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T ONGA 1. CONTEXT 1.1 Demographics Tonga"s estimated population for 2009 was 103 023, giving a population density of 158 per square kilometre. About 23.3% of the population live in urban settings. The population is young, with 38% in the 0-14 year-old age group. The fertility rate remains high, although it has been falling slowly, decreasing from 4.1 in 1986 to 3.7 in 2008. The population growth rate is around 0.4%, a low figure taking into consideration a crude birth rate of about 28.5 per 1000 and the fact that child mortality rates are the lowest in the Pacific. The explanation is found in the high net emigration rate, which averaged 19.8% between 1986 and 1996. It is estimated that as many as 100 000 Tongans live overseas, most of them in Australia, New Zealand and the United States of America. The Tongan community in New Zealand alone accounts some 50 000 people. 1.2 Political situation Tonga is a constitutional monarchy with almost absolute power given to the head of state, King Siaosi Tupou V, who succeeded his father in 2006. The King"s Cabinet consists of the Prime Minister, the ministers of the Crown and the governors of Vava"au and Ha"apai, all directly appointed by the King. The unicameral Parliament consists of the cabinet members, the Speaker of the House (appointed by the King), nine nobles elected by the peers from among Tonga"s 33 hereditary title holders, and nine democratically elected peoples" representatives. Important political reforms are being implemented in 2010 that affect various sectors of public life, including the powers of the monarchy, parliament, government and the prime minister. 1.3 Socioeconomic situation Agriculture forms the backbone of the economy, and the export of pumpkins for the Japanese market plays a particularly important role as a foreign exchange earner. The second biggest industry, fishing, is in recession due to decreasing catches over several years. Tourism is slowly increasing in importance, although the prospects of Tonga developing a mass-tourism industry are limited. Remittances from relatives living abroad play an increasingly important role in the economy. The total value of private remittances was estimated at TOP 200 million (US$ 105 million) in 2004, roughly 55% of the gross domestic product (GDP), which was estimated at TOP 361 million (US$ 189.6 million). The Government is heavily dependent on development support for capital investments. Economic development has been sluggish in recent years and real growth in GDP fell from 2.3% in 1998- 1999 and 5.4% in 1999-2000 to only 1.4% in 2003-2004. The figure was 2.5% in 2004-2005, giving an average GDP growth per year for 1998-2005 of 2.9% per year. The Government has liberalized the economy in recent years and has abolished government monopolies and allowed competition in several areas, including telecommunications, power supply and civil aviation. Tonga joined the World Trade Organization in December 2005 in an agreement that saw the country reduce its import tariffs for most goods to 15% and open its domestic markets, including health care provision and education, to foreign investors. A 15% consumption tax was introduced on goods and services in April 2005 and compensates for the loss of income from import duties. The tax base is small, with only about 4000 people having a taxable income, and income tax is low (10%) and non-progressive, resulting in a revenue from income taxation of less than TOP 2 million (US$ 1.05 million) per year. Property taxation is negligible and land ownership is concentrated among the royal family, churches and nobles. The labour force participation rate in 2003 (Labour Force Survey 2003) was 64% (75% for men and 53% for women). The literacy rate is very high (99%) and most children complete compulsory primary school classes. Education absorbed 14% of the national budget in 2004. While most primary schools teach in Tongan, COUNTRY HEALTH INFORMATION PROFILES | 447 TONGA secondary education is mainly conducted in English. The education rate is similar for both genders, with some advantages for girls at the secondary level. Despite equal opportunities in education, the number of women in leading positions remains limited. An important step was taken in 2005 when the first female Member of Parliament was elected. Tonga has ratified the Convention on the Rights of the Child (CRC), but has failed to fulfil the reporting requirements. It has yet to sign the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW). Women continue to be discriminated against in legislation, including land ownership rights, child support rights and inheritance laws. The standard of living has improved dramatically over the last 50 years and there is now little absolute poverty. The country is placed 99th in the United Nations Development Programme"s Human Development Index ranking (HDI), the highest ranking of any Pacific island state, reflecting the comparatively high GDP per capita of US$ 2 319 (2006), high life expectancy and near-universal literacy. Disposable income per capita is considerably higher than GDP per capita as a result of remittances from Tongans working abroad. The value of those remittances is also increasing much faster than the domestic economy and official development assistance, and the strong performance in the HDI is partly explained by the high disposable income. However, many families are dependent for food security on what they can produce on their farmland, and limited access to such land is an increasing problem. An estimated 4% of the population live on less than US$ 1.00 per day and about 6.7% of households live below the food poverty line. The Government uses the term "hardship" to describe economically disadvantaged groups in Tonga and hardship is defined as "having difficulties in meeting basic needs, such as education and transport". When translated into monetary terms, hardship is the equivalent of living on less than TOP 28.17 (US$ 14.79) per week (indexed value), and an estimated 23% of the population falls into that category. People who live on the outer islands, where access to education and health care is poor, transport costs are high and income opportunities few, have higher rates of hardship. 1.4 Risks, vulnerabilities and hazards No available information. 2. HEALTH SITUATION AND TREND 2.1 Communicable and noncommunicable diseases, health risk factors and transition Tonga has gone through an epidemiological transition since the 1950s, with increasing life expectancy and falling fertility rates, childhood mortality rates and maternal mortality. Life expectancy at birth increased from 40 years in 1939 to 67.3 years for males and 73 years for females in 2008. The proportion of deaths caused by infectious diseases fell from 32% in the 1950s to 6% in the 1990s, while the proportion of deaths from diseases of the circulatory system grew from 5.6% to 38% over the same period. However, there is likely to be considerable underreporting for many noncommunicable diseases. Post-mortem examinations are limited to criminal cases and death certificates are, at best, based on clinical findings and frequently on reports from relatives. More importantly, as many as 18% of deceased people do not have a proper death certificate stating the cause of death, and unknown cause of death actually ranks second when included in the list of leading causes of death. While the mortality data are considered to be fairly consistent over time for those who die in hospital, there are clearly distortions in morbidity reporting caused by misclassification and inconsistent ICD-10 coding, particularly for communicable diseases. The steep increase in the burden of noncommunicable disease (NCD) is worrying and is the most important current health problem. Obesity, diabetes and cardiovascular diseases have increased to levels of epidemic proportion and prevalence rates now surpass those of most industrialized countries. Tonga developed a multisectoral national strategy to prevent and control NCD in 2003. There are multiple reasons for the rapidly growing NCD burden, of which the most important include increasing rates of overweight and obesity, reduced physical activity, smoking, and, to some extent, the ageing of the population. Economic development, motorization, improved access to processed imported food and the adoption of "western" dishes with high fat and high sugar contents have had a strong negative impact on people"s health. 448 | COUNTRY HEALTH INFORMATION PROFILES Food, gifts of food and feasting traditionally play an important role in Tongan culture. Higher economic standards, improved communications and better access to processed and high-fat and high-sugar foods have led to a rapidly increasing overweight and obesity problem. Figures from 2004 show that the average weight for a Tongan male increased over 30 years by 17.4 kg to 95.7 kg, while the average weight for a woman increased by 21.1 kg to 95.0 kg, a rise in body weight with few comparisons in the world. There are also indications that people are becoming overweight and obese earlier in life; girls and young women in particular tend to gain weight during adolescence and pregnancy. The overall adult obesity rate (BMI>30) was 60% in the 2004 survey. Women have higher obesity rates than men over all age groups and they are more obese (mean BMI 34.5 compared with 31.0 for men). As a consequence, they have higher rates of diabetes than men, with 19.1% of women and 16.5% of men meeting the definition of diabetic. Most people continue to perceive fatty food as something desirable, a taste that may be explained partly by the scarcity of fat in the traditional fishing and farming society and by historic periods of food shortage. Other findings indicate that the quantity of food consumed by Tongan adults is as much to blame as its composition. Studies have shown that the average Tongan male consumes double the quantity of food and amount of calories consumed by the average Australian male. Women are more overweight than men, while men have a higher prevalence of other risk factors, including hypertension, elevated blood lipids and smoking. The overall adult prevalence of diabetes type II has increased from 7% to 18% over the last 30 years. A