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ORIGINAL RESEARCH article
Sec. Neuro-Oncology and Neurosurgical Oncology
Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.673836
Cortical Excitability and Connectivity in Patients With Brain Tumors
- 1Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- 2Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
- 3Department of Biomedical Science and Morphological and Functional Images, University of Messina, Messina, Italy
Background: Brain tumors can cause different changes in excitation and inhibition at the neuronal network level. These changes can be generated from mechanical and cellular alterations, often manifesting clinically as seizures.
Objective/Hypothesis: The effects of brain tumors on cortical excitability (CE) have not yet been well-evaluated. The aim of the current study was to further investigate cortical–cortical and cortical–spinal excitability in patients with brain tumors using a more extensive transcranial magnetic stimulation protocol.
Methods: We evaluated CE on 12 consecutive patients with lesions within or close to the precentral gyrus, as well as in the subcortical white matter motor pathways. We assessed resting and active motor threshold, short-latency intracortical inhibition (SICI), intracortical facilitation (ICF), short-latency afferent inhibition (SAI), long-latency afferent inhibition, cortical silent period, and interhemispheric inhibition.
Results: CE was reduced in patients with brain tumors than in healthy controls. In addition, SICI, ICF, and SAI were lower in the affected hemisphere compared to the unaffected and healthy controls.
Conclusions: CE is abnormal in hemispheres affected by brain tumors. Further studies are needed to determine if CE is related with motor impairment.
The “maximal safe resection” represents the goal standard of the modern surgical treatment of brain tumors located in eloquent areas. Various techniques supply important anatomical and functional information regarding the brain functional organization. Different neuroimaging and neurophysiological techniques can be used to plan a surgical strategy to preserve functional networks and to increase the maximal safe resection. Navigated transcranial magnetic stimulation (nTMS) is a helpful tool for preoperative cortical mapping and planning before surgery of brain tumors located in eloquent areas (1–5). Brain tumors like brain trauma, hematoma, and focal cerebral ischemia can cause brain parenchyma compression that can produce changes in excitation and inhibition, even in the absence of histologically significant cell injury, often manifesting clinically as seizures. The precise mechanism producing seizures after cortical compression remains elusive (6). Recent studies used preoperative nTMS as a predictor of motor outcome in patients with brain tumors. Rosenstock et al. showed that an abnormal interhemispheric resting motor threshold (RMT) ratio was related to a higher risk for poor postoperative outcome in the 1st week, but not in the following 3 months (7). This proposed stratification model, based on functional–anatomical and neurophysiological measures, could allow quantification of the functional impairment or recovery potential. Several parameters of cortical excitability have been studied in patients with traumatic brain injury (8) and stroke (9). In a recent paper, Neville et al. (10) described an increase in motor threshold (MT) that was paralleled by an alteration in short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) (10). However, the authors did not check other important parameters of cortical excitability such as short-latency afferent inhibition (SAI), long-latency afferent inhibition (LAI), cortical silent period (CSP), recruitment curve (RC), and interhemispheric inhibition (IHI). The aim of the current study was to further investigate cortical–cortical and cortical–spinal excitability in patients with brain tumors using a more extensive TMS protocol.
Materials and Methods
The present study was conducted in accordance with the ethics committee of the University of Messina and the Declaration of Helsinki. Informed consent was obtained from every patient.
The cortical excitability measurements by transcranial magnetic stimulation (TMS) were carried out on 12 consecutive patients with lesions involving the primary motor cortex (M1) and corticospinal tract (CST). Not all 12 patients participated in all cortical excitability measurements (see below). Table 1 reports all nosographic data and neurological status of patients. Exclusion criteria for brain stimulation were the same as for magnetic resonance imaging (MRI). Patients were examined for handedness, motor impairment, medical history, and use of medication (see Table 1). The WHO classification was used for tumor histology (11).
Measures of Cortical Excitability
Patients and controls were seated in a “comfortable reclining chair and surface EMG was recorded from the right or left first dorsal interosseus (FDI) muscle using disposable disc electrodes with a belly-tendon montage. EMG was filtered by Neurolog System supplied by Digitimer with a time constant of 3 ms, and a high pass filter set a 3 kHz.” Single or paired pulses were given to the right or left M1 using a standard figure-of-eight coil connected with a single (for single-pulse TMS) or two (for paired-pulse TMS) high-power Magstim 200 stimulators. “Signals were collected via a CED 1401 laboratory interface (Cambridge Electronic Design, Cambridge, UK) and fed to a personal computer for offline analysis” (12).
In 10 patients, we evaluated RMT and active MT (AMT). “RMT was defined as the minimum intensity that evoked a peak-to-peak motor evoked potential (MEP) of 50 μV in at least 5 out of 10 consecutive trials in the relaxed FDI muscle. AMT was defined as the minimum intensity that elicited a reproducible MEP of at least 200 μV in the tonically contracting FDI muscle in at least 5 out of 10 consecutive trials” (13).
In 12 patients, we evaluated input–output RC. “Motor evoked potentials (MEPs) input–output recruitment curve was performed at stimulus intensities ranging from 100 to 150% RMT (in steps of 10%). Fifteen peak-to-peak MEP at each stimulation intensities were averaged” (12).
Intracortical Paired-Pulse Excitability
In 10 patients, we studied SICI and ICF. SICI and ICF were determined according to the paired-pulse method described by Kujirai et al. (14). The intensity of the conditioning stimulus was set at 80% of AMT, while the test stimulus was adjusted to elicit MEPs with amplitudes of 0.5–1.0 mV at baseline (115–125% of RMT in healthy subjects, and ~140–150% of the RMT in patients with brain tumors). SICI and ICF were assessed at ISIs of 2 and 12 ms, respectively. The mean amplitude of the conditioned MEP was expressed as percentage of the amplitude of the unconditioned MEP. This characterized the strength of SICI and ICF.
Cortical Silent Period
In eight patients, we evaluated CSP. CSP was measured during slight tonic contraction of the right or left FDI muscle at ~10–15% of maximum force level measurements. The intensity of the test stimulus was 130% of resting MT. The duration of the CSP was measured in each trial (15).
Sensorimotor Intracortical Inhibition
In nine patients, we studied SAI and LAI, which were studied using the conditioning test protocol described by Tokimura et al. (16). The median nerve was stimulated through bipolar electrodes at the wrist (cathode proximal). The intensity was set just approximately three times the perceptual threshold. The intensity of the transcranial test stimulus was adjusted to evoke a muscle response in relaxed abductor pollicis brevis (APB) with a peak-to-peak amplitude of ~0.5–1 mV (115–125% of RMT in healthy subjects, and ~140–150% of RMT in patients with brain tumors). SAI and LAI were probed at ISIs of 20, 25, and 200 ms, respectively. The relative change in MEP amplitude induced by the peripheral stimulus was taken as a measure of SAI and LAI.
“A conditioning-test protocol as described by Ferbert et al. (17) was used to evaluate IHI of the right or left M1. IHI was studied in 8 patients. A conditioning stimulus was applied to the left or right M1, and the test stimulus was applied to the homologous right or left M1. We set the intensity of the first (conditioning) stimulus to obtain an inhibition of the test MEP to about 50% at an ISI of 10 ms. The second (test) stimulus was set at an intensity that, when given alone, would evoke an EMG response of 0.5–1 mV peak-to-peak amplitude (115–125% of RMT in healthy subjects, ~140–150% of the RMT in patients with brain tumors). IHI was tested at three conditioning-test intervals (8, 9, 10 ms)” (18).
Factorial ANOVA was computed to show differences in RMT; SAI 20 and 25 ms; LAI; SICI; ICF; IHI at 8, 9, and 10 ms; and CSP between the affected hemisphere, unaffected hemisphere, and controls. MEP RCs were evaluated in separate repeated-measures ANOVA in the different sets of subjects. We performed a two-way repeated-measures ANOVA with intensity (six levels: 100, 110, 120, 130,140, 150% of MT) as within-subject factor, and group (three levels: affected hemisphere, unaffected hemisphere, and controls) as between-subjects factor. If appropriate, post hoc t-tests were performed. Post hoc Fisher's PLSD analysis was executed for RC. Significance was set at p < 0.05. Data are given as mean ± standard error of the mean.
No participants reported any adverse effects during or after the study.
RMT and AMT were significantly higher in patients than in controls [RMT: F(2,26) = 4.03, p = 0.029; power = 0.66; AMT: F(2,26) = 4.1, p = 0.028, power = 0.65] (Figure 1). Post hoc t-tests revealed relative change only between controls and the affected hemisphere of patients [for RMT: t(1,9) = 2.6, p = 0.017; for AMT: t(1,9) = 2.2, p = 0.03].
Figure 1. RMT and AMT levels in controls and patients with brain tumors (affected and unaffected hemispheres). RMT and AMT are expressed as % of max output. *p < 0.05.
MEP amplitudes increased with increasing stimulus intensity in controls and patients. However, MEP RC was significantly less steep in patients in both hemispheres compared to controls (Figure 2). Indeed, repeated ANOVA indicated a significant effect for intensity [F(2,29) = 50.9, p < 0.0001; power = 1.0] with a significant interaction between intensity and groups [F(2,29) = 18.780, p < 0.0001; power = 1.0]. Post hoc Fisher's PLSD analysis showed that MEP amplitudes were significantly higher in control subjects compared to the affected (p < 0.001) and unaffected hemispheres of patients (p < 0.001). On the contrary, there were no differences between the RCs of both affected and unaffected hemispheres (p = 0.9) of patients.
Figure 2. RC in controls and patients with brain tumors (affected and unaffected hemispheres). Stimulus intensities ranging from 100 to 150% RMT (in steps of 10%). *p < 0.05.
Intracortical Paired-Pulse Excitability
Paired-pulse stimulation consistently produced SICI at an ISI of 2 ms and ICF at an interval of 12 ms in controls, but not so well in patients. The data showed a lower degree of inhibition and facilitation in brain tumor patients (Figure 3). ANOVA showed a main effect between patients (affected and unaffected hemispheres) and controls for ICI [F(2,27) = 3.87, p = 0.03; power = 0.65] and ICF [F(2,27) = 3.58, p = 0.042; power = 0.58]. Post hoc t-tests revealed relative change only between controls and affected hemisphere of patients for ICI [t(1,9) = 4.10, p = 0.0006] and ICF [t(1,9) = 2.13, p = 0.046], but none between controls and unaffected hemisphere of patients [ICI: t(1,9) = 1.8, p = 0.08; ICF: t(1,9) = 1.7, p = 0.1].
Figure 3. SICI and ICF in controls and patients with brain tumors (affected and unaffected hemispheres). Mean amplitude of the conditioned MEP was expressed as percentage of the amplitude of the unconditioned MEP. The relative change in MEP amplitude induced by the conditioning stimulus characterized the strength of SICI and ICF. *p < 0.05.
Sensorimotor Intracortical Inhibition
ANOVA showed a selective reduction in SAI (20 and 25 ms) but not in LAI (200 ms) (see Figure 4). For SAI, there was a prominent main effect for ISI at 25 ms [F(2,29) = 5.33; p = 0.01; power = 0.8] and 20 ms [F(2,29) = 4.29; p = 0.02; power = 0.7]. Post hoc t-tests revealed significant change only between controls and affected hemisphere of patients for SAI at 25 ms [t(1,9) = 3.6, p = 0.0015] and 20 ms [t(1,9) = 2.7, p = 0.011]. For LAI, ANOVA demonstrated no main effect [F(2,29) = 2.7; p = 0.08].
