text:
#pragma once
#include <aws/application-autoscaling/ApplicationAutoScaling_EXPORTS.h>
#include <aws/core/utils/memory/stl/AWSString.h>
#include <aws/core/utils/memory/stl/AWSVector.h>
#include <aws/application-autoscaling/model/MetricStatistic.h>
#include <aws/application-autoscaling/model/MetricDimension.h>
#include <utility>

namespace Aws
{
namespace Utils
{
namespace Json
{
  class JsonValue;
  class JsonView;
} // namespace Json
} // namespace Utils
namespace ApplicationAutoScaling
{
namespace Model
{

  /**
   *
Represents a CloudWatch metric of your choosing for a target tracking scaling
   * policy to use with Application Auto Scaling.

For information about the
   * available metrics for a service, see Amazon
   * Web Services Services That Publish CloudWatch Metrics in the Amazon
   * CloudWatch User Guide.

To create your customized metric
   * specification:

Add values for each required parameter from
   * CloudWatch. You can use an existing metric, or a new metric that you create. To
   * use your own metric, you must first publish the metric to CloudWatch. For more
   * information, see Publish
   * Custom Metrics in the Amazon CloudWatch User Guide.

   *
Choose a metric that changes proportionally with capacity. The value of the
   * metric should increase or decrease in inverse proportion to the number of
   * capacity units. That is, the value of the metric should decrease when capacity
   * increases, and increase when capacity decreases.

For more
   * information about CloudWatch, see Amazon
   * CloudWatch Concepts.

See Also:
   AWS
   * API Reference

   */
  class AWS_APPLICATIONAUTOSCALING_API CustomizedMetricSpecification
  {
  public:
    CustomizedMetricSpecification();
    CustomizedMetricSpecification(Aws::Utils::Json::JsonView jsonValue);
    CustomizedMetricSpecification& operator=(Aws::Utils::Json::JsonView jsonValue);
    Aws::Utils::Json::JsonValue Jsonize() const;

    /**
     *
The name of the metric.

     */
    inline const Aws::String& GetMetricName() const{ return m_metricName; }

    /**
     *
The name of the metric.

     */
    inline bool MetricNameHasBeenSet() const { return m_metricNameHasBeenSet; }

    /**
     *
The name of the metric.

     */
    inline void SetMetricName(const Aws::String& value) { m_metricNameHasBeenSet = true; m_metricName = value; }

    /**
     *
The name of the metric.

     */
    inline void SetMetricName(Aws::String&& value) { m_metricNameHasBeenSet = true; m_metricName = std::move(value); }

    /**
     *
The name of the metric.

     */
    inline void SetMetricName(const char* value) { m_metricNameHasBeenSet = true; m_metricName.assign(value); }

    /**
     *
The name of the metric.

     */
    inline CustomizedMetricSpecification& WithMetricName(const Aws::String& value) { SetMetricName(value); return *this;}

    /**
     *
The name of the metric.

     */
    inline CustomizedMetricSpecification& WithMetricName(Aws::String&& value) { SetMetricName(std::move(value)); return *this;}

    /**
     *
The name of the metric.

     */
    inline CustomizedMetricSpecification& WithMetricName(const char* value) { SetMetricName(value); return *this;}

    /**
     *
The namespace of the metric.

     */
    inline const Aws::String& GetNamespace() const{ return m_namespace; }

    /**
     *
The namespace of the metric.

     */
    inline bool NamespaceHasBeenSet() const { return m_namespaceHasBeenSet; }

    /**
     *
The namespace of the metric.

     */
    inline void SetNamespace(const Aws::String& value) { m_namespaceHasBeenSet = true; m_namespace = value; }

    /**
     *
The namespace of the metric.

     */
    inline void SetNamespace(Aws::String&& value) { m_namespaceHasBeenSet = true; m_namespace = std::move(value); }

    /**
     *
The namespace of the metric.

     */
    inline void SetNamespace(const char* value) { m_namespaceHasBeenSet = true; m_namespace.assign(value); }

    /**
     *
The namespace of the metric.

     */
    inline CustomizedMetricSpecification& WithNamespace(const Aws::String& value) { SetNamespace(value); return *this;}

    /**
     *
The namespace of the metric.

     */
    inline CustomizedMetricSpecification& WithNamespace(Aws::String&& value) { SetNamespace(std::move(value)); return *this;}

    /**
     *
The namespace of the metric.

     */
    inline CustomizedMetricSpecification& WithNamespace(const char* value) { SetNamespace(value); return *this;}

    /**
     *
The dimensions of the metric.

Conditional: If you published your
     * metric with dimensions, you must specify the same dimensions in your scaling
     * policy.

     */
    inline const Aws::Vector<MetricDimension>& GetDimensions() const{ return m_dimensions; }

    /**
     *
The dimensions of the metric.

Conditional: If you published your
     * metric with dimensions, you must specify the same dimensions in your scaling
     * policy.

     */
    inline bool DimensionsHasBeenSet() const { return m_dimensionsHasBeenSet; }

    /**
     *
The dimensions of the metric.

Conditional: If you published your
     * metric with dimensions, you must specify the same dimensions in your scaling
     * policy.

     */
    inline void SetDimensions(const Aws::Vector<MetricDimension>& value) { m_dimensionsHasBeenSet = true; m_dimensions = value; }

    /**
     *
The dimensions of the metric.

Conditional: If you published your
     * metric with dimensions, you must specify the same dimensions in your scaling
     * policy.

     */
    inline void SetDimensions(Aws::Vector<MetricDimension>&& value) { m_dimensionsHasBeenSet = true; m_dimensions = std::move(value); }

    /**
     *
The dimensions of the metric.

Conditional: If you published your
     * metric with dimensions, you must specify the same dimensions in your scaling
     * policy.

     */
    inline CustomizedMetricSpecification& WithDimensions(const Aws::Vector<MetricDimension>& value) { SetDimensions(value); return *this;}

    /**
     *
The dimensions of the metric.

Conditional: If you published your
     * metric with dimensions, you must specify the same dimensions in your scaling
     * policy.

     */
    inline CustomizedMetricSpecification& WithDimensions(Aws::Vector<MetricDimension>&& value) { SetDimensions(std::move(value)); return *this;}

    /**
     *
The dimensions of the metric.

Conditional: If you published your
     * metric with dimensions, you must specify the same dimensions in your scaling
     * policy.

     */
    inline CustomizedMetricSpecification& AddDimensions(const MetricDimension& value) { m_dimensionsHasBeenSet = true; m_dimensions.push_back(value); return *this; }

    /**
     *
The dimensions of the metric.

Conditional: If you published your
     * metric with dimensions, you must specify the same dimensions in your scaling
     * policy.

     */
    inline CustomizedMetricSpecification& AddDimensions(MetricDimension&& value) { m_dimensionsHasBeenSet = true; m_dimensions.push_back(std::move(value)); return *this; }

    /**
     *
The statistic of the metric.

     */
    inline const MetricStatistic& GetStatistic() const{ return m_statistic; }

    /**
     *
The statistic of the metric.

     */
    inline bool StatisticHasBeenSet() const { return m_statisticHasBeenSet; }

    /**
     *
The statistic of the metric.

     */
    inline void SetStatistic(const MetricStatistic& value) { m_statisticHasBeenSet = true; m_statistic = value; }

    /**
     *
The statistic of the metric.

     */
    inline void SetStatistic(MetricStatistic&& value) { m_statisticHasBeenSet = true; m_statistic = std::move(value); }

    /**
     *
The statistic of the metric.

     */
    inline CustomizedMetricSpecification& WithStatistic(const MetricStatistic& value) { SetStatistic(value); return *this;}

    /**
     *
The statistic of the metric.

     */
    inline CustomizedMetricSpecification& WithStatistic(MetricStatistic&& value) { SetStatistic(std::move(value)); return *this;}

    /**
     *
The unit of the metric.

     */
    inline const Aws::String& GetUnit() const{ return m_unit; }

    /**
     *
The unit of the metric.

     */
    inline bool UnitHasBeenSet() const { return m_unitHasBeenSet; }

    /**
     *
The unit of the metric.

     */
    inline void SetUnit(const Aws::String& value) { m_unitHasBeenSet = true; m_unit = value; }

    /**
     *
The unit of the metric.

     */
    inline void SetUnit(Aws::String&& value) { m_unitHasBeenSet = true; m_unit = std::move(value); }

    /**
     *
The unit of the metric.

     */
    inline void SetUnit(const char* value) { m_unitHasBeenSet = true; m_unit.assign(value); }

    /**
     *
The unit of the metric.

     */
    inline CustomizedMetricSpecification& WithUnit(const Aws::String& value) { SetUnit(value); return *this;}

    /**
     *
The unit of the metric.

     */
    inline CustomizedMetricSpecification& WithUnit(Aws::String&& value) { SetUnit(std::move(value)); return *this;}

    /**
     *
The unit of the metric.

     */
    inline CustomizedMetricSpecification& WithUnit(const char* value) { SetUnit(value); return *this;}

  private:

    Aws::String m_metricName;
    bool m_metricNameHasBeenSet;

    Aws::String m_namespace;
    bool m_namespaceHasBeenSet;

    Aws::Vector<MetricDimension> m_dimensions;
    bool m_dimensionsHasBeenSet;

    MetricStatistic m_statistic;
    bool m_statisticHasBeenSet;

    Aws::String m_unit;
    bool m_unitHasBeenSet;
  };

} // namespace Model
} // namespace ApplicationAutoScaling
} // namespace Aws

redpajama_set_name: RedPajamaGithub


Glossier's pretty popular over here (there's a store nearby) and I've seen a few bloggers reviewing their products.
The color of the Wowder matches my skin well, and even though I was expecting the lipstick to be a little too light, it had a darker tint and looks really nice 🙂 I'm hoping to try it out in the other colors, as well.
So, I've been seeing a few bloggers mention or request pen pals, and I've decided to give it a try!
what did you think? ever tried any glossier products? would you be interested in being my pen pal (or emailing, for location privacy reasons)?
thanks!! ooh glad to hear it!
ooh, i gotta try out some of those products!! i've seen a few glossier hauls around the blogosphere too. loved the haul.
i would love to pen-pal, em! i have a few already but another one can't hurt, right? XD we're moving, so i'll email you my new address.


This small but very ingenious device allows you to rivet each 5/8 pitch connecting link with hollow pin head .
You can press easily the loose side plate onto the pins.
The exact distance, in order to obtain the correct pressure on the X-rings, is indicated.
Afterwards you can easily rivet the hollow pin connecting link.
This device belongs in the toolbox of every do it yourselfer.
All DC and AFAM chains are equipped with a hollow pin rivet type connecting link.


NRZ-QPSK transmitter that uses two dual drive Mach-Zehnder modulators (MZM) is simulated. The MZMs are driven by two polar NRZ signals corresponding to in-phase and quadrature data. The pulse shape is assumed to be raised-cosine.
4c.1 Repeat 4b.1, 4b.2 by changing BPSK to QPSK.
4c.2 Modify the source code to realize 16-QAM.


If you want complete and confidential STD testing in the city of Lake Isabella, California, look no further. We offer tests for the most common STDs at affordable prices. Call ahead for an appointment or walk into one of our various locations. Most tests can be administered in as little as 5 minutes, and results usually arrive within one week. Go to tests & pricing.
There are several STD testing locations in or near Lake Isabella, CA. You should be able to find a testing center near you. Browse the list of centers below or enter your zip code in the search area above. View test packages and pricing.
If you feel you may have contracted an STD, we recommend you get tested as soon as possible. Regardless of where you live in Lake Isabella, California, one of our testing centers should be convenient for you. Appointments can be scheduled over the phone or online, and walk ins are also available. Your test will take around 5 minutes to administer, and you don't have to get undressed. All we need is a blood or urine sample.
Every year the Center for Disease Control and Prevention collects and analyzes data regarding sexually transmitted diseases within Lake Isabella, CA, and within the nation as a whole. The numbers indicate how prevalent STDs are, which populations are being affected, and if the numbers are increasing or decreasing.
STDs are usually the most common disease spread throughout the state of Lake Isabella, CA. Regular testing can greatly reduce this spread. Because not all STDs present symptoms, you may be infected and not even know it. The only sure way to know if you have contracted an STD is through proper testing. Nearly half the individuals within the state of Alabama will contract an STD sometime during their lifetime. By getting tested regularly, you can avoid this scenario.


text:
Handsontable 5.0.2 released
Peter Plesa Release Notes / September 12, 2018
Today we've released version 5.0.2 of Handsontable (CE/Pro). This version brings with it a fix for the bug that was causing the window to scroll to the top of the page when selecting cells in different columns. We've also corrected a pesky typo in the handsontable.d.ts file. The rest of the fixes were minor in nature, as we've been concentrating most of our time and energy on the new feature that we're planning to release around the end of the month.
Fixed a bug with column headers improperly rendering after expanding a previously-collapsed column. (#105)
Fixed a bug where editor focusing caused the window to scroll. (#5220)
Fixed a problem where double-clicking the fill handle filled the cells towards the left instead of down. (#5023)
Fixed a bug where editing a cell showed improper values after sorting and using the setDataAtRowProp method. (#4289)
Fixed a problem with editing autocomplete-typed cells after using similar cells in a different Handsontable instance. (#3374)
Corrected a typo in AutoColumnSize typescript definition file. (#5364)
Fixed a bug with calculating how many rows/columns need to be rendered. (#5365)
Finished the ESLint warning correction task (#107, #137, #4536), which included resolving problems with:
arrow-parens(#108, #5358)
eqeqeq (#114)
no-extra-semi (#115)
newline-per-chained-call (#112, #5341)
linebreak-style (#110)
no-constant-condition (#113, #5343)
no-unused-vars (#116)
prefer-template (#119)
consistent-return (#109)
object-curly-spacing (#118, #5347)
prefer-arrow-callback (#117)
max-depth (#111)
prefer-spread (#122)
prefer-const (#125, #5348)
no-unneeded-ternary (#126)
object-shorthand (#121)
space-before-function-paren (#124, #5357)
prefer-rest-params (#127)
no-plusplus (#123, #5345)
no-eq-null (#120)
one-var (#128, #5349)
no-var (#129)
no-undef (#130, #5363)
vars-on-top (#131)
no-use-before-define (#132, #5362)
no-restricted-properties (#133, #5361)
no-restricted-syntax (#134, #5342)
no-param-reassign (#136, #5368)
no-shadow (#135)
Peter Plesa
Generic bio alert: I like doing things and learning more about stuff.

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Add a number of weeks using a variable as the week amount php I am trying to use the code seen below to add a specific number of weeks to a starting date. The variable "weekdate" refers to the number of weeks to be added, this can range from 1 all the way up to ∞.
I have taken 1 from each of the dates for a reason that is right but hard to explain but this is not the issue.
What is the mistake I have made here?
$weekdate = $row['Week'];
//sets weekdate = 1 -> any number
$weekdate = $weekdate - 1;
//take 1 from that start number
$newdate = date($startdate, strtotime("+" . $weekdate . " Week"));
//add weekdate number of weeks to the start date.
echo $newdate . "<br>";
//echo out.

example,
24-10-2016 start date,
+1 week
result output: 31-10-2016

A: try this code. define start date as your variable. i don't have so i put it manually.
<?php
$weekdate = 2;
//sets weekdate = 1 -> any number
$weekdate = $weekdate - 1;

$start_date = "2016-10-24";
$date = strtotime($start_date);
$date = strtotime('+'.$weekdate.' weeks', $date);
echo date('d-m-Y', $date);
?>

A: Judging from the comments, you want something that shows all of the options from the starting point the user puts in.

for ($weekdate = $row['Week']; $weekdate >= 0; $weekdate--) {
    $newdate = date('d m y', strtotime("+" . $weekdate . " Week"));
    echo $newdate."\n";
}

It will look something like this: https://3v4l.org/lKYVh
If you want the list to be the other way, change the for line to be this:
for ($weekdate = 0; $weekdate <= 18; $weekdate++) {

It will look like this: https://3v4l.org/GmXkB

A: Have you tried using Carbon, a very good php library for manipulating dates.
Installation with composer:
composer require nesbot/carbon

then
require 'vendor/autoload.php';
use Carbon\Carbon;

Installation without composer
download Carbon.php from https://github.com/briannesbitt/Carbon/blob/master/src/Carbon/Carbon.php
then
require 'path/to/Carbon.php';
use Carbon\Carbon;

Usage
$date = Carbon::create(2016,10,24);
$a_week_from_now = $date->addWeek();
//or
$a_week_from_now = $date->addWeeks(1);
$three_weeks_from_now = $date->addWeeks(3);

Then you can format the final date however you want it using any of the formats of PHP's DateTime (http://php.net/manual/en/datetime.format.php):
$a_week_from_now->format('d-m-Y');  // 31-10-2016

Further documentation http://carbon.nesbot.com/docs/

redpajama_set_name: RedPajamaStackExchange


Business Description: We do our work the way we would want it done if we hired our self,the best quality possible.
Business Description: We offer a high quality finish with very competitive pricing. We take pride and integrity in every project. There is no job to small.
Business Description: We are a family owned and operated company. A 25% deposit is required on most jobs to cover equipment and material costs. We bill upon completion of the job and provide 10 business days to receive full payment. We offer frequent discounts and sales.


Our motivation is our clients success. We see the invisible and we can achieve the impossible. TIE-Fountain Scholars are also Life Transition Coach apart from being a professional in Foreign and Nigeria Exams. We are life changer!
TieFountain has never and will never encounter any problem in registering students for the test and in delivering effective lectures to students. We have a score of 600 out of the total score of 800 as our pass mark in both verbal and..


text:
Megan Fox's New Tattoo Appears to Be a Loving Tribute to Boyfriend Machine Gun Kelly
Megan Fox and Machine Gun Kelly may have only started dating over the summer, but it looks like the actress has already dedicated some special ink on her body to the rapper.
When the couple made their official red carpet debut at the 2020 American Music Awards on Sunday night, social media users spotted a new tattoo inked across Fox's upper left collarbone that many fans believe is a tribute to MGK, as Page Six first reported.
The tattoo, which is written in a lowercase script lettering, reads "el pistolero" — the Spanish word for "the gunman." Fans quickly became convinced that the ink was Fox's way of professing her love to the "Drunk Face" rapper.
"Megan Fox's new tattoo says 'el pistolero,' apparently it's rumored to be MGK's nickname," one Twitter user wrote.
?s=20
Fox, 34, and MGK, 30, also showed their love for each other by sporting matching minimal manicures by NAILSOFLA founder, Brittney Boyce, who used Orly nail polishes on both stars.
RELATED: Megan Fox and Machine Gun Kelly Make Their Red Carpet Debut as a Couple at 2020 AMAs
The geometric designs featured bright half circles with a black line down the center painted on a neutral nail.
The couple went for nearly identical colors, with Fox opting for a vibrant coral and MGK choosing a neon pink.
After Fox and MGK began dating this summer when they met on the set of their upcoming movie Midnight in the Switchgrass, they took a big step in their relationship in October when he was introduced to her children, Noah Shannon, 8, Bodhi Ransom, 6, and Journey River, 4.
"He recently met her kids for the first time. Megan thought it was a natural step since they are getting more serious," a source told PEOPLE at the time.
"They are in a committed relationship and it's not just a fling. They are planning a future together," the source said, adding that the two "spend as much time together as they can" and are "doing great."
Tags American Music Awards B beauty
Lisa Vanderpump says 'many restaurants will not reopen' amid COVID-19 pandemic
The Bachelorette: Things Take a Dramatic Turn for Tayshia Adams in Emotional Sneak Peak
The world has been fascinated with Princess Diana ever since she married Prince Charles in 1981. Even after she died...


"Search Republic let us know very quickly that they weren't happy with our website's conversion funnel and especially our enquiry form. We worked closely with Search Republic to come up with our current application process. As soon as it went live we saw a huge 175% jump in the conversion rate and the average cost per conversion dropped 26%. This means we can now invest more in the online marketing channel as it provides a much higher ROI."
AA Finance sells car loans and receives a significant volume of leads from online channels. Search Republic identified issues within the sales funnel and made detailed recommendations to improve conversion rates and decrease the average cost per acquisition. One of the issues was that the form was not mobile friendly and mobile conversions rates were very low.
Search Republic reviewed conversion funnel data to identify points of friction that were causing prospects to abandon the funnel.
The existing application form was lengthy and contained several questions that were unnecessary from a lead generation perspective and discouraged prospects from continuing the application process.
Other fields were moved further down the form and replaced with less intrusive information fields such as name and basic contact information that prospects are comfortable submitting.
The new form design was also updated to align with the aesthetics and new branding of the main site.
This alleviated any trust issues that arose when prospects transitioned from the main site to the lead form which was hosted on a different domain.
1) Increase the number of conversions from all traffic sources into car loan enquiries/applications.
When comparing overall conversion rates for the last full month with the old form, vs the conversion rates for the first full month with the new form, conversion rates increased 175%.
Loan application costs reduced by 25.9% after the new form was implemented, compared with same time frame with the old form.
When comparing mobile conversion rates for the last full month with the old form, vs the conversion rates for the first full month with the new form, conversion rates increased 160%.
"Search Republic let us know very quickly that they weren't happy with our website's conversion funnel and especially our enquiry form. We worked closely with Search Republic to come up with our current application process. As soon as it went live we saw a huge 175% jump in the conversion rate and the average cost per conversion dropped 26%. This means we can now invest more in the online marketing channel as it provides a much higher ROI.


text:
Social Issues | Livable Wages/Working Families News
MN Supreme Court Upholds Mpls. Higher Minimum Wage
Advocates Push NY to Increase Home-Care Workers' Pay
For Parents in Recovery, Expanded Child Tax Credit Provided "One Less Stressor"
Labor Groups: ND Keeps Losing Ground on Minimum Wage
The Minneapolis minimum wage ordinance, which has survived a legal challenge, requires both large and small companies to pay at least $15 an hour by the year 2024. (Clem Onojeghuo/Librestock)
In 2020, 42% of New York's direct care workers lived in or near poverty. (Adobe Stock)
The Biden administration's American Rescue Plan increased the Child Tax Credit for more than 65 million kids nationwide, according to the Center for Budget Policy and Priorities. (Adobe Stock)
Montana, South Dakota and Minnesota have minimum wages that hover around the $10 level, but North Dakota remains at $7.25, which is also the federal wage. (Adobe Stock)
Nadia Ramlagan, Producer
ST. PAUL, Minn. -- The legal fight over the $15 an hour minimum wage ordinance in Minneapolis appears settled for now, after it was upheld by the Minnesota Supreme Court.
Supporters of the ordinance are celebrating the decision. The higher minimum wage was approved in 2017 and is being phased in over a several-year period.
Opponents argue that it conflicts with existing state law and is harmful to businesses, especially smaller companies.
But Ken Jacobs, a labor economist at University of California Berkeley, says research on similar laws shows little evidence of higher wages having a negative effect.
"Workers are earning more, which is what the laws are intending to do," he points out. "And we are not seeing measurable effects on employment. So, the predictions that this would result employment decreases haven't come through."
Jacobs notes in Seattle, there was initial concern the higher wage there was slowing job growth, but research didn't bear that out.
The local branch of the Federal Reserve Bank has been asked to examine the Minneapolis ordinance. Those findings are due in the coming weeks.
It's unclear what sort of ripple effect the Minnesota high court ruling might have. But St. Paul has already adopted a similar ordinance.
And Jacobs says that seems to be the pattern in states where higher wages have prevailed in larger cities.
"So, we have seen in states that allow cities to raise the minimum wage, that we've seen a number of cities, especially in higher cost urban areas, choose to do so," he states.
The patchwork of higher wages in California led to a statewide law of $15 an hour.
In Minnesota, Democrats -- including Gov. Tim Walz -- have voiced support for a statewide $15-an-hour law.
But Senate Republicans argue that the current minimum wage is higher than in neighboring states, and is keeping pace with inflation.
Advocates for New Yorkers with disabilities are calling on state lawmakers to take action on policies that would raise earnings for home-care workers.
The Fair Pay for Home Care Act would increase the pay for workers in home- and community-based care services to at least 150% of the minimum wage.
Heidi Siegfried - health policy director with Center for Independence of the Disabled New York - said low pay in this field has contributed to high worker turnover, which could leave people without the care they need.
"So, the person may end up going without care for a day," said Siegfried. "Not able to get out of bed, not able to transfer. Depending on your disability, some people are very dependent on the worker to live their lives."
Siegfried said her group also hopes New York Gov. Kathy Hochul will slate a home-care worker pay raise in the state budget being announced tomorrow.
Federal funding for these workers through the Build Back Better Act is still up in the air since the U.S. Senate hasn't voted on the plan.
According to the home-care staffing company PHI National, in 2020, the median income for care workers in New York was just over $21,000 a year.
Siegfried said the state must tackle the problem of low wages.
"We would really like to see New York step up to the plate and say, 'We are going to provide these services. Our people with disabilities need to be able to get care in their homes,'" said Siegfried.
For many people who require these services, Siegfried noted, another impact of high turnover in home care is the potential loss of independence.
"But the other thing that can happen is that people can end up being unnecessarily put into nursing facilities," said Siegfried. "People would prefer to be living at home, and we need to have a home-care workforce that can support them in that."
The Fair Pay for Home Care Act is now in the Senate Health Committee in Albany.
Disclosure: Center for Independence of the Disabled New York contributes to our fund for reporting on Disabilities. If you would like to help support news in the public interest, click here.
N.Y Senate Bill S5374A, Relates to fair pay for home care aides the New York Legislature 2022
New York States Direct Care Workforce Factsheet PHI National 6/29/20
West Virginia families can expect a smaller federal Child Tax Credit this year, and no more advance monthly payments now that the Build Back Better Act has hit a dead end in Congress.
Advocates say the extra cash helped alleviate burdens on parents recovering from a substance-use disorder.
JoAnna Vance, a community organizer for the Recovery Advocacy Project based in Beckley and a parent in long-term recovery from substance use disorder, explained the extra income helped stabilize individuals working to rebuild their lives and care for their children.
"Absolutely the child tax credit has been beneficial to families in West Virginia, specifically those in recovery and early recovery," Vance asserted. "To just have one less stressor off of their life."
Last year, Congress temporarily expanded the child tax credit to more than 35 million families, up to $3,600 per child. Studies showed most households used the money to buy food and pay for other basic necessities. Opponents say the $2 trillion Build Back Better Act is too costly.
Vance also pointed out many households across the state are struggling with winter expenses.
"We know that in January is when all of the electric bills and the gas bills spike," Vance noted. "It's when it snows, and you need tires or something like that for your vehicle."
She emphasized West Virginia Families are hurting.
"We need child care, we need jobs, we need internet, we need transportation," Vance outlined. "If they're not going to pass the Build Back Better, then what are they going to do?"
In the journal Health Affairs, researchers argued the expanded Child Tax Credit and other federal funding measures outlined in the Build Back Better Act could help reduce addiction in communities by reducing economic challenges for families that may directly or indirectly contribute to substance use.
House Resolution 5376 2022
Tax credit analysis Urban Institute 11/04/2021
Substance abuse report Health Affairs 06/10/2021
The start of the new year saw a number of states boost their minimum wage, but not North Dakota. Labor leaders say it's remained at $7.25 an hour for far too long, especially with neighboring states continuing to go higher.
South Dakota, Montana and Minnesota rang in the new year with higher minimum wages, with those increases tied to inflation.
Kooper Caraway, president of the South Dakota Federation of Labor, said not only does it put more money in the hands of workers and their families, but it helps to keep jobs filled.
"Since the minimum wage was increased and tied to inflation, South Dakota's always had one of the lowest unemployment rates in the country," Caraway observed. "And the good thing is that we also have a robust labor movement, and that robust labor movement is raising wages much higher than the minimum wage."
South Dakota's latest increase, the result of a voter-approved measure in 2014, brought its wage to $9.95 an hour.
In North Dakota, worker advocates fear residents will abandon the state, even with jobs available, because the lower threshold will make it harder to survive. Last year, North Dakota lawmakers rejected a proposed hike, with concerns raised about the impact on businesses.
Landis Larson, president of the North Dakota AFL-CIO, said it is frustrating cost-of-living measures are similar in the four-state region. He argued it gives North Dakota policymakers no excuse for not taking action.
"They really want to do their best to make a friendly business climate, but they forget about the worker climate," Larson asserted. "It's a two-way street."
Rep. LaurieBeth Hager, D-Fargo, was behind last year's plan to increase North Dakota's minimum wage, and said being far behind other states is especially troubling right now.
"When you look at the increases in housing costs, and fuel costs and grocery costs, all of those things are exponentially rising, and the minimum wage has just bottomed out," Hager stated.
Hager added a more likely scenario in which North Dakota increases its minimum wage is by taking it to the voters, but other supporters say such a plan has to be tied to inflation.
Disclosure: North Dakota AFL-CIO contributes to our fund for reporting on Livable Wages/Working Families. If you would like to help support news in the public interest, click here.
Minimum wages U.S. Dept. of Labor 2022
Measure 18 (2014) Ballotpedia 11/04/2014
Cost of living index World Population Review 2022
The federal minimum wage has been $7.25 since 2009. (Artur/Adobe Stock)
Ohio's Minimum-Wage Increase Largest in 15 Years
More than 300 health-care workers at McKenzie-Willamette Medical Center began their strike on Monday. (SEIU Local 49)
OR Health-Care Workers on Strike Front Line Call for Greater Protections
A proposal by Milwaukee City Alder Marina Dimitrijevic would provide 12 weeks of paid leave for new parents, regardless of their gender. (Adobe Stock)
Milwaukee Alder Floats Proposal to Expand Paid Parental Leave
A new report says child-care expenses make up roughly 10% of a family's income in South Dakota. The percentages are much higher for families of color. (Adobe Stock)
New Report Details Child-Care Issues in SD


Dan Huschke, a member of St. Hubert in Chanhassen, walks in front of the Planned Parenthood building on Ford Parkway in St. Paul April 22 (Good Friday) carrying a wooden cross during the annual Carry the Cross of Abortion prayer vigil.
Father James Livingston, a priest of the Archdiocese of St. Paul and Minneapolis, blesses a rosary for Lana Nguyen, a member of St. Anne/St. Joseph Hien in Minneapolis, during the vigil. Archbishop John Nienstedt led the opening prayer and Father Livingston was one of several priests of the archdiocese and clergy of other denominations who took a turn reading Scripture and a meditation during the day-long event. This is the last time the annual vigil will be held at this location. Planned Parenthood plans to move to another location in St. Paul later this year.
See more photos from the Carry the Cross of Abortion prayer vigil.


text:
"""
requests-toolbelt.adapters
==========================

See https://toolbelt.readthedocs.io/ for documentation

:copyright: (c) 2014 by Ian Cordasco and Cory Benfield
:license: Apache v2.0, see LICENSE for more details
"""

from .ssl import SSLAdapter
from .source import SourceAddressAdapter

__all__ = ['SSLAdapter', 'SourceAddressAdapter']


Which of These App Stores Is Better for the App Developer and Why?
Undoubtedly, the two major mobile platforms in the market today are iOS and Android. Each of these OS' comes with its own advantages and disadvantages, thereby confusing a developer about the path he or she should take ahead. While the debate on the better mobile OS continues unabated, here is an analysis of the iOS App Store vs. Google Play Store as far as mobile app developers are concerned.
Selling their app via the Apple App Store is beneficial to developers, as it gives them a lot more visibility than any other app marketplace. The app, once it is approved by the App Store, stands a good chance of being promoted via multiple channels on the store, such as being featured on the Popular App category, App of the Week category and so on.
While the initial registration fee is reasonable, the returns are also high, as the developer gets 70 percent of the sales of the app. This makes it easier for the app developer to make a profit from the sales of his or her app. The returns would become substantially higher if the app got popular with the masses.
Though the app approval process is long-drawn-out at the Apple App Store, the plus side is that the efficient app review team gives the developer a clear idea as to why his or her app has been subjected to rejection. This, while seemingly annoying for developers, is ultimately for their benefit, as it hones their own skills of mobile app development.
The biggest problem for app developers is to get their app approved at the iOS App Store. This is the process that takes the maximum amount of time. Sometimes, apps are rejected for the slightest errors and this can prove to be very frustrating for the app developer, who has a certain idea about the exact way his or her app is designed and should function.
After an app has been approved by the Store, the bigger challenge that the developer faces is to achieve and maintain enough visibility to make a decent profit out of its sales, month after month. The level of competition is very high, with newer apps coming in every single day. Each and every category is saturated with apps and so, developers find it difficult, if not impossible, to make their app stand out from the rest. Of course, this problem is common to all other app stores as well.
The app submission process stipulated by Google Play is much less tedious than the iOS App Store. The app developer also enjoys more freedom as concerns the general editorial content of his or her apps.
Once an app is live on the Google Play Store, the developer can then proceed toward building his or her own customer base and raise a successful business with his or her app, provided of course, that the app does offer a certain utility value to the customer.
The initial cost of registration is only $25, which makes it much more affordable to the developer to submit apps to this marketplace.
The freedom of editorial content that the Google Play Store offers can sometimes prove to be a bane to app developers, as they do not get the guidance that the iOS App Store provides to its developers.
The highly fragmented Android platform further complicates the issue for the app developer. This aspect, combined with the fact that Android developers are pretty much on their own for setting up their business, makes it very difficult for inexperienced developers to achieve success in this app marketplace.
Most of the apps on the Google Play Store are free apps. Not only that, it has been seen that Android users generally prefer to download free apps, as opposed to iOS users, who do not mind paying up for good apps. This inevitably forces the developer to think of alternative ways to make money on his or her app.
Both the iOS App Store and the Google Play Store come with their share of pluses and minuses. App developers first need to analyze each one and understand what exactly they want out of their app before they go ahead to develop apps for any of these mobile platforms.


Sneyders is looking for bright people. To support our growth we want to hire additional sales people, assembly technicians (no experience needed) and service technicians.
We are a group of enthousiast colleagues with a passion for technology and filling and packaging machines. Next to our on-the-job-training, our more than competitive remuneration package, we offer a nice working environment and routes for personal development.


Notice that by default, the annotation description is enabled. This is useful for taking a picture of the entire window showing the annotations for each picture. As you can see, the annotation overlays the bottom of the picture, which is why you might desire to eliminate the description for overall screen snapshot purposes.
The Load Picture menu option (Ctrl-L) allows you to replace the picture with a different image from anywhere on the hard drive of your computer.
The Clear Picture menu option (Ctrl-X) allows you to clear out a picture that you don't want to keep. Should you later choose to save the pictures as a group, you will receive a warning error when the viewer screen attempts to save this [now] non-existent picture.
The Clear Picture and Shift menu option (Ctrl-Y) also allows you to clear out an unwanted picture, but also shifts the remaining pictures left one postion to elimenate the gap between pictures.
The Save & Clear menu option (Ctrl-E) allows you to save a picture and then clear it out. Like the Ctrl-X option, should you later choose to save the pictures as a group, you will receive a warning error when the viewer screen attempts to save this [now] non-existent picture.
The Clipboard Picture menu option (Ctrl-P) allows you to copy this picture back to the Clipboard. One use of this feature is that you can then use this picture with the Shift-Click option of the Snapshot Screen, putting a new copy of this picture at the end of the viewer screen's group of pictures.
The Picture Zoom menu option (Ctrl-Z) allows you to Zoom in on the thumb-nail image for a more detailed look at its content.


text:
package hclu.hreg.domain

import java.util.UUID
import javax.crypto.SecretKeyFactory
import javax.crypto.spec.PBEKeySpec

import hclu.hreg.common.Utils
import org.joda.time.DateTime

case class User(
  id: UUID,
  login: String,
  loginLowerCased: String,
  email: String,
  password: String,
  salt: String,
  token: String,
  createdOn: DateTime,
  firstname: String,
  lastname: String,
  active: Boolean
)

object User {

  def withRandomUUID(
    login: String,
    email: String,
    plainPassword: String,
    salt: String,
    token: String,
    createdOn: DateTime,
    firstname: String,
    lastname: String,
    active: Boolean = true
  ): User =
    User(UUID.randomUUID(), login, login.toLowerCase, email, encryptPassword(plainPassword, salt), salt, token,
      createdOn, firstname, lastname, active)

  def encryptPassword(password: String, salt: String): String = {
    // 10k iterations takes about 10ms to encrypt a password on a 2013 MacBook
    val keySpec = new PBEKeySpec(password.toCharArray, salt.getBytes, 10000, 128)
    val secretKeyFactory = SecretKeyFactory.getInstance("PBKDF2WithHmacSHA1")
    val bytes = secretKeyFactory.generateSecret(keySpec).getEncoded
    Utils.toHex(bytes)
  }

  def passwordsMatch(plainPassword: String, user: User) = {
    user.password.equals(encryptPassword(plainPassword, user.salt))
  }
}


text:
Saudi Arabia, Israel, Egypt 'Knocking on Putin's Door,' Not Obama's
© AP Photo / Susan Walsh
https://sputniknews.com/politics/201510171028689293-Saudi-Arabia-Israel-Egypt-Knocking-Putins-Door/
Some of the US's major allies appear more and more convinced that Barack Obama is losing his political influence on the Syrian conflict and the fight against the self-proclaimed Islamic State terror group, according to an analysis in the US media.
Key US partners are increasingly fixing their eyes on Moscow rather than Washington, writes Dan de Luce, a columnist for Foreign Policy.
© AP Photo / Hadi Al-Abdallah
US War in Syria, Iraq Part of Bigger Plan Aimed Against Iran and Beyond
According to de Luce, the recent visit of Saudi Arabia's defense minister Mohammed bin Salman to the Russian city of Sochi showcases on the one hand to what extent the "power dynamics" in the Middle East has changed, and on the other — that, in US allies' eyes, President Putin is close to taking Barack Obama's place of "regional kingmaker." The author pointed out that high-profile representatives of Saudi Arabia and other Gulf countries are now "knocking on Putin's door instead of that of the Oval Office."
The visit of the Saudi minister, de Luce noted, suggests Riyadh is looking into the opportunity of an agreement under which Syrian president Bashar al-Assad would stay in power for a longer period of time in exchange for the creation of Russian-Saudi joint forces in the fight against IS.
"If the Saudi visit was coordinated with the US, that would be one thing, but if it wasn't, it was the Saudis again saying to us, 'You're irrelevant,'" FP quoted former US ambassador to Syria Ryan Crocker as saying.
© Sputnik / Dmitriy Vinogradov
Battle Against ISIL: Russia Exposes US Lies in Syria
The US' key allies, alarmed by the recent Iran nuclear agreement between Tehran and the P5+1 powers, seem to be arriving at the conclusion that Obama is losing his significance and influence in terms of the Syrian war and fight with IS.
Despite the fact that the US maintains long-term alliances in the Middle East and has huge military and economic might, some of their partners are seeking reassurance amid ongoing events in Syria, and are probing into Moscow-proposed initiatives.
For instance, the visit of the Saudi defense minister to Russia coincided with that of a senior military representative from the United Arab Emirates, Abu Dhabi's Crown Prince Mohammed bin Zayed Al Nahyan, de Luce added.
Another crucial regional ally of the US, Egypt, is also attempting to improve relations with Moscow. The country's leader Abdel Fattah al-Sisi has four times visited Russia since coming to power in 2013, and has also invited Putin to Cairo once. At the same time, the Egyptian president has made only two trips to the US, and was supposed to be hosted at the White House only once.
© AFP 2020 / ZEIN AL-RIFA
The Phantom of Syria: Does 'Moderate' Syrian Opposition Really Exist?
Israel has also joined the list of those "knocking on Putin's door," de Luce noted, referring to the late-September meeting of president Putin with Israeli prime minister Benjamin Netanyahu.
The White House, in its turn, has hopes that Russia will stumble in Syria. Vali Nasr, a former senior State Department official, argued that if Moscow achieves its objective and transforms its wins on the battlefield to a political resolution of the war, it will eventually "translate into much more regional influence [for Russia] in the Middle East."
"And also many other countries in other regions of the world may come to the conclusion that it's not America that's the indispensable nation," he concluded.
Moscow, Arab League Head Discuss Coordination of Efforts in Middle East
Dude, You Failed: Russia, Afghanistan Reveal Fiasco of US Foreign Policy
Countries Fighting ISIL Should Follow the Lead of Russia – Iranian FM
Daesh, Syrian conflict, Vladimir Putin, Barack Obama, Israel, US, Russia, Saudi Arabia, Egypt
15:34 GMT 'Cringe-Worthy Obsequiousness': Tehran Slams Attempts to Lure US Into Confrontation With Iran


Footage shows the moped being driven off.
A man had his £25,000 Rolex stolen by moped thieves in a "horrifying" knifepoint robbery in St John's Wood High Street.
The 64-year-old was left "angered and shaken" by the attack and had to be taken to hospital with injuries to his arm, leg and face.
Officers have released grainy phone footage of the mugging but believe there is more to be found, and have urged people to come forward.
The man was walking along the street at 7.45pm on September 7, a Friday night, when he was threatened at knifepoint by two thugs on a grey and white moped.
They stole his luxury watch and drove off. Police think people were filming it on their phones.
Det Con James Drummond from Westminster CID said: "This was a horrifying ordeal for a man just out enjoying a summer evening.
"He was confronted by masked men brandishing a large knife and they have forcibly removed his watch.
Anyone with information or footage concerning this robbery attack is requested to call 101 quoting CAD 6669 of September 7.
Alternatively tweet @MetCC or contact Crimestoppers anonymously on 0800 555 111.


text:
Best Job in the World inducted into Hall of Fame
Tourism and Events Queensland's (TEQ) Best Job in the World campaign has been inducted into the PR News Platinum PR Awards Hall of Fame at an awards ceremony in New York City.
The Best Job in the World campaign launched in 2009 to an unprecedented level of national and international media interest, propelling Queensland, and in particular the Islands of the Great Barrier Reef, into the global tourism spotlight.
TEQ Chief Executive Leanne Coddington welcomed the accolade saying it further highlighted the organisation's role in showcasing the unrivalled beauty of Queensland's destinations.
"The Best Job in the World experience has been an extraordinary success story for TEQ and Queensland, showcasing the spectacular tourism experiences of the state's Great Barrier Reef," said Ms Coddington.
"We're proud that the campaign has been inducted into the PR News Platinum Hall of Fame. It underscores many of TEQ's innovative marketing initiatives to promote Queensland as one of the world's leading travel destinations."
Launched in 2009, the Best Job in the World sought to appoint a caretaker to the Islands of the Great Barrier Reef with nominations open to applicants from anywhere in the world.
Beating out almost 35,000 applicants, Ben Southall, a 34-year-old British charity events organiser, was announced as the winner of the Best Job in the World on 6 May 2009 and embarked on a six month whirlwind of travel, social media, and interview opportunities.
His experience was also captured in a six-part series that aired on National Geographic around the world.
The campaign, which achieved more than $400 million in global publicity value for Queensland, attracted coverage from a number of distinguished media bodies including the BBC, CNN, Good Morning America, Canada TV, Sky News London, The Times in London, and The Sunday Times, plus a vast array of domestic media.
"I believe the simplicity behind the campaign, and the ease at which it translated across global boundaries, made the Best Job in the World such a success," said Ms Coddington.
The PR News Platinum PR Awards highlight the most outstanding communicators, initiatives and organisations within the public relations arena.
TEQ is the Queensland Government's lead marketing, destination and experience development, and major events agency, working toward achieving $30 billion in annual overnight visitor expenditure by 2020.
Media Contact: TEQ Brisbane Office: Bethany Lawrence +61 7 3535 5020 / +61 431 294 625
TEQ Americas: Leigh Arredondo, Arredondo, Wiggington and Associates +1 310 695 3255


text:
Reading: Cervical Cancer Screening in HIV-Positive Farmers in South Africa: Mixed-Method Assessment
XML (EN)
Cervical Cancer Screening in HIV-Positive Farmers in South Africa: Mixed-Method Assessment
Molly Lieber,
Icahn School of Medicine at Mount Sinai, US
Omara Afzal,
Kathryn Shaia,
Adrienne Mandelberger,
Christine Du Preez,
Hoedspruit Training Trust, ZA
Ann Marie Beddoe
Background: In 2015, a See and Treat cervical cancer screening program was implemented at a local HIV clinic in Limpopo, South Africa, where infrastructure limited adequate Pap smear usability.
Objective: The purpose of this evaluation was to determine the quality and sustainability of the implemented program.
Methods: A mixed-methods program analysis was conducted at 18-months post implementation. Data collection techniques included in-depth interviews of staff and patients, observation of healthcare workers delivering screening, and review of charts and patient logs.
Findings: Eighteen in-depth interviews revealed improved cervical cancer screening understanding and awareness. Privacy concerns and negative perceptions of medical care were barriers to screening. Informal observations revealed continued clinical competence among healthcare workers who had been previously trained. Review of charts demonstrated positive correlation between VIA and Pap smear results. In evaluating loss to attrition, about half of the first cohort of patients were lost to follow-up. VIAs and Pap smears were offered on an ongoing basis, and month-over-month change for overlapping four months of programming between 2015 and 2016 showed a 4.4% negative change in number of Pap smears and a 57% negative change in VIAs.
Conclusion: Our evaluation reveals successful integration of See and Treat into current clinic services in rural South Africa and increased awareness of cervical cancer among health workers and participants. Program sustainability was challenging to assess as many patients were lost to follow-up, given the migrant and transient population attending this clinic. Acceptance by health workers and patients alike is vital for the long-term impact on cervical cancer incidence in this region.
How to Cite: Lieber, M., Afzal, O., Shaia, K., Mandelberger, A., Du Preez, C. and Beddoe, A.M., 2019. Cervical Cancer Screening in HIV-Positive Farmers in South Africa: Mixed-Method Assessment. Annals of Global Health, 85(1), p.58. DOI: http://doi.org/10.5334/aogh.37
Published on 15 Apr 2019
Each year, 528,000 cases of cervical cancer are diagnosed worldwide, and cervical cancer accounts for 266,000 deaths [1]. While the incidence and mortality have decreased in high-income countries, they remain high in less-developed regions, including Southern Africa. In 2012, South Africa had a cervical cancer incidence of 7,735 per 100,000, and mortality was 4,248 per 100,000 [1]. Although human papilloma virus (HPV) vaccines are available to prevent cervical cancer, financial and political barriers contribute to their underutilization and inaccessibility. These barriers contribute to women in lower-resource populations seeking care for this cancer late in the course of their disease when symptoms occur. The disease burden is high, and outcomes are poor [2, 3]. Consequently, a large emphasis is put on cervical cancer screening. Traditional cytology-based screening, such as Pap smears, has been successful in reducing cervical cancer rates in high-income countries, but it is less accessible and efficacious in low-income countries due to the requirement for robust infrastructure [4]. Specifically, challenges in rolling out cytology-based screening include lack of trained health workers, availability of appropriate equipment, finances, and logistics for follow-up care [2, 4, 5].
As a result, many low-income settings have adopted a See and Treat method for cervical cancer screening [4, 6, 7]. The See and Treat method, which includes visual inspection with acetic acid (VIA) for diagnosis and cryotherapy for treatment, has been recommended by the World Health Organization (WHO) for low-resource settings and for populations where women may be lost to follow-up [8]. Serving as a low-tech screening method, VIA involves application of acetic acid to the cervix and subsequent visual inspection [4]. Results are available immediately, and treatment can be offered at the time of screening to avoid multiple patient visits and possible loss to follow-up [4, 7, 9]. Because shortages of physicians are historic barriers to providing care in low-resource and rural areas, the See and Treat method has been proposed for these settings as trained healthcare workers can be readily trained to perform both VIA and cryotherapy procedures [10, 11]. Results from previous studies show that nurses are able to master the numerous steps involved in a See and Treat program, including recruitment, education, and performance of clinical exams and treatment [12]. While the See and Treat method is the best option for many settings, there are limitations, including procuring and transporting cryotherapy machines and gas tanks, refilling tanks, and repairing damaged cryotherapy machines [13].
Although there is no consensus about the length of training and education needed for VIA training, most programs agree that both didactic and clinical training components are essential. Previous studies show varied lengths of training and education, ranging from two days to two weeks [4, 5], and programs developed from varying organizations often include didactic lectures, simulation, and clinical practice [2]. One review showed that after 10 days of training, nurses agreed with experts' VIA assessments more than 60% of the time [16].
The major problem with VIA is that quality assurance and quality improvement have not been standardized, and various methods have been used to assess consistent health worker performance and overall success of See and Treat programs. Confirmation of VIA results through review of VIA photographs by gynecologists and medical officers, confirmation of diagnosis through web-based instruments, and follow-up visits by initial program implementers have all been utilized to assist with program monitoring and evaluation [5, 17]. Repeat trainings and periodic refreshers have been shown to increase average test scores and confirm or improve clinical practices [18].
In developing countries where HIV rates are high, the double burden of HIV and HPV infections makes integration of VIA screening services ideal as access to target populations is secured and sustainability of programming is increased [10]. For HIV positive populations, cervical cancer screening is of utmost importance, as there is an increased risk of invasive cervical cancer among HIV positive women [15]. This known association occurs for many reasons, including similar risk factors for HPV infection and HIV positive populations and higher susceptibility to HPV infection among HIV positive populations [14]. More rapid progression and higher rates of cervical intraepithelial neoplasia are seen among HPV and HIV co-infected individuals, and disease progression is not affected by use of anti-retroviral therapy (ART). HIV positive individuals accessing ART have higher life expectancy and thus higher cumulative risk for HPV infection [14].
In 2015, in Limpopo, South Africa, we introduced a cervical cancer screening program in an existing HIV screening and treatment clinic servicing HIV positive migrant farm workers and sex workers [19]. The South Africa National Policy for cervical cancer screening recommends three Pap smears in a lifetime. As discussed separately, chart reviews revealed poor Pap smear quality, long delays in addressing abnormal results, and many lost results [20], initiating our introduction of See and Treat cervical cancer screening. In order to determine the quality and sustainability of the program, we conducted an evaluation utilizing a mixed-method approach at 18 months post-implementation. Using a mixed-method approach, an outcome-based evaluation was designed with the primary objective of assessing whether the program was sustained and functional. The secondary objective was to determine next steps to improve quality of the program in the future.
The initial program design followed the World Health Organization VIA guidelines and was adjusted for this population; it was implemented in 2015 as previously reported [19]. Researchers conducted a one-week training and spent three months overseeing implementation of the program. At the end of three months, trained health workers continued to run the program and educate additional nursing staff using the "train the trainer" model. Program participants were female patients who attended the HIV clinics; they were offered screening for cervical cancer using VIA and cryotherapy if screening results were positive. The implemented algorithm included six-month follow-up post VIA to troubleshoot and reinforce procedures and guidelines (Figure 1).
Algorithm used in current program.
Our aims were to (i) assess advancements in knowledge and skills of providers and improvements in knowledge, attitudes, and behaviors of participants; (ii) assess perspectives and experiences of participants and providers; and (iii) determine gaps in the program that would inform overall necessary improvements moving forward. Institutional review board approval was obtained from both the United States and South Africa.
The evaluation was conducted at a farm-based HIV clinic in Limpopo Province, South Africa, where cervical cancer screening was introduced 18 months earlier. Participants were recruited from the clinic and included health providers, ancillary health workers, and patients. Our measurement tools included interviews, focus groups, clinical observation, review of charts, and review of clinic logs.
Qualitative interviews were completed using a field guide of 12 questions. Questions were developed to illicit responses regarding acceptability of cervical cancer screening, particularly VIA, among health workers and patients. Additionally, questions focused on understanding of screening, knowledge of cervical cancer and HPV, and barriers to receiving reproductive healthcare. Interviewees were recruited at the clinic using convenience sampling over the course of five days. All nurses and community health workers spoke English and acted as interpreters for patients whose first language was not English.
One focus group was conducted with nurses to assess their perspectives and experiences with the addition of cervical cancer screening into their routine HIV counseling and treatment program.
Health workers who underwent initial training in cervical cancer screening were observed by the ObGyn team from the United States during the course of their activities. Providers were observed during patient interviews, speculum examinations, and VIA performance and graded as "poor," "fair," or "good."
Quantitative data, Pap smear and VIA results, and cryotherapy was obtained from chart reviews and patient logs. Charts of the first patient cohort (N = 403), those screened at program rollout, were reviewed and logs were evaluated 18 months post initial program integration.
Qualitative data was recorded and transcribed by research team members and was coded to elicit themes. SPSS and Microsoft Excel were used for analysis of data.
Eighteen in-depth interviews were conducted with patients (12) and healthcare providers, including counselors (3), nurses (1), and peer educators known as nompilos (2). One focus group of nurses was conducted. The focus group revealed high levels of cervical cancer screening understanding and awareness, as well as privacy concerns and negative perceptions of medical care as barriers to screening.
Cervical Cancer Screening and Treatment: Comfort and Challenges
Acceptability by Health Workers. Nurses expressed a sense of empowerment for their acquired See and Treat skills. One nurse conveyed pride when discussing her ability to heal patients at the clinic.
"If had not been seen, sent to hospital. Now, can help them right away, straight away." (Community Health Worker)
Comfort. In discussing comfort level within the concept of screening and the actual screening process, patients discussed their experiences and nurses considered the perceived comfort of patients. Most referenced a discomfort with the position required for undergoing screening, and that comfort increased with each visit. Additionally, patients mentioned feeling more at ease with explanations from the nurses at the clinic.
"First time, tool they're using is uncomfortable. Nervous about getting results. Cryo, afraid at first. Can't see what's going on her own body. New and unseen." (Patient)
"At first she was afraid she thought maybe she would have pains, and she asked them and they said no it's not painful and now she's comfortable." (Patient)
Anatomy and Purpose: Patients expressed understanding of Pap smears and VIA screening in terms of both anatomy and purpose. Most were able to identify cervical cancer as the disease being screened for and understood the importance of screening.
"The most important thing is that if you go for cervical cancer and then you're still on the first stage, early stage, you will get help. Yea, it's very important to get it on early stage before it spread." (Patient)
"If you got infection, they will get it earlier than when it's too late and you will get help here if it's not too much, you will get it in the early stage." (Patient)
"Because cancer is a dangerous disease. If you don't go for a check then you go later then you can die." (Patient)
Privacy As a Challenge. When asked about challenges to screening, nurses referenced patients' concerns about privacy, specifically referencing a feeling of older patients not wanting to be seen by younger nurses.
"About 10–20% refuse Pap smear because they are too nervous or concerned with privacy. Some have fear and don't want to ask questions. They don't want to be taught, even at meetings or churches." (Community Health Worker)
"Largest challenge, patients don't want be seen. Older women didn't want young nurses to see her. Not comfortable with the position and being seen." (Community Health Worker)
Negative Perceptions of Medical Care As a Challenge. Medical services are lacking in this area of South Africa as the hospital is understaffed and has a high rate of turnover among top administrators and lower level workers. Consequently, when patients seek care at the hospital, they wait for many hours, possibly days, they are uninformed about practices and procedures, and they are often left behind in follow-up care. Nurses and patients alike cited many of these issues as reasons for having negative perceptions of medical care.
"Some of the people they say I'm going home I don't want to go there because maybe they will cut me something, so they go home." (Patient)
"Largest challenge for patients to receive treatment at the hospital—they have to wait many hours just to book an appointment. Sometimes the hospital doesn't book them. Most of the patients don't wind up going." (Community Health Worker)
Training and Education Approach
Train the Trainer: Patients and nurses expressed satisfaction with the train the trainer method of education. With their current network of clinics, they are able to provide additional nurses with hands-on training after the original trainers left.
"They sometimes teach at the clinic they used to teach everyone. Yes, because if the other people they don't know maybe they would be happy to know now." (Patient)
Challenges. Nurses expressed a desire for continuous education as they were unclear how to move forward when facing challenges they were unfamiliar with.
"[We] need more education. Challenges, unable to help with certain things; couldn't do VIA. Finally find cervix and os and there is oozing at the top. [I think] who to ask, how do they refer to the hospital. Pap is negative, but VIA looks strange. (Community Health Worker)
Nompilos. Community educators are called nompilos and work to spread HIV prevention and treatment information to the community. Patients expressed gratitude for the current HIV work of nompilos. Additionally, they felt the best way to disseminate information was to go to the people and tell them about it.
"I think it's helpful like here where I'm working, I'm also spreading the information and people are coming to get help here at [clinic] so it's helping because we share the information." (Nompilo)
"Like those care groups walk door to door, they can increase the awareness when they going into communities, spreading that information that contraception is good and yes, you can use it." (Patient)
"The best is to go to people. Yes, go to people. Try to orient them by maybe doing workshops … telling them the advantages & disadvantages, show them close example." (Patient)
Patients and the community health workers were asked what gaps they felt existed in the current screening process and what they would like to see in the future. Both groups discussed expansion to other clinics and more education.
More Locations. The nurses expressed a desire to expand the See and Treat approach to other clinics, as the main clinic is the only one currently offering cryotherapy.
"Other clinics in the area do not have cryo." (Nurse)
"More patients are being referred now, they are telling their families and friends but if they are not HIV+ they can not receive treatment at [clinic]. What will they do? They need cryotherapy at other clinics." (Nurse)
More education. Health workers and nurses both cited a need and want for more education, specifically about cancer. Patients wanted additional information about cancer, specifically the causes, symptoms, stages, and available treatment options for each scenario.
"If she gets cervical cancer, what happens if she gets pregnant? Can she become pregnant if she has cervical cancer? What would happen?" (Patient)
"What are the symptoms of cancer? What is the cause of the growth? How does it come?" (Patient)
Informal observations revealed continued clinical competence among healthcare workers; nurses were able to correctly perform the procedure and triage patients appropriately for treatment without assistance. After training, nurses had improved in speculum insertion and ability to examine the cervix. Assessment of quality and performance showed those who were taught to perform VIA and cryotherapy maintained and continued these skills.
Chart Review
Validity. As patients routinely undergo both Pap smear and VIA screening, we analyzed the correlation between VIA and Pap smear results. Review of charts demonstrated a positive correlation between VIA and Pap smear results [r = 0.321, n = 82, p = 0.003; r = 0.463, n = 183, p = 0.000] in 2016 and 2015, respectively.
Loss to Attrition. In evaluating loss to attrition (Table 1), about half of the first cohort of patients were lost to follow-up (54.8% of VIA+ patients and 61% of VIA– patients). Of those patients who received treatment, necessitating additional screening, 60% were lost to follow-up. VIAs and Pap smears were offered on an ongoing basis, and month-over-month change for overlapping four months of programming between 2015 and 2016 showed a 4.4% negative change in number of Pap smears and a 57% negative change in VIAs. Clinic records were often incomplete or missing, and thus assessment for percentage seen was not calculable.
Loss To Attrition.
Visual Inspection with Acetic Acid (VIA)
Yes 403 (100%) 13 (11%) 87 (21.6%)
VIA Positive 124 (30.8%) 4 (3.5%) 7 (8.0%)
Cryotherapy 114 (92%) – –
VIA Negative 279 (69.2%) 9 (7.9%) 80 (92%)
Ineligible 0 (0%) 1 (0.9%)
No 0 (0%) 33 (29%) 79 (19.6%)
Loss to Follow-Up – 68 (60%) 237 (58.8%)
Yes 183 (45.4%) 30 (26.3%) 96 (23.8%)
Pap Positive 49 (12.2%) 11 (36.7%) 14 (14.6%)
Pap Negative 134 (33.3%) 19 (63.3%) 77 (80.0%)
No 199 (49.4%) 21 (18.4%) 57 (14.1%)
Loss to Follow-Up 21 (5.2%) 63 (55.3%) 248 (61.5%)
* VIA is the abbreviation for Visual Inspection with Acetic Acid.
† Time 1 (T1) is program implementation, Time 2 (T2) is 6 month follow-up for those who received cryotherapy at T1, Time 3 (T3) is 1-year follow-up for all those who were screened at T1.
Our evaluation reveals increased awareness of cervical cancer among health workers and participants and successful integration of See and Treat into a clinic in rural South Africa. Using the See and Treat approach and following guidelines for triaging of positive screens, abnormal results can be readily addressed and treated promptly. The program was maintained and patients were treated on site without additional referrals for treatment. Although patients were lost to follow-up, given the migrant nature of the participants, program sustainability was achieved in that clinic healthcare workers are continuing to perform See and Treat exams and awareness of cervical cancer is increasing. Other factors that affect the implementation of the See and Treat program include HIV treatment policy changes made by the South African government. Specifically, HIV treatment is now offered to all HIV-positive individuals, regardless of immune system status (CD4 cell count), which previously determined eligibility for treatment. Consequently, other programs that do not fit in line specifically with HIV treatment may take a back seat while this new policy is enacted. HIV-affected individuals are a recognized unique population, often with needs and challenges that affect multiple aspects of their social and health status, which may play into the feasibility of implementing a widespread cervical cancer screening program.
Limitations include loss to follow-up based on participant status as migrant farm workers. As a result, 237 of the original 403 participants who were screened using VIA (59%) were lost to follow-up. Moreover, as is common in many under-resourced settings, accuracy and consistency in record keeping was lacking, and as is common with document review, content was unreliable and possibly biased. Additionally, turnover among staff at the local clinic was a factor. The main nurse administrator who took on leading the implementation of the See and Treat method left shortly after program implementation. As a result, there is less organization of women undergoing cervical cancer screening. Additionally, the clinic is now short-staffed because filling a nurse's position is difficult. Even with these challenges, successful See and Treat exams are ongoing.
Interviews with patients and health care providers showed interest and growing understanding of cervical cancer screening and implications on health care. Interviews conducted with the use of a translator may possibly have been subject to bias or limited patient response given the provider-patient relationship. However, the community health workers have been trained in objective and ethical research practices prior to interviewing, and patients appeared open and frank with their answers, which was encouraged. Acceptance by health workers and patients alike is vital for the long-term impact on cervical cancer incidence in this region. Although loss to follow-up occurred, the success of this program can be seen with its continuation and increased public awareness of cervical cancer by patients and health care workers alike.
The results of this assessment will inform ongoing cervical cancer screening programs in low-resource settings and with similar patient populations by highlighting the successes and barriers that must be addressed for successful and widespread program implementation. Given the new guidelines for HPV screening and the awareness that has been created regarding the role of HPV in cervical cancer in this region, transitioning to Screen and Treat is now being considered. Using HPV screening with triage to VIA in the same setting will allow us not only to widen our screening coverage, but also to readily treat patients where the migrant nature of the population accounts for high rates of loss to follow-up.
Data Accessibility Statement
All authors had access to data and a role in writing this manuscript.
TheWomen.Org
The authors have no competing interests to declare.
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Lieber M, Afzal O, Shaia K, Mandelberger A, Du Preez C, Beddoe AM. Cervical Cancer Screening in HIV-Positive Farmers in South Africa: Mixed-Method Assessment. Annals of Global Health. 2019;85(1):58. DOI: http://doi.org/10.5334/aogh.37
Lieber, M., Afzal, O., Shaia, K., Mandelberger, A., Du Preez, C., & Beddoe, A. M. (2019). Cervical Cancer Screening in HIV-Positive Farmers in South Africa: Mixed-Method Assessment. Annals of Global Health, 85(1), 58. DOI: http://doi.org/10.5334/aogh.37
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Lieber, Molly, Omara Afzal, Kathryn Shaia, Adrienne Mandelberger, Christine Du Preez, and Ann Marie Beddoe. "Cervical Cancer Screening in Hiv-positive Farmers in South Africa: Mixed-method Assessment". Annals of Global Health 85, no. 1 (2019): 58. DOI: http://doi.org/10.5334/aogh.37
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text:
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Total and CMA CGM complete world's largest liquefied natural gas bunkering operation at Port of Rotterdam
By editor on Jan 5, 2021
Liquefied fuel transferred via ship-to-ship operation, allowing cargo operations to continue simultaneously
The CMA CGM Jacques Saadé at Westports' Port Klang, Malaysia (Credit: Westports Malaysia)
Total and CMA CGM undertook a ship-to-ship bunkering operation to transfer Liquefied Natural Gas (LNG) to the world's largest LNG-powered cargo ship in a world's first.
It was performed by the bunker vessel the Gas Agility at the Rotterdam World Gateway terminal, while the CMA CGM Jacques Saadé carried out cargo operations simultaneously.
Refuelling took approximately 24 hours to complete, and the supply of LNG was provided by Total Marine Fuels Global Solutions, Total's dedicated business unit in charge of worldwide bunkering activities.
The 23,000 TEU CMA CGM Jacques Saadé is the first of her class and began operations very recently, being launched in September 2020 in Shanghai.
The shipping industry is putting a lot of its hopes on LNG as an alternative fuel in light of tightening emissions regulations and more scrutiny on the industry's role in the fight against climate change. CMA CGM says that it estimates that one these new class of LNG-powered vessels removes 99% of sulphur emissions, 99% of fine particles emissions, and lowers nitrogen oxide emissions by up to up to 85% and carbon dioxide by 20%.
Total said in a release that the carbon footprint of the LNG delivered was further reduced with the introduction of biomethane, which made up approximately 13% of the quantity delivered, through the Guarantee of Origin (GO) certificates mechanism. The biomethane is produced in the Schipol area in the Netherlands, mainly by organic municipal waste.
"We are really proud of this landmark achievement, which is the culmination of a 3-year close collaboration between Total and CMA CGM," said Jérôme Leprince-Ringuet, Vice President Marine Fuels at Total. "It also marks the shipping industry's first commercial use of biomethane on this scale. Such introduction reflects Total's ambition to get to Net Zero by 2050 and our commitment to help reduce the carbon intensity of the energy products used by our customers."
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text:
Пентакозапалладийнонагерманий — бинарное неорганическое соединение
палладия и германия
с формулой GePd,
кристаллы.

Получение
 Сплавление стехиометрических количеств чистых веществ:

Физические свойства
Пентакозапалладийнонагерманий образует кристаллы
тригональной сингонии,
пространственная группа P 3,
параметры ячейки a = 0,7351 нм, c = 1,0605  нм, Z = 1
.

В некоторых работах соединению приписывают формулу GePd.

Соединение образуется по перитектической реакции при температуре 970°C
и существует при температуре выше ≈560°C.

Примечания

redpajama_set_name: RedPajamaWikipedia


What's up with the name? Chansoda, as in "jackie chan, soda can." The name is of Khmer origin, "Chan" meaning Monday and moon, me, being born on a Monday.
2019 Copyright Chansoda Roeun. All rights reserved.
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Situated 2 miles northeast of St. Just, Geevor was formerly known as North Levant. There has been a mine of some sort on this particular stretch of north Penwith coast from at least the early part of the eighteenth century. The historian John Norden wrote of Carn Meal Bal (Wheal Bal) in 1690 whilst nearby Penzance was granted status as a coinage town some thirty years earlier. As different investors and mine adventurers tried to make their fortune so the names of their mining enterprises changed. It is recorded that 'Huel an Gever' was working this ground in 1716 along with other nearby mines at Wheal Geavor, Wheal Mexico and Wheal Stennack.
The name Geevor comes from an anglicised form of the area's cornish name of 'Stennack an Gever' - the tin ground of the goat. The tin concentrate produced in the mill and froth flotation plant would then be sent to the smelter at Capper Pass on Humberside. On return ceremonial tin ingots from Geevor were stamped with a fish-tailed goat to signify their origin. A new company was formed in 1851 called 'North Levant' and within nine years were investigating the possibility of working the richer subsea lodes. The mine grew gradually over the next quarter century or so expanding into the former workings of Wheal Bal and Wheal Carne.
In 1891 'North Levant' stopped working due to the generally depressed state of the mining industry in the far west. The mine lay idle until 1905 when it was purchased by the West Australian Gold Fields Company. The new management renamed the company as 'North Levant and Geevor Ltd.', with its main shaft being Wethered Shaft. The mine survived the turmoil of the First World War and a new shaft was sunk in 1919 to commemorate the Allies victory the previous year. This was Victory Shaft.
Further exploration continued over the next few decades as known reserves were depleted. New ore bodies were discovered at Grenfell Lode (Victory shaft) and the rich Simm's Lode (near Boscaswell Lode) in the early 1960's. In 1975 the decision was taken to drive a sub-incline shaft from Victory Shaft to connect Geevor's 18th level with the lower submarine levels of Levant Mine - at the 278 fathom main tramming level. This extension was opened by completed in 1979 and opened by Her Majesty the Queen on 28th November 1980. There were also plans to run another sub-incline shaft from Victory Shaft over to the ore reserves remaining in the Botallack Sett. New headgear was erected over the refurbished Allen's shaft near to the Botallack Counthouse and exploratory work carried out.
All these plans were to come to nothing in October 1985 when the price of tin crashed drastically from over £10,000/ton to round about £3,500/ton. This was caused by a couple of factors: Firstly new alluvial tin was discovered in Malaysia and Brazil and secondly the United States decided to release all their strategic tin stockpile reserve onto the open market at the London Metal Exchange. This glut of tin drove prices down in free-fall and made the remaining Cornish mines basically unviable overnight. This was the death knell for Geevor (closed 16 February 1990) and within a few years all Cornish Mines.
After three years of uncertainty following the closure 'Geevor Tin Mine Heritage Centre' rose from the ashes of what remained due largely to the foresight of Penwith and Cornwall County Councils with a dedicated group of volunteers from the area. I have visited the mine three times since its opening in August 1993 and each visit has offered something new. Currently there are exhibits of mine memorabilia, technical displays, a tour of selected surface buildings including the Drill Shop and the Miner's Dry. There are tours of the milling area at selected times and a chance to visit the underground workings of Wheal Mexico with some excellent guides. In short, I would strongly recommend that no visit to Cornwall would be complete without a visit to Geevor. On 27th May 2006 it was announced that the Heritage Lottery Fund has pledged £2.5m to help expand and enhance Geevor as the Premier mine heritage site in the country.