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Journal of Parasitology Research
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Volume 2016, Article ID 1769585, 13 pages
Immune Profile of Honduran Schoolchildren with Intestinal Parasites: The Skewed Response against Geohelminths
José Antonio Gabrie,1 María Mercedes Rueda,2 Carol Anahelka Rodríguez,2 Maritza Canales,2 and Ana Lourdes Sanchez1,3
1Department of Health Sciences, Brock University, St. Catharines, ON, Canada
2School of Microbiology, National Autonomous University of Honduras (UNAH), Tegucigalpa, Honduras
3Microbiology Research Institute, National Autonomous University of Honduras (UNAH), Tegucigalpa, Honduras
Received 16 August 2016; Accepted 10 October 2016
Academic Editor: Emmanuel Serrano Ferron
Copyright © 2016 José Antonio Gabrie et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Soil-transmitted helminth infections typically induce a type-2 immune response (Th2), but no immunoepidemiological studies have been undertaken in Honduras, an endemic country where the main control strategy is children's annual deworming. We aimed to characterize the immune profile of Honduran schoolchildren harbouring these parasitoses. Demographic and epidemiological data were obtained through a survey; nutritional status was assessed through anthropometry; intestinal parasites were diagnosed by formol-ether and Kato-Katz; and blood samples were collected to determine immunological markers including Th1/Th2 cytokines, IgE, and eosinophil levels. A total of 225 children participated in the study, all of whom had received deworming during the national campaign five months prior to the study. Trichuriasis and ascariasis prevalence were 22.2% and 20.4%, respectively. Stunting was associated with both age and trichuriasis, whereas ascariasis was associated with sex and household conditions. Helminth infections were strongly associated with eosinophilia and hyper-IgE as well as with a Th2-polarized response (increased levels of IL-13, IL-10, and IL4/IFN- ratios and decreased levels of IFN-). Pathogenic protozoa infections were associated with a Th1 response characterized by elevated levels of IFN- and decreased IL10/IFN- ratios. Even at low prevalence levels, STH infections affect children's nutrition and play a polarizing role in their immune system.
Soil-transmitted helminths (STH) or geohelminths infect more than 2 billion people worldwide, especially in developing countries located in tropical and subtropical regions. The most prevalent species are Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and hookworms (Necator americanus and Ancylostoma duodenale). STH infections account for about 40% of global morbidity due to infectious diseases [1]. Children and women of childbearing age are among the high-risk groups for these parasitic diseases. The morbidity caused by STH infections is highly associated with the size of the worm population residing in the intestines (also known as worm burden). Infections of heavy intensity are more likely to cause impaired physical growth and cognitive development as well as micronutrient deficiencies, including iron-deficiency anaemia [1, 2]. Further, due to their chronic and insidious nature, even light intensity infections may compromise health outcomes. To reduce the morbidity caused by these parasitoses, the World Health Organization (WHO) recommends cyclical (annual or biannual) benzimidazole-based mass drug administration to groups at high-risk of infection, especially pre- and schoolchildren [1]. The basic premise of this strategy is that even though this intervention may not decrease transmission and prevalence, it will in time reduce hosts' worm burden with the ensuing reduction in health impact.
In addition to health impact, STH infections affect the human host in more subtle manner: as extracellular metazoan parasites, helminths trigger type-2 immune response mediated by T-helper type 2 (Th2) cells. This response is typically characterized by expansion of mast cells, eosinophils, basophils, group 2 innate lymphoid cells (ILC-2), and alternatively activated macrophages (AAMs), as well as increased production of Th2 cytokines (e.g., IL-4, IL-5, IL-9, and IL-13) and IgE [3–5].
On the other hand, intracellular pathogens such as viruses, bacteria, protozoa, and fungi elicit a type-1 response, characterized by increased numbers of phagocytic neutrophils and macrophages, as well as cytotoxic CD8+ T cells and Th1 cells. Antigen-presenting dendritic cells (DCs) secrete interleukin- (IL-) 12 promoting differentiation of naive CD4+ cells, first into null T-helper (Th0) and then into Th1. Via production of interferon-gamma (IFN-) and IL-2 to a lesser degree, Th1 cells direct, maintain, and enhance the antimicrobial effect of type-1 response [6]. Both subsets of T-helper cells antagonize and negatively regulate each other. Naturally, a healthy resolution of infections relies on a dynamic combination of the two [5, 7].