community survey in 2000 showed that as many as 80% of people with diabetes remain undiagnosed and untreated. Access to health services for people with diabetes and its complications has improved, but the health system does not have the capacity to provide quality care for all those who need it, and primary and secondary prevention have so far not been enough. The number of registered diabetic patients at the specialist clinic at the referral hospital on Tongatapu increased by 54% between 1999 and 2003 from 1463 to 2247, which corresponds to more than 9% of the serviced population aged 30 years and over. A hereditary predisposition towards impaired glucose tolerance is likely to play some role in the high rates of diabetes, but this is a non-modifiable factor and has in itself little to contribute to the design of public health interventions. Physical inactivity is also thought to be an important cause of overweight, particularly for women and middle-aged people. It is unusual today for people to walk or bicycle, as the number of vehicles is increasing rapidly. The increasing number of cars on the roads, together with outdated traffic safety measures, contributed to the record 24 traffic-related deaths in 2003, a figure that puts Tonga ahead of the United States of America in the number of traffic deaths per 100 000 population. Seatbelts are not compulsory and only 1% of drivers were found to be using them in a Ministry of Health survey in 2004. The single most important cause of traffic injury is driving under the influence of alcohol, kava or marijuana. All 24 deaths in 2003 were caused directly or indirectly by intoxication. The section on alcohol in the current Traffic Act is antiquated and not enforceable in practice, and neither the health services nor the police have the equipment to measure blood alcohol or to "breathalize" motorists. The health and social problems caused by the harmful use of alcohol has received increasing attention in Tonga lately and this will hopefully result in measures aimed at reducing access to alcohol and enforcing drink-driving controls in the future. The incidence of cancer is perceived to be increasing, but weaknesses in diagnosis, surveillance and reporting do not allow for reliable analysis of trends. The sharp increase in overall cancer incidence is likely to be partly or entirely explained by changes in reporting rather than by a true increase. Diagnostic capacity is limited for many malignancies, and it is not always obvious when the reported figure refers to cytological diagnoses or when clinical (non-confirmed) diagnoses have been included. A cancer register was established in 2004 to capture both clinically determined cancers and laboratory-confirmed cases. Although this important development improved the statistical information on cancer incidence, the proportion of cytologically and histologically confirmed cancer cases remains low compared with overall cancer incidence, and the autopsy rate is very low. A pilot project on Pap-smear screening for cervical cancer was started in 2005. Mammography is not available. Liver cancer, which is closely related to hepatitis B virus infection (HBV), is common in Tonga, where HBV infection rates in the adult population are hyperendemic (10%-14%). It will take another two to three generations until immunization against HBV, which was introduced in 1989, impacts on incidence. Lung cancer now ranks COUNTRY HEALTH INFORMATION PROFILES | 449 TONGA among the three most common cancers, a result of smoking, and it is expected that the incidence will continue to increase. Of the 17 hospital-certified deaths in the 1-4 age group in 2003, eight were from infectious causes, one from dehydration, two from malignancies and two from road trauma. Of the eight children who died as a result of infection, six were from septicaemia and CNS infection, one from dengue fever and one from pneumonia. This picture resembles the situation in an industrialized country more than that of a poor developing one. There is limited information available on childhood morbidity, but the two deaths from road trauma indicate that child safety is a potential area for improving child health. Infectious diseases have, to a large extent, been brought under control in the last 30-40 years, with some important exceptions. Tonga does not have the vector for malaria, but a few imported cases are diagnosed each year in people returning from visits to areas with malaria transmission. A fifth and final round of mass drug administration (MDA) for the eradication of lymphatic filariasis took place in 2005, with 100% geographical coverage and an estimated population coverage of >90%. A nationwide post-MDA-campaign serosurvey was conducted in 2006 to evaluate the results. Leprosy has, in practice, been eradicated, although the latest infection was diagnosed in 2004. This was an imported case in a Tongan adult who returned after having lived his entire life in American Samoa. The last case of indigenous transmission was in 1998 and today there are a handful of well documented people living with complications of leprosy. Hepatitis B is highly endemic in Tonga and screening of blood donors, government employees and visa applicants shows that more than 10% of the adult population are positive for HbsAg. A survey in pregnant women in 2005 found an HbsAg-positive rate of 13.9%. Childhood immunization against hepatitis B started in 1989 and the first immunized cohorts are now entering reproductive life. A serosurvey of 211 preschool children in 1998 found a 3.8% prevalence of chronic hepatitis B infection, indicating a lower-than-expected efficacy for hepatitis B immunization. Increasing efforts are now being made to improve particularly the timeliness of hepatitis B vaccine delivery. A study using convenience testing for HbsAg in children admitted to Vaiola Hospital started in 2005 for surveillance purposes; of more than 100 children tested so far, none has been positive for HbsAg. Poor household hygiene and sanitation, as well as contamination of drinking-water sources, are thought to contribute to the average 10-20 cases of typhoid fever recorded annually (22 confirmed cases in 2003). The Ministry of Health places great importance on finding and treating asymptomatic chronic typhoid carriers through contact-tracing and stool-sampling, and this limits the spread of typhoid. However, it can be argued that Tonga is in the position to eliminate typhoid fever altogether if adequate coordinated resources were to be allocated to treat carriers, improve sanitary practices and ensure the supply of safe water in all villages. Thirteen new cases of tuberculosis (all types) were reported in 2008. All tuberculosis treatment follows the directly observed treatment, short-course (DOTS) strategy and there is active contact-tracing. The success rate for patients diagnosed in 2007 was 93%. HIV prevalence remains very low. Fourteen people have been diagnosed with HIV infection over the last 16 years and, as of January 2006, there was only one person known to be living with HIV infection. The volume of HIV serology testing is high, with an average of 2500-3000 HIV tests carried out annually as part of screening of blood donors, government employees and visa applicants, and an estimated 45 000 HIV tests have been carried out since the start in the 1980s. A pilot trial of voluntary counselling and testing (VCT) at the antenatal clinic at the referral hospital reported a very high uptake, but no decision has been taken to continue to offer antenatal screening. Risk-behaviour surveillance and high-risk group serosurveillance started in 2005 and will provide valuable information on the risk of transmission. Antiretroviral treatment (ART) is not available through the public health system and there are no officially endorsed guidelines for treatment of HIV infection or prevention of mother-to-child transmission. The diagnostic capacity for sexually transmitted infections (STIs) is limited to gonorrhoea and syphilis (with the exception of HIV). The number of cases is thought to be much higher than revealed by the 450 | COUNTRY HEALTH INFORMATION PROFILES statistics, as many patients are treated by private practitioners who do not notify the Ministry of Health. The ratio of men to women receiving treatment for gonorrhoea is 10:1, indicating weak contact-tracing and a lack of appropriate services for women. A serosurvey in pregnant women in 2005 found a high overall prevalence of chlamydial infection of 14.5%. The rate was 27.5% in women <25 years of age, an indication that transmission may be increasing in younger women. The RPR-positive rate for syphilis was 3.2%, which is alarming considering that the Ministry of Health took the controversial decision to discontinue syphilis screening in pregnancy a few years ago. The same study also asked questions about sexual risk behaviour, which showed that the condom use rate is very low and that condoms are primarily seen as a method of contraception to be used within marriage, and not as a means to protect against STIs. 2.2 Outbreaks of communicable diseases The country experienced a large outbreak of dengue fever (serotype 1) in 2003, causing six deaths in children, and transmission continued into 2005. The outbreak was confined to the main island of Tongatapu in the first year, but transmission then spread to all island groups except the Niuas. Two adult deaths due to dengue were recorded in 2005. It is unlikely that dengue will become endemic in Tonga because the population is not large enough to sustain transmission over time. However, vector control and vector surveillance is poor and the measures introduced to prevent fatalities and control transmission during outbreaks are suboptimal. It looks inevitable that the introduction of another serotype will cause a new outbreak of dengue fever, with fatalities. Tonga experienced an outbreak of watery diarrhoea from December 2005 to February 2006, with altogether six fatalities in children below one year of age. This was an unusually large outbreak and, for the first time, Rota virus was confirmed in a sample sent to the Pasteur Institute in New Caledonia. 2.3 Leading causes of mortality and morbidity See Section 2.1. 