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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
The PDQ childhood brain tumor treatment summaries are organized primarily according to the World Health Organization classification of nervous system tumors.[1,2] For a full description of the classification of nervous system tumors and a link to the corresponding treatment summary for each type of brain tumor, refer to the PDQ summary on Childhood Brain and Spinal Cord Tumors Treatment Overview.
Dramatic improvements in survival have been achieved for children and adolescents with cancer. Between 1975 and 2002, childhood cancer mortality has decreased by more than 50%.[3] Childhood and adolescent cancer survivors require close follow-up because cancer therapy side effects may persist or develop months or years after treatment. (Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for specific information about the incidence, type, and monitoring of late effects in childhood and adolescent cancer survivors.)
Primary brain tumors are a diverse group of diseases that together constitute the most common solid tumor of childhood. Brain tumors are classified according to histology, but tumor location and extent of spread are important factors that affect treatment and prognosis. Immunohistochemical analysis, cytogenetic and molecular genetic findings, and measures of mitotic activity are increasingly used in tumor diagnosis and classification.
Brain stem gliomas are classified according to their location, radiographic appearance, and histology (when obtained). Brain stem gliomas may occur in the pons, midbrain, tectum, dorsum of the medulla at the cervicomedullary junction, or in multiple regions of the brain stem. The tumor may contiguously involve the cerebellar peduncles, cerebellum, the cervical spinal cord, and/or thalamus. The majority of childhood brain stem gliomas are diffuse, fibrillary astrocytomas that involve the pons (diffuse intrinsic pontine gliomas [DIPG]), often with contiguous involvement of other brain stem sites.[1,2] The prognosis is extremely poor for these tumors. Focal pilocytic astrocytomas have a more favorable prognosis. These most frequently arise in the tectum of the midbrain, focally within the pons, or at the cervicomedullary junction where they are often exophytic, and they have a far better prognosis than diffuse intrinsic tumors.[3,4,5]
The genomic characteristics of DIPG appear to differ from those of most other pediatric high-grade gliomas and from those of adult high-grade gliomas. Approximately 80% of DIPG tumors have a mutation in a specific amino acid in one of two histone H3 genes (H3F3A or HIST1H3B).[6] These mutations are less common in non–brain stem pediatric high-grade gliomas and are uncommon in adult high-grade gliomas.[6,7] Other recurring DIPG genomic alterations include PDGFRA amplification in approximately 30% of cases, with lower rates of amplification observed for some other receptor tyrosine kinases (e.g., MET and IGF1R). DIPG tumors also commonly show deletion of the P53 gene on chromosome 17p.[8,9] The gene expression profile of DIPG similarly differs from that of non–brain stem pediatric high-grade gliomas, further supporting a distinctive biology for this subset of pediatric gliomas.[9]
Primary tumors of the brain stem are most often diagnosed based on clinical findings and on neuroimaging studies using magnetic resonance imaging.[10,11] Histologic confirmation of presumed DIPG is usually unnecessary. Biopsy or resection may be indicated for brain stem tumors that are not diffuse and intrinsic or when there is diagnostic uncertainty based on imaging findings. New approaches with stereotactic needle biopsy may make biopsy safer.[12]
There is no generally applied staging system for childhood brain stem gliomas.[1] It is uncommon for these tumors to have spread outside the brain stem itself at the time of initial diagnosis. Spread of malignant brain stem tumors is usually contiguous; metastasis via the subarachnoid space has been reported in up to 30% of cases diagnosed antemortem.[2] Such dissemination may occur prior to local relapse but usually occurs simultaneously with or after local disease relapse.[3]
The less common tumors of the midbrain, especially in the tectal plate region, have been viewed separately from those of the brain stem because they are more likely to be low grade and have a greater likelihood of long-term survival (approximately 80% 5-year progression-free survival vs. <10% for tumors of the pons).[1,4,5,6,7,8] Similarly, dorsally exophytic and cervicomedullary tumors are generally low grade and have a relatively favorable prognosis. Children younger than 3 years may have a more favorable prognosis, perhaps reflecting different biologic characteristics.[9]
Many of the improvements in survival in childhood cancer have been made as a result of clinical trials that have attempted to improve on the best available, accepted therapy. Clinical trials in pediatrics are designed to compare new therapy with therapy that is currently accepted as standard. This comparison may be done in a randomized study of two treatment arms or by evaluating a single new treatment and comparing the results with those that were previously obtained with existing therapy.
Because of the relative rarity of cancer in children, all patients with brain tumors should be considered for entry into a clinical trial. To determine and implement optimum treatment, treatment planning by a multidisciplinary team of cancer specialists who have experience treating childhood brain tumors is required. Radiation therapy (including 3-dimensional conformal radiation therapy) of pediatric brain tumors is technically very demanding and should be carried out in centers that have experience in that area in order to ensure optimal results.
Diffuse Intrinsic Pontine Gliomas
Conventional treatment for children with diffuse intrinsic pontine glioma (DIPG) is radiation therapy to involved areas. Such treatment will result in transient benefit for most patients, but over 90% of patients will die within 18 months of diagnosis. The conventional dose of radiation therapy ranges between 54 Gy and 60 Gy given locally to the primary tumor site in single daily fractions.
Hyperfractionated (twice daily) radiation therapy techniques have been used to deliver a higher dose, and studies using doses as high as 78 Gy have been completed. Evidence demonstrates that these increased radiation therapy doses do not improve the duration or rate of survival for patients with DIPG whether given alone,[1,2] or in combination with chemotherapy.[3] Hypofractionated radiation therapy does not improve survival.[4][Level of evidence: 2A] Studies evaluating the efficacy of various radiosensitizers as a means for enhancing the therapeutic effect of this modality have been undertaken but to date have failed to show any significant improvement in outcome.[2,3,5,6,7] Radiation-induced changes may occur a few months after the completion of radiation therapy and may mimic tumor progression. When considering the efficacy of additional treatment, care needs to be taken to separate radiation-induced change from progressive disease.[8]
The utility of chemotherapy in the treatment of patients with newly diagnosed DIPG is unproven.[2,3,6,7,9,10,11]; [12,13][Level of evidence: 2A]; [14][Level of evidence: 3iiiA] Currently, no chemotherapeutic strategy—including neoadjuvant, concurrent, post-radiation survival or immunotherapy—when added to radiation therapy has led to long-term survival for children with DIPG.[15,16,17]; [18][Level of evidence: 2A] Similarly, studies utilizing high-dose, marrow-ablative chemotherapy with autologous hematopoietic stem cell rescue have been ineffective in extending survival.[19] Consonant with other brain tumors, radiation therapy is often omitted for infants with DIPG and chemotherapy-only approaches are utilized.
Focal or Low-Grade Brain Stem Gliomas
In general, maximal surgical resection should be attempted.[20,21] Patients with residual tumors may be candidates for additional therapy including 3-dimensional conformal radiation therapy approaches with or without adjuvant chemotherapy. Information about ongoing clinical trials is available from the NCI Web site.
Patients with small tectal lesions and hydrocephalus but no other neurological deficits may be treated with cerebrospinal fluid diversion alone and have follow-up with sequential neuroradiographic studies unless there is evidence of progressive disease.[20]
Children with neurofibromatosis type I and brain stem gliomas may have a different prognosis than other patients who have intrinsic lesions. Patients with neurofibromatosis may present with a long history of symptoms or be identified on screening tests; a period of observation may be indicated before instituting any treatment.[22] Brain stem gliomas in these children may be indolent and may require no specific treatment for years.[23]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with untreated childhood brain stem glioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Given the dismal prognosis for patients with diffuse intrinsic pontine glioma, progression of the pontine lesion is anticipated generally within 1 year from initial radiation therapy. In most cases, biopsy at the time of clinical or radiologic progression is neither necessary nor recommended. To date, no salvage regimen has been shown to extend survival. Patients should be considered for entry into trials of novel therapeutic approaches because there are no standard agents that have demonstrated a clinically significant activity. Concomitant palliative care should be provided for these patients whether or not disease-directed therapy is administered.
