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Bilateral macular thickening in mild unilateral anterior uveitis: is HLA-B27 involved?
BMC Ophthalmology volume 12, Article number: 30 (2012)
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Macular thickening (MT) without clinically recognized macular edema has been described in anterior uveitis (AU). Although fellow-eyes of patients have been used as controls in several studies, little is known about macular thickness in these eyes. We studied the rate and extent of MT in both AU-affected and quiescent fellow-eyes of phakic AU patients with good visual acuity (VA). We also assessed macular thickness related to HLA-B27 presence and to recurrence, since these issues have been almost unexplored by previous optical coherence tomography (OCT) studies.
Patients with AU were prospectively included and macular thickness was measured with OCT initially and on follow up. Macular thickness in patients' affected eyes (n = 30) as well as in their quiet fellow-eyes (n = 28) was compared with eyes of age- and gender matched controls. Inter-ocular differences in macular thickness between AU affected eyes and their fellow-eyes were assessed in patients (n = 28), also in a subgroup with visual acuity ≥ 0.8 (n = 23) by one-sample Student's t-tests. Inter-ocular differences were also assessed related to HLA-B27 presence and related to the status of current AU episode (initial or relapse).
Subclinical MT is present in both quiet fellow-eyes and AU-affected eyes of patients. MT was found in most cases of AU, even in phakic eyes with good VA. There was a larger increase in macular thickness in HLA-B27-positive than in HLA-B27-negative patients. No differences in macular thickness were found between patients with their first AU episode and patients with recurrent episodes.
MT probably reflects systemic immune-mediated response to the inflammatory disorder in AU, and it is possible that HLA-B27-related factors are involved in the pathogenesis of AU. These observations are in line with and extend the current understanding of the mechanisms behind MT in AU.
Anterior uveitis (AU) refers to a group of infectious and/or immune- mediated inflammatory disorders primary involving the iris and/or the anterior ciliary body of the eye [1, 2]. A common key sign of an active AU, along with eye discomfort, is temporary reduced visual acuity (VA), whereas it is the complications of an AU that may lead to a long-lasting visual impairment.
Impairment of central vision due to persistent macular edema is the most frequent complication of uveitis, the occurrence rate of which differs for specific uveitis entities [3–5]. Although the rate of macular edema is lowest in AU, it contributes greatly to the overall visual impairment in the general population because of its high prevalence [6, 7].
Macular edema involves macular thickening (MT) with or without cystoid space formation [8–10], which may be detected and objectively quantified by the optical coherence tomography (OCT) even in cases where MT escapes clinical detection [11, 12]. MT may occur in the course of an AU even in eyes without posterior segment disease, and it may or may not correspond to VA or the grade of anterior chamber inflammation [11, 13–15]. The duration for MT after an AU episode has not been established [16]. Although inter-eye asymmetry has been used to demonstrate MT in uveitis-affected eyes [11, 13], we did not find any literature reporting macular thickness values in fellow-eyes during an uveitis episode.
HLA-B27- related AU is a distinct clinical entity with a high association with systemic rheumatic diseases [17, 18]. The prevalence of the HLA-B27 antigen, its polymorphism and association strength with AU varies in different populations, the latter probably due to a combination of environmental and genetic factors [19–22]. Higher rates of macular edema and more complicated course have been reported in HLA-B27-related AU [23, 24], although results differ between studies. It is feasible that not only macular edema but also MT is associated with the HLA-B27 antigen. However, although a possible association between moderate to severe acute anterior uveitis and HLA-B27 was mentioned in a previous letter [11], we found only one study comparing OCT in HLA-B27 positive vs. HLA-B27 negative AU patients [13].
For these reasons we investigated a homogeneous sample of phakic AU eyes with no clinically recognized macular edema, and their fellow-eyes by OCT in order to determine the frequency and extent of bilateral MT in hospital-based patient population. Macular thickness was also analysed with regard to the presence of HLA-B27 and by recurrence status in order to improve our understanding of the AU pathogenesis in our HLA-B27-rich population [25, 26]. Our data suggest that MT also is present in quiet fellow-eyes of AU patients and that MT is rather the rule than the exception, even in phakic affected eyes with excellent visual acuity.
Adult (>18 years old) patients with AU classified according to the primary anatomic site of the intraocular inflammation [27] were prospectively recruited from Department of Ophthalmology, St. Olavs University Hospital. Initially 38 patients consented to participate in the study. Their records were reviewed on inclusion and re-reviewed at least 6 months later in order to ascertain correct classification of the AU [2]. The study was approved by the Regional Ethics Committee in May 2005. It was conducted in accordance with the Declaration of Helsinki recommendations.
AU was defined as the presence of inflammatory cells in the anterior chamber and corneal endothelium and absence of posterior vitreous cells and/or other signs of intraocular inflammation. Inclusion criteria were AU of non-traumatic, non-infectious origin [28] without clinically recognized posterior segment involvement such as vasculitis, macular edema or optic nerve involvement seen on slit lamp biomicroscopy, best corrected VA (Humphery automatic refractor HARK 597, Dublin, CA) ≥0.2 with spheric equivalent of ±6, and intraocular pressure between 8 and 21 mmHg. Subjects with current or previous ophthalmic history other than AU, significant lens opacities, intraocular lens implants after cataract or refractive surgery, glaucoma or diagnosed diabetes were excluded.
Medical history regarding present and previous eye symptoms, their laterality, duration and treatment was recorded. For the purpose of this study time elapsed from the diagnosis of an AU flare-up was used as an approximation of time elapsed from initial AU flare-up. Symptoms of coexistent spondyloarthropathy, morning muscle stiffness and/or joint pain were asked for. The onset, duration and course of the AU and anterior chamber cells grading was managed according to Standardization of Uveitis Nomenclature [2]. Laboratory investigations were tailored individually to rule out infectious/ systemic origin/ association of AU. HLA-B27 presence was assessed in all patients, chest x-ray was performed in cases where oral corticosteroids were instituted, sacroiliac spine x-ray was performed if spondyloarthropathy was suspected, and patients with considerable systemic complaints were seen by a rheumatologist.
One patient was excluded due to amblyopic AU eye, one due to previous uveitis-related cystoid macular edema, one due to coexisting pigment dispersion syndrome, one due to abnormal pigmentation in macula of the affected eye. Three eyes of two patients were excluded due to lens implants, and another patient was excluded due to presence of posterior vitreous cells during the follow up period. Both eyes of two patients were excluded due to lens opacities and low OCT signal strength in the affected eye, leaving in total 59 included eyes of 30 patients.
All patients were treated with dexamethasone 0.1% eye drops and mydriatics according to the severity of their AU [29]. Eight subjects received a short course of oral prednisolone in addition to eye drops, because the AU did not respond promptly or adequately to initial topical treatment. Treatment was tapered down slowly after all clinical signs of AU had gone into remission. Three patients were using immunomodulatory agents which had been instituted before the actual AU episode.
All patients but one (who was Asian) were white. One patient had undergone LASIK surgery in both eyes more then 2 years prior to initial AU episode.
Data from healthy subjects reported by us earlier [30] were used as controls. Their HLA-B27 status is not known. Controls were age and gender matched to patients: mean age in female patients (n = 15, 50% females in sample) was 40.7 (SD 12.8) range 19–56. Female controls ≤53 years were included, their mean age was 40.5 (SD 9.7) range 21–53 (n = 47, 51% females in sample). Mean age in male patients (n = 15) was 40.3 (SD 13.0) range 21–69 and in male controls (n = 45, 49% males in sample) was 39.0 (SD 12.0) range 22–63. Controls were further gender-and age matched according to patient subgroups.
OCT (Optic Coherence Tomography STRATUS, Carl Zeiss Meditec, Inc., Dublin, CA) scans in macular thickness protocol (software v.5.0.1) were obtained by a single operator on inclusion and on follow up. Follow up intervals were individually tailored depending on the severity of AU, type of treatment and treatment response, as well as practicability for ophthalmologist and patient. Scans with signal strength ≥3 qualified for inclusion. Scans were qualitatively evaluated as to the presence of epiretinal membrane, vitreomacular traction, cystoid space formation and serous macular detachment. Only one scan was excluded due to cystoid space formation. Mean macular thickness was used in subsequent analyses.
The macula was divided into 9 areas as described in our previous paper [30]: Mean foveal thickness (MFT = F1) from a central macular area of one millimeter in diameter, the inner ring (F2-F5) and the outer ring (F6-F9), each divided into four quadrants. The outer ring diameters measured 2.22 and 3.45 millimeters respectively. Regional variables MCT (mean central thickness) and MPT (mean peripheral thickness) were defined by averaging middle (MCT = (F2 + F3 + F4 + F5)/4) and outer (MPT = (F6 + F7 + F8 + F9)/4) ring data (Figure 1). Averaged mean total macular thickness (MTT) was calculated by averaging the nine macular areas (F1 + F2 + F3 + F4 + F5 + F6 + F7 + F8 + F9)/9. The inner region (MFT = F1) and mean minimal foveolar thickness (MMFT = F0) were also analyzed.
In total 126 scans from both eyes in 29 patients, several of which were repeatedly taken on follow-up were available. Inter-ocular differences between AU-affected and their fellow- eyes were analyzed in relation to time elapsed from AU flare-up.
Cases were grouped in two by time elapsed from flare-up. Early measurement was defined by ≤2 weeks, late measurement by 7–12 weeks follow-up. Scans taken at 3–6 weeks and at long time remission were not included (favoring polarization). In cases where several observations of same subject were available in each group (early or late) the observation with shortest follow-up was chosen. Finally bilateral scans from 21 patients measured early and 8 patients measured late were available. Post-hoc two-sample test was performed on inter-ocular differences in macular thickness by the Mann–Whitney U-test.
For further inclusion in statistical analysis only one bilateral scan from each patient was chosen from 126 scans. In cases where several scans of a same patient were available, the scan taken 1–2 weeks after flare-up was preferred. Finally 59 scans (29 bilateral and one unilateral) from 15 males and 15 females were analyzed.
Normal MTT ranges were defined by MTT ±2SD, stratified by gender in controls; (238.35 μm - 259.33 μm) in females and (243.95 μm - 271.81 μm) in males.
Macular thickness in AU eyes of 30 patients were compared with macular thickness in gender- and age matched controls (n = 92) (one eye of each subject in both groups) by two-sample Student's t-test. Inter-ocular differences in macular thickness between affected and fellow-eyes (n = 28) were assessed in all patients and in a subgroup with best corrected visual acuity ≥0.8 (n = 23), by one-sample Student's t-tests (expected value = 0).
Macular thickness in currently quiet fellow-eyes (n = 28) (defined by no symptoms of AU for at least 3 months prior to assessment) and in a subgroup of fellow-eyes with no previous uveitis (n = 16) in patients was compared with macular thickness in correspondingly gender- and age matched controls (n = 85, n = 77) by two-sample Student's t-test.
Inter-ocular differences in macular thickness between AU and their fellow-eyes were compared by HLA-B27 (positive n = 17 versus negative n = 8). Inter-ocular differences were also compared between the initial AU episode (n = 15) and subsequent episodes (n = 9). Both analyses were carried out in scans taken at ≤ 6 weeks from flare-up. A non-parametric test for two independent samples (Mann–Whitney U-test) was used.
SPSS v.17.0 was used for statistical analysis. All tests were two-sided and a p-value < 0.05 was set to be statistically significant.
Patient demographics and their clinical history and investigations are described in Table 1.
The change in inter-ocular differences in mean macular thickness between affected and fellow-eyes as a function of time elapsed from an AU flare-up in 63 bilateral OCT scans of 29 patients is demonstrated in Figure 2 (one non-repeated scan in 9 patients, 2 repeated scans in 11 patients, 3 repeated scans in 5 patients, 4 repeated scans in 3 patients and 5 repeated scans in one patient). Patients measured late had larger inter-ocular differences in macular thickness: mean differences for MMFT (18.8 μm p = 0.057), MFT (19.4 μm p = 0.068), MCT (13.4 μm p = 0.040), and MPT (9.7 μm p = 0.081).
Macular thickening was observed in 70% of all 30 AU patients; in 79% of patients with acute AU and in 55% of patients with recurrent or chronic AU (Table 1). Maculae in patients were significantly thicker in all regions of AU eyes (p < 0.0005; Table 2).
Maculae were also thicker in most regions of quiet fellow- eyes compared with gender-and age matched controls (Table 3). Thicker foveola and a trend towards thicker fovea were also observed in a subgroup of patients with no previous uveitis in fellow- eyes (Table 3).
Maculae in AU eyes were thicker than in their fellow- eyes, also in a subgroup of patients with excellent visual acuity (≥0.8) (Table 4).
The majority of our patients were HLA-B27-positive (70%), they had acute AU (63%) which was of limited duration (77%). Most patients had mild anterior chamber inflammation (grade ≤1+) (73%) and excellent VA (≥0.8) (80%) when scans were taken (Table 1). Inter-ocular differences in macular thickness were larger in HLAB-27-positive than in HLAB-27-negative patients (on scans taken at ≤6 weeks from AU flare-up); MMFT: p = 0.43 MFT: p = 0.083 MCT: p = 0.032 MPT: p = 0.025 MTT: p = 0.011 (exact two-sided p-values). Mean inter-ocular differences are shown in Figure 3.
Inter-ocular differences were compared between patients in which the current AU was their initial episode (n = 15) with those in which the episode was subsequent (n = 9) (on scans taken at ≤6 weeks from AU flare-up). Differences were small and did not achieve the set statistical significance; MMFT: p = 0.27, MFT: p = 0.44, MCT: p = 0.83, MPT: p = 0.69, MMT: p = 0.77) (exact two-sided p-values).
In the present study we report a new observation: macular thickening is present in quiet fellow-eyes of AU patients, also in the foveola of fellow-eyes with no previous uveitis. This finding suggests that an AU episode is accompanied by a systemic immune-mediated response which affects both patients' eyes. Another important finding in the present study was that MT is rather the rule than the exception even in phakic AU eyes with good VA, suggesting that some extent of relative MT accompanies most, even uncomplicated AU cases. In addition, MT seems to be larger in HLA-B27-related than in HLA-B27-negative AU, suggesting a stronger subclinical involvement of the posterior segment in HLA-B27-positive patients, which is probably not related to recurrence. These observations are in line with and extend the current understanding of the mechanisms behind MT in AU. It is assumed that they are similar to those involved in uveitic macular edema. It is thought that trans-cellular mechanisms along with a functioning blood-retina barrier regulate the fluid equilibrium in the retina [31]. Biologically active substances related to inflammation together with other predisposing factors may compromise the functional integrity of this barrier with a consequential MT in uveitis [32, 33].
MT has been previously described in eyes with chronic or severe AU [11, 34] and in AU with a broader range of inflammation severity [13]. The latter study reported an overall rate of MT in 42% of AU patients, although eyes with pseudophakia and cystoid macular edema were included. Since cataract surgery and cystoid space formation may contribute to MT [10, 35, 36], we expected to find lower rates of MT in our sample, from which eyes with psedophakia and detectable cystoid space formation were excluded. In addition our definition of MT was strict and gender- adjusted. Nonetheless MT was observed in 70% of AU eyes in our sample. Our data suggest that MT is rather the rule than the exception even in phakic eyes with excellent VA.
Besides the possible genuine differences in the rate and degree of MT between Castellano et al.'s [13] and our samples, the measured differences may also be attributed to dissimilar time intervals between the AU flare-up and OCT examination. Castellano et al. [13] included only OCT scans taken on first visit, although 56% of their patients had chronic AU. Our data may indicate that MT lags several weeks behind the clinical AU flare-up, which is coherent with Traill et al.'s assumption [11]. Hegde et al. [37] observed no MT in patients with acute AU of ≤ 1 week duration, and it seems that MT peaks at about 6–12 weeks after the initial flare-up, often after a clinical resolution of the AU.
