Merfolk Planeswalker Kiora came to Theros during the events of Theros block and the novel Godsend. She was—and is—on a quest to find the greatest denizens of the seas of many worlds. Kiora hopes to return to her native Zendikar and fight against the world-devouring creatures called the Eldrazi with the help of her summoned allies. But she will not return until she has found a weapon worthy of the fight.
Kiora arrived on Theros during the Silence, a time when the gods of Theros were magically barred from interfering in the mortal world. She took full advantage of this circumstance, posing first as an avatar of the sea god Thassa, then as the mythic rareal navigator Callaphe. The native merfolk, called tritons, were desperate for any sign of their god's return, and many of them embraced Kiora's claims.
Elspeth Tirel and Ajani Goldmane, meanwhile, sought to journey into Nyx to stop the ascended Planeswalker-god Xenagos. They recovered Callaphe's ship, the Monsoon, but they needed a navigator. "Callaphe" soon arrived, and the trio set out for Kruphix's temple at the edge of the world. Like Callaphe herself, however, their journey was not what it seemed. The Monsoon was a living creature, and it—not Kiora—knew the way to the edge of the world. Kiora had a different destination in mind, and instead urged the Monsoon to take them to the legendary lost city of Arixmethes—which she knew was not a place, but a massive living creature with an entire city built upon it.
The novel Godsend followed Elspeth and Ajani's path into Nyx, leaving Kiora's tale behind. When we last saw Kiora, she was locked in combat with Thassa herself, and the outcome of that battle has been unknown—until now.
Kiora's heart pounded as the prow of the Monsoon came to rest at the edge of a vast and ruined city. The surface did a fine impression of land, if you didn't look too hard, but it was too dark, too rubbery. She frowned at the ornate buildings dripping seawater, clinging to this great curved surface like barnacles. How could anyone mistake the great kraken Arixmethes for an island?
The human, Elspeth, asked something about Kruphix's temple, and the cat-man answered her, but Kiora wasn't listening. Finally!
"Welcome to Arixmethes!" she cried, leaping off the ship and onto the soft, pliable surface. "The sunken ruins! At last, I've found him."
"Him?" asked Elspeth. They still didn't understand. But she and the leonin, Ajani, stayed on the Monsoon just the same.
"You're not Callaphe, are you?" asked Ajani.
"Not even close," Kiora replied, smiling back at him.
The cat-man had suspected all along she wasn't who she said she was, but he'd come aboard the Monsoon anyway because she had something he wanted. They'd used her to get to Nyx, and she'd used them to get to Arixmethes. Now she was here, and they could take the Monsoon and go and get themselves killed. It was like a trade. Everyone got what they wanted.
Behind them, the waves became turbulent, and there was a rushing sound deep below the surface.
Well…not everyone. Best hurry, then.
"Who are you?" Ajani asked.
"You can call me Kiora," she said. She didn't bother mentioning that she was a Planeswalker; he clearly knew. And Elspeth was hardly a Theran name. So she hadn't been the only one concealing her identity, had she? "I needed the Monsoon to find Arixmethes. I couldn't have done it without you. Good luck getting to Nyx."
"But where is the edge of the world?" Elspeth asked.
"Ask the ship," said Kiora, over her shoulder.
Thassa was close. Arixmethes would wait, and she no longer needed the drywalkers. What she needed were allies.
Kiora cast a spell to aid her swimming, and her arms grew longer with a cracking sound as she dove beneath the waves. The last thing she saw before the water closed around her was the Great Eye—the sea god Thassa in one of her many guises—bursting out of the water, fixing its terrible gaze first on her, then on the two drywalkers. Elspeth, the Betrayer, so people called her. Kiora had never caught the exact details of her crime—you don't get to ask many questions when you're posing as a god—but hopefully Elspeth's presence would draw Thassa's ire long enough for Kiora to prepare.
She dove straight down, down and down, her elongated body propelling her through the water. It grew darker, and colder, and more silent. The pressure became immense, the water flowing through her gills shockingly cold. She could feel great shapes moving around her, but saw nothing—the darkness was total. Just when she thought she would have to turn back, her palm came to rest on the cold and silent surface of the sea bed. She paused, upside-down, and for a disorienting moment imagined that she was hanging from the ceiling of the depths, dangling precariously above thousands of feet of water and the hard, unyielding surface of the sea. She smiled and began a spell.
She sent a pulse of power outward, calling to the enormous animals she could feel moving all around her. These were the creatures she hadn't found on her arrival—the true colossi of the deep, the ones Thassa kept out in the deep ocean—like cattle, or tuna. But now she'd found them. She was in Thassa's secret seas, and the god herself, though nearby, was distracted. Hear me, Kiora told the krakens and leviathans. Heed me. I am not your master. But I will set you free.
They stirred in the depths around her, waking from their slumber. Spots of bioluminescence winked on and slowly brightened, bathing the murky depths in eerie greens and blues. Plates of chitin scraped together, claws snapped, and long, sleek bodies uncoiled. They were listening.
But that? That was the easy part.
Reaching out across the Blind Eternities, she gathered to her the essence of every sea-beast she had ever called her own. She pulled those essences to her one by one, manifested them in Theros's seas. The strain was immense. New shapes dove out of the darkness, and grating squeals and clicking rumbles sounded challenge. The newcomers and the natives circled and snapped, investigating, testing each other, trying to work out a pecking order. Good.
You've slept too long, Kiora thought at them. You are awake. You are hungry. You are mine. Upward, to feed!
They surged around her, eager, a hurricane of flesh and chitin. She grabbed the spines of a passing serpent, one with a long, straight horn, and nestled against its back for the climb to the surface. Not one of Thassa's, just in case that proved important. No need to spend any more of her own strength when these fabulous creatures had so much to spare.
Kiora no longer knew whom to pray to for good fortune. For many years she had prayed, in secret, to Cosi, the trickster god of Zendikar's merfolk. She'd never thought of herself as a trickster, a devoted member of Cosi's cult, but she'd prayed to him. And she silently scorned the devout worshipers of those useless figureheads Emeria and Ula. How little she had known! The gods were not gods, and the deceiver Cosi was revealed, with horrific irony, as a sham—a twisted memory of the Eldrazi titan Kozilek, passed down in an idiot's game of whispers. Emeria and Ula, likewise, proved monstrous and deceitful; Cosi, at least, had never pretended to virtue. Perhaps that was why she no longer feared gods, why she had steered this course in direct opposition to an angry deity of the sea. Praying to the gods, she reasoned, was for people who had never fought one.
The sea grew lighter around her, and at last she could see the armada she had assembled, massive creatures from a dozen worlds swimming together with the precision of a school of fish. They broke the surface in a boiling mass, and Kiora whooped from the back of her serpent. In the distance, she saw Thassa, in triton form, standing on the deck of the Monsoon. She bristled—even if she no longer needed the ship, even if she was happy to let Elspeth and Ajani ride it to the edge of the world, she'd be damned if she'd let Thassa have it.
She willed a black, barnacled, titanic squid to surface next to the ship. The Monsoon pitched and rolled in agitation. Arixmethes had had enough jostling from the lesser leviathans, and dove beneath the waves. No matter. She would find him. But she had to deal with Thassa first.
Thassa stepped off the deck of the Monsoon, and a great wave vaulted the ship-serpent skyward, with Elspeth and Ajani clinging to it. Apparently they'd convinced Thassa to aid them, or at least to send them away. Kiora hoped they made it. They seemed alright, for drywalkers. And as far as she could tell, their mission was a worthwhile one. She waved a quick goodbye as they vanished into the sky and the great wave carried them away.
Thassa transformed back into the Great Eye in midair and floated toward Kiora over the water. Water swirled around her as she shifted between shapes—the Eye, a waterspout, a flock of seabirds, and finally her triton form, holding the bident that was her signature weapon and her power over the sea. This…was going to be tough.
The sea boiled. More krakens emerged, propelled from seas all over Theros, answering Thassa's call. In the distance, Arixmethes himself breached the water, his black bulk both beautifully sleek and impossibly massive. Even the largest of the other krakens were minnows beside him. He crashed back down, and the sea shuddered. He was perfect. He was also, for the moment, on Thassa's side.
"You'll never claim Arixmethes!" cried Thassa.
She called her titans to her, and Thassa did the same. Thassa had far greater command of the sea itself, so Kiora focused on keeping her own little patch of it stable and let the sea god come to her. She arrayed her krakens around her.
Thassa and her attendants rose up on a great wave, Thassa's bident pointed straight at Kiora. A tide of saltwater and flesh crashed into Kiora's army. The serpent Kiora was riding bucked and twisted, snapping at a massive octopus that wrapped strong, slimy tentacles around it. It bit ragged holes in the octopus's body, and the enormous creature fell away into the surf.
Distantly, on the edge of the tangle of thrashing serpents, Kiora saw heads pop out of the water—tens, then hundreds. Tritons! How had they come all this way?
"Welcome, my children!" bellowed Thassa, in a voice that shook Kiora's bones. "Bear witness to the fall of the pretender!"
She'd brought them, used no small amount of her strength to pull them through the sea, just so they could see her fight Kiora. Was that just pride? Or was it…need?
"You're making an example of me?" yelled Kiora, trusting that the god of the sea itself could hear her through the waves, if not over them. "What's the matter? Has their faith in you flagged so much?"
"I will grind you into sand," said Thassa, a voice simmering out of the ocean itself.
Did she need their belief? Had Kiora taken that from her? Was that what this was about? If Kiora's little charade on her way to Arixmethes had actually weakened Thassa for their fight…how delicious that would be!
Kiora's serpent surged forward through the crush of enormous bodies and choking tentacles, pointed not toward Thassa, but toward Arixmethes. Thassa had to defeat her in order to win. Kiora just had to form a bond with that kraken. She gripped the serpent tightly, trying to balance between lending strength to her forces and saving her own for what was to come.
The serpent thrashed and twisted, sometimes swimming along the surface like a river-snake, sometimes diving below, even leaping out of the water—anything to get through. And she was getting through. Thassa had all the krakens of Theros, minus the few that Kiora had suborned. But Kiora had titans from a dozen worlds, things that Thassa had never seen, never even imagined. Many of them were larger than Thassa's largest children, save Arixmethes. Slowly it dawned on her: she was winning.
Arixmethes tore his way through the fray, biting Kiora's off-world krakens in half or swallowing them whole, and simply pushing the krakens she had taken from Thassa to one side. He was inexorable, impossible. He was at least as big as Kozilek.
Thassa rode atop Arixmethes without holding on, bident in one hand, staying effortlessly on his back as he pushed his way through. Kiora's little serpent, a hundred feet long, was dwarfed before him. Thassa smiled.
"Now you will learn," she said, in that same amplified voice, "what it is to defy me."
"Happy to teach your followers how it's done!" yelled Kiora.
This was it. Kiora stretched out her hand and poured every ounce of strength she had into Arixmethes's ancient, languid thoughts. She felt her other krakens begin to flag, saw a few of them go over to Thassa's side. That didn't matter. Nothing else mattered. Nothing but him. He opened his enormous mouth, big enough to swallow her and her serpent in one bite.
She and Thassa were as close as they'd ever been, perhaps a hundred yards apart, and whether through magic or divinity or just an overactive imagination, Kiora could make out every detail of the fury on the god's face.
She wouldn't normally try to wrest an animal away from the one who commanded them. It wasn't really her specialty. What she was doing wasn't truly mind magic, more like…instinct magic. And she knew the instincts of the sea better than any others.
You are not mine, she thought at him. You are not Thassa's. You are your own. And I need your help. Will you come when I call?
His great mouth closed again, and for a moment she dared hope. Come to me, she willed him. I need to get the sense of you.
Nothing happened. The melee around them grew quieter, too many of Kiora's allies killed or brought over to Thassa's command. Come on.
"You poor fool," boomed Thassa. "You truly thought to steal a kraken from the god of the sea?"
"No!" cried Kiora. But the serpent she rode was no longer hers to command.
She could only watch as the serpent scooped up a mouthful of screaming tritons, devouring dozens in one bite.
"You see?" boomed Thassa. "She does not care for you! She cannot harm me, so she lashes out at my faithful."
Behind Kiora, half her krakens had turned against her, even those from other worlds.
Thassa raised the bident and sent a great wave crashing toward Kiora and her serpent, to whelm them and "protect" her followers. The serpent reared back above the water as the wave sped toward them. Thassa was going to let it take another mouthful of her own followers before the wave hit, just to prove a point.
Kiora shook with fury. She pushed her hands against the serpent's great back and willed away, banished it back to the Æther from which it came. She sent more of her krakens with it, the ones that had turned against her. The great body beneath her vanished in a shimmer of turquoise light, and Kiora plunged toward the ocean like a stone, stretching her body out to turn an awkward fall into a smooth dive.
The water began, horribly, to recede. Thassa's bident glowed brightly as she pushed back the sea in a great bowl, somewhere between a whirlpool and an arena. The remaining krakens were pushed outside the growing well of water, swirling around, and Thassa's followers became an audience arrayed around a sloping, circular wall of water.
"The price of treachery!" cried Thassa. And now her followers cheered her.
Kiora fell. She spread her body out, no longer diving but falling. She couldn't feel her army. Thassa had bested them, driven them off, or taken them from her. Arixmethes receded into the deep. Below Kiora, the well of air opened onto the blank and pitiless bottom of the sea.
She didn't think Thassa was going to let her hit the sea floor—the sea god clearly meant to make a show of it—but she wasn't taking any chances. She reached out with her magic to the newly exposed sea bottom, and did something Thassa couldn't: she pulled roots and vines up out of ground that had never seen the sun, a rush of new growth snapping and creaking to life. She closed her eyes, tucked into a ball, and slammed into the cushion of greenery at high speed, coming to rest upside-down in a tangle of vines just a few feet above the slimy earth.
She smiled. She was alive, at least. That was a good start.
Before she could free herself from the vines, a wave of grasping hands made of sea foam rushed through her little forest, tearing the still-green branches apart, ripping the vines, and pulling her out of the greenery. The hands of water deposited her on her knees on the sea-bottom, Thassa's arena towering around her. Behind her, the wall of water surged forward over her forest, drowning it.
She stood up, arms and legs covered in gray, oozing mud. The water behind formed a sheer wall, rushing by so quickly she couldn't see through it. Around her rose flat-sided boulders like the teeth of some great serpent, although she was fairly sure they weren't. Thassa's arena had become an amphitheater. Along the sloping wall opposite, Thassa descended, gliding down on a pristine wave. The tritons gathered around their god, sticking out of the wall of seawater in a mass of silent, disapproving faces.
"You led my people astray," said Thassa, her voice echoing across the expanse of seafloor. "You stole my children. You besmirched the name of my devotee Callaphe and aided Elspeth, the Betrayer in her quest."
So did you! thought Kiora, but she didn't bother saying it. Her army was gone. Arixmethes had returned to the depths. She'd had high hopes. But this fight was over.
She dove for the wall of rushing water, hoping to get away long enough to planeswalk.
Thassa threw her bident, and it sailed through the air with astonishing speed, shrinking as it flew toward her. Kiora twisted in the air, but the bident followed her movement. It slammed into her and pinned her to one of the boulders that littered the sea floor, its prongs fitting snugly around her neck. She lay against the boulder, dazed, the coral-like surface of the bident pressing into her throat.
"Pathetic," said Thassa, her feet coming to rest on a carpet of clean water that flowed before her over the oozing muck.
Kiora wrapped her hands around the bident's handle and pulled, but it held fast. She choked and struggled, then went limp. She began to gather mana for one last, desperate spell, and tried to keep Thassa talking.
"You're right," she wheezed. She heard her own voice carried out over the seabed to the assembled tritons. "I was a fool to think I could defeat you."
"Oh, how kind of you to say!" laughed Thassa. She walked toward Kiora, the carpet of seawater expanding in front of her so her divine feet never touched the slimy sea bottom. "A simple triton is willing to grant that it was ill-advised to anger the god of the seas, who commands every ocean under Nyx!"
"There are more oceans than you know," said Kiora. Thassa frowned and gestured, and the bident drove further into the rock. Kiora choked and fell silent.
Thassa was close to Kiora now, leaning down, and she spoke for Kiora alone in a voice as cool and mirthless as an ice floe.
"What is that supposed to mean?" she asked.
"Thh—" said Kiora. Her vision swam. "Thhhh—"
Thassa moved one hand dismissively, and the bident's grip on Kiora's throat loosened. Kiora kept her hands wrapped tightly around its handle.
"For what?" asked Thassa. "The lesson in humility?"
Kiora's silent, desperate spell reached its climax.
"The bident," she hissed, and melted away into the void, Thassa's weapon still clutched in her hands. The last thing she heard before she slipped between worlds was the anguished cry of an angry god.
In the space beyond space, Kiora clutched her stolen prize and laughed.