At the time of recurrence, a complete evaluation to determine the extent of the relapse may be indicated for selected low-grade lesions. Biopsy or surgical resection should be considered for confirmation of relapse when other entities such as secondary tumor and treatment-related brain necrosis, which may be clinically indistinguishable from tumor recurrence, are in the differential. Other tests, such as positron-emission tomography, magnetic resonance spectroscopy, and single-photon emission computed tomography, have not yet been shown to be reliable in distinguishing necrosis from tumor recurrence in brain stem gliomas. Radiation-induced changes may occur a few months after the completion of radiation therapy and may mimic tumor progression. When considering the efficacy of additional treatment, care needs to be taken to separate radiation-induced change from progressive disease.
Treatment considerations at the time of recurrence or progression are dependent on prior treatment. Considerations include: further surgical resection, irradiation including 3-dimensional conformal radiation therapy, or chemotherapy. The need for surgical intervention must be individualized on the basis of the initial tumor type, the location within the brain stem, the length of time between initial treatment and the appearance of the mass lesion, and the clinical picture.[1]
Chemotherapy with agents such as a carboplatin and vincristine may be effective in children with recurrent low-grade exophytic gliomas.[2,3]
Treatment Options Under Clinical Evaluation
Early-phase therapeutic trials may be available for selected patients. These trials may be available via Children's Oncology Group phase I institutions, the Pediatric Brain Tumor Consortium or other entities.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood brain stem glioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Untreated Childhood Brain Stem Glioma
Added Warren et al. as reference 18 and level of evidence 2A.
This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of childhood brain stem glioma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Childhood Brain Stem Glioma Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Pediatric Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Childhood Brain Stem Glioma Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/child-brain-stem-glioma/HealthProfessional. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
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We are advising the public that the Animal and Plant Health Inspection Service has prepared a preliminary determination regarding a request from Dow AgroSciences LLC seeking a determination of nonregulated status for cotton designated as DAS-8191Ø-7, which has been genetically engineered for resistance to the herbicides 2,4-D and glufosinate. We are also making available for public review and comment our preliminary plant pest risk assessment, draft environmental assessment, and preliminary finding of no significant impact for the preliminary determination of nonregulated status.
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subset: commoncrawl


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A tubby suburban dad watching hunting and adventure shows on TV and wondering could I do that? This is the chronicle of my adventures as I learn to learn to Forage, Hunt and Fish for food that has lived as I would wish to myself - Wild and Free.
Thursday, 30 August 2007
Sofa King Whacked
It's that time again: your pal SBW was forced off the sofa and the TV remote prised from his chubby little hand – "Off to the running club fat boy" said Mrs SBW.
And oh what torture it was, Greenwich Park is steep, way steep, and the guys from British Military Fitness had us hopping, (yes Hopping, you know travelling on ONE foot!) up the hill before we were allowed to run up the hill, it was murder. But as mentioned in a previous post at least it keeps the existential angst at bay.
I've taken to asking other victims, I mean participants, about their motivation. " I just don't want to be last" is quite a common one – myself I'm too busy not wanting this to be my last breath to care about anyone else.
After the hill-climb came the long jog, I'd have thought it was a long walk, but no we ran – well for most of it anyway. As we jogged we passed a rosy-cheeked young couple, enjoying the warm evening air, sitting on a park bench, happily drinking what looked like a bottle of whiskey. As people ran past they shouted encouragement. "You can do it" and "faster you're winning". I like to think of myself as the master of the witty retort, but all I could muster, through gritted teeth, was a "that's easy for you to say" as my hart tried to leave my body.
The thought of tromping the hills of bonny Scotland with a pack and rifle in search of Red Stags and then later more of the same with a compound bow in my sub arctic search for the Elk of my dreams was all that kept me going. I'd rather die now than face coming home with no meat due to general laziness.
When I got home Bushwacker Jnr was eagerly awaiting my arrival: "Hey dad there's a new film coming out, mum says you'd like it, its called Run Fat Boy Run!!
You've gotta love 'em haven't you? It's not legal to use them as bear bait!
run fat boy run trailer
4 comments:
- Pablo said...
This is one of he best blogs I've read for a long while. OK I'm converted. What do I do now?
- 30 August 2007 at 21:36
- Phillip said...
Well, you can't use them for bear bait, but if you want a little vengeance, they make great bird dogs!
Take him on a pigeon shoot.
- 31 August 2007 at 06:14
- Pablo said...
Thanks for the comments on my blog. Now added to the blogroll.
- 31 August 2007 at 17:00
- Dana said...
*laughing* Your comment about the people shouting encouragement "faster you're winning" brought back a great memory for me. Last fall I ran/walked my first marathon ever, in Dublin. In the last 1/3, a little kid said, "C'mon! This is the last hill!" and I thought, Alright! The last hill!! Until I got to the next hill and another little kid said "It's the last hill!" and I thought Ok, this one's probably telling the truth. Until I got to the next hill, and by that time I was past hearing what little kids had to say. No you can't use them as bear bait...but you can probably run away faster than they can...
Great blog by the way!!
- 7 September 2007 at 04:11


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Release Date: 2004 |
[quote=Review]Punk Rock. The genre name immediately brings up images of mohawked, nose-pierced young adults slamming out power chords at many miles an hour, with profanity-laced lyrics that don't quite make sense half the time.[/quote]
What have you been listening to?This Message Edited On 12.20.05
you did aight for a first review. My sister makes me listen to this guys whenver she is driving and i cant stand them.
This still needs to undergo a lot of editing. I remember there's a couple songs off here I don't mind listening to.
Album Rating: 4.5This album has a lot of really standout tracks. I can't listen to it all the way through, but there is some great musicianship here... Say what you like about the genre as a whole, but this band stands out for doing stuff that's actually musically interesting.
did you save this as a word document?
if you did, copy and paste the document into the review over the code-ridden one
otherwise, i can't read this, sorry
All that you have to do is go back to 'edit review' and click submit, and it should clear away all of the extra coding.
Album Rating: 3.0Oops, sry about that messy code. I had to wait for it to be approved by a moderator and had to leave within half an hour of writing this.
Well still can't get rid of some of those annoying little code-quriks, but maybe the asterisks will make it easier to read.... :P
Album Rating: 3.0Ah, crap it got rid of my bolds and italics too... ah well...
Those don't matter much anyway. (I use 'em though :D)
Pretty good for a first, but IMO I loathe these guys.
Ew Reliant K is not I repeat NOT punk rock. At least the dont try to pretend to be punk by wearing black and stuff, but this is pure pop/rock.
Album Rating: 3.5the newer stuff is okay. the older is a little better though
Album Rating: 1.01) two lefts dont make a right
tied 2) MMHMM and Apatheic ep
there we go i havent hear the debut
wait dont they hae 3 guitars?
Album Rating: 4.0They do now, when Dave left they went and got two more guitarists, which was a stupid move in my opinion
I like relient K and I think they have definately grown up a bit Sadie hawkins dance,mood rings and Gibberish are still good songs though.
why would a band have three guitarists when none do anything different (cough) Hawthorne Heights (cough), but either way i like relient k though ive never heard their old stuff
Album Rating: 4.0their old stuff is ALOT better, see "Two Lefts Don't Make a Right but Three do" that was my favorite album for several years
if "shitty music" wasa category, relient k would be in it. right along with good charlotte and MCR
Album Rating: 4.5There are nicer ways to say you don't like this album
Who I Am Hates Who Ive Been is surprisingly quite good. It's really changed my opinion of Relient K. Meybe their not a bad band...
Bands: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


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Prior to co-founding investment management firm AQR Capital Management, Clifford S. Asness was at Goldman Sachs, where he was a managing director and director of quantitative research for the asset management division.
Asness has authored articles on many financial topics, receiving awards from the Journal of Portfolio Management and Financial Analysts Journal. In addition, he earned the CFA Institute's James R. Vertin Award, given to individuals who have produced a "body of research notable for its relevance and enduring value to investment professionals."


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Complete reference to conquer a level 10 NPC
All I intend to do is to make place for a complete reference for a first timer and to share my experiences so that others can just take the lessons out of it. I wish to thank other posts without which I would not have taken a level 10 NPC myself. Recently, I did some experimental hits to analyse and post the outcome of them for first-timers.
A level 10 NPC is primarily taken for the level 10 buildings it has. Those 37 x lvl 10 farms (+ 3 x lvl 9) when coupled with 10 x lvl 10 lakes plus a decent Politics Hero like say 120 provide a food production of ~1.5m per hour. For adv. players, it serves as war town or gets customized to another resource town esp. due to the lvl 10 cottages.
