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Article content
In a regular season that finds the Canucks easily perched atop their division with an outside chance at another conference and/or regular season title, it should be hard to be disappointed. But after last season, which found the Canucks rarely taking their foot off the gas as they went essentially wire-to-wire to earn the franchise's first ever President's Trophy as the leading regular season team, the uninspired and ineffective play of recent weeks has the always neurotic fan base (or, at least, media contingent) looking for answers.
And, on paper, their struggles are apparent. Since their victory over Boston in the "game of the season", the Canucks, despite posting an impressive 17-8-5 record, have had troubles outplaying their opponents at even strength (their even strength goal differential being only plus 5 during the thirty games since the Boston game – as opposed to plus 18 in the 42 games before that). Further, of those 17 wins, eight have come in bonus time (overtime or shootout), which really normalizes their record to a very lackluster 9-8-13 in the wake of the taking of Boston.
Even more troubling, since the departure of Cody Hodgson (who had been the Canucks' most efficient five-on-five performer), the Canucks have posted a 3-5-1 record, being outscored 22 to 14 at even strength – an alarming one goal per game negative differential.
Why should we care so much about five-on-five performance? Because we all know that come playoff time, the whistles get put away. Come playoff time, a lethal power play becomes less of an advantage. Not that the Canucks' power play is still lethal. Since the Boston game (where they scored four times with the man advantage), the power play has executed at 15% – a far cry from the 24% figure that led the league in the first half.
But in all fairness to our Canucks, with a second overall conference placing all but clinched and the memories of last year's agonizing playoff run still fresh, you can't blame them for not finding any jump these days, saving themselves for what they know is coming next – another grueling run at the ultimate prize.
Though the trouble is we don't know that for sure. It's possible that they are physically spent after last year's deep run. And if they are spent now, what will happen come mid-April? It's even possible that they've tuned out Coach Alain Vigneault, whose post game comments after last night's disappointing loss to the lowly Minnesota Wild were sharply critical of his team – a huge departure from the usual sugar coating of his team's performance.
If it's true that the Canucks have been saving themselves for the post-season, we would expect their performances during the regular season against quality teams (the next best thing to a playoff encounter) would be relatively more inspired. Meanwhile, we might expect their play declining to the level of inferior opponents.
Sadly, that is not entirely true. The Canucks have padded their stats against the bottom feeders (defined here as teams that were out of playoff contention both this season and last), compiling a 14-3-1 record against the league doormats. And they've done so in dominant fashion, winning twelve times in regulation time and outscoring their lowly opponents 47 to 27 at even strength in those 18 games while scoring with 25% efficiency on the power play. In short, this is a very dominant performance. Against nearly AHL caliber opposition.
Against teams that they should rightfully "get up" for (defined here as elite eastern conference teams or prime western conference rivals; that is, the teams they will need to beat on the way to a Stanley Cup), they have posted a seemingly impressive 13-8-3 record. Though upon further investigation, six of those wins are in bonus time, again normalizing their record to an unflattering 7-8-9. What success they have had in these games has been driven by their power play, again soaring at 25%. And at even strength in those 24 games, they've been outscored 55 to 47. As a barometer of future playoff success, where 5-on-5 play rules, there appears some legitimate cause for concern.
Against everyone else, the mediocre middle of the NHL (otherwise stated as teams the Canucks are likely to face in the first round of the playoffs), the Canucks are 16-10-4, normalized to 12-10-8 when accounting for bonus time – hopefully, for Canucks fans, a simple instance of the Canucks playing down to the level of their opposition.
So while the Canucks' place in the NHL standings is notable and cause for some celebration, their on-ice play has been nothing better than mediocre most of the time. That is not to say they can't get re-energized come mid-April, flipping their playoff switch to "on". It is something we've seen before in this market. And something we'd love to see again though indications are it's less likely to happen this time around.
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The Making Of
Director Gary Hustwit discusses breaking into the rarified world of top designers and how his own curiosity about a typeface has driven him to make two more films about the ubiquity and impact of design.
Independent Lens: What impact do you hope this film will have?
Gary Hustwit: I think it's important that we all think more about the design of the objects we buy and use every day. Industrial design permeates every aspect of our lives. The computer you're reading this on, the chair you're sitting on right now, the lighting fixture above you—on average we each touch 600 different objects a day. We fill our homes with them, go into debt to purchase them and sometimes destroy the environment in using them. So the more we understand about what goes into making them, the better informed we can be about our role as consumers of all this stuff.
IL: What led you to make OBJECTIFIED?
GH: In 2005 when I began the process of making my first documentary, Helvetica, I wasn't planning on making a series of films about design. But after completing it, I found that I still had so many questions about design's role in our lives, and that the documentary form was an excellent way to try to answer those questions and explore a subject that interested me. One design film wasn't enough!
IL: What were some of the challenges you faced in making this film?
GH: Probably the biggest challenge was encapsulating the subject matter—there's just too much to talk about. Cars, computers, furniture, soda bottles, toothbrushes. How do you make a film about every manufactured object in our environment? What ends up connecting all these different objects is the thinking of the people behind them, the challenges they face and their creative processes.
IL: How did you gain the trust of the subjects in OBJECTIFIED?
GH: Since I'd already made Helvetica, and a lot of the subjects I approached had seen that film, they had an idea about what I did and what I was trying to do with OBJECTIFIED. That made it a lot easier.
IL: What would you have liked to include that didn't make the cut?
GH: We shot 80 hours of interviews and observational footage, so there is so much material we didn't get to use. There was a lot of candid observational footage that we filmed on the streets, just watching how people interact with objects, which I found fascinating. We included quite a few of those moments in the film, but I could probably do an entire film of that stuff.
IL: Why did you choose to present your film on public television?
GH: Public television audience members are interested in the world around them, they're curious about other people's lives and they want to make a difference. That's the kind of audience I'd like to think I'm making these films for.
IL: What didn't you get done when you were making your film?
GH: Nothing… making films is now all I do!
IL: What's next for you?
GH: While I was making OBJECTIFIED, it felt so much like a companion piece to Helvetica in a way, like it was an extension of the same exploration I'd started in the first film. And midway through OBJECTIFIED, I had an idea for a third film, which could complete the trilogy. So I'm starting that one now, we'll release more details about it soon.
Get the DVD >>

subset: commoncrawl


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UK staff are working the longest hours in Europe and need to be offered more
flexible working arrangements, according to a TUC report.
The report, Changing Times, criticises the culture of
"presenteeism" whereby employees expect staff to work rigid hours
within a set work space.
The labour market in the UK is among the least regulated in Europe and staff
work on average more than 43 hours a week, nearly four hours longer than their
counterparts elsewhere, says the report.
TUC general secretary John Monks says, "Although we live in an age
where high-quality goods and services are demanded outside of what we once
considered to be normal working hours, employers will not be able to deliver
successfully on these unless they involve their staff in the process of change.
"Too many employees are expecting to work long hours and inflexibly for
no return."
The report includes a best practice case study on car safety company TK-ECC
which has nearly eliminated absenteeism through the introduction of
The Northern Ireland-based company was concerned that skilled workers were
not returning to work after maternity leave and production workers had high
absence rates.
It conducted a workforce survey that revealed shift patterns that conflicted
with family commitments. A pilot jobshare scheme has allowed female staff to
continue their careers after maternity leave.
Will Hutton, chief executive of the Industrial Society, which contributed to
the report, said flexible working practices such as job shares also improve
He said, "Balancing work and life is critical to better workplace
performance and productivity. Traditionally UK employers have found it
difficult to reconcile flexible working with the embedded culture of
"The irony is that this inflexible approach to work-life balance
decreases employee motivation and results."
By Paul Nelson


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We specialize in a full range of
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We sincerely appreciate the opportunity to serve our patients' dental needs. Our goal has been, and always will be, to provide the highest quality of care in a comfortable environment.
Our entire staff operates as a team and will do whatever is needed to make you feel comfortable and well cared for. We value our relationship with our patients and want it to last for many years.
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"I appreciate that Dr. Hull's office accommodated my request for appointment reschedule. Because of the reschedule, I had a different hygienist. The hygienist today repeatedly scraped my gums. She was pleasant but not as good a hygienist."
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"Dr. Hull filled some notches in my teeth. He provided explanations during the course of the procedure. The level of pain was minimal. I am very pleased with the results. The procedure started on time and lasted the amount of time Dr. Hull estimated. The staff treats me like family."
by Nici on 4/23/2019
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"They were able to combine my annual cleaning with the finalization of my crown. The whole thing took less than an hour. Everyone was friendly, courteous and professional. No one loves going to the dentist, but at Dr. Hull's office they make it as enjoyable as possible!"
by Geoff on 2/14/2019


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Learn to cook healthy vegetarian Thai food and practice yoga in our scenic mountainous village environment.
Our three day cooking courses offer you a chance to learn how to cook 11 Thai dishes and find out more about the Gin Dee U Dee concept of eating well and living well.
We host and instruct yoga retreats and meditation retreats at the farm throughout the year. The yoga style taught is inspired by Iyengar and Ashtanga traditions.


