text:
Assessing Factors that affect Childbirth Choices of People living positively with HIV/AIDS in Abia State of Nigeria
Ezinne E. Enwereji, Kelechi O. Enwereji
Enwereji EE, et al. OMJ. 25, 91-99 (2010); doi:10.5001/omj.2010.27
Objectives: Poor interpersonal relationships with women especially those living positively with HIV/AIDS can make them take risks that would expose their new born and others to infection during childbirth. The factors that influence childbirth choices of people living positively with HIV/AIDS (PLWHA) deserve attention. Sometimes, women, especially PLWHA, for several reasons, resort to the use of other health care services instead of the general hospitals equipped for ante-natal care (ANC). This study aims to identify factors and conditions that determine childbirth choices of PLWHA in the Abia State of Nigeria.
Methods:A cross-sectional descriptive study was carried out using a total sample of 96 PLWHA who attend meetings with the network of PLWHA and also a purposive convenience sample of 45 health workers. Data collection instruments were questionnaire, focus group discussions and interview guides. Data was analyzed both qualitatively and quantitatively using simple percentages.
Results: There was a low patronage for hospital services. A total of 79 (82%) PLWHA did not use hospital services due to the lack of confidentiality. In total, 61 (64%) PLWHA had their childbirth with Traditional Birth Attendants (TBAs) at home. Embarrassment, rejection, interpersonal conflicts with health workers, non-confidentiality, cultural stigma and stigmatization were among the factors that encouraged childbirth choices. On the whole, 82 (85%) of the PLWHA discontinued ANC services because of stigmatization.
Conclusion: Poor interpersonal relationships between health workers and PLWHA facilitated PLWHA childbirth choices more than other factors. PLWHA and health workers termed management of belligerent tendencies against each other as their greatest concern. Therefore, concerted effort is needed to improve health workers/PLWHA relationship in hospitals. This would minimize factors and/or conditions that encourage HIV infection. Exposing PLWHA to factors that influence childbirth at home demonstrates high risks of mother-to-child transmission, infection to others and obstetric complications.
From the Department of Medicine, Abia State University, Uturu, Abia State, Nigeria
Received: 05 Feb 2010
Accepted: 27 Mar 2010
Address correspondence and reprint requests to: Dr. Ezinne E. Enwereji, Department of Medicine, Abia State University, Uturu, Abia State, Nigeria
E-mail: firstname.lastname@example.com
Enwereji EE, et al. OMJ. 25, 91-99 (2010); doi:10.5001/omj.2010.27
Enlightening 'people living positively with HIV/AIDS' (PLWHA) on the need to use health care services so as to minimize mother-to-child transmission is an important aspect of HIV prevention program.1 In Africa including Nigeria, reproductive health services have not been very well patronized by PLWHA especially females despite the overwhelming knowledge and skills of health workers in care of PLWHA.2,3 It is felt that noting factors and conditions that determine childbirth choices of PLWHA, and deterrents to the use of health care services would be beneficial especially this period when many countries including Nigeria are committed to reduce their HIV prevalence rates.
Nigeria is one of the countries with high HIV prevalence rates. Ministry of Health's 2007 HIV/Syphilis sero-prevalence sentinel survey revealed a national HIV prevalence of 5% among women attending antenatal clinics aged between 15-49 years. With this high prevalence rate, it is necessary to encourage conditions that could positively influence the reduction in HIV/AIDS prevalence.
In Nigeria, like most developing countries, males control household expenditure and decision-making in families including reproductive health matters.4 Females' lack of decision-making power limit their access to health care and this could negatively affect maternal health outcomes.5,6,7 Males as the principal decision-makers on health care seeking, allow little communication with females as to their choice of health care during pregnancy and childbirth.8,9
Culturally, there are conditions that influence childbirth choices of females including those that are HIV positive. In cases of suspected extra-marital sexual relationships that probably result to pregnancy, childbirth would be at home preferably in a secluded place where elderly women in the community would watch for signs of protracted labour. If protracted labour occurs, it presupposes culpability and the affected woman would be abandoned. If eventually she dies in the process of childbirth, her cadaver with that of her newborn would be deposited in a thick forest usually far away from residential areas. Today, Christianity has modified some of these practices, but nevertheless, some rural communities are still practicing them.
Cordial relationship between health workers and PLWHA is very crucial in acceptance and utilization of health care services.10,11 Studies have shown that good interpersonal relationship increases health seeking behaviour of PLWHA.12,13 Individuals including PLWHA are unlikely to seek health care if they suspect disrespect, loss of privacy, stigmatization, rejection, and discrimination during health services.14-17 Also, the need to encourage PLWHA to have babies in hospitals where professionals could handle emergencies, blood and "mess" to minimize HIV transmission should not be over emphasized. It is in the attempt to contribute to further reduction of HIV prevalence in Nigeria, especially mother-to-child transmission, that the researchers undertook the study.
The study objectives include determining the factors that discourage PLWHA from having childbirth in hospitals where professional services are available. But also, to note the extent to which PLWHA encourage prevention of mother-to-child transmission. The study equally aims to identify the obstacles women/PLWHA face in accessing antenatal and obstetric services. Understanding these factors could be used to improve services in rural areas.
Abia State is located in the South-eastern part of Nigeria and comprises of 17 local government areas with a common language. The population is over 3 million (1991 census report). However, the population has dropped to a little over 2 million (2006 draft census report), probably as a result of high HIV prevalence rate that stands at 3.6%.2 Notwithstanding this prevalence, only a negligible number of people who are HIV positive belong to the network of PLWHA. Others are not interested to identify with the network. Out of the number that registered with the network, only a few accept to attend meetings, others conceal themselves in the rural areas.
There are also few health centers and general hospitals with qualified health care professionals that provide "antenatal'' (ANC) services. Moreover, these "antenatal'' ANC services are linked to STI services at all health care levels in Abia State. In addition, HIV pre- testing and post-testing counseling are also available.
In Abia State, about 50% of people in the communities have neither access to potable water nor good roads. Most people depend on stream water for domestic use. Only few individuals afford borehole water. Those who cannot fetch water from the stream depend on water they purchase from boreholes.
Also, approximately 30% of the land mass is hilly. Gullies made by erosion make means of transportation slightly difficult. There are tarmac roads in the major roads connecting rural areas, while the roads leading to the rural areas are dirt roads. About 85% of houses are zinc-roofed with the walls made of either un-burnt bricks or mud. The remaining houses are thatch-roofed with the walls made of mud.
The main means of livelihood in the rural areas is subsistence farming. It is estimated that 75% of the people earn their living from subsistence farming. Only about 7% of people in the rural areas have paid jobs. The rest earn their living by working as hired labourers to other farmers.
The study was a cross-sectional descriptive study. The study used both qualitative and quantitative methods. Qualitative research process enabled the researchers to assess the views of PLWHA on childbirth choices. This also helped to promote the participation of the samples in the study. The study explored the views of PLWHA on risks of having childbirth elsewhere other than hospitals.
The study population was comprised of PLWHA as well as health workers. A total sample of 96 members of network of PLWHA (56 females and 40 males) was used. These are individuals who have made public their sero-status and are active in the network activities. They present themselves regularly at the monthly network meetings. The President of PLWHA listed and invited these members for interview. In addition, a list of all health workers working in health institutions in rural and semi-urban areas was obtained from Ministry of Health. The health workers provide health care services to every individual including those living positively with HIV and AIDS. A purposive convenience sample of 45 health workers (20 in semi-urban and 25 in rural area) was studied. Network of PLWHA was used because of the difficulty the researchers encountered in locating PLWHA. Individuals who are HIV positive are reluctant to disclose either their sero-status or that of others. The researchers considered it safer to use the network of PLWHA whose sero-status is already known. The health workers were also studied because of their expected roles in the treatment, care and support of PLWHA. They were considered the most knowledgeable and trusted group in the community who should care and protect the interest of PLWHA.
Males (PLWHA) were included in this study because of the stringent roles men play in decision-making in the family. Culturally, males take all decisions including where females seek care, and childbirth. Including male PLWHA in the study was designed to overcome these practical obstacles. It was considered that planning interventions that require behavioural changes, long-term thinking and decision-making for females without involving males would have no positive impact.
Data was collected with qualitative and quantitative instruments. Data collection involved three methods, these were; questionnaire, focus group discussions and interview guides. These contained both structured and unstructured questions. 15 focus group discussions (10 for PLWHA and 5 for health care workers) were conducted to explore the conditions that influence childbirth choices of PLWHA. Each focus group had 9-10 participants. The health workers were aggregated by discipline while PLWHA were aggregated by sex, age and marital status during the focus group discussions.
Two training and briefing sessions were conducted for three research assistants who carried out the interview and the focus group meetings. One session was for data collection using in-depth interview guide, and the other session was for note-taking, observing and moderating using focus group discussion guides. During the training sessions, the research assistants were acquainted with the objectives of the study. This ensured uniform data collection because the same interviewing/note-taking standards and procedures were adopted. All discussions were conducted in the local language and also tape-recorded. This enabled participants especially the illiterates to take active part in the discussions. Participants were encouraged to talk freely among themselves. The tape-recorder used for focus group discussion was checked regularly to ensure its dependability.
Two types of instruments characterized by open-ended and closed-ended questions, one for PLWHA and the other for health workers were used.
The University Ethical Committee vetted and approved the study before its commencement. Following this approval, permission to conduct the study was obtained from Abia State Ministry of Health and also from the President of network of PLWHA in the State. Furthermore, the consent of all active PLWHA in the network and that of the health workers was sought and obtained. This enabled the researchers to collect information from the participants.
The instruments used for the study did not request the participants to write their names or to give any details that would identify them. In addition, statements of confidentiality were given. During the study, participants were briefed on the study objectives and permission to tape-record the session was sought and guaranteed.
The population of PLWHA studied was mainly people that belonged to the network who also attended network meetings. Those that neither belonged to the network nor attended network meetings were excluded. This means that the study only included the PLWHA who were available during network meeting. It may be possible that the PLWHA excluded from this study are the ones that encourage PMTCT by using hospital services during childbirth. The findings therefore, may not be generalized for all PLWHA in Abia State.