1. Troops
This depends upon two factors -
1. Proximity of your target level 10 NPC from your attacking city(-ies)
2. Method you are able to choose for this process.
i. Single City Method - 180,000 Archers, 140,000 Warriors & 10,000 ballistae [6-10 Heroes] Time taken: about 60 - 90 minutes(from Hit#1)
ii. Multiple City Method - 140,000 Archers, 320,000 Warriors & 10,000 ballistae [40 Heroes approx.] Time taken 30 sec - 2 min from Hit#1
Note: First wave aka Spearhead wave should take down the fortifications and troops inside it. Some fortifications might still remain and regeneration will be higher initially. Second and third waves should be slightly bigger than the rest.
What I have mentioned is only a guideline for archer/warrior numbers, archers are the firepower and warriors help removing traps - hence the numbers are fully customisable as per player's requirements.
2. Extra Town Slot
This is quite obvious, however if you want to do this exercise while you are a Marquis or Duke and that you don?t have an extra town slot, you might depend on your attacks for the medal drops and thereby you await your next title during the course of action. This is absolutely fine as long as you need about 4 justice medals and 4 nation medals. If you need more, then you must be prepared with a few additional troops to prolong the attacking sequence.
3. Penicillin, Corselet & War Horn
For a first timer, these can be of great help, otherwise you must be prepared for the losses. Horn takes highest priority as it roughly adds about 20-30 levels to the hero in its impact on firepower and hence the number of rounds needed per battle and therefore the total losses taken.
4. Scouting Heroes inside the NPC
Whenever you scout the NPC, the Hero inside it changes. Keep doing this until u find a Hero with level less than 5 or so. He can still have an attack of about 80 or more which we are not so sure of. However, the point is we all expect a low level Hero to be weaker than a higher level Hero. At the end of scouting, you can launch your attack. This hero will remain the same throughout the whole process.
5. Technology Levels
Archery, MT, Medicine & IW should be maxed out. Additionally, Compass/HBR when maxed will be of use too.
6. Heroes to be sent
Get ready with the heroes to be sent. All should have ATT greater than 100 or so. Based on the no. of waves to be maintained in action, you will need about 5 to 10 heroes. If the hero for spearhead has an attack of ~150, it's fair enough to reduce losses. As per Method#1, 6-10 Heroes will be needed. As per Method#2, 40+ heroes will be needed.
7. Buildings
Rally point ? This building should be of level 9 min.(lvl 10 serves the best). For those who aren?t aware of, a level of Rally Point adds up 10,000 troops to be sent in a single wave.
Feasting Hall ? For a similar reason as above(in this case the no. of heroes engaged), this needs to be of level 9(min.) to make the best use of it.
Note: If you attack an NPC in next tile of distance 1 mile, you will probably end up in a round trip of about 7 minutes. Since 1 minute is a nice gap to be maintained, you will need 7 waves in action to keep it going. However, if the distance is 3 miles or more, the round trip will be mostly 16 minutes or more and hence you need to space out wider which means you take more losses.
8. War Ensign(Optional)
This is an item which can be applied by ticking the small checkbox located in the top left of Marching Window. This will include as much as 25% additional troops to be deployed out of a single wave, so this finds its use in the Spearhead wave to take minimal losses. From the next wave onwards, don?t forget to un-tick it, else you keep losing this item unnecessarily. If you have only lvl 9 Rally Point, then this will prove to be of great use for the spearhead wave.
1. Wave composition
a. Single City Method ?
The NPC should be on next tile, ideally. If it's more than 3 miles away, then this method will have considerable losses.
Spearhead - 90,000~115,000 archers(approx.) + 10k ballistae (based on whether you have applied war ensign or not)
Note: Before Spearhead, a few waves of warriors can be sent but that doesnt give a big impact esp. due to the high initial regen.
Wave 2 - 3 ?
20,000 archers +
10,000 warriors
After Wave 3, ?
15,000 archers +
10,000 warriors +
#1. If spearhead hero has attack less than 180, sending ballistae has a good impact. For those who think ballistae dont enter battle around round 13, please do the maths with the warrior movespeed and ballistae movespeed, yes.. they help take out warriors thereby reducing the losses on archers due to warriors impact.
#2. Archer losses due to ATs arent so significant, so warriors can help take out traps a bit. If we add other troops as rainbow, it only reduces the firepower of archers.
b. Multiple City Method
Spearhead - 100,000~125,000 archers(approx.) (based on whether you have applied war ensign or not)
Wave 2 - 3 ?
20,000 archers +
10,000 warriors
After Wave 3, ?
7,000 warriors
Note: Since this is for long distance captures, workers/trans might need to be added. Also the 7k warrior wave can be replaced by 7k archer wave depending upon player's context.
Detailed Explanation of method #2 can be found in http://bbs.evony.com/showthread.php?t=45727, thanks to arislan1999
2. Medals drop / Wave timings balance
Medals drop only when a good no. of troops are killed. The spearhead wave usually gets a medal (where you slaughter 400,000 warriors). In the subsequent waves, only fortifications regenerate, so you may not get medals. Troops regenerate as 40,000 warriors once in about 6 minutes where you can expect a medal drop. If you look out for more medal drops, you wud like to prolong the process, so you can maintain the wave gap as 2 minutes or so. Otherwise, it can be as less as that can be sustained. 4 Justice and 4 Nation medals are quite normal to be set as minimum expectations.
Note: Method#1 is apt for medal hunt. Method#2 is for advanced players and for long distance captures.
3. Loyalty reduction
The starting value is 91 at the level 10 NPC. It loses 3-4 per successful attack(depends on the wave compostion) till the value goes down to ~60 and thereafter it loses 2-3 per attack, totalling to ~40 attacks.
4. Level up Heroes when they return
When a wave returns, don?t rush to send them back again. Check out the timings of the wave that has just marched out, level up the Hero who has just returned and then send the next wave.
Spearhead Wave with Hero attack 182 [on two different NPCs ]
without War Horn:
with War Horn applied:
Note: These are fresh reports, so please replace 2000 trans with archers The idea is to portray the impact of warhorn [No other buffs applied]
Waves 2-3 as per Method #1 [Sorry, these are on another NPC, War Horn applied]
After wave #3,
Note: I hit a few lvl 10 NPCs just for the sake of posting here, so didnt bother to proceed to take it. Other waves will be much similar to Wave 4 (which will accomodate 40,000 Warriors spawn in itself). In Method #2, you will be taking it before the 40,000 Warriors spawn.
Military Tradition - Level 10
Iron Working - Level 10
Compass - Level 10
Horseback Riding - Level 10
Archery - Level 10
Medicine - Level 10
After this process, you can refer to http://bbs.evony.com/showthread.php?t=39681 for getting an idea of how to re-build a lvl 10 NPC, thanks to ByronXAN
Thank you for your support; comments/feedback welcome.


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Hello dear friends.
I wrote to IRC, but it's now time to go, so I'll leave message here.
Hello to all. I tried to make tremolo .sfz instrument, but fault into this error: https://bugs.linuxsampler.org/cgi-bin/s ... cgi?id=300
Do anybody checked it?
Also I reported this bug earlier: https://bugs.linuxsampler.org/cgi-bin/s ... cgi?id=301
Seems, that it's fixed, but I can't check this on my machine, I can't compile it. Maybe someone has ready .deb packages for it ?
Or, maybe, do you know, is Linux Sampler present in KXStudio distributive ?
And if it is, than, is it's version more recent than "2017-02-14 15:16:35 CET SVN" ?
I use Linux Mint 18.2 x64
Sorry for disturbing.
Thank you very much.
Best regards,


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It's been two weeks since Stanford physics professor Andrei Linde found out that his Big Bang theory was true, but he's still reeling from the repercussions.
Since the announcement was made public Monday, 2.4 million people on YouTube have watched Linde react to news that evidence from the BICEP2 experiment in the South Pole supports his cosmic inflation theory of how the universe began.
For many, the two-minute video felt more real than any glammed-up episode of reality television could ever be. Hundreds tweeted, Facebooked and GIF'd it, leaving no doubt that the news had sparked the beginning of many discussions on life, evolution and the universe.
Lawrence Krauss, director of the Origins Project at Arizona State University, perhaps summed it up best in the New Yorker, explaining that the discovery could "allow us to peer back to the very beginning of time—a million billion billion billion billion billion times closer to the Big Bang than any previous direct observation."
