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GRAND RAPIDS, Mich. — Grand Rapids police say there's no need for concern if you see a helicopter flying outside your window over the next couple weeks.
The International Transmission Company will be flying helicopters as part of a semi-annual inspection of high-voltage power lines throughout the city. At some points, the helicopters will be low-flying so crews can get accurate measurements from the lines.
Police said the flights are currently scheduled from Sept. 19-27.

subset: commoncrawl


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Opinions run high on where the best place for dogs is in DC and we'd like to settle the matter once and for all. Tell us the parts of town your dog loves the best, where he or she can read the "pee-mail" without ever getting bored, and where the owners can relax a little too. With all the technical difficulties we've had this week we'll keep the poll open through early next week, but let us know at our tipline if you have problems. We figured since today is Take Your Dog To Work Day we couldn't leave this uber-important question go unanswered. The dog park that gets the most votes will be where intrepid members of Curbed staff hide several gift cards to a local pet store for a few lucky owners to seek out and redeem for the canine members of their family.
· Take Your Dog To Work Day [Official Site]


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Question 1 Describe how nutrients are replenished in the soil? Question 2 How is the growing of a leguminous crop in the fields beneficial to the framer? Question 3 How nutrients are replenished in the Soil by adding Fertilisers and manures? Question 4 What is the function of cytoplasm? Question 5 What is function of mitochondria? Question 6 What are … [Read more...] about Replenishment of Nutrients In The Soil
Significance of Health
Question 1 What is health? Question 2 What is a disease? Question 3 State the conditions essential for good health? Why do we fall ill Cells are fundamental units of living organism.They are made up of variety of chemical substances.Cells moves from place to place.Even if cell is not moving,in it repairing may go on. There are various specialised activities going … [Read more...] about Significance of Health