2.4 Maternal, child and infant diseases More than 98% of pregnant women attend antenatal clinics, 98% deliver in a health facility and 100% of deliveries are attended by trained staff. The maternal mortality ratio (MMR) was 76.1 per 100 000 live births in 2008. Indicators that are based on relatively uncommon events, such as MMR and IMR, will show large variations between years due to chance and it can be more informative to either compare absolute numbers or to examine rates over five-year or 10-year periods. The mean MMR for the five-year period from 1999 to 2003 was 39.4 per 100 000 live births, which translates to one death per year. It is of concern that the MMR has been stable over the last two decades and that it has proved very difficult to reduce it further. The absolute majority of maternal deaths took place in hospital, which is an indication that patient monitoring and emergency services, such as availability of blood for transfusion, need strengthening. Tonga is the best performing country in the Pacific in terms of infant and child mortality. The unusually low infant mortality rate of 9.1 deaths per 1000 live births at the 1990 baseline for the Millennium Development Goals (MDGs), together with the fact that the IMR has remained unchanged for the last decade, makes it unrealistic for the country to achieve the MDG for infant mortality. There are several explanations for the low IMR, but at the core is the Government"s commitment to delivering key interventions, such as immunizations, antenatal care and trained delivery care, to the entire population. The result shows that it is possible to provide high coverage of essential services in an island state with isolated populations, and that it pays off. There is little absolute poverty in Tonga, no chronic undernutrition (stunting), no important micronutrient deficiencies and no malaria, all factors that contribute to well nourished and healthy mothers and children. The comparatively low teenage (<20 years) pregnancy rate (4.1% in the 2000-2003 period) is another protective factor. Breast-feeding promotion is receiving increasing attention as an important public health intervention. The goal of establishing Vaiola Hospital as a baby-friendly hospital in 2005 was, unfortunately, not achieved. This would have meant that two-thirds of all children in Tonga would be born in a baby-friendly environment. Work has started to translate the International Code on Marketing of Breast-milk Substitutes into national law and regulations. COUNTRY HEALTH INFORMATION PROFILES | 451 TONGA The challenge for child health lies in protecting the impressive gains made so far while at the same time identifying and implementing affordable and sustainable interventions that will reduce mortality rates further. Mortality from Haemophilus influenzae type B (Hib) infection lies almost entirely in the 0-1 age group and the introduction of routine childhood immunizations against Hib in 2005 is a good example of an affordable new intervention to improve child health. Immunization rates are higher than in many industrialized countries, and neonatal tetanus and poliomyelitis have been eliminated. Rubella vaccine (measles-rubella [MR] vaccine) was added to the immunization schedule in 2002 in response to a large outbreak of the disease, and there have been no detected cases of congenital rubella syndrome (CRS) since. The immunization campaign with MR vaccine to break the epidemic included all children of 0-15 years and all women up to 45 years of age, with a coverage rate of above 80%, meaning that population immunity against measles can be expected to be high. The last confirmed measles infection was in 1998 and Tonga set 2007 as a target for measles elimination. Immunization against Hib was introduced in April 2005, with a catch-up immunization campaign for children below two years of age. It has been estimated that Hib vaccine will prevent one to two infant deaths and several more cases of severe sequelae per year caused by Hib meningitis. The hospital paediatric departments are documenting the impact of Hib vaccine on admissions for meningitis and pneumonia. 2.5 Burden of disease See Section 2.1. 3. HEALTH SYSTEM 3.1 Ministry of Health's mission, vision and objectives Mission: To support and improve the health of the nation by providing quality, effective and sustainable health services and being accountable for the health outcomes. Vision: By 2020, we are the healthiest nation compared with our Pacific neighbours, as judged by international determinants. Objectives: (1) To fight the NCD epidemic and communicable diseases by using effective preventive measures, being good role models and developing public participation and commitment. (2) To deliver the range and quality of services needed to meet the basic health requirements of the public. (3) To provide appropriate health services to all the outer islands and community centres through effective resourcing. (4) To build staff commitment and development by demonstrating to staff that they are valued. (5) To deliver services in a professional and friendly manner. (6) To continue to improve the standard of existing facilities and ICT, and to construct new facilities and introduce new ICT where needed. (7) To improve the management of financial resources through: better revenue collection, balanced budgeting, compliance with procurement procedures, timely processing of payments, and compliance with proper financial procedures. 452 | COUNTRY HEALTH INFORMATION PROFILES 3.2 Organization of health services and delivery systems The Ministry of Health works in four programme areas: (1) policy formulation and administration; (2) preventive health services; (3) curative health services; and (4) dental health services. Government health services are provided free of charge and physical access to care is good for the majority of people, with the exception of small populations living on isolated islands. Primary curative care and preventive services are delivered through a system of 14 health centres. There are four hospitals in Tonga: the tertiary Vaiola Hospital in Nuku"alofa, with 196 beds; and three district hospitals, Prince Ngu"s hospital in Vava"u, Niu"ui hospital in Ha"apai and Niu"eki hospital in Eua. The overall bed occupancy rate is low, 34% in 2003, an indication that the hospital system is oversized and has not adapted to the changes in the disease pattern and to improvements in physical access. However, transportation between islands remains difficult and acute referrals to the tertiary hospital are uncommon, making centralization of services problematic. The four hospitals also serve the populations on their respective islands with primary health care and they all run busy outpatient and emergency departments. Patients requiring specialist care that is not available in Tonga can be referred to New Zealand under two treatment schemes, one funded by the Government of Tonga and one by the Government of New Zealand. The decision to refer is made on a case-by-case basis by the Medical Transfer Board. Specialist treatment teams in such areas as eye surgery, plastic surgery, corrective orthopaedic surgery and rheumatic heart disease visit Tonga regularly. 3.3 Health policy, planning and regulatory framework See Section 3.2 3.4 Health care financing Total health expenditure amounted to US$ 11.3 million in 2008. The Government covers 68.7% of total expenditure on health, while private expenditure covers 31.3%. When expenditure on traditional healers and international referrals is excluded, it becomes obvious that the Government covers the absolute majority of both curative and preventive care costs and that "out-of-pocket" payments for health care are low, 27.3% in 2008. About 12% of the population have some kind of health insurance. The private sector is still small and consists mainly of traditional healers and "after-hours" practising government-employed doctors. About 14% of total expenditure on health is for traditional healers, although they are mostly paid in kind. Expenditure on drugs accounts for approximately 7.8% of total expenditure on health. There is a health insurance system, but it only covers government employees. 3.5 Human resources for health There are large variations in equipment, staffing and catchment populations depending on location but, on average, a health centre serves 7200 people and is typically staffed by a health officer and one to three nurses. There were 57 physicians in 2007 (0.6 doctors per 1000 population). In the same year, there were 345 nurses (3.4 nurses per 1000 population). There were 11 dental officers and dental therapists. The number of private providers is increasing, but the majority of private doctors remain government employees and run part-time private clinics, many out of their homes. The Ministry of Health had a total of 945 established posts in 2002, with an overall vacancy rate of 25%, making it one of the biggest employers in the country. Doctors normally train in Australia, Fiji or New Zealand, often on bilateral scholarships or WHO fellowships. Three-year health-officer training courses are organized by the Ministry of Health when required. Nurses train at the Queen Salote School of Nursing in Tonga. On average, 30 nurses graduate each year from the basic nursing training programme. A decision has been made to increase the intake several-fold in order to make up for the continuous loss of nurses to Australia, New Zealand and the United States of America. The Nursing School also runs a postgraduate certificate training programme in collaboration with the nursing department at the Auckland University of Technology, New Zealand. The first training programme in intensive care nursing started in COUNTRY HEALTH INFORMATION PROFILES | 453 TONGA 2005 and postgraduate training programmes in midwifery, internal medicine, surgery and public health were offered in 2006-2007. 