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Most children with JIA will require referral for regular slit lamp screening examinations. Poorly controlled chronic anterior uveitis may result in permanent eye damage, including blindness. Systemic JIA: children with the Systemic JIA subtype often experience extra-articular manifestations including fever, rash, enlarged lymph nodes, enlarged liver or spleen, serositis and anaemia. Complications JIA is a chronic disorder, which if neglected, can lead to serious complications. However, with regular follow-up and modern treatments, complications have reduced and outcomes improved. If inflammation is not treated, it can damage the joint, the cartilage and the bone. With the advent of modern therapies, these complications of JIA have become much less common.
Children with JIA may have a reduced overall rate of growth, especially if the disease involves many joints or other body systems. This may be due to a combination of the disease itself, as well as its treatments, particularly corticosteroid use. Paradoxically, limbs where a large joint (such as the knee) is inflamed may have increased growth in the short term, leading to limb-length discrepancy (ie one arm or leg is slightly longer than the other). This is due to increased blood supply to the bony growth plates surrounding the inflamed joints. Bone density and bone strength may be reduced through a combination of inflammation, corticosteroid use and reduced physical activity levels.
Other musculoskeletal complications may include joint contractures, muscle weakness or muscle wasting. Uveitis, if left untreated, can result in scarring, glaucoma, cataracts, and even blindness. Regular monitoring allows for early detection and treatment. Steroid eye drops are usually the first line treatment for anterior uveitis. However, other treatments - many of which also treat arthritis (eg Methotrexate, biologics) - may be required to keep the inflammation under control, and to minimise steroid use over the longer term. Long term steroid use can cause contribute to the development of cataracts. Macrophage activation syndrome (MAS) is a severe, potentially life-threatening complication that can occur in patients with the Systemic subtype of JIA.
MAS involves uncontrolled activation of the immune system, sometimes referred to as a 'cytokine storm', which can present with a Sepsis-like picture of fever, rash, enlarged liver and spleen, enlarged lymph nodes and cardiorespiratory compromise. It is recognised by a series of characteristic changes in laboratory parameters, including a high ferritin and a paradoxically low Erythrocyte Sedimentation Rate. Causes The cause of JIA remains unknown. However, the disorder is autoimmune — meaning that the body's own immune system starts to attack and destroy cells and tissues (particularly in the joints) for no apparent reason. The immune system is thought to be provoked by changes in the environment, in combination with mutations in many associated genes and/or other causes of differential expression of genes.
Experimental studies have shown that certain mutated viruses may be able to trigger JIA. The disease appears to be more common in girls, and is most common in Caucasians. The cause of JIA, as the word "idiopathic" suggests, is unknown and an area of active research. Current understanding of JIA suggests that it arises in a genetically susceptible individual due to environmental factors. Diagnosis The diagnosis of JIA can be difficult, in part because joint pain in children is so common and may be from many causes other than JIA. The characteristic feature of arthritis is joint swelling which is sometimes - but not always - associated with pain.
The presence of joint stiffness is another typical feature, particularly when present in the morning and improving with activity. No single test can confirm a diagnosis of JIA: a combination of presenting signs and symptoms, blood tests, and if necessary medical imaging, is used to make the diagnosis. The blood tests may measure levels of inflammatory markers, as well as the presence of specific immune markers which may include Anti-nuclear antibody, HLA-B27, Rheumatoid factor and Anti–citrullinated protein antibody. These serological markers may be negative in children with JIA, and are often present in healthy children; as such they should not be interpreted in isolation but in the context of the clinical presentation.
Many children with JIA have normal blood work. X-rays may be required to ensure that the joint pain and swelling is not from a fracture, cancer, infection, or congenital abnormality. In some cases, fluid from the joint can be aspirated and analysed to assist in making a diagnosis. This test can assist by ruling out other causes of arthritis such as infection. Classification The current classification system by the International League of Associations for Rheumatology (ILAR) recognizes 7 distinct subtypes of JIA, based on their presentation within the first 6 months: Each subtype has a specific pattern of features as outlined in the table and descriptions below.
(The seventh category, not included in the table, is 'Undifferentiated' and includes any patient with JIA who does not meet criteria for other subtypes, or who meets criteria for two or more subtypes). Oligoarticular Arthritis Oligoarticular (or pauciarticular) JIA is the most common JIA subtype, and occurs when there are up to 4 joints involved during the first 6 months of disease. Two subtypes of oligoarticular arthritis exist: persistent oligoarthritis, where no more than 4 joints are affected throughout the whole disease course; and extended oligoarthritis, where more than 4 joints are affected after the first 6 months of disease.
Patients in this subtype are often young, typically aged 2–3 years and with a female preponderance. The most commonly involved joint is the knee, but other affected joints may include the ankles, wrists, elbows and others. The Anti-nuclear antigen (ANA) is positive in up to 80% of patients with oligoarthritis and is associated with a higher risk of associated eye disease (Uveitis), particularly in younger patients. The prefixes "oligo-" and "pauci-" mean "few". Polyarticular (Rheumatoid Factor Negative) Arthritis Arthritis involving 5 or more joints in the first 6 months of disease. In this subtype of arthritis both small and large joints are typically involved, usually in an asymmetric pattern.
Involved joints may include the jaw (Temperomandibular joint) and cervical spine. Patients in this subtype are Rheumatoid factor negative; Anti-nuclear antibody is positive in approximately 25% of patients. Children with polyarticular JIA are also at risk of developing Uveitis and should also be monitored by an optometrist or ophthalmologist. Polyarticular (Rheumatoid Factor Positive) Arthritis Arthritis involving 5 or more joints in the first 6 months, with a positive Rheumatoid factor on at least 2 occasions, tested 3 months apart. In this subtype of arthritis both small and large joints are typically involved, usually in a symmetric pattern. The Anti-nuclear antibody may also be positive in up to 75% of patients.
This subtype of arthritis behaves in a very similar fashion to the equivalent adult disease Rheumatoid arthritis. It affects mostly adolescent girls and is typically more aggressive than other forms of JIA in terms of joint damage and the development of erosions in surrounding bone. The clinical presentation is similar to that of Rheumatoid arthritis with a symmetric polyarthritis typically involving the PIP and MCP joints. Children may develop rheumatoid nodules and similar complications to adult disease, including joint erosions. Systemic-onset Arthritis This subtype is an arthritis which involves one or more joints and is associated with a fever of at least 2 weeks’ duration that is documented to be daily for at least 3 days.
The fever is typically ‘quotidian’ in nature, occurring once or twice a day (often in the late afternoon or evening) with normal baseline temperatures in between. It is also associated with one or more of the following: a transient erythematous rash that often occurs in association with the fever; enlargement of multiple lymph nodes; the presence of an enlarged liver or spleen; or the presence of Serositis (inflammation surrounding the heart, lungs or abdominal cavity). The rash is often discrete, salmon-pink macules of different sizes which may migrate to different parts of the body. Patients with Systemic-onset juvenile idiopathic arthritis are at risk of a potentially life-threatening complication called Macrophage activation syndrome.
