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Body burden of heavy metals among HIV high risk population in USA.
- Additional Document Info
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OBJECTIVE: HIV high risk population may face not only the threat of HIV infection but also a higher chance of exposure to environmental contaminants. However, no previous studies have examined the body burden of environmental pollutants including heavy metals among HIV high risk populations. The aim of this study was to investigate whether adults aged 20-59 years old at high risk of HIV infection have higher blood levels of heavy metals compared to those with low risk of HIV infection in United States. MATERIAL AND METHODS: We used the National Health and Nutrition Examination Survey (NHANES) 1999-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury by HIV risk status. RESULTS: The results showed that people at high risk of HIV had higher blood concentrations of all heavy metals compared to their counterparts with lower HIV risks. In multivariate linear regression models, HIV risk status was significantly associated with increased blood cadmium, lead, and total mercury after adjusting for age, sex, race, education, and poverty income ratio. CONCLUSIONS: Our study suggests that people at high risk of HIV have significantly higher body burden of heavy metals including cadmium, lead, and mercury compared to those with low risk of HIV. Further longitudinal study collecting more pollutants are warranted to determine the potential health effects of these elevated pollutants on both HIV-infected and HIV high-risk populations.
author list (cited authors)
Xu, X., Hu, H., & Hong, Y. A.
complete list of authors
Xu, Xiaohui||Hu, Hui||Hong, Yan Alicia

domain: biology


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Before Barbie…there were Seminole dolls! Dolls are having their cultural moment right now. But, did you know they have been an important and celebrated part of Seminole culture much longer than Barbie has even been around? This week, we will be exploring the beauty, simplicity, and impact of Seminole dolls. Seminoles have been making them for their children for generations. But, as Seminole tourism began to take off in the early 1900s, Seminole dolls and other crafts became important tourist commodities. We will also be shining a spotlight on the University of Florida Seminole doll collection and other South Florida collections. Much of these are online for your perusal! In our featured image this week you can see a young Seminole girl with a very early cloth head doll, circa 1900 (2001.32.1, ATTK Museum). Before the recognizable palmetto dolls you can still find today, Seminoles would make simple cloth or wooden
Critter Count! Join us in Big Cypress National Preserve, as we discover its diverse animal inhabitants.
Welcome back to our latest installment of our Decades of Seminole Tourism series! This week, join us for the triumphs of 2000s, as the Seminole Tribe rocks through Y2K. In this decade, the Seminole Tribe would expand by leaps and bounds, with the construction of Hard Rock Hollywood and Tampa in 2004 and acquisition of Hard Rock International in 2007.
This week, we delve into the rich history of Seminole fashion, exploring its evolution over time and its profound significance within Seminole tourist ventures.
The 71st Annual Florida Folk Festival is next weekend, May 26th-28th, 2023 at the Stephen Foster Folk Culture Center State Park in White Springs, FL. This Friday, join us on the blog to learn about Seminole presence at the festival, its history, and how you can attend!

domain: history


Secondhand Smoke and Kids in Cars
Keep our kids safe from secondhand smoke!
The Proposed Law:
Smoke-free cars legislation would protect persons under 18 from breathing in dangerous secondhand smoke while riding in a vehicle. In 2009, Minnesota Senator Sandy Pappas was the primary author of this bill.
Read the full text of the 2009 proposed bill on the Minnesota Senate web site.
Minnesota would NOT be the first to pass this type of law. Jurisdictions that ban smoking in vehicles that transport children include:
The air quality in a car where someone is smoking can reach nearly 10 times over the hazardous levels set by the United States Environmental Protection Agency.
Read more about secondhand smoke, kids, and cars:
How Dangerous is Smoking in Cars?
Watch this video to learn a little more about the science behind what happens when someone smokes in a car.


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Snow Puff Corn Seed for White Popcorn
Snow Puff corn seeds are perhaps one of the tastiest and most sought-after popcorn seeds known for their signature tender, melt-in-your-mouth white popcorn. Much like other types of corn, popcorn is incredibly easy to grow and should be planted just like other types of corn. After all danger of frost has passed, either in spring or early summer, it is best to direct-sow your seeds into your garden, as corn does not transplant well. This specific variety of corn seed will mature in about 100 days.
Not only is growing your own popcorn seed a fun experience for adults and children alike, but the taste of fresh-popped homegrown popcorn is far superior to anything store-bought. It’s a real treat that is worth the time and effort, and the popcorn can even be dried and used throughout the winter.

domain: agronomy


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The Space and Atmospheric Science (SAS) division at NESAC has been actively engaged to understand and characterize some of the major drivers of climate change over the North Eastern Region (NER) of India. The group mainly focuses on aerosol characterization and aerosol-cloud interaction, atmospheric chemistry, atmospheric boundary layer dynamics, cloud microphysics, and the atmospheric coupling processes dominant over the NER of India that is responsible for the complex weather and climate system over the region including the eastern sub-Himalayan region. The group has done extensive work to improve the short and medium range weather prediction through numerical weather prediction models over the NER of India. The group has developed a regional facility with state-of-the art instruments to conduct and promote atmospheric science research in collaboration with academic institutes and other research organizations. It has established and operates a network of Automatic Weather Station, network of Lightning detectors, S-band polarimetric Doppler Weather Radar, UHF wind profiler, and several other instruments useful for weather and climate science. SAS division provides nowcasting services for severe storms, lightning, intense rainfall, etc. The group also provides meteorological support for early warning of disasters like floods, landslide, health disasters, etc.
Space & Atmospheric Science Division (SASD)
Dr Arup Borgohain, Sci/Engr ‘SF’
Dr Aniket Chakravorty, Sci/Engr ‘SD’
Shri Rosly Boy Lyngdoh, Sci/Engr ‘SD’
Dr Abhay Srivastava, Sci/Engr ‘SC’

domain: geography


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( 1948 1949 1950 1951 1952 1953 1954 )
Listing Expired for: 1951 Willys Cj3b
Please click on "INVENTORY" to see full selection of vehicles available, or use the "Quick Search" function.
This 1990 Chevrolet 454SS pick up is for sale in our Louisville KY showroom. Chevy released the 454SS in 1990 as a modern muscle truck. They were an instant success with over 13000 units sold. The engine.....
This 1966 Ford Mustang Coupe is for sale at our Louisville KY. The 1966 Mustang was pretty much a rollover from the last series 65. Minor trim renditions and new grill were all that was done due to the.....
This 1971 Chevrolet Corvette is for sale in our Louisville KY showroom. The 1971 Corvette is still known for its great looks with chrome bumpers on the front and rear making it one of the most sought after.....
© Copyright 2019, Gateway Classic Cars | All Rights Reserved
Gateway Classic Cars
1237 Central Park Dr. O'Fallon, IL. 62269 | 618.271.3000 | 800.231.3616
0 Classic and Exotics For Sale Today

domain: hobby


text:
'Al Pacino and Anthony Hopkins are so humble I was pinching myself through the process': interview with Leah McKendrick
Cinema / Interview - 11 June 2020 16:45
Leah McKendrick is actress
Leah McKendrick is actress and singer. She worked in movie Misconduct (2016) starring Al Pacino, Anthony Hopkins; Bad Moms (2016) with Mila Kunis, Kathryn Hahn, Kristen Bell . She's working on the movie Unicorn.
In the movie "Misconduct" what is your role?
1 di 6
© All right Reserved

domain: celebrity


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Disney's mean-girls comedy "You Again" is adding some familiar faces.
"Pushing Daisies" star Kristin Chenoweth, "The Proposal's" Betty White, " Beverly Hills Chihuahua's" Jamie Lee Curtis and " Cloverfield's" Odette Yustman have signed on, according to The Hollywood Reporter.
The movie follows a woman ( Kristen Bell) who learns her brother is engaged to her high-school nemesis (Yustman). Curtis and White will play Bell's character's mother and grandmother, respectively, and Chenoweth will step into the role of a hyper wedding planner.
Filming is scheduled to begin later this summer in Los Angeles.