For these reasons we assume that macular thickness increases with time elapsed from the initial flare-up, although the statistical evidence for this assumption is rather weak. Individual clinically tailored follow-up intervals were not optimal for the statistical analyses, which eventually resulted in a small study sample for the "late" follow-up group. However, Peizeng et al. [38] detected inflammatory changes in the ciliary body on ultrasound at 6 weeks follow-up in acute AU in spite of absence of inflammatory anterior chamber cells. It is accordingly possible that a continuous release of inflammatory mediators from the ciliary body can explain the time lag.
We observed that differences in macular thickness between affected eyes and fellow-eyes of patients were smaller than differences between patient's affected eyes and controls. This observation can be explained if the increase in macular thickness after a previous AU episode lasts for at least 3 months (n = 12). However, the duration of residual MT after an AU episode has not been established. Traill et al. found MT in 45% of eyes at 6 months [11] while Moreno-Arrones et al. found no MT at 6.3 months [16]. Bilateral AU (n = 1 in our sample) will decrease the inter-eye MT difference.
Subclinical AU in some fellow-eyes should also be considered. Indeed central maculae in fellow-eyes with no previously diagnosed uveitis (n = 16) were thicker than in controls. We did not find any literature dealing with macular thickness in unaffected fellow-eyes during an uveitis episode. We do not know the reason for this observation. However activation of the peripheral immunoregulatory mechanisms and increased levels of ocular autoantigens have been found in AU patients [39, 40]. Furthermore, up-regulated levels of IL-22 which may compromise the blood-retina barrier and allow biologically active substances and water to enter the retina were found in peripheral blood in uveitis [41, 42]. We hypothesize that similar mechanisms may also influence fellow-eyes of AU patients, explaining the simultaneous increase in MT in both eyes of patients even when AU is unilateral.
Posterior segment involvement in HLA-B27-related uveitis is not uncommon, and it is probably under-recognized [43–45]. Power et al. [23] reported that cystoid macula edema was five times more frequent in HLA-B27-positive than HLA-B27-negative AU, the occurrence of which may predict a less favorable visual outcome [46]. However, Castellano et al. [13] found no differences in MT by HLA-B27 on patients' first visit. We observed a larger MT in HLA-B27-related than in HLA-B27-negative AU. It is possible that early MT is independent of the antigen, while the magnitude of further increase is related to both the HLA-B27 and/or its polymorphism, along with the time perspective discussed above. It is accordingly possible that HLA-B27-related AU is accompanied by a larger or a more prolonged MT than HLA-B27-negative AU.
We wonder whether the above described dispute about the duration of residual MT after an AU episode [11, 13, 16] is partly related to different HLA-B27- antigen distribution in studied samples; Traill et al.'s sample was dominated by HLA-B27-positive patients (as the case is with our sample, while only 42% of Castellano et al.'s sample are HLA-B27-positive. Moreno-Arronez et al. do not mention the distribution of HLA-B27 antigen in their sample.
The absence of cystoid spaces and detectable epiretinal membrane is consistent with good VA [8, 10] which probably carries a beneficial long-term visual prognosis for patients in our sample. Markomichelakis et al. [8] demonstrated complete resolution of uveitic edema in 47% of eyes by 12 months follow-up with medical treatment. They suggested that diffuse MT could carry a negative prognostic significance because it was not treated due to good VA. However, diffuse MT may adversely affect visual function on persistence or during inflammatory relapse [47]. We did not observe differences in MT on recurrence. However, other aspects of visual function such as central visual field impairment may occur even on complete resolution of edema despite good VA [48, 49]. The prognostic relevance of MT on long-term visual function in AU is not yet known.
The present study has some limitations. Although hospital records were examined in all cases, the previous history depended on patients' recollection ability in some cases.
Follow-up intervals were individually tailored depending on the AU severity, treatment intensity and response, as well as practicability for ophthalmologist and patient. Intervals were therefore not standardized for the purpose of statistical analyses. In order to demonstrate an increase in thickness as a function of time elapsed from AU flare-up, mean inter-ocular differences were averaged from different cases at different intervals in lack of sufficient repeated longitudinal data. Longer follow-up intervals could preferentially select the more severe or longer-lasting cases, biasing the time frame towards larger measured thickness (if MT is related to severity and/or chronicity, which we do not know) in our small study sample. However, according to medical records this is not the case. Nevertheless, these data should be interpreted with care until confirmed in larger samples.
Three patients had been receiving an immunomodulatory agent for rheumatic disease other than uveitis before current AU flare-up. Eight patients received a short course of oral prednisolone during current AU episode. Prednisolone alone or in combination with other immunomodulatory agents is the mainstay treatment in uveitis and uveitic edema [32, 33, 50, 51]. Immunomodulatory agents may even reduce frequency of recurrence [52, 53]. Thus systemic treatment these 11 patients received may have protected their retinae from further thickening. Macular thickness may have otherwise reached even greater values than observed in this study.
Subclinical MT is present in both affected eyes and quiet fellow-eyes of AU-patients. MT is detected by OCT during most cases of AU, even in phakic eyes with good VA and in quiet fellow-eyes with no previous uveitis. MT probably reflects systemic immune-mediated response to the inflammatory disorder in AU, and it is possible that HLA-B27-related factors are involved in the pathogenesis of AU. These observations are in line with and extend the current understanding of the mechanisms behind MT in AU.
- 1.
Hooper C, McCluskey P: Intraocular inflammation: Its causes and investigations. Curr Allergy Asthma Rep. 2008, 8 (4): 331-338. 10.1007/s11882-008-0053-3.
- 2.
Jabs DA, Nussenblatt RB, Rosenbaum JT: Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol. 2005, 140 (3): 509-516.
- 3.
Rothova A, Suttorp-van Schulten MS, Frits Treffers W, Kijlstra A: Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol. 1996, 80 (4): 332-336. 10.1136/bjo.80.4.332.
- 4.
Durrani OM, Tehrani NN, Marr JE, Moradi P, Stavrou P, Murray PI: Degree, duration, and causes of visual loss in uveitis. Br J Ophthalmol. 2004, 88 (9): 1159-1162. 10.1136/bjo.2003.037226.
- 5.
Lardenoye CW, van Kooij B, Rothova A: Impact of macular edema on visual acuity in uveitis. Ophthalmology. 2006, 113 (8): 1446-1449. 10.1016/j.ophtha.2006.03.027.
- 6.
Maini R, O'Sullivan J, Reddy A, Watson S, Edelsten C: The risk of complications of uveitis in a district hospital cohort. Br J Ophthalmol. 2004, 88 (4): 512-517. 10.1136/bjo.2002.013334.
- 7.
Chang JHM, Wakefield D: Uveitis: A global perspective. Ocul Immunol Inflamm. 2002, 10 (4): 263-279. 10.1076/ocii.10.4.263.15592.
- 8.
Markomichelakis NN, Halkiadakis I, Pantelia E, Peponis V, Patelis A, Theodossiadis P, Theodossiadis G: Patterns of macular edema in patients with uveitis: Qualitative and quantitative assessment using optical coherence tomography. Ophthalmology. 2004, 111 (5): 946-953. 10.1016/j.ophtha.2003.08.037.
- 9.
Estafanous MF, Lowder CY, Kaiser PK: Patterns of macular edema in uveitis patients. Ophthalmology. 2005, 112 (2): 360-author reply 360–361
- 10.
Iannetti L, Accorinti M, Liverani M, Caggiano C, Abdulaziz R, Pivetti-Pezzi P: Optical coherence tomography for classification and clinical evaluation of macular edema in patients with uveitis. Ocul Immunol Inflamm. 2008, 16 (4): 155-160. 10.1080/09273940802187466.
- 11.
Traill A, Stawell R, Hall A, Zamir E: Macular thickening in acute anterior uveitis. Ophthalmology. 2007, 114 (2): 402-10.1016/j.ophtha.2006.07.028.
- 12.
Brown JC, Solomon SD, Bressler SB, Schachat AP, DiBernardo C, Bressler NM: Detection of diabetic foveal edema: Contact lens biomicroscopy compared with optical coherence tomography. Arch Ophthalmol. 2004, 122 (3): 330-335. 10.1001/archopht.122.3.330.
- 13.
Castellano CG, Stinnett SS, Mettu PS, McCallum RM, Jaffe GJ: Retinal thickening in iridocyclitis. Am J Ophthalmol. 2009, 148 (3): 341-349. 10.1016/j.ajo.2009.03.034.
- 14.
Akduman L: Can we be more objective in determining the response to treatment in uveitis patients aside from recording anterior chamber reaction?. Ocul Immunol Inflamm. 2009, 17 (4): 265-266. 10.1080/09273940802702587.
- 15.
Ducos de Lahitte G, Terrada C, Tran TH, Cassoux N, LeHoang P, Kodjikian L, Bodaghi B: Maculopathy in uveitis of juvenile idiopathic arthritis: An optical coherence tomography study. Br J Ophthalmol. 2008, 92 (1): 64-69. 10.1136/bjo.2007.120675.
- 16.
Moreno-Arrones JP, Gorrono-Echebarria MB, Teus-Guezala MA: Macular thickening in acute anterior uveitis with a 6-month remission period. Canadian Journal of Ophthalmology-Journal Canadien D Ophtalmologie. 2010, 45 (1): 91-92.
- 17.
Braakenburg AM, de Valk HW, de Boer J, Rothova A: Human leukocyte antigen-b27-associated uveitis: Long-term follow-up and gender differences. Am J Ophthalmol. 2008, 145 (3): 472-479. 10.1016/j.ajo.2007.11.009.
- 18.
Zeboulon N, Dougados M, Gossec L: Prevalence and characteristics of uveitis in the spondyloarthropathies: A systematic literature review. Ann Rheum Dis. 2008, 67 (7): 955-959.
- 19.
Khan MA: Hla-b27 and its subtypes in world populations. Curr Opin Rheumatol. 1995, 7 (4): 263-269. 10.1097/00002281-199507000-00001.
- 20.
Khan MA, Mathieu A, Sorrentino R, Akkoc N: The pathogenetic role of hla-b27 and its subtypes. Autoimmun Rev. 2007, 6 (3): 183-189. 10.1016/j.autrev.2006.11.003.
- 21.
Chang JH, McCluskey PJ, Wakefield D: Acute anterior uveitis and hla-b27. Surv Ophthalmol. 2005, 50 (4): 364-388. 10.1016/j.survophthal.2005.04.003.
- 22.
Sheehan NJ: Hla-b27: What's new?. Rheumatology (Oxford). 2010, 49 (4): 621-631. 10.1093/rheumatology/kep450.
- 23.
Power WJ, Rodriguez A, Pedroza-Seres M, Foster CS: Outcomes in anterior uveitis associated with the hla-b27 haplotype. Ophthalmology. 1998, 105 (9): 1646-1651. 10.1016/S0161-6420(98)99033-9.
- 24.
Rothova A, van Veenedaal WG, Linssen A, Glasius E, Kijlstra A, de Jong PT: Clinical features of acute anterior uveitis. Am J Ophthalmol. 1987, 103 (2): 137-145.
- 25.
Gran JT, Mellby AS, Husby G: The prevalence of hla-b27 in northern norway. Scand J Rheumatol. 1984, 13 (2): 173-176. 10.3109/03009748409100382.
- 26.
Bakland G, Nossent HC, Gran JT: Incidence and prevalence of ankylosing spondylitis in northern norway. Arthritis Rheum. 2005, 53 (6): 850-855. 10.1002/art.21577.
- 27.
Blochmichel E, Nussenblatt RB: International uveitis study group recommendations for the evaluatioon of intraocular inflammatory disease. Am J Ophthalmol. 1987, 103 (2): 234-235.
- 28.
Deschenes J, Murray PI, Rao NA, Nussenblatt RB: International uveitis study group (iusg) clinical classification of uveitis. Ocul Immunol Inflamm. 2008, 16 (1–2): 1-2.
- 29.
Lyon F, Gale RP, Lightman S: Recent developments in the treatment of uveitis: An update. Expert Opin Investig Drugs. 2009, 18 (5): 609-616. 10.1517/14728220902852570.
- 30.
Wexler A, Sand T, Elsas TB: Macular thickness measurements in healthy norwegian volunteers: An optical coherence tomography study. BMC Ophthalmol. 2010, 10 (1): 13-10.1186/1471-2415-10-13.
- 31.
Marmor MF: Mechanisms of fluid accumulation in retinal edema. Doc Ophthalmol. 1999, 97 (3–4): 239-249.
- 32.
Okhravi N, Lightman S: Cystoid macular edema in uveitis. Ocul Immunol Inflamm. 2003, 11 (1): 29-38. 10.1076/ocii.22.214.171.12482.
- 33.
Rothova A: Inflammatory cystoid macular edema. Curr Opin Ophthalmol. 2007, 18 (6): 487-492. 10.1097/ICU.0b013e3282f03d2e.
- 34.
Brar M, Yuson R, Kozak I, Mojana F, Cheng L, Bartsch DU, Oster SF, Freeman WR: Correlation between morphologic features on spectral-domain optical coherence tomography and angiographic leakage patterns in macular edema. Retina. 2010, 30 (3): 383-389. 10.1097/IAE.0b013e3181cd4803.
- 35.
Biro Z, Balla Z, Kovacs B: Change of foveal and perifoveal thickness measured by oct after phacoemulsification and iol implantation. Eye. 2008, 22 (1): 8-12. 10.1038/sj.eye.6702460.
- 36.
Kecik D, Makowiec-Tabernacka M, Golebiewska J, Moneta-Wielgos J, Kasprzak J: Macular thickness and volume after uncomplicated phacoemulsification surgery evaluated by optical coherence tomography. A one-year follow-up. Neuro Endocrinol Lett. 2009, 30 (5): 610-614.
- 37.
Hegde V, Pagliarini S: Macular analysis with optical coherence tomography (oct-3) and its role as a screening tool in acute anterior uveitis. Invest Ophthalmol Vis Sci. 2004, 45: U989-U989.
- 38.
Peizeng Y, Qianli M, Xiangkun H, Hongyan Z, Li W, Kijlstra A: Longitudinal study of anterior segment inflammation by ultrasound biomicroscopy in patients with acute anterior uveitis. Acta Ophthalmol. 2009, 87 (2): 211-215. 10.1111/j.1755-3768.2008.01194.x.
- 39.
Deschenes J, Char DH, Kaleta S: Activated t lymphocytes in uveitis. Br J Ophthalmol. 1988, 72 (2): 83-87. 10.1136/bjo.72.2.83.
- 40.
Heiligenhaus A, Rebmann V, Neubert A, Plewa S, Ferencik S, Vogeler U, Steuhl KP, Grosse-Wilde H: Soluble hla class i and hla-dr plasma levels in patients with anterior uveitis. Tissue Antigens. 2004, 63 (4): 369-375. 10.1111/j.0001-2815.2004.00201.x.
- 41.
Li Z, Liu B, Maminishkis A, Mahesh SP, Yeh S, Lew J, Lim WK, Sen HN, Clarke G, Buggage R, et al: Gene expression profiling in autoimmune noninfectious uveitis disease. J Immunol. 2008, 181 (7): 5147-5157.
- 42.
Kebir H, Kreymborg K, Ifergan I, Dodelet-Devillers A, Cayrol R, Bernard M, Giuliani F, Arbour N, Becher B, Prat A: Human th17 lymphocytes promote blood–brain barrier disruption and central nervous system inflammation. Nat Med. 2007, 13 (10): 1173-1175. 10.1038/nm1651.
- 43.
Uy HS, Christen WG, Foster CS: Hla-b27-associated uveitis and cystoid macular edema. Ocul Immunol Inflamm. 2001, 9 (3): 177-183. 10.1076/ocii.184.108.40.20663.
- 44.
Dodds EM, Lowder CY, Meisler BM: Posterior segment inflammation in hla-b27+acute anterior uveitis: Clinical characteristics. Ocul Immunol Inflamm. 1999, 7 (2): 85-92. 10.1076/ocii.22.214.171.12415.
- 45.
Rodriguez A, Akova YA, Pedrozaseres M, Foster CS: Posterior segment ocular manifestations in patients with hla-b27-associated uveitis. Ophthalmology. 1994, 101 (7): 1267-1274.
- 46.
Rothova A: Medical treatment of cystoid macular edema. Ocul Immunol Inflamm. 2002, 10 (4): 239-246. 10.1076/ocii.10.4.239.15589.
- 47.
Markomichelakis NN, Halkiadakis I, Pantelia E, Georgalas E, Anthi K, Theodossiadis P, Moschos M, Theodossiadis G, Kouvatseas G: Course of macular edema in uveitis under medical treatment. Ocul Immunol Inflamm. 2007, 15 (2): 71-79. 10.1080/09273940701244509.
- 48.
Kiss CG, Barisani-Asenbauer T, Simader C, Maca S, Schmidt-Erfurth U: Central visual field impairment during and following cystoid macular oedema. Br J Ophthalmol. 2008, 92 (1): 84-88. 10.1136/bjo.2007.124016.
- 49.
Paroli MP, Spinucci G, Fabiani C, Pivetti-Pezzi P: Retinal complications of juvenile idiopathic arthritis-related uveitis: A microperimetry and optical coherence tomography study. Ocul Immunol Inflamm. 2010, 18 (1): 54-59. 10.3109/09273940903311999.
- 50.
Lim L, Suhler EB, Smith JR: Biologic therapies for inflammatory eye disease. Clin Experiment Ophthalmol. 2006, 34 (4): 365-374. 10.1111/j.1442-9071.2006.01225.x.
- 51.
Sharma SM, Nestel AR, Lee RWJ, Dick AD: Clinical review: Anti-tnf alpha therapies in uveitis: Perspective on 5 years of clinical experience. Ocul Immunol Inflamm. 2009, 17 (6): 403-414. 10.3109/09273940903072443.
- 52.
Braun J, Baraliakos X, Listing J, Sieper J: Decreased incidence of anterior uveitis in patients with ankylosing spondylitis treated with the anti-tumor necrosis factor agents infliximab and etanercept. Arthritis Rheum. 2005, 52 (8): 2447-2451. 10.1002/art.21197.
- 53.
Sieper J, Koenig A, Baumgartner S, Wishneski C, Foehl J, Vlahos B, Freundlich B: Analysis of uveitis rates across all etanercept ankylosing spondylitis clinical trials. Ann Rheum Dis. 2010, 69 (1): 226-229. 10.1136/ard.2008.103192.
Pre-publication history
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2415/12/30/prepub
We thank all colleagues at St. Olavs University Hospital for their effort volunteering for OCT measurements and disclosing relevant health related information for the study. This study would not be possible without the administrative support from the head of Department of Ophthalmology, Dr Kjell-Morten Møen, Mrs. Guri Helene Broum Olsen and Mrs. Marit Fagerli. We acknowledge the contribution of Mrs. Ingrid Riphagen, Unit for Applied Clinical Research, Norwegian University of Science and Technology for managing literature references.
Additional information
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
TBE suggested the initial concept and together with AW was responsible for planning the study design. AW carried out the data collection including OCT measurements. TS helped with the statistical analysis and interpretation. All authors have participated in the writing and approval of the final manuscript.
Authors' original submitted files for images
Below are the links to the authors' original submitted files for images.
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Cite this article
Wexler, A., Sand, T. & Elsås, T.B. Bilateral macular thickening in mild unilateral anterior uveitis: is HLA-B27 involved?. BMC Ophthalmol 12, 30 (2012). https://doi.org/10.1186/1471-2415-12-30
- Optical Coherence Tomography
- Uveitis
- Macular Edema
- Cystoid Macular Edema
- Anterior Uveitis