3.6 Partnerships One of the core values of the Ministry of Health is to develop and sustain partnerships with relevant health stakeholders. An example of a recently established successful partnership is the Tonga-Australia partnership for development. Its aim is to support progress towards poverty reduction and improvement in living standards for Tongans, through improved health outcomes. This partnership will support the Government of Tonga to implement the Ministry of Health Corporate Plan 2008/09-2011/12 to achieve the targets of : Reduced prevalence of noncommunicable disease risk factors including: o Tobacco use: 2% decrease in prevalence of smokers by 2015 o Obesity: 2% decrease in overall prevalence of obesity by 2015 Budget for preventive health care reaches 10% of total public health operational budget by 2015 Primary health care to all communities in Tonga to follow common national standards, including the utilization of the service. There are also other examples of partnerships between the Ministry of Health and other organizations, such as the Health Promoting Church Partnerships and the Health Promotion Foundation. There is close collaboration with WHO in strengthening the health system, based on primary health care principles. The Ministry of Health also has very good working relationships with the governments of Australia, Japan, New Zealand the People"s Republic of China, and recently, the Government of Cuba assisted in providing medical training for students from Tonga. There are ongoing partnerships with the following organizations: the United Nations Children"s Fund (UNICEF), the United Nations Population Fund (UNFPA), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the European Union, the Global Fund, the Asian Development Bank, and several others. 3.7 Challenges to health system strengthening The most critical question for the health system today is how to increase the resources available for health. Government health expenditure is about US$ 100 per capita per year and, given that this pays for free medical treatment and free drugs, it is fair to say that Tongans get a lot of value for their money. Around 10%-15% of the Government"s total budget has been spent on health for the last two decades and it is unlikely that share will increase substantially in the future. Since government income is likely to grow only slowly in the coming years, there will be little space for growth in health sector spending within the current health financing system. At the same time, the pressure on the health system will increase with the increasing burden of noncommunicable diseases and the ageing of the population. Identifying alternative sources of health care financing is thus one of the top priorities of the Ministry of Health. In December 2005, Cabinet approved the introduction of user fees. A decision has also been made to introduce social health insurance within the next three to five years. Initially it will cover civil servants, but the intention is to gradually include larger sections of the population. Tonga has achieved many of the health goals within its reach given its existing health spending level, and the challenge now is to increase the resources for health promotion and health care without jeopardizing the health of poor and disadvantaged groups in the population. The increase in noncommunicable diseases (NCD) has now reached epidemic proportions. In addition to human suffering, NCD can have a negative impact on family economies. The loss of income due to disease and the cost of treating chronic conditions can put enormous strain on families and destroy years of work to improve a family"s situation. Ultimately there will be a negative impact on the country"s economic development as more resources have to be used for health care and productive and experienced middle-aged people in the workforce are lost to chronic disease or death. Identifying and implementing effective population-targeted preventive measures that can slow the increase of disease and, in the future, reverse the trend, are of the highest priority. The national multisectoral strategy for the 454 | COUNTRY HEALTH INFORMATION PROFILES control and prevention of noncommunicable diseases, developed in 2003, is a sign that the Government takes the issue very seriously. There are plans to establish a Health Promotion Foundation with funding from dedicated taxation on tobacco and alcohol. Such a mechanism could provide crucial resources for health promotion, an area of health that is currently heavily dependent on external support. There is a recognized need to improve both the quality of and access to health care, particularly for NCD, in view of the increasing burden of the ageing population. A large proportion of patients with diabetes and cardiovascular disease remain undiagnosed and untreated. It is therefore a priority to both increase access to care and improve the quality of care for people with noncommunicable diseases. This must include solutions for financing the treatment of chronic conditions and for increasing patients" knowledge of their condition and their responsibility for care. Active participation in treatment and patient empowerment are essential for successful treatment of chronic conditions. There is a need to strengthen both the collection of information and the analysis and dissemination of health statistics for decision-making. The outcomes of investments in health care financing and prevention of NCD must be able to be evaluated so that strategies can be modified when needed. The information must be easily available, cheap and reliable, and should therefore be based on ongoing surveillance rather than repeated and costly surveys. A first step towards such a system is the strengthening of vital statistics on births and deaths, as well as a consistent hospital-based diagnosis registration system. The Government has already started important work in this area, but there is a need to strengthen the system of data collection as well as increase the capacity to process and interpret the information gathered. The Ministry of Health is expected to invest substantially in the area of health information in the coming years, partly with resources made available through a World Bank loan. 4. PROGRESS TOWARDS THE HEALTH MDGs Goal 4: Reduce child mortality On track to meet target for MDG4 by 2015, but needs sustained action: Tonga is one of the best- performing Pacific island countries in the area of infant mortality. The infant mortality rate (IMR) declined progressively from approximately 90 infant deaths per 1000 live births in 1966, to 26 per 1000 live births in 1990, and 16.4 per 1000 live births in 2008. The under-five mortality rate (U5MR) has also decreased, from 32 in 1990 to 24 per 1000 live births in 2008. The neonatal mortality rate was estimated at 12 per 1000 live births in 2006. Tonga is thus on track to achieve the MDG4 target by 2015. Major reasons for this healthy declining trend lie in the policy to prioritize children"s health and the drive for universal immunization coverage. Presently this is estimated at 97%. Tonga is one of the few countries that has made immunization mandatory by law. Goal 5: Improve maternal health Good progress in MDG5: Tonga"s maternal mortality rate (MMR) is also one of the lowest in the Pacific, with no more than two or three deaths per year and no deaths recorded in recent years. This may reflect further improvements in health care facilities and services, especially the high proportion (95%) of deliveries attended by skilled health personnel. Goal 7: Ensure environmental sustainability Improved water and sanitation have no doubt also contributed positively, as 100% of households now have sustainable access to an improved water source and 96% of households have access to improved sanitation. 5. LISTING OF MAJOR INFORMATION SOURCES AND DATABASES Title 1 : Annual reports 1995 to 2004; Ministry of Health Corporate Plan 2001-2004; Ministry of Health Corporate Plan 2005-2008; EPI and Reproductive Health Services annual reports 2000-2003 Operator : Ministry of Health COUNTRY HEALTH INFORMATION PROFILES | 455 TONGA Title 2 : Tonga Department of Statistics Web address : http://www.spc.int/prism/country/to/stats Title 3 : Social and economic update and pro-poor policy formulation, Tonga. Pacific Island Economic Report series Operator : Asian Development Bank TA6245 (reg) Title 4 : Tonga's report on progress towards the Millennium Development Goals (MDGs) Title 5 : Annual report of the National Reserve Bank 2003-2004 Title 6 : Health Sector Support Project (HSSP/WB) Project Implementation Plan (PIP) Title 7 : National Health Accounts report of July 2004 Title 8 : Tonga's health 2000 6. ADDRESSES MINISTRY OF HEALTH Office Address : Ministry of Health, Vaiola hospital Postal Address : P.O. Box 59, Nuku"alofa, Kingdom of Tonga Official Email Address : email@example.com Telephone : (676) 23 200 Fax : (676) 24 291 Office Hours : 08.30 – 16.30 WHO COUNTRY LIAISON OFFICER IN TONGA Office Address : Ministry of Health, Nuku"alofa, Tonga Postal Address : P.O. Box 70, Nuku"alofa, Tonga Official Email Address : firstname.lastname@example.com Telephone : (676) 23217 / 25522 Fax : (676) 23 938 Office Hours : 08.30 – 16.30 Time zone Manila +5 hrs, CET + 12 hrs 456 | COUNTRY HEALTH INFORMATION PROFILES 7. ORGANIZATIONAL CHART: Ministry of Health COUNTRY HEALTH INFORMATION PROFILES | 457
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The Sweetwater High School varsity and JV girls golf teams not only hosted a tournament Wednesday at Sweetwater Country Club, but also made off with most of the hardware.
Learn more in Friday's e-edition (subscription required) or in print.
If the bad weather that has made a mess of this week's local high school sports schedule improves enough, Sweetwater hopes Saturday to play a baseball double-header at Sportsman's Park and one softball game at the Jerry Collins Complex.
Read more in Friday's edition, in print or our e-edition (subscription required).
The Highland girls basketball team begins defending its Region II-1A title when it plays Garden City at 1 p.m. Friday. The Lady Hornets and Lady Bearcats will hold their semifinal contest at Abilene Christian University's Moody Coliseum. Should Highland win, it will advance to play either O'Donnell or Cross Plains for the regional title at noon Saturday, also at Abilene Christian. The Lady Hornets' ultimate goal is to go to San Antonio next week and play in the Class 1A girls state tournament for the third straight year.
As fate would have it, the Highland and Garden City girls basketball teams are meeting in the Region II-1A tournament for the third consecutive year.
