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Описание: On a Thursday evening in late October 2009, Cleveland Police detectives arrived at the home of Anthony Sowell--an ex-Marine and a registered sex offender--to arrest him on week-old rape charges.
But this was no ordinary house, nor would it be a routine arrest.
For even though Sowell was not at home, officers knew immediately something was horribly wrong. After initially finding two rotting corpses inside the home, their investigation would lead them to discover the bodies of eleven women.
This is the shocking true account of Sowell's legacy of depravity and cold-blooded murder. His mannered and well-spoken veneer masked a monster who felt no mercy for those he butchered. His twisted existence spent among the decaying bodies of his victims. And how he picked his victims from the fringes of society--lost souls with criminal records or drug habits that would make them less likely to arouse alarm if they simply disappeared.
Описание: In "Wealth, Poverty, and Politics," Dr. Thomas Sowell of the Hoover Institution, Stanford University, examines the reasons for large differences in income and wealth between nations and among groups within nations. A wide range of geographic, demographic, cultural, and political factors are examined, not to find a single factor or a single combination of factors that will explain all economic differences, but to show how particular combinations of factors limit or expand the possibilities for specific nations and peoples at specific times and places. Dr. Sowell also examines some popular explanations of these differences and shows why they will not stand up under scrutiny. In doing so, he takes on some of the reigning titans of the redistributionist movementincluding John Rawls, Thomas Piketty, Paul Krugman, and Joseph Stiglitzand shows how a remarkable number of their claims cannot withstand plain common sense, expressed in plain English."
Автор: Sowell Lynette Название: A Season of Change ISBN: 1426753551 ISBN-13(EAN): 9781426753558 Издательство: Random House (USA) Рейтинг: Цена: 1662 р. Наличие на складе: Поставка под заказ.
Описание: Amish widower Jacob Miller believes it was a mistake to visit the Amish village of Pinecraft for winter vacation, especially after his daughter is struck by a car. Stranded in Sarasota until his daughter recovers, Jacob grows increasingly wary of events that unfold in his unfamiliar surroundings--including the strange curiosity of Englischer Natalie Bennett. Natalie never thought her circus career as an aerial silks artist would end with a blown-out knee at the age of 25. She also never knew her late mother had a secret--that she was once Amish. When Natalie meets the Millers at the Sarasota hospital, she is attracted to their warm hospitality and simple ways--and soon wonders if they can help her find her mother's family. As Jacob and Natalie fall in love, their worlds collide. Will their differences tear them apart? Or will their love be strong enough to blend their clashing cultures?
Автор: Lynette Sowell Название: Tempest`s Course ISBN: 1426752768 ISBN-13(EAN): 9781426752766 Издательство: Random House (USA) Цена: 1200 р. Наличие на складе: Поставка под заказ.
Автор: Sowell Название: The Quest For Cosmic Justice ISBN: 0684864630 ISBN-13(EAN): 9780684864631 Издательство: Simon & Schuster Цена: 2057 р. Наличие на складе: Поставка под заказ.
Описание: This is not a comforting book -- it is a book about disturbing issues that are urgently important today and enduringly critical for the future. It rejects both "merit" and historical redress as principles for guiding public policy. It shows how "peace" movements have led to war and to needless casualties in those wars. It argues that "equality" is neither right nor wrong, but meaningless. The Quest for Cosmic Justice shows how confused conceptions of justice end up promoting injustice, how confused conceptions of equality end up promoting inequality, and how the tyranny of social visions prevents many people from confronting the actual consequences of their own beliefs and policies. Those consequences include the steady and dangerous erosion of the fundamental principles of freedom -- and the quiet repeal of the American revolution.
Автор: Sowell Название: Inside American Educatio ISBN: 0743254082 ISBN-13(EAN): 9780743254083 Издательство: Simon & Schuster Рейтинг: Цена: 3019 р. Наличие на складе: Поставка под заказ.
Описание: An indictment of the American educational system criticizes the fact that the system has discarded the traditional goals of transmitting knowledge and fostering cognitive skills in favor of building self-esteem and promoting social harmony.
ООО "Логосфера " Тел:+7(495) 980-12-10 www.logobook.ru

domain: library


LSU football is one of several programs hoping to land a commitment from five-star quarterback Caleb Williams.
Five-star quarterback Caleb Williams is one of the top recruits in the country and LSU football is firmly in the mix to land him.
Williams, 6-foot-2/209 lbs from Washington D.C., is rated in 247Sports’ composite rankings as the No. 1 dual threat quarterback in the nation and the No. 4 overall recruit.
The highly coveted quarterback had previously indicated he would commit this spring, but a recent report from Rivals suggests that Williams is more likely to commit in August, just before the start of his senior season.
Williams will visit Oklahoma this week.
The Sooners appear to be LSU’s top competition for the DC native. Rivals noted that before passing game coordinator Joe Brady left Baton Rouge for the NFL, the Tigers were the presumed favorite.
But with Brady out of the picture, Oklahoma now looks like the favorite (thanks to Williams’ close relationship with Sooners head coach Lincoln Riley).
In fact, Rivals national recruiting analyst Adam Friedman’s FutureCast currently says Oklahoma.
Of course, things can change quickly in recruiting. Williams hasn’t had much time to build a relationship with new LSU passing game coordinator Scott Linehan. If those two are able to build a solid relationship, then it’s possible that LSU could surge back to the front of Williams’ recruitment.
Williams is taking his decision incredibly serious. When he commits, I don’t think there will be any flipping him. So they next four to five months are extremely important for the Tigers if they hope to sign the dynamic quarterback.


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OFB Raw Choc Chip Bar 50g
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Organic Food Bar-OFB Raw Choc Chip Bar (50g)We pack this sumptuous bar with antioxidant-rich, non-dairy certified organic dark chocolate chips. With this bar, you get outstanding taste and the nutrition you need to stay healthy. Kids and adults will love this tasty delicious snack in between meals for steady, sustained energy.

domain: health


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love, love, love .pdf pattern download with sizes up to 10! $8.50More
Crafts - Sewing
MANY years away, but it's still fun!!
Lil girl fashion <3
Adorable little dress patternMore
fall toddler dress + gold cardigan = adorableMore
An adorable outfit for that first Christmas EveMore

domain: artistic


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Tuesday, 24 April 2012
Demand Side Economics
There is an economics that works, that rescued the nation from the depths of the Great Depression, that organized the mobilization of World War II, that executed a successful transition from war to peace and prosperity, that explained the instability and decline, and that predicted the Great Financial Crisis. That economics points a way out of the current stagnation and embraces the challenges of world poverty and global climate change.
That economics was abandoned for the benefit of a corporate oligarchy and a casino capitalism. Demand Side Economics draws the history and explores the evidence of this school through the work of nine of its advocates, from the 1930's and John Maynard Keynes to the 2010's and Nouriel Roubini.
Economists included are John Maynard Keynes, Leon Keyserling, John Kenneth Galbraith, Hyman Minsky, Joseph Stiglitz, James K. Galbraith, George Soros, Steve Keen and Nouriel Roubini.
This is a cogent treatment of complex events and concepts that will lead the reader to an understanding of what has happened and why.


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The Rise of Karzoug
Lady Almara Jarnith
Representative of Magnimar in Sandpoint
Class & level unknown.
Sandpoint is a vassal city to Magnimar, one of the four large city states of Varisia. Sandpoint elects a mayor from among the property owning population who is responsible for collecting tax and delivering it to Magnimar, while Magnimar has pledged to protect Sandpoint against military threats.
Lady Jarnith is the representative of Magnimar’s Lord-Mayor Haldmeer Grobaras and is responsible for auditing the tax collection, communicating the city’s wishes, and making recommendations to the government in Magnimar. She spends the majority of her time in a small manor within the city proper and is attended by a bodyguard assigned by the Magnimar town guard (presently Tegan Declan).
Her official title is “Envoy of the Council of Ushers”.

domain: geography


Marshall Crenshaw Begins Tour in Montclair
Singer-songwriter Marshall Crenshaw plans to rock the crowd at Outpost in the Burbs' next show as he kicks off his new tour.
Marshall Crenshaw kicks off his 2014 tour with Outpost in the Burbs. With the release of his new EP, Stranger and Stranger, in 2013, Marshall Crenshaw is back on the road again for his 2014 tour. His first stop is right in Montclair with Outpost in the Burbs at the Unitarian Universalist Congregation Church, located […]


All Michael Mosier articles
Acting FinCEN head to step down; new search underway
The Treasury Department has launched a public search for a new permanent director of the Financial Crimes Enforcement Network after the acting head of the agency announced his intentions to step down.
FinCEN Director Kenneth Blanco to step down
FinCEN Director Kenneth Blanco, who has served in the position since December 2017, will step down April 9, and Michael Mosier, formerly the deputy director of FinCEN, will return to the agency as acting director.