text:
Make sure the birthday boy or girl knows you really care by giving the gift
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birthday party recipes, and when the candles are blown out, everyone's
wishes have already come true.
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text:
Sunday, August 09, 2020
Election Results
Wednesday, November 7, 2018
We will sort through the results of the midterm elections with Rachel Bitecofer, Assistant Director of the Wason Center for Public Policy at CNU. We will also talk to the winners about what they want to do in office. Give us a call at 1-800-940-2240 or 757-440-2665.
Today's Guests:
Rachel Bitecofer - Wason Center for Public Policy, CNU


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Humanity is reaching a weird sort of nexus point. We have the capacity to render our species extinct, and the costs in terms of labor and intellectual capacity required continue to decline. There will be a point at which a small number of people could, in theory, destroy the whole species. When that time comes, I fully expect the trigger man to be of a certain, oft-mentioned religious persuasion.
In the meantime, expect terrorist and extra-state entities to increase their attacks, and one up one another in terms of violence, evil, and body count. Iron age philosophy + high technology = corpses piled on top of one another. Even if Islam is defeated and cordoned off, quarantined from the rest of the planet, they are not the only group of people espousing radical kill-them-all ideology. Africa is full of people dedicated to this belief system, and not all of them are necessarily Muslim. Petty tyrants and genocidal warlords are a dime a dozen on the African continent.
Add to this the increasing resistance of disease (especially bacterial disease) to treatment and we have the possibility that mother nature may do the job if, for whatever reason, humans fail to do so.
Space is the solution. Humanity is vulnerable to a single extinction-level event so long as it resides on one planet. Humanity spread to the stars is nearly invulnerable.
Otherwise, the possibility that someone, or some thing, will render humanity extinct one day approaches unity.
But, go along about your business, Leftists, and muse about how blind girls depositing the fecal matter from their guide dogs is, somehow, indicative of the evils of White Racism. The Emperor has no clothes. He hasn't for as long as I've been alive. It's debatable whether or not he even knows what clothes are.