Linde called the media attention "a pleasant bump on the road."
"We are not exposed to this kind of attention, but that has changed," Linde said Thursday. "We developed these ideas almost 30 years ago, nobody cared at that time, and only now they are being discussed seriously."
So what exactly is inflation?
"Inflation is a brief stage of exponential expansion of the universe, which made the universe large and uniform, and produced the seeds for the large-scale structure of the universe," Linde said.
He added that he is not entirely sure yet that his theory is true.
"I'm 95 percent convinced it's true, but extraordinary statements need extraordinary proof. If these results are correct, they are among the most spectacular results in observational cosmology obtained in the 21st century. We should wait a little before they are analyzed and confirmed by other observers."
As for his now-famous reaction on camera, Linde said that it was all real.
In the video released by Stanford University, assistant professor of physics Chao-Lin Kuo gets ready to deliver the good news to Linde.
"He has no idea I'm coming."Kuo says into the lens, walking toward Linde's house.
"So I have a surprise for you," Kuo tells Linde and his wife when they open their door. "It's five sigma at point two."
Linde's wife, Standford professor of physics Renata Kallosh, says something that sounds like, "Discovered it?"
Then Linde asks Kuo to repeat himself again, and again, and then stops him mid-sentence, exclaiming: "Point two?"
Later, while celebrating over some champagne, Linde tells Kuo that the couple hadn't been expecting anybody and Renata had asked him whether he had ordered delivery from Amazon.
"Yeah," he says in the video, "I ordered it 30 years ago. Finally it arrived."
"My head is turning on my shoulders [since I found out]," Linde told NBC Bay Area Thursday. "There are some miracles about our world which do not allow us to sleep well … any results that support inflation, indirectly support the idea of the multiverse as well."
When asked where the discovery and subsequent validation of his theory falls in the pantheon of great scientific discoveries (Linde counts Einstein, Newton and Niels Bohr among his heroes), Linde said that although he wouldn't compare it with quantum mechanics or the theory of relativity, it's really important to him.
"It's changed our vision of life, the universe and our place in the world," he said.


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Isuzu Amigo Ignition Lock Cylinder Replacement Cost
Know what price you should pay to get your vehicle fixed.
What is an ignition lock cylinder?
The ignition lock cylinder and ignition switch are two separate components. The lock cylinder is the portion that the key slides into and allows the ignition to turn. This is one of your vehicle's defenses against theft.
How does the ignition lock cylinder work?
If the correct key is inserted, small actuators on the lock cylinder will allow it and ignition switch to rotate.
What are the symptoms related to a bad ignition lock cylinder?
When the ignition switch lock cylinder fails, it can create a situation where the ignition cannot be turned, or takes much wiggling and shaking before it finally turns. Or, it's possible the ignition will turn and run with the key removed, or lets the key be removed in any position.
Lastly, the lock can fail to release your key, or not allow the key to travel all the way into the ignition lock cylinder.
Can I drive with an ignition lock cylinder problem?
When the ignition lock cylinder is malfunctioning, it may be impossible to insert the key, turn the ignition, or remove the key from the ignition. If the key won't go in or turn, you won't be able to drive the car, obviously. If the key won't come out, theft is a major concern. Either way, you'll want this fixed quickly.
How often do ignition lock cylinders need to be replaced?
Theres no set maintenance routine for the ignition lock cylinder. Lock cylinders fail somewhat commonly, but mostly for higher-mileage vehicles. Most vehicles will never need the lock cylinder replaced. You can help yours last by cleaning your ignition key, making sure there's no lint on it before putting it in the ignition, and keeping your keychain fairly light, so as not to put added pressure on the cylinder while you drive.
How are ignition lock cylinder issues diagnosed?
If the ignition key stops working, or won't come out of the cylinder, the ignition lock cylinder is usually the culprit. A mechanic can confirm it's the problem after disassembling it.
Ignition Lock Cylinder Replacement Cost Estimates
The average cost for an Ignition Lock Cylinder Replacement is between $100 and $130 but can vary from car to car.
How is an ignition lock cylinder replaced?
In most cases, the steering column plastic covers will be removed, and the ignition lock cylinder will be turned and released. A new cylinder will be installed, which usually will come with a new key.
RepairPal recommendations for ignition lock cylinder issues
It's best not to force open a stuck lock cylinder at home, as it's easy to damage to the ignition switch, plastic covers or the steering column. Ignition switch wiring is bundled with wiring for the airbags, and tampering with the airbag electrical wiring can result in serious injury.
Can I replace the ignition lock cylinder myself?
This job is best left to a professional repair shop. Newer ignition systems have more advanced security and can be difficult to access or remove.
- Repair shops in Sterling, VA
- Repair shops in Dulles, VA
- Repair shops in Leesburg, VA
- Repair shops in Herndon, VA


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The cycling heartland of South America.
Colombia is a magical place to ride your bike. Its location and topography are unique: you can be chilled to the bone while riding a mountain pass at 3,500m, and a couple hours later feeling the tarmac's heat melting your tyres as you ride a valley floor. This is a country that breathes cycling, and the long mountain passes have forged some of the climbing greats – join us to ride in their shadows.
Upcoming Trips
A land of extremes.
The 'cordillera' mountain ranges cross down through the middle of Colombia, featuring snow-covered volcanoes and road passes that would inspire fear and awe in even the hardiest of riders. Tropical beaches spread along the north and west, while the deserts fill in the north and vast grasslands, called Los Llanos, lie in the east. In short, a land of extremes.
History and Culture
A rich blend of cultures and ethnicities.
Colombia's history has been a rocky one, marked by the appropriation of indigenous land and slavery from when the Spanish 'conquistadores' arrived, and political instability, civil war and drug-related violence in recent years. Despite this, the culture is a rich blend of Spanish traditions, tribal customs and Afro-Caribbean heritage that leaves a lasting impact on all who visit.
Cycling history
The rise and fall (and rise again) of 'los escarabajos'.
Despite cycling having been a popular tradition for most of the 20th century, Colombian racers didn't make an impact on the world scene until the 1980s, when the likes of Lucho Herrera and Fabio Parra put the best European climbers to the sword. Following a barren generation or two, 'los escarabajos' have now risen again, with Nairo Quintana, Esteban Chaves and Sergio Henao just a few of the world class riders currently lighting up the WorldTour.
Food and drink
Delicious variety from the seas to the mountains.
From hearty Andean stews and Caribbean seafood to the fruits of the Amazon jungle, you're bound to find something interesting and delicious to eat and drink in Colombia. For cyclists, panela is a sugar-based natural isotonic drink that has been fuelling 'los escarabajos' for years. You can't visit Colombia without trying it.
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Published at Monday, April 22nd, 2019 - 12:42:44 PM. Trekking Poles. By Robinetta Gautier.
To properly size your poles, stand upright and hold your elbows at a 90-degree angle. You should be able to hold the primary grip with the tip touching the floor. For difficult terrain and off-trail hiking, I prefer my poles shorter by a few centimeters. For long downhills, some people like to lengthen them.
The Quick Locks include extension grips—sections of foam below the main grip that extend your range of carry options—and are available with either cork or foam grips. Both options will work fine, though the faux cork and two-piece construction isn't as slick as Leki's seamless grips. Cascade Mountain Tech includes snow baskets for winter use and rubber tip covers for paved surfaces, options that cost extra with other brands.
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VS M08 - VELUX Manual Venting Deck Mount Skylight
Shipping Included!
Designed for deck mounted installations, the VS manual venting skylight enables any home to embrace the best of what nature has to offer. Opening for maximum fresh air, the venting skylight contributes to a home's proper moisture balance and comfort level by allowing stale, humid air to be released.
The VS package includes the operator hook and insect screen. Operating controls are sold as an additional option, but are required to open and close the skylight.
Installation slope
The VS skylight installs on roofs with slopes between 14° (3:12) and 85° (137:12).
Product details
Convenient manual control
The VS skylight is easily opened and closed manually with VELUX control rods when installed out-of-reach. A smooth turning handle is available when skylights are installed within reach.
Pick&Click! ™ pre-installed
The new innovative Pick&Click! ™ brackets make blind installation a snap! Every VS (VSE, FS) skylight comes pre-installed with Pick&Click! ™ brackets that allows for fast and easy installation of sunscreening blinds and accessories.
