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This section contains important advocacy and regulatory information for nonprofit Medicare certified home health service providers reimbursed under Medicare Parts A and B, Medicare Advantage and the Veterans Administration. LeadingAge provides updates on funding and regulations that impact Medicare Certified home health, research reports released about Medicare Certified home health, and resources and information to assist not for profit Medicare Certified home health providers to operate quality services and remain financially viable in a competitive market.
We've featured some articles below, but be sure to check out all of our home health content.
On October 29, 2015, the Centers for Medicare and Medicaid Services (CMS) released the CY 2016 Home Health Prospective Payment System (PPS) final rule. The final rule will be published in the Federal Register on November 5, 2015. The good news is that in the final rule, CMS states that payments to home health providers would be reduced by about 1.4%, or $260 million, instead of the $350 million as proposed in June
The Centers for Medicare and Medicaid Services (CMS) published star ratings on Home Health Compare. According to CMS, the star ratings for Medicare Certified Home Health will help consumers obtain information about a home health agency's performance, and will help the home health agencies by providing data to help identify areas for improvement.
The Home Health Care Planning Improvement Act of 2015 (S. 578) was introduced in the U.S. Senate by Sen. Susan Collins (R-ME) and Sen. Charles Schumer (D-NY) on Feb. 26. On the U.S. House of Representatives side, Rep. Greg Walden (R-OR), Rep. Ron Kind (D-WI) and Rep. Danny Davis (D-IL-7) introduced their version, H.R. 1342, on March 6, 2015.
In the Feb. 2, 2016 Federal Register, CMS announced the extension of temporary moratoria on the enrollment of new Medicare Part B ground ambulance suppliers and Medicare home health agencies, subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse.
Beginning July 1, 2016, physicians must document a face-to-face encounter with a patient (including through the use of telehealth) for Medicaid to cover home health services and medical equipment according to a final rule (CMS-2348-F, RIN 0938-AQ36) published in the Federal Register on February 2.


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Match the artwork to the presenter to see Toulouse-Lautrec exhibit
Congratulations to Leisha Robertson of Wynnum who has won the Toulouse-Lautrec competition.
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Leisha has won a trip for 2 to Canberra to visit the National Gallery of Australia to see the Toulouse-Lautrec: Paris and the Moulin Rouge exhibit in March.
The prize includes return flights for 2 people with twin share accommodation for 2 nights at a 4.5 star hotel. The winner and their guest will enjoy a tour of the exhibit with the ABC's Tony Delroy folowed by an exclusive cocktail function at the French Ambassador's residence.
All becuase Leisha corrrectly matched the artworks here on the right of the page, to the 612 ABC Brisbane presenter who owns them and has them on display at their home.
You can hear the audio of Spencer announcing the winner on-air here.
Full terms and conditions for the competition are available here.
The runners up who will receive a copy of the exhibition catalogue for Toulouse-Lautrec: Paris and the Moulin Rouge are:
Lesley Yates
E. Webb
Sandra Mitchell
Peter Williams
Janet Tutin
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FreeThe story's informal tone broadens into a twisted, underlying theme, both immoral and political: fiends created by man achieve man's detestable covert scheme under auspices of two mega corporations. The first credible child victims do not escape from unpredictable beasts that conduct devious interactions in storm drain tunnels under Brownsville, Texas where fathers band together to war with them
FreeA man craves revenge against a young woman but indirectly uses his enormous canine that ultimately wants to kill her. Which one survives?EXCERPT: "We hear a bellowing bark. At once, Hannibal releases my ravaged shoe. Like a human suddenly distracted, his angry expression switches to astonishment: his bottom jaw drops as if he recognizes the bark. He promptly peers down from the Caterpillar roof,
FreeSome friends are more memorable than others, such as Steven and Linda. After the Priest gave him his last rites, Steven continued to live. And not until decades later, we understood why.Excerpt: "Mother snapped her fingers. 'Get down on your knees,' she said while pointing to the floor. We knew she meant it by the stern look on her face. In her bedroom, we gathered closer together in front of the
FreeRare books in Rabbi Stadt's office reveal Jewish Holocaust truths not taught in schools, and thirty years later she lives to see it happen.Excerpt:As I was greatly intrigued by the facts of the Holocaust for so many years, I waited for weeks, hoping for the right opportunity to ask the Rabbi my question, which surely he could satisfy. On this hot summer morning, the bright sun shined through his
Free(Chosen by 4 newspaper editors in Texas) Days before Christmas in 1959, a 10 year old daughter and distraught mother walk to visit the mother's best friend Mary. While the mother tells Mary she is packed and ready to leave her husband, the saddened daughter listens and suddenly finds a framed photo of her once happy parents in Mary's parlor. Mary convinces the mother to.......
FreeDuring wee hours of morn, a panicked family tries to escape from home where violent flood waters engulf the entire subdivision. While struggling for their lives, the realization of how much they mean to each other dominates terror. "Our neighbors' distant, bloodcurdling screams bounce off the water's surface. Unable to help them, we act as if unaware. What must my friends be going through?
FreeEarly 1900s Anglo-Saxon society redirects Angela's life. Minimally daunted by hardship, a fiery character based on a real Texas woman faces obstacles with gritty conviction while struggling to reach a near impossible dream on the land of her murdered father. A huge silver wolf's unconditional love manifests and rules him to battle until bloody during harrowing encounters when the devoted alpha
$0.99Martin likes to be prepared in advance for any potential disaster. Obsessive door locking and checking, stockpiles of food, torches within easy reach ... he's a very organized guy. However, the one calamity he'd never thought to prepare for turns up in the form of a a beautiful, free-spirited artist called Anna. When cyclone Anna arrives, Martin is completely defenseless in the face of her
Harriet, the Moses of Her PeopleIn 1869, Sarah Hopkins Bradford published Scenes in the Life of Harriet Tubman. Though often disjointed, this account presented to the public a legendary figure of the Underground Railroad. In 1886, Bradford substantially rewrote the biography at the request of Tubman, who hoped its sales would raise enough funds for the building of a hospital for old and disabled colored people. This second
Eternal Love: The Immortal Witch Series"My inspiration has always been Maggie Shayne...." –New York Times Bestselling Author Christine Feehan For the first time, all three books of Maggie Shayne's Award winning IMMORTAL HIGH WITCH trilogy are together in a single volume. "A rich, sensual, bewitching adventure of good vs. evil with love as the prize." –Publisher's Weekly on ETERNITY Raven is a witch from the 1690s who flees the


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Made a pretty quick find here after I poked a hole in my leg with a downed branch. I guess I still had some blood left after my mosquito bloodletting earlier today in Adams County! Thank for the cache!
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ACE Fit Share
James Prochaska, Ph.D. and Michael Mantell, PhD
Once a health and fitness program has run its course, it's often easy for people to revert back to their old ways. In this episode of 15 Minutes to Wellness, Dr. Mantell is joined by James Prochaska, PhD, professor of psychology, author and director of the Cancer Prevention Research Center at University of Rhode Island to discuss how to successfully maintain lifestyle change.
James O. Prochaska, PhD, serves as director of the Cancer Prevention Research Center at the University of Rhode Island, where he is also a professor of clinical and health psychology. Prochaska has written more than 350 publications, including three books, Changing for Good, Systems of Psychotherapy and The Transtheoretical Approach. Internationally recognized for his work as a developer of the stage model of behavior change, he is the principal investigator on a $70 million research project focused on the prevention of cancer and other chronic diseases. Prochaska is the founder of Pro-Change Behavior Systems, and he has won numerous awards including the Top Five Most Cited Authors in Psychology from the American Psychology Society and an Innovator's Award from the Robert Wood Johnson Foundation. He is also the first psychologist to win a Medal of Honor for Clinical Research from the American Cancer Society.
Hosted by Dr. Michael Mantell,
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Fit Facts®
20 Active Ways to Be Social at Work
You'd like to mingle more with your co-workers, but every opportunity seems centered around eating and drinking. Don't fret. There are plenty of ways to integrate your healthy lifestyle with your on-the-job social life.
Staying Fit with Lung Conditions
Years ago, people with lung conditions were advised to take it easy, and sit out of strenuous activities. Thanks to medical research, those days are over.
It's established that regular exercise is beneficial for people with lung disease.
10 Fun Summer Activities for Kids
Summer is here! There is no better time for kids to enjoy the outdoors and get the recommended 60 minutes of physical activity per day.