domain: artistic


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- Can you have Stage 4 cancer and not know it?
- What is the most aggressive cancer?
- Will cancer kill me?
- Is Stage 4 always terminal?
- Is Stage 4 cancer the same as terminal cancer?
- What are the 7 warning signs of cancer?
- How long does cancer take to develop?
- Can you beat Stage 4 cancer?
- Can you survive stage 4 cancer?
- What are the symptoms of stage 4 cancer?
- Is Stage 4 cancer the highest?
Can you have Stage 4 cancer and not know it?
When people are diagnosed with cancer, most of them are diagnosed at an early stage.
I was a rarity and was diagnosed at stage 4.
Every cancer case is different, some people diagnosed at an early stage have obvious symptoms, some of us diagnosed at a late stage have no symptoms or very insignificant symptoms..
What is the most aggressive cancer?
Because pancreatic cancer progresses rapidly, and no method of early detection has been discovered, it is one of the most dangerous types of cancer. The one-year survival rate is 25 percent, and the five-year survival rate sits at only 6 percent.
Will cancer kill me?
Cancer kills by invading key organs (like the intestines, lungs, brain, liver, and kidneys) and interfering with body functions that are necessary to live. Untreated cancer commonly causes death. In contrast, cancer treatment often saves lives – especially when cancer is found and treated early.
Is Stage 4 always terminal?
Stage 4 mesothelioma is a rare, malignant cancer in an advanced stage. Stage 4 cancer cells have metastasized, spreading to distant areas in the body. Stage 4 is the final mesothelioma stage and considered terminal.
Is Stage 4 cancer the same as terminal cancer?
Although stage 4 cancer may not be curable, it doesn’t mean that you have terminal cancer.
What are the 7 warning signs of cancer?
These are potential cancer symptoms:Change in bowel or bladder habits.A sore that does not heal.Unusual bleeding or discharge.Thickening or lump in the breast or elsewhere.Indigestion or difficulty in swallowing.Obvious change in a wart or mole.Nagging cough or hoarseness.
How long does cancer take to develop?
Scientists have found that for most breast and bowel cancers, the tumours begin to grow around ten years before they’re detected. And for prostate cancer, tumours can be many decades old. “They’ve estimated that one tumour was 40 years old. Sometimes the growth can be really slow,” says Graham.
Can you beat Stage 4 cancer?
In most cases, however, stage IV cancer is not curable – but that doesn’t mean that there is no effective treatment (Improving Quality of Life is a reasonable goal even if cure is not). Stage IV disease is different for every person afflicted by this condition.
Can you survive stage 4 cancer?
Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer (MBC) cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent; median survival is three years. Annually, the disease takes 40,000 lives.
What are the symptoms of stage 4 cancer?
If they do have symptoms, they may be vague and can include:Loss of appetite or feeling full early.Fatigue.Fever.Itching.Pain in the abdomen.Swelling in the legs.Weight loss.Yellowing of the skin or whites of the eyes, called jaundice.
Is Stage 4 cancer the highest?
Grade 4: These have the most abnormal-looking cells. They are the highest grade and typically spread faster than lower-grade tumors.

domain: medical


June 8, 2018
Trip Report: Galway, Cliffs of Moher, and Aran Islands in Ireland
After spending a few wonderful days in Cork, we rented a car and made our way to Galway. There isn’t a whole lot to do or see in Galway itself since it’s a fairly small city. We spent the first day walking around and exploring Galway. We took a day trip on the second day and visited the Aran Islands and the Cliffs of Moher-two stunning sites worth visiting if you’re in the area.
Although there wasn’t a whole lot to do in Galway itself, the city had plenty of the traditional Irish touches which made it worthwhile. Look up the Latin Quarter in Galway to find the long street above. Located in the middle of the city, it’s full of shops, pubs, and street entertainment. The whole area is a lot of fun and well worth a visit. Every pub is slightly different. You’ll find tons of Irish, and non-Irish cuisine here, and plenty of live music to keep you entertained.
Europe is built on thousands of years of history. I’m used to seeing old structures pop up where they don’t belong, but this was an eye opener even to me. There’s a large shopping mall in the center of Galway which is built around the city’s old medieval walls. I mean, how cool is that?!
The Aran Islands are a chain of three islands off the West coast of Ireland. To get there, you need to drive about an hour and a half from Galway to Doolin. Then you take a ferry from Doolin out to the islands. We ended up visiting Inisheer, the smallest of the Aran Islands.
The drive down from Galway to Doolin goes along a route commonly called the Wild Atlantic Way. You’ll drive through several small towns and the coast of Ireland with plenty of beautiful spots for photos. We saw this donkey on the side of the road near an old medieval well.
There isn’t much to do on Inisheer island once you get there, and that’s the point. The island is tiny and has a small local population. It’s a cool place to visit to see unspoiled parts of Ireland. You can rent a bike, a van, or a pony drawn carriage to take you around the whole island in one hour. You’ll find the ruins of an old castle at the very top and a shipwrecked vessel on the shores of the West side of the island.
— ArisTravels (@realArisTravels) June 8, 2018
Cliffs of Moher
Pictures don’t really do justice to the Cliffs of Moher. They’re 700 foot tall cliffs rising out of the Atlantic Ocean. Our ferry back to Doolin came up close to the bottom of the cliffs. We saw tons of birds flying around, we saw jellyfish around the boat, and we even saw a few puffin birds swimming!
The top view is very different from the bottom view. There’s a left side and a right side at the top of the cliffs and they’re both worth exploring. We only had time to see one so we went left. It’s a remarkable place to visit.
Ireland is scattered with castles. We just happened to see this one on the side of the highway while driving back to Galway.


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In an age where there are about as many internet DJs as there are remixes of Avicii’s ‘Levels’, it is always refreshing to witness a breakthrough DJ who seems to have found an original voice. Up and coming Austrian producer Tobias Rieser, producing under the name Klangkarussell, has generated a wave of popularity after his song ‘Sonnentanz’ went viral, being dubbed by many as the song of the summer.
The career of Rieser, who has been producing music since the age of 15, is in such an early stage that there is not yet a full EP released – only a couple of mixes on his Soundcloud page, one of which includes ‘Sonnentanz’ (‘Sun Dance’). Despite the reaction to the song being so widespread, with well over one and a half million views across different websites, Rieser told Cherwell that he ‘did not expect any reactions to the song at all.’
Having grown up in Salzburg, the home of Mozart, classical music has given a “wonderful influence” on the music of Rieser, who was born into a musical family, playing the trombone from an early age and learning from his father, a music teacher.
Klangkarussell’s music has been described by some as ‘deep house’, and by himself as ‘jazz house’ – but he says that “over the last few years it has become really difficult to talk about electronic music in terms of genres.
“There are some tracks you can easily connect to a genre, but I am proud of the fact that I would not try to assign my tracks to a special genre”. Although stating that his influences range from producers such as Marek Hemmann and Oliver Koletzki, to soul legends such as Otis Redding and James Brown, Rieser has stressed the need to have a diverse range of influences.
“You have to walk through the world with open eyes and ears and soak up everything and process it afterwards. There are beautiful tunes in every genre, you just need to listen carefully and sometimes hear music in the right context.”
How would Rieser recommend young DJs to manage to find an original, unique voice? “Just do what you want to do” he replies; “don’t think you need to follow any trends. Try to be an individual, and listen to your inner voice”.
Rieser was best friends in school with fellow Austrian producer Herald and I and who now, eight years on, is producing with Rieser under the name Helden:klang. “We are planning to release our first EP with ‘Sonnentanz’ and ‘Netzwerk’ [one of many popular Helden:klang collaborations] but we are not there yet”.
Dubbed as the next Paul Kalkbrenner, big things are expected of the man behind Klangkarussell.