Chronic helminth infections such as the ones caused by STH exhibit a modified type-2 response, in which a superimposition of regulatory mechanisms exerted over the basic response pattern takes place. This regulation is mainly achieved by the expansion and induction of regulatory T cells (Treg). Increased levels of anti-inflammatory cytokines IL-10 and transforming growth factor beta (TGF-) are hallmarks of this response [4, 8, 9]. It has been suggested that, during chronic helminthiases, this anti-inflammatory network may play a key role in the lower prevalence of allergic disease observed in Th2-skewed populations [7, 10–12]. Conversely, helminth-induced IL-10-mediated immunosuppression has raised concerns for populations in which STH infections coexist with other morbidities such as HIV/AIDS, malaria, and tuberculosis, as clearance for the latter depends on an active and timely type-1 response [8, 13–16].
In this context, successful deworming treatment has been proposed as a practical and inexpensive way to rebalance the immune response [17, 18]. Recent studies have observed that after administration of anthelminthic medication, eosinophil counts [19], IL-10 levels [19–21], and IgE concentrations [17] show a significant decrease from pretreatment values. Moreover, in HIV-1 infected individuals, deworming was shown to promote a significant decrease in plasma HIV RNA levels [18, 22] and CD8+ T cells counts [18]. Also, a randomized control trial in Kenya demonstrated a significant increase in CD4+ T cell counts after deworming [22]. Other studies, however, found no evidence of this effect [18, 19].
The principal aim of the present study was to characterize the immune profile in schoolchildren infected with geohelminths. Secondary aims involved assessing the health impact and epidemiological determinants of such parasitoses.
2.1. Study Population and Ethical Approval
The study was conducted in April 2014 and data were collected from schoolchildren living in Linaca, a rural community of the Municipality of Tatumbla, Department of Francisco Morazán in Honduras. The study was approved by Brock University's Bioscience Research Ethics Board (file number BU 12-262, dated June 27, 2013) as well as by the Research Ethics Board of the Master's Program in Infectious and Zoonotic Diseases, School of Microbiology, National Autonomous University of Honduras, UNAH (file number CEI-MEIZ 01-2013, dated September 23, 2013). Linaca school authorities also approved the study. The school of Linaca participates in the Honduras National Deworming Program, which provides enrolled children with a 400 mg single-dose albendazole annually. At the time of the study, the last deworming round occurred in November 2013. Children who had not received deworming treatment from other sources in the past 3 months were included in the study. Written informed consent was provided by children's parents. Children's oral assents were individually obtained and documented through a child assent form.
2.2. Data Collection
Basic demographic and epidemiological data of participant children were obtained using a structured questionnaire during a 5-minute face-to-face interview conducted in Spanish. Body weight and height of participants were measured twice by different researchers and their average was used to calculate the following anthropometric indicators: (a) height-for-age -score (HAZ), (b) weight-for-age -score (WAZ), and (c) body-mass-index-for-age -score (BAZ). These indicators were used to ascertain children's nutritional status as per international parameters: stunted growth (chronic malnutrition), thinness, and underweight, respectively [23].
2.3. Stool Collection and Parasite Determination
A same-day single stool sample was provided by each participant the morning of the interview. Samples were kept in portable coolers and examined early afternoon at the laboratory facilities of UNAH's School of Microbiology. The presence of intestinal parasites was assessed using both Kato-Katz and formol-ethyl acetate concentration methods. For the latter, an aliquot was preserved in 10% formalin. Microscopic examination of Kato-Katz smears was done between 30 and 60 min of preparation. Helminth eggs were identified and counted and the number of eggs per gram (epg) was calculated. Infection intensities were classified as light, moderate, or heavy, based on the epg calculations, according to WHO criteria [1]. Diagnostic accuracy was ensured by having 100% of negative and 10% of positive smears read again by a different researcher immediately after the first reading. Formol-ethyl acetate was done one month after sample collection and sediments were observed with dry and immersion oil objective lenses in order to identify helminth and protozoa stages, respectively.
2.4. Blood Collection and Hematological Analyses
Blood samples obtained from the cubital vein were collected in 3 mL tubes of each K2EDTA and serum separator and clot activator (BD Vacutainer, NJ, USA). The latter were centrifuged within 4 hours and serum was stored at −21°C until immunological analysis. Hematological automated analyses were performed within 4 hours of sample collection and were done with an ABX Pentra 120 (HORIBA-ABX-SAS, Montpellier, France). According to the parameters established in the most recent (2011-2012) Demographic and Health Survey in Honduras (DHS-HN) [24], anaemia was defined as Hb concentration < 12 g/dL. Eosinophilia was defined according to international standards as eosinophil count ≥ 500/μL in peripheral blood. Mild, moderate, or severe eosinophilia were defined if cell counts were 500–1500/μL, >1500–5000/μL, or >5000/μL, respectively [25].
