a political hero. Yet what constituted political heroism then was very different than our conception of it today.
According to Wills, "Like the Roman Cincinnatus, Washington perfected the art of getting power by giving it away. He did this when he resigned as Commander in Chief of the Revolutionary Army, and again when he declined to run for a third term as President. This was virtuous in the sense of the word when Washington did these things: public spirited."[19]
"Washington resigned his Commission as Commander in Chief of the Revolutionary Army in a series of goodbyes, the last in Annapolis, Maryland, on December 23, 1783. He had served for seven years, never returning to his home in Mt. Vernon. [Some biographers have argued that if he had gone home the Revolutionary Army would have gone home too and the American Revolution would have been lost.[20]] He had served with no pay and always with the understanding that when independence was won, he would resign."[21]
At Annapolis on that morning, Washington delivered what he expected to be his last goodbye, in a speech written in part by Thomas Jefferson. As Wills describes it,
"His horse waiting at the door, to carry him to Mount Vernon by Christmas Eve...At that moment the ancient legend of Cincinnatus--the Roman called from his plow to rescue Rome, and returning to his plow when danger had passed--was resurrected as a fact of modern political life."
Wills relates a story of a conversation during the Revolutionary War between the British King George III and the artist Benjamin West, who who knew both the King and Washington. Asked by the King what General Washington would do if he prevailed, West told the King he thought that Washington would return to his farm. "If he does that," the King is supposed to have remarked, "He will be the greatest man in the world."[22]
I have practiced law for thirty-four years, including immigration law for a considerable part of that time. One of the absolutely most depressing things I ever heard about the state of our country's governance was at an immigration law conference where a senior attorney of the Senate Judiciary Committee (the Senate Committee responsible for immigration law legislation) said that every single member of his Committee--from the most conservative Republican to the most liberal Democrat--supported stapling a green card to every Ph.D awarded by an American university to a non-American citizen in math, science or engineering. But the majority of the Committee members did not want such a provision to pass other than as part of a comprehensive immigration bill because enacting it separately would mean that there would be less motivation thereafter to pass comprehensive immigration reform. The attorney implied that different Senators had constituents for whom other aspects of immigration reform were important, like greater border security or certain provisions desired by organized labor, and these constituents would be less likely to provide additional financial support to members of the Committee if they thought comprehensive immigration reform was less likely to be enacted because the provision on which everyone agreed had already been enacted.
How has the culture in Congress evolved so far away from Washington's values?[23] How did we get to a place where things all our legislators agree would be good for America don't get enacted because of partisan politics or for reasons related to generating continuing political contributions? Our elected officials' job is to move this nation forward, regardless of whether doing so means they are putting their own reelection at risk.[24] We need more Washingtons in Washington.
The famous philosopher John Rawls has stated, "In constant pursuit of money to finance campaigns, the political system is simply unable to function. Its deliberative powers are paralyzed."[25] This is true. And our political culture needs to evolve so that the politicians we admire most are the ones who, like George Washington, are willing to sacrifice personal power for the public good. Hopefully when some of them start doing so, they won't go quietly, but will rip as much rot out as they can as they go.[26]


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An eventful year has passed with exciting projects and events. All stories are now collected in the new GFF magazine. Get fascinating insides into the world and work of the Greenfinity Foundation. Find out more about gardening projects in the Philippines and Czech Republic as well as constructions in Brazil and Nigeria.
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subset: commoncrawl


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Amazing And Stand-Out WordPress Themes You'll Adore.
Innovation has turned into the order of the day in a lot of countries since it makes a considerable measure of work more simple. The business world is the most profited sector as innovation has automated numerous procedures that were previously extremely tiring and tedious. A good example is the automation of accounting processes which results into more accurate results. This has made it essential for each and every business to have a website or blog where they can advertise their goods and services. This is on the grounds that they can reach a huge number of individuals on the web which makes it the best publicizing forum. A business having a website is no longer something new as all organizations have their own websites.
If you want to ensure you get as many visitors to your website as possible, you have to guarantee that your website is engaging and attractive for prospective customers to be drawn to it. If your business has a normal website like all the rest, you will not get a lot of visitors thusly you have to make your website as attractive as possible for you to get more visitors. There are various layouts that you can use for your website and keeping in mind the end goal to ensure it is novel from the rest, you can utilize an assortment of formats which are perfect for organizations. One of the basic factors that you will look at when you are looking for such themes is the cost which ought to ideally be within your budget.
Here are some affordable themes that you can use for your website or blog that will make it unique from all the rest. The best theme that you can use for your blog is Soigne which has a interactive interface that can enable visitors to your website to successfully navigate your blog. It has an extremely appealing format which will get the attention of any guests to your blog in this manner getting you an impressive number of imminent customers. Another awesome theme that you can use for your website or blog is Typology. Typology is a perfect format for bloggers or websites that for the most part contain more compositions and less pictures.
For blogs and websites that contain a great deal pictures, the best theme for them will be Them which has a considerable measure of room for pictures and is best suit for websites and blogs about fashion and way of life. Another amazing theme that you can use for your website or blog is the Elitemag which can make your website striking and straightforward as well and it is perfect for websites and blogs that expound on engineering and stylistic layout. You can undoubtedly make an astounding website utilizing wordpress and to ensure this, you should think of some few factors for instance remaining consistent with your organization's image and customizing your pictures to your image.


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How to write a winning scholarship essay. Tips for students.
Publication date: 2018 Jul 03 | Author: EastMaster Posted in: Blog | Essay Writing | Tips for studentsTags: future essay | purpose of writing | scholarship essay | tips to write | Winning Scholarship Essay | write a winning scholarship essay | writing assignment Every year the admission panel ofRead More


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Choosing to be healthy, through an exercise regimen, is something that everyone should strive for, and in addition, some of us want to improve our muscle mass. Now that you've made that choice, you might be wondering the best way to get started. Here are some of the best tips on the net to help you start building muscle and improve your life! Read them so that you can receive some ideas on how you can build the amount of muscle that you are striving for.
A lot of people try to workout too quickly. It is always better to perform exercises slowly and focus on proper technique. This gives far better results than just trying to pump out reps as fast as possible. Take all the time you need and make sure you perform the exercises like you should.
Do not neglect carbohydrates in your muscle-building diet. Your body needs carbs to survive the grueling workouts to which you are subjecting it. Also, if you don't eat sufficient carbohydrates, your body will use protein as an alternative energy source. If you take in enough carbs, your body will function at a higher level during workouts.
Making short-term goals, attaining them, and then rewarding yourself for doing so, can be a great motivator. Motivation plays a key role in any long-term commitment. Try making some of the rewards things that will help you to build more muscle. For instance, get a massage; they increase the body's blood flow and assist you in recovering on your off days.
If you are going to use creatine supplements to assist with your muscle gain, you should use caution, especially when taking them for an extended period of time. If you already suffer from kidney problems, ceatine could make it worse. In addition, they have been known to cause muscle compartment syndrome, heart arrhythmia, and muscle cramps. Adolescents using this supplement are at the highest risk. Only take these supplements under the care of a doctor.
Building Muscle
For success in building muscle, carbohydrates are essential. Carbohydrates fuel your body to allow it to perform the exercises that you need to do each day. If are taking an aggressive approach to building muscle mass, you should consume between 2,000 and 3,000 milligrams of carbohydrates per pound of your body weight.
Train opposing muscles while in the same session including your chest and back, or quads and hamstrings. This is a good way to let a muscle rest while you focus on another one. As a result, you can increase your workout intensity because you are limiting the amount of time that you have to spend in a gym.
If you want to add bulk, it is important to do bench presses, squats and dead lifts. By doing these exercises, you will build muscles and get in shape fast. These certainly shouldn't be the only exercises you do, but they are truly essential to muscle development success.
Muscle Groups
Some muscle groups are harder to bulk up than others. Fill sets are an effective means of targeting those difficult muscle groups. A fill set is a short set focusing on your weak groups of muscles you can do a few days after working hard on this same group.
Adjust your diet to make sure you are getting what your muscles need. Bodybuilding needs a high protein, low fat diet. This doesn't mean that you need to consume more food; this means that you need to have a balanced diet. You can build your muscles more quickly by taking vitamins and a protein supplement.
Carefully choose the exercises that you include in your routine; certain ones may actually make it more difficult to build muscle. Exercising your neck, doing split squats, and doing dips can all compromise your joints and put you in jeopardy of getting seriously injured. Some exercises where you can safely use larger weights include: presses, rows and deadlifts.
Muscle Mass
Gaining muscle mass takes effort and follow-through. If you possess these two qualities, then the other qualities will simply fall into place. With proper nutrition and good exercise techniques you will see an improvement in your health and an increase in your muscle mass.
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Simply click right here , and that can help you get on with your existence.