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Portfolio assignments are due next Friday! Students need to make sure they have their pictures uploaded into the file, as well as all of their written documentation! Parents can check Gradelink to see what students still have to do.
Wilkins Winners
The biggest hero of the week is Makenna! 8th graders had to present their 1930s essay in PowerPoint to prepare the class to read To Kill a Mockingbird. Makenna's presentation was outstanding! Not only were her slides beautiful, her public speaking skills were quite impressive. Congratulations, Makenna, on a job well done!
I also want to give a big shout out to Peyton. Fr. Eugene visited our class and laid on the praise for his performance during altar serving.
Top Dojo Point Earners
8th grade: Jenicca
7th grade: Mariano
6th grade: All of 6th grade did a great job this week and earned more points than both 7th and 8th grade!
8th Grade Social Studies
This week in social studies, 8th graders learned about the War of 1812. They did a scavenger hunt while watching a documentary to help them learn about the geography of the war. They also finished their test on the chapter this week.
6th/7th Grade Social Studies
6th & 7th grade finished up notes on the chapter on Egypt. They also had their last day in class to complete their projects. I am excited to have our Egyptian burial ceremony next week. I'll be sure to post pictures!
Language Arts:
In 6th and 7th grade, Writer's Workshop was our main focus. This gave the students time to create their own stories while I had one on one time with students to help them work on their essays. This is a slow process, but the personal touch is worth the effort on all of our parts!
In 8th grade we have begun our unit on To Kill a Mockingbird. The students presented their 1930s PowerPoints and turned in their essays. We started the art portion of a project this afternoon where students began to create a visual representation of their personal identity. Since the main character of our novel struggles with personal identity, this is a good way to start the students understanding of what personal identity means.
Upcoming Events
- 16th THU- Parent Information Night about Washington D.C. Trip for 6th & 7th graders in room 14 (Mrs. Wilkins Classroom)
- 17th FRI- Stations of the Cross
- 20th MON- Mrs. Johnston's birthday
- 24th FRI- Stations of the Cross
- 31st FRI- Stations of the Cross
- 7th FRI- Minimum Day
- 13th THU- Holy Thursday
- 14th FRI- Good Friday- NO SCHOOL
- 16th SUN- Easter
- 17th-22nd MON~FRI- 8th Grade Trip to Washington D.C.!!!!!
- 1st-5th Teacher Appreciation Week
- 4th THU- May Crowning- 8th grade only- Noon dismissal
- 5th FRI- Minimum Day
- 8th-12th 6th Grade Camp- Mrs. Wilkins will be out with 6th Grade


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Kids push, and push, and push, and then push a little more to test their limitations and our patience. And it's our job, as parents, to push back and draw the proverbial line in the sand. But because we are human and fallible, that line often moves. As a result, it sends a message to our children to continue that quest of pushing us to the brink of giving in to their every whim.
Don't do it. Stay the course. Stay strong.
It can be even more difficult when there are two (or three!) of us trying to set those limits who have all have drawn our own line in the sand. So the tantrums, the yelling, fighting, and sometimes hitting continue. Good stuff.
So what are we to do? How do we be consistent with our rules when we all have different schedules and aren't always together to set those boundaries collectively?
Once kids understand the concept of choices and the ensuing consequences, they begin to weigh their options and make their OWN choices. If you do X, you get Y. If you don't do X, you don't get Y and you lose Z.
Simple math.
But it works, at least most of the time. And it teaches them invaluable lessons about life and consequences while simultaneously empowering them to determine their own fate and the fate of their use of that iPad that they so love.
Our kids are given choices and are reminded that they themselves are empowered to make those decisions. They listen, pause, and then act. While sometimes they make the right choice, other times they don't. But with each bad decision and ensuing reaction, it reinforces the fact they they don't like consequences.
And it's that enlightenment that might just make my house, and yours, a little less chaotic, loud, and stressful.
Give it a try and let us know if it works for you or if you've found other options that work for your family.