Rheumatoid factor and ANA are generally negative in systemic JIA. Enthesitis Related Arthritis This subtype of arthritis is diagnosed by the presence of arthritis and enthesitis, or by the presence of arthritis or enthesitis alone with 2 or more of the following features: (1) Presence or history of sacroiliac joint tenderness and/or inflammatory back pain; (2) Presence of the HLA-B27 antigen; (3) Onset of arthritis in a male over 6 years of age; (4) Acute (symptomatic) anterior uveitis; or (5) a history of Ankylosing spondylitis, enthesitis related arthritis, sacroiliitis with Inflammatory bowel disease, or acute anterior Uveitis in a first-degree relative.
Enthesitis is tenderness at the insertion sites of tendons, ligaments and fascia caused by inflammation. This type of arthritis is common in adolescent boys and typically affects large joints in the lower limbs, including the hips. It can also involve the Sacroiliac joint and the spine. Psoriatic Arthritis This subtype of arthritis is diagnosed by the combination of arthritis and Psoriasis or, arthritis and at least 2 of the following: Dactylitis, nail-pitting, or Psoriasis in a first-degree relative. Psoriatic arthritis is typically asymmetric in its pattern of joint involvement and can involve both large and small joints. A characteristic feature of this type of arthritis is dactylitis, which is caused by inflammation of the flexor tendon and synovium, resulting in sausage-shaped swelling of an entire finger or toe.
Undifferentiated Arthritis This subtype is diagnosed when a child has JIA that fulfils criteria in none of the subtypes, or in 2 or more of the subtypes of JIA. Differential diagnosis There are several other disorders and diseases that present with symptoms like JIA. These causes include, but are not limited to, infectious (for example Septic arthritis or Osteomyelitis) and post-infectious conditions (Reactive arthritis, Acute rheumatic fever, and in some geographic areas Lyme disease); hematologic and neoplastic diseases such as leukemia or bony tumors; and other connective tissue diseases (such as Systemic lupus erythematosus). For the Systemic-onset form of JIA, the differential diagnosis also includes Kawasaki disease and periodic fever syndromes.
Rarely, skeletal dysplasias or metabolic diseases, such as Farber disease and forms of Mucopolysaccharidosis, may also mimic JIA, as they may present with joint swelling, joint restriction, stiffness, and pain. Patients with Farber disease typically have subcutaneous nodules and a hoarse or weak voice due to growth of nodules on the larynx. Treatment The major emphasis of the treatment of JIA is helping the child or young person regain normal levels of physical and social functioning by controlling inflammation and extra-articular symptoms. Clinical remission should be the primary target for all patients and treatment should be adjusted until this is achieved.
Prompt recognition and management is important as early initiation of therapy increases the likelihood of a response to first-line treatments and of achieving drug-free remission later in life. While overarching consensus treatment guidelines exist, all treatments should be specifically tailored to the individual's needs in discussion with the child or young person and their family. Optimal management of JIA requires a multidisciplinary team working to address the needs of an individual patient. Optimising physical and social functioning is accomplished via a two-pronged approach: non-pharmacological strategies such as physical therapies, pain management strategies, and social supports; and the swift use of medication to control inflammation and extra-articular symptoms.
Early diagnosis and treatment are imperative in helping reduce joint damage and other symptoms, which will help reduce levels of permanent damage leading to long term disability. Pharmacological treatments Major advances in drug treatments have been made over recent decades. Intra-articular steroid injections and Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, are often used as first line treatments for most subtypes of JIA. NSAIDs have useful analgesic and anti-inflammatory properties, although they are generally unlikely to lead to remission if used in isolation. Systemic corticosteroids (oral or intravenous), such as prednisolone, dexamethasone and methylprednisolone, are highly effective treatments, however their utility is limited by their side-effect profile.
They have a role in short-term disease control for some patients, but should generally be avoided as long-term treatment options. Disease-modifying antirheumatic drugs (DMARDs) are required to achieve sustained clinical remission in some patients. Conventional DMARDs include Methotrexate, Sulfasalazine and Leflunomide. Biologic DMARDs are generally reserved as second-line therapy for patients where treatment with a conventional DMARD has failed. These medications target specific inflammatory cytokines such as Tumor necrosis factor alpha (etanercept, adalimumab, infliximab), Interleukin 6 (tocilizumab) and Interleukin 1 (anakinra). There are several research groups exploring novel treatments for patients with JIA. Several new biologic DMARDs (anti-interleukin-17A, anti-interferon-gamma) and targeted small molecules (Janus kinase inhibitors) have shown promise in other diseases and are currently undergoing clinical trials in patients with JIA.
Evidence regarding the efficacy of complementary and alternative treatments in managing JIA is generally lacking. There are no controlled studies looking at dietary interventions for JIA and current recommendations suggest a healthy, balanced, age-appropriate diet that meets all nutritional needs. Non-pharmacological treatments The optimal approach to treating a child with JIA typically involves a team of medical professionals, which may include (but is not limited to) paediatric rheumatologists, paediatric rheumatology nurses, general paediatricians, general practitioners, adult rheumatologists, physical therapists, occupational therapists, podiatrists, psychologists, social workers, pharmacists, ophthalmologists and orthopaedic surgeons. The multi-disciplinary team (MDT) work in conjunction with the child and their parents, the local health service and medical team, the child's school and teachers, community leaders and sports coaches to best support the child and their family.
Together, the team help children to participate as fully and independently as possible in their daily activities by maximising quality of life, maximising function and minimising disruption to the life of the child or young person. The multidisciplinary team work together to provide the child and their family with support and education about JIA, strategies to promote age-appropriate self-sufficiency and help the child to adapt and adjust to any challenges they face. There are many ways to make daily tasks easier or more manageable. One of the key ways the multidisciplinary team helps children with JIA is to involve them, and their families, in the decision-making process regarding their treatment and rehabilitation.
In young children with JIA, symptoms may result in either delay or regression in developmental milestones such as walking, running or climbing. Upper limb function may also be affected. Members of the multidisciplinary team can perform developmental assessments to identify deficits and guide treatments. The information gathered can be shared with schools and child care facilities. One of the key ways occupational or physical therapists help young children with JIA is by developing a home therapy program based around play. Exercises are prescribed by both PTs and OTs to increase the range a child can move a joint, to strengthen the muscles around a joint, to decrease pain and stiffness and to prevent further limitations in their joint movements.
OTs and PTs can provide children with age-appropriate games and activities to allow the children to practice their exercises while playing and socializing with friends. Examples are crafts, swimming, and sports. Children with JIA may experience challenges with low mood, social interaction, reduced self-confidence and negative self-image. Psychologists, OT's, nurses, social workers and other team members can work with the child and their family to develop strategies to help with these issues. Many JIA support organisations run camps and activities for children with JIA and their families. Surgery is only used to treat the most severe cases of JIA and is now rarely required.
Physical therapy and Exercise Maintaining physical activity is important in all children, but especially for children with JIA. The physical therapist has a role in guiding physical rehabilitation (muscle stretching and strengthening, enhancing joint range of movement, improving balance, etc); optimising physical functioning; goal-setting; and improving a child’s confidence in their own body. They usually work with the child and family to develop a home exercise program which changes over time as the child makes progress. Arthritis in childhood can be associated with muscle weakness and wasting around the affected joints. It can also lead to low bone density, which may predispose to osteoporosis and fractures in adulthood.
Getting regular exercise is an important part of the management of JIA to promote bone and muscle health. There is variation in the exact exercise prescription which best promotes musculoskeletal health whilst reducing fatigue, pain and swelling. Consensus is that children with JIA should be following national public health standards of physical activity and participating in moderate fitness, flexibility, and strengthening exercises, compatible with their abilities and disease restrictions. It is important that - across the week - the exercise is a combination of moderate to vigorous cardiovascular activity (eg walking to school, scooting, bike-riding, playing tag, dancing, doing P.E, sports such as basketball or football) and strengthening exercises.
Bone strengthening activities build up muscles; by having the muscles push and pull against the bone, the bones themselves get stronger. This can include things like playing on climbing equipment, swinging on monkey-bars, using weights, carrying groceries, skipping or running. A Cochrane meta-analysis looking at existing RCT’s showed in all studies that exercise does not have a detrimental effect on JIA. In fact, there is evidence to show that both low and high-intensity exercise programs result in improved physical function and reduced pain in children with JIA. Guidelines indicate that children with JIA should be encouraged to be physically active and can safely participate in sports without disease exacerbation.
Those with actively inflamed joints should limit activities within pain limits, then gradually return to full activity following a disease flare. It may be necessary to use aids like splints or casts to correct biomechanics, but prolonged splinting and casting are now rarely indicated for children with JIA. Following joint injections, children are often advised to ‘take it easy’, often undertaking 1–2 days of low activity, although advice around this varies. When a joint (usually a knee) loses range of motion due to prolonged inflammation and pain, a series of plaster casts may be used to gradually extend shortened muscles and restore range.
These serial casts are usually applied over days to weeks. Active strengthening and lengthening is used in conjunction with serial casting for optimal results. Some children may benefit from foot orthotics to support and correct body position and function. Orthotics maintain biomechanical alignment and may reduce discomfort in the legs and back when children participate in physical activities such as sports. Occupational Therapy Many children with JIA will benefit from seeing an Occupational Therapist, who can provide strategies to assist in to maximizing independence in activities and routines. For example, thinking about how to simplify tasks or using aids or equipment can allow a child to complete tasks themselves; OT’s also provide advice on how to make tasks easier, less painful and more enjoyable.
This may include suggestions around types of clothes or shoes to wear; using ergonomic cutlery or pens to make writing and eating easier; and learning how to conserve energy and protect joints while completing routine tasks. Pacing is an important skill, so that children learn to make the most of their energy by prioritizing jobs, learning to break tasks down into smaller components, to be flexible with changing plans and to build up muscle strength and stamina to maximize fitness. During periods of flare, splints may be used to support the joints during activity, to reduce the children's pain and increase participation in their preferred leisure activities.
If prescribed, these are only for short periods of time as prolonged splinting can result in further muscle weakness. Resting splints, usually worn at night, are now rarely prescribed. Nursing care in JIA Paediatric rheumatology nurses provide health and medical care for children and young people with rheumatic disease, from birth through to late adolescence. They are employed by many large hospitals, and also in some private rheumatology practices. They work as part of the multidisciplinary team to support the child and their family at the time of diagnosis and throughout the child’s illness. Paediatric rheumatology nurses have specialist skills and experience which allow them to work with children, young people and their families to address any concerns, fears and problems, including those around treatment and medication administration.
Paediatric rheumatology nurses work holistically with the entire family unit. They are often involved with the child and family in the planning of care, determining the child’s capabilities and working with day care, early childhood education and schools to ensure the patient has comprehensive support in all aspects of their life. The diagnosis of a rheumatological condition can be devastating for the child and parents, and often has a ripple effect on the family unit. The paediatric rheumatology nurse provides support, education, advocacy, information, empathy and understanding to both the patient and their family, and assists in alleviating the anxieties and concerns of the parents / carers.
The goals of paediatric rheumatology nursing care include: assisting in normalising the life of the child after diagnosis; minimising the impact of the child's condition; optimising growth and development; assisting the family in developing realistic, functional and coordinated home care plans; respecting the roles of the families in the care of their children; prevention of disease; and promotion of the overall health of the child. Education on paediatric rheumatology conditions and medications is a core part of the role of the paediatric rheumatology nurse. Empowering the patient, and their family, with age appropriate knowledge and understanding of the child’s condition is crucial.
Nurses also work with patients to help them accept and adjust to the hospital setting, and prepare them for medical treatments and procedures in the event they are required. They often provide advice and instruction at a time of disease flare or other acute medical issue. Many of the medications used in paediatric rheumatology suppress the immune system. It is imperative that an understanding of all facets of all prescribed medications is imparted to the patient (age dependant) and their families. This is usually the combined role of the rheumatologist and the rheumatology nurse. Self Management Pain is the most common and often the most distressing symptom of JIA (although some children with JIA do have joint inflammation without any pain at all).
Pain can occur even when children are receiving effective doses of therapies which are managing their underlying disease. Pain has been found to negatively impact all aspects of quality of life and is associated with a reduction in physical, social and emotional functioning. Children who have higher levels of pain, tend to have reduced levels of socialization, school attendance and participation in activities. Increased pain is also correlated with poor sleep and higher fatigue in children with JIA. The causation of pain in JIA is multifactorial. There are disease related factors, which relate to the inflammatory process, and anatomical or biomechanical changes that are associated with joint swelling and joint disease.
There are psychological factors around dealing with stress, coping with a chronic illness and managing anxiety or depression which can influence the perception of pain and the degree of functional impairment. There are also social factors, which relate to family and peer relationships, parental distress and social and financial supports. Given the waxing and waning nature of JIA, children’s physical abilities, pain and mood can change during periods of flare or remission. Coping with chronic illness during childhood and adolescence is associated with significant stress that can put children at risk for emotional or behavioural distress and can interfere with compliance and adherence to treatment regimes.
Managing JIA can be a challenge and it is important to have a toolbox of skills, supports and strategies to draw upon to manage the ups and downs of having a chronic illness. There are many things that can help children with JIA to grow up to have full and active lives. Having good sleep habits and routines gives a child the best chance of having a refreshing night's sleep and preventing daytime fatigue. This in turn affects concentration, energy levels, memory and mood. Most children need between 8 to 12 hours of sleep to feel refreshed, depending on age.
Simple strategies like maintaining regular bed-times, limiting screen time to two-hours before bed, having a sleep ritual, avoiding napping during the day, avoiding sugary and caffeinated drinks, having a healthy well-balanced diet, regular exercise and using relaxation techniques can assist in having good night’s sleep. Relaxation techniques can also help to reduce stress, physical tension and be a useful pain management technique. There are a variety of mindfulness strategies which include things like deep breathing, guided-imagery or progressive muscle relaxation. All techniques need to be practiced over time, and it may be necessary to try different combinations to find the method that works best for each individual.
These techniques are readily available online, in books, recordings, apps or by seeing a trained professional such as a psychologist. Education and Employment Most children with JIA will be able to consistently attend school, without too many disruptions, even during a disease flare. However, they may require extra help or adaptations in order to do so. Maximising school attendance involves collaboration between the family, the school and the health care team. Prolonged or repeated school absences can have academic, social and emotional implications; except in rare circumstances they are rarely necessary (other than absences for medical or therapy appointments). These adaptations may include requiring extra time to get between classes or during examinations, using specialised pens or switching to typing rather than handwriting, or minimising the load of heavy books or equipment to be carried in a child’s school bag.
The exact requirements will vary from child-to-child and will depend on the joints affected. In many instances, the child’s treating team will be able to provide specific advice and information for teachers and coaches to smooth the transition back to school. This may take the form of an individualized plan outlining any extra measures that need to be taken at school, what to do in the case of unexpected events or medication administration during school hours. It is important to remember that JIA can be disruptive not just to the academic aspects of school. It is equally important to optimise school attendance so that the child can maintain friendships and keep up with opportunities to socialize with peers.
As adolescents progress through high school, they may need to factor their current medical status and functional abilities into decisions around their future education and employment plans. Most children with JIA will not be restricted in their study goals or professional aspirations. Students with JIA can usually apply for special arrangements during assessment periods, such as additional time to allow for rest / stretch periods and use of adaptive equipment in some situations. These applications often need to be supported by the treating medical team. The treating team can assist adolescents in finding ways to tell their employers about their condition in a positive way.
OTs and social workers can also help teenagers understand their rights as an employee with a chronic illness. It is important that adolescents with JIA understand how to take care of themselves and manage their disease when working full-time or attending higher education. The team will also support those patients who still require medical input through the transition process from paediatric to adult services. Prognosis At the time of receiving a JIA diagnosis, children and their families often have many questions regarding prognosis. Recent therapeutic advances in the management of JIA have made inactive disease and clinical remission achievable goals for the majority of children with access to modern treatments.
Clinical remission can be defined as the absence of signs and symptoms of inflammatory disease activity, including extra-articular manifestations of the disease. Differentiating subtypes of JIA helps to target treatment and leads to more positive outcomes, however subtype is not the only predictor of JIA outcome. Poor prognostic factors include arthritis of the hip, cervical spine, ankles or wrists; prolonged elevation of inflammatory markers; and radiographic evidence of joint damage including erosions or joint space narrowing. Patients with RF-positive polyarthritis often have worse outcomes associated with more aggressive disease. Despite this, the probability of this subgroup achieving inactive disease at least once within 5 years was shown to be 90% in a large Canadian study.
Research is currently being undertaken into clinical prediction models to allow earlier identification of children who are likely to have a worse prognosis. Compliance with therapy, especially medication, has a positive correlation with disease outcome. Research into specific JIA biomarkers is currently underway, with the goal of forming more personalized treatment plans, reducing medication side effects and improving remission rates. Current areas of investigation include clinical, protein, genetic and radiological markers, amongst others. Children with JIA demonstrate similar levels of depression and anxiety to children with other chronic diseases however causality has not been established. The unpredictable and undulating course of JIA disease activity and the need for ongoing procedural interventions may contribute.
It has been previously suggested that children with JIA are at an increased risk of malignancies when being treated with anti-TNF therapy. More recent data has not confirmed this association: it is thought that the disease itself is linked with a slightly higher background risk of malignancy. Ongoing data analysis on large patient populations continues in this area. Epidemiology Juvenile Idiopathic Arthritis is the most common, chronic rheumatic disease of childhood. In high-income countries, yearly incidence has been estimated at 2–20 cases per 100 000 population; prevalence in these areas is estimated at 16–150 cases per 100 000 population. However, there is also a suggestion that these numbers underestimate disease prevalence: one community-based survey of school children in Western Australia reported a prevalence of 400 per 100 000.
Overall prevalence is often summarised as 1 per thousand children. Incidence and prevalence data vary across different population and ethnic groups, with lower overall prevalence in Afro-Caribbean and Asian populations. There are also ethnic differences in the frequency of JIA subtypes: for example, oligoarthritis is the most common subtype in European populations, whilst polyarticular disease predominates in many other countries including Costa Rica, India, New Zealand, and South Africa. There are differences in age of onset, gender and disease outcomes based on JIA subtype: these are outlined in the table above. Terminology The terminology used to describe JIA is evolving, and each term has some limitations.
Previous terminology included Juvenile Rheumatoid Arthritis and Juvenile Chronic Arthritis. These terms were replaced in 1997 with the release of the revised ILAR (International League of Associations for Rheumatology) classification criteria. There is currently an international movement underway to further revise the classification criteria for JIA, although this is in a preliminary phase. MeSH uses "juvenile arthritis" as the primary entry, and uses "idiopathic", "chronic" and "rheumatoid" in alternate entries. Society Some famous people with this condition are: Antoni Gaudi, architect Clark Middleton, actor Claire Cottrill, singer-songwriter References External links Arthritis Australia, Juvenile Idiopathic Arthritis JIA@NRAS (UK) American College of Rheumatology - Juvenile Arthritis Video guide to joint injections in JIA Paediatric Musculoskeletal Matters BSPAR Standards of Care for children and young people with JIA World Young Rheumatic Disease Day JIA - NIH Medline Plus.
Category:Arthritis Category:Pediatrics Category:Rheumatology Category:Connective tissue diseases Category:Inflammatory polyarthropathies Category:Idiopathic diseases
Mains electricity by country includes a list of countries and territories, with the plugs, voltages and frequencies they commonly use for providing electrical power to appliances, equipment, and lighting typically found in homes and offices. (For industrial machinery, see Industrial and multiphase power plugs and sockets.) Some countries have more than one voltage available. For example, in North America most sockets are attached to a 120 V supply, but there is a 240 V supply available for large appliances. Often different sockets are mandated for different voltage or current levels. Voltage, frequency, and plug type vary, but large regions may use common standards.
Physical compatibility of receptacles may not ensure compatibility of voltage, frequency, or connection to earth (ground), including plugs and cords. In some areas, older standards may still exist. Foreign enclaves, extraterritorial government installations, or buildings frequented by tourists may support plugs not otherwise used in a country, for the convenience of travellers. Main reference sourceIEC World Plugs The International Electrotechnical Commission publishes a web microsite World Plugs which provides the main source for this page, except where other sources are indicated.
World Plugs includes some history, a description of plug types, and a list of countries giving the type(s) used and the mains voltage and frequency.j Although useful for quick reference, especially for travellers, IEC World Plugs may not be regarded as totally accurate, as illustrated by the examples in the plugs section below, and errors may exist, such as Indonesia being listed as using both 220 V and 110 V when the Indonesian Standard SPLN 1 clearly states the voltage as 230 V, and the official travel website says "electric power supply is 220 volts in all regions." Voltages Voltages in this article are the nominal single-phase supply voltages, or split-phase supply voltages.
Three-phase and industrial loads may have other voltages. All voltages are root mean square voltage; the peak AC voltage is greater by a factor of , and the peak-to-peak voltage greater by a factor of 2. Plugs The system of plug types using a single letter (from A to N) used here is from World Plugs, which defines the plug type letters in terms of a general description, without making reference to specific standards. Where a plug does not have a specific letter code assigned to it, then it may be defined by the style sheet number listed in IEC TR 60083.
World Plugs gives a (not always correct) list of what plug types are used where. The Type N description is of the two variations of Brazilian plug (Brazilian national standard NBR 14136); however, the original plug and socket is defined in IEC 60906-1 and has been adopted as a South African national Standard (SANS 164-2). The Brazilian version is non-compliant with the IEC standard. Not all plugs are included in the letter system; for example, there is no designation for the plugs defined by the Thai National Standard TIS 116-2549, though some web sites refer to the three-pin plug described in that standard as "Type O".
Identification guide Table of mains voltages, frequencies, and plugs See also AC power AC power plugs and sockets Alternating current Delta-wye transformer Electrical wiring Electricity Electric power transmission Electrification Electric grid List of railway electrification systems Mains electricity NEMA connector Telephone plug Utility frequency References External links Category:Electrical standards Category:Electric power Category:Mains power connectors Elect Category:Electrical wiring fi:Verkkovirta ur:مینز برق بلحاظ ملک
Helium-4 () is a stable isotope of the element helium. It is by far the more abundant of the two naturally occurring isotopes of helium, making up about 99.99986% of the helium on Earth. Its nucleus is identical to an alpha particle, and consists of two protons and two neutrons. Alpha decay of heavy elements in the Earth's crust is the source of most naturally occurring helium-4 on Earth, produced after the planet cooled and solidified. While it is also produced by nuclear fusion in stars, most helium-4 in the Sun and in the universe is thought to have been produced by the Big Bang, and is referred to as "primordial helium".
However, primordial helium-4 is largely absent from the Earth, having escaped during the high-temperature phase of Earth's formation. Helium-4 makes up about one quarter of the ordinary matter in the universe by mass, with almost all of the rest being hydrogen. When liquid helium-4 is cooled to below 2.17 kelvins (−271.17 °C), it becomes a superfluid, with properties that are very unlike those of an ordinary liquid. For example, if superfluid helium-4 is kept in an open vessel, a thin film will climb up the sides of the vessel and overflow. In this state and situation, it is called a "Rollin film".
This strange behavior is a result of the Clausius–Clapeyron relation and cannot be explained by the current model of classical mechanics, nor by nuclear or electrical models – it can only be understood as a quantum-mechanical phenomenon. The total spin of the helium-4 nucleus is an integer (zero), and therefore it is a boson (as are neutral atoms of helium-4). The superfluid behavior is now understood to be a manifestation of Bose–Einstein condensation, which occurs only with collections of bosons. It is theorized that at 0.2 K and 50 atm, solid helium-4 may be a superglass (an amorphous solid exhibiting superfluidity).
Helium-4 also exists on the Moon and—as on Earth—it is the most abundant helium isotope. The helium-4 atom The helium atom is the second simplest atom (hydrogen is the simplest), but the extra electron introduces a third "body", so the solution to its wave equation becomes a "three-body problem", which has no analytic solution. However, numerical approximations of the equations of quantum mechanics have given a good estimate of the key atomic properties of , such as its size and ionization energy. Stability of the 4He nucleus and electron shell The nucleus of the helium-4 atom is identical to an alpha particle.
High-energy electron-scattering experiments show its charge to decrease exponentially from a maximum at a central point, exactly as does the charge density of helium's own electron cloud. This symmetry reflects similar underlying physics: the pair of neutrons and the pair of protons in helium's nucleus obey the same quantum mechanical rules as do helium's pair of electrons (although the nuclear particles are subject to a different nuclear binding potential), so that all these fermions fully occupy 1s1s orbitals in pairs, none of them possessing orbital angular momentum, and each canceling the other's intrinsic spin. Adding another of any of these particles would require angular momentum, and would release substantially less energy (in fact, no nucleus with five nucleons is stable).
This arrangement is thus energetically extremely stable for all these particles, and this stability accounts for many crucial facts regarding helium in nature. For example, the stability and low energy of the electron cloud of helium causes helium's chemical inertness (the most extreme of all the elements), and also the lack of interaction of helium atoms with each other (producing the lowest melting and boiling points of all the elements). In a similar way, the particular energetic stability of the helium-4 nucleus, produced by similar effects, accounts for the ease of helium-4 production in atomic reactions involving both heavy-particle emission and fusion.
Some stable helium-3 is produced in fusion reactions from hydrogen, but it is a very small fraction, compared with the highly energetically favorable production of helium-4. The stability of helium-4 is the reason that hydrogen is converted to helium-4, and not deuterium (hydrogen-2) or helium-3 or other heavier elements during fusion reactions in the Sun. It is also partly responsible for the alpha particle being by far the most common type of baryonic particle to be ejected from an atomic nucleus; in other words, alpha decay is far more common than cluster decay. The unusual stability of the helium-4 nucleus is also important cosmologically.
It explains the fact that, in the first few minutes after the Big Bang, as the "soup" of free protons and neutrons which had initially been created in about a 6:1 ratio cooled to the point where nuclear binding was possible, almost all atomic nuclei to form were helium-4 nuclei. The binding of the nucleons in helium-4 is so tight that its production consumed nearly all the free neutrons in a few minutes, before they could beta decay, and left very few to form heavier atoms (especially lithium, beryllium, and boron). The energy of helium-4 nuclear binding per nucleon is stronger than in any of these elements (see nucleogenesis and binding energy), and thus no energetic "drive" was available to make elements 3, 4, and 5 once helium had been formed.
It is barely energetically favorable for helium to fuse into the next element with a higher energy per nucleon (carbon). However, due to the rarity of intermediate elements, and extreme instability of beryllium-8 (the product when two 4He nuclei fuse), this process needs three helium nuclei striking each other nearly simultaneously (see triple alpha process). There was thus no time for significant carbon to be formed in the few minutes after the Big Bang, before the early expanding universe cooled to the temperature and pressure where helium fusion to carbon was no longer possible. This left the early universe with a very similar hyrdogen–helium ratio as is observed today (3 parts hydrogen to 1 part helium-4 by mass), with nearly all the neutrons in the universe trapped in helium-4.
All heavier elements—including those necessary for rocky planets like the Earth, and for carbon-based or other life—thus had to be produced, since the Big Bang, in stars which were hot enough to fuse elements heavier than hydrogen. All elements other than hydrogen and helium today account for only 2% of the mass of atomic matter in the universe. Helium-4, by contrast, makes up about 23% of the universe's ordinary matter—nearly all the ordinary matter that is not hydrogen (1H). See also Superfluid helium-4 External links Superfluid Helium-4 Interactive Properties References Helium-04
P. C. George (born 28 August 1951) is an Indian politician. George is a six-time and current Member of the Legislative Assembly (M.L.A.) of the Poonjar constituency in the Kottayam district of Kerala state. Currently he is one of the two National Democratic Alliance (NDA) MLAs in Kerala Legislative Assembly. P.C. George served as the Chief Whip of the Legislative Assembly from 2011 to 2015, under Kerala Congress (M) party of the UDF government. George later became an independent politician. In 2017, he formed the party Kerala Janapaksham. Before 2019 Indian general election, his party joined in the National Democratic Alliance (NDA).
Personal life George married Usha George on 25 January 1981 and has two sons Shone and Shane. One of his sons, Shone, is married to Parvathy, daughter of veteran actor Jagathy Sreekumar. Usha has been running the Mayflower Beauty Parlour and Tailoring Centre in Erattupetta Political career His political career started through students' movement. He was Ernakulam District President of K.S.C. (1971–73); General Secretary of K.S.C. (1973–76). He was arrested several times in connection with students agitations. He was Chairman of the Petitions Committee of the Legislative Assembly for seven and a half years. He was Chairman of the Subordinate Legislation Committee for two and a half years; Chairman of the Committee on Papers Laid on the Table for two and a half years.
He was General Secretary, Kerala Congress; and Party leader of Kerala Congress (Secular) (2003–2010). He served as K.S.R.T.C. Board Member for ten years. He was elected to the Niyamasabha in 1981, 1982, 1996, 2001 and 2006, all from Poonjar constituency. He is the incumbent MLA from Poonjar constituency in Kottayam District of Kerala. George was also vice-chairman of Kerala Congress (M), a splinter faction of Kerala Congress. The splinter groups of Kerala Congress are known for frequent splits and mergers. PC George was formerly a leader of the Kerala Congress (Joseph) party and was critical of K.M. Mani, the leader of Kerala Congress (M).
Later PC George quit the Joseph group and formed his own group and named it "Kerala Congress (secular)". Recently, PC George merged his group with K.M Mani's faction. Before joining Kerala Congress (M) his party was affiliated with the LDF. P.C. George served as the Chief Whip, Government of Kerala in the UDF Government from 2011, until he was removed from the post on 7 April 2015. This removal was triggered based on the fights within the Kerala Congress (M), spurred due to the bar scam allegations on K M Mani. Mr. P. C. George has been strongly criticized for his derogatory comments against women.
He was summoned by the women's commission for his derogatory reference about a Catholic nun, who was a victim of rape. After these dramatic incidents, PC George made a huge comeback in the 2016 panchayat elections and was looking forward to the upcoming Assembly election. Just before the election, PC George was removed from "Kerala Congress (Mani)" party. And hence he decides to face the election without the support of any parties and to compete in the election as independent candidate. It was a fight unlike anything seen in this elections in the district: One man against the three major political formations.
In the end, P.C. George came out victorious in style with a thumping margin of 27,821 votes. Mr. George was ousted from both the LDF and the UDF and even dubbed as the man leaders loved to hate. He was a marked man by CPI(M) leader Pinarayi Vijayan and hated by K.M. Mani, P.J. Joseph, and even Oommen Chandy. Though he expected the Left to take him back, it was not to be so. In fact, during the protracted campaign period, Mr. Vijayan had personally visited Poonjar twice to ensure that Mr. George was defeated. However, it appears that his major success was in operating a major split in the local unit of the CPI(M) and the UDF.
In 2011, the LDF Independent Mohan Thomas received 44,105 votes. This time, LDF candidate P.C. Joseph could only muster just half the votes at 22,270 votes. Mr. George, in fact, raised his vote share from 59,809 in 2011 to 63,621. The UDF share came down to 35,800. On 10 April 2019, Kerala Janapaksham, led by PC George joined the NDA. Filmography 2010: 9 KK Road as Himself 2017: Achayans as Himself 2018: Daivame Kaithozham K. Kumar Akanam as Chief Minister References External links Category:Living people Category:Politicians from Kottayam Category:Kerala MLAs 1980–1982 Category:Kerala MLAs 1982–1987 Category:Kerala MLAs 1996–2001 Category:Kerala MLAs 2001–2006 Category:Kerala MLAs 2006–2011 Category:Kerala MLAs 2011–2016 Category:Kerala MLAs 2016– Category:Year of birth missing (living people)
Sherwood Stewart and Ferdi Taygan were the defending champions but they competed with different partners that year, Stewart with Mark Edmondson and Taygan with Cássio Motta. Motta and Taygan lost in the semifinals to Eric Fromm and Drew Gitlin. Stewart and Edmondson won in the final 7–6, 6–1 against Fromm and Gitlin. Seeds Champion seeds are indicated in bold text while text in italics indicates the round in which those seeds were eliminated. The top four seeded teams received byes into the second round. Draw Finals {{2TeamBracket-Tennis3 | RD1=Final | RD1-seed1=1 | RD1-team1= Mark Edmondson Top Half Bottom Half External links 1983 Volvo International Doubles Draw Doubles
Leukopoiesis is a form of hematopoiesis in which white blood cells (WBC, or leukocytes) are formed in bone marrow located in bones in adults and hematopoietic organs in the fetus. White blood cells, indeed all blood cells, are formed from the differentiation of pluripotent hematopoietic stem cells which give rise to several cell lines with unlimited differentiation potential. These immediate cell lines, or colonies, are progenitors of red blood cells (erythrocytes), platelets (megakaryocytes), and the two main groups of WBCs, myelocytes and lymphocytes. On the basis of the history of associated leukemic diseases, it's divided into two main groups: acute and chronic.
The incidence of both chronic and acute leukaemias is higher in males than in females. See also Lymphopoiesis Myelopoiesis External links Category:Hematopoiesis
Trypanosoma evansi is a species of excavate trypanosome in the genus Trypanosoma that causes one form of surra in animals. It has been proposed that T. evansi is—like T. equiperdum—a derivative of T. brucei. Due to this loss of part of the mitochondrial (kinetoplast) DNA T. evansi is not capable of infecting the invertebrate vector and establishing the subsequent life-stages. Due to its mechanical transmission T. evansi is not restricted to transmission via the tsetse fly but shows a very broad vector specificity including the genera Tabanus, Stomoxys, Haematopota, Chrysops and Lyperosia. It rarely causes disease in humans, indeed, it has only been recorded in cases where the patient lacks a normal component of human serum, Apolipoprotein L1.
T. evansi is very common in India and Iran and causes acute disease in camels and horses, and chronic disease in cattle and buffalo. In Pakistan, it has been found to be the most prevalent trypanosome species in donkeys. References External links Disease card on World Organisation for Animal Health Category:Trypanosomatida Category:Parasites of mammals Category:Parasitic excavates
Wallace Maynard Cox (December 6, 1924 – February 15, 1973) was an American actor and comedian, particularly associated with the early years of television in the United States. He appeared in the U.S. television series Mister Peepers from 1952 to 1955, plus several other popular shows, and as a character actor in over 20 films. Cox was the voice of the animated canine superhero Underdog of the TV show of the same name. Although often cast as meek, he was actually quite athletic, as well as a military veteran. He married three times. Cox was also featured in the first episode of the television series Mission: Impossible.
Early life and education Cox was born on December 6, 1924, in Detroit, Michigan. When he was 10, he moved with his divorced mother, mystery author Eleanor Blake, and a younger sister to Evanston, Illinois, where he became close friends with another child in the neighborhood, Marlon Brando. His family moved frequently, eventually to Chicago, then New York City, then back to Detroit, where he graduated from Denby High School. During World War II, Cox and his family returned to New York City, where he attended City College of New York. He next spent four months in the United States Army, and on his discharge attended New York University.
He supported his invalid mother and sister by making and selling jewelry in a small shop and at parties, where he started doing comedy monologues. These would lead to regular performances at nightclubs, such as the Village Vanguard, beginning in December 1948. He became the roommate of Marlon Brando, who encouraged him to study acting with Stella Adler. Cox and Brando remained close friends for the rest of Cox's life, and Brando appeared unannounced at Cox's wake. Brando is also reported to have kept Cox's ashes in his bedroom and conversed with them nightly. Career In 1949, Cox appeared on the CBS network-radio show Arthur Godfrey's Talent Scouts, to the great amusement of host Godfrey.
The first half of his act was a monologue in a slangy, almost-mumbled punk-kid characterization, telling listeners about his friend Dufo: "What a crazy guy." The gullible oaf Dufo would take any dares and fall for his gang's pranks time after time, and Cox would recount the awful consequences: "Sixteen stitches. What a crazy guy." Cox's decidedly different standup routine was infectious in its ridiculousness, and just as the studio audience had reached a peak of laughter, Cox suddenly switched gears, changed characters, and sang a high-pitched version of "The Drunkard Song" ("There Is a Tavern in the Town") punctuated by eccentric yodels.
"Wallace Cox" earned a big hand that night, but lost by a narrow margin to The Chordettes, but he made enough of a hit to record his radio routine for an RCA Victor single. The "Dufo" routine ("What a Crazy Guy") was paired with "Tavern in the Town." He appeared in Broadway musical reviews, night clubs, and early television comedy-variety programs between 1949 and 1951, including the short-lived (January–April 1949) DuMont series The School House and CBS Television's Faye Emerson's Wonderful Town starring Faye Emerson. Cox had a huge impact in 1951 with a starring role as a well-meaning but ineffective policeman on Philco Television Playhouse.
Producer Fred Coe approached Cox about a starring role in a proposed live television sitcom, Mister Peepers, which he accepted. The show ran on NBC Television for three years. During this time, he guest-starred on NBC's The Martha Raye Show. In 1959, Cox was featured in the guest-starring title role in The Vincent Eaglewood Story on NBC's Western series, Wagon Train. Cox played a prominent supporting role as Preacher Goodman in the Earl Hamner novel brought to the screen, Spencer's Mountain (1963). Cox played the role of a Navy sonar man in The Bedford Incident (1964) and the role of a drug-addicted doctor opposite Brando in the World War II suspense film, Morituri (1965).
Other roles were as the hero of The Adventures of Hiram Holliday, based on a series of short stories by Paul Gallico and co-starring with Ainslie Pryor. He was a regular occupant of the upper left square on the television game show Hollywood Squares, and voiced the animated cartoon character Underdog. He also was a guest on the game show What's My Line? and on the pilot episodes of Mission: Impossible and It Takes a Thief. Cox made several appearances on Here's Lucy, as well as The Beverly Hillbillies, Lost in Space, I Spy, and evening talk shows. He played a pickpocket in an episode of Car 54, Where Are You?.
He also appeared on The Twilight Zone, season five, episode number 140, titled "From Agnes—With Love". He played character roles in more than 20 motion pictures and worked frequently in guest-star roles in television drama, comedy, and variety series in the 1960s and early 1970s. These include a supporting role in the 20th Century Fox´s unfinished film Something's Got to Give (1962), the last film of Marilyn Monroe. He was cast in a role as a down-on-his-luck prospector seeking a better life for his family in an episode of Alias Smith and Jones, a Western comedy, and Up Your Teddy Bear (aka Mother) (1970) in which he starred with Julie Newmar.
His television and screen persona was that of a shy, timid, but kind man who wore thick eyeglasses and spoke in a pedantic, high-pitched voice. Cox wrote a number of books, including Mister Peepers, a novel created by adapting several scripts from the television series; My Life as a Small Boy, an idealized depiction of his childhood; a parody and update of Horatio Alger in Ralph Makes Good, which was probably originally a screen treatment for an unmade film intended to star Cox; and a children's book, The Tenth Life of Osiris Oakes. Personal life In a 1950s article on Cox's Mister Peepers TV show, Popular Science reported that Cox kept a small workshop in his dressing room.
(Cox's Hollywood Squares colleague, former Hollywood Squares "square-master" Peter Marshall, recalled in his memoir, Backstage With The Original Hollywood Square, that Cox installed and maintained all the wiring in his own home.) Such misperceptions no doubt contributed to the sarcastic and peevish personality that Cox displayed as a comedian; they might also have helped inspire the character of Underdog, whose "Shoe-Shine Boy" persona, in the animated cartoons, reflected the kinds of roles Cox was often given. TV viewers did, however, get to see a glimpse of Cox's physicality on an episode of I've Got a Secret transmitted on May 11, 1960, in which he and host Garry Moore ran around on stage assembling furniture while the panel was blindfolded.
On the May 15, 1974, installment of The Tonight Show, actor Robert Blake spoke of how much he missed his good friend Cox, who was described as being adventuresome and athletic. Cox married three times, to Marilyn Gennaro, Milagros Tirado, and Patricia Tiernan, and was survived by his third wife and his two children. His close friendship with Marlon Brando was the subject of rumors. Brando told a journalist: "If Wally had been a woman, I would have married him and we would have lived happily ever after." Writer/editor Beauregard Houston-Montgomery said that while under the influence of marijuana, Brando told him that Cox had been the love of his life.
However, two of Cox's wives dismissed the suggestion that the love was more than platonic. A Democrat, he supported the campaign of Adlai Stevenson during the 1952 presidential election. Death Cox was found dead on February 15, 1973 in his Hollywood, California home; he was 48. According to an autopsy, Cox died of a heart attack caused by a coronary occlusion. Initial reports indicated that he wished to have no funeral and that his ashes would be scattered at sea. A later report indicated his ashes were put in with those of Brando and another close friend Sam Gilman and scattered in Death Valley and Tahiti.
Partial filmography The Sniper (1952) as Man Pressing Clothes at Dry Cleaners (uncredited) State Fair (1962) as Hipplewaite Car 54 Where Are You?
- "No More Pickpockets" (1962) as Benny Something's Got to Give (unfinished Marilyn Monroe film, 1962) as Shoe Salesman Spencer's Mountain (1963) as Preacher Clyde Goodman The Twilight Zone - "From Agnes With Love" (1964) as James Elwood Fate is the Hunter (1964) as Ralph Bundy Underdog (1964–1973) - Underdog (voice) The Yellow Rolls-Royce (1964) as Ferguson Morituri (1965) as Dr. Ambach The Bedford Incident (1965) as Seaman Merlin Queffle The Beverly Hillbillies (1966) as Professor P. Caspar Biddle A Guide for the Married Man (1967) as Technical Adviser (Married 14 years) The One and Only, Genuine, Original Family Band (1968) as Mr. Wampler Quarantined (1970) as Wilbur Mott The Young Country (1970) as Aaron Grimes/Ira Greebe The Cockeyed Cowboys of Calico County (1970) as Mr. Bester The Boatniks (1970) as Jason Up Your Teddy Bear (1970) as Clyde King The Barefoot Executive (1971) as Mertons The Night Strangler (1973) as Mr. Berry References External links Watch Wally Cox in The Copper Retrieved August 19, 2016.
Category:1924 births Category:1973 deaths Category:American male television actors Category:American male voice actors Category:Donaldson Award winners Category:RCA Victor artists Category:Male actors from Detroit Category:Male actors from Evanston, Illinois Category:Military personnel from Detroit Category:United States Army soldiers Category:20th-century American male actors Category:California Democrats Category:Illinois Democrats
Parboiling (or leaching) is the partial or semi boiling of food as the first step in cooking. The word is from the Old French 'parboillir' (to boil thoroughly) but by mistaken association with 'part' it has acquired its current meaning . The word is often used when referring to parboiled rice. Parboiling can also be used for removing poisonous or foul-tasting substances from foods, and to soften vegetables before roasting them. Basic technique The food items are added to boiling water and cooked until they start to soften, then removed before they are fully cooked. Parboiling is usually used to partially cook an item which will then be cooked another way such as braising, grilling, or stir-frying.
Parboiling differs from blanching in that one does not cool the items using cold water or ice after removing them from the boiling water. Parboiled rice Sometimes raw rice or paddy is dehusked by using steam. This steam also partially boils the rice while dehusking. This process generally changes the colour of rice from white to a bit reddish. This type of rice is eaten in the districts of Udupi and Dakshina Kannada of Karnataka state, in the state of Kerala, and in most parts of Tamil Nadu, Bihar, and West Bengal in India. West Africa and the Afro-Caribbean diaspora are also accustomed to parboiling rice.
See also Blanching Parbaking Parcooking References Category:Cooking techniques Category:Culinary terminology
Ig (; formerly Studenec, ) is the largest settlement and the seat of the Municipality of Ig, central Slovenia. Name The name Ig was first attested in 1249 as Yge (and as Ighe, Iglem, and Iglom in 1261, Yg in 1262, and Hyco and Hyc in 1299). During the Middle Ages, Ig was a regional name, and the settlement now known as Ig was called Studenec until the beginning of the 19th century. The etymology of the name Ig is unclear. It may be connected with the Slovene common noun igo 'yoke' (in reference to the course of the Iška River), or to the Slovene common noun iva 'goat willow' (through borrowing into and then from German), or it may derive from a pre-Slavic substratum.
History After the Second World War, a Yugoslav labor camp for political prisoners operated in Ig. Landmarks Parish church The parish church in Ig is dedicated to Saint Martin and belongs to the Roman Catholic Archdiocese of Ljubljana. It was built in 1780. The painting of Saint Martin in the church is a work by Josip Egartner. A second church, built on Pungrt Hill west of the main settlement, is a 14th-century building, now in ruins. It was dedicated to Saint George. World heritage site In the vicinity of Ig, the remains of prehistoric pile-dwelling (or stilt house) settlements, since 2011 protected as part of the Prehistoric Pile dwellings around the Alps UNESCO World Heritage Site.
References External links Ig on Geopedia Ig municipal site Category:Populated places in the Municipality of Ig
The word hijab refers to both the head-covering traditionally worn by some Muslim women and Islamic styles of dress in general. The garment has different legal and cultural status in various countries. In the Indonesian Aceh province, Muslim women are required to wear the hijab and all women are required to do so in Iran. France has banned overt religious symbols, including many religious headcoverings, in public schools and government buildings. Kosovo (since 2009), Azerbaijan (since 2010), Tunisia (since 1981, partially lifted in 2011) and Turkey (gradually lifted) are the only Muslim-majority countries which have banned the hijab in public schools and universities or government buildings, while Syria and Egypt banned face veils in universities from July 2010 and 2015 respectively.
In other Muslim states such as Morocco, there have been complaints of restriction or discrimination against women who wear the hijab. The hijab in these cases is seen as a sign of political Islam or fundamentalism against secular government. Islamic dress, notably the variety of headdresses worn by Muslim women, has become a prominent symbol of the presence of Islam in western Europe. In several countries, this adherence to hijab has led to political controversies and proposals for a legal ban. Laws have been passed in France and Belgium to ban face-covering clothing, popularly described as the "burqa ban", although it does not only apply to the Afghan-model burqa.
Other countries are debating similar legislation, or have more limited prohibitions. Some of them apply only to face-covering clothing such as the burqa, boushiya, or niqāb, while other legislation pertains to any clothing with an Islamic religious symbolism such as the khimar, a type of headscarf. Some countries already have laws banning the wearing of masks in public, which can be applied to veils that conceal the face. The issue has different names in different countries, and "the veil" or hijab may be used as general terms for the debate, representing more than just the veil itself, or the concept of modesty embodied in hijab.
Although the Balkans and Eastern Europe have Muslim populations, most Muslims in western Europe are members of immigrant communities. The issue of Islamic dress is linked with issues of immigration and the position of Islam in Western Europe. There are currently 16 nations that have banned the burqa (not to be confused with the hijab), including Tunisia, Austria, Denmark, France, Belgium, Tajikistan, Latvia, Bulgaria, Cameroon, Chad, Congo-Brazzaville, Gabon, Netherlands, China, Morocco Europe European Commissioner Franco Frattini said in November 2006, that he did not favour a ban on the burqa. This is apparently the first official statement on the issue of prohibition of Islamic dress from the European Commission, the executive of the European Union.