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Sterile Processing Tech Schools
Statistics From SurveysStatistics From Surveys
Stats here are for those who have completed the program. Of those starting the program, 6 out of 9 (67%) of people surveyed successfully completed it.
|Survey Question
|Program Completion Time
|13 month(s)
|Attended School Mostly Full-Time
|Program Difficulty (1-100)
|Satisfied With the School
|Well-Prepared for Career
|Would Choose Program Again
|Career is Directly Related to Program
|Easy to Find Job
|How Long to Find First Job
|9 month(s)
|Working Mostly Full-Time
|Salary (Not Necessarily Full-Time)
|Salary Met Expectations
|Trouble Making Loan Payments
|Satisfied With the Career
Schools Offering This Program, by StateSchools Offering This Program, by State
► Common Careers for this Major▼ Common Careers for this Major
People getting a certificate in this major often choose among careers such as (among others):
- Surgical Technologists
- Medical Equipment Preparers
Why did people choose this program of study?Why did people choose this program of study?
"I picked this field because I enjoy the manufacturing setting. I think that working in this environment can translate to pharmaceutical industry."
"It was something that could get me into the door a hospital. Plus, the program was relatively short and was completed in a few months. As opposed to a whole year at other institutions."
"I wanted to work in the healthcare field. This career is in high demand in my state."
"Great pay and potential for job growth. The class offerings meshed well with my family needs."
"When I chose this program I really felt like I wanted to do something involved with the medical industry. I have since learned that it really wasn't what I wanted to do for the rest of my life but it was a great stepping stone."
What surprised people about this program of study?What surprised people about this program of study?
"I was surprised by the flexibility. My schedule is easily maneuverable."
"It is a very messy field but has more science and testing than one would expect. I think it is a wonderful field for someone wanting to break into the medical field and learn everything they would need to know about surgical professions."
"I was extremely surprised to find out that you really don't even need to go to school to be a sterile processing technologist. Everything is on the job training. Almost everyone I work with did not go through any formal training outside of the hospital. So I felt a little robbed that I actually even had to go through a program in the first place."
"I was surprised at how much microbiology was needed."
"How important it is. Css techs are the unsung heros of a hospital. Without them it sounded exist."
"I think what surprised me the most was that the employees at hospitals were very clickish. I often felt like I really didn't belong because I wasn't really mainstream."