Figure 4. SAI at 20 and 25 ms, LAI at 200 ms in controls and patients with brain tumors (affected and unaffected hemispheres). The relative change in MEP amplitude induced by the peripheral stimulus was taken as a measure of SAI and LAI. *p < 0.05.
Cortical Silent Period
The duration of CSP did not differ between patients (affected and unaffected hemispheres) and controls [F(2,21) = 0.75; p = 0.48] (see Figure 5).
Figure 5. CSP and IHI at 7, 8, and 9 ms in controls and patients with brain tumors (affected and unaffected hemispheres).
Figure 5 shows also the time course of IHI in patients (affected and unaffected hemispheres) and controls. Repeated-measures ANOVA did not reveal a significant interaction between the two main factors of ISI and population for no interval [8 ms: F(2,23) = 3.17; p = 0.07; 9 ms: F(2,23) = 2.34; p = 0.11; 10 ms: F(2,23) = 2.82; p = 0.08].
Our data yielded three main findings. First, affected and unaffected hemisphere excitability in patients with brain tumors was reduced compared to healthy controls. Second, SICI, ICF, and SAI were lower in the affected hemisphere. Third, IHI, LAI, and CSP showed no differences between patients and healthy controls. These findings indicate that the effects of brain tumors on cortical excitability are mostly localized to the affected hemisphere.
Effects on Corticospinal Excitability
MT is an indicator of cortical excitability reflecting membrane excitability (19). In our study, RMT and AMT were significantly higher in patients, especially in the affected hemisphere, than in healthy controls. This result may be due to a reduced density and number of corticospinal neurons in relation to motor impairment. However, in our study, only one patient had a moderate left upper limb weakness. In addition, higher MT may predict a poor motor outcome in patients with brain tumors (20). Picht et al. speculated that patients initially without hemiparesis but with high RMT were at a higher risk in the long term of a decline in motor function (20). Rosenstock et al. studied abnormal RMT interhemispheric ratio was related to a higher risk for poor postoperative outcome in the 1st week, but not in the following 3 months (7). Similar to previous findings, Neville et al. reported an increase in MT in patients with brain tumors (10). Furthermore, in stroke patients, Swayne et al. (21) demonstrated that corticospinal excitability of the affected hemisphere, measured as AMT and RMT, increased in the acute phase, but this increment became weaker at 3 months and it continued for 6 months (chronic phase of stroke). The authors concluded that, in the chronic phase of stroke, the motor function could be dependent on the reorganization of alternative cortical networks (21). Moreover, our data show that MEP RC was significantly less steep in patients in both hemispheres compared to controls. RC illustrates a graded profile of cortical spinal tract (CST) function, providing a more global measure of cortical excitability than MT (22). Alterations in the slope of the RC can predict more substantial CST damage, motor impairment, and poor recovery in patients with brain injury (23). RCs are widely used in stroke because they are believed to reflect CST gain and output from the primary motor cortex (24). In our study, MEP RC was significantly less steep in patients in both hemispheres compared to controls. Experimental data in animal model suggest that glioma cells release high amounts of glutamate resulting in excitotoxicity and tumor invasion (25, 26). Therefore, it is likely that excitotoxicity at a chronic stage may result in a significant loss of motor neurons within primary motor area and a loss of CSTs as indexed by the increase in RMT and AMT and by the reduced slope of RC. The excitotoxicity promoted by infiltrating glioma cells may also in turn affect fast-spiking GABAA interneurons, and a reduced GABA availability may create a vicious circle where increased pyramidal neurons firing amplify glutamate excitotoxicity (27), producing neuronal cell death (see below).
Effects on Cortical Excitability
We showed that SICI, ICF, and SAI are reduced in the affected hemisphere compared to the unaffected and healthy controls. On the other hand, there were no significant differences of LAI and CSP between patients and healthy controls. SICI is mediated by GABAA receptors, while CSP is a marker for the excitability of long-lasting (presumably GABAB) intracortical interneurons. Conversely, ICF is mediated by glutamate and is associated with excitatory cortical circuits (28–30). In a case report, only the lack of inhibition, assessed by SICI, had been demonstrated in two patients with focal motor seizures caused by a circumscribed glioblastoma or metastasis (31). The results of our study are in agreement with similar findings of Neville et al., who reported an alteration of SICI and ICF in the affected hemisphere (10). The novel finding of a reduced SICI and ICF in the affected hemisphere could be caused by the simultaneous selective reduction in GABAergicA inhibition and glutamatergic excitation because of either reduced excitability or loss of inhibitory/excitatory neurons or changes in GABAergic/glutamatergic receptor function. The presence of a disruption of GABAA mechanisms in the affected hemisphere could explain the high percentage of seizures (50%) in our population. On the other hand, this disinhibition could also be an adaptive plastic mechanism recruited by the affected hemisphere to counteract the reduced overall excitability caused by tumor-related brain edema and swelling (see above). These findings parallel evidences in stroke patients where SICI is reduced in the affected hemisphere in the first 6 months with normal CSP and may contribute to cortical reorganization and recovery (32).
This reduced GABAA intracortical inhibition is in line with several findings coming from the bench side. The largest class (40–50%) of GABAergic interneurons is represented by fast-spiking, parvalbumin-positive cells, which are present in all layers and form synapses on the soma and proximal dendrites of pyramidal cells (33). Several pieces of evidence in animal models have demonstrated a loss of fast-spiking interneurons, and more in general a reduced firing rate in the peritumoral glioma area (34). This dysfunction of fast-spiking GABAa interneurons is critically involved in tumor-associated epileptic seizures (34).
Interestingly, it has been demonstrated that the selective optogenetic stimulation of parvalbumin-positive GABAA interneurons induces a significant reduction in glioma cell proliferation (27). Human glioblastoma cells may express functional GABAA receptors, and that endogenous GABA release may attenuate tumor proliferation (35). On the other hand, pyramidal cell stimulation enhances cell proliferation in tumor mass (36). It is likely that fast-spiking GABAA interneuron vulnerability to tumor-induced excitotoxicity may trigger a vicious circle where reduced GABA availability may increase pyramidal neuron firing, producing an enhanced tumor growth. Future studies in humans are needed to better understand the relationship of SICI with tumor proliferation.
Another important finding was a selective reduction in SAI (20 and 25 ms) but not in LAI (200 ms) in the affected hemisphere. LAI and SAI are mediated through different sensorimotor circuits. SAI is controlled by muscarinic neurotransmission (37). LAI is significantly understudied compared to SAI, and the neural circuitries underlying these phenomena are unclear (38). SAI has been used to assess and predict functional recovery following ischemic stroke, where larger SAI reductions correlate with improved long-term recovery 6 months following injury (39). The presence of a reduced SAI in the affected hemisphere of patients with brain tumor needs to be better investigated in future longitudinal studies, especially in low-grade glioma, to see if SAI reduction is heralding a good recovery after surgical operation.
Effects on IHI
Our study demonstrates no differences in IHI between patients and controls. The normalcy of IHI confirms previous evidence suggesting that a physiological interplay between the two primary motor cortices is required to maintain a good motor function in patients with brain tumor (40). In a very elegant study, brain connectivity was measured in patients with glioma using task-free functional MRI to probe motor networks. Patients with motor weakness showed reduced interhemispheric and left primary motor cortex and the right premotor area connectivity compared to healthy controls. Conversely, in patients without motor deficit, motor performance assessed on the grooved pegboard was not related to interhemispheric connectivity, which was unchanged but correlated with ipsilateral connectivity between the premotor area and supplementary motor area (40).
The absence of motor impairment in our cohort of patients could be explained by the normalcy of transcallosal connection evaluated using the IHI. Indeed, Otten et al. showed that an integrity of transcallosal pathway between the two motor areas is needed to maintain a normal motor function (40). Since TMS is a non-invasive technique, future longitudinal studies are warranted to explore the role of IHI to predict motor outcome in patients with brain tumor.
This study investigates cortical–cortical and cortical–spinal excitability in patients with brain tumors using a more extensive TMS protocol. Different measurements of cortical excitability are abnormal in brain hemispheres affected by tumors, but further studies are needed to determine their relationship to motor impairment and subsequent motor recovery. Finally, it will be important to explore the correlation between brain tumor molecular features and the impairment of cortical excitability in a lager sample population.
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by AOU G. Martino. The patients/participants provided their written informed consent to participate in this study.
CT, GR, GM, SC, and FA contributed to the acquisition, analysis and interpretation of data, and writing of the first draft. VR and AQ were responsible for the conception and design, data acquisition, analysis and interpretation as well as the review, and critique of the manuscript. MQ, PG, and AG contributed to interpretation of data and the review and critique of the final manuscript. All authors contributed to the article and approved the submitted version.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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38. Turco CV, El-Sayes J, Savoie MJ, Fassett HJ, Locke MB, Nelson AJ. Short- and long-latency afferent inhibition; uses, mechanisms and influencing factors. Brain Stimul. (2018) 11:59–74. doi: 10.1016/j.brs.2017.09.009
39. Di Lazzaro V, Profice P, Pilato F, Capone F, Ranieri F, Florio L, et al. The level of cortical afferent inhibition in acute stroke correlates with long-term functional recovery in humans. Stroke. (2012) 43:250–2. doi: 10.1161/STROKEAHA.111.631085
40. Otten ML, Mikell CB, Youngerman BE, Liston C, Sisti MB, Bruce JN, et al. Motor deficits correlate with resting state motor network connectivity in patients with brain tumours. Brain. (2012) 135:1017–26. doi: 10.1093/brain/aws041
Keywords: cortical excitability, brain tumors, transcranial magnetic stimulation, motor function, recovery
Citation: Rizzo V, Terranova C, Raffa G, Cardali SM, Angileri FF, Marzano G, Quattropani MC, Germanò A, Girlanda P and Quartarone A (2021) Cortical Excitability and Connectivity in Patients With Brain Tumors. Front. Neurol. 12:673836. doi: 10.3389/fneur.2021.673836
Received: 28 February 2021; Accepted: 29 June 2021;
Published: 26 August 2021.
Edited by:Pierpaolo Peruzzi, Brigham and Women's Hospital and Harvard Medical School, United States
Reviewed by:Claudia Katharina Petritsch, Stanford University, United States
Tomofumi Yamaguchi, Juntendo University, Japan
Copyright © 2021 Rizzo, Terranova, Raffa, Cardali, Angileri, Marzano, Quattropani, Germanò, Girlanda and Quartarone. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Vincenzo Rizzo, firstname.lastname@example.org