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Saturday, October 31 2015
Breeders' Cup Mile Quotes
Mark Casse (trainer, Tepin, 1st) – "I said to Norman (son and top assistant) after Stephanie's Kitten's performance today that if she (Tepin is going to be champion Turf Mare, she's going to have to win today. I whispered that in her ear. To be in the same company with Goldikova, Miesque and Royal Heroine, beating the boys in the mile, I'm not sure I have the words. Am I dreaming? She just continues to amaze me. I'm still in shock (at how easily she won and by how many lengths) so I'll have to watch the race a few more times, and then I'll be even more surprised. I can't put it into words what great work Norman did with this horse. It's special. He worked really hard with her. It's hard to describe (my emotions)."
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45-year-old Rivers Cuomo lives in Storrs, Connecticut. He has also lived in Los Angeles, California; Santa Monica, California and Hartford, Connecticut. He is an alumnus of the Harvard University and Berklee College Of Music. He has worked for Rock Star, Late Show With David Letterman, Guitarist, Vocalist, Songwriter, Pinkerton, Make Believe, Ian, Weezer, Smallville, Singer-songwriters, The Sopranos, Aquamarine, Maladroit, Holiday In The Sun, Mallrats, Italian-american Musicians, Rock Singers, Accepted, American Pie 2, Out Cold, Bring It On: All Or Nothing, Drillbit Taylor, German-american Musicians, Raditude, The Hot Chick, Mr. Deeds, Beavis And Butt-head, Guitar Hero Iii: Legends Of Rock, Comedy Central Roast Of Larry The Cable Guy, Musicians Of Italian Descent and Musicians Of German Descent. Positions he has held include Singer and Musician. Kiss, Techno, Emo, Poison, O-town, Indie Rock, Power Pop, Pop Punk, Alternative Rock, Justin Timberlake and Van Halen are some of his favorite bands. Rivers loves American Idol, Mtv, Vh1 and Total Request Live. Rivers loves the film Mysteries. He likes Peanut Butter a lot. On the web, Rivers goes by the alias weezerfrontman.


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B/W Video is a nice idea. With sound it would be perfect :)
Holly, she seems to enjoy what he's doing enough to buck and squirt for him. What you like isn't necessarily what she likes!
this looks so annoying. It's like he's scratching his nose. Put your tongue on it!
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- It's Christmas & I'm Grieving! December 17, 2015
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- The Immobilization That Follows Grief And Loss July 19, 2012
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Pletcher Lassos Gotham With Cowtown Cat
If trainer Todd Pletcher doesn't manage to win a spring 3-year-old Classic this year, it won't be for lack of trying. On the day he saddled Circular Quay for a convincing victory in the Louisiana Derby (gr. II), he was also taking the $200,000 Gotham (gr. III) with Cowtown Cat at Aqueduct Saturday.


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Store Manager
Location: Brighton, East Sussex, BN43 6TB
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Founded in the late 1970's American golf now have in excess of 100 stores nationwide and nearly 1,000 employees in the UK and Ireland and we're still growing! Our vision is to 'improve our customer's game through our passion and knowledge' and we ... more about Store Manager - Brighton, East Sussex, BN43 6TB
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NewsMarch 20 2012
Presho Celebrates St. Patrick's Day
Posted by Lucy
Tim and Peg Boysen drove their team and wagon through Presho's 30th Annual St. Patrick's Day Parade Satruday, March 17, carrying grandkids and other family members. See this week's Lyman County Herald for more photos and stories.
- May Day Flowers
- Herald and SUN recognized at Association Convention
- Murder suspect sited in Lyman County, apprehended in Wyoming
- Forum introduces Republican candidates for commission
- Foundation awards $22,000 in 2016.
- 29th annual Band Dinners
- Candidate forum to be held in Presho
- Presho to test fire siren April 26
- Unofficial City Election Results for Presho and Kennebec
- Kicking up their heels at a Country Chic Prom
- Postage rates will decrease
- GLF Spring Event to be held at Oacoma


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This Community Lens looks at single mothers in Halton using the 2011 Census data.
This Community Dispatch reviews recent understandings of loneliness and social isolation among older adults, while at the same time outlining distinguishing characteristics.
The Social Planning Program at Community Development Halton undertakes a wide range of activities and research to help Halton identify its strengths and weaknesses and determine ways to improve the quality…
Perhaps you would like to make new contacts, learn skills, gain work experience, build self-esteem, or look for personal development.


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|Publication number
|Publication type
|Publication date
|Nov 27, 1888
|Publication number
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (3), Classifications (1)
|External Links: USPTO, USPTO Assignment, Espacenet
2 Sheets Shee t 1.
(No Model.)
' Patented'Nov. 2 7, 1888.
WITNESSES I N. PETERS. Fhnhrlihwmphlr, Washingion. D C.
(No Model.) 2 Sheets-Sheet 2.
R. S; KIRKPATRICK. BOOK SUPPORT QR HOLDER. No. 393,649. Patented Nov. 27, 1888..
nnnnnnnn 'n-Lilhogmphur. Washington. o.;c.
$3935G'Il-EIGATION forming part of Letters Patent No. 393,649, dated November 27, 1888.
Application filed June16,1888. Serial No. 277.335. (No model.)
To aZZ whom it may concern.-
Be it known that I, ROBERT SAMUEL KIRK- PATRICK, a citizen of the United States, residing at Harlan, in the county of Shelby and State of Iowa,haveinventedcertain new and useful Improvements in Book Supports or Holders; and I do hereby declare the following to be a full, clear, and exact description of the invention, such as will enable others skilled in the art to which it appertains to make and use the same.
This invention relates to improvements in book supports r holders; and it consists in the novel construction and arrangement of the same,whereby said support can be adjusted to different positions,at the same time providing a self-acting rest for the book when the latter is placed thereon, all as will be hereinafter fully described.
The annexed drawings, to which reference is made, fully illustrate my invention, in which- Figure 1 represents aside view of my device. Fig. 2 is a detail sectional view of the sliding arms. Fig. 3 is a top view of the same. Fig. 4 is a sectional view taken on line mm, Fig. 1; and Fig. 5 is a similar view in different position.
Referring by letter to the accompanying drawings, A designates a pivoted bracket designed to be attached to a table, wall, or other convenient support, and the same provides lateral as well as vertical adjustment for the holders,furtherexplainedherein. Thisbracket is composed of upper and lower horizontal arms, a a, the latter, a, being pivoted on a vertical bar or rod, 1), and is provided with a set-screw, 7), whereby the bracket,with its holders, may be held in place after being adjusted vertically, and this rod 1) has its upper and lower end hearings in suitable arms,c,secured to a table or other support. The ends of this rod are pivoted in these arms a, and permit the bracket and its holder to be moved laterally. The outer end of the lower bracket or arm,a,is vertically perforated, through which perforation passes the lower end of a rod, 0, and in which said rod is free to turn, and at the upper end of said rod an arm,a,is pivoted, at the outer end of which the holders are pivoted.
The letter (1 indicates a pivotal pin, the upper end of which is screw-threaded to receive a thumb-nut, d,and it has a shoulder,e,whioh rests upon the outer end of the arm a, while the lower portion, 6', enters the perforation in said arm. This pin is provided with a square fiat portion, (2, which enters the slotsfin the armsf ofthe holder. These arms slide upon one another, and are held and guided in their movement by the lips g, which overlap the sides of said arms, as shown in the drawings.
It will be observed that I provide two rests or holders for each bracket, and the mechanism of each holder being a duplicate of the other I will proceed and describe but one of said holders and its operating parts.
B represents a U-shapcd arm, having an enlarged circular portion, 9, which is perforated to receive a bolt,h,having a thumb-nut, h, whereby said arm B is pivoted to the outer end of the slotted arm, which latter also has an enlarged circular perforated portion,t',corresponding with the enlargement on theU- shaped bar aforesaid. By this connectiomj ust described, the holders can be adjusted to a horizontal position, an inclined and vertical position,and held in proper place by tightening the thumb-screw on the U-shaped bar or arm.
At the upper portion of the arms 2" i of the arm B is pivoted a cross-bar, j, and a similar cross bar,j, is pivoted to the lower portion of said arm, as shown at k k. The outer ends of these barsjj are in turn pivoted to the arms 'Z Z of the angle-irons m m, which latter are socured to the book-receivers n n,and the springs oand receiversnare connected to the U-shaped bar B by the cross-bars jj, as shown in the annexed drawings. This construction of the bars jj', U-shaped arm, and angle-irons m m presents a pivoted frame, whereby the bookreceivers n n can be raised or depressed to accommodate themselves to a book. I provide springs o 0 for this frame, which springs cross one another,the ends thereof being connected to the pins 12 10 pp on said frame, and at the upper and lower portions of said frame, as shown in Figs. 4 and 5, and the same permits of the desired tension for the receivers. designed to hold and adjust the receivers when the latter are relieved from the weight of a book,thereby keeping the twin receivers on a line with one another.
It will be observed that by the construction ICO of a booksupport, as herein described and shown, the same can be adjusted to many positions, and the receiver's, being connected to the pivoted l'rame,have an up-and-down movement and' accommodate themselves to the book placed thereon, thus supporting a book in proper-position for reading,and the device can he used by a person either standing or in a sitting position, and it is simple in operation, and easily and quickly adjusted to different positions.
I-Iavingdescribed my i nvention, whatlelaim, and desire to secure by Letters Patent, is
The book holder orsupport herein described, consisting of the receivers a a, the pivoted frame composed of the barsjj and ZLCarrying the Ushaped arm I having the enlargement y, the sliding arms f f, provided with the ltdlllllll'l Silllllh lillllil'li'llllllli.
(l. l). (lawn, W. E. (l none is.
|Citing Patent
|Filing date
|Publication date
|Sep 8, 1959
|May 2, 1961
|Berlin Fred H
|Attachable receptacle
|Aug 24, 1992
|Aug 31, 1993
|Automated Monitoring And Control International, Inc.
|Universal computer support bracket
|Nov 22, 1995
|Jun 30, 1998
|Hirsch; Steven
|Adjustable stand for mounting on a wall or the like
|Cooperative Classification