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AIDS and HIV Infection after Thirty YearsView this Special Issue
Research Article | Open Access
Akinsegun Akinbami, Adedoyin Dosunmu, Adewumi Adediran, Sarah Ajibola, Olajumoke Oshinaike, Kikelomo Wright, Olanrewaju Arogundade, "CD4 Count Pattern and Demographic Distribution of Treatment-Naïve HIV Patients in Lagos, Nigeria", AIDS Research and Treatment, vol. 2012, Article ID 352753, 6 pages, 2012. https://doi.org/10.1155/2012/352753
CD4 Count Pattern and Demographic Distribution of Treatment-Naïve HIV Patients in Lagos, Nigeria
Background. CD4 count measures the degree of immunosuppression in HIV-positive patients. It is also used in deciding when to commence therapy, in staging the disease, and in determining treatment failure. Using the CD4 count, this study aimed at determining the percentage of HIV-positives who require antiretroviral therapy at enrollment in an HIV treatment and care centre. Methods. The Baseline CD4 count, age and gender of 4,042 HAART-naïve patients, who registered between December 2006 and June 2010, at Lagos State University Teaching Hospital, Ikeja, were retrospectively studied. Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, Ill). Results. Patients consisted of 2507 (62%) female and 1535 (38%) males. The mean age of males was years and that of females years. Overall, the mean CD4 count was of cells/mm3. The mean CD4 count of males was cells/mm3 and that of females cells/mm3. A total of 72.3% males, 64.3% females and 67.4% overall registered patients had CD4 count <350 cells/mm3, while only 15.1% males , 20.3% females, and 18.3% overall registered patients had CD4 count >500 cells/mm3 at registration. Conclusion. Females account for more than half of registered patients in HIV clinic and have a relatively higher CD4 count than males. About three-quarter of HIV positives require antiretroviral therapy at registration.
1. Introduction
Worldwide Nigeria has the second highest number of new HIV/AIDS infections reported each year [1]. About 300,000 new infections occur annually with people aged 15–24 years contributing 60% of the infections and 1.5 million people living with HIV require antiretroviral using the new WHO guidelines. Only about 30% of people living with HIV who need antiretroviral have access to it [2].
In 2009 an estimated 3.6% of 150 million Nigerians are living with HIV and AIDS [3]. Approximately 215,000 people died of HIV/AIDS in Nigeria in 2010 [4].
CD4 count measures the degree of immunosuppression in HIV-positive patients. There is an inverse relationship between CD4 count and degree of immunosuppression. CD4 count is used in monitoring disease progression, deciding when to commence therapy, staging the disease, determining treatment failure, and defining the risk for mother-to-child transmission.
Laboratory markers used in monitoring management in HIV-positive patients are HIV-RNA assay (Viral load) and CD4 count. The former is the gold standard, its use is, however, limited because of its cost and technology. Furthermore, there is a mismatch between an undetectable viral load (<50 copies/mL) and the absence of immune reconstitution, which can be confusing to both the treatment provider and patient.
Several studies have shown that CD4 count is the strongest predictor of disease progression and survival [5, 6]. The cost of CD4 count is cheaper than viral load, it is increasingly becoming more affordable to patients in resource-poor countries [7, 8]. All HIV-positive patients in resource rich and an increasing number of patients in resource-poor countries have baseline CD4 count on enrollment [9].
The CD4 cell count is the strongest predictor for risk of death and AIDS [10] at the time of initiating therapy, initiating highly active antiretroviral therapy (HAART) at higher CD4 cell counts has been demonstrated to "the risk of death, opportunistic infections and non-HIV related comorbidities" [11, 12]. Robert et al. [13] assessed CD4 count and the risk of death in HIV-infected patients on HAART, nearly all deaths occurred in patients with fewer than 50 CD4 cells/mm3.
A common denominator amongst all the guidelines on initiating HAART in HIV-positive patients is the use of CD4 count in deciding when to initiate ART in HIV-positive patients. While some HIV-positive patients present at registration with low CD4 count, that is, less than 200 cells/mm3 probably due to late presentation or diagnosis and are commenced on HAART almost immediately on enrollment irrespective of clinical symptoms. Some asymptomatic HIV-positive patients do not require antiretroviral (ART) drugs on enrollment because of their high CD4 count at registration hence their inability to meet criteria for initiation of therapy laid down by various organizations like World Health Organization (WHO), Centre for Disease Control, (CDC) Atlanta, Presidential Emergency Program for AIDS relief (PEPFER), Working Group of AIDS Research Advisory Council (OARAC), and European AIDS Clinical Society Guidelines, among others.
What is controversial is the optimal time to initiate antiretroviral therapy (ART). Various guidelines exist on the optimal time to initiate ART in adult asymptomatic patients. There seems to be consensus of opinion on deferral of ART in asymptomatic HIV patients whose CD4 count is greater than 500 cells/mm3. However, the revised 2010, the World Health Organization (WHO) [14] recommended that all adult and adolescent including pregnant women with HIV infection presenting with CD4 count ≤350 cells/mm3, should start ART regardless of the presence and absence of clinical symptoms. Those with severe and advanced clinical disease (WHO clinical stage 3 and 4) should start ART irrespective of their CD4 cell count.
The U.S. Department of Health and Human Services (DHHS) [15] recommended that treatment of HIV infection shold be commenced, in patients with CD4 counts between 350 and 500 cells/mm3. A randomized trial still in progress (START) [16] is randomizing people with a CD4 cell count of greater than 500 per μL to either start antiretroviral therapy (ART) immediately or defer to a CD4 cell count of 350 per μL. However, Severe et al. [17] recommended that access to antiretroviral therapy should be expanded to include all HIV-infected adults who have CD4+ T-cell counts of less than 350 cells/mm3 in those who live in areas with limited resources.
The U.S. Centre for Disease Control (CDC) and the prevention [18] staging system used the CD4 count as a tool to stage HIV into categories A, B, and C based on whether the CD4 count is >500 cells/mm3, between 200–499 cells/mm3 and <200 cells/mm3, respectively. It defines AIDS as all HIV-positive patients with CD4 count <200 cells/mm3 or CD4% < 14%. On the contrary, the WHO staging is based on clinical findings and does not require CD4 count in order to accommodate for resource-constrained settings where CD4 count testing may not be available.
CD4 count is an important tool in determining treatment failure in HIV-positive patients. The 2010 World Health Organization (WHO) [14] revised guideline defined immunological failure as a fall of CD4 count to baseline level or below, or 50% fall from on-treatment peak value or persistent CD4 count below 100 cells/mm3. There must, however, be absence of concomitant infection to cause transient CD4 count decrease. A patient presenting with immunological or clinical failure (new or recurrent stage 4 disease) with viral load copies >5000 copies/mL is deemed to have treatment failure and switched to second-line regimens [14].
The introduction of HAART as a modality of treatment in HIV positives has resulted in a dramatic decrease in AIDS-related morbidity and mortality and a great improvement in CD4 count of patients [19]. In order to determine the true picture of CD4 count pattern in HIV positives, HAART-experienced patients must, therefore, be excluded from the study. There is paucity of data on the pattern of CD4 count of HIV-positive, HAART-naïve patients at registration in Nigeria. The data may be used to determine the percentage of HIV-infected patients who require ART at registration. This will assist clinicians and policy makers in determining the point to begin treatment and the percentage of infected patients who require treatment at registration. Thus, this study aimed at determining the percentage of HIV positives who require treatment at enrollment using the CD4 count as a tool.
2. Materials and Methods
The records of 4,042 HAART-naïve, HIV-positive patients who registered at the HIV clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja, between December 2006 and June 2010 were retrospectively reviewed.
Lagos is Nigeria most prosperous and arguably the most populous city. It has one of the highest standards of living as compared to other cities in Nigeria as well as Africa. All ethnic groups in Nigeria are well represented in Lagos because of its cosmopolitan constitution. LASUTH, the only teaching hospital owned by the State Government and one of the two in Lagos, is located in the state capital Ikeja. It serves as a referral centre to 26 other secondary (General) hospitals serving an estimated 17 million Lagosians.
Data retrieved included baseline CD4 count, age, and gender. All HAART-experienced, registered patients referred from other centers were excluded from the study.
3. Statistical Analysis
Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, Ill); a statistical computer software. The descriptive data were given as means ± standard deviation (SD). The differences were considered to be statistically significant when the value obtained is less than 0.05.
4. Results
Data from 4,042 registered patients were reviewed, consisting of 2507 (62%) females and 1535 (38%) males (Table 1). The overall minimum age was 15years and the maximum 85 years with a mean of years (Table 1). A majority 2414 of 4042 (59.7%) of all patients were between 31–50 years, 1318 of 4042 (32.6%) between 15–30 years and only 310 of 4042 (7.7%) were older than 50 years (Table 1).
The minimum age for male was 15 years and the maximum of 85 years with a mean of years (Table 1). A majority of males, 1035 of 1535 (67.4%) were between 31–50 years, 364 of 1535 (23.7%) between 15–30 years and 136 (8.9%) older than 50 years (Table 1).
The minimum age for female was 15 years and the maximum 76 years with a mean of years (Table 2). The majority of females, 1379 of 2507 (55%) were between 31–50 years, 954 of 2507 (38.1%) between 15–30 years and 174 of 2507 (6.9%) older than 50 years (Table 1).
Overall, the minimum CD4 count was 2 cells/mm3 and the maximum 1868 cells/mm3 with a mean of cells/mm3 (Table 2). Seven hundred and forty-one of 4042 (18.3%) had CD4 count of >500 cells/mm3 consisting of 414 (55.8%) in the age group 31–50 years, 271 (36.57%) between 15–30 years and 56 (7.55%) older than 50 years. While 3301 of 4042 (81.7%) had CD4 count of <500 cells/mm3, consisting of 578 (14.3%) with CD4 count of between 350–500 cells/mm3, 2723 (67.4%) with CD4 <350 cells/mm3 and 1712 (42.4%) with CD4 count <200 cells/mm3. Only 522 of 4042 (12.9%) had CD4 count of <50 cells/mm3. This consists of 319 of 522 (61.1%) in the age group 31–50 years, 166 (31.8%) between 15–30 years, and 37 (7%) older than 50 years (Table 2).
The minimum CD4 count for males was 3 cells/mm3 and the maximum 1416 cells/mm3 with a mean of cells/mm3 (Table 2). A total of 233 (15.1%) of 1535 male patients had CD4 count >500 cells/mm3 consisting of 169 of 233 (65.23%) between the age of 31–50 years, 60 (25.75%) between 15–30 years, and 21 (9%) older than 50 years. The majority 1302 of 1535 (84.9%) had CD4 count <500 cells/mm3. A total of 193 of 1535 (12.6%) had CD4 count between 350–500 cells/mm3, while 1109 of 1535 (72.3%) had CD4 count <350 cells/mm3, 740 of 1535 (48.3%) with CD4 count <200 cells/mm3. Only 245 (16%) of males had CD4 count <50 cells/mm3 consisting of 169 (68.97%) between 31–50 years, 51(20.81%) between 15–30 years, and 25 (10.2%) older than 50 years (Table 2); .
The minimum CD4 count for females was 2 cells/mm3 and the maximum of 1868 cells/mm3 with a mean of cells/mm3 (Table 2). A total of 508 of 2507 (20.3%) had CD4 count >500 cells/mm3 consisting of 262 of 508 (51.57%) between 31–50 years, 211 of 508 (41.53%) between 15–30 years and 35 (6.8%) older than 50 years. A total of 1999 of 2507 (79.7%) females who had CD4 count <500 cells/mm3 consisted of 385 of 2507 (15.4%) with CD4 count of between 350–500 cells/mm3 1614 of 2507 (64.3%) of females with CD4 count <350 cells/mm3, and 972 of 2507 (38.77%) with CD4 count <200 cells/mm3. A total of 277 of 2507 (11%) had CD4 count <50 cells/mm3 consisting of 150 of 277 (54.15%) between 31–50 years, 115 of 277 (41.51%) between 15–30 years, and 12 of 277 (4.3%) older than 50 years (Table 2); .
5. Discussion
In Nigeria, the first case of HIV/AIDS was reported in 1986. HIV prevalence declined from 6% in 2001 to 4.3% in 2005, 4.2% in 2008, and 4.1% in 2010. HIV response in Nigeria was health sector driven from 1986–1989,, but a multisectoral response commenced in 2000. Funding for the HIV response in Nigeria is obtained from both domestic (Federal Government of Nigeria, private sectors and state governments) and international sources like the U.S. Government, DFID, UN agencies, and global funds. It is pertinent to determinethe percentage of HIV-infected patients who require ART at registration vis-à-vis percentage benefiting from care services in order to appreciate progress made in reaching out to those in need of accessing care and treatment.
In Nigeria, prevalence among young women aged 15–24 years is estimated to be three times higher than among men of the same age. Females constitute 58% (about 1.72 million) of persons living with HIV in Nigeria and each year, 55% of AIDS death occurs among women and girls [2] The female:male ratio in the present study of 1.6 : 1 is similar to 1.8 : 1 obtained by Omoti et al. [20] in Benin City, Nigeria. The disparity in gender prevalence is age dependent as reported by Glynn et al. [21] who reported HIV prevalence was six times higher in women than in men amongst sexually active 15–19 years old, but it drops to three times that in men among 20–24 years old and equal to that of men among 25–49 years old. The present study did not consider age in groups in relation to gender and HIV status. However, 59.7% of the studied population was between 31–50 years, a ratio of F : M of 1.6 : 1 obtained was, therefore, similar to 1 : 1 reported by Glynn et al. in those between 25–49 years. Generally, females are more predisposed to contracting HIV because of pregnancy or use of oral contraceptive, conditions which induced cervical ectopia in which there is replacement of squamous by columnar epithelium, thus increasing the risk of HIV infection for women 5-fold. Sexual intercourse during menstruation and presence of genital ulcer also increases the risk of HIV infection in females. Pelvic inflammatory disease predisposes to microulceration of the genital tract thus increasing risk of HIV infection. Culturally, the majority of males in this part of the world are circumcised, male circumcision affords some degree of protection, perhaps due to large numbers of langerhans cells in foreskin, so that the incidence of infection is reduced 8-fold over uncircumcised men [22]. Glynn reported that, despite all the predisposing factors in females, women married younger than men, and marriage was a risk factor for HIV, women often had older partners and men rarely had partners much older than themselves.
The mean ages of years and years for females and males, respectively, obtained in this study are similar to earlier study [21] of and for females and males, respectively, and also similar to 38 years reported by Omoti et al. [20] in both genders. This is understandably so because the majority of patients in HIV clinic are between 31–50 years being the age when sexual activity is at its peak.
This study reported mean CD4 counts in HAART-naïve, HIV positives of and cells/mm3, respectively, for males and females and an overall mean of cells/mm3. This could be compared with cells/mm3 and cells/mm3, respectively, for males and females and an overall mean CD4 count of cells/mm3 reported by Akinbami et al. in an earlier study [23]. In both studies, females were found to a have a higher CD4 count than males.
Oladepo et al. [24] established in healthy Nigerian adults a reference value for CD4 of 365 to 1,571 cells/μL. with a mean CD4 count of 847 cells/μL similar to the mean value of 828 cells/μL reported by Aina et al. [25] in an earlier study in Nigeria. Females were found to have significantly higher values of absolute CD4 counts in Oladepo's study in contrast to the earlier limited study by Aina et al. in Nigeria. This observation of higher CD4 count in females was also reported in several other countries among Nigerians [26], Ugandans [27], and Ethiopians [28]. A sex hormone effect is one possible explanation for the reported difference in CD4 counts between genders that has been suggested [28].
Using the 350 cells/mm3 CD4 count as cutoff from 2010 WHO [14] revised guideline for initiation of therapy in asymptomatic HIV patients, 72.3% males, 64.3% females and 67.4% overall registered patients require treatment on enrollment, while only 15.1% males, 20.3% females, and 18.3% overall registered patients with CD4 count >500 cells/mm3 may require antiretroviral therapy deferral at registration.
In Sub-Saharan Africa, an estimated 10 million need treatment in 2010, only 5 million received it [1]. In Nigeria as at 2009, only 31% of people living with HIV have access to care services [29], the government, through the National HIV/AIDS strategic framework for 2005–2009, set out to provide ARV to 80% of adults and children with advanced HIV infection and 80% of HIV-positive pregnant women, all by 2010 [30].
ARV treatment coverage in Nigeria remains low, the slow progress led to revising the strategic framework, and resetting treatment goals in its revised 2010–2015 framework [31]. By 2010, only a quarter of adults and 7% of children in need of treatment received it. Currently, 1.4 million adults and 262,000 children eligible for antiretroviral treatment remain without it [1].
In Africa, Botswana at the end of 2010 has the highest coverage rate around 93%, other countries that have achieved more than 80% coverage are Rwanda and Namibia [1]. Access to antiretroviral therapy in Somalia is the lowest in Africa at 3% while only 55% of those in need in South Africa are receiving it [32].
Cameroon, Cote d'Ivoire, Chad, Nigeria, and Ghana are some of the countries in Sub-Saharan Africa where between 20–39% of people requiring antiretroviral drugs are receiving them [1].
Being a retrospective study, some of the limitations of this study is the nonavailability of data on clinical manifestations of the patients, lack of data on records of distribution of the CD4 count, and percentage in need of treatment per year and lack of information on HIV risk factor, area of residence, family income, and marital status.
Extra efforts must be made by the Nigerian Government at all levels to meet the need of people living with HIV/AIDS eligible for treatment so as to reduce the spread of the pandemic.
6. Conclusion
About three-quarter of HIV positives require antiretroviral therapy at registration when 2010 WHO criteria are used for initiation of therapy, female population in HIV clinic is higher than males and the former has a relatively higher CD4 counts than the latter.
Conflict of Interests
There is no conflict of interest declared.
Authors' Contribution
A. A. Akinbami conceptualized, designed, and did data entry and analysis of the study. A. O. Dosunmu drafted the paper and revised it critically for important intellectual content. A. Adediran made substantial contributions to conception and design of the paper and reviewed it before final submission. S. O. Ajibola reviewed the paper critically for important intellectual content and gave final approval of the version to be published. K. O. Wright was involved in the drafting of the paper and reviewed it critically for important intellectual content. O. Oshinaike reviewed paper before final submission. O. Arogundade carried out the CD4 count assay.
The Institute of Human Virology Nigeria provided registration, laboratory investigations, and treatment free to all registered HIV patients used for this study. The authors are also grateful to Mr. Obadeyi Oluwaseun, the ICT (information and communication technology personnel) who retrieved the data used for the study.
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Copyright © 2012 Akinsegun Akinbami et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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Consider the follow scenario. In Windows 7, you create a new simple volume in Disk Management or DiskPart.exe on a non-removable disk. If your Windows 7 system experiences a sudden power loss within a few minutes of volume creation, you may notice the volume you created before the power loss is inaccessible and is not assigned a drive letter when you power the system back on.
Additionally, in Disk Management the volume may not have a status (for example, "Healthy") or a file system type listed. If you try to modify the volume in Disk Management, you may receive the following error message:
The operation failed to complete because the Disk Management console view is not up-to-date. Refresh the view by using the refresh task. If the problem persists close the Disk Management Console, then restart Disk Management or restart the computer.
To have us fix this problem for you, go to the "Fix it for me" section. If you prefer to fix this problem yourself, go to the "Let me fix it myself" section.
Fix it for me
To fix this problem automatically, click the Fix this problem link. In the File Download dialog box, click Run and then follow the steps in the Fix it Wizard.
Microsoft Fix it 50651
Note This wizard may be in English only. However, the automatic fix also works for other language versions of Windows.
Note If you are not on the computer that has the problem, you can save the automatic fix to a flash drive or to a CD so that you can run it on the computer that has the problem.
Then, go to the "Did this fix the problem" section.
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If you are experiencing the issue described in the "Symptoms" section, reinstalling the volume will resolve the issue. Please follow these steps to reinstall the volume.
- Open Device Manager. You can access Device Manager by typing "Device Manager" or "devmgmt.msc" in the Start Search box.
- Once Device Manager is open, click on "Storage Volumes" to expand the Storage Volumes portion of the device tree.
- Under Storage Volumes, you should notice a volume listed as "Unknown device." Right click on this device and choose "Uninstall." When asked to confirm, choose OK.
- Restart the system if you are prompted to do so. The volume should be accessible once the system finishes restarting. If you are not prompted to restart the system, right click in Device Manager and choose "Scan for hardware changes." Once the scan is complete and installation of the volume completes, you will be able to access the volume.
Note: If the power loss occurs within a few seconds of volume creation, in rare circumstances you may be prompted to format the volume after you follow the above steps. If this occurs, the file system configuration was not written by the time the power loss occurred. You may need to reformat or recreate the volume.
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- Check whether the problem is fixed. If the problem is fixed, you are finished with this section. If the problem is not fixed, you can contact support.
- We would appreciate your feedback. To provide feedback or to report any issues with this solution, please leave a comment on the "Fix it for me" blog or send us an email message.