But Friday's matchup has a little different twist.
Read more in Thursday's e-edition (subscription required) or in print.
At least three of today's sports events that involve local athletes — and at least two more scheduled Friday — have been called off due to the threat of more bad weather in the area.
Read more in Thursday's edition, either in print or our e-edition (subscription required).
Sweetwater JV and varsity girls host tournament at Sweetwater Country Club.
Sweetwater JV boys at Lamesa tournament.
Sweetwater varsity (Field 1) and JV (Field 2) will host Abilene Cooper at 4 p.m.
Sweetwater varsity plays at Granbury tournament.
Sweetwater middle school teams at season-opening Colorado City meet.
Sweetwater varsity plays at Granbury tournament.
Sweetwater varsity boys will compete at regional preview tournament held at Lubbock's Shadow Hills course.
BIG SPRING — After a start that saw six lead chan-ges, the Highland girls bas-ketball team took charge of Tuesday's Class 1A regional quarterfinal playoff with a 56-39 win over Grady — sending them to the Region II-1A tournament for the third straight year at Abilene Christian University, where the Lady Hornets are two-time defending champions.
Learn more in Wednesday's edition, by subscribing to our e-edition or in print.
After going 9-3 overall at their Lady Mustang Classic, Sweetwater has two softball teams in action again today as they host Abilene Cooper at 4 p.m. on both fields at the Jerry Collins Complex.
Get all the details in Wednesday's print edition or our e-edition (subscription required).
Sweetwater Middle School basketball teams' season-ending results--scores and individual stats--can be found in Wednesday's print edition or by subscribing to our e-edition.
Here are results from the Sweetwater sub-varsity high school boys basketball teams' season-ending games vs. Snyder and Levelland:
Find scores and stats in Wednesday's edition, either in print or our e-edition (subscription required).

subset: commoncrawl


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Marriage Coalition in Rhode Island Holds Media Training
April 19, 2011 by Tony Wagner, Western Regional Field Director
The following post is from Dawn Euer, Field Organizer for Marriage Equality Rhode Island:
One of the best things about working on the marriage equality campaign is the wonderful people I've been meeting. Along with wonderful people come amazing stories. This past Saturday, Justin Ward, GLAAD Media Field Strategist, joined us in Providence. Justin led a media training for a group of Rhode Islanders who are helping fight for marriage equality. Justin began the training by explaining the importance of the media as part of our social dialogue. After a brief lecture, attendees had the opportunity to practice interviewing, with Justin as the interviewer.
Two of the training participants, Al and Nancy, are parents of three children. During their mock interview, Al spoke with obvious love for his children. He told us that he wants each of his children to be happy and that included being able to marry the person they love. We also heard from Bill and Ernie who have been together for 20 years. They had to go to Canada in order to get married and want their relationship to be recognized in the state they call home. The many stories I heard on Saturday highlighted that the time is now for marriage equality in Rhode Island.
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Hipster Trolling
July 7th, 2011
Hipsters are a strange breed, especially the ones on Tumblr. They love their vague and over-emotive desaturated photoshops on that site. There are just so many of them, they needed culling. Ergo. They were ripe for trollin'
4 Comments / Add Comment
Now I feel stupid. That's ceaelrd it up for me
Hey, that's the gertaest! So with ll this brain power AWHFY?
pox9Zb oohgkozqvbrx
Ya learn stomehnig new everyday. It's true I guess!
Funny Sh#t Abum Macho Video One Humor Pugorama LiveDump BoredTown Humor and Fun SuperFunBlog Viral Station Killer Kool Games Fashionistas Friday Funnies Funny Links Adult Humor Hot Videos Shiny New Want Girl Videos Celeb Buzzer Humor4You Voomed Top 50 Funny Sites Existenz Heavenly Babes


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I recently started my first batch of homemade wine using homegrown concord grapes. It is only in the second day of fermentation and it has turned into a pinkish color. Almost like a dark pepto bismol color...Is this normal?
My concord wine is blush colored when finished. So, yes, I'd say it's pretty normal.


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Successful African American businessman or man arms folded in a suit in a modern city
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Mass Media and Society Mass Communication Theory At this point in the class there are two directions we can go with an introduction to mass communications class. We can continue to look at communication and mass communication and how it works. Some schools in this state and this country go this route and spend the bulk of the rest of the semester looking at mass communication theory. The second route we can take is to look at the various mass media and see how they operate. This is the route most schools take and the one we'll take. We'll look at the media and discuss not only how they operate, but how they got to where they are (history) and where they are headed. The media we'll look at are outlined in the next lecture: Media Themes. But before we leave media theory behind, there are three major theories I'd like to introduce you to. They are: • The two-step flow theory • The gatekeeper theory • The agenda-setting theory They'll come up again in discussions this semester. Scholars for years have tried to find a single theory that explains how mass communication works. Some theories look good and receive a lot of attention for a while until a new one comes along. No one theory completely explains how it all works, but there is value to each in understanding the overall process. Two-Step Flow Theory The two-step flow theory of mass communication builds on the reality that it is not always possible to get your message directly you your intended audience. Because of selectivity problems discussed in a previous lecture, communication is facilitated by a filtering process. Rather than seek out everyone you want to get your message to, you instead seek out opinion leaders in society. Get your message to them and they will filter it down to those who listen to them. Some of those listeners are opinion leaders for others and will filter the message down to their followers. An example of an opinion leader in the mass media might be a movie critic. The message sender, in this case the movie team, shows the movie to the critic who then writes a review that others will read. The review will influence the readers, who will decide whether or not to go to the movie. Of course, it is well known that the best opinion leaders are people you personally know. How many of you know a movie critic? You will look to the opinion leaders you know for information. But where do they get their information and how do they form their opinions? One source is the movie critic. We can each be opinion leaders and followers/listeners in different situations. The trick for the mass media folks is in identifying opinion leaders and then reaching them. Gatekeeper Theory Imagine that you are in charge of a flock of sheep. You've got the sheep in a fenced off field and they've eaten most of the grass. Next to your field is another field of luscious grass, but it is only half the size of the field your sheep currently are in. If you let all the sheep into the new field there will not be enough grass to go around. You've got to decide which sheep to allow into the new field. So you stand by the gate that joins the two fields and make decisions. Will you allow only the white sheep into the new field? Only the black sheep? The spotted sheep? The healthy sheep? The sickly sheep that need the grass the most? You are the gatekeeper and you decide the criteria. Gatekeepers in the media are the same. They have many more messages --stories, ads, movies, television shows, songs, etc.-- to send than they can accommodate. So they decide which messages get through, which stories will appear in today's paper, which television shows will be broadcast, which songs to broadcast, etc. Newspaper editors, news directors, and others in the media are gatekeepers. Agenda-Setting Theory What's the newest must-see movie? What is the popular pharmaceutical? What's the latest on that war overseas? How do you know what I am talking about? It's because of the media, that's why. We are all free to think what we want to think about the latest movie, but the fact that we are even talking about the movie is because the media have told us it is important. The idea behind the agenda-setting theory is that the media are good at telling us what to think about. A plane crashes or there is a disaster in another country. We all have feelings about it even though it does not affect our lives at all. The media has set the agenda by the choices the gatekeepers have made. An interesting aspect of the agenda-setting function is that editors --gatekeepers-- are all making independent decisions all over the country every day. But if you were to pick up a copy of the New York Times, The Washington Post, the Chicago Tribune, the Atlanta Constitution, the Denver Post, etc. you would find some of the same stories on the front page of each. Further, you'd find those same stories leading the national, and perhaps local, television newscasts. The news media at times can be quite homogenous even though their decisions are all made independently. Do you suppose that even the gatekeepers have their opinion leaders? Reading Assignment You should be reading Chapter One in your textbook to get more information about communication. Exercise Take a look at a local daily newspaper. Give an example of each of the following from today's news. Give a brief explanation of how each is an example. Send answers to firstname.lastname@example.com. • Two-step flow • Gatekeeping • Agenda-setting Note that when submitting the answer start the subject line with: J100x – YourLastName – Theory Send to email@example.com
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Huisman successfully delivers 600mt Pedestal Crane "MPI Resolution"May 10, 2011
On Tuesday 8 March 2011, Huisman, the Dutch-based specialist in lifting, drilling and subsea solutions, successfully completed the load testing of the new build 600mt Pedestal Crane onboard Wind Turbine Installation Vessel "MPI Resolution". The load test was the final step before the crane was handed over to the clients Centrica Renewable Energy Ltd and MPI Offshore Limited.