Sunscreening options for optimal light control
The VS skylight is compatible with two sunscreening types in a variety of colors. These blinds are solar powered with a battery back-up that allows use at night or overcast conditions:
- Solar Blackout Blinds – Blocks the light.
- Solar Light Diffusing Blinds - Diffuse the light and eliminate glare
Energy efficient glass options for added safety and energy efficiency
All VELUX skylight glazings are built using energy efficient, LoE3, Argon gas injected dual glass panes. The VS skylight comes with your choice of the following glazing options, each designed to meet the needs of specific building situations:
- Impact glass - Special safety glass designed to meet code requirements for hurricane prone areas (Available for select sizes)
- Laminated glass - Tempered safety glass with extra laminated pane for added safety and comfort
- Tempered glass - Tempered safety glass
- Snowload glass - Special safety glass required in some heavy snow areas
Quality construction
The VS skylight comes with pre-finished white frames and sashes that eliminate the need for secondary high cost trips by a painter. An insect screen, a stainless steel chain operator and aluminum or copper cladding is also included in the package.
Streamlined exterior
The smooth, low-profile of the VS skylight does not obstruct your roofline.
Flashing options for a weathertight installation
A complete line of flashing systems help ensure a weathertight installation for your VS skylight, no matter what your roofing material:
- Shingles and shakes
- High Profile Roofing
- Metal Roofing
Easy skylight replacement option
Our trim kit provides a clean interior finish when replacing older "drop-in" or "flush-mount" skylights.
The VELUX warranty covers 20 years on insulated glass seal, 10 years on the skylight, 10 years on installation and 5 years on the electronics.
Videos and Literature
Installation Videos
Deck Mount Skylight Installation Instructions
|Vented Manual
|Rough Opening
|30 1/16" x 54 7/16"
|S - 3 to 5 Business Days


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Discovering Italian High Renaissance Artists
If you are familiar with any Renaissance, it is with the Italian High Renaissance. In this article, you encounter names of master artists that have become household words. Now you can put those names in context and find out how to appreciate the characteristics shared by the High Renaissance masters.
Leonardo da Vinci
Leonardo da Vinci's most Renaissance work is probably not his Mona Lisa or Woman with an Ermine, in Krakow, Poland, or even the Annunciation in the Uffizi. It's his manuscript with mind-boggling drawings in the collection of the Queen of England and sometimes on display in the Queen's Gallery near Buckingham Palace. This has his studies of waves — symbolic of the penetrating scientific searchings current in the late 15th and early 16th centuries, a phenomenon paralleled only in antique times.
The decade-long restoration of the Last Supper was finished in 1999. Some of the original, bright colors of the master have been revealed. (The Last Supper in Santa Maria delle Grazie in Milan was already falling onto the floor in pieces during Leonardo's lifetime and was a shadow of its true imagery, as shown in Figure 1.) Unlike other restorations, glue — which tended to dull the fresco — wasn't used, and the parts that had dropped off from the wall haven't been repainted. Visitors should be warned that the wait to see the work may be long because only very few people will be allowed in the former refectory in Santa Marie delle Grazie at one time per day.
Far more authentic and exciting is another series of Leonardo frescos in Milan that depict nothing more than the intertwining tops of ash trees, yet in an unbelievably expressive way — they are in the Castello Sforzesco under Sala delle Asse (Salon of the Ash Trees). No one ever sees them, and to do so is something of a coup.
Today, the reputation of Raphael Sanzio — in the 19th century known as "the divine" — has somewhat faded. There's no apparent reason, although probably what has, wrongly, been interpreted as his sweetness — and therefore weakness — since the 1920s when the harsh and crude in art were much appreciated may have helped put him in the shade.
His works are not overly sweet. Just pop into the dynamically powerful frescoed stanze (rooms) in the Vatican Palace to see the fresco of The School of Athens or the Disputa (1510-11), both in the Stanza della Segnatura, to see that Raphael was equal to his competitor Michelangelo whom he rather admired, although Michelangelo rather didn't like Raphael. (See Figure 2.)
For the thrill of an art lifetime, when in Milan, do not miss the small and gemlike museum, the Ambrosiana, in which there are Raphael's enormous preparatory drawings, called "cartoons," for the famous Vatican Disputa arranged in a theater like some Imax presentation. (Note: All the paintings in this blockbuster of a museum are in about the best condition ever because they have never been mucked about over time. Professionals, when thinking about the purchase of a work by Caravaggio or Jan "Velvet" Brueghel or Jacopo Bassano — they should be so lucky! — go to the Ambrosiana to see what perfect state really is.)
Titian is the least "Renaissance" of the greats because his glowing color and apparent disinterest in creating "proper" anatomy are a bit at odds with what was considered important. He's more a Romantic than a strict Renaissance man. He could create sweet images, devout religious scenes, earthy nudes, steamy mythological images, and works in which there's a sub-text of horror. In the United States, Titian's best work (in fact, it's one of the finest old masters in the entire country) is the brilliantly colored and vigorous Rape of Europa (1559-62), in Boston's Isabella Stewart Gardner Museum. Second to none is his late Christ Crowned With Thorns (1573-75) in Munich's Alte Pinakotek in which the swirling paint looks like a painting by the 20th-century German Expressionist Oskar Kokoschka.
A Renaissance artist who was praised lavishly in his lifetime and who is now overlooked is Parma's Correggio. His style combines a lyrical naturalism with a particular use of light and shade creating a remarkable softness of contour and a dazzling atmospheric effect. His night scenes are particularly memorable.
His finest works are to be seen in Parma, in the ceiling of the convent of S. Paolo, which depict humanistic allegories (1518) and in the cathedral. There, his frescoes (1523) in the dome portraying The Assumption of the Virgin are strikingly illusionistic. He treats the whole surface of the dome as a single all-encompassing "canvas" comparing the dome with heaven. The astonishing way the figures in the clouds seem to come right into the spectators' space is, for his time, a daring use of foreshortening.
Correggio's altarpieces are splendid, and many became so famous that they now have nicknames. Be sure to see his Day, or The Madonna of St. Jerome, (1530) in the National Gallery of Parma, and the superb Night, or The Adoration of the Shepherds, in the Picture Gallery of Dresden.
Correggio could be almost unbelievably sensual, too, in his mythological paintings. One is in the Kunsthistorisches in Vienna, representing Jupiter Coming to the Nymph Io (1532) in the form of a lusting thunderhead. Another is in the Borghese Gallery in Rome showing Jupiter Coming to Danae as a Shower of Gold (both date to c. 1530).
No other artist than Michelangelo symbolizes the pure and ideal Renaissance — not only because of his sculpture, which contemporaries said was imbued with a special strength they called "terribiltà," but because of his incomparable architecture seen in the dome of Saint Peters in Rome (1546-64) and, in Florence, the Laurentian Library (for Lorenzo de' Medici) with its soaring stairs.
If the Renaissance was striving to capture the central importance of mankind, anatomy, movement, religious emotion, the classical ideal, the monumental, and the unforgettable, what sculpture more perfectly resounds with all that than the glorious David (1501-1504) in Florence's Galleria dell' Accademia?
Michelangelo was of the Renaissance and at the same time far beyond it. Indeed, after the successful cleaning of the Sistine Ceiling and the Last Judgement and the revelation that his true colors are, to the contemporary eye, more garish than suspected, running to somewhat harsh tones of fuschia and puce with lemon-yellow and crackling blue, he is already becoming known less as a High Renaissance artist than all of that plus the genius who gave birth to the style called Mannerism.


text: Bob Russell was considered the best defensive forward in Boston State College ice hockey history and was a member of the legendary team that finished a perfect 20-0-0 in 1965-66. An All-New England selection in 1967-68, Russell was a rare four-year letterman in an era when freshman didn't see the site of competition, but he played on the first line of that undefeated team as a freshman and helped them to a number one national ranking. Success would follow him again as he helped the '67-68 squad to the NAIA Final Four and a 16-9-1 mark as part of a career that saw his teams compile a 59-31-1 record for a .654 winning percentage. Russell is just one of three players in college hockey history to have been a member of four teams to have won the coveted Codfish Bowl trophy and was named to the All-Tournament team in 1969. The forward tallied 107 points on 49 goals and 58 assists in 87 career games for an average of 1.23 points per game and ranks 10th on the Warriors' all-time points list, while being a member of the first line power play and penalty killing units his entire career. Russell had a knack of putting the puck in the net when it counted, racking up eight game-winners to rank third on the Boston State career ladder and his total of four career hat tricks is also the third-highest mark in school history. Russell's playing days didn't end with his 1970 graduation from BSC as he spent a pair of five-year stints in the New England Amateur League and the Southern New England Hockey League. He also bestowed his hockey knowledge as an assistant coach for the Warriors from 1970-73, Lowell High School from 1973-74 and Reading High School from 1974-77 and also served as a player/coach for the East Hartford Canadians, who won a pair of SNHAL championships. Russell proved to be a great success in the sport of softball as well, enjoying a 15-year career as a player and manager in the American Softball Association with the Medford Hydronique from 1970-85 and pitched in three ASA Regional Championship tournaments, including a sixth-place showing in 1979. Russell has also given his time as a premier fundraiser for ALS Alliance Therapy and The Angel Fund.


