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1 CHAPTER 5 INFRASTRUCTURE 5.1 INFRASTRUCTURE CONSIDERATIONS FOR HEALTH CENTRES This chapter addresses the challenges posed by a health centre s space, design, power, water, hygiene and sanitation and equipment requirements for it to be able to deliver quality HIV prevention, care and treatment services that are integrated with basic essential primary care services. The physical work environment often influences (positively or negatively) the mindset of the service providers and their efficiency and ability to innovate in delivering expanded services. A good work environment can facilitate better HIV services and reduce workload. A disorganized work environment impairs the health centre team. To improve the work environment, you need to start with improving how you use existing resources. This chapter should help you reorganize the existing space in your health centre and to consider important renovations and refurbishments. First, the chapter presents essential infrastructure requirements (sections 5.2 through 5.13; summarized in the table on the next page), followed by the infrastructure requirements for each area of the health centre (sections 5.14 to 5.21). The final section provides a quality management approach to developing an enabling physical work environment (the 5 Ss). However, the chapter does not deal with design and construction of new health centres. The chapter will also provide guidance on improving infection control within your health centre. The emphasis is on preventing TB and HIV transmission; special sections are devoted to these subjects. The material also covers safe water, hygiene and sanitation to avoid transmission of enteric and other pathogens. This is essential to providing quality HIV services, as patients with suppressed immune systems are especially vulnerable to water and airborne contamination. The chapter material 60 l CHAPTER 5 l INFRASTRUCTURE
2 Latrine Table 1. Essential infrastructure requirements Space Space Adequate space for HIV care integrated within primary care private & confidential Privacy and confi dentiality Protect the privacy of the patient s diagnosis and avoid stigma TB control TB infection control Prevent TB transmission between patients and to health workers, without stigma HIV infection control Prevent HIV transmission through safe infections, phlebotomy, sharps disposal, gloves and other personal protection equipment Water, sanitation and hygiene for infection control Water Water supply To provide safe drinking water Latrine Handwashing Waste Management Hand washing, other hygiene practises and waste water To provide suffi cient quantities for handwashing, personal hygiene, laundry, cleaning and food preparation Safe waste management at health centre Suffi cient quantities of safe water for handwashing, personal hygiene, laundry, cleaning and food preparation Latrines/toilet Patients, staff and care givers able to use a toilet without contaminating the health centre or its water supply Cleaning Cleaning Visibly clean health centre Communication Communications Phone or radio to communicate with district clinician and management team, mentor Power BATTERY Power Electricity for essentials (mobile phone, microscopy, emergency lights) Fire safety Fire extinguisher or sand OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 61
3 reflects WHO essential environmental health standards for health care settings. Improving ventilation, cough hygiene and patient flow for TB infection control are particularly important and urgent since these interventions will also prevent the transmission of other respiratory infections. Most interventions for HIV infection control will also reduce transmission of other blood-borne infections such as hepatitis B. These infrastructure interventions need to be accompanied by providing information about and promoting hygiene with staff, patients, and care givers so that they are knowledgeable about essential necessary behaviours to limit disease transmission at health facilities and in the home. 5.2 SPACE NEEDED FOR HIV SERVICES (INTEGRATED WITHIN PRIMARY CARE) Determining the space requirements will depend on how many HIV patients you have or anticipate having, how many are on ART, and the room size. Based on the size of your HIV patient population and your staff, decide whether: outpatient HIV services will be fully integrated with other basic services (patients returning for chronic care are mixed with other patients attending for other problems), or; you will have a special HIV clinic either full-time or part-time. For example, providing an integrated HIV clinic one day a week for routine continuity of HIV services should be sufficient for 100 HIV patients. Additional HIV patients will require more HIV clinics per week, or more space. This decision will dictate the amount of space required and how it is configured. Planning for adequate space for HIV services within a health centre must accommodate the reality of existing basic clinical services. Table 2 (over) presents the suggested minimum space requirements. The Operations Manual Adaptation Guide provides additional details and guidelines for district planners and managers to determine optimal space use. 62 l CHAPTER 5 l INFRASTRUCTURE
4 Table 2. Suggested space requirements for HIV/AIDS services at the health centre* Functional spaces Quantity Dimensions (minimum) Remarks Waiting area One Careful attention to ventilation required to minimize nosocomial transmission of TB Adequate waiting space for an additional 25 visits per 250 PLHIV in care, including room for stretchers and/or wheelchairs Registration/triage area One 1.5m x 1.5m (2.25m 2 ) minimum; optimal 9m 2 Medical records/hmis One 1.5m x 1.5m (2.25m 2 ) Consultation exam rooms Three minimum + one for every 250 to 500 additional HIV-positive patients 3.0m x 3.0m (9m 2 ) minimum; optimal 16m 2 Labour and postpartum room One 3.0m x 6.0m (18m 2 ) Delivery room One 3.0m x 6.0m (18m 2 ) Counselling rooms HIV counselling and testing (CITC, PITC), adherence, psychosocial support Three minimum + one for every 250 to 500 additional HIV-positive patients 1.5m x 1.5m (2.25m 2 ) Additional waiting space may be needed near counselling, laboratory/phlebotomy and pharmacy venues if these are not near the OPD Consultation-examination rooms used for ANC, family planning, OPD, EPI, MCH, under-5, TB/DOTS and HIV services and counselling and testing Small health centres may not have labour and delivery services A bathroom should also be easily accessible Counselling requires visual and auditory privacy, but may otherwise include less formal spaces, such as booths, tents, and outside (covered) areas Testing and counselling may be conducted in a number of different private spaces, including allocated rooms and other spaces OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 63
5 Group counselling space Laboratory analysis of specimens Phlebotomy/side laboratory Specimen labelling, preparation, results Large room or covered outdoor space for people One 3.0m x 3.0m (9m 2 ) One 2.0m x 2.0m (4m 2 ) One 1.5m x 1.5m (2.25m 2 ) May be outside (covered) space or in waiting area. For group counselling, support group meetings, and peer education/ support groups Minimum of one metre of working surface for each individual, each piece of equipment, and for staining. Rapid testing may be conducted in consulting or counselling rooms provided a work surface is available May not be a separate room, but you need to identify suffi cient space for phlebotomy and ensure its rational layout in relation to the laboratory and clinic Usually within the lab TB sputum collection Open air Conducted in the open air Pharmacy/dispensary One 3.0m x 3.0m (9m 2 ) Pharmacy stores One 1.5m x 1.5m (2.25m 2 ) With compounding space, sink, dispensing/counselling area The store needs to be large enough to fi t all supplies. It should be a room or, in the case of a very small health centre, a cupboard or cabinet that is kept locked Toilets staff Two 1.5m x 1.5m (2.25m 2 ) Toilets patients Two 1.5m x 1.5m (2.25m 2 ) Use one for urine collection * Adherence and psychosocial rooms can be used for counselling and testing during the initial scale-up of PITC before there is a large patient population in care and treatment. 64 l CHAPTER 5 l INFRASTRUCTURE
6 5.3 PRIVACY AND CONFIDENTIALITY Unfortunately, profound stigma continues to surround HIV infection, which means that attention to patient confidentiality is very important. It is important for health centres to maintain the privacy of HIV clinics and ensure that a person s HIV status is not identifiable to others in any way. Examples include: Signage that is discreet, as well as clear and helpful. Patients may be more likely to attend a clinic labelled family care clinic, comprehensive care clinic, or even infectious diseases clinic than one labelled HIV/AIDS clinic. Appointment systems that shield patient s names from view (of the public/or other providers). Appointment books need to be considered private medical records, and whenever possible health centre staff need to avoid calling out patients names in public areas such as waiting rooms. How is this possible? HIV-positive and HIVnegative patients need to be processed in the same manner (e.g. their names called out in the same way) so that their status is not identified by others in the waiting room. Medical records that minimize accidental or involuntary disclosure of HIV infection. A patient s HIV status needs to be clearly indicated on their medical charts; however, this marking needs to be discreet to avoid unnecessary disclosure. Patient medical records need to be secured at all times. Colour-coding or obvious marks that designate HIV status on patient-held records need to be avoided. In addition, written referrals to services such as radiology and laboratory testing need to look as much like referrals from other areas of the health centre as is feasible. For example, simple codes may be used to record HIV status, CD4 counts and ARV drugs dispensed on patient-held maternal health cards. These concerns need to be balanced with the efforts to normalize HIV infection as a chronic disease and to emphasize the confidentiality that applies to all clinical care within a health centre. You are strongly encouraged to seek feedback from PLHIV on the issues of privacy and stigma. The ability to gain PLHIV input will vary from facility to facility. In some cases, including PLHIV on community advisory boards will be the best way to obtain information, while in others, focus groups or less formal methods may be equally revealing. See chapter 4,Community for more details. OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 65
7 5.4 TB INFECTION CONTROL TB control TB infection control at the health centre is a very high priority to prevent transmission of TB between patients and to health workers. WHO and the StopTB Partnership have just released a 10-step programme for TB infection control. The version below to health centres: 10 Essential actions for effective TB infection control: safety without stigma 1. Include patients and community in advocacy campaigns. The community needs to be well-educated about TB infection, prevention and control. Patients need to understand that they will be better off if they know their HIV status, may be eligible for isoniazid preventive therapy (IPT), and have a right to rapid TB diagnosis and treatment. They need to know that TB can be spread by coughing, and to expect health settings and community services to require people who are coughing to cover their mouths when doing so. They need to understand that health workers may wear personal respiratory protection sometimes, or that patients may be asked to wear a mask in order to protect others. Safety without stigma should be the goal. A request to wear a mask or provide a sputum outside the centre, or in a well-ventilated room should not be stigmatizing, but should seem as part of a safer clinic for everyone. Patient and health worker safety may include receiving health care in the community to avoid unnecessary admissions to health care facilities. Information, education, and communication (IEC) campaigns need to include themes such as Our community is TB-safe, or Our health facilities are stopping TB. 2. Adapt an infection control plan. Each health centre should have an infection control (IC) plan and a staff person or team responsible for IC. The plan identifies high-risk areas for TB transmission, and provides information on TB and HIV rates for health workers and patients. The plan provides area-specific infection control recommendations for the health centre, including special standard safety procedures for its laboratory. 3. Ensure safe sputum collection. Sputum collection can be potentially hazardous for health workers and other patients. Workers need to explain to patients that safety without stigma is the goal of good TB infection control. they need to stress that sputum need to be collected outdoors if feasible (see chapter 8, Laboratory). 4. Promote cough etiquette and cough hygiene. In at least the waiting area, every health centre should have a poster on TB infection control and cough 66 l CHAPTER 5 l INFRASTRUCTURE
8 etiquette (see figure 3) When coughing, patients need to be instructed to cover their mouths and nose with hands, a cloth such as a handkerchief, a clean rag, tissues, or paper masks. All staff are responsible for safety and are advised to work together to help patients adhere to this practise. When tissues, cloths or face masks are not available, patients need to be instructed to lift their arm up and cover their nose and mouth with the inner surface of the arm or forearm when they cough or sneeze. No-touch receptacles for disposal of used tissues and masks should be available in the waiting areas. 5. Triage TB suspects for fast-track or separation (see also Service integration chapter). Screen all patients on arrival for chronic cough (i.e. >two to three weeks), fever, weight loss, night sweats, haemoptysis, or contact with a person with TB. Explain to all health centre visitors that safety without stigma is the goal, and that the screening is part of quality care. Patients need to understand that it is in their interest to know their HIV status, that they may be eligible for IPT and have a right to rapid TB diagnostic services and treatment. Individuals suspected of having TB should be fast-tracked for rapid diagnosis and care services, or should be asked to wait near an open window, or in a comfortable area separate from the general waiting room (outdoors when possible). When possible, use community-based treatment. Patients with known or suspected drug-resistant TB should be separated from other TB suspects. 6. Assure rapid diagnosis and treatment initiation. Patients suspected of having TB should move to the front of the queue for all services and need prompt evaluation for TB. (This preference does not put them before patients with emergency problems such as difficulty breathing or bleeding). Sputum collection should be done away from other people, and specimens sent to a quality-assured laboratory for AFB (acid-fast bacillus) smear and culture (when possible). Turn-around time for sputum AFB smear results should be no more than 24 hours if testing is done on-site. A patient-tracking system assures that TB suspects who are AFB smear-negative receive additional procedures (e.g. chest x-ray and referral visits), or treatment as quickly as possible. DOTS treatment for TB begins immediately when TB is diagnosed, and a plan for assuring adherence to treatment is developed. All people with HIV who are not TB suspects should be eligible to start on IPT. 7. Improve room air ventilation. Patient waiting areas should be open and well-ventilated. This includes leaving windows and doors open when possible OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 67
9 to maximize cross ventilation. Appropriately placed simple fans can assist ventilation. When weather permits, open-air shelters with a roof to protect patients from sun and rain are recommended. Patients should not wait for services in narrow, poorly ventilated corridors. When health centre renovations are being carried out, the management team should consider TB infection control as integral to new building plans. 8. Protect health workers. Health workers should know the symptoms of TB and be given a health assessment including screening for TB and HIV at least every year. All workers are encouraged to know their HIV status, and those with HIV infection should be given the opportunity to minimize exposure to people with TB, e.g. offered a change of duties. HIV-infected workers should be screened for isoniazid preventive therapy as part of basic HIV care and treatment. 9. Capacity building. All health workers should receive TB infection control training, and be engaged in improving their own and patient safety. This training may be combined with other infection control training (see Human Resources chapter). 10. Monitor infection control practises. Overseeing infection control practises should be a part of every supervisory visit. This should include a facility tour to check that IC is being implemented and that all essential IC supplies are available. At the very least, facilities should have an IC plan. When feasible, monitoring annual TB cases among health workers can also provide useful information on transmission of TB in facilities. Surveillance of TB disease among health workers is another means of evaluation. Additional on-site measures include examining medical records of a sample of TB patients, looking at the time interval from admission to suspicion of TB, time to ordering sputum for AFB, time from ordering to collection of sputum, collection of sputum to reporting of results, to initiation of TB treatment and interviewing patients to discuss their understanding of infection control, safety and stigma. How to promptly identify TB suspects in the waiting areas Before patients enter an enclosed part of the facility, a designated staff person should ask each adult and any child capable of coughing forcefully (usually age 14 or older) about symptoms or recent history of TB. The questioning should occur before patients wait in line for long periods to register or obtain services. Attention should be paid the patient s right to privacy, and screening should be conducted in a manner that is sensitive to the issues of stigma that may surround TB. 68 l CHAPTER 5 l INFRASTRUCTURE
10 Simple screening questions are: Do you have a cough? If patient answers yes, ask: For how long have you been coughing? An adult who has coughed for two weeks or more may be considered a TB suspect for pulmonary TB. To determine whether a patient may be under investigation, or is a diagnosed case of TB who may still be infectious, the staff member needs to ask: Are you being investigated or treated for TB? If the answer to either is yes, the person doing the screening classifies the patient as a TB suspect or case. OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 69
11 Figure 3. General medical out-patients waiting room Respiratory patients wait the other patients Before ventilation Figure 4. General medical out-patients waiting room Respiratory patients relocated to outside waiting area New consulting room entrance After ventilation Courtesy of: Dr Rod Escombe; Imperial College London 70 l CHAPTER 5 l INFRASTRUCTURE
12 5.5 HIV INFECTION CONTROL Minimizing occupational and nosocomial exposure to HIV is also dependent on work practise and administrative controls, including training and supervision in injection safety, and in the safe and appropriate use and disposal of sharps. Additional environmental controls include ensuring adequate and appropriate space and layout for phlebotomy services and areas; accessibility of sharp disposal containers; personal protective equipment for staff; and the availability of post-exposure prophylaxis. More detail on this can be found in the Human Resources chapter. 5.6 WATER SUPPLY AND WASTEWATER Both the quantity and quality of water and safe disposal of wastewater are important in health centres. Water quantity Water Water quality is a key element of infection control within health facilities. Particular care is needed to ensure that immunocompromised patients have access to safe drinking water, given their high susceptibility to infection. It is essential that the water presents no risk to health, and that it is protected from contamination inside the health setting. The following section assumes the health centre has a supply of safe water always available. Provide safe drinking water from a protected groundwater source (spring, well or borehole), or from a treated supply, and keep it safe until it is drunk or used. Untreated water from unprotected sources can be made safer by simple means such as boiling or filtering, chlorination and disinfection. Water quality is also important for food preparation, pharmacological and treatment applications, and for bathing. It is particularly important to provide adequate water for hand washing at multiple sites in the health centre (see next section). Non-potable water (water that is below drinking-water quality) should be used only for cleaning, laundry, and sanitation. OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 71
13 Water quantity Water quantity is a major factor in meeting all essential needs of the health centre, especially those which require large daily supplies, such as laundry and basic floor, bed and clinical equipment cleaning. The actual quantities of water required will vary depending on climate. But when considering local water-use practises for health centre infrastructure (toilets or latrines and laundry facilities), WHO estimates a health facility requires approximately five litres of water for every outpatient visit. This includes water used for all purposes: hand washing, cleaning, laundry and drinking. Water storage is also important and experience suggests that when possible, facilities should have a three-day supply of stored water (cistern or other). Minimum water quantity required 1 Outpatients Inpatients Operating theatre/maternity Dry supplementary feeding centre (depending on waiting time) Wet supplementary feeding centre Inpatient therapeutic feeding centre 5 litres/consultation litres/patient/day 100 litres /intervention litres/consultation 15 litres/consultation 30 litres/patient/day 1 These guidelines include water used for all purposes: hand hygiene, cleaning, laundry, drinking and cooking. The fi gures should be used to plan and design water-supply systems. The actual quantities of water required will depend on several factors such as climate, availability and type of water-use facilities (including type of toilets), level of care and local water-use practises. An increase in water quantities may involve only minor modifications in piped supplies, or expansion of pumping rates. However, in many cases major supply increases may require costly infrastructure investments in new water sources (wells, boreholes, river intakes, etc.) or water collection facilities (ponds, reservoirs, storage tanks). Any decision to expand a water system will need to consider current and future needs, water quality, available water resources and costs. Waste water disposal Wastewater is produced from washbasins, showers, sinks, etc. (grey water) and from flushing toilets (black water). Wastewater should be removed rapidly and cleanly from the point where it is produced. 72 l CHAPTER 5 l INFRASTRUCTURE
14 Wastewater drainage from health settings should be built and managed to avoid contamination of the setting or the broader environment. Wastewater should be removed in standard waste drainage systems to off-site sewers or on-site disposal systems. It is best if the health centre wastewater can be connected to a properly built and functioning sewer system, which is in turn connected to an adequate treatment plant. If the sewer does not lead to a treatment facility, an on-site retention system with treatment will be necessary before wastewater is discharged. Open wastewater drainage systems should be covered to avoid the risks of disease vector breeding such as mosquitoes, and contamination from direct exposure. Small quantities of infectious liquid wastes (e.g. blood or body fluids) may be poured into sinks or toilets. Most pathogens are rendered inactive by a combination of time, dilution and the presence of disinfectants in the wastewater. Toxic wastes (e.g. reagents from a laboratory) should be treated as health-care waste. They should not be poured into sinks or toilets that drain into the wastewater system. 5.7 HAND WASHING AND OTHER HYGIENE PRACTISES Provide water for hand washing after going to the toilet/latrine, before handling food, and before and after performing health care. This may be done using simple and economical equipment, such as a pitcher of treated water, a basin and soap or wood ash in some settings. This should be available for every clinical consultation room; in labour, delivery, postpartum, and other inpatient areas such as in the laboratory, near waste disposal areas and near the latrine/toilet. Handwashing Hygiene basics Basic hygiene measures by staff, patients and carers (hand washing in particular) should not be compromised by lack of water. Water (with soap or a suitable alternative) needs to be available at all critical points, and located close to users in order to encourage them to use water as often as required. Train staff on infection control procedures. OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 73
15 Infection control is a key component of health worker training and supervision. Hand hygiene is particularly critical, and should be facilitated by ensuring easy access to hand washing facilities and supplies (soap, disinfectants) and through ongoing education and surveillance. In larger settings, non-clinical staff such as cleaners, waste technicians, and kitchen staff are also responsible for infection control, and should be able to apply ITS basic principles to their daily work. Promoting correct hygiene is important for staff, patients and care givers. All should receive ongoing reminders of the routine measures required to prevent the spread of infections, whether in the health facility or at home. This education may be as simple as identifying the location and correct use of toilets and hand washing points. Managers should stress that promoting hygiene is intended to change personal behaviours that enable the spread of infectious organisms. Without behaviour change by all stakeholders at the health facility, hygiene both personal and institutional will not lead to safe and healthy conditions. 5.8 LATRINES/TOILETS Latrine Latrine This may entail measures as basic as digging simple pit latrines. (Note that the risk of transmission of soil-based helminths is increased with the use of defecation fields. Wearing shoes or sandals provides protection from hookworm infections). Basic requirements for latrines/toilets at a health centre Number of latrines/toilets four: one for staff (two if separate toilets are required for male and female staff); one for male patients; one for female patients; one for young children. In large health centres, more toilets or latrines are required. The number required depends on several local factors including the average time patients wait before consultations latrines/toilets. Design to respond to local cultural and social conditions (e.g. anal cleansing with water). Equip patient toilets to make them easy to use by people with physical handicaps, heavily pregnant women, elderly people and people who are sick 2. Children s toilets are particularly useful where latrines are used, and where the size of the drop-hole and the conditions inside a normal latrine are off-putting for children, or inconvenient for carers. 2 See Jones and Reed 2005 for detailed design features. 74 l CHAPTER 5 l INFRASTRUCTURE
16 Signpost toilets/latrines clearly to help users find them. Water points, with soap and adequate drainage should be provided at the exit of all toilets, and their use should be actively encouraged. Design, build and maintain toilets/latrines so they are hygienic and acceptable to use and do not become a source for disease transmission: Measures to control fly and mosquito breeding are needed; A regularly monitored cleaning schedule is required. Minimize the risk of violence (including sexual violence). Latrines/toilets should be carefully located, with locks for the user (to protect people while using them), and with lights for use at night (both the toilet and access areas). 5.9 CLEANING Management needs to provide cleaning supplies that enable staff to routinely clean surfaces and fittings to ensure the health-care environment is visibly clean and free from dust and soil. Ninety per cent of microorganisms are present within visible dirt. The purpose of cleaning is to eliminate this dirt. Cleaning 5.10 HEALTH CENTRE WASTE MANAGEMENT Use appropriate standard precautions at all times in handling wastes (see IMAI or IMPAC or other clinical guidelines). Segregate at the point of generation the four categories of waste Waste Management (sharps, non-sharps infectious waste, non-sharp non-infectious waste, and hazardous waste): Have three colour-coded containers at convenient locations in all work areas. Keep hazardous waste containers in lab and pharmacy. Train all staff in waste management. Make sure waste treatment and disposal happen properly and consistently: Properly identify waste packages to warn health personnel and waste handlers about their contents. Locate the waste-disposal zone at least 30 metres from groundwater sources. Fence off the waste-disposal zone. OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 75
17 Put a water point with soap/detergent and disinfectant to clean and disinfect containers, next to the waste treatment and disposal area with a soak-away system or sewer for wastewater disposal. Discuss with the appropriate local authorities the efforts that are underway to reduce waste management risks, and try to obtain their support for additional measures if necessary. Health care waste workers should be immunized against HBV Table 3. How to set up three colour-coded waste containers for most rooms in the health centre (plus a hazardous waste container in the pharmacy and laboratory only) Waste Management Waste category Sharps (needles, scalpels, etc.) infectious or not Non-sharps infectious waste* (anatomical waste, pathological waste, dressings, used syringes, used single-use gloves) Non-sharp, non-infectious waste (paper, packaging, etc.) Segregate using colour-coded waste containers Collect Dispose YELLOW Safe sharps container puncture-proof covered closable upright and stable during use leakproof at sides and bottom clear label for user YELLOW or RED bags or containers litre capacity with lids BLACK containers litre capacity Close lid or cover, seal with tape, and submit for waste pickup when they are no more than ¾ full. Never overfi ll or force items into these containers Collect regularly for disposal Should be collected, emptied, cleaned, disinfected and replaced after each intervention (e.g. in an operating or maternity unit) or twice daily The bags should not cleaned and reused Should be collected, emptied, cleaned and replaced daily; alternatively, plastic bags may be used inside the containers Sharps should be disposed of in a sharps pit (buried drum in small centres or emergency structures, concrete-lined sealed pit in other settings) Off-site disposal may be necessary for safe incineration at the district hospital (if available) or a private facility in charge of collection and treatment Non-sharps infectious waste should be buried in a pit fi tted with a sealed cover and ventilation pipe for on-site treatment in small health centre settings or, on-site or off-site high-temperature incinerated or steam sterilized. Special arrangements may be needed for disposing of placentas, according to local custom Joins the municipal waste stream or buried in a pit, a landfi ll site or non-food and non-medical items recycled. If space is limited, it should be incinerated. Ashes and residues should be buried in a pit * Cholera stools, body fluids from other highly infectious diseases. 76 l CHAPTER 5 l INFRASTRUCTURE
18 Table 4: Hazardous waste container Waste category Waste containers Collect Dispose Hazardous waste.* Hazardous Waste Appropriately labelled containers placed in secure location Health centres produce very small quantities of this waste. These can be stored in a small, labelled container at the pharmacy Send to district hospital or another central health facility for specifi c treatment and disposal Manage stock of chemicals and pharmaceuticals well to reduce waste quantities and save on purchase costs * Hazardous waste includes some outdated drugs, laboratory reagents, strong disinfectants; radioactive waste, batteries, mercury, etc. Each hazardous waste requires specific treatment and disposal methods based on national regulations. Transport sharps boxes to a treatment facility High temperatures (e.g. steam or incineration) kill microorganisms and reduce the volume of waste. Some hospitals have on-site treatment facilities; health centres usually do not, but may be able to transport full sharps boxes for treatment elsewhere. Sharps disposal requires special facilities and personnel. Health facilities can try to use waste treatment options available at other facilities such as cement factories for incineration or municipal centralized facilities. Cecile Arnaud, Consultant, WSH-WHO OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 77
19 5.11 POWER Power BATTERY All health centres need some electricity. Ambient light can be used during the day for most tasks, but emergency lights, electricity to charge a mobile phone, and (in health centres performing malaria or sputum microscopy) minimum levels of electricity for a microscope are required. These can be powered or recharged from the mains electricity supply or, if this is not available by: solar panels; generator; using a vehicle battery. (This is an option when a vehicle is regularly available and a second battery can be installed). How you achieve temperature control in your pharmacy storage area will also influence your power needs: First, use methods that do not require power: add ceiling and air vents; keep windows and doors open. Second, add a fan. If an air conditioner is needed, it will require significant energy. The reagents for essential laboratory tests, and drugs required for services described in this Manual (including first-line ARV drugs) do not require refrigeration. If possible, avoid formulations and laboratory reagents which require refrigeration beyond what is needed for the cold chain for vaccines. If a refrigerator is required, it can be run on propane, or from a bank of batteries (referred to as a solar refrigerator). Decisions need to be made based on the power required and the times of the day it is needed (total possible load). See Annex 5.1 for a guide to estimate the power requirements at your health centre. 78 l CHAPTER 5 l INFRASTRUCTURE
20 PV/Generator Hybrid System for your PV Home CHARGE CONTROLLER BATTERY BANK DC LOAD CENTER PV ARRAY GENERATOR INVERTER WITH BATTERY CHARGER BATTERY CHARGER DC TO AC CONVERSION (INVERTER) AC LOAD CENTER AUTOMATIC TRANSFER SWITCH Courtesy of: Blackwood Solar Systems If batteries are used as the main power source, decisions need to be made as to whether AC electricity is generated via an inverter (with about a 10% loss in energy) or direct current is used (see Operations Manual Adaptation Guide) COMMUNICATION INFRASTRUCTURE IIt is essential that the clinical team has the physical means to communicate with each member and to consult on side-effects, other complications, etc. The centre must have reliable distance communication between it and the district-based medical officer (also a part of the clinical team). Furthermore, clinical mentors need to be available to offer advice by cell phone, landline or radio. Communication This is particularly important when initiating ART in uncomplicated patients at the health centre, under the supervision/standing orders/prescription of the medical officer. In addition, if oral morphine is used in palliative care, communication may be needed between the palliative care nurse-specialist or district medical officer able to prescribe the drug, and health centre staff that are providing medical back-up to home-based care. Distance communication is also important for transmitting management information and laboratory test results. OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 79
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text:
Sitter in Buffalo
Hi, my name is Kristen and im interested in this babysitting position. Im a mother to a 5 year old boy and for the past 10 years have also watch my friends kids and friends of friends kids of all different ages as needed. Ive also had a few babysitting jobs off of craiglist in the past before I had my son. I'm available 24/7 and on short notice. I live on the border of Kenmore and North Buffalo and do have my own car and do not mind doing pick ups and drop offs. Im available to watch your child in my home as I have to care for my son and get him on and off the bus for school. We have tons of toys, games, movies, books, arts and crafts, all kinds of kids stuff and also a back yard with a swing set and tons of outdoor toys to play with for the summer time. If interested please call me or email me atwith any questions you may have for me....Also if you need references then just let me know and I would be glad to provide them. Thank you and hope to hear from you soon.
Sitter Details
|Email Address
|Phone Number
|716-602-... Confirmed
|Years of Experience
|Provider Type
|Age Group
Newborn (0-12 months)
Toddler (1-3 years)
Early School Age (4-6 years)
Children's Crafts
School Pick-up and Drop-off
Swimming Supervision
Light Meal Preparation
Run Errands
Sitter Owns Transportation
|Hourly Rate
|Number Of Children
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General enquiries
+44 (0) 20 7079 4399
Call HCA from 8am-8pm Mon-Fri and 9am-5pm Sat
HCA Healthcare UK
A-Z of Services and Treatments
Bone Marrow Transplants
Download Brochure
A bone marrow transplant involves replacing a patient's damaged bone marrow with healthy bone marrow. HCA is the only private hospital group with a quality-accredited bone marrow transplant unit, offering a highly specialist approach to the treatment of conditions that cause damage to bone marrow. These include severe aplastic anaemia, leukaemia, non-Hodgkin's lymphoma and specific genetic blood and immune system disorders.
Our treatment programmes include both autologous transplants (from the patient's own body) and allogenic transplants (from a donor's body) for adults and children.
When you have a bone marrow transplant in one of our hospitals:
Are you paying for yourself? Click here for our self pay prices.
You can choose the consultant and hospital most convenient for you by simply entering the treatment into our 'Consultant finder'.
With us, you can be sure you are getting the best treatment available. When you have any treatment in one of our units or hospitals, you will experience a number of benefits:
What to do next
Once you have decided that you would like to be treated at an HCA hospital, or would like further information, here's what to do next:
Back to A-Z of Services and Treatments
Cick here for payment options
© copyright 2008 - 2017 HCA Healthcare UK.
Registered Name: HCA International Limited; The part of the UK in which it is registered: England and Wales;
Registered Number: 03020522; Registered Office Address: 242 Marylebone Road London NW1 6JL.
£500m has been invested by HCA International in the latest medical technologies and facilities over the last 10 years.
Your hospital will be one of our world-class private hospitals: HCA's world-class hospitals are accredited by The CHKS Accreditation Unit, a leading provider of healthcare intelligence and quality improvement services. The accreditation is a measure of the overall quality of a hospital and hospitals with CHKS accreditation have been shown to provide a better quality of service.
Your safety will be protected because we have more critical care beds than any other private hospital group: HCA hospitals achieved 100% compliance with all Care Quality Commission inspected outcomes of care in 2011.
Your treatment will be undertaken using the most advanced diagnostic and treatment facilities: Oliver Wyman, Corporate Accounts: Driving quality and value, January 2012.


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Koblenz 45-0435-3 Vacuum Cleaner Scrub Brush
45-0435-3 Koblenz 18 Inch Vacuum Cleaner Scrub Brush Fits 20 Inch Koblenz Models
Availability: Ships in 3-5 Days
List Price: $119.99-
Price Break: -$30.00
Our Price:
The Koblenz 45-0435-3 15 inch scrub brush is used with the Koblenz Floor Machines. They have a unique flow-thru brush design that helps your floor machine thoroughly clean all types of floors.
They have tampico and cocoa bristles that provide long durability. They also work as support for the pads on the floor machines. For wood floors you should try polishing pads instead of these scrub brushes.
The Koblenz 45-0435-3 comes with one eighteen inch floor machine scrub brush. Floor machine is not included.
- Model: 45-0435-3
- Product Type: Vacuum Cleaner Scrub Brush
- Application: Scrub brush helps to thoroughly clean all types of flooring
- Product Type: Vacuum Tool(s)
- Includes: 18" Vacuum Cleaner Scrub Brush
- Compatible With (Manufacturer's Part Number): 20" Koblenz Industrial Floor Machine
- Has a flow-thru brush design.
- Has tampico and cocoa bristles provide long durability.
- These scrub brushes work as support for pads.
- This scrub brush measures eighteen inches.
- Thoroghly cleans all types of floors.
Safe, Secure Shopping
Vacuum Home is rated as a trusted store from the following online authority sites:


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Franz Quill was a Solarian citizen and an officer of the Solarian League Navy.
Holding the rank of Admiral, he served as Fleet Admiral Imogene Tsang's staff operations officer for Task Force 11.6. He was known to be grumpy in the morning, and did not like Captain Sherwood Marceau, the task force's communications officer. (HH13)


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TORTOLITA BECAME A town on September 2, 1997, when the Pima County Board of Supervisors unanimously voted to approve the incorporation after Pima County Recorder Ann Rodriguez certified that 72 percent of the registered voters living in the area had signed petitions in favor of the town's creation.
State law sets out two methods to incorporate, both by petition. If 10 percent of the registered voters sign on the dotted line, there's an election, as we'll see in November in Casas Adobes and the Catalina Foothills. But if two-thirds of the voters sign petitions, their community automatically becomes a town. Tortolita took the hard way.
When was the last time you heard of 72 percent of anybody favoring anything--and then signing a petition to support it? Knock off the sludge everybody knows remains on the voter rolls, and that 72 percent pushes 90 percent. We could've gotten more if needed from folks on vacation or by camping on some more doorsteps. Tortolita, in fact, is the only town in Arizona history to incorporate by petition.
The Steering Committee, consisting of anybody who came to the meetings, ended up with 37 people. Fifty-six others helped as petition passers. More than 100 people made financial contributions. When needed, as when we decided to pack the Oro Valley Council meeting to protest that town's attempts to annex us apart, we could turn out over 300 folks on short notice--about 20 percent of our adult population. The first town council was chosen by 250 people attending a town meeting--held on three day's notice on the evening of Labor Day--to review 15 candidates, seven of whom were elected and forwarded to the Board of Supervisors for ratification. That's a higher turnout than Tucson got in the city primary.
Politicians love to prattle about the virtues of citizen participation, which usually means six staffers, four suits and a few shills sitting in a government building eating donuts at taxpayer expense and representing no one. In Tortolita citizen participation is so damn authentic that if Frank Capra were still around, he'd make a movie with Jimmy Stewart playing Lan Lester.
LESTER WAS ELECTED to the town council by acclamation and a standing ovation. No one person did more to create this town and everybody here knows it. He and his wife Judy spent six months of their lives working on a vision and got hundreds of people to back it. They're continuing their efforts by using an office in their home as a temporary town hall, with Judy Lester serving as a volunteer, unpaid town clerk. Tortolita may be unique in one other way: It's the only town I know where almost everybody actually likes the mayor.
Lester was far from alone. Kathy Dhyr and Bernie Zabel turned over their home for two months as petition headquarters and lived with strangers (who are now new friends) popping up at all hours with petitions in their hands. The champion petition passers were Lou and Robyn Benson, who knocked out 178 sigs by themselves--folks who drove Thornydale and La Cholla saw them regularly parked on street corners. And mention must be made of Robert Hassan, who was handed a list to troubleshoot--in alphabetical order--and brought back a full petition--in the same alphabetical order. The new flooring in our living room waited from July 4 to Labor Day for installation as my wife Kathy, the former Pima County voter registrar, meticulously checked every petition, resulting in a final count that differed from the official one by exactly four signatures. There were others, too numerous to mention, whose contributions where similarly phenomenal. Suffice that this was a textbook case of civic responsibility.
WE WEREN'T EXACTLY concerned with many of those high-priced services everybody else is talking about in other incorporations because we don't get much of anything now. We pay for our own trash and fire, most of us have our own wells and septic tanks (which works fine on large lots), and we don't need streetlights and sidewalks on the many dirt roads we're quite happy to drive. Like several similar towns in California without commercial uses, we can get along just fine on revenue-sharing money even if Pima County does gouge us a little. We've already computed we get less than our assessed valuation pays for--which, for the record, is larger than Sahuarita and South Tucson combined.
At the town election, I held in my hand a ballot that had more good candidates listed than I could vote for. And the next morning most of the losers came to the Pima County Board meeting to watch the winners sworn in. Try that one anywhere else.
Much of this stems from Tortolitans' many years of participation in several home-owner groups and the Northwest Coalition for Responsible Development, chaired by Lester. A lot of people got to know each other through years of banding together for a variety of projects and fights against bad development.
A lot of people are saying that certain incorporations are motivated by questionable forces. Ours was motivated by a simple desire to preserve lifestyles, whether it's the folks in Cholla Air Park who want to keep flying their planes, family members in a single-wide who want to keep riding their horses, or the retirees who like watching wildlife and wondrous, unobstructed sunsets. That can only be done by leaving saguaros and ironwoods alone and letting wildlife have a sanctuary somewhere between all those tacky roofs in Marana and Oro Valley. Preservation of lifestyle means preservation of the Sonoran Desert.
WE'VE BEEN SUED by just about everybody and it isn't over yet. We're the Growth Lobby's worst nightmare--a bunch of real people in charge of the zoning and permitting on 22 square miles of reasonably pristine desert who plan to keep it that way. Every suit from here to Hong Kong is going bonkers and every lawyer who ever had a land speculator client is getting rich figuring new ways to try to screw us over. Unfortunately for them, so far they've been outnumbered by Tortolita Town Attorney Bill Risner.
Politically, Tortolita is a crazy mix of hard righties, hard lefties, and even a few militant moderates. You can tell by the first council--four Republicans, two Democrats and a Libertarian, with a Democrat placing as first alternate. Trust me, nobody cared.
Councilwoman Kathleen Franzi, who's not exactly a liberal, made the motion to appoint the town's most notable left-winger, Lou Benson, to the post of Town Marshall. It carried unanimously. So far, Benson's main job has been policing the town's rights of way for illegally posted signs and replacing the Tortolita signs that have been continually defaced and broken by some anonymous scumbag. Like the Lesters, Benson serves without pay.
Oro Valley and Marana both did us a big favor by proposing fast-track annexations for the sole purpose of cutting us into three pieces to negate our ability to be a town. All that did was make our people work harder and convince a couple hundred more folks that we weren't blowing smoke when we asked them to support us or get annexed by Caddyshack or Dogpatch. Thanks, turkeys--you gave us the margin.
We're hardly no-growthers. We hope our growth accelerates and we build out the town with more people who think and live like we do. As long as they do it the way we did, we'll be delighted to welcome them.
Tortolita could handle another 10,000 people some day--but not the 150,000 you'll find in that putrid document called the Pima County Comprehensive Plan. Remember that next time somebody extols the virtues of "having a regional plan." We do, and it sucks.
Lawyers for our opposition are trying to make the case that we can't be a town because we don't fit the definition of a "community." Pardon us, but we think we just proved we're one of the few places left that really is one.
Their argument, as voiced by their lap-dogs at Inside Tucson Business, suggests that Tortolita is too sparsely populated to be considered an "urban area," which is not supposed to contain things like agriculture. Guess what--we don't have any agriculture. That's all next door in annexation-happy Marana, which has less density than we do. And in Oro Valley, where developers are still taking big tax breaks for running cows on vacant land in places like Honey Bee Canyon.
THE COMPREHENSIVE PLAN isn't the only problem in these parts. The majority of the Amphitheater School District governing board reeks with corruption, arrogance, conflicts of interest and blatant stonewalling. It wasn't the Tucson Weekly that gave it the 1996 Brick Wall award for failure to produce public information, it was the Arizona Press Club.
As The Weekly's Jim Nintzel wrote last year, obvious conflicts of interest abound where a school board picks a political crony as its sole real estate agent and allows him to get paid by the seller on a commission that gets bigger as the price of the land grows. The 73-acre parcel agent Bill Arnold picked for a high school site--at four times the land's assessed value--is at the district's border with the Marana School District. It's a flood-prone parcel covered with prime wildlife habitat, ideal for the now-famous pygmy owl, which Tortolitans have adopted as their official town bird.
The Amphi School Board's pygmy owl argument--that this is a case of "owls vs. kids"--is a rationalization for the board's failure to check the environmental impact of building a school on the site. (But the lack of environmental studies shouldn't be surprising, since the board also didn't even have the land appraised.) Last month, the board members told a packed--and hostile--public hearing that there probably aren't any pygmy owls on the property, and besides, who cares? There are plenty of them left in Mexico. That's an interesting interpretation of the Endangered Species Act by Amphi Board member Gary Woodard, who ought to know better. Yeah, and you can still see a bald eagle at the Desert Museum.
Woodard's argument exposes the total environmental callousness of the Amphi Board and other bulldoze-at-any-cost folks. You destroy endangered species by destroying their habitat--it doesn't matter if there are any owls there now. The three washes running through the property are where they like to live. Destroy them and they have fewer places to go.
The school site was picked partly based on future development, and Amphi bought it before Tortolita was incorporated. Marana officials recently annexed--after publicly promising they'd wait--1,200 acres, including a 309-acre parcel owned by Forest City Development of Cleveland. Forest City originally had this parcel zoned for a shopping center, but has since modified it for--what else?--high-density housing. That annexation is on shaky ground, as Tortolita has filed suit citing specific legal problems, not limited to the fact that the Marana Council passed a tabled ordinance on the consent agenda. The lawsuit isn't the only problem besetting the annexation--enough signatures were gathered on referendum petitions from Marana residents to place this annexation on the ballot in their spring election. There are some real people in Dogpatch who are tired of the town's reputation.
Marana also covets 900 acres of state-trust land next door, where more blading and grading is planned. Forest City, which has a "planning permit" from the State of Arizona for this parcel, is looking forward to acquiring it--on their time frame--from the State of Arizona, so they can do another massive development. All the company will need is a rezoning. While this Board of Supes probably wouldn't grant the rezoning, Marana most likely would.
But as things have shaken out, that 900 acres now just happens to be in Tortolita, where the odds of rezoning are lower than a pygmy owl's life expectancy at an Amphi School Board meeting.
All of which gives you some insight into the reasons attorney Si Schorr, of the law firm Lewis and Roca, which represents Forest City, will throw as many lawsuits as he can at Tortolita to destroy us. He's actually arguing that Forest City will be injured by not making a profit on land they have yet to acquire! And Inside Tucson Business is parroting this bullshit by attacking great big nasty Tortolita for picking on a poor little Cleveland mega-developer.
The state land department is convinced it'll get more money for land planned for high-density usage, and the bureaucrats have rigged the sale process accordingly. If that were true, several acres in crowded south-central L.A. ought to worth more than similar dirt in Beverly Hills--or that Bangladesh should have higher real estate prices than Switzerland.
The irony in all this stems from the state constitutional mandate to sell land at the highest price to support education--a policy that fails to take into account that selling the land to high-density developers dumps thousands of kids into already overcrowded local schools with insufficient tax revenue to cover their cost. This is consistently proved by the fact that many school districts are maxed out on bonds and property taxes, as Amphi is right now.
TORTOLITA IS FIGHTING several other lawsuits. One is from the folks who are trying to incorporate Casas Adobes, who are concerned about several issues that were resolved by the Board of Supervisors when they simultaneously incorporated Tortolita and placed the Casas Adobes incorporation on the November ballot. (The Casas Adobes people originally wanted to grab most of what is now Tortolita, but after a couple of meetings they decided we'd be too hard to digest. And we decided we didn't need to be part of a New Marana.) This lawsuit mainly involved the creation of "islands"--which had been done by the Casans themselves, some think as a set-up to screw Tortolita. Many aren't surprised by this sleazy move from a bunch of folks who count former Pima County Supervisor Ed Moore as their "senior advisor." They've yet to drop the lawsuit, even though its issues are moot, causing us to wonder if it's part of a grander Growth Lobby strategy to keep us in court and tap us out. We're also faced with a similar suit from Marana land owner John Kai, who just happens to be represented by Ed Moore's personal attorney, Larry Schubart.
But the major lawsuit Tortolita--and all other incorporations--faces is from the City of Tucson's appeal of the decision by Pima County Superior Court Judge Michael Alfred, who upheld the constitutionality of the 1997 law allowing incorporations within six miles of existing towns and cities. This case will be decided by the Appellate Court on October 27, and, we hope, address something the trial judge dodged--the constitutionality of the 1961 law setting up the six-mile "disenfranchisement zones" in the first place.
Pima County, which chose to vigorously oppose the city's suit after some intense lobbying by Tortolitans and others, is ably represented on this matter by attorney Tony Ching, former Solicitor General of the State of Arizona under three Attorneys General--Bruce Babbitt, Bob Corbin and Grant Woods. Ching is generally considered one of the finest constitutional lawyers in Arizona. The Town of Tortolita recently added Ching to its battery of attorneys by approving a consulting contract. We're currently the only Arizona town that has no paid staff--just lawyers.
EVERYBODY IS SERVING for free and will continue to as long as is necessary, from Town Engineer John Alexander to Town Clerk Judy Lester. The back of Lester's home is town hall, and meetings are held on Thursday nights at the Tortolita Presbyterian Church on Thornydale Road. After having seen how shabbily Amphi Schools and Marana treat citizens and their input, we decided to begin and end Tortolita Council meetings with a call to the audience.
Which is why the Growth Lobby is in for a helluva fight in its attempts to bust us up and deal us off to its running dogs in Marana and Oro Valley. Every sleazy move, every phony lawsuit, every dipshit hit from rags like Inside Tucson Business just toughens us more. We're dug in for the duration.
The only problem we have is understanding the failure by some urban environmentalists and a few others to grasp what this is all about. We can figure out why a condo-living, Beemer-driving, politically correct liberal can't understand what's happening. But Tucson officials like Councilwoman Janet Marcus, who weeps over the death of tropical rain forests and worries about the impact of Styrofoam cups, doesn't have a clue about the role of Tortolita in preserving ironwood forests. Marcus had committed to vote with Council members José Ibarra, Steve Leal and Molly McKasson to remove Tortolita from the city's lawsuit, but she took a dive after Mayor George Miller pulled her chain. Miller once again has validated the thesis that he's been nothing but a Growth Lobby stooge for his entire career. There are other supposed environmentalists, particularly in the Catalina Foothills area, who are so busy fighting that incorporation that they haven't noticed the benefits of Tortolita's to preservationists everywhere.
This is not about taxes or crime or elitism or race. It's about a bunch of folks on the northwest side who can keep about 20 square miles of ironwoods, saguaro and wildlife from being plowed up forever. And it has nothing to do with the City of Tucson. We're trying to keep away from George Miller's new best friends, Marana and Oro Valley. We've sacrificed long, and we'll continue to.
You should judge us by the enemies we've made. We're extremely proud that the Growth Lobby wants our ass--we gotta be doing something right.
To reach the Town of Tortolita, write P.O. Box 90048, 85752-0048; call (520) 544-4057; Fax 544- 2395; or Email email@example.com. Visit their websites at http://www.azstarnet.com/~franzi/ and http://www.mypages.com/tortolita/
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Bollywood Diaries 2016 Hindi Full Movie HD DvdRip Free Download,Watch Online Bollywood Diaries 2016 Hindi Full Movie,Bollywood Diaries 2016 Hindi Full Movie Torrent Download,Bollywood Diaries 2016 Hindi Full Movie 720p 1080p 480p Free Download Torrent.
|Movie Information Box
Directed by K.D. Satyam
Produced by Dr.Sattar Diwan
Written by K.D. Satyam
Starring Raima Sen, Salim Diwan, Ashish Vidyarthi
Music by Vipin Patwa
Cinematography Dev Agarwal
Production company-Rehab Pictures Pvt Ltd
Distributed by ZeeStudios
Release dates 26 February 2016
Running time 125 minutes
Country India
Language Hindi
Bollywod Diaries Movie Description/Synopsis:
Bollywood Diaries is a 2016 Indian Hindi-language drama film, written and directed by K.D. Satyam and featuring Raima Sen,Salim Diwan and Ashish Vidyarthi in title roles along with Karuna Pandey and Vineet Kumar Singh in supporting roles. Produced by Dr. Sattar Diwan under the banner of Rehab Pictures Private Limited, Eagle Eye Entertainment LLP as Associate Producer. The film will be distributed by Zee Studios and the digital marketing is being handled by CineMArkets Digital Solutions. The film was released worldwide on 26 February 2016.[citation needed]
Satyam is known for his work as a writer for Gattu, a film that was awarded at the Berlin Film Festival and won another two awards at the Indian Film Festival of Los Angeles. It also became a part of the list of India's Oscar Nominations in 2012.
Movie Plot: The passionate journey of three Bollywood fanatics who wish to make it big in the industry.
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Easy to reach from the Piazzale Roma Terminal and the railway-station, the Pantalon Hotel is situated close to Venice's University area and the art academy. In a few minutes from the hotel on foot you can reach the Basilica dei Frari, the Scuola di San Rocco, the Accademia di Belle Arti, the Rialto Bridge and even Piazza San Marco can be reached in just 15 minutes on foot.
Recently refurbished and Venetian in style, the Hotel Pantalon has numerous elegantly styled rooms which are air conditioned and offer satellite television, mini bars and an internet point. The hotel reception is open 24 hours a day and the there is a breakfast room where you can get a good start ready for a day of sightseeing and shopping.
Distance from Airport:
10 miles - Marco Polo
All have - bathroom/shower - WC - telephone - satellite TV - minibar - air conditioning - safe - hairdryer - internet access - (certain amenities may be payable locally)
Please note: The city of Venice is introducing a new city tax. This tourism tax is to be paid before the end of stay DIRECTLY to the hotel. This is 3� per day, per person.
Transfer time:
20 minutes
Eating and Drinking:
The hotel has a breakfast room.
Swimming pools:
The hotel does not have a swimming pool.
Right choice:
The hotel is perfect for couples, families and friends looking for a comfortable three star property in a central location that is perfect for exploring Venice.
Suitable for:
Families, Friends and Couples


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Richard H. "Dirk" Gringhuis (22 September 1918 – March 1974) was the artist who illustrated the 39th Oz book, The Hidden Valley of Oz (1951).
He was born in Grand Rapids, Michigan, and trained at the American Academy of Art in Chicago. He wrote and illustrated 28 books, half of them on Michigan history. He served as Curator of Exhibits at the Museum and Associate Professor in Elementary Education at Michigan State University. He also had experience as a television producer and on-air host, with the program "Open Door to Michigan."
Among the many books Dirk illustrated were three in the Boxcar Children series by Gertrude Chandler Warner.


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Not sure if its called signal strength security or not. But I messed with some wireless device a while back that would let you set if a PC could connect to your access point based on its signal strength. Like you had to be within a certain range in order to authenticate and connect.
Does that sound familiar to anyone and do any low end access points support this?
3 Replies
Nov 3, 2009 at 11:02 UTC
I wouldn't say that was the best way of securing a wireless network but I do believe you can reduce the power of the wireless antenna on many AP's to reduce its signal range (and therefore peoples ability to connect from too far away) if thats something vaguely related?
Nov 3, 2009 at 11:10 UTC
I know its not the best way, and security really isn't the purpose. Its mainly we don't want people sitting out in the parking lot connecting (even though they are allowed to). I guess we could tune down the power and that would do the same thing. I just for some reason thought some equipment I had worked on had that feature.
Can Linksys or D-link access points, turn down the signal strength? I don't have one readily accessible right now.
Nov 4, 2009 at 3:37 UTC
Alas I have not actually tried this before so I can't really help much more but have you tried looking at the location of the AP's?
You could move some of them deeper into the building so that they still cover the interior but don't project too far outside.
This discussion has been inactive for over a year.
You may get a better answer to your question by starting a new discussion.


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I arrived at midnight. Shuttle picked me up. Room was filthy. Tile floor hadn't been swept or mopped in days. Room was moldy, musty smelling. Dirty towel & shirt hanging on back of bathroom door. TV had something all over it. Stay away!!!!!!!
Getting you more information on this room
Getting you more information on this room
"The rooms on the first floor are perfect for people with pets with direct access to the large back yard."


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Thailand is a country in southeast Asia with a population a of 68 Million. The government has been a constitutional monarchy but a military coup in 2014 ended Democracy at least for now. The Thai legal system doesn't respect Free speech or Human rights.
Liking and sharing a photoshopped image of the Thai King can lead to a 30-year Prison sentence. Sharing information about corruption in Thailand makes things worse. [1] Trials in Thailand take place without a jury and there are suspicions that trial judges may make decisions due to political pressure. For example, two Burmese migrant workers were sentenced to death based on DNA evidence that wasn't independently tested. Many people doubt the reliability of the verdict [2] as does Amnesty International. [3]
Thailand shares a border with Burma, Laos, Cambodia, and Malaysia. The coastal regions border the Andaman Sea, part of the Indian Ocean on one side and the Gulf of Thailand, part of the Pacific Ocean on the other side. [4] [5] [6] [7]
Buddhism was and is an important factor shaping Thailand's history and culture.
- ↑ Man Faces 32 Years For 'Liking' Facebook Post
- ↑ Myanmar men sentenced to death for murder of British tourists in Thailand
- ↑ Thailand beach murders: Myanmar plea over convictions
- ↑ Thailand profileThe BBC on Thailand
- ↑ Thailand Info Please on Thailand
- ↑ Thailand Encyclopædia Britannica on Thailand
- ↑ Thailand Encyclopedia of the Nations on Thailand