A major strength of this research is that PLWHA were encouraged to identify problems militating against the use of health care services provided to them by health workers. They were also encouraged to analyze the causes of such problems from their own perspective. Through this process, the PLWHA were not only aware of the result of the study but also they made important contribution into the research process which assisted the researchers in identifying strategies for improving the health services.
The study was mainly carried out with PLWHA who belong to an organized body such as the network of PLWHA. The instrument for study was tested with members of other organized bodies offering similar functions to some individuals. Three trained research assistants were used for data collection.
Data was analyzed, qualitatively and quantitatively. Tables with simple percentages were utilized. Focus group discussions were recorded, transcribed, and translated. The transcripts were reviewed to identify the themes. Data was manually coded and categorized according to the themes. Related ideas and information from both the focus group discussions and interview guide were pooled together and reported. Data reporting was conducted in two sections, one for PLWHA and the other for health workers. In addition, important information and/or ideas from participants' specific responses were highlighted. Simple percentages were used to clearly identify the specific factors that encouraged PLWHA childbirth choices at home. This enabled the researchers to note realistic intervention techniques needed to create positive changes.RESULTS
The PLWHA studied were comprised of 56 (58%) females and 40 (42%) males between the ages of 20-69 years. Their education and occupation varied. A total of 32 (33%) had no formal education, 16 (17%) had tertiary education, 27 (28%) had primary school education, while 21 (22%) had secondary school. In terms of occupation, 29 (30%) were artisans, 9 (9%) were civil servants, while 58 (60%) were subsistence farmers. With regards to their place of residence, 63 (66%) lived in rural areas while 33(34%) lived in semi-urban areas. Out of those studied, 18 (19%) were single, 39 (41%) were married, 21 (22%) were separated and/or divorced and 18 (19%) were widowed. Out of those who were married, 5 (13%) of them, all females, have discordant sero-status families.
In terms of the reactions of PLWHA on learning about their HIV sero-status, the findings show that PLWHA reacted in various ways when they first learnt of their HIV positive sero-status. The commonest thing 29 (30%) males and 30 (31%) females did was to attempt suicide. Also 20 (21%) females and 5(5%) males withdrew from public functions; while a negligible proportion 3 (3%) females and 6 (6%) males joined the network of PLWHA. The rest of the PLWHA took actions like such as resigning fate to God, buying drugs from patent medicine stores to treat themselves, confiding in the Pastor, and going to herbalists for treatment. Out of the number studied, only 2 (2.1%) of them, all females, reported that they told their family members but they also complained of maltreatment after disclosure.
In order to note the extent to which PLWHA accept their sero-status, they were asked their perceptions about HIV positive test. Findings showed that PLWHA viewed HIV positive test as synonymous with death, hatred, abandonment, rejection, stigmatization, and violence. A good number of PLWHA had the notion that life is 'not worth living' with HIV positive status. Stigma and discrimination were identified as the main problems of HIV test. Some PLWHA 33 (34%) females and 17 (18%) males complained of being badly treated, blamed and disowned for testing positive.
One of the main factors that influenced childbirth choices of PLWHAis cultural stigma. This was also amongst the factors that encouraged childbirth choices of some PLWHA. A good number of the female PLWHA during the focus group discussions reported that they were accused of causing the death of their husbands and as such, were subjected to inhuman treatment. Quoting from four female PLWHA, "we were pregnant when our husbands died but our husbands' relatives accused us of extra-marital sexual relationships. As such, we were confined to places where we were denied access to antenatal and obstetric care. We were strictly monitored for probable prolonged labour during childbirth so as to justify their accusations and apportion more punishments."
The findings revealed that the most worrisome factor that encouraged a good number of PLWHA to have babies outside the hospital was the unfriendly attitude of health workers. Quoting from six PLWHA "the nurses and laboratory attendants are very unfriendly, they shout, boo and curse us during health care services." (Table 1)
From these findings, both male and female PLWHA 67 (70%) reported unfriendly relationship with health care workers. Particularly mentioned were Nurses and Laboratory Scientists. The attitudes and/or behaviors of the health care workers that PLWHA termed as unfriendly were explored. (Table 2 contains summaries of some of the responses)
From the summary in Table 2, the commonest unfriendly attitude 53 (55%) PLWHA encountered with health workers was using eye contacts to make caricature of their sero-status.
Lack of confidentiality was a factor in non-utilization of hospital services. A good number of the PLWHA reported that "they withdrew from hospital services because the nurses told others about their sero-status." As high as 79 (82%) PLWHA did not use hospital services because of non-confidentiality. (Table 3 for details)
Further probing during the focus group discussion, revealed that nurses and laboratory scientists carelessly disclosed PLWHA sero-status to others without their consent. Quoting from four PLWHA, "the nurses and laboratory scientists are wicked. They
told others about our HIV test results." One of the PLWHA reported that "I am ashamed at the behavior of the Doctor who treated me. The Doctor went about telling people in the community including church members that I have AIDS and that I should be isolated. Since then, I have neither gone to his clinic nor to Church. As a result of the Doctor's actions, people jeer at me anytime I pass. It was after I joined the network that I was encouraged and now, I no more bother about such actions."
Discrimination was one of the factors the majority of PLWHA reported to have influenced their childbirth choices during focus group discussion. Quoting from six PLWHA, "the nurses and laboratory scientists discriminate against us. The nurses wear hand gloves when giving us drugs as opposed to what they do to other patients. If there were no gloves for nurses to wear, they would throw the drugs at us. For the laboratory scientists, they usually fling our HIV result on us thereby indirectly telling others about our sero-status."
A good number of PLWHA during the interview and focus group discussion reported that stigmatization affected their childbirth choices. As high as 82 (85%) PLWHA reported that antenatal and obstetric services were discontinued as a result of stigmatization. (Table 4 for details)
PLWHA mentioned that some of the attitudes health workers meted to them indicated stigmatization. For instance, ten PLWHA reported that "health workers jeered at us, called us dishonorable names, and even denied us medical attention." Using the report of one PLWHA, "because my wife is HIV positive, health workers in my community health center humiliated and denied her antenatal care (ANC) and obstetric care. Subsequently, I registered her with a traditional birth attendant (TBA) in the community. The TBA gave her antenatal services on the first visit. On the second visit, the TBA refused her medical attention stressing that health workers in the health care center warned her not to attend to my wife again because of her HIV status. I felt bad and abused the nurses for their dastardly act. After that encounter, my wife then registered with another TBA outside the community. There she eventually had her baby."
A good number of the PLWHA perceived services they received from health workers as very poor. They assessed services provided by TBAs at home as better than that of health workers in hospitals. Subsequently, the PLWHA were requested to give reasons for their assessment. (Table 5 contains some of the reasons)
The findings show that the most popular (81 (84%) PLWHA) reason for assessing services given by TBAs as better than that offered by health workers was that TBAs always provided the needs of newborns. They emphasized that while health workers grudgingly clean, dress, and/or immunize their newborns, that TBAs gladly provide these services. They reiterated that if not for the intervention of TBAs, their newborns especially males, would remain uncircumcised. From the females' responses, there was no identifiable strategy mounted by the health workers in the hospitals to assist HIV positive women during pregnancy and childbirth.
During the focus group meeting, a good number of PLWHA complained of non-acceptance by health workers. Majority of the PLWHA mentioned a list of variables that connoted non-acceptance. Seven PLWHA quoted "we stopped attending ANC because the nurses at ANC examination rooms would scold, abandon and/or boo at us especially when we delay in undressing before they (nurses) enter the examination rooms." One PLWHA specifically reported that "Nurses would deliberately fail to give appropriate instruction on what to do and/or where to go during ANC so as to scold and ridicule someone."
PLWHA complained of long waiting hours during ANC. Although findings showed that PLWHA had designated hospitals for their regular antenatal care services, yet 52 (54%) reported waiting for more than 2 hours before receiving medical attention. A good number of them confirmed that on several occasions, they had to abandon ANC services for maternity homes where they received prompt attention.
PLWHA also complained that high treatment bills influenced their childbirth choices. The findings showed that PLWHA paid as high as US $115 for laboratory investigations, and delivery charges. Also, they spent between US $6 to US$ 54 on monthly transportation to the ANC venue, and US $46 for hospital bed charges. In addition to these bills, the hospital would expect a carton of JIK bleach, and three packets of disposable gloves from each PLWHA during childbirth. Four PLWHA reported "when we had our babies in the hospital, our discharge was delayed because we were unable to pay our bills. We had to borrow money to defray the hospital bills before we were finally discharged home."
Consequently, PLWHA compared the cost for
having babies with health workers in hospitals and that with TBAs at home.
Findings showed that it costs as low as
PLWHA complained of long distances to access ARV and ANC services. Approximately 32 (33%) females reported traveling between 32-65 kilometers to access ARV and ANC services. Also, 25 (26%) males reported of traveling up to 65 kilometers to access ARV at a cost of $100 while 11 (12%) said they travel as far as 770 Kilometers to access ARV at a cost of US $ 8. In total, 6 (6%) PLWHA did not respond because they reported that they were not on drugs.
This study aimed to explore the extent to which PLWHA disclosed their sero-status to contact persons including family members, health workers, and TBAs. The finding revealed that majority of PLWHA did not disclose their sero-status to others. Of the 41 (43%) PLWHA who reported that they had their babies with TBAs at home, none of them admitted that they disclosed their sero-status to the TBAs.
Realizing the danger inherent in non-disclosure, PLWHA were hypothetically asked whether "If you were diagnosed living positively with HIV before or during pregnancy, and your health care provider does not insist that he/she knows your sero-status before childbirth, would you like to disclose to him/her your sero-status yourself or tell someone else to do so?" The question enabled the researchers to note the extent to which TBAs and other health workers are exposed to HIV infection in the course of discharging their functions. This question brought a lot of confusion as a good number of PLWHA responded in the negative. About 52 (54%) females and 38 (39%) males responded that they would not disclose their sero-status for reasons of rejection, isolation and stigmatization.
PLWHA were also asked "who makes the decision on where childbirth takes place in the family?" The responses to this question showed that males had greater influence on childbirth choices than females. A total of 43 (45%) females and 27 (28%) males admitted that generally, males decided childbirth choices while 7 (8%) females and 12 (13%) males said females decide childbirth choices. Overall, 61 (64%) PLWHA, comprised of 45 (47%) from the rural and 16 (17%) from semi-urban areas had babies with TBAs at home.
Realizing the number of PLWHA who had childbirth with TBAs at home, they were asked whether they perceived that there could be risks of obstetric complications during childbirth at home. The results showed that neither TBAs nor PLWHA viewed having obstetric complications during childbirth at home as a concern. Pregnancy was termed as a natural phenomenon for which no special attention should be required.