text: The divine is God's concern; the human, man's. My concern is neither the divine nor the human, not the true, good, just, free, etc., but solely what is 'mine,' and it is not a general one, but is - 'unique,' as I am unique. Nothing is more to me than myself!


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A day after India inked the Rafale deal with France, Congress Saturday raised a series of questions and demanded that the contract be made public. It said there was massive escalation in cost from the price estimated by the UPA government, and said that the absence of provision of technology transfer would cost India heavily.
Former Defence Minister A K Antony argued that the IAF currently has 32 fighter squadrons against an authorisation of 42, and these 36 aircraft make for only two squadrons. "Is it enough to meet the operational requirements of the Indian Air Force?" he asked. He said the UPA had decided to purchase 126 aircraft to meet urgent requirements of the Indian Air Force.
"Of late, the security situation is becoming more and more critical and volatile… How will the government equip the air force with more aircraft? What is the plan? During UPA's time, it was decided to purchase 126 aircraft, now it is only 36 fighter jets. How they will fill the gap, especially when Pakistan is building more and more air strength?," he asked.
He said the agreement negotiated by the UPA government was to buy 126 aircraft, out of which 18 were to be in a flyaway condition. The rest were to be produced in India with HAL with a technology transfer component. "That condition is gone. Make-in-India is gone. There is no provision/condition for transfer of technology… This will cost us very heavily," he said.
Addressing a press meet at the AICC office with Antony, Congress leader Manish Tewari asked, "Is it true that when the UPA left, the non-negotiated price of the Rafale was in the range of Rs 715 crore an aircraft, and what has been negotiated today for 36 jets in flyaway condition is
Rs 1,600 crore per aircraft, which is 123 per cent escalation?"


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Parker Duofold Vest Pocket Pen and Pencil
- Auction:
- Lot:
- 414
- Sold for:
- $185$150
- Auction:
- Clocks, Watches & Scientific Instruments - 3147M
- Location:
- Marlborough
- Date / Time :
- October 05, 2018 10:00AM
Parker Duofold Vest Pocket Pen and Pencil, Janesville, Wisconsin, a vest pocket pen and pencil set in Moderne black and pearl, fine, gold, nib marked "Parker Duofold Deluxe, Made in U.S.A.," pen capped lg. 3 3/8 in.
Estimate $300-400
Some discoloration of pen barrel. Twist pencil functions as it should. Barrel imprints have hand wear but still legible.
The absence of a condition statement does not imply that the lot is in perfect condition or completely free from wear and tear, imperfections or the effects of aging. Condition requests can be obtained via email (lot inquiry button) or by telephone to the appropriate gallery location (Boston/617.350.5400 or Marlborough/508.970.3000). Any condition statement given, as a courtesy to a client, is only an opinion and should not be treated as a statement of fact. Skinner Inc. shall have no responsibility for any error or omission.


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6/27/2016 by Stephen Perrino
Competition continues to grow in the bottom third of the price level, putting upward pressure on entry-level home prices, with price levels increasing significantly faster than more expensively priced homes, according to this Zillow Market Report. Entry-level home prices, usually targeted by first time home buyers, grew at nearly twice the rate (about 8 percent) over the past year as top-tier home values.
The number of high priced homes for sale has remained relatively constant, but the entry-level tier has had a diminishing inventory, making it difficult for first time home buyers and those looking to downsize to find suitable housing and forcing them to pay more for the limited inventory that is available. This makes it imperative that buyers looking to find a home in this entry-level price range be as prepared as possible to make an offer when they do find the right house that meets their needs and their budget. Alternately, the slowdown in prices in the higher end price market suggests that buyers looking in that upper level should find reduced prices, more options, and less competition for those houses, making at good time to buy for those looking to expand into a better home in a stronger neighborhood. It's a stark contrast to the tough, competitive market that is in front of entry-level first time home buyers.
Over the past 18 months, the number of homes on the market that have reduced list price have slightly increased, while entry-level priced home list price reductions have decreased over the same period. This further indicates that we are dealing with two very distinct markets with there being a seller's market with rising prices on the low end while the higher end home buyer has a bit of a buyer's market situation going on.
"The top of the market is starting to stabilize, and people are beginning to take notice," says Zillow Chief Economist Dr. Svenja Gudell. "First time home buyers looking for entry-level homes are having bidding wars in many markets, while it's not uncommon for high priced homes to stay on the market a few months longer. The housing market is much more forgiving for current homeowners looking to move into a bigger, more expensive home. These buyers can be a bit more selective, and may even get a good deal."
It's hard to pin down one specific reason for this price stability at the top, even as the bottom and middle sections of the market continue to rapidly increase. It's very likely the result of several factors.
The inventory of low- and middle-tier homes for sale fell by 8.9 percent and 9.7 percent, respectively, in May compared to a year ago. Top-tier inventory, over the same period, fell a scant 0.5 percent. Don't forget rising rents. The U.S. median rent in May was $1,407 per month, up 0.3 percent from April and 2.9 percent from May 2015, according to the Zillow Rent Index. U.S. rents have grown year-over-year for 45 consecutive months.
Looking ahead, Zillow expects national home values to continue growing, rising another 3.1 percent through May 2017 to a Zillow Home Value Index of $191,800. U.S. rents are also expected to keep growing over the next year, at a 3.2 percent pace through May 2017 to a Zillow Rent Index of $1,452. It seems as though we're going to have stiff competition, especially among first time home buyers and other entry-level price consumers in the Real Estate market for the foreseeable future.
Sellers looking to move up are in a very good position, able to get top dollar for their entry-level homes with a lot of options for them to seek a higher level property without much competition driving the prices out of their range. If you're thinking about selling, be sure to check out our 13 things to do before listing your home blog. First time home buyers? Check out our free first time home buyer's guide.
The above article, "First Time Home Buyers Finding Strong Competition with Entry-Level Home Prices Rising", has been provided by Stephen Perrino as part of our homeowner tips series. Stephen is a professional, full-time Realtor with PAIVA Realty Group and has helped many people buy and sell homes throughout the entire Greater Providence area for many years! If you are in the market to BUYor SELL a home, he would love to connect with you and can be reached via email at [email protected] or by phone at 401-206-8907.
Are you thinking of selling your home? I'm very good at marketing homes to sell quickly, and for more money. If you're a first-time home buyer then you'll be in good hands. I've helped countless first-time home buyers through the entire process of buying that first home! I have a real passion for helping folks buy and sell homes here in the great state of RI and I would love to connect with you!