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£2bn vision to boost Midlands rail services
Transport chiefs submit business case to Westminster for greater investment into services in Birmingham and across the Midlands region
Transport chiefs want to spend £2bn improving rail services across the Midlands including revamping Moor Street station (Image: Grimshaw)
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West Midlands transport chiefs have taken the fight for greater regional investment to Westminster after outlining £2 billion worth of rail improvements in Birmingham and the wider Midlands.
Central to the proposals are plans for 20 new train services per hour to and from Birmingham Moor Street station.
Called the 'Midlands Rail Hub', the report outlines 15 pieces of new or improved infrastructure to be built across the Midlands to enable 24 extra passenger trains every hour on the regional network, reduce journey times and grow the economy by bringing the East and West Midlands closer together.
A so-called 'Strategic Outline Business Case' has been submitted to the Government by transport body Midlands Connect in partnership with Network Rail and other organisations including councils, the combined authority, HS2 and Birmingham Airport.
The planned work would be carried out in phases between 2024 and 2033.
Midlands Connect said that, in the last two years, rail usage in the Midlands had grown faster than anywhere else in the UK, with growth of 121 per cent over the past decade in the West Midlands.
How the main entrance of Moor Street station could look (Image: Grimshaw)
But the transport body claims the car still dominates journeys between West and East Midlands with only 13 per cent done by train between Birmingham and Leicteser, 18 per cent between Birmingham and Nottingham and 22 per cent between Birmingham and Derby.
Key regional proposals include:
- Estimated six million more rail journeys per year with an annual economic benefit of £649 million by 2037
- Two extra trains per hour in both directions between Birmingham and stations in Leicester and Derby
- One extra train per hour in both directions between Birmingham and stations in Nottingham, Hereford via Worcester, Cardiff and Bristol
- Journey time savings of up to 20 minutes on services between Birmingham and stations in Leicester, Nottingham and Hereford
Key local proposals in Birmingham include:
- Two new viaducts to link services from South West and East Midlands into Moor Street - known as 'Bordesley Chords' and a revamp of the station with extra platforms and link to HS2, costing up to £950 million
- Two extra hourly services in both directions between Kings Norton and Moor Street, via Hazelwell, Kings Heath and Moseley
- Enhancements worth up to £30 million at Snow Hill including reinstating the fourth platform and allowing additional services to call and terminate there
- 'Kings Norton Turnback Siding' to create new passing places and additional space for extra Camp Hill Line services between Birmingham and Kings Norton at, costing up to £35 million
Initial concept designs for the revamp of Moor Street were revealed in March with plans for a 'One Station' concept which would link the site seamlessly with New Street station and the new HS2 terminal.
Midlands Connect chairman Sir John Peace said: "The Midlands Rail Hub is a cost-effective, evidence-led plan to upgrade our Victorian infrastructure to meet the demands of the future.
"These proposals capture the enormous economic potential of the Midlands, with 320,000 new jobs estimated by 2030, mainly in professional services firms who depend on good rail connectivity to attract skilled workers.
Major plans to revamp the interior of Moor Street are in the pipeline (Image: Grimshaw)
"This investment must happen alongside delivering HS2 in its entirety, from the West Midlands to the East Midlands and on to the north of England.
"The next Prime Minister must not ignore the Midlands, the ten million people who live here or our £220 billion annual contribution to the UK economy.
"Now is the time for the Government to prove to the Midlands it's listening to us."
Following the submission of the report to the Department for Transport, Midlands Connect has requested an additional £25 million to bring the project to 'Outline Business Case' stage of development, which will include specific development, a full overview of benefits, project designs and risk assessment.
CBI West Midlands director Richard Butler said: "Fixing the fundamentals is critical to unlocking future jobs, training and regeneration opportunities that will benefit us all.
"We have world-leading businesses and enterprises based in the East and West Midlands but they are relying on creaking Victorian era infrastructure.
"This needs to change, not only to deliver for existing business but to attract continued inward investment.
"Reliable infrastructure and connectivity from east to west is vital to increasing the region's growth and productivity which in turn will lead to a stronger regional economy and increased prosperity.
"At the heart of this plan is HS2, something we need to see delivered."
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Moor Street Station

redpajama_set_name: RedPajamaCommonCrawl


Description Photograph shows Henry J. Akagi seated in automobile as siblings (l. to r.) Joe, Bessie Jean, and Betty Jane Akagi stand holding school books nearby.
Location Photographed near Sheldon, Tex.
Lender Xian Akagi (Nellie Akagi Camacho).