One important finding in this study was that majority of PLWHA had absolute confidence in the professional skills of TBAs. They (PLWHA) were of the opinion that whatever complications that arose during childbirth with TBAs, that the TBAs would competently handle such complications. This confidence on the effectiveness of TBAs in managing obstetric complications may have partly contributed to the decision of male PLWHA to prefer their wives to have childbirth with TBAs at home than with health workers in hospitals.
Perhaps, the most provocative finding was the fact that during the focus group discussion, a good number of PLWHA reported that they discontinued use of iron tablets and/or ante-retroviral (ARV) drugs for the unconvincing reasons of having big babies and threatened abortion respectively. This practice showed that PLWHA lacked knowledge of the advantages of iron tablets and ARV during pregnancy.
There was substantial need to determine the extent to which PLWHA and their newborns were protected from HIV infection and/or re-infection during childbirth. To ensure this, they were asked whether they had been taught the dangers of having frequent pregnancies, and/or discussions on reasons to limit pregnancies. Findings showed that 26 (27%) of the females and 9 (10%) males admitted having been taught the dangers of having frequent pregnancies, while 21 (22%) females and 12 (13%) males reported that they have had discussions on why people should not have many children. The rest responded in the negative.
During focus group discussion, the study noted five main concerns of PLWHA. Firstly, accessing free medical services. Majority of PLWHA reported that they paid for virtually all services they received. Secondly, having meaningful means of livelihood. A good number of PLWHA including those working in hospitals affirmed that they lost their jobs while those in school reported that they quietly withdrew from school as a result of their sero-status. Thirdly, they were concerned on increased acceptance. Majority of the PLWHA worried about being stigmatized and discriminated against in the society. Fourth, on having more babies for social acceptability. A good number of the female PLWHA complained of difficulty in getting pregnant as a result of irregular menstruation. Culturally, the more children one has, the richer and more socially acceptable the individual would be assessed. Fifth, on improved relationship with health workers. Majority of the PLWHA complained of constant interpersonal conflicts with health workers.
The health workers studied comprised of 20 (44%) males and 25 (56%) females between the ages of 21-59 years. They constituted of 12 (26%) nurses, 5 (11%) laboratory scientists, 4 (9%) Pharmacists, 19 (42%) medical doctors, and 5 (11%) TBAs. In terms marital status, except 8 (18%) that were single, the rest were married.
The health workers were asked to enumerate types of services each provide to PLWHA. (Table 6)
The findings showed that the commonest service health workers provided to PLWHA was treatment of opportunistic infections. Only few nurses provided circumcision and immunization to the children of PLWHA. Quoting from three nurses, "expecting us as nurses to immunize and circumcise children of PLWHA who may also be infected, would mean exposing us and others to risks of HIV infection." Furthermore, analysis of the findings revealed that none of the health workers studied mentioned counseling whether for HIV or general counseling as one of the services they offered to PLWHA.
Health workers were asked the extent to which they insist on knowing the sero-status of those they served. From the responses, only 13 (29%) of the health workers mainly Doctors reported that they insist on knowing the HIV status of patients and even refer some to laboratory test. Others reported that they do not insist on knowing patients' HIV status because of misunderstandings and personality clashes with patients.
Health workers were asked of their relationship with PLWHA. To determine this, some indices on good relationship were provided. The finding showed that 32 (71%) of health workers especially nurses and laboratory scientists had had some disagreements with PLWHA. Three nurses reported "we are careful in dealing with PLWHA because they are very violent, obstinate, abusive and are prepared to fight at the least provocation." Specifically, two laboratory scientists narrated instances where PLWHA exhibited acts of aggression on receipt of their HIV test results.
The extent to which health workers including TBAs protect themselves and/or the newborn against HIV infection was explored. To ensure this, health workers were requested to mention HIV prevention strategies they used when providing services to PLWHA. The findings showed that health workers
adopted a limited number of prevention strategies including PMTCT measures during services. From the findings, 15 (33%) Doctors said they used Caesarean sections, administration of ARV to pregnant women from the third month of gestation, and also to the new born to prevent PMTCT. The rest of the health workers, 30 (57%) admitted they used only globes, sterilization of all instruments, JIK bleach, and apron to prevent HIV infection. From these findings, none of the health workers used other universal precautionary measures to protect themselves and others against HIV infection when providing services.
There was need to note the extent to which the health workers were exposed to trainings on HIV and AIDS. To record this, the health workers were requested to list as many training exposures they had received on HIV and AIDS. The findings showed that a total of 29 (64.4%) of the health workers said they had attended training seminars and workshops on advocacy, awareness creation, emergency obstetric care techniques, pathogenesis and treatment. The rest reported that they had not been trained.
The health workers had six striking concerns. Firstly, how to manage aggressive tendencies of PLWHA. Secondly, the negative policy on free treatment for PLWHA. The amount of money PLWHA pay for hospital services justifies this concern. Thirdly, the fear of being infected. The numbers of health workers in the study group especially nurses who are already infected could heighten this concern. Fourth, the incidence of obstetric problems due to constant pregnancies among PLWHA. Fifth, the inaccessibility of drugs especially ARV for PLWHA. Sixth, the need to attract sponsorships to conferences, seminars and workshops both nationally and internationally.DISCUSSION
This study provides confirmation to the multiple risks PLWHA take in their childbirth choices. Striking similarities on information given by both health workers and PLWHA confirm that factors such as unaffordable hospital fees, inaccessible hospital services, poor quality services, lack of confidentiality, stigmatization, poor interpersonal relationship, and others encouraged childbirth choices at home.
Among the factors that influenced childbirth choices at home, poor interpersonal relationships with health workers remained the most important factor that influenced PLWHA childbirth choices with TBAs at home. Nearly two thirds of the PLWHA who had childbirth at home with TBAs did so as a result of poor interpersonal relationships with health care professionals. PLWHA assessment of poor interpersonal relationship was largely based on the experiences they had with health workers during ANC and obstetric services. For instance, PLWHA enumerated actions such as beating, scolding, shouting, name calling, discriminatory provision of health care services and other health workers meted to them that amounted to poor interpersonal relationships. This finding on poor interpersonal relationship is relevant because measures to improve interpersonal relationships constituted the major concerns of both the PLWHA and the health workers. The finding that PLWHA had poor interpersonal relationship with health workers was also confirmed in other studies.1,3 This poor interpersonal relationship could be part of the reasons why PLWHA perceived the services of TBAs better than that of health workers. The fact that TBAs undertook to immunize and circumcise PLWHA newborns and also assisted in cleaning blood and mess after childbirth shows that health workers in hospitals had little or no plans to assist HIV positive women during pregnancy and child birth.
Therefore, it is felt that if health workers in hospitals promote positive values and avoid interpersonal conflicts with PLWHA, such could constitute motivating factors to increase PLWHA childbirth choices in hospitals. This is necessary because full ANC and obstetric care services provided by health workers in hospitals rather than that by TBAs at home will likely reduce the risk of mother to child transmission (MTCT). PLWHA preferring childbirth at home with TBAs than with health workers in hospitals could result in apparent increased risk of mother-to- child transmission (MTCT).
The fact that males had the prerogative to decide childbirth choices for PLWHA suggests that male dominance and power imbalances in the family set up also apply to PLWHA. The finding that males influenced decisions on childbirth choices of PLWHA agrees with that reported that males take most decisions in the family.5,7,8 Unfortunately, the subordinate positions of women including PLWHA limit their participation when family issues including childbirth choices are discussed.
Reviewing the social environment to a large extent, there was poor knowledge of HIV prevention methods among the participants. This poor knowledge could be a reflection of inadequate exposure to seminars, conferences, workshops and trainings. This was noted by the limited use of universal prevention measures health workers adopted during health services. There was also limited knowledge on benefits of PLWHA disclosing their sero-status to contact persons including health workers. This limited knowledge which is detrimental to HIV prevention and the finding calls for adequate intervention strategies to enlighten participants on benefits of disclosing HIV sero-status.10,13,14
Another inertia to poor knowledge of HIV prevention is the unwillingness of PLWHA to take either ARV or iron tablets due to fear of abortion and/or having large babies. There was fear that taking iron tablets during pregnancy could result to having large babies. Having large babies connoted attracting extra expenditure for their husbands because of the likelihood of undergoing Caesarean operation which could occasion loss of life. Also, taking ART during pregnancy was implicated as the cause of incessant abortion among PLWHA.CONCLUSION
The findings from this study provide valuable information on factors determining childbirth choices of PLWHA. These factors need to be taken into account when policy makers are planning and/or providing services to PLWHA. For example, Government should be made aware that PLWHA need to be supported and encouraged through training to enable them to learn more about their reproductive health rights as well as the benefits of childbirth in hospitals.
Regular training and retraining is crucial for health workers. Emphasis should be laid on regular training of health workers on benefits of good interpersonal relationships, as well as in all aspects of HIV preventions. There should not be an assumption that health workers are knowledgeable and competent. However, PLWHA and health workers, regardless of their personal HIV prevention experience, need sufficient HIV prevention knowledge and good interpersonal skills so that they can confidently minimize HIV infection and MTCT.
The health workers should assist PLWHA with obstetric and other problems needing prompt medical attention. This recommendation necessitates the importance of health workers to mainstream services to PLWHA to enable them to make adequate use of hospital services during pregnancy and childbirth. This recommendation is premised on the fact that PLWHA, because of poor interpersonal relationships they experienced with health workers especially nurses, tended to patronize childbirth at home with TBAs rather than in hospital with health workers. There is great need for policy makers to address the plight of PLWHA by funding periodic seminars for PLWHA and health workers.
Bills for services rendered to PLWHA should be free or at least a token. Free services will motivate PLWHA to patronize health workers in the hospitals.
There is need for more detailed research to be conducted on the plight of PLWHA during health services. Elaborate research will highlight the areas policy makers, stakeholders and gatekeepers need to pay more attention in the implementation of HIV and AIDS prevention. The findings of such study will also alert them on the actual problems PLWHA face.
Authors acknowledge organizers of the international conference for Third World Organization of Women in Sciences (TWOWS) in Bangalore, for the opportunity to undertake this work and for sponsorship. We thank the Ministry of Health for approving the study the PLWHA for volunteering. There is no conflict of interest. The researchers bore all the financial implications of this work. The study was conducted n order to contribute towards the well being of people living positively with HIV and AIDS.