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Ride + Play KV PKSP
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Ages: 3 - 7
Participants: 16
Open Spots: 16
Sports & Recreation
Health & Wellness
OPTIONAL ADMISSIONS ADD ON IS FOR PARENT RIDE. CLICK 1 OR 2 OPTIONAL ADD ONS TO RESERVE 1 OR 2 PARENT BIKES. Hey Parents! Don't forget your class starts at 8:30am down the street at SoulCycle PKSP! We recommend arriving 10 minutes early to confirm your spot! The $39 optional "Add On" includes your bike reservation, shoe rental and a water!
8 am Greeting and Introduction We'll greet our playdate squad in the Kidville Park Slope lobby. We'll say our goodbyes to moms and dads and get to know each other with some casual crafting and open play. Specialists may ask little ones to wear a green PAL pinnie, depending on the location and programming at that time.
8:30 am Facilitated Open Play Time Specialists will engage children with fun games and imaginative play. Children will crawl, slide and climb! By helping children associate physical activity with fun and feeling happy, we can instill healthy behaviors at a young age that will affect their desire to be active and healthy as they grow! Specialists will be spread throughout the gym area and toddler room to provide supervision on all equipment.
9 am Cognitive Group Learning Our Group Challenge is designed to instill teamwork, drive problem solving and bring home our "Play It Forward" theme of the day! From scavenger hunts to our favorite "I Got Your Back, PAL" guessing game, children will work together to successfully complete the challenge!
10 am Pick Up and Highlights We'll wind down our day with story time. We always encourage our older children to read to our younger children, with some assistance from our team. Mixed age playdates unlock opportunities for leadership and role modeling from our older friends. We'll be ready for pick up at the very spot you left us, but this time, we'll get to share all the fun we've had while you've been away! Specialists will make sure Parents names match authorized persons for pick up. Thanks for coming! Hope to see you next time.
Pricing and Cancelation Policy
Price will be confirmed the next day from RSVP date.
Cancellation Fee of $10 within 48hrs or $5 within a week.


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Pleural Effusion: Aetiology, Clinical Presentation and Mortality Outcome in a Tertiary Health Institution in Eastern Nigeria - A Five Year Retrospective Study
Received Date: Dec 23, 2014 / Accepted Date: Jan 31, 2015 / Published Date: Feb 13, 2015
Aim: This retrospective notes review determined the aetiology, clinical presentation and mortality in patients with pleural effusion over a 5-year period. Method: A retrospective audit of patients' folders from January 2008-December 2012. Data collected included demographics, clinical presentation, and laboratory and mortality outcome. Results: Of 199 folders reviewed, 108 were males. Male:female ratio was 1.18:1. Major symptoms were cough 156(78.4%), chest pain 142(71.4%) and dyspnoea 130(65.3%). Major signs included pyrexia 120(60.3%), ascites 48(24.1%) and hypotension 42(21.1%). The more common aetiology were TB 84(42.2%), parapneumonic 28(14.07%) and cardiac failure 28(14.07%). Forty-six (37.1%) of 120 patients screened were HIV positive. Mortality was 33(16.6%). Conclusion: Pleural effusion is a common presentation in our clinical practice. Bacterial infection particularly TB is the most common cause. The mortality rate in patients with pleural effusion is still high. Determining the aetiology and early intervention are needed to reduce the mortality in patients with pleural effusion.
Keywords: Pleural effusion, Aetiology, Clinical features, Mortality, Eastern Nigeria
Pleural effusion is a frequent clinical condition observed in pulmonary pathology. It also occurs in many other disease entities such as cardiac failure, liver diseases, renal diseases, endocrine disorders, malignancies and connective tissue diseases [1,2]. The clinical presentation varies from mild asymptomatic effusion to life threatening effusions with dyspnoea and chest pain.
Pleural effusion may be detected clinically when it is moderate to massive but only radiologically when it is mild. Chest x-ray is the commonest radiological approach used in detecting pleural effusion but ultrasound and computerized tomography scan of the chest are important in making a diagnosis. Qureshi et al. [3] in 2009 demonstrated the importance of thoracic ultrasound in differentiating malignant from benign pleural disease in patients presenting with suspected malignant pleural effusion. While Evans et al. [4] working in South Africa have demonstrated a high diagnostic yield of ultrasound guided trans-thoracic fine needle aspiration and ultrasound-assisted cutting needle biopsy in patients with superior vena cava syndrome with associated intra thoracic mass lesion. Cytology and laboratory evaluation of the pleural fluid is required to confirm the aetiologic cause of the effusion [1,5,6].
Aetiologic factors in pleural effusion have widely been studied in many African regions and beyond. The most common cause of the condition in low or moderate income countries has been attributed to infective causes and tuberculosis (TB) has remained the main cause in many areas; while in high income countries malignancy is a more common cause [7-10]. Its prevalence seems variable in West Africa (1.7- 23%) [2,7]. In Western Nigeria, Onadeko et al. [11] found lymphocytic effusion in 76% of TB patients and 22% in patients with malignancy. Ezemba et al. [12] in Eastern Nigeria found non-specific pleurisy/ empyema as the commonest cause of pleural effusion in a percutaneous needle biopsy of 37 patients. Sutherland et al. [6] in Gambia noted that TB was the commonest cause of pleural effusion but notoriously difficult to diagnose due to paucibacillary nature of the fluid. In Ghana the most common cause is TB with 63.5% of all effusions attributed to tuberculosis [10]. Desalew et al. [13] in Ethiopia noted that TB was the commonest cause of pleural effusion in that region with mortality in 6.4% of the patients. The work done in Cotonou Benin republic revealed 13% mortality in patients with pleural effusion. Likewise, a prospective study in Qatar revealed TB as the commonest cause of pleural effusion in that region with 32.5% of all causes, most patients being Asian immigrant workers [14]. Parasitic infections associated with pleural effusions have been documented; microfilaria have been detected in pleural effusions associated with malignancies [15-17].
Objective of the Study
Our study aimed at reviewing the aetiology and clinical presentation of patients with pleural effusion and the mortality outcome of these patients in a five-year retrospective study in a tertiary health institution in the South Eastern Nigeria.
This was a retrospective study which reviewed all in-patients seen with pleural effusion from January 2008 to December 2012. All in-patients folders seen during the period were selected. The folders were cross- checked with the register in the radiology Department of the Federal Medical Centre Owerri. Uncompleted folders were removed from the data. A form for data collection was created. The data collected included demographics (age, sex, location of effusion and year in review); clinical (medical history, symptoms, and physical signs elicited); laboratory (haemogram, microbiology, biochemistry, serology, cytology, radiology) and mortality outcome. Pleural effusion was radiologically classified as right hemithorax, left hemithorax and bilateral using Chest X-ray. They were also classified as exudates (pleural fluid protein>30 g/dL) or transudates (pleural fluid protein<30 g/dL).
Ethical Clearance
The Ethical clearance was obtained from The Ethics Committee of Federal Medical Centre Owerri, Imo State Nigeria.
Data Analysis
Data was analyzed using SPSS version 16 Chicago IL.
During the period, 214 patients' folders were reviewed. Fifteen folders were excluded due to incomplete data. One hundred and ninetynine folders were analyzed. The mean age was 51 years. The maximum age was 96 years while the minimum was 15 years. There were 108 males and 91 females with male to female ratio of 1.18:1 (Table 1).
|Age Range (Years)
|Frequency No. (%)
≥ 65
|36 (18.09)
22 (11.06)
24 (12.06)
26 (13.07)
32 (16.08)
59 (29.64)
108 (54.27)
|199 (100.00)
Table 1: Age and Sex distribution.
Average age=51years, Range=81 years (15-96 years).
The major symptoms found in these patients were cough 156(78.4%), chest pain 142(71.4%), and dyspnoea 130(65.3%). Major signs elicited were pyrexia 120(60.3%), and ascites 48(24.1%), hypotension 42(21.1%), trachea Deviation 36 (18.1%) and hypothermia 12(6.0%) (Table 2).
Chest pain
Sputum production
Weight loss
Night sweats
|156 (78.4)
142 (71.4)
130 (65.3)
126 (63.3)
82 (41.2)
64 (32.2)
56 (28.1)
26 (13.1)
|Associated Signs
Trachea deviation
|120 (60.3)
48 (24.1)
42 (21.1)
36 (18.1)
12 (6.0)
|Medical History
Occupation exposure/Industrial hazard
|66 (33.2)
54 (27.1)
32 (16.1)
46 (37.1) out of 120 patients screened.
26 (13.1)
9 (4.5)
Table 2: Distribution of symptoms, signs and medical history of patients.
Medical history revealed tobacco and alcohol use in 66(33.2%) and 54(27.1%) respectively. 32(16.1%) had been treated for TB while 46(37.1%) of the 120 patients screened for HIV were positive. (Table 2).
The annual case presentation of pleural effusion increased steadily from 24 in 2008 to 56 in 2012. The commonest causes were infective with TB diagnosed in 84(42.2%) and parapneumonic in 28(14.07%). Cardiac failure was found in 28(14.07%) and malignancies in 24(12.06%) (Table 3).
|Year specific mortality rate No(%)
34 (17.1)
40 (20.1)
45 (22.6)
56 (28.1)
5 (14.7)
6 (15.0)
7 (15.6)
8 (14.3)
|199 (100.00)
|Mortality N (%)
Cardiac failure
Chronic kidney diseases
Chronic liver diseases
Systemic lupus erythematosus
Rheumatoid Arthritis
Pulmonary embolism
|84 (42.21)
28 (14.07)
28 (14.07)
24 (12.06)
10 (5.02)
8 (4.02)
4 (2.01)
4 (2.01)
3 (1.51)
6 (3.02)
|6 (18.2)
5 (15.1)
2 (6.1)
3 (9.1)
2 (6.1)
1 (3.0)
0 (0.0)
2 (6.1)
1 (3.0)
|199 (100.00)
|33 (100.00)
Table 3: Year specific mortality rate, Aetiology and mortality in patients with pleural effusion
Overall mortality recorded was 16.6%. Mortality remained at approximately the same level in the past four years. However, the year specific mortality rate dropped from 29.2 in 2008 to 14.7% in 2009; then with slight reduction in 2012 (Table 3). Malignancy was the commonest cause of death. The primary location of malignancy was the breast in 28%, the liver in 12%, the lung in 10% and lymphoma in 7%.
The macroscopic appearance of thoracentesis fluid was documented in 118 patients. It was haemorrhagic in 49%, straw coloured in 31% and purulent in 20%. Pleural effusion was exudative in 82%.
Postero- anterior Chest X-ray finding showed that pleural effusion were frequently located on the right side of the chest in 57.5%, 24.5% on the left side and bilateral in 18% of cases (Figure 1).
Pleural effusion is a common presentation in medical and surgical practice both in low and middle income countries and high income countries. The cause of pleural effusion is primarily infective in low and middle income nations and malignant in the high income nations [2,7,8]. Most studies showed a tendency of more presentation in males [2,14]. Our study supported this with a slight male preponderance. The reason for this was attributed to more males who indulge in drugs including tobacco and alcohol in our sub-region [2,18]. In line with other findings cough, chest pain and dyspnoea were the common symptoms found in our study [2,10,13]. Pyrexia, ascites hypothermia, trachea deviation and hypotension were the main clinical signs common to many of our patients; with pyrexia and ascites as common finding in previous studies [2,10].
Our study showed that the commonest cause of pleural effusion was tuberculosis followed by parapneumonic effusions. This supported the findings in many other studies within the sub-region [2,10,13]. We further found that many of the patients with tuberculosis were on retreatment for a recurrent TB infection. A good proportion of our patients with pleural effusion had TB/HIV co-infection and this is in agreement with studies done elsewhere [19-21]. A recent work done in Spain by Ferriro et al. showed that tuberculous pleural effusion is more common in males with Human immunodiffciency virus infection; who fall within the age group of 15-45 years of age [21]. A significant number of our patients with cardiac failure also had pleural effusions that were mild to moderate and detected on chest X-ray. Other aetiologic factors like rheumatoid arthritis, systemic lupus erythematosus, chronic kidney and chronic liver diseases were observed in our study and these are established causes of pleural effusion. There was also an increase in the number of case finding with better diagnostic workup employed in the year 2012. This reflected enhancement in the level of practice because more superior investigative approach such as polymerase chain reaction (PCR) and cytology were employed. Advanced radiological approach such as computerized tomography scan (CT scan) and Magnetic resonance imaging (MRI) were increasingly being used by doctors in the centre to search for occult malignancy. The centre used to be a general hospital which used to see patients at secondary care level but over the years but has been elevated to a tertiary health care facility.