The crane was constructed, installed, commissioned and tested at the Huisman facility in Schiedam, The Netherlands with the final load test taking place at the Keppel Verolme yard in Rozenburg, The Netherlands. The fact that the handover took place within 15 months after signing of the first agreement was a major achievement of all parties involved.
The 600mt Pedestal Crane is custom-designed for the installation of offshore wind turbines and derives from Huisman's many years of experience in the design, fabrication and service of heavy lifting equipment. The state-of-the-art crane combines unique technical features, such as a full electric variable frequency drive system, a low overall construction weight and a small minimum operating radius. Furthermore all the major equipment, such as hoist winches, is installed inside the enclosed crane house. This offers a good protection for the harsh marine environment.
With the new crane the MPI Resolution is prepared to handle larger wind turbine components for long term vessel charterer Centrica. The upgraded vessel is scheduled to be deployed for turbine installation operations upon the 270MW Lincs wind farm project.
Huisman has scheduled to deliver a second 600mt Pedestal Crane for another client in the fourth quarter of this year.
For more information please contact:
Admiraal Trompstraat 2 - 3115 HH Schiedam
P.O. Box 150 - 3100 AD Schiedam
The Netherlands
Harbour no. 561
Tel: + 31 (0) 88 070 22 22
Fax: + 31 (0) 88 070 22 20
E-mail: email@example.com
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What is this plant? Attractive foliage...
Hi, can anyone I.D. this plant? I am guessing it is tropical and I will need to take it inside for the winter. The foliage is very attractive and distinctive but no flowers yet. The nursery got a bunch of them in a shipment and was selling them but did not know what they were. (I have never posted any pics here before, so I hope this works.) Thanks, Brandy
Brandy, Hi! Wonder if this is what you have? Got mine in wall pots, spreads out in large trailing fan shape each year and gets covered in flowers...eventually! Had this ID'd on the GW Name this plant forum, (was given a cutting and neither of us had no idea what it was), they told me it's called Spanish Shawl/Heterocentron Elegans...any good??
Greenclaws, I think you've got it! I have not seen any flowers yet but I was told it flowered. (I would rather have purple or blue or yellow flowers than pink though.) Even the owner at the nursery said they would love to know what it is. Where can I find out more about it? Is it tropical? I don't know what your temps are like there, but here it is in the 90's most of the summer, winter it gets down around 20 usually a few times, but rarely any snow, and temps are more like 40's and 50's through the winter. Thanks, Brandy
Brandy, think it's classed as a tender perennial here in the UK. I wouldn't risk leaving it out for our winters so it lives in the greenhouse for the coldest part of the year. We keep that heated to keep it frost free. Last year it remained in leaf all year, I just shortened the branches by half so it didnt take up too much space. Noticed some of the stems had touched the soil and were rooted when I came to re-pot it this spring, so I potted them together in another wall-pots of their own.
Our temps where we live occasionally get up to 80, but not often and we also get frosts and snow. Where's 'coastal NC' btw??
Glad to help.
Gill: the muggy, hot and humid coast of North Carolina, USA. Quite a distance from you. Living in England, you probably hear this a lot from us North Americans, but James Herriot was one of my favorite writers. I read the bio his son wrote on him, too. Are you English? Do you live in the country or in town? It's very rural where I live. Brandy
Hi there, yep I'm English through and through!...as are the vast majority of folks in our area. Live in small village, one pub, no school or shop, 100 houses or so in North Staffordshire area called Staffordshire Moorlands, 4 miles over fields and down dale from Alton Towers. You can see some of the area around us in this pic taken in our old greenhouse last summer...
and in this one too....
I enjoy the challenge of trying to grow 'tropical' stuff and the current g/house is stuffed full at present!
I had heard that parts of England have fairly temperate weather due to the influence of the Gulf Stream, so am not surprised that folks there can grow tropicals.
But check out the palms and cycad forum where a person in Chicago has palms and other tropicals growing outdoors in the back yard ...
I am amazed ...
The photo of the plant in England looks more like Centradenia grandifolia than Heterocentron. It is a larger growing plant to 3 foot tall by 5 foot across if not frozen back in winter, and is more subtropical cloudforest than lowland tropical, and comes from southern Mexico into central America. It tends to bloom best in mild summer climates, or spring and fall in hot summer areas, and can bloom nearly 8 months out of the year here along the coast of California, where there are some at Strybing/San Francisco Botanic Garden that are 5 foot tall by 8 foot across. The foliage and stems also color up better in cooler weather, when the plant takes on a reddish cast all over.
Bahia and Longwood, did you look at the pic of my plant on Photobucket? It has the same characteristics as greenclaws plant, the best I can tell. I would prefer it had yellow flowers, or red, or purple or blue, or any color but pink! I bought 3 of them and gave two to neighbors. One of them thinks she saw the same type of plant last summer w/ salmon-colored flowers. Is there a site to look up the two plants?
Greenclaws, your tropical plants and the green, green background are striking! I didn't know there was so much open ground in England- thought most of it was towns and cities. Thanks for sharing the pics. Brandy
Hi, me again, I totally agree with you on the new ID!!!...let me explain?
Was given ID of Spanish Shawl/Centradenia Grandifolia on GW forum but couldnt access my old post to check it for some reason. I remembered the S. Shawl bit but not the C.G. part, so googled S. Shawl and was given Heterocentron Elegans with no mention of C.G whatsoever. It didnt ring a bell, and I wrongly assumed it was correct. When you gave the ID of C.Grandifolia I recognised it immediately as the Latin name I was given originally....sorry to confuse you!! but it just goes to show us how important these Latin names really are as several differing species can be known under the same common name.
Brandy, the UK most definately has large urban areas of cities and the like, but conversley, there are miles and miles of open countryside with forests, pasture, dales, heath and moorlands like the area in which I live. The only thing we are short on is a desert I think! The site 'Google Earth' will give you a good aerial view of what its like over here.
Regards and thanks for correcting me!
Brandy, I think the plant you may be more in love with is Lysimachia. I can't remember a common name, but it is also a sprawling plant, perfect fo ra container or hanger, with limey-fuzzy leaves and little yellow bell-rippled flowers.
The plant you have is definitely in the Tibouchina family, and as such, the flowers are typically always purple or pink (rarely white).
I'd suggest you simply do a google search and look at images for the two Melastome species. I always considered the flower color of both to be more towards the magenta color range than pink. I know of no melastomacea plant similar to these two that would have salmon colored flowers. You might also try growing some of the hebaceous Melastomes from Asia and South Africa that would be hardy in the Carolinas. These would include Rhexia and Osbeckia and some of the Melastoma. The winter deciduous ones only do well here in northern California if you give them lots of water, and don't perform well here in cool coastal conditions as do the more cloudforest species. Therefore I don't grow any of them, but they do have flowers that are more purplish than pink, and would love your summer heat.
I think it is the Centradenia Grandifolia, so I appreciate having a name for it!
Greenclaws- It's not a desert here, fortunately, but there is a lot of sand! I'm just over an hour from any beaches, but I've got plenty of sand! And lots of tall pine trees.
Longwood- there are several plants called lysimachia in my catalog (Bluestone perennials) but none of them fits that description.
Bahia- thanks for the suggestions.
Now, can someone suggest a company to order such plants from? Thank you! Brandy
Brandy, the plant I mentioned is often called Golden Globe (among other things). It's botanical name is Lysimachia procumbens and it's hardy zones 6-9. We can only marginally grow it year round in south Florida as our summer heat makes it melt.
It is back in the big box stores here in nice hanging baskets again.
I forget to list Dissotis, another Melastome that is winter deciduous and loves hot wet summers. This species may actually be available in general nurseries back east. It needs more heat and water than I can give it to bloom well here, and after all, Heterocentrons, Centradenias, Monochaetums, etc thrive in our cool foggy summers if watered.