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Michael Jackson This Is It
"This Is It" is being produced with the full support of The Estate of Michael Jackson and will be drawn from hundreds of hours of rehearsal and behind-the-scenes footage, captured in high definition with state-of-the-art digital sound as the late singer was preparing for his concert series in London. The film, which will also offer select sequences in 3-D, will provide a unique career retrospective and feature interviews with some of Jackson's closest friends and creative collaborators.
1hr 52mins long
Michael Jackson
Kenny Ortega

subset: commoncrawl


text:
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text:
The Scarecrow Stomp is coming to Dahlonega and Lumpkin County
Name: The Scarecrow Stomp is coming to Dahlonega and Lumpkin County
Date: August 27, 2018 - September 23, 2018
Trip Builder: View Trip
Event Description:
The Scarecrow Stomp is making its way through Dahlonega and Lumpkin County with the arrival date of August 29. Voting begins September 1 and continues through September 23. After selecting your favorite "Crow," go to www.surveymonkey.com/r/scrows to cast your vote. Maps of the 47 scarecrow placements are available at the Dahlonega Lumpkin County Chamber of Commerce Visitor's Center. For further information, please contact Betty Petrie at 706-867-0958 or Lori Stapleton at 706-867-6694
or email firstname.lastname@example.com
or email email@example.com


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You are here
There are two Cadet Units at the school.
Emergency Services Cadets (ESC)
Emergency Services Cadets are a group of 40 - 60 girls and boys Yrs 7-12 who meet regularly after school in Ocean Reef Senior High School gymnasium and on some weekends to learn new and exciting skills. These skills are the same skills used by our many volunteer and professional Fire and Emergency crews.
ESC is an affiliate of DFES (Department of Fire and Emergency Services) and much of our training is based on State Emergency Service training. By Year 11, cadets have received leadership instruction and are expected to take lessons and act as role models for the lower ranks. Although we are not a military unit discipline is an important aspect of our values. 2018 planning is under way but previous years saw the cadets go on camps to Pt. Peron, Gin Gin, Byford, Gidgegannup, Rottnest, Pt. Peron, Dwellingup, Harvey and Yanchep.
Emergency cadets cover a wide range of DFES volunteer and Professional service groups. It teaches skills used by them in emergency situations. Good swimming ability is not essential.
Surf Life Saving Cadets (SLS)
Surf Lifesaving Cadets are a group of 100 - 120 students, years 7-12. Year groups meet once a week after school and on some weekends. A majority of activities are conducted outside of the school and cadets learn new and exciting skills, form friendships, learn to work as a team and develop leadership skills. The Surf Life Saving Cadet Unit is an affiliate of SLSWA (Surf Life Saving Western Australia). 2018 planning is underway but previous years saw the cadets go on camps to Point Peron, Bickley, Augusta, Rottnest, Yallingup and Margaret River.
For the start of 2018 we are looking forward to our incoming Year 7's joining the programmes. Cadets will need to be prepared to give up two hours after school and two weekends throughout the year.
Lifesaving Cadets work towards helping the community through improving their surf qualifications and knowledge. Good swimming ability is required.
Can you join ESC and Lifesaving cadets?
No, funding is limited so cadets can be a member of only one unit.
More information can be found at http://www.cadetswa.wa.gov.au/ If you are interested in joining please phone the front office on (08) 6206 2700.