2.5. Immunological Biomarkers
Cytokine concentrations in serum samples were measured using a MagPix magnetic beads platform (Luminex xMAP, Austin, TX, USA). Multiplex panels containing magnetic beads covered with fluorescent dyed conjugated to a monoclonal antibody specific for each target molecule were used to quantify Th1/Th2 cytokines (IL-2, IL-6, IL-8, IL-12p70, IFN-γ, GM-CSF, TNF-α, IL-4, IL-5, and IL-13) and the regulatory cytokine IL-10.
Serum concentrations of total IgE were also quantified using magnetic beads platform but with singleplex kits, Bio-Plex Pro™ Human IgE Isotyping (Bio-Rad laboratories, Inc. Hercules, CA, USA). Hyper-IgE was defined as a serum concentration exceeding 100 IU/mL and was classified as mild (>100–399 IU/mL), moderate (>399–999 IU/mL), or severe (≥1000 IU/mL) [26]. Cytokine and IgE tests were performed according to the manufacturer's instructions (Bio-Rad laboratories, Inc. Hercules, CA, USA).
2.6. Statistical Analyses
Descriptive statistics were used to characterize the study population. Point prevalence with 95% confidence intervals (95% CI) was calculated for overall STH infections and for each parasite species, as well as for mixed STH infections (i.e., infected with two or more species). Anthropometric indicators were calculated using the WHO AnthroPlus software ver. 1.04 (WHO). Associations between nutritional indicators and parasite infections were explored using both univariate and multivariable logistic regression models. Unadjusted and adjusted odds ratio (OR and adj. OR) with 95% CI were determined. Due to the non-Gaussian distribution of the immunological markers, nonparametric methods were used as follows. Geometric means and 95% CI were calculated for each marker. Relationships were evaluated through Spearman's rank correlation coefficient. Kruskal-Wallis test was used to assess differences among groups, followed by Dunn's test to investigate individual group differences. All statistical analyses were conducted using Stata 13 (StataCorp LP, TX, USA) and the level of significance was defined as .
3.1. Characteristics of the Study Population
Table 1 summarizes the characteristics and parasitological findings in the study population. A total of 225 schoolchildren attending grades 1 to 6 (age 6–13) participated in the study. All provided stool samples and all but one child agreed to provide blood samples. Most of the children lived in households with piped water (88%) and flushing toilet and/or latrines (98%) but 40% lived in households with earthen floor.
Table 1: Characteristics and parasitological findings of the study population ().
3.2. Parasitological Findings
Qualitative Kato-Katz results were 100% correlated with those of formol-ethyl acetate. No cases of S. stercoralis or hookworm infections were found with either technique but one case of Taenia solium was identified by the presence of gravid proglottids in the stool sample. Among pathogenic protozoa, Giardia intestinalis and Entamoeba histolytica/dispar were present in 4% and 9% of the samples, respectively. Additionally, one case of Cyclospora cayetanensis was identified.
The overall STH prevalence was 30% (95% CI = 24.1–36.1). Prevalence for T. trichiura and A. lumbricoides was 22.2% (95% CI = 17.2–28.2) and 20.4% (95% CI = 15.6–26.2), respectively. Mixed STH infections represented 43% of all infections observed. While the majority (84%) of trichuriasis cases were light intensity, about one-third (32.6%) of ascariasis cases were moderate-to-heavy intensity (Table 1). Only 20% of moderate-to-heavy infections with both A. lumbricoides and T. trichiura occurred as single infections. In the multivariable analysis, age was not associated with parasitism. Ascariasis was associated with sex and some household conditions of participating children. Almost three-quarters (71.7%) of ascariasis cases occurred in boys and they had almost three times the odds of having A. lumbricoides infections compared to girls (adj. OR = 2.82, 95% CI = 1.34–5.94, and ). Children living in households with earthen floor had twice the odds of helminthic infections (adj. OR = 2.29, 95% CI = 1.15–4.55, and ). Conversely, children with access to piped water in their households showed 64% reduced odds of ascariasis (adj. OR = 0.36, 95% CI = 0.14–0.93, and ). T. trichiura infections were not significantly associated with any of the abovementioned risk factors.