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- Research article
- Open access
- Published:
The role of medical equipment in the spread of nosocomial infections: a cross-sectional study in four tertiary public health facilities in Uganda
BMC Public Health volume 20, Article number: 1561 (2020)
With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda.
A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for susceptibility/resistance to common antibiotics. The data collected analyzed in STATA version 14.
A total of 192 locations on 65 equipment were swabbed, with 60.4% of these locations testing positive (116/192). Nearly nine of ten equipment (57/65) tested positive for contamination in at least one location, and two out of three equipment (67.7%) tested positive in two or more locations. Of the 116 contaminated locations 52.6% were positive for Bacillus Species, 14.7% were positive for coagulase negative staphylococcus, 12.9% (15/116) were positive for E. coli, while all other bacterial species had a pooled prevalence of 19.8%. Interestingly, 55% of the remote locations were contaminated compared to 66% of the user contacted locations and 60% of the patient contacted locations. Further, 5/17 samples were resistant to at least three of the classes of antibiotics tested including penicillin, glycylcycline, tetracycline, trimethoprim sulfamethoxazole and urinary anti-infectives.
These results provides strong support for strengthening overall disinfection/sterilization practices around medical equipment use in public health facilities in Uganda. There's also need for further research to make a direct link to the bacterial isolates identified and cases of infections recorded among patients in similar settings.
More than 50% of all deaths in Africa are caused by infectious diseases [1]. In Uganda, bacterial infections alone were responsible for 26% of all admissions, 23% of all mortalities and 20% of all deaths in children under the age of 5 in 2018 [2]. With high numbers of admission and long patient delays, the risk of transferring infections across patients and health workers is expected to be high. The burden of nosocomial Infections is estimated to be up to twenty times higher in low-and middle-income countries (LMICs) than the high income countries [3]. Some studies conducted in sub-Saharan Africa reported prevalence rates ranging from 7 to 28% among patients admitted [3, 4]. A study by Seni et al. in Mulago National Referral Hospital, Uganda found that about 10% of patients undergoing surgical procedures become septic [5]. High incidence of nosocomial infections consequently increases the mortality and morbidity of patients especially in vulnerable populations including pediatrics, pregnant women, surgical patients and those with chronic illnesses such as HIV/AIDS that lower their immunity and often time have frequent visits to the health facilities [6,7,8].
Several studies have been conducted to identify the sources of bacterial infections in hospitals. Indeed bacterial colonies have been identified at various hospital environment sites including beddings [9], stethoscopes [10], computers [11], catheters [12], and other small electronic devices and instruments used by health workers [13]. However, little research has been done on the medical equipment in sub-Saharan Africa and how they can contribute to the spread of hospital acquired infections across patients and health workers.
Globally, more than 50,000 different kinds of medical equipment are estimated to be used on patients every day in hospitals [14, 15]. Despite their importance in supporting healthcare service delivery, maintenance and appropriate management of medical equipment in LMICs remains a widely recognized challenge. Medical equipment in LMICs are poorly maintained and many often neglected [16]. Studies have shown that between 30 and 50% of the equipment in low resource countries are out of service [17, 18] . Poor medical equipment maintenance in the region is partly due to lack of trained medical engineering staff to manage and maintain the available equipment as well as the highly overwhelmed healthcare workers by patient numbers [19]. This, combined with the fact that the available equipment is shared among hundreds of patients, greatly increases the risk of spread of nosocomial infections or hospital acquired infections between health workers and patients in health facilities in low resource settings. This increased risk is associated with several interrelated factors such as equipment design, user training, user competency, facility design, water quality, sterilization and disinfectant quality, infection control policies among others [17]. These risks are magnified in LMICs due to resource limitations manifested through practices such as reusing and sharing of single use medical devices or consumables as well as poor implementation of risk management policies.
The spread of nosocomial infections is worsened by the emergence of anti-microbial resistant strains of bacterial organisms which significantly increase the mortality and morbidity of bacterial infections as well as the cost of healthcare [20,21,22]. Preventing the spread of nosocomial infections across patients and health workers is therefore of paramount importance towards reducing the morbidity and mortality rates in low resourced countries.
Little research has been done to investigate the role of medical equipment in the spread of nosocomial infections in low resource settings. The aim of this study therefore was to identify bacterial isolates present on surfaces of medical equipment ready to be used on patients so as to assess the role of medical equipment as agents of spread of hospital acquired infections in public health facilities in Uganda.
Study setting and sampling
This cross-sectional study was conducted from December 2017 to January 2018, in four public health facilities located in four geographical regions in Uganda: Gulu Regional Referral Hospital (Northern Region), with a bed capacity of 397 and serving 5 districts; Kisenyi Health Centre IV (Central Region) with a bed capacity of 50 in a very busy part of Kampala, the capital city; Mbale Regional Referral Hospital (Eastern Region) with a bed capacity of 355 and serving 9 districts; and Mbarara Regional Referral Hospital (Western Region) with a bed capacity of 600 and serving 6 districts. The health facilities were chosen to represent the four different regions in Uganda. Each of them has a catchment area with a population of over 2,000,000 [Uganda MoH]. The study included all equipment that were in good working conditions in the Operation Theatre, Imaging Department and Neonatal Department. The study focused on these three departments because they employ the majority of equipment and are common across all of the chosen health facilities. All participants and hospital administrators gave written consent to participate in this study.
The different equipment and points of contact used in this study were identified with the help of unit heads as well as users and cleaners. The medical equipment employed in this study were primarily for diagnostics that had been subject to a disinfection protocol prior to use on patients. Medical equipment excluded were those not in use at the time of the study, those that were in use outside the targeted three departments, and those that had not been disinfected and considered ready to be used on patients. Medical instruments such as syringes, surgical knives, scalpels also were excluded from the study. All equipment included in the study had been disinfected within 24 h before collecting swabs.
Samples were collected from each equipment using sterile swabs at three points: (i) the point of contact with patient, (ii) point of contact with the user and (iii) a hard to reach point which was defined as a point on the surface of equipment unlikely to be touched by neither the user nor the patient as illustrated in Fig. 1. The study however included three Overhead Phototherapy machines which did not have point of contacts with the patient thus were only swabbed at the points of contact with the user and the hard to reach points. A total of 65 pieces of equipment were swabbed with 192 total number of samples collected (62 × 3 + 3 × 2).
After analysis of samples in the case study, the single most contaminated equipment in each department at Kisenyi Health Centre IV was included in a control study. This was one ultrasound machine from the imaging department, one baby warmer in the Neonatal department and one anesthesia machine in the theatre department. This three equipment were thoroughly disinfected using 70% alcohol with great care to clean all the three points of contact targeted in the study. A 15-min time gap was allowed between disinfection and swab collection.
Analysis of samples
The collected samples were transported to the microbiology laboratory for culture in tubes containing Amies transport medium (Biolab, Budapest, Hungary). These were packed in biohazard bags and carried in cooler boxes to the bacteriology laboratory of the Department of Microbiology at Makerere University College of Health Sciences. The samples were delivered to the laboratory within 24 h after collection and cultured upon arrival. The Samples were initially cultured on blood agar and incubated for 24 to 48 h at 37 °C in an incubator (MEMMERT) which supplies extra ingredients for accelerated bacterial growth [23, 24]. Samples were subjected to gram stain [25] and investigated using a microscope (Bestscope, Beijing, China) to differentiate the gram positive bacteria (for example coagulase-negative staphylococci, S. aureus MRSA, and Bacillus species) from the gram negative bacteria (for example K. pneumoniae, E.coli, P. aeruginosa, Enterococcus species). These colonies were further cultured on selective media using MacConkey agar and differential medial using Mannitol Salt agar to differentiate mannitol fermenting bacteria and non-mannitol fermenting bacteria for like Staphylococcus aureus. They were then incubated at 37 °C overnight. Thereafter, the bacterial isolates were identified using biochemical identification tests including sulfide indole motility agar for gram negative enteric bacteria (Enterobacter Species), Triple sugar Iron for Pseudomonas aeruginosa, Urea agar base for Micrococci species and Citrate for Escherichia coli. A negative control swab and a positive control swab for each of the identified bacterial isolates were included for verification.
Seventeen bacterial isolates were randomly selected and tested for susceptibility/resistance to common antibiotics. The antibiotics panel was selected based on recommendations for a standard drug susceptibility test by Clinical and Laboratory Standard Institute (CLSI) [26]. Tests were performed with the BD phoenix 100 machine (serial number: PX1302) which performs antimicrobial susceptibility testing using the broth dilution technique in which bacteria is exposed to serial dilutions of antimicrobial agents to determine whether the organisms are resistant or susceptible to the antimicrobial agent. The procedure was performed using reagents provided by the manufacturer and following the manufacturer's instruction [27]. Briefly, the procedure was as follows; Colonies of identified micro-organisms were picked from the respective media with the tip of an applicator stick and suspended in the phoenix I.D/inoculum broth (identification broth) using 0.5 McFarland standard and vortexed for 5 s. One drop of Antimicrobial Susceptibility Testing indicator (AST) solution was then added to a labelled phoenix AST broth tube. Using a pipette, 25 μl of the bacterial suspension from the I. D tube were transferred into the AST broth tube and mixed. The AST broth inoculum was then poured into fill port on the AST side of the panel (the AST side of the combination panel contains up to 84 wells with dried antimicrobial panels and 1 growth control well). The panels selected were specific for gram negative and gram-positive bacteria as previously identified. The panels were loaded into the machine within 30 min of inoculation and incubated for sixteen hours. The results were tabulated to indicate the number of bacterial isolates resistant to each drug.
Data analysis
The data obtained was entered into Excel and exported to STATA version 14 (College Station, Texas, USA) for analysis. Discrete variables were summarized by their means and standard deviations whereas categorical variables were presented as frequencies and percentages. Multilevel generalized linear models were used with Generalized Linear Latent and Mixed Models (GLLAMMs) for univariate analysis of factors associated with bacterial isolation from samples [28]. A three-level model was considered which included equipment level, department level and health facility level. We also specified the logit link and the binomial family in the GLLAMM model. The binomial variable for presence/absence of bacterial isolates on each sample was input as the outcome variable. The individualized associations of the health facility, department, point of contact, number of patients per equipment and number of users per equipment with the outcome was assessed in univariate analysis. A unique variable was created to test for the statistical significance of interactions between the variables that had significant associations to the outcome in the same model. The Odds ratios with respective 95% confidence intervals were used to measure the strength of associations.
As illustrated in Table 1, there were 65 medical equipment investigated in this study. These included; Anesthetic Machines (8), Baby Warmers (8), Infusion Pumps (4), Operating Tables (7), Oxygen Concentrator (13), Patient Monitors (2), Phototherapy Machines (6), Pulse Oximeter (5), Suction Machines (6), Ultrasound Machine (5), and one infant weighing Scale. Of this equipment 30.8% (20/65) were in Mbarara Regional Referral Hospital, whereas Gulu Regional Referral Hospital and Mbale Regional Referral Hospital had 26.2% (17/65) each. The lowest number of equipment was found at Kisenyi Health Centre IV, 16.7% (11/65). More than half of the equipment were from the Neonatal Department, 55.4% (35/65), whereas 38.5% (25/65) were from Surgery Theatre and the remaining 7.7% (5/65) were ultrasound machines from the Imaging Department. In general, each piece of equipment served a mean of 29 patients per week ranging from 2 to 150 and a mean of 8 users ranging from 1 to 50.
Various choices of disinfectants were used for various equipment and departments as shown in Table 1. The rationale for the choice of disinfectants was reported by the users as "we use what is available." Some equipment such as suction machines and oxygen concentrators had autoclavable parts that get in contact with the patient. These were also swabbed as points of contact with the patient.
Nearly nine out of ten of the equipment (57/65) had bacterial isolates identified from samples taken in at least one of the three points tested, two out of three equipment (67.7%) tested positive in two or more locations and 27.7% (18/65) of the equipment had bacteria isolated from samples taken at all three points.
In total, 192 swabs were collected from all 65 medical equipment. Of these, 60.4% (116/192) were found colonized with a bacterial microorganism. The prevalence of bacterial isolates on samples collected from the equipment's point of Contact with User was 66% (95% CI: 54–78%), which was significantly higher (p-value = 0.025) than that of samples collected from the point of contact with patient where 60% (95% CI: 47–72%) of the samples had bacterial microbes present. 55% (95% CI: 43–68%) of the samples collected from the hard to reach point where also found to have bacterial isolates present. Of the bacteria found, the most frequent isolates were Bacillus species 52.6% (61/116), Coagulase negative staphylococcus 14.7% (17/116) and E Coli 12.9% (15/192). The colonization of bacterial isolates also varied across departments as shown in Table 2. Klebsiella pneumoniae for example, which is commonly known to cause hospital acquired pneumonia, was most prevalently found at the points of contact with the patient (6.4% of the swabs from this point) and in the neonatal department (4.8% of the swabs taken from this department) which represents a potential risk to babies hospitalized in these wards.
In univariate analysis, presence of bacteria isolated from samples was associated with the categorical variables; health facility, department and point of contact from which the sample was collected. Results shown in Table 3 indicate that swabs taken from equipment in various health facilities and departments had significantly variant odds of testing positive for bacteria. Swabs from the neonatal department were more than 4 times more likely to have bacteria than swabs from the imaging department (p-value < 0.001). The percentage of samples that were found to have bacterial isolates from each department were: 73% (77/105) in the Neonatal Department, 60% (9/15) in the Imaging Department and 42% (30/72) in the Surgery Theatre Department. This also represents the level of risk to patients and health workers in each department. Further analysis to determine interaction between variables indicated that the interactions between the variables; health facility and department were not statistically significant (p value = 0.377).