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Beijing To Offer Free Training To Medical Care WorkersOctober 27, 2009 | Print | Email | Comments | Category: Health, Labor
Chen Jing, a representative from Beijing Municipal Health Bureau, has told local media that Beijing will offer free training on a trial basis to medical care workers.
At present, most of the workers taking care of patients in hospitals are migrant workers who have not received any formal training and this has brought many potential problem for the hospitals' management — including safety issues. To address the problem, BMHB and Beijing Municipal Administration for Industry and Commerce have jointly issued a document which states free training and skills verification will be offered on a one-time basis to migrant workers who are engaged in taking care of sick people, and only those who have passed the exams and obtained the qualification certificate will be permitted to work as medical aides.
In addition, the document requires medical institutions to employ trained care workers and allocate them according to relevant standards.
The final timescales and details of where the trials will be undertaken are still under discussion.
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Metro Station 20 Proposal / ZNA
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Sofia's new Metropolitan Station 20 on line 1 connects the nearby historic city with a modern and developing city center. It creates an underground world inspired by the cities' culture and modern day aspirations. The design strategy by ZNA (Zeybekoglu Nayman Associates, Inc.) seeks to take advantage of the overlapping relationship between Obikolna Street and the proposed station below. The design of a centralized median, which moderates traffic, becomes the glass spine of the station. Composed of high angled walls in white architectural concrete the station is formed to capture natural light. More images and architects' description after the break. The sun penetrates down through sculptural skylights illuminating the entire station in a warm glow. The use of daylight as an architectural element assists orientation for passengers and provides a sense of security. It allows for the atmosphere of the station to be transformed by the color of the sky. Underground the station is efficient, easy to read and comprehend through its organized masses.
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Transcript Vice President of Programs - Council of Supply Chain Management
Vice President Programs
One CSCMP
Who Am I? What Makes Me Qualified to Discuss This Topic?
Robin Haddock Group Director Coca-Cola Refreshment Member CSCMP Atlanta Roundtable Prior roundtable secretary (2 years) Work Experience (34 years with Coca-Cola) United Steel Worker hourly associate Warehouse management Transportation management Production management Production scheduling Customer service management Marketing & Sales Business liaison, strategic planning Mid & Short term production, distribution & procurement planning SAP SME APO SNP, PPDS & ECC S&OP/S&OE process management
VP Programs Review Agenda
VP Programs: Role Responsibilities, Day in Life & Challenges US Industry Overview: Labor statics & projected growth are as Roundtable Programs Current State: Locations & programs trends Recommended Programs Calendar – Cornerstones of Supply Chain Management – Traveling Speaker Bank Cornerstones of Supply Chain Management
Vice President Programs Programs & Challenges Leader of Local Community leveraging a broad network of resources Relationships are key with community business leaders to help drive continued membership growth
Mission Statement
"To lead the Supply Chain profession by Connecting, Developing and Educating the world's Logistics and Supply Chain Management Professionals throughout their careers"
The role of Vice President of Programs is to facilitate the organization of roundtable programs that are relevant to local industry issues and audience interests. An important aspect of managing programs is insuring effective communications between the roundtable and each speaker. As a leader with the roundtable board, the VP of Programs is expected to attend all roundtable events and to support other roundtable board functions including membership growth and marketing.
For many roundtables, the Programs Officer is considered second-in-command to the Roundtable President, and is often a planned successor to the Roundtable President. With this future responsibility in mind, the Programs Officer is expected, in the Roundtable President's absence, to preside over and manage board events, as well as to support the Roundtable President as needed.
Establish an overall program for the entire roundtable year (based on the Supply Chain Cornerstones), spearheading the effort and leading the roundtable to the successful development and execution of a quality roundtable program and successful roundtable events.
Insure that budgetary constraints are observed; make sure that there is enough seed money to pay the deposit on an upcoming event & make sure that events do not incur losses, or that the roundtable board is aware of an expected loss in revenue.
Manage Programs Committee/Team, recruit event coordinators who are then each responsible for managing a single event. Work with the Roundtable President to promote required CSCMP Membership to the local roundtable board. Verify the membership status of current board members and communicate the renewal process for Roundtable Board members to receive the Board membership rate. Promote membership to non-member committee members.
Attend and actively participate in all Roundtable Board meetings, Roundtable Events, and the CSCMP Roundtable Leadership Forum.
Typical Duties
Establish the program schedule based on the Supply Chain Cornerstones for the entire roundtable year. This should include preparing a back-up speaker/topic/event to replace a speaker who has to cancel at the last minute.
Ensure that speakers are identified, contacted, and committed. Several details of the event should be communicated in writing to the speaker, including: content, audience, attendance & event schedule.
Day of event: make sure that the speaker has transportation and directions to and from the event, make sure the event starts & ends on time, thank speaker as event closes and follow-up with thank you letter. Develop strategies for ensuring program material stays audience relevant and current with changes in the business & market dynamics.
Share best practices & feedback on speakers and tours with other VP's of programs.
Current Roundtable Program Challenges
Open Discussion
What is working??
What are the challenges??
Ability to secure speakers???
Ability to secure tour locations??
Are you having trouble keeping the momentum going?? Keeping it fresh and aligned with ever changing US economy and labor requirements
Atlanta Feedback
The greatest challenge is matching up the quality of the speaker with the quality of the speakers "brand". Coke, Home Depot, UPS, and Georgia Pacific can always fill a room but the world supply chain is so much larger than just those in Atlanta.
Creating a buzz and interest for small names but quality content is tough.
The other challenge is competing with the internet. In this day and age, our "competition" is no long just WERC or APICS or the local Traffic club, but can be a blogger or university 800 miles away. How do we convince an audience that a topic heard in person provides greater value than one read from the convenience of an office or team meeting. The interaction of the network (more than just shippers bombarded by service providers) has to be something people see as tangible and real.
Reflect on the value you are adding
VP Programs – Day in the Life
CSCMP VP Programs Attend Program Network Review Emais Deal with crisis Du Jour Confirm Speaker or Tour Venue
Day in Life
Look Ahead to the next event Follow up Calls Check Registration Status
US Industry Overview
US Department of Labor: Bureau of Labor Statistics
Projected Job Growth Markets
"Made in America" Again
Recent articles in conflict to US Department of Labor future state statistics indicating a 0.5% reduction of manufacturing jobs
Roundtable Programs Current State
One CSCMP
47 Active Roundta
Over 4,100 members
Twin Cities Roundtable Atlanta Roundtable Cabinet Kansas City Heartland Roundtable Cincinnati Roundtable Southern California Roundtable San Diego/Baja Roundtable Columbus Roundtable Philadelphia Roundtable Chicago Roundtable New England Roundtable Dallas/Fort Worth Roundtable St. Louis Roundtable Charlotte Roundtable Baltimore Roundtable Middle Tennessee Roundtable Eastern Michigan Roundtable Upstate South Carolina Roundtable Central Florida Roundtable Jacksonville Roundtable Puget Sound Roundtable Arizona Roundtable Cabinet Lehigh Valley Roundtable New Jersey Roundtable South Central Pennsylvania Roundtable Raleigh Roundtable Mid-South Roundtable New York City Roundtable Northeast Wisconsin Roundtable Northern Nevada Roundtable Cleveland Roundtable National Capital Area Roundtable Indianapolis Roundtable Savannah/Hilton Head Roundtable Milwaukee Roundtable Ozark Roundtable Cabinet Central Virginia Roundtable South Florida Roundtable NYCONN Roundtable Spain Roundtable Western Michigan Roundtable Mumbai Roundtable Peoria Roundtable Rocky Mountain Roundtable Utah-Idaho Region Roundtable
Roundtable Events 2013 – 2014 YTD
Supply Chain Concepts
4 4 3 5 3 4 5 1 3 8 2 5 2 1 1 1 1 1 2 4 1 2 4 1 2 1 1 4 4 1 1 1
Demand Planning
Procurement & Supply Manufacturing & Service Management
1 1
1 3 3 1 2 1 1 1 2 3 1 1 1 1 2 2 1
3 3 4 5 4 2 2 3 3 2 6 4 3 6 2 1 2 1 2 2 4 4 1 3 1 1
Inventory Management
Warehouse Management
2 1 4 1 2 1 1 4 2 4
Order Fulfillment & Customer Relationships Networking
1 1 7 1 2 1 1 1 2 1 1 1 3 1 2 6 3 1 1 4 1 2 3 2 1 2 1 2 6 1 1 1 2 2 2 2 3 4 1 4 1 1 1 1 2 1 1 2 2 1 1 2 2 1 8 4 4 2 1 1 1 3 2 1 1 4 2 2 1 1 1 1 2 1 1 1 1 1 1 9 9 9 8 6 6 4 4 12 12 7 5 4 4 3 3 2 2 2 1 1 1 1
Total Events
12 19 15 14 14 12 11 9 18 18 15 12 11 10 9 8 8 7 7 7 10 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1
Cornerstone Balance
6 5 5 5 5 5 5 5 4 4 4 4 4 4 4 3 4 4 4 4 4
Recommended Programs Calendar
August 15: Schedule of Actives Due
Set the complete annual calendar in July to ensure a successful and well budgeted program year Be Sure to Have a Theme!
SCPro Education: Level One Certification
The Cornerstones of Supply Chain Management Education is defined within the 8 learning blocks of SCPro Level One Certification
Supply Chain Management Demand Planning Procurement & Supply Management Manufacturing and Service Operations Transportation Management Inventory Management Warehousing Management Order Fulfillment and Customer Service What is the value? Today's supply chain is complicated and requires diversity of thought and strategy for a supply chain professional to be successful!
Why the 8 Learning Block recommendation?
Ensure the balance of focus across all disciplines of the supply chain & attract members from each of those critical areas. SCPro ™ Professional Certification Program is a CSCMP strategic initiative
Roundtable Purpose:
Forum for Supply Chain professionals to connect with one another and develop their own skills through interaction with other volunteer members of the roundtable. Deliver the value of the mission statement to the local community Attract new members – each supply chain disciplines – my experience & vision The annual programs calendar is the ideal forum to explore beyond the traditional focus on transportation/warehousing & to broaden roundtable memberships by drawing in members from the under represented disciplines.
CSCMP – Event Calendar
Cornerstones of Supply Chain Management Process Flow
Networking Social Networking Tour or golf outing
(1 ) Supply Chain Concepts
(2) Demand, (3) Procurement & Supply Management
Manufacturing & Service Operations (4) Guest Speaker Guest Speaker * Operations VP or Director accountable for end to end supply system. Able to connect supply chain with business unit *Demand planning or Supply VP/Director accountable for S&OP processes & the importance of integrating the supply chain partners Plant Tour *Facility history and capacity overview. Explanation how plant is guided on production requirements needed to fulfill customer requirements
Transportation Land, Air & Sea (5)
(6) Inventory & (7) Warehouse Management Guest Speaker *VP or Director of transportation accountable for freight procurement, tendering & carrier relationship management Warehouse Tour *Facility history overview. Explanation of inventory policy & how product is efficiently received, stored and shipped & review of KPIs.
(8) Order Fulfillment & Customer Relationships Guest Speaker *VP or Director of Customer Care accountable for "perfect order" & supporting sales in maintaining customer satisfaction
Networking Social Networking Tour or golf outing
Traveling Speaker Bank Concept: Leverage members of CSCMP who travel, can speak on the various Cornerstone topics & can coordinate their future travel schedule in advance synchronized with Roundtables programs calendar.
What is needed to execute? Formalize programs event calendar Data base of qualified speakers Coordination between roundtable & speaker Contingency plan if travel plans altered Benefits to CSCMP & Speaker Networking across roundtables Knowledge sharing of new Cornerstone concepts
Name Position Company Subjects
Rob Haddock Group Director, Supply Planning Coca-Cola Refreshments Supply Chain Concepts, Demand Procurement & Supply Management
Presentation Length Frequent Travel Destinations
30 -45 minutes Florida, Houston, California
The Eight Learning Blocks of Supply Chain Management
Supply Chain Concepts
Interest in supply chain management, both in the private and public sectors, has grown rapidly over the last two decades. Leading organizations now recognize the positive outcomes — enhanced competitive strategy, increased market share, and greater shareholder value — that can be achieved through effective supply chain management.
These organizations are taking steps to achieve a competitive advantage through supply chain management, and they need skilled individuals who can design, execute, and manage their supply chains. For these individuals, skill development begins with having a solid foundation of knowledge in supply chain management concepts and principles.
Demand, Procurement & Supply Management
Sales and operations planning (S&OP) is a decision-making process to balance supply and demand by integrating demand and sales forecasts with operational plans from suppliers, production, and logistics. The goal of the S&OP process is to integrate demand forecasts with capacity forecasts so that the supply chain operations are integrated with the marketing and sales functions. Demand planning is a key step in the sales and operations planning process. The demand plan specifies what should be sold and when given the organization's supply capabilities and constraints. The goal of demand planning is to estimate orders for products and services over some future time period using information such as historical sales data, information about planned promotions, and market intelligence. Demand forecasting is a key step in the demand planning process. Strong relationships with trading partners can be developed through successful supplier relationship management programs and supply management processes that integrate the procurement function with other internal functions and external supply chain partners. These relationships can be the key to increasing the efficiency and effectiveness of several supply chain business processes. The purchase of materials, work-in-process, finished goods, and services by the procurement function is a critical business process within all supply chain operations. The procurement processes can provide organizations with a sustainable competitive advantage through lower costs, higher quality, and better service for both internal and external customers.
Manufacturing & Service Operations
To be successful in manufacturing and service operations, managers should possess both technical and behavioral skills. They should apply these skills to achieve improved transformational processes and outputs in operations management contexts throughout the supply chain. This includes manufacturing, warehousing, and all related business service processes, such as inventory management and customer service
Transportation – Land, Air & Sea
Transportation involves the physical movement of people and goods between origin and destination points.
From a business standpoint, transportation links geographically separated partners and facilities in an organization's supply chain — customers, suppliers, channel members, plants, warehouses, and retail outlets. Whether by truck, train, plane, ship, pipeline, or fiber optic wire, transportation facilitates the creation of time and place utility in the supply chain.
Inventory & Warehouse Management
Inventory management is focused on determining how much inventory to carry across the supply chain, where to carry it, and how much safety stock is required to meet the organization's cost and customer service objectives. The management of inventories will depend upon the value of the product, the cost to carry the product in inventory, the variability of demand and lead time, the cost of stocking out of the product, the number of locations where inventory is held, and the importance of the product to customers. Warehousing is a critical logistics function that manages the storage and handling of materials, work-in-process, and finished goods within supply chains. The warehousing function provides economic benefits, such as transaction efficiencies and the consolidation and breaking bulk of inventories. It also plays a critical role in meeting customer requirements for the timely delivery of goods and services. This is accomplished through value-added services and fulfillment processes, while at the same time efficiently managing inventory costs.
Order Fulfillment & Customer Relationships
Order fulfillment is the complete process from point-of-sale inquiry to delivery of a product to the customer to returns processing. In the broadest terms, it refers to the way organizations respond to customer orders. Order fulfillment is a crucial process since it is the last link in the supply chain. It may be the only direct contact some organizations have with their end customers, and it can make or break an organization's reputation with its customers. Customer service is a series of activities designed to enhance the level of customer satisfaction. Satisfaction is based on the feeling that a product or service has met or exceeded the customer's expectations— before, during, and after a purchase.
Key Message
doing what you are doing in the area of Transportation, Warehousing, Networking & Supply Chain Concepts.
on the importance of Inventory Management when the program topic or tour is warehousing.
to include 1 event focused on Demand, Procurement & Supply Management.
National office for program ideas to fill tour & speaker gaps (speaker bank)
SCPro CSCMP Certification
Leveraging the programs calendar to provide exposure to all faucets of the supply chain: 1. Supply Chain Concepts 2. Demand Planning 3. Procurement and Supply Management 4. Manufacturing and Service Operations 5. Transportation 6. Inventory Management 7. Warehousing 8. Order Fulfillment and Customer Relationships What is the Value? Today's supply chain is complicated and requires diversity of thought and strategy for a supply chain professional to be successful The annual programs calendar is the ideal forum to explore beyond the traditional focus on transportation/warehousing & to broaden roundtable memberships by drawing in members from the under represented disciplines


