text:
Emergency triage assessment for hypoxaemia in neonates and young children in a Kenyan hospital: an observational study
Michael K Mwaniki a, D James Nokes a, James Ignas a, Patrick Munywoki a, Mwanajuma Ngama a, Charles RJC Newton a, Kathryn Maitland a & James A Berkley a
a. Centre for Geographic Medicine Research, Kenya Medical Research Institute, PO Box 230, Kilifi, 80108, Kenya.
Correspondence to Michael Mwaniki (e-mail: firstname.lastname@example.com).
(Submitted: 01 November 2007 – Revised version received: 24 June 2008 – Accepted: 04 August 2008 – Published online: 13 February 2009.)
Bulletin of the World Health Organization 2009;87:263-270. doi: 10.2471/BLT.07.049148
Recognizing and correcting poor oxygenation early is an essential aspect of paediatric emergency care. The management of hypoxaemia includes establishing an open airway and alveolar ventilation, providing supplemental oxygen, restoring circulation and treating the underlying cause. Hypoxaemia correlates with mortality,1 and early assessment and prompt oxygen therapy probably improve survival.2,3
In developing countries, bottled oxygen is expensive and commonly in short supply. However, most hospitals providing secondary care cannot perform pulse oximetry or measure arterial oxygen concentration to properly target oxygen delivery. Furthermore, clinical assessment is often carried out by relatively inexperienced health workers, as a result of which simple algorithms for identifying hypoxaemia have been developed and studied. However, the studies have been conducted almost entirely among children with lower respiratory tract infection (LRTI),4–9 and little prospective validation has been performed.
Certain clinical signs have been identified as predictive of hypoxaemia: a fast respiratory rate for age, lower chest wall indrawing, grunting, head nodding, cyanosis, the absence of crying during the examination, and the inability to breastfeed or drink. No single sign is a reliable predictor, and sensitivity is generally low for any single sign.10 WHO currently recommends giving oxygen urgently to children with cyanosis, signs of shock, severe respiratory distress, the syndrome of "very severe pneumonia" or a respiratory rate of 70 breaths per minute (min) or more.11
Given the paucity of data outside the context of LRTI, we first aimed to describe the prevalence of hypoxaemia in relation to the WHO clinical syndromes of "pneumonia" at admission and the final diagnoses made at discharge. We then tested the hypothesis that hypoxaemia could be identified on the basis of clinical signs by studying a large population of children consecutively admitted to a rural, Kenyan district hospital, irrespective of their diagnosis. We report findings from 15 289 children and neonates admitted during a 3-year period and validate our findings using data from 4695 admissions over a fourth year.
Study setting
Since 1998 we have conducted continuous inpatient surveillance to describe the causes and clinical features of common illnesses among children admitted to Kilifi District Hospital in Kenya.12,13 The hospital is located at sea level in an area with endemic malaria. Government-employed clinical officers not involved in research refer children to the paediatric ward (40 beds) or the high-dependency unit (6 beds). On admission, discharge or death, standardized clinical and laboratory data are collected by clinical officers, who in Kenya receive 3 years of basic medical training, or by fully trained medical officers with less than 5 years of paediatric experience.12,13 For this analysis, we used data collected at admission from January 2002 to December 2005 and final discharge diagnosis for each consecutive admission over the same period of time. The Kenyan National Scientific and Ethical Review Boards and the Coventry Research Ethics Committee approved the study.
Clinical definitions
WHO defines a set of clinical syndromes of "pneumonia" on the basis of clinical history and clinical signs at presentation for the purpose of determining the need for admission and the type of antibiotic treatment required.11,14 The definitions have high sensitivity with respect to LRTI, but they lack specificity. The "syndrome of pneumonia" is defined as a history of cough or difficulty breathing plus an elevated respiratory rate for age (if < 2 months, ≥ 60 breaths per min; if 2–11 months, ≥ 50 breaths per min; and if 1–5 years, ≥ 40 breaths per min), and no signs of severe pneumonia syndrome. "Severe pneumonia syndrome" is defined as a history of cough or difficulty breathing plus lower chest wall indrawing or nasal flaring and no signs of very severe pneumonia syndrome. "Very severe pneumonia syndrome" is defined as cough or difficulty breathing plus any of the following signs: cyanosis, inability to drink or breastfeed, convulsions, lethargy or unconsciousness.
Regarding signs not included in the above definitions, prostration was defined as the inability to sit unsupported for a child ≥ 9 months of age, or the inability to breastfeed or drink for a child < 9 months of age. Level of consciousness was assessed using the Blantyre coma scale.15 Shock was defined as the presence of any one of the following signs: capillary refill delayed for > 3 seconds (s), a noticeable temperature gradient or a weak pulse volume. For this analysis, we defined severe anaemia as a haemoglobin concentration ≤ 4 g/dl. Malaria screening was performed on every admission with thick and thin blood films stained and examined by standard techniques.
Oxygen saturation (SaO2) was measured at admission by trained clinical assistants using fingertip pulse oximetry (Nellcor Puritan Bennett NPB-40, United States of America). We defined hypoxaemia as an SaO2 < 90%. Bottled oxygen was always available for hypoxaemic children. LRTI and other conditions were managed according to current WHO guidelines.11 All final diagnoses, including LRTI, were made prospectively by the discharging clinician after a review of admission history, inpatient management notes and all available laboratory and radiologic tests.
For this analysis, we first used the WHO pneumonia syndromes to classify children according to the clinical findings observed at admission. We then examined up to two final diagnoses recorded at discharge or death using all available clinical, laboratory and radiological information. Thus, the sum of all final diagnoses may exceed 100%.
Statistical methods
At the point of contact, clinical data were entered into a FileMaker Pro database 5.5v1 (FileMaker Inc., USA). Laboratory data were double entered and verified using FoxPro 2.5b for Windows (Microsoft Corporation, Seattle, WA, USA). Stata version 9.2 (Stata Corp, College Station, TX, USA) was used for the final analysis.
We split the data into a 3-year derivation set and a 1-year validation set. We divided admissions into three age groups because we hypothesized that the prevalence, causes and predictors of hypoxaemia could differ among neonates, young infants and older children. We first determined the prevalence of hypoxaemia in all age groups. We then examined hypoxaemia in relation to the WHO clinical syndromes of pneumonia at admission and final diagnosis at discharge. After excluding children in whom oximetry was not performed or with a failed oximeter reading or who had known cardiac disease or asthma, we developed predictive models of hypoxaemia in three stages by means of likelihood ratios (LRs). The LR indicates the degree to which a positive or negative result increases or lowers, respectively, the odds of having the disease in question (hypoxaemia in this case). LRs change less under the influence of disease prevalence than sensitivity and specificity, and they may be calculated for multiple test results.16 For each putative clinical sign used to predict hypoxaemia, we first calculated the crude LR for a positive result and for a negative result. Signs with crude LR ≥ 2.0 or ≤ 0.5 were considered clinically useful. We then used the method of Speigelhalter and Knill-Jones to adjust for the confounding effects of related variables, as determined by multivariate analyses, in four separate groups: respiratory, cardiovascular, neurological and general signs.13,17,18 In the third step, we constructed practical prediction rules for hypoxaemia using signs with adjusted likelihood ratios of ≥ 2.0 or ≤ 0.5, prioritized by strength of prediction and clinical practicability. We finally evaluated the final rules using the area under the receiver operating characteristic (ROC) curves using the validation data set. Distributions of age were compared by means of the Wilcoxon rank sum test.
Between 2002 and 2004, 15 401 children were admitted (derivation set) to the hospital. Of these children, 13 183 were aged ≥ 60 days; 991 were aged 7–59 days, and 1115 were aged < 7 days. Excluded from the study were 112 children: 35 without pulse oximetry results; 59 with known cardiac disease and 18 with known asthma.
Admissions aged ≥ 60 days
Among the 13 183 children admitted, the proportion of males was 56% and the median age was 32 months (interquartile range: 11–42). The most common final diagnoses were malaria (4982, or 38%), LRTI (2869, or 22%), gastroenteritis (2026, or 15%), malnutrition (1261, or 10%) and severe anaemia (717, or 5%).
Hypoxaemia was found in 693 (5.3%) of the children admitted. The median age of the children with and without hypoxaemia was 18.9 and 22.9 months, respectively (P = 0.036). The most frequent final diagnoses among hypoxaemic children were malaria (244, or 35%), LRTI (221, or 32%), malnutrition (68, or 10%) and gastroenteritis (49, or 7%). Severe anaemia was found in 30 children (< 1%). Overall, 753 (6%) children died, including 150 of the 693 (22%) with hypoxaemia. Irrespective of the final clinical diagnosis, hypoxaemia was strongly associated with inpatient death (age-adjusted risk ratio, RR: 4.5; 95% confidence interval, CI: 3.8–5.3).
Very severe pneumonia syndrome
Of the children admitted, 2525 (19%) satisfied the WHO criteria for very severe pneumonia: 291 (12%) of these children were hypoxaemic and 287 (11%) died. The final diagnoses included severe malaria (1268, or 50%), LRTI (514, or 20%), gastroenteritis (185, 7%), acute febrile convulsion of unknown cause (without malaria, meningitis or epilepsy) (181, or 7%), malnutrition (173, or 7%), meningitis (75, or 3%) and severe anaemia (56, or 2%). In 86 (3%) children, both malaria and LRTI were present. Of the 291 hypoxaemic children, 119 (41%) had a final diagnosis of malaria and 82 (28%), of LRTI. The case fatality rate among hypoxaemic children was 30% (89/291).