The Lysimachia I am most familiar with is L. nummularia, which grows like a thick weed if well watered, and does have forms with great chartreuse foliage.


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Steamboats have been around since 1787 when John Fitch made his maiden voyage up the Delaware. When people think of them they think of the Belle of Louisville, Delta Queen and the Great Steamboat race every year at Derby time. Everyone is excited to see who is going to win those Golden Antlers. Kids and adults alike love the sound of the whistles and watching the turning of the great paddles on the back. It makes one wonder what James Howard saw through the lens of his camera at his tender young age when he began to photograph Steamboats in the late 1800's and early 1900's. Did he picture the steam billowing up through the big stacks? Did he see the soot on the bow and landing, even at times the clothing? James 'Captain Jim' Howard experienced all of this, and more...and his wonderful photography shows it all.
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MEDFORD, Ore. — A strong storm will bring heavy rain and strong winds to the region Wednesday through Thursday. Wind gusts could reach hurricane force along the Coast Range Mountains, while gusts near 50mph are anticipated across the Valley. The strongest winds will be this afternoon and evening through early Thursday. High wind warnings and … Continue reading »
Dangerous Storm Affecting Mountains
With an approaching weather system, many weather advisories are in place across our region. A very strong area of low pressure is pushing inland and will bring moderate to heavy snowfall to the higher elevations and high winds through Monday morning. Up to 2 feet of snow can be expected in the mountains, especially the … Continue reading »


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Winnipeg Free Press - PRINT EDITION
Farmers have new way to fix Lake Winnipeg
Study suggests artificial wetlands
RM of THOMPSON -- When freshwater scientists sat down to figure out the source of Lake Winnipeg's ecological problems, farmers wound up with a large portion of the blame.
In 2006, the Lake Winnipeg Stewardship board determined agriculture was responsible for five per cent of the nitrogen and 15 per cent of the phosphorus flowing into the world's 10th-largest lake, which suffers from algae blooms and low-oxygen "dead zones" as a result of heavy loads of these fertilizers.
Given the vast size of the Lake Winnipeg watershed, which stretches from the Rocky Mountains to lakes west of Thunder Bay, no individual farm can be held responsible for an algae bloom. But the portioning of blame was an unpleasant surprise for farmers in this province, who shoulder an even heavier load of the blame for the nutrient loads that originate within Manitoba's borders.
Agriculture turned out to be the source of no less than 38 per cent of the nitrogen and 32 per cent of phosphorus that originates within Manitoba and winds up in Lake Winnipeg, the stewardship board concluded in its landmark report.
In the aftermath, the province enacted a moratorium on hog-barn construction and created new agricultural land-use maps that came under heavy fire for being imprecise. But there are less onerous means for agricultural producers to reduce the amount of nutrients that wind up flowing downstream from their farms, according to newly published research led by University of Manitoba soil scientist Kevin Tiessen.
Farmers in areas of Manitoba with rolling hills can reduce nutrient loading into Lake Winnipeg by creating small artificial wetlands, Tiessen and fellow researchers at the U of M and a trio of federal agencies suggest after analyzing nine years worth of water-quality data from a pair of small dams on the South Tobacco Creek, west of Miami, Man.
The dams in question were originally built on farms at the top of the Manitoba Escarpment to prevent erosion from scarring the hillside below and damaging downstream roads during serious flood seasons. One is a "dry dam" that simply holds back water temporarily, while the other is a "multi-purpose dam" that functions as an artificial wetland -- complete with marsh plants -- but also serves as a water source for cattle.
In an article published this May in the Journal of Soil and Water Conservation, Tiessen and his colleagues found the dry dam reduced the downstream flow of nitrogen by 20 per cent a year and phosphorus by nine per cent a year. The multi-purpose dam reduced nitrogen outflows by 15 per cent a year and phosphorus loads by 12 per cent.
The researchers conceded they weren't sure why the artificial wetlands were so effective. During the spring snowmelt, it's too cold for marsh plants to filter out phosphorus and nitrogen because they aren't growing. And during summer rains, brief downpours provide too short a window for plants to take up nutrients.
The dams themselves seem to play a role in reducing nutrient loads, possibly by mellowing out the peak water flows that cause the most erosion and free up nutrients that occur naturally in the soil.
"It is clear that small headwater dams and reservoirs are an effective tool to reduce downstream nutrient loading," concluded the researchers, recommending the construction of small dams on agricultural land anywhere in southern Manitoba with undulating terrain.
Their research adds to a body of work that demonstrates how flooding of agricultural land affects the water quality of Manitoba's largest lakes.
After analyzing the 2009 spring flood, U of M geography student Reanne Pernerowski found the Portage Diversion, an artificial floodway, was responsible for 93 per cent of the phosphorus and 60 per cent of the nitrogen that wound up in Lake Manitoba at the time.
During the same flood season, U of M geographer Greg McCullough also found elevated nutrient loads on the La Salle River. McCullough also found nutrient loads into Lake Winnipeg were roughly four times higher in 1997, the year of the Flood of the Century, than they were in 2003, a low water year.
Republished from the Winnipeg Free Press print edition August 30, 2011 A5
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About Bartley Kives
Bartley Kives wants you to know his last name rhymes with Beavis, as in Beavis and Butthead. He aspires to match the wit, grace and intelligence of the 1990s cartoon series.
Bartley joined the Free Press in 1998 as a music critic. He spent the ensuing 7.5 years interviewing the likes of Neil Young and David Bowie and trying to stay out of trouble at the Winnipeg Folk Festival before deciding it was far more exciting to sit through zoning-variance appeals at city hall.
In 2006, Bartley followed Winnipeg Mayor Sam Katz from the music business into civic politics. He spent seven years covering city hall from a windowless basement office.
He is now reporter-at-large for the Free Press and also writes an outdoor-recreation column called Offroad for the Outdoors page.
A canoeist, backpacker and food geek, Bartley is fond of conventional and wilderness travel. He is the author of A Daytripper's Guide to Manitoba: Exploring Canada's Undiscovered Province, the only comprehensive travel guidebook for Manitoba – and a Canadian bestseller, to boot. He is also co-author of Stuck In The Middle: Dissenting Views of Winnipeg, a collaboration with photographer Bryan Scott and the winner of the 2014 Carol Shields Winnipeg Book Award.
Bartley's work has also appeared on CBC Radio and Citytv as well as in publications such as The Guardian, explore magazine and National Geographic Traveler. He sits on the board of PEN Canada, which promotes freedom of expression.
Born in Winnipeg, he has an arts degree from the University of Winnipeg and a master's degree in journalism from Ottawa's Carleton University. He is the proud owner of a blender.
On Twitter: @bkives
Email: firstname.lastname@example.com
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- Selinger wins on second ballot at NDP leadership convention
- Property tax increase capped, but frontage levies, garbage fees to increase
- Before meeting with mayor, Chipman wants written response
- Judge doesn't buy tale of biker's bounty
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Kukla's Korner Hockey
Fighting Canes
by Paul on 10/09/06 at 08:29 AM ET
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Kevyn Adams suffered a cut over his left eye in a fight with teammate Bret Hedican midway through an hour-long skating session as the tension of a winless season overflowed on the RecZone ice. On what had been a scheduled off day, the Hurricanes went through an unscheduled rough day as Hurricanes coach Peter Laviolette attempted to take corrective action after only three games to prevent things from getting worse in the next 79. "We have to start playing the game the right way," Laviolette said. "The biggest thing that I can take from exhibition season and the first three games of the year is that we're not paying a price to be successful. If we're not going to do it in games, we have to do it in practice."read on
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About Kukla's Korner Hockey
Paul Kukla founded Kukla's Korner in 2005 and the site has since become the must-read site on the 'net for all the latest happenings around the NHL.
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Going to be releaseing some new content very soon be sure to check it out.
Nice work much success. Thanks for the support!
Really cool, original tracks here!
Amazing sounds my friends!! Glad to be a fan!! Stay blessed!!
"son of the sun" & "morse code..." awesome sounds !! nice work & congrats on rank #1!!
Great 16bit Music, sounds like classical Digital Analogue, lovely, thank you for sharing!
Dig your sounds!
Good job keep it up! I really like your music especially "The Son of The Sun" .Check out my music I hope you find something you like I think "Love is not Enough" is a track for you !