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Polycystic Ovarian Disease is a hormonal disorder resulting in enlarged ovaries and cyst formation. PCOS disease develops either early in life during teenage or later during adulthood. It is difficult to identify PCOS because of undefined causes and several symptoms. Many women fail to understand the severity of PCOS and subsequently it is left untreated.
With the rate of prevalence of PCOS is growing, it is vital that one is completely aware about it. Being completely aware about the condition is very important. Every woman should know the following 5 things about PCOS.
1. It is quite common: PCOS is a health problem that affects 1 in 5 women The prevalence of PCOS is higher in younger women and also correlated to a sedentary lifestyle. Factors like stress, genetics, unhealthy diet and erratic diet patterns may also lead to PCOS.
2. Can be controlled: PCOS is a hormonal disorder that can be controlled with natural remedies. One can try a combination of herbs like Shilajit, neem, and devdar. The anti-inflammatory property of these herbs reduces inflammation (symptom of PCOS) and aids regulation of estrogenic level of the body. Along with this, one can practice yoga to release the anxiety and stress caused by PCOS disease.
3. No Identified cause: The exact cause of this hormonal disorder is still unknown. However, doctors believe that many factors like genetics, unhealthy lifestyle choices and diet play a role in the occurrence of PCOS. Other possible causes include excessive prenatal exposure to androgens (male hormones) and insulin production.
4. One may face only a few symptoms: Not all women suffering from PCOS experience all symptoms. One may experience different symptoms depending on age, lifestyle choices, diet and environmental conditions. The severity of the symptoms may also vary from mild to extreme.
5. May lead to other health issues: PCOS is a serious health issue. If left untreated, the hormonal imbalance may affect the overall health. Women are at a risk of developing type 2 diabetes, obesity, Hirsutism (facial hair) and Alopecia (baldness). It has now become imperative for one to undertake a healthy lifestyle to reduce the PCOS symptoms and avoid further complications.
PCOS is a very common hormonal disorder and ironically one of the most underdiagnosed disorders as well. It is a serious health issue and one must understand there is a silver lining to it thus, preventive action is critical. With certain changes in one's lifestyle this disorder can be managed. Nurturing health with smart daily choices will help to balance the hormones and protect against major health risks of this disorder.