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There will soon be respite for motorists plying Agege-Pen Cinema axis in Lagos, as State Governor Babajide Sanwo-Olu assures accelerated completion of the abandoned Pen-Cinema Bridge.
The Governor spoke on Sunday while inspecting ongoing rehabilitation work on major roads in Iju area of the state by Lagos State Public Works Corporation.
Sanwo-Olu, in company of his deputy, Dr. Obafemi Hamzat, said the contractor handling the bridge construction was being prepared for re-mobilisation back on the site.
Expressing concern over the pains residents go through due to regular gridlock on the alternative routes occasioned by abandoned project, Sanwo-Olu said his government would compensate for the discomfort by ensuring timely completion of the bridge.
He said: "I can assure you that we are currently in talks with the contractors handling key road projects in Ikorodu, which are Igbogbo and Ishawo roads, and also a critical project in Agege area, which is the Pen-Cinema Bridge. Our promise is that, if it is not by end of this month; then, by next month, the contractors will be fully mobilised back on sites to complete the work.
"We are particularly concerned about the pain motorists are going through because of the incomplete construction of Pen-Cinema Bridge. We are hoping that the contractor handling the bridge construction, too, will be mobilised back on site. Once we push these three critical infrastructures and get them completed, relief would come to residents in these areas."
The Governor said the ongoing road repair across the state was an outcome of his Executive Order, which declared emergency rehabilitation of critical roads.
Sanwo-Olu said the repair was being carried out in six segments, pointing out that the highways and arterial carriages were captured in the first set of repair across the state.
He said repair work would begin on roads captured in other segments in succession. The Governor urged commuters to be patient while the repair is being carried out.
He expressed satisfaction on the level of work done, while assuring that the road rehabilitation would be ongoing to until 100 major roads marked for repair in all Local Government Areas across the state get done.
Sanwo-Olu said his administration would continue to be responsive to the challenges confronting the people, assuring the actions of his government would focus on bringing relief to taxpayers.
"We have risen up to the expectations of Lagosians and we believe there is still a lot more to do. It is a work in progress. But we can feel the immediate relief that are coming to residents of all the areas where the rehabilitation work is being done currently," the Governor said.
Also joining the Governor during the inspection is the Head of Service, Mr. Hakeem Muri-Okunola, and General Manager of Lagos State Public Works Corporation, Engr. Daramola Olufemi.
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EDITORIAL: Healthcare Reforms in Nigeria; A Mere Political Statement Lacking Commitment
By Manny Ita
Nigeria has since her independence in 1960 had a very robust verbiage or policies by successive gobernments on health reforms but with very little progress or success recorded in what might well be a lack of political will in reforming the health sector.
Over 90% of the Nigerian population are without health insurance coverage. The inability to effectively address the country's numerous public health challenges has contributed to the persistent and high level of poverty and weakness of the health system.
Political instability, corruption, limited institutional capacity and an unstable economy have also been major factors responsible for the poor development of health services in Nigeria. Households and individuals in Nigeria bear the burden of a dysfunctional and inequitable health system – delaying or not seeking health care and having to pay out of pocket for health care services that are not affordable.
The health challenges of the country include:
National Health Insurance Scheme (NHIS),
National Immunisation Coverage Scheme (NICS),
Midwives Service Scheme (MSS)
Nigerian Pay for Performance scheme
After many attempts at implementing legislation on health insurance since 1960, NHIS, although established in 1999, was eventually launched only in 2005 with the goals to ensure access to quality health care services, provide financial risk protection, reduce rising costs of health care services and ensure efficiency in health care through programmes such as the: Formal Sector Social Health Insurance Programme (FSSHIP), Mobile Health, Voluntary Contributors Social Health Insurance Programme (VCSHIP), Tertiary Institution Social Health Insurance Programme (TISHIP), Community Based Social Health Insurance Programme (CBSHIP), Public Primary Pupils Social Health Insurance Programme (PPPSHIP), and the provision of health care services for children under 5 years, prison inmates, disabled persons, retirees and the elderly.
The NHIS was expected to provide social and financial risk protection by reducing the cost of health care and providing equitable access to basic health services with the most vulnerable populations in Nigeria including children, pregnant women, people living with disabilities, elderly, displaced, unemployed, retirees and the sick.
Free health care services and exemption mechanisms are expected to provide financial risk protection for the most vulnerable populations but evidence suggest that they are ineffective and have failed to achieve this aim.
The maternal mortality ratio for Nigeria remain quite high at 814 per 100000 live births according to 2016 World Health Statistics. Across the country, pregnant women and children under five years are generally charged fees when accessing health care services, despite the federal government's declaration of free health for pregnant women and children under five years in 2005.
The Minister of Health, Professor Isaac Adewole in 2016 announced the Federal Government's plan to provide free health services to 100 million Nigerians in the next two years. Under this new health agenda, pregnant women across Nigeria are expected to enjoy free maternal and delivery services at the primary health care (PHC) level.
Unfortunately, Free health care services and exemption mechanisms often arise as campaign promises of political actors to the electorate and fall short in meeting the health needs of the most vulnerable populations. According to Nigeria Demographic Health Survey (NDHS) in 2013, over 60% of pregnant women aged 15-49 deliver their babies at home without any antenatal care visits. In rural areas, this value reaches 76.9%. The situation is critical in North East and North West regions of Nigeria where over 79% of pregnant women age 15-49 deliver their babies at home. Over 60% of pregnant women in Bayelsa, Plateau and Niger deliver at home rather than a health facility.
The cost of health care and the low quality of care by the public have been argued to be the reason for the poor utilisation of maternal and child health services in Nigeria.
In addition, health spending in Nigeria is low and this is responsible for the over-reliance on out of pocket payments for health care services.
Despite its launch in 2005, NHIS covers less than 10% of the Nigerian population leaving the most vulnerable populations at the mercy of health care services that are not affordable. This means the most vulnerable populations in Nigeria are not provided with social and financial risk protection. Poor people constitutes about 70% of the Nigerian population. They lack access to basic health services, which social and financial risk protection should provide, because they cannot afford it.
CBSHIP was expected to meet their health needs as well as provide social and financial risk protection to this group, which mostly reside in rural areas. As evidenced in the high rate of out of pocket payments for health care services , poor people financially contribute more to health care than official care and funds programmes in Nigeria. Out of pocket payments for health care services limit the poor from accessing and utilising basic health care services.
The quality of health care services delivered is poor and remains a huge source of concern. Most of the PHC facilities that are supposed to meet the health needs of the poor and rural dwellers are in a poor state due to poor budgetary allocation.
In trying to solve these issues, healthcare in the country must be tackled headlong in order to stem the detyeriorating development therein, which could portend grave danger for citizens of the country in the no-ditant future.
Policy makers and political actors need to devise health care reforms to address the lack of social and financial protection for the poor and vulnerable populations. Part of this reform is the expansion of the NHIS. States should be mandated to provide health insurance coverage to all residents. Making health insurance optional for states over the years has affected the ability of the NHIS to increase the level of coverage for the people.
While the mandatory CBHI scheme is being scaled-up as a supplementary measure, state governments should enrol poor residents in a private health insurance plan and bear the responsibility of paying the monthly premium per person to Health Maintenance Organisations (HMOs). It is not enough to have a national health insurance policy, it is important to ensure that health insurance coverage is provided to the poor and most vulnerable populations as a matter of the human right to health.