Severe pneumonia syndrome
Of the children admitted, 2267 (17%) satisfied the WHO criteria for severe pneumonia, 156 (7%) were hypoxaemic and 107 (5%) died. The final diagnoses included LRTI (1654, or 73%), malaria (349, or 15%), malnutrition (180, or 8%), gastroenteritis (49, or 2%) and severe anaemia (43, or 2%). A further 155 (7%) children had both malaria and LRTI. Of the 156 hypoxaemic children, 113 (72%) had a final diagnosis of LRTI and 18 (12%), of malaria. The case fatality rate was 16% (25/156) among children who were hypoxaemic.
Pneumonia syndrome
Of the children admitted, 697 (5%) satisfied the WHO criteria for pneumonia, and of this group, 14 (2%) were hypoxaemic and 33 (5%) died. Frequent final diagnoses among these children were malaria (245, or 35%), LRTI (197, or 28%), malnutrition (93, or 13%), gastroenteritis (76, or 11%) and severe anaemia (26, or 4%). Of the 14 hypoxaemic children, 8 (57%) had a final diagnosis of malaria and 4 (29%), of LRTI. The case fatality rate was 21% (3/14) among children who were hypoxaemic.
Overall, 461 of 693 (67%) hypoxaemic children who were admitted met the clinical criteria for one of the WHO pneumonia syndromes, and 215 of 693 (31%) of the hypoxaemic children admitted had a final discharge diagnosis of LRTI (Fig. 1).
Fig. 1. Distribution of LRTI and hypoxaemic cases across the WHO "pneumonia" syndromes
Admissions aged 7–59 days
Of the 991 children aged 7–59 days who were admitted (57% males) 78 (8%) were hypoxaemic and 82 (8%) died. The main final diagnoses were neonatal sepsis (497, or 50%); LRTI (301, or 30%) and neonatal jaundice (37, or 4%). Of the hypoxaemic children, 37 (47%) had a final diagnosis of LRTI and 25 (32%), of neonatal sepsis. Among 78 hypoxaemic children, 22 (28%) died. Hypoxaemic children had higher mortality (age-adjusted RR: 4.3; 95% CI: 2.8–6.6).
Admissions in the first week of life
Of 1105 children (58% males) admitted during the first week of life, 206 (19%) were hypoxaemic on admission, and 336 (30%) died. Common final diagnoses were neonatal sepsis (600, or 54%); prematurity (216, or 20%); birth asphyxia (153, or 14%) and uncomplicated neonatal jaundice 98 (9%). Among those with hypoxaemia, neonatal sepsis (80, or 39%), birth asphyxia (62, or 30%), prematurity (49, or 24%) and neonatal jaundice (7, or 3%) were common. Among 206 children admitted with hypoxaemia, 118 (57%) died. This represented 35% of all deaths. Hypoxaemia was associated with inpatient death (age-adjusted RR: 2.4; 95% CI: 2.0–2.8).
Clinical indicators of hypoxaemia
Admissions aged ≥ 60 days
Clinical signs that appeared predictive on univariate analysis (LR ≥ 2.0 or ≤ 0.5) were lower chest wall indrawing, nasal flaring, central cyanosis, irregular breathing, deep breathing, stridor, auscultatory crackles, dullness on percussion, respiratory rate ≥ 60 breaths per min, weak pulse volume, delayed capillary refill (≥ 3 s), heart rate < 80 beats per min, impaired consciousness with a Blantyre coma scale < 3, prostration, convulsion on admission, restlessness and hypothermia (Table A1 in Appendix A, available at: http://www.kemri-wellcome.org/images/appendixa.pdf). On multivariate analysis within each group, central cyanosis, heart rate < 80 beats per min, irregular breathing, impaired consciousness with a Blantyre coma scale < 3, respiratory rate ≥ 60 breaths per min, delayed capillary refill (≥ 3 s) and weak pulse volume remained predictive of hypoxaemia (Table A2 in Appendix A).
The overall sensitivity and specificity of these signs in the validation data set are shown in (Table 1). Although lower chest wall indrawing did not meet our criteria as a useful predictor when included with other signs in the respiratory group, we re-tested it with the final list of predictive signs because it is easy to recognize clinically and WHO recommends it as an indication for oxygen therapy when severe. Although including lower chest wall indrawing improved sensitivity, significant specificity was lost (Table 1). The area under the ROC curve of these signs in the validation set was 0.80 (95% CI: 0.77–0.84) overall, 0.77 (95% CI: 0.73–0.82) among children who fulfilled the clinical criteria for a pneumonia syndrome, and 0.81 (95% CI: 0.75–0.89) among children who did not fulfil them.
Table 1. Performance of clinical predictors of hypoxaemia in children ≥ 60 days of agea admitted to Kilifi District Hospital, Kenya
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Admissions aged 7–59 days
The clinical signs that appeared predictive on univariate analysis were cyanosis, irregular breathing, nasal flaring, crackles on auscultation, respiratory rate > 80 per min, weak pulse, delayed capillary refill (≥ 3 s), heart rate < 100 beats per min, absent cry, unresponsiveness to painful stimuli, convulsions present on admission, restlessness, a bulging fontanelle and axillary temperature < 36°C (Table A3 in Appendix A). Cyanosis, heart rate < 100 beats per min, respiratory rate > 80 breaths per min, irregular breathing, unresponsiveness to painful stimuli, restlessness, inability to breastfeed and delayed capillary refill (≥ 3 s) remained predictive after controlling for other signs (Table A4 in Appendix A). For the reasons given above, we also re-tested lower chest wall indrawing in the final list of signs. The sensitivity and specificity of the signs are shown in Table 2. The area under the ROC curve for the prospective validation data set was 0.77 (95% CI: 0.71–0.84).
Table 2. Performance of clinical predictors of hypoxaemia in children 7-59 days of agea admitted to the Kilifi District Hospital, Kenya
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Admissions the first week of life
In this group of children, predictive signs on univariate analysis were cyanosis, irregular breathing, deep breathing, respiratory rate > 80 breaths per min, auscultatory crackles, indrawing, nasal flaring, heart rate < 100 beats per min, weak pulse, delayed capillary refill (≥ 3 s), absent cry, unresponsiveness to painful stimuli, history of birth asphyxia and birth trauma (Table A5 in Appendix A). Signs that remained significantly associated on multivariate analysis were cyanosis, heart rate < 100 beats per min, irregular breathing, absent cry, unresponsiveness to painful stimuli, respiratory rate > 80 breaths per min, history of birth asphyxia, delayed capillary refill (≥ 3 s) and inability to breastfeed (Table A6 in Appendix A). The sensitivity and specificity of the signs are shown in (Table 3). For these signs, the area under the ROC in the validation set was 0.76 (95% CI: 0.72–0.81).
Table 3. Performance of clinical predictors of hypoxaemia in children less than 1 week of agea admitted to Kilifi District Hospital, Kenya
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Most studies of the prevalence and clinical signs of hypoxaemia have focused on children with LRTI. We therefore chose to examine unselected paediatric admissions. Hypoxaemia was present in 5%–19% of all children admitted to a Kenyan district hospital, depending on age, and this concurs with recent data from the Gambia.19 Although two-thirds of hypoxaemic children aged ≥ 60 days presented with one of the clinical syndromes of pneumonia, only one-third had a final diagnosis of LRTI. Most children meeting the WHO criteria for very severe pneumonia were finally diagnosed with severe illnesses other than LRTI, most commonly severe malaria or shock. Children who have metabolic acidosis in severe malaria may present with respiratory distress (Kussmaul's respiration) and could thus overlap with the syndrome of very severe pneumonia.11,20,21 The situation may differ in geographical regions where malaria is not endemic.
Clinical signs were relatively poor predictors of hypoxaemia. The most sensitive rules we developed still missed 5–15% of hypoxaemic children, depending on age. As in other studies, specificity posed a significant problem, as it was markedly reduced when we included lower chest wall indrawing (82–67% among children ≥ 60 days of age and 77–50% among infants aged 1 week to 59 days) and the inability to breastfeed among infants in the first week of life (66–45%). Had we followed these rules, even after excluding lower chest wall indrawing at all ages and an inability to breastfeed in the first week of life, we would have given bottled oxygen to a total of 862 of 4695 (18%) children in the validation set who were not hypoxaemic by pulse oximetry. Although the false positive and false negative assessment results were fewer than reported recently from Papua New Guinea, they still represent a significant financial burden.22 At an estimated daily cost of US$ 6–14 per child on oxygen at 1 litre per min (depending on the size of cylinder available), in our setting this would have translated into US$ 5172 to US$ 12 068 in 1 year had each child not requiring oxygen (862) received it for 1 day.2 A hand-held pulse oxymeter costs less than US$ 1000.
Where supplies of oxygen are limited and pulse oximetry is unavailable, as in most health facilities that treat severely ill children in resource-limited settings, prioritization depends on clinical signs. The signs we found to be most strongly predictive of hypoxaemia among admissions aged ≥ 60 days correspond with those given in the combined chapters of "triage and emergency conditions" and the "cough and difficult breathing" in the current WHO guidelines.11 The signs of shock (delayed capillary refill and a weak pulse volume) included in the triage guidelines have not been evaluated in previous studies of hypoxaemia in this setting, and including them in the WHO emergency care guidelines appears to be justified as part of the assessment of the airway, breathing and circulation. Importantly, hypoxaemia detected by transcutaneous measurement may be due in part to poor tissue perfusion (hence poor peripheral oxygenation), and oxygen may therefore be needed only in the initial stabilization phase. Although a slow heart rate and irregular breathing are not included in the currently recommended triage assessment, they were among the strongest predictors of hypoxaemia in our study. These signs, together with the signs of shock, led to identification of 50% of the cases of hypoxaemia and had reasonable specificity (85%). Importantly, although cyanosis alone was a very strong positive predictor (LR: 24), few of the children admitted had this sign, and the absence of cyanosis was not predictive of normal oxygenation (LR: 0.94).