domain: entertainment


two black cadillacs
If Carrie Underwood’s music videos were true, then “Two Black Cadillacs” would be proof that her criminal actions are escalating. And this is from an artist whose 2006 video for “Before He Cheats” showed her brandishing a Louisville […]
Finally, we get to see Carrie’s video for “Two Black Cadillacs”…it was definitely worth the wait!
With a narrative centering around infidelity and murder, Carrie Underwood’s new single, “Two Black Cadillacs,” isn’t exactly a lighthearted number. But it sure is compelling.


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September 7, 2019 at 6:01 am #62491
In order to get a better understandig of the different Weather Adjustment Methods available with OpenSprinkler I have run a comparision for Ausgust 2019. Our weather in August was typical for a middle European summer. We have had temperatures close to 85 °F (30 °C) during the day, which are also sometimes gone down to 59 °F (10 °C) at the early morning. There have been also a mix of rain showers and local thunderstorms.
The attached diagrams schow the Watering % results of the ET and Zimmerman Weather Adjustment Methods. My OpenSprinkler is programmed to water the garden at 7 am in the morning. The diagrams and the corresponding weather data are related to this 7 am sprinkler operation.
The baseline ETo value for my specific location is retrieved as 0.113 inch/day. The baseline humidity is set to 65%. All other Weather Adjustment baseline parameters are kept to the default values.
The different watering % results for the Zimmerman Weather Adjustment Method are caused by the discrepant precipitation values received from DarkSky. They don’t describe the actual rainfall at my home location as measured by the rain gauge installed with my local PWS.
The ET Weather Adjustment Method results in greater changes of the watering % values. It is maybe necessary to modify the baseline ETo value to reflect the watering needs for my home location? Another good idea will be to use the local rainfall measurements as input for the ET watering % calculation? However this requires some OpenSprinkler weather service program modifications.
I’m actually using the Zimmerman (Local PWS) Weather Adjustment Method to water my garden, as this gives the best results for me. However I’m free for any changes in the future. I hope this short analysis gives some ideas what can be achieved by using the OpenSprinkler’s Weather Adjustment Methods?
Attachments:September 14, 2019 at 4:03 pm #62589
I have the same problem with DarkSky — the precipitation amounts are wildly different than what my PWS reports (and the station apparently used by DarkSky is less than one mile away). I often see DarkSky reports of small amounts of precipitation when I know there has been absolutely none. This may be caused by morning dew accumulating on that weather station’s rain sensor. I stuck with Zimmerman and the data from my local PWS (delivered locally through a local instance of weatherserver).
- You must be logged in to reply to this topic.


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Press Release: Statement by IMF Managing Director Christine Lagarde at the Conclusion of her Visit to South Africa
January 7, 2012Press Release No. 12/1
January 7, 2012
Ms. Christine Lagarde, Managing Director of the International Monetary Fund (IMF), made the following statement today in Pretoria:
“It is a great pleasure to be in South Africa for my first visit as Managing Director of the IMF. I had the privilege to meet President Jacob Zuma, and had very productive meetings with Finance Minister Pravin Gordhan, Minister in the Presidency in charge of the National Planning Commission Trevor Manuel, and Central Bank Governor Gill Marcus.
“South Africa’s recent economic performance has been impressive. Good macroeconomic policies which, together with a flexible exchange rate and sound financial sector, have mitigated the output drop during the global recession. Prudent fiscal management in the mid-2000s created the space that allowed fiscal policy to be supportive in recent years, mitigating the worst effects of the global economic slowdown and domestic recession.
“South Africa has become increasingly integrated into the global economy. In our highly interconnected world, this integration also exposes South Africa to global business cycles. The ongoing difficulties in the euro area, one of South Africa’s main export markets, present significant downside risks to the economic outlook.
“In this context, we agreed that the challenge now is to ensure that monetary policy remains supportive and competitiveness improves. At the same time, moderation in wage growth and enhanced competition would support the ongoing recovery and lay the foundation for higher growth in the medium term.
“In these difficult times for the global economy, emerging economies are a key part of the solution. South Africa has an important role to play on behalf of the interests of developing economies and the African continent in particular. As a member of the G-20, it has a leadership role to play in making the voice of Africa heard. I’m confident that it will continue to do so.”

domain: news


Proposed city ordinance would create stricter penalties for drag racing behind Lake Charles Civic Center
LAKE CHARLES, La. (KPLC) - As the sun sets on the lakefront, the Lake Charles Civic Center becomes an arena for what some witnesses call the “car show.”
“Revving up engines, mufflers, screaming, hooting, and hollering, a lot of people obviously getting drunk.” That’s how Henry Gil, a witness to the “show” would describe it.
Gil says the reckless driving isn’t the only problem.
“I’ve actually been to the car show once, and I’ll never go again because it was a very odd experience,” says Gil. “[There was] definitely a lot of drugs, a lot of drinking and no COVID-19 protocols.”
Gil goes on to say he’s witnessed solicitation.
“Just a lot of women trying to do prostitution. They would just say ‘Hey do you wanna go to the back of your truck and have some fun?’ And stuff like that for money,” claims Gil.
“We [LCPD] have not received any reports regarding to any prostitution or anything,” says Deputy Chief Franklin Fondel of the Lake Charles Police Department. “The complaints that we have been receiving is regarding to the volume of speeding vehicles and vehicles in the parking lot drag racing.”
The speed limit behind the Civic Center is posted at 25 miles per hour, but some people are putting the pedal to the metal. Witnesses say some drivers are tripling that speed limit and creating visible marks on the road.
“There’s just tire marks all over the grounds, and it’s just not presentable,” says witness, Chad Moreno.
A new ordinance has been introduced before Lake Charles City Council regarding reckless driving on the grounds and enforcing stricter penalties for violators.
“That will be discussed tonight, regarding having repeat offenders that go out and be cited more than one time for the same event,” says Chief Deputy Fondel.
“I get it, the kids are probably going to do this somewhere,” says Moreno. “But they’ve just picked the most prominent part of our city and our downtown lakefront to do this. And that’s just not the place for it.”
The newly proposed ordinance will be discussed in the upcoming council meeting on April 21.
Copyright 2021 KPLC. All rights reserved.