Come test drive this 2018 Chevrolet Malibu. With less than 20,000 miles on the odometer, this 4 door sedan prioritizes comfort, safety and convenience. It features a front-wheel-drive platform, an automatic transmission, and an efficient 4 cylinder engine. The engine breathes better thanks to a turbocharger, improving both performance and economy. Top features include cruise control, delay-off headlights, variably intermittent wipers, turn signal indicator mirrors, power windows, remote keyless entry, an overhead console, and 1-touch window functionality. Chevrolet also prioritized safety and security with features such as: dual front impact airbags with occupant sensing airbag, front and rear side impact airbags, traction control, brake assist, a security system, onStar, and 4 wheel disc brakes with ABS. This car was designed with safety in mind, allowing you to drive with even greater assurance. A Carfax history report provides you peace of mind by detailing information related to past owners and service records. We have the vehicle you've been searching for at a price you can afford. Stop by our dealership or give us a call for more information.


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Q: Custom View GI Navigation I'm having an issue with navigation in a GI that references a custom view.
I have a custom view and associated DAC created and used in a GI.  When I add navigation links to the GI it always does the navigation using the values in the first row of the grid.
I have another custom view where the navigation works fine.
I assume it has to do with having key fields defined in the DAC, but I do have IsKey assigned to several fields in the DAC.
Any ideas?

A: I suspect that you might not have a PXPrimaryGraph configured. This link should show you a few examples of setting one up.
https://help-2020r2.acumatica.com/(W(1))/Help?ScreenId=ShowWiki&pageid=1dceb511-4e98-3700-7d7f-231688a7ac74

redpajama_set_name: RedPajamaStackExchange


Answer: Hello dear. The number of weeks are calculated by your last period date. Your last period first day will be day 1 and then you need to add weeks to it to get ur current week and day in pregnancy. Hope it helps.
Question: How many ultrasounds are left m 24 week pregnant?
Answer: In the third trimester your will be offered a growth scan or fetal wellbeing scan between 28 and 32 weeks. You may also be offered colour doppler studies between 36 and 40 weeks. These scans will show your doctor how your baby is growing.
Question: I m in 27th week pregnant then how many months pregnant I m?


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Singapore reports 14% drop in HIV cases in 2022
by NewsDesk Lord, save her
Singapore's Ministry of Health reports that a total of 171 new cases of human immunodeficiency virus (HIV) were reported among residents in the first 10 months (January-October) of 2022. The number of notifications is 14% less than the number of HIV cases (HIV). In the same period in 2021.
The Ministry of Health analyzed 102 cases reported in the first six months (January-June) of 2022. Among these cases:
me. 93 percent male;
Secondly. 40% are between the ages of 20-39 and 44% are between the ages of 40-59; And the
Third. 59% had HIV infection at a late stage at diagnosis. This is 1% lower than in the same period last year.
Artist's depiction of HIV (rendered). The handles (purple) covering the virus are the sugar protein particles, including gp120, that protect the rest of the virus (pink).
Image/National Cancer Institute
Sexual contact remains the main mode of transmission of HIV, accounting for 91% of 102 cases. Heterosexual transmission accounted for 39% of cases while 52% of cases occurred in men who have sex with men, including men who have sex with bisexual men (3%).
55% of newly reported cases were detected by HIV tests conducted during the course of medical care and were usually late-stage HIV infection. Another 17% were detected during routine, programmatic HIV screening While 15% are detected through HIV self-examination. The remainder were detected by other forms of examination. A higher proportion of MSM (23%) are diagnosed with HIV by HIV self-testing than heterosexuals (8%).
The most effective way to prevent HIV infection is to remain faithful to your spouse/partner and avoid casual sex, or sex with sex workers. People who engage in high-risk sexual behavior, such as having multiple sexual partners or having casual or commercial sex, are strongly advised to use condoms to reduce the risk of contracting HIV and other sexually transmitted diseases. Condoms must be used consistently and correctly during each sexual encounter. In addition, the use of preventive measures such as pre-exposure prophylaxis with HIV is very effective when used as part of a comprehensive HIV prevention strategy.
Subscribe to Outbreak News TV
Taking an HIV test is the only way to know a person's HIV status. Everyone should know their HIV status and be tested at least once. The Department of Health and the Health Promotion Board (HPB) urge at-risk individuals to have a regular HIV test every three to six months. HIV testing and regular early diagnosis allows people living with HIV to receive early treatment and better treatment outcomes. An HIV-infected person can protect their sexual partner from infection, if they are on regular treatment and have an undetectable viral load. With early and effective treatment, people living with HIV can continue to live lives no different than others.
Chinese shingles vaccine receives clinical trial approval from Philippines FDA
New California Laws (part 15)


Individual cybersecurity awareness focuses on the individual's understanding of their roles and responsibilities in reducing the occurrence of security incidents that undermine national security and degrade operational capabilities.
Individual awareness allows individuals to review their cybersecurity training, to educate themselves about cybersecurity and to become more aware of cybersecurity and the cyber threats facing the Army, themselves and their family and friends.
Cybersecurity is critical to all Army functions. Cyber attacks and user negligence threaten Army networks and information every day, putting Army operations and personnel at risk. Raising individual cybersecurity awareness and enforcing compliance helps improve the Army's cybersecurity posture and reduces the security risk to the Army.
In May 2013, the Army published a handbook to provide leaders at all levels the information and tools needed to address cybersecurity challenges and to ensure that all organizations adopt the practices necessary to protect their information and the Army's network.
The Army also published the Protect Operational Information Brochure to educate all personnel about operations security and what they can do to reduce cyber risk.
In October 2013, the Army held an Information Assurance/Cybersecurity Awareness Week. This week provided an opportunity to heighten individual and collective knowledge about cybersecurity threats and individuals' roles and responsibilities in protecting the Army.
The Army will continue this effort by holding an annual Cybersecurity Awareness Month. To maintain access to Army information systems, the Army will continue to require personnel to annually complete their cybersecurity training.
The Defense Department gets hit with approximately 10 million cyber attacks each and every day, and a very large number of them are aimed directly at the Army. The potential for compromise of the network and the information it carries, and thereby harm to the Soldiers and leaders who rely on them, is simply enormous.


I love doing this exercise. And I'm amazed by how it changes each time I do it. During the past few months I've been thinking a lot about what I love doing and what I'm good at and how to mix them together.
The thing that jumped out at me during this exercise, which I filmed, was how much I focused on Illustrating. It seems to be something I really want to do more of. And it screams to be done – above the noise of all the stuff I 'should' do. And perhaps collate it into a book when I'm done.
So for this 2019 100 Day Project I'm going to be illustrating web characters. I love characters and want to bring them into as much of what I do as possible. And for the first 26 days I'll be using the alphabet as my guide – creating something web-related beginning with A, B, C, and so on. So I'll be illustrating Annie Anchor, Mr. Bradly Bold, etc. Follow my journey on Instagram or Dribbble.


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Babylon Revisited Study Guide
Babylon Revisited by F. Scott Fitzgerald
Babylon Revisited is a collection of short stories dealing with the Lost Generation, those who came to adulthood during the dehumanizing horrors of the First World War. Its diverse stories deal with the fallout of the stock market crash, the dissolute behavior of wealthy American students and artists abroad in Europe, and with the lingering horrors of World War I and the looming threat of a second brutal, bloody conflict.
Babylon Revisited Book Notes
External Study Guides
Babylon Revisited - BookRags
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Self-esteem issues affect all of us at various points in our lives, probably more than we realize, and it's something we would do well to understand better.
Have you ever felt that you just needed something more – more time, more energy, more sleep, more rest, more peace? No matter what you do, say, or change in your routine, do you still feel like you need more?
Maybe you feel like Chuck Norris, or maybe you feel you are not worthy of life itself. Wherever you land on the scale of self-worth, it is directly tied to your view of self and your self-esteem.
According to Wikipedia, "Smith and Mackie (2007) defined it by saying…the positive or negative evaluations of self, as in how we feel about it." So in other words, you can view yourself through a favorable lens or a lousy one.
In this article, I will share different self-esteem facts, self-esteem boosting activities, reasons why you are probably awesome, and I'll help you view yourself that way (unless you already know you are awesome and in that case keep on keeping on, and be contagious!).
There are two types of self-esteem.
Global self-esteem is how you view yourself overall.
Specific self-esteem is how you view yourself in specific roles (i.e professional, parent, friend, etc).
Your general self-esteem influences your specific self-esteem and vice versa.
Self-esteem varies from day to day and minute by minute.
Exceedingly high self-esteem can be bad too!
Narcissists tend to have too much self-esteem, but can self-destruct by the littlest critique.
Physical attractiveness does not correlate with self-esteem.
Whether one has high or low self-esteem, they will be perceived depending on how they present themselves.
Positive feedback has a negative effect on people with low self-esteem, which is kinda ironic if you ask me.
Positive affirmations can actually hinder someone with low self-esteem, because they are constantly thinking, "I can't even attract…" fill in the blank.
Quick fix self-esteem exercises, programs, and products don't work!
When people participate in self-help programs/workshops on the psychological front, their memories play tricks on them. Participants' memories of beginning levels of self-esteem are actually lower than what they originally started at, making it feel like there was an increase.
Having a higher self-esteem is like having a high functioning emotional immune system.
People with higher self-esteem tend to recover from stress, rejection, and failures better than their lower self-esteem counterparts.
Your overall self-esteem is managed and maintained by yourself.
Whether you have high or low self-esteem you are the one in control of its level.
No one can fix your low self-esteem but you!
Your self-esteem affects you on every level. So if you have low self-esteem let's dive into different methods of addressing it!
Growing up in the church, I wanted to find a Bible passage that could help with low self-esteem.
Can you see how my previous point self-destructs with a positive affirmation?
I'm not going to sugarcoat my thought process on this one. I am seriously questioning my self-esteem at the moment. Writing an article on self-esteem makes me have to take a deep look at my own self-esteem. Just saying this makes me feel really inadequate because my life is NOT where I want it to be. But even in this moment when my thoughts are low, I know they will pass and I can focus on all the good in my life.
There must be hope… right?
Taking the time to do something kind for someone will immediately have an impact on you. It's science. Conduct the experiment, gather the data, and share the results. You can thank me later!
Go to work a different way. Take an unplanned trip. Do something out of the ordinary. Spontaneity brings about excitement from the ordinary and can help raise self-esteem.
Vision and dream boards help keep your dreams on point. Write down your accomplishments and post them in the same way. This will keep your thoughts on the up and up!
Not only will you solidify your knowledge on the topic, but you'll share your knowledge and improve someone's life. Go you!
Do you ever take time to sit and think? Don't get stuck on all the bad in life or all the things that you wish you could have done differently. Acknowledge those things and make a plan to visualize their departure in your life.
When we spend time doing things we enjoy, we will infect the other parts of our lives we passively endure.
Exercise has the fastest impact and biggest return on investment in boosting self-esteem. When we get our blood pumping it helps circulate our blood, which clears out our organs and increases hormone production, leaving us in a euphoric feeling. So try something new, join a gym, take that yoga class, con a friend into going on a walk with you. Whatever you do, just move it, move it.
Whether you've had a good day or a not so good day, understand that days will come and days will go, but you are forever. Either on this Earth or in the next stage of life, you are worth every ounce of you. Don't tear yourself down and don't throw stones at others.
Find your hope, find your tribe, and trust that this journey will take you where you desire.
Jennifer is a wife, mom, educator, writer, dancer, and house plant enthusiast. Her life mission is to work smart to make people smarter.


In partnership with Watson's Hat Shop. Pick to or 3 colors and get your hat size. Place an order. I will call to follow-up and discuss before beginning painting. After painting is complete hat liner is sent to Watson's for liner installation to complete your hat.


text:
A powerful woman at P&G on the rise
Jessica Shambora
by Jessica Shambora
We're toiling away on this year's Fortune Most Powerful Women in Business list, due out September 10. Anything can happen up to the minute we go to press, and this news today caused us to shuffle those yet-to be-unveiled rankings: Procter & Gamble's Melanie Healey is moving up to head the company's enormous North American business, effective October 1.
No. 37 on last year's MPWomen list, Healey currently heads global feminine & health care, a $9 billion business that includes Tampax, Vicks and Prilosec OTC. Her new purview brings in 40% of P&G's total revenue. That's $32 billion in sales.
Actually, Healey, 48, was destined to be a global operator. She was born in Rio de Janeiro to a British father and a Chilean mother. She went to college in the U.S.–graduating from the University of Richmond–but began her career back in Brazil with S.C. Johnson and then Johnson & Johnson . She joined P&G in 1990. Over the next 11 years until she got worldwide responsibilities, she helped build the company in Brazil, Mexico and Venezuela.
Healey's promotion follows a raft of management changes at the consumer-goods giant. In March, Susan Arnold, president of global business units and No.7 on Fortune's 2008 Most Powerful Women list, announced she was leaving. She was a contender to succeed CEO A.G. Lafley. Soon after came the news that COO Robert McDonald would replace Lafley. That transition happened in July.
Healey's promotion, says P&G spokesman Paul Fox, is simply part of the company's leadership development program. (She's swapping jobs with Steven Bishop, who held the top North America post and will now run global feminine care.) Clearly, though, Healey's new job sets her up to be part of the next generation of P&G leadership.
Whatever the future holds for her, Healey has a claim to fame that's practically unmatched. Last year at a late-night bridge tournament at the Fortune Most Powerful Women Summit, she beat Warren Buffett.


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Our workshops are 90 minutes long and led by people who care about delivering and developing fantastic education. After each workshop, you will leave with tips, tricks and ideas that you can immediately use when you return to your department. Sign up sheets will be available on the day for you to attend TWO sessions.


text:
Online since Friday, April 10, 2015
The narrow road to the indigenous rotavirus vaccine p. 203
BK Das
Ureaplasma: Current perspectives p. 205
P Kokkayil, B Dhawan
Ureaplasma species are the most prevalent genital Mycoplasma isolated from the urogenital tract of both men and women. Ureaplasma has 14 known serotypes and is divided into two biovars- Ureaplasma parvum and Ureaplasma urealyticum. The organism has several genes coding for surface proteins, the most important being the gene encoding the Multiple Banded Antigen (MBA). The C-terminal domain of MBA is antigenic and elicits a host antibody response. Other virulence factors include phospholipases A and C, IgA protease and urease. Besides genital tract infections and infertility, Ureaplasma is also associated with adverse pregnancy outcomes and diseases in the newborn (chronic lung disease and retinopathy of prematurity). Infection produces cytokines in the amniotic fluid which initiates preterm labour. They have also been reported from renal stone and suppurative arthritis. Genital infections have also been reported with an increasing frequency in HIV-infected patients. Ureaplasma may be a candidate 'co factor' in the pathogenesis of AIDS. Culture and polymerase chain reaction (PCR) are the mainstay of diagnosis. Commercial assays are available with improved turnaround time. Micro broth dilution is routinely used to test antimicrobial susceptibility of isolates. The organisms are tested against azithromycin, josamycin, ofloxacin and doxycycline. Resistance to macrolides, tetracyclines and fluoroquinolones have been reported. The susceptibility pattern also varies among the biovars with biovar 2 maintaining higher sensitivity rates. Prompt diagnosis and initiation of appropriate antibiotic therapy is essential to prevent long term complications of Ureaplasma infections. After surveying PubMed literature using the terms 'Ureaplasma', 'Ureaplasma urealyticum' and 'Ureaplasma parvum', relevant literature were selected to provide a concise review on the recent developments.
An analysis of underlying factors for seasonal variation in gonorrhoea in India: A 6-year statistical assessment p. 215
M Kakran, M Bala, V Singh
Purpose: A statistical assessment of a disease is often necessary before resources can be allocated to any control programme. No literature on seasonal trends of gonorrhoea is available from India. Objectives: The objectives were (1) to determine, if any, seasonal trends were present in India (2) to describe factors contributing to seasonality of gonorrhoea (3) to formulate approaches for gonorrhoea control at the national level. Materials and Methods: Seasonal indices for gonorrhoea were calculated quarterly in terms of a seasonal index between 2005 and 2010. Ratio-to-moving average method was used to determine the seasonal variation. The original data values in the time-series were expressed as percentages of moving averages. Results were also analyzed by second statistical method i.e. seasonal subseries plot. Results: The seasonally adjusted average for culture-positive gonorrhoea cases was highest in the second quarter (128.61%) followed by third quarter (108.48%) while a trough was observed in the first (96.05%) and last quarter (64.85%). The second quarter peak was representative of summer vacations in schools and colleges. Moreover, April is the harvesting month followed by celebrations and social gatherings. Both these factors are associated with increased sexual activity and partner change. A trough in first and last quarter was indicative of festival season and winter leading to less patients reporting to the hospital. Conclusion: The findings highlight the immediate need to strengthen sexual health education among young people in schools and colleges and education on risk-reduction practices especially at crucial points in the calendar year for effective gonorrhoea control.
Utility of whole-cell repetitive extragenic palindromic sequence-based PCR (REP-PCR) for the rapid detection of nosocomial outbreaks of multidrug resistant organisms: Experience at a tertiary care center in North India p. 221
G Singh, M Biswal, V Hallur, KLN Rao, P Ray, V Gautam, SB Appannanavar, N Taneja
Background: There is a huge need to develop molecular typing methods which are simple to perform, rapid and cost effective to confirm clonality of nosocomial isolates in outbreak situations. Objectives: The aim of the study was to investigate a hospital outbreak of multi-drug resistant (MDR) Klebsiellapneumoniae septicemia in a paediatric surgery intensive care unit (PSICU) using a repetitive extragenic palindromic polymerase chain reaction (REP-PCR). Materials and Methods: MDR Klebsiella pneumoniae isolates from an outbreak of nosocomial sepsis were typed byREP-PCR using consensus primers. Isolates from different intensive care units (ICUs) but with similar antibiogram were also genotyped for comparison. Results and Conclusion: A cluster of twelve MDR K Pneumoniae septicemia cases was identified at the PSICU by genotyping using REP-PCR. Surveillance cultures failed to pick up any source of infection. REP-PCR was found to be a rapid and simple tool for investigation outbreaks in hospitals. Due to early detection we could initiate infection control practices with focus on hand washing and prevent the further transmission of the organism.
Emergence of HIV-1 drug-resistant variants in women following antiretroviral prophylaxis for the prevention of mother to child transmission p. 225
M Mani, VV Ramalingam, J Lionel, SA Christina, J Sachithanandham, A Peedicayil, R Kannangai
Purpose: Emergence of drug resistance following HIV prophylaxis has an important impact on ART program. Objective: To investigate the emergence of drug resistance in HIV-1 infected pregnant women. Materials and Methods: Fifty-three HIV-1 infected pregnant women who had received 4-12 weeks of antenatal AZT followed by Nevirapine during delivery and Combivir [AZT + 3TC] for 1 week postpartum (group-1, n = 48) or who come at the time of delivery and received Nevirapine followed by Combivir for 1 week (group-2, n = 5) were recruited. Samples were collected prior to the start of the prophylaxis and 5-8 weeks postpartum. In addition, a third sample was collected between 26-65 weeks postpartum from 7 women. Amplification of HIV-1 pol gene and drug resistance analysis was done. Result: Two (3.8%) women in group-1 showed transmitted drug resistance and they continued to show this even at 6 weeks postpartum. One (2%) woman from group-1 showed a mutation after 6-8 weeks of prophylaxis. Among the samples collected between 26-65 weeks postpartum, 3/7 (43%) showed mutations and all these women belong to group-1. Women belonging to group-2 didn't show mutation prior to or following prophylaxis. Conclusion: In contrast to the available data among pregnant women with ART prophylaxis, our data showed reduced frequency of mutations following 5-8 weeks of postpartum but an emergence of mutation later (26-65 weeks). The addition of Combivir with the single dose Nevirapine during delivery and the early stage of the disease with higher CD4 counts could be the reasons for this.
High prevalence of class 1 integrons in clinical isolates of methicillin-resistant Staphylococcus aureus from India p. 231
NP Marathe, SS Nagarkar, AA Vaishampayan, MH Rasane, SA Samant, V Dohe, A Kagal, YS Shouche, N Deshpande
Introduction: Class1 integrons are one of the prevalent mechanisms of antibiotic resistance gene transfer in Gram-negative organisms, but their prevalence and role in the spread of antibiotic resistance genes in methicillin-resistant Staphylococcus aureus (MRSA) is unexplored. The purpose of this study was to investigate the prevalence of class 1 integrons in clinical isolates of MRSA. Materials and Methods: Total 143 MRSA isolates obtained from two different cities in India (Pune and Mumbai) were characterized by biochemical tests, and the antibiotic sensitivity was performed using the Clinical and Laboratory Standards Institute (CLSI) guidelines. The presence of class 1 integrons, sul1/qacE0Δ1 region of class 1 integron and mecA gene among these isolates was determined by polymerase chain reaction (PCR). Results: All 143 isolates were mecA positive and coagulase-positive. Overall, 71% of the MRSA isolates carried class 1 integrons; 58% (45/77) of the isolates obtained from Mumbai and 85% (56/66) of the isolates from Pune carried class 1 integrons. In all, 39% of these isolates carried sul1/qacEΔ1 region, thus confirming the association of class 1 integrons with antibiotic resistance genes. Along with β-lactam antibiotics the MRSA isolates were resistant to several other antibiotics, with resistance to erythromycin, ciprofloxacin and trimethoprim-sulfamethoxazole being observed in 75%, 66% and 60% of the isolates, respectively. Conclusion: To the best of our knowledge, this is the first report of class 1 integrons in MRSA isolates from India. The study provides insights into the prevalence of a novel mechanism adapted by MRSA for the propagation of antibiotic resistance genes.
Comparative evaluation of two rapid Salmonella-IgM tests and blood culture in the diagnosis of enteric fever p. 237
KJ Prasad, JK Oberoi, N Goel, C Wattal
Purpose: Enteric fever is a major public health problem in developing countries like India. An early and accurate diagnosis is necessary for a prompt and effective treatment. We have evaluated the diagnostic accuracy of two Rapid Salmonella-IgM tests (Typhidot-IgM and Enteroscreen-IgM) as compared to blood culture in rapid and early diagnosis of enteric fever. Materials and Methods: A total of 2,699 patients' serum samples were tested by Rapid Salmonella-IgM tests and blood culture. Patients were divided into two groups. Test group - patients with enteric fever and blood culture positives for Salmonella Typhi; and three types of Controls, i.e. patients with non-enteric fever illnesses, normal healthy controls and patients positive for S. Paratyphi- A. In addition to this we have also evaluated the significance of positive Salmonella-IgM tests among blood culture-negative cases. Results: The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the Typhidot-IgM test and Enteroscreen-IgM test considering blood culture as gold standard were 97.29% and 88.13%, 97.40% and 87.83%, 98.18% and 92.03%, 96.15% and 82.27%, respectively. Typhidot-IgM test was found to be significantly more sensitive and specific as compared to Enteroscreen-IgM. Among blood culture-negative patients, Rapid Salmonella-IgM tests detected 72.25% additional cases of enteric fever. Although the Rapid Salmonella-IgM tests are meant to diagnose S. Typhi only, but these tests detect S. Paratyphi- A also. Thirty-eight patients who were blood culture-positive for S. Paratyphi- A were also positive by Rapid Salmonella-IgM tests. Conclusion: Rapid Salmonella-IgM tests offer an advantage of increased sensitivity, rapidity, early diagnosis and simplicity over blood culture.
Is non-woven fabric a useful method of packaging instruments for operation theatres in resource constrained settings? p. 243
GS Devadiga, VMP Thomas, S Shetty, MS Setia
Introduction: Studies have highlighted the advantages and disadvantages of woven and non-woven fabrics. The present study assessed the change in resterilisation proportion after introduction of non-woven fabric for packaging of instruments and to evaluate the cost-effectiveness of non-woven fabrics compared with woven fabrics. Materials and Methods: The present study is a secondary data analysis of resterilisation data collected from November 2009 to August 2013. We calculated the proportions (and their 95% confidence intervals) of resterilisation done every month. The proportion over time was compared using a Chi-square test for trend. We used linear regression analysis to adjust for the number of surgeries performed every month. We also compared the cost of woven and non-woven fabrics. Results: Of the total 117,335 surgical packets prepared during the study period, 1900 were resterilised; thus, the overall proportion was 1.62% (95% CI: 1.55% to 1.69%). The resterilisation proportion was 8.95% (95% CI: 7.73% to 10.17%) in November 2009 and was 0.38% (95% CI: 0.16% to 0.62%) in August 2013 (P < 0.001). After adjusting for the total number of surgeries conducted every month, we found that the number of packets resterilised reduced every month (per month reduction: -1.97, 95% CI: -2.76 to -1.18). The total cost (initial preparation and resterilisation) for 100 units of woven fabric is INR 6359.41 per month (confidence limit estimates: 6228.20 to 6430.62) and for non-woven fabric was INR 6208.50 (confidence limit estimate: INR 6194.90 to 6223.35) (P < 0.01). Conclusions: The introduction of non-woven spunbond-meltblown-spunbond fabrics did reduce the proportion of resterilisation of packaged instruments. The decline was sharp and sustained over time, even after accounting for the change in the number of procedures. Furthermore, though the switch from woven to non-woven fabric was cost-effective in our situation, it may not be directly translated to other scenarios.
Incidence, risk factors, microbiology of venous catheter associated bloodstream infections - A prospective study from a tertiary care hospital p. 248
M Kaur, V Gupta, S Gombar, J Chander, T Sahoo
Purpose : Central venous catheters (CVCs) though indispensable in current medical and intensive care treatment, also puts patients at risk of catheter related infection (CRI) resulting in increased morbidity and mortality. We analysed the incidence, risk factors, bacteriological profile and antimicrobial susceptibility pattern of the isolates in central venous catheter associated bloodstream infection (CVC-BSI) in the intensive care unit (ICU) patients and studied the formation of biofilm in CVCs. Materials and Methods: The following case control study included 115 patients with CVC in situ. Quantitative blood cultures (QBC) and catheter tip cultures were performed for the diagnoses. Direct catheter staining was done for an early diagnosis by acridine orange (AO) and Gram staining methods. Biofilm production in catheters was detected by 'tissue culture plate' (TCP) method. The results were analysed using the computer-based program statistical package for the social sciences (SPSS). Results : In 25/115 patients, definite diagnosis of CVC-BSI was made. The mean age was 48.44 ± 17.34 years (cases) vs 40.10 ± 18.24 years (controls) and the mean duration of catheterisation was 25.72 ± 8.73 days (cases) vs 11.89 ± 6.38 days (controls). Local signs of infection (erythema, tenderness and oozing) were found more significantly in CVC-BSI cases. The AO staining was more sensitive and Gram staining of catheters showed higher specificity. Staphylococcus aureus followed by Pseudomonas aeruginosa and non-albicans Candida were common CVC-BSI pathogens. Multidrug-resistant (MDR) strains were isolated in bacterial agents of CVC-BSI. Non-albicans Candida and Enterococcus faecalis showed strong biofilm production. Conclusion : The incidence of CVC-BSI was 21.73% and the rate was 14.59 per 1000 catheter days. Prolonged ICU stay and longer catheterisation were major risk factors. S. aureus was isolated most commonly in CVC-BSI cases. The menace of multidrug resistance and biofilm formation in CVCs is associated with CVC-BSI.
Impact of informational feedback to clinicians on antibiotic-prescribing rates in a tertiary care hospital in Delhi p. 255
C Wattal, N Goel, S Khanna, SP Byotra, R Laxminarayan, A Easton
Context: Antimicrobial use has been associated with increasing antimicrobial resistance. There is an urgent need for judicious use of antimicrobials. Informational feedback has been shown to result in changes in behavioural practices of physicians in certain healthcare settings. We conducted this study to see if the passive informational feedback can reduce in antimicrobial usage in a tertiary care centre. Aims: The study was undertaken to evaluate if the feedback to clinicians on their own antibiotic prescription results in any change in their antibiotic prescription habits. Settings and Design: The study was conducted at a tertiary care setting involving 33 units of different specialties. These units were split into 10 groups based on specialty and were allocated randomly to the control (16 units) and intervention (17 units) arms of the study. This study was a prospective intervention to assess the effect of prescribing feedback on clinical prescribing practices. Materials and Methods: In the intervention arm, information on resistance rates and antibiotic-prescribing patterns was provided to all doctors. Behavioural change was assessed by comparing baseline prescribing rates of each unit with prescribing rates after the intervention. In the control arm, only information on monthly resistance rates was provided. Statistical Analysis : Change in the antimicrobial prescribing rates in the treatment group was assessed by using a Student's t-test. Results: The mean antibiotic use for all the specialties was 189 DDDs/100BDs. The prospective intervention did not elicit any effect on the antibiotic prescribing practices of the physicians. Low prescribers continued to prescribe antibiotics at a low rate, and high prescribers continued to prescribe at a high rate. Conclusions: In view of unfavourable results of passive intervention in the above study, active intervention may be more effective.
Feedback to clinicians on antibiotic prescription habits: How effective are they? p. 260
S Joshi
Vancomycin MIC creep in methicillin-resistant Staphylococcus aureus (MRSA) isolates from 2006 to 2010 in a hospital in China p. 262
W Chang, Xiaoling Ma, P Gao, X Lv, H Lu, F Chen
Purpose: To assess whether vancomycin minimum inhibitory concentration (MIC) creeps among clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) in a regional hospital in China. Furthermore, to analyze the causes of vancomycin MIC creeps and the relationship between vancomycin MICs and the outcome among patients with MRSA infection. Materials and Methods: All clinical isolates of MRSA from 2006-2010 were retrieved and tested by the broth microdilution procedure to determine their vancomycin MIC. Meanwhile, related patient records were analyzed. Results: While all isolates were susceptive to vancomycin, the percentage of isolates with a vancomycin MIC = 1 mg/L increased significantly from 2006 (37.0%) to 2010 (75.7%). Meanwhile, vancomycin usage density (DDDs/1000 bed-days) had increased significantly from 2006-2010. Mean linear correlation analysis showed a statistically significant positive correlation (r = 0.905, P < 0.05) between the consumption of vancomycin and the percentage of MRSA isolates with a vancomycin MIC = 1 mg/L. Clinical records revealed high vancomycin MIC was associated with a higher microbiologic failure rate in MRSA bloodstream infections. Conclusions: The data demonstrated vancomycin MIC creep among clinical isolates in our hospital, and the MIC creep may be caused by the increasing usage of vancomycin. Furthermore, the analysis strongly suggested this shift of vancomycin MIC within the susceptible range may be associated with an increasing probability of treatment failure.
Spoligotype patterns of Mycobacterium tuberculosis isolated from extra pulmonary tuberculosis patients in Puducherry, India p. 267
G Kandhakumari, S Stephen, S Sivakumar, S Narayanan
Purpose: Genotyping studies like spoligotyping are valuable tools in understanding the genetic diversity and epidemiology of Mycobacterium tuberculosis. Though there are reports of spoligotyping of M. tuberculosis isolates from pulmonary specimens from different parts of India, spoligotyping of extra pulmonary tuberculosis isolates are very few. Puducherry has not yet recorded spoligopatterns of M. tuberculosis from either pulmonary or extra pulmonary (EPTB) specimens. The aim of this study is to analyze the spoligotype patterns of EPTB strains circulating in Puducherry and neighboring districts of Tamil Nadu. Materials and Methods: During June 2011 to December 2013, 570 EPTB specimens were processed by culturing on to Lowenstein Jensen (LJ) medium and automated Mycobacterium Growth Indicator Tube system (MGIT960). Identification of M. tuberculosis was carried out as per standard procedures, and MPT 64 antigen positivity in a commercial immunochromatography kit. Spoligotyping was carried out at National Institute of Research in Tuberculosis (ICMR), Chennai. Results: M. tuberculosis was isolated from 67 single EPTB specimens (11.8%) like pus/cold abscess (34), TB spine (10), pleural fluid (10), urine (5), tissue bit (2), lymph nodes (2), ascitic fluid (2), synovial fluid (1) and endometrial curetting (1). Among 67 isolates with 41 spoligopatterns, EAI lineage with 28 isolates (41.8%) predominated followed by 18 orphans (26.9%), 10 Beijing (14.9%) and 8 U (11.9%). BOVIS1_BCG (ST482), T1-T2 (ST78) and H3 (ST50) were represented by one strain each (1.5%). C onclusions: Spoligotyping plays a significant role in the epidemiology of tuberculosis. Three spoligotypes, T1-T2 (ST78), EAI6 (ST292) and U (ST1429) are reported for the first time in India.
Development of touch down-multiplex PCR for the diagnosis of toxoplasmosis p. 271
V Hallur, R Sehgal, S Khurana
Purpose: The diagnosis of toxoplasmosis is challenging since conventional methods like culture and immunofluorescence are not universally available. Serology, which is used regularly might be negative during early phase of infection and in immunosuppressed patients or may remain positive for a long time. Several molecular tests have been used for the diagnosis of toxoplasmosis, but none of them have an internal control which would inform us regarding the presence of polymerase chain reaction (PCR) inhibitors thus, undermining the confidence of a laboratory physician. Materials and Methods: We designed a multiplex PCR containing primers targeting human beta globin gene which would act as internal control and two primers against the B1 gene and 5s gene which aid in sensitive detection of T. gondii. Results: Multiplex PCR had a sensitivity of 83.3% and specificity of 100%. Conclusion: Multiplex PCR may provide a sensitive and specific tool for diagnosis of human toxoplasmosis.
Poor performance characteristics of conventional PCR in detection of respiratory syncytial virus-experience of a tertiary care centre in Southern India p. 274
G Nandhini, S Sujatha, N Jain, R Dhodapkar, T Kadhiravan, S Krishnamurthy
Respiratory syncytial virus (RSV) is a significant cause of contagious acute respiratory infections in children and older adults. Since there are contradictory reports regarding the efficacy of different methods to detect RSV, we evaluated the performance of the conventional PCR versus real-time PCR in 222 patients with acute respiratory infections (ARI) recruited between January 2012 and March 2013. Conventional PCR had a very poor sensitivity of 40% (95% CI: 19.2-63.9%) and failed to detect RSV in respiratory samples with low viral load. Thus, it may be prudent to replace it with real-time PCR to achieve precise diagnosis.
Detection of mutations in mtrR gene in quinolone resistant strains of N.gonorrhoeae isolated from India p. 277
SV Kulkarni, M Bala, J Bhattacharya, A Risbud
Background and Objectives: Emergence of multi-drug resistant Neisseria gonorrhoeae resulting from new genetic mutation is a serious threat in controlling gonorrhea. This study was undertaken to identify and characterise mutations in the mtrR genes in N.gonorrhoeae isolates resistant to six different antibiotics in the quinolone group. Materials and Methods: The Minimum inhibitory concentrations (MIC) of five quinolones for 64 N.gonorrhoeae isolates isolated during Jan 2007-Jun 2009 were determined by E-test method. Mutations in MtrR loci were examined by deoxyribonucleic acid (DNA) sequencing. Results: The proportion of N.gonorrhoeae strains resistant to anti-microbials was 98.4% for norfloxacin and ofloxacin, 96.8% for enoxacin and ciprofloxacin, 95.3% for lomefloxacin. Thirty-one (48.4%) strains showed mutation (single/multiple) in mtrR gene. Ten different mutations were observed and Gly-45 → Asp, Tyr-105 → His being the most common observed mutation. Conclusion: This is the first report from India on quinolone resistance mutations in MtrRCDE efflux system in N.gonorrhoeae. In conclusion, the high level of resistance to quinolone and single or multiple mutations in mtrR gene could limit the drug choices for gonorrhoea.
Frequency of extended spectrum β-lactamase producing urinary isolates of Gram-negative bacilli among patients seen in a multispecialty hospital in Vellore district, India p. 282
B Nandagopal, S Sankar, K Sagadevan, H Arumugam, MV Jesudason, K Aswathaman, A Nair
Extended-spectrum beta-lactamase (ESBL) producing strains of Coliform bacilli are on the rise and present a major threat especially in India. We assessed the frequency of ESBL producers among urinary isolates from patients presenting urinary tract infections. ESBL screening was done using Double Disk Synergy Test (DDST) and confirmed using E-test and Polymerase Chain Reaction (PCR). With E-test, 92.2% were positive for ESBL. In PCR, 100% strains were positive for any of the three gene targets tested. CTX-M was positive in majority of the strains followed by TEM and SHV. Two (3.22%) strains were positive for all the three genes; 21% strains were positive for both TEM and CTX-M genes. There was no statistically significant difference in the findings of E-test and PCR testing in the determination of ESBL producers (Fisher exact test P = 0.15). The strength of agreement between them was 'fair' (k = 0.252). Continuous monitoring of ESBL producers among Indian strains is important to rationalize the antibiotic policy to be followed.
Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era! p. 286
S Qureshi, C Agrawal, M Madan, A Pandey, H Chauhan
The rise in super bugs causing Ventilator-Associated Pneumonia (VAP) is a major cause of mortality and morbidity despite recent advances in management owing to the looming 'antibiotic apocalypse'. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU) and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV) for ≥48 hrs. Endotracheal aspirates (ETA) from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP), while Nonfermenting Gram negative bacilli (NFGNB) were significantly associated with late onset VAP (LOVAP). Most of the isolates were multi drug resistant (MDR) super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.
A simple and rapid method for the quantitation of secreted hepatitis B virions in cell culture models p. 290
J Samal, M Kandpal, P Vivekanandan
Cell culture models for hepatitis B virus (HBV) remain the mainstay for screening and testing the efficacy of anti-hepatitis B virus agents. Gradient-based ultracentrifugation followed by Southern Blotting is used for hepatitis B virion estimation in cell culture; this method has several limitations. We report the development of an assay using a commercially available HBsAg-ELISA plate for immunocapture followed by real-time PCR for quantification of hepatitis B virions in cell cultures. This assay is rapid, highly sensitive (50 copies/reaction) and highly specific for virion-associated DNA. In addition, the assay requires only 20 μL of supernatant, allowing scaling down of transfections.
A cost-effective carbohydrate fermentation test for yeast using microtitre plate p. 293
A Kali, S Srirangaraj, PMV Charles
Carbohydrate fermentation test is a well-established technique for speciation of bacteria and fungi. However, long incubation period, cost and procedural complexity may limit its use. Here, we describe a simple modification of conventional carbohydrate fermentation technique using microtitre plate. Thirty-one yeast isolates were identified based on their fermentation property by microtitre plate method and results were compared with conventional method. The modified method had 85.7% sensitivity and 100% specificity. The average time taken to produce positive reaction was 24 hours. When compared with conventional method, modified method reduced turn-around time and cost of processing without significant increase in discordant results.
Small colony variants of Staphylococcus aureus: A clinical and laboratory challenge p. 296
MO Ahmed
Emergence of balamuthia mandrillaris meningoencephalitis in India p. 298
S Khurana, V Hallur, MK Goyal, R Sehgal, BD Radotra
We report two cases of fatal chronic meningoencephalitis caused by Balamuthia mandrillaris in immunocompetent men. Diagnosis of amoebic meningoencephalitis was made ante-mortem in one case and postmortem in another by histopathological examination and confirmed by demonstration of B. mandrillaris deoxyribonucleic acid (DNA) by polymerase chain reaction (PCR).
Ludwig's angina by Salmonella Typhi: A clinical dilemma p. 300
RK Mahajan, S Sharma, P Madan, N Sharma
Salmonella Typhi has rarely been associated with focal abscesses; and in literature, there is no evidence of its association with abscesses in the neck spaces. Ability of Salmonella Typhi to invade and localise in the neck spaces not only poses a diagnostic challenge but also underscores the necessity to understand the mechanisms that facilitate Salmonella Typhi to establish infections at sites completely non-traditional to the organism.
Mycotic keratitis due to Engyodontium album: First case report from India p. 303
DC Thamke, DK Mendiratta, A Dhabarde, AK Shukla
Engyodontium album is a rare and an unusual human pathogen. It is a common inhabitant of waste and moist material and frequently isolated from substrates such as paper, jute, linen and painted walls. This fungus grew within 3 days on SDA with chloramphenicol from corneal scrapping of a 70-year-old male farmer with a history of trauma by unknown vegetative matter. The fungus can be confused with Tritirachium sp and Beauveria sp.
Bordetella trematum bacteremia in an infant: A cause to look for p. 305
R Saksena, V Manchanda, M Mittal
Bordetella trematum spp. nov. has been isolated from wounds, ear infections and diabetic ulcers. We report a case of a 7-month-old infant with fever, vomiting and abnormal body movements with bacteremia caused by this novel species. The infant responded to fluoroquinolone and macrolide combination therapy.
An unusual case of lung abscess caused by Acremonium species treated with itraconazole p. 307
MS Qazi, SS Bowalekar, VS Wanjare, A Shankar
We present a report of a 37-year-old female with lung abscess due to Acremonium species that responded to oral itraconazole. There was a marked clinical as well as radiological improvement in patient. To the best of our knowledge, this is the first case of lung abscess due to Acremonium species which was treated by oral itraconazole. This cost-effective treatment modality proved to be significant in improving symptoms as well as morbidity in this patient.
Pyonephrosis due to Chryseobacterium gleum: A first case report p. 311
S Garg, SB Appannanavar, B Mohan, N Taneja
Chryseobacterium spp are widely distributed in nature but data of their isolation from clinical samples is scanty. Here, we report the first case of AmpC producing C. gleum causing pyonephrosis in a patient having bilateral nephrolithiasis on double J (DJ) stent. The present isolate was resistant to vancomycin, erythromycin, clindamycin, carbapenems and ciprofloxacin and susceptible to tetracycline and minocycline. The patient was treated with tetracycline and recovered without the need for removal of the DJ stent. The environmental surveillance carried out to trace the nosocomial origin of the isolate was negative. Since antimicrobial susceptibility of this isolate is different from previous reports, we emphasise that in vitro susceptibility testing should be sought to choose optimal antimicrobial agents for these Nonfermentative Gram-Negative Bacilli (NFGNBs) with different susceptibility patterns.
A rare case of onychomycosis caused by Emericella quadrilineata (Aspergillus tetrazonus) p. 314
D Sharma, MR Capoor, V Ramesh, S Gupta, MR Shivaprakash, A Chakrabarti
Onychomycosis is a common chronic nail disorder where dermatophytes are the predominant pathogens. However, non-dermatophytic moulds like Aspergillus can also be implicated as the causative agents. Herein, we report a rare case of onychomycosis due to Emericella quadrilineata ( Aspergillus tetrazonus) in an apparently immunocompetent host.
Aspergillus infection in urinary tract post-ureteric stenting p. 316
P Rao
Fungal infections of the urinary tract are usually encountered following prolonged antibiotic use, instrumentation and indwelling urinary catheters. These type of infections are mostly seen in immuno-compromised patients. Candida is the most common among the fungal infections of urinary tract followed by Aspergillus infection. Here is a case report of a 26 year old diabetic female who presented with abdominal pain, fever, nausea and vomiting. She had undergone double-J stenting 15-20 days back. The cause of the symptoms was not detected till the patient underwent C.T Scan-KUB with excretory urography which showed the displaced D-J stent. Then on performing replacement of D-J stent, cystoscopy was done and the tissue sample was sent for microbiological and histopathological examination. On Microbiological examination, Aspergillus flavus was isolated from the tissue, which was culprit behind the disease. Patient was then treated with anti-fungal drugs, following which she gradually improved.
Biofilm formation by bacterial isolates from patients on indwelling medical devices p. 319
M Gogoi, A Sharma, NK Hazarika
Comparison of selective and enrichment media for isolation of vancomycin-resistant enterococci from rectal swab specimens p. 320
G Ongut, OK Ozyurt, BO Baysan, D Daglar, D Ogunc, D Inan, D Colak, YY Senol, F Gunseren
Urban leptospirosis: A report of two cases p. 321
P Sarguna, M Raja Rao, S Sivakolundu, R Chaurasia, M Sritharan, K Shankar
An interesting case of pyelonephritis due to inactive and an atypical uropathogenic Escherichia coli p. 323
KA Chopdekar, A Singh, CA Chande, SG Joshi, AS Chowdhary
Human ocular thelaziasis: A case report from Karnataka p. 324
SK Prabhakar, GS Vijaykumar, BS Mahesh, Shanthamallappa
Clinical and demographic profile of patients reporting for Clostridium difficile infection in a tertiary care hospital p. 326
C Vaishnavi, M Singh, P Kapoor, R Kochhar
Prevalence of inducible clindamycin resistance among Staphylococcal isolates in a tertiary care hospital in North India p. 327
S Tyagi, A Oberoi
Cases of "Measles" in adult age group of St. John's Medical College Boy's Hostel, Bangalore, South India p. 328
DP Sinha, CG Raut, NJ Shaikh, H Jayaprakash, MJ Manjunatha, H Hanumiah
Isolation of Francisella tularensis from blood culture p. 329
SD Nirkhiwale, GS Gehlot, AK Bandi, AN Jasani
Seroprevalence of chlamydia trachomatis in infertile women in a tertiary care hospital: A pilot study p. 331
DG Mohan, AK Borthakur
Uncommon causes of fungal sinusitis from Eastern India p. 332
R Ujjwayini, S Dutta
RESEARCH SNIPPETS
Snippets p. 334
Molecular epidemiology of methicillin resistant staphylococcus aureus colonizing the anterior Nares of school children of Udupi Taluk: Erratum p. 337


Do you really need a security system in Chickasha?
According to FBI crime statistics, Oklahoma has a higher crime rate than the average rate throughout the United States. According to the Oklahoma State Bureau of Investigation there were 89 violent crimes and 515 property crimes reported in Chickasha during 2015. A monitored security alarm system significantly reduces the chance of becoming one of these potential victims.
Chickasha was incorporated in 1902. Chickasha is the county seat of Grady County in Oklahoma. In the 2010 census, population was 16,036 or a 1.2 percent growth from 15,850 at the 2000 census. According to the 2010 census, Chickasha's 16,035 residents consisted of 6,434 households and 4,111 families. Of Chickasha's 6,434 households, 29.6% had children under the age of 18 living with them, 46.6% were married couples living together, 13.5% had a female householder with no husband present, and 36.1% were non-families.


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It's easy to imagine the Coen brothers having a lot of fun with Killer Joe. Tracy Letts' story concerns a redneck family up to their necks in bad decisions, with a debt to a hired killer putting them all in jeopardy. The plot rapidly escalates out of control in a darkly comic fashion, but filmmakers like the Coens would have maintained an ironic distance to events, rather than plunging headfirst into violence and depravity, as William Friedkin has done so bracingly in his film adaptation. This is the second time Friedkin and Letts have collaborated – after the excellent and overlooked Bug in 2006 – and they appear to be a perfect match, with Friedkin having no qualms about matching Letts stride for stride as he charts his characters' journey into craziness.
In fairness, the journey isn't a long one. Friedkin sets the tone in the opening scene, which turns the volume up to 11 as a storm rages, a chained-up dog barks incessantly, and a young man hammers desperately on the door of a trailer. This is Chris (Emile Hirsch), a man in debt to bad people, and he is greeted at the door by his stepmother Sharla (Gina Gershon), who is naked from the waist down and thinks nothing of thrusting her unkempt bush in his face. Chris's father Ansel (Thomas Haden Church) justifies his wife's state of undress by explaining that she didn't know it was Chris at the door, with the actor's dull-witted delivery of this salient point being the first of many laugh-out-loud lines in the film.
Killer Joe is essentially a comedy – and it is one of the funniest films I've seen all year – but it's the kind of comedy that tries to make us choke on our laughter, which is a tricky balance to pull off. That the film works as well as it does is largely down to the small cast, all of whom are a perfect fit for their roles, but two knockout performances stand out, one from a young actress hitting new heights, and the other from familiar face showing us aspects of himself that we never knew he had.
Chris' sister Dottie is that the centre of the drama and she is a perfect character for Temple, who brings just the right detached, dreamy tone to her performance. Naïve and coquettish, Dottie comes across as a little girl in a young woman's body and she inspires a powerful protective urge in Chris, although the film suggests that incestuous desire might be confusing his feelings. When Chris' plan to bump off his mother and claim the insurance money leaves him indebted to corrupt lawman Joe (Matthew McConaughey), the hitman decides to take Dottie as collateral, and McConaughey takes control of the picture. It has been a long time since I have been excited by anything McConaughey has done, but this is an extraordinary resurrection for a once-promising actor who has spent too many years slumming it with lousy material. Joe is the role that McConaughey so desperately needed, as it allows him to utilise his undeniably screen presence while pushing his persona into darker, more twisted places.
Friedkin is unafraid of exploring such places; in fact, he appears to relish it. He is perfectly at home with the lurid, sensational aspects of Killer Joe, and he remains admirably committed to following through on them. In doing so, he risks alienating the audience (the hysterical climax to the picture is often disgustingly violent, and the chicken scene is already notorious) but with Letts' finding large doses of humour and horror in this scenario, often simultaneously, Friedkin is capable of serving up a queasily compelling spectacle. A film version of Letts' 2008 play August: Osage County is currently in production and I'm a little disappointed that Friedkin isn't taking the reins on that picture. Working with Tracy Letts on his last two pictures appears to have revitalised this director, and I'd love to see push an A-list cast to the kind of unexpected heights he achieves with Killer Joe.


When Team Sky announced their roster for the 2017 Giro d'Italia (May 5-28) there was one surprise omission: Italian sprinter Elia Viviani.
The 28-year-old will miss the race for the first time since 2012, and the first time since joining the British WorldTour team in 2015.
Viviani's absence from the race appears to go against tradition, where teams tend to pick their foremost 'home' riders for what is undoubtedly Italy's biggest race. Viviani is a Giro stage winner and 2016 omnium Olympic Champion, and therefore a high-profile figure. New recruit Diego Rosa and domestique Salvatore Puccio are Sky's two Italian riders in the race.
Confusingly, Viviani's name appeared on provisional lists for the race, even appearing on an official release regarding the 'sprinters to watch' issued by Giro organiser RCS Sport as recently as last Friday, April 21.
The reason behind Viviani's non-selection is clear: Team Sky are building a team behind its co-leaders, Briton Geraint Thomas and Spaniard Mikel Landa, with no space left for a sprinter. In such a team, a sprinter would have to fend for themselves in the bunch without a dedicated lead-out, which would be far from ideal against the likes of Fernando Gaviria (Quick-Step Floors) and André Greipel (Lotto-Soudal).
Viviani's exclusion, therefore, is a strong signal that Team Sky is very serious about this year's Giro general classification – it's the overall win, or nothing. Sky's relationship with the Giro has not been a good one: despite dominating the Tour de France and placing riders on the podium in the Vuelta a España, there has been no such consistency at the Giro. Colombian Rigoberto Uran's second place in 2013 is the team's only podium spot so far since 2010.
Although Landa's lead-up to the 2017 Giro has been steady rather than spectacular, Thomas has already shown that he is in good form, placing fifth in Tirreno-Adriatico and then winning the Tour of the Alps overall.
However, Landa has the better result in the Giro, having placed third in 2015 – which led to him being signed to Sky from Astana. Having been handed sole leadership in the Giro last year, Landa was forced to abandon due to illness on stage 10, leaving Sky with no other leadership option. Sky's race was saved with a fine stage win from Mikel Nieve, who went on to claim the mountains classification.
Thomas has not raced in the Giro since 2012, when he came 80th. Two 15th places in the past two Tours de France in the service of winner Chris Froome show that Thomas has great Grand Tour GC potential, and this year's two long time trials in the Giro play into his hands.
The Sky pair's biggest rivals will be defending champion Vincenzo Nibali (Bahrain-Merida) and Nairo Quintana (Movistar). Both have proven Grand Tour winning ability.
So Thomas and Landa are Sky's plan A and plan B (whichever way around that is), but with Viviani absent there is no plan C.
As Italian sports paper Gazzetto dello Sport's headline says, "Sky – Viviani will not be at 100th Giro. All for Landa and Thomas".
Team Sky for the 2017 Giro d'Italia: Philip Deignan (Irl), Kenny Elissonde (Fra), Michal Golas (Pol), Sebastian Henao (Col), Vasil Kiryienka (Blr), Mikel Landa (Esp), Salvatore Puccio (Ita), Diego Rosa (Ita) and Geraint Thomas (GBr).


text:
Non-Sports Streaming Bundle Closer to Launch: Report
By Jon Lafayette
A low-price skinny bundle of entertainment cable networks that excludes the broadcasters and other carrying the biggest sports events, is expected to launch in the next few weeks, according to a published report.
Viacom, AMC Networks, A+E Networks, Scripps Networks Interactive and Discovery Communications are putting some of their networks into the over-the-top package, which will cost less than $20 a month, according to the Wall Street Journal.
Some of those companies have had marginal success getting into the skinny bundle streaming packages that have already been launched such as Sling TV, Hulu, YouTube TV and DirecTV Now. Those packages include broadcast networks and ESPN and cost about $40 a month.
The new service will be called Philo, named after both Philo Farnsworth, who invented television, and Philo, a company that specializes in streaming TV for college campuses.
The number of traditional pay-TV customers has been steadily dropping, raising concerns over lost revenue for both programmers and operators. Some media companies, such as the Walt Disney Co., have reported the digital virtual multichannel video programming distributors are offsetting the loss of traditional subscribers.
Some programmer including HBO and CBS, have made their networks available direct to consumer and a variety of other direct-to-consumer video products have launched or are in the process of being launched.
Jon Lafayette
Jon has been business editor of Broadcasting+Cable since 2010. He focuses on revenue-generating activities, including advertising and distribution, as well as executive intrigue and merger and acquisition activity. Just about any story is fair game, if a dollar sign can make its way into the article. Before B+C, Jon covered the industry for TVWeek, Cable World, Electronic Media, Advertising Age and The New York Post. A native New Yorker, Jon is hiding in plain sight in the suburbs of Chicago.
Paramount to Provide CBS Network Feed to Fubo if Affiliates Opt Out of Deal (Updated)


Exercise is not just to keep your body fit, it also makes your mind stress free. Any exercise- walking, yoga, swimming, aerobics, playing etc.- release feel-good chemicals in your body keeping whole of your and mind stress free and healthy.
Am an middle aged American with naturally thicken hair, I suffered a lot with hair falling problem for many years, so searched for a good solution by googling then I found the best ever I used. As I saw many good reviews on "sl handy hair started to use for couple of weeks and didn't see any changes except increase of hair fall by massage.. from the mid of third week it completely stopped my hair falling. not even when massaging. very happy with the product and almost am using it for 2 months, left is enough for another couple of months. I don't think that I need another bottle as this showed the best result. bought another bottle which contains 160ml to my wife to increase the thickness of hair, will give an update of the status once i got a time with the results on increasing thickness of hair.


It was only after Mrs. Fennelly's prize-winning butter sculpture "A Day in the Life of My Family" had melted that the clean-up crew at the Iowa State Fair discovered the likenesses of her four family members were the direct result of her having actually used each of her family members.
Ran Walker is the author of sixteen books. He currently teaches creative writing at Hampton University. He can be reached at ranwalker.com.


text:
Q: jQuery tabs and showing database strings I am attempting to call data from the db at the head of the page and then use the array information in a foreach to populate the tables in the tab.. currently i am testing with tab 2 but i will want this to originally show in tab 1 unless moved by the user. I am unsure where or how to include the db query and result so that it will populate correctly. Here is what i have so far.
{source 0}
<?php
$user =& JFactory::getUser();
    if (!$user->guest)
$name = $user->username;
$db =& JFactory::getDbo();
$query = $db->getQuery(true);
    $query = "
         SELECT image_url, name_test, image_date
         FROM #__image_data
         WHERE user_name = '$name'";
$db->setQuery($query);
echo $name."'s Pets" . "
";

$list = $db->loadObjectList();
    foreach ($list as $item){
}
?>

    <meta charset="utf-8">
    <title>jQuery UI Tabs - Simple manipulation</title>
    <link rel="stylesheet" href="/Joomla3/jquery/themes/base/jquery.ui.all.css">

    <link rel="stylesheet" href="/Joomla3/jquery/demos/demos.css">

    <form>
        <fieldset class="ui-helper-reset">
            Title
            <input type="text" name="tab_title" id="tab_title" value="" class="ui-widget-content ui-corner-all" />

        </fieldset>
    </form>

<button id="add_tab">Add Tab</button>

Main

Tab 2

Test information.

                        <?php"
"."image_url'>" . "" . $item->name_test . "" . $item->image_date ."
"?>

Item 2

Item 3

Item 4

Item 5

{/source}

A: Since you already have a foreach loop set up for your db data can create all the html stored in a variable like this:
$tableHtml='
';
foreach ($list as $item){
   $tableHtml.="
image_url."'>" . $item->name_test . "	" . $item->image_date ."
";

}
$tableHtml='</table';

Then in the part of page you want table :
<?php echo $tableHtml; ?>


A person's face is usually the first feature noticed by others. The signs of aging including loose, sagging, and wrinkly skin can lower an individuals self-esteem when socializing or meeting new people. Many people want the noticeable results from a facelift without having the surgical procedure done. So, this lead to the invention of the FaceTite, a new way to improve the appearance of your facial skin.
The FaceTite was created to show a dramatic improvement in the appearance and laxity of the facial skin. This minimally procedure can be used on the face and neck without the use of surgical tools. Melting away fat and giving the patient and fresh and youthful look.
FaceTite is a different type of face procedure in comparison to a facelift. Through the use of radio-frequency energy, the technology tightens skin and gives it a younger appearance. Patient will not have large scars after the procedure, and will also have less swelling than other procedures. Any additional questions can be answered by Dr. David Altamira.
How Does FaceTite Compare To A Facelift?
FaceTite provides a more natural looking result then a Facelift. In addition to less scarring from the less invasive procedure. Patients will also notice less discomfort and swelling after the treatment is over. They can resume normal activities much sooner than a Facelift.
How Long Does It Takes For Results?
With the FaceTite, the patient can see results immediately. The results from the procedure are most noticeable 6 weeks after treatment.
FaceTite is a minimally invasive treatment so there is little to no recovery. Patients can continue daily activities shortly after the procedure. However, wearing a compression garment will provide the best results.
If you are looking for a minimally invasive way to lift your face with FaceTite, call us 713-271-9000 at to schedule a consultation.