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Cara Trust has merged with River House Trust,
please visit www.riverhouseuk.org
Welcome to Cara Trust
We're here to try and make life better for people with HIV who might need a little extra help…so we target our limited resources on those people who need us the most – whether that's down to poverty, ill-health, isolation or old age. We think it's important to remember that, whilst many people with HIV are now able to work and live relatively unaffected lives, there remain a significant number for whom that's not the case, and for whom daily life can be a real struggle. On top of that, HIV remains a deeply stigmatised condition, which can lead to discrimination or worse.


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Best Western Plus Dockside Waterfront Hotel: 2105 Hotel Reviews
- Mackinaw City Hotels
- Best Western Plus Dockside Waterfront Hotel: Hotel Reviews
- Traveler Review #4625
Best Western Plus Dockside Waterfront Hotel
Traveler reviews
114 rooms on property
Hotel Website
Best Western Plus Dockside Waterfront HotelAAA rating
Traveler reviews
505 South Huron AveToll-Free: 800-944-1615
Mackinaw City, MI 49701
Mackinaw City, MI 49701
114 rooms on property
Hotel Website
FREE Wi-Fi
FREE Breakfast
FREE Indoor Waterpark
Make a Reservation Write a ReviewLakefront Rooms with private European style balconies. Close to Mackinaw Crossings, featuring free nightly laser show, concerts, live theater. Adjacent to Mackinac Island Ferry Docks & Restaurants. Free 25' Breakfast Bar. High Speed Internet Access, Indoor Pool & Oversized Whirlpool. Unlimited access to new waterpark across street. Honeymoon suites with heart-shaped jacuzzis. Hair Dryers, Irons, Boards, Air Conditioning, Color TV with HBO. In room coffee.
- #2
- of Mackinaw City Hotels from Traveler Reviews
The Best Western Dockside has earned the highest AAA rating in Mackinaw City for quality and service. We are conveniently located adjacent to Mackinac Island Ferry Service and across the street from the main shopping district.
Our luxurious lake front rooms, extravagantly decorated, overlook the beautiful Straits of Mackinac and Lake Huron. Each has a private balcony.
Best Western Plus Dockside Waterfront Hotel is rated 4.5 out of 5 based on 2105 user reviews.
Traveler Review
Best Western Dockside Inn is the Best Hotel My Wife and I Had Stayed atTraveler Rating: 5 out of 5 stars
Best Western Plus Dockside Waterfront HotelBest Western Plus Dockside Waterfront #4625 stayed June 2012. Gerald from Sterling HeightsBest Western Dockside Inn is the best Hotel my wife and I had stayed at. We have been going up to Mackinaw City for the last 5 years trying new Hotels each time, we finally found a Hotel that we will return to. The staff is outstanding, everyone made our stay pleasent from the time that we checked in to the time we left. The women in the check-in office greeted us with smiles and energy and even let us check in a little early, they explain everything to us that the hotel had to offer and were more then helpful with any questions we had. The cleaning staff walked around with smiles and always said hi, we needed an ironing board and my wife seen a maintenance guy and asked him ( im thinking she should be asking the cleaning crew to my surprise he said he would find one ) two min later we had an ironing board. Rooms look very nice larg flat screen on the wall very clean, beds and blankets and pillows made you want to sleep in all morning, we had a room on the lake patio was nice size for sitting and drinking coffee I liked their locks on the patio doorwall we were able to leave it partily open and still have it locked so we could listen to waves of the water at night. The beach is awsome, the swimming pool and the jacuzzie was very relaxing and clean. The breakfast bar was simple but filling if you decided to eat there. I could go on and on. I dont normaly write reviews but I felt the Dockside Inn deserved it. Cant wait to go back next year. Did I mention it is also the closest hotel to all the restraunts and shopping, yes that was a bonus to walk hand and hand with my wife most everywhere we went.
Reason for staying: visiting the area


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Design Review ProcessPosted by LDDA on Jan 9, 2017 in Permits | Comments Off on Design Review Process
DESIGN REVIEW PROCESS – PDF Version HERE
1. Applicant must determine if subject property is located within the Downtown Area outside the Munn Park Historic District (Lakeland Downtown Development Authority Boundary: SEE MAP
2. Call (863) 687-8910 or meet with Lakeland Downtown Development (LDDA) staff to determine what type of review is necessary, outline the design review process and application and determine the anticipated approval schedule. Please see document "When do I need a Certificate of Review?"
3. Complete and return a Certificate of Review Application to the LDDA along with the following attachments, if they apply:
Site plan that shows the location of the structure including setbacks, existing and proposed construction, mechanical equipment if located outside, retention ponds (if required), sidewalks, access and driveways, parking, fencing and signage.
Architectural elevations or photo simulation or other drawings that show all four elevations of the proposed building or project.
Provide material samples and/or specification sheets of:
A. Overhangs, roofing material, brackets and other architectural features
B. Siding materials, exterior trim, paints and finishes
C. Specifications and photos of windows and doors
D. Column and porch details
E. Details of roof vents, chimneys
Information regarding zoning, setbacks and variances which may apply to this project.
4. Meet and consult with LDDA staff to review the application and attachments for consistency with the Design Guidelines and for a determination of readiness to proceed to the LDDA Design Review Committee.
5. When ready, the LDDA Design Review Committee shall meet with the applicant or the applicant's agent who shall be prepared to present the project. Questions will be directed to the applicant or the applicant's agent. Based on the Certificate of Review Application, associated materials, previous meetings, the presentation and question/answers, the Design Review Committee will vote on the project.
6. If Applicant's project is approved, a copy of the Certificate of Approval will be forwarded to the Applicant if desired. Application denials will include an explanation of the Design Review Committee's assessment of the deficiencies of the project.
7. Approved Certificates of Review will be sent to the Building Official and placed on file in the LDDA Office.
8. The Applicant or the Applicant's Agent shall submit plans to the City of Lakeland's Building Division for a permit (First Floor of City Hall). Plans will be checked by the Building Inspection Official to confirm that plans for permit are in accordance with the Certificate of Review.
9. Certificates of Review expire one year after the date of Committee approval or building permit application; whichever comes first. Once a Certificate of Review has expired, the LDDA Design Review Committee must review the project again.
10. Complications or unforeseen conditions during construction that force changes to the approved design outlined in the Certificate of Review must be reviewed and re-approved by the City and possibly the LDDA Design Review Committee.