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The bride is a 2007 Monett graduate and a 2011 graduate of Drury University. She received a bachelor's degree in biology and chemistry. The groom is a 2007 Monett graduate and is currently employed by Meeks Lumber, of Monett.
The wedding was held on June 4 at the First Baptist Church in Monett with Rev. Paul Walhert officiating.
The wedding party included: Kelsey Henson, best friend of the bride, who served as maid of honor; and Kaylie Meeks and Erin Gasser, both friends of the couple, who served as bridesmaids.
Tyler Swope served as the best man. Groomsmen were Ethan Davis, brother of the bride, and Dennis Ray, friend of the groom.
The flower girl was Noelani Welters, niece of the groom, and the ring bearer was Vincent Welters, cousin of the groom. Door greeters were Shana Paulsen and EmiLee Davis, both cousins of the bride. The ushers were Matthew Welters, brother of the groom, and Gary Welters, cousin of the groom.
A reception followed the ceremony at the First Baptist Church multi-purpose building in Monett. An ice cream bar with various toppings was served by Mary Blinzler, Stacy Tottingham, Crystal Judy, Pearl Davis, Genesis Paulsen and Kristi Hayes. The cake was made by Jessica Velton, and other refreshments were made by Pearl Davis.
Following a honeymoon trip to Hawaii, the couple currently reside in Monett.


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Academic Patronage in the Scottish Enlightenment: Glasgow, Edinburgh and St Andrews Universities
Edinburgh University Press, 2008 - History - 638 pages
This book considers the politics of patronage appointments at the universities in Glasgow, Edinburgh and St Andrews. Emerson explores the ways in which 388 men secured posts in three Scottish universities between 1690 and 1806; from the purge following the Revolution of 1688 to the end of Henry Dundas's political career. Most professors were political appointees vetted and supported by political factions and their leaders. This comprehensive study explores the improving agenda of political patrons and of those they served and relates this to the Scottish Enlightenment. Emerson argues that what was happening in Scotland was also occurring in other parts of Europe where, in relatively autonomous localities, elite patrons also shaped things as they wished them to be. The role of patronage in the Enlightenment is essential to any understanding of its origins and course.This book is based on much archival study and adds substantially to what is known about the Scottish professoriat during the period. For some its arguments will be of importance; for others it will serve as a useful reference work on the universities, enriching our knowledge of them.
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St. Augustine resident Neil Amato took home the golden fire extinguisher in the 5th annual Datil Pepper Eating Contest at Hot Shot Bakery.
Amato loves hot foods. After reading about the contest, he thought "Why not?
"This one was a lot of fun last year, so it was an easy decision for me," Amato said.
As the winner, Amato received $50 in cash, lunch for two at Hot Shot Bakery, a keepsake gold fire extinguisher and a charter fishing trip with Capt. Luke from Fish St. Augustine.
This simple and versatile soba noodle stir-fry is for those nights when your cravings for Asian food aren't strong enough to get you out the door.
One of my favorite ways to welcome spring picnics or summer barbecues with little effort and great results is Herb-Crusted Grilled Beef Tenderloin. I usually serve this with a seasonal vegetable salad and hearty crusty bread, such as sourdough or shepherd's bread.
St. Johns County 4-Hers recently put their baking skills to work when they participated in the 4-H pie contest.
Judged best of show out of the 27 entries were Olivia Bradley, Crunchy Carmel Apple Pie, junior division; Ellie Leach, Key Lime-Mango Pie, intermediate; and Amber Savard, Chocolate Ribbon Pie, senior category.
Youth participating in this year's contest were as follows.
When the people of Dublin, Ireland elected their first Jewish mayor, Robert Briscoe in 1956, baseball legend Yogi Berra allegedly exclaimed "Only in America!" This St. Patrick's Day recipe for corned beef and potato pancakes with pickled cabbage creme fraiche was created in that same spirit.
Potato latkes, traditionally served at Hanukkah, are the inspiration for these crispy potato and onion patties. But in this version, flavorful shreds of corned beef along with a pickled cabbage topping are added as a tribute to Ireland.
Even with "beefy" in its title, this homey comfort-food dish can be made vegetarian by substituting soy crumbles for the meat. You'll save calories and fat, and meat eaters in your house might not even be able to tell the difference.
Start your shopping at the grocery store salad bar to save time on prep: Use sliced bell peppers and shredded carrots.
Adapted from "Eat What You Love," by Marlene Koch (Running Press, 2009).
Nutty Beefy Noodles
4 or 5 servings
6 ounces dried spaghetti
6 ounces yellow bell pepper slices or pieces
1There we were, admiring the landscape of rural St. Johns County and breathing in the fresh country air, when one of my students asked our host, John Sykes -- a young, fifth-generation farmer -- a very good question: "Mister, are you a Yankee?"
It's not just the alluring taste of desserts that makes any mouth water, but the words Boston Creme Pie come to mind when I think of desserts.
Not only is the recipe simple to make, it also is a beautiful dessert presentation.
While baking with Chef Castleberry at First Coast Technical College's award-winning School of Culinary Arts, I have discovered new techniques and found this recipe to be one of my favorites to prepare thus far.
For about a year now I've been trying to find a good way to infuse my basic baked "fried" haddock with the taste of Thai red curry paste.
And the solution has repeatedly escaped me. Until now.
My haddock couldn't be simpler. I whisk eggs, mayo and mustard in one shallow bowl, and fill a second with panko breadcrumbs. I then dredge haddock fillets through the egg mixture, then through the panko, then bake them on a sheet in the oven.
That's it. And they're delicious.
Not only do health experts say it's the key to making -- and sticking with -- healthy eating choices, it also goes a long way to making the healthy foods we choose more pleasurable.
Sweeteners are a good example of a place in the American diet where moderation can make a big difference. While the massive amount of high-fructose corn syrup consumed by many people isn't a great choice, a more moderate amount of natural sweeteners can be a wonderful complement to a healthy diet.
Joann Pelikan from Baltimore was hoping to locate a recipe for a dish she called Spanish steak. She said she enjoyed eating this when she was growing up in the 1960s and described it as steak that was slow-cooked with green pepper, onions and ketchup to yield a tender piece of meat with a tasty sauce.
St. Augustine Record ©2016. All Rights Reserved.


text:
Valley soccer fever
SDSU expansion depends on pro sports
Matt Potter 7 p.m., May 4
Full Frontal, Wienermobile, Oceanside, CA
Photo by Bonnie Maffei
Posted November 9, 2010
Matt Potter 7 p.m., May 4
Dave Good 6 p.m., May 4
Donovan Roche 4:30 p.m., May 4
Matt Potter 4 p.m., May 4
Ian Anderson 3 p.m., May 4
Eve Kelly 2 p.m., May 4
© 2016 San Diego Reader. All rights reserved. No part of this site may be reproduced without our written permission.
Each newsletter subscription means another chance to win!Close


text:
léonie Sep 25, 2012 12:36 AM
in response to Photo Ninja
What is your MacOS Version? This signature cannot be correct: iMac, Mac OS X (10.7.3)
When you upgraded to Aperture 3.4, did you experience crashes, and if yes, how did you fix them?
If I switch to Split view and make a tiny adjust, the thumbnail displays correctly?
Your thumbnails may not be rendered correctly, try to generate them again.
- Select the images that need new thumbnails in the Browser
- Go to Aperture's main menu bar: Photos > Generate thumnails
This should bring the thumbnails back.
It should not be necessary to do this. Have you imported so many images, that Aperture still has not finished processing your imported images
by now?
Also, you may have a slight corruption in your Aperture library. I'd recommend to use the "Aperture 3 Library First Aid Tools" to repair your Aperture Library, just in case. This is always a good precaution before upgrading software or after a crash.
Aperture 3 User Manual: Repairing and Rebuilding Your Aperture Library


text:
So what I am trying to do here is:
Title0 --Subtitle1 - Hidden - onClick toggle() --Subtitle2 - Hidden - onClick toggle()
When the user clicks "Title0", Subtitle1, Subtitle2 show on the left hand side and the page loads the content from another file. When that other file loads "Title0" along with "Subtitle1" and "Subtitle2" show be showing and depending on the links they click it should load that file and not collapse the menu.
so how do I go about doing that?