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Several old smooth-hackle patterns call for product no more out there. Species which include snipe and plover are protected underneath US Fish and Wildlife laws. The good news is usually that these hens give a variety of colors and fiber lengh great for tying these flies.
All my saltwater/striper stuff is in soft, flat baggage referred to as Finsport streamer wallets and carried in An even bigger shoulder bag with reels/leaders/and so forth.
The fly tier really should not be devoid of a number of great skins at their disposal. These birds are skined Along with the wings on.
CORK BODIED BASS BUGS (SEE DIAGRAM 10) These higher floaters are simple to make and may be tied on most any sizing hook ideal. Kinked shank hooks must be employed to forestall your body from turning around the hook. Colored lacquer or enamel can be employed to enhance the bodies, and eyes is often both painted on, or frequent compact glass eyes inserted and held set up with water-evidence glue or lacquer. Any of the flamboyant feathers which have been made use of for normal bass flies can be employed for wings. Hair or feathers can be employed for tails, and many others. Let's initially make 1 of these cork bodied Bugs over a dimension one/0 hook. Take a one/2" cork cylinder and with a razor blade condition it approximately as Diagram 10, Figs. 1 and 2. Then which has a piece of 00 sandpaper held in the appropriate hand as well as the cylinder inside the remaining This is a very simple subject to offer the human body a good sleek, shapely complete.
For dry flies and smaller soaked flies a gossamer silk measurement 000 and 0000 is the greatest to utilize. Even though the power of the high-quality silk is much less than the dimensions 00, it's got the edge that extra turns can be used, along with the heads can be produced Significantly scaled-down.
Stan Headley is credited with initial tying a black hackle at the rear of the brown hackle which fly is a sensible choice for when the light fades being a darker tone. There is great scope for experimentation with Mixing of hackles on loch ordies.
Sooner or later I used to be fishing a peaty somewhat dour west aspect loch using a Solid of common peat h2o loch patterns on and not catching A lot. Abruptly a car screeched up and out rushed a group of visiting anglers and almost immediately their rods were being bent double with very good sized trout. I thought it had been a mirage so i went in excess of to discover the things they have been catching on and This can be the fly they showed me before they screeched off once again. As I sat about the shore considering what I had just witnessed I seen that dung flies had been becoming blown on the drinking water along with the trout had been lined up finding them off .
It is often value experimenting with not merely the colour from the fly, but in addition the tone of your fly to find out what temper the fish are in according to the light-weight or perhaps the menu, a lesson acquired residence right after observing Davie Pottinger fish a dim loch ordie and a lightweight loch ordie on the identical cast. Up until eleven o clock The sunshine loch ordie caught each of the fish then as The sunshine light the darkish loch ordie was the favorite .
The gentle webby feathers on these hen capes immediately take in h2o, maintaining your fly down below the surface.
Idea- Dip it in liquid floatant on the tying bench and retain within a separate box to any subsurface styles. Experiment Along with the retrieve and don't be afraid to fish these flies static or gradual.
The affect of Kingsmill Moores bumble patterns cannot be underestimated and The truth that there are numerous variants speaks volumes to your achievement of his designs. The principle from the bumble will be to wind two distinctive coloured hackles collectively to ensure to start with look they Mix collectively to type one colour but when viewed from underneath and from unique angles different colours will shine by means of.
THE HELGRAMITE (SEE DIAGRAM seven) The Helgramite Nymph, larva in the Dobson Fly, is this sort of a wonderful bass and trout food items, the producing of this nymph justifies Specific mention. As my individual way of constructing this distinct nymph differs significantly from Those people previously described, I take into consideration it recommended to go into additional particulars about the construction of the sample.
tie it in then fold the environmentally friendly tinsel back and safe it Along with the silver rib.increase the throat, Establish up The top and fix eyes. I prefer to drop this in to little hill lochs and find out what grabs onto it and also fishing it close to rocky shallows . This fly also won a trout Competition Competitiveness for me when Solid into open up h2o on the sluggish sinking line. In a nutshell value the hassle of tying.
Suggestive of a number of aquatic lifetime this is surely a sample never to forget about and experiment with. A memorable working day using this type of sample occurred a single afternoon on the west side loch, the standard gaudy coloured loch flies stopped Doing work And that i found olives beginning to hatch, i rummaged by means of my box for one thing similar and noticed a march brown concealed away neglected, on it went and when fished bit by bit sub visit the site surface the action was instantaneous.

domain: hobby


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Reit tax machinations just much ado about nothing
"Some tax incentives and relaxations on development should help the Hong Kong reit sector to capture the next wave of capital inflow from the world's largest real estate investors," said Victor Yeung, the chief investment officer at property management company Admiral Investment.
South China Morning Post, January 30
Note those two words "tax incentives". They are critical to the debate about whether local real estate investment trusts should be forgiven taxes that others must pay. I draw your attention to them because, in the latest instalment of this debate, they were avoided by the Securities and Futures Commission in a consultation paper on reits.
"None of our business. Go talk to the financial secretary," said the SFC in wording that strongly hinted, "and we don't fancy your chances".
Quite right. The real debate is not about whether a ban on reit participation in development ventures should be lifted. Developers say it would make reits too risky (as if they really care), while the SFC is happy with the idea as long as the right boxes are ticked. But the real debate is about tax.
Let's take a step back here. Reits are an American idea to give small investors direct participation in rental income from big investment properties that are otherwise held outright by financial concerns.
The key is that the reits pay little or no tax at the reit level so long as they pay out at least 90 per cent of their earnings in dividends. Uncle Sam then collects his toll lower down in the form of dividend, income, and capital gains taxes on the reit unit holder.
Reits have undoubtedly been very successful in the US, and countries with similar tax laws, in bringing the public into property investment.
But then we come to Hong Kong. We do not levy dividend taxes or include dividends in personal taxable income and we do not levy capital gains tax. If we also forgave reits profit tax our government would derive no fiscal revenue at all from reits.
Fine, you may say, but the difficulty is that tax-paying property investment companies widely held by the public already have a sizeable presence in our stock market and there really is not much to distinguish them from reits. They may not pay out 90 per cent of their earnings as dividends but their shareholders mostly do not want big dividends. They have invested in a property firm because they value its skills in the business. Why then take out money when it is best left where it is?
In fact, the only thing that really distinguishes a reit from the likes of a Hongkong Land is that the reit gets an official piece of paper, which says, "You now have the right to call yourself a reit", leaving unsaid, "if that really cranks your crank. Can't see why."
Things would be different, of course, if reits were forgiven profits tax. But this would be monstrously unfair to existing property companies unless we accorded them equal treatment. And then the utilities would line up. Why not tax-free utilities too?
This obviously poses a conundrum to the stockbroker who wishes to sell Hong Kong reits to a foreign client. That client is dunned for profits tax in Hong Kong but then is also hit for personal taxes at home. There is no advantage to him at all in buying a Hong Kong reit.
It is one of the big reasons reits have never really taken off in Hong Kong. They offer nothing special. They are a tax dodge that doesn't dodge taxes here. They are devised to create an investment opportunity that has long existed here. In Hong Kong, they are pointless.
So reit boosters now fall back on arguing either that we must have reits because they are a big thing in Singapore and Sydney, as if we really want the high-tax regimes of those places, or alternatively, that we will "capture the next wave" of investment inflow, as if this were a Somalia rather than a place that already has a surfeit of investment capital.
Take a hike, fellas.

domain: news


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Foreign Portfolio Investors or FPI can invest in the primary issues of non-convertible debentures or bonds by a public company issued in demat form, provided that the issuing company does not use the borrowing proceeds for real estate activities, purchase of land, investing in capital market or on-lending to other entities, the Reserve Bank of India said on Monday.
The Reserve Bank of India (RBI) placed a draft circular on its website in regard to foreign portfolio investments in unlisted corporate debt securities and securities debt instruments.
According to the draft, as far as investment in securitised debt instrument is concerned, the RBI said FPIs can invest in any certificate or instrument issued by a special purpose vehicle (SPV) set up for securitisation of assets where banks, FIs or NBFCs are originators. FPIs can also invest in any certificate or instrument issued and listed in terms of the SEBI regulations on public offer.
RBI details new norms for FPI investment

domain: finance


Latest 'agustin alessio' news
EXCLUSIVE: “Time Runs Out for The Avengers in Alessio’s Variant Covers
"Time Runs Out" for both "Avengers" and "New Avengers" this September, and CBR has the first look at variant covers by Agustin Alessio.
Andy Diggle Says “Captain America: Living Legend” is Worth the Wait
Writer Andy Diggle discusses "Captain America: Living Legend," the sci-fi-tinged series first announced by Marvel in 2010 as "Astonishing Captain America" as it hits stores starting this week.