Although the NHIS Act made provision for children, who constitute the largest population in Nigeria, many children still have to pay for health care services in spite of being born into poor families that do not have the ability to pay for health care services and suffer financial hardship as a consequence. The free health policies and exemption mechanisms provided by some states, targeted at children, pregnant women and the elderly, are not social and financial risk protection policies, as these groups are largely responsible for the cost of health care with the free health care programme barely covering their basic health care services.
Another way of providing social and financial risk protection for poor and vulnerable populations is by establishing a legislative framework for a UHC scheme and setting aside funds for it. Evidence from Thailand has shown the effect of UHC schemes through PHC on expanding access to health care for the poor and vulnerable populations.
Political actors, policy makers and all stakeholders in the health sector should establish a government funded social and financial risk protection scheme through a general tax financing system for the poor and vulnerable, and invest in basic infrastructure for health care in rural areas for quality health care service delivery. UHC schemes are important in addressing the problem of poor coverage, limited access to health care, and poor quality of health care services.
Nigeria is yet to adopt innovative ways to protect the poor and vulnerable populations against financial risk of ill health. It is important to guarantee by law the right to health care of all citizens in Nigeria. Although the National Health Act (NHA) that was signed into law in 2014 stated that all Nigerians are entitled to basic minimum package of health care services, it is not clear if the provisions made in the NHA are capable of achieving UHC in Nigeria. In addition, the NHA is yet to be implemented over two years after its signage into law.
Some low- and middle-income countries (LMICs) have been able to provide social and financial risk protection schemes for poor and vulnerable populations as a matter of the human right to health. Therefore, there is a need to provide social health protection schemes targeted at these groups in Nigeria. The poor and vulnerable populations should not become impoverished because of failure to obtain much needed health care services. Governments must reduce out of pocket payments for health care services by households through the adoption of a tax financed non-contributory UHC scheme.
Protest Rocks Alausa Over Supreme Court Verdict On Agidingbi Community
Scores of community leaders and residents of Agidingbi area of Ikeja on Thursday embarked on peaceful protest against the judgment of Supreme Court which awarded ownership of 398 acres of landed property in the community to a traditional land-owning family, Akinole-Oshiun.
The possession order is said to cover a large section of the Lateef Jakande Road, Acme Road, Fagba Close, and other streets around the area, totaling over 2000 buildings.
The protesters, who marched from Agidingbi to House of Assembly complex in Alausa, said Akinole-Oshiun family, which is the judgment-creditor in the case, had already given them seven days ultimatum to vacate their houses, urging the government to quickly intervene to avert bloodshed.
They displayed placard of various inscriptions such as "There is no ancestral link between Akinole and Agidingbi Land, Land Grabbers are enemies of Lagos State," among others.
Leader of Ojodu Legislative Arm, Hon Wasiu Bolaji-Seidu who is also a community leader in Agidingbi said the news of the possession order came to the community as a big surprise as nobody from the area was served with the court process that led to the judgment.
He said: "On Friday, they (judgment-creditor) brought a judgment and placed it on our houses and said they have taken over the entire Agidingbi land. The issue is Agidingbi was not mentioned in the judgment; nobody from Agidingbi was part of the case and I don't know how you will enforce a judgment against a person that was never part of the case.
"Agidingbi has been in existence for over 200 years ago. I was born and bred in Agidingbi; my forefathers were born and bred in Agidingbi and I don't see any reason why somebody will just wake up and say they are the owner of the community.
"I am over 50 years; my father lived for over 90 years in this community before he died; my great grand-father died at the age of 150 years and I don't know where Akinole is coming from and we have people like Habibatu Mogaji who was the Yeye-Oba of Agidingbi; we have Femi Okunnu who is our father in the community and we don't know where Akin-ole came from."
He particularly urged the State Government to activate the provisions of the Anti-Land Grabbing Law of the State, and prevent the matter from degenerating into a full blown crisis.
"To the best of my knowledge, I know that Lagos State has enacted a law duly signed by the Governor prohibiting land grabbing in the State because this is a clear example of such case. That is why we are here to call on the Lagos State House of Assembly to look into it and find a lasting solution, failure of which there will be bloodshed," Bolaji-Seidu said.
Also speaking, Baale of Agidingbi, Chief Ganiyu Ayinde Haruna, said they were embarking on the peaceful protest to call the attention of government to the silent crisis that is brewing in the community.
Narrating how it all began, Haruna said: "On Friday last week, we woke up to see people posting possession order on our property and we don't know these people. We have been living here for several years and the issue is we don't know this family that is laying claim to ownership of our land.
"We have never heard any relationship with this Akinole family and so it is surprising to us. Nobody knew anything about the court case. I mean how can you enforce court judgment against a party that was never part of the case? We are peaceful people and we are urging the Lagos State Government especially Governor Akinwunmi Ambode and the House of Assembly to intervene urgently in this matter because we don't want bloodshed in our community."
Also speaking, an 83-year old resident and Iyalode of Agidingbi, Evang Dorcas Faworaja said her great grand-parents were born in the area, therefore the claimant cannot just come from anywhere and lay claim to the community.
Receiving the protesters, Deputy Majority Leader of the Assembly, Hon Olumuyiwa Jimoh commended them for conducting themselves peacefully, assuring that the House would look into their case.
"Let me assure you that we are going to look into your petition without any fear or favour and I can assure you also that you will receive judgment at the end of the day," Jimoh said.
Abia 2019: Why Ikpeazu Won with a Landslide
By Jude Ndukwe
The March 9 governorship poll has come and gone in Abia, and the people have since moved into post-election mood and activities. They have also since resumed their normal businesses after the rigours of what was an intense campaign period for some and simply a test of popularity for others.
The final result as announced by the Independent National Electoral Commission (INEC) is as follows: PDP: 261,127; APC: 99,574; APGA: 64,366
The good news about the governorship election in Abia is that while some other States are still at it, grappling with needless violent deaths of not few Nigerians starting from when campaigns were flagged off last year, the conduct in Abia recorded no violence.
The free, fair, transparent, credible and violence-free conduct of the election in Abia State can be attributed to the peaceful and gentlemanly nature of the governor, Dr Okezie Ikpeazu, who does not see any election as a Do-or-Die affair but simply the exercise of the people's rights to freely choose their leaders. Despite all the shenanigans of his opponents, the bitterness of their campaigns, their twisting of facts to suit their warped narratives, their belligerent posturing etc, the governor never replied in kind. He was rather busy telling the people what he had done and the need to reelect him so as to continue to take Abia on the path of irreversible prosperity.
Abians are peace loving people. That is why the State has remained one of the most peaceful States in Nigeria under Ikpeazu, and it showed during the election, so that no matter how good one's manifesto is, belligerent posturing put them off. After their ugly experiences in the past, there was no way Abians were going to elect anyone of bellicose nature to lead them and cause bitter divisions among them based on party and or tribal lines, entrench crime and criminalities and turn the state to a breeding ground for hoodlums. So, it was only natural that they queued behind Dr Okezie Ikpeazu who has been able to restore Abia to a State of peace which Abians earnestly craved for before the coming of the incumbent.
It is instructive to note at this point that in a report by the Open Society Initiative for West Africa (OSIWA), for election-related killings between November 16, 2018 to March 10, 2019, while neighbouring States like Imo, Enugu, Anambra, Rivers, Akwa Ibom, Ebonyi, recorded 2, 1, 8, 55, 4 and 2, respectively, Abia recorded no single casualty.
The massive infrastructural development taking place in Abia is another factor that got Ikpeazu an easy reelection. With 74 road projects completed and over 90 others of strategic importance to the people and the State ongoing, Abians knew that they have never had it so good and reelecting Ikpeazu based on this was a no brainer.
Having constructed 4 new Model Schools, 359 new classroom blocks, and renovated about 70 of them across the three senatorial zones of the State, the educational sector of Abia received a massive boost under the governor to the extent that the State sits with pride atop all other States of the federation in WASCE in 2015, 2016, 2017, 2018 and still counting, and could not be dislodged by others no matter their resources.
Abia has remained the only State throughout the federation where all her primary school pupils are fed in school every school day. While the federal government feeds children of Primary 1 – 3 nationwide, Abia feeds her pupils from Primary 4 – 6, despite her lean resources, thereby making her the only State of the federation where all her primary school pupils are fed every school day.
The result of this massive investments keep showing in the result the State posts every year in WASCE and other external exams.