text:
PLANS for a bird sanctuary stretching along 60km of coast from Dry Creek to Parham has raised doubts about using land west of Port Wakefield Rd for housing.
The government last week bought 2300ha of salt flats from the Ridley Corporation for $2 million to create an international bird sanctuary.
The deals comes a year after Ridley Corporation said it was in talks with the government about a plan to build 10,000 homes on its salt fields.
What do you think of the plans for a new bird sanctuary?
However this week Ridley Land Corporation general manager Steve Butler said the company was focused on closing and then selling the saltfields at Dry Creek.
"Ridley's plan is to close its facility and exit the site," Mr Butler said.
"We don't have any plans for anything on that site."
Ridley Corporation no longer needs the land as it was used to produce salt for Penrice, which closed its operations at Osborne in June.
Salisbury Council has long been pushing the idea of building more homes west of Port Wakefield Rd and Salisbury Highway — a move partly contingent on relocating the Bolivar Waste Water Treatment Plant.
Environment Minister Ian Hunter this week said there was no intention to move the Bolivar Plant as its ponds helped "preserve the conditions which provide a habitat for the birds".
Mr Hunter said the sanctuary could be expanded to include more land in Dry Creek.
"In the longer term, there may be an opportunity to extend the park to include Crown Land currently part of the saltfield, however this would not occur until (closing the saltfields) has been completed," Mr Hunter said.
Salisbury Mayor Gillian Aldridge said the Bolivar plant needed to go.
"I think it's time to move it," Ms Aldridge said.
"There's some amazing development land there."
Ms Aldridge said the council would speak with the State Government about its plans for the rest of Ridley Corporation's land at Dry Creek that is up for sale.
"I think it could be an outstanding development there but if the State Government have plans for a bird sanctuary there we have to work with them," Ms Aldridge said.
More than 200 species of birds have been recorded at the Dry Creek saltfields, including the sooty oystercatcher, the bar-tailed godwit, the red-necked stint and the banded stilt.
The State Government will spend $1.7 million over four years to develop a management plan for the park, prepare the site with works such as pest control, rehabilitation, weeding and fencing, and build visitor facilities, such as boardwalks, signage and bird hides.
Birdlife Australia chief executive Paul Sullivan said the bird sanctuary could be a drawcard for birdwatchers from all over the world and would deliver good environmental and economic outcomes.
What do you think of the plans for a new bird sanctuary?
Originally published as Birds find refuge but 10,000 homes now in doubt


text:
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A perfect blend of style and function, the portable PHILIPS PD9000/37 DVD player enables you to enjoy your movies anytime, anywhere. The 9" TFT LCD screen brings vivid presentation and accurate color for great viewing experience. Up to 5 hours of battery time allows continuous play during your commute or trip. Last but not least, this unit supports multiple disc format and DivX encoded files so it can handle almost any disc you throw at it.
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text:
And it is still Early yet
When all the rats leave the sinking ship it's the best time to buy and make a profit. I bought many shares and even threw in the kitchen sink today and tomorrow I will be making some profits as we go up.
Not all the rats have left the ship yet, some have not heard the alarm and others are sure the ship is not going to sink and are trying to order diner from room service.
Silver futures are up. Right now 1.28%..


text:
Flash website static menu Jobs:
|Price (USD)
|Price (USD)
|Static Website
|...to 12 static webpages with minimal nesting.? Standard header menu bar and space for future flash and pictures
|PHP, Project Management, Engineering, User Interface / IA, Software Architecture, Software Testing, Website Testing, MySQL, Amazon Web Services, Website Management, Web Hosting
|Aug 28, 2008
|Aug 28, 2008Ended
|Converting Flash page into static
|I have one header/menu in flash that is replicated on all the pages of the website. This causes delays...delays as the flash is reloaded every time. I need to leave the main flash animation on the first page only...and have a static picture in its place in the following pages, while keeping the dynamic menu active.
|Adobe Flash, Visual Arts
|Jun 17, 2009
|Jun 17, 2009Ended
|20 page static website
|Need a website with flash banner, Flash Top Menu, content writing, Hosting. Very Good Graphics Work
|PHP, Website Design, HTML5
|Jul 26, 2011
|Jul 26, 2011Ended
|Static Website needed
|...get a static website design built. This will be 15-17 pages. The site will contain top menu navigation...need a logo to be designed for the website name. I also need a flash banner for this site.
|PHP, Logo Design, Project Management, Engineering, CSS, Software Architecture, Software Testing, Website Testing, Visual Arts, Website Management, Web Hosting
|May 22, 2011
|May 22, 2011Ended
|16225 Flash Menu Edit
|I have a flash menu on a website that I did not create and therefore dont' have enough knowledge of to...much about flash learning it for this seems pointless. There are 7 lines on the flash menu, four of them...exists.. I need it edited to point to some new static webpages that have been created... I have the
|Adobe Flash, Anything Goes
|Jun 16, 2006
|Jun 16, 2006Ended
|Need to design flash menu entries with flash animation
|Need to design 5 flash menu entries with animation and 2 static images for a website menu. Description
|Adobe Flash
|Dec 15, 2009
|Dec 15, 2009Ended
|Static Simple Website
|...following template: <http://www.templatemonster.com/website-templates/10797.html> But instead of using green...not needed to make the menu or picture in flash, just static menu and static picture/illustration is...structure of it (left menu): * Country/Region Selection (link to right website) * First Page *
|PHP, Engineering, User Interface / IA, Software Architecture, Software Testing, MySQL, Visual Arts
|May 31, 2006
|May 31, 2006Ended
|Simple Flash Menu
|I need an Flash actionscript menu guru to create an engaging menu to integrate with a static html website...major menu items, and a number of submenu items which link to the actual html page. This is the menu content:...just a simple menu, and because it has a small budget, please concentre mainly on how the menu will look
|PHP, Adobe Flash, Graphic Design, Audio Services, Engineering, User Interface / IA, Software Architecture, Software Testing, MySQL
|Jul 22, 2004
|Jul 22, 2004Ended
|Small almost Static website
|I'm in need of a small website; basic layout already have been made on paper (its just a center table...table or div), website of around 6 pages. 1 dynamic and the other ones are static. Will support, but i dont... - the center block will be divided into left (menu), top (logo), right (content). - content block
|PHP, Engineering, CSS, Software Architecture, Software Testing, Website Testing, MySQL, Website Management, Web Hosting
|Jun 26, 2008
|Jun 26, 2008Ended
|Simple static website
|I need to have a website done for a singer.? This is a simple website with 4-5 pages where you basically...basically put up a menu, copy/ paste the text and you're basically done. The site needs to look appealing...and professional, but there's not graphical nor flash design to do. The text is already done,
|PHP, Translation, Engineering, CSS, Software Architecture, Software Testing, MySQL
|Sep 18, 2008
|Sep 18, 2008Ended
|designing simple static website
|an expert web designer needed for a very simple website. requirements: 1. excellent and proven...they have designed. 2. one master page with a menu. 3. 4-6 content pages (the same design as the...updateable news item. 5. a flash movie upon opening the website. 6. easy to update current
|PHP, Adobe Flash, Engineering, Software Architecture, Software Testing, Website Testing, MySQL, Website Management, Web Hosting
|Nov 18, 2006
|Nov 18, 2006Ended
|Finish simple static website
|...com (a static website). Here are the issues I'm looking at: 1. Remove flash intro 2. Menu a. Make...drop-down menus b. Remove "on sale" from products > menu 3. Home a. Fashion news - link to fashion section
|Website Design, Graphic Design, HTML
|Jun 16, 2012
|Jun 16, 2012Ended
|Static WebSite Design(Ins)
|This project is to design a website for an insurance agency. full details about color range, page layout...site will have one main homepage design with a top menu and banner. All other pages will have the same top...11. **flash intro movie & homepage banner : -** if you don't know or don't wish to make a flash intro
|PHP, Engineering, Software Architecture, Software Testing, Website Testing, MySQL, Website Management, Web Hosting
|Jan 2, 2007
|Jan 2, 2007Ended
|Dropdown Menu for Html Static website
|...replace Main Dropdown Menu on our website ( all pages ). Its static html site. The Menu MUST work with ALL...ones like IE8 ... This is absolutely must ! All Menu Items ( Main and Dropdowns ), must be managable...be exactly the same as now ... See the website and the menu on top there in attached file ... The
|Javascript, AJAX, jQuery / Prototype
|Dec 24, 2013
|Dec 24, 2013Ended
|Build a small static website
|I am looking to upgrade my ancient website. I've created an approximate mockup of what I want in Wix;...changes to the website by modifying the CSS and/or HTML in clear ways. - Quality of the website layout. The...The website should look clean and professional. - Speed. I will favor quicker responses. What I do
|Bootstrap, CSS, HTML, Website Design
|Dec 7, 2014
|Dec 7, 2014Ended
|Static website with One Flash...
|Content is here: nawat.com.sa/langua ## Deliverables 1) All deliverables will be considered "work made for hire" under U.S. Copyright law. Employer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the employer on the site per the worker's Worker Legal Ag...
|Logo Design, User Interface / IA, Illustration
|Oct 10, 2010
|Oct 10, 2010Ended
|Static Flash Website needed
|I am in need of a very good flash website designer. I need to have a site built that will be just a few...few pages but will be flash based animation. It needs to look REALLY good and make your jaw drop! No
|Adobe Flash, Website Design, Graphic Design, Photoshop, HTML
|Feb 3, 2011
|Feb 3, 2011Ended
|Develop a static flash website
|We need to build static flash website. Contents and images will be provided.Need a black and grey, blue...There should be fancy,attractive animations in flash. Specifications will be given.First page should
|PHP, Website Design, Graphic Design, HTML
|Jun 30, 2015
|Jun 30, 2015Ended
|ASP, Javascript, Website Design, CSS, HTML
|Jan 30, 2011
|Jan 30, 2011Ended
|Flash website needs to be static
|I have a flash website that needs to be converted to a static html site. there are 5 pages to the current
|Adobe Flash, Website Design, Graphic Design, Photoshop, HTML
|Feb 20, 2012
|Feb 20, 2012Ended
Showing 1 to 20 of 1691884 entries
Hire the Top Flash website static menu Freelancers:


text:
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text:
AMERICAN FOOTBALL ASSOCIATION'S ALUMNI CLUBS: Hall of Fame Ring Order FormAFA Hall of Fame Ring Order Form
All ring orders will be verified with the AFA to validate AFA Hall of Fame Membership
Looking To Upgrade Your Hall of Fame Ring? (click here)
The American Football Association and Jostens are providing you with the opportunity to exchange your original 10k yellow gold Minor League Hall of Fame ring for the newly designed Semi-Pro Hall of Fame ring.The cost for the exchange is $100.00 plus your local sales tax. All you have to do is return this completed form along with your original ring and payment.
New Design Hall of Fame Plaque Order Form (click here)
The official American Football Association Hall of Fame plaque is now available for purchase. Order yours today!!!!!


text:
The Speedo Seed Jr. Vanquisher Swim goggle use G.O. Fit System, inner eye fit design technology. Get a precision fit with the sleek, low profile inner eye fit. Gasket rests snugly and securely in the eye socket. Excellent corrective lenses competitive and training goggle. Goggles provide a panoramic lens and has cushioned silicone seal. 4 nosepiece options for a custom fit. Goggles come equipped with anti-fog lens with UV protection. The Jr. Vanquisher Optical Goggles have durable polycarbonate lenses and, PVC and Latex free and are designed for youngsters or people with smaller faces. Diopters are available from -1.5 to -8.0 in 0.5 increments.
This product has a limited warranty of 3 months.
(888) 477-3336


text:
Welcome Mass Medical Society Members!
What is Business Class Online Backup?
Healthcare providers serious about protecting patient data need a business class cloud storage provider. Don't wait until a major data loss or breach to discover your backup provider cannot protect and restore your data.
How do you know you're choosing a business-class online backup provider?
- Fast backups – unrestricted Internet pipe to ensure quick, efficient backups for all clients.
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text: Hardy should have a version compatible with 3.0.3 in hardy-updates. Does this work? ** Changed in: firefox-3.0 (Ubuntu) Importance: Undecided => Medium -- Firefox and xulrunner language pack not in good version https://bugs.launchpad.net/bugs/402984 You received this bug notification because you are a member of Mozilla Bugs, which is subscribed to firefox-3.0 in ubuntu.


text:
Store Information
Extra 25% Off Friends & Family Sale
It's here & just in time for Mother's Day! Shop in store and take an extra 25% off during our Friends & Family Sale.
Pricing, promotions, and availability may vary by store. See sales associate for more details.
Valid through May 1, 2016


text:
GARDENA 380 Hand Reel MowerItem # HN-GARE059
- Cutting cylinder made of non-stick coated steel
- Features contact-free cutting technique
- Compact mower for small-to-medium-sized lawns
- Detachable handle for compact storage and transportation
- Dimensions: 22L X 16W X 11H in.
Similar Lawn Equipment
GARDENA Hi Cut Reel Mower
GARDENA 380C Hand Reel Mower
Gilmour Adjustable Hand Reel Mower with Grass Catcher
GARDENA Cordless Hedge Trimmer
Pro Mow Backlap Sharpening Kit
Precision 130 lb. Commercial Tow Broadcast Spreader
Reviewed by 1 customer
Comments about GARDENA 380 Hand Reel Mower:
The Gardena reel mower is another fine product of German engineering--solidly constructed for long use.
Assembly was simple, and, even though not mentioned in an otherwise complete manual (but no parts list), checking the proper cutting distance with the enclosed feeler gauge revealed that the Gardena had been properly assembled at the factory.
This is not a mower for the old (I am 87) or the weak (I'm that too), but it is the mower to use if you really want a mower that is quiet. You have to use it to appreciate the no-touch blade/cutter bar alignment.
If you ever have to do any adjustments, despite the fact that this is a German machine, you will need a 1/2" wrench for adjusting the cutter bar.
Go mow!
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text:
|English for Beginners Practical English Travel English Telephone English Banking English Accounting English Dictionary
|Audio English.org » Dictionary » P » Property Master ... Propyl Group
Dictionary entry overview: What does proprioception mean?
• PROPRIOCEPTION (noun)
The noun PROPRIOCEPTION has 1 sense:
1. the ability to sense the position and location and orientation and movement of the body and its parts
Familiarity information: PROPRIOCEPTION used as a noun is very rare.
Dictionary entry details
|Sense 1
|proprioception [BACK TO TOP]
The ability to sense the position and location and orientation and movement of the body and its parts
Classified under:
Nouns denoting cognitive processes and contents
Hypernyms ("proprioception" is a kind of...):
interoception (sensitivity to stimuli originating inside of the body)
Hyponyms (each of the following is a kind of "proprioception"):
kinaesthesia; kinaesthesis; kinesthesia; kinesthesis; kinesthetics; muscle sense; sense of movement (the ability to feel movements of the limbs and body)
kinanesthesia (inability to sense movement)
equilibrium; labyrinthine sense; sense of balance; sense of equilibrium; vestibular sense (a sensory system located in structures of the inner ear that registers the orientation of the head)
Holonyms ("proprioception" is a part of...):
somaesthesia; somaesthesis; somataesthesis; somatesthesia; somatic sense; somatic sensory system; somatosensory system; somesthesia; somesthesis (the faculty of bodily perception; sensory systems associated with the body; includes skin senses and proprioception and the internal organs)
|Learn English with... Proverbs of the week
|PROPRIOCEPTION: related words searches


text:
- Sofia the First: The Secret Library
- TAURTIS HIGH SCHOOL ( YANDERE Edition ) - Survival Block Mini Game with Multiplayer
- T-REX CRAFT ( EATS STUDENTS ): Survival Hunter Block Mini Game with Multiplayer
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- TURF WARS - Survival Hunter Mc Mini Game
Download Blazier Hair iPhone iPad iOS
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text:
iHerb Customer Reviews
Savings of: $12.93 (35% off)
Very good
Posted by Reviewer1925191 on Oct 07, 2012
I was having lung problems, I read about oregano, is good for respiratory problem, potent antioxidant, bronchial problems, etc. I tray it and after five days I was much better.
Posted by Reviewer1481784 on Sep 06, 2011
One of the best oregno oils out there
Posted by Reviewer2694630 on Mar 29, 2010
This product is great because it gives you 250mg of oregano oil without that oily skin feeling afterwards. It's great for when you feel a cold or fly coming on, an upset stomach, I've even had success with it from bad headaches.
Great Product But ...
Posted by IanGoldsmid on Feb 03, 2010
Totally love New Chapter Products - top brand - fantastic quality - however, on this product the capsules are rather "fat" and VERY hard - so that when I swallow them, they tend to get caught a bit in my throat - that's somewhat disconcerting ...
Was this review helpful to you?
2 people found the following review helpful
New Chapter, Oregano Force
Posted by Reviewer1657229 on Mar 06, 2008
I did not know if the potency was going to work for me. I had a few times when I was not feeling well it took a few hours then I felt better. Great product
Was this review helpful to you?
3 people found the following review helpful
new chapter oregano
Posted by Reviewer2641742 on Mar 05, 2008
Items 1-6 of 6 total


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PGi And Intelisys Expand Strategic Partnership To Include IMeet® And GlobalMeet®
PGi (NYSE: PGI), a global leader in virtual meetings, today announced an expansion of its five-year partnership with Intelisys, the nation's leading master agency distributor of business communications services. Under the expanded agreement, Intelisys will now sell PGi's latest innovative virtual meetings solutions, iMeet and GlobalMeet, to its more than 350 master agents. "Intelisys has been a valued partner to PGi for several years, and it is one of the most respected brands in the channel," said Ralph Hawkins, senior vice president, PGi Partner channel. "Identifying the next generation of collaboration technologies propelled Intelisys to deepen our existing relationship and bring iMeet and GlobalMeet to their base of Sales Partners."Launched in 2011, iMeet and GlobalMeet are PGi's latest innovations in online meetings. iMeet is a fresh approach to video conferencing that gives users their own, personal video meeting room online. The iMeet experience is simple, social and enjoyable – without the hassle of software downloads, hardware investments or IT support. GlobalMeet tightly integrates traditional audio and web conferencing into one complete solution, with no software downloads for meeting guests and a "connect me" feature that calls participants automatically, making dial-in numbers and passcodes obsolete. "Using group video technologies like iMeet to host our team meetings strengthens connections and improves business productivity, which is why we want to offer iMeet to our agent base," says Dana Topping, co-owner of Intelisys. "We also believe that with its market-leading pricing, GlobalMeet is an ideal solution for small businesses looking for a powerful, yet affordable audio and web meeting product." The PGi Partner channel is an important, growing part of PGi's global business. The PGi Partner team is focused on building strategic partnerships with companies like Intelisys to resell and use its suite of meeting technologies. For more details about registering as an Intelisys agent to sell PGi's suite of audio, web and video conferencing solutions, please visit http://www.intelisys.com. For more information about PGi and its portfolio of meetings solutions, visit http://www.pgi.com. About Premiere Global Services, Inc. │ PGi PGi is a global leader in virtual meetings. For 20 years, we have innovated technologies that help people meet and collaborate in more enjoyable and productive ways. Every month, we bring together over 15 million people in nearly 4 million virtual meetings. Headquartered in Atlanta, PGi has a presence in 24 countries worldwide. For more information, visit us at http://www.pgi.com. About Intelisys Intelisys is the only telecom master agency focused exclusively on supporting the Channel's top-producing sales agents. The company specializes in providing a broad suite of telecom value-based solutions to ensure the top-producing agent's success. Intelisys services include a complete selection of carrier voice and data services, wireless and wired access, auxiliary services such as voice and web conferencing, mobility solutions, professional service offerings and Intelisys' proprietary telecom asset management tool, Audex. Since its inception in 1994, Intelisys' growth is a result of the unique formula of recruiting top-producing agents, capitalizing on industry trends, and most importantly, providing exceptional operational and back-office support. This formula has positioned Intelisys as the recognized thought leader in the telecommunications independent sales channel.
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I may be wrong as I have not got too much experience with Java, but here is a question.
I have a class which contains many methods (basically it is a simple library).
I create an object of this class let's say
MyLibrary obj = new MyLibrary(parameters);
The parameters set up any necessary functionality for the library to run correctly.
Then I can call
obj.createSomething etc etc...
In my main class I really need only one this kind of library object.
Now... Would it be more useful for me not to use it as an object, but put it as
extends and then create a function inside of the library like a constructor which I would call manually?
The relation between the one class and MyLibrary is very close. Basically, I have many classes which do similar things but have some different higher layer functionality. So I separated method which must be in all those classes.
It seems it is very similar to
shape class and
square example. So
MyLibrary is similar to
shape which contains all the foundation.


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Alta's JV boys basketball opened the 2006 portion of its season with a 63-42 win here over Marcus recently.
Jordan Hinkeldey paced the 'Clones with 21 points and nine rebounds. Alex Peterson had a great game with 12 points, six rebounds, three assists and three steals. Tyler Sliefert followed with 11 points, two rebounds and three steals.
Alan Hinkeldey scored nine points and grabbed 11 rebounds. Jordan Letzring tallied five points while Austin Stille scored four and had two steals. Chris Schmitz added one point and had 3 assists plus a steal.
The win moves Alta's record to 8-0 on the season.
Alta's JV boys basketball team moved to 9-0 on the season with a 47-36 win at Storm Lake.
Jordan Hinkeldey led the way with 17 points, including 11-12 shooting from the charity stripe. He also pulled down 11 rebounds.
Alan Hinkeldey followed with seven points and five rebounds, with Austin Stille adding six points and four rebounds.
Tyler Sliefert and Alex Peterson each collected five points with Peterson topping the rebounding charts with nine.
Chris Schmitz scored four points and had two rebounds.
The Alta (JV) basketball team defeated Sioux Central 49-32 here last week.
Jordan Hinkeldey led the Alta JV in scoring with 13 points and 11 rebounds. Adam Holton and Alex Peterson followed with nine points each.
Peterson also pitched in with six steals while Holton had two.
Jordan Letzring scored seven points while Tyler Sliefert added six points and two rebounds. Austin Stille, seeing his first JV action of the season, scored four points and had 1 assist.
Chris Schmitz scored one point and notched two rebounds and two assists.
Alan Hinkeldey had 5 rebounds and 2 steals. The Alta JV also beat Fort Dodge recently, 54-20.
Jordan Hinkeldey led in scoring with 15 points and added eight rebounds.
Adam Holton registered 12 points and had 1 assist. Alan Hinkeldey notched nine points with three rebounds.
Stille and Alex Peterson each 7 points.
Tyler Sliefert and Jordan Letzring each scored two points to round out the scoring.
Chris Schmitz had four rebounds and totaled two assists. The Cyclones now head home for a matchup with South O'Brien.


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"No one is better informed than Lester Brown of the multi-faceted crisis facing our planet. And no one has spelt out so clearly how our civilisation could be saved from falling 'over the edge' while there is—hopefully—still just time." —John Rowley, founder/editor www.peopleandplanet.net on World on the Edge: How to Prevent Environmental and Economic Collapse
"There is no such thing as big society… why we should listen to Mr. Brown," Blog on Lester in Brussels
May 12, 2010
Blog posting from Michael Wells on Lester's presentation at the European Parliament in Brussels. Posted May 12, 2010.


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Lymphatic filariasis control in Tanzania: effect of six rounds of mass drug administration with ivermectin and albendazole on infection and transmission
Tropical and parasitological diseases
Control of lymphatic filariasis (LF) in most countries of sub-Saharan Africa is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. We present findings from a detailed study on the effect of six rounds of MDA with this drug combination as implemented by the National Lymphatic Filariasis Elimination Programme (NLFEP) in a highly endemic rural area of north-eastern Tanzania.
The effect of treatment on transmission and human infection was monitored in a community- and a school-based study during an 8-year period (one pre-intervention and 7 post-intervention years) from 2003 to 2011.
Before intervention, 24.5% of the community population had microfilariae (mf) in the blood, 53.3% had circulating filarial antigens (CFA) and 78.9% had specific antibodies to the recombinant filarial antigen Bm14. One year after the sixth MDA, these values had decreased considerably to 2.7%, 19.6% and 27.5%, respectively. During the same period, the CFA prevalence among new intakes of Standard 1 pupils in 10 primary schools decreased from 25.2% to 5.6%. In line with this, transmission by the three vectors (
Six MDAs caused considerable decrease in all the measured indices for transmission and human infection. In spite of this, indices were still relatively high in the late period of the study, and it may take a long time to reach the recommended cut-off levels for interruption of transmission unless extra efforts are made. These should include increased engagement of the target population in the control activities, to ensure higher treatment coverage. It is expected that the recent initiative to distribute insecticide impregnated bed nets to every household in the area will also contribute towards reaching the goal of successful LF elimination.
Lymphatic filariasis (LF), a disfiguring and disabling disease caused by a mosquito-borne parasitic infection, is a major public health problem in many developing countries with a warm and humid climate. The causative nematode parasite in sub-Saharan Africa is
A large Global Programme to Eliminate Lymphatic Filariasis (GPELF), launched in 2000 by the World Health Organization, has targeted LF for elimination
In Tanzania, with an estimated 34 million people at risk and 6 million people affected
Study sites
All study sites were located in rural areas of Tanga District in Tanga Region, north-eastern Tanzania. The study had two parts, a community based and a school based (Figure
Figure 1
Map of study area showing location of the three villages (Kirare, Kiomoni and Kisimatui) and ten schools
Map of study area showing location of the three villages (Kirare, Kiomoni and Kisimatui) and ten schools. Schools: 1. Kirare, 2. Mapojoni, 3. Marungu, 4. Kiomoni, 5. Mafuriko, 6. Maweni, 7. Kange, 8. Pongwe, 9. Kigandini, and 10. Ziwani.
MDA for LF control in the study area
The Tanzanian National Lymphatic Filariasis Elimination Programme (NLFEP) administered the first three rounds of MDA in Tanga District in October 2004, February 2006 and May 2007, as reported
Design of community study
Entomological surveillance started in Kirare in November 2003, i.e. about one year before the first MDA, and continued uninterrupted until the end of the present reporting period.
Cross sectional community surveys for filarial infection (microfilaraemia, circulating filarial antigenemia and antibodies to Bm14) and clinical manifestations were carried out in Kirare immediately before the first MDA (September 2004; survey 1). It was intended to make similar follow-up surveys for infection shortly before each of the following MDAs, but due to irregularities in timing of the MDAs this plan could sometimes not be adhered to (Table
In the following two surveys (7 and 8) several changes were introduced (Table
Design of school study
The new Standard 1 pupils from ten selected primary schools were examined for CFA in the late part of each year, as previously described
Ethical considerations
Meetings were held regularly in the study communities to inform the inhabitants about the study contents and findings and to obtain their cooperation. Prior to any examination, the individuals were asked if the purpose and consequences as explained during the meetings had been understood, questions for clarification were answered, and written consent to participate (from adults, and from parents or guardians of individuals less than 15 years old) was obtained.
Prior to each years' school surveys, meetings were held with the head teacher, the relevant teachers and the parents committee for the individual schools, to explain the contents and consequences of the study. The members of the parents committee provided written informed consent, on behalf on the children and their parents. Children who refused to participate in the examinations were not included.
Ethical and research clearance for the study was provided by the Medical Research Coordinating Committee of the National Institute for Medical Research, Tanzania, and the study protocol was reviewed by the Central Scientific Ethical Committee in Denmark.
Test for microfilariae
Blood was examined for mf by use of the counting chamber technique
Tests for circulating filarial antigens and antibodies to Bm14
During community surveys 1-5, venous blood samples were collected from volunteers from the mosquito collection houses in Kirare, and serum was prepared and examined for circulating filarial antigens (CFA) by the TropBio Og4C3 ELISA and for antibodies to the recombinant filarial antigen Bm14 by an in-house ELISA as previously reported
During community surveys 7-8, and during all school surveys, individuals were screened for CFA by use of rapid immunochromatographic test cards (ICT cards, Binax Now®, Inverness Medical Innovations Inc., USA). One hundred microliters of finger-prick blood were applied to the sample pad on the test card, and the result was read after exactly 10 minutes as either positive or negative.
During community survey 8, and during school surveys 7 and 8, finger-prick blood was moreover collected on filter paper collection disks (TropBio Pty. Ltd., Townsville, Australia) from some individuals for later detection of antibodies to Bm14. Each protrusion on the disk was saturated with blood from one individual. The disks were dried overnight, placed individually in plastic bags and frozen at -20°C until use. Elution of the dried blood samples and subsequent determination of antibodies to Bm14 was done by use of the Filariasis CELISA test kit (Cellabs Pty Ltd, Brookvale, Australia). The test was performed according to the procedure from the manufacturer and as described elsewhere
Entomological surveillance
Vector mosquitoes were collected from 50 originally randomly selected village houses using Centre for Disease Control light traps (John W. Hock Company, Gainesville, USA) hung beside an occupied, untreated bed-net
Assessment of treatment coverage and bed net use
Three different methods were used to assess the treatment coverage. First, the official programme coverage for Tanga District was obtained from the regional office of the NLFEP in Tanga. According to the programme, these "reported coverages" were calculated as the number of treatments delivered divided by the eligible population (estimated as 80% of the total population). In addition, a "surveyed community coverage" and a "surveyed school coverage" was obtained from questionnaire surveys carried out among the inhabitants from the study communities and the Standard 1 pupils from the study schools, respectively, shortly after each MDA. In these surveys, individuals were asked in privacy whether or not they had taken the drugs that had been distributed for LF elimination (in communities, parents answered on behalf of their children below 15 years of age).
Only few houses in Kirare possessed bed nets at the start of the study in 2003, but nets were observed to gradually become more common. During the post-MDA 5 and 6 community questionnaire surveys for MDA coverage, individuals aged ≥ 15 years were therefore also asked about the number and type of bed nets possessed in their household (was checked by visual inspection when inhabitants allowed), and the number of individuals ≥ 1 year sleeping in the household. After MDA 5, net coverages were 27.6% (366 nets/1326 individuals) for any kind of net and 6.6% (87/1326) for insecticide treated nets in Kirare (all four hamlets). After MDA 6, these net coverages were 27.0% (452/1674) and 7.1% (118/1674), respectively, for the study hamlets of Kirare, Kiomoni and Kisimatui combined. Insecticide impregnated bed nets were distributed to every household in Tanga District in September 2011, shortly before completion of the present study.
Data analysis
Mf intensities were adjusted for sampling time by multiplying with a time-specific factor, as previously described
During community surveys 7 and 8, when only CFA positive individuals were examined for mf, the community mf prevalence was calculated as: (b/a) × (d/c) × 100, where a = number of individuals in the community examined for CFA, b = number of those examined for CFA being positive, c = number of CFA positives examined for mf, and d = number of those examined for mf being positive. In these surveys, the community mf GMI was calculated as antilog [(Σlog x + 1)/(c/b × a)]-1, with x being the mf/ml and (c/b × a) being the number of individuals examined (taking into account that sometimes not all CFA positive individuals were examined for mf).
Entomological indices for vector biting and transmission were calculated as previously described
Lymphatic filariasis in Kirare before treatment
Dissection of mosquitoes caught from the 50 collection houses during the 11 months pre-MDA period indicated that the area had three species of vectors (Table
Figure 2
Vector-biting and transmission in the pre-MDA period and the six post-MDA periods in Kirare
Vector-biting and transmission in the pre-MDA period and the six post-MDA periods in Kirare. A shows mean monthly biting rate (MBR) and B shows mean monthly transmission potential (MTP).
Figure 3
Seasonal variation in monthly vector-biting and transmission in Kirare (November 2003 to November 2011)
Seasonal variation in monthly vector-biting and transmission in Kirare (November 2003 to November 2011). A shows monthly biting rate (MBR) and B shows monthly transmission potential (MTP). Thick black line = all vector species combined; Thin green line =
Effect of MDAs on mf in community surveys
In the early part of the study (survey 1-6), all individuals in Kirare were examined for mf. The mf prevalence and mf GMI for all 4 hamlets combined in survey 1-5 were presented previously
Figure 4
Effect of six rounds of mass drug administration (MDA) on
Effect of six rounds of mass drug administration (MDA) on
When looking at the two hamlets of Kirare which were also examined in the later part of the study (Table
The mf prevalence and mf GMI in Kiomoni and Kisimatui (Table
Effect of MDAs on CFA and antibodies to Bm14 in community surveys
In the early part of the study (survey 1-5), the effect of MDAs on CFA and antibodies to Bm14 was assessed by ELISA on serum samples from volunteers from the 50 mosquito collection houses in Kirare (see details in
Figure 5
Effect of six rounds of mass drug administration (MDA) on circulating filarial antigen (CFA) prevalence
Effect of six rounds of mass drug administration (MDA) on circulating filarial antigen (CFA) prevalence. Brown line = volunteers from mosquito collection houses located in all four hamlets of Kirare examined for CFA by ELISA in survey 1-5. Green line = all individuals ≥ 1 year from two hamlets of Kirare (Mtambuuni, Mashine) examined for CFA by ICT cards in survey 7 and 8. Red lines = all individuals ≥ 1 year from one hamlet of Kiomoni (Mabavu) and one hamlet of Kisimatui (Majengo) examined for CFA by ICT cards in survey 7 and 8. Vertical stippled lines indicate rounds of MDA.
In survey 7 and 8, all individuals in the study communities were examined for CFA with ICT cards (Table
In survey 8, children aged 5-14 years from Kirare, Kiomoni and Kisimatui were examined for antibodies to Bm14 by CELISA (Table
Effect of MDAs on vectors and transmission in Kirare
A considerable change in vector species composition was observed already in the early study period
When analysed for the three vector species combined, the vector infectivity rate decreased markedly and statistically significantly in the early part of the study, from 1.43% in the pre-MDA period to 0.10% in the post-MDA 3 period (p < 0.001, chi-square test; see also
Effect of MDA in school surveys
Approximately 800 new Standard 1 pupils from the 10 study schools were examined each year shortly after enrolling in school. The overall CFA prevalence was 25.2% in the pre-MDA survey (Table
Figure 6
Effect of six rounds of mass drug administration (MDA) on circulating filarial antigen (CFA) prevalence in Standard 1 children
Effect of six rounds of mass drug administration (MDA) on circulating filarial antigen (CFA) prevalence in Standard 1 children. Thick line = prevalence for all 10 schools combined. Thin stippled lines = prevalence in school clusters according to their location to the south-west (Kirare, Mapojoni and Marungu schools; no. 1-3), north-west (Kiomoni and Mafuriko schools; no. 4-5), close west (Maweni and Kange schools; no. 6-7) and more distant west (Pongwe, Kigandini and Ziwani schools; no. 8-10) of Tanga. Vertical stippled lines indicate rounds of MDA.
The Standard 1 pupils from four of the schools (Kirare, Marungu, Kiomoni and Mafuriko) were moreover examined for antibodies to Bm14 in survey 7 and 8 (Table
MDA treatment coverage
The treatment coverage in MDA 1-6, as assessed by three different methods, is shown in Table
Following the launching of GPELF in 2000 and the targeting of LF for global elimination, most endemic countries have established national control programmes and many are in the process of implementing annual MDAs with the recommended two-drug combinations
The coastal area of north-eastern Tanzania is well known to be endemic for LF, and has been a focus for comprehensive research on epidemiology and measures for control of LF in the past e.g.
The study design and methodology and the effects of MDAs in the early study period was reported previously for Kirare
In Kirare, the mf prevalence and community mf GMI generally decreased progressively with increasing number of MDAs. An exception to this was survey 5, where slight but statistically insignificant increases in these indices were seen, most likely due to the long interval between MDA 3 and 4 (21 months). An increase in mf and CFA was reported from Haiti after a single MDA with DEC/albendazole had been missed
CFAs are primarily released by adult
The specific antibody response to the filarial antigen Bm14 is used as an indirect marker of exposure to
The vector species composition changed considerably during the study period from predominantly anopheline during the pre-MDA period, to almost exclusively culicine in the late study period. This remarkable shift has been documented and analysed in more detail elsewhere
Transmission, assessed by dissection of vectors and recovery of L3s, decreased after each MDA, from high levels in the pre-MDA period to very low levels in the post MDA 6 period. It is likely that most of the decrease in transmission was due to the MDAs, which reduced the availability of microfilariae in the human population to the vectors. However, part of the decrease may also be due to the shift in vector species composition, whereby long-lived strongly anthropophilic anophelines (and thereby highly efficient vectors) were replaced by shorter lived and less strongly anthropophilic culicines (and thereby less efficient vectors)
The school based study was used as an alternative approach to assess the effect of MDAs on transmission in the area. The idea being that a reduced transmission will lead to reduced acquisition of infection in young children, and thereby a reduction in prevalence of CFA when examining children of the same age from year to year after start of MDA
Sustained high drug-intake coverage during MDAs for LF control is critical in order to reach the programme target within a reasonable time-frame, in particular in areas like the present with very high pre-MDA levels of infection
The present study demonstrated that, when compared to the pre-MDA scenario, six MDAs resulted in considerable decrease in infection and transmission of LF in the study populations, whether these were communities or schools and whether measures were based on detection of mf, CFA, antibodies to Bm14 or mosquito vector dissections. In spite of this, there is still some way to go before the recommended target cut-off level of 1% CFA for interrupting transmission and stopping MDA
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
PES, YAD, WK, SMM, MNM and EMP conceived and designed the experiments. PES, YAD, SMM and EMP performed the experiments. PES, YAD and EMP analysed the data. PES, YAD and EMP wrote the paper. All authors read and approved the final manuscript.
The authors are grateful to the villagers and village helpers in Kirare, Kiomoni and Kisimatui and to the children and their teachers in the study schools for their dedicated cooperation, to the technical staff from Amani Medical Research Centre Filariasis Laboratory in Tanga (Kassembe Mdira, Charles Mbezi, Maembe Mzee, Justin Mkeni, Demitrius Max, John Samwel) for their skilled assistance in the field and the laboratory, to the NLFEP officer for Tanga Region (Rehema Maggid) for providing data on the district treatment coverages, and to the technician from DBL in Denmark (Jakob Felsager) for meticulously performing the Bm14 CELISAs. The study received financial support from Danida Development Research Council (grant no. 09-096LIFE) and DBL-Centre for Health Research and Development, University of Copenhagen.
Neglected tropical diseases in Subsaharan Africa: Review of their prevalence, distribution, and disease burden
The emerging story of disability associated with lymphatic filariasis: A critical review
Eliminating LF: A progress report from Tanzania
Lymphatic filariasis control in Tanzania: Effect of repeated mass drug administration with ivermectin and albendazole on infection and transmission
Monitoring lymphatic filariasis control in Tanzania: effect of repeated mass drug administration on circulating filarial antigen prevalence in young schoolchildren
Bancroftian filariasis: a comparison of microfilariae counting techniques using counting chamber, standard slide and membrane (nuclepore) filtration
Applicability of the filter paper technique for detection of antifilarial IgG4 antibodies using the Bm14 filariasis CELISA
A multicenter evaluation of a new antibody test kit for lymphatic filariasis employing recombinant
Bancroftian filariasis: patterns of vector abundance and transmission in two East African communities with different levels of endemicity
Mathematical models and lymphatic filariasis control: monitoring and evaluating interventions
Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: A comprehensive assessment
The impact of repeated rounds of mass drug administration with diethylcarbamazine plus albendazole on bancroftian filariasis in Papua New Guinea
The impact of a filariasis control program on Lihir Island, Papua New Guinea
Impact of five annual rounds of mass drug administration with diethylcarbamazine and albendazole on
Assessing transmission of lymphatic filariasis using parasitologic, serologic, and entomologic tools after mass drug administration in American Samoa
Effect of annual mass administration of diethylbarbamazine and albendazole on bancroftian filariasis in five villages in south India
Epidemiological assessment of continuing transmission of lymphatic filariasis in Samoa
Epidemiological and entomological evaluations after six years or more of mass drug administration for lymphatic filariasis elimination in Nigeria
Evidence for stopping mass drug administration for lymphatic filariasis in some, but not all local government areas of Plateau and Nasarawa States, Nigeria
Studies on the transmission and prevalence of bancroftian filariasis in four coastal villages of Tanzania
Control measures against bancroftian filariasis in coastal villages in Tanzania
Bancroftian filariasis: analysis of infection and disease in five endemic communities of north-eastern Tanzania
Long-term effect of three different strategies for mass diethylcarbamazine administration in bancroftian filariasis: follow-up at 10 years after treatment
Bancroftian filariasis: the pattern of microfilaraemia and clinical manifestations in three endemic communities of northeastern Tanzania
Bancroftian filariasis infection, disease, and specific antibody response patterns in a high and a low endemicity community in East Africa
The effect of single dose ivermectin alone or in combination with albendazole on
Diagnostic tools for filariasis elimination programs
Assessing the impact of a missed mass drug administration in Haiti
The effect of eight half-yearly single-dose treatments with DEC on
Comparative evaluation of three new tools for diagnosis of bancroftian filariasis based on detection of specific circulating antigens
Mass drug administration trial to eliminate lymphatic filariasis in Papua New Guinea: change in microfilaraemia, filarial antigen, and Bm14 antibody after cessation
Is the current decline in malaria burden in sub-Saharan Africa due to a decrease in vector population?
Change in composition of the
Effect of ivermectin on
Short report: Ivermectin mass drug administration to humans disrupts malaria parasite transmission in Senegalese villages
The role of monitoring mosquito infection in the Global Programme to Eliminate Lymphatic Filariasis
Mathematical modelling and the control of lymphatic filariasis
Mathematical models and lymphatic filariasis control: endpoints and optimal interventions
Will mass drug administration eliminate lymphatic filariasis? Evidence from northern coastal Tanzania
Pre-publication history
The pre-publication history for this paper can be accessed here:


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Police from 6 States Collaborate for Operation Border to Border
There are 8 comments on the NBC29 Charlottesville story from Jun 6, 2013, titled Police from 6 States Collaborate for Operation Border to Border. In it, NBC29 Charlottesville reports that:Six state police and highway patrol agencies this weekend will engage in Operation Border to Border, a coordinated traffic safety enforcement initiative targeting approximately 791 miles of U.S. Route 15, which originates in Waterboro, S.C., and ends in Corning, N.Y. The corridor is a heavily-traveled thoroughfare for summer vacationers and for ... (more)
Join the discussion below, or Read more at NBC29 Charlottesville.
#1 Jun 6, 2013
This is big brother coming at you in a coordinated effort
#2 Jun 7, 2013
I drive a truck and have traveled 15 a lot in my years. There is no place to pull over for a car more over a large truck you have to stop in the middle of the road. I don't know what they are thinking...Yes I do money. I can see it now armored cars bullet prof vests AR 15s dogs, they are charging there tazers rite now thumping there chest like Tarzan. And as always it is for our own safety. Wait until you head for home this weekend and come over a hill and there is a four mile backup or worse pop over a hill and rear end someone setting in the road. I cant wait to here the outcome of this,lunacy, I feel for the people from Gordonsville to Farmville. Just give them the hiel Hitler sign out the window and they will let you go. I might get my camera out and go make a YouTube video this weekend. Ill send word what jail I am in maybe someone would be kind enough to bring me some cigs....
#3 Jun 7, 2013
Probably a major drug route but if so, nothing like advertising your intensions.
#4 Jun 8, 2013
yes I can brother yes I can...
#5 Jun 8, 2013
We are spending your money for your safety....you don't know what's right we will do it for you. Not until the voter wake up and stop tolerating the overly bloated "public safety" excuse will these swine stop there actions
#6 Jun 8, 2013
They are stealing our liberty and we are allowing it...don't worry we will do it legally and with lots of integrity
#7 Jun 9, 2013
So now they'll switsch to 95? Like they don't use that anyway?
#8 Jun 10, 2013
I've been told, yes it is. I've also been told due to budget constraints, they use advertising as a deterrent as opposed to awareness. In other words, there may or may not actually be an increased presence.
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Nov. 20, 1935--Oct. 8, 2005
COLLINS, Mo. -- Bobbie Jane Freeman, 69, died Saturday (Oct. 8, 2005) at her home near Collins, Mo., surrounded by her family and friends after a long battle with breast cancer.
She was born Nov. 20, 1935, in Gatesville, Texas, to Robert and Jean Kitley.
She married Max Cook on Nov. 20, 1954. They farmed and raised livestock for many years. Bobbie was a dedicated farm wife who loved taking care of the animals.
After moving to Missouri in 1981, she married Roy Freeman on May 20, 1982. She enjoyed raising cattle, which she did for many years. Later on, she cleaned homes for several people, who became her friends.
Her greatest passions were her garden and saving animals. She could not pass by or turn away a suffering animal.
She was preceded in death by her father and infant sister, Betty.
She is survived by Roy; her mother; her daughters, Gail Kathol and husband Mike of Kearney and Diane Donnell of Collins, Mo.; son, Mike Cook and wife, Cindy of Grand Island; stepsons, Roy Freeman and wife, Judy and David Freeman and wife, Lois of Collins, Mo.; stepdaughters, Stephanie Matoon and husband, Jim of Fort Collins, Colo., and Linda McDermott and husband, Jim of Denver, Colo.; sixteen grandchildren; and eleven great-grandchildren.
Services were held at Coon Creek Baptist Church in Collins. Private inurnment will take place at a later date.
Memorials are being accepted in her name at the Osceola Veterinary Clinic in Osceola, Mo.


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This review is from: Logitech M510 910-001822X Gray / Black Tilt Wheel USB RF Wireless Laser Mouse
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