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Basic Winter French Bulldog Vest Jacket
This Basic Winter French Bulldog Vest Jacket in Rose Red or Black will look great all winter long.
- Waxed cotton for durability
- Harness hole on the back
- Adjustable front touch fastener closure for a secure, comfortable fit
- Pocket on the back
- High-cut, stay-dry belly
Why We Love It:
The stylish basic Winter French Bulldog Vest Jacket is a real deal! Fully lined with soft plush fabric fur will keep the chill off your adorable dog. Made of 100% polyester with plastic snaps closures. Great for your loving pup!

domain: pet


More than P57 million has been assessed by the Capitol as collectibles from at least two utility firms encroaching the province-owned lots along Osmeña Boulevard in Cebu City.
During the June 2 meeting of Cebu Governor Gwendolyn Garcia with the officials of the Metropolitan Cebu Water District (MCWD) and the Visayan Electric, said utility companies were informed of their obligation to the Capitol.
Yvonne Gomos, the Capitol's consultant, made a presentation and said the MCWD has P44.5 million in obligation to the Capitol of its wells and distribution channels located in the 851.126 square meters lot of the Capitol for 48 years.
The Capitol Information Office report said that from the said figure, 743. 206 square meters cover the Capitol lot in Osmeña Boulevard while the 107.92 square meters has been in another Capitol lot in Banilad since 1975.
The lease rate along Osmeña Boulevard, according to Gomos, is P400 per square meter as of March 2023 while in Banilad area the lease is P500 per square meter.
MCWD Chairman Jose Daluz III told Garcia that the water district is willing to pay the Capitol its obligation but requested they be given liberal paying terms.
The governor responded positively and asked Daluz to submit a counter-proposal to the Provincial Economic Council for review.
As to the Visayan Electric, the firm owes the Cebu Capitol P13.4 million for the said encroachment.
According to Sugbo News, the news arm of the Cebu Provincial Government, the electric utility firm encroached a total of 473.49 square meters to the claimed Capitol lot along Osmeña Boulevard since 2004.
The computation, according to the Capitol, is the rate per square multiplied by the total encroached land area and multiplied again by the height of the Visayan Electric's 14 primary and 13 secondary utility poles whose height reaches to 13 meters.
Gomos said they use this year's current rental rate per square meter in their computation. They are also based on the Consumer Price Index to get the inflation rates in the previous years.
Engr. Raul Lucero, the president of Visayan Electric, told the governor he would bring this matter to the board of directors of their firm considering that they have some questions as to the computation of their payable.
For several months, the Capitol has been in coordination with the different firms and establishments whose structures are said to be encroaching in the Capitol claimed lots along Osmeña Boulevard.
The Capitol is asking these establishments to give the Cebu Province 'a just compensation' for the said encroachment as the rightful owner of some lots along Osmeña Boulevard.
The compensation expected to be received by the Capitol from these establishments will add to the Province's coffers. - (FREEMAN)


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Persepolis director Marjane Satrapi talks Agenda through her offbeat comedy-thriller that features a murderous Ryan Reynolds, a talking cat and Gemma Arterton’s severed head…
Off with her head — “I absolutely didn’t want to have the severed head on greenscreen, because the actors are working with nothing, they’re not doing things together. It’s boring for me, boring for the cinematographer, boring for everyone. You have to have a very good actress to understand that she’s a severed head. And it happened that Gemma [Arterton] is a great actress. She’s very beautiful and she has a sense of humour, but she’s really professional. At one point she was on the table next to the double of the head and I came in and I didn’t know which one was her.”
- Movies & Television > The Voices (2014) > Related Clippings > Total Film (UK) – June 2014
She is set to take on the lead in the West End musical of version Made in Dagenham. But Gemma Arterton looked anything other than a factory worker when she arrived to co-host The Laurence Olivier Awards on Sunday evening at the Royal Albert Hall alongside Stephen Mangan.
The 28-year-old looked the picture of cool dressed in a fitted pale blue gown, which looked particularly striking as she walked the red carpet. In keeping with her sophisticated look, the former Bond girl wore a pair of stunning crystal drop earrings, while her hair was styled in a voluminous bob.
Speaking on the red carpet the actress revealed that she believes British theatre is better than film industry in roles for women.
Speaking the Daily Mail’s Baz Bamigoye before the awards she admitted that she hadn’t found the time to see all of the Olivier-nominated productions admitting. ‘I think I’ll have to wing it on the night. I have seen a lot, but I have been away working, and was in the theatre myself.’
The actress is in the theatrical spotlight at the moment. She started the year in the title role in The Duchess Of Malfi at the new Sam Wanamaker Playhouse at Shakespeare’s Globe, and will finish it by starring in the musical adaptation of the film Made In Dagenham, at the Adelphi Theatre from October.
While rehearsals for the Rupert Goold musical don’t start until August, Gemma has already having six hours of singing lessons a week.
She said: ‘I’m freaking out because it’s the first time I would have done eight shows a week where there’s one hour of pure singing each performance. I need to build up stamina, and I need to get myself in shape,’ she said, of her preparations for her role as a sewing machinist at Ford in Dagenham in 1968, who helped lead female workers in a fight for equal pay. (source)
Ahead of Sundance London and the UK premiere of The Voices there, the new film from Persepolis co-director Marjane Satrapi that stars Ryan Reynolds, we have two new images from the film to give you a taste of what’s in store.
We’re promised that this will be “a genre-bending film which centers around Jerry, a lovable but disturbed factory worker who yearns for the attention of a woman in accounting. When their relationship takes a sudden turn, we follow Jerry’s perspective as his talking pets, a sinister cat and benevolent dog, lead him down a fantastical, murderous path.”
The film also stars Anna Kendrick, Gemma Arterton and Jacki Weaver, and received quite a bit of praise for its humour and wild tone when it premiered at the Utah Sundance earlier this year. There’s no UK release date for The Voices just yet, but hopefully we’ll see it before too many more months pass. If you can get there, the film will be showing at Sundance London on April 26.
Gucci collaborator Frida Giannini was the toast of the Curzon Mayfair on Tuesday evening as the West London cinema played host to a documentary celebrating the legendary Italian designer’s life and work.
But outside on a chilly night in the capital it was gold that dominated –and plenty of it – as Gemma Arterton and Mollie King led the way prior to a special screening of forthcoming film The Director: An Evolution In Three Acts, hosted by Vanity Fair.
Arriving alone, actress Gemma Arterton stood out in a gold trench as she made her way towards the cinema, where Vanity Fair’s European editor-at-large Jemima Khan was preparing for a Q&A with the film’s Brooklyn based director, Christina Voros.
The 28-year-old star matched her sweeping coat with a tan coloured handbag, while the remainder of her outfit was comparatively low-key. Gemma opted for a simple cream sweater, skinny jeans and trendy loafers ahead of her night out with fellow VIPs and Gucci ambassadors.
Several photos from the event have been added to the gallery!
- Public Events > Gucci And Vanity Fair: The Director – Special Screening
- Candids > April 08, 2014
The actress likes to take risks
Gemma Arterton admits she’s drawn to powerful men.
The pretty actress, who split from Italian husband Stefano Catelli last year, can understand why shrewd male characters are so popular with film-makers and viewers alike.
‘It’s the control and cool that they have,’ says Gemma, 28.
‘I speak for myself; there’s something sexy about a guy that’s in control.
‘I’m not attracted to the Gordon Gekko character that we like to watch. They’re Machiavellian – they’re fun to play and people enjoy them and watch them.
‘There’s something just wrong; it’s like they’re the devil. But you are captivated by these characters. And I guess that’s why they resonate in the end.’
Gemma always plays it safe with money, though.
‘I am a risk-taker and that’s why I don’t gamble – because I know I would be totally bankrupt,’ the St Trinian’s star tells TV Extra.
‘I like to procrastinate – but I am quite impulsive in other ways. It’s good to be impulsive sometimes. It’s fun.’
Added in the gallery a portrait of Gemma and her Olivier Awards co-host Stephen Mangan did for promoting the award ceremony!
The BBC is to boost its coverage of the arts in what its director general calls its “strongest commitment to the arts in a generation. The arts are for everyone, and from now on BBC Arts will be at the very heart of what we do,” said Tony Hall.
Tate director Sir Nicholas Serota and National Theatre director Sir Nicholas Hytner are among leading arts figures appointed to key consultation roles.
Performances from Glyndebourne and Shakespeare’s Globe will also be aired.
iPlayer coverage will include The Duchess of Malfi, the first production at the Globe’s recently opened Sam Wanamaker Playhouse, that saw former Bond girl Gemma Arterton play the title role. (source)