text: You will receive an email confirming your order, which includes your booking details - booking id, event id and event name. Tickets are usually attached to your mail as a pdf file. You can easily download the e-tickets from your mail. Your e ticket contains information like name of the event, venue, order reference number, type of the ticket and quantity.


text:
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Whether you need the help of medical equipment to live independently or require the assistance of a nurse with your everyday needs, Alpha Medical Equipment & Supplies Inc has the supplies you're looking for.
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text:
We use Fuller's earth for acne because of the presence of magnesium chloride, and its ability to do away with the excess oil which is one of main causes of acne. It also unclogs pores and soothes and cools the skin. While most people with oily skin swear by it, Multani mitti is also good for dry skin when combined with ingredients with moisturizing properties.
If you are battling acne and acne marks, these three packs with multani mitti for acne should help immensely.
Multani Mitti Face Packs for Acne & Pimples
#1 Smooth and Clear Pack
A pack with multani mitti, honey, lemon juice and yoghurt works on several levels. Multani mitti unclogs pores and absorbs excess oil in the skin. Honey is known as a smoothening and bleaching agent. Both yoghurt and lemon juice lighten the skin. This pack tackles the pimples and the marks that it has left behind. In addition to this, it improves the overall health and texture of skin. The pack needs to be left on till it is almost dry and then washed with cold water. If your skin is too oily, avoid using honey and curd, and replace them with rose water.
#2 Power Pack
Another multani mitti face pack for pimples packs the combined power of multani mitti and neem to fight off the most stubborn pimples. Neem is known for its anti-bacterial properties. Like multani mitti, it is also known to tame excess oil in the skin. You can make a juice out of the neem leaves after washing them thoroughly. This can be added to the multani mitti. If fresh neem leaves are hard to find, you can purchase neem powder in stores. Apply this pack for at least 30 minutes and wash it off with cold water. If your skin is extremely dry, add some yoghurt while making the paste.
#3 Scrub Pack
Coarse orange peel powder mixed with multani mitti and lemon juice can be used as both an exfoliator and a pack that removes dead cells and cleanses. You start by rubbing the mixture in a circular motion. Take care to not be too harsh. And then apply a layer of it and leave it on until it dries. Wash off the pack with cold water to reveal skin that is clearer.
You could add a bit of turmeric powder to all these packs as turmeric is known for its antibacterial properties. Kasturi turmeric can be powdered and used for best results. Other ingredients that work well with multani mitti based on skin types are honey, tomato juice, papaya, oatmeal powder and sandalwood powder.
If you notice that any of these multani mitti packs for pimples are aggravating the pimples, you need to stop using it immediately. It could be that your skin is reacting to one of the ingredients. Read more homemade multani mitti face pack for oily skin.If you are using any products prescribed by a dermatologist, avoid using packs and follow only the skincare regimen advised. Skin can be very sensitive, so even if you are not getting any treatments, use skin care products from Olay to be your best beautiful always!
Also, check out 5 ways to use curd (dahi) for skin care problems here at our blog.
Find more useful daily skin care tips here.
Get complete beauty tips at Reward Me.


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Using fresh ginger juice mixed with honey to baste wings gives them an addictive flavor. F&W's Justin Chapple tosses the grilled chicken wings with salted peanuts and fresh cilantro before serving them with lime wedges, which amps up the flavor even further. For a party, consider buying the wings already cut into drumettes and wingettes, which are easier to pick up and eat. Slideshow: More Chicken Wing Recipes
How to Make It
Finely grate the ginger into a fine sieve set over a bowl. Press the juice from the ginger; you should have 1/3 cup. Discard the solids. Whisk in the honey and a generous pinch each of salt and pepper.
Light a grill and oil the grate. In a large bowl, toss the chicken with the 2 tablespoons of oil and season generously with salt and pepper. Grill over moderate heat, turning, until lightly browned on both sides, about 7 minutes. Continue to grill, turning and brushing with the ginger-honey mixture occasionally, until lightly charred and cooked through, about 8 minutes longer. Transfer to another large bowl and toss with the peanuts and cilantro. Serve with lime wedges.


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In every country the impact of technology on workers is managed through the laws that govern the relationships between workers, employers and government.
In many developed countries workers have had substantial experience of dealing with the introduction of new technology, and so there is existing legislation on this. For example, Canada has Article 51 of the Labour Code dedicated to technological change.
Most regulatory frameworks deal with the issue of technological change from the following areas:
- Regulating how and why technology can be introduced by an employer.
- Regulating how this affects workers.
- Regulating what forms of compensation or training workers are provided.
The most successful regulatory frameworks are the product of tripartite engagement between workers, employers and government.
In essence, a positive regulatory framework for technological change and workers gives workers input into the design of the system itself, provides certain guarantees to workers, effectively regulating when and how technology can be introduced.
There are many positive examples of this type of engagement from around the world. In this toolkit we are presenting two main examples from Singapore and Belgium.
The Singaporean system is based on a tripartite model in which workers, employers and government cooperate to develop a strategy that will ensure Singapore develops economically, that business can remain competitive and adapt cutting edge technology, and that workers can be prepared for the demands of the new digital economy. To this end Singaporean unions have cooperated in building a system heavily based upon training, skills and education of workers.
To prepare workers who may be displaced with technology, various tripartite committees are looking at re-defining the jobs and creation of new roles in order to bridge the skills gaps these workers may have. Workers are also encouraged to embrace technology and automation as a tool for better productivity. Workers who are inevitably made redundant are supported through various tripartite guidelines on managing excess manpower to ensure a "soft" impact on such probable retrenchment.
Singaporeans unions are also using their Employment and Employability Institute (e2i) to support skills training to enable working people to upgrade and/or deepen their skillsets. Displaced workers are also encouraged to make use of the services in e2i for for reskilling and job placements for continued relevance in the respective industries. It is expected that this will help improve wages and employment conditions.
The Belgian National Labour Council is the highest instance of bargaining between employers and unions. Collective Labour Agreements (CLA) are binding for every private company. CLA No. 39 of December 1983 deals with the consultation process and the social consequences of the introduction of new technologies. Employers are obliged to give workers at least 3 months' notice of the introduction of new technology and the rationale for it. They must also consult with unions with regard to the impact on work and working conditions, health and safety and possible retraining. This national level agreement is often complemented by workplace agreements. The weakness of the system is that employers cannot be forced to begin the information and consultation process.


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Online application is invited from District Magistrate Malda for the Data Manager post in connection with implementation of Kanyashree Prakalpa. Candidates who already applied for that post must need previous year question papers. Here you will get model question papers and sample question papers for you written examination preparation.
Eligibility Criteria:
Age: Not less than 18 years and not more than 37 years as on 01/07/2017
Essential Qualification: Graduate in any discipline.
Computer Knowledge: Certificate in Computer Application from a reputed and recognize Institute
Experience: Minimum 1 year for working experience. (Computer related work)
Job Responsibility: Maintain data entry operation
Recruitment Procedure: Computer Test: 25 marks. Candidates shall secure 30 wpm speed written test: 20 marks on general knowledge. Personality Test: 5 marks.
Tenure of Service: 3(three) years on contract.
Last date of application: 13-07-2017
Date of Examination: Written examination will be held on 16-07-2017
Malda District Data Manager Examination Syllabus & Question Paper PatternCandidates who are applying for Malda District Data Manager jobs are searching for Syllabus for their preparation. For that purpose, we are giving syllabus and written exam question paper pattern of Malda District Exam. Applicants can download syllabus along with exam pattern from our site. Syllabus is the very important for the candidates who are going to write these Data Manager jobs. Hence the people can start their practice by downloading the proper details of Malda District syllabus. We are providing Malda District jobs test pattern details to get a brief idea about Malda District exam pattern. Aspirants can download pdf below previous questions papers. Previous year question papers are solved with answer. We prepare some model question papers and some sample questions papers for your preparation.
Malda District Data Manager Previous Question PapersAspirants always search Previous Question Papers before appearing the examination. The candidates who are applying for the Data Manager Jobs can start your preparation for the Written Test going to organize previous question papers. Those can check this page for the Malda District Data Manager exam materials. Aspirants can refer the Malda District Data Manager Syllabus & Exam Pattern 2017 once before going to begin the preparation. Then, you will get an idea about the test pattern, subjects and so on. So that you will get perfect plan for the Malda District Exam preparation after practicing our sample question papers. After the planning, you will download the Malda District Data Manager Model papers from the enclosed links. Start preparation and spend more time on practicing with these Malda District Previous Questions Papers PDF.
Malda District Data Manager Previous Papers are uploaded here to help the candidates who are appearing for the Data Manager Exam. The Applicants who are about to start their preparation for the Data Manager Exam can refer the Malda District Data Manager Model papers. So, interested candidates can click on the direct links given below for downloading the Malda District Data Manager Practice Papers along with Solutions or Answer Keys. Download the Malda District Data Manager Ten Years Previous Papers within few seconds for free of cost.
Malda District Question PapersYou can download Malda District Question Papers form our website. Candidates who are going to write for the examination must searching Malda District previous question papers. You are in right place. Malda District question papers are only model question papers. This sample question papers are for practice purpose only. We never assure you that you will get the same questions.
Malda District Data Manager Model Question PapersThe aspirants must practice Malda District Data Manager Model Question Papers for getting qualify in the examination. By practicing a vast number of Malda District Data Manager Sample Papers, your level of knowledge will be uplifted. Therefore, download Malda District Previous Question Papers from the below free downloading links. All these Model Question Papers are given in pdf format along with solutions. So, candidates have no need to search for the answers to the questions in Malda District Previous Papers and can download those papers within one click only. Practice the Malda District question papers.
Along with practicing Malda District Data Manager Model Question Papers, candidates must study all the topics in the syllabus. Because applicants can know only the pattern of the questions asking in the examination. But they don't get the same questions in the final exam. Hence, contenders must prepare all the topics in the Data Manager Study Material. Individuals can refer the Malda District Data Manager Syllabus and Exam Pattern in the below table.
Malda District Data Manager Sample Question PapersThe Malda District has dispatched the advertisement for hiring aspirants to the available Data Manager vacancies. Many contenders have sent applications to the Malda District. Now, they are busy in searching the Malda District Sample Question Papers. Hence to help the candidates, we gave the free downloading links of Last 10 years Malda District Previous Question Papers with Answers.
The applicants should start the preparation for the Malda District Written Exam as early as possible. Download the Malda District Sample Question papers, Last 5 year question papers, of the Malda District Data Manager. On our website, we have also provided the preparation tips for the applicants. Therefore, the contenders can download the Malda District Data Manager previous papers from our website along with preparation tips. These Preparation tips will be very helpful for the candidates to solve the questions in a much less time. So, the candidates can answer the objective questions quickly. Interested candidates can Download the Malda District Data Manager previous papers and make use of them.


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Reference: 262972
Call: FP7-SPACE-2010-1
Theme: space
Scientist: Enrico Lorenzini
Department: Industrial Engineering
UNIPD: participant
Total cost: 2,337,317 €
Eu Funding: 1,772,801 €
Email: email@example.com
Project Description
Concern about the growth of space debris, aggravated by the increase in the number of countries with direct access to space, made the SPA. 2010. 2. 3-02 Call Topic suggest "preventing generation of new debris and de-orbiting upper stages and spacecraft after mission completion". The Project proposed involves Research and Technology Development of an efficient deorbit system, to be carried in the future by every launched spacecraft. A dedicated system is needed because satellites naturally orbit at ionospheric altitudes where air drag is very weak. The system considered involves magnetic drag on a current- carrying conductive tether, uses no propellant and no power supply, and generates power on board.
It beats alternative systems (enhanced air drag, and rocket and electrical thrust) in simplicity and in the combined basic metrics: Frontal Area x Deorbit Time and System-to-Spacecraft Mass Ratio. Like air drag, magnetic drag is a dissipative mechanism arising from the orbital tether motion relative to the corotating magnetized plasma, which induces the current in the tether.
The Work Programme includes studies of plasma-tether interaction under ambient-plasma variations along orbit, performance dependence on orbital altitude/inclination, and trade-off against alternative systems; numerical simulations of current to a bare tether; and studies of orbit/ tether dynamics, and of both tether survival and the tether itself as debris. Deorbiting a satellite representative in both orbit and mass in Low Earth Orbit is considered. Tasks involve i) Design and manufacturing the tether as a tape with possible materials-structure both lengthwise and in its cross section, and a study of materials; ii) deployment strategy, and design / manufacturing of subsystems: tether-deployment mechanism, end mass, electric control and driving module, electron-ejecting plasma contactor, and interface elements; and iii) microgravity, and hypervelocity- impact and tether-current laboratory tests.
Coordinator: Universidad Politecnica de Madrid
Participants: Board of Governors of the Colorado State University System, Embedded Instruments and Systems S.L, Fundacion Tecnalia Research & Innovation, Office National d'Études et de Recherches Aerospatiales, Deutsches Zentrum für Luft - und Raumfahrt EV, Università degli Studi di Padova
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Google has an ad for Prop 8 on my blog today (and everyone that uses Google AdSense). Wow - they must have a LOT of money. I'm not going to remove AdSense for one day, then put it back. But it's not my idea to have it there.
Please know that the opinions expressed on this blog are solely those of its owner. While I might tell you how I'm voting, (which would, I'm sure, bore you to tears, and you wouldn't care anyway) I'm not going to tell anyone else how to vote. Not that you'd listen to my pea-brained reasons, anyway.
Just know that my underlying motives for voting propositions the way I do come back to this:
Is it kind?
Is it just?
Does it best serve the majority of the people, or a select few?
Does it advocate stewardship of the earth, our money, our time?
Does it demonize someone that is created in God's image?
I will tell you to vote, though. Vote your conscience, vote your pocketbook, spin-the-vote, whatever. Just vote, okay? And remember the old adage, if you don't vote, I don't want to hear you complain.
Monday, November 3, 2008
1 comment:
- Hal Johnson said...
Usually, I stay out of politics. But, as a straight married guy (I'm sure that dream I had about watching Pee Wee Herman and Sylvester Stallone play Naked Frisbee didn't mean anything), I don't understand what the fuss is about. If two gay people get married, it has absolutely no bearing on the integrity of my marriage.
I just don't get it. I'm no Bible scholar, but I've read the Four Gospels a time or two, and I don't recall one instance of Jesus condemning homosexuals. Not one.
- November 3, 2008 at 2:20 PM
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A Little Rock auto insurance class action lawsuit has been filed on behalf of policyholders who were involved in an auto accident resulting in injury and whose insurance company wrongfully deducted money from the settlement of their bodily injury claims. If you feel that your auto insurance company wrongfully caused your personal injury to be reduced, you may be eligible to participate in a made whole class action lawsuit. Contact Linville Johnson today to learn more about your options.
According to Arkansas state law, an injured party is considered to be "made whole" when they are fully compensated for his or her injuries. Insurance companies are not allowed to recover medical payments or reimbursements until the policyholder has been made whole for his or her injuries in the claim against an at-fault party.
Under the law, individuals who are injured in an automobile accident at no fault of their own may be able to pursue compensation for all damages caused by the accident, including medical costs, lost wages, and pain and suffering with the help of a Little Rock car accident lawyer.
In some cases, however, insurances companies ignore the law and wrongfully recover medical payments from their policyholders who have not yet been made whole, resulting in a reduction of the policyholder's injury settlement.
If you believe that your auto insurance company wrongfully caused your personal injury to be reduced, contact Linville Johnson today.
The Time You Have to File a Claim is Limited. Contact Us Today.
After you contact us, an attorney will follow up to answer questions that you might have. There is no cost or obligation to speak with us, and any information you provide will be kept confidential.
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text: Delhi, India - More than a thousand people thronged into the heart of India's capital for the fifth edition of the Delhi Queer Pride Parade that took place on Sunday in support of the LGBT (Lesbian, Gay, Bisexual and Transgender) community. Carrying rainbow-coloured flags and placards with slogans, supporters marched to the beats of traditional dhol drums. While some broke into hip-swinging Bollywood-style dance, there were many who kept their identities under wraps by wearing colourful masks. Delhi's Pride Parade takes place annually on the last Sunday of November. Many other cities host pride parades in the month of June, commemorating the 1969 Stonewall riots in New York City. While the first gay pride parade in India took place in 2003, Delhi got its first parade in 2008. It was only in 2009, after such marches and protests hit cities across the country, that the Delhi High Court repealed section 377 of Indian Penal Code - according to which homosexual sexual relations was deemed a criminal offence. Each year, new issues are addressed at the parade. "This year the theme is 'gender', and we are addressing something that oppresses us all - the straight-jacket of gender," Mohnish Kabir Malhotra, a member of the Delhi Queer Pride organising committee, told Al Jazeera. The parade brought together members of the LGBT community to support those who face discrimination, violence, abuse and ostracisation because of their gender or sexual identity, Malhotra added. The parade in its initial years received limited support, from members of the community and mainly young allies, but recent parades have seen a change. "Parents, siblings, grandparents and relatives now come out and participate in the parade," said Malhotra. "The Pride Parade has brought homosexuality into the open and it is being accepted. It is not something that one only talks about behind closed doors."


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From the moment Max reached out to offer to help me promote The Fashion Records to the moment I learned about his background in the US Army, I just knew Max is, uniquely, helping others along the way to the top. Max Philisaire is a Haitian U.S Army Veteran, Fitness Model, Actor, and Celebrity Trainer. Look for him on the second Season 2 of Spike TV's Deadliest Warrior.
Did I mention he has a killer "body of work" that reveals flexibility, intuitive eating and…a fascinating sculpture. Check out this Hot Choclates and Muscles man in his Essence feature.
Find Max On: His Website, Facebook
Workout with Max on Youtube.
First off – can we have a little background information – Where you live? How old you are? What motivates you? Inspires you?
I live in Los Angeles, CA. I'm 25 years old. Life motivates. Everything between its beginning to its end. People that live a great live inspire me to live better and people that have a rough life inspire me to help them live better.
What is your best attribute?
My best attribute is my mind. Everything about me starts and ends there. It's my sense of purpose.
How do you go about marketing your business? What has been your most successful form of marketing?
I market myself online through my website, social networks such as Facebook, Myspace, and twitter. In person marketing has been the most successful because I'm able to engage the consumer. I'm able to make a connection in person, which makes more an impact on a consumer.
You are also a celebrity trainer. Who are some of the celebrities you have worked with?
I have worked with Movie directors, Actors, Singers, models. The names of clients I've worked with are confidential.
Your story is unique once we realize that your family left Haiti to come to America for a better life. What can you tell us about the most challenging part of moving to a new world to pursue your dreams and how you overcame that?
Moving to the states didn't feel like much of a move at all. As long as I was with my family I was always at home. I'm sure that wasn't the case for my parents since they had more responsibilities than I did at the age of 8. Some America children ridiculed me at school because I was from a third world country but I knew how to handle myself. That didn't make moving here more challenging.
What is the best advice you have ever been given?
That is a tough one, since I have been given such great advice. Treating others the way you would want to be treated is a great one. That would make the world a better place if everyone felt and lived that way.
You are basically a brand. You do so many things. How do you achieve balance in your life?
I achieve balance through self-awareness. We all have our gifts and are capable of achieving different things. Getting to know yourself and coming to grips with your purpose allows things to fall into place. What I do may seem a lot to some but feels just right to me.
What are some of the stresses and pressures involved with your business?
The entertainment business is very superficial but you get used to it. It's entertainment, not real life so I've learned not to take certain things too seriously. There is less work for a black man in the industry but I believe that we have the power to provide more work for ourselves. Although there is stress and pressures, we have the ability to deal with them if we find it in ourselves.
Excluding yours, what company or brand do you admire the most?
I admire P. Diddy because he didn't get comfortable with the music industry. He branched out into fashion. He is first a businessman. I like how Kim Kardashian took over the scene. She wasn't in the entertainment business but saw an opportunity to capitalize on exposure in the media. Unlike many socialites, she has partnered up with GNC, Carls JR, E Reality TV, clothing store and a fragrance.
Give us 4 fitness/health tips……
1. Work smarter and not harder by doing a little bit of research and not working towards a goal clueless.
2. Diet will make or break you, so eat lean complete meals.
3. Health and Fitness is a lifestyle, not a race. People tend to rush to failure or stress over not seeing results by the date they would like to see a certain amount of change.
4. More exercise doesn't mean more results. Like everything else in life, there needs to be a balance between exercise, rest, and diet.
The secret to getting achieving great results is that there is no secret. Like Nike says "Just Do It"
Favorite lyrics from a song?
I don't memorize lyrics as much as I'd like to but off the top of my head I will quote T.I in the track "Live your life"- "Unhappy with your riches cause you're piss poor morally."
What are your future goals?
My future goal is to be in a better position to use my gifts to make the world a better place. To be on a bigger platform, so I'll be able to reach more people. I'm achieving my goals today but 5 years from now I would like to have opened fitness facilities in poor cities throughout the states. I'd like to set up a program that will motivate homeless people to take better care of themselves.
Word you live by?
"Love and be loved"


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What is Honeybee Capital Foundation?
Our work is rooted in the premise that investing helps to shape our world, and in the recognition that we all are investors - of our time, our energy, and our resources. We believe that investing is both art and science, so Honeybee Capital Foundation is dedicated to relevant and rewarding cross-pollination of ideas. Our written work and book lists highlight wisdom from a wide range of disciplines, and our giving program supports nonprofit organizations that inspire and inform.
What We Believe
We believe that investing is inherently a hopeful activity, and that hope is the highest form of strength in a cynical world. We rely on wisdom from natural systems and spiritual traditions to reconnect investing with purpose that goes beyond simple utility, creating a regenerative economy and supporting resilient communities.
How We Operate
Our operating model is simple: in our blog and on this site, we share resources that have been helpful to our own work; and through our giving program we support organizations that align with the key themes of (re)thinking, (re)investing, and (re)generation.
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From white papers to solution sheets; you'll find it all here.
Preparing for guided pathways - A readiness assessment for colleges and universities
As interest in structured pathways continues to grow, many institutions have begun the challenging work of mapping their programs of study, helping students select and stay on their chosen pathways, and tracking outcomes. If your institution is considering a guided pathways approach, this questionnaire can help you determine your readiness.
Building a global university
When Heriot-Watt University set out to build a global institution, it didn't just want disparate branch campuses around the world—it wanted to create a unified whole of its parts. But students from different countries have different recruiting and admissions needs. Creating a cohesive, efficient experience for applicants—on a system that worked for recruitment administrators based around the world—was a priority for Heriot-Watt.
This is Ellucian Ethos
Ellucian Ethos is the higher education framework connecting people, processes and applications to power student success.
Guided Pathways helps bolster student success
Students who juggle education and family responsibilities need a clear path to graduation. Guided Pathways, a community college program supported by Ellucian software, provides a roadmap to earning a degree in four years. Hear how this program is helping one student succeed.
Latest Resources
Keeping students on track with digital interventions
To keep their students on track, Connecticut State Colleges and Universities uses Ellucian Degree Works for degree planning and auditing. Watch their chief information officer explain how the solution is improving communications between students and advisors.
Focusing on what students need to succeed
Texas Tech University System implemented Ellucian CRM Advise to focus on relationship management with students. Watch Chief Information Officer Kay Rhodes explain how centralizing data has made it easier to identify what students need next in their academic career and keep them on the path to graduation.


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TS performer Kelly Clare announced her sponsorship of the 2018 TEAs. Her website, TSKellyClare.com, is also nominated for Best Solo Site.
"I'm honored to support and sponsor the TEAs for the first time this year," said Kelly Clare. "It's been a few years since I've attended and I'm excited to see how much the shown has grown since then!"
"We're really appreciative of Kelly's support and enthusiasm for the upcoming TEAs," said TEA Executive Producer Kristel Penn. "The success of the show is completely dependent on our sponsors and it says a lot to see Kelly and others in our community pitch in to make the TEAs what it is today."
Visit Kelly Clare's official website at TSKellyClare.com. Fans can also follow her on Twitter at @KellyClareBabi.
The 2018 sponsorship packages are now posted on the website here: http://www.theteashow.com/
Sponsor and media inquiries can be directed to Kristel Penn at firstname.lastname@example.com.
The 2018 TEAs are a three-day event held in Hollywood, CA, kicking off with an official pre-party at the Bardot on March 9, a daytime fan convention at the Avalon on March 10, and ramping up to the awards ceremony on March 11 at the Avalon. The awards will be hosted by viral sensation TEA Lifetime Achievement recipient TS Madison.
More details about the event will be released in the months to come. Visit their official website at theTEAShow.com.
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Some mornings I feel I could walk across America. Rising sunlight filtering through tree branches, brisk dog walk, my full breath with lungs wide…
Strength is being present and awake. My lab gets it. This is "whispering" – no effort, our tandem strides are in sync moving through the crisp morning air.
Light surrounds me. The morning scent is clean, soft and cool. Out of the trees into the neighborhood – it awakens too – shop windows sparkle lit by the rising sun, casting shadows across the street.
I am grateful no car separates me from the sight, sound, smells and breath of this morning. The light is my breakfast, it energizes me.
I will transfer this brilliance in all that I touch today.


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Iron and steel plus moisture often equals rust. Uncontrolled airborne moisture in a storage facility for iron and steel-will therefore usually have dramatically negative business consequences.
Among the many problems you're likely to encounter are:
- Corrosion on iron and steel rolls, plate, girders or semi-finished products
- Impacts on the value of iron and steel products while in storage
- Higher operating costs
- Too many customer complaints and compensation payments
- Increased warranty claims
Controlled humidity prevents corrosion
and maintains product quality
Humidity challenges where iron and steel are stored
Moisture and metals are never a good combination. High levels of moisture in the air – humidity – almost inevitably result in corrosion of iron and steel while in storage – whether in the form of rolls, plate, girders or semi-finished products.
Uncontrolled humidity, and the corrosion it causes, quickly impacts the value of iron and steel while in storage.
Avoiding corrosion and glitches
Corrosion flourishes on any surfaces of metals whenever the relative humidity in the air reaches levels above about 60%. Whereas if the relative humidity is 45% or less, the basic laws of physics make it virtually impossible for any corrosion to occur – especially in clean air.
Cotes adsorption dehumidifiers are the most cost-effective, reliable way to bring airborne moisture under full control in any kind of storage facility used for iron and steel, and thus enable you to eliminate all the problems that stem from condensation and corrosion.
By keeping stored iron and steel under carefully controlled conditions that prevent corrosion and condensation from ever occurring, you can keep the customers for your storage operations satisfied as well as keeping costs down and limiting claims, complaints and compensation issues.
How you benefit
Maintain better control of humidity levels anywhere you store iron and steel, thus making corrosion simply impossible
Maintain product value, by minimising damage and insurance claims
Minimise energy consumption while doing so, by using unique Cotes heat recovery modules
Prevent corrosion and other humidity-related damage to structures, fittings and equipment in your storage facility, resulting in lower building maintenance costs
How Cotes solutions stand out
Compact, robust and reliable
Built for resilience – long service life
Capable of removing large quantities of moisture from big volumes of air
Available with additional modules and control systems for specific needs
Exceptionally energy efficient


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AWWW. Sev's pain is adorable.
I can resist everything except temptation. ~ Oscar Wilde
Half Moon Bay Weyr - Weyrling Training Field
Near the tall black eastern wall of the crater is a cleared field. The earth there has been churned many times over by the landings and take offs of young dragons and only a few patches of grass cling to life in this active area. Wooden props and markers used to assist the weyrlings as they learn the precise maneuvers required for the rescue and protection work that the weyr is famous for, litter the training field. Close to the rimwall, in the east where the sun is usually shaded is a large wooden slat barracks for the weyrlings to live in. Tropical trees and shrubs have been allowed to grow here, perfuming the air with a floral scent.
It is late in the evening, just after dinner, and S'van is sitting beneath a tree, as far from the weyrling barracks as he could get while still being considered "close" enough. There is a dark sort of expression on his face, brows drawn down and lips pressed into a thin line. His dragon is nowhere to be seen, and Sev does not seem concerned by this. Instead, he seems intent upon destroying every blade of grass that dared to sprout near his spot.
"You missed some" says a small voice from somewhere above the tall man. There is scuffling sound of boots on branches and some twigs rain down on the other side of the tree but he voice still does not show itself.
Is S'van surprised that there is a child in his tree? Maybe. But he hides it well enough, though the grass in front of him shows surprising resilience at not withering immediately under his gaze. "I'm getting to it," he huffs in response, upset but not unwilling to play along. Another few blades are taken, torn into teeny-tiny minuscule fingers before he lets them flutter away on the mild sea-breeze. "What're you doing in a tree, in the Weyrling field?" he asks, tipping his head back to squint up and look for the owner of the voice, ducking a little at the fall of branches and debris that movement causes.
Sea foam green eyes stare back at the tall Weyrling, the lads close cut hair has branches and debris clinging too it and his face is dirty "climbing it, best tree to be able to watch the dragons" The tree it self does have what looks like old leather straps wrapped between two branches like a make shift bench. "How come you are out here from your lifemate?" the child will ask curiously.
"Suppose that's a good answer," decides the weyrling, snorting in mild amusement, even if his face doesn't display the same emotion. Just darkness, there. Hard eyes and tense jaw. "Not much to see at this hour, though," he notes, dropping his chin and staring forward again, uninterested in getting a crick in his neck just to make eye contact with a weyrbrat. "Most of 'em are asleep or getting' near it. Eating dinner." As for his own beast? He rolls his shoulders forward and reaches for another blade of grass. "He's sulking. Best if he does that away from me." Even if S'van looks like he's doing some serious sulking of his own.
You say, "Did he get a spanking? My brother always sulks when he gets one" he leans over to hang upside down above S'van "I fell asleep earlier, you woke me up so Thank you". he pulls a piece of jerky out of a pocket and takes a nibble and will offer some to S'van "Want sum?""
"A spanking?" repeats S'van. This actually prompts a little bit of a twitch to the corner of his mouth, the beginnings of something that may one day resemble a smile. "Yeah. Sort of," he decides. "Might as well have. Same feelings." His eyes lift, though he doesn't move his head, to peer at the little upside-down tree-creature. "Must be nice," for falling asleep in the tree. "Wish I could nap whenever I wanted," dry. As for the offer of the jerky? He hesitates, looking like he's going to say no, then shrugs and decides, "Sure, why not. I haven't had dinner yet," and he'll take what's offered. "Thanks."
Ekese grins and says "I am Ekese, but most people call me eek on account of I show up strange places" The jerky is spiced a little hot but still rather well done and only a few days old. "Did you get the spanking too?"
"I'm guessing that's because they say 'eek' when you jump out at them?" wonders S'van, looking a bit more like he might smile. MIGHT being the key word there. He takes an experimental bite of the jerky, hmms approvingly, and chews thoughtfully as he considers his answer. "Well, sorta," he says. "I got in trouble. Not exactly spanked, though. More like time-out."
Ekese ahhs and looks like he is going to say something but there is a loud cracking sound and the child is no longer suspended in the air. No he is falling directly upon S'van "ahhh" is all he can say before impact will happen..
Maybe it's having Aedeluth as a lifemate, but S'van's reflexes are pretty on-point by now, and that snapping branch and falling child has him acting rather quick, if just to get his darn head out of the way and direct the body towards something other than his sensitive areas. There's a general tangle of limbs and flailing arms as weyrling catches weyrbrat, and both likely end up in some sort of prone state on the ground. Sev? Wheezing and trying to catch his breath, as the impact to his diaphragm is like getting punched in the gut all over again. Only with a child on top.
Ekese is dazed and blinks alot trying to get his own bearings as he looks about. Rubbing his head he looks like he might cry but will look at S'van and try to dislodge himself which may or may not be what the man needs right now. "oww, are you ok? I didn't mean to hurt you" he knows that hurting the weyrlings is bad news.
For his part, there is just the attempt at breathing as his muscles protest the movement. Wheezing, then coughing, S'van rolls to his side as soon as the crushing weight of a ten-turn-old (not that crushing but, still. Force of impact and all that) is dislodged so that he can curl himself around his stomach. There's a furious nodding of his head, an attempt to answer the 'are you ok' though his voice and lungs are not cooperating enough to get actual words out. And then a few sucked in breaths, a wince, and he manages to croak, "…had worse…"
Ekese sits up still dazed and dizzy, weyrlings are hard! "Thank you" he says abit shyly now as he rubs his own head. "Ma says if you pull you knees to your chest it will make the muscles relax and you can breath"
S'van does as he's recommended, as best he can; drawing his knees up to his chest to try and relief the pain of muscle spasms. But he's getting things under control and the pain is starting to ease away a bit. "Trust me," he breaths out, barely audible but there, "I have definitely had worse. I got this…" even if he still can't really take a deep breath. "You make a habit of falling on people?" he asks, glancing over at the weyrbrat. And despite the pain, there's a bit of amusement in his grey eyes and yes, that tone was a bit of a tease.
Ekese shakes his head and almost falls over saying "only my brother when he over sleeps." he is still abit crossed and says "is your liftemate mad I hurt you?" he glances back at the barracks looking like he might bolt.
"Oh good," wheezes S'van, getting his breathing under control. "There's more of you." Meaning the brother. He pushes back up into a sitting position, wincing only a little as he rubs at his tender abdomen. "Aede?" he questions, casting a glance towards the barracks. "Nah. Not at all. Think he'd punch me himself sometimes, if he could." Now that he's back upright, he takes a proper look at Ekese. "You OK?" he asks. "It's alright. I'm not mad or anything."
Ekese eyes are a little spinny, but for the most part the kid looks ok, he does how ever crawl over and sit next to the bronze weyrling. "I think I don't like falling from trees" he says as he rubs his head more. He looks up and blinks with large green eyes at S'van "Why does your dragon want to punch you? Does he love you?"
S'van is not a healer, and therefore, not qualified diagnosing whether someone is about to die. Or maybe has a small head wound. Or maybe is just concerned about getting caught. Not to mention, he's much more preoccupied with his own various hurts, which are being made known to him now that the breathing issue is under control. Sore muscles from the impact of child and ground. But still, not too bad. "Yeah, I don't either," for falling from trees. "Best not to do that again, hm?" A roll of his shoulder, and he lifts his right hand across his chest so that he can rub at the left shoulder. "Of course he does," for his lifemate. "But he also thinks I'm an idiot sometimes. He's probably right," but the way he says it is filled with affection for his beast. "He's tough. He wants me to be tough, too. And I try to be."
Ekese will point to his head and say "your plenty tough, maybe he should teach you to be soft" but he smiles at the older man and says "Well you are a nice person, so I think you shouldn't change" yes wisdom from a ten turn old is absolute and must be followed.
Ekese's assessment earns a laugh of genuine humor from S'van, which makes him wince as it pulls at sore muscles. "I think I like you, kid," he decides, grinning at him. "And I try to be," tough. "But there are things I'm not good at, too. You know? No one is perfect." A beat, and he drops his arm from massaging his shoulder to ask, "How's your head hurt? Need to see a Healer?" Yes. Ask the child if he wants to see the doctor.
Ekese bends down so he can show the large bump on "I don't know, can we see the nice girl with the puppy?" he doesn't seem to mind the doctor but he will say "and can we not tell the Headwoman she always gets cranky when we get hurt and then we have to stay indoors for a sevenday."
S'van glances over, looking at Ekese's head with analytical eyes. And then a hiss of his breath through his teeth in sympathy. "Yeah… that probably needs to get looked at," he says with grimace. "Come on, I'll take you. And I can't promise for the Healer, but I can promise that I won't tell the headwoman, OK? This time, at least." He pushes himself to his feet, dusting himself off briefly as he waits for Ekese to join him.
Ekese will get up and copy S'van same way he dusts himself as well as how he walks, as they go he will snake his hand into the bronze riders walking happily to the Healers.
AWWW. Sev's pain is adorable.
I can resist everything except temptation. ~ Oscar Wilde


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Every small business should be on social media, especially Facebook. From its powerful advertisement options to Facebook groups, Facebook has many tools small businesses can and should use. A solid Facebook presence helps you engage potential customers and grow your business.
"Having a Facebook page helps to legitimize your business in the customer's eye," said Jake McKenzie, content manager for AutoAccessoriesGarage.com. "Or another way to look at it is a business without a Facebook profile may seem outdated at the best or untrustworthy at worst."
With so many ways to promote your business on Facebook, it can be difficult to know where to start. Here are six easy steps to make Facebook work for you.
1. Create a business page.
If you want to have a solid and professional Facebook presence, you need to create a separate page for your business – your personal Facebook profile won't cut it. A page is like a regular profile, but it's for brands and business. Also, instead of asking to "friend" someone, users must "like" a page to see its posts.
When you set up your Facebook page, you'll notice there are a lot of options to customize it. You should add as much information about your business as possible, including your address, contact information, website, business hours, products, etc. It's important to also add profile and cover photos that reflect what your business does.
Editor's note: Looking for information on social media management services? Use the questionnaire below and our vendor partners will contact you to provide you with the information you need:
2. Post regularly.
To use Facebook to promote your business, you need to do more than set up a Facebook page – you need to use it and post regularly.
"Post as frequently as you can and, at a minimum, once per day," said Katie Campbell, social media manager at Fundera. "Your audience and customers want to feel like they know your business and can relate to you."
While it's important to post regularly, it's just as important to post quality content. Campbell suggests posts that share behind-the-scenes information and photos about your employees and that shows off your products or services. This shows your dedication to transparency and quality.
If you're unsure what your customers want to see, experiment. You can use Facebook's poll features to ask what they want to see or take a look at Facebook Page Insights, which helps take the guesswork out of sharing.
Facebook Insights is free for every business page and shows valuable information, such as how many people engage with each post and how many people it reaches.
3. Promote your page.
What good is sharing and creating great content if no one sees it? Fortunately, there are ways to build a following on Facebook. When you first create your page, send invites through Facebook to your current customers.
Traditional marketing techniques can also help you grow your audience. You should put a link to your Facebook page in your email signature and on your business cards. It's also good practice to include all of your social profiles on your website and any marketing materials you produce.
Put a special coupon or promotion on your Facebook page, and tell customers to like your page to get the deal. If you create a simple and memorable Facebook URL, it's easier to promote it.
4. Engage your followers.
Facebook's new algorithm favors posts and pages that create engagement. Before posting anything on Facebook, you should ask yourself if it will create a conversation. It's also important to remember that Facebook is a social media platform, so you should be social.
"Businesses should interact with followers by responding to customer comments, questions and concerns," Campbell told Business News Daily. "Use your Facebook page for what it's meant to be: a social site. Get to know your customers' needs by hosting polls and responding to reviews."
The key to engagement is posting quality content. For best results, try to be friendly and conversational. Keep updates timely and respond to comments and private messages.
5. Leverage friends of fans.
People are most likely to try something if their friends already use it.
"Social media is the new 'word-of-mouth.' You want people to be able to tag your business when they're talking about you," said Cat Smith, owner of Get Social with Cat. "Your customers are your best advocates."
When customers interact with your page, their friends will see the activity in their newsfeeds. You can also foster more interactions using polls and asking questions followers want to answer.
Encourage customers to check in to your business on Facebook when they visit by offering a small discount for anyone who does. Checking allows users to notify their friends where they are. Host a contest or sweepstakes and encourage users to post about your business.
You can also create special events and limited-time promotions and invite your followers, who can invite their friends in turn.
6. Try Facebook ads.
If you're having problems reaching users organically, try Facebook ads. Promoted Facebook posts look like regular posts but are highly targeted and reach more people.
Facebook's tools are very effective and make it easy to target a specific audience. You can target people who like your page or by location, age, gender and interests. Because Facebook collects user data, it can target your advertisement to those who are most likely to be interested in your product or service.
The platform also features an analytics tool to helps you understand which ads drive interest and sales.
For more information about Facebook for business, read this Business News Daily guide.