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Ownership and use of insecticide-treated nets during pregnancy in sub-Saharan Africa: a review
Megha Singh1,
Graham Brown1 &
Stephen J Rogerson2
Over the past decade, significant gains have been made in the implementation of malaria prevention measures in pregnancy in sub-Saharan Africa, including the distribution of insecticide-treated nets (ITNs). These have been shown to cause a reduction in the incidence of malaria and its consequences such as maternal anaemia, stillbirths and intrauterine growth restriction. Currently most nations in Africa have policies for distributing ITNs to pregnant women through various mechanisms, however coverage remains well below the targets. This review summarizes recent evidence regarding the correlation between ownership and use of ITNs and the determinants of both, in pregnancy in sub-Saharan Africa, and reviews interventions directed at improving coverage. A review of the literature using Pubmed, CINAHL and scanning of reference lists was conducted in October 2012 and 59 articles were selected for final review. The research obtained was a mixture of national and district level surveys, and a narrative synthesis of the data was undertaken. Ownership of ITNs varied from as low as 3% to greater than 80%, and the main determinants were found to be education level, knowledge of malaria, community involvement, socio-economic status and parity, although the significance of each varied between the different settings and studies reviewed. In more than half the settings where data were available, the combination of lack of availability and lack of use of an available net meant that less than half of all pregnancies received the recommended intervention. Supply and cost remain major barriers to achieving optimal coverage, but the additional important contributor to reduced efficiency of intervention was the clear discrepancy between ownership and use, with available ITN use below 60% in several settings. Cited reasons for not using an ITN, where one was available, included discomfort, problems with hanging up nets and lack of space, low awareness of need, and seasonal variations in use. These findings highlight the need for context-specific approaches and educational components to be incorporated into ITN distribution programmes to address some of the reasons why some pregnant women do not use the ITNs they own.
The World Health Organization (WHO) 2011 World Malaria Report demonstrates the enormity of the burden of malaria, with 216 million cases and 655,000 deaths attributable to this mosquito-transmitted parasite in 2010 alone. The burden is largely borne by Africa where 91% of deaths occurred, with pregnant women and children under five years of age most at risk of infection and adverse outcomes [1]. Each year, there are an estimated 25 million pregnancies in sub-Saharan Africa at risk of malaria, the consequences of which can be serious for both mother and foetus in terms of morbidity and mortality. Sequelae of malaria in pregnancy include maternal anaemia, stillbirths, low birth weight and intrauterine growth restriction [2].
The main malaria prevention strategies in pregnancy include the use of intermittent preventative treatment with anti-malarial medications, as well as the regular and timely use of long-lasting, insecticide-treated nets (LLINs). The WHO and Roll Back Malaria (RBM) partnership now recommend that distribution of LLINs be free or heavily subsidized to achieve greater equity of coverage, and that a variety of distribution systems be used to achieve universal access, including targeted campaigns to deliver nets to most-at-risk populations, which include pregnant women and children under five years of age [3]. The investment into this simple yet effective intervention has been substantial. In 2010, there were enough insecticide-treated nets (ITNs), primarily LLINs, procured on the African continent to cover 73% of the at-risk population, yet achieving equitable distribution and providing ongoing supply remain a challenge [1, 4].
The evidence for the efficacy of ITNs in preventing malaria infection and its consequences in pregnancy is strong, as reported in a Cochrane review in 2009 [5], and in a more recent meta-analysis [6], which examined malaria prevention in pregnancy datasets from different African nations. The evidence showed a strong correlation between the use of ITNs and reduction in stillbirths, improvements in birth weights of babies and a reduction in the prevalence of parasitaemia and anaemia in pregnant women. A communal protective effect of ITNs and reduction in overall vector density has also been observed in some settings [7, 8].
Despite the widespread roll out of policies, and substantial financial investments in ITN distribution, coverage remains suboptimal in many regions, particularly with respect to pregnant women. Recently published data from sub-Saharan Africa found that although 96% of countries surveyed had a policy for ITN coverage, reported coverage of pregnant women with ITNs was only 17% [9]. The main delivery system for ITNs was through antenatal clinics (ANCs), using free distribution or a voucher system. Interestingly, attendance at an ANC was not found to be a major factor in limiting coverage. Supply has been identified by the WHO as the primary barrier to achieving optimal coverage, with the latest World Malaria Report suggesting that in the general population, there is a high correlation between ownership and use of ITNs (range 93-99%) [1]. This is despite wide variation in this relationship at a national level in the African region, as shown by Eisele et al. in their summary of demographic and health surveys (DHS) and malaria indicator surveys (MIS) from 15 countries [10].
The relationship between ITN ownership and use has been explored by only a few authors, and largely neglected when concerning pregnant women. A 2011 qualitative systematic review of the uptake of malaria prevention interventions in pregnancy in Africa found that relationships with health workers, cost and distance to health facilities, knowledge of antenatal care and local contextual factors influenced women's uptake of interventions [11]. Pullford et al. also conducted a review regarding the reported reasons for not using a bed net when one was available (in the general population) and found that reasons such as discomfort and perceived low mosquito density were the most common reasons for non-use [12].
Given that pregnant women and their unborn children are a particularly vulnerable group susceptible to malaria and its consequences, a review of the current literature was conducted, to better clarify the relationship between ownership and use of ITNs, and the determinants of both, in this target population.
This review summarizes the body of evidence published in the last five years, regarding the determinants of ITN ownership and use in pregnant women in sub-Saharan Africa, and examines the relationship between these two outcomes. Successful strategies that have been employed to increase ITN coverage amongst pregnant women are identified, and key gaps in ownership and use that should be addressed are highlighted. In the past few years there has been an increased focus on, and improvements in, coverage in some areas, and thus a timely review, limited to the last five years, seemed to be most relevant for addressing the current coverage gaps.
In this review paper, the term ITN will refer to nets that have been treated with insecticide and need ongoing treatment, or LLINs, which are the most frequently distributed type of net in Africa [1].
Ownership is based on reported household ownership of an ITN, as per the DHS definition [13]. The RBM indicator for coverage is 'the proportion of pregnant women who have slept under an ITN the previous night' [14], and in this paper coverage has been used interchangeably with overall use. There remains an unclear definition of coverage in many studies, with some studies using ownership as a proxy for coverage (assuming all nets owned are used), and others using coverage as per the RBM definition. These definitions are distinct from 'available ITN use' (a key indicator in this review), which is expressed as the proportion of pregnant women who have slept under an ITN the previous night, when at least one ITN was available in the household. Universal coverage is achieved when all members of a household are protected by an ITN the previous night, at the optimal intrahousehold target of one ITN for every two members [3].
A comprehensive search of literature was carried out using electronic databases Pubmed and CINAHL (2007–2012), as well as scanning reference lists in October 2012. The searches were limited to the English language, and to studies published from 2007 onwards. The CINAHL search excluded Pubmed articles. The search terms used were ITN; Bed Net; Mosquito Net and these were all combined using the boolean operator 'AND' with either pregnan*; strateg*; ownership; utilization; prevention; control; supply; and distribution (some were Medical Subject Headings).
The overall search strategy generated 838 articles, after duplicates were removed using the Endnote® data management programme. There were 820 articles from Pubmed, two from CINAHL, with a further 16 obtained from scanning reference lists. These 838 articles were screened by reading abstracts, and after applying inclusion and exclusion criteria (listed below), there were 194 articles remaining. These full text articles were read, and after application of selection criteria, there were 59 articles chosen for final review (see Figure 1). Fifty-five articles were from Pubmed, and four articles from reference lists.
Search strategy. Adapted from the PRISMA 2009 Flow Chart [15].
The initial search was limited to articles published in English. The articles selected for final review examined populations in sub-Saharan Africa, were original studies (not review articles), and were either specific to bed nets and pregnant or post-partum women, or were studies that extracted data specific to pregnant or post-partum women from wider household or national data sets. Articles were excluded if they primarily concerned the economic aspects of ITN distribution or efficacy of ITNs, as these topics were outside the scope of this review. Articles reporting qualitative studies were excluded, as there had been a recently published systematic review of qualitative data regarding malaria prevention interventions in pregnancy [11].
Articles were classified based on year of publication, country of study, type of study, sample size, urban/ rural/mixed residence, location of study (household/ health facility/ANC) and whether the study concerned pregnant women alone, or a mixed population. Selected articles were saved in Endnote® and their characteristics manually entered into Microsoft Excel for ongoing data management. From these articles, data corresponding to the definitions, above, was extracted.
Characteristics of studies
Of the 59 articles selected for review, almost one third of the data came from Nigeria (30.5%), with multiple contributions from Ethiopia, Kenya, Tanzania and Ghana (see Figure 2).
Country where studies were undertaken.
There were 29 articles specifically concerning pregnant women, and 30 articles with household data from which information regarding pregnant women had been extracted. Eighty-six percent of articles reported studies that were cross-sectional in nature, with 8% longitudinal, and one case control, one cohort and one cluster randomized control trial. Sixty-four percent of data came from household surveys, and 34% from surveys conducted at antenatal clinics or at hospitals. Residence of study subjects was largely mixed between rural and urban (49%), with the remaining studies concentrating on rural subjects alone (30%) or urban subjects (20%).
The articles selected contained a mix of routine ITN coverage data from DHS and MIS for mixed populations and pregnant women at national and district levels, as well as contextually specific data regarding ownership and use following the implementation of a specific programme or intervention as well as Knowledge Attitude Practice studies of households and pregnant women attending health facilities or ANCs. The articles selected for review, and the type of information they provided, are summarized in Additional file 1.
The Malaria Indicator Survey differentiates between non-treated, treated and LLIN bed nets. Most of the articles reviewed concerned insecticide-treated nets, and where this was not specified, it was assumed that the nets were insecticide treated, as this is the most common net currently being distributed. If there was specific data pertaining to untreated nets, this was not included in data presented.
ITN coverage and available ITN use
A wide variation in the ITN coverage rates found in sub-Saharan Africa has been reported, however the general trend showed improvements in both ownership and use of ITNs amongst pregnant women in the last decade [9, 10]. In households containing pregnant women, ownership ranged from 3 to 44%, in a summary article of data from 2003 to 2007 from 15 African nations [10].
As per the analysis of Van Eijk et al.[9], the poorest performing countries at a national level, in terms of overall coverage (ITN use the night prior), were Swaziland 1% (DHS 2006–07), Nigeria 5% (2008 DHS) and Zimbabwe 6% (2007 MIS). The best performing countries or regions were Zanzibar 51%, Tanzania 26% (MIS 2007–08), Kenya 49% (2008–09 DHS) and Madagascar 46% (2008–09 DHS). A few declining trends were also observed. In Ethiopia overall household ownership of ITNs reduced from 66% in the 2007 MIS [16] to 49% in a 2009 HH survey [17], which also corresponded to an overall decline in available ITN use from 84% in 2006 to 59% in 2009, although this was highly variable within different regions. Between 2000 and 2004, there was a reported decline in ITN use from 58 to 46% in Nigeria, despite an increase in ownership rates (statistical significance of this difference was not calculated), representing a large increase in unused bed nets [18]. The surveys had been conducted in the same districts and in the same seasons, and the authors were unable to account for this decrease. Unfortunately they did not explore whether the deterioration of pre-existing ITNs could have contributed to this result.
Fourteen of the articles directly measured pregnant women's use of available ITNs (where there is at least one ITN in the household), and this statistic was able to be calculated from a further 11 studies. The details of these are presented in Figure 3 and Additional file 2, which stratifies data into national household surveys, observational studies and baseline data from intervention studies. In general, national data showed lower rates of available use by pregnant women, whereas studies conducted at health facilities showed higher rates of available ITN use and coverage. There were only two household surveys targeting pregnant women specifically. One of these, a large study from Nigeria (n= 2,348), revealed low rates of available ITN use (26%), when compared with DHS data and sampling from women attending ANC [19]. This reflects the wide variation that can occur even within a country, and the biases that occur between the various methods of data collection. Specific intervention studies, as expected, showed higher rates of ITN use and coverage. In Uganda and Tanzania there was less discrepancy between ownership and use of ITNs, meaning that 67-89% of pregnant women were protected by ITNs.