Several case reports have been documented on filariasis as a cause of pleural effusion and in association with malignant pleural effusion [15-17]. This finding was lacking in our study.
Malignancy ranked 4th position in our study with breast cancer being the commonest cause in women and primary liver cell carcinoma in men. Whilst the high incidence of breast cancer in women is already known [8,9], the frequent finding of primary liver cell carcinoma in our environment contrasts with the incidence of bronchogenic carcinoma in other studies. This may be related to the high prevalence of hepatitis B infection in our sub-region [22,23].
Mortality in patients with pleural effusion was high 33(16.6%). This is higher than that recorded in Ethiopia (6.4%) [13] and in Benin Republic (13%) [2]. The year specific mortality rate was highest in 2008 with 7(29.2%) recorded for that year. This remained fairly stable over a period of three years with slight drop in 2012 to 8(14.3%) table 3. This may not be readily explained but is thought to be due to early diagnosis and improvement in level of care. The highest mortality was found among our patients with malignancy, heart failure, TB/ HIV co-infection and chronic kidney diseases. The reason is not farfetched since most patients with malignancies present late and lack of equipped oncology centre in our sub-region. This calls for a need for a well equipped oncology centre with surgeons knowledgeable in the management of malignant pleural effusion with full application of the BTS guidelines for the management of malignant pleural effusion [8]. However, it is also worthy of note that malignant pleural effusion is associated with high mortality rate even in developed countries since it is a sign of metastatic spread [24,25]. The patients with heart failure were mostly elderly people and probably with other co-morbidities. The increase in mortality in TB patients was high in most of the patients who were on retreatment for TB and patients with TB/HIV co-infection due to the immune compromised state and other co-morbidities. It was noted that these patients had other complications of tuberculosis such as chronic obstructive pulmonary disease and lung collapse. There was also marginal anaemia in most of the patients which further compounded the problem. There is therefore need for early detection of TB, early initiation of anti-tuberculous chemotherapy and close monitoring of TB chemotherapy using directly observed treatment (DOT). This will in turn reduce complications of TB including pleural effusion and also reduce mortality.
Implication for Future Research
The findings in this study shows that in our environment pleural effusion has variable aetiologic factors with tuberculosis and parapneumonic effusion topping the list. Doctors practicing in our sub region should have these differentials in mind as they are treatable causes. Further investigations such as pleural biopsy and histology should be considered to diagnose other conditions like malignancy to ensure early and appropriate therapy. The use of polymerase chain reaction, like the Gene-Xpert machine for diagnosis of mycobacterium tuberculosis and rifampicin resistance should be readily employed to enhance case detection of TB. The study is a retrospective study. A prospective study will be required to confirm some of the findings in this research work.
Pleural effusion is a common clinical presentation in our clinical practice with variable aetiology. Bacterial infections particularly tuberculosis remain the commonest aetiology. The mortality rate in patients with this condition is still high. Early investigation to determine the aetiology and appropriate early intervention is needed to reduce the mortality in patients with pleural effusion.
We wish to acknowledge the house officers who served in the unit during the study period who helped us in collecting the data.
- Longo D L, Fauci AS, Kasper DL, Hauser SL, Jameson JL, et al. (2012) Harrison's Principles of Internal Medicine. (18th ed). The Mc Graw-Hill companies, New York, NY.
- Agossou M, Bashi BJ, Azon-KouanouA, Zannou DM, Ade g, et al. (2013) Pleural effusion at the Internal Medicine Unit . Centre National HospitalierUniversitaire, Cotonou Benin. African Journal of Respiratory Medicine 9: 17-18.
- Qureshi NR, Rahman NM, Gleeson FV (2009) Thoracic ultrasound in the diagnosis of malignant pleural effusion. Thorax 64: 139-143.
- Evans AL, Gleeson FV (2004) Radiology in pleural disease: state of the art. Respirology 9: 300-312.
- Sahn SA, Huggins JT, San José ME, Álvarez-Dobaño JM, Valdés L (2013) Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone? Int J Tuberc Lung Dis 17: 787-793.
- Sutherland JS, Garba D, Fombah AE, Mendy-Gomez A, Mendy FS, et al. (2012) Highly accurate diagnosis of pleural tuberculosis by immunological analysis of the pleural effusion. PLoS One 7: e30324.
- Koffi N, Aka-Danguy E, Kouassi B, Ngom A, Blehou DJ (1997) [Etiologies of pleurisies in African milieu. Experience of the CocodyPneumology department (Abidjan-Côte d'Ivoire)]. Rev PneumolClin 53: 193-196.
- Antunes G, Neville E, Duffy J, Ali N; Pleural Diseases Group, Standards of Care Committee, et al. (2003) BTS guidelines for the management of malignant pleural effusions. Thorax 58 Suppl 2: ii29-38.
- DiBonito L, Falconieri G, Colautti I, Bonifacio D, Dudine S (1992) The positive pleural effusion. A retrospective study of cytopathologic diagnoses with autopsy confirmation. ActaCytol 36: 329-332.
- Afful B, Murphy S, Antunes G, Dudzevicius V (2008) The characteristics and causes of pleural effusions in Kumasi Ghana - a prospective study. Trop Doct 38: 219-220.
- Onadeko BO, Junaid TA, Odor EI (1978) The significance of cytological examination of the pleural fluid in the diagnosis of pleural effusion in Nigerians. Ir J Med Sci 147: 383-388.
- Ezemba N, Eze JC, Anyanwu CH (2006) Percutaneous needle pleural biopsies in pleural effusion of uncertain aetiology in a Nigerian teaching hospital. Trop Doct 36: 112-114.
- Desalew M, Amanuel A, Addis A, Zewdu H, Jemal A (2012) Pleural effusion: presentation, causes and treatment outcome in a resource limited area, Ethiopia. Health4:15-19.
- Khan FY, Alsamawi M, Yasin M, Ibrahim AS, Hamza M, et al. (2011) Etiology of pleural effusion among adults in the state of Qatar: a l-year hospital-based study. East Mediterr Health J 17: 611-618.
- Singh SK, Pujani M, Pujani M (2010) Microfilaria in malignant pleural effusion: an unusual association. Indian J Med Microbiol 28: 392-394.
- Navaz AK, Raikar MP, Acharya V, Shetty SK (2013) Pleural effusion: An unusual cause and association. Lung India 30: 158-160.
- Marwah N, Singh P, Singh S, Kalra R, Manchanda M, et al. (2007) Filarial pleural effusion. Trop Doct 37: 262.
- Jaquet A, Ekouevi DK, Aboubakrine M, Bashi J, Messou E, et al. (2009) Tobacco use and its determinants in HIV-infected patients on antiretroviral therapy in West African countries. Int J Tuberc Lung Dis 13: 1433-1439.
- Frye MD, Pozsik CJ, Sahn SA (1997) Tuberculous pleurisy is more common in AIDS than in non-AIDS patients with tuberculosis. Chest 112: 393-397.
- Joseph J, Strange C, Sahn SA (1993) Pleural effusions in hospitalized patients with AIDS. Ann Intern Med 118: 856-859.
- Ferreiro L, San José E, Valdés L (2014) Tuberculous pleural effusion. Arch Bronconeumol 50: 435-443.
- Nwokedi EE, Emokpae MA, Dutse AI (2006) Human immunodeficiency virus and hepatitis B virus co-infection among patients in Kano Nigeria. Niger J Med 15: 227-229.
- Adewole OO, Anteyi E, Ajuwon Z, Wada I, Elegba F, et al. (2009) Hepatitis B and C virus co-infection in Nigerian patients with HIV infection. J Infect Dev Ctries 3: 369-375.
- Bernard A, de Dompsure RB, Hagry O, Favre JP (2002) Early and late mortality after pleurodesis for malignant pleural effusion. Ann ThoracSurg 74: 213-217.
- Ozyurtkan MO, Balci AE, Cakmak M (2010) Predictors of mortality within three months in the patients with malignant pleural effusion. Eur J Intern Med 21: 30-34.
Citation: Mbata Godwin C, Ajuonuma Benneth C, Ofondu Eugenia O, Okeke Ernest C, Chukwuonye Innocent I, et al. (2015) Pleural Effusion: Aetiology, Clinical Presentation and Mortality Outcome in a Tertiary Health Institution in Eastern Nigeria – A Five Year Retrospective Study. J AIDS Clin Res 6:426. Doi: 10.4172/2155-6113.1000426
Copyright: © 2015 Mbata Godwin C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Upadhyaya, H.D. and Sharma, S. and Ramulu, B. and Bhattacharjee, R. and Gowda, C.L.L. and Reddy, V.G. and Singh, Sube (2010) Variation for qualitative and quantitative traits and identification of trait-specific sources in new sorghum germplasm. Crop and Pasture Science, 61 (8). pp. 609-618.
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Assembling, collecting and characterising the unique germplasm accessions for morphological and agronomic characteristics are essential activities of a dynamic genebank. The phenotypic diversity and agronomic performance of 667 newly acquired sorghum germplasm accessions, representing five basic races, eight intermediate races and two wild species, originating from 34 countries were assessed for seven qualitative and eight quantitative traits. Large variability was observed among these accessions for various qualitative and quantitative traits. Trait-specific accessions for early flowering (108), short plant height (8), medium panicle exsertion (34), and medium-sized seeds (78) have been identified. The diverse traitspecific promising accessions have the potential for their utilisation in future breeding programs for developing improved sorghum cultivars with a broad genetic base. The hierarchical cluster analysis grouped five races, six intermediate races, and two wild species into three clusters. The present study has played a significant role in filling up the gaps and has also identified region(s) to carry out future explorations, and in providing the trait-specific germplasm for use by the breeders.
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|International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru 502 324, Andhra Pradesh, India
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|Sandhya Gir
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|01 Feb 2011 23:16
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Tag Archives: Christmas
After Christmas sales 2018: the best deals the day after Christmas
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A few weeks ago I was at a church leadership retreat, and one of the speakers (Hi, Kathy!) played this video. I wept. It is so very powerful, so affirming of life, happy and heartbreaking at the same time. It set me even further in the resolve I have about every life, even "flawed" life, being of Divine purpose and immense significance. It's an extremely well-done video, and appropriate for even kids to watch (preview it first, though).
(To read more of the story of Eliot's life, visit his dad's blog, here.)
Posted on January 31, 2008, in Birth, Christianity, Family, Medical Stuff, Parenting, Sad Things, Scary stuff. Bookmark the permalink. 8 Comments.
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Delicious and easy recipe for snow peas! Thyme compliments the fresh snow pea flavour. Try sugar snap peas too. Serve with oven baked sesoned tomatoes, grilled lamb cutlets or salmon steaks.