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East Grand Boulevard in Corona reopened Monday morning, Oct. 12, a little more than two days after a freeway onramp bridge being constructed above the road partially collapsed and injured nine workers.
Construction of the onramp was part of a a larger freeway widening project that was suspended over the weekend, but was planned to resume Monday. Since the collapse did not affect the 91 freeway itself, it remained open throughout the weekend.
John Standiford, deputy director at the Riverside County Transportation Commission, said Sunday that a number of structural engineers have assessed the bridge and concluded it's safe for Grand Boulevard traffic to resume beneath.
The street, which has been narrowed to one lane in each direction during the 91 project, will reopen that way.
RELATED: 91 overpass partially collapses
The accident happened about 11 p.m. Friday as a team was lowering a section of the onramp bridge into place. For reasons still under investigation, the wooden support beams gave way, causing the slab to drop about 16 inches, Standiford said.
The broken beams struck several of the workers. By Sunday night, seven remained hospitalized, Standiford said; an eighth who had been hospitalized Saturday was released.
Standiford said he could provide no more information about the conditions of the seven hospitalized people because of medical privacy issues.
All injured workers are affiliated with the Atkinson Walsh Construction Joint Venture.
RELATED: 91 freeway projects have seen trouble before
Investigators from Atkinson Walsh, the transportation commission and the California Occupational Safety and Health Administration were on the scene Saturday investigating the accident.
Anne Mayer, RCTC executive director, said Atkinson Walsh will hire a forensic engineer who is not associated with the project to evaluate what happened.
The $1.4 billion widening project began in July 2014, and is one of two major projects along the 91 in Riverside County. It will extend two tolled express lanes in both directions on the 91, from the border of Orange and Riverside counties east to the I-15/91 interchange in Corona.
It also will add one regular lane in both directions from the I-15/91 interchange east to Pierce Street in Riverside, and improve five local interchanges, as well as the I-15/91 interchange.
It is scheduled for completion in 2017.
The other ongoing project is adding a carpool lane along five miles of the 91 through Riverside. That project was not affected by Friday's accident, officials said.


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Sing My Caged Bird Sing
I Know Why the Cage Bird Sings depicts a time period in American history that many Americans would rather leave behind and forget for its illiberal and subordinate actions towards the minority black community. Maya Angelou wrote this autobiography to acknowledge such events in history, and to make Americans remember the hardships people faced during this time period; with the hope to have an end to this immense setback in history. Maya describes her childhood in a southern town of Stamps, Arkansas during the 1930's. As a child, Maya was introduced to a world of segregation, displacement and racism; which molded her life and character as an adult. She then describes her new life in California during the 1940's where she finds new opportunities and becomes aware of life itself. Maya is faced with overwhelming obstacles and barriers throughout her lifetime that make her progress and develop a distinct viewpoint towards life.
During the 1930's the black community faced a verity of barriers that hindered their progression in society, especially in the south. Blacks faced segregation, prejudice and racism that diminished their statues and mobility in society, and black women faced an additional barrier of sexism. Maya illustrates this world with the viewpoint of a young black girl who is vulnerable to all of these setbacks in society. Three events took place where Maya describes such factors being displayed in her personal life; a dentist denying her as a patient, her white boss replacing her name to Mary, and at her eighth-grade graduation where the speaker looks down upon the black community in higher education. All of these occasions were influenced by the establishment of segregation and prejudice taking place in society. Blacks and whites were so apart in Stamps that Maya did not even believed in the existence of whites on earth and saw them as aliens. Society was able to overcome such barriers by taking refuge in church activities, keeping their dignity when disrespected by others, and even using extreme measures like violence as Vivian's family did in St. Louis, Missouri.
The climax of the story was Maya's accomplishment of reaching adolescence and developing a full understanding of her obstacles in life. When Maya moves to California to live with her father she has an argument with his girlfriend, and then sheepishly runs away for a month. During that time she comes to her realization of life and is taught life lessons about the acceptance and appreciation of diversity. This allows her to strive for awareness in prejudice and challenges society's barriers towards women and the black community. In result she becomes the first black streetcar conductor that establishes her first step in her long life of change in the world. At the very end of her autobiography Maya enters the world of motherhood while holding her baby and finally understanding love and companionship in a lonely world. Before, she would avoid her son because of her fear of causing him any harm or not being able to handle herself having him in her arms. One day her mom, Vivian, gives her a lesson in motherhood and advised her to just have her heart in the right place which would guide her with the right decisions towards her son's wellbeing. Her mother's advises has a hidden message and apology of not being there during her early years and making her feel lonely in life, but also gives off Vivian's remorse of being apart from her children during that time. Vivian finally persuades Maya to sleep with her son in the same bed. Maya is still shaken by the overall sensation of being so close to her son that see tries to stay awake, but fails to do so. At the very end she closes her eyes and lies with her son peacefully beside her.
The time period of the autobiography takes place during the 1930's through 1950's where segregation is still emplaced in American society and the black community as well as other minority races are being targeted by prejudice actions. Segregation and prejudice are emphasized in this book to illustrate the overall theme of rising from the ashes like a phoenix by surpassing and destroying such barriers. Blacks were not treated equally as whites, and women were also victims of sexism during Maya's childhood and adulthood that influenced her own perspective. Maya states that her life was a nightmare fill with ugliness and would soon be awaken into her true body having blond hair and blue eyes. This statement illustrated Maya's true perspective of her own race and sees it as unattractive and incomparable to the beautiful and perfection of white folks. She later states that she would rather be a boy then a girl; which demonstrates the different status and acceptance of both genders in society. In spite all of these negative ideas about her; Maya was able to overpass them and development a strong character determined for a change. Maya is able to connect to the modern world by choosing a universal aspect in life, racism and prejudice; which today unfortunately is still seen in America. The minority population in America is still being hindered by these factors in society, and one way to prevent such matters is by surpassing them and addressing their long term effects. Maya addresses this aspect and is an ideal example of a survivor of these cruel actions of human beings.
The most interesting part about this book is the emphasis in philosophical actions and thoughts of human beings especially with children. The viewpoint of a child in Maya's autobiography gives the reader a fuller understanding of her own life and development from childhood into adulthood. Her viewpoint is very different from today's ordinary eight year old because of the exposure to more sever situations; segregation and constant prejudice emplaced in society at that time. The one thing that surprised me was the cruel actions of Mr. Freeman of rapping Maya as a child. I was not expecting such betrayal from him or to even consider having those thoughts towards Maya. Mr. Freeman took advantage of Maya who was lonely, in need of affection, confused and made her believe his actions were acts of love towards her. This event devastated a child's life and destroyed her purity and childhood. Maya's autobiography demonstrates the cruelty and hardship of black children during the 1930's through 1950's and the influence of ideology in a society. As a whole I Know Why the Caged Bird Sings deserves a five star rating from its twisted and turns to its magnificent and elaborate intertwining of threading events.
Rhetorical Triangle
Maya Angelou is the author and main character in her autobiography that describe the hardships for the black community during the 1930's through 1950's in America. Maya's ethos demonstrates a very creditable source of information even though it mainly accounts her as a child. Her reliability, expertise and fairness can also be reinforced by her position as a civil-right activist in later years. The overall message Maya wants to portray is hope in overcoming barriers that may hinder ones progression in life. Maya directs this message towards Americans and more specifically the black and minority community as well as those ignorant to such matters in history described in her book. The importance of this message to the audience is to inform and prevent prepetition of our past mistakes and to also acknowledge the hardships the black community faced during this time period. Her tone of philosophical observations in her personal life strengthens the message to the audience because it gives a more real and universal feeling. In other words her tone gives the audience the sensation of reality and a "you are there" feeling. Maya is able to communicate her message by depicting the setting in a southern town during the 1930's. Right away Maya lets the audience develop some connotative thoughts by linking the setting to segregation, racism, and prejudice towards the black community. This image also invokes both pathos and logos appeals to the audience. The overall idea of segregation depriving groups of people from certain things or opportunities is a logos appeal which is logical. This story however, focuses more on emotional or pathos appeals that deliberately help convey a stronger message to the audience. Describing the event when she was raped by a man who she trusted invoked a verity of emotions from sadness, to anger, to fear, to irony. Another way Maya evoked emotions was when she gave birth to her first child something that could relate among the audience and share emotions of happiness or fear. The overall purpose of this book is awareness towards these historical events that consist of segregation and diminishment of minorities in society.
Side Notes from: www.csus.edu
The Rhetorical Triangle
Three important elements come into play when creating any kind of argument. These are illustrated by the rhetorical triangle:
Logos: Rational or Logical Appeals. Appeal to logical reasoning ability of the audience through use of facts, case studies, statistics, experiments, logical reasoning, analogies, anecdotes, authority voices, etc. Are writer's claims reasonable? Is there sufficient evidence to support those claims? Does the speaker make logical conclusions? Does he/she talk about counter-arguments, other opinions or points of view?
Pathos: Emotional Appeals. Appeal to beliefs/feelings of the audience. An appeal of pathos can move an audience to anger or tears as a means of persuasion. May attempt to invoke particular emotions such as fear, envy, patriotism, lust, etc. Or, an appeal of pathos may stem from shared values between the author and the audience, or from an argument that caters to an audience's beliefs.
Ethos: Ethical Appeals. Appeal based on the character, persona, and/or position of the speaker. This kind of appeals give the audience a sense of the author as competent/fair/an authority figure. Such an appeal may highlight the author's trustworthiness, credibility, reliability, expert testimony, reliable sources, fairness, celebrity, etc.
Using the Rhetorical Triangle to Analyze Media Messages
The media – advertisements, and often TV shows and movies, are visual arguments. They attempt to persuade readers to buy a product/viewpoint using the same kinds of appeals authors use when constructing a written argument. So, when you analyze a piece of media, it is important to remember the rhetorical triangle. Ask yourself: Who is the author? How is the author trying to represent himself/herself? What is the message and how is that message coming across? Is the argument logical/emotional? Who are the intended receivers of the message? Is the argument having its desired effect on those receivers?
Specific Questions to Consider (No, not necessarily all at once…):
The Author
- Who is the author? Is it a business firm trying to sell you a product or a service, a public organization seeking to inform you about its policies, a politician trying to win your allegiance, an interest group or media member trying to change your opinion about an issue? Other?
- What is the ethos (general credibility) of the author?
- What is the ad trying to accomplish? In other words, what is the sender's "problem?" There is often some kind of communication problem behind an ad or campaign. For example, the authors may seek more awareness on the part of the receiver, or more legitimacy for themselves. Are you aware of any problems the sender (company) may be having within that specific industry, market, or area of activity?
The Message
- What is the simple message of the media? What product is the ad trying to sell? What is the subject of the movie/TV show?
- What is the true message of the media? Are there any hidden meanings the receiver is intended to observe? Do any connotations come to mind when you view the media?
- What ideologies or values does the piece of media invoke? In other words, what images, discourses, concepts, myths, etc. of the culture does the media use when making an appeal?
- How is the message presented? In an advertisement, what is the layout? What images, text appear, etc.? If it is a TV Show or movie, who are the characters? What is the setting, etc?
- How does the media connect concrete features with abstract values? In other words, how does the presentation of the message communicate deeper/abstract meanings (our values/norms) in addition to the simpler meaning (what is being sold)?
The Receiver
- Who is the targeted audience? What individuals/group of individuals is/are intended to receive the message?
- Is the media having the desired affect on the targeted audience? Are the logical/emotional/ethical appeals working? Is the audience being persuaded to buy what the media/advertisers are selling? If yes, why? If not, why not?
- If the desired message comes across effectively, might there be any consequences for the receivers? For society as a whole?


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There are over 1,400 functioning satellites currently orbiting the Earth, but that number could grow exponentially if Elon Musk has his way. The entrepreneur, through his company SpaceX, has submitted an application to the Federal Communications Commission (FCC) to launch 4,425 satellites. The goal? To provide high-speed internet coverage to the whole planet.
Business Insider reports that the satellites are intended to orbit the Earth at altitudes ranging from 715 to 790 miles, effectively providing 1,300 miles of coverage each. SpaceX says their proposal will provide the global community with high-speed service of 1 Gbps; currently, users average about 5.1 Mbps, which is 200 times slower.
"The system is designed to provide a wide range of broadband and communications services for residential, commercial, institutional, governmental and professional users worldwide," the company wrote in its application.
Proposed roll-out
In its application, the company detailed a two-phase launch plan; the first phase would launch approximately 1,600 satellites at one altitude and the second phase would introduce another 2,825 satellites placed in four shells at different altitudes.
While the full number of satellites will provide worldwide coverage from North Pole to South Pole, SpaceX says the first 800 satellites to launch will provide service to much of the world.
"With deployment of the first 800 satellites, SpaceX will be able to provide widespread U.S. and international coverage for broadband services. Once fully optimized through the Final Deployment, the system will be able to provide high bandwidth (up to 1 Gbps per user), low latency broadband services for consumers and businesses in the U.S. and globally," the company said.
Getting more people online
SpaceX points out that its plan will go a long way towards providing all countries with usable broadband service, citing a July report by UNESCO's Broadband Commission for Sustainable Development that "4.2 billion people (or 57% of the world's population) is offline for a wide range of reasons, but often also because the necessary connectivity is not present or affordable."
The company states that being cost-effective and reliable are main focuses for the project – all the way from production to the prices that subscribers will pay for the service. Each satellite is estimated to last between five and seven years before it begins to decay. However, the company says that it will be looking to periodically improve the satellites over the deployment period.
SpaceX has stated that it will begin launching prototype satellites as early as next year, though the launch of the actual constellation of satellites will not be realized until the end of the decade, according to a BBC report.
Keep an eye on your inbox, the lastest consumer news is on it's way!


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He holds my tomorrows!
Verse for Today: Saturday, December 31, 2011
Verse for Today: Saturday, December 31, 2011
Revelation 1:8 – "I am the Alpha and the Omega," says the Lord God, "who is, and who was, and who is to come, the Almighty."
God's people have the privilege to begin and end the years of their sojourn with the Almighty who is beyond beginning or end. All living things on earth have a beginning and an end. The affairs of all that exist in this universe have their beginning and end as directed by the Almighty who controls our lives from the beginning. But it is amazing to realize that God's people were seen by His eyes before the foundation of the world was laid. Our ancestry was directed by Him through the centuries and at the right time we were made to be born and born again into God's family. We were known to Him before time ever broke into being and our eternal life is also known to Him. Our years are important to Him because we are part of His plan and program. So every seemingly insignificant and unimportant event in our lives has His hands behind it all. He has a plan for us each day of our lives, but it is up to us to know and live according to that plan. He leads us a step at a time so that we would accomplish this plan daily. Days and years come and go, but His hands are with us as we rest in His mighty arms. Each evening, we have the privilege to see how He led us that day and what we received from Him. At the end of every period of time like the year, we can take stock of our mistakes, failures, disobedience and lost opportunities and feel sorry for it all. We can also enlist the innumerable blessings that we enjoyed from Him and thank Him. The failures teach us lessons to guard against and blessings are for us to trust Him to move forward.
Dear friend, the end of the year is a time for you to take stock of the year that is passing. We all need to search our souls to see how we made use of the opportunities in serving the Lord and to learn lessons to avoid failures and losses. Failures need not pull us back, but push us forward with greater trust in the Lord. Our God is able to take glory to Himself even through our failures. If the Lord has closed certain doors, let us not force it open. Let us thank Him for the doors which He closed and for those that He has opened. Remember, He is the Alpha and the Omega and knows the beginning from the end. He leads us with an eternal perspective and not with the temporal. His valuation of our lives and struggles is on the basis of how it has added to our spiritual welfare and His glory. It is also a great assurance that He will be with us now and throughout the upcoming year. He is not finished with us yet and will continue to work on us and with us to accomplish His purpose in us. We progress from year end to a New Year and go on to timelessness when we reach our eternal home. Let our vision and goal for the coming year be faithfulness to Him and His cause. He will be with us each day of the New Year and will lead us through all the life experiences which are yet unknown to us, but known to Him. He has already prepared His resources and ways to meet all our future needs and all the experiences which await us in the New Year and beyond. So let us praise Him for the unknown days, months and years which unfold before our eyes day by day.
Psalms 68:19 – Praise be to the Lord, to God our Savior, who daily bears our burdens.
Thought for Today
We do not need to know our tomorrows because we know our Lord who knows all our tomorrows and has already made provisions for it all.
CONTACT US: email@example.com


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Diamond Guide
Every diamond is unique. Whether buying or selling a diamond it is important to understand how diamonds are evaluated. Diamond shape and the universal 4 C's (cut, carat weight, color and clarity) of assessing a diamond's quality are explained below.
Diamond Shape
A diamond's shape refers to the general outline or silhouette of the diamond. Note that diamond shape is not the same as a diamond's cut. Below are some examples of diamond shapes.
Diamond Cut
Diamond cut should not be confused with diamond shape. A diamond with the same shape can have a different cut. Regardless of its shape, a well-cut diamond determines its fire and brilliance. This is what makes a diamond sparkle. If a diamond is cut to ideal or perfect proportions, light will reflect and refract making it sparkle. If a diamond is poorly cut, or cut too shallow or too deep, light will escape out of the bottom or sides of the diamond making it appear more dull.
Here are some examples of different cuts of diamonds.
Below is a diagram of a diamond's cut from GIA.
Below is a comparison of shallow, ideal and deep cut proportions of a diamond and how light is refracted. Notice how only an ideal cut diamond refracts light out of the top making it appear bright and sparkly. Also, note how much smaller the table (top) of a deep cut diamond appears compared to an ideal cut diamond. If you had two one-carat diamonds side by side, the deep cut diamond would not only look darker and duller, but also considerably smaller.
Diamond Carat Weight
Carat weight is the standard measurement of a diamond's size, but technically carat weight is a measurement of weight, not size. This means although two diamonds that are the exact same weight are generally the same size, the diameter (measured in millimeters) could differ. Consider the example used above with an ideal cut diamond compared to a deep cut diamond.
One carat is equal to 100 points meaning a 0.75-carat diamond is the same as a 75-point or three-quarter carat diamond.
Also, note that the combined carat weight of a grouping of several smaller diamonds is not as valuable as a single diamond of the same carat weight. For example, 20 diamonds that are .05 carats each and total 1 carat is less valuable then one diamond that is 1 carat.
Diamond Color
White diamonds are graded on a color scale of D through Z. D having the least color; Z having the most color. A color grade closest to D is most valuable.
Diamonds that naturally have color, which include yellows, pinks and blues, are called fancy diamonds. Certain fancy colored diamonds are much sought after because of their extreme rarity. Their quality is graded by the intensity of the hue, and unlike white diamonds, the more color the rarer the stone.
Note that a white diamond that appears yellow is not considered a fancy diamond or yellow diamond, but instead it is considered a dark white diamond and is much less desirable and less valuable.
Brown diamonds are the most common kinds of diamonds found in nature. Although some retailers market them as chocolate diamonds with a hefty price tag, these are not very valuable and will not fetch much when reselling.
Diamond Clarity
Diamond clarity refers to the number of imperfections, or inclusions that exist within a diamond. Diamonds with the least amount and smallest inclusions possess the highest clarity and are the most valuable. Diamonds with a greater number and size of inclusions posses a lower clarity grade and are less valuable.
Virtually all diamonds contain imperfections or birthmarks, most of them too small to see with the naked eye. These inclusions, when viewed under magnification may look like dark sports, feathers, clouds or crystals.
Diamonds are graded on a scale of FL (Flawless) - I3 (Included). Diamonds that have no inclusions under 10x magnification will be graded as Fl (Flawless) and be higher in value while diamonds that have obvious inclusions under 10x magnification that may affect transparency and brilliance will be graded I1 - I3 (Included) and be much lower in value.
VS1 and VS2 - Very Slightly Included: Inclusions are minor and range from difficult to somewhat easy for a skilled grader to see under 10x magnification
SI1 and SI2 - Slightly Included: Inclusions are noticeable to a skilled grader under 10x magnification
I1, I2 and I3 - Included: Inclusions are obvious under 10x magnification and may affect transparency and brilliance
FL - Flawless: No inclusions or blemishes are visible to a skilled grader using 10x magnification
IF - Internally Flawless: No inclusions and only blemishes are visible to a skilled grader using 10x magnification
VVS1 and VVS2 - Very, Very Slightly Included: Inclusions are difficult for a skilled grader to see under 10x magnification


text: for Emma Stone. I'm clapping right now (well, not really. I'm typing)! But this is tailored menswear at it's best. Emma arrived at the Earth Hour Kick-Off with Spider Man in a sleeveless Balenciaga jacket that looks chic and polished over her colour-block tank and cropped black trousers. Her tousled waves and strappy sandals add a subtle touch of femininity. I think she could have pulled off a bolder/brighter lip, but overall I'm loving this look. What do you think?


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Pacific Pines State High is a happy, friendly school where strong relationships
exist between staff, parents and students. We believe that these relationships
underpin the teaching and learning journey which in turn creates a strong,
positive school culture. The only way of discovering this for yourself is
to pay us a visit, I would love to personally take you on a tour of our amazing
At PPSH we instill a sense of personal and collective integrity in
our students which will serve them well throughout their lives regardless
of what happens in the future. In conjunction with our families we nurture our
students with a sense of purpose and a clear set of values.
We continue to cultivate an expert teaching team who are trained in
understanding how each individual student learns and thus provide a
comprehensive curriculum.
The staff at PPSH have a strong commitment to their ongoing
professional development, with a significant number of them who undertake study
in further understanding adolescent learning and improving student outcomes.
Staff consistently provide students with immediate feedback and create lessons
where students are actively engaged in class rather than passively sitting in a
classroom just listening to their teacher. This approach enables students to
improve their level of achievement in their respective subjects.
At PPSH we are proud to cater for all of our students whether
they are interested in our Centre of Excellence Programs in academics, creative
arts or physical education. We offer Centre of Excellence programs in
mathematics, engineering, applied science, creative writing, creative arts,
young innovators and sports as well as offering traineeships , design and
construction which we believe expertly caters for our diverse range of student
learning styles to strengthen our dynamic school.
Promoting school pride in our staff and students has enabled us to create a
sense of belonging.
I would like to welcome you to our school on behalf of myself and our 150
committed staff members who work at this fabulous school.
Regards,Mark PeggremPrincipalSchool Improvement Unit - Pacific Pines State High School -Executive Summary - 2017


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Mesh Media is a division of the VCU Student Media Center. It is a network of student-run, multimedia, journalistic websites that cover specific aspects of VCU and Richmond culture.
In the fall of 2009, six freshmen started a VCU Student Media Center pilot program in order to add video news and commentary to student-run coverage of VCU sports. After Rams Review launched, Shafer Bird began in the spring of 2010 to cover campus dining and Richmond cuisine. The group added coverage of the Richmond music scene with The Horn RVA in the summer of 2010.
The websites unified to form Mesh Media, which became an official division of the VCU Student Media Center in the spring of 2011. The newest addition to the network, River City Fashion Uprising, started in the spring of 2012 covering Richmond's fashion culture.


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151 people were interested in MTransformer today
Pitch shifting, frequency shifting, daemonic and robotic voices... that's MTransformer, a unique spectral processor that lets you transform any frequency to any other, transform their levels...
Included in: MCreativeFXBundle MTotalFXBundle MCompleteBundle
Price: € 69 (± $ 78)
Transform any frequency to any other
Frequency shifting and pitch shifting are very different processes and yet they share the same core - they transform each frequency to a different one. And with MTransformer you can literally change the frequencies in any way that you want. That can lead to all sorts of creative processing useful for all kinds of audio materials.
Transform levels of each frequency
In any audio material there are loud frequencies and there are also, well, silent frequencies. Have you ever thought about what would happen if they changed places? Or what would happen if the silent stuff was removed completely? Well, now you can find out ;).
Modulation heaven
Looking for a little extra variation in your sound? Look no further than our extensive modulation options. Modulate any parameter from sources such as an LFO, audio level follower, envelope generator, randomizer, or pitch detector. Your sound will never be static again.
MeldaProduction goodies
As always you'll find the standard MeldaProduction features: 16x upsampling, M/S, surround support as well as other channel modes, A-H presets for easy comparisons, and our easy to use integrated help system.
Additional Resources
Key features
The most advanced user interface on the market - stylable, resizable, GPU accelerated
Modern user interfaces must not only be easy and quick to use, but also versatile and the whole visual appearance should inspire you. MTransformer features the most advanced GUI engine on the market. It is still the first and only GUI engine, which is freely resizable and stylable. It also lets you choose between knobs, sliders or buttons, whichever you like the most.
The plugin can look as an ancient vintage gear, if you are working on old-school rock music. Or as super-modern futuristic device if you are working on modern electronic music.
If your display doesn't have a high resolution, you can make the plugin smaller. If the fonts are too small, you can make the plugin bigger and save your eyes.
All the graphics is accelerated using your GPU, graphical interface, providing ultimately quick response and keep your CPU focused on the audio.
Dual user interface, easy screen for beginners, edit screen for professionals
MTransformer provides an arsenal of features you probably didn't think it was possible. But even as a beginner you can use it thanks to the dual graphical user interface.
First there is an Easy screen with several predefined modes, but just a few controls. This lets you start quickly and easily without any knowledge. All you need to do is choose what you want and use a few knobs.
Then there is an Edit screen for those of you, who are not afraid of all the amazing features the plugin has under the hood.
Unique visualisation engine with classic meters and time graphs
Your ears should always be the main judge, but a smart metering system can often be a huge help. MTransformer provides the most advanced metering system out there. The plugin can display the measurements of all relevant values using classic meters, or it can even show them in time using the time graphs. Everything is customisable as usual.
MTransformer provides 4 fully-featured modulators which can control any set of parameters including other modulators. Each modulator works as an LFO, level follower, midi/audio triggered ADSR enveloper, randomizer or pitch detector, or even a combination and can listen to the plugin\'s side-chain.
You can make the sound move in time, be less static and more interesting. You can make various parameters depend on the input (or the sidechain) level or even listen to the input pitch.
Check this video tutorial for information about modulators.
Adjustable oscillator shape technology
Every oscillator in MTransformer uses the most versatile oscillator algorithm on the market. It provides mix of predefined oscillator shapes, custom waveforms edited using our MeldaProduction Envelope System (MES), a step-sequencer and several methods for algorithmic postprocessing.
It also provides a harmonic mode, which lets you control the harmonic content instead of oscillator shape. This is especially useful for high frequency oscillators.
Check this video tutorial for information about oscillators.
MTransformer lets you control multiple parameters using a single so-called multiparameter. This may not only come handy for automation for example, but the multiparameters are very smart units and you can use them to smartly morph between banks of settings for example. All in the name of creativity!
Check this video tutorial for information about multiparameters.
M/S, single channel, up to 8 channels surround processing...
MTransformer can handle not only mono and stereo signals, but also mid/side encoding for stereo field processing, separate left & right channels, separate mid or side signal and up to 8 channels of surround audio. It is perfect for audio production for music, movies, games...
Check this video tutorial for more information about channels modes and mid/side processing.
Smart randomization
Being creative is sometimes complicated and one often needs an inspiration. By clicking a single button you can walk through the billions of possible settings and find the best one for you. The smart randomization algorithm wisely selects good sounding combinations of parameters. It can even randomize modulators for you. And if that\'s too much, you can just hold ctrl and MTransformer will just slightly modify existing settings.
Automatic gain compensation (AGC)
Most plugins change loudness of the output audio, which makes browsing presets inconvenient, not mentioning randomization. MTransformer includes automatic gain compensation, which quickly adapts to current settings and ensures the output sounds as loud as the input. This even protects you from thinking that something sounds better in cases it is just louder.
Safety limiter
Some plugins can intensely increase gain when exposed to specific audio materials. MTransformer provides a safety brickwall limiter, which ensures the output stays below 0dB and prevents your equipment and your ears from potential danger automatically.
Adjustable up-sampling 1x-16x
Digital audio provides very superior audio quality compared to ancient analog gear, but there are problems too. The main problem is the aliasing, which may be noticeable, when using nonlinear processes such as compression or saturation. MTransformer includes both minimum-phase and high-quality linear-phase upsampling algorithms, which avoids the aliasing.
Check this video tutorial for information about aliasing.
Synchronization to host tempo
Every oscillator and modulator in the plugin can automatically synchronize to the host. But it can be out-of-sync if you want of course.
MIDI controllers with MIDI learn
MTransformer contains a powerful MIDI processor, which listen to MIDI controllers and MIDI keyboard and control any parameters realtime.
Check this video tutorial for information about MIDI.
64-bit processing and an unlimited sampling rate
MTransformer provides the maximum audio quality you can get. It uses 64-bit audio processing and can handle any sampling rate. It does not make much sense to go over 192kHz, but if you think it is a good idea, the plugin can do that.
Extremely fast, optimized for newest AVX2 and AVX512 capable processors
Computers are now extremely fast, but the algorithms are more complex and projects bigger, so we still need to use the processing power with care. MTransformer uses the fastest algorithms, takes advantage of the newest processor capabilities, lets your GPU handle the graphics, and shares the resources with other MeldaProduction plugins. The plugin is among the fastest on the market, yet it provides the best possible audio quality.
Global preset management and online preset exchange
MTransformer presets are carefully stored in a system database and you can quickly access them from any project in any host. The plugin can automatically share your presets and download presets of other users from our servers. We are building a community and you can be a part of it!
Supports VST, VST3, AU and AAX interfaces on Windows & Mac, both 32-bit and 64-bit
MTransformer supports all major hosts on both platforms. Check system requirements for information about compatibility and installation.
No dongle nor internet access is required for activation
How many times did you forget your USB dongle? We are an honest company and expect the same from our customers. Our software uses licence files to activate your software. And the licences are to-person, so you can use it on all your computers as long as you are the user.
Free-for-life updates
When you buy the software you are entitled to free updates, forever. No more money wasted on major upgrades like it is with other companies. And we upgrade our software a lot!
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I am White/GreenTake The Magic Dual Colour Test - Beta today!Created with Rum and Monkey's Personality Test Generator.
^I'm a calm guy :)
Couple of links: YouTube I'm there pretty much every day. Some random videos may appear.
DeviantArt Fairly active there these days.
Moc of the Day: 1Popular this week: 1Most discussed: 050 likers: 2100 likers: Still behind200 likers: Kinda a high goal264 people call me favorite.
Contest achievements:
-2011 Bio Cup - 3rd place-2012 Bio Cup - Winner!