Reported rates of available ITN use by pregnant women (ownership 100%). Each bar represents reported rates of ITN use by pregnant women in households owning at least one ITN, from the specified country and year. National survey data have been presented by year of survey, whereas data from observational and intervention studies have been presented by the year of publication. Where a range for ITN use was reported (e.g., between districts), the higher rate has been charted.
Determinants of ITN ownership and use
Forty-four of the selected articles made comment on factors influencing ownership and/or use of ITNs amongst pregnant women. The statistically significant determinants are presented in Additional file 3. Factors significantly associated with ownership included: education, knowledge of malaria or ITNs, and marital status. Factors associated with use included: education, household income, socio-economic status or ownership of goods, malaria and ITN knowledge, and urban residence. In the larger studies where sample size exceeded 1,000 persons, factors found to be significantly associated with use included: wealth, urban residence, malaria or ITN knowledge, lack of misconceptions, older age (variable comparison groups between studies), and number of ITNs in the household [17, 19–22]. Whether these factors were statistically significantly associated with ITN use varied considerably by study, independent of sample size, and the direction of the association was not consistent between countries.
Paradoxically, in two large household studies conducted in Uganda and Nigeria, a lower education was associated with significantly higher rates of ITN use amongst pregnant women [20, 21]. This was postulated by Auta et al.[21] to be related to an increased perceived vulnerability to malaria in poorer households. The study found that the lowest wealth quintile also demonstrated higher rates of ITN use (OR 2.3, 95% CI 1.1-5). This finding could also be the result of targeted public health campaigns.
Stock-out (or unavailability), cost, and failure to issue vouchers were frequently identified as barriers to ownership [23–25]. Cost was identified as a barrier to ownership even in settings where subsidies via voucher schemes were available. Regarding failure to use available ITNs, reported reasons included discomfort, heat or inconvenience, limited perceived benefit of ITNs, and preference to use other malaria prevention methods. A summary of these barriers is presented in Figure 1. As this data came from disparate sources, it was difficult to determine the scale and importance of each of these factors, which are likely to be context specific.
Specific interventions
Where specific interventions were evaluated for their effect on ownership and use, they have been presented in Additional file 4 (n=19). Studies looking at the effect of national campaigns using DHS data were not included in this part of the review, only those that evaluated a particular strategy or aspect of distribution.
Nine studies looked at ITN distribution in which a behavioural or educational component was a key part of the intervention. These included a variety of techniques including demonstrations by volunteers, information leaflets, social marketing and 'hang up' campaigns, and provision of materials and tools. All the studies identified showed considerable gains in terms of increasing ownership, use and retention in the target groups, except for one programme in Uganda, where both ownership and use remained low despite an intervention for distributing subsidized ITNs with education. The authors of that study concluded that the programme had been inequitable and that the information delivered was inadequate [20]. The successful programmes saw increases (pre- to post-intervention) in ITN coverage from 25 to 80% in the Democratic Republic of Congo [26], 50 to 100% in Ghana [27], 37 to 87% in Sierra Leone [28] and 55 to 63% in Tanzania [29]. Interestingly, only one article made mention of the role of social marketing in improving ITN ownership and use amongst pregnant women [30]; this study saw increases in ownership of ITNs from 13 to 35% in Burkina Faso. It would appear that the improvements in coverage rates were not only due to increased ownership, but also due to increases in available ITN use (where this was specifically measured).
Five articles evaluated voucher schemes for ITNs at ANCs, two from Ghana and three from Tanzania. Another study evaluated a voucher scheme run through household distribution and pick-up points in Sierra Leone [28]. All studies highlighted the several steps involved in achieving targets, from voucher distribution, offering, acceptance, redemption and ownership, to ITN use. The cumulative effect of the voucher schemes in the various settings appeared to be hampered by inadequate issuing of vouchers, and failure of recipients to redeem the given vouchers. Failure to issue vouchers was most often related to perceived or actual ineligibility or client refusal. In some instances vouchers were not distributed if health workers assumed that potential recipients would be unable to afford even the subsidized ITN [23].
Another five articles assessed free ANC distribution of ITNs (n=3) and integrated campaigns with other interventions such as childhood vaccination (n=2), all of which were successful in increasing ITN ownership. In the Ugandan example, routine free ITNs at ANCs were compared with two once-off mass campaigns for ITN distribution at a household level. Ownership increased to greater than 90% in all test groups, with high rates of retention, and use was highest amongst women receiving ITNs via ANC (99%) compared with 74 and 97% in the test groups [31].
The last five years have seen significant gains made in sub-Saharan Africa in terms of scaling up coverage of ITNs in pregnancy, especially in light of supportive policies and financial investments from national governments, but there remains a wide range in the coverage rates at both national and subnational levels.
This review highlights the disappointing discrepancy between ownership and use of ITNs amongst pregnant women in many settings, representing a missed opportunity for distribution programmes to address the reasons for this trend. Bed net use cannot simply be assumed in households receiving and owning ITNs. Available ITN use by pregnant women was as high as 82% in Kenya, and as low as 29% in Zimbabwe, in national data sets. Cited reasons for this discrepancy included non-modifiable factors, such as discomfort and inconvenience, but interestingly issues of knowledge and perceived vulnerability to malaria were also frequently mentioned. Available ITN use should be measured more frequently as an important part of programme evaluations, and where low, the underlying reasons should be explored further.
Some of the aforementioned barriers to ITN use could be overcome by including education at the time of distribution. Unfortunately there were no comparative studies that examined programmes with and without an educational component, but where an educational or marketing campaign was employed as part of an ITN delivery programme there appeared to be encouraging results, with coverage rates increasing to greater than 70% post intervention [26, 27, 32, 33]. Additionally one cluster study from Nigeria showed that a community designed and implemented ITN distribution and educational programme was more successful in increasing coverage (by an additional 7-9%) than routine national ANC distribution [34]. This type of innovative participatory approach to engage communities and facilitate behaviour change has been used successfully for other public health interventions, and may be useful in settings where ITN coverage remains low. Other interventions such as hang up campaigns, provision of tools and use of community volunteers for home visits demonstrated how some of the physical barriers to use, such as problems with hanging or incorrect use could be overcome.
At the individual level, ownership rates ranged from 8-90% in larger household and surveillance data sets, and from 9-100% in smaller studies. Similarly, available ITN use ranged from 29-84% to 26-100%. In general, smaller studies showed higher rates of ownership and usage, particularly where a specific intervention was employed. Despite this, overall it would appear that only half of pregnancies in sub-Saharan Africa are covered by this effective intervention, with ownership being influenced by delivery systems, areas of residence and attendance at antenatal clinics.
At the supply level, unpredictable supply and frequent stock-outs were commonly reported in the literature as a barrier to ownership. In settings where voucher schemes had been adopted, there were additional potential bottlenecks reported, including the supply of vouchers, health personnel's attitudes towards distributing vouchers, customer acceptance and redemption of vouchers, and stock-outs of ITN supply at a market level. In both Ghana and Tanzania, a considerable drop in the cumulative success of the voucher schemes was attributable to both stock-outs and failure to issue ITN vouchers to women who were eligible to receive them, possibly because the health worker responsible for distributing vouchers did not think the pregnant woman would be able to afford the required financial contribution [23, 25]. This highlights the need for adequate training of health care workers and attention to all building blocks of the health care system in delivering interventions.
There are several steps involved in achieving adequate ITN coverage (see Figure 4), and the sequential steps between each process represent potential bottlenecks if the health system is to deliver the intended benefits. The barriers to achieving adequate ITN coverage (see list of 'Reported Barriers' section) should be considered prior to implementing and running a malaria intervention programme, to ensure its success. The high level of variability found throughout sub-Saharan Africa, in terms of determinants of, and barriers to, ownership and use, as well as the successes of different interventions, suggests that context specific responses are required, and that community participation can perhaps increase the chances of a successful programme. The Nigerian and Ethiopian examples of declining ITN ownership post mass distribution campaigns serve as reminders that interventions must be maintained, and ongoing supply ensured to keep up progress that has been made initially [17, 18].
Steps in achieving ITN coverage in pregnancy.
Reported barriers to ownership and use of ITNs amongst pregnant women (Presented in decreasing frequency of being reported)
Supply/ Distribution
○ Stock out of ITN or vouchers
○ Failure to issue voucher to eligible clients
○ Failure to redeem vouchers
○ Lack of ANC attendance
○ Refusal of coupon
○ Lost coupon
○ Cost
○ No belief in ITN as prevention method
○ Other methods preferred (sprays, window nets)
○ Did not know where to get
○ Wanted to have own choice in net
○ Did not like ITNs
○ Increased distance from ANC
○ Felt that bought ITNs were better
○ Discomfort (heat/ sweat/ breathing)
○ Not enough room/ place to tie/ burdensome to tie
○ Low awareness of need
○ Misuse (hung over windows, used as blanket)
○ Low awareness of how to use
○ Low mosquito activity/ seasonal
○ Someone else in family using net (children mostly)
○ No belief in protection method
○ Mosquitoes still bite
○ Saving use for post partum period
○ Net too small for family
○ Stolen/ damaged
○ Not retreating nets
The findings in this review echo and add to the information from Pell's review, which was confined to qualitative studies, of factors influencing women's uptake of malaria interventions in Africa [11]. Recurring themes include perceived risk, malaria beliefs and knowledge, seasonality, ITN inconvenience and health worker attitudes.
Measuring the uptake of malaria interventions in pregnant women, and particularly ITN use, is fraught with many difficulties. First, the coverage indicator for ITN use (use of ITN the night prior) is based on self-reporting and liable to information bias, such as overreporting by women, especially post partum women asked to recall their use habits during pregnancy, who may feel obliged to respond in a certain way. Behaviour may also be subject to seasonal variation, a particular problem for cross-sectional studies. Also lacking is the differentiation between overall use of nets, and the use of available nets, which would help define whether low use of bed nets amongst pregnant women is behavioural or related to a supply issue.
Additionally, adequate coverage in pregnancy is not well defined. Evidence suggests that malaria prevention is likely to have benefit from very early in pregnancy, before the first ANC visit, which is often after 20 weeks [35]. There was a paucity of data concerning the timing of implementation of the intervention, or what proportion of an individual pregnancy was protected by ITNs. This important information gap could be examined in future studies.
Evidence-based rationalization of ITN coverage targets is needed, but more research is required into setting-specific vector behaviour and malaria transmission trends, to predict what levels of community coverage might provide protection to all members, including those not sleeping under a net. Until then, targeting those most at risk (such as pregnant women and children) would be appropriate. Encouragingly, Baume et al.[18] looked at intra-household net use, in households containing nets in six different sub-Saharan countries, to determine who was most likely to use nets and found that younger children and pregnant women were more likely to sleep under a net, in net owning households (compared with men and older children). A few other studies also found that pregnant women were more likely to use bed nets in households owning more than one bed net [17, 26, 28]. It would have been interesting to be able to take into account the likely non-random distribution of nets and where in the hierarchy a pregnant woman stood when insufficient nets were available for all members of a household.
In the studies reviewed here, sampling bias was evident. In particular, most studies that focused on pregnant women were carried out at a health facility, which does not adequately sample the women who do not attend health care facilities for antenatal care, and may only capture women later in their pregnancies. The gaps in coverage during early pregnancy, and of women who do not attend health care facilities for antenatal care, could be addressed with improvements in community level interventions.