3.3. Nutritional Status
About 12% of the children were overweight, and this condition was significantly higher in boys than girls (73% versus 27%, ); only one of these children was stunted. Stunted growth was observed in 9.8% of the studied children. Multivariable logistic models controlling for age and sex were constructed, and adjusted OR were calculated. In this population, stunting was significantly associated with the age of participants as well as with trichuriasis. Per every year of age, the odds of stunting increased in 34% (adj. OR = 1.34, 95% CI = 1.03–1.73, and ). Similarly, children harbouring T. trichiura infections had almost four times the odds of being stunted (adj. OR = 3.93, 95% CI = 1.03–14.93, and ) when compared with children without STH infection. Further, children harbouring moderate-to-heavy trichuriasis had an additional 70% increased odds of being stunted (adj. OR = 6.64, 95% CI = 1.19–37.09, and ).
3.4. Eosinophilia and IgE Levels
Figures 1 and 2 depict the variation observed in eosinophils count (cells/L) and serum levels of IgE by STH infection and infection intensity. The geometric means and 95% CI of these parameters by STH infection are shown in Table 2. The overall prevalence of eosinophilia was 31.7% (95% CI = 25.9–38.1), and mild eosinophilia accounted for the vast majority (91.5%) of cases. No severe cases of eosinophilia were identified.
Table 2: Geometric means (95%CI) of immunological markers determined in schoolchildren by STH infection status .
Figure 1: Association between STH infections and eosinophils count and serum levels of IgE in studied children. Higher counts in eosinophils were significantly associated with trichuriasis and mixed infections (a). Higher total IgE levels were associated with mixed infections (b). Moderate positive correlation of eosinophils count and total IgE levels (c).
Figure 2: Association between STH infection intensity and eosinophils count and serum levels of IgE in studied children. Moderate-to-heavy infections of A. lumbricoides (a, c) and T. trichiura (b, d) were associated with higher eosinophils count and total IgE levels. Geometric means (GM) are depicted in their respective boxes.
Multivariable logistic models found no association between eosinophilia and sex or age of the studied children. Significantly higher mean counts of eosinophils were found in children infected with T. trichiura alone or in those harbouring mixed infections compared to nonparasitized children. A significant association was found between eosinophilia and STH infection and infection intensity. Children harbouring mixed infections had 2.5-fold increased odds of having eosinophilia when compared to nonparasitized children (adj. OR = 2.59, 95% CI = 1.13–5.90, and ). Similar increased odds were observed in children with single infection by T. trichiura, although this effect was only marginally significant (adj. OR = 2.48, 95% CI = 0.98–6.26, ). Eosinophilia was positively correlated with intensity of infection by both A. lumbricoides and T. trichiura ( = 0.26, and , resp.). Children with moderate-to-heavy ascariasis had five times the odds of presenting eosinophilia (adj. OR = 5.23, 95% CI = 1.69–16.12, and ) compared to their nonparasitized counterparts. Likewise, moderate-to-heavy trichuriasis was associated with a 7-fold increased odds of eosinophilia (adj. OR = 7.19, 95% CI = 1.41–36.70, and ).
The overall prevalence of hyper-IgE was 90.2% (95% CI = 85.5–93.5). More than half of these cases (51.0%) were severe, whereas mild and moderate hyper-IgE accounted for 24.3% and 24.7% of the cases, respectively. No significant correlation was found between IgE levels and sex or age of participant children. Compared to those without STH infections, children with mixed STH infections had significantly higher mean levels of IgE (Table 2). There was a moderate positive correlation between IgE serum levels and eosinophils count (). Similarly, IgE levels were positively correlated with intensity of infection of both A. lumbricoides and T. trichiura. Children with moderate-to-heavy ascariasis or trichuriasis had significantly higher mean values of IgE compared to those uninfected or with only light infections () (Figure 2).
3.5. Serum Cytokines Levels
Th1 and Th2 representative cytokines were determined in serum samples. Table 2 summarizes the geometric mean values and 95% CI of these cytokines by STH infection. In general, cytokine mean concentrations did not differ significantly when comparing the parasitized with the nonparasitized group. However, children with single infections by A. lumbricoides had significantly higher levels of IL-10 and IL-13 compared to children without infection, with single T. trichiura infections or with mixed infections ( and , resp.). Spearman's rank correlation coefficients showed a significant, although weak, negative correlation between IL-10 levels and age (). IL-10 levels were not significantly correlated with infection intensity, whereas for IL-13 a weak but significant positive correlation with A. lumbricoides infection intensity was found (). Significantly lower values of IFN-γ were found in children with single infections by T. trichiura () and these values showed a weak, negative correlation with T. trichiura infection intensity, although this correlation was not statistically significant () (Figure 3).