All the 17 samples of bacteria species tested for susceptibility to antibiotics were resistant to at least four different kinds of drugs. Table 4 shows the number of bacteria colonies resistant to the various antibiotics included in the susceptibility test. All the bacterial colonies tested were resistant to Ampicillin (Penicillin class), Cephalothin (Cephalosporins class), Cefuroxime (Cephalosporins class) and Trimethoprim sulfamethoxazole class of antibiotics. Further, 5/17 samples were resistant to at least three of the classes of antibiotics tested including penicillin, glycylcycline, tetracycline, trimethoprim sulfamethoxazole and urinary anti-infectives.
9 samples were collected in the control study at Kisenyi Health Centre IV, of these 6/9 samples had no bacterial growth, 2/9 tested positive for bacillus species and 1/9 samples has E coli. Of the three samples that tested positive for contamination, one (1) was from the point of contact with the patient and the other two (2) were from the hard to reach point.
The number of equipment found in the four hospitals varied due to the level of each facility in the Ugandan healthcare system. Kisenyi Health center is at level four thus has less equipment than Mbarara, Gulu and Mbale Regional Referral Hospitals which are at level six. Mbarara has the biggest regional referral hospital in the country and therefore had 31% of the equipment included in the study. Similarly, the variation in the number of equipment across departments was dependent on the number of patients and services offered in the departments. For instance, the imaging department in some cases might be limited to one ultrasound machine serving up to 150 patients per week whereas the neonatal department would have several equipment with each serving one in-patient continuously over long periods of time. The phototherapy machines used to treat babies with jaundice, for example, only served 2 babies in a week.
The study showed that 88% of the medical equipment were colonized by various bacterial isolates. This is within the range of other similar studies on contamination of equipment and devices in hospitals which reported colonization rates ranging from 72 to 95% [10, 11, 13, 29]. The study found that significantly more samples collected from the neonatal department (66.4%) were colonized by bacteria than in operation theatre (25.9%). The significance of pathogens in the neonatal department was investigated by a study in Vietnamese pediatric hospitals which found a prevalence of 33% among pediatric patients [30], although studies investigating nosocomial infections among patients in sub-Saharan Africa show that surgical site infections are the most prevalent [3]. This is attributed to open surgical wounds which increase the risk of patients contracting bloodstream infections [31].
In the control study, 33.3% (3/9) of the samples still had bacteria despite being disinfected with 70% alcohol which is one of the most frequently used disinfectant against infections on hospital surfaces especially in low resourced health facilities [32]. This study showed that not all bacteria is destroyed by 70% alcohol even when properly used, which is similar to previous studies on the effectiveness of 70% alcohol in disinfecting surfaces in hospitals that showed that 36.9% of surfaces previously disinfected with alcohol tested positive for bacterial isolates [33]. However, the prevalence of infections in the control study is much lower than in the case study where 60.4% of the samples were infected which shows a lapse in the disinfection of these materials.
The isolated bacterial organisms in the case study were Bacillus species, Coagulase negative staphylococcus, E. coli, Klebsiella pneumoniae, Enterobacter species, Pseudomonas aeruginosa, Staphylococcus aureus, Micrococcus species and Enterococcus species in that order of prevalence (Table 2). These have been isolated in other similar studies although the colonization rates differ across different study settings. A case study by Seni et al. in Mulago National Referral Hospital, Uganda concluded that Staphylococcus aureus were predominantly circulating in all the surgical wards [34]. Another study investigating the prevalence of bacterial isolates on hospital surface in Nigeria [35] found the following isolates with prevalence: Escherichia coli (34.4%), Klebsiella species. (21.9%), Pseudomonas species. (15.6%), Staphylococcus species. (12.5%), Proteus species (9.4%). Another similar study reported that the most common pathogen was Enterobacter cloacae followed by E. coli, Staphylococcus aureus and P. aeruginosa [36]. Other studies have identified; Micrococcus species, Enterococcus Species, Acinetobacter species., enterococci, coagulase-negative staphylococci, Bacillus species, Legionella, Proteus mirabilis, and Serratia marcescens [37, 38].
Correlation to burden of infectious diseases in Uganda
The leading bacterial infections in Uganda are Pneumonia, acute diarrhoea, septicaemia, urinary tract infections, bacterial respiratory infections and bacterial meningitis. Pneumonia accounted for 9% of 1.5 million admissions recorded in 2018 and is the one the biggest killer for all ages in Uganda, second to malaria [2].. E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus are common causes of hospital acquired pneumonia. In our study, these bacteria were most prevalent in samples collected from in the neonatal ward with E-coli being the most prevalent at 10.5% (Table 2), which illustrates a significant risk for children in admitted in these hospitals to contract hospital acquired pneumonia from the equipment.
Acute diarrhoea was the second most prevalent infectious diseases among admitted patients in Uganda with more than 72,000 reported causes of hospital admission in 2018. It has been shown that 90% of the cases of acute diarrhea are caused by microbial infections including viruses, bacteria and protozoans [39]. The bacterial causing agents of acute diarrhea that were also isolated in this study include toxin secreting species of E-coli, and Staphylococcus aureus have been previously found to cause acute diarrhea [39, 40].. These were also isolated on equipment in this study especially in the neonatal department (Table 2).
Septicaemia is also a common burden especially to post surgery patients, pregnant mothers and neonates. Septicemia Blood samples cultured by Kajumbura, 2014 at Makerere University College of Health Sciences yielded 187 bacterial isolates including 27% coagulase negative staphylococci, 18% Staphylococcus aureus, 10% Klebsiella species, 8% E-coli, 8% Enterobacter species, 6% Enterococcus species, 3% Pseudomonas species [41]. Bacillus species can also cause septicemia especially in patients who are immune-compromised due to HIV infection [42]. HIV is common in Uganda with more than 2 million people estimated to be living with HIV according to the ministry of Health [2].
Urinary Tract infections (UTIs) are especially common in women due to the proximity of their urethra and anal orifices. In 2018, more than 1.7 million cases of UTIs were reported in the OPD section and accounted for 50,000 admissions in Uganda Hospitals [2]. The leading cause of UTIs is E-coli accounting for 80% of the cases [43, 44]. Klebsiella species have also been reported to cause UTIs [45]. With prevalence rates of 12 and 6% for Escherichia coli and Klebsiella pneumonia respectively, Medical equipment pose a significant threat to the spread of UTI infections among women in Ugandan Hospitals.
Although upper respiratory tract infections are the most commonly reported infections in Ugandan hospitals with prevalence of 27% in OPD attendances, majority (85%) are caused by viruses such as rhinovirus, coronavirus, respiratory syncytial virus and the parainfluenza viruses [46]. Nonetheless, up to 15% of upper respiratory infections have been reported to be caused by bacterial species including S. pyogenes, H. influenza, Corynebacterium diphtheria, L. pneumophila, Pseudomonas aeruginosa and Neisseria gonorrhoeae [47]. Pseudomonas aeruginosa was isolated in 2.6% of the cases identified especially in the neonatal ward (Table 2).
Bacterial meningitis is relatively uncommon in Uganda hospitals but has a relatively high death toll with about 500 annual deaths [2]. Bacterial meningitis in pediatrics is commonly caused by Staphylococci, Streptococci and gram negative bacilli, while in adults, is commonly caused by S. pneumoniae and M. tuberculosis and Cryptococcus neoformans [48]. The presence of Streptococcus and Bacillus species on equipment in the neonatal ward therefore poses a level of risk for hospital acquired bacterial meningitis among patients in these wards (Table 2).
The AMR test conducted shows that all the species tested were resistant to at least four variant strains of antibiotics and about 30% were resistant to at least three classes of antibiotics. A previous study by Sani et al., 2013 reported 78% multi drug resistance (MDR) from samples collected in Mulago national referral hospital, Uganda [5]. While, there was discrepancies likely due to the small sample space in our study, these results indicate that equipment shared among patients are a serious threat to the spread of Multi Drug Resistant strains of bacteria.
Generally, for all equipment, significantly more bacteria were isolated from the points of contact with Users than any other point on the equipment. This can be explained by the reported inappropriate use of gloves among health workers such as failure to change gloves between patients, touching multiple surfaces and patients with gloves and failure to perform hand hygiene after use [49]. The results are also probably because the healthcare workers generally use their hands more than the patients to touch the equipment, patients, medicine containers and other hospital surfaces whereas the patients on get in contact with the equipment as guided by the health workers. Indeed, approaches to strengthening medical equipment infection control practices in health facilities in low resource settings must focus on the health workers as key actors in the spread of nosocomial infections.
The significance difference in colonization rates between hospitals and departments points towards differences in infection control practices across the departments and health facilities. The theatre for example is known to have stringent rules on protective wear, restricted access which contribute to the observed significantly lower colonization rate. The neonatal department on the other hand have patients and their care takers moving about the department which increases the colonization and spread of bacterial microorganisms as seen in Table 3.
We also noted high variability in the choice of disinfectants for similar equipment even in the same health facility. This was reportedly due to variations in procurement options although it was not clear why these procurement decisions were made. There was generally a lack of uniform infection control protocols across departments and health facilities sampled which could also contribute to the high bacterial colonization rates. Previous studies have reported that decontamination of medical equipment with 70% alcohol can reduce the infection rates on medical equipment surfaces by more than 80% [50], however, low compliance to established infection control practices in health facilities in low resource settings is a major limitation to proper infection control driven by complacency among health workers and limited supply of infection control supplies when working with medical devices [51].
Given the small dataset available in this study, it was difficult to perform elaborate multivariate or multivariable logistic regression and account for the role of confounders. This study did not perform quantitative analysis of the bacterial colonies found which could have been useful in comparing various methods of disinfection used. This was because the laboratory used did not have any quantitative detection tools such as Rodac plates at the time of the study. Although internal controls are generally not as strong as external controls, the control study conducted in this study fulfilled its objective which was to highlight that using recommended infection control practices reduces the number of bacterial colonies on the medical equipment.
Understanding the role Medical equipment plays in the spread of hospital acquired infections is extremely important in public health management since patients and health workers come into contact with this equipment very frequently. Nearly 9 of every 10 pieces of medical equipment tested in this study were positive for bacterial microorganisms which are associated with common bacterial infections in Uganda, and 2 of every 3 pieces of equipment were contaminated at two or more locations. While the user and patient contacted locations showed the highest percentage of contamination (60 and 66%, respectively), the observation that over half of the remote locations were also contaminated (55%) suggests that this equipment were not properly disinfected equipment. Further, the bacterial organisms identified were resistant to multiple antibiotics which indicates a greater risk of spread of MDR bacterial strains in the community. These results provide strong support for strengthening overall disinfection/sterilization practices around medical equipment use in public health facilities in Uganda. There's also need for further research to make a direct link to the bacterial isolates identified and cases of infections recorded among patients in similar settings.
Availability of data and materials
The datasets generated and/or analysed during the current study are not publicly available due to ethics restrictions but are available from the corresponding author on a reasonable request.
Acquired Immunodeficiency Syndrome
Antimicrobial resistance
Antimicrobial Susceptibility Testing indicator
Becton, Dickinson and Company
Confidence Interval
Clinical and Laboratory Standard Institute
- E-Coli:
Escherichia coli
- GLLAMMs:
Generalized Linear Latent and Mixed Models
- H. influenzae :
Haemophilus influenzae
Health Centre 4,
Human Immunodeficiency Virus
- L. pneumophila :
Legionella pneumophila
Low-and middle-income country
Multi Drug Resistance
- MoH:
Ministry of Health
Methicillin-resistant Staphylococcus aureus
Outpatients Department
Odds ratio
- P. aeruginosa :
Pseudomonas aeruginosa
Regional Referral Hospital,
- S. pyogenes :
Streptococcus pyogenes
Standard Deviation
Uganda National Council for Science and Technology
Urinary Tract infections
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The authors would like to thank the in-charges of the theatre, neonatal and imaging departments at Mbarara RRH, Gulu RRH, Kisenyi HC4 and Mbale RRH; Calvin Abonga, Kiwanuka Martin, Muhimbise Owen and Bulondo Fred for their assistance during data collection; Hannington Baluku for the excellent laboratory technical assistance; Ronald Ssenyonga, a biostatistician at Makerere University Clinical Trials Unit who gave excellent consultation in data analysis, Ivan Segawa, a pharmacist at Makerere University Lung institute we consulted in antimicrobial testing and all staff in Biomedical Engineering at Makerere University College of Health Sciences for their support.
This research was funded by the NIH Forgarty International Center under grant number 1D71TW010337–01. The funder provided funds as part of a large study and did not contribute in the design of this study and collection, analysis, and interpretation of the data or writing of the manuscript.
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RTS conceived the idea, designed the study, wrote the IRB protocol and wrote the first draft with SO. SO collected data and analyzed data and wrote on the first draft, IGM contributed to data analysis and the first draft. MST, BAN, CN, BM, JM, participated study design, data collection, analysis and manuscript writing. WMR, MLJ provided critical review of the manuscript. All authors read and approved the final version of the manuscript.
Corresponding author
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Ethical approval was obtained from the Institutional Review Board of the School of Biomedical Sciences at Makerere University College of Health Sciences and the Uganda National Council for Science and Technology (UNCST; # SS 4166) and written consent was obtained from the participants.
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Not applicable as no individual person's data was revealed in this manuscript.
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Ssekitoleko, R.T., Oshabaheebwa, S., Munabi, I.G. et al. The role of medical equipment in the spread of nosocomial infections: a cross-sectional study in four tertiary public health facilities in Uganda. BMC Public Health 20, 1561 (2020). https://doi.org/10.1186/s12889-020-09662-w
DOI: https://doi.org/10.1186/s12889-020-09662-w