This review identifies several gaps in health systems in delivering successful ITN distribution programmes, as well as highlighting issues at an individual level that prevent pregnant women from using the bed nets that they own. Cost, stock-outs and failed distribution and redemption of vouchers were found to be barriers to ownership, and inconvenience and lack of knowledge about ITNs and malaria were frequently cited as reasons for not using nets.
The combination of low ownership rates and available nets not being used resulted in disappointing coverage rates, leaving more than half of all pregnancies at risk of malaria in several settings. Encouragingly, there were some successful national programmes, such as the voucher system in Tanzania, as well as some innovative regional interventions, which employed the use of additional education, marketing and community participation. These provide examples of how some of the barriers to ownership and use can be overcome.
Future research needs to be directed at clarifying the relationship between ITN ownership and use in pregnancy (by specifically measuring indicators for available ITN use, in households owning at least one bed net), as well as rationalising coverage targets to achieve desired the effects in terms of reduced disease burden. Consideration could be given to targeting all women of reproductive age, to ensure optimal coverage for the duration of an entire pregnancy. Health systems need to reflect on the contextual barriers to ownership and use when planning ITN distribution programmes, with attention to funding, procurement, staff training and sustainability. Consideration should be given to how community involvement and educational components may have a greater role in scaling up ITN interventions, particularly in settings where coverage rates are low.
ANC:
Antenatal clinic
DHS:
Demographic and health survey
ITN:
Insecticide-treated net
LLIN:
Long-lasting insecticide net
MIS:
Malaria indicator survey
RBM:
Roll Back Malaria
IPT:
Intermittent preventive treatment.
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Pettifor A, Taylor E, Nku D, Duvall S, Tabala M, Mwandagalirwa K, Meshnick S, Behets F: Free distribution of insecticide treated bed nets to pregnant women in Kinshasa: an effective way to achieve 80% use by women and their newborns. Trop Med Int Health. 2009, 14: 20-28. 10.1111/j.1365-3156.2008.02179.x.
Rickard DG, Dudovitz RN, Wong MD, Jen HC, Osborn RD, Fernandez HE, Donkor CI: Closing the gap between insecticide treated net ownership and use for the prevention of malaria. Prog Community Health Partnersh. 2011, 5: 123-131. 10.1353/cpr.2011.0018.
Bennett A, Smith SJ, Yambasu S, Jambai A, Alemu W, Kabano A, Eisele TP: Household possession and use of insecticide-treated mosquito nets in sierra Leone 6 months after a national mass-distribution campaign. PLoS One. 2012, 7: e37927-10.1371/journal.pone.0037927.
West PA, Protopopoff N, Rowland MW, Kirby MJ, Oxborough RM, Mosha FW, Malima R, Kleinschmidt I: Evaluation of a national universal coverage campaign of long-lasting insecticidal nets in a rural district in north-west Tanzania. Malar J. 2012, 11: 273-10.1186/1475-2875-11-273.
Muller O, De Allegri M, Becher H, Tiendrebogo J, Beiersmann C, Ye M, Kouyate B, Sie A, Jahn A: Distribution systems of insecticide-treated bed nets for malaria control in rural Burkina Faso: cluster-randomized controlled trial. PLoS One. 2008, 3: e3182-10.1371/journal.pone.0003182.
Kolaczinski JH, Kolaczinski K, Kyabayinze D, Strachan D, Temperley M, Wijayanandana N, Kilian A: Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda. Malar J. 2010, 9: 102-10.1186/1475-2875-9-102.
Thwing J, Hochberg N, Vanden Eng J, Issifi S, Eliades MJ, Minkoulou E, Wolkon A, Gado H, Ibrahim O, Newman RD, Lama M: Insecticide-treated net ownership and usage in Niger after a nationwide integrated campaign. Trop Med Int Health. 2008, 13: 827-834. 10.1111/j.1365-3156.2008.02070.x.
Gerstl S, Dunkley S, Mukhtar A, Maes P, De Smet M, Baker S, Maikere J: Long-lasting insecticide-treated net usage in eastern sierra Leone - the success of free distribution. Trop Med Int Health. 2010, 15: 480-488.
Okeibunor JC, Orji BC, Brieger W, Ishola G, Otolorin E, Rawlins B, Ndekhedehe EU, Onyeneho N, Fink G: Preventing malaria in pregnancy through community-directed interventions: evidence from Akwa Ibom state, Nigeria. Malar J. 2011, 10: 227-10.1186/1475-2875-10-227.
Kiwuwa MS, Mufubenga P: Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda. Malar J. 2008, 7: 44-10.1186/1475-2875-7-44.
Baume CA, Marin MC: Gains in awareness, ownership and use of insecticide-treated nets in Nigeria, Senegal, Uganda and Zambia. Malar J. 2008, 7: 153-10.1186/1475-2875-7-153.
Pettifor A, Taylor E, Nku D, Duvall S, Tabala M, Meshnick S, Behets F: Bed net ownership, use and perceptions among women seeking antenatal care in Kinshasa, democratic republic of the Congo (DRC): opportunities for improved maternal and child health. BMC Public Health. 2008, 8: 331-10.1186/1471-2458-8-331.
Jima D, Getachew A, Bilak H, Steketee RW, Emerson PM, Graves PM, Gebre T, Reithinger R, Hwang J: Malaria indicator survey 2007, Ethiopia: coverage and use of major malaria prevention and control interventions. Malar J. 2010, 9: 58-10.1186/1475-2875-9-58.
Karunamoorthi K, Deboch B, Tafere Y: Knowledge and practice concerning malaria, insecticide-treated net (ITN) utilization and antimalarial treatment among pregnant women attending specialist antenatal clinics. J Public Health. 2010, 18: 559-566. 10.1007/s10389-010-0335-9.
Graves PM, Richards FO, Ngondi J, Emerson PM, Shargie EB, Endeshaw T, Ceccato P, Ejigsemahu Y, Mosher AW, Hailemariam A, Zerihun M, Teferi T, Ayele B, Mesele A, Yohannes G, Tilahun A, Gebre T: Individual, household and environmental risk factors for malaria infection in Amhara, Oromia and SNNP regions of Ethiopia. Trans R Soc Trop Med Hyg. 2009, 103: 1211-1220. 10.1016/j.trstmh.2008.11.016.
Belay M, Deressa W: Use of insecticide treated nets by pregnant women and associated factors in a pre-dominantly rural population in northern Ethiopia. Trop Med Int Health. 2008, 13: 1303-1313. 10.1111/j.1365-3156.2008.02159.x.
Oduro AR, Fryauff DJ, Koram KA, Rogers WO, Anto F, Atuguba F, Anyorigiya T, Adjuik M, Ansah P, Hodgson A, Nkrumah F: Sulfadoxine-pyrimethamine-based intermittent preventive treatment, bed net use, and antenatal care during pregnancy: demographic trends and impact on the health of newborns in the kassena Nankana district, northeastern Ghana. Am J Trop Med Hyg. 2010, 83: 79-89. 10.4269/ajtmh.2010.10-0066.
Webster J, Kweku M, Dedzo M, Tinkorang K, Bruce J, Lines J, Chandramohan D, Hanson K: Evaluating delivery systems: complex evaluations and plausibility inference. Am J Trop Med Hyg. 2010, 82: 672-677. 10.4269/ajtmh.2010.09-0473.
O'Meara WP, Smith N, Ekal E, Cole D, Ndege S: Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya. PLoS One. 2011, 6: e25949-10.1371/journal.pone.0025949.
Hightower A, Kiptui R, Manya A, Wolkon A, Vanden Eng JL, Hamel M, Noor A, Sharif SK, Buluma R, Vulule J, Laserson K, Slutsker L, Akhwale W: Bed net ownership in Kenya: the impact of 3.4 million free bed nets. Malar J. 2010, 9: 183-10.1186/1475-2875-9-183.
Njoroge FK, Kimani VN, Ongore D, Akwale WS: Use of insecticide treated bed nets among pregnant women in Kilifi district, Kenya. East Afr Med J. 2009, 86: 314-322.
Gikandi PW, Noor AM, Gitonga CW, Ajanga AA, Snow RW: Access and barriers to measures targeted to prevent malaria in pregnancy in rural Kenya. Trop Med Int Health. 2008, 13: 208-217. 10.1111/j.1365-3156.2007.01992.x.
Ouma P, van Eijk AM, Hamel MJ, Parise M, Ayisi JG, Otieno K, Kager PA, Slutsker L: Malaria and anaemia among pregnant women at first antenatal clinic visit in Kisumu, western Kenya. Trop Med Int Health. 2007, 12: 1515-1523. 10.1111/j.1365-3156.2007.01960.x.
Kulkarni MA, Vanden Eng J, Desrochers RE, Cotte AH, Goodson JL, Johnston A, Wolkon A, Erskine M, Berti P, Rakotoarisoa A, Ranaivo L, Peat J: Contribution of integrated campaign distribution of long-lasting insecticidal nets to coverage of target groups and total populations in malaria-endemic areas in Madagascar. Am J Trop Med Hyg. 2010, 82: 420-425. 10.4269/ajtmh.2010.09-0597.
Skarbinski J, Mwandama D, Luka M, Jafali J, Wolkon A, Townes D, Campbell C, Zoya J, Ali D, Mathanga DP: Impact of health facility-based insecticide treated bednet distribution in Malawi: progress and challenges towards achieving universal coverage. PLoS One. 2011, 6: e21995-10.1371/journal.pone.0021995.
Mathanga DP, Luman ET, Campbell CH, Silwimba C, Malenga G: Integration of insecticide-treated net distribution into routine immunization services in Malawi: a pilot study. Trop Med Int Health. 2009, 14: 792-801. 10.1111/j.1365-3156.2009.02295.x.
Mbachu CO, Onwujekwe OE, Uzochukwu BS, Uchegbu E, Oranuba J, Ilika AL: Examining equity in access to long-lasting insecticide nets and artemisinin-based combination therapy in Anambra state, Nigeria. BMC Public Health. 2012, 12: 315-10.1186/1471-2458-12-315.
Ordinioha B: The use and misuse of mass distributed free insecticide-treated bed nets in a semi-urban community in Rivers state, Nigeria. Ann Afr Med. 2012, 11: 163-168. 10.4103/1596-3519.96879.
Aluko JO, Oluwatosin AO: Utilization of insecticide treated nets during pregnancy among postpartum women in Ibadan, Nigeria: a cross-sectional study. BMC Pregnancy Childbirth. 2012, 12: 21-10.1186/1471-2393-12-21.
Akinleye SO, Ajayi IO: Knowledge of malaria and preventive measures among pregnant women attending antenatal clinics in a rural local government area in southwestern Nigeria. World Health Popul. 2011, 12: 13-22.
Amzat J: Assessing the progress of malaria control in Nigeria. World Health Popul. 2011, 12: 42-51.
Tongo OO, Orimadegun AE, Akinyinka OO: Utilisation of malaria preventive measures during pregnancy and birth outcomes in Ibadan, Nigeria. BMC Pregnancy Childbirth. 2011, 11: 60-10.1186/1471-2393-11-60.
Wagbatsoma VA, Aigbe EE: ITN utilization among pregnant women attending ANC in Etsako west Lga, Edo state, Nigeria. Niger J Clin Pract. 2010, 13: 144-148.
Afolabi BM, Sofola OT, Fatunmbi BS, Komakech W, Okoh F, Saliu O, Otsemobor P, Oresanya OB, Amajoh CN, Fasiku D, Jalingo I: Household possession, use and non-use of treated or untreated mosquito nets in two ecologically diverse regions of Nigeria–Niger delta and Sahel Savannah. Malar J. 2009, 8: 30-10.1186/1475-2875-8-30.
Isah AY, Nwobodo EI: Awareness and utilization of insecticide treated mosquito nets among pregnant mothers at a tertiary health institution in north-western Nigeria. Niger J Med. 2009, 18: 175-178.
Sam-Wobo SO, Akinboroye T, Anosike JC, Adewale B: Knowledge and practices on malaria treatment measures among pregnant women in Abeokuta, Nigeria. Tanzan J Health Res. 2008, 10: 226-231.
Yusuf OB, Dada-Adegbola HO, Ajayi IO, Falade CO: Malaria prevention practices among mothers delivering in an urban hospital in southwest Nigeria. J Vector Borne Dis. 2008, 45: 217-224.
Adeneye AK, Jegede AS, Mafe MA, Nwokocha EE: A pilot study to evaluate malaria control strategies in Ogun state, Nigeria. World Health Popul. 2007, 9: 83-94.
Enato EFO, Okhamafe AO, Okpere EE: A survey of knowledge, attitude and practice of malaria management among pregnant women from two health care facilities in Nigeria. Acta Obstet Gynecol Scand. 2007, 86: 33-36. 10.1080/00016340600984670.
Napoleon RP, Anyang AS, Omolocan J, Ongus JR: Preventing malaria during pregnancy: factors determining the use of insecticide-treated bednets and intermittent preventive therapy in Juba. Southern Sudan Medical Journal. 2011, 4: 33-35.
Hassan D, Malik EM, Okoued SI, Eltayeb EM: Retention and efficacy of long-lasting insecticide-treated nets distributed in eastern Sudan: a two-step community-based study. Malar J. 2008, 7: 85-10.1186/1475-2875-7-85.
PubMed Central Article Google Scholar
Ambrose EE, Mazigo HD, Heukelbach J, Gabone O, Mwizamholya DL: Knowledge, attitudes and practices regarding malaria and mosquito net use among women seeking antenatal care in Iringa, south-western Tanzania. Tanzan J Health Res. 2011, 13: 188-195.
Marchant T, Hanson K, Nathan R, Mponda H, Bruce J, Jones C, Sedekia Y, Mshinda H, Schellenberg J: Timing of delivery of malaria preventive interventions in pregnancy: results from the Tanzania national voucher programme. J Epidemiol Community Health. 2011, 65: 78-82. 10.1136/jech.2008.085449.
Hanson K, Marchant T, Nathan R, Mponda H, Jones C, Bruce J, Mshinda H, Schellenberg JA: Household ownership and use of insecticide treated nets among target groups after implementation of a national voucher programme in the united republic of Tanzania: plausibility study using three annual cross sectional household surveys. BMJ. 2009, 339: b2434-10.1136/bmj.b2434.
Sangare LR, Weiss NS, Brentlinger PE, Richardson BA, Staedke SG, Kiwuwa MS, Stergachis A: Determinants of use of insecticide treated nets for the prevention of malaria in pregnancy: Jinja, Uganda. PLoS One. 2012, 7: e39712-10.1371/journal.pone.0039712.
Steketee RW, Sipilanyambe N, Chimumbwa J, Banda JJ, Mohamed A, Miller J, Basu S, Miti SK, Campbell CC: National malaria control and scaling up for impact: the Zambia experience through 2006. Am J Trop Med Hyg. 2008, 79: 45-52.
Aina BA, Ayeni FA: Knowledge and use of insecticide treated nets as a malaria preventive tool among pregnant women in a local government area of Lagos state, Nigeria. Journal of Applied Pharmaceutical Science. 2011, 1: 162-166.
This review was supported by the Nossal Institute for Global Health, in particular by Dr. Alison Morgan, who helped conceive the idea for the original project. Dr. Jenny Hill of the Liverpool School of Tropical Medicine and Dr. Matthew Lynch of the Bloomberg School of Public Health both critically reviewed an earlier draft of the manuscript.
Nossal Institute for Global Health, University of Melbourne, Carlton, VIC, Australia
Megha Singh & Graham Brown
Department of Medicine, University of Melbourne, Carlton, VIC, Australia
Stephen J Rogerson
Megha Singh
Graham Brown
Correspondence to Megha Singh.
The authors have declared that they have no competing interests.
MS, GB and SR developed the review topic and objectives. MS conducted the literature review and drafted the initial manuscript. All authors contributed to the review and production of the final manuscript.
Summary of the 59 articles selected for review (organized by country)
Additional file 1: [36]-[72].(PDF 152 KB)
Additional file 2: Use of available ITNs by pregnant women.(PDF 120 KB)
Additional file 3: Determinants of ITN ownership and use in pregnancy (arranged by country).(PDF 126 KB)
Additional file 4: Interventions to improve ITN coverage.(PDF 136 KB)
Singh, M., Brown, G. & Rogerson, S.J. Ownership and use of insecticide-treated nets during pregnancy in sub-Saharan Africa: a review. Malar J 12, 268 (2013). https://doi.org/10.1186/1475-2875-12-268
Malaria prevention
Insecticide-treated nets


My wife and I saw a documentary a couple of weeks ago called Twelve O'Clock Boyz. It's a story about a 10 year-old kid, in inner city Baltimore, whose goal in life is to become a member of this bike club. Their club is called Twelve O'Clock Boyz because what they strive for is the perfect wheelie. Unfortunately, the film was not done as well as it could have been. It was an interesting subject that suffered from poor execution. Part of the problem may have been the venue. It was shown in a gallery in NE Minneapolis. The acoustics were not great and neither was the seating.
My interest in the movie came from an article I had read last fall about these urban dirt bike riders. It's been going on for quite a few years in Baltimore, Philadelphia, New York and a lot of other cities. They call themselves clubs not gangs. The riders all claim that this is a better way to live than running with gangs and selling drugs. None of them seem to understand that they are breaking the law and are a danger to others. The bikes and ATVs they are riding are not street legal or designed to be ridden on the street. The common rule for the police in these cities is a no-chase policy. This creates a whole new thrill for these riders. They taunt and challenge the cops whose hands are tied because of their concern for public safety.
I know a few people who ride or have ridden motorcycles with clubs. Some of them outlaws and some not. I understand the desire to be part of a group and to partake in group activities. I can relate to the adrenalin rush that comes from riding a motorcycle both legally and illegally. What I can't buy into is thinking that some laws shouldn't apply to certain individuals or groups. People are getting killed because of these dirt bike riders. There are efforts being made in some of these cities to create places for them to ride their off-road bikes legally but from what I've read and seen it may not be the answer.
People ride motorcycles for a variety of reasons. They want to be seen, heard and rebel. They want the freedom of the open road. They want to challenge themselves with speed and endurance. They want the solitude as well as the camaraderie of like-minded folks. I've ridden for all these reasons and more. My guess would be that if off-road parks were created in these cities, they would go primarily unused. These riders want to be seen and they want to disrupt. They are riding for notoriety and recognition for their mad wheelie skills.
If it were up to me, I'd build the parks and take these 10 year-old kids and teach them to ride. Give them the responsibility and freedom, with adult supervision, to develop the parks into a riding environment they would enjoy. There has to be a way to make it cooler to ride legally than it is to tear up and down city streets.
So if you see a group of dirt bike riders tearing down our city streets, please don't encourage them by posting videos or photos. If possible, try to flag them down and tell them about Minnesota's great OHV riding areas. They might not be interested but you may delay them long enough for the cops to grab them.


Boiler flues are vital accessories for boiler and heating systems. The boiler flue is a chimney that is used to remove waste gases created by the boiler during the combustion process. These waste gases are mostly Carbon Dioxide and steam which need to be correctly extracted from the property.
There is a range of flueing options and styles for every type of domestic and commercial boiler installation, this variety also allows for site flexibility. A number of accessorises are available such as a boiler flue guard which is useful for flues showing wear and a boiler flue cover for safety regulations.


Pictures of EverGrain composite decks built in the Greater Kansas City area by All Weather Decks. Every picture on this page is a Kansas City Deck built in the Kansas City Metro area.
Composite decking has a more flexible feel than wood primarily during the heat of summer. This is a natural condition that will not affect the ability of the decking to perform as warranted.
EVOLVE composite decking systems offer all the beauty of natural wood, but the eco-friendly boards will never rot, and never need to be stained or painted. The planks are colored to the core, so scratches and scrapes are nearly invisible.
The lawsuit claims that such Decking Materials are or were prone to splitting, warping, swelling, shrinking, or surface decay and to develop pervasive mold, mildew, or fungal or other growth. Defendant claims that the Decking Materials were not defective, and there has been no determination of wrongdoing by the Court.
Patented new technology uses reverse threads to remove composite material as the screw is driven in allowing the Grabber composite screw to drive and seat better than any other composite screws. Stripouts and mushrooming are virtually eliminated.
04-Jul-2017 Closed Tuesday July 4th We are open today Saturday normal hours. And we are open Monday July 3rd normal hours We will be close..
Pressure-treated timber is treated for protection against termites Pressure-treated timber is treated for protection against termites fungal decay and rot. With its rustic natural-looking character this pressure-treated wood is a great choice for a wide variety of outdoor applications such as play sets decking landscaping walkways and more.


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Seven Swiss institutions join forces to found ESG association
Seven of the largest pension and insurance providers in Switzerland have joined forces to create an association for sustainable and responsible investment.The SVVK-ASIR was founded to help its members fulfil their "fiduciary duties" of including ESG criteria in their investments.The first part of the acronym stands for the German name Schweizer Verein für verantwortungsbewusste Kapitalanlagen, the second for the French Association Suisse pour des investissements responsables.The founding members include the first-pillar fund AHV, the public pension fund Publica, the pension fund for the canton of Zurich BVK, the pension plan of telecommunications company Swisscom (ComPlan), the pension fund of the postal service (PKPost), the pension fund of federal railways SBB (PKSBB) and the accident insurance fund Suva. Together, they manage more than CHF150bn (€122bn) in assets.Patrick Uelfeti, deputy CIO at Publica, was named president of the association, which is still looking for a managing director.Uelfeti said the SVVK-ASIR was founded as a service provider to suit the "individual needs" of its founding members.The new organisation will screen the portfolios of its members based on defined criteria, focusing on international companies rather than those based in Switzerland.The SVVK-ASIR said it would begin engaging with those companies it deemed "critical".Uelfeti confirmed the organisation was looking for external specialists for screening and engagement activities.The SVVK-ASIR will also be open to larger institutional investors such as retirement providers, compensation funds or insurers.Swiss institutional investors have a tradition of engagement with respect to equity holdings.In 1997, two Pensionskassen founded the shareholder engagement group Ethos, which focuses on engagement with Swiss companies.Ethos has more than 100 members, most being from the private pension fund sector. read more
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Finland's Varma calls for re-evaluation of euro-zone economic policy
"Monetary policies are very much focused on stimulus measures, and the measures used by central banks are highly exceptional," he said."Record low interest rates and quantitative easing now support the markets, and, for pension investors, this shows as negative deposit rates."He concluded: "While it is beneficial for at least one area of economic policy to strive for growth and inflation, nevertheless, economic policy as a whole should be re-examined within the euro-zone."The European Central Bank's policy options are all but exhausted, and even now the policy entails major long-term risks."Meanwhile, returns from Varma's equity portfolio – 38.3% of its total investments – were -3.1%, compared with 9.6% for Q1 2015, with listed equities returning -5% (11.7% in 2015).Reima Rytsölä, CIO at Varma, said: "January was bleaker than ever in the equity markets, as concerns over China's economy escalated and the US economy faced headwinds."The equity markets plummeted, with the Chinese stock exchanges leading the way."However, Varma dampened the effect by active diversification of its investment portfolio, markedly reducing the weight of equities in favour of fixed income and real estate.Listed equities make up 78.9% of the equity portfolio, but private equity (16.3% of the portfolio) returned 2.5%, slightly less than for Q1 2015.Unlisted equities (4.8% of equities as a whole) were the highest-performing asset class over the entire portfolio, with a 8.2% return, compared with 1.5% in 2015.Varma said that, in addition to unlisted equities, fixed income and real estate were also unaffected by market fluctuations, returning 0.2% and 1.2%, respectively, for the quarter.Fixed income returns were positive because of a decline in the price of corporate bonds, caused by higher pricing of credit risk in the face of a weakening global economic outlook.As of the end of March, the average annual nominal investment return over five years was 4.4%, and, over 10, 4.3%.Turning to the second quarter, Rytsölä was more optimistic about the economic backdrop."US economic growth seems to be holding, and China's situation is no longer completely hopeless," he said."The recovery of commodity and especially oil prices has helped to balance market sentiment." Risto Murto, president and chief executive at Finnish pensions insurance company Varma, has called for a re-evaluation of euro-zone economic policy, as the insurer reported an investment return of -1.4% for the first quarter of 2016, compared with 5.3% for the same period in 2015.Varma, whose portfolio stood at €41.1bn at 31 March, blamed the losses on market uncertainty earlier in the year, in response to concerns over the Chinese and US economies.However, Murto also questioned the direction of economic policy within the euro-zone.Since the financial crisis, fiscal policies have focused on balancing public deficits, with responsibility for active economic policy transferred to central banks. read more
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Vattenfall seeks permit changes for two Swedish offshore wind projects
The government announced that the amendment application is complete and the time for comments has closed. The plan is to obtain all significant permits by 2023, carry out geotechnical surveys in 2022-2023, and install and commission the wind farm in 2026. Source: Vattenfall In the next few years, the Swedish company will work to obtain the remaining permits. Project procurement could take place in 2023–2024 and installation in 2025–2027, dependant on the progress of the permits. The total investment cost is estimated at around SEK 20 billion (circa EUR 1.9 billion) for the entire wind farm, including foundations and connections to the Swedish electricity grid. Work is also underway for an application for a Natura 2000 permit, which requires a number of environmental impact studies to be conducted. Vattenfall is preparing to apply for permit changes related to the Stora Middelgrund offshore wind project in Sweden, acquired from Universal Wind in the spring of last year. Additionally, Vattenfall has submitted an application to the Swedish government to reduce the number of turbines at the Kriegers Flak offshore wind project and extend the construction deadline until 2027, from the initially set October 2018. Kriegers Flak The Stora Middelgrund project has a permit from 2008 which includes the construction of 108 8 MW turbines that are 200 meters tall and which must be installed by 1 September 2020 some 40 kilometers west of Halmstad. Vattenfall now plans to apply for the adjustment of the existing permit in order to install up to 75 turbines that are 290m tall, as well as request an extension of the construction deadline. read more
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Taylor on the mend
West Ham midfielder Matthew Taylor is making a good recovery after being knocked unconscious at Stoke on Saturday. The 31-year-old was caught in the face by Peter Crouch's boot as the striker attempted an overhead kick while Taylor was aiming to head clear. Taylor was treated quickly by medical staff on the pitch at the Britannia Stadium, and was able to travel back home with the West Ham club doctor before being assessed again after a period of rest. "I am not too bad. My head is fine and I am feeling a lot better," Taylor told the club's official website, www.whufc.com "It is the first time I have been knocked out in my career, or in my life for that matter, that I can recall. "If it was going to happen anywhere, then on a football pitch is not a bad place because of all the medical staff being there. "I don't have any recollection of heading the ball. My only memory I have is the ball going over my head [from the corner] and following my runner. "I then remember waking up in their treatment room on the treatment table. I don't have any other memory. I don't remember walking off or anything, which was a bit scary." Taylor added: "It was just one of those things and he clearly didn't mean to do it. There was no malice on his behalf. "I know Crouchy and played for England Under-21s with him and he came to see me afterwards, but I'd already left for home with the doctor. "There was no malice and you could see that, as soon as it happened, he held his hands up and was very apologetic so I don't hold any grudges. It's just one of those things." Press Association read more
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Van Gaal has faith in Blind
Manchester United's summer transfer dash continued on deadline day with the signing of Dutch international Daley Blind for £14million. Press Association Blind has agreed a four-year deal with United and his versatility will provide options for Van Gaal, whose initial attempts to shift United to 3-5-2 have proved a struggle. Blind is comfortable across the back line, at wing-back or as a defensive midfielder. He told United's official website: "It is a real honour to sign for Manchester United. "I have been at Ajax since I was seven years old and I will always have very fond memories of the club and of my time there. "Louis van Gaal is a tremendously talented coach, I have worked with him at Ajax and also for the Netherlands national team and I cannot wait to work with him at the biggest club in the world." The United boss added: "I am delighted Daley has signed for the club. "He is a very intelligent and versatile footballer that can play in many positions. "Daley is a great reader of the game, he has played under my philosophy over a number of years and he will be a great addition to the team." Blind, 24, had long been expected to join his former Holland boss Louis van Gaal at Old Trafford and the deal was finally signed off just over three hours before the end of the window. Blind's arrival from boyhood club Ajax takes the Red Devils' spending to around £150million on permanent signings, following the big money acquisitions of Luke Shaw, Ander Herrera, Marcos Rojo and Angel di Maria, the latter becoming Britain's most expensive player having cost £59.7million from Real Madrid. read more
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Rising artists Citizen Queen are setting the scene for female a cappella
"I didn't imagine in a million years that I would perform at Madison Square Garden that early [in my career], but here we are," bass singer Dalley said. "Wherever we went, the crowd was so receptive of us and very welcoming, and it seemed like they were very impressed with what they heard. It gave me a little bit of fire sometimes whenever I had down days. I'd just think of how people receive us and how we bring a lot to the table." From left to right, Cora Isabel, Kaylah Sharve', Nina Nelson, Hannah Mrozak and Kaedi Dalley compose the group. (Photo courtesy of Citizen Queen Instragram; Design by Ellie Gottesman) "One day in sixth grade, I was sitting at the lunch table singing some Adele song to myself," Isabel said. "I remembered being able to just hum and beatbox with it and make cool noises with it and was like 'That sounds cool,' and it honestly just became a habit." The tour was not only a productive learning experience for Citizen Queen but also a chance for the group to gain a large fan base. "We are so passionate about our original music and are working with some heavy hitters in the industry," Sharve' said. "We're excited about it, I'm excited about it and the label is excited about it." Although the group hasn't released original music yet, there's a lot to look forward to in Citizen Queen's future, according to Sharve'. Citizen Queen's most memorable moment on tour was when the group was able to perform near each of the members' hometowns for family and friends, Mrozak said. "Just because the five of us are amazing singers, it doesn't mean that we'll have the chemistry that is needed for an audience to love us," Nelson said. "It doesn't mean that we'll get along, you know, so we were kind of put to the test." SoCal VoCals alumnus and member of the world-renowned a cappella group Pentatonix Scott Hoying, along with alumni Ben Bram and Shams Ahmed, two acclaimed vocal arrangers and producers, hand-selected each member of Citizen Queen. The co-founders spent months sorting through hundreds of audition tapes until they hosted in-person callbacks in Los Angeles and New York, according to the members. "It's so easy to let your identity slip when you don't see people like you on the screen, and representation is so important when you're a young person trying to build self esteem and confidence," Nelson said. "We live in a specific time in history where more and more women are taking less shit, and our music is becoming less about the man and more about empowering ourselves." No single member of a cappella girl group Citizen Queen is alike: All five women come from different states and different ethnic backgrounds, but that's only the beginning. As vocalists, each has a distinct sound and style. Instead of fitting a group mold, these women draw inspiration from one another's strengths and lean into their individuality, coming together like pieces in a puzzle. Shortly after discovering their sound and harmony, the members of Citizen Queen received their second test: a nine-week world tour opening for Pentatonix. Although they didn't know each other that well yet, the tour gave Citizen Queen the opportunity to understand what it was like to be professionals in the music industry, and sharing that experience bonded the women greatly. Isabel, the group's gifted beatboxer, was still in high school when she joined Citizen Queen as its first member. After only sending in a couple of videos to Hoying, Bramm and Ahmed, she was quickly chosen without an in-person audition. Even more impressive is that her beatboxing abilities are self-taught. "I don't think I've met a group of people who are more different from each other, but that's the beauty of it," Nelson, the group's soprano, said. "Musically, in personality, in what kind of things or experiences we've had in order to get to this point … it can't be about competition when there's so much to learn from each other." "When I saw them live for the first time … I was screaming because all five of them … come together, and their blend is so incredible," Ellis said. "I remember almost having a mental breakdown, if not one for sure, because it was so brutal and so hot … It was supposed to be a continuous shot, so we had to nail every single scene, so there was a lot of reviewing things," mezzo-soprano Mrozak said about the filming of the music video. "I think there was a moment in there where we were all like 'Is this even worth it?' But then we all ended up realizing very quickly that this is what we want to do with our lives, you have to put in the work … but it's the finished project that counts. We were so happy with it … and I remember we saw the views just go up and up and up, and we were genuinely taken aback." Tyler Ellis, a 2020 graduate, had been close friends with Nelson since his freshman year when he was able to see Citizen Queen twice on its first tour. He described how he knew Citizen Queen had untapped potential after observing the members' powerful stage presence. "For me, it was beneficial to just be in that setting of being on tour and sound checking every night and being on the road and being in a tour bus with all of these people," alto Sharve' said. "It's just getting us prepared for what's to come, and I'm believing [in] great things." Unstoppable is exactly how members of Citizen Queen want their listeners to feel. Their mission is to empower women and help every girl listener realize that they have a queen living inside of them, which is precisely how they came up with the name Citizen Queen, according to Dalley. Whether it's because of their different cultural backgrounds or their diverse life experiences, the women hope that any listener can identify with at least one member of the group. Once all the members were chosen, Citizen Queen's spark came to life at an Airbnb in L.A. where they recorded four fully produced songs and music videos in one week. The women faced obstacles right off the bat: Mrozak had strep throat, Isabel was sick and ants had infested their living space, Nelson said. Despite these hurdles, the group's dynamic was magnetic; this was their first time collaborating in any way, shape or form. To their delight, not only did the women have unimaginable chemistry but their first projects were well-received. Their most popular video to date, "Evolution of Girl Groups," has accumulated more than 18 million views. Beginning in 1954 with The Chordettes and ending in 2014 with Fifth Harmony, Citizen Queen takes us on a seamless journey through legendary hits of past and present girl groups. The concept of the video is wildly creative and was difficult to compose and choreograph. Nina Nelson, Kaedi Dalley, Hannah Mrozak, Cora Isabel and Kaylah Sharve' compose Citizen Queen. They've already stunned millions of viewers on YouTube with their perfect harmony and created magic on stage during their first tour as openers for Pentatonix. It's shocking to learn that they were complete strangers before the group's founding, aside from Nelson and Sharve', who both graduated from USC and were members of the SoCal VoCals, the University's oldest a cappella group. read more
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Officials Investigate Death Of Inmate At Brocton Facility
Top Prize-Winning Take 5 Ticket Sold In Dunkirk
Eric Bogosian Gets Carnal and Unforgiving
Wedding and Funeral Extend Off-Broadway
Beatles Tribute Let It Be Will Return to the West End
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redpajama_set_name: RedPajamaCommonCrawl


Battle of the Barristers is the Seattle KingCounty REALTORS® annual scholarship fundraiser that brings real estate attorneys together to discuss and debate real estate legal topics in front of an audience of real estate professionals. Helsell's own Mike Spence will both stoke the debate and keep the battling barristers on point.
The annual event takes place Wednesday, April 3rd and the Real Estate Legal Update is good for 3 clock hours.


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Q: How to remove a group from an ExpandableListView Widget? I'm using a SimpleCursorTreeAdapter to fill an ExpandableListView widget. I start by providing the Adapter with a Cursor object that contains the info on the group nodes in the listview, and I define a method in the Adapter (getChildrenCursor()) to return a Cursor containing the info on the children for a specified group node.
Everything works fine, but I want to know how can I programmatically remove a group (and its children) from the ExpandableListView widget? I want to do a long-click on the group item in the list, have a popup context menu appear, and give the user the option of deleting the selected group item. I've got the context menu working ok with the long-click event, but I can't figure out how to remove a group from the list.
Can anyone offer some advice?
Thanks.

A: When the user clicks the context menu entry for deleting the group you have to remove the entries in the database which match this group. After this you do a new query on the database and pass the new cursor to the adapter. Now you list should be updated and the deletes group should be gone.

redpajama_set_name: RedPajamaStackExchange


This topic shows you where to access standard accounts receivable reports.
There are several standard reports in NAV to assist in the management of accounts receivable. When you want to access standard reports, you can do so by using the following path.
The image below shows a list of the standard reports.


The Fourth of July celebrates the birth of a new, independent nation for the United States. It is a famous day known around the world, even though it's a celebration held in America. Like its neighbor the United States, Mexico has its own Independence Day—and it's not Cinco de Mayo. What Is Mexico's Independence Day?


A couple of weeks ago, a conversation about our grandchildren's class projects developed into an intergenerational reminiscence about Blackpool Tower.
You see, my family used to live near Blackpool and my husband's family went there often for day trips, so to us it was just down the road. It was a Mecca for young people with its funfair, arcades, annual illuminations and of course the famous tower with its ballroom, aquarium, menagerie and circus. My brother also went to college there and I remember we all visited him in the depths of winter when I was very pregnant and spent most of the visit scouring the streets for a shop that sold the object of my craving, an Orange Maid ice lolly. No other kind would do, of course.
Inspired by the Eiffel Tower and opened in 1894, Blackpool Tower is 158m tall and reputed to be the 120th highest freestanding building in the world.
(Circus, left, Ballroom right. Images from the official Blackpool Tower site, link above).
The main attractions in the tower include its splendid circus ring (still in action today, but thankfully with no wild animals since 1990) and its magnificent opulent ballroom, designed by Victorian architect, Frank Matcham. This stately setting features in the BBC 'Strictly Come Dancing' programme when, halfway through each series, the show gets very excited with itself as it heads for the splendour of the sprung, woodblocked, 11msq ballroom. It's a dancer's dream and where the original 'Come Dancing' series of the 1970s was filmed. You can still attend daily tea dances there.
This wonderful ballroom has also witnessed less glamorous dancing as my mum testified, when she had us in stitches with her tales of going dancing at the tower on a Saturday after work with her friends.
Apparently, in the 1940s, a special train ran to Blackpool at about 5pm for 'the couples' and young people having a night out, dancing. She and her friends would catch the bus to the station, using the journey time to put in their metal curlers and do their make-up, then they would tie up their hair in a turban with a headscarf (like the factory workers in wartime). These curlers were kept in for the entire journey and when they arrived at the tower, they would head straight for the ladies cloakroom where the curlers were removed and they would primp and powder until glamorous enough to make an appearance on the dancefloor! She doesn't remember what they did with their curlers while they danced. Any suggestions?
Mum remembers live dance-bands like Joe Loss and his Orchestra (I remember seeing them on tv and hearing them on the radio, a bit too old-fashioned for me even at that young age). In the interval, the now world-famous Wurlitzer organ would slowly ascend through the floor, with Reginald Dixon the renowned organist playing as it did so. He would play until the band was ready to resume. Reginald Dixon designed the tower's second Wurlitzer and he played there for 40 years. You can still witness this phenomenon at the tea dances today.
Later, my mum and dad would go dancing together at the Tower Ballroom. She misses those days, they both loved ballroom dancing. The labels on the 78s we used to have were all marked as 'foxtrot' or 'waltz' and so on. In the late 1950's I remember her teaching me to rock 'n' roll to Cliff Richard!!
One of these stories involves a trip to Blackpool on the back of his cousin's scooter at the ages of 16 & 17. You see, right there, it doesn't get off to a promising start. From past experience, straight off the bat you know that any story with this combination of characters is not going to end well!
Along the way, they have a puncture. My husband falls off the back and breaks his arm. Unperturbed by this misadventure, they decide that, as they are more than halfway there, they would carry on. So, Cousin takes the wheel to a garage but can't get it to inflate properly, they then decide to make use of the inner tube from the too-large spare wheel tied to the back of the vehicle!
Somehow they make it to Blackpool and have a jolly time – Husband sets great store by the fact that they won a tiny 2″ model of Blackpool Tower on the Pleasure Beach before throwing themselves about on the dodgems. With a broken arm. With torn jeans and blood running down his leg.
He did, however, contribute to the project by remembering the zoo which prodded Mum's memory a bit more. She remembered those poor animals in cages: big cats, polar bears and so on. They lived in cages underneath the tower. Thankfully, no longer. She said the aquarium was wonderful, with beautiful small fish of all colours and some large evil-looking ones too! The aquarium was the first attraction in the tower since the first owner bought the existing aquarium and planned to build the tower around it.
Mum and I couldn't remember whether we went to The Blackpool Tower Circus or not. I recall one visit to a circus as a child, but I think that might have been Billy Smart's Circus in a proper circus tent on the local park. The memories are confused because the clowns at the Tower Circus included the famous Charlie Cairolli and Paul, whom I remember well, but I don't know if I saw them live there or just remember them from television.
Then there was the time we went to see Blackpool Illuminations and the queue of traffic was so long I couldn't put my foot on the floor of the Morris Minor because it was over-heating so badly! Our son had been keeping his much younger sister awake, chatting and singing and pointing out things of interest, until we finally reached the start of the brilliantly colourful spectacle along the Promenade. We turned round to see the wonder and delight on our daughter's face, only to discover she was fast asleep after all.
I love occasions such as these, when we share family memories.
Family history is important because it acts as an anchor. It holds people together and prevents geographically distant family members drifting apart. My grandsons rarely see my mum, they have little interaction with her other than perhaps seeing her once in 18 months and receiving a birthday card. She is deaf and becoming increasingly forgetful and confused. She doesn't use technology other than a basic tv and an even more basic landline phone. These stories help them see her as a person, to see that they are linked by more than a £10 note in a Christmas card. They help her feel involved in their lives when she knows that these titbits will be used in their schoolwork and she enjoyed making them laugh about her curlers on the bus.
I am aware of time passing and soak up as much as I can when we chat. Nowadays, though, it is often I who provide her with the memories as she confuses different events, times or personnel in the near past or present. But the distant past is mostly still there. She laughs at the time she outwitted her dad to go off with her friend to meet their boyfriends, only to find him waiting for her at the bottom of the stairs when she snuck back in. She loves to tell how she used to go to the pictures every week on a Friday after work and my dad would pretend that he was going there too so that he could go with her. They worked for the same company and his colleagues had bet him he would have no chance asking her out!
I write everything down and one day I will put it all together so my grandchildren can read the whole story and not have to pay a fortune to genealogy sites searching for information about their ancestors like I have!
Posted on March 20, 2017 August 9, 2017 by thejuicenutPosted in happiness, Historic Places To Visit, Life - It makes you smile!, Original Writing, UncategorizedTagged 1940s, Blackpool Tower, dancing, family, humour, life, memories, school, Strictly Come Dancing, Wurlitzer.
Three generations talking and sharing events and memories is a rare occasion and one to be celebrated and recorded. I particularly like the bit about the curlers.
What a great way to teach an appreciation of history that can also be used as a family bonding event! A+ for the school!!
The 40's is one of my favorite periods of history, even though I can't recall them personally, so I anticipated this post greatly. I was not disappointed – not by FAR. I can't wait to read about your Stonehenge adventure.
The images from Blackpool Tower are stunning. I miss the opulence of days gone by, and am grateful every time I see that another example has not been allowed to deteriorate. Glorious ballrooms seem to have given way to dance lofts and rave venues, and I haven't even heard the term "tea dances" in decades. I'd be first in line were I to visit. I have adored ballroom dancing since I was a very young teen and my mother taught the kids in our neighborhood on our back patio – another memory long buried until reading here.
The image of the Wurlitzer brings to mind the one at NYC's Radio City Music Hall, and another in a refurbished movie theatre in Knoxville, Tn. And 78's – how long has it been since any of us even laid eyes on 33's, much less those old thick platters of days gone by? Then you brought to mind that there was a time in my youth where a Morris Minor was my dream car. It never happened, and I forgot all about it until reading here.
This might be my favorite read in the past year. Thanks so much for sharing.
Such lovely memories. I visited the ballroom once during the labour Party Conference. It was huge. I also have fond memories of watching Come Dancing. Thank you for sharing these precious stories.


LP extends the tape usage by 1. Turning Off the Image Stabilizer The image stabilizer compensates for camcorder shake even at full telephoto. Capture all the details with vivid clarity. The limited warranty is only effective upon presentation of your Bill of Sale or other proof of purchase. Three still images in different exposures are recorded to the memory card. Environmental Parameters Min Operating Temperature. Playing Back the Added Sound You can select to play back Stereo 1 original sound , Stereo 2 added sound , or adjust the balance of both sounds.
Setting The Print Effect image Optimize Setting the Print Effect Image Optimize This function uses the camcorder's recording information to optimize the image data, yielding high quality prints.
So whether you are right next to your subject or feet away, you get crisp images with life-like detail that you can view on your computer or TV, or even make a print for your whole family.
Turn off the camcorder. Using the Self-Timer The self-timer can be used for recording movies and still images. Displaying Date and Time during Recording You can display the date and time in the lower left corner of the screen.
Auto Focus Points Zones Qty. Oct 27, 9: The trimming frame appears. Mississippi Windows 98, Apple Mac Os 9. No more fumbling with two different digital cameras! Mini Digital Video Cassette Please read also the following instruction manuals. Included Memory Card Capacity. Lithium-Ion batteries, unlike Nickel-Cadmium batteries, have no "memory effect" which can optuea the usable power of the battery over time.
Mini DV Model Number: Make sure that the SET dial.
This limited warranty is only effective upon presentation of a bill of sale or other proof of purchase for this Canon digital video equipment to a Canon Service Facility when repairs are required.
Setting the White Balance You can use the preset modes to reproduce colors more accurately, or set a custom white balance to obtain the optimal setting. Protect your camcorder with the professional-quality SC Soft Carrying Case, featuring secure compartments for filters and extra battery packs.
That's why professionals and consumers alike cnaon trusted the name Canon to capture all of life's most vivid moments. Discussion threads can be closed at any time at our optyra. If you lack the money of buying the newest HD camcorders by canon,this is your best bet! For still shots where your subject is not in the center of the frame, you can also choose from three Auto Focus Frames to keep them in sharp focus.
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Any help is appreciated. Using the Multi-Image Screen You can operate the multi-image screen only in the following playback modes: The setting changes with each press of the button. Adjust the dioptric adjustment lever.
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Open the terminal cover. Changing the Remote Sensor Canoj Two remote sensor modes and an off setting are available to prevent interference from other Canon wireless controllers being used nearby. White Balance White Balance.
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Q: Explanation for the orders of subgroups and number of groups with these orders. This was a question on my exam that was just given back and I need help understanding why both (a) and (b) and (c) are the answers they are.
In each group listed below, give the orders of the subgroups of the given group and how many different subgroups there are for each order.
(a) D5
There is 1 subgroup of order 1, 5 subgroups of order 2, 1 subgroup of order
5, and 1 subgroup of order 10.
(b) V4
There are 3 subgroups of order 2, one subgroup of order 1, and one subgroup of
order 4.
(c) $Z_{100}$
There is one subgroup of each of the following orders: 1, 2, 4, 5, 10, 20, 25, 50,
100

A: (a) $D_5$ has order $10$ and is generated by a rotation $r$ (the unique element of order $5$, spanning the unique subgroup of order $5$) and by a reflection $s$, which satisfies $s^2=1$, but also $s^{-1}r=r^{-1}s^{-1}$ This should tell that the elements of order $2$ are exactly $s,rs,r^2s,r^3s,r^4s$.
(b) I do not know the notation but it seems to be the Klein group $\mathbb Z_2\times \mathbb Z_2$. I'll leave it to you, it has only four elements.
(c) $\mathbb Z_{100}$ is cyclic. Its subgroups are cyclic as well. There is exactly one cyclic subgroup for each divisor of the order. (In general, there is exactly one cyclic group of order $n$, for each $n$).
Added.
If $n=|G|$ is the order of a cyclic group $G$, there is exactly one cyclic sugroup of order $m$ (up to isomorphism), for every divisor $m\,|\,n$. (The unicity is easy, because cyclic groups are unique up to isomorphism, for any order.) Indeed, if $u$ is a generator of $G$, then the element $u^{n/m}$ will have order $m$ in $G$. Thus it generates a subgroup $H\leq G$ of order $m$, unique up to isomorphism. Note that $u^{n/m}$ is not the possible generator of $H$, but any of the $\phi(n/m)$ generators produces an isomorphic copy of $H$.


I am so behind in my fanfic. So many unread in my inbox. I will have to check this out... later.
Wow! I haven't read many fanfics...I don't wanna end up ruining the actual story ya know?!
Is started this one this afternoon and I'm a little over halfway done! I like it! I just like that it happens the way I want it to...which may not be the case in the real story!
I know...that's why I usually stay away from "real" fanfic - I like the kind when they're human or whatever and it's a completely different story.
Yeah I hear ya about the typos! the few I tried to read I didn't care for cuz the "tone" of the characters was too off! This one does a pretty good job! There are 2 I read on the TM site that are REALLY good too! I think they were by an amy16 or something like that!
Wow...finally finished it! I liked it, I like that they go more into the future beyond the "expected" things to happen in BD! Thanks for the heads up on it!!


The Lord Is Knocking At The Door Of Our Hearts.
On March 13, 2013 cardinals stunned the world when they elected Pope Francis, the first Latin American Pope. Through unedited testimonies, we hear from those who know him best, those who lived with Bergoglio. From his only living sister, Maria Elena, to his successor as superioi-general of the Jesuits in Argentina.


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St. Paul Lutheran Church 617 St. Lawrence Ave. Beloit WI 53511 608-365-7064
"St. Paul Lutheran Church is called to be an Inviting, Christ-Centered, Spiritually-Growing and Community-Serving church where we are led by love to implement Jesus' teachings."
About Us Other Interesting Links Worship Service & Study Our Newsletter Welcome! Our Staff Contact Us Follow Us on Facebook! Evangelical Lutheran Church in America South Central Synod ELCA Online Giving Return to Home Page
Click Here for 2019 Stats
Click Here for 2019 Softball Schedule
Close but no cigar as the saying goes. St. Paul lost to Hope Black and Blue Sport Ministries by identical scores of 11-12. That makes 3 loses by a total of 4 runs, and a one run victory. So all games decided by a total of 5 runs. Close games but … Almost half the total runs in each game have been scored in the first inning. On May 30 both Hope Black and St. Paul scored 5 times in the first inning. The each scored one in the second. Hope charged ahead for an 11-6 lead after 5 innings. Hope scored once and St. Paul 3 times in the 6 th to make it 12-9. In the 7 th St. Paul scored twice but could not get that tying or winning run over the plate. James Wagner was 4 for 5 with a double and 3 RBI's while almost everyone else had 2 hits. Next game, June 6, first inning Blue Sport 4, St. Paul 5. St. Paul built a 9-4 lead before Blue Sport scored 5 in the 4 th to tie. St. Paul scored once to regain a 10-9 lead. Blue Sport added 3 in the 5 th to make it 12-10. But while they were held scoreless the last two innings, St. Paul could only garner a single run in the bottom or the 7 th for a final of 11-12, AGAIN. Travis Alexander and Sean Behm each went 4 for 4 while 4 others chipped in with a pair of hits. The big blow in the first inning was a 3 run Home Run by James Wagner. The first 5 St. Paul batters hot hits and scored in that first inning. St. Paul is now 1-3 for the season. Next week's game will be at Telfer at 6:30 against Berean Baptist. Come on out for a fun time and cheer on the team.
St. Paul Loses Two by Identical Score of 11-12


This particular variety has also hit a number of blogs. Hopefully some brilliant techie will sort it soon.
Another forum that I frequent, which uses the same software, is having a similar problem and has had for several months now. Hope it's not a weakness in the software, as it's very helpful for forum templates otherwise!
Mom to Rebecca, now 16 and honor student. 37-week, two months in NICU for her thanks to NEC and meningitis. One month in hospital for me, HELLP syndrome and severe hyper-reflexia. All healthy now, more or less!
thanks for looking into the problem!
Thanks! Yes, we're working on it, they appear to be exploiting a weakness in the software to make it very hard to delete their posts. Please do be extra cautious about clicking on any links in those posts.
Upon hitting the review unread posts button, I noticed that there seems to be quite a bit of spamming this weekend. It's not by one individual or about anything in particular, but there are some links attached that could potentially contain viruses. I just thought I would let you know.