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Bent's Old Fort, Reconstructed
Bent's Old Fort was built near present-day La Junta in 1833 by the trading partners Ceran St. Vrain and William and Charles Bent. The fort was the center of trade along the Santa Fé Trail until about 1850. This reconstruction of Bent's Old Fort was completed in 1976.
Otero County, located along the Arkansas River in southeast Colorado, encompasses 1,270 square miles and has a population of 18,831.
Otero County is located in southeastern Colorado and covers 1,270 square miles of rolling plains and the fertile Arkansas River valley. It is bordered by Pueblo County to the west, Crowley and Kiowa Counties to the north, Bent County to the east, and Las Animas County to the south and southwest.
The county is named for Miguel Otero, the nineteenth-century New Mexican politician who helped found the county seat of La Junta. The La Junta and Rocky Ford areas are known for producing high-quality cantaloupe and watermelons. Areas of natural and historic significance include the Comanche National Grassland, the Purgatoire River dinosaur track site, the Koshare Indian Museum at Otero Junior College, and the Bent's Fort National Historic Site. Although La Junta experienced a revival of business interest during the 1990s, farming and ranching remain the main pillars of the Otero County economy, which currently supports a population of 18,831.
Rumors of Spanish Exploration
Although it is commonly asserted that Spanish explorers first visited Colorado's stretch of the Arkansas River in the mid-sixteenth century, there is no conclusive evidence that either the expedition of Francisco Vasquez de Coronado in 1541 or of Francisco Leyva de Bonilla in 1593 made it to present-day Colorado. An attack by Native Americans, possibly Plains Apache, killed all but one of the Bonilla party. This attack was subsequently thought to have occurred on the Purgatoire River, which flows through Otero County and southeastern Colorado. In some accounts, the river's name refers to the unblessed Catholic souls who were allegedly sent to purgatory along its banks ; yet it may refer to the lost souls of men who never reached it, as the location of the Bonilla expedition's demise remains uncertain.
By the 1720s, the Comanche had driven the sedentary Plains Apache from the Arkansas River valley. At this time, the area of Otero County was in the heart of an expanding Comanche territory that ran north and south between the Arkansas and Cimarron Rivers, and stretched from the Sangre de Cristo Mountains in the west to what is today south-central Kansas in the east. The Comanche built their empire on the backs of massive horse herds, trading the animals for food and weapons, and using them to raid Spanish and Native American settlements throughout the Great Plains and Southwest. They occasionally clashed with the Arapaho, who roamed the plains north of the Arkansas. In the 1740s, the Comanches formed an alliance with the Taovaya Wichita on the eastern edge of their territory, and in 1790 they made peace with the Kiowa, their rivals on the eastern Colorado plains.
Meanwhile, the Cheyenne were pushed southward over the Colorado plains by the powerful Lakota farther north. By 1820 the Cheyenne also claimed territory north of the Arkansas that included present-day Otero County. The Cheyenne acted as middlemen for the Comanche horse traders for about a decade, until they were again pressed from the north by the Lakota. With their resource base seriously threatened, the Cheyenne and Arapaho decided to invade Comanche territory along the Arkansas. There they vied with the Comanche for access to stands of cottonwood trees along the river, which offered essential shelter, fuel, and forage during the plains' harsh winters.
Trade Development and Bent's Fort
During the eighteenth century, French, Spanish, and Native American traders frequented what became known as the Santa Fé Trail in southeastern Colorado. The trail, which connected Missouri and New Mexico, followed the Arkansas and Purgatoire Rivers in present-day Otero County. In the early nineteenth century, the trail cut across the Comanche heartland. Jealously patrolled by the Spanish, it was opened to American traders after Mexican Independence in 1821.
In 1830, following the advice of a young Cheyenne leader, the American traders Ceran St. Vrain and William and Charles Bent relocated their trading post on the Arkansas River to a large adobe fort further downstream, just east of present-day La Junta. Completed in 1833, Bent's Fort became the trading center of the plains and the most prominent post along the Santa Fé Trail. Wares were brought from and distributed to all parts of the continent; items traded included Navajo blankets, Iroquois beads, New Mexican corn, Cheyenne buffalo robes, Louisianan molasses, gunpowder, rifles, flour, iron tools, and cookware from across the United States. Throughout the 1830s, the fort represented a threat to the Comanche; the Cheyenne were the Bents' primary trading partners, and it was through trade at the fort that they obtained weapons to fight the Comanche.
The war exacted heavy casualties among both the Comanche and Cheyenne before peace was brokered in 1839. Over the next year, the Arapaho, Cheyenne, Comanche, Kiowa, and Naishan formed an unprecedented alliance of Plains Indians. The agreement granted all Native American groups the right to winter in the cottonwoods along the Arkansas, and allowed the Comanche to begin trading directly at Bent's Fort. In 1841 alone, as many as 1,500 Comanches visited the fort. They sent horses and mules to American farmers in the Midwest in exchange for weapons and ammunition that helped them carry out raids farther south.
Decline of Trade at Bent's Fort
The lucrative trade centered at Bent's Fort did not last long. The Comanches killed large numbers of bison to keep up their massive raid-and-trade empire, and by the late 1840s, overhunting and a period of extreme drought combined to decimate the bison population. Bison had not only fed the Native American groups trading at Bent's Fort but also were the source of robes and other commodities; the sudden shortage scattered the Plains Indians in different directions as they searched for better sources of food and supplies. Also by this time, American pioneers began using the Arkansas as a westward corridor; their wagon trains trampled grazing grass and consumed precious timber supplies as fuel wood. A cholera epidemic in 1849 ravaged all the Plains Indian groups and doomed any hope of continued trade at Bent's Fort.
Distraught over the trading post's failure, William Bent stocked powder barrels against its adobe walls and blew it up. He built another trading post further downriver in 1853, but the escalating tensions between whites and Native Americans ensured that his trade business would never recover. He leased the new fort to the army, which renamed it Fort Lyon in 1862. Bent continued to trade with Native Americans, even serving as Indian Agent for the upper Arkansas tribes in 1859, but the warfare following the Sand Creek Massacre (1864) finally isolated him from the Indian groups with whom he had spent most of his life. In 1869, he died of pneumonia on his Las Animas ranch.
County Establishment
American cattle and sheep raisers established ranches in the Otero County area in the 1860s. By the mid-1870s, a combination of resource woes and immense pressure from the American military brought an end to Comanche dominance of the Otero County area. In 1875, Miguel Otero, then a merchant following the railroads westward, moved his company buildings to the new terminus of the Kansas Pacific Railroad—a spot along the Arkansas called La Junta, Spanish for "junction." Otero's small community had barely existed for a year before it nearly became a ghost town and the Kansas Pacific went bankrupt. But in 1876 the Santa Fe Railroad made La Junta a stop on its Chicago–Los Angeles line, and the town was saved. La Junta was incorporated in 1881.
In 1871, George Washington Swink and Asa Russell were traveling with a westbound wagon train when they decided to set up a general store near a shallow, stony crossing of the Arkansas that Kit Carson had earlier named "Rocky Ford." Three years later, the Rocky Ford Ditch was completed, and in 1877 Swink planted the community's first melon crop. The Arkansas River valley is subject to wide daily temperature swings during the growing season, which encourages cantaloupes and watermelons to sweeten considerably before harvest. Swink started the Watermelon Day tradition in 1878 when he shared some of his crop with riders of a passing train, and by 1881 he was growing nearly 300 tons of watermelons per year. Rocky Ford was incorporated in 1887, and Swink was elected the town's first mayor.
The state legislature created Otero County in 1889, designating La Junta as the county seat. In addition to Rocky Ford's famous melons, the farms in the county produced beans and alfalfa and, of course, raised plenty of cattle and sheep.
Otero Junior College and Koshare Indian Museum
In 1933 Colorado Springs scoutmaster "Buck" Burshears established the Koshare Indian Dancers with a group of Boy Scouts interested in Native American culture and accurate replications of native dances. Otero Junior College, Otero County's only institute of higher education, was founded in 1941, and in 1949 the college became the site of the Koshare Indian Museum. Using extra funds from the Koshare program, dancers and supporters constructed an authentic replica of a kiva, a one-room ceremonial structure built by many Puebloan cultures in the Southwest. The kiva serves as a performance area for the Koshare dancers, while the attached three-level museum houses a large and distinguished collection of Native American art and other artifacts.
Comanche National Grassland
Like many of Colorado's plains counties, Otero County was hit hard by the Dust Bowl (1934–40) and the Great Depression (1929–39) that accompanied it. The Dust Bowl prompted Congress to take action to preserve the ecology and economic viability of the Great Plains. In 1935 Public Law 46 made soil and water conservation a national policy. The federal government also bought 440,000 acres of cultivated land in southeastern Colorado, much of it in southern Otero County, and returned it to native grassland. In 1960 this land was designated as the Comanche National Grassland. It is managed by the US Forest Service, which maintains an office in Springfield, Colorado.
Dinosaur Tracks and Fossils in Picket Wire Canyon
After staging tank drills in the area for twenty years, the US Department of Defense gave Picket Wire Canyon to the Comanche National Grassland in 1991. The canyon—named for the Anglo mispronunciation of the Purgatoire, the river that cuts through it—has since been the site of numerous paleontological discoveries, including some 1,300 tracks left by packs of leaf-eating sauropods and solitary carnivorous dinosaurs nearly 150 million years ago.
Other notable discoveries in Picket Wire Canyon occurred in 2001–2, when volunteers and paleontologists unearthed major portions of a huge sauropod skeleton, and in 2013, when a team of Boy Scouts, volunteers, and Forest Service paleontologists found forty-five additional sauropod tracks along a portion of the riverbed that was previously covered with sediment.
Phil Carson, Across the Northern Frontier: Spanish Explorations in Colorado (Boulder: Johnson Books, 1998).
Pekka Hämäläinen, The Comanche Empire (New Haven: Yale University Press, 2008).
M. F. Hockemeyer, "Don Miguel Antonio Otero, 1829–1882," Otero County Genealogy and History.
"History of Rocky Ford," City of Rocky Ford, Colorado.
"Koshare History" and "Koshare Kiva History," Koshare Indian Museum.
"New Dinosaur Tracks Found in Picket Wire Canyon," Mountain Mail, June 18, 2013.
"Otero County," Colorado County Histories Notebook (Denver: History Colorado, 1989–99).
Dave Phillipps, "The Lost World: Comanche National Grassland," Gazette (Colorado Springs), May 16, 2003.
Bent's Old Fort National Historic Site, National Park Service.
"History of La Junta," La Junta Chamber of Commerce.
"History of Otero County" in Frank Hall, History of the State of Colorado (Chicago: Blakely Printing, 1895), vol. 4.
Rocky Ford Growers Association
otero county colorado
bent's fort
la junta colorado
otero county history
Purgatoire River
miguel otero
rocky ford canteloupe
Bent County Courthouse and Jail
Bent's Forts
Boggsville
Bridger Fire
Hispano Settlement in the Purgatoire Valley
Nineteenth-Century Trading Posts
The Fort
William Bent

redpajama_set_name: RedPajamaCommonCrawl


My spring break is officially here! I cannot help but be a little sad that this is probably my last one ever, but I am determined to make the most of it. First I will be spending a few days on the Florida coast, then it is off to Jackson for a few days. Since I will be at the beach I am packing a ton of swimsuits and tshirts. There is no need for real clothing. I hope everyone enjoys their week of freedom, and takes advantage of the nice weather we are expected to have.


on your timing for the walktest how and where did you come up with the W0, I looked through the pdfs and manual and I'm not finding it so on mine I went "symbol counter=b1, 1-60" but I'm not sure if thats correct or will work either but added it under walktest on the program I'm working on so we'll see.
does the chip you are using have a pin for "a/d input".
would that be the same as an adc input ? if it is then yes I have adc 0, adc 1 and adc 2 inputs.
I think I'm on to it here in the manual, because when I use the "symbol" for the counter its using the b1 register (WO), I think !!!
for chips that have adc inputs, one of the tricks you can use to have multiple inputs on one pin is to use a switched resistor network. dont' panic - big words for a simple concept.
see figure 1 for a schematic of how to build the resistor network.
if adc is > 160 then the right pir has detected and i need to go out of this loop routine and move the camera to point to the right direction and record.
THANK YOU VERY MUCH, that is exactly what I am wanting to accomplish but really had no Idea or enough know how to get it done. I was reading a post on a chip forum about using multiple pirs in series and using just one pin of the IC for economical reasons of this individuals. so I knew it could be done , just did'nt know how to accomplish it... I'll work on it..
thanks again bud, very much appreciated.
I really like the name you chose for the project! It's one of the things on my to-do list too, so I'm sure interested in what you learn, and how you do it.
That will point out where you have a problem in the code.
This works in the editor now, but I don't know if it works a camera yet.
symbol counter=b1 'define variable b1 as "counter"
symbol led=6 'define pin 6 as "led"
symbol campower=11 'define pin 11 as "campower"
George, I think I found a problem there. Try this if you can.
symbol shutter=12 'define pin 12 as "shutter"
I've been toying with this too. Depending on what you are try to accomplish, one idea that might simplify things is to use 2 sensors rather than 3 if faster detection/triggering is what you're after. That way, you can put a super wide angle lens in front of one sensor and then a narrow (0.65) in front of the other. Now use the WA for turning the cam on and the .65 for triggering. An advantage of 3 would be that you could use a .65 in front of all 3 so that you would still get good distance though.
my idea was to build a cam that simulates a security cam but use a still cam instead. I have a case I'm building that the cam will see 180 degrees across the case with 3 pir's positioned at one straight forward and the other 2 at 75 degrees from center (off 90 deg) to the left and right of center (probably hard to picture). my buddy is doing a cad drawing of it so when its done I'll post it so you can see how its setup.
I figured if 1 of the 3 pirs was triggered I'd have the cam move to position and then take a pic, or setup the cam to do short video clips and then reposition to what I'd call home position (straight forward). basically it would be able to sense motion from around 270 degrees from where ever I hang it. we have alot of intersecting migration trails that spread and some follow parallel so thats where the thought came from. I could hang the cam and get pics from 3 different angles from 1 spot and cover a bunch of trails at the same time.
hope all that made sense !!!


text:
Q: Hiding Images With JQuery, but can't seem to find the correct class I'm trying to hide broken images with the following code. When I do this, all images display:none rather than the affected images. If anyone could help that would be extremely kind. Thanks in advance.
There's a lot of code below, but I wanted to give the full context.

$("img").closest('.mcnImageContent').hide();

redpajama_set_name: RedPajamaStackExchange


I told my wife: "I divorce you." I just told her once. Does it count as a divorce? Also is there a 3 month waiting period for man too or is it just for woman?
Divorce is of two types. Divorce may either be Sareeh or Kinayah.
A Sareeh divorce is one in which clear words of divorce are used.
Kinayah divorce is where the intention of divorce is expressed using ambiguous words.
A divorce that was issued with clear words maybe revocable. However, a divorce that was issued with ambiguous words may not be retracted without having to re-perform a nikah.
To say "I divorce you" are clear words of divorce and falls under the category of Sareeh Divorce. To issue a divorce once using clear words is sufficient for divorce. If it was said once or twice, the husband can revoke the divorce before the expiry of the three months period (iddat). This could be by saying "I take you back as my wife" or to be physically intimate with your wife etc.
There is no waiting period of iddat for a man. Iddat of divorce or death is only for women.


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Welcome to Paws Inn Animal Hospital
Your Veterinarian in Dayton, OH
Where Your Pet Is Our Priority!
Paws Inn Animal Hospital is a full service veterinary hospital serving Dayton, Ohio since 1996.We recently changed ownership in 2018; however, our goals remain to provide the highest quality professional health care for your pet in a friendly, relaxed setting with affordable pricing. Our facility also offers a spacious boarding kennel and grooming services for dogs and cats to conveniently fulfill all of your pet's needs. We are proud of our hospital and staff and are pleased that you have chosen us to care for your pet.
Our pharmacy has also expanded to include an online pharmacy to offer more options for your pet's medication needs .
Our facility also offers a spacious boarding kennel and grooming services for dogs and cats to conveniently fulfill all your pet's needs.
We realize the special place your pets occupy in your hearts and we work hard to involve you in their care. We appreciate you voicing all your concerns so we can provide the best care possible.
Please browse through our site and follow us on Facebook and Instagram to stay current on all we have to offer. Thank you for visiting and we look forward to helping you enjoy many years with your healthy friend and faithful companion.
At Paws Inn Animal Hospital, we treat your pets like the valued family members they are.
Paws Inn Animal Hospital | (937) 435-1500
8926 Kingsridge Drive
Emmy Baker
Emmy is originally from Springboro, Ohio. She has had a lifelong love of animals which began on the small farm on which she grew up. Although she has worked in other occupations in the past, she has found true fulfillment in working as a pet groomer who can make animals look and feel their best. Emmy says, 'I consider myself to be very lucky to work with animals every day. I truly love my job.'
Mak .
Makayla started her vet career at Miami Valley Career Tech School where she studied veterinary science. After graduating in 2017, she remained in the animal field until she started working at Paws Inn in July of 2019. She lives with her boyfriend of three years in Kettering where they care for their four dogs and two cats. They also enjoy an array of nerdy hobbies. She enjoys working with the clientele and helping animals get the care they need.
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Alex .
Alex started working in the kennel while he was in high school You will see him in our exam rooms everyday helping our doctors and patients during their appointment.
Brittany .
Brittany graduated from Sinclair Community College in 2010 and joined our team in July 2013. Along with her tech job, Brittany also handles our social media! She lives in Cincinnati with her boyfriend Ben and their three dogs Archer, Lana and Mabel, and Berlioz the cat.
Tracy .
Tracy graduated from The Ohio State University where she received a bachelor's degree in Zoology. She joined the Paws Inn team in September 2004. Tracy is the proud parent of her son Quinn and her dog Alex and 5 cats.
Serenity Salome
Kennel Manager
Serenity has been our kennel manager for over a year but has worked here with our boarding pets since 2016. She makes this a home away from home for so many furbabies. Serenity lives in Middletown with her daughters Sam and Adia. Plus her dogs Henry and Otis and kitties Larkin, Oliver, Church and Charly.
Dr. Lisa Mendenhall
Head Veterinarian/Owner
Dr. Lisa Mendenhall was raised in Eugene, OR. She acquired a Bachelor's of Science in Biology from Old Dominion University in Norfolk, VA. After volunteering for a Veterinary Clinic she realized her passion for animal care and medicine.
Dr. Jessica Rossel
Dr. Jessica Rossel is an graduate of The Ohio State University School of Veterinary Medicine. She is a an amazing addition to the Paws Inn family.
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While some people have naturally good skin, others have to work hard for it. Thank your lucky stars for the clear complexion, but remember that no matter in which group you belong to, a skincare routine is essential. Not only to fight off acne and breakouts but also due to the daily exposure to dirt and germs that take a toll on our skin.
But sometimes, despite all the serums, creams, and oils you use, your skin will still look dry and dull. Well, this is where face scrubs come in. Scrubbing removes dead skin, dirt accumulated in your skin pores, excess oil, and sweat. But most importantly, you don't have to spend a fortune as you can make them at home with natural ingredients.
Skin is our largest organ, and everything we put on our face the skin absorbs it, eventually finding its way into our bloodstream, which is yet another reason to try out beauty remedies at home. We should aim for natural ingredients on our skin, and that's why homemade face scrubs are the ideal solution. You'll save money, avoid unfamiliar chemicals, and have glowing skin as a result.
According to Teal Notes, essential oils and exfoliating agents (sugar, coffee, oatmeal) are two additions that make every homemade scrub more effective. Remember that, and follow us for the best homemade scrub for glowing skin. None of it will take more than five minutes to make, tops.
Coffee has antioxidants that keep the skin firm, whereas oil keeps your skin moisturized. For this scrub, you're going to need half a tablespoon of powdered sugar, one tablespoon of coffee powder, and one tablespoon of almond or olive oil. Mix the ingredients in a bowl and use it for your face as well as your body, at least once a week. If you use the scrub regularly, it will make your skin shine, according to Beauty Health Tips.
Suited for all skin types, this scrub will leave your skin with a soft and silky complexion. Take two tablespoons of sandalwood powder, one tablespoon of powdered saffron, two tablespoons of dried rose petals' powder, and a few drops of rose water, and mix them to form a smooth paste. After wetting your hands, apply the mixture to your skin and gently massage in circular motions. Do this for 10 minutes then rinse it with cold water.
It's a gentle scrub that you can use daily. According to Wendy Polisi, it's super-easy to make with only three ingredients: oatmeal, powdered coconut milk, and essential oils. You can also use regular milk, but preferably organic. First, you put one cup of oatmeal in the food processor until it's ground, then mix it with 1/2 cup of coconut milk in a small bowl. Finally, add in essential oils (8 drops of Soft Skin) and mix them. When it's ready to use, mix a teaspoon of water in your and then apply to face.
Lemon has beta hydroxy acid (BHA) that helps eliminate dead cells, and alpha hydroxy acid (AHA) that hydrates the skin, prevents pores from clogging and enhances cell renewal through exfoliation. Sugar also removes dead cells and leaves your skin soft. What you will need to do is mix both the ingredients well together, and apply it to your face. Before using, make sure to wet your face with warm water as it opens the pores so that the scrub can be more effective. After gently scrubbing your face, rinse it off with warm water.
Take two tablespoons of orange peel powder and oats, and add one tablespoon of honey. Then add a little water and mix them well. Apply the mixture on clean skin, massaging gently in circular strokes. After letting it sit for a few minutes, rinse it with water. This scrub will leave your skin looking bright, claims ETimes.
Midget Momma swears by this scrub! For its preparation, you will need two limes, one teaspoon of lime juice, one cup Epson salt, half a cup of coconut oil, and one teaspoon coconut extract. The Epson salt is a great exfoliator, while the coconut oil will keep your skin moisturized. Use a microplane zester to zest the green of the limes, but remove only the outer green. In a bowl, mix up the lime juice, Epson salt, coconut oil, and the coconut extract. After adding the lime zest into the mixture, store it in an airtight glass container.


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India's new Modi Government attempts to unshackle economic growth
October 2014 | SPOTLIGHT | FOREIGN INVESTMENT
Financier Worldwide Magazine
India's newly-elected Prime Minister, Narendra Modi, is acutely aware of the high expectations placed on his government by the Indian electorate as well as the international community – to place India back on a trajectory of high economic growth.
Modi has adopted a two-pronged approach. First, he is pursuing a slew of administrative reforms to expedite project implementation and routine governance matters. Success in harnessing these has begun to meet some expectations, allowing him greater latitude to pursue the more difficult, longer-term task of initiating substantial policy reforms and establishing a stronger and more synergistic centre-state relationship within the overall federal structure.
Pragmatic and efficient governance: Modi's hallmark
Even before Modi formally took office on 26 May 2014, detailed instructions had been issued to the administrative heads of select ministries to prepare presentations highlighting key priorities as well as diagnosis of their core challenges. Modi personally headed the review of each presentation, and with the Prime Minister's Office (PMO) monitoring the progress, these government agencies are now working to achieve the specific targets earmarked for the first 100 days, aligned to the targets for the five-year term of the government.
A principal finding of the PM-led review was that a large number of projects were stalled due to the slow and opaque process of review by the Ministry of Environment and Forests (MoEF). Within two weeks, the MoEF announced it would work with the state governments to ensure that reviews are now completed efficiently such that clearances can be granted within 60 days. On 1 August 2014, the MoEF also launched an online system for submitting and tracking clearance applications. This will help expedite the approval of more than 400 projects, with estimated investments exceeding US$70bn.
Another crucial administrative reform was the abolition of the 30 Groups of Ministers (GoMs) and empowered GoMs (EGoMs) set up by the previous United Progressive Alliance (UPA) government to tackle cross-jurisdictional issues involving more than one ministry. Since the GoMs and EGoMs slowed down decision-making considerably, Modi has instructed that the administrative aspects of such issues shall be tackled by the Cabinet Secretariat, while those related to policy aspects shall be referred to the PMO.
Indian markets and foreign investors warm up to Modi's initiatives
On the monetary front, the Reserve Bank of India (RBI) has indicated its growing confidence in the Modi government's reform agenda, especially its efforts to address supply-side constraints in tackling stubborn inflationary pressures. While the RBI opted to keep interest rates unchanged, it lowered the statutory liquidity ratio (the proportion of a bank's deposits to be held in government bonds), facilitating greater liquidity in the domestic market and the borrowing of capital from external markets. According to the latest data compiled by the market regulator, the Securities and Exchange Board of India, net investments by foreign institutional investors (FIIs) into Indian equity and debt markets stood at US$26bn in 2014. About US$2.8bn of investment has come into the equity market and US$3.8bn into the debt market in July alone – the highest inflow for a month so far this year. This indicates a positive bias on the part of foreign investors toward the Indian markets based on the reform decisions by the new government, favourable returns and easy exit options.
Adopting a business-friendly policy stance
In the Union Budget 2014-15 presented on 10 July 2014, the new Finance Minister, Arun Jaitley, announced a host of measures to promote growth and investment. These included seed capital of INR 1bn each for several much-needed programs, increased government spending on infrastructure, tax incentives for savings and investment, and raising FDI limits in sectors such as insurance, railways and defence.
Opposition demands forced the government to appoint a select committee that will examine the operational terms for FDI in insurance before it can be debated and adopted during the next session of the parliament. But the government did manage to secure formal passage of the bills to raise FDI limits in railways and defence up to 49 percent, while mandating Indian management control.
Despite having the world's largest railway network and being the largest employment generator in India, productivity per employee of the Indian Railways is woefully short of international standards. The government has taken the bold, though unpopular, measure of raising passenger and freight fares, with the plan to deploy the additional revenue to significantly upgrade safety, electronic signals and coach quality. Foreign investment is now permitted in rail operations like dedicated freight lines, high-speed trains and mining and port connectivity, besides allowing up to 74 percent FDI in some projects like construction of new lines, gauge conversion, doubling of lines and maintenance projects under the public-private partnership model.
The Modi government raised the FDI limit in the defence sector from 26 to 49 percent. It reportedly wanted to raise this limit further but had to hold off due to internal political considerations. India's current annual import bill is over US$10bn – the highest in the developing world – betraying a low level of indigenous defence manufacturing. The government is determined to improve India's defence industrial base by streamlining procurement norms, providing greater operational control to foreign manufacturers, simplifying procedures for foreign OEMs to source from Indian companies as per the mandatory offset provisions and incentivising technology transfers. It wants top-tier OEMs to form JVs with Indian companies, the Defence Research & Development Organisation or defence public sector units, create skilled jobs, optimise costs and improve performance – lowering the defence import bill and creating a fungible pool of technologies that can meet future defence requirements that, in any case, are assessed within a dynamic threat environment.
Ease-of-doing-business related initiatives
The Modi government has carried forward a welcome initiative of its predecessor UPA regime called e-Biz, which is a portal through which all registered users – foreign and domestic – can make secure payments for a range of public utilities and obtain government receipts without visiting these offices. A new initiative, e-Kranti, seeks to radically improve the delivery of government services while other initiatives aim to facilitate distance education through virtual classrooms, provision of e-visas and boosting the role of technology across various segments of the Indian market. It is similarly extending the 'right to (timely) service' to many more areas.
With an aim toward greater financial inclusion, the government has launched Jan Dhan Yojana – a scheme under which it wants every single Indian to have a bank account. Under this scheme, account holders can maintain accounts even at zero balance, get life insurance of INR 30,000 and accident insurance coverage of INR 100,000, and have a debit card. This will enable an employer to deposit salaries directly into employees' accounts, particularly useful to the uneducated labour force, eliminating a major source of corruption and improving the lives of the poorest section of society.
Looking beyond the first 100 days
The Modi government will complete 100 days in office on 6 September 2014. It has planned a calibrated media campaign where each department will highlight its accomplishments and note its specific ongoing efforts. The leadership wants to improve transparency and accountability, and exhort citizen participation in relevant schemes and enforcement drives.
From the ramparts of the historic Red Fort on India's 68th Independence Day (15 August), Modi had issued a clarion call to clean up India, including its major rivers, Ganga and Yamuna, improve sanitation and provide toilets in every home and school. The Indian corporate sector responded swiftly, with companies such as TCS, Hindustan Lever, Adani, ITC and the Aditya Birla Group committing INR 1bn each to finance hygienic sanitation facilities for girl students across 10,000 schools in the country. In part, this flood of offers is the result of the new Companies Act 2013, which mandates a 2 percent spend on Corporate Social Responsibility (CSR) initiatives for all profitable companies. Modi's call for toilets has allowed them to align their need to find outlets for CSR spend with a politically-defined national objective.
The import of the above efforts, or of asking members of parliament to use their development-dedicated funds to create one model village in their constituency each year, stems not just from empowering marginalised sections, but from stimulating demand and creating newer models to make development a more profitable enterprise.
India currently ranks 134th on the Global Ease of Doing Business Index. To improve the national score, the Modi government plans to reform India's archaic labour laws. Inspired by the Rajasthan government recently amending four key laws – the Industrial Disputes Act, the Factories Act, the Contract Labour Act and the Apprentices Act – the central government wants to follow suit, and in the process improve the ability of employers – domestic or foreign – to hire and fire workers and determine their salaries, benefits and insurance coverage.
Another significant decision is to replace the Planning Commission, created in 1950 and inspired by Soviet-style central planning, with a think-tank of experts drawn from public and private sectors – one that is better aligned to meeting 21st century requirements.
Modi's style of governance is likened to that of a CEO: careful selection of key personnel, clear targets with specific deadlines, and relentless monitoring. Thus far, his approach seems imbued with his vision of keeping India's economic growth at the core, strengthening economic and security ties with its South Asian neighbours, a strong Look East policy, and selectively engaging key capital farther ashore.
Over the past two months, New Delhi has substantively engaged US and UK leaders and fellow BRICs leaders. PM Modi has a busy September – starting with a much-awaited trip to Japan where he and Japanese PM Shinzo Abe are expected to outline the contours of the revised Indo-Japanese ties, followed by the visit to India of Australia's PM Tony Abbott when they are expected to sign a bilateral civil nuclear pact and other agreements to facilitate much-needed imports of high quality coal and natural gas. The following week, Modi will host Chinese President Xi Jinping, with major announcements expected about Chinese companies setting up an industrial park in India and being granted permission to bid for major infrastructure projects across India. During the last week of September, Modi will meet President Obama in Washington DC to boost defence, high-technology and investment ties while making a fresh attempt to address India's food-subsidy-related concerns and pave the way for formalising the trade facilitation agreement (TFA) in the stalled World Trade Organisation negotiations.
The Modi government is clear that its business-friendly policies will generate resources to expedite India's all-round economic development, and toward this end, his Independence Day speech also exhorted the international community to make India a manufacturing hub, inviting global businesses to manufacture goods in India with 'zero defect' and 'zero (negative) effect' on the environment. The track record thus far affirms the Modi regime's commitment to walk the talk. Time will tell how well the international community responds and how ably the new government is able to calibrate its reforms with long-haul policy changes to spur India's economic growth and meet rising expectations at home and abroad.
Dr Anupam Srivastava is a senior business adviser at SKP Group, a member of Nexia International. He can be contacted on +91 22 6730 9000 or by email: anupam.srivastava@skpgroup.com.
© Financier Worldwide
Dr Anupam Srivastava
SKP Group


Vernon bought this picture for 40 guineas in May 1839, following an exhibition at the British Institution. Creswick was a Sheffield-born artist who studied under the Birmingham landscape painter J.V. Barber. He came to London in 1828. His consistent truth to nature was particularly admired, as were the cool greens he used in his palette which he combined with silvery effects of aerial perspective. In this he might perhaps have been influenced by the landscapes of the Frenchman J.B. Corot (1796-1875). Creswick soon became known as a landscape artist who, in a favourite expression of the time, 'always takes us out of doors'.


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Drugs & Diseases > Rheumatology
Polyarteritis Nodosa Workup
Author: Dana Jacobs-Kosmin, MD, FACP; Chief Editor: Herbert S Diamond, MD more...
Polyarteritis Nodosa
Sections Polyarteritis Nodosa
Idiopathic (Non–HBV-Related) PAN
HBV-Related PAN
HCV-Related PAN
Cutaneous PAN
Long-Term Monitoring
Evidence of peripheral neuropathy should be sought carefully with history and electromyography (EMG), since it is a common complication of polyarteritis nodosa (PAN), being found in as many as 60% of patients. Mononeuritis multiplex is the most common form of PAN neuropathy, but other forms can be present.
Many neurologic and systemic disorders can present with headache. Pathologic headaches are often difficult to differentiate from benign headaches solely on clinical grounds. Severe, persistent headaches, with or without neurologic deficit, warrant complete neurologic evaluation, including brain-imaging studies.
Even though stroke is a late complication in many cases of PAN, it certainly can occur early. PAN and other vasculitic diseases should be considered in many patients with stroke with multiple foci or a combination of hemorrhage and infarction.
Electroencephalography (EEG) may show nonspecific findings of generalized slow wave activity during periods of encephalopathy or toxic delirium.
Laboratory findings in PAN are nonspecific but can help to establish the systemic nature of the disease. Findings include the following:
Elevated erythrocyte sedimentation rate (ESR) and/or C-reactive protein - These markers may be useful in evaluating some patients for active disease but do not correlate with activity in all patients [7]
Leukocytosis, normochromic anemia, or thrombocytosis
Hepatitis B surface antigen and hepatitic C serologies
Elevated creatinine level
Mild proteinuria
Elevated levels of liver enzymes
Hypergammaglobulinemia - Found in 30% of patients with PAN
Cryoglobulins, circulating immune complexes, and decreased levels of serum complement (ie, C3, C4) may be observed in patients with HBV-related PAN but are otherwise uncharacteristic of idiopathic PAN.
Cerebrospinal fluid findings often are usually normal in PAN, but polymorphonuclear pleocytosis can be seen when meningeal signs are present.
ANCA testing is rarely positive in PAN. If ANCA testing is positive, the tests more commonly show a perinuclear (rather than cytoplasmic) pattern and antibodies to proteinase-3 and myeloperoxidase will be negative. [7] Antinuclear antibodies and rheumatoid factor are generally negative, but low positive titers may be detected. [7]
Angiography should be considered if clinically involved tissue is inaccessible. Conventional angiography is preferred. Computed tomography angiography or magnetic resonance angiography are not as sensitive for smaller abnormalities but can reveal larger aneurysms and stenoses. [20, 52]
Positive findings include aneurysms and stenoses of medium-sized vessels. (Note that these findings are not pathognomonic for PAN but rarely occur in MPA). [20]
Aneurysms are most commonly found in the kidney, liver, and mesenteric arteries, and their presence is associated with more severe and extensive disease.
Angiography has a higher yield in cases with evidence of intra-abdominal involvement, including clinical symptoms or signs and laboratory abnormalities of liver or renal function. Arteriograms reveal microaneurysms in the small- and medium-sized arteries of the kidneys and abdominal viscera.
For images and discussion, see Imaging in Polyarteritis Nodosa
Turkish investigators report on the use of Doppler ultrasonography in the diagnosis of seven cases of childhood PAN. These authors recommend that Doppler ultrasound be considered in the first-line approach in the diagnosis of PAN, particularly in children. [53]
Computed tomography (CT) scanning and magnetic resonance imaging (MRI) of the GI tract may show nonspecific abnormal findings, including bowel wall thickening, mesenteric vascular engorgement, ascites, bowel obstruction, or diffuse mucosal fold thickening. For PAN with CNS involvement, new techniques, including susceptibility for blood, diffusion, and perfusion-weighted images, make MRI a very powerful modality for differentiating intracranial hemorrhage from potentially reversible ischemia (since PAN lesions are typically irreversible and progressive).
Electromyography (EMG) and nerve conduction studies (NCS) can be useful in revealing axonal nerve involvement and identifying asymmetry in nerve involvement. EMG/NCS can be used to guide a nerve biopsy, if necessary. [20, 45]
When possible, a biopsy sample of involved, accessible tissue should be collected to aid in the diagnosis. The most accessible tissue sites for biopsy include the skin, sural nerve, testes, and skeletal muscle. The results of a retrospective study suggest muscle biopsy may be helpful for the diagnosis of systemic vasculitides, even in the absence of myalgias or creatine kinase level elevation. [54] Kidney biopsy carries a risk of aneurysmal rupture and bleeding.
Biopsies should be performed correctly to allow for adequate sampling of medium-sized arteries. Biopsy samples of skin nodules or ulcers should be collected at the edges and include deep dermis and subcutaneous fat. [7] In addition, nearby central ulcer areas, including subcutaneous tissue, should be included to increase diagnostic yield. [55]
Biopsy of small arteries from the abdominal viscera in conjunction with arteriography facilitates identification of the vasculitis.
Combined nerve and muscle biopsy is preferred. Biopsy of the sural nerve should be full-thickness to include epineural vessels. [45]
Histology reveals a focal necrotizing arteritis of generally mixed cellular infiltrate within the vessel wall. Nerve biopsy characteristically reveals axonal degeneration and fiber loss. Segmental demyelination may also be seen. [45]
When an inflammatory infiltrate is present around a vessel wall without necrotizing changes, features on nerve biopsy that strongly suggest angiopathic nerve injury include Wallerian degeneration and fiber loss in part of a fascicle, perineural necrosis, and neoangiogenesis around the epineurium or perineurium. [45] An occlusion of a muscular artery and leukocytic infiltrate is seen in the slide below.
Polyarteritis nodosa (PAN) is characterized by fibrinoid necrosis of the arterial wall with a leukocytic infiltrate. In this slide, a large, pale occlusion of a muscular artery can be seen. Within this collagenous tissue is a leukocytic infiltrate, which is the hallmark of PAN. Courtesy of Urbana Atlas of Pathology.
Despite a general recommendation to avoid kidney biopsy owing to a risk of aneurysmal rupture and bleeding, renal biopsy abnormalities in PAN patients have been described. Biopsies from 15 patients with PAN with no or mild renal involvement at study entry only showed abnormalities in one patient. This patient, with HBV-related PAN, had renal vasculitis and membranoproliferative glomerulonephritis (MPGN). [56]
The Birmingham Vasculitis Activity Score and disease extent index have been validated to assess the level of disease activity in children with vasculitis, including PAN. [57]
Stanton M, Bhimji SS. Polyarteritis Nodosa. 2018 Jan. [Medline]. [Full Text].
Ozen S. The changing face of polyarteritis nodosa and necrotizing vasculitis. Nat Rev Rheumatol. 2017 Jun. 13 (6):381-386. [Medline].
Kussmaul A, Maier R. Ueber eine bisher nicht beschriebene eigenthümliche Arterienerkrankung (Periarteritis nodosa), die mit Morbus Brightii und rapid fortschreitender allgemeiner Muskellähmung einhergeht. Dtsch Arch Klin Med. 1866. 1:484-518.
Forbess L, Bannykh S. Polyarteritis nodosa. Rheum Dis Clin North Am. 2015. 41 (1):33-46, vii. [Medline].
Matteson EL. A history of early investigation in polyarteritis nodosa. Arthritis Care Res. 1999 Aug. 12(4):294-302. [Medline].
Davson J, Ball J, Platt R. The kidney in periarteritis nodosa. Q J Med. 1948 Jul. 17(67):175-202. [Medline].
Stone JH. Polyarteritis nodosa. JAMA. 2002 Oct 2. 288(13):1632-9. [Medline].
Lightfoot RW Jr, Michel BA, Bloch DA, Hunder GG, Zvaifler NJ, McShane DJ. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum. 1990 Aug. 33(8):1088-93. [Medline].
Jennette JC, Falk RJ, Andrassy K. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum. 1994 Feb. 37(2):187-92. [Medline].
Colmegna I, Maldonado-Cocco JA. Polyarteritis nodosa revisited. Curr Rheumatol Rep. 2005 Aug. 7(4):288-96. [Medline].
Trepo C, Guillevin L. Polyarteritis nodosa and extrahepatic manifestations of HBV infection: the case against autoimmune intervention in pathogenesis. J Autoimmun. 2001 May. 16(3):269-74. [Medline].
Mahr A, Guillevin L, Poissonnet M, Aymé S. Prevalences of polyarteritis nodosa, microscopic polyangiitis, Wegener's granulomatosis, and Churg-Strauss syndrome in a French urban multiethnic population in 2000: a capture-recapture estimate. Arthritis Rheum. 2004 Feb 15. 51(1):92-9. [Medline].
Guillevin L, Lhote F, Cohen P, Sauvaget F, Jarrousse B, Lortholary O, et al. Polyarteritis nodosa related to hepatitis B virus. A prospective study with long-term observation of 41 patients. Medicine (Baltimore). 1995 Sep. 74(5):238-53. [Medline].
Zhou Q, Yang D, Ombrello AK, Zavialov AV, Toro C, et al. Early-onset stroke and vasculopathy associated with mutations in ADA2. N Engl J Med. 2014 Mar 6. 370 (10):911-20. [Medline].
Navon Elkan P, Pierce SB, Segel R, Walsh T, Barash J, et al. Mutant adenosine deaminase 2 in a polyarteritis nodosa vasculopathy. N Engl J Med. 2014 Mar 6. 370 (10):921-31. [Medline]. [Full Text].
Gonzalez Santiago TM, Zavialov A, Saarela J, Seppanen M, Reed AM, Abraham RS, et al. Dermatologic Features of ADA2 Deficiency in Cutaneous Polyarteritis Nodosa. JAMA Dermatol. 2015 Nov 1. 151 (11):1230-4. [Medline].
Caorsi R, Penco F, Grossi A, Insalaco A, Omenetti A, et al. ADA2 deficiency (DADA2) as an unrecognised cause of early onset polyarteritis nodosa and stroke: a multicentre national study. Ann Rheum Dis. 2017 May 18. [Medline].
Soufir N, Descamps V, Crickx B. Hepatitis C virus infection in cutaneous polyarteritis nodosa: a retrospective study of 16 cases. Arch Dermatol. 1999 Aug. 135(8):1001-2. [Medline].
Saadoun D, Terrier B, Semoun O, Sene D, Maisonobe T, Musset L, et al. Hepatitis C virus-associated polyarteritis nodosa. Arthritis Care Res (Hoboken). 2010 Oct 27. [Medline].
Hughes LB, Bridges SL Jr. Polyarteritis nodosa and microscopic polyangiitis: etiologic and diagnostic considerations. Curr Rheumatol Rep. 2002 Feb. 4(1):75-82. [Medline].
Somer T, Finegold SM. Vasculitides associated with infections, immunization, and antimicrobial drugs. Clin Infect Dis. 1995 Apr. 20(4):1010-36. [Medline].
Patel N, Patel N, Khan T, Patel N, Espinoza LR. HIV infection and clinical spectrum of associated vasculitides. Curr Rheumatol Rep. 2011 Dec. 13(6):506-12. [Medline].
Imanishi H, Tsuruta D, Oshimo T, Sowa J, Mizuno N, Nakagawa K, et al. Cutaneous polyarteritis nodosa induced by Mycobacterium tuberculosis. J Dermatol. 2012 Aug. 39(8):738-9. [Medline].
Watts RA, Mooney J, Lane SE, Scott DG. Rheumatoid vasculitis: becoming extinct?. Rheumatology (Oxford). 2004 Jul. 43(7):920-3. [Medline].
Nakano H, Ooka S, Shibata T, Ogawa H, Ito H, Takakuwa Y, et al. Cutaneous polyarteritis nodosa associated with HLA-B39-positive undifferentiated spondyloarthritis in a Japanese patient. Mod Rheumatol. 2012 Sep. 22(5):783-6. [Medline].
Pagnini I, Simonini G, Lippi F, Azzari C, Cimaz R. Cutaneous polyarteritis nodosa and common variable immunodeficiency: a previously unreported association. Clin Exp Rheumatol. 2012 Jan-Feb. 30(1 Suppl 70):S169. [Medline].
Oulego-Erroz I, Gautreaux-Minaya S, Martinez-Sáenz de Jubera J, Naranjo-Vivas D, Fernéndez-Hernández S, Muñíz-Fontán M. Coexistence of polyarteritis nodosa and psoriatic arthritis in a child: an unreported association: Polyarteritis nodosa and Psoriatic arthitritis. Eur J Pediatr. 2011 Sep. 170(9):1213-5. [Medline].
Hasler P, Kistler H, Gerber H. Vasculitides in hairy cell leukemia. Semin Arthritis Rheum. 1995 Oct. 25(2):134-42. [Medline].
Ambrosio MR, Rocca BJ, Ginori A, Onorati M, Fabbri A, Carmellini M, et al. Renal infarction due to polyarteritis nodosa in a patient with angioimmunoblastic T-cell lymphoma: a case report and a brief review of the literature. Diagn Pathol. 2012 May 8. 7:50. [Medline]. [Full Text].
McMahon BJ, Heyward WL, Templin DW, Clement D, Lanier AP. Hepatitis B-associated polyarteritis nodosa in Alaskan Eskimos: clinical and epidemiologic features and long-term follow-up. Hepatology. 1989 Jan. 9(1):97-101. [Medline].
Selga D, Mohammad A, Sturfelt G, Segelmark M. Polyarteritis nodosa when applying the Chapel Hill nomenclature--a descriptive study on ten patients. Rheumatology (Oxford). 2006 Oct. 45(10):1276-81. [Medline].
Levine SM, Hellmann DB, Stone JH. Gastrointestinal involvement in polyarteritis nodosa (1986-2000): presentation and outcomes in 24 patients. Am J Med. 2002 Apr 1. 112(5):386-91. [Medline].
Kato A, Hamada T, Miyake T, Morizane S, Hirai Y, Yamasaki O, et al. Clinical and Laboratory Markers Associated With Relapse in Cutaneous Polyarteritis Nodosa. JAMA Dermatol. 2018 Aug 1. 154 (8):922-926. [Medline].
Falcini F, La Torre F, Vittadello F, Rigante D, Martini G, Corona F, et al. Clinical overview and outcome in a cohort of children with polyarteritis nodosa. Clin Exp Rheumatol. 2014 May-Jun. 32(3 Suppl 82):S134-7. [Medline].
Eleftheriou D, Dillon MJ, Tullus K, Marks SD, Pilkington CA, Roebuck DJ, et al. Systemic polyarteritis nodosa in the young: a single-center experience over thirty-two years. Arthritis Rheum. 2013 Sep. 65(9):2476-85. [Medline].
Mahmood-Rao H, Ding T, Gandhi N. Gangrenous digital infarcts in a severe case of cutaneous polyarteritis nodosa. BMJ Case Rep. 2017 Jun 29. 2017:[Medline].
Agarwal A, Bansal M, Pandey R, Swaminathan S. Bilateral subcapsular and perinephric hemorrhage as the initial presentation of polyarteritis nodosa. Intern Med. 2012. 51(9):1073-6. [Medline].
Battula N, Tsapralis D, Morgan M, Mirza D. Spontaneous liver haemorrhage and haemobilia as initial presentation of undiagnosed polyarteritis nodosa. Ann R Coll Surg Engl. 2012 May. 94(4):e163-5. [Medline].
Parent BA, Cho SW, Buck DG, Nalesnik MA, Gamblin TC. Spontaneous rupture of hepatic artery aneurysm associated with polyarteritis nodosa. Am Surg. 2010 Dec. 76(12):1416-9. [Medline].
Yuce M, Davutoglu V, Sari I, Onat AM. Polyarteritis nodosa with multiple coronary aneurysms presenting as acute myocardial infarction. Am J Med Sci. 2011 May. 341(5):409. [Medline].
Pagnoux C, Le Guern V, Goffinet F, Diot E, Limal N, Pannier E, et al. Pregnancies in systemic necrotizing vasculitides: report on 12 women and their 20 pregnancies. Rheumatology (Oxford). 2011 May. 50(5):953-61. [Medline].
Kocyigit I, Koyuncu S, Mavili E, Unal A, Tokmak TT, Cilan H. Unusual clinic presentation of polyarteritis nodosa: involvement of axillary and brachial artery. Ren Fail. 2011. 33(10):1043-5. [Medline].
Guillevin L, Lhote F, Gayraud M, Cohen P, Jarrousse B, Lortholary O. Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome. A prospective study in 342 patients. Medicine (Baltimore). 1996 Jan. 75(1):17-28. [Medline].
Fernandes SR, Coimbra IB, Costallat LT. Uncommon features of polyarteritis nodosa: psychosis and angio-oedema. Clin Rheumatol. 1998. 17(4):353-6. [Medline].
Griffin JW. Vasculitic neuropathies. Rheum Dis Clin North Am. 2001 Nov. 27(4):751-60, vi. [Medline].
Rosenberg MR, Parshley M, Gibson S, Wernick R. Central nervous system polyarteritis nodosa. West J Med. 1990 Nov. 153(5):553-6. [Medline]. [Full Text].
Haroon M, Bermingham N, Keohane C, Harney S. Polyarteritis nodosa presenting with clinical and radiologic features suggestive of polymyositis. Rheumatol Int. 2012 Apr. 32(4):1079-81. [Medline].
Yang SN, Cho NS, Choi HS, Choi SJ, Yoon ES, Kim DH. Muscular polyarteritis nodosa. J Clin Rheumatol. 2012 Aug. 18(5):249-52. [Medline].
Filippone EJ, Foy A, Galanis T, Pokuah M, Newman E, Lallas CD. Segmental arterial mediolysis: report of 2 cases and review of the literature. Am J Kidney Dis. 2011 Dec. 58(6):981-7. [Medline].
Kermani TA, Ham EK, Camilleri MJ, Warrington KJ. Polyarteritis nodosa-like vasculitis in association with minocycline use: a single-center case series. Semin Arthritis Rheum. 2012 Oct. 42(2):213-21. [Medline].
Bezier M, Perceau G, Reguiai Z, Remy-Leroux V, Tchen T, Durlach A. [Necrotic leg ulcers induced by vitamin K antagonists: five cases]. Ann Dermatol Venereol. 2011 Oct. 138(10):657-63. [Medline].
Higuchi T, Sugimoto N, Hayama M, Tanaka E. The usefulness of 3D-CT angiography in polyarteritis nodosa. Intern Med. 2012. 51(11):1449-50. [Medline].
Özçakar ZB, Fitöz S, Yıldız AE, Yalçınkaya F. Childhood polyarteritis nodosa: diagnosis with non-invasive imaging techniques. Clin Rheumatol. 2017 Jan. 36 (1):165-171. [Medline].
Hervier B, Durant C, Masseau A, Ponge T, Hamidou M, Mussini JM. Use of muscle biopsies for diagnosis of systemic vasculitides. J Rheumatol. 2011 Mar. 38(3):470-4. [Medline].
Ricotti C, Kowalczyk JP, Ghersi M, Nousari CH. The diagnostic yield of histopathologic sampling techniques in PAN-associated cutaneous ulcers. Arch Dermatol. 2007 Oct. 143(10):1334-6. [Medline].
Gheita TA, Khairy NA, Nasrallah MM, Hussein H. Subclinical renal involvement in essential cryoglobulinemic vasculitis and classic polyarteritis nodosa. Joint Bone Spine. 2012 May. 79(3):274-80. [Medline].
Demirkaya E, Ozen S, Pistorio A, Galasso R, Ravelli A, Hasija R. Performance of Birmingham Vasculitis Activity Score and disease extent index in childhood vasculitides. Clin Exp Rheumatol. 2012 Jan-Feb. 30(1 Suppl 70):S162-8. [Medline].
Campanilho-Marques R, Ramos F, Canhão H, Fonseca JE. Remission induced by infliximab in a childhood polyarteritis nodosa refractory to conventional immunosuppression and rituximab. Joint Bone Spine. 2014 May. 81 (3):277-8. [Medline].
Matsuo S, Hayashi K, Morimoto E, Kato A, Sada KE, Watanabe H, et al. The Successful Treatment of Refractory Polyarteritis Nodosa Using Infliximab. Intern Med. 2017. 56 (11):1435-1438. [Medline]. [Full Text].
Inoue N, Shimizu M, Mizuta M, Ikawa Y, Yachie A. Refractory cutaneous polyarteritis nodosa: Successful treatment with etanercept. Pediatr Int. 2017 Jun. 59 (6):751-752. [Medline].
Krusche M, Ruffer N, Kötter I. Tocilizumab treatment in refractory polyarteritis nodosa: a case report and review of the literature. Rheumatol Int. 2018 Nov 21. [Medline].
Seri Y, Shoda H, Hanata N, Nagafuchi Y, Sumitomo S, Fujio K, et al. A case of refractory polyarteritis nodosa successfully treated with rituximab. Mod Rheumatol. 2015 Mar 12. 1-3. [Medline].
de Luna G, et al; French Vasculitis Study Group (FVSG). Plasma exchanges for the treatment of severe systemic necrotizing vasculitides in clinical daily practice: Data from the French Vasculitis Study Group. J Autoimmun. 2015 Dec. 65:49-55. [Medline].
Frohnert PP, Sheps SG. Long-term follow-up study of periarteritis nodosa. Am J Med. 1967 Jul. 43(1):8-14. [Medline].
Gayraud M, Guillevin L, le Toumelin P, Cohen P, Lhote F, Casassus P. Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum. 2001 Mar. 44(3):666-75. [Medline].
Guillevin L, Mahr A, Cohen P, Larroche C, Queyrel V, Loustaud-Ratti V, et al. Short-term corticosteroids then lamivudine and plasma exchanges to treat hepatitis B virus-related polyarteritis nodosa. Arthritis Rheum. 2004 Jun 15. 51(3):482-7. [Medline].
Guillevin L, Lhote F, Leon A, Fauvelle F, Vivitski L, Trepo C. Treatment of polyarteritis nodosa related to hepatitis B virus with short term steroid therapy associated with antiviral agents and plasma exchanges. A prospective trial in 33 patients. J Rheumatol. 1993 Feb. 20(2):289-98. [Medline].
Guillevin L, Lhote F, Sauvaget F, Deblois P, Rossi F, Levallois D. Treatment of polyarteritis nodosa related to hepatitis B virus with interferon-alpha and plasma exchanges. Ann Rheum Dis. 1994 May. 53(5):334-7. [Medline].
Erhardt A, Sagir A, Guillevin L, Neuen-Jacob E, Häussinger D. Successful treatment of hepatitis B virus associated polyarteritis nodosa with a combination of prednisolone, alpha-interferon and lamivudine. J Hepatol. 2000 Oct. 33(4):677-83. [Medline].
Wicki J, Olivieri J, Pizzolato G, Sarasin F, Guillevin L, Dayer JM. Successful treatment of polyarteritis nodosa related to hepatitis B virus with a combination of lamivudine and interferon alpha. Rheumatology (Oxford). 1999 Feb. 38(2):183-5. [Medline].
Molloy PJ, Friedlander L, Van Thiel DH. Combined interferon, famciclovir and GM-CSF treatment of HBV infection in an individual with periarteritis nodosa. Hepatogastroenterology. 1999 Jul-Aug. 46(28):2529-31. [Medline].
de Menthon M, Mahr A. Treating polyarteritis nodosa: current state of the art. Clin Exp Rheumatol. 2011 Jan-Feb. 29(1 Suppl 64):S110-6. [Medline].
Fernanda F, Serena C, Giustina R, Antonella B, Alessandra D, Alessio M. Mycophenolate mofetil treatment in two children with severe polyarteritis nodosa refractory to immunosuppressant drugs. Rheumatol Int. 2012 Jul. 32(7):2215-9. [Medline].
Berlit P. Diagnosis and treatment of cerebral vasculitis. Ther Adv Neurol Disord. 2010 Jan. 3(1):29-42. [Medline]. [Full Text].
Kawakami T, Soma Y. Use of mizoribine in two patients with recalcitrant cutaneous polyarteritis nodosa. J Am Acad Dermatol. 2011 Jun. 64(6):1213-4. [Medline].
Kluger N, Guillot B, Bessis D. Ulcerative cutaneous polyarteritis nodosa treated with mycophenolate mofetil and pentoxifylline. J Dermatolog Treat. 2011 Jun. 22(3):175-7. [Medline].
Nonspecific, firm, tender subcutaneous nodules without livedo reticularis and/or systemic involvement may be the first sign of polyarteritis nodosa (PAN).
Tender, hyperpigmented, firm subcutaneous nodules with a background of livedo reticularis common in cutaneous polyarteritis nodosa (PAN).
Tender erythematous nodules with central "punched out" ulcerations common in cutaneous polyarteritis nodosa (PAN).
Livedo reticularis in polyarteritis nodosa (PAN).
Dana Jacobs-Kosmin, MD, FACP Attending Physician, Department of Medicine, Division of Rheumatology, Einstein Medical Center; Clinical Assistant Professor of Medicine, Jefferson Medical College of Thomas Jefferson University
Dana Jacobs-Kosmin, MD, FACP is a member of the following medical societies: American College of Physicians, American College of Rheumatology, American Medical Association
J Mark Jackson, MD Clinical Professor of Medicine/Dermatology, Division of Dermatology, University of Louisville School of Medicine
J Mark Jackson, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Kentucky Medical Association, Texas Medical Association
Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa
Mahendra Agraharkar, MD, MBBS, FACP, FASN, Clinical Associate Professor of Medicine, Baylor College of Medicine; President and CEO, Space City Associates of Nephrology
Mahendra Agraharkar, MD, MBBS, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Nephrology, and National Kidney Foundation
Disclosure: South Shore DaVita Dialysis Center Ownership interest
Bruce A Baethge, MD, Faculty, Texas A&M Medical School
Bruce A Baethge, MD is a member of the following medical societies: Alpha Omega Alpha; American College of Physicians; American College of Rheumatology and Arthritis Foundation
Kanwarpreet Baweja, MD, Fellow in Nephrology, Division of Renal Diseases and Hypertension, University of Texas Health Science Center
Kanwarpreet Baweja, MD is a member of the following medical societies: American Medical Association, American Society of Nephrology, Medical Council of India, and National Kidney Foundation
Steve Chung, MD, Director, Clinical Epilepsy Research, Assistant Professor of Clinical Neurology, Residency Director, Department of Neurology, Barrow Neurological Institute
Steven Chung, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Medical Association, California Medical Assocation, and Phi Beta Kappa
Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
B Mark Keegan, MD, FRCPC, Assistant Professor of Neurology, College of Medicine, Mayo Clinic; Master's Faculty, Mayo Graduate School; Consultant, Department of Neurology, Mayo Clinic, Rochester
B Mark Keegan, MD, FRCPC is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Minnesota Medical Association
Disclosure: Novartis Consulting fee; Bionest Consulting fee
Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Carlos J Lozada, MD Director of Rheumatology Fellowship Program, Professor, Department of Medicine, Division of Rheumatology and Immunology, University of Miami, Leonard M Miller School of Medicine
Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology
Disclosure: Pfizer Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching
Christopher Luzzio, MD, Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health
Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology
Vasanta P Weiss, MD, Consulting Staff, Department of Nephrology, University of Virginia Medical Center
encoded search term (Polyarteritis Nodosa) and Polyarteritis Nodosa
Vasculitis and Thrombophlebitis
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Appel Osborne is proud to see that our running track design at Westhill CSD offers a perfect venue for the "Last Chance Warrior Steeple Challenge" which the school has hosted for the past few years. The event involves a 3,000-meter run and occasional jumps off of large hurdles including one with a water hazard. Westhill coach Dan Reid said they host this event because it is a part of several invitational meets, and it's a league, sectional, and state championship event. The track at Westhill CSD, which was completed by Appel Osborne in 2012, has a steeplechase water pit which allows for training in this event. Congratulations to those who participated and to those who qualified to compete at the state level. Click the link to read an article about the event.


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Kabwohe Clinical Research Centre
We Care But life comes from God
Free Safe Male Circumcision
Anti Retroviral Therapy (ART) Program
News & Studies
Research for better Health and Prosperity!
News, Programs & Events
Dr. Elioda in the White House Summit for International Development
TWO STUDIES TO BE ACTIVATED AT KCRC.
TIPPING POINT AWARD TO CHAIRMAN BOARD OF DIRECTORS
URA APPRECIATES KCRC FOR BEING TAX COMPLIANT
KCRC LABORATORY TESTING MENU & TURN AROUND TIME
KCRC LABORATORY CAPACITY
Validation of a Portable Instrument for Point-of-Care CD4 Testing
Staphylococcus Aureus Colonization Study
Determinants of Fertility Intentions among HIV discordant couples in rural Uganda
Objective Measures of Adherence in an HIV Prevention Trial
Pre-Exposure Prophylaxis (PrEP)
Kabwohe Clinical Research Center (KCRC) was founded by Hon. Dr. Elioda Tumwesigye and a group of clinical researchers interested in finding ways to prevent HIV infection and dedicated to improving the health of the rural people. The center has flourished dramatically into a diverse community of talented clinical investigators. Kabwohe Clinical Research Centre (KCRC) is situated in the Kabwohe – Itendero Town Council in Bushenyi District, on the Southern Western Uganda.
The center is about Three hundred and Twenty kilometers from the capital Kampala, and less than thirty kilometers from the neighboring town of Mbarara and Mbarara airstrip. It is easily accessible by road from both Entebbe airport and Kampala city. The center is on the main bus and taxi route and therefore easily accessible by public transport.
The centre comprises of several buildings. The building known as the Upper KCRC building is situated on one side of the main road. This building houses the main clinic, where outpatient ARV patients are currently been seen, a pharmacy room, chemistry, microbiology and haematology laboratories, offices for the clinical officers, an X-ray and ultrasound rooms as well as counseling offices. The Lower KCRC building is situated on the other side of the main road opposite the main Upper KCRC building. This building serves as a general clinic and comprises of several offices, consulting rooms, data room, pharmacy room and a phlebotomy room. Other buildings are used specifically and particularly for clinical studies. They have reception areas, laboratory space, data-rooms, and several other offices used for by counsellors and clinicians.
The centre has an already established service for caring for HIV infected individuals with over 3,000 (three thousand) individuals already accessing care and support. Other services rendered at the centre are HIV prevention, community education which includes Home Based Voluntary Counseling and Testing through working with our parent Non Governmental Organization ICOBI.
mail@kcrc.or.ug
Kabwohe Town, Sheema District.
P.O.Box 347, Bushenyi
Copyright © 2020 Kabwohe Clinical Research Centre


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I would be willing to volunteer anywhere in Asia, Europe and South America.
I am Alexis from the Philippines, 28 years old, a registered nurse and humanitarian worker at the same time. As a child protection advocate, children and their welfare is one of my passions.
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The Loudoun Museum is a private, non-profit institution in Loundon County, the third fastest- growing county in the United States. Ongoing research projects and exhibits examine slavery in Loudoun County and the quality of life for African Americans in the county since Emancipation.
Virginia Foundation for the Humanities, "Loudoun Museum," African American Historic Sites Database, accessed April 21, 2019, http://aahistoricsitesva.org/items/show/252.


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Symptom clusters after surgery for esophageal cancer predict poor prognosis
A new study from Karolinska Institutet show that several months after surgery for esophageal cancer, different symptoms cluster together in different types of patients. In addition, patients with certain symptom clusters have an increased risk of dying from their disease. The findings are published in the scientific journal Cancer.
Esophageal cancer is an aggressive cancer with a very poor prognosis, and surgery to remove the esophagus offers the only chance of a cure. Only about a quarter of patients who are diagnosed receive surgery, in the rest, the tumour is too advanced to remove. In patients who do undergo surgery, only 30 percent are still alive five years after the surgery. The surgery is very extensive, and patients experience severe post-operative symptoms and limitations that affect their quality of life and daily living. Common symptoms include eating and swallowing problems, acid reflux, pain, and fatigue.
Research of symptoms in other cancers suggests that symptoms experienced by patients may present in specific groupings or clusters, and that these clusters may have an important impact on patient outcomes.
The current study includes 402 patients who underwent surgery for esophageal cancer in Sweden during the period 2001-2005. Researcher Anna Wikman, PhD, and her colleagues at Karolinska Institutet, found that symptoms reported by patients six months after surgery clustered together in three groups: one symptom cluster included symptoms related to fatigue and pain, another cluster included symptoms related to reflux and cough, and a third cluster included symptoms related to eating difficulties. The patients who experienced the reflux/cough symptom cluster and the eating difficulties cluster were more likely to die within five years than patients who did not experience these symptom clusters.
"This is the first study of symptom clusters in surgically treated esophageal cancer patients and further research is required to confirm the findings, however the present study suggest that that post-operative symptoms should not be considered in isolation," says Dr Wikman. "It seems that patients who experience clustering of certain symptoms also have an increased mortality risk over and above the effect of other known prognostic factors. It may be important to address these symptom clusters in the clinical setting in order to potentially reduce the increased mortality risk associated with them."
Anna Wikman is a health psychologist and holds a postdoc position at Karolinska Institutet's Department of Molecular Medicine and Surgery. The study was funded with grants from the Swedish Research Council, The Swedish Cancer Society, and the Cancer Society in Stockholm. Study leader was Pernilla Lagergren, professor of surgical care sciences at Karolinska Institutet
View a press release about the findings
Presence of symptom clusters in surgically treated esophageal cancer patients; implications for survival
Anna Wikman, Asif Johar, Pernilla Lagergren
Cancer – a peer-reviewed journal of the American Cancer Society, online 25 November 2013, doi: 10.1002/cncr.28308
Webb Admin 10-02-2014
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text:
47 percent of workers want more recognition; top 5 complaints from employees about recognition in the Workplace: Survey
Why has recognition at work become more important?
A new way of "doing everything"
Burnout factors
What employees need from their workplace to feel recognized
7 ways employees want to be recognized
The benefits of making employees feel recognized
A different approach to the employer-employee relationship
A survey by Eagle Hill Consulting has found that 47% of workers in the U.S. would like more recognition for the work that they do while 21% say that they are never recognized for their efforts at all [1].
Melissa Jezior, president and CEO of Eagle Hill Consulting, says that "employers need to double down on employee recognition programs. Far too many employees are burnt out from their workload and say they aren't recognized for their efforts … Failing to acknowledge workers is a recipe for subpar organizational performance and high attrition, the last thing employers need in a volatile economy".
Yet, according to Eagle Hill's survey, only 36% of workers said their employer developed new ways of recognizing employees in the past year and just 25% asked workers how they would like to be recognized [2].
Mike Byam, executive chairman of Terryberry in Grand Rapids, Michigan, said "the lack of appreciation of performance is one of the things that's driving the resignation and people moving jobs. So that's something that can be addressed … it's been encouraging that even in this time, with so many different challenges, people recognize the value of it" [3].
There are many reasons for the exodus of people leaving their jobs during and after the pandemic, but the heart of the issue was that people's tolerance levels for many things had decreased sharply.
The pandemic, followed closely by complicating economic factors, brought with it a slew of rules and regulations that shifted constantly like sand amidst fearmongering, confusion, and uncertainty. Organizations, governments, and people hesitated at every turn, trying their best to decide what the next best step to take was.
The pressure, stress, and onslaught of change after massive change left the general public drained. They were forced to adjust to a new way of doing everything in their life – shopping, interacting with their families, dating, meeting friends, studying.
For employees who had to work from home, they suddenly found themselves stretched in a billion different directions. They needed to learn how to work remotely, make their own meals, teach their children, make time for their friends, family, and spouses, and still find time for their own interests.
Somewhere in the midst of all that chaos, it appears that people learned the value of their time and effort. They were constantly spread too thin. The ongoing burnout meant that their tolerance levels for toxicity, rudeness, and effort that went unrecognized tanked. Additionally, while it's easy to speak to friends and family about wanting more recognition, it isn't so easy in the workplace.
Moreover, the pandemic showed people how their workplaces felt about them. A workplace's response to the pandemic as well as government rules and guidelines told employees if their workplace really cared about their safety, how connected the workplace and employees were, and how treasured the employee was.
Chris Vyse, VP of sales and marketing at OC Tanner in Burlington, Ontario said, "we used to talk a lot about employee engagement for a number of years, but now it seems to be more about connection, employees feeling connected to the organization, to their colleagues and to the purpose of the organization. It's required creativity, and that continues now that we're in the hybrid model" [4].
A previous feature on "Burnout" in the workplace>>
Burnout is caused by many factors, including workload, anxiety and other workplace stresses. Even lack of appreciation from supervisors can contribute to burnout.
The most common symptom of employees that feel unrecognized and disconnected to their workplace is doing the "bare minimum". Sometimes also called quiet quitting, this is a phenomenon where employees do only exactly what their job entails and not a smidge more. This is because they feel that there is no point to go outside the parameters of their job role since their workplace doesn't appear to care about what they do.
Quiet quitting can create imbalances in teams, as more engaged employees pick up the slack that their disengaged colleagues left them. This can morph into burnout, frustration, and increasing difficulty to deliver high-quality, efficient output.
The biggest and most impactful ways to show employees that they are important to the workplace are of course salary and benefits, but it's imperative that a workplace doesn't stop there.
A 2022 survey of employers in Canada indicates a salary increase is projected across most industries in 2023
The Eagle Hill Consulting survey showed that the top 5 complaints of employees about recognition were the following: 38% of employees think that recognition programs should be more frequent, 30% said that they would like these programs to be shared more broadly across the organization, 26% said that they should be easier to provide, and 24% said that they should be unbiased [5].
As to how they wished to be shown recognition, employees said that they preferred the following means:
cash or gifts (54%)
time off (34%)
a thank you email or note (32%)
points to choose a reward (23%)
experience opportunities like tickets (22%)
public recognition (20%)
employee of the week/month programs (19%) [6]
These means of recognition are neither difficult to set up nor cost-ineffective. Melissa Jezior, president and CEO of Eagle Hill Consulting notes that "the key to success is creating a culture in which thanking workers is woven into the fabric of day-to-day operations from the top to the bottom, not just a one-off effort that checks the box on recognition" [7].
Ensuring that employees feel recognized brings many positive effects to employees.
Of those surveyed, 60% of workers said that recognition makes them feel that the work they do is meaningful, 51% say that it makes them feel their team supports them, 32% said that it makes them more motivated at work, and 29% said that it makes them feel they are achieving something higher than just their career potential [8].
When they feel that their work is recognized, employees are more likely to:
go above and beyond their responsibilities (53%)
stay with their organization (48%)
be more motivated to support their team (43%)
go above and beyond for customers (38%) [9]
It's clear that the benefits of workplace recognition positively affect employees' emotional wellbeing and performance. Natalie Wickham, VP of marketing at Quantum Workplace, says that "employees want to feel valued at work. They want recognition for their contributions to team and organizational success … while extremely important, recognition isn't only about making employees more engaged or feeling good about their job. It can be a differentiator for organizations in their employee value proposition and can affect an employee's intent to stay at an organization" [10].
Ensuring employees feel recognized doesn't just keep employees at a job, but it can entice them to a job as well. Knowing or hearing of a workplace that has a culture of recognition can be a factor for people when they are deciding between potential workplaces.
The survey shows that having a culture of recognition positively impacts employees' mental, emotional, and even physical well-being. It motivates employees to do their best, contribute value to the company, and builds a sense of security in their role.
Included in a culture of recognition is showing gratitude. According to Michael Timms, a leadership development consultant, gratitude reinforces desirable behaviors and results, serving as a positive consequence for employees' actions. As a result, it helps the organization enjoy increased output, efficiency, and efficacy.
Timms says, "the reason why gratitude actually works to reinforce behaviors is that when we are praised for doing something, our brain releases a chemical called dopamine. And dopamine feels really good … here's the key: behavior that is praised gets repeated simply because we are all addicted to dopamine. We are going to repeat the behavior that we've been praised for previously. That's why gratitude works as a leader's tool to increase accountability in the workplace" [11].
The surveys, experts, and leaders in this article have concluded that making employees feel recognized is a worthwhile effort to invest in. Not only does it benefit employees directly, but it benefits the company indirectly as well.
While life may be slowly returning to normal, the changes and trends that the pandemic caused are still being felt today. It's imperative that organizations keep up so that they can stay on top.
[1] [2] [5] [6] [7] [8] [9] [10]
https://www.hrreporter.com/focus-areas/performance-management/what-are-top-5-complaints-about-recognition-programs/371461
https://www.hrreporter.com/focus-areas/culture-and-engagement/the-latest-trends-in-employee-recognition/367744
https://www.hrreporter.com/focus-areas/compensation-and-benefits/whats-the-best-way-to-show-gratitude-to-employees/362037


The Common Safety Methods (CSMs) describe how the safety levels, the achievement of safety targets and compliance with other safety requirements should be fulfilled.
The CSMs are directly applicable and enforceable in the Member States. Depending on their scope, they are applied either by authorities or bodies, or by specific actors of the railway system (e.g. railway undertakings, infrastructure managers, entities in charge of maintenance), or even by both.
The CSMs are established in accordance with Article 6 of Directive (EU) 2016/798.
The harmonised design targets for technical systems which should help with mutual recognition of those systems across the European Union.
It applies to the proposer as defined in Article 3(11) of Regulation (EU) No 402/2013 when making any change to the railway system in a Member State.
This Regulation sets out a harmonised framework for monitoring all safety-related processes. It shall be applied by railway undertakings, infrastructure managers and entities in charge of maintenance to enable the effective management of safety of the railway system during its operation and maintenance activities.
It should contribute to improve the safety management system of railway undertakings and infrastructure managers and the system of maintenance of entities in charge of maintenance.
This Regulation sets out the requirements to be complied with by railway undertakings and infrastructure managers when establishing their safety management system.
This Regulation provides a common purpose for supervision to make sure national safety authorities give appropriate effect to overseeing that the railway undertaking or infrastructure manager has and implements effectively its safety management system (SMS) so that the railway system operates safely.
It applies to national safety authorities only.
To support the assessment of how well a railway undertaking or infrastructure managers' SMS is working, ERA has developed a maturity model. This model can be directly used via the ERA SMS app.
This Regulation sets out Common Safety Targets (CSTs) with the aim of ensuring that safety performance does not decrease in any of the Member States. It provides in the short term control of safety performances and in the longer term, convergence of safety performance in Europe, through the use of national reference values (i.e. common ways of measuring and assessing safety performance on a macro level).
ERA assesses the achievement of CSTs in the Member States based on the data collected from Eurostat.
The assessment of achievement of CSTs is facilitated by the collection and use of a common set of rail safety data, the Common Safety Indicators (CSIs).
National safety authorities use CSIs to gather information from railway undertakings and infrastructure managers, which combined with other relevant data, makes a comparative analysis possible, and serves as basis for policy recommendations at EU level.
ERA publishes both these indicators and the assessment of the achievement of CSTs in its safety performance report and in the ERADIS database.
Monitoring safety performance is a priority task of the Agency in its mission to promote a harmonised approach to railway safety in Europe.
The principles for supervising compliance with the requirements of Directive 2004/49/EC after the national safety authority has granted the safety certificate/authorisation.
Regulations (EU) No 1158/2010 and (EU) No 1169/2010 are repealed with effect from 16 June 2025. They apply to safety certificates and safety authorisations issued in accordance with Directive 2004/49/EC until their expiry date. For the same reason, the national safety authorities should continue to apply them for the purposes of supervision.


Expressing a circle in terms of a mathematical form expression when the circle passes through the origin of the Cartesian coordinate system and the centre of the circle lies on the y-axis of the Cartesian coordinate system is defined equation of the circle when the circle passes through the origin and centre of the circle lies on the y-axis.
A circle can be passed through the origin of the Cartesian coordinate system and also the centre of the circle can also lie on the y-axis of the Cartesian coordinate system. It can be written in mathematical form by understanding the relation of the circle with the Cartesian coordinate system and the equation of the circle exactly reveals how exactly the circle is in the Cartesian coordinate system.
Imagine a circle in the Cartesian coordinate system and assume it passes through the origin of the Cartesian coordinate system by having a radius of r units and also assume the centre of the circle lies on the vertical y-axis.
Assume, the centre of the circle is called as point P. It lies on the vertical y-axis. So, the distance from origin to centre of the circle in horizontal x-axis direction is zero units. Assume, the distance from the origin of the coordinate geometric system to centre of the circle is b units. So, the coordinates of the centre of the circle is P (0, b).
Consider a point on the circle and assume it represents all the points on the circle. Assume the variable point is located at x and y units distance from the origin in horizontal and vertical axis directions. It is assumed to call point R and coordinate of this point is R (x, y).
Draw a perpendicular line from point P and that should be parallel to the x-axis. Similarly, draw a line from point R and it should be perpendicular to the x-axis. These two lines are intersected at a point, called Q. Thus, a right angled triangle ΔRPQ is constructed.
The right angled triangle consists of three sides and the relation between them can be expressed in mathematical form according to Pythagorean Theorem.
The length of the every side of the right angled triangle can be evaluated from the right angled triangle ΔRPQ.
Length of the hypotenuse is PR = r.
Length of the adjacent side is PQ = x.
Length of the opposite side is RQ = y – b.
Substitute lengths of all three sides in the mathematical form relation, derived from the Pythagorean Theorem.
The circle is passing through the origin. So, the distance from the origin to centre of the circle is OP, known radius of the circle. In fact, the length of the OP is already assumed b units. It means OP = b = r. So, substitute b instead of r to get the simplified equation.
This algebraic expression is required mathematical form equation which represents an equation of a circle when the centre of the circle lies on the vertical axis and the circle passes through the origin of the Cartesian coordinate system.


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'Mary Poppins Returns': First Look At Emily Blunt As The Charismatic Nanny
By Amanda N'Duka
Amanda N'Duka
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March 3, 2017 1:19pm
Disney has released the first image of Emily Blunt as the magical and charming Nanny from the upcoming film Mary Poppins Returns, the sequel to the 1964 pic Mary Poppins, which starred Julie Andrews. Rob Marshall is directing, with production underway in London. The film is slated for release Christmas Day, 2018.
In the new photo – see it below – we spot the title character standing in front of the Banks' residence, holding her magical bag of endless wonders.
The new installment is set during the Depression, 25 years after its predecessor, and follows the grown up Banks children Michael and Jane, Michael's three children and their housekeeper Ellen, living on Cherry Tree Lane. After Michael suffers a personal loss, the nanny Mary Poppins returns to the lives of the Banks family, and, along with the optimistic street lamplighter Jack, uses her magical skills to help the family rediscover the joy and wonder missing in their lives.
Lin-Manuel Miranda, Ben Whishaw, Emily Mortimer and Julie Walters co-star with Colin Firth, Meryl Streep, Angela Lansbury, and original cast favorite Dick Van Dyke.
Marshall also serves as the film's producer along with John DeLuca and Marc Platt. The screenplay is by David Magee based on The Mary Poppins Stories by PL Travers, with Marc Shaiman and Scott Wittman writing all new songs and Shaiman composing an original score.