domain: medical


MediaPad M2 launched in Paris, France, over this weekend, with an Huawei P8 inspired design.
Huawei has quietly announced over the weekend in Paris, a new MediaPad series tablet dubbed MediaPad M2. The newest tablet draws key design features from the flagship smartphone Huawei P8, announced not long ago in London alongside P8 Max.
The MediaPad M2 feature an anodized Aluminium housing, encased in which sits an 8-inch IPS Full HD display. The M2 is powered up by an 64-bit octa-core HiSillicon Kirin 930 processor clocked at 2GHz coupled by 2GB of RAM. It comes in either 16 or 32GB variants with a microSD card slot included, 8MP and 2MP cameras, 4,800 mAh battery, Android 5.0 Lollipop with Emotion UI 3.0 on top of it and there’s also WiFi a/b/g/n/ac, Bluetooth 4.0, NFC and 4G LTE (sim slot) connectivity.
Huawei MediaPad M2, which is sequel to MediaPad M1 from last year, measures only 7.8mm in thickness and it weighs 310 grams. It will be available in Europe for 349 Euros.


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Ask any Friends of Acadia staff member for their favorite spot in Acadia, and they’ll likely answer, “the place I went yesterday!” With Acadia in our backyard and inhabiting a very special place in our hearts, it’s impossible to choose just one place. Still, a number of spots consistently rise to the top.
Homans Path on Dorr Mountain
Giant Slide Trail
Day Mountain summit
Echo Lake Bluffs
The Bowl on the Beehive
With Small Kids
Hunters Beach (easy hiking and oceanside exploration)
Wonderland (easy hiking and oceanside exploration)
Echo Lake Beach (swimming)
Witch Hole carriage road loop (biking, skiing, strollers, walking…)
If you have only limited time in Acadia…
You’ll probably focus on Mount Desert Island. These suggestions are all in that area.
1) Drive or take the Island Explorer around Ocean Drive. Stop at the Wild Gardens of Acadia, Sand Beach, and/or Thunder Hole.
2) Get to the top of a mountain (any mountain!) by car or by foot. If hiking, take a “South Ridge” trail (for sweeping views) or a trail featuring iron rungs/ladders.
3) Get out on the carriage roads, on foot, bike, ski, or horse. Two recommendations: around Eagle Lake, Jordan Pond Stream.
4) Have popovers at the Jordan Pond House. Take time to walk at least part way around Jordan Pond, and go see the Jordan Pond Gate House.
5) Watch a sunrise or sunset from a pink granite ledge (either at sea level or from a mountaintop!).
6) If you have time, take a boat trip to see Mount Desert Island from the water.

domain: geography


text: Lead monoxide (PbO) is a potential solid lubricant for use at elevated temperatures in oxidizing environments. The objective of this research was to grow thin films of PbO by Pulsed Laser Deposition (PLD). Film stoichiometry, crystallinity, and chemistry were adjusted by varying substrate temperature and O2 partial pressure during deposition and the effects of changes in film properties on friction coefficients and wear lives were investigated. Chemistry and crystallinity were evaluated using X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, and glancing angle X-ray diffraction (XRD). Friction coefficients and wear lives were measured in dry nitrogen and at room temperature using a ball-on-flat tribometer. Films deposited at room temperature retained the crystal structure of the target material, but were oxygen deficient. The O/Pb ratio was increased by raising the O2 partial pressure and by increasing the substrate temperature during deposition; the crystal structure and orientation changed with stoichiometry. Friction coefficients ranged from 0.20 – 0.45 and the wear lives were typically less than those obtained from MoS2 films.

domain: literature


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SteveR Posted April 9 Share Posted April 9 Was diagnosed with stage 1a NSCLC in December 2018. Had a lobectomy with no further treatment. Fast fwd to June 22 when I had a pain in my hip that appeared very suddenly. Orthopedic doc said it was a soft tissue injury. CT however revealed a lytic lesion. In January my pelvis fractured due to the lesion. My pelvis was stabilized and the lesion was removed. Follow up scans indicate NED. 1 oncologist wants me to begin systemic therapy. Another says to wait. I'm not quite sure what to do. Targeted therapy is no available. Physicians keep telling me it's treated like a chronic disease. What does that mean. I'm only 55 years old. I want to live a long life. Is that possible? Thanks in advance! Tom Galli 1 Quote Link to comment Share on other sites More sharing options...
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Paolo Roversi’s Secrets is a beautifully printed book released in connection with an October 2013 exhibition at the Fotografiska Museum. It contains unbound folded pages with a card DJ and sturdy slipcase. Roversi is an influential photographer, whose romantic and poetic Polaroid images have been printed in the world’s leading fashion magazines for almost forty years. With his personal attitude towards fashion and the aura of mystery that surrounds his pictures, he has created a world of his own, somewhere between dream and reality.
Out of stock

domain: library


This specific ISBN edition is currently not available.View all copies of this ISBN edition:
The standard work on the Hawker heavy fighter from the development of the Typhoon and Tornado as interceptors in the late 1930s to the final service of the Tempest a decade and a half later. It covers the attributes of the aircraft, developmental and operational problems, roles of the Typhoon and Tempest during World War II, and veterans' memories of the aircraft. Profusely illustrated, with maps, color views and more. Details of all squadrons, losses, performance and production data. An essential resource for the Hawker historian.
"synopsis" may belong to another edition of this title.
Book Description Arms & Armour, 1988. Hardcover. Condition: New. Never used!. Seller Inventory # P110853688788
Book Description Arms & Armour, 1988. Condition: New. book. Seller Inventory # M0853688788


(SACRAMENTO) – Governor Newsom signed AB 1628, authored by Assemblymember Robert Rivas (D-Hollister). “I am thrilled that Governor Newsom has signed AB 1628 into law, a critical step towards achieving environmental justice for communities that too often bear a disproportionate share of harmful pollution,” stated Rivas.
(SACRAMENTO) – Assemblymember Robert Rivas (D-Hollister) released the following statement on the Trump Administration’s illegal decision to revoke California’s authority to combat air pollution from vehicle tailpipe emissions.
(SACRAMENTO) –The California State Legislature passed AB 936, authored by Assemblymember Robert Rivas (D-Hollister), which improves the state’s preparedness to protect people and communities from a potential spill of nonfloating oil.
(SACRAMENTO) – The California State Legislature has passed two strong environmental justice bills, AB 1252 and AB 1628, authored by Assemblymember Robert Rivas (D-Hollister). The two bills take important steps to assist and empower low-income and minority communities throughout California. The legislation, which enjoyed bi-partisan support, now heads to the Governor for consideration
(SACRAMENTO) – Today, the California Legislature passed AB 1783, legislation introduced by Assemblymember Robert Rivas (D-Hollister) to provide quality, dignified housing for farmworkers in California. AB 1783 will now be considered by the Governor.
“I am proud of my colleagues in the Legislature, who have stood up for the needs of farmworkers and their families,” said Rivas. “This bill will provide the opportunity for children of farmworkers throughout the state to climb out of homelessness and move toward the California dream.”
(SALINAS) – Today, Assemblymember Robert Rivas (D-Hollister) responded to the mass shooting at the Gilroy Garlic Festival on Sunday, July 28, 2019.
“I was devastated to learn about the shooting at the Gilroy Garlic Festival last night. My heart breaks for the families who are suffering because of this outrageous violent attack. This senseless act has left many injured and claimed the lives of three young individuals, including Stephen Romero, who was just six years old.”
(SACRAMENTO) – Today, the California State Senate Housing Committee passed AB 1783, legislation introduced by Assemblymember Robert Rivas (D-Hollister) that creates a streamlined process to build dignified, family-friendly housing for farmworkers in California. The bill passed with a vote of 7 - 3 and now heads to the Senate Governance and Finance Committee.
“This is a humanitarian crisis, and I believe we have a moral responsibility to act,” explained Assemblymember Robert Rivas, who himself grew up in farmworker housing. “AB 1783 helps make it easier for farmers and non-profit organizations to build dignified, family-friendly housing for the workers who keep us fed and help drive our agricultural communities and state economy. I thank the members of the committee for their support and implore more Senators to step up to make this opportunity a reality for our farmworker families.”


I have a S&W 317 Airlight. A few weeks ago, I loaded it and hid it well in my bedroom. Today, I decided to retrieve it, and I was surprised to find that I could not eject the rounds. I eventually used my cleaning rod to gently push each round out of the cylinder from the front; even then, each one took a firm push to get out. Upon inspection, it looks like there is a slight corrosion around the copper-coated bullet (not the brass). I've cleaned the cylinder and stored the revolver empty this time. But anyone have a clue where this corrosion might have come from? I did clean the gun just prior to loading and storing it, if that matters.


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This story was produced in partnership with the Center for Public Integrity
Meridian is not alone under the DOJ magnifying glass. In a somewhat similar case in Tennessee, the DOJ says the Juvenile Court of Memphis and Shelby County has failed to inform children of the charges against them and of failing to make sure the children know what their legal rights are ahead of questioning. Like Meridian, the juvenile court is also accused of failing to hold timely hearings. There are varying definitions of a school-to-prison pipeline, said Jim Freeman, senior attorney at Advancement Project, a nonprofit legal action group that fights racial injustice. “How I like to define it,” Freeman said, “is the use of policies and practices that increase the likelihood that young people become incarcerated.”
That includes at-school arrests for minor behavioral incidents, as well as what he calls more indirect actions, like suspensions, expulsions or references to juvenile court or alternative schools.
The first time I skipped school I was 13 years old. Up until then I had achieved perfect attendance for eight years. But in ninth grade I put an ignominious end to my record. That year, I had a friend, Jack, who lived down the street. His parents both went to work early, and he was left to his own devices to get to school.
Lesbian, gay, bisexual and transgender (LGBT) youth across America are facing a crisis in the juvenile justice system as a result of harmful discrimination in their homes, schools and communities. Recent studies demonstrate that continued harassment of LGBT youth in their schools place them at a higher risk for involvement with the system. LGBT youth are more likely to skip school to avoid victimization and in the process face truancy charges. Additionally, other LGBT students end up in the system on assault or disorderly conduct charges after they try to defend themselves against bullying by their classmates. In other instances, LGBT youth are disproportionately targeted by school officials for punishment, often referring them to juvenile court for conduct that is more appropriately handled in school.
We moved to Clayton County, GA in 1974. I was 14 years old. I had lived in nine different cities from California to New York, and back to our southern roots when my father was transferred to the Centers for Disease Control and Prevention (CDC) in Atlanta. My childhood took me many places. I met a lot of kids of all physical, emotional, spiritual, and social shapes and sizes. Benjamin Disraeli once said that “Travel teaches toleration.” In hindsight I must agree with the former British Prime Minister. My travels have introduced me to different religious beliefs, political and social thoughts, and people of all colors and cultural backgrounds. My childhood friends were white, black, red, yellow, and brown. They were Jewish, Buddhist, Hindu, Islamic, Christian of all denominations, atheist, and agnostic. They came from families of varying political persuasions from conservative to liberal, from Republican to Democrat to Independent, and with economic tastes from capitalism to socialism in varying degrees.
My many childhood friends from coast to coast in a thirteen year time span expanded my understanding of diversity and taught me to be tolerant of those with different cultures and beliefs. However, toleration, I have learned, is a double edge sword. In the words of Edmund Burke, “Toleration is good for all, or it is good for none.” The determinative question when the tolerant sword is cutting is “Which side of the sword is doing the cutting?” Is it the cutting edge that promotes the acceptance of people regardless of their differing beliefs or the edge that promotes the acquiescence of conduct hurtful toward others? The former is good for al l, the latter is good for none. This concept of toleration raises an interesting paradox when applied to the arrest of kids on school campuses. I think we can all agree that there should be no toleration of student disruption of any kind. I helped to raise three children. They are now adults and doing quite well. All my kids attended public schools.

domain: sociology


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Home » Games » Find katherine Heigl
Find katherine Heigl by yotreat
By Using your observing skills find Alphabets katherine Heigl
Attract your valentine by giving gorgeous gifts! Find some hidden gifts among the pictures.
Romantic Bike ride!! Make couple’s bike ride more joyful by helping them to kiss each other.
Start New Year bash by finding the hidden objects in grant manner.
Christmas Time! Santa Claus needs to collect gifts for kids
Do naughty things while you are with girlfriend.Yes seduce other girl without getting noticed by girlfriend and other people.
Guide Andrew the Droid through 25 levels in three different worlds, solve puzzles and gain new amazing skills.
Control the little monster and destroy everything you can found on the city
Defend yourself from the alien invasion shooting your way out and uncover the secret image.!!!
The warrior doll must to get in combat, give her the perfect look for the battle.

domain: game


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Are you considering getting All-on-4 Implants? This procedure is becoming increasingly popular as an effective way to replace missing teeth. But before you make a decision, it’s important to understand what All-on-4 Implants are and what they can do for your smile. In this article, we’ll provide you with all the information you need to know about All-on-4 Implants.
Benefits of All-on-4 ImplantsAll-on-4 implants provide an array of advantages over other tooth replacement options. The most obvious benefit is that they require only four implants per arch, reducing the cost and complexity of treatment.
Additionally, the implants are typically placed in a single procedure, meaning that patients can receive a full arch of teeth in as little as one day. Another major benefit is that All-on-4 implants provide superior stability compared to other implant options. This makes them ideal for patients who have experienced significant bone loss due to periodontal disease or aging. In addition, All-on-4 implants are also less invasive than other tooth replacement options. This means that patients will experience less post-operative discomfort and a quicker recovery time. Finally, All-on-4 implants provide a natural looking smile and feel like real teeth. This allows for improved self-confidence and improved quality of life.
What are All-on-4 Implants?All-on-4 implants are a type of dental implant that can replace an entire arch of missing teeth in just one day.
They consist of four dental implants that are inserted into the jawbone, and a full set of prosthetic teeth is then attached. This is a less invasive alternative to traditional dental implants, which require multiple implants to be placed in the jawbone. All-on-4 implants use a specially designed angle to ensure that the implants are properly placed in the jawbone for maximum stability. This allows the implants to support a full arch of prosthetic teeth, rather than just one or two implants being used to support individual teeth.
The angle also helps to spread the load of the prosthetic teeth, reducing stress on the jawbone and making the whole process less invasive. The All-on-4 implant system is typically used on patients who are missing all or most of their teeth. It can also be used to replace severely damaged or decayed teeth, as well as patients who have suffered from bone loss due to gum disease. The system is a viable option for many patients who may not be able to receive traditional dental implants due to bone loss or other factors.
Who Is a Good Candidate for All-on-4 Implants?All-on-4 implants are an ideal solution for many people who are missing teeth or need to replace existing dental work. The procedure is suitable for those with a healthy jawbone who need to replace a full arch of teeth, or those who are missing multiple teeth.
Generally, patients who are good candidates for All-on-4 implants have healthy gums and can commit to good oral hygiene practices. In addition, those who have had difficulty wearing dentures may be ideal candidates for the All-on-4 implant system. This is because the implants provide a permanent and secure solution that won’t move or shift in the mouth. Those who grind their teeth or suffer from TMJ problems may not be good candidates for the procedure. Finally, patients should also have realistic expectations of the outcome of the procedure.
All-on-4 implants can provide a beautiful and natural looking smile, but they won't be able to replicate natural teeth exactly. Patients should also be aware of the cost and commitment involved with the procedure before deciding to pursue it.
Procedure for All-on-4 ImplantsThe All-on-4 procedure is a revolutionary dental implant system that can provide a full arch of teeth in just one day. The procedure begins with the patient receiving a thorough dental examination to ensure they are a suitable candidate for the treatment.
During this exam, the dentist will take X-rays and create a 3D model of the patient’s mouth to plan the placement of the implants. Once the initial exam is completed, the patient will be prepared for the implant surgery. During the procedure, the dentist will use special instruments to carefully place four titanium implants into the jawbone. These implants act as the foundation for the new teeth.
After the implants are in place, the dentist will attach abutments, or posts, to the implants. These posts will help to secure the new teeth in place. The dentist will then take impressions of the patient’s mouth and send them off to a laboratory to be crafted into custom dentures. Once the dentures are ready, they will be placed onto the abutments and secured in place with special screws.
The patient can then enjoy their new teeth immediately!
Types of All-on-4 ImplantsAll-on-4 implants are a revolutionary dental implant system that can provide a full arch of teeth in just one day. There are three main types of All-on-4 implants available. These are: Conventional Implants Conventional All-on-4 implants consist of four titanium posts that are surgically implanted into the jawbone. These posts act as anchors for a custom-made prosthetic arch of teeth.
This type of implant is ideal for those who have enough healthy jawbone to support the implant posts.
Zygomatic ImplantsZygomatic implants are a variation of the conventional All-on-4 implant. These implants are longer than conventional implants and are placed directly into the cheekbones instead of the jawbone. This type of implant is ideal for those who do not have enough healthy jawbone to support conventional implants.
Subperiosteal Implants Subperiosteal implants are placed on top of the jawbone instead of underneath it. This type of implant is ideal for those who do not have enough healthy jawbone to support either conventional or zygomatic implants. All-on-4 implants offer numerous benefits, including improved aesthetics, increased comfort, and improved chewing ability. They also require less invasive surgery and have a faster recovery time than traditional dentures.
Recovery From All-on-4 ImplantsAll-on-4 implants are a relatively simple and straightforward procedure that can be completed in just one day, and the recovery process is often surprisingly quick. The patient can generally expect to see the final results within three to six months after the surgery.
It's important to note, however, that the recovery period may vary depending on the individual, and it's important to follow all of your dentist's instructions carefully to ensure a successful outcome. Immediately following the procedure, your mouth will be swollen and sore, but this should subside within a few days. Your dentist will likely prescribe you pain medication to help you manage any discomfort you may experience during the initial stages of recovery. Additionally, they may also suggest anti-inflammatory medications or antibiotics if needed.
The first few weeks after surgery are especially important for the healing process. During this time, your dentist will likely ask you to follow a special diet, avoid strenuous activities, and not touch or disturb the area around the implants. Your dentist may also recommend that you use special oral care products to keep your mouth clean and promote healing. This may include special rinses or gels that contain antimicrobial properties. After about six weeks, your dentist will likely check on your progress to ensure that the implants are properly healing and that the jawbone is fusing with the implant.
Once this process is complete, you can then begin using the implants for everyday activities such as chewing and speaking.
Costs and Risks of All-on-4 ImplantsCosts of All-on-4 Implants The cost of All-on-4 implants can vary greatly depending on the complexity of the treatment, the type of implants used, and the location of the dental clinic. Generally speaking, All-on-4 implants cost between $25,000 and $40,000 in the U.S. The cost is typically lower in other countries, such as Mexico, India, and Costa Rica. It is important to understand that the cost of All-on-4 implants includes not just the implants themselves, but also the cost of the surgery, x-rays, anesthesia, and follow-up visits.
Risks of All-on-4 ImplantsAll-on-4 implants are generally considered a safe procedure with few risks or complications. However, there are some potential risks to consider. These include pain and swelling at the implant site, infection, nerve damage, and implant failure. It is important to discuss any potential risks with your dentist before undergoing All-on-4 implant surgery.
Your dentist can help you decide if this type of procedure is right for you. All-on-4 implants are an innovative and revolutionary type of dental implant that can provide a full arch of teeth in a single day. These implants are suitable for those missing all of their teeth, or who want to replace existing dentures. They offer a number of benefits, including improved stability, increased comfort, and reduced recovery time. All-on-4 implants can be made from a variety of materials, including zirconia and titanium, depending on the patient's needs and preferences.
The procedure for All-on-4 implants is relatively simple, with minimal discomfort and a relatively quick recovery period. However, it is important to remember that these implants are not suitable for everyone, so it is important to consult with your dentist to determine if this type of implant is the best option for you. Ultimately, All-on-4 implants are a great option for those looking to restore their smile.


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TopoGrow D-Door 96"x48"X80" Indoor Grow Tent Room 600D Mylar High Reflective Non Toxic Hut 8'x4'
- UPC: 612324130174
- Brand: TopoGrow
- Size: 96"X48"X80"
- Manufacturer: TopoGrow
Description: Our grow tent has all stable construction, 600D oxford cloth outside and 96% highly reflective waterproof diamond Mylar inside, with exterior zippers design ensure safety use and easy to set up. And it also has multiple vents to accommodate fans and filter. Great for you to grow exotic fruits, herbs, vegetables or seasonal fruits out o... [read more]

domain: agronomy


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Fall prevention programs are now considered to be one major area of focus for the nursing care aspect, especially for the long term care in the resident group of patients. Taking a look at this program, some level of successes has been achieved at various levels, especially in the aspect of enhancing the patient experience. Some of the programs are now referred to a national patient safety priority which is meant to help achieve quality improvement strategy (MacLaurin & McConnell, 2011). Avoiding falls, or fall prevention strategies are major specific safety concerns in nursing practice that help the patient avoid falling, or associated injuries.
Falls is a major public health challenge worldwide. Hospitalization has been noted to contribute to increase the chances/risks of falls worldwide (Dykes et al., 2011). The main reasons noted for this change relates to the associated unfamiliar environment, the illness and treatment modalities. The results or consequences of the fall are usually devastating to patients, family members and healthcare personnel in charge of the patient.
Nurses are the major health professional that spends the most time with patients. This creates an important attachment/integral role in keeping the patient safe hence it is important for the nurse to understand effective measure/modalities that help or can be instituted to achieve fall reduction goals. It is an important protocol/modality to ensure that patients and the families are engaged in the safety discussion for better understanding and reduction of falls (Nitz et al., 2014).
Another important measure is a continuous monitoring of patient at risk especially while toileting. Shortening of pajama length to prevent tripping is also very important (Stanford hospital & clinic, 2013). Fall prevention committees are created to ensure close monitoring, especially of those at risk and gathering of information from nurses whose patient fell. This is to understand those factors causing a fall at such hospital (Stanford hospital & clinic, 2013).
The use of a fall prevention tool kit in hospital settings has been found to significantly reduce the patient fall rate when compared to the usual care programs in similar settings (Dykes et al., 2011). It is also important to note that educating those nurses at the control units still plays a great role in fall prevention.
Various approaches have been tried to help reduce the associated risk simply because of the health hazards and problems that falls are liable to cause. Such measures that seem to be currently used by nurses or built for those that are under nursing care are the; modifications placed in home and health care environment to reduce the risk (Kozier, 2008). This modification can be considered for patients, especially those on the wheel chair. They need modifications that will support and secured them because of their status and simply because they are prone to falls. In such situations side rails and safety bars for toilets, wheel locks on beds & wheelchairs are all beneficial in fall prevention measures. It is important to understand that the patient's health condition and management status play a major role in determining the fall prevention strategies or measures that can be used for such patient (Kozier, 2008).
Measures can also be classified as Stairs, Handrails, floor coverings, and orientations (Kozier, 2008). These listed measures are newer categories of measures that are focused majorly on prevention of falls by older adults. In the case of stairs, obstruction caused by protruding objects needs to be removed, proper lighting of each tread needs to be considered while the edge of the tread needs to be made with contrasting colors.
It is important to understand that materials that can cause obstructions, such as excess furniture and equipment needs to be removed, while patients, that are not very strong needs to be monitored in terms of what such patients wear (Kozier, 2008). They need to wear rubber-soled shoes or slipper that will make the walking easier (Nitz et al., 2014). Nurses also need to consider the need to remove clutter from halls, stairs and traffic areas around any patients at risk. Patients that are in need of aids or uses aids already needs to be ensured that such uses walking sticks, crutches or walkers that are made with rubber tips (Kozier, 2008).
The major rationale for the stairs aspect of measures is that of ensuring that there is a uniform size stairs which will lessen the need for continuous vision adjustment for older adults (Kozier, 2008). When the colors are made in a way to also consider their visions that can't adjust also easily, it tends to reduce the falls that could occur in such areas. Handrails need to be installed in such a way that makes it slip resistant, and firm. Once the handrail is installed in the bathrooms, it allows the patient to have a good support while rising to standing position. It also needs to be constructed with 5cm distance to the wall so that the patient or person can grasp the handrail easily (Kozier, 2008).
For older adult, the floor covering is an essential measure, which ensures that there is a reduction in the chances of slipping. Patients are ensuring they wear properly fitting shoes or slippers that will not skid on such surfaces (Nitz et al., 2014). Carpets, mats and tiles around where this group of patients is must be secured so as to prevent any form of slipping lead to fall (Nitz et al., 2014). Orientation fall prevention measures must be strategies in such a way that will ensure that patients are not disoriented. This can be achieved by ensuring that such patient at risk are frequently observed, especially by the nursing staff on duty (Barbara, 2008). Patients that are confused needs to be properly supervised so for them not to wander out of the bed. Considering the psychological aspect of restraint that is placed around patients to reduce the fall risk, such patients have the natural tendency of trying to remove such restraints. This then placed them at an increased risk if such is eventually removed. Another major problem as indicated by studies is that which states that the patient that is immobilized by restraints has the predisposition of developing pressure ulcer formation, fecal incontinence or urinary retention.
MacLaurin and McConnell from the safety research project found that there are certain important processes and outcomes that need to be considered when falls prevention and injury reduction programs are being mentioned (MacLaurin & McConnell, 2011). We need to ensure that such factors relate to outcome measures of falls per 1000 resident days, percentage of falls that cause harm, percentage of falls risk assessment completed on admission or change in status, percentage of "at risk" residents with intervention or those with restraint use. The great thing about these listed factors is that understanding the presented data plays an important role in supporting improvement.
It can be seen from the provided information that fall prevention programs or modifications has undergone various modifications which all falls to be reduces greatly. Nursing roles are essential in most of the fall prevention measure simply because of the relationship and the amount of time nurses spent with their patients. Hence it is essential to ensure nurses understand the measures and involve in the full incorporation.
Kozier, B., (2008). Fundamentals of Nursing: Concepts, Process and Practice. Developing a culture of safety and quality. Chapter 15. Page 287. Pearson Education.
Dykes C.P et al., (2011). Fall prevention in acute care hospitals. A randomized trial. US National Library of Medicine. National Institute of Health.
Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC3107709/
MacLaurin, A. & McConnell, H.(2011). Utilizing quality improvement methods to prevent falls and injury from falls: Enhancing resident safety in long-term care. Progress report. National safety council. Journal of Safety Research 42 (2011) 525–535.
Nitz et al., (2014). Outcomes from the implementation of a facility-specific evidence-based falls prevention, intervention program in residential aged care. Feature Article. Geriatric Nursing, Volume 33, Number 1.
Stanford hospital & clinic (2013). Fall prevention. Patient Centered Care. Stanford Nursing, Medical Services.
Retrieved from Stanfordhospital.org/clinicsmedicalservices/nursing/patients/fallprevent.html/


GISAGARA – Traders in Nyaruteja market in Nyanza sector, Gisagara district have complained over the sector’s decision to increase levies which they say has pushed some of them out of business.
According to the traders, the levies have been increased from Rwf 300 per day to Rwf 1500.
“The levies have increased sharply. At least it could be raised to Rwf500 because our buyers remain constant.
They are the same and still have the same means,” one trader said, adding that they were afraid of increasing prices for fear of driving customers away.
Another trader said they cannot pay high taxes without getting benefits. Some vendors have reportedly opted to operate from outside the market, to avoid the dues which they say do not match their revenues.
The new modern market was completed in 2008.
However, the Executive Secretary of Nyanza sector, Jean Bosco Uwimana said that residents have no reason to complain because the decision to set the taxes was taken after several consultations.
“Residents should not complain over the taxes because we held several meetings with them before setting the rate.
They have to know that all development activities require a financial means to be achieved,” Uwimana said.


On July 23, 2020, Secretary Ben Carson announced in a press release that the U.S. Department of Housing and Urban Development (HUD) will terminate the Affirmatively Furthering Fair Housing (AFFH) regulation issued under the Obama administration. The rule required cities and towns that receive federal funding to examine local housing patterns for racial bias and design a plan to address any measurable bias.
In its place, HUD has created a new rule, called Preserving Community and Neighborhood Choice, which defines fair housing more broadly to mean housing that, among other attributes, is affordable, safe, decent, free of unlawful discrimination, and accessible under civil rights laws. It then defines “affirmatively furthering fair housing” to mean any action rationally related to promoting any of the above attributes of fair housing. The new rule will rely on local governments to self-certify that they are furthering fair housing.
The public will not have a chance to weigh in on this new rule and it is considered final.
On March 16, 2020, CHAPA submitted comments to HUD opposing its proposed change to the AFFH rule.


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Two pubs close each day as cheap supermarket beer, high taxes and property prices threaten the traditional "local".
The average closure rate has risen to about 60 a month, according to the Campaign for Real Ale (Camra). Four-fifths of the closures are in towns but many country pubs are also suffering as cuts in bus services have added to drink?drive laws and other factors keeping drinkers at home.
Mike Benner, Camra's chief executive, said: "There is nothing to replace a well?run pub. Yet they are being lost at an incredible rate."
High demand for housing has tempted many owners to sell to developers, who often turn pubs into flats.
There are thought to be about 59,000 pubs in the UK but closures look likely to cut this by several thousand over the next few years.
Neil Williams, of the British Beer and Pub Association, said: "Pubs are facing a perfect storm of rising costs and falling demand for draught beer.
"That, coupled with the impact of the smoking ban, is making trading conditions very difficult. Your typical street-corner community pubs are the ones really feeling the pinch. The answer seems to be to diversify into offering quality food and other services. We know of some that have opened up as sub-post offices."
Camra wants a 1p a-pint cut in beer duty in next month's Budget to help encourage people back into local pubs.
Campaigners are also urging ministers to close a loophole that lets developers demolish pubs without planning permission.

domain: news


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Quilting, projects, family...life!
Bwahahahahahaha... I gotta get started on grandbaby #2's quilt. She's due in November. Also have some doll clothes to make for #1. I want her to have something special, too!Hugs!
Thank you so much for taking the time to comment!

domain: artistic


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lampe diy // abat jour récupéré + bois flotté ramassé
Walking Path Upgrade using Quikrete WalkMaker System
How To Make A Stand Cast Birdbath in Leaf Shape
22 Creative Furniture Hacks For Inventive Minds-usefuldiyprojects.com (22)
garderob under snedtak - Sök på Google
Corner Drawer for the Kitchen... HECK YA I need one of these!!! I'll take these over a lazy Susan any day
Boxy top free sewing pattern from Sew Different. It says make in 2 hours but I make it in less. Tutorial for every step of the way. I have made this top so many times - looks different in every fabric. Love it!

domain: design


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Endorsements from fellow lawyers are an important consideration for many when selecting the right attorney. Be the first to endorse your colleague!
Are you an attorney? Endorse this lawyer
|Managing Partner||rogers, wughalter kaufman corredine & zinno||1982 - Present|
|Association name||Position name||Duration|
|Bronx Bar Association||Board of Directors||1983 - Present|
|Pace University School of Law||law||N/A||1982|

domain: law


Light weight fly sheet keeping your horse free from flies. Keeps your horse cool by allowing airflow. It has a lycra join over the wither for comfort and flexibility
A light weight fly sheet which allows the air to flow through and so keeping your horse cool while keeping the flies at bay. A lycra wither joins the neck to the rug to ensure maximum comfort and flexibility.


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The staff is friendly, they treat the animals well, and are even starting to remember who Wendell is.
Welcome to Pet Spot
The Pet Spot is Cincinnati’s premier luxury pet facility. The Pet Spot combines the Midwest’s largest indoor & outdoor doggie daycare with luxury dog boarding, and top-notch grooming & training. At The Pet Spot, we strive to make your furry family member’s stay enjoyable and fun whether you are dropping your pet off for a social day in daycare, a spa treatment, extended stay in our villas, or all three!
We’re excited to welcome your Dog or Cat to The Pet Spot family!
- Sable B.
The Pet Spot is the best place to take your dog for day care or boarding. We love this place!Jessi G.
When I first walked in to gather some information, the staff was very welcoming, friendly and helpful.Becca B.
Subscribe with us for daily e-mail

domain: pet


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- John Leguizamo almost played Michael Keaton's character in "Spider-Man: Homecoming."
- The "Birdman" star said he was asked to pass on the role after Keaton wanted to be involved again.
- "They asked me if I would give it up. I said, 'Well, okay I guess,'" Leguizamo told ComicBook.com.
John Leguizamo revealed in a new interview that he almost played the villain in the 2017 film "Spider-Man: Homecoming," but lost out on the role to Michael Keaton.
"I was supposed to be the Vulture," Leguizamo told ComicBook.com's Chris Killian. "We had negotiated and I was about to play him, and they said that Michael Keaton wanted it back and they asked me if I would give it up. I said, 'Well, okay I guess.'"
"They said, 'No, we'll work with you again, we're gonna...' That's what happened there," the actor added.
According to Leguizamo, filmmakers ultimately offered him a "tiny" part in a follow-up project.
"I went, 'Nuh uh,'" Leguizamo said in the interview.
Keaton, who played superhero Bruce Wayne/Batman in 1989's "Batman" and 1992's "Batman Returns," ended up playing Adrian Toomes/Vulture in the 2017 Spider-Man film. In the story, his character faces off against Tom Holland's Peter Parker/Spider-Man. Robert Downey Jr., Donald Glover, Gwyneth Paltrow, and Zendaya also starred in "Spider-Man: Homecoming."
Leguizamo, for his part, recently starred in the 2022 Christmas action movie "Violent Night." David Harbour of "Stranger Things" fame played Santa in the film, while Leguizamo played Scrooge, a murderous villain holding a Connecticut family hostage.


Ravell Unveils New Latin House Single, "Baila"
The single is out now via KAZAA.
OFFICIAL PRESS RELEASE
NEWS PROVIDED BY
Get In! PR
LA-based DJ and producer Ravell is back with his first single of the year and second offering from his newly founded imprint, KAZAA. “Baila,” the latest from Ravell, follows his long-awaited return with the December release of his highly-lauded single “Siento,” a high-power, bass house track that reflects his rebranded sonic direction. Continuing to pay homage to his Latin roots through sound, “Baila” oozes with a high-spirited Latin-pop flair that emphasizes his freshly found signature production elements. “Baila” is out now via KAZAA.
Latin House is undoubtedly the EDM “It Girl” of the summer, but Ravell has been ahead of the trend since breaking into the scene in 2016. In 2016, he was tapped for an official remix of Spanish Pop king Enrique Iglesias and Reggeaton pioneer Wisin’s “DUELE EL CORAZON,” which amassed nearly a million streams on Soundcloud alone. A couple of years later, he worked his magic on Jesse & Joy and J Balvin’s hit single, “Mañana Es Too Late,” transforming it into a 3-minute slice of pop dance heaven. With his recently launched label, KAZAA, Ravell aims to continue blending his two favorite worlds - Latin and Dance - together to create powerful dancefloor weapons and give like-minded up-and-coming artists a platform to showcase their takes on the fast-rising genre.
“Baila” is yet another example of Ravell’s innate ability to elevate a scintillating festival bass production using Spanish vocals. Led by an alluring Spanish vocal loop, the track climaxes into an explosive bass drop that echoes Ravell’s signature hard-hitting reverberating sound. “Baila” gushes with vibrancy, liveliness, and immense energy that is sure to set any dancefloor ablaze. From start to finish, the pulsating rhythm delivers an awe-inspiring listening experience. Building upon Ravell and KAZAA’s discography, 'Building upon Ravell's established discography, “Baila” further expands upon his evolving, signature sound.
Richard Garcia, better known as Ravell, has been turning heads and captivating ears with his spellbinding, groove-forward, and energy-drenched take on house music since breaking into the scene. Taking off with releases on Kaskade's label, Arkade, and official remixes for globally known stars, Ravell went on to check off a myriad of career milestones. Ravell proved to be an unmistakable talent as he continued to secure coveted slots at some of the world’s most in-demand festivals, including Coachella, HARD Summer Festival, and Beyond Wonderland. 2019 marked a huge year for the esteemed talent, with the sold-out debut of his ‘Ravell & Friends’ party at LA’s legendary Academy Nightclub as well as the release of single, ‘Rockin,’ with close to 2 million Spotify streams to date. Ravell has spent the majority of 2021 playing notable shows such as his performance at The Hollywood Palladium with ARMNHMR and at HARD Summer’s HARDER stage and Passport Lounge. Now marking a huge turning point for the Los Angeles-based DJ and producer, Ravell has taken the time to carve out his own path in the landscape, with his newly-launched imprint, KAZAA.
Source Get In! PR
July 14, 2022 6:00pm ET by Get In! PR


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Welcome to the Marks Street Walmart in Henderson and the optometry office of Trang T. Tran O.D. and Esther H. Tan O.D. Our mission is to provide our patients with great vision and eye health. In addition to offering all types of specialty contact lenses (including soft, bifocal, monovision, toric (astigmatism), and gas permeable) we also perform comprehensive eye exams, ocular disease evaluations, and treatment for eye infections, inflammations, dry eyes and allergic eyes. Dr. Tran and Dr. Tan are both trained and experienced in screening/diagnosing ocular diseases and conditions such as glaucoma, macular degeneration, diabetic retinopathy, hypertensive retinopathy, and cataracts. We welcome adults and children of all ages. We also respond to emergency visits.
To accommodate our patients, we are open six days a week, including Saturdays and welcome walk-ins. Our payment options include Visa and MasterCard credit cards as well as many insurance plans. Below is a partial list of some of the plans we accept.
VSP (Out of Network)
Dr. Trang Tran received her Bachelor of Science degree in Biology from University of California, Irvine. In 1999, she obtained her Doctorate of Optometry from the Southern California College of Optometry . She then relocated to Las Vegas in 2000 to work for a Lasik vision center doing co-management of Lasik and other refractive surgeries. She has been in private practice at this Henderson location for more than 20 years. She is a member of Nevada Optometric Association and the American Optometric Association. Dr. Trang is committed to providing quality eye care catering to each of her patient's specific visual needs. She is fluent in Vietnamese and can also do eye exams in Spanish. In her spare time, she enjoys exercising, floral arrangements/ event plannings and spending time with her husband and two children.
Dr. Esther H. Tan received her OD (Doctor of Optometry) degree from Illinois College of Optometry in 2000. She is a member of the Nevada Optometric Association and the American Optometric Association. In addition to quality vision and patient care, Dr. Tan specializes in astigmatism, multifocal contact lenses examinations, dry eye syndrome, and treatment and management of eye infections, inflammations, and allergies. She has over 20 years of experience and has examined patients 3 years old to 103 years old! She is also able to do eye exams in Spanish. In her spare time, Dr. Tan enjoys tennis, yoga, and karaoke.
Dr. Janet Tran completed her undergraduate education from the University of California, Irvine and received her Doctorate of Optometry from the Souththern Califorina College of Optometry. Sheis an established and highly skilled optometrist with over 20 years of experience in family eye care, contact lenses, ocular disease management, LASIK and Cataract surgery co-management.
Dr. Tran’s passion is driven by the bonds she builds with her patientsand the pridein the care she provides to them.
We are located at 540 Marks Street, Henderson, NV 89014. If you would like more information about our services or to request an appointment, please call us at (702) 434-2441. Please enter your zip code or city, state below for door-to-door directions.


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This week at Google I/O, the company announced a slew of new features for Google+ – 41 new features, if you’re counting. These new additions inarguably make Google+ better: It’s smarter, more interactive, better looking, faster. Not to mention the massive upgrades to Photos and the Hangouts chatting client.
On paper, Google+ is a beautiful, compelling, rich product. So why don’t I care?
When Google’s answer to Facebook first launched nearly two years ago, I was a cheerleader. Like everyone else, I was frustrated by the lack of control I had over Facebook and the early signs of “Facebook fatigue” (a phrase we’re now gratuitously throwing around) were starting to set in. Google+ had been under wraps for years; it was like this Internet-wide Easter Egg that we were so excited to finally see.
And I tried really, really hard to like it. And I still don’t.
I will be the first to admit that there are a handful of features that make Google+ a more viable, attractive option than Facebook. (First let’s get this out of the way: I’m not going to compare G+ to Twitter or Instagram or Tumblr because it is an all-encompassing, multi-feature, no-niche-nonsense social network … comparable, really, only to Facebook. Yell at me all you want.) For starters, photos: At launch, G+ had a bevy of options Facebook didn’t – editing tools, a slicker layout, instant emailing capabilities, higher res uploads. While Facebook’s retort has been to up its own photo game – and buy Instagram – it’s certainly not giving us anything close to the same toolbox. The new photo features just make it an even more comprehensive platform for photo-sharing (although their effectiveness thus far is debatable. Still – it’s something Facebook hasn’t given us).
The new, interactive, algorithm-learning news stream is also interesting, and certainly seems like something I should favor in comparison to the Facebook News Feed/bane of my Internet existence. It’s multi-paned, it learns from me, and discovery is hugely aided by the subject auto-tagging Google’s enabled.
Google is doing so, so much with G+. It’s incorporated photo editing, GIFs, hashtags, natural language processing technology, news feed refinement … generally, all of the things we’re constantly complaining about with Facebook. But for some reason, we can’t be convinced to buy into this beautiful madness.
And that’s because it feels like it’s all for show. Look, when G+ first launched, there was a genuine clamoring for invites – a clamoring I was not immune to (I … uh … I begged. There I said it, are you happy?). But that moment was shortlived and followed by a breathtakingly fast drop in activity.
It all feels pushed, pulled, and prodded into Google+ instead of organically originating there.
Soon after this, Google started instituting ways to make you a G+ user whether you wanted to be one or not. If you wanted to have or sign up for a Gmail account, you became a G+ user. If you wanted a YouTube account, same deal. Same went for Drive, Calendar, Music … the list went on and on. This means that people have been unwittingly and unwillingly using Google+ and filling up its stream; if you upload a YouTube video or +1 something … or even use the client for Hangouts … it’s being fed into the social network.
Some people know they’re doing this and are meaningfully posting to G+ – but some aren’t, and it’s creating a false sense of social. When I look at my feed, which is notably devoid of my close friends and family, I don’t know what was purposefully uploaded to the site and what just happened to get pulled in thanks to Google’s G+ feeding agenda. It all feels pushed, pulled, and prodded into Google+ instead of organically originating there.
When I login to Facebook, I peruse my News Feed, I respond to posts, I “like,” I might post a link. But when I login to G+ (something I haven’t done in months) and actually look at the page, something just feels … off. My general feed is full of links to industry articles from people I don’t know; my friends tab is mainly links from 1-2 people. Nothing is personal or for that matter, social.
And that’s because Google+ isn’t for us – it’s for Google. At a fireside chat during I/O, Google+ developers address some of the lurking questions about why we should be using the service. “There happens to be a product at plus.google.com and an app,” said G+ director of engineering David Glazer (via Forbes). “But really it’s a way for Google to get to know our users. Who they have relationships with. We give them the ability to share. That layer, that spine, that backbone, is intended to help us make search, Maps, YouTube, Gmail, etc. better. That’s the real point of Google+.”
All the data Google could ever want to get out of a social network it’s getting, so there’s less of an impetus to really, truly create a user experience that rivals Facebook. Of course, more user activity and data is good, but the wide reach of Google’s services means that the layer of G+ is doing plenty when it comes to amassing user data – but it’s why we continue to feel unsatisfied whenever we login and actually look at Google+. Of course we’re also learning that the answer to Facebook isn’t a new Facebook, hence the rise of niche networks like Snapchat, Tumblr, and Instagram.
It’s all sort of disappointing, because there are a lot of great things about Google+, but perhaps our expectations were too high all along. We, the pundits, were the ones talking about a Facebook exodus and a Facebook Killer – not Google. Because Google never intended for G+ to be any such thing. We wanted a platform and what Google churned out was a sheep in wolf’s clothing – a feature in a platform’s disguise.
And while it’s a very, very beautiful one, you can’t reverse engineer social. Even if you really, really want to.
- Inside job: Why Zoombombing isn’t as random as you might think
- Google Assistant 2.0 isn’t just a minor evolution. It’s a game-changing upgrade


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Who can donate?
- Donors must be at least 17 years old and weigh at least 110 pounds.
- Donors must be in good health and feel well on the day of donation.
- All donors must show a photo ID at the time of donation with name and date of birth.
How often can I donate?
- Whole Blood donors may donate every 8 weeks or 56 days.
- Platelets donors may donate every 3 days.
Is it safe to give blood?
- Yes! The needle and bags used to collect the blood are used only once, and then discarded. You cannot get HIV or other infectious diseases from donating blood.
May I eat before I donate?
- Yes. It is very important to drink plenty of fluids and eat a good meal within 4 hours before donating. It is also important to have a good night's sleep before donating.
What should I bring with me when I come to donate?
- You must show a photo ID, such as a Driver's License. In addition, it is helpful if you bring the following:
- A list of medications you are taking.
- A list of places you have visited outside of the U.S. in the past 3 years.
How long does it take to donate?
- It takes about an hour to go through the steps to donate Whole Blood and a little longer for other donation types:
- Registration. Give us your name, date of birth, address and other demographic information.
- Medical Screening. Answer confidential medical history questions and have a finger stick to get a hemoglobin check from a drop of blood. Also have a blood pressure, temperature and pulse check.
- Blood Donation. Donate a unit of blood through a needle in your arm which takes about 10 minutes. This step may be longer for different donation types.
- Snacks. Stay 15 minutes after your donation and enjoy refreshments.
Does it hurt?
- There is a little sting when the needle is inserted, but you should be comfortable during the donation.
How will I feel after I donate?
- Most people feel fine after donation. You will enjoy refreshments after you donate and we will instruct you to drink plenty of fluids for the next 24 hours.
Can I exercise right after donating?
- Avoid strenuous activity and heavy lifting for about 24 hours after donation. Most donors can resume normal activity after that time.
Is my blood tested before it is used?
- Every time you donate, blood samples are taken for testing. These tests include your blood type and testing for viruses such as Hepatitis and HIV. IIf your blood tests show that your blood may make someone sick, it will not be used and you are notified. Please note we are not a testing facility. You may contact us for a list of testing facilities.
Why do I have to answer the same medical history questions every time I donate?
- To make sure that we are providing the patient with the safest possible blood, the FDA requires that we ask about your medical history every time you donate.
What blood type is the universal donor?
- Type O- is the universal donor and can give red blood cells to any other blood type.
- Type AB+ is the universal recipient and can receive red blood cells from any other blood type.
- Type AB- is the universal plasma donor and can give plasma to any other blood type.
What is the most common blood type?
- This is an average distribution of the blood types in the United States. The distribution may be different for specific ethnic groups:
- O Rh-positive - 38 percent
- O Rh-negative - 7 percent
- A Rh-positive - 34 percent
- A Rh-negative - 6 percent
- B Rh-positive - 9 percent
- B Rh-negative - 2 percent
- AB Rh-positive - 3 percent
- AB Rh-negative - 1 percent
How much blood do I have in my body?
- As a rule, women have approximately 10 pints and men have approximately 12 pints of blood.
What do the different blood components do?
- Plasma: Fluid portion of blood, contains water, albumin, hormones and clotting factors.
- Red Cells: Carry oxygen from the lungs to all the tissues in the body and return carbon dioxide to the lungs.
- White Cells: Protect against disease and infections.
- Platelets: Small plate-shaped cells that cluster together to help form blood clots when bleeding occurs.
Where does my blood go after I donate?
- After you donate, your unit of Whole Blood is divided into different components and transfused into patients who need the specific component. Some examples of how your blood is used are:
- Auto Accident: 50 units.
- Heart Surgery: 60 Red Cells, 2 Platelets from Automated Collection.
- Organ Transplant: 10-40 Red Cells, 5-10 Platelets, 20 Cryoprecipitate, 25 Fresh Frozen Plasma.
- Bone Marrow Transplant: 20 Red Cells, 25-100 Platelets.
- Burn - 3rd Degree: 20 Red Blood Cells 20 Platelets.
What blood type is needed the most?
- All blood types are needed for blood donation. We often have requests for the following:
- All donation types - Whole Blood and Platelets.
- AB donors - Plasma.
- O, A and B donors - Red Cells.
Does the Stony Brook Blood University Blood Bank pay donors?
- The Stony Brook University Blood Bank depends on the generosity of volunteer donors since studies have shown that the safest blood comes from volunteer donors.


text: Dr. Decesari is senior researcher at the Institute of Atmospheric Sciences and Climate (ISAC) of the National Research Council of Italy. He has been working in the field of physical and chemical processes in multiphase atmospheric systems (aerosols and clouds) for 20 years. He is a specialist of atmospheric organic aerosol chemistry with documented experience on biomass burning aerosols and biogenic organic aerosols. He has developed original methodologies based on nuclear magnetic resonance (NMR) spectroscopy for chemical characterization and source attribution of complex organic atmospheric particulate matter. He is author or coauthor of more than 100 peer-reviewed publications (H-index = 49). He took part to ten EU research projects dealing with atmospheric particulate matter climate and air quality impacts, and he coordinated three international experimental field campaigns. He coordinated the EU project “Himalayan Brown Cloud” (FP7 MSC IEF) focusing on the combustion aerosols impacts on the high Himalayan environment, and he is currently coordinator of the 1 M€ project “IPA/BC-Monitor” (POR FESR 2014 – 2020 Emilia-Romagna) dealing with the development of an innovative instrument for monitoring black carbon and organic pollutants. He is board member of the Italian Aerosol Association and member of the atmospheric working group of the International Arctic Science Committee (IASC).

domain: chemistry