This investment has also seen the State owned university, Abia State University, Uturu (ABSU), improve massively in the National Universities Commission (NUC) ranking, from 96th when Ikpeazu assumed office in 2015 to currently being in the first 10.
The revolution in agriculture where over 4 million high yielding tenera palm seedlings have been distributed to farmers is another factor that has endeared the governor to Abians of all status. Government-supported mushroom farming, poultry clusters and local rice production have all empowered many Abians.
The infrastructural development of the state and the peace she is enjoying under Ikpeazu have also given massive boost to the governor's objective of attracting foreign investors to the state. The Enyimba Economic City, EEC, which is the governor's prime investment creation and already labeled the "Dubai of Africa" by global investors has already attracted massive foreign direct investment to the extent that the World Bank rated Abia as the third most preferred investment destination for foreign investors after Abuja and Lagos in that order, for the last quarter of 2018.
The deliberate policies put in place by the Ikpeazu administration for Ease of Doing Business have also earned the state a rating as the fifth best state in that area, hence, giving the State the needed edge above others for investors.
Also, Dr Ikpeazu's commitment to SME development in the State has earned him several awards including one from the federal government even though he is of a different party from the government at the centre. He has been aggressively leading the "Made in Aba" campaign to a huge success to the extent that the military and some paramilitary organisations have ordered for thousands of pairs of booths from Aba entrepreneurs. This is in addition to the fact that the government of Ikpeazu sponsored thirty of the Aba shoe and other leather works manufacturers to China to enhance their skills and acquire the requisite modern technological know-how to improve both quality and quantity of their works. The thirty young entrepreneurs have since returned and are in the process of cascading down their newly acquired knowledge to others back home. This is more so as the governor has acquired the needed advanced shoemaking machines for their use.
There have been revolutions also in the health sector where medical facilities are now easily accessible to all citizens of the State just at the dial of a number in the Dial-a-Doc Telehealth Initiative. This is particularly beneficial to the aged who might not have the strength to visit a health facility and are either attended to via telephone or visited by the mobile medical staff of the state. These are all in addition to 4 new General Hospitals built by the governor and strategically located in different parts of the State in addition to the already existing ones.
There is hardly any sector or population group in Abia State that the governor has not touched directly. It is therefore not surprising that long before the March 9 governorship election, Dr Ikpeazu had received a gale of endorsements from notable groups including political blocs, religious groups, traditional rulers, civil servants, artisans, traders, entrepreneurs, professional bodies, student and youth groups, women groups etc.
Among all the contenders, it was only Dr Okezie Ikpeazu who ran a comprehensive and energy sapping campaign that took him round all the 17 local government areas of the state despite his extremely tight schedule as governor. His wife, Deaconess Nkechi Ikpeazu also took to the streets vigorously campaigning for her husband from one local government to the other. While all these were on, the other candidates locked up and made themselves comfortable within the confines of their air conditioned campaign offices without reaching out to the people even if in, at least, five local governments of the 17 in the State. Throughout the campaign, a majority of Abians could not reach nor interact with them in person. They cordoned themselves off from the people and only made feeble attempts to reach out to the electorate through the media and social media which, most rural people where the bulk of votes come from, do not even have easy access to. While Ikpeazu was busy selling himself, his programmes and projects to the people in person, and even featured several times on all the radio stations in Abia State in no holds barred phone-in programmes, others were relying on "federal might" and "red eyes" for magic! Tragic!
From the foregoing, no objective political observer would be surprised at Ikpeazu's landslide victory at the last governorship poll.
His case was even made easier by the Charter of Equity as bequeathed by Abia's founding fathers which stipulates that, for the sake of fairness and peace, the Abia State governorship should be rotated among the three senatorial zones of Abia North, Abia Central and Abia South. Having taken their own turns from 1999 – 2007 (Abia North through Orji Uzor Kalu), and from 2007 – 2015 (Abia Central through Senator T.A. Orji), it was only fair and just that the people of Abia South where Ikpeazu hails from be allowed to complete their own eight years of two tenures as did his predecessors. This is more so given the achievements of the incumbent which have more than justified the Charter.
There was no way Abians were going to jettison the Charter just to satisfy the selfish yearnings of few politicians who hail from the same senatorial zones that had already taken their turn at the governorship in the past. That would have been a recipe for disaster in the State. To avoid such a political catastrophe, Abians overwhelmingly rejected the other contenders and stuck with Ikpeazu in order to preserve the sanctity of the Charter of Equity that has been an effective template for the peaceful transition of power from one administration to the other in the state, hence, Ikpeazu's landslide victory at the polls had long been foretold by political historians and scientists, and unfolded as expected based on the variables enumerated above and even more!
An attempt by anyone to challenge this people-oriented election in court will court the people's anger against such a person and will further diminish the little of what is left of the person's image before the people.
— firstname.lastname@example.com; Twitter: @stjudendukwe
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text:
- Abu Dhabi Grand Prix
Button powerless to hold off Vettel
- Race:
- Abu Dhabi Grand Prix
- Drivers:
- Jenson Button
- Teams:
- McLaren
Jenson Button said it was "impossible" to hold off Sebastian Vettel for third place in the Abu Dhabi Grand Prix.
Having held third comfortably for much of the race, a late safety car allowed Vettel to erase a 20-second gap and pass around the outside of turn 11 on lap 52. Button said that the difference in tyre compounds coupled with his own struggles meant there was no way to hold on for a podium.
"It was quite a fun race, but at no point did I have pace," Button said. "I really struggled; very different to my run on Friday as I just couldn't find the grip - really, really strange. It was fun all the same, I had some good battles out there but just at the end there was impossible because he's on brand new tyres, and you just can't get traction on old tyres - especially old prime tyres and he's on new options - so it was very difficult, but that's the way it is."
Button added that it was a shame to lose out further to Ferrari in the battle for second in the constructors' championship.
"Lewis's retirement meant we dropped more points to Ferrari in the constructors' world championship. That was a great pity, but we have two big races remaining in which to make up the balance."


text:
This is going to be the last chibi comic book character I do for the day, but instead of a Marvel hero, I will submit a lesson on one of DC Comics notorious villainous faces, "how to draw chibi Joker". I love the way he came out, and if you asked me personally, I would say that he came out looking like Joker from Dark Knight. I think I will make a habit of drawing some cool comic book heroes and villains for a week or so, just because I know everyone loves them. Joker is far from being a sane individual, which is why he is loved even though he is hated. I read an article that said the Joker is one of the most perfect villains out of all the evil characters that hit the big screen, and in books. I know that you guys will love this tutorial because I absolutely loved drawing him out. I can't wait to show you guys what I have in store for you when I go live today on Livestream. I made sure I drew in his straggly looking green hair, the black bold circles around his eyes, and that messy red lipstick job on his mouth. Of course the purple suit is also an absolute necessity. I mean without it, Joker would look just blah. Well, I'm gonna bust a move and get the heck out of this description because I still have more work ahead of me. Enjoy learning "how to draw chibi Joker", step by step, and in the end have even more fun coloring him in. Peace!
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text:
lawsuit(redirected from Civil trial)
Also found in: Dictionary, Thesaurus, Medical, Encyclopedia.
Related to Civil trial: Jury trial
A popular designation of a legal proceeding between two parties in the courts, instituted by one party to compel another to do himself or herself justice, regardless of whether the action is based upon law or Equity.
n. a common term for a legal action by one person or entity against another person or entity, to be decided in a court of law, sometimes just called a "suit." The legal claims within a lawsuit are called "causes of action." (See: cause of action, case, suit)
lawsuitnoun action, action at law, case, case for deeision, cause in court, claim, contention, contest, controversy, controversy before a court, court accion, dispute, judicial contest, legal action, legal argument, legal contest, legal controversy, legal dispute, legal prooeedings, lis, litigation, matter for judgment, proceeding, suit at law, suit in equity, trial
See also: action, case, legal proceeding, matter, proceeding, suit, trial


text:
Call of Duty: World at War - Wii
- Genre: Shooter
- Publisher: Activision
- Developer: Treyarch
Call of Duty: World at War throws out the rulebook of war to transform WWII combat through a new enemy, new tactics and an uncensored experience of the climatic battles that gripped a generation. As U.S. Marines and Russian soldiers, players will employ new features like cooperative gameplay, and weapons such as the flamethrower in the most chaotic and cinematically intense experience to date.
- Reviewed on:
- · PlayStation 3