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Comfort on a geological scale.
When you get back to the campsite after a long day of hiking, slip into The North Face Women's Glacier Pant, fix yourself a refreshing drink, and get ready to relax. This lightweight fleece pant is ideal for relaxing by the campfire, lounging on your couch, or enjoying a cool morning yoga session.
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Worst quality North Face product ever...
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Docking a boat terrifies me. Ask any member of my family about this and they will launch into any of several stories about my docking SNAFUs (an acronym for Situation Normal, All Fouled Up!). My personal favorite is a tale of a three hour tour, a Florida afternoon storm, a 40-foot houseboat, and the
My clients and former students know too well how easy it is to get me off track. Bring up anything remotely related to the military and I will dust off a well-worn "war story." Having spent, so far, two-thirds of my life living a nomadic life in service to my country, it's hard not to succumb to
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My friend, let me ask you this: What is your leadership purpose? Have you identified your leadership purpose, and are you living it in every moment? Don't worry if you haven't, a 2014 Harvard Business School study found that only about 20% of leaders say they "have a strong sense of their own


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Want more from your career but don't know how?
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As more time is included in this session you can explore a few different areas that are bespoke to your needs.
How can I support you?
This is a client centered session which involves elements of career counselling and careers advice which means you can talk about anything that is bothering you that goes deeper then just your career. For example many women feel conflicted about wanting more from their career whilst being a mum because they feel guilty etc.
The approach taken during this session is holistic and although your career is a big part of the picture you will be able to understand other areas of life that could be stopping you from pursuing what you actually want.
Helping you get a plan around your career wants and needs in a bespoke way. Through the career happiness seeker quiz. Which will allow you see what areas you can develop and work in your career and help you move forward.
The 3 hours in this session helps you look at more then one aspect of your career and life. For example we could explore your lack of career clarity in the session and why you feel confused. As well as what careers you are interested or aspects of career confidence. It would up to you and this allows you to come away from the session feeling more supported.
We will work together in a collaborative career counsellor and client way where I will guide you, be honest with you and at times challenge you to understand what some of your blocks could be and confront your fears. This will be you have awareness of what you need to do and be reassured at the same time.
Why Choose me?
I am a qualified careers adviser with over 10 years in careers advice and helping individuals through mentoring, counselling and Information, advice and guidance (IAG).
I have had my business for over three years and my work has been featured in Guardian and Happiful magazine.
The experience you get with me isn't just about goals, but it will be a discussion based around your past, present and future. Which will allow us to see how you can develop your career even further.
To find more about what careers counselor does please visit the following link my Happiful story is mentioned here.
I have been unhappy in my career on more then one occasion and understand what it's like to be there. Please see my story here
I have seen first hand the struggles of a lone parent as my mum was a widow (see Instagram post here) and am advocate for working mums and have helped many mums return to work. See testimonials page here
What can you expect?
1. This is a 3-hour session designed to address key areas that we will explore from your detailed questionnaire.
2. It also includes a quiz to help you look at the type of career happiness seeker you are (see video) We will explore why this is important.
3. A recording of the session is included if we do this over Zoom.
4. If this session is done in person lunch will be included and there will be a 10% increase added to this due to travel and lunch costs. The venue will be in central London.
5. A session delivered by a qualified careers counsellor you get to decide what main areas you want to focus on at the beginning of the session.
6. A 30 minute follow up call will be included two weeks after the session.


text: Book the best airfares from Sacramento (SMF) to NicaraguaSacramento (SMF) to Managua (MGA)Depart: 11/09/19,Return: 11/23/19from$ 539*Viewed: 48 minutes ago*Prices have been available for round trips within the last 48 hours and may not be currently available. Fares listed may be Basic Economy, which is our most restrictive fare option and subject to additional restrictions. Additional baggage charges and fees for other optional service may apply. Other terms and conditions may apply.


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Words and pictures by Butch Eggert. It started with the idea to visit the African
These articles featured in the February 2014 magazine. You can browse the articles for the month below or order a back copy by clicking this link.
Words and pictures by Butch Eggert. It started with the idea to visit the African
Words and pictures by Bridgestone SA. The penultimate round of the 2013 Bridgestone 4×4 Club
As I climbed off the Airlink 41 turboprop at Phalaborwa airport, I was struck first
Words and pictures by Eef Lenaerts. Lying 100 m below sea level, with an average
Words and pictures by Grant Spolander. Product shootout: LED versus fluorescent camp lights. Technophobia is
Words by Jess Fogarty Many of us are familiar with Garmin's tried-andtested MapSource software, but
Words and pictures by Tim Forssman. Storm Shelter has been described as the greatest rock-art
Words by Grant Spolander Pictures by Grant Spolander and Jess Fogarty Most South Africans love
Words and pictures by Bryan Havemann. Many of us will have fond memories of the


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Speed Punches
From the leaders in knock out technology comes the new SPEED PUNCH Systerm. The patent pending "no thread" design eliminates cross-threading, while the innovative SPEED LOCK mechanism quickly secures the punch in place. This means longer tool life and faster punches, saving you time and money on the job. SPEED PUNCH is availiable in 3/4"-2" conduit sizes and 3 kit configurations.
Showing 1 to 16 of 16 (1 Pages)