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Franciscan Health is dedicated to providing successful treatment and hope to those facing limb loss due to chronic disease. Our multidisciplinary approach to limb preservation offers the best chance for success.
Limb Preservation: Treatment to Avoid Amputation
It can be distressing to learn that you could lose your arm or leg due to infection or low blood flow caused by medical conditions such as diabetes or peripheral artery disease. However, advances in limb preservation techniques might allow you to keep your limb.
Limb preservation services at Franciscan Health involve vascular surgery, internal medicine, cardiology, nephrology, podiatry and wound care specialists. This multidisciplinary approach to limb preservation offers the best chance for success, using both interventional and non-interventional techniques to induce healing, decrease pain and avert amputation.
Limb preservation services at Franciscan Health
The endovascular program at Franciscan Health diagnoses and treats blood vessel diseases or conditions. Our highly-trained specialists provide the most advanced techniques using minimally invasive procedures to treat blockages in the carotid, renal and peripheral arteries.
Hyperbaric oxygen therapy is used to increase the amount of oxygen in the blood. Hyperbaric oxygen therapy is one of several advanced wound care treatments offered at Franciscan Health.
Tobacco addiction is a serious issue and the leading cause of illness and death in our society. Tobacco cessation programs at Franciscan Health help you break free from the addiction to tobacco and lead a healthier life.
Vascular services at Franciscan Health treat problems relating to or blood vessels within the body. Vascular care covers the relatively simple issues involving varicose veins to the complex issues surrounding arterial disease and aneurysms.
Non-healing wounds need a comprehensive approach for successful wound management and healing. At Franciscan Health patients with non-healing wounds get customized care and innovative wound care treatments.
Additional services include:
- Non-invasive vascular labs
- Cardiac and pulmonary evaluation and treatment (if needed)
- Advanced surgical reconstructions
- Risk factor modification
Physicians, as a coordinated team, will consider all of the patient's needs and develop a prioritized, individual treatment plan. Our medical team consists of specialists in the following areas:


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The Super Bowl isn't just about football. Because the halftime show is massively celebrated. Only the best of the best make an appearance to keep the fans happy at half-time. Some people we know set their alarm clock because they want to see the show. So sometimes football comes second. Especially when Rihanna plays the music alone. And besides the music, we are interested in what she wears. This year she opted for the Salomon Margiela collaboration in bright red. The reason for this and that was certainly the most interesting topic of the evening: Rihanna is pregnant with baby number 2. All information about the shoe and the show can be found here in the article.
In the run-up to a Super Bowl performance, many questions are asked. Are special guests coming? What song does she open the show with? what will she wear We have the answers: Special guest was Rihanna's Baby Bump. She opened the show with “Bitch Better Have My Money”. And her outfit was bright red all over, including the shoes. The choice fell on the collaboration between Salomon and Maison Margiela, which was launched at the end of 2022.
THIS IS LIKE SALOMON
We're quite surprised because with baby number 1, Rihanna wore heels a lot. But that was probably too risky for the halftime show. But the Salomon Margiela fit perfectly. The sneaker comes with an upper made of red, orange and pink tones and costs just under 300 euros. For all those who have tasted blood, the shoe in black and beige is still online at maisonmargiela.com , Solebox and Luisa Via Roma . At StockX there is of course the red one. But you can imagine the prices have absolutely skyrocketed. If you want to see the shoes in action again: You can watch the 2023 halftime show here .
WHERE TO BUY THE SALOMON MARGIELA SNEAKER
The Salomon Margiela was launched at the end of 2022. At that time there were three colourways: red, black and green-beige. If you don't want to miss such releases in the future, check our release calendar . If you always want all the information with one click, download our free app and favorite your favorite releases. Such Salomon releases usually also come from a.plus . As soon as a similar Salomon collab drops, we will inform you immediately.
If you have any questions for us, you can easily reach us via the message function of all social media channels.


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Vengurla To Redi Distance
Distance between Vengurla and Redi is 683 KM
(kilometers) and 185.15 meters. Vengurla is 424.5 miles away from Redi.
Vengurla and Redi Location
Vengurla is located in the India state of Maharashtra at the longitude of 73.6 and latitude of 15.9. Redi is located in the India state of Andhra_Pradesh at the longitude of 80 and latitude of 15.5.
Vengurla direction from Redi
Vengurla is located nearly west
side to Redi. Vengurla To Redi road map direction from google will be integrated.
Time difference between Vengurla and Redi
Time difference between Vengurla and Redi is 0.42474941333333 decimal hours (0 : 25 : 29.097888
). Vengurla universal time is 4.9086666666667 UTC and Redi universal time is 5.33341608 UTC. Vengurla is behind Redi 0 hours and 25 Minutes and 29.097888 seconds.
Travel distance from Vengurla
Traveling distance are available for the following cities Vengurla to Kudal distance
, Vengurla to Malvan distance
, Vengurla to Pune distance
, Vengurla to Redi distance
, Vengurla to Tarkarli distance
, Venice to Airport distance
Vengurla To Redi Travel Time
Travel time from Vengurla To Redi will take 17 hours and 4.78 minutes if the vehicle keep an average speed of sixty kilometer per hour. Travel time by walk may take around 85.4 hours if you continuously walk at the speed of 6KM.
Vengurla to Redi direction
The follwing Vengurla to Redi direction map comming from google. Google distance may vary from our crow fly distance.
Vengurla Redi information Note:
All information in this page about Vengurla and Redi are approximate details. It is crow flies distance so the above travel information may be differ from motor road distance.
Dear Travellers / Visitors you are kindly welcome write more about Vengurla and Redi.
- Previous traveling experience from Vengurla to Redi.
- Various travel routes from Redi.
- Tourist spots between Vengurla and Redi road.
- Hotels details, travel guide and booking information about Vengurla and Redi.
- You are welcome to provide accurate information about Vengurla and Redi if the above information is not accurate.
- Travel photos and other information related to Vengurla and Redi.


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We are pleased to inform that new cards will start becoming available this Wednesday, March 2nd!
Here’s the schedule of upcoming attractions:
MARCH 2ND – MARCH 4th: Fresh Hero booster available for purchase! An all new Hero, the warrior Katja, for your crafting pleasure!
MARCH 7th – MARCH 11th: Fresh Card booster available for purchase! A single card with a never before seen skill for just 999 Diamonds!
MARCH 14th – MARCH 18th: New Cards booster available for purchase! Three hot cards with totally new skills!
MARCH 19th – MARCH 20th: A special Tournament with all of the new cards available as rewards!
This new set of cards features 4 wholly original skills. Both the Fresh Card and New Cards boosters have a chance of dropping any of them. Collect them all and enhance your strategy!


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American Ballet Theatre (ABT) is one of the great dance companies in the world and is internationally celebrated as a cultural institution dedicated to preserving and extending the great legacy of classical dancing. Presented by the Auditorium Theatre, ABT will bring 20 acclaimed artist-athletes to a live performance outdoors at Jay Pritzker Pavilion in Millennium Park as part of the company’s cross-country road trip, ABT Across America, traveling to 8 U.S. cities this July.
This FREE 50-minute performance features the Chicago premiere of Lauren Lovette’s La Follia Variations; Jessica Lang’s Let Me Sing Forevermore set to the music of Tony Bennett; the famous pas de deux from Don Quixote; and Indestructible Light created by Darrell Grand Moultrie during quarantine and featuring music by Duke Ellington, Count Basie, and Billy Strayhorn.
Photo of Catherine Hurlin in the Don Quixote pas de deux by Erin Baiano, courtesy Vail Dance Festival.
This engagement is supported by the Arts Midwest Touring Fund, a program of Arts Midwest that is funded by the National Endowment for the Arts, with additional contributions from Illinois Arts Council Agency and the Crane Group.


Updated: Oct 11, 2019
I visited the University of Akron on September 26th. My good friend, Professor John Huss made the arrangements. I sat in on 3 of his ethics classes to warm up for the main event, which was attended by 100 or so people, including some members of the local refugee population. It all went very well and Akron is certainly a place we’ll want to show the film when it’s done.
In the Ethics classes, we considered the moral question of refugee resettlement: Should we or shouldn’t we? Via all the major moral theories they had covered to date, Utilitarianism (do the greatest good for the greatest number of people), Divine Command Theory (do what God says), Natural Law Theory (individuals have basic rights that must be respected), and Ethical Egoism (do what’s best for yourself), refugee resettlement calculates as the right thing to do. Students quoted passages from religious texts to support welcoming refugees, calculated overall happiness, and even noted that one’s self interest would be well served by extending a hand.
Armed with this theoretical basis, addressing the larger audience that evening was a piece of cake! Akron has a good-sized refugee population and people in attendance were aware of the some of the subtler benefits of refugee resettlement. Fewer area homes are empty now. New restaurants and stores have opened up. And the obvious moral benefit of having done the right thing by welcoming someone who has suffered was clear to all. We broke into discussion groups after I answered questions about the clips from the film that had been screened. It was especially satisfying to me to watch three nervous freshmen interact with a group of Burmese and Laotian refugees. Their open-mindedness and solid listening were exemplary. One of them shared that she’d learned a lot from the exchange. In my experience, 99% of people come away from interactions with refugees with great respect for what they’ve been through and how they conduct themselves here. So that’s one clear way to generate respect for resettlement: create opportunities for people to interact with refugees.
Though I wasn’t aware of it going into the trip, this is exactly the kind of thing I want to do with the film when it’s finished. The larger project we’re trying to build, tentatively named America Refuge, would be an attempt to change the conversation around refugee resettlement in the United States. Despite the Fox TV noise, most people have a sense that refugees don’t pose a security threat and that they aren’t a big economic drain. But these sorts of events cement the idea that resettlement is a win-win proposition, and make it clear there are plenty of reasons to passionately support resettlement. And meeting actual refugees? Well that’s the truly priceless part. I’d really like to organize screenings in areas like Akron, where there is a sizable refugee population, and help audiences see firsthand what they’re gaining in their new citizens. I don’t know about you, but the US does a better job of representing me when it shows up internationally as a welcoming country. More of that please.


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Have you checked Lalqila Karachi Menu? If not, then what are you waiting for? A royal place with the right ambiance where you can do fine dine experience with your family is waiting for you. This thematic restaurant is for royal people who want to experience the life of Mughal kings and queens. At this place, you can eat pure Pakistani, Chinese, and Asian food at economical prices. Their special Mughalai traditional food is ready to steal your heart. There is good news for food lovers that they are also offering hi-tea and buffet to their beloved customers. Now you can royally experience a live buffet with your loved ones. If you are looking for the Menu Prices of Lalqila Karachi than you can find it from this website. You can get complete detail of their buffet and special deals.
Lalqila Karachi Menu
Lalqila restaurant Karachi is a special place for royal people who are looking for a restaurant with Mughal curtesy. They have a variety of cuisines that you can try while visiting this place. If we talk about the Lalqila Karachi buffet than they are one of those restaurants that are offering more than 100 dishes at a very economical price. For complete details of their prices, you can simply scroll down.
Lalqila Karachi Menu Prices:
Those food lovers who want to visit this place must check Lalqila Karachi Menu prices from here. We have shared the complete detail of their complete menu with prices for the help of food lovers. Personally, if you ask me then this restaurant is a great choice if you are going for lunch or dinner buffet. We have shared a complete buffet menu of Lalqila Karachi, so check their main course in their buffet menu.
Lalqila Karachi Buffet Menu:
Buffet lovers can check the complete Lalqila Karachi buffet Menu for lunch and dinner buffet. Their mouth-watering dishes are enough to steal your heart. If we talk about their taste then they are the ones who are serving the real taste of Mughal food. For complete details of their buffet menu with prices, you can check these images that are taken from Lal Qila Karachi.
Lalqila Karachi Membership:
Do you know that Lalqila Karachi offers membership to its beloved customers? There are several benefits to getting Lalqila Karachi Membership. One of the best benefits of getting their membership is that you can get a flat 20 to 25% discount on their entire menu. Further, you can get a complimentary cake on your birthday if you have this card.
Hi-Tea Cum Buffet:
At this place, you can do hi-tea cum buffet in which you can enjoy more than 75 dishes at the price of simple hi-tea. Check the Lalqila Karachi hi-tea menu and decide to visit. It is also offering brunch to its customers so you can also visit this place for brunch.
Lalqila Karachi Birthday Celebration:
At this place, you can also celebrate your birthday with your friends and family. They are offering free cake to their members who celebrate their birthday with this restaurant. If you want to check Lalqila Karachi’s birthday celebration packages then simply check the below images that include free and paid décor.
As I mentioned that this restaurant also offers a special brunch to their beloved customers. They only offer brunch on Sundays. So, if you want to go out with your family on weekend then you can visit this place for brunch. You can also check the complete Lalqila Karachi brunch menu.
The contact number of this place is given on the below side. You can contact Lalqila Karachi’s phone numbers for pre-booking and reservation.
021-111 524 745
The complete address of this place is as follows.
10/A, M.A.C.H.S، Main Shahrah-e-Faisal Rd, Karachi, 75350
Opening and Closing Time:
The opening and closing time of this restaurant is as follows.
Opening Time: 12:00 pm
Closing Time: 12:00 am
We never share the review of any restaurant on our own. We always encourage our readers to share their honest reviews if they have visited this place. This can help thousands of foodies to decide either the restaurant is worthy of a visit or not. So, if you want to give an honest review then share review through comments.
This is the complete detail of Lalqila Karachi Menu prices. If you want to get more details about this restaurant then you can visit the official website of this restaurant. For other restaurants, you can simply scroll down.

domain: food


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As we watch the ramp-up of COVID-19 vaccination, we can marvel at the ingenuity that brought these vital agents to market in under a year. But it also starkly underlines the importance of vaccines as a whole to society. Unfortunately, a decline in routine vaccination was among the unwelcome consequences of the pandemic lockdowns that began in March 2020, which significantly altered health care as we know it. Patient visits for routine and emergency care began to decrease.1 This has resulted in a reduced rate of vaccinations for vaccine-preventable diseases (VPD) across the nation.
For individuals 18 years and younger, vaccine rates have been down by as much as 30% compared to previous years, although the rate for newborns remained generally stable (with some variability for individual states).2 On a global scale, the disruption to vaccine distribution programs and access has also been altered.3 The World Health Organization estimates that globally, 94 million children will not receive the measles vaccine because of COVID-related closures and decreased access to care. A recent report stated that measles cases in 2019 were the highest they have been since 1996, and are expected to rise.3
Fig. 1. At left, ocular involvement of herpes zoster with associated rash of the ocular adnexa and surrounding skin; above, classic presentation of herpes zoster. Click image to enlarge.
With the decrease in vaccine rates, both in the US and globally, there is increased potential for reemergence of VPD, particularly in children. VPDs have significant and wide-ranging systemic effects (including ocular manifestations) with the potential to be fatal, so the decrease in vaccine rates globally has significant ramifications for both at-risk individuals and health care providers.
This article provides an overview of the ocular manifestations of many VPDs so that we can be vigilant for them in appropriate patients.
Ocular Signs of VPD
Pediatric vaccine-preventable diseases may present with ocular involvement, but more often will present with systemic signs or symptoms. Symptomatic patients usually present to the pediatrician, primary care practitioner or emergency medicine provider. Eye care providers (ECPs) in hospital or multidisciplinary settings may be more likely to encounter these cases as part of the patient care team, but sequelae of primary infections may present to ECPs in all settings, including community-based optometrists.
The Value of Vaccines
The goal of any vaccine is twofold: first, to keep the individual healthy and prevent future disease, and second, to halt spread within a population by increasing herd immunity. This is especially necessary for protecting vulnerable populations such as infants, pregnant women and immunocompromised individuals. The amount of herd immunity needed to stop the spread of infection varies by the contagiousness of the disease. This is defined by the basic reproduction number (R0), which is the average number of individuals a single person is likely to infect in a completely susceptible population.4 The higher the R0 value, the more contagious the disease—and therefore the increased importance of vaccinations.
The Centers for Disease Control and Prevention (CDC) has a recommended vaccine schedule for people of all ages. The highest number and frequency of vaccinations are recommended during childhood. Most vaccines require several doses throughout the first six years of life (e.g., DTap, MMR, polio, hepatitis A and B, pneumococcal, varicella, meningococcal), some require boosters and some—namely, influenza—require an annual administration.
While the following conditions are rare in optometric practice, they might be considered in abnormal red eye presentations, or in cases where acute disease does not resolve with the typical treatment regimen. Providers may elect to add questions about vaccine history to intake questionnaires and consider VPDs when other systemic conditions present concurrently, especially rashes or persistent coughing.
|Table 1. Ocular findings of vaccine-preventable diseases. Click image to enlarge.|
This viral infection is highly transmissible due to its high R0 value and the trend for declining vaccine rates. There were several recorded outbreaks in the United States prior to the COVID-19 pandemic.5 Measles infection has an incubation period of nine to 10 days followed by systemic signs, which include high fever, cough and Koplik spots (blue-gray lesions on an erythematous base) with an eventual onset of the classic skin rash.
Ocular manifestations include a non-purulent papillary conjunctivitis. Rarely, Koplik spots can be visualized on the conjunctiva. Keratitis leading to scarring and blindness can occur and is more likely in patients with poor vitamin A intake. Other reported ocular manifestations include subconjunctival hemorrhages, posterior uveitis and pigmentary retinopathy.5-9 Measles-related posterior uveitis is characterized by disc swelling, arteriolar attenuation, diffuse retinal edema and scattered retinal hemorrhages with exudative stellate macular lesions.
Fig. 2. Sectored red-eye presentation in a three-year-old. All pediatric red eyes, especially unusual presentations, should have a full vaccine history included in the work-up. Click image to enlarge.
Measles retinopathy is usually bilateral and occurs in immunocompetent patients. Upon resolution, signs such as disc pallor, peripapillary vascular sheathing and pigmentary changes result in a “salt and pepper” fundus appearance. In congenital cases, the electroretinogram (ERG) may be normal. In acquired cases, the ERG is reduced during active infection and can improve with time. Neuroimaging may show white matter abnormalities. Secondary outcomes of viral infection, such as acute disseminated encephalomyelitis (ADEM), have also been reported.5-9
A rare sequela of a mutant variant of measles relevant to all ECPs is subacute sclerosing panencephalitis (SSPE.) Patients are school-aged children whose primary infection occurred before age two. While the condition is rare, early SSPE mimics typical pediatric malingerers. Signs include painless vision loss and possibly chorioretinitis starting in the macula or posterior uveitis. Ocular findings are common and occur in up to 50% of cases.
SSPE results in cognitive decline and eventually death. Visual symptoms and retinal findings precede neurologic findings by weeks to years. Associated findings of focal necrotizing retinitis, ground-glass retinal whitening, RPE mottling, papilledema, optic atrophy, retinal folds, retinal hemorrhages, serous detachments and occlusive vasculitis with minimal vitreous inflammation have all be described.5-9
Though primary infections of mumps are less common in the United States, sporadic outbreaks have been reported. The severity of the systemic illness is variable; prior to vaccine development 15% to 27% of infections were asymptomatic. After an incubation period of 12 to 25 days, patients develop parotiditis, fever, headache, muscle aches and malaise. Reported ocular signs include dacryoadenitis, follicular conjunctivitis, episcleritis, scleritis, keratitis, retinitis, optic neuritis, opsoclonus-myoclonus syndrome and facial nerve palsy.5,10-20
This often presents to the eye care practitioner as a sequelae of a primary or congenital exposure. In primary cases, ocular signs are mild. Conjunctivitis is common, though central epithelial keratitis has also been reported. Fuchs’ heterochromic iridocyclitis—a unilateral uveitis with a triad of heterochromia, predisposition to cataract and glaucoma, and keratic precipitates—is associated with rubella infection. In congenital cases, severity is inversely related to gestational age at the time of maternal infection.
The triad of congenital rubella syndrome includes auditory, cardiac and ocular defects, which occur in 30% to 40% of cases. Nuclear cataracts, microphthalmos and congenital glaucoma are more likely in the first trimester. The most common outcome is pigmentary retinopathy, which can occur when maternal exposure occurs before gestational age of 20 weeks. Rubella retinopathy is usually benign, non-progressive and visually insignificant, though rare complications such as hemorrhages and disc edema can reduce vision.
Once a leading cause of childhood death, widespread vaccine use has led to near eradication of diphtheria in the United States. As such, reports in the literature of ocular involvement are sparse but generally address two areas of concern: membranous conjunctivitis and nerve dysfunction secondary to toxic demyelination. Diphtheria conjunctivitis is described in the literature as both pseudomembranous and membranous, resulting from formation of a gray plaque of necrotic tissue. Though involvement of extra-respiratory sites is uncommon, this severe conjunctivitis can cause secondary problems such as symblepharon, conjunctival and corneal scarring, and other ocular surface irregularities.
This anaerobic infection is generally a concern in emergency cases of penetrating ocular injuries. Clostridium tetani spores can germinate, leading to production of toxins that act on the nervous system, resulting in the well-known associated muscle rigidity.5,26,27
Also known as whooping cough, this condition generally affects the eye in one of two ways. The most common ocular sign is a subconjunctival hemorrhage resulting from the characteristic cough. Less commonly, retinal hemorrhages have been reported, though it is essential in all pediatric cases involving retinal hemorrhages to fastidiously rule out non-accidental trauma. Although not currently employed as such, the conjunctiva has been proposed as a site for vaccine delivery.5,26,27,30,31
Human Papilloma Virus (HPV)
Vertical and contact transmissions of HPV are the most likely routes of ocular infections in children, though several routes exist, including sexual contact and autoinoculation. HPV is categorized into high risk and low risk subtypes; the former leads to anogenital and cervical cancers while the latter causes dysplasia that does not progress to cancer. HPV has been found in conjunctival and eyelid lesions such as inverted papillomas and pterygia. While both subtypes have been identified in ocular tissue, low-risk HPV is more commonly associated with ocular lesions.5,6,33-39
Meningococcal disease earns its name due to its strong association with meningitis. While it is not the only organism which causes meningitis, Neisseria meningitidis is a leading cause of bacterial meningitis in babies, children and adults.
Pediatric cases of endophthalmitis without meningitis have also been reported. Other reported ocular signs include severe photophobia, hyperacute conjunctivitis, retinal and peripapillary hemorrhages, and optic nerve edema. Systemic signs can include fever, headache, neck stiffness, vomiting, lethargy and seizure. Meningococcal disease is potentially blinding and fatal and must be quickly treated both reactively and proactively. In these cases, immediate referral to emergency care is warranted.5,40-46
In children, pneumococci are generally involved in cases of bacterial meningitis and acute otitis media, but cases of pneumococcal conjunctivitis, keratitis and endophthalmitis have been reported. Pneumococcus is found in one third of bacterial keratitis cases.5,47-56
Varicella Zoster Virus (VZV)
Primary varicella infections have dropped dramatically since 1995, when the VZV vaccine was introduced, though reactivation of infections such as herpes zoster ophthalmicus (HZO) can occur. Postherpetic neuralgia is less likely in children than adults.
Primary VZV infections can cause eyelid lesions (Figure 1), conjunctivitis, episcleritis, keratitis and anterior uveitis. Retinitis, common in adults, is rare in children in primary infection, though congenital VZV infection can leave discrete white chorioretinal scars. After vaccination, mild non-infectious keratitis has been reported.
Those who have had a primary VZV infection and those who received the vaccine are less likely to develop HZO. As is the case with adults, early anti-viral treatment, close follow-up and careful corneal management is important in pediatrics. Children who are immunocompromised or have systemic disease should be hospitalized and treated with IV antiviral therapy. Damage to ocular structures in the course of pediatric HZO can lead to deprivational amblyopia.5,6,57-58
Fig. 3. Same patient, right and left eyes, respectively. Typical presentation of acute-onset red eyes in a school-aged child. Click image to enlarge.
The seasonal flu can produce the following ocular signs: orbital inflammatory syndrome, acute conjunctivitis, conjunctival injection, anterior chamber inflammation, uveal effusion syndrome, vitritis, vasculitis, frosted branch angiitis, macular edema, submacular hemorrhaging, exudative retinal detachment, retinopathy, peripheral retinal necrosis, choroiditis, neuroretinitis and optic neuritis. Pain and decreased vision have been reported. Visual acuity loss has also been reported as the presenting sign of simultaneous retinal and lateral geniculate body infarct.
Influenza is unique in that a yearly vaccine is needed to reduce contraction, as the virus itself mutates frequently. However, both severity and duration of symptoms tend to be reduced in individuals who have received the vaccine.5,59,60
Though they only became a household name in 2020, human coronaviruses are quite common, and often lead to fever, fatigue, rhinitis, headache, sore throat and other common cold-type symptoms. The hallmark signs of COVID-19 additionally include shortness of breath, and loss of taste or smell.
While literature on SARS-CoV-2 continues to develop, there are several reports of COVID-19 conjunctivitis developing in individuals who test positive for SARS-CoV-2. Red eyes generally present as a typical viral conjunctivitis, with a unilateral presentation that transitions to bilateral, watery discharge, and mild to moderate redness.61,62 Children, especially those under 10 years of age, continue to have lower reported symptomology from COVID-19, although they may be asymptomatic carriers. Those who do show symptoms can rarely develop multi-system inflammatory syndrome in children (MIS-C).
Most reports of this condition show high levels of antibodies to SARS-CoV-2, indicating a previous infection. Associated signs and symptoms include fever in 100% of cases and bilateral conjunctival injection in 55% of cases, in addition to significant gastrointestinal, cardiovascular, hematologic and respiratory involvement; however, there is a high rate of recovery for these patients.63
There are several theories as to why children are less impacted by the coronavirus. One suggestion relates to the spike glycoprotein, which is present on the envelope of the coronavirus and helps the virus bind to ACE2 receptors. It has been theorized that children perhaps have less (or immature) ACE2 receptors, which reduces binding of the virus.64 Another theory is that the proteins on the spike glycoprotein are similar to those found in measles and rubella. Since children are frequently exposed to both coronaviruses and the measles/rubella proteins through routine vaccinations, their immune systems may be able to ward off the Sars-CoV-2 virus more effectively than adults who have decreased antibody titers.64
Recognizing and Reducing Infectious Disease
As healthcare providers, optometrists should stay up to date on their own immunizations and encourage patients to do the same. Providers may consider keeping in place some or all of the general cleaning and sanitization protocols that have increased in the past year, to continue to prevent spread of any pathogen that may present to the office.
Clinicians should also be aware of local outbreaks of infectious disease to assist in differentiating ocular manifestations. In cases of red eyes or unusual presentations of ocular disease, it will become increasingly important to inquire about a patient’s immunization history and consider vaccine-preventable disease as a differential once common causes have been ruled out, particularly in cases that do not improve with standard treatment or that present with associated systemic findings.
Dr. McDowell is an associate professor at the Michigan College of Optometry, where she serves as Chief of the Pediatric and Binocular Vision Service, and is the Pediatric Residency Supervisor. She is also involved in the Pediatric Eye Disease Investigator Group (PEDIG) and chairs the Michigan Optometric Association Children’s Vision Care Committee. Dr. Williamson is a clinical assistant professor of ophthalmology at the Cleveland Clinic Lerner College of Medicine and associate staff member at the Cole Eye Institute. She is a PEDIG investigator and fellow of both the American Academy of Optometry and the Contact Lens Society of America.
1. Hartnett KP, Kite-Powell A, DeVies J, et al. Impact of the COVID-19 pandemic on emergency department visits — United States, January 1, 2019–May 30, 2020. MMWR. 2020;69(23):699–704.
2. Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration — United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:591–593.
3. Patel M, Lee AD, Clemmons NS, et al. National update on measles cases and outbreaks — United States, January 1–October 1, 2019. MMWR Morb Mortal Wkly Rep. 2019;68:893–896.
4. Delamater PL, Street EJ, Leslie TF, et al. Complexity of the basic reproduction number (R0). Emerging Infectious Diseases. 2019;25(1):1-4.
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