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Kissy JRPG Exstetra Gets Box Art, New Screenshots
FuRyu just released the box art for both the PS Vita and the 3DS versions of its upcoming JRPG Exstetra, that will be released in Japan on November the 7th.
We also gets three new screenshots, showing a pre-battle scene and two of the characters that still haven't been fully detailed: Akari and Kotone. Of course, given the theme of the game, there'll probably be a lot of kissing going on with them as well.
You can check out all the assets below.


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- iPhone
- iPad
- iPod
- Watch
- Macbook
- Galaxy Note
- Galaxy S
- Galaxy A
- Galaxy J
- Samsung - Other Models
- htc
- K Series
- Stylo Series
- G Series
- V Series
- LG - Other Models
- All LG Replacement Parts
- oneplus
- Droid Series
- Moto G Series
- X Series
- Z Series
- E Series
- Kindle Fire
- Asus
- Huawei
- Essential
- Tablet
- Console
Galaxy Note 8.0 Replacement Parts
Although it may be tempting to replace the entire device, this can be expensive, and there is a much more affordable option available right here at RepairsUniverse. We offer screen replacements and repair parts for the Samsung Note N5100 that can restore your device to just like new again for a much lower price than a new Note N5100. All of the Samsung Note 8.0 N5100 screen repair and replacement parts shown below are available in stock and will be shipped within 24 hours of your order. Browse our selection and choose the part that will work best to restore the damaged screen on your Note 8.0.
When you purchase any screen replacements or other repair parts for your Samsung Note 8.0 N5100 from RepairsUniverse, you will also receive a free safe open pry tool with your order. This plastic tool will assist you with safely taking your device apart so you can install the new screen without difficulties. Be sure to also check out our Samsung Note 8.0 accessories and repair tools before placing the order so you can purchase everything you need at once.


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Chrissy Teigen is embracing everything about her post-baby body - especially her stretch marks!
While stories about supermodels daring to flaunt their "imperfections" inspire little more than an eye-roll from us mortals, we'll admit it is refreshing to receive the occasional reminder that stretch marks are a totally normal part of life.
Chrissy Teigen seems to get this, rejecting the praise she received for a recent stretch mark selfie, admitting she actually just "likes the pattern".
"I do not post stretchies [sic] for the praise. I post it because the wine," Chrissy said, admitting she was not exactly "sober" when she posted the photo.
"Also, I like the pattern and they're so soft."
Whatevs pic.twitter.com/D67Qtt12gv— christine teigen (@chrissyteigen) January 19, 2017
The 31-year-old model's nonchalance towards her "stretchies" has nonetheless excited other women who too have embraced this part of their bodies.
"Stretch marks develop when tremendous growth happens in a short period of time," one Twitter user responded. "They're a source of pride, embrace them."
"Stretch marks are strength marks," another wrote.
Chrissy and her husband, John Legend, welcomed their first child, Luna, in April last year.


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In Teenage Mutant Ninja Turtles: Amazing Adventures, Chris Bradford, formerly also known as Dogpound and now also known as Rahzar, is a former human and twice-mutated mutant akita inu. He is also a ninja in the service of Oroku Saki and the Foot Clan.
This version of Chris Bradford is branched off from his original version in the 2012 TV series. His history before the events of Amazing Adventures is the same as that of his animated version.
In "Zodiac", Bradford is one of several mutants brainwashed by the Zodiac Key in the service of Tetsumi Onamota, who calls himself Zodiac. The same thing happens to Anton Zeck, Tiger Claw and Karai, and they all leave the Foot Clan. This prompts the Shredder to get them back, mainly because Karai was among those stolen from him. Splinter and the turtles manage to break the Zodiac Key, causing Tetsumi to vanish and restoring everyone to their own senses, including Bradford. The Shredder orders Bradford and Tiger Claw to grab Karai and escape with a smoke bomb.
In "Instru-Mental", it is revealed that a young Bradford co-starred with the members of rock band "Glamourshok" in a failure of a film titled First Grade Fireman. At the end of the story, a stereo is thrown into Foot Headquarters and Rahzar approaches it, turning it on and enjoying the music within, before Baxter Stockman warns him to destroy it before Shredder hears it. Rahzar does so, but he keeps the tape (labeled "Shellshok") for himself.
- The Shredder calls Bradford "Rahzar." This is different from the TV series, where the Shredder always called him "Bradford" and never "Rahzar."


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Jan. 23 (UPI) -- Some 3,000 years after he died, Nesyamun, an ancient Egyptian priest, is uttering vowels. The sounds aren't coming from the mummified priest himself, but from a computerized voice box.
To best understand what Nesyamun would have sounded like, researchers in Britain used CT scans to image and measure the dimensions of his voice tract. Scientists then used the images to build a 3D-printed model called the Vocal Tract Organ.
Scientists combined the 3D voice box with an artificial larynx, commonly used for artificial speech, to produce a vowel-like sound similar to the baa of a sheep.
"I was demonstrating the Vocal Tract Organ in June 2013 to colleagues, with implications for providing authentic vocal sounds back to those who have lost the normal speech function of their vocal tract or larynx following an accident or surgery for laryngeal cancer," David Howard, professor at Royal Holloway, University of London, said in a news release.
Howard was approached by John Schofield, professor of archaeology and cultural heritage at the University of York, about using the technology to investigate the voices of the past.
The researchers settled on Nesyamun as their first subject. The mummified priest's vocal box was surprisingly well preserved.
Howard and Schofield described their effort to bring Nesyamun's voice back to life in a new paper, published Thursday in the journal Scientific Reports.
"It has been such an interesting project that has opened a novel window onto the past and we're very excited to be able to share the sound with people for the first time in 3,000 years," Howard said.
Nesyamun served at a state temple of Karnak in Thebes during the reign of pharaoh Ramses XI, who ruled from 1099 to 1069 BC. Nesyamun and his vocal tract would have been required to sing as part of his daily duties as a state priest.
"The voice is such a significant part of being human, and every voice is distinctive," Schofield said. "As an archaeologist, the opportunity of recreating a voice from the past with greater accuracy than has even been done before was an exciting and unexpected prospect."
In addition to exciting scientists, the new technology could offer a fresh way to engage with and excite visitors to museums. Visitors to the Leeds Museum where Nesyamun is on display will not only get to see the ancient Egyptian, but also hear what he sounded like.


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Hot bikini photos of Shonali Nagrani, the former Miss India International in 2003 and Bollywood actress. Shonali was one of the Top 5 Femina Miss India and first runner-up of Miss International 2003.
Shonali has appeared in a number of Indian television programs.She has hosted Popcorn on Zoom TV. She was host of the Great Indian Laughter Challenge on Star One, host of Mr. and Ms. TV on Sony, and host of Filmy Cocktail on Filmy channel, BSNL present DUMDAAR HITS on Sony TV. She has anchored the show Ponds Beauty "Salaam-E-Ishq" on Star one.
Shonali's other work includes co-hosting of 2010 T20 World Cup show on ESPN-Star Sports, Extra Innings T20 in MAX for the DLF IPL T20 Tournament. She has also hosted Cricket World Cup matches in South Africa.
Her movie appearances include a role in Rab Ne Bana Di Jodi (2008), Pyaar Ka Funda(2009). She can be seen on Colors for Khatro Ke Khiladi season 2.
Shonali also appeared in Yash Chopra's film "Dil Bole Haddipa".


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Intervention: The Battle for Better Business [Paperback]
By Elliot H. Forte (Business Think)
Amazon Price: £7.50*
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* Please note, this is the RRP set by the author excl. shipping. However, the purchase price may fluctuate slightly due to Amazon's price tracker policy.
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You will need to supply contact details only to initiate the file download, which can then be read on most devices and computers. If you have any questions, please email email@example.com
File Format PDF | File Size 3MB Register for Free Download


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Ohana is a photo of kenstock author. This photo includes Ohana, Dolls, Hinamatsuri, Hina doll, Hina doll tags. To download photo (S, L, M sizes) you need to register the account and log in.
As the free account, you can download for free with some limits.
As the premium account, you can download unlimited, no waiting time, etc. Enjoin premium membership at here


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From German Intersexe; corresponding to inter- + sex.
- (General American) IPA(key): /ˈɪntɚsɛks/
- (Received Pronunciation) IPA(key): /ˈɪntəsɛks/
intersex (plural intersexes)
- Any of a variety of innate conditions (in a dioecious species) whereby an individual has sex characteristics which differ from those of a typical male and female; for example, the state of having physical features of both male and female sexes; intersexuality.
- 1953, Time, 23 Feb 1953:
- A Canadian believes that he has solved the diagnostic problem in human intersex. All human cells, says Dr. Murray L. Barr of the University of Western Ontario, contain something called sex chromatin.
- 2003, Andrew J Lawrence et al., Effects of Pollution on Fish, page 204:
- A much more common condition caused by early exposure of fish larvae to oestrogenic substances is intersex, which in males usually takes the form of ovotestis.
- 2007, Catherine Harper, Intersex, Berg (→ISBN), page 129:
- The British Association of Paediatric Surgeons Statement (2001) indicated that among the range of intersex conditions that particularly present with genital ambiguity are 'true hermaphroditism' and gonadal dysgenesis.
- 2008, Emine Saner, The Guardian, 30 Jul 2008, G2, page 12:
- It is thought that around one in 1,000 babies are born with an "intersex" condition, the general term for people with chromosomal abnormalities.
- 1953, Time, 23 Feb 1953:
- (biology, zoology) An individual with any of these conditions.
- 1948, Alfred Kinsey; Wardell Baxter Pomeroy, Clyde Eugene Martin, Sexual behavior in the human male, page 659:
- Goldschmidt and others who have thought of the homosexual individual as an intersex have relied upon incidence figures which were pure guesses and which, as the data in the present chapter will show, bear little relation to the fact....
- 1955, Curt Stern, (Please provide the book title or journal name), page 374:
- Conversely, a fertilized egg with one X-chromosome would develop not into a male but into an intersex [...].
- 2003, Peggy Tine Cohen-Kettenis; Friedemann Pfäfflin, Transgenderism and intersexuality in childhood and adolescence, page 155:
- Genital surgery on intersexes has been performed for about a century
- 2009, Mary C Smith & David Sherman, Goat Medicine, page 609:
- An intersex, then, is an animal that shows both male and female characteristics.
Usage notes[edit]
- Since about the turn of the millennium (2000), the adjective intersex and noun phrase intersex person have been preferred to hermaphroditic and hermaphrodite as being more appropriate when the referent is human. The noun intersex has also become more common than intersexuality.
condition — see intersexuality
- The translations below need to be checked and inserted above into the appropriate translation tables, removing any numbers. Numbers do not necessarily match those in definitions. See instructions at Wiktionary:Entry layout § Translations.
Translations to be checked
intersex (not comparable)
- (of an individual) Having an intersex condition.
- 2006, Alice Domurate Dreger, "Intersex and Human Rights: The Long View", in Sharon E. Sytsma (editor), Ethics and Intersex, Springer, →ISBN, page 81:
- If you would not obfuscate the medical history of a person who was born without intersex, then you ought not to do so when dealing with a person born intersex.
- 2006, Dean Spade, "Compliance Is Gendered: Struggling for Gender Self-Determination in a Hostile Economy", Paisley Currah et al. (editors), Transgender Rights, University of Minnesota Press, →ISBN, page 225:
- His confidentiality was broken, and soon the entire staff and residential population were aware that Jim was intersex. […] we faced the fact that most programs were gender segregated and would not be a safe place for Jim to be known as intersex.
- 2010, Sean Saifa Wall, "I am the 'I'", in Kate Bornstein and S. Bear Bergman (editors), Gender Outlaws: The Next Generation, Seal Press, →ISBN, page 109:
- When I had learned that I was intersex, I brought this issue to my mother.
- 2010, The Age, 3 Jun 2010:
- A survey of 1100 lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) people by Griffith and Bond University researchers found that the overwhelming majority had been victims of targeted harassment as well as physical and sexual abuse.
- 2006, Alice Domurate Dreger, "Intersex and Human Rights: The Long View", in Sharon E. Sytsma (editor), Ethics and Intersex, Springer, →ISBN, page 81:
- intersexed
- intersexual
- (sometimes offensive): hermaphroditic, hermaphrodite
- (clinical, sometimes offensive): pseudohermaphroditic, pseudohermaphrodite
- (on forms and documents): indeterminate, X
Derived terms[edit]
having an intersex condition
intersex (third-person singular simple present intersexes, present participle intersexing, simple past and past participle intersexed)
- (nonstandard) To make intersex.
- 2013, Patrick Colm Hogan, Ulysses and the Poetics of Cognition (→ISBN), page 176:
- The point is significant in light of current political issues surrounding real intersexed individuals. [...] It is clearly the case that physical intersexing and psychological androgyny do not conform to sex and gender norms in society. [...]
- Synonym: intersexualize
- 2013, Patrick Colm Hogan, Ulysses and the Poetics of Cognition (→ISBN), page 176:
to make intersex
See also[edit]
- English terms borrowed from German
- English terms derived from German
- English words prefixed with inter-
- English 3-syllable words
- English terms with IPA pronunciation
- English lemmas
- English nouns
- English countable nouns
- English terms with quotations
- en:Biology
- en:Zoology
- English adjectives
- English uncomparable adjectives
- English verbs
- English nonstandard terms
- en:Gender
- en:Intersex
- en:Sex


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Through the ELCA Pension and Other Benefits Program, Portico strives to empower members to live well for life — physically, financially, and emotionally. By living well as whole people of God, we can better enhance the lives of others — doing God's work in Christ's name for the sake of the world.
The Wholeness Wheel reflects our call to care for our whole self. By balancing the interconnected dimensions of well-being, we are able to live well in Christ and pass on our faith.
Use the Wholeness Wheel to improve your well-being
Wellness Voices >>
Please correct the errors on this page to continue.
We're called to make the most of all we have been given. That's one reason the stewardship team at Lutheran Church of the Holy Spirit, Emmaus, Pennsylvania, took the lead in planning a year of activities to encourage health and wellness in their congregation.
Lorie Stout Sherman
Emmaus, Pennsylvania
July 2017
Stewardship is a year-round activity encompassing much more than a fall giving campaign and budgetary dollars. Our stewardship is an expression of thanks and appreciation to God for all that has been entrusted to us. That includes not only being good stewards of our time, talents, and treasure, but also good stewards of the earth and good stewards of our physical, emotional, and spiritual selves.
That's why the Stewardship Team at Holy Spirit chose to spend a year encouraging our people to live well, grow in well-being, and become good stewards of their personal selves. We worked with our Adult Faith Formation Team, Faith Formation for Children Team, and parish nurse and her action group to champion these intergenerational activities:
We were intentional about choosing activities that would engage members of all ages and physical abilities. The focus is to live well, so we can be good stewards of our selves. By living well as a whole people of God, we can better enhance the lives of others — doing God's work in Christ's name for the sake of the world.
This submission describes a personal perspective and may or may not reflect the experience of others..
Share your Wellness Voice at firstname.lastname@example.com
The Wholeness Wheel
Join us on Facebook
Phone 800.352.2876
A Ministry of the ELCA
Plan member rights under the plans are governed by the plan documents, which are the full, legal descriptions of the plans. If any of the information on this page is inconsistent with the corresponding plan document, the plan document is the controlling document.
© 2020 Portico Benefit Services
Learn about changes to your health benefits and how easy it is to enroll online.
If you plan to enroll in a 2013 health care or dependent (day) care flexible spending account (FSA), you must enroll online.


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Maudie's Tex-Mex shares their family-friendly recipe that will satisfy hungry tummies and keep everyone at the table happy.
Flautitas de Pollo
Makes 30 flautitas
Flautita Chicken Filling:
- 1 ¼ C Diced Onions
- 1 ½ Tbsp Finely Diced Serrano
- *can be omitted or reduced
- 2 ½ C Diced Tomatoes
- 1 ¾ lbs Shredded Chicken
- 1/3 C Chicken Stock
- 4 tsp Oil of your choice
- 4 oz Shredded Jack Cheese
- Salt and Pepper to taste
For Flautitas:
- 30 4" Corn Tortillas
To Make the Filling:
- In a saucepan over medium heat, sauté onions in oil for 1-2 minutes then add serranos and cook for 2 more minutes until soft.
- Add diced tomatoes, sauté for 2 more minutes
- Add shredded chicken and stir. Add stock and salt and pepper to taste. Bring to a boil.
- Once chicken is hot, place into a strainer to drain off excess liquid. After chicken is drained, place it in a pan to cool.
- Once chicken is cool, add the jack cheese.
To Make the Flautitas:**
- Rub tortilla with a little oil and place 1.5 oz of chicken along middle of tortilla.
- Roll up tightly and secure with a toothpick.
- In saucepan, heat oil to 350° and fry flautitas for 4-5 minutes until crispy.
- Serve on a bed of shredded lettuce, topped with a sprinkle of cotija cheese, cilantro and pickled red onions. Dip in Maudie's Tomatillo Avocado Sauce or your favorite dipping sauce.
- **For a healthier version, place flautitas on a foil-lined baking sheet. Bake at 400° for 15 minutes, turning once, until desired crispiness.