Figure 3: Association between STH infection and cytokines in studied children. A. lumbricoides infections were associated with higher levels of IL-13 (a) and IL-10 (b), whereas lower levels of IFN-γ were associated with T. trichiura infections (c) and moderate-to-heavy ascariasis (d). Geometric means (GM) are depicted in their respective boxes.
On the other hand, IFN-γ values were significantly negatively associated with A. lumbricoides infection intensity (). Children with moderate-to-heavy ascariasis had lower IFN-γ mean values (37.6 [15.7–90.0] pg/mL) compared with those having no or light infections (131.5 [98.4–175.8] pg/mL and 214.4 [99.0–464.4] pg/mL, resp.) (Figure 3). Th2/Th1 ratios, as well as IL-4/IFN-γ and IL-10/IFN-γ, were also calculated; significantly higher IL-4/IFN-γ ratios were obtained in children with moderate-to-heavy infections by A. lumbricoides (0.020 [0.010–0.042]), compared to those without (0.011 [0.08–0.014]) or light infections (0.007 [0.002–0.022]) ( and , resp.) (Figure 4). A very similar pattern in IL-4/IFN-γ ratio was found for T. trichiura infection intensity, although differences were only marginally significant ( and , resp.). Conversely, no significant differences in IL-10/IFN-γ ratios were observed.
Figure 4: Association between STH infection intensity and Th2/Th1 cytokines ratio in studied children. Higher IL-4/IFN-γ ratios were associated with moderate-to-heavy ascariasis (a) and trichuriasis (b), although marginally significant in the latter. In children without STH infections, pathogenic protozoa were associated with higher levels of IFN-γ (c) and lower IL-10/IFN-γ (d). Geometric means (GM) are depicted in their respective boxes.
Finally, the potential effect of pathogenic protozoa in children's immune response was assessed but this assessment was done only in children without STH infections. It was found that IFN-γ mean values were significantly higher in children harbouring pathogenic protozoa (i.e., G. intestinalis and/or E. histolytica/dispar) compared to those infected with commensals only or to those with no protozoa at all (332.9 [146.7–755.8] pg/mL, 93.7 [60.9–144.2] pg/mL, and 145.6 [93.8–225] pg/mL, resp.). IL-10/IFN-γ ratios were significantly lower in children infected with pathogenic protozoa when compared to those uninfected or infected with commensals only (0.044 [0.019–0.105], 0.095 [0.062–0.144], and 0.124 [0.072–0.214], resp.) (Figure 4). No statistically significant associations could be established between protozoa infection and eosinophil counts, IgE levels, or the remaining cytokines studied.
The parasitological findings of this study demonstrate a moderately high (30%) overall STH prevalence and specific prevalence for T. trichiura and A. lumbricoides of about 20% among schoolchildren living in Linaca. School teachers reported that the school is reached by the national deworming program and thus receives a single-dose 400 mg albendazole tablet per child on a yearly basis. No records are kept at the school in terms of deworming tablets intake and no parasitological baseline data have been obtained during governmental surveys (data reviewed in [27]). To our knowledge, prior to the present study, two parasitological surveys had been undertaken in the study community. In 1985, a study investigating causes of diarrhea in Honduras included a small number of preschoolchildren and found prevalence of 48% and 30% for A. lumbricoides and T. trichiura, respectively [28, 29]. More recently, a study involving schoolchildren determined prevalence of 64% for A. lumbricoides and 46% for T. trichiura (Canales et al. 2008, unpublished). Compared to the STH prevalence found in the present study, it appears that there has been an important decrease in STH prevalence among Linaca's children. Due to insufficient data on deworming, we did not attempt to identify if this strategy has served an important function in decreasing STH prevalence or at least worm burden. Thus, whether or not deworming has contributed to STH prevalence reduction remains an open question. Our findings, however, show that improved household conditions were strong protective factors for ascariasis. In this case, there might be a synergy between the built environment and anthelminthic medication, which may not be sufficient to protect against T. trichiura infection as one dose of ALB treatment is largely ineffective to clear this parasite.
Even though a similar proportion of children were found with either excess weight (12%) or chronic malnutrition (stunted growth, ~10%), the latter was strongly associated with parasitism. Similarly, despite the fact that trichuriasis prevalence was at a moderate level and that the majority of infections were light, a significant association was documented between stunting and both T. trichiura infection and infection intensity. This finding aligns with observations from other studies conducted in Honduras [30], Ethiopia [31], Mexico [32], and Brazil [33, 34].
The concerning association between trichuriasis and chronic malnutrition, along with the fact that T. trichiura has been found consistently as the most prevalent geohelminth in Honduras [27, 35, 36], suggests that (i) a reexamination of the current deworming guidelines are necessary; (ii) improvements in sanitary conditions and health education are indispensable components of STH control initiatives; and (iii) it is important to monitor for potential benzimidazole resistance in this parasite [37].