Lower chest wall indrawing by itself was a weak predictor of hypoxaemia, and signs such as pallor, dullness on chest percussion, wheeze or crackles were not predictive. We did not include laboratory results in the final models because they are seldom available when an initial decision regarding oxygen therapy has to be made.
We performed separate analyses for different age groups on the hypothesis that predictive signs may differ in each. However, we found the signs to be remarkably similar. Few studies have looked at hypoxaemia in neonates and young infants in this setting. One study of 132 neonates in Papua New Guinea showed that a model of cyanosis, respiratory rate > 70 breaths per min, or respiratory rate < 30 breaths per min and reduced activity could predict hypoxaemia with a sensitivity of 84% and a specificity of 55%.23 A recent study from the Gambia showed that the prevalence of hypoxaemia in neonates was about 16.5%.19 However, in that study 40% of all neonatal admissions were missed. Importantly, no neonates were recruited in the first week of life.
Our study has several weaknesses. We did not collect data on head nodding and grunting, which have yielded variable findings in previous studies.4,9 Pulse oximetry was performed routinely during admission, and the admitting clinicians were not blinded to the SaO2 results during their initial clinical assessment. However, the low sensitivity of signs such as cyanosis, commonly regarded as a cardinal sign of hypoxaemia, and the fact that the predictive value of the clinical signs was similar to that reported in other studies, suggest that clinicians were not unduly influenced when recording their findings.1,8 A generalized problem is that among children admitted with overt shock and signs of poor circulation, peripheral pulse oximetry results may not always accurately reflect core hypoxaemia.24
We defined hypoxaemia as an SaO2 < 90% by pulse oximetry.11 However, children aged ≥ 60 days whose SaO2 was 90–94% had a higher case fatality proportion (102/1339, or 7.6%) than those whose SaO2 was ≥ 95% (503/11 203, or 4.5%) (P < 0.001). Some children with an SaO2 of 90–95% may benefit from oxygen supplementation; further studies are needed to elucidate if oxygen affects the outcome at this level.
Our findings strongly support current WHO recommendations surrounding triage for the detection of hypoxaemia. This is important because almost all prior studies have only included children thought to have pneumonia, and none has evaluated the triage signs of shock. Based on our findings, we advise against excessive emphasis on LRTI, which may potentially result in the underdiagnosis of other conditions associated with respiratory distress and hypoxaemia. Rather, we recommend a structured approach to assessment and triage that will target children likely to have hypoxaemia irrespective of the working diagnosis. Finally, pulse oximetry is essential for detecting hypoxaemia and is likely to save costs. ■
We thank the Kenya Medical Research institute (KEMRI) and The Wellcome Trust (Grants codes 061584, 076278, 081186) for their support. We also thank the Medical Officer of Health, the Medical Superintendent and the paediatric staff of Kilifi District Hospital. This article is submitted for publication with the permission of the Director of the KEMRI.
Competing interests: None declared.
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- Oxygen therapy for acute respiratory infections in young children in developing countries. Geneva: World Healh Organization; 1993 (ARI/93.28). Available from: http://www.who.int/child-adolescent health/New Publications/CHILD_HEALTH/WHO_ARI_93.28.htm [accessed on 23 February 2007].
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- Laman M, Ripa P, Vince J, Tefuarani N. Can clinical signs predict hypoxemia in Papua New Guinean children with moderate and severe pneumonia? Ann Trop Paediatr 2005; 25: 23-7 doi: 10.1179/146532805X23317 pmid: 15814045.
- Lodha R, Bhadauria PS, Kuttikat AV, Puranik M, Gupta S, Pandey RM, et al., et al. Can clinical symptoms or signs accurately predict hypoxemia in children with acute lower respiratory tract infections? Indian Pediatr 2004; 41: 129-35 pmid: 15004298.
- Reuland DS, Steinhoff MC, Gilman RH, Bara M, Olivares EG, Jabra A, et al., et al. Prevalence and prediction of hypoxemia in children with respiratory infections in the Peruvian Andes. J Pediatr 1991; 119: 900-6 doi: 10.1016/S0022-3476(05)83040-9 pmid: 1960604.
- Smyth A, Carty H, Hart CA. Clinical predictors of hypoxemia in children with pneumonia. Ann Trop Paediatr 1998; 18: 31-40 pmid: 9691999.
- Usen S, Weber M, Mulholland K, Jaffar S, Oparaugo A, Omosigho C, et al., et al. Clinical predictors of hypoxemia in Gambian children with acute lower respiratory tract infection: prospective cohort study. BMJ 1999; 318: 86-91 pmid: 9880280.
- Weber MW, Usen S, Palmer A, Jaffar S, Mulholland EK. Predictors of hypoxemia in hospital admissions with acute lower respiratory tract infection in a developing country. Arch Dis Child 1997; 76: 310-4 doi: 10.1136/adc.76.4.310 pmid: 9166021.
- Ayieko P, English M. In children aged 2-59 months with pneumonia, which clinical signs best predict hypoxemia? J Trop Pediatr 2006; 52: 307-10 doi: 10.1093/tropej/fml036 pmid: 16943216.
- Pocket book for hospital care of children: guidelines for the management of common illness with limited resources. Geneva: World Health Organization; 2005.
- Berkley JA, Maitland K, Mwangi I, Ngetsa C, Mwarumba S, Lowe BS, et al., et al. Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study. BMJ 2005; 330: 995- doi: 10.1136/bmj.38408.471991.8F pmid: 15797893.
- Berkley JA, Ross A, Mwangi I, Osier FH, Mohammed M, Shebbe M, et al., et al. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ 2003; 326: 361- doi: 10.1136/bmj.326.7385.361 pmid: 12586667.
- Shann F, Hart K, Thomas D. Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission. Bull World Health Organ 2003; 81: 301-5 pmid: 12764498.
- Management of severe malaria: a practical hand book. Geneva: World Health Organization; 2000. ISBN 92 4 154523 2.
- Centre for Evidence-Based Medicine. Likelihood ratios. Available from: http://www.cebm.net/index.aspx?o=1043 [accessed on 1 February 2009].
- Spiegelhalter DJ, Knill-Jones RP. Statistical and knowledge-based approaches to clinical decision-support systems, with an application in gastroenterology. J R Stat Soc [Ser A] 1984; 147: 35-77 doi: 10.2307/2981737.
- Seymour DG, Green M, Vaz FG. Making better decisions: construction of clinical scoring systems by the Spiegelhalter-Knill-Jones approach. BMJ 1990; 300: 223-6 pmid: 2106929.
- Junge S, Palmer A, Greenwood BM, Kim Mulholland E, Weber MW. The spectrum of hypoxemia in children admitted to hospital in The Gambia, West Africa. Trop Med Int Health 2006; 11: 367-72 doi: 10.1111/j.1365-3156.2006.01570.x pmid: 16553917.
- Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, Marsh V, et al., et al. Indicators of life-threatening malaria in African children. N Engl J Med 1995; 332: 1399-404 doi: 10.1056/NEJM199505253322102 pmid: 7723795.
- English M, Punt J, Mwangi I, McHugh K, Marsh K. Clinical overlap between malaria and severe pneumonia in Africa children in hospital. Trans R Soc Trop Med Hyg 1996; 90: 658-62 doi: 10.1016/S0035-9203(96)90423-X pmid: 9015508.
- Wandi F, Peel D, Duke T. Hypoxemia among children in rural hospitals in Papua New Guinea: epidemiology and resource availability − a study to support a national oxygen programme. Ann Trop Paediatr 2006; 26: 277-84 doi: 10.1179/146532806X152791 pmid: 17132292.
- Duke T, Blaschke AJ, Sialis S, Bonkowsky JL. Hypoxemia in acute respiratory and non-respiratory illnesses in neonates and children in a developing country. Arch Dis Child 2002; 86: 108-12 doi: 10.1136/adc.86.2.108 pmid: 11827904.
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text:
No sailors watched as the al Qaeda leader's body was dropped into the North Arabian Sea from the USS Carl Vinson.
The operation was shrouded in secrecy, which included the corpse being referred to as "the package" delivered by "Fedex".
The emails, obtained under the Freedom of Information Act, are heavily blacked out but are the first public disclosure of government information about the terrorist's death.
Bin Laden was killed on May 1, 2011, by a Navy SEAL team that swooped on his compound in Abbottabad, Pakistan.
One email stamped secret and sent on May 2 by a senior Navy officer briefly describes how his body was washed, wrapped in a white sheet, and then placed in a weighted bag.
According to another message from the Vinson's public affairs officer, only a small group of the ship's leadership was informed of the burial.
"Traditional procedure for Islamic burial was followed," the May 2 email from Rear Admiral Charles Gaouette reads.
"The deceased's body was washed (ablution) then placed in a white sheet. The body was placed in a weighted bag. A military officer read prepared religious remarks, which were translated into Arabic by a native speaker.
"After the words were complete, the body was placed on a prepared flat board, tipped up, whereupon the deceased's body slid into the sea."
The email also included the cryptic reference to the intense secrecy surrounding the mission.
Gaouette, then the deputy commander of the Navy's Fifth Fleet, used code words to discuss whether the helicopters carrying the SEALs and bin Laden's body had arrived on the Vinson.
"Any news on the package for us?" he asked Rear Adm. Samuel Perez, commander of the carrier strike group that included the Vinson.
"Fedex delivered the package," Perez responded. "Both trucks are safely en route home base."
Although the Obama administration has pledged to be the most transparent in American history, it is keeping a tight hold on materials related to the raid.
In a response to separate requests for information about the mission, the Defence Department said in March that it could not locate any photographs or video taken during the raid or showing his body.
It also said it could not find any images of the corpse on the Vinson.
The Pentagon also said it could not find any death certificate, autopsy report or results of DNA identification tests, or any pre-raid materials discussing how the government planned to dispose of the body if he were killed.
The Defence Department also refused to confirm or deny the existence of helicopter maintenance logs and reports about the performance of military gear used in the raid.
One of the stealth helicopters that carried the SEALs to Abbottabad crashed during the mission and its wreckage was left behind.
People who lived near bin Laden's compound took photos of the disabled chopper.

subset: commoncrawl


text:
Legal Question in Criminal Law in Virginia
search warrants
how many days to execute a search warrant from day the judge signed?
Asked on 5/28/01, 10:20 am
1 Answer from Attorneys
Glenn R. Tankersley Regency Legal Clinic
Re: search warrants
In Virginia, fifteen days.
See § 19.2-56, Code of Virginia.
Answered on 6/23/01, 7:36 pm
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text:
Published Editorial
A setback for alternative investment funds
Financial Express
Subramaniam Krishnan
Tax Partner, EY
Contributed by:
Jaiman Patel
Senior Tax Professional, EY
The Securities and Exchange Board of India (Sebi)—recognising the need for long-term, cost-effective funding source from the private sector, capital markets or private pool of capital for start-ups, small & medium businesses and infrastructure—notified the alternative investment fund (AIF) regulations in May 2012 after extensive stakeholder consultation. As of May 2014, Sebi had granted registrations to over 100 AIFs and, until March 2014, AIFs had raised net commitments totalling R13,465 crore.
Currently, there is a provision in the tax law that provides a pass-through tax status on specified income to AIFs that are registered under the venture capital fund (VCF) sub-category of category 1 AIFs. The same status is also available to VCFs registered under the erstwhile Sebi (VCF) Regulations, 1996. However, funds registered as category 1 (other than VCF), category 2 and category 3 AIFs—which include small & medium enterprises, social ventures, private equity, debt and hedge funds, majority of which have been formed as a trust—have to deal with ambiguities and uncertainties of the trust taxation provisions in the Indian tax laws.
The Central Board of Direct Taxes (CBDT) may have compounded the uncertainty by issuing a circular on July 28, 2014, to clarify certain tax aspects for AIFs (other than VCFs). The circular addresses that if a trust deed does not either name the investors or their beneficial interest, the provisions dealing with taxation of trust whose beneficiaries' share is unknown would come into play and the entire income of the fund shall be taxable at the maximum marginal rate (MMR, 30% plus applicable surcharges) in the hands of the AIF's trustee. In such cases, the income tax authorities should not seek to directly assess the AIF's investors. Further, where the trust deed contains the names of the investors and their beneficial interest, the tax on whole of the income of the AIF, consisting of or including business profits, shall be taxable at MMR in the hands of the AIF's trustee.
Conceptually and by regulation, AIFs raise funds from investors by issuing units which represent the investors' beneficial interest in the AIF. The manner and timing of distribution of invested capital and returns thereon by the AIF to its investors is discernible from the AIF's trust deed and associated documentation, which are legally binding. Typically, there is no discretion on this matter granted to the AIF's trustee. However, due to the manner in which AIFs raise funds, it is not always possible to ensure that the names of the investors and their beneficial interest are identifiable on the date of the trust deed.
Courts have examined this matter, albeit not specifically in the context of AIFs, and have held that the names of the beneficiaries need not be mentioned in the trust deed so long as the trust deed gives details of the beneficiaries and the description of the person who is to be benefited. It has also been held that the requirement of specifying individual shares of beneficiaries would stand fulfilled where the basis and mechanics of sharing is specified in the trust deed, although some computation may be needed to find out the individual shares.
Clarifications issued by the CBDT in the past indicate that the intention of imposing a requirement that the name and share of the individual beneficiaries should be stated in the trust deed on its execution date was to prevent misuse of the trust tax provisions. On this issue, it would have really benefited the sector if, in addition to the clarification provided, the CBDT had stipulated that so long as the AIF's constitution documents clearly provide a mechanism for the trustee to identify beneficiaries and their respective share, the AIF should be regarded as a specific trust (i.e. trust taxed on pass-through basis). Without this clarity, there is a clear risk that, armed with the circular, the tax authorities regard AIFs as not being specific trusts and tax their income at MMR, leading to avoidable litigation.
The second issue dealt with by the circular relates to the characterisation of income earned by the AIF and the resultant tax consequences. In essence, the circular states that if an AIF earns profits and gains of business, the whole of the AIF's income shall be taxable at MMR. The predominant source of income for AIFs, depending upon the strategy adopted by the AIF, could be gains from sale of investments in shares and other securities. Characterisation of income as capital gains or business income has always been a vexed issue for financial investors. The recent Budget, in order to impart certainty to the foreign portfolio investors, has provided a deeming provision that income from securities transactions will be characterised as capital gains. It would have been useful if the circular provided guidance on this aspect. In its absence, on this issue as well, the circular can be used by the tax authorities to characterise the AIF's income as business income and thereby tax the same at MMR.
AIFs are a vital source of risk capital and significantly contribute to nurturing investment activity across many sectors which, in turn, promotes employment and growth. The tax law provides a specific tax code for mutual funds, securitisation trusts and the recent Budget has also introduced a tax code for real estate investment trusts and infrastructure investment trusts. The AIF sector has been operative for more than a decade and has faced tax uncertainties with flip-flops in tax approaches. The sector has sufficient scale and potential to warrant a specific tax code consistent with the recommendations of various committees and global practices, i.e. AIFs should be granted an automatic tax pass-through at the fund level on registration with Sebi, while maintaining taxation at the investor level without any other requirements under tax laws. To restore investor confidence in this asset class, the CBDT should relook at the circular and engage in a constructive dialogue with all the stakeholders.


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Asymptomatic HIV infection is a phase of HIV/AIDS during which there are no symptoms of HIV infection.
During this phase, the immune system in someone with HIV slowly deteriorates, but the person has no symptoms. How long this phase lasts depends on how quickly the HIV virus copies itself, and how the person's genes affect the way the body handles the virus.
Some people can go 10 years or longer without symptoms. Others may have symptoms and worsening immune function within a few years after the original infection.
Reitz MS, Gallo RC. Human immunodeficiency viruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 171.
Review Date 5/1/2015
Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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Review of "The Tragedy of William Jennings Bryan"
This review is courtesy of "Choice" Magazine, which is published by the American Library Association:
This brief but intriguing book argues that although most studies focus on successful constitutional movements, failure is also instructive, specifically the doomed Populist reforms of the 1890s. Although Bryan failed to gain the presidency and the Populists produced negligible immediate legal reform, Magliocca (Indiana Univ. School of Law) claims that the movement's effects were dramatic, though unintended. Constitutional doctrine changed radically, becoming more reactionary because of anti-Populist backlash. Virtually all of Magliocca's contentions will invoke sharp controversy, especially his reliance on a cyclical/generational theory of US politics, yet his sober although provocative assessment of failed reform is powerful and original. Joining the fray concerning realignments, Magliocca shares with Walter Dean Burnham, Critical Elections and the Mainsprings of American Politics (1970), a defense of realigning elections as the motors of political change and an assessment of 1896 as a pivotal, realigning election. Magliocca, however, contributes new dimensions to the literature by highlighting the huge constitutional changes produced by the "system of 1896." A good read for undergraduates and the general public as well as advanced scholars, this history of politics in the Gilded Age presents crucial background for contextualizing contemporary constitutional debates. Summing Up: Recommended. All readership levels. — A. B. Cochran, Agnes Scott College


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Photo 5 of 5
Turn Down the Monitor
"I think it's OK to turn off the baby monitor or turn it down for 15 minutes. Studies show that for women to enjoy sex and have an orgasm, the parts of the female brain that are associated with stress, anxiety, and worry have to deactivate and shut down. So when you have a baby monitor and you hear the baby move or gurgle, it takes you right out of the moment. Men and women need to do things that allow you to get into the moment. Turning off the monitor for a half hour is one of them."
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New Delhi, Aug 3 (IANS) The government's "Grant-in-Aid to Tribal Research Institutes (TRIs)" increased by six times to Rs.16.41 crore during 2014-15, the ministry of tribal affairs said on Monday.
"The grant was increased to Rs.1,641 lakh (Rs.16.41 crore) in 2014-2015 from Rs.274.41 lakh (Rs.2.74 crore) in 2013-14 . During the first four months of the current financial year an amount of Rs.464.37 lakh was released," the ministry said in a statement.
The ministry is implementing the scheme of "Grant-in Aid to Tribal Research Institutes" to extend financial assistance for strengthening them in the areas of research and documentation of tangible and intangible heritage and training and capacity building.
The TRIs functions include working as a body of knowledge and research, supporting evidence-based policy, planning and legislation, capacity building, dissemination of information and generating public awareness.


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The Most Incredi-BULL Seats In The House!
Gunner and Michele have your shot to watch the PBR in style at the Sundome Saturday February 9th! One lucky listener and their guest will be watching the PBR from Recliners courtesy of Isaaks Home Furnishings! Here's the best part… the winner gets to keep the recliners!
Congratulations to the finalists! George Torrez and Missy Heaverlo! They'll be in studio with Gunner and Michele Friday Morning to compete for the Grand Prize.


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Canadian boxers Mandy Bujold, Ariane Brochu-Fortin and Arthur Biyarslanov secured Olympic berths on Thursday at the 2016 American qualification event in Buenos Aires.
Bujold had a decisive semifinal victory over Grazieli Jesus de Sousa of Brazil.
The Kitchener, Ont. fighter easily outpointed Brazilian opponent 3-0 in the 51-kilogram division, advancing to Saturday's final.
Bujold, 28, is a two-time Pan American champion, and she also captured gold at the 2014 Commonwealth Games.
I'M GOING TO RIO!!!!!!!! Words can't describe the way I'm feeling right now! All I can say is Hard Work really does pay off!!! #TeamBujold—
Brochu-Fortin had a stiffer test in Andreia de Oliviera Bandeira of Brazil, but still walked away with a 2-1 victory in the 69-75 kg division.
Result | Résultat 75kg Ariane Fortin won | gagne 2-1 Andreia de Oliveira (BRA) #olympicqualifiers #RoadToRio pic.twitter.com/8pf3HpXRaf—
The Russian-born Biyarslanov, who moved to Canada at the age of 10, defeated Guatemalan Carlos Tobar, punching his ticket to Rio.
The three-time Canadian champion had no trouble with Tobar, defeating him 3-0 in the 64 kg division.
Result | Résultat 64kg Arthur BIYARSLANOV Win | gagne 3-0 Carlos Tobar (GUA) #olympicqualifiers #theWolf pic.twitter.com/Lnk2LjL3kH—
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What can I do for a butt, it hurts when I sit down?
Carry with you a memory foam cushion
Baltimore, MD
If you did fat injections i this area, ypu can have 3 cpmplications, Absortion, Necrosis or calcification. The last one will hurt and you will need to remove it. Contact you plastic surgeon as soon As possible.
Santo Domingo 10126
Related Questions
Will ultrasound massage to breasts disrupt the fat graft or kill the fat?
Can fat from my stomach be placed in my breast?
How do I find the best plastic surgeon for fat grafting?
I want to use my abdominal fat to increase my breast size, is that possible?
Can fat from arms be removed and injected into my buttocks?


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RenewableUK/GWO Approved. Provides sufficient knowledge to allow a person to work safely in wind turbines.
This work at height & rescue training course is for technicians who are required to access and work on wind turbine generators. The course covers several module areas over two days; including the elements of a safe system of work, equipment selection and inspection, use of tools, risk assessment, method statements and emergency procedures.
Rescue practices are covered in this work at height course. Evacuation and rescue using industry standard equipment are practiced at height.
For access to any area of a WTG where candidates may need to carry out installation, inspection or servicing on a variety of structures.
Includes the Foundation for Work at Height syllabus plus content defined in the RenewableUK Approved Standard "Working at Height".
This two day work at height & rescue training course has been successfully audited by RenewableUK. heightec are approved by RenewableUK and The Global Wind Organisation for work at height training.
Also available:
The GWO / RUK Working at Height & Rescue Training for Wind Turbines certificate is valid for two years. After this, a revalidation of the course will be required. Please see RUK/GWO Working at Height and Rescue – Revalidation. This 1 day revalidation course is only for those who have an in date GWO / RUK certificate for Working at Heights and Rescue.
Global Wind Organisation (GWO) have launched their new Global Wind Industry Training Records Database – WINDA. To enter onto any GWO course, trained individuals are now required to register as Delegates on the WINDA database. For more information please refer to our news article.


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Philosophy of Science
The word science
is derived from the Latin scio, meaning to know
But how do we come to know? What are some ways we acquire knowledge?
Reliance on authority is the oldest approachScientists study a huge variety of things: medicine, chemistry, physics, biology, . . . and even psychology.
Intuition and subjective experience (unique perceptions of things)
Logic and rational thought . . . is foundation of scientific process
Logical Positivism, which emphasizes observation (rather than
intuition) as basis for rational explanations about our world
Which approaches are considered to be most (or least) scientific?
Why? Agree/Disagree?
So, how do we know what is considered to be scientific?What you study doesn't determine whether it's scientific,
e.g., why is psychology a science, but astrology isn't?
(or is psychology not really a "real science"?)
not the topic, but rather the methods used to study the topic
**that is why Psychology majors are required to take a class on research methods
Despite the seemingly endless array of scientific specialties, there is a set of common goals that run throughout all of science
DescriptionWhat do each of these four mean? Why is each important?
Explanation (understanding)
Control (influence)
These goals are, essentially, a description of a scientific attitude.
There are important assumptions
that such an attitude makes --
thus we need to recognize and understand these assumptions:
Assumptions of the Scientific Attitude
1) Nature is ordered -- the world is not simply a series of random, unpredictable events
2) Determinism -- which is the belief that since nature is ordered, certain factors cause other factors
thus, theoretically it is possible to identify the causes of all natural events (including human behavior)3) Empiricism -- which is belief that sensory experiences (i.e., direct observations) are a better foundation for knowledge than relying on intuition and subjective sources of information
theoretically possible doesn't mean easy, or even practical, oftentimes
this assumption ruffles feathers of staunch free will advocates (which is why Skinner addressed it directly) . . . what do you think?
4) Parsimony -- states that, all else being equal, the simpler of two explanations is best
**leads to emphasis on finding generalizable conclusions5) Falsifiability -- was famously argued to be a cornerstone of science by Karl Popper
**means that it is possible to try to disprove a theory/explanation
**if can't directly test a theory, then it's not a scientific explanation
**if can test it, then the possibility exists that can disprove it
(i.e., if it really is false, there is some way to show that's the case)


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Active Wear for Stylish Women
Isaac Mizrahi designs active wear with a dual purpose: to have you performing at your best while looking your best. This covetable range of exercise apparel features select tank tops, hoodies, tees and shorts to have you reaching your workout goals in style. Plus, Isaac Mizrahi's knitted jackets and rain coats will make you ditch your bad weather exercise excuses, and have you pounding the pavement rain, hail and shine.
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TWU junior Brandie Lander has been named Lone Star Conference pitcher of the week for April 16-22. She earned the honor for the first time in her career.
Lander helped the Pioneers to a 4-1 record on the road last week, including a three-game sweep at Incarnate Word. She picked up two of the four wins and posted a team-best 1.91 ERA.
Lander recorded a nine-inning, complete-game victory at Tarleton State on April 16 and tossed five shutout innings at Incarnate Word on Saturday. She came on in relief in the series finale and struck out the final two batters to seal the win.
She is the team leader with a 1.99 ERA, 18 wins and 113 strikeouts.


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I HAVE considerable sympathy with W Mathers' criticism of the scaremongering surrounding whether Scotland would automatically become a member of the European Union in the event of a vote for independence, (Letters, 8 December).
While the SNP administration clearly favours such an outcome, it is equally obvious that some pro-independence supporters – including, for example, the former SNP MP Jim Sillars – would rather have an independent Scotland sign up to the European Free Trade Association (Efta).
In this respect can I point out that a Yes vote in the 2014 referendum will not settle the question of continuing EU – or Efta – membership for all time, but that either option will remain open not just to the country's elected politicians at the Holyrood parliament but, conceivably also, to the electorate as a whole in subsequent referendums focused on the terms of membership negotiated with either or both supra-national bodies.
However, on one point I must strongly disagree with Mr Mathers. Neither a UK nor an independent Scottish decision to withdraw from the EU would result in the removal of European Court of Human Rights legislation from our legal systems, as the UK signed up to the European Convention for the Protection of Human Rights as far back as 1950. In other words, prior to the foundation of the EU – or Common Market, as it was initially called – in 1957.
In or out of the EU, I would therefore confidently expect the majority of our MSPs in all parties to continue to respect the ensuing ECHR legislation.
Clarence Drive
The confusion surrounding an EU membership of an independent Scotland must be done and dusted well ahead of any referendum.
If not, we shall all be voting in the dark for a pig in a poke. Doubtless some might see no harm in that, but I hope, in that case, that the majority will refuse to take part to the extent that the result is invalidated.
East Lothian


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Ferguson claims talks ongoing over Tevez deal
Carlos Tevez still seems certain to leave Manchester United despite Sir Alex Ferguson revealing an offer has been made to keep the striker at Old Trafford.
Tevez was on the scoresheet again tonight, grabbing the all-important equaliser as United secured a 2-1 win at Wigan Athletic to move within a point of another league championship.
The glee on Tevez's face suggested he was a happy man, with United boss Ferguson then claiming an offer had been lodged in discussion with the South American that he hoped would be accepted.
However, Tevez's advisor Kia Joorabchian immediately responded with a statement of his own, hinting the Argentina star no longer wishes to remain at Old Trafford.
In a statement released by Joorabchian said: ''It is true (chief executive) David Gill came to see Mr Joorabchian and they had a cordial meeting. It is categorically untrue that Manchester United made an offer to try to persuade Carlos Tevez to stay at the club.
''In 2007 Manchester United agreed a two-year loan deal for Carlos Tevez and at the same time agreed the terms that would make the transfer permanent. They have not taken up that option.''
Joorabchian's stance will not endear him to the United support, who chanted 'Fergie, sign him up' when Tevez found the net with an impudent back-flick minutes after his introduction as a substitute.
''The fans love him because he is a trier,'' said Ferguson. ''He has great skill, of course, but he never gives in and that is a great quality to have. He has a hunger to fight all the time. It is wonderful to see.
''David Gill has had a good meeting and I have spoken to him. We have given him an offer and we hope he accepts. The problem is we are not negotiating with a football club.''
Tevez originally arrived on a two-year loan deal, which gave United an option to buy his registration this summer.
However, dealing with Joorabchian has proved to be a difficult process and Wednesday night's development hardly indicates it is going to get easy, especially as Tevez's advisor knows his player has many suitors.
For United, those problems will be shelved on Saturday if they get a point from their home match with Arsenal.
It would mean that for only the second time during Ferguson's spell in charge, the Red Devils would clinch the title in front of their own fans.
''We still have a job to do,'' said Ferguson. ''I have not listened to all the criticism Arsenal are getting. This is a good Arsenal team and we will need to be at our best to beat them.''
Michael Carrick's 87th-minute strike ensured United do not actually have to win, while condemning Wigan to a ninth defeat in nine meetings with United.
It had looked so good at half-time as the Latics led through the excellent Hugo Rodallega. But the Colombian's efforts proved to be in vain, leaving Wigan manager Steve Bruce still without a win against his old club.
''I think I will just give up now,'' he smiled ruefully. ''At half-time we had a chance and were doing really well. But this is what happens against United.''
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West Mudball All Bouldering4 routes in boulder
First time here?theCrag.com is a free guide for rock climbing areas all over the world, collaboratively edited by keen rock climbers, boulderers and other nice folks.You can log all your routes, connect and chat with other climbers and much more...» go exploring, » learn more or » ask us a question
Stats and downloads
Get directions to here using Google Maps.
A smallish boulder a bit past (north of/uphill from) "Moby Dick". It is set into the hill-side providing an easy descent down the back side, and has three obvious cracks up the front.
Access issues inherited from Santee Boulder Field
Land is privately owned by large developers, but no signs are in place restricting access. Tagging and littering are common issues and groups including Allied Climbers of San Diego regularly hold clean-ups.
Ethic inherited from Santee Boulder Field
Be sure to wipe dirt from your shoes before climbing to reduce the polishing of footholds. Chipping is unacceptable.
Check out what is happening in West Mudball.


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Freebie: Christmas Icons Set (110 Icons, AI, PSD, EPS)
- By The Smashing Newsletter Team
- December 18th, 2015
- 6 Comments
It's Christmas time, and we're happy to release a brand-new freebie today, just for you! A set of 110 Christmas icons and illustrations that you can you use for sending your Christmas greetings and for any commercial projects.
You might be interested in the following related posts:
- Christmas Wallpaper Calendars: December 20161
- 25 Free Christmas Advent Icons To Bring Festive Mood To Your Site2
- 60 Beautiful Christmas Photoshop Tutorials3
The set has been designed by Anastasia Kolisnichenko4 from Minsk, Belarus, and released for Smashing Magazine's readers. Feel free to use all of them for your projects. Grab what you need for a poster or website. You can customize everything you want: stroke width, size, color, shape — everything.
Each illustration is provided in four different formats (AI, PSD, PNG and EPS). So even if you don't work with vector graphics, you can still easily use the illustrations to create great designs in any graphics software.
The kit is licensed under a Creative Commons Attribution-ShareAlike 4.0 International licence. As long as you don't resell bundles of the illustrations, you can use the illustrations for anything you need.
Download The Christmas Icons Set For Free! Link
- Download The Christmas Icons Set11 (.zip, 137 MB)
Insights From The Illustrator: Link
I enjoyed creating this set because I really love that cozy Christmas atmosphere, you know? ;-) Since I was working on that set in such a cozy atmosphere, it helped me a lot to get the work done I needed to do. I truly appreciate the opportunity to share this set with you as a little present for Christmas. Thanks everyone for your comments and have wonderful holidays!
Sincere thanks to NastiFunny12 (Anastasia Kolisnichenko) for releasing the illustrations — we're very grateful for your talent and generosity!
(ms, og)
Footnotes Link
- 1 https://www.smashingmagazine.com/2016/11/christmas-wallpaper-calendars-2016/
- 2 https://www.smashingmagazine.com/2016/12/freebie-christmas-advent-icon-set-25-icons-ai-eps-svg-png-pdf/
- 3 https://www.smashingmagazine.com/2008/12/beautiful-christmas-photoshop-tutorials/
- 4 https://www.behance.net/nastifunny
- 5 /wp-content/uploads/2015/12/Santa-and-Christmas-Icons-Set.png
- 6 /wp-content/uploads/2015/12/Santa-and-Christmas-Icons-Set.png
- 7 /wp-content/uploads/2015/12/Santa-and-Christmas-Icons-Set-2-large.png
- 8 /wp-content/uploads/2015/12/Santa-and-Christmas-Icons-Set-2-large.png
- 9 /wp-content/uploads/2015/12/Santa-and-Christmas-Icons-Set-1-large.png
- 10 /wp-content/uploads/2015/12/Santa-and-Christmas-Icons-Set-1-large.png
- 11 https://www.dropbox.com/s/3bu343t2v7loed4/Christmas%20Icon%20Set.zip?dl=0
- 12 https://www.behance.net/nastifunny


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|You are in: Audio/Video: Programmes: UK Confidential
Tuesday, 1 January, 2002, 11:28 GMT
Transcripts: Patrick McClean - The Internee
Patrick McClean was one of the 342 men interned in Northern Ireland in 1971. He had previously been arrested in 1969 and held at Cromlyn Road Prison.
BBC Television's UK Confidential programme spoke to him about his experiences as an internee.
Documents released under the 30-year rule reveal that the British Government were lent on at the time by the Irish Prime Minister Brian Faulkner, to offer their support for internment and they agreed to try and avoid direct rule.
McClean describes being tortured and badly fed during his days in prison in an interview to UK Confidential. Here are the edited highlights of that interview.
So why did they intern you?
I can't answer that question because I have never got an answer to that question.
Even after all these years?
Even after all these years. Brian Faulkner who was Prime Minister at the time, said there were three types of people interned: There were active gun men; there were those who would have supported active gun men, and there were those who would have protested about the introduction of special paras act, and against internment.
So I'm afraid, I'm sorry to say, I can't answer your question. I don't know, other than, the whole political implications of it, and I do know perfectly well in that sense, because the government of the day had to be seen to be doing something.
Whether it was the British Government, or our own local government, or a combination of both. And, the story was put out although it wasn't accurate, that internment had quailed all the Storments before, and it would do so again. They found out different, and we told them before it, that that wasn't any solution.
Did you suspect internment was coming?
We knew, and I knew, that there would be internment because I was arrested in 1969 - and that was two years before it - and taken up to the police station, and when the local sergeant rang up for me to Mr. Porter, who was Minister at the time to his office, he came back and he said to me: "Porter wants heads in Cromlyn." That was in Cromlyn Road Prison. So at any time internment could have happened.
Just tell me what happened when you were actually lifted that morning?
I remember it well because I had been sitting up with my mother in law who was very ill and she died the next day. So I had just had a few hours in bed when the door was knocked and the army came, not the police, the army came, got me up out of bed. Took me into the army camp.
What did they say when they came knocking on your door?
They didn't say anything. They just said: "Come on," and I had to sort of beg to get on my clothes. My wife begged as well: "Let this man put on his clothes."
Did they check who you were? Did they say, "Are you Mr. P.J. McClean?"
I can't remember them saying anything, other than, "come with us." and I was expecting to be taken into the police barracks, but I was taken into the army camp, and that was at four o'clock in the morning.
From there, lorries were provided to take all the others who were arrested as well on to McGilligan Camp, and we were kept there for two days and processed there.
And when I was going there I was stopped by a military policeman, and he said: "No, that's wrong. You are not going there, you are going there." Those four including me, were then taken away to an unknown destination, and we didn't reappear for another seven days.
And what happened to you at that destination?
At that destination, I thought that I was the only one because I didn't see anybody else all that time. I thought I was the only one. And I was put through various forms of what I would call torture, but what was described subsequently as cruel and degrading treatment.
What were you wearing? Can you describe how you looked?
I was put into an army boiler suit, and a hood was tied over my head.
Yes, and that's the way that I was kept for most of that time, until I was due to come back to Cromlyn Road Prison.
And what did they do to you?
All sorts of, what I would describe as torture, but what they described as other things. And that included getting me up on their shoulders, throwing me on the ground, starving me for long periods against the wall. Running me over a table, back and forth. Putting me up against a wall until you fell.
All that sort of thing. It's all recorded and I don't want to really live there, you know, I want to get away from that, and have got away from that.
There was noise wasn't there?
There was a white heat and a white blinding noise, that reminded me at the time of a jet engine in an aeroplane. And that level of noise kept going all the time.
What about food and drink?
I didn't get food. I didn't get drink for a number of days.
And food?
No food. I didn't get food.
I thought there was dry bread?
No, I didn't get food. I'm talking about food that you can eat with a knife and fork. I didn't get that sort of food for days, until I was ready to come back to the Cromlyn Road Prison, but they came round with dry bread, as you say, and water.
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Embassy Iraq rally
THERE were protests outside the US Embassy in London yesterday after rockets were fired at a camp for Iranian exiles in Iraq, killing six people.
The attack was at Camp Liberty, a former American military base close to Baghdad.
Members of the Iranian community in Britain gathered to call on the US to transfer the 3,100 Iranian dissidents back to another location in Iraq, Camp Ashraf.
Lord Carlile, on behalf of the British Parliamentary Committee for Iran Freedom, which supports the Iranian opposition, said: "We should demand that the UK government brings this matter to the UN Security Council so they are returned to Camp Ashraf."


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By Derrick Lane
Actress Nia Long has graced many movie screens in some black America's most iconic movies. Now, the star, 43, is a mother of two and has turned her priorities to not only her family, but the community.
Here are just some of Nia's empowering words to our community:
On Making Breast Health A Priority
More than 200,000 women in the U.S. were diagnosed with breast cancer in 2011. Also, black women diagnosed with breast cancer are more likely to die from the disease than white women.
Unfortunately, the health challenges we face don't stop there: Black women have higher rates of many preventable diseases, including diabetes, heart disease and HIV/AIDS.
I am very concerned about what I see happening in our community — women and girls who don't have access to the affordable, quality healthcare services that they need. As a result, my community — our community — is literally dying.
On Making Women A Priority
What our mothers and grandmothers fought so hard for could be taken away too easily, and I know how hard it has been to make these gains for women. For example, my mother was a public school teacher. She made so many sacrifices for me to have the life that I have today. But when she retired, the cost of the health care options presented to her was astronomically high, and we had to investigate other options to ensure that she was covered.
On Making Health Care A Priority
We need health care reform so women don't have to struggle to find affordable care the way my mother had to. I am shocked that some politicians want to roll back the gains afforded to women under healthcare reform and prevent access to critical healthcare providers like Planned Parenthood.
Both my mother and grandmother, who is in her 90s, firmly believe that a woman should have access to the type of care she deserves, and should have the right to make her own health decisions. I couldn't agree more.
I refuse to allow those rights to be taken away — not on my watch.


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Jolson Sings Again. Zestful sequel to the film biography of mammy's favorite son; with Larry Parks and Jolson's voice (TIME, Sept. 5).
Madame Bovary. Jennifer Jones in a faithful portrayal of Flaubert's unfaithful French provincial lady; with James Mason and Van Heflin (TIME, Aug. 15).
Lost Boundaries. A true story, movingly enacted, of Negroes who "pass" as whites (TIME, July 4).
Sorrowful Jones. The boozy sentiment of Damon Runyon's Broadway, heavily spiked with Bob Hope gags (TIME, June 27).
The Window. A boy's-eye view of murder in a Manhattan tenement, with Bobby Driscoll (TIME, May 23).
Home of the Brave. A tight little war film that...


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Supreme Court: Two Holyland Affair Suspects to Remain in Jail
Lupolianski released to house arrest; suspected of accepting more than NIS 3m in bribes.
The Supreme Court on Sunday denied appeals filed by businessman Hillel Charney and Avigdor Kelner to be released from prison, after the two were arrested a week ago over suspicions of involvement in the alleged Holyland bribery affair.
Supreme Court Justice Uzi Fogelman said that the two should not be released to house arrest as "there is reason to believe that the suspects could attempt to obstruct the police investigation if released now."
Charney, the former director of the Holyland residential project in Jerusalem, is suspected of paying the bribe to the Jerusalem's chief engineer Uri Shitrit and to the mediator, legal attorney Uri Messer. Charney was arrested on suspicion of paying hundreds of thousands of shekels to Jerusalem municipality officials.
The Rishon Letzion Magistrate's Court released former Jerusalem mayor Uri Lupolianski to house arrest on Sunday.
Lupolianski was arrested Wednesday on suspicion of accepting more than NIS 3 million (approximately $750,000) in bribes during the construction of the contentious Holyland project in the capital.
On Friday, the Petah Tikva District Court rejected an appeal submitted by Lupolianski, requesting to abort his five-day remand for alleged involvement in the Holyland case.
Lupolianski, who served as deputy mayor under Ehud Olmert before being voted mayor, rejected the allegations against him, saying that "this was 20 years ago, I don't know why everyone suddenly remembers now. A deputy mayor has no responsibility, it's merely a title, so that it will be nice for him."
The prosecution in the Holyland affair informed the Supreme Court that hundreds of more witnesses are expected to be investigated.
At the center of the corruption probe is former prime minister Ehud Olmert, who is suspected of taking bribes in exchange for furthering development of the Holyland luxury housing project in Jerusalem.
The lawyer presiding over the prosecution, Liat Ben-Ari, said that an enormous amount of evidence has been collected thus far, and that the police have been instructed to wrap up the investigation as early as possible.
Meanwhile, Haaretz has learned that the investigation into the Holyland affair will continue for another six weeks, with 140 investigators focusing on it. This means that all other activities of the National Fraud Squad will be put on hold.
Haaretz learned that the office of State Comptroller Micha Lindenstrauss has given the police information on investigations into Olmert, including the Holyland affair, a former adviser to the comptroller said.
"As part of the process of relaying information ... in the various Olmert affairs, we also delivered to the police material on the Holyland affair, where former city engineer Uri Sheetrit, and a former associate of Olmert, attorney Uri Messer, and [Olmert's] office manager, Shula Zaken, were involved," Yaakov Borovsky, a former adviser to the state comptroller on combating corruption, told Haaretz over the weekend.
"We also received material regarding additional suspicions in connection with Olmert regarding various projects in Jerusalem and the receipt of funds for paying for election campaigns."
But he says the material was insufficient for basing a criminal case against the former prime minister.
Borovsky said that the suspicions against the people involved in the Holyland affair revolved around "unreasonable and unclear advantages in the Holyland project, which raised suspicions of flawed management and criminal violations."
The intensity of the work schedule was decided by State Prosecutor Moshe Lador and the chief of investigations at the police, Yoav Segalovich.
A senior law enforcement source told Haaretz that despite Olmert's efforts during his television appearance Thursday to blame Lupolianski, who succeeded him as mayor in Jerusalem, suspicions against Olmert are well founded.
The source said the evidence against Olmert is not only based on a state witness but also on documents and other testimony the police hold. If the police and the prosecution did not agree on this point, Jerusalem District Attorney Eli Abarbanel would not have asked the District Court to put on hold the proceedings against Olmert, the source says.
Even though the state has a major witness whose identity remains under a gag order, the police and the prosecution are trying to secure another state witness.
As far as law enforcement is concerned, Eli Hasson, the accountant for the Holyland project during the past 15 years and responsible for managing the company's funds, is the person who could serve as a state's witness. Hasson is suspected of keeping records and taking part in the transfer of bribes, mostly from Hillel Charney, owner of the property.
A source familiar with the investigation said this weekend that Hasson had not paid any bribes and did not receive any, but he is well versed in the system used to transfer money and cover up the money trail.
The source said the police and prosecution see Zaken as a potential state's witness. She is involved in various court cases against Olmert, and now also the Holyland affair. Her only way out may be to cooperate with the law-enforcement authorities, the source said.
More suspects in the case are expected to be interviewed by the police. One of these suspects is a senior figure who has chaired the Jerusalem District Planning and Building Committee. Another is a senior figure in the Israel Lands Administration.
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George Osborne is pursuing the Tesco strategy: every little helps. In his conference
speech today, he will announce that he has found £805 million to freeze council tax next year, which will save taxpayers £72. Not a
lot, you might think – and that's
Labour's view – but the chancellor is adamant that he won't "stand on the sidelines" while living standards contract. Substantial tax cuts have been ruled out by Osborne, but he is expected to make further announcements on benefits. Last week,
it was rumoured that he would reverse changes to child benefit for a parent who earned around
£42,000 per year. (There are also rumours that the income tax threshold might be increased at some stage, fulled by IDS' comments at a fringe event last night.) If those rumours prove
true, then there is little doubt that Osborne is pitching his camp in Middle England, among those C1 and C2 voters who have remained tepid about the Cameroons thus far.
Osborne is an inveterate schemer and he has not limited himself to one tactical ploy. His proposed council tax cut will not be automatic, but councils that choose to implement the cut will receive
extra funds to spend, providing they have restrained spending increases to less than 2.5 per cent. Similar strategic logic inspired Eric Pickles' weekly bin collection policy: reward councils that take the decision, blame those that do not. The coalition has tried
to make councils responsible for their spending decisions in era of constrained public finance. Put crudely, Pickles gave councils a choice: save public libraries or hire diversity
officers. Voters would, it was thought, blame local government rather than central government for choices that cut "frontline services". It's not yet clear if the ploy has
worked and perhaps Osborne has raised the stakes with his latest proposal: daring councils not to adopt the freeze.
Finally, the chancellor will concentrate on defending his deficit reduction plan, drawing a contrast with the vacillating Eurozone. He will also bolster his growth agenda. He told the Today
programme that he will reinvest "underspend" in infrastructure projects, such mobile phone coverage and scientific research. Osborne's immediate challenge is to convince
sceptics in the hall and the country that these piecemeal initiatives will be sufficient to
deliver Britain from disaster.
Subscribe to The Spectator today for a quality of argument not found in any other publication. Get more Spectator for less – just £12 for 12 issues.
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text:
What is the probability of drawing a spade?
What is the probability of drawing a spade each time a card is drawn from a deck of 52 cards 3 times, if replacement occurs each time?
Tutor Answer
Brown University
1271 Tutors
California Institute of Technology
2131 Tutors
Carnegie Mellon University
982 Tutors
Columbia University
1256 Tutors
Dartmouth University
2113 Tutors
Emory University
2279 Tutors
Harvard University
599 Tutors
Massachusetts Institute of Technology
2319 Tutors
New York University
1645 Tutors
Notre Dam University
1911 Tutors
Oklahoma University
2122 Tutors
Pennsylvania State University
932 Tutors
Princeton University
1211 Tutors
Stanford University
983 Tutors
University of California
1282 Tutors
Oxford University
123 Tutors
Yale University
2325 Tutors


text:
Chartered Standardizes On Calibre For Deep-Submicron Verification; Another Win For Mentor Graphics In Physical Verification
Post a comment
Wilsonville, Ore.--Oct. 30, 1997--Mentor Graphics Corporation,the leader in physical verification of integrated circuits(ICs), announced that Chartered Semiconductor Manufacturing (CSM) hasselected Mentor Graphics' Calibre physical verification tool for internaluse with its advanced deep-submicron IC technology. Calibre provides CSMtechnical staff and customers with highly accurate and consistent physicalverification of 0.35- and 0.25-(m ASICs and ICs destined for consumer,communications, and computer electronics products.
Beginning immediately, Mentor Graphics will supply Calibre to the CustomerEngineering Division at CSM. Calibre's design independence makes it aversatile tool for verifying designs from CSM's wide range of customers. Otherverification tools require time-consuming rule file changes for everydifferent design topology.
In July, several leading semiconductormanufacturers, including SGS-Thomson, Samsung, and Toshiba, licensed Calibre toverify 0.25-(m chips for consumer applications. Recently, HAL ComputerSystems, Inc., a Fujitsu company, used Calibre to verify a 17 milliontransistor design in 19 hours, and design implementation provider, AspecTechnology, adopted Calibre for its production flow.
According to Collett International, a design technology managementconsulting firm in San Jose, Calif., the bulk of all IC and ASIC designs willhave shifted to 0.35 (m by the end of 1997. Such density mandatesaccurate and fast physical verification and parasitic extraction technology toensure reliable chip fabrication and chip performance. Calibre's proprietaryHierarchical Injection and Selective Promotion algorithms allowoptimum performance in any design style or layout methodology.
Chartered Semiconductor Manufacturing
Mentor Graphics
8005 S.W. Boeckman Road
Wilsonville, Oregon 97070-7777


text:
Noel Gallagher has predicted that Adele's music career will be short lived.
The singer commented on the London singer's recent success in an interview with the Mail on Sunday.
'I feel sorry for girls in the music industry. They do have a very short shelf life. For instance, Duffy: who? Gone. She was massive. And I don't doubt for a second that the same thing will happen to Adele.'
Margaret Thatcher, Dogs, Drugs, Death: Noel Gallagher's Best Quotes
Meanwhile, Adele is set to make her comeback at this month's Grammy Awards in LA.
The London singer is nominated for a total of six awards on the night and has made a full recovery following throat surgery last year.
Adele said in a statement: It's an absolute honour to be included in such a night and for it to be my first performance in months is very exciting and of course nerve-racking, but what a way to get back into it all.
She also took to Twitter, writing: "Ima be, Ima be singing at the Grammys. It's been so long I started to forget I was a singer! I can't wait, speak soon xx"
Working With The Family


text:
The anti-bomb squads have sealed major markets in the Federal Capital Territory (FCT) to search for any explosive devices.
Police officers from the FCT Command on Tuesday barricaded the popular Wuse and Garki Ultra-Modern Markets in the FCT to prevent traders from gaining entrance as the anti-bomb squad appeared to check the markets.
At the time of the report, traders have gathered outside the markets waiting to see whether the markets would be re-opened for business.
According to the FCT police spokesman, Altine Daniel, who commented the matter during phone interview, the temporary closure was due to intelligence report received by the police.
He said that the markets would be opened as soon as men of the anti-bomb squad had finished sweeping the markets trying to search of any explosive devices.
The bomb scare has come almost two months after a bomb blasts that occurred at the Nyanya Motor Park in Abuja, leaving over 70 dead.
The Boko Haram insurgents claimed responsibility for the blast. While, over 200 girls abducted from a secondary school dormitory in Chibok, Borno State are currently held hostage by the group. They say they would release the girls in exchange for members held at detentions camps across Nigeria.
If you wish to know how this story develops, use
Know more about this news? Update the info!


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The Totally NEW Team Corwin Thread
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December 31st, 2011, 01:04
At guild level 55 (only 2.5 levels to go) we get 3 extra small ship slots. Those can be used to add an int shrine and maybe even a dex shrine plus an electric shrine and a cold shrine (if we don't pick the dex shrine). So the best way to get the int shrine is to get us to guild level 55.
We have all the astral diamonds for the upgrade so we just need to play to get there.
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text:
Swachh M'luru Kicks Off! Math to give Kudla a 'Extreme-Makeover'
"So long as you do not take the broom and the bucket in your hands, you cannot make your towns and cities Clean" – Mahatma Gandhi. Ramakrishna Mission's "Swachh Mangaluru 3rd Phase" Kicks Off, and the Math is all geared up to give Kudla 'A Extreme- Makeover'.
Mangaluru: Finally the day has come for the official launch of the the Third Phase of Swachh Mangaluru Abhiyan undertaken by Ramakrishna Mission-Mangaluru. With 40 Teams, 40 Weeks, 400 Drives, 4000 Volunteers, 10 Drives every consecutive Week, Ramakrishna Mission is all ready to give Kudla a "Extreme-Makeover" during the next forty weeks.Over 5000 tools/cleaning equipment, buckets, brooms, pans, shovels, etc will be put into use during this Abhiyan to beautify the City. The Abhiyan kicked off today, 2 October 2016 on "Gandhi Jayanthi' at the Ramakrishna Mission premises at 7.30 am.
The programme began with invoking God's blessings through a prayer rendered by the Math Monks, followed by welcome address by Capt Ganesh Karnik, Coordinator of the Swachh Mangaluru project who said, " Swacch Bharath Abhiyan was initiated all over India on the Gandhi Jayanti Day, i.e. 2nd October 2014. Central government has undertaken several initiatives to effectively carry on this Abhiyan at different levels. As it is a public movement unless common mass and general public are involved it will not see the light of the day. Realizing this, the Central Government requested several organizations to actively take part in the mission along with their followers. When the Ramakrishna Mission Headquarters at Belur in West Bengal received such a request it forwarded the same to all its branch centres. This set the ball rolling in Mangaluru with Ramakrishna Mission actively starting Swacch Mangaluru Abhiyan. And today we are commencing our Third Phase of our Abhiyan, for which we request your support and encouragement "
"Ramakrishna Mission at Mangaluru has successfully completed 40 weeks of Swacch Mangaluru Abhiyan in 2 phases starting from 2015 February till 2016 February in 2 phases. Thanks to the active support and cooperation of the friends and well-wishers of our Ashrama, the Abhiyan was a grand success in creating an awareness about hygiene and cleanliness among the general public. Hence apart from sweeping the streets clean, several seminars and workshops on the theme of Swacch Bharath, Art Camps, competitions for students and children, rallies and door to door campaign by distribution of awareness literature made our initiative meaningful. As the first 2 phases were carried out on an experimental basis and we got a good feedback from our volunteers and the general public, we are continuing with the 3rd phase." added Capt Karnik.
Briefing about the Abhiyan, Swami Jitakamanandaji – Head of Ramakrishna Mission-Mangaluru said, "The 3rd phase of the Swacch Mangaluru Abhiyan will commence today and will continue for 10 months. Teams will be given maximum freedom to function as per the local situation. Each team will offer service on just one Sunday in a month. To elaborate, the first set of 10 teams will work on first Sunday of each month, and that is all for that month. The second set of 10 teams on 2nd Sunday and the third and fourth sets on third and fourth Sundays. In one word, forty programmes will be covered during each month. The Third Phase will be from October 2, 2016 to July 2017. However, during south-west monsoon outpours, for two months Abhiyan will be suspended."
Swami furthers aid, "On the whole 40 Sundays will be covered during the period October 2016 to July 2017 and the Abhiyan will go on for 10 months between October 2016 to July 2017. In other words, each team will work for 10 months – one Sunday each month and it will take up 10 programmes. This will be preceded by Swacch Manas programme – An orientation programme for youths & students every Saturday from 3.00 ppm to 6.00 pm. Several institutions will be deputing their representatives for this programme where they will be briefed about Ashrama activities, need for Swacchata Abhiyan and their role in ensuring the success of this Abhiyan."
The programme was inaugurated by lighting of the traditional lamp by chief guest Swami Bodhasaranandaji, Asst. General secretary, Ramakrishna Math & Mission, along with other dignitaries on the dais namely Swami Jitakamanandaji, Head, Ramakrishna Mission, Mangalore, Dr. N Vinay Hegde, Chancellor, Nitte University, MLA J R Lobo, MLC Captain Ganesh Karnik, BHV Prasad, GM, MRPL and AK Sahu- Director of Finance, MRPL. During this occasion about 35 Poura Karmikas of Mangaluru City Corporation were honored for their services in keeping the city of Mangaluru clean for the past several decades – they wake up early in the morning and see that the city is clean by the time other citizens get up off the bed.
Addressing the gathering Swami Bodhasaranandaji said, " We should compliment Ramakrishna Mission-Mangaluru and its members for their dedication and commitment in taking up the Swachh Mangaluru Abhiyan for the last two years, and now stepping into their third phase. A job well done to bring awareness about the importance of cleanliness and to make Mangaluru a clean city. They could do it because of the love, sympathy and benevolence shown by the citizens of this great city. Another initiative taken by the Math is to recognize and honor the Poura Karmikas for their service to the community. To carry on this Abhiyan we need dedicated and committed volunteers, who are ready to sacrifice and work for others."
" Just like Jesus Christ sacrificed his life for others, we should also follow in his footsteps in caring and serving others. Science and technology can't give us peace, it's only through our hard work and unity where we can promote and spread peace. We should know that Swachh Bharath is not the only responsibility of PM Modi, it is the duty of every citizen of this country to maintain cleanliness around our surroundings-only then we can make Swachh Bahrath Abhiyan a successful one. Swami Vivekananda said 'Money and all will come of themselves, we want men, not money. It is man that makes everything, what can money do? So richness doesn't count here, we need common and dedicated people to come forward and work hard towards making our Country, our states and our cities clean. During my visits to Dubai and Japan, I was so astonished to see the cleanliness of the cities and houses-if these countries can maintain cleanliness, why can't India also do it? Let's answer this question, and make a strong commitment to see that we keep India and our cities clean" added the Swami.
Also speaking during the occasion, MLA J R Lobo said, "So long as you do not take the broom and the bucket in your hands, you cannot make your towns and cities Clean" has said Mahatma Gandhi. So it is our duty to pick a broom and a bucket and go around our surroundings at least 5-10 minutes every day and see that cleanliness is maintained. This project undertaken by Ramakrishna Mission will be an added asset to the Mangaluru Smart City project. To make the Smart City happen we all need to work together in unity and dedication for a better and cleaner City. We should come up with an ambitious objective of achieving 'Swachh Bharath/Mangaluru' specifically by eliminating open defecation by the year 2019 which is the birth anniversary of Mahatma Gandhi. We have already announced about Mangaluru Open Defecation Free city, and much more has to be done. It is also very crucial that state and district thrusts a strong focus on the improvement and sustenance of environmental sanitation and hygiene that would directly benefit its tourism industry which is a major contributor of economic growth. So let's all work hard along with the Math for a better and cleaner Mangaluru".
Dr Vinay Hegde and BHV Prasad also spoke, and while complimenting the efforts taken by Ramakrishna Mission, they also urged the audience to support and encourage the volunteers of this Abhiyan in achieving their goal in making Mangaluru Swachh. Soon after the formal function, the Abhiyan was flagged off, and Cleaning equipment were handed over to all the 40 team leader, and their teams got into action cleaning the designated areas assigned to them. This will be followed by a Seminar, "Swacch Manas for Swacch Bharath" for the Swacchata Abhiyan volunteers which was inaugurated by Swami Bodhasaranandaji. Padmabhushan Dr. B M Hegde and Air Vice Marshal Ramesh Karnik were the resource persons. The vote of thanks was proposed by the compere of the occasion, Smitha Shenoy- Professor in Journalism at Besant Women's College.
Swami Ekagamyanandaji- Co-Convener of Swachh Mangaluru Abhiyan speaking to Team Mangalorean said, " We have already earmarked 40 interested teams and have interacted with the members from each team. Each team will consist of 50 to 100 members. They should be committed to participate in the 10 Abhiyans without fail. All the cleaning materials like brooms, gloves etc. are supplied to them from the Ashram along with motivational T shirts, banners and awareness literature. Ashrama will also give each team Rs. 5000/- per month to carry on some minor repair work in their area like fixing slab stone in damaged footpath etc This will also be used for breakfast for the Abhiyan volunteers. Ashram will coordinate each team's work with an appointed coordinator. Justice K S Hegde Foundation and MRPL have voluntarily come forward to support he cause. Already 5000 Cleaning equipment like broom, basket etc have been purchased. 5000 T shirts have been purchased and have been distributed among each team".
Mahatma Gandhi dreamt of an India which was not only free but also clean and developed. Mahatma Gandhi secured freedom for Mother India. Nowit is our duty to serve Mother India by keeping the country neat and clean. Let me conclude the column with the 'Swachh Bharath' pledge administered to the Volunteers by Swami Jitakamanandaji –
" I take this pledge that I will remain committed towards cleanliness and devote time for this.
I will devote 100 hours per year, that is two hours per week, to voluntarily work for cleanliness.
I will neither litter nor let others litter.
I will initiate the quest for cleanliness with myself, my family, my locality, my village and my work place.
I believe that the countries of the World that appear clean are so because their citizens don't indulge in littering nor do they allow it to happen.
With this firm belief, I will propagate the message of Swachh Bharath Mission in villages and towns.
I will endeavor to make them devote their 100 hours for cleanliness.
I am confident that every step I take towards cleanliness will help in making my country clean".


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Los Angeles Galaxy forward Robbie Keane, Ireland's all-time leading scorer, will captain the team Sunday when it opens the European Championship
against Croatia.
An estimated 20,000 fans are in Poznan for the game, and Keane credits Ireland's 73-year-old Italian coach, Giovanni Trapattoni, with building support behind the team.
"The job the manager has done has been great," says Keane. "We're a small country [population 4.5 million] and we came really close the past few years, like in France where we did well to win the game. We don't need to talk about what happened after that, but we've been close."
France eliminated Ireland in the 2010 World Cup playoffs with the help of a goal created when Thierry Henry handled the ball, but Trapattoni stayed with the team despite his age.
Trapattoni has coached AC Milan, Fiorentina, Juventus and Cagliari in his native country as well as in Portugal, Germany and Austria. He was Italy's coach from 2000 to 2004 and though his appointment by the Irish soccer federation was regarded by some as a strange one, he was born on St. Patrick's Day.
"Every goal I face is a challenge. I still have the same determination, the same concentration and the same attention to detail," Trapattoni said. "I'm really grateful to the Irish people because they believe in us -- they believe in what we've done."
Trapattoni says it's important his players appreciate the support they have.
"I repeat always," he said, "you must be proud about our country, our people, because they make a very big sacrifice -- the money, the travel, the trip. The players know this. All players before the training, I repeated this to them. Our country expects, our supporters expect. Football is about the 90 minutes, but it's important that we guarantee our people total and complete commitment."
Keane is eager to see how the presence of Irish brightens the tournament and if they can add a bit of push to Ireland's longshot ambitions to advance.
"To have a manager like we have, with the places he's been and the experience he has, he's completely changed the atmosphere of the whole country with the way he [carries] himself," says Keane. "It's great for the team that we're back in a major tournament because everybody loves to see the Irish fans covering the town."