"Morse Code" Sounds Great! Enjoying my listen here. Stop by anytime, take a listen and let me know what you think. ThanX Mykoman


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Sun Check Tool 1.3
Published on 05 October 2007 07:46 PM EDT
Written by
Michael Larabel
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If you're curious about Solaris/OpenSolaris support on your computer hardware, Sun's Check Tool 1.3 is now available. Check Tool 1.3 is an update to the previously reviewed
Check Tool 1.2
, but adds the Solaris 10 8/07 kernel, X.Org driver detection for video devices, and an updated driver database. Previous to this 11/06 kernel upgrade, Sun's Check Tool had used the Solaris 10 11/06 kernel. The X.Org driver detection now makes it possible to detect what X.Org driver you'll need for your graphics hardware. More information on the x86 Installation Check Tool is available at the
BigAdmin HCL
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text: Two magnificent white flowers captured in a luxurious, elegantly simple bouquet. Limit 1 order per day. Price: $90.00 - $150.00 This exquisite fragrance combines the rich essences of precious Tuberose and exotic Gardenia. It was originally created by Aerin Lauder for herself and her closest friends. The Eau de Parfum Spray cap is a work of art with a hammered gold texture, inspired by a necklace Aerin Lauder inherited from her grandmother, Estée Lauder. Fragrances are available in different concentrations. The concentration determines the strength of the scent. Perfume (Women's) contains between 20-40% of aromatic compounds making it the strongest and purest, richest and longest lasting of the fragrance line. Eau de Parfum (Women's) contains between 10-30% of aromatic compounds, making it the second strongest of the fragrance line. Eau de Toilette (Men's and Women's) contains between 3-5% of aromatic compounds. Eau de Cologne/Cologne Spray (Men's & Women's) contains between 2-5% of aromatic compounds. Eau Fraîche contains between 1-3% of aromatic compounds. More


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Tim Allen gets a fourth season!
Tim Allen stars as Mike Baxter, marketing director of an outdoor sporting goods store, fighting for his manhood while constantly being surrounded by women, including his wife and three growing daughters.
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Whole Foods Market
Today:8:00 am - 11:00 pm
1020 Alton Rd,
Miami Beach, FL 33139
(305) 938-2800
Business Details
in Business
- Hours:
Regular Hours
- General Info:
- Whole Foods Market Inc. is one of the world's leading natural and organic foods supermarket in the United States. It is America's first national Certified Organic grocer. Whole Foods Market Inc. is a Texas corporation incorporated in 1980. The Company conducts business through various wholly owned subsidiaries. It additionally has one operating segment, natural and organic foods supermarkets. Whole Foods Market Inc. operates around 284 stores, of which 273 stores in 38 U.S. states and the District of Columbia; six stores in Canada and five stores in the United Kingdom.
- Extra Phones:
Phone: (305) 532-1707
- Payment method:
- amex
- Neighborhoods:
- Lenox Manor, Flamingo-Lummus
- Other Link:
- Categories:
- Grocery Stores, Fruit & Vegetable Markets, Health & Diet Food Products, Supermarkets & Super Stores


text:
Junior Member
Give me back my fon please
hi im BRNA
Senior Member
Can you put the time area back to the left side not way to the right.. for some reason my screen cuts off and I can't see the time):
54 riot post in NA, 6 in EUW and 2 in EUNE. Just saying.
You think players will like to type or scrolling down a mile long list more instead of 2-3 fast click?
And where is the promised slot for consumables?
Oh great unnamed god who gifted us with the Age of Strife! Please we beseach thi to answer our pleas of inqurie! Is it moral or is it not moral to take another's idea? Whether to improve opon the idea you have barrowed or to improve your own idea with it? Warever you may rest, warever you may wander, can you gift us with your insight? He already has... For when The Great Sage Eul reincarnated AoS in DotA, his silence was his blessing and with it DotA flourish and prospered. With many different sages with there own incarnations of AoS but all were mearly copies of the first reincarnation, DotA, still they shine in their own way untill there was a prophet! This prophet was none other then Guisoon! He looked upon all the incarnations saw the shining light unique to them all but he saw they could be so much more! He worked tirelessly with other sages, combining the lights of all untill it was ready, DotA All Stars! As the name implies it is a comalation of many the ideas of the many sages that shined, every dota was one, all thanks to this great prophet! THAT is his answer! To SHARE ideas! All DotAs, ALL MOBAs, have this history! If any of them Monday Night Fight, Minoins, LoL or even DotA2 say ANYTHING was stolen from them by another moba I ask thi what of AoS, what has YOUR GOD said about his idea being used by someone else? What has he said about others profiting from the vary game he has not seen a cent of! He says NOTHING! For whetherr he rests or wanders he takes pride in what he has started! In all it's aspects!
Sorry for posting this so late, just got around to it.
i don't like this new item shop and HUD, it seems like their trying to make LoL more like HoN or DOTA with this item shop and HUD. What's next being able to level to 25 and upgrading stats.
Is there any way to not have the searching start with enter and just start if you start typing? Like in firefox I have "Search for text when I start typing" enabled, so if I start typing without being in a box of some sort, it just starts searching the page. I feel this would be quite a nice minor addition in the options somewhere
Looks really good
Question: When will this be in game like with a patch and if so when will the patch be put?
cant wait looks great
The new HUD I don't mind, but the new shop interface is gonna take some time getting use to considering most of us have been using the old one for a while now. I'm not a fan of the new one at all.
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The Landing at Newport Condominium-Hotel
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State slogan: "Oregon! Closed for maintenance."
... piece of paper was on the door telling me that it was closed for maintenance until January 6! I was a little disappointed, and I only got to see the outside of the place. There were other people pulling up, walking up to the door, shaking their head and looking disgusted, then leaving. At least I wasn't the only one disappointed.
We head back out to the coast, checking out lighthouses, vistas, and beaches. There are small towns that come right ...
Lava Dome Growing!
... Observatory you can see wisps of gases escaping the quiet innards of the monster. Hikers can get a permit to hike to the rim with the knowledge that burning tephra can be ejected at any time. No thanks.
With Bud's senior park pass, we toured Johnston Observatory and watched the movie detailing the events of the eruption. I wish there were some way for me to illustrate the magnitude of this event...the landscape was changed for as far as ...
Day 23
... 2011 estimate listed Newport's population at 9,968 residents.
One thing about Newport is its magnificent bridge, which is called the Yaquina Bay Bridge, named after the American Indian Tribe of the area. This bridge was crossed by us as we were traveling to the Oregon Coast Aquarium. This is a world class attraction and nestled in the Yaquina Bay by the bridge. There were many people at the aquarium and we saw ...
"We did it! We win...at life!"
... just across the street but could not see them. We left the sliding door open as we researched our dinner options. Within a short walking distance was the highly rated Chowder Bowl at Nye Beach. So, we walked down with the dog, Andy took some pictures while I ordered carryout. We returned to our room and enjoyed dinner of delicious clam chowder, garlic ...
Pacific Coast Highway
Miles Today 192 Total 9753
Not a good sleep last night even though it was a very quiet site. Up early and tried to Skype Jayne but without luck. Hit the road but it was cloudy and cold.....yup, cold !Just outside of Raymond ( I think) I popped into a McDonalds for breakfast and for their Wi-Fi. Jayne STILL wasn't available.......women !! A lady biker arrived, on a bike that Madam would ...


text:
The rupee trimmed its initial gains and was flat at 60.36 against the US currency in morning trade today on sustained dollar demand from banks and importers on the back of firmness of the American currency overseas.
It resumed higher at 60.30 per dollar as against the last closing level of 60.37 at the Interbank Foreign Exchange market.
Later, it declined to overnight level of 60.37 on heavy dollar demand from importers.
The domestic unit hovered in a range of 60.37—60.26 per dollar during morning trade.
In New York market, the US dollar rose against major rivals late yesterday after a better—than—expected reading on US industrial production in March suggested the economic recovery is strengthening.
Meanwhile, the benchmark 30—share Sensex was trading higher by 197.69 points, or 0.89 per cent, to 22,474.92 at 1040 hours.
Keywords: rupee-dollar index, forex, interbank foreign exchange, opening trade


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