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Plant some perennials in your garden that repel slugs. These mollusks are capable of consuming an entire garden full of flowers in a single night. These pests gravitate to young perennials with smooth, tender, thin leaves. Perennials that have tough or hairy leaves are often times unappetizing to snails and slugs. Excellent varieties include heuchera, achillea, euphorbia, campanula, and helleborus.
Digging in hard clay soil is made even more difficult because it sticks to the shovel. Take the hard work out of using a shovel in clay soil by rubbing a light coat of car or floor wax over the surface with a clean cloth and buff the surface. The clay won’t stick to it, and the end will not rust as an added bonus.
Know when is the best time to harvest your vegetables. Each type of vegetables has its own ideal time for picking for the best flavor. As an example, zucchini and baby peas both have the best flavor when they are harvested at a young age. On the other hand, tomatoes taste best when they are as ripe as possible from the vine. Find out what the best harvest time is for your vegetables.
To deter meddlesome dogs from destroying your garden, you should use heavily scented substances around the perimeter. You can even use perfume! These scents overpower the garden’s scents, which causes your dog to lose interest.
Pre-soak seeds overnight in a dark place. Use a small container filled with water to nearly the top and place several seeds in it. When you do this, you hydrate your seeds and they can start growing. This way, the seeds you have planted will have some chance of growing.
You need water for a healthy garden. Plants, just like humans, need a fresh supply of water in order to survive. During the hot days of summer, water your plants often to ensure that your plants do not dry out. Consistent watering contributes to a flourishing garden.
If you plan on growing peas, you should consider starting them indoors instead of beginning them outside. The seeds will have a better germination rate if you start them indoors. It will create heartier seedlings, which means they will more easily resist the pests and diseases they will encounter in an outdoor environment. Once the seedlings are sturdy enough, they can be transplanted to their rightful place in the garden.
In conclusion, these gardening tips are easy to follow and simple to understand. You simply need to know some basic approaches and then you can carry those techniques into your garden. Monitor the response of your plants when you apply these tips. If one thing fails, give another a go. Be patient and your garden will eventually be envied by your neighbors.
If you are really into gardening and take great joy to grow your own plants and vegetables, you’ll love what this lady has created. It is a raised garden system that will prevent you from being required to bend over and hurt your back while gardening. Check out what she has created, it’s truly extraordinary. Click Here to see the raised garden rack system.
Hope you enjoyed our guest bloggers article. 🙂

domain: agronomy


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24+ Good Interior Design Websites
Background. If you're looking for interior design inspiration, there's no shortage of ideas to be found online. But while it can be a fantastic resource, the web can also be a labyrinth.
The good weather is finally here. Elegant home decor inspiration and interior design ideas, provided by the experts at elledecor.com. Use these inspirations to create something stunning of your own.
Stylish, beautiful interior designs, home décor ideas for your home with the latest.
That depends on what type of interior design you need to do, along with your knowledge and skill level in using these. Emily henderson began as a blog dedicated to interior design. Browse the best user friendly room planners. See more of best interior design ideas on facebook.

domain: design


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Percy and Dexter, our two miniature Dachshunds are our first Dogs and are the loves of our lives.
Percy and Dexter
We had thought about getting another Puppy but decided against it and we said we’d only get another Dog if one ever needed a home.This is when I registered our names on The Red Foundation database after having contact with Sharon and hearing so many good things about them. It’s one thing registering interest, but, nothing quite prepares you for getting that phone call from TRF admin say there’s a Dog who needs a home – can you help?
This is what we signed up for so I asked Helen to send me the details. She told me he was a big lad for 19 weeks, with his present owners for only 4 weeks, unfortunately their marriage was breaking down and couldn’t keep him. They had taken great care of him and he wanted for nothing, he wasn’t a rescue, just needed to be re-homed.
I discussed this briefly with my wife Amanda and we of course said we’d take him.
That was the moment I promised to look after him forever.
Our first photo of Hugo as a Puppy
Before going to his first owners, Hugo had been smuggled into the UK from a Hungarian Puppy Farm and sold by a backyard puppy seller as a miniature – he certainly wasn’t a mini! Thankfully he’s in great health, but I can’t stop thinking about his poor Mother.
The day after Helen called we got Hugo’s address and arranged to pick him up. This in itself was a difficult thing to do – it was a massive decision for his current owners and I hadn’t realised how emotional it would be for all of us.
I kept thinking about Hugo, how he was waking up as normal, but, that day his life was going to change forever
We took Percy and Dexter into the house to meet him on his territory, I went into the house first, Hugo was in the back garden and came running in wagging his tail to greet me, he looked so happy, all I could say was “hello mate”
Such a beautiful looking lad, very friendly and full of fun.
It was a tearful goodbye as they obviously loved him – the last thing I said to them was I promise to look after him and love him forever.
We got him home, took him for a walk on the beach and he settled in very quickly. His only issue was his runny tummy, he came to us on Royal Canin and Hills Vet I/D food to try him settle his stomach. I started him immediately on a Raw diet and his stomach symptoms cleared up straight away – he’s never looked back!
I was filling in Hug’s adoption papers, I looked around and he was looking at me like this.
After a few teething problems, mainly to do with having three male Dogs, Hugo’s become an amazing part of our family.
He’s a beautiful Dog, so big and strong, 12kg of solid muscle, amazing temperament, so friendly, he’s loved by everyone, he loves everyone. Every day is a new adventure for him. He loves running on the beach, through the woods,barking through the window, playing with new friends – the bigger the better – he loves a bit of rough and tumble.
Hugo loves life and it’s such a pleasure to enjoy it with him. We couldn’t imagine life without him. We all adore him and absolutely love him. He’s a helluva lad.
Amanda and I are eternally grateful to The Red Foundation for bringing Hugo into our lives.
We are incredibly proud to give him his forever home and to be part of this amazing organisation
Thank You xxxxx
Percy, Dexter and Hugo Dawson aka The Sausage Brothers
He’s a big lad!
Dawson Family Vacation
The Main Man

domain: pet


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No Females in Heat
Crate-Trained Dogs Only
Renee and her husband were wonderful!! We planned a last minute trip to the beach and Renee was gracious to accept our girl for the week on short notice. We received regular updates and pictures and could see how happy our gal was - she was spoiled rotten and so happy! We highly recommend Renee and will definitely contact her for our next beach trip!
My husband and I were from out of town and boarded our Maggiemae with Renee in order to continue our trip a few days later with our camper after spending several days at a condo with our daughter and family. Maggie took to her and her husband instantly! That was proof to me that Renee loved dogs! Dogs know! She took excellent care of Maggie, sent pics to put our mind at ease, and texted ...
Renee is a wonderful sitter and so sweet. She was very accommodating when we decided to add another day to our vacation. She took great care of our Harley and sent pics and messages to let us know how he was doing. I actually think Harley is missing playing rope "Tug of War" with Oskar. I highly recommend Renee if you ever need a sitter!!! :)
Dog Lover, teacher, fur-mom of 3
I have cared for many different breeds of dogs and have three small dogs that I love like my own children. I have a big, fenced yard and also live close to the dog park in Frank Brown. The only other person that would be present during your dog's stay is my husband, who loves dogs as much as I do. Your dog would be in great hands during their stay with me! If your ...
What Renee would like to know about your dog
I would like to know how your dog interacts with other dogs.


Major cities in South East Asia often experience severe traffic along with increasing air and noise pollution. Places like Jakarta, Bangkok, Hanoi, and even our very own Manila are already feeling these problems, making it very hard to raise the standard quality of living. For example when driving around Metro Manila, it can take you hours to reach a destination just a few kilometers away. While our governments are doing the best they can, Nissan is also trying to help improve the situation; making South East Asia's cities more liveable.
Yutaka Sanada, Regional Senior Vice President, Asia & Oceania at Nissan says that one of the ways the automaker is doing so is by the promotion of electric vehicles (EVs) through Nissan Intelligent Mobility. With the use of EVs, emssions within the cities are expected to drop by a relatively large margin. It is also easy to integrate EVs into our homes and offices. In fact, many consumers in South East Asia are ready to make the shift to a greener mode of transportation, with consumers open to buying an EV as their next vehicle.
According to Nissan, having the right incentives will help spur the electrification in the region. The automaker cites in their study that consumers named tax waivers as one of the motivators in switching to EVs. That said, there is also the convenience of having charging stations built into apartment and office buildings.
That said, both the government and private sectors need to invest time energy and resources to make this work. For example, Norway has already given tax breaks and invested in charging infrastructure to speed up the adoptions of EVs. Closer to home, Singapore has already launched the first electric car sharing program with 2,000 charging points expected to rise by 2020.
Nissan hopes that with the adoption of electrification, key cities in South East Asia could be more liveable in the future.