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To become a successful player, you have to learn certain terms often used at the tables, regardless of whether you are playing free poker, cash games, or tournaments.
Here are some of the most common Poker terms and phrases you, as a player, need to familiarize yourself with-
The situation when only two players play the game. In a tournament, the game becomes 'heads-up' when there are only two players left on the table.
A hole card that itself doesn't play any role in forming the hand. When two or more players are holding cards of the same rank, the player with the highest kicker wins.
Limp in
Entering the pot with a call pre-flop, instead of a raise. Limping is considered a sign of weakness as players with strong hands usually raise as a strategy to make others fold.
When a player folds his hand and throws it into the pile of discarded cards to keep it separate from the cards in play. The term is also used when you lose a hand and decide not to show your cards to the opponent.
An aggressive player who plays almost every hand and constantly raises/re-raises to put pressure on the opponents. Your understanding of the game is reflected in the words you choose at the tables. If you are a new player, use the list as a resource to reference while creating your Poker strategy to beat the opponent and win the hand.


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Key Fundamentals To Watch Out During the Week; June 28, 2021
Fundamental News: June 28 – July 02
We @ TP GLOBAL FX, help you to provide a list of high impact data for the week to make systematic planning for Currency Trading.
A new week will remain calm as few key economic events are scheduled which could drive the major currency pairs. The most watchful event for the week will be U.S. Non Farm Employment Change along with the U.S. ISM Manufacturing PMI data. In addition, U.K.'s Final GDP, Euro zone's CPI and OPEC – JMMC meeting will provide further directions to the FX markets.
Let's Take a Look on Day Wise List of the Key Economic Indicators:
June 28:
1200 GMT/1730 IST U.K. MPC Member Haldane Speaks
1300 GMT/1830 IST U.S. FOMC Member Williams Speaks
June 29:
1300 GMT/1830 IST U.S. House Price Index (HPI)
June 30:
0600 GMT/1130 IST U.K. Final GDP q/q
1215 GMT/1745 IST U.S. ADP Job Results
1345 GMT/1915 IST U.S. Chicago PMI
1400 GMT/1930 IST U.S. Pending Home Sales
July 01:
0830 GMT/1400 IST U.K. Final Manufacturing PMI
0900 GMT/1430 IST U.K. BOE Gov Bailey Speaks
1400 GMT/1930 IST U.S. ISM Manufacturing PMI
All Day – OPEC – JMMC Meetings
July 02:
1230 GMT/1800 IST U.S. NFP Employment Change
1400 GMT/1930 IST U.S. Factory Orders
Take a look and do trade wisely!
Good Luck


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Regular price $149.99 Sale
SPECIES Cymatoceras sp.AGE CretaceousLOCATION Mahajanga Province, Madagascar
This is a beautiful fossil nautilus (Cymatoceras) from the Cretaceous aged formations of Madagascar. The shell has been polished to a glossy finish. These nautiloids are much rarer than the ammonites so frequently seen. There are two unidentified fossils latched to this side of this nautilus.
The shell of a Nautilus is made up of two layers. The inner layer has the iridescent shine while the outer layer provides protection from external forces. Inside the shell are septa which divide the living area of the shell into compartments and help the animal maintain balance and position in the water column.
Nautilus are "living fossils" in that species similar to this one still exist in our oceans.


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'Spirit Quest' Mastermind Colin Read Directs Latest Danny Brown Video Ft. Run The Jewels
Back in 2016, we named Colin Read's Spirit Quest the Best Independent Video Of The Year. The full-length's clever blend of tricky VX camerawork and unique artistic transitions set it apart from everything released that year. Read's been parlaying his idiosyncratic style to the world of music videos: Danny Brown's latest single, '3 Tearz,' featuring El-P and Killer Mike (aka Run The Jewels), takes all of Spirit Quest's spirit and transfers it to an underground rap cipher and the effect is mesmerizing. (Read handed VXes to real-life RTJ fans to capture a truly organic feel.) This in-your-face production gets up close and personal, and we love it!
Watch '3 Tearz' above, and pick up Brown's latest record uknowhatimsayin¿ here.


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Disclaimer: Any views expressed by individuals and organisations are their own and do not in any way represent the views of The Heritage Portal. If you find any mistakes or historical inaccuracies, please contact the editor.
On the 14th of December 2019, Sydney, Australia, opened a new light-rail tram service between the CBD and Randwick which is to the south-east of the City. There is also another service to the south-west of the City which has been in operation for some years. The new service goes right past the famous Sydney Cricket Ground and the Royal Randwick Racecourse. I rode the full length of the new line recently and it is the trams themselves that I want to comment on.
These new trams, supplied by Alstom, are typical of the current world-wide trend in light-rail design where a set comprises 5-segments that are articulated with concertinas in-between each segment. Sydney Light-Rail operates two sets coupled together as a single unit which makes for a pretty long tram overall. As the new tram negotiated sharp curves in the City, going around corners and turn-outs, the vehicle groaned and squealed - voicing its discomfort!
The tram that we rode in (Carol Pivnic)
Coming off the tram after the full ride, I was mentally comparing this ride with the trams in Johannesburg, many years ago. The Johannesburg trams that I was comparing the Sydney lot with, are those 50 all-steel, streamlined trams that were built in the UK by Metro-Cammell in Birmingham in 1936 for the British Empire Exhibition. They ran between the City and Milner Park for the duration of the Exhibition and then were used on all the major routes around the City to the suburbs. Those 50 Johannesburg trams were known locally as "liners" due to their streamlined shape. They rode exceptionally softly and smoothly on the track laid in the City streets or on reserved sections on ballasted track. Claims were made that they could travel at 60mph in their heyday!
Here is an official Johannesburg Municipal photo of one of the streamliners in the tram shed – taken when they were virtually brand-new.
Noteworthy, are the tinted upper panes of glass on each window to reflect the hot Summer heat. This tram is also carrying the original older municipal crest amidships just below the waist. These crests on all JMT trams were later changed to the newer municipal crest as shown in the main image. I took the colour photo on the corner of Market and Loveday Streets in February 1961– only one month before all the trams were withdrawn from service. The "liner" is approaching the starting point for the Malvern service.
Now - for the crunch! The brand-new Sydney trams don't come close in comfort or silence to the Johannesburg "liners" that were built 84 years ago!!! There is no comparison between the two types - the Johannesburg "liners" for comfort, silence and speed, put these brand-new trams to shame! In the Johannesburg "liners", the seat-backs were reversable when the tram reached the terminus - here in the Sydney Light-Rail cars, the limited number of seats are fixed and close together - several facing each other, resulting in people having to face each other at really close quarters which is not pleasant and something that I experienced on my journey. I could hardly believe that trams built 84 years ago are vastly superior to the modern-day version.
Interior of a new Sydney tram (Les Pivnic)
So, to my mind, the march of progress over time does not always mean something better! The 84-year-old Johannesburg trams built in the UK by Metro-Cammell for the British Empire Exhibition in 1936, still reign supreme for comfort, seating and smooth almost silent operation.
About the author: Les was born in a private house in Brixton on July 7, 1935. He attended Twist Street Primary School from 1946 to 1948, after returning from Durban where he spent 3 years during World War II when his dad was in the Army. He attended Parktown High and after that, he started his working life for the CNA in their Fancy Goods Department. Les then trained as a window dresser with Jacoby & Co in Kerk Street where he remained for 15 years of his working life. All this time, his heart was in railways and he had made a private study of the SAR's steam locomotives and other rolling stock - especially dining cars. This led to an invitation from the SA Railway Administration to join the SA Railway Museum as Assistant Curator in July 1972. He was overjoyed at this development and remained in their employment for the remaining part of his working life. During this time, SA Transport Services published his book on the history of all catering vehicles used on the SAR - dining/kitchen/lounge cars etc. He was boarded on pension in 1989.
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The Franklin County Courthouse was built in 1890
While in Hampton, we suggest that you spend some time exploring the area. There are several city parks, a 20 mile bike path where you can walk or ride through farmland and woods on the old railroad easement. Near Hampton are park lands and wooded wildlife conservation areas along meandering rivers where you can get in touch with nature. About 35 miles north of Hampton is Mason City, the home of Meredith Wilson, and his inspiration for the famous Broadway play, "The Music Man". Music Man Square is an interesting tourist spot in Mason City.
Beeds Lake State Park
Beeds Lake State Park is approximately two miles northwest of Hampton, offering picnic shelters, lodge building for special events, camping, boating and fishing opportunities.
Reservations may be made 24 hours a day, 7 days a week online at www.reserveiaparks.com. Reservation can also be made by calling the reservation call center at 1-877-427-2757 Monday through Friday, 8:00 am to 4:30 pm (CST), closed on State holidays.
Hampton Historical District
Much of historical downtown Hampton is still intact. The town has a city park with a band stand shell across the street from the beautiful historic courthouse. Surrounding the courthouse are several specialty shops in the square. It is a charming example of a Victorian era Midwestern town. Within a block of the Hampton Historical jail is the Courthouse, Civil War Memorial Hall, the historic (and haunted) Windsor Theater, the old United Methodist Church, historic Main Street and other historical buildings.
Franklin County Historical Museum
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7 Stars Family Restaurant $ Address: 709 4th St SE, Hampton, IA 50441 Phone:(641) 456-5378 Basic and simple American food. Breakfast, Lunch and Dinner. Closed on Mondays. (This restaurant is one of the vendors used for food service at the jail)
Willies Sports Bar and Grill $$ Great food and service. My favorite is the Brisket Sandwich. It is really good! 10 1st St NW; Hampton, Iowa 50441. Phone: (641) 456-2080. (This restaurant is one of the vendors used for food service at the jail)
Subway Sandwich Shop $ Fast Food. Address: 217 Central Ave W, Hampton, IA 50441. Phone:(641) 456-4000. Hours: 7AM–10PM. Casual counter-serve chain for build-your-own sandwiches & salads, with health-conscious options.
B & C Kitchen $$ Chinese food. Excellent food, friendly service. I have never had such yummy egg drop soup anywhere. All of the food is good. The restaurant is clean and pleasant. (Sometimes we use this as one of the food vendors for the jail)
Hardee's $ Fast Food. Fast-food chain serving fried chicken, big burgers & made-from-scratch breakfast biscuits. (For you west coast folks, this is owned by Carl's Jr.)
10 3rd St SW. Hampton IA 50441 Phone:(515) 456-3312. Hours: 6AM–10PM
McDonald's $ Fast Food. 411 Central Ave E. Hampton Iowa 50441
Godfather's Pizza $ Pizza Restaurant. Address: 805 Central Ave W, Hampton, IA 50441. Phone:(641) 456-3355. Chain eatery specializing in thick-crust pizzas, also offering calzones, sides & desserts. (This restaurant is one of the vendors used for food service)
Rustic Brew $$ Address: 117 1st St NW; Hampton, Iowa 50441. Phone:(641)456-2141. This place has really good sandwiches, soups, daily specials, as well as having a fun ambiance. This is a great place to visit just to have some coffee and hang out as well. Hours vary. call for hours. (This restaurant is one of the vendors used for food service at the jail)


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Birth Name: David Thompson
Occupation: Basketball Player
Place Of Birth: Shelby
Date Of Birth: July 13, 1954
Date Of Death: February 10, 1857
Cause Of Death: N/A
Ethnicity: White
Nationality: British
David Thompson was born on the 13th of July, 1954. He was best known for being a Basketball Player. Four-time NBA All-Star who was selected first overall in the 1975 NBA Draft; played for the Denver Nuggets and Seattle SuperSonics in a career that spanned from 1975 to 1984; scored 73 points in a single game on April 9, 1978.
David Thompson was born in Shelby. He grew up in Shelby, North Carolina with his cousin, future NBA coach Alvin Gentry . In 1974, he led North Carolina State to its first-ever NCAA championship.
David Thompson was a Cancer and was born in the Baby Boomers Generation.
JUMP TO: David Thompson's biography, facts, family, personal life, zodiac, videos and related celebs.
David Thompson was born in 1950s. The 1950s is often viewed as "baby boom" and a period of conformity, when young and old alike followed group norms rather than striking out on their own. The 50s were also the beginning of the Space Race, Cold War and the Civil Rights Movement. Discover what happened on this day.
David Thompson is part of the Baby boomers generation. Also known as "boomers", are the result of the end of World War II, when birth rates across the world spiked. They are associated with a rejection of traditional values. These hippie kids protested against the Vietnam War and participated in the civil rights movement.
David's education details are not available at this time. Please check back soon for updates.
David Thompson's mother's name is unknown at this time and his father's name is under review. We will continue to update information on David Thompson's parents.
Associated with
Personal Life
Like many famous people and celebrities, David Thompson kept his personal life private. Once more details are available, we will update this section.
David Thompson was born in the Year of the Horse.
Fast Facts
REAL NAME: | David Thompson |
NICKNAME: | David |
RELIGION: | Unknown |
AGE GENERATION: | Baby Boomers Generation |
BIRTH SIGN: | Cancer |
BIRTH DAY: | Tuesday |
DEATH DAY: | Tuesday |
Zodiac Sign: David Thompson was a Cancer. People of this zodiac sign like home-based hobbies, relaxing near or in water, helping loved ones, and dislike strangers, revealing of personal life. The strengths of this sign are being loyal, emotional, sympathetic, tenacious, persuasive, while weaknesses can be moody, pessimistic, suspicious, manipulative and insecure. The greatest overall compatibility with Cancer is Capricorn and Taurus.
Chinese Zodiac: David Thompson was born in the Year of the Dragon. People born under this sign are seen as warm-hearted and easygoing. Independence is one of their greatest strengths, but sometimes they're overly frank with others.
Ruling Planet: David Thompson had a ruling planet of Moon and has a ruling planet of Moon and by astrological associations Sunday is ruled by moon. The Moon represents one's nurturing and emotional instinct. People who are born with Moon as the ruling planet are sensitive, nurturing, and usually have fluctuating moods.
David Thompson's birth sign is Cancer and he had a ruling planet of Moon.
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Why Choose ReactNative to Develop Mobile App
We do know that Mobile is one platform that has witnessed tremendous growth in the last decade. Today, businesses see it as the first digital point of contact with consumers and it is the best platform to engage, attract, market the products and retain the clients of your business (Mobile Apps) And what better than React Native to help your Apps get off the ground for achieving this business goal? The technology is powerful, has immense potential and isn't going anywhere. Choose React Native, choose it now.
Last year – 2018, mobile accounted for 52.2% of all web traffic generated across the globe. The statistic doesn't surprise since consumers spend 86% of their time on mobile on an average with a majority of the time invested in social media and gaming.
Did you know the mobile app revenue is expected to reach up to approx. $190bn in 2020? No wonder, there is an incursion of better, faster and more innovative mobile apps given how consumers prefer using those that deliver a best performance, have seamless navigation and swank of oodles of exquisite.
A native mobile app is the best solution for businesses to target any complex features and engage their customers and to generate the ROI however, since the bit high cost of Native development and a time-consuming proposition, businesses are always on the observation for advance / innovative and powerful technologies that can resolve the issue.
Thus, nowadays React Native has emerged to be the best and viable solution.
Popular brands like Tesla, Airbnb, Skype, and Bloomberg have implemented React Native.
What is React Native?
The technology is based on the JavaScript library of Facebook, React that is known to build user interfaces. It was further developed with an aim to develop effective mobile applications with a single code for platforms – iOS and Android.
According to GitHub, React Native is the 14th most popular repository on the platform, with contributors committing approx. 8,000 times in 45 branches with 124 releases.
A recent Google Trends report states the search terms for React Native have surpassed that of Android and iOS development in the year 2018, and that has been the case since 2015-16.
Cross-platform compatibility
A recent Google Trends report states the search terms for React Native have surpassed that of Android and iOS development in the year 2018, and that has been the case since 2015-16.
Although React Native was initially introduced for iOS, Facebook realized its immense potential early on and quickly developed the technology for Android as well.
The majority of React Native APIs are cross-platform, meaning if you write one React component, that will work seamlessly on both Android and iOS applications.
You can even embed a native code on your App to contribute a more platform-specific authenticity like design aesthetics.
The functionality reduces the app development significantly which also saves time as the developer doesn't have to write two codes, which was the case before the existence of the technology.


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EasyToys Fetish Set with Collar, Ankle and Wrist Restraints
- Innovative restraint set complete with ankle cuffs, wrist cuffs, collar & connecting chain
- Detachable restraints can be worn independently of one another
- Fully adjustable restraints & collar for customised fit
- Made from fine quality faux leather & padded with foam for optimum comfort
- Collar features additional D-rings or attaching to other leads or restraints
It's certainly not difficult to see why this six piece full restraint set from EasyToys is so popular!
This comprehensive kit will have them on lockdown at a moment's notice! The EasyToys Fetish Set with Collar, Ankle and Wrist Restraints will enable you to take complete control of your sub's movements and put them in their place. Boasting a brutal, yet beautiful, BDSM look, it features a heavy-duty metal connecting chain that looks incredible, but also adds a delectable weighty feel. The collar and each of the cuffs is easily detachable with simple clip fasteners. Wear these versatile restraints independently, or pair up with some of your other all-time BDSM faves, for customised gratification every time you play. The collar even features additional D-rings for attaching to other leads or restraints depending on your mood. You'll certainly show them who's boss and keep them from reaching for things that don't concern them, with the EasyToys Fetish Set with Collar, Ankle and Wrist Restraints!
Constructed using fine quality faux leather and padded with foam, this six-piece restraint is incredibly comfortable to wear, even for long periods of time. In addition, it is heavy-duty and durable, so you can be as rough as you like! The collar, wrist restraints and ankle restraints are all fully adjustable, ensuring the optimum fit, while the simple buckle fastenings will keep the restraints securely in place for the duration of your play. You'll be dying to get your hands on this restraint set!
Brand | EasyToys |
Circumference | Wrist Cuffs: 11cm - 28cm (4.33 inches - 11.02 inches) / Ankle Cuffs: 13cm - 30cm (5.19 inches - 11.81 inches) / Collar: 35cm - 53cm (13.78 inches - 20.87 inches) |
Colour Filter | Black |
Material Filter | Faux Leather, Foam, Metal |
- Standard USA Shipping $13 (rates may fluctuate) - 7 Working Days
- DHL Tracked Shipping $28 (rates may fluctuate) - 3 Working Days
You know what they say, "The early bird catches the worm"! Well, you don't have to be that early, simply place your order before 3.45pm (GMT) Monday to Friday and it will be dispatched the very same day.
Your privacy is of the utmost importance to us and with our discreet packaging you can shop in confidence. With totally plain packaging, the only person getting excited by your delivery is you.
Payment Privacy
Want to keep your UberKinky preferences our little secret? Well, all that you'll find detailed on your receipt and bank statement is NES Mail order, our limited company name. We like to keep things on the down-low!
You can return any unopened and unused product with its packaging or tags intact to us within 30 days of receiving it for a full refund or exchange


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Millennium Hotels and Resorts Middle East and Africa has announced the addition of Millennium Place to its portfolio.
A modern hotel concept that will cater to the new generation of business and leisure travellers, Millennium Place is slated to open in the first half of 2019.
The hotel features 453-rooms and suites offering views of the Dubai Marina and Palm Islands.
"The Millennium Place Marina will focus on things that make a difference to our guests' stay, from the in-room entertainment, the pillow, and hotel facilities to food and our excellent service. We want our guests to call their room a place of their own when staying at Millennium Place," said Atef El Eskndarany, the director of sales and marketing at the property.
Eskndarany will serve as an integral part of the pre-opening team and will be responsible for leading the sales and marketing efforts for the property. He brings almost nineteen years of sales and marketing experience in the UAE, Oman, and Egypt.
Prior to this role, Eskndarany was the cluster director of sales and marketing for Radisson Blu Dubai Marina and has been a part of the pre-opening phase for six hotels of various international brands such as InterContinental Hotel Group, Movenpick, and Radisson Hotel Group.


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Clear the Way and Empower Your Soul For Your Ideal Future
YES! John, I am ready to get started Now with The Clearing Trance for JUST $27 Only $9.97 and make way for a brighter future
Clear the Way and Make Things Easier with these Perfect Partners Hypnosis Sessions: Just Lie Back, Relax and Get Ready for a More Empowering Future
The Clearing Trance
This Breakthrough hypnosis session is perfect for any area of life that you want to remove blockages to your success.
As you relax and listen to this hypnosis session it sweeps away subconscious negativity and negative blocks while opening up new opportunities.
Set an intention and focus on improving any area of your life with this hypnosis session
Making Things Easier
Ever over complicate things? Does life seem like an ongoing series of struggles and problems?
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I think you will be surprised how comprehensive and yet simple to implement this series is and that you will be 100% satisfied.
Your satisfaction is my #1 priority, so if you are not happy, I don't want your money. It's as simple as that. Love it or your money back.
ClickBank is the retailer of products on this site. CLICKBANK® is a registered trademark of Click Sales, Inc., a Delaware corporation located at 917 S. Lusk Street, Suite 200, Boise Idaho, 83706, USA and used by permission. ClickBank's role as retailer does not constitute an endorsement, approval or review of these products or any claim, statement or opinion used in promotion of these products.


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"Chilling Adventures Of Sabrina" is a good & even much better show. The show is fast-paced and one thing that is totally disliked is the Cuts of the Scenes. It totally feels awkward in some moments with sudden cuts and sound effects.
Table of Contents
What Is In It?
She is not too good, she will do anything for the people she loves. She is a good person but she also has a little dark side to her. The love story between Sabrina and Kinkle is lovely, hopefully, they get back together. Hopefully, the ending of this show is Sabrina changing the witches' rules, making them think for themselves, freeing them of all evil. And take all the darkness that comes with being a witch. So far the show is amazing, well done.
Sometimes people feel annoyed with the plot favoring too much to lead Character. Where she nearly breaks every Rule of Witching World and still get away with that. She is special somehow where many will mention & you will see in next season's.
Previously, Sabrina was a good girl having some nice and erotic features. But that one is her one side. But now in season 2, Sabrina will show her second side the dark side.
Who Is In It?
The Girl Sabrina looks like Emma Watson & I don't think I'm the only one feels that way, she did a good job along with rest of the Cast. It is one of the scary shows. But the actors are amazing, especially the girl that plays Sabrina. Her acting is so powerful that you forget it's a show and you feel with her.
When It Will Release?
Sabrina Season 2 will be coming out on 5th April 2019. Rush towards cinemas to knows the dark side of Sabrina. And enjoy season 2.
If you had not seen any shot of Sabrina then this Chilling Adventures Of Sabrina Season 2 trailer will help you to make the decision of watching a movie or not at 5th April. Have a look below":


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A Spanish prosecutor is reportedly set to seek a maximum of 8 years in prison and a $23 million fine against superstar singer Shakira for tax evasion, according to documents seen by Reuters.
The three-time Grammy winner is accused of not paying nearly $15 million taxes from 2012-2014. The superstar says she has already paid about $17.5 million to the Spanish tax office to settle her obligation. Yet in July of last year, a judge ruled that there was enough "evidence of criminality" for the singer, who is the star and EP of NBC's Dancing With Myself reality competition, to be tried.
While Shakira is Columbian, the prosecutor's office alleges she was "ordinarily resident in Spain between 2012 and 2014 and in May 2012 bought a house in Barcelona." That home, officials contend, was for not just the singer, but husband Gerard Pique, who plays for FC Barcelona, and their son, who was born in Spain in 2013. The duo announced they were separating last month.
A statement from the superstar's representatives to the BBC contends she is "fully confident of her innocence" and views the case as a "violation of her rights." She reportedly recently rejected a settlement offer from prosecutors.
No date has yet been set for a trial.


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Good choice for the area
"Room was nice. It was clean and comfortable also Friendly staff, good location. Nice pool and very kind staff. Over all this is a great choice to explore the area. Definitely recommend this hotel to anyone travelling in the Colombia area."
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IRIS and others pioneered this effort to offer students from countries not normally included in traditional high school exchange program to experience a year in an American high school. Since becoming affiliated with the YES program in 2003, IRIS has made it possible for more than 900 high school scholars to live and study in Iowa!
Learn More
If you want more information about a particular student or hosting in general, contact IRIS today! Schools have limited spots for exchange students, so time runs out quickly to get students placed in some districts.
Call 515-978-4464 or email firstname.lastname@example.com!
Our Student's Point of View
The Kennedy-Lugar Youth Exchange and Study (YES) program were established by Congress in October 2002 in response to the events of September 11, 2001. The program is funded through the U.S. Department of State and sponsored by the Bureau of Educational and Cultural Affairs (ECA) to provide scholarships for high school students from countries with significant Muslim populations to spend up to one academic year in the United States. In addition to attending school, students live with volunteer host families and engage in volunteer service and participate in activities to learn about American society, acquire leadership skills and help educate Americans about their country and culture.
The program has continued to expand and now includes students from the following countries: Albania, Bahrain, Bangladesh, Bosnia and Herzegovina, Bulgaria, Cameroon, Egypt, Gaza, Ghana, India, Indonesia, Israel (Arab Communities), Jordan, Kenya, Kosovo, Kuwait, Lebanon, Liberia, Libya, North Macedonia, Malaysia, Mali, Morocco, Mozambique, Nigeria, Pakistan, Philippines, Saudi Arabia, Senegal, Sierra Leone, South Africa, Suriname, Tanzania, Thailand, Tunisia, Turkey, and West Bank. To learn more about the Kennedy-Lugar Youth Exchange and Study Program, visit the YES website.
Why these students?
The YES program focuses on countries with significant Muslim populations. The program also helps these students live the American high school experience for one academic year. With the goal of helping educate Americans about the students' countries and cultures,
the YES program provides scholarships to scholarly, English-speaking high school students worldwide. These students are viewed as the future leaders of the world. Each student has been chosen for the YES program to represent their country and promote
international understanding, development, and peace. Although the majority of IRIS' YES exchange students have come from Nigeria and Tanzania, since 2002, Kennedy-Lugar Youth Exchange and Study students have come from 30 different countries worldwide.


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Do you want to set an own plumbing business? This video gives you all the top tips and tricks and some great advice on the best way to start your own business in drain cleaning. Experts in this field for years and he knows all of the great tips on how for starting your own company. The expert will guide you through all the necessary devices needed to establish a residential drain cleaning service. The process will put you in the right direction without investing a large sum. Just a few tools and equipment and a lot of the same functions as he performed.
It is important to seek advice from professionals who have been in the industry for quite a while. They can tell you how they run their business and help you locate potential clients for your business. They've been there been there and know how to assist when you're stuck. They're a valuable resource. This video will help you in the beginning.


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Official websites use .mil
Secure .mil websites use HTTPS
Located in Ahsahka, Idaho, this congressionally authorized project includes Dworshak Dam, Dworshak Reservoir lands, powerhouse, recreation facilities, wildlife mitigation and Dworshak National Fish Hatchery.
Read More
The Mill Creek project consists of the Mill Creek Channel, Bennington Lake and associated federal lands. The dam and reservoir portions of the channel and lands are operated and maintained by the Corps. The project provides for flood risk management, recreation, wildlife habitat and irrigation.
This congressionally authorized project consists of Lower Granite Dam, navigation lock, powerhouse, a fish ladder and associated facilities. The project provides hydroelectric generation, navigation, recreation and incidental irrigation.
This congressionally authorized project includes Lower Monumental Dam, powerhouse, navigation lock, two fish ladders, a juvenile fish facility (JFF), and appurtenant facilities providing for navigation, hydroelectric generation, recreation, and irrigation.
The Little Goose project includes a dam, navigation lock, power plant, fish ladder and appurtenant facilities. It provides navigation, hydroelectric power generation, recreation and incidental irrigation.
This congressionally authorized project consists of Ice Harbor Dam, powerhouse, navigation lock, two fish ladders, a removable spillway weir and a juvenile fish bypass facility. It provides navigation, hydroelectric generation, recreation and incidental irrigation.
The McNary project includes McNary Dam, Lake Wallula, powerhouse, navigation lock, two fish ladders and a system of levees and pumping plants. The project provides for slackwater navigation, hydroelectric power generation, recreation, wildlife habitat and incidental irrigation.
The Lucky Peak project includes the dam, Lucky Peak Lake, federally owned lands managed by the Corps, and operational and recreational facilities. The project provides flood control, fish and wildlife habitat, irrigation and recreation. Since 1961, more than $2.37 billion in potential flood damages have been prevented.
Dworshak Dam and Reservoir Phone: 208-476-1255
Mill Creek and Bennington Lake Phone: 509-527-7160
Lower Granite Lock and Dam Phone: 509-843-1493
Lower Monumental Lock and Dam Phone: 509-282-3219
Little Goose Lock and Dam Phone: 509-399-2233
Ice Harbor Lock and Dam Phone: 509-547-7781
McNary Lock and Dam Phone: 541-922-2252
Lucky Peak Dam and Lake Phone: 208-343-0671


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Betty W. Handbag Set (Brown)
Regular price $75.00
Unit price per
Beautiful handbag set with croc design. The Betty W. Handbag Set comes with a matching wallet which adds to its usage.
In addition, it is made from vegan leather.
✅ Fashionable -- Classy handbag set with V gold-tone accent.
✅ Quality -- Made with vegan leather. Dimensions: Handbag - L 10.8" x H 8" x W 4.5"; Wallet - L 7.5" x H 4" x W 1"
✅ Versatile -- Comes with a detachable shoulder strap.
❤ Operated with high levels of customer care.
🧐 All products carefully picked and analyzed for quality.
✈ Secure shipping with the U.S. Postal Service with tracking number.


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Slow-Aging Routine Set - 18%
$114.00 $94.00 Tax included. ⬤ For plump and radiant skin
All the essentials for plump, toned and young-looking skin: Smoothing Eye Serum, Hyaluron Serum and Slow-Aging Moisturizer all contain high-quality hyaluron and plump up the skin from the inside. Smoothing Eye Serum has a brightening effect thanks to the caffeine and reduces any signs of tiredness. Slow-Aging Moisturizer is the perfect antioxidant day care for supple skin.
Made with ❤ in Germany & Austria
- ✨ Brightening and effective against dark eye circles
- Dark circles and a puffy eye area can be prevented by a daily application of the Smoothing Eye Serum. Caffeine has been proven to stimulate circulation and also contains a decongestant and brightening effect.
🕘 Slow-Aging - The high-quality hyaluron plumps up the skin from the inside and thus reduces wrinkles and lines. The cell-regenerating and cushioning effect of hyaluron and aloe vera ensures reduced dryness, wrinkles and lines in the long term. The rosehip seed oil contained in the slow-aging moisturiser protects against free radicals and prevents premature skin ageing.
- 💧 Provides intensive moisture
- Dehydrated skin layers of the eye area and facial skin are intensively cared for and regenerated by the unique hyaluron formulation (four different molecule sizes).
After cleansing, place 1-2 drops of Smoothing Eye Serum on the hand and gently pat under the eyes. Gently massage 3-4 drops of Hyaluron Supreme onto the facial skin, allow to absorb briefly, and finally apply a hazelnut-sized amount of the Slow-Aging Moisturizer.
Hyaluronic acid
Ingredient of: Smoothing Eye Serum und Hyaluron Serum
As the body's own "filler" between the individual skin cells, highly concentrated hyaluronic acid provides an immediate padding effect: lines and wrinkles are visibly smoothed in the long term.
Ingredient of: Smoothing Eye Serum
The All-Star of eyecare: stimulates the skin's microcirculation and reduces dark circles and puffiness. It protects against free radicals and thus counteracts skin ageing.
Roseflower water
Ingredient of: Hyaluron Serum und Slow-Aging Moisturizer
Thanks to its antibacterial and anti-inflammatory effect, roseflower water supports the healing process of the skin and thus fights impurities & pimple marks. It also has a calming and pH-balancing effect and provides the skin with long-lasting moisture in a natural way.
Smoothing Eye Serum (15ml): Aqua, Pentylene Glycol, Propylene Glycol*, Sodium Hyaluronate, Caffeine, Polyglyceryl-6 Caprylate, Polyglyceryl-4 Caprate, Citric Acid, Rosmarinus Officinalis Leaf Oil, Linalool, Limonene, Benzyl Alcohol
*natural origin
Made in ❤ Germany
Hyaluron Serum (30ml): Aqua, Rosa Damascena Flower Water, Alcohol*, Betaine, Sodium Hyaluronate
*From controlled organic cultivation
Slow-Aging Moisturizer (50ml): Rosa Damascena Flower Water, Helianthus Annuus Seed Oil, Rosa Canina Fruit Oil, Glyceryl Stearate Citrate, Prunus Armeniaca Kernel Oil, Glycerin, Oenothera Biennis Oil, Cetyl Alcohol, Aqua, Sodium Levulinate, Glyceryl Caprylate, Citric Acid, Sodium Hyaluronate, Sodium Anisate, Tocopherol, Xanthan Gum, Rosa Canina Fruit Extract, Citronellol, Rosa Damascena Flower Oil, Parfum, Geraniol, Limonene, Linalool, Eugenol.
Made in ❤ Austria
- 🚫 Without mineral oils, parabens, paraffins, PEGs, silicones and sulphates.
- 🚫 Without artificial fragrances, colours and preservatives.
- 🌿 100% natural ingredients.
- 🐰 Peta Approved


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Kifaru, 25th July 2020 : The new building for the boys of RUPERT CHILDREN HOME is inaugurated today. The new building is named as DON RENZO BLOCK. The program of the day began with Adoration to the Blessed Sacrament. Then the parents/guardians of the children had a session on the Children's right and the importance of education. After a good learning session, all gathered to thanksgiving Eucharist for the gift of new building.
The boys dormitory was inaugurated by Rev. Fr. Alwyn D' Souza, the Mission Director and Rev. Fr. Hilary Lobo blessed the new building.
RUPERT CHILDREN HOME project was started in 2018 and the first building was built to accommodate the very poor children. The children of class V, class VI and Class VII stay here and go to the local school. They are given all the facilities to stay; they are guided well and given coaching to excel in studies. Their integral formation is taken care in this home. Both boys and girls were in the same building and now we have separate buildings for boys and girls. Presently we have 46 children in two batches. The two buildings have the facility to accommodate 120 children.
This building is a miracle from God. In this very difficult time , God in his great mercy and love made it possible to complete the work. The building is named DON RENZO block as per the wish of the main donor Mrs. Marilena and her team from Italy.
The next immediate need of the RUPERT CHILDREN HOME is a building for the Kitchen, dining and class rooms to give coaching to the children. Presently the boys have to go to the girls block for the class and eating and girls have to go to the boys block for class and computer learning. Therefore we need a separate block for kitchen, dining and classes.