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Chicago: Plan To Revitalize Public Housing With "Mixed Income" Development Remains Empty Promise
Alderman Walter Burnett
The Chicago Housing Authority's ambitious Plan for Transformation, begun in 2000, was meant to replace the city's notorious public housing developments – including many violence-plagued, crumbling high rises – with vibrant mixed-income developments where former public housing residents could live.
But the housing authority has not fulfilled its promises to thousands of public housing residents as well as thousands of low-income Chicagoans seeking affordable housing through the Section 8 voucher program.
On July 29, aldermen re-introduced the Keeping the Promise ordinance, which demands significant progress and accountability measures from the housing authority. Twenty-three aldermen are sponsoring the measure, with backers demanding a vote in the housing and real estate committee so that it can advance to a full council vote. The ordinance was introduced last fall but did not progress before 2015 municipal elections that changed the makeup of city council.
"The CHA has broken many promises," said Demetrice Davis, who was told she could get a new unit when she was displaced from the ABLA public housing project on the near west side, only to wait a decade before finally getting a home in a different development.
The CHA had promised that as it demolished most of the city's public housing buildings, residents could move to 25,000 new or rehabbed units by 2010. But the plan is woefully behind schedule and those units won't be completed until 2020 at the rate the CHA is going, as shown in an analysis by the Chicago Housing Initiative, a coalition of eight groups that work with low-income renters.
The Chicago Housing Initiative has been denouncing the fact that the CHA has about $440 million in surplus funds that are not being spent even as the lack of affordable housing is dire. The initiative notes that since deregulation of public housing, the CHA is not obligated to spend federal grants meant for replacement housing construction.
Since 2008 the CHA has left unspent between $54 million and $138 million each year. And it has not distributed more than 13,000 available vouchers for subsidized housing, which allow low-income families to rent apartments and pay only a third of their income toward rent.
The ordinance demands that the CHA use all available voucher funds and also reform the voucher program so that it reduces segregation and voucher holders have access to more desirable neighborhoods across the city. That move would be in keeping with the federal rule announced this month demanding cities develop plans to address segregation.
The ordinance also demands that the CHA replace one-for-one all public housing units subject to future redevelopments or conversions to mixed-income housing. An analysis by the initiative shows that at 11 high-profile CHA developments, less than half of the replacement units promised were actually built. And even the units promised were much fewer than the number of units demolished. For example the infamous Robert Taylor Homes used to include 4,415 units. The CHA promised 851 replacement units, but only 305 have been built, with 21 under construction.
For more please see Sjnnchicago.org
As public housing reform and other critical housing-related issues unfold in Chicago in coming months, Social Justice News Nexus Fellows will be there – part of our next cycle focused on housing, segregation and urban development. Applications for the fellowship are open through August 30.
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- Ann GarrisonFebruary 22,2018 @ 08:03 PM
I think you have "Filtered HTML" turned on here. If you switch to "Full HTML," it will probably...
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- 3 beds
- 2.5 baths
- $214,900 price
- 235608 mls id
- Half Baths: 1
- Square Feet: 1,704 sqft
- Year Built: 1963
- Lot Size: 0.97 acres
- Neighborhood: River Park
- Status: Active
Beautiful, 1 acre, corner lot with lots of landscaping in a quiet neighborhood with community pond & large lots. Large deck with built in seating. Oversized 2-car garage, PLUS a 2432 pole barn for storing your tools & classic cars! Many upgrades that will impress your friends & family! Curved, 5ft-wide front walk. Leaded glass front entry with side lights. Circular floorplan. Lots of light. All windows have high end, 2-inch wide, faux wood blinds. Wonderful wide trim throughout home. Cathedralceiling & large bay window in family room. Beamed ceiling, large windows, brick fireplace, & leaded glass rear entry in living room. Custom half bath with hammered copper sink off living room. Formal dining with large windows overlooking deck. Cathedral ceiling & Brazilian flooring in beautiful, updated kitchen! Master bedroom has his & her closets with shelving. Full bath has been completely remodeled with granite top, furniture style, double sink vanity & curved tub with shower. Must see!
Courtesy of: Coldwell Banker Hubbell BriarWood-Holt
Office Phone: 5176996600
Listing Agent: J. Jeff Watson
Updated: 18th October, 2019 8:00 PM.
12796 Melody Road Grand Ledge, MI


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Set up a regular schedule for your yard maintenance. After an initial consultation, we can set up an annual plan to make sure your yard is always at its best! Plan includes crabgrass pre-emergent and timely fertilizer with weed control during the season,
Our organic program focuses on soil amendment applications to promote healthy turf naturally.
We also offer core-aeration with over seeding, insect control including grubs, fleas, ticks and many other nuisance lawn pests.


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We would like your Austin garage door to very last you for years to come. Our Licensed specialists only leading model pieces and equipment to make certain toughness, which include rust resistant components and for a longer period Long lasting springs.
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How big is your God?
How we handle life depends on how big we believe God is. If He's too small: 1) We'll live in constant anxiety thinking everything depends on us. We think we need to fix things on our own and become overwhelmed with problems. 2) Our outlook will be dictated by our surroundings and circumstances. We will be focused on what's in front of us rather than on the God who can move any mountain that stands in our way. 3) Without the acceptance of a loving God we'll be people-pleasers who are influenced by other people's opinions. The words and actions of others will influence our emotions and behaviours. 4) We'll constantly crave recognition because we don't understand that God sees us, cares for us, and loves us. He sees everything we do for Him. Hebrews 6 says: 'For God is not unjust. He will not forget how hard you have worked for him and how you have shown your love to him by caring for other believers' (v.10 NLT). When Goliath threatened the Israelites, they were 'dismayed and terrified' (1 Samuel 17:11 NIV). They didn't think their God was big enough for the job. But David thought differently. David volunteered himself to fight the giant Goliath. He remembered that God had saved him before, and believed that He would save him now (have a read of 1 Samuel 17:32-37). We can face anything when we know what David knew – 'the battle is the Lord's'. And God's never lost a battle. We don't have to depend on our own resources. David may have felt small, but he knew that didn't matter, because his God was big enough. When we face battles in our lives, let's remember how big God is and how able and willing He is to come through for us.
What Now?
Write a list of all the tough situations you, and those you know, are facing right now. Then, in bold letters, write 'My God is bigger' at the top.
The UCB Word For You
Read More


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Thank you Minister. Honourable media representatives.
Regarding the EU fiscal rules, let me first thank Professor Niels Thygesen for an excellent report and for presentation. It indeed provided lots of food-for-thought.
During the discussions, many colleagues said that our current EU fiscal rules are actually working reasonably well. But they are not perfect. But results are there:
- The excessive budget deficits of European countries has been brought down. This is the first time since the crisis that we have no Member State under the Excessive Deficit Procedure.
- The public debt level in the EU is decreasing and is expected to be at 80% of GDP this year, down from 88% in 2014.
- It's true that these improvements were often happening thanks to stronger economic growth, but it is also evidence that the EU's fiscal governance works.
- Many also acknowledged the need for a degree flexibility and adaptability to balance fiscal sustainability and growth .
But there is always room for improvement.
Having directly dealt with the implementation of the Stability and Growth Pact for the last 5 years, I can agree with most of the shortcomings identified by the European Fiscal Board – complexity, loss of ownership, some pro-cyclicality bias in good and bad times, to name few elements.
The many Member States spoke in favour of simplifying the rules to increase transparency and predictability. Notably, the number of indicators in the assessment could be reduced and we could rely less on unobservable variables such as output gaps. The EFB for instance proposes to rely only on a debt anchor and an operational target defined by an expenditure benchmark.
Several colleagues also called to focus on better implementation and enforcement.
Overall, the discussion seemed to confirm to me that we must approach cautiously a possible revision of the legislation.
We need further analysis and discussion, including in the context of a review of the Six-Pack and Two-pack legislation, which the Commission has to deliver by the end of the year.
We will also have to assess whether we can realistically achieve agreement on simpler rules without opening the legislation.
Once again, I warmly welcome the Finnish Presidency's timely decision to give us the opportunity to discuss the topic of energy taxation because this is an area where it is essential that the next Commission makes progress.
As you know, President-elect Ursula von der Leyen announced in her political guidelines several policy actions for a European Green deal. A revision of the Energy Taxation Directive could be part of this package.
The Commission services this week published an evaluation of the 2003 Directive. The aim is to assess the performance of the Directive against its objectives and evolving policy goals.
In terms of results: on one hand, the Energy Tax Directive has contributed to the proper functioning of the internal market by establishing harmonised rules.
But the evaluation also shows that EU rules are clearly out of step with the considerable evolution of technology and energy markets over the past 15 years. They no longer contribute effectively to the new EU regulatory framework and policy objectives in the area of climate and energy.
So I was glad to see that many ministers share the Commission's view that energy taxation has a key role to play in achieving the Union's climate and environmental objectives.
There are a number of possible solutions to address the main challenges we are facing. Some countries raised the option of aviation taxation, or tackling the imbalances between the tax rates of energy products such as diesel and petrol. Or promoting the use of renewable energy and increasing energy efficiency.
We will of course take into consideration all views for the next Commission as part of the European Green Deal.
To reiterate: we must make concrete progress on this issue during the next mandate because we must live up to the promises we have made to Europeans on climate and environmental issues.
Thank you.
Credit: https://ec.europa.eu/commission/presscorner/detail/en/speech_19_5575


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Diva Rubber Duck
Diva Rubber Duck
The diva of Essex Duck knows what she wants and how to get it. This deluxe collectible duck is individually hand painted and detailed. Made from safe phthalate-free plastic. Not a teething toy. Exercise proper supervision for children under three. Please note, this duck range is primarily intended as a collectable item. Due to bespoke shapes, especially with some of the more elaborate moldings and designs with hats, they might not float upright in the bath. Measures 4" long x 3" wide x 4.6" high.
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There is no better way to see everything Fresno has to offer than by getting behind the wheel of your Enterprise rental car. Stop spending your vacation waiting on the bus, or being nickel and dimed with ride-shares or taxis. Having your own car allows you to go to the sites you want to see the most, when you want. Make your next getaway to California even more enjoyable with an Enterprise car rental.
CarRentals.com puts you in the driver seat
Fresno has over half a million people, which probably means this area is just sizable enough for a little exploration. Many travelers come to have fun at Fresno's local attractions. No matter what you decide on first, you'll want to see as much of Fresno as possible while on your trip. You'll be able to explore of this city once you get the keys to your Enterprise rental car.
CarRentals.com works with several of the finest businesses in the business. Enterprise started back in 1957 with only seven automobiles. Today, they're recognized as world-wide leader in the car-rental industry, with over 7,600 locations in 85 countries. Enterprise prides themselves on fabulous customer service and being ready when you need them the most.
Frequently asked questions
How do I get a Fresno Enterprise rental car at a great price?
We strive to get you the lowest rates, no matter when you reserve your car. But getting ahead of your trip can help keep spending low. Make sure to keep the car under one driver's name and go over the mileage policy to avoid any surprise fees.
Do I need to bring anything special when I get my car rental in Fresno?
Be sure to present credit card, as well as your driver's license.
What's Fresno's minimum age to rent a car?
Enterprise's minimum age to rent a car in Fresno is 21. Make sure to review Enterprise's policies, as there could be added fees if you are under 25 in most cases or for higher category cars especially.
What kind of Enterprise rental car should I get for my trip to Fresno?
That depends on your needs and what activities you want to do in Fresno. Compact or economy cars are ideal for short commutes and are easier to park. If you are traveling with colleagues or family, then a sedan or SUV is going to have more room and be a more comfortable ride on longer trips. Those looking for a dash of extravagance on their Fresno vacation can choose a higher-end category like a Mercedes C-Class or Cadillac XTS or similar.
Is insurance required when you rent a car in the United States?
You are required to have insurance before you rent in the United States. Although many of the major card issuers, like MasterCard or Visa, provide some coverage, there are usually restrictions. For instance, they may not cover your rental car if you book a luxury or larger vehicle. Make sure to check credit card issuer's policy before you decide. Additionally, as a U.S. citizen, you can also add on Collision Damage Coverage with CarRentals.com at checkout.
Does Enterprise require a deposit at the time of booking my rental car?
Enterprise does require a deposit when you reserve your rental car. Enterprise will block the deposit on your credit once you reserve your car for your trip. Please be aware that the deposit may vary greatly depending on the make and model of the car.
What is the fuel policy on my Enterprise car rental?
At CarRentals.com, we suggest a full tank policy. You receive the vehicle with full tank, and you should bring it back it filled up. For a cheaper rate, it is best to find a gas station before you bring the car back to Enterprise.
Why should I get unlimited miles?
Fresno has over half a million people, so there should be plenty to do. Unlimited miles allow you to go out in Fresno's downtown or go out in Fresno's downtown without being concerned about your limits. If you need to add some adventure to your Fresno trip, you can also drive to Blackbeard's Family Entertainment and spend an evening riding the park's attractions.
Does Enterprise offer one-way rentals in Fresno?
Enterprise offers one-way rentals in most cases. You may find it easier to return your vehicle at a different Enterprise. However, there is typically an additional fee when you opt for one-way.
Reserve your ride today!
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New, Clinically more Relevant Model for Nerve Root Injury in the Rat.
Spine (Phila Pa 1976). 2013 Sep 15;38(20):1744-8
Authors: Finskas O, Blixt A, Fujioka Y, Olmarker K
STRUCTURED ABSTRACT: Study Design. Exposure to nucleus pulposus and displacement of intra spinal nervous structures with assessment of spontaneous behavior changes in rats.Objective. To develop a controlled, experimental model for nerve root injury.Summary of Background Data. There are a number of experimental models presented for studies on radiculopathies. One often utilized model is based on exposure to nucleus pulposus and displacement of the dorsal root ganglion (DRG). However, it is clinically more common that the nerve roots are displaced/compressed than the DRG. In the present study, we developed a model for displacement of the nerve root by modifying the DRG model.Methods. After removing the left L3-4 facet joint the underlying disc was punctured and the L4 nerve root was displaced laterally by an injection needle (n = 10). In sham experiments the same procedure was performed without disc puncture and displacement (n = 10). In ten rats, the left L4-5 facet joint was removed. The underlying disc was punctured and the L4 DRG was displaced medially by an injection needle. Assessment of spontaneous behavior changes were performed at days 1, 3, 7, 14 and 21 post surgery.Results. There was a clear increase in duration of the behavior Unloading of the paw following displacement of the DRG that was most pronounced at day 1 and then gradually declined. There was a similar patter for this behavior induced by nerve root displacement although the duration was higher than for the DRG displacement. No apparent trends in behavior changes were observed for the other behaviors studied.Conclusion. Displacement of the nerve root induced more changes in pain behavior than displacement of the DRG but only for the behavior Unloading of the paw. Since nerve root injury is more common than DRG injury, this model may be more clinically relevant than the DRG model.
PMID: 24042709 [PubMed – in process]