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Bahrain, officially the Kingdom of Bahrain, is an island country in Western Asia. It is situated on the Persian Gulf, and comprises a small archipelago made up of 50 natural islands and an additional 33 artificial islands, centered on Bahrain Island which makes up around 83 percent of the country’s landmass. Bahrain is situated between Qatar and the northeastern coast of Saudi Arabia, to which it is connected by the King Fahd Causeway. According to the 2020 census, the country’s population numbers 1,501,635, of whom 712,362 are Bahraini nationals. Bahrain spans some 760 square kilometres, and is the third-smallest nation in Asia after the Maldives and Singapore.
These are the most popular photos on Unsplash for Bahrain.
Photographer: Ajmal Shams
Photographer: Charles-Adrien Fournier
Photographer: Todd Gardner
Find even more on unsplash.com/s/photos/Bahrain


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5 minutes ago
PHILADELPHIA — Miles Sanders enjoyed one of the most productive rookie seasons in the NFL last season.
The Eagles running back leapfrogged names such as LeSean McCoy and DeSean Jackson in the franchise’s record books, and he topped the class in categories such as scrimmage yards and all-purpose yards.
But when it came to postseason awards, Cardinals quarterback Kyler Murray, 49ers defensive end Nick Bosa and Raiders running back Josh Jacobs took home the hardware. Sanders, despite helping lift an Eagles team left for dead to an NFC East title, flew under the radar.
Sanders wants to change that in 2020. After sitting out his team’s Week 1 loss at the Washington Football Team with a hamstring injury, the former Penn State and Woodland Hills standout said he’s “ready to go” and feels 100% for Sunday’s Week 2 game against the Rams. And he wants to make a significant impact.
“Personally, my main goal is just to get respect,” Sanders said on a Zoom call Friday. “I want to be noticed as one of those top backs because I believe I am, and I believe I will be. And that just comes with me just grinding every day, just staying to myself and being humble and just working hard every day, and I know all that stuff will pay off, and Sunday, just let it loose.”
Sanders rushed for 818 yards last season, which broke McCoy’s rookie record. Sanders recorded 1,327 scrimmage yards, which broke Jackson’s rookie record. He totaled 1,641 all-purpose yards last season, which broke Heman Hunter’s rookie record.
But Sanders still didn’t get the accolades Murray or Bosa or Jacobs or even Titans wide receiver A.J. Brown got on the national stage. Maybe it was his position. Maybe it was because of the notable strides forward quarterback Carson Wentz took down the stretch, or maybe it was because the Eagles struggled for much of the year.
Either way, Sanders is ready for Year 2, in which he is expected to carry the load in the Eagles backfield
“Just more disciplined in the run game, just trying to be that more complete back in the run game,” Sanders said. “Showed a lot of glimpses of what I can do outside of the backfield, just trying to tighten up my run game more, being more decisive and downhill and more effective, and just getting positive yards for our offense, so we can just keep rolling.”
The Eagles missed Sanders in Week 1. Fellow running backs Boston Scott, Corey Clement and Jason Huntley combined to average 3.4 yards per carry in the loss, and none of the three could make plays on his own once Wentz started struggling.
Sanders showed he can make things happen with the ball in his hands, and if he can provide a consistent threat in the backfield, it should make things a little easier for Wentz and the rest of the Eagles offense.
Plus, some Eagles have hinted at an expanded involvement of the running backs in the passing game, which is a phase of the game where Sanders already acquitted himself well last season with 509 receiving yards and three touchdowns.
The Eagles also missed Sanders’ pass blocking. He made significant strides in that phase of the game under assistant head coach/running backs coach Duce Staley last season, and a couple of the eight sacks allowed by the Eagles last season were on the running backs in pass protection.
Sanders credited his college career for his ability to excel there.
“I want to give most of my credit to Penn State,” Sanders said. “I did a lot of pass blocking at Penn State. We didn’t just run the ball and catch the ball and stuff. We really took pass protecting seriously as running backs, as far as Penn State. So I was used to it. We couldn’t be on the field unless we protect the quarterback.
“It’s a big part of my game. I can’t play unless I protect 11. So my job is just to be dialed in, locked in with the offensive line and just keep that pocket as solid as possible for 11 so we can just keep rolling and be the offense that I know we can be.”
Sanders said he felt like he could have played last week after he suffered a hamstring injury in camp. But the team decided to sit him for another week, and Sanders framed it as the Eagles would rather have him for 15 games instead of one game.
Now that he’s healthy, he wants to pick up where he left off last season when he helped lift the team to a division title.
“Whatever’s in the best interest for me and for the team,” Sanders said, “I’m ready to do whatever.”
NFL | Sports
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- COVID-19: شیوع تایید در Haida Gwaii
- The Biden Adviser Who Gives Climate Activists Nightmares

domain: sports


There are so many...
But definitely check out Imogen Heap. Song Hide & Seek on Album Speak for Yourself. Crazy vocal effects, but beautifully produced.
I am not a gear-geek nor an audiophile, but FWIW I have two albums that sprang to mind instantly when I read the question:
Sade - Promise (I have this on vinyl - simply amazing)
A Perferct Circle - Mer de Noms (the louder the better)
Of course, in a completely different interpretation of the question, I might also pick The Trinity Session by Cowboy Junkies... total goosebumps.
Rest assured I will be making an effort to listen to some of the previous suggestions!
"Nickel Creek. The vocal blend is foremost, but also the clarity and depth of the each instrument is among the best I'm aware of."


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I just started posting some things for a site called the Master Mentors program. It’s a pretty cool opportunity for young people looking to get a start in the music or film industry. This particular post is about BUTTER, a creative team of individuals that write and produce music for moving pictures.
If you’re interested, here is the site where you can learn more information and upload your resume.
Words like bossy, pushy and know-it-all have an impact on girls. Watch this video by ad agency BBDO that highlights the price we pay for discouraging girls from leading and calls on all of us to change the future and encourage leadership in girls. Pledge to #banbossy at banbossy.com.


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Village Christmas: And Other Notes on the English Year by Laurie Lee
Reviewed by Fiona Wilson
Last year eight unseen essays by Laurie Lee, author of Cider with Rosie, were stumbled across at the British Library. Nineteen years after Lee’s death, the essays are finally available in this slim volume, arranged by season (I’m focusing on Winter), which celebrates the landscapes and traditions of the author’s Gloucestershire home.
“What I loved and still love, about that small pocket of England was that it was odd, radiant and unlike anywhere else. So static, indeed, and immovable, that our staying put within its boundaries seemed to magnify the qualities of where we were, so that it seemed natural to know every blade of grass, each stone and roof tile . . . its slopes, shadows, oblique angles of light, deep woods


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Laurel Hill Park Central Green
Laurel Hill Park conveniently located in between Lorton, Occoquan, & Fairfax Station/Burke. Less than one minute from the Workhouse arts center off Ox Road!
Meet up near the first shelter closest to the entrance.
8780 Lorton Rd.,
Lorton, VA 22079
Sorry, we don't have any schedule info for this month.


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When it comes to finding the best alcohol and drug rehab center, there are plenty of options available. These centers offer many of the same amenities that a hospital offers, such as full-service detox and 24 hour on-site medical staff. You can get the help you need from qualified professionals at these facilities. They will help you through your recovery and get you back to living a normal life.
Alcohol and Drug Rehab in Pennsylvania offer treatment for both physical and mental health. They work to give you the tools you need to manage your addiction outcomes and keep your body and mind healthy. Treatment programs offer education, counseling, therapy, and more so that you can learn how to live without relying on substances again. You receive close, personal care and are surrounded only by other recovering addicts. Alcohol and Drug Rehab in Pennsylvania offer a safe environment for you to successfully come off any substances in your body.
The goal of the professionals at an alcohol and drug rehab clinic is to get you well enough to do everything possible to achieve sobriety. They offer treatment that focuses on the physical, mental, and emotional health. They focus on rebuilding your life and breaking the cycles of addiction. Your treatments include detoxification and education on how to remain sober. Your treatments may include medication, group activities, personal therapy or individual therapy.
The physical health of an alcoholic or addict is often very poor. The most common issues that face many patients at an alcohol and drug treatment center are insomnia, pain, infections, heart disease, infections, diabetes, malnutrition, and many other serious problems. Alcoholism is a serious condition that leads to many other issues, so you will be given the best possible care. The staff can even provide you with counseling if needed.
Inpatient care is one of the most important parts of treatment. You can go to the facility to receive inpatient care or receive outpatient care. Inpatient care allows you to stay at the facility for the entire duration of your treatment, or until you have completed the program. Many people choose outpatient care because it allows them to go to their own homes, but there are also partial hospitalization programs that can be quite effective for severe cases.
Alcohol and drug withdrawal symptoms are some of the most dangerous when you are attempting to quit using substances. These symptoms can cause serious damage to your physical health. There are several treatment options available for alcohol and drug withdrawal. You can choose to use medications to control the symptoms of withdrawal, or opt for a more natural method of treatment. Both choices will result in a successful recovery.
The reason why many people cannot achieve lasting sobriety is due to the fact that they are not able to commit to the recovery process. Many substance abuse treatment programs utilize programs that require a person to be in therapy on a daily basis. Alcohol and drug rehab success rates are much higher when individuals are willing to dedicate themselves to their treatment plans. If you are committed to achieving sobriety, it is imperative that you choose an addiction treatment program that is equipped to assist you for the entire duration of your treatment.
Many alcohol and drug rehab facilities offer a 30-day recovery plan. These plans are designed to help you through the detoxification process and to help you cope with your symptoms for the first several days after leaving the facility. Once you have completed the program, you will be able to participate in additional outpatient or inpatient care, depending on the severity of your addiction. By completing a 30-day program, you will ensure that you are taking significant steps towards healing yourself.

domain: medical


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National Pain Issues Included in Healthcare Reform Bill
In March, the American Pain Foundation (APF) announced that several provisions from its National Pain Care Policy Act were included in the healthcare reform bill signed into law by President Obama in March. Pain affects more than 76 million people in the United States, including those with bleeding disorders.
Provisions from APF’s National Pain Care Policy Act 2009 (S. 660) include:
- Mandating an Institute of Medicine conference on pain to address key medical and policy issues affecting the delivery of quality pain care;
- Establishing a training program to improve the skills of healthcare professionals to assess and treat pain; and,
- Enhancing the pain research agenda for the National Institutes of Health.
“Including the provisions from the National Pain Care Policy Act into the National Health Care Reform Bill was not only a victory for people in pain but for healthcare providers as well,” said Will Rowe, APF CEO. “When people have access to the pain treatment that they deserve and doctors are provided the appropriate training they are seeking to treat them, many people in pain can resume active, productive lives worth living.”
APF is a nonprofit organization serving people with pain through information, advocacy and support.
Source: American Pain Foundation news release dated March 23, 2010


While most of us tend to use FTP or FTPS / FTPES (the secure version of them), you might want to use the SSH-based SFTP protocol. SFTP will allow us to download and upload files very easily while ensuring the confidentiality and authentication of the data being transmitted. Today at RedesZone we will recommend you the best SFTP servers that you can install on Windows operating systems. Unlike a File Transfer Protocol (FTP) server where we don’t have any kind of security, as the user’s credentials are sent unencrypted, along with all data traffic.
SFTP (SSH File Transfer Protocol or Secure File Transfer Protocol) allows you to transfer encrypted data between your local computer and the server where the SFTP Buy Email Database server is located, using SSH to do so. Whenever possible, it is recommended to use FTPES (the secure version of FTP) or the SFTP protocol. For this reason, we are going to see different SFTP servers that you can use from Windows, some of these programs also support FTP / FTPS and FTPES protocols so that we can use them without a problem.
Free FTPd This completely free program supports SFTP protocol, we can create different virtual users without having to create them locally on Windows PC. Additionally, this will allow us to create different virtual directories to share only the folders or directories we want, and later associate registered users with those folders. It will also allow us to authenticate with an SFTP client via public key, without using a username / password.


With a presence in so many markets, Samsung has its hands full with trying to stay ahead of the game across its product lines. From phones and cameras to laptops and televisions, Samsung is an incredibly multifarious company. At IFA 2011, Samsung’s powerful new laptop, the Series 7 CHRONOS, rose to the top of everything the company announced at the trade show.
One of the major features of the Series 7 CHRONOS is speed. An Intel Core i7 Quad Core processor and 8GB of additional flash memory, thanks to Express Cache technology, give this laptop incredible performance. Named for the Greek god of time, the CHRONOS notebook does its best to cut down on time across the board. It boasts a startup time of 19 seconds and 30% faster web browsing.
While the Series 7 CHRONOS cuts down time, it also extends it in necessary areas. Battery life is a purported 8 hours on a single charge. With Samsung’s Battery Life Plus technology, 80% of the battery’s original capacity will be maintained for up to 1,500 charge cycles.
The laptop keeps a slim profile. With a reduced bezel, however, Samsung can fit 15 inch display inside a 14 inch profile. Similarly, a 15.6 inch display fits inside a 15 inch profile. The display is an incredibly vibrant one with SuperBright 300nit brightness, 16 million colors, an anti-reflective screen, and a 1600 x 900 HD+ LCD. The AMD Radeon HD6750M graphics card greatly enhances the viewing experience and matches the Core i7 in terms of performance, especially where games are concerned.
It’s hard to find fault with the Series 7 CHRONOS looking at the specs. It packs a lot of power into a small profile. It’s an attractive option for those who don’t want a Mac. The base price will be $999 which goes up to $1,149 with options. The release date is set as October 2, 2011.


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An intense low-pressure trough off the coast of southeast Australia has brought torrential rains, floods, damaging winds, and dangerous waves to southeast Queensland and northern New South Wales over the weekend, with authorities describing the impacts as similar to that of a Category 1 cyclone. While the threat has eased on Monday, December 14, severe thunderstorm and flood warnings remain in force.
In Queensland, up to 738 mm (29 inches) of rain fell in Upper Springbrook a 72-hour period to Monday, including 323 mm (13 inches) in six hours overnight, from December 12 to 13, triggering coastal flooding.
"Many of the impacts from this weather event will be similar to a category-one cyclone event," Queensland emergency services minister Mark Ryan told ABC.
Queensland Fire and Emergency Services Commissioner Greg Leach added that the storms represented a "significant change in the weather pattern" in the state.
"Only last week we were dealing with bushfire situations and now the big wet has arrived… and so we need to be prepared not only for the weather we are dealing with now but we’re likely to see over the coming month."
A king tide, combined with heavy rain and strong winds, is causing a mass rain event up the east coast.
— 9News Queensland (@9NewsQueensland) December 14, 2020
— 10 News First Queensland (@10NewsFirstQLD) December 14, 2020
The @Westpac Lifesaver Rescue Helicopter captured this footage of the dangerous surf conditions while flying over the Gold Coast Seaway today.
Please stay out of the water. pic.twitter.com/UaYUPcjlSi
— Surf Life Saving Queensland (SLSQ) (@lifesavingqld) December 13, 2020
In NSW, the highest rainfall totals were recorded in Burringbar with 424 mm (17 inches) in 72 hours. Areas of Northern Rivers, Mid North Coast, and Northern Tablelands Districts were among the worst hit, according to the State Emergency Service (NEWS SES).
The rescue team accommodated 900 calls for assistance and conducted four flood rescue operations in NSW alone. Combined, both states received more than 6 000 calls for help.
"There have also been some big seas off the coast with wave heights around 10 m, leading to coastal erosion and inundation," BOM reported.
Among the areas significantly affected was the coastline along Byron Bay, which has been severely eroded by dangerous waves of up to 8 m (26 feet).
Several severe thunderstorm and flood warnings remain in force for NSW and Queensland on Monday, despite the threat of damaging winds and heavy rainfall easing, said BOM, noting that surf and tide hazards continue on the coast.
Featured image credit: NSW SES
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- Research article
- Open access
Ghana’s National Health Insurance Scheme: a national level investigation of members’ perceptions of service provision
BMC International Health and Human Rights volume 13, Article number: 35 (2013)
Ghana’s National Health Insurance Scheme (NHIS), established into law in 2003 and implemented in 2005 as a ‘pro-poor’ method of health financing, has made great progress in enrolling members of the general population. While many studies have focused on predictors of enrolment this study offers a novel analysis of NHIS members’ perceptions of service provision at the national level.
Using data from the 2008 Ghana Demographic Health Survey we analyzed the perceptions of service provision as indicated by members enrolled in the NHIS at the time of the survey (n = 3468; m = 1422; f = 2046). Ordinal Logistic Regression was applied to examine the relationship between perceptions of service provision and theoretically relevant socioeconomic and demographic variables.
Results demonstrate that wealth, gender and ethnicity all play a role in influencing members’ perceptions of NHIS service provision, distinctive from its influence on enrolment. Notably, although wealth predicted enrolment in other studies, our study found that compared to the poorest men and uneducated women, wealthy men and educated women were less likely to perceive their service provision as better/same (more likely to report it was worse). Wealth was not an important factor for women, suggesting that household gender dynamics supersede household wealth status in influencing perceptions. As well, when compared to Akan women, women from all other ethnic groups were about half as likely to perceive the service provision to be better/same.
Findings of this study suggest there is an important difference between originally enrolling in the NHIS because one believes it is potentially beneficial, and using the NHIS and perceiving it to be of benefit. We conclude that understanding the nature of this relationship is essential for Ghana’s NHIS to ensure its longevity and meet its pro-poor mandate. As national health insurance systems are a relatively new phenomenon in sub-Saharan Africa little is known about their long term viability; understanding user perceptions of service provision is an important piece of that puzzle.
Financing health care costs through health insurance schemes are a crucial tool for developing countries to avoid financial barriers to health care and protect individuals from catastrophic health care spending. Generally, those covered by insurance are more likely to have access to care and less likely to be burdened by health care costs . Ghana is generally believed to have made progress in the implementation of a national level health insurance program and has often been touted as a good example for many other developing countries, including those in Africa that are looking to implement a health insurance program [2, 3]. Largely subsidized through government investment and value added taxes, Ghana’s National Health Insurance Scheme (NHIS) asks for modest annual premium payments from its members, and many citizens are exempt from any payment at all. The scheme received the national government’s assent in 2003 and began operation in 2005, though exact dates vary by district.
Before the NHIS came into operation, Ghana’s health care ran on a model commonly referred to as cash-and-carry, which required individuals to make out-of-pocket payments at point of service usage [4, 5]. Cash-and-carry, however, was wildly unpopular and socially regressive. This is largely because the poor and other marginalized populations had very little ability to access mainstream health care, and the model created disincentives to provide care in remote rural areas of the country. Ghana’s health care system during this era was chronically under staffed, under stocked and generally failed to meet the basic health needs of the populace that it set out to address in the first place [5–9]. Thus, the implementation of the NHIS in 2003 was directly purported to deal with the shortcomings of the cash-and-carry system. During the 2000 general election in Ghana, the New Patriotic Party (NPP) campaigned, and subsequently won, on a platform that promised to get rid of cash-and-carry and introduce a pro-poor health insurance model for the country .
The National Health Insurance Scheme (NHIS) was established under Act 650 of 2003 by the Government of Ghana, and technically requires all citizens to be enrolled in some form of health insurance coverage, be it private coverage, the NHIS coverage, or a combination of the two. However, in practice there is no enforcement of this rule and many citizens are without health insurance coverage of any kind . These individuals must therefore pay out-of-pocket should they need treatment at a health facility, meaning that the cash-and-carry system still lives on in some form. This has resulted in a system with multiple payers – NHIS, private insurance and cash-and-carry – and a potential for hierarchies of prioritizing care. NHIS cardholders may only receive coverage at NHIS accredited facilities, though these facilities are owned and managed by different players including the government, private ownership, mission ownership and quasi-government ownership (see Table 1) . While an NHIS member may be able to access the same health facility as someone paying with private insurance or paying out-of-pocket, we do not know if they are treated by the health facilities in a different manner. For instance, media reports suggest that those paying in cash get pushed to the front of the line making NHIS members wait hours for treatment . Additionally, there are many private health facilities that do not recognize NHIS payments, and therefore are not accessible to NHIS members. Anecdotal accounts amongst Ghanaians recognize these facilities as higher end, especially as government facilities suffer from staffing shortages or strikes . The implications of these multiple sources of health financing and multiple facilities providing service – the public’s perception of service provision via the NHIS – have yet to be explored in the literature.
Despite these open questions, Ghana’s NHIS is in many ways regarded to have come into its own since its establishment in 2003 . Previously, emphasis has been accorded to informing the population about the benefits of the scheme while encouraging people to join. The National Health Insurance Authority (NHIA), along with frequent endorsement from the World Bank, boasts an impressively high level of national enrollment starting with 1.3 million people in 2005 and increasing to 14.5 million people by 2009 (or 62% of the population) and a reported 18 million in 2010 [11, 15]. However, studies suggest that enrolment varies largely by region, gender, ethnicity, and wealth, amongst other important factors . Further, it has been suggested that the NHIA’s calculations for the active membership (i.e., the portion of registered members with up-to-date premium payments and card renewals) overestimate active membership by improperly tracking membership identification cards. A report by Oxfam International suggests that “the official figures used by Ghana’s NHIA are exaggerated, highly inaccurate and misleading” . The Oxfam report proposes that enrolment rates may actually be as low as 18% of the population when non-renewals are taken into account, though another study suggests the 2008 rate is about 30-40%, depending on respondent’s gender . More recently, the NHIA has revised its methodology for calculating active memberships putting the 2010 national rate at 33.7% of the population (8.1 million people) .
Irrespective of this debate, enrolment numbers mark only one of many metrics to measure the success of this health care policy. Previous research into the NHIS has focused on the social and financial characteristics of those enrolling [16, 19–21] and thus far there has been limited examination of the factors associated with the perception of services once members are enrolled. Or to say otherwise, many studies have focused on barriers to enrolment, but very few have addressed the various challenges of keeping members content with the NHIS services. Given that enrolment in Ghana’s NHIS is not mandatory, and that multiple payers and providers create a competitive terrain for the NHIS, the longevity of the scheme will rest on its ability to compete with other methods of health care financing. Yet only a few studies have even remotely touched on the question of members’ perceptions of the services provided by the NHIS.
For instance, in a study of Ghana’s Dangme West District, Bruce et al.  point to a dissatisfaction of insured members who perceive they are given poorer quality of care and tend to wait longer compared with those making out-of-pocket payments . As well, Atinga et al.’s  study in two hospitals in the Upper East and Northern regions of Ghana found that the care, environment of the facility and waiting time were strong determinants of patients’ perception of quality with the healthcare delivery, though they made no distinction between those enrolled and not enrolled in the NHIS.
The most noteworthy study on this topic to date is probably from Jehu-Appiah et al. . Jehu-Appiah and colleagues examined household decisions to not only enroll in the NHIS, but to renew (or not renew) membership. The study, which was conducted solely in the Central and Eastern Regions, identifies, ranks and compares perceptions of insured and uninsured households on various domains of the health insurance (such as technical quality of care, convenience of the NHIS, provider attitudes, etc.). The authors found that while previous enrolment was significantly associated with the perceptions of benefits arising from the NHIS, those that no longer maintained their memberships were also less likely to find these positive elements within the scheme. The authors suggest that “even though the previously enrolled perceive NHIS to be beneficial and convenient overall, it may be that they saw fewer advantages in NHIS than originally expected” . Simply put, those that dropped out perceived lower levels of service provision with the NHIS. Jehu-Appiah and colleague’s work is an important building block for understandings perceptions regarding the NHIS, however the study is limited by its regional focus and gives little insight into respondent characteristics that would help to predict such perceptions.
Thus, previous studies make relevant contributions to the literature, but leave an important issue unaddressed; there is no systematic study at the national level in Ghana on perception of service provision that provides reasonable basis for generalizations about NHIS members as a whole. Our research fills this void by examining the perceptions of members already enrolled in the scheme regarding their evaluation of the service under the NHIS, as compared to others.
Understanding the perceptions of NHIS members is important for three primary reasons. First, since the implementation of the NHIS arose from dissatisfaction with the cash-and-carry system, it is reasonable to expect that the longevity of the scheme would come from staying attune to the populace’s needs in regards to the health care system. If the alternative forms of payment (such as private insurance or paying directly out-of-pocket) are perceived as more viable alternatives, the NHIS may not be able to retain its current membership numbers and the system will falter from lack of premium contributionsa. Regardless of objective reality of the quality of service provision, members’ subjective evaluations are ultimately what will determine their participation in the NHIS. Second, there have been anecdotal reports that new methods of health facility payment via the health insurance authority may result in cash flow problems and thus a decline in patient care . Thus, members’ perception of service provision may be the first indication of these problems.
Third, while national level health insurance schemes have been researched extensively in developed countries, they are relatively new endeavors in developing countries such as Ghana. Noting that numerous sub-Saharan countries including Rwanda, Burkina Faso, Nigeria, Kenya and South Africa have either started a national health insurance program or are in the advanced stages of starting one, the insights from Ghana may be helpful in their developments. We attempt to fill this important gap by examining the predictors of members’ perceptions of service provision using the most recent version of Ghana Demographic and Health Survey. The novelty of this research is therefore beneficial not only for further policy development in Ghana, but potentially also for other health insurance schemes starting up around the continent.
Data and sample
We used data from the 2008 Ghana Demographic and Health Survey (GDHS), which is made free and publically available upon registration with the DHS (http://www.measuredhs.com). The Ghana Demographic and Health survey (GDHS) is a nationally representative data set administered by Ghana Statistical Service and Macro, and the fifth in such surveys of the Global Demographic and Health Surveys Program. The GDHS provides high quality and reliable quantitative data on basic demographic and health indicators and quite recently has introduced a module on the National Health Insurance Scheme (NHIS). The GDHS identified about 5096 eligible women aged 15–49 from 11,778 households out of which 4916 were interviewed, yielding a response rate of 97%. Approximately 4769 eligible men aged 15–59 were also identified with 4568 interviewed from the same household resulting in a response rate of 96%. The analysis for this study was however restricted to 1422 males and 2046 females who are already enrolled in the NHIS.
The dependent variable for this study ‘perception of NHIS service provision’ was measured with the question: “In your opinion, do NHIS card holders get better/same/worse service than others?” This question was only asked to respondents who indicated they had health insurance and then specified “National/District Health Insurance” as the type of health insurance coverage. Although the literature on the perceptions of health insurance in developing countries is thus far quite scant, available studies show economic, socio-cultural and demographic variables as important correlates of enrolment in health insurance [16, 19–21, 25, 26]. Taking cues from these studies, we examine the effects of socio-economic variables (wealth and education) and socio-demographic and cultural variables (age, ethnicity, marital status, place of residence, and region of residence) on perception of service provision with the NHIS in Ghana. The wealth quintile, which we employ as a socio-economic variable, was constructed from weighted scores on household ownership of consumer items and dwelling characteristics. This was coded as ‘Poorest’, ‘Poorer’, ‘Middle’, ‘Richer’, and ‘Richest’. The educational background of respondents is also coded as ‘no education’, ‘primary education’ and ‘secondary/higher education’. Other theoretically relevant socio-demographic variables include marital status (never married, currently married, formerly married), age of respondent, religious affiliation (Christians, Muslims, Traditionalists, and no religion), ethnicity (Akan, Ga Dangbe, Ewe, Northern languages and other), urban or rural residence, and finally region of residence (Southern Ghana or Northern Ghana). Northern, Upper East, and Upper West regions were classified as Northern Ghana. Greater Accra, Central Western, Brong Ahafo, Volta, Eastern and Ashanti regions were grouped as Southern Ghana.
The Ordinal Logistic Regression technique was applied to examine the relationship between perception of NHIS service provision with coverage and socioeconomic and demographic characteristics. This method is appropriate given that the response variable employed for analysis is polytomous and has a natural ordering to it. Of the three possible responses (worse, same or better service), “worse” was used as the reference category. Thus, an odds ratio greater than one indicates a greater likelihood of saying the health insurance scheme service is the same or better, than to say it is worse. On the contrary, an odds ratio less than one indicates a lower likelihood of reporting that the health insurance scheme service is the same or better, than to say it is worse.
Univariate results in Table 2 are provided for the dependent variable and selected explanatory variables for the sample of male (n = 1422) and female (n = 2046) respondents who were card-carrying members of the NHIS. The majority of male respondents (55.3%) and a high percentage of female respondents (46.9%) identified their level of service with the NHIS as better. Respectively, about 34.2% and 43.2% of males and females rated their level of service as the same. Finally around one tenth of respondents felt that their level of service was worse (10.5% of males and 9.9% of females).
Respondents were fairly evenly distributed amongst the five wealth quintiles, though there were slightly more males and females identifying as either ‘rich’ or ‘richer’. Similarly, the large majority of this sample had secondary or higher education (about 77% of males and 62.7% of females respectively. Most respondents were married at the time of the survey (56.1% of males and 63.0% of females), while 41.2% of male and 29.8% of females had never been previously married. Around three quarters of males and females identified their religious affiliation as Christian, followed by Muslims at around a fifth of the sample. A small proportion identified themselves as traditionalists. In terms of ethnicity, a high proportion of those sampled identified themselves as either Akan or of the Northern languages, followed by the Ewe or Ga Dangbe ethnicity. Males and females were split relatively even between urban and rural residency. About a third of respondents were from the North compared to two-thirds from the South.
Table 3 provides results of the bivariate relationships between the dependent variable ‘perception of NHIS service provision’ and selected independent variables. Findings suggest that wealthier Ghanaians are significantly less likely to report that their perceived NHIS service was the same or better than to report it was worse. This relationship holds true for both males and females, though is stronger for the male respondents. Similar observations are made for females with higher levels of education. When compared to those with no education females with secondary or higher education were 38% less likely to indicate that their perception of NHIS service was the same or better, than to report it was worse.
Bivariate results also indicate that compared to males that were never married, formerly married males were less likely to report that their perception of NHIS services were the same or better, than worse when compared to the previous cash-and-carry model and other existing alternatives. Regarding religion, Muslim males and female Traditionalists were significantly less likely to report that the NHIS was same or better, than to report it was worse, compared with Christians. Males who identified their ethnicity as ‘Northern ethnic group’ were 74% more likely to report that they perceived NHIS cardholders received same or better service than worse service when compared to males of Akan ethnicity. Similarly, females of Ga Dangbe and other ethnicities were about half as likely to rate their perception of service as same or better than to rate the service as worse, compared to females of Akan ethnicity. The rural–urban and regional divide is particularly notable at the bivariate level. Respectively, both males and females in rural areas were significantly more likely (48% and 24%) to perceive that NHIS cardholders received same or better service than worse service, compared to those in urban areas. Similarly, when compared to males and females in the Southern regions of the country, those from the Northern region were significantly more likely to perceive cardholders received same or better service than worse.
Mulitvariate models are presented in Table 4. Three main models each are built for both males and females. In the first model, we examine the relationship between socioeconomic variables (wealth and educational background) on perception of NHIS service provision. The second model adds sociodemographic variables including marital status, age, religious affiliation, ethnicity, and rural/urban residence. Finally, the third model controls region of residence, which we have earlier identified as crucial for NHIS enrolment.
Consistent with the bivariate results, wealth was found to be a statistically significant predictor of respondents’ perceptions regarding NHIS service, especially for men. Compared to the poorest, wealthier men are about 51% less likely to perceive that services from the NHIS were the same or better than to perceive it as worse (see Table 4, model 3). It is worth noting however that the statistical significance of wealth was attenuated when region of residence was controlled for in the final model (see models 2 and 3 in Table 4). Although wealth was not statistically associated with the perception of NHIS service provision for female respondents, education was. Compared to females with no education, those with secondary or higher education were less likely (0.759 times) to perceive the NHIS service as the same or better than to perceive it as worse. Compared to males that had never been married, males that were formerly married were almost half as likely to perceive the NHIS service as the same or better than to perceive it as worse. Ethnicity did not appear to be an important influencing factor for male respondents. However, it did appear to be a strong influence for female respondents. Compared to Akans, women of Ewe, Ga Dangbe and of other ethnic backgrounds were significantly less likely to perceive the NHIS service was the same or better.
Arguably, the most significant finding is the influence of wealth on perceptions of the service provided by the NHIS. We observe in particular that wealthier men were significantly less likely to perceive NHIS services as the same or better compared to perceiving the services as worse. In other words, wealthy Ghanaian men perceived lower levels of services provided by the NHIS than other financing options. Possible explanations include the fact that, although enrolled in the NHIS, wealthy Ghanaian men have alternative health financing options including purchase from private facilities or travel abroad, and thus the NHIS service would seem worse in comparison. These results are punctuated by the national media’s focus on Ghana’s now deceased President and other high-ranking public officials traveling overseas for personal medical treatment [27–29]. Alternatively, those that cannot afford to pay for health care out-of-pocket would certainly find any level of service to be better under the NHIS as they are not financially obliged to pay per use for their medical treatment, as was the case under the cash-and-carry system. Therefore the perceived level of service provision among Ghanaian men may be linked with the ability to purchase alternatives to the health care provided under the NHIS.
Notwithstanding, this finding is still intriguing considering that across the board, studies have found that the wealthy are more likely to enroll in the NHIS [16, 19–21, 25, 26]. It is however not very clear as to why the wealthy will be more likely to enroll in the NHIS, while simultaneously perceiving the service provision to be worse than the alternatives. A potential explanation could be that the wealthier are often making a substantial contribution to the NHIS through their Social Security taxes, and this may raise their expectations above the poor. Furthermore, considering that the NHIS premiums are relatively cheap, another plausible reason is that rich males may purchase it only for a back up, and not use it as a primary source of care. This may also mean that these men have firsthand experiences being served with alternative payment options (i.e., private insurance) providing them with the opportunity to make comparisons with the NHIS. This result does, however, imply that the reports of NHIS’ cash flow issues  which would result in poorer patient care and those paying by cash being pushed to the front of the line may not be severe enough to impact the perception of service provision with the NHIS. Were this the case, we would expect that poor males would respond similarly to rich males, and find the NHIS to be the worse than other forms of payments. Since poor males rated their perception of NHIS service provision to be relatively high, we understand that they are receiving better care than they would be via the cash-and-carry system, the assumed alternative for the poor.
In contrast to male respondents, wealth was not significantly associated with women’s perceptions of NHIS service provision, and we suggest that this result throws light on the gender dynamics of intra-household resource allocation. Tolhurst et al.  reveal that in Ghana the decisions regarding healthcare are primarily about access and control over resources between household members. Commonly in Ghanaian households, women are expected to seek the male household head’s approval before they or the children spend resources on health care. Approval to spend household resources is intimately tied with a bargaining process that is influenced by norms of power and the women’s responsibility for children, norms of responsibility for payment, and marital status. During the cash-and-carry era it was not uncommon for women or children to delay seeking medical treatment due to the absence of the father or his refusal to pay for health care . Though men are expected to cover health care costs, in reality women would often take on the burden these payments. If women were not receiving sufficient support from their husbands, Tolhurst and Nyonator  found that they would often attempt to renegotiate support by withholding co-operation on other responsibilities in the household, or ‘reporting’ the man to the elders.
It is important to point out that the wealth ranking given to female respondents is applied at the household level and does little to elucidate their actual ability to make out-of-pocket payments for health care. If a woman previously had to go through the male household head in order to access money every time that she or the children were in need of health services, then health insurance coverage could serve as a way around this bargaining process. As only one annual premium payment is required for full NHIS coverage, regardless of their wealth status women would stand to benefit from being insured by avoiding frequent bargaining and debates regarding health care payments. Or to say otherwise, women would actually be able to access care via the NHIS, which is better service than no care at all if they were relying on their husband to pay in cash up front. Thus women’s perception of service with the NHIS would have little to do with their household wealth ranking, as provided by the GHDS. Further, the status of educated women as somewhat empowered and independent or engaged in the household decision making regarding health matters likely speaks to a modern move away from these traditional intra-household bargaining experiences, and therefore would more likely reflect the tendency among males to generally report poor perceptions of the NHIS’ services, as our results have demonstrated.
Our study does however point to the strong influence of ethnicity on women’s perception of NHIS services, specifically that the Akan women are far more likely to report perceiving NHIS services to be the same or better as alternatives. Some studies suggest that quality of care impacts perceived benefit of health insurance [32, 33]. There is evidence to the effect that the Akan-speaking areas, primarily the Ashanti region, have some of the best facilities and strongest usage of health services out of the entire country. For instance, in both 2008 and 2009 the Ashanti region had the second lowest doctor-to-person ratios in the country next to the Greater Accra Region and a very high hospital bed usage (see Table 5) . It is possible therefore that the quality of healthcare delivery in the Akan dominated areas reflects in the high usage and positive perceptions of the NHIS services derived from such health facilities, and that these may be mutually re-enforcing. Furthermore, the reason that this relationship would show up significantly in women and not men, relates back to the culturally determined roles that either men or women are expected to fulfill. In Ghana, women tend to be more closely linked with caring for the health of the family and children , and would be the ones to realize the benefits of having the health insurance and usage of the health facilities.
While this study has produced interesting findings, there are a number of limitations. First, we are unable to draw ‘causal’ relationships between the dependent and independent variables due to the cross-sectional nature of the data. Second, caution must be exercised with the interpretation of results as the GDHS’ question on members’ perception of NHIS services as the question tapped the subjective interpretations of respondents and may not reflect an objective assessment of members’ experiences with the scheme (i.e., perceived provision of services tells us little about the actual access, utilization and level of care that a respondent received). This problem characterizes most survey research where data are self-reported, and signals the need for more conceptually rigorous survey questions. Notwithstanding, the study provides important insights and raises relevant policy questions regarding members’ perception of services and, in turn, the overall sustainability of the NHIS in Ghana.
This paper provides important insights into the factors associated with the ongoing viability of Ghana’s NHIS. Using a national level sample we have assessed the factors associated with perception of NHIS service provision as compared to other options and, we argue, this is a key component to its longevity. Though not technically legal, the de facto continuation of cash-and-carry in addition to media reports of better services via private insurance or at privately run clinics means that the NHIS faces competition on many fronts. While respondents for this study do not specify which alternative they are comparing NHIS service provision to, we argue that the strength of the NHIS depends on being competitive with all the alternatives. Given that Ghana’s move towards the NHIS was politically motivated by the public’s strong dissatisfaction with the cash-and-carry system, the focus of the current policy makers must reflect an appropriate balance of the need to optimize enrolment while minimizing opt out rate. This will not succeed if current members perceive other options as providing better service.
The results of this study stand in contrast to previous work that has solely looked at influences on enrolment on the NHIS, thus demonstrating a difference in influences between those who are enrolling in the NHIS and those who do enroll and perceive the services they receive to be comparatively worthwhile. Simply put, there is a difference between originally enrolling in the NHIS because one believes it is potentially beneficial, and alternatively, using the NHIS and finding it to truly be of benefit. For instance, while our previous study demonstrated a positive relationship between wealth and the likelihood of enrolment for men and women , this study shows a negative relationship between wealth and perception of NHIS service provision.
Perception of NHIS service provision differs greatly between males and females, with wealthy men less likely to perceive the service to be the same or better than the alternatives. We suggest this is based largely on the power of choice that money provides, cultural norms, gender relationships and intra-household resource allocation. This could also mean that if such men become disgruntled with the NHIS, or perceive better service via other forms of payment, they could discontinue their memberships altogether and it would be women and children who are likely to be left behind.
Further, it was proposed in this previous work that some of the differences geographically in enrolment patterns could be attributed to social networks and ‘word of mouth’ encouragement to sign up for the NHIS. Similarly, Jehu-Appiah et al.  found that a household’s decision to enroll is influenced by community attributes such as health beliefs, attitudes and peer pressure. If this holds true, it seems that community encouragement to join the scheme may work the first time, but does little to influence perceptions once they have already enrolled in the NHIS.
There are also other important implications that emanate from this investigation. One of the underlying tenants of a health insurance program is that a wide variety of citizens – healthy and unhealthy, rich and poor, and so on – must enroll in order to balance out the input and drain on the financial pool that sustains the system. For instance, economist often raise concerns about the problems of voluntary health insurance and the creation adverse selection, where unhealthy people who would foresee heavy use of the health care system are more interested in enrolling in the health insurance and healthy people self select out of the insurance. This, down the road, could potentially impact health care costs and contributions, and lead to the discontinuation of the health insurance program [35, 36]. Unless policy makers can maintain relatively equal enrolment from all areas of the population, the NHIS will face stability problems in the future. Thus, determining and understanding what variations in perceptions towards the NHIS is the first step in being able to tailor the program to meet the needs of all Ghanaians.
aAt the time of data collection (2008) only 5% NHIS total inflow was attributed to premium payments. In contrast, a large majority of inflow (61.5%) was derived from the 2.5% tax levy, and a sizeable amount (16.9%) from Social Security contributors, who are provided exemptions from premium payments for NHIS enrolment. This low inflow from premium payments can be attributed to the large proportion of members who are exempt from making premium payments; in 2009 this constituted 70.6% of all members . While this policy supports the scheme’s ‘pro-poor’ stance, the NHIS has been challenged with financial difficulties, as indicated in annual reports  and notably made public with the NHIA’s inability to pay outstanding bills to Mission owned facilities in 2013 . Though we are not suggesting here that this financial instability has been caused by the numerous exempted users (instead corruption and internal misuse of resources are more likely culprits), nonetheless an erosion of premium paying members from the scheme would not help this situation.
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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-698X/13/35/prepub
This study was supported by the lead author’s Doctoral Award from the Social Science and Research Council of Canada. We would also like to thank the reviewers for their extremely useful comments and suggestions.
The authors declare that they have no competing interests.
JD was the primary author and completed the literature review and discussion sections, and participated in the design of the study. EYT took the lead in the design of the study, carried out the statistical analysis, created all the tables and helped in reading and proofing and manuscript drafts. IL assisted in study design, and helped in reading and proofing and manuscript drafts. All authors read and approved the final manuscript.
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Dixon, J., Tenkorang, E.Y. & Luginaah, I. Ghana’s National Health Insurance Scheme: a national level investigation of members’ perceptions of service provision. BMC Int Health Hum Rights 13, 35 (2013). https://doi.org/10.1186/1472-698X-13-35

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Italy has a special place in my heart because my aunt and cousin are Italian. I’ve visited countless times over the years and each time is unique and special in its own way.
The tiny little town of Padua where my aunt lives makes me think of her home cooked pasta and pizza that’s more like a hearty casserole. In the winter we walk through the town center and eat warm chestnuts from the street vendors. And when I just want to reflect and read a book, I visit the Scrovegni Chapel with its beautifully frescoed walls or the St. Anthony. Sometimes, we drive up to the Dolmite mountains to the little town Cortina. It's a special place for Italians and much less visited by tourists. My favorite restaurants are Ristorante Ospitale, Ristorante Al Camin, and a more local place, Scoiattoli Restaurant has the most stunning view of the mountains!
Milan & Venice
Sometimes, my cousin and I would travel to Milan for a fashion show or go shopping in the Grand Galleria Vittorio Emanuele II (I know I’m mixing my Italian and English here). There’s an endless assortment of cathedrals and castles and my personal favorite is the Castello Sforzesco because of its extensive grounds and gardens. In Venice we like to be tourists and ride gondolas through the canals. I love the blown glass and Venetian mask artists. My favorite is the Murano Glass Factory on “blown glass island” where you can take a tour and watch the blown glass demonstrations. But, we usually just wander and get lost because it’s a great walking city. I only visited Saint Mark’s Basilica in St. Mark’s Square once because I’m not a fan of all the pigeons outside that land on you! Regardless, it’s still a beautiful, landmark cathedral.
Firenze is where my Italian heart lives. Whenever I see the Duomo I know I’m there! I’ll usually rent a Vespa and mob around the cobblestone streets with friends, eating authentic gelato or enjoying a three hour lunch (afterwards, I climb the Duomo stairs to work off all those carbs!). At sunset I like to be near the Piazzale Michelangelo so I can catch a golden view of the Florence skyline. If you’re there in the spring, don’t miss Note Bianca, “White Night!” At the end of April, Firenze hosts its hottest block party with live music, performances and art all throughout the city. Most importantly, I love to get out of the city and drive through the Fiesole hills. It’s breathtaking and you can always find small restaurants serving food made from the produce grown from their own garden. To me, the Tuscan country life is truly Italian.