text: Windshield Repair Claims Posted on February 9, 2018February 9, 2018 by Denny Toth Author Recent Posts Denny TothAuto Glass Expert at Three Rivers Auto GlassDenny is an expert in auto glass repair and paint protection. He has been working through Three Rivers Auto Glass to provide these services and spread knowledge to those in Pittsburgh and surrounding areas. Latest posts by Denny Toth (see all) Cracked Windshield on a Leased Car - November 11, 2019 Car Paint Protection for Winter - October 4, 2019 The Effects of Air Temperature on Your Windshield - September 6, 2019


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Whether you are travelling solo, with a partner a group, we warmly invite you to discover, explore and enjoy the vast array of sites and experiences that Ghana has to offer. Situated on the West Coast of Africa, Ghana takes pride in being one of the most thriving democracies on the continent.
The Ghanaian commitment to preserving biodiversity is mirrored in the country's abundance of national park, from Aburi Botanical Gardens, an oasis of tranquility only 30km away from the hustle and bustle of the capital city, to Mole National Park in the northwest, which holds Ghana's largest wildlife refuge
Take a scroll in the rainforest at kakum National Park, pet the wild creatures at the Page Crocodile pond and have your photos taken in front of the the Wli waterfalls, jump in. Relax by the beach and listen to some hiplife.
Learn to dance. Sample West Africa delicacies. Go to one of the many colorful festivals celebrating the heritage of the people. Join in
Sunny days and strarry nights along the endless coastline, where emerald blue merge with white sandy beaches, awaits you. Sights, sounds and tastes: a treat for the sense. Happiness distinguishes Ghanaians as warm and welcoming people that enjoy life. Let this happiness rub off on you too.


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Stray dogs have been a hot topic of the 2014 Winter Olympics in Sochi. The Russian government hired a company to poison the strays before the Olympics began, and then a Russian billionaire financed a shelter in an effort to save the dogs.
While some dogs were unfortunately killed, and many were brought to the shelter, the problem has not been completely taken care of. During a practice run, a stray dog ran onto a cross country course and started barking at the athletes, and even now, eight days into the Olympics dogs are hanging around the grounds.
Here's a photo from Saturday of two stray dogs fighting in front of the Gorki Media Center. It's pretty terrifying, and we can see why the Russian government was worried about everyone's safety with the stray dogs wandering around:


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Megan & The Common Threads have achieved the ultimate when it comes to an EP: Stories To Tell doesn't *seem* like an EP. In both production values and narrative arc, the six track knits together cohesively like a full release. Whether told through funky Americana pop or aching ballads, the relationship between place and identity infuses the record.
An undeniable highlight is the belter of an opening track, London City Ghosts. Recently praised during a solo acoustic preview at at the Americana Music Association UK Songwriter's Workshop, the song really shines as a full band production. It takes an interesting turn musically with something of a Celtic calypso cadence, but the real power is in the controlled delivery of an earworm that you won't mind at all.
Somewhere between Megan O'Neill's delivery and the lyrics comes a knack for storytelling, particularly in subverting expectations. This wordplay is evident in Blessing Or A Curse: "leaving home when you're still too young/one more whiskey then you'll be done" and again in Walls: "funny how this home's become a house."
Walls movingly explores the immediate shock and lasting impact of a home invasion: "those dark eyes are with me in my sleep/and when I wake they walk these streets with me/underneath my skin and in my blood/this home that I used to love so much." The music echoes the words with drum fills ramping up the tension as the stranger breaks hearts as well as glass, and steals more than he could ever know.
While the protagonist in Walls can't wait to leave, Devil and The Deep focuses on those who have no choice. The title is as much descriptive as it is metaphorical. The song casts us amongst refugees fleeing a war zone on a precarious boat. It's undeniably apt give the Syrian refugee crisis of our times, though the conflict in the song is kept deliberately vague.
It's a mature piece of songwriting; thought-provoking without being sensationalist or sanctimonious. Instead of taking sides politically, the levelling effect of desperation is emphasised. The boat is packed with both rich and poor, all with the same scant choices and chances. The refrain "spare a thought for the refugee/between the devil and the deep blue sea" crashes and repeats like waves on the hull. Similarly, the electric guitar and fiddle rise up until they dissipate into nothing. We never learn if the refugees make it to a safer place.
There is an element of 'from the frying pan into the fire' even when a journey does lead somewhere new, with different disappointments as in the line "wanna find a life far from this small town/city lovers left you in the dust." Be careful what you wish for, indeed. Yet Megan O'Neill delivers these songs with such confidence that you feel she'll adapt to anywhere and anything. By the final song, Awake Into The Light, the importance of forging relationships to forge a path shines through: "if you can't rely on your own heart to take part/you can borrow mine to find your way/I'll be here to tell you."
In essence, the EP is a soundtrack for the displaced; a journey through conflict, escape, dislocation and bittersweet memories to ultimate acceptance. It's encapsulated in the title track:
"I'm left with that was then and used to bes/
Times, good and bad and inbetween/
And even though the city don't remember me so well/
I'll always have my stories to tell"
Check out meganandthecommonthreads.com for music and tour dates.
WordPress: redrospective.com
Twitter: @redrospective
Instagram: redrospective
Facebook: redrospective


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Huaptec offers a great range of models to resolve any kind of cell phone signal problems. GSM amplifiers eliminate dropped calls and help to maintain reliable coverage all around your area. 3G or 4G models provide high-speed 3G or 4G data download and always easy access to mobile Internet. If you experience coverage difficulties both with voice and 3G/4G, you'll put an end to them with dual (GSM+3G) or tri band models (GSM+DCS/4G+3G).
Look through the catalogue below and choose a booster solution which best meets your needs!