The prevalence of eosinophilia was high among the studied children. It has been shown that, in developing countries, eosinophilia is most commonly induced by tissue-invasive parasites, particularly helminths [25, 38]. STH infections have been largely associated with eosinophilia, especially in early stages of infection, when larval migration occurs. The association between eosinophilia and STH in the present study is consistent with results from previous work conducted in Honduras [39, 40] and other countries such as Brazil [41, 42], Philippines [43], Indonesia [44], and Spain [26].
Whereas other causes of eosinophilia cannot be ruled out, it is likely that, in this particular group of children, such eosinophilia was reactive (i.e., secondary to an external stimulus) and most likely associated to STH infection. This inference is supported by data contained in Linaca's Health Centre morbidity report for 2014, which shows that <2% of children's visits were due to asthma or allergic dermatitis (Linaca Health Care Centre 2014 report, unpublished). Moreover, a comprehensive socioeconomic and life conditions study conducted in the municipality of Tatumbla, where Linaca is located, contained no reference to allergic conditions being a health issue among inhabitants. Rather, it revealed that childhood acute respiratory infections accounted for >50% of visits to the health centre [45].
The use of eosinophilia as a biomarker for helminthiases remains without consensus. As a predictor of current helminthic infections, some authors consider eosinophilia's predictive value very limited [38], while others regard it as a suitable indicator of helminthiases in people from tropical and subtropical areas [26, 42, 44, 46]. Our data support the latter since eosinophilia correlated with both STH infection and intensity. Future studies should investigate eosinophilia at the individual level in order to better understand this dynamic relationship.
Our study revealed strikingly high prevalence of hyper-IgE among the studied children; it also highlighted a significant association between STH infections and increased total IgE levels. Such findings are consistent with observations in studies conducted in Nigeria [47, 48], Ecuador [49], Venezuela [50], Spain [26], and Brazil [41, 51, 52]. Helminth-induced IgE is mostly characterized by a nonspecific polyclonal stimulation with only a small fraction of parasite-specific IgE. However, it is the parasite-specific IgE which plays an important role in helminth clearance as well as in preventing reinfection [48, 50, 53–55]. In a study of Venezuelan children, Hagel and collaborators demonstrated that total IgE levels were inversely correlated with parasite-specific IgE levels. They also showed that reinfection with A. lumbricoides was significantly associated with high pretreatment total IgE but low parasite-specific IgE levels [50].
Another interesting finding in the present investigation was the significant association observed between high total IgE levels and intensity of infection (i.e., worm burden). Other researchers have made the same observation [49, 51, 56]. Some studies have shown that specific IgE levels reflect the parasite infection intensity; therefore, higher specific antibody levels would be expected in lightly infected individuals when compared with those heavily infected [57]. Total IgE levels in the studied children were significantly positively correlated with eosinophils counts; this finding is not surprising due to the ability of IgE to induce a cytotoxic response against helminthic parasites mediated by mast cells and eosinophils [55].
It has been demonstrated that helminth infections strongly induce an immune response involving elevated Th2 cytokines (i.e., IL-4, IL-5, IL-9, and IL-13), IgE, IgA, eosinophilia, and mucus secretion [58–60]. Helminth-caused tissue damage triggers the response by releasing danger-associated molecular patterns (DAMPs) and cytokine alarmins, particularly IL-25 and IL-33. These alarmins promote the activation of basophils and innate lymphoid cells (ILC-2) to support a type-2 innate immune response needed to signal the type-2 adaptive immunity. In this context, large quantities of IL-5 and IL-13 are primarily produced by ILC-2 cells. IL-5 promotes the eosinophils differentiation and activation which promote IL-4 production, the main primer of CD4+ Th2 cells activation and expansion, with further release of IL-4, IL-5, and IL-13 by this type of cells [3, 60–62]. In this environment, IL-4 and IL-13 induce AAMs, which mainly promote tissue repair and fibrosis by expression of different markers such as arginase-1, Ym1, Ym2, and RELM-. These AAMs also express regulatory IL-10 and TGF- able to downregulate inflammatory response [3–5, 9, 61–63].
Our study could not find a significant correlation between IL-5 and eosinophilia. Instead, the majority of children showed either low or nondetectable values of this cytokine. This was an unexpected finding since IL-5 is essential for eosinophilic differentiation, proliferation, and activation. There are a few potential explanations for this finding. Since the participant children have probably experienced repeated STH infections since they were much younger, their immune response may have already changed to a modified Type 2 response, where inflammatory Th2 shifted to an attenuated phenotype characterized by the shutdown of effector cytokines such as IL-5, retention of IL-4, and reinforcement of anti-inflammatory cytokines such as IL-10 and/or TGF- [4, 9]. Instead, as recently determined by Fulkerson and colleagues, an alternative IL-5-independent pathway for promoting eosinophilia might be in place. This pathway would contribute to persistent eosinophil differentiation and survival even after a complete IL-5 withdrawal [64]. Finally, periodic deworming followed by reinfection along several years is likely disturbing the antiparasitic immune responses as described in the literature.
We found that IL-13 levels were significantly increased in children infected with A. lumbricoides and that these levels were positively correlated with worm burden. IL-13 is a Th2 pleiotropic cytokine with an important function in the intestinal epithelia, controlling the rate of transit of epithelial cells toward the outmost layer and promoting a harsh environment that might help in gut parasite expulsion (i.e., increased luminal fluids, mucus, from goblet cells, increased edema, and muscle contractility) [7, 60, 61]. Gallo and colleagues demonstrated that IL-13 may also be produced by Th1 and Th17 cells, suggesting that this cytokine can have either a pro- or anti-inflammatory effect, depending on the environment [65]. Nevertheless, demonstrating an association between STH and IL-13 overproduction has not been achieved by other research groups in India [66] and Brazil [67]. Some studies in Cameroon [68, 69] found high levels of IL-13 associated with lower intensity of infection, but the present study did not establish such association.
IL-10 is the anti-inflammatory cytokine by excellence. It can be produced by diverse type of cells such as macrophages, dendritic cells (DC), B cells, and various subsets of CD4+ and CD8+ T cells. Regardless of the type of infection, IL-10 limits Th1 and Th2 effector responses by suppressing function of macrophages and DCs. The timing, site of its production, and strength may favor (a) simultaneous pathogen clearance and suppression of downstream pathologies; (b) potential benefit to both the host and the pathogen (limiting pathology and allowing persistent infection); (c) severe tissue damage; or (d) overwhelming infection [70, 71]. In our study, statistically significant higher IL-10 values were found in children with ascariasis, although they did not correlate with infection intensity of this parasite. Similar findings have been frequently reported by other researchers [66, 69, 72–74], with some exceptions [47]. We also found a negative correlation between children's age and IL-10 levels. This is congruent with previous studies conducted in a different community in Honduras [75] as well as with other studies in Nigeria [73] and Cameroon [68, 76]. This might be due to altered immune modulation provoked by deworming treatment. Although its efficacy is species-dependent, albendazole generally reduces the duration and/or intensity of helminth infections [75].
In our study, IFN- levels were significantly inversely associated with intensity of infection by A. lumbricoides. It is well known that IFN- is downregulated by type-2 cytokines making our finding consistent with the literature. IFN- is the most important type-1 cytokine and is produced by a diverse type of cells from both innate and adaptive immune arms such as natural killer (NK), CD4+ Th1, CD8+ Tc, and eosinophils. It interacts with macrophages to activate direct antimicrobial and antitumor mechanisms as well as upregulating antigen processing and presentation pathways [77].
The overall interpretation of the different cytokines, their levels, and relationships with helminthic infections is an interesting challenge. In moderate-to-heavy ascariasis, we observed a distinctive type-2 immune response. This response was characterized by upregulation of IL-13 and downregulation of IFN-, as well as by significantly higher IL-4/IFN- ratio and IgE levels. Results from T. trichiura infections were not as well-defined as those from ascariasis. Nonetheless and similarly to A. lumbricoides, infections of high intensity were associated with lower values of IFN- and higher IL-4/IFN- ratios and IgE levels. These findings confirm that a type-2 response against this parasite was also displayed in our study population.
As mentioned earlier, a type-1 immune response is needed for the control and clearance of intestinal protozoa such as Entamoeba histolytica, Cryptosporidium spp., and Giardia intestinalis. Although, particularly in the case of G. intestinalis, mixed Th1-Th2 responses have been reported, human and animal studies have shown that increased levels of IFN- play a crucial role in orchestrating the immune response and appear to be one of the main signatures in individuals with these parasitoses [78–81]. This description is in agreement with our findings of significantly higher (up to 3-fold) levels of IFN- found in children harbouring G. intestinalis and/or E. histolytica/dispar without the immune influence of STH infections (i.e., negative for helminthic infections). Moreover, the significantly lower IL10/IFN- ratios observed in this group of children indicate a Th1-biased response. Additionally, in a 6-year longitudinal study in Bolivia, Blackwell and colleagues described an antagonist relationship between G. intestinalis and geohelminths where giardiasis was less likely to be present in helminth-infected individuals. Likewise, they also found that infection with helminths was less likely for individuals with giardiasis [82]. Our data, though cross-sectional, support these observations: none of the children infected with Giardia intestinalis had ascariasis and only 10% of them had concomitant trichuriasis. Since clearance and protective immunity against G. intestinalis require also Th2 cytokines and antibodies, IgA, IgG, and IgE [78, 79, 81], a plausible scenario has been suggested: helminth-induced Th2 response might provide cross-immunity against this protozoan. We believe that the STH/G. intestinalis interaction is worth investigating.
A proper interpretation of our findings must be done considering the limitations of the present study. Firstly, its cross-sectional nature only allows establishing associations but no causality and, therefore, strong inferences cannot be made. Secondly, we did not obtain a complete medical history from participating children or an accurate deworming history. This is important as a variety of unmeasured confounding variables (e.g., bacterial and viral infections, autoimmune diseases, asthma, and other allergic diseases, as well as environmental and genetic factors) may have contributed to skew the Th1/Th2 balance among research participants [6]. Thirdly, we measured circulating levels of cytokines, which may not be an accurate representation of local immune responses in the gut milieu. Notwithstanding, the study has several strengths: an adequate sample size, determination of both helminthic and protozoal infections, and the use of highly sensitive and accurate methodology for biomarkers analysis.
This is the first study providing a comprehensive immune profile in Honduran children infected with geohelminths or pathogenic protozoa. Our study shows that higher intensities of STH infections are associated with a polarized Th2 response, characterized by reduced proinflammatory and increased regulatory cytokines, eosinophilia, and hyper-IgE. It also demonstrates that an enhanced Th1 response is elicited by pathogenic protozoa. The interpretation of the host's immune response against helminth represents challenging undertaking due to the high complexity of multiple host-parasite interactions and potential unmeasured confounders. Pivotal to characterizing and understanding the immune response is obtaining a meticulous clinical history from study participants, their deworming history, and very importantly the existence of multiple infections including pathogenic protozoa. Further, the role of the intestinal microbiota and its interplay with the host and its parasites can no longer be ignored. Longitudinal studies are required to better characterize such immune responses.
All authors declare that there is no conflict of interests regarding the publication of this paper.
The authors thank all the children who participated in this study, as well as their parents and school authorities of Linaca. They also thank all volunteers from the School of Microbiology (UNAH) for their cooperation and enthusiasm which ensured the successful completion of this study. This study received partial financial support from UNAH through an internal grant.
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California company buys Overland Park hospital – Kansas city
A California-based hospital operator now owns Promise Hospital of Overland Park after its parent company, Promise Healthcare, filed for Chapter 11 bankruptcy in November.
Strategic Global Management, a for-profit hospital operator run by main investor and orthopedic surgeon Kali Chaundhuri, recently bought the Overland Park facility. Chaundhuri is chairman and founder of the KPC Group of Companies, which includes Strategic Global.
Promise Hospital of Overland Park is a 56-bed, long-term, acute-care hospital at 6509 W. 103 St. Hospital officials said all questions about the transaction should be directed to KPC. It's unclear what the new management plans for the facility; KPC officials did not respond to a request for comment.
Promise Healthcare, based in Boca Raton, Fla., filed for bankruptcy in November and is selling 14 hospitals and two skilled nursing facilities through U.S. Bankruptcy Court.
The company, now led by a chief restructuring officer, has more than $565 million in debt, plus unpaid interest of $110 million, accrued expenses and accounts payable of $94 million, and capitalized leases of $13 million, according to its motion to obtain a loan to keep its operations ongoing.
Promise Health Care of Overland Park reported declining gross revenue year over year, with $11.25 million in gross revenue from Jan. 1, 2018, to Nov. 4, 2018, compared with gross revenue of $13.99 million the year prior. The hospital also reported $26.39 million in assets and $97.07 million in liabilities at the time of filing.
READ ON KANSAS CITY
KPC Group Offers $610M For Four Verity Health Hospitals
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redpajama_set_name: RedPajamaCommonCrawl


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Phryxe educata är en tvåvingeart som beskrevs av Robineau-desvoidy 1863. Phryxe educata ingår i släktet Phryxe och familjen parasitflugor.

Artens utbredningsområde är Frankrike. Inga underarter finns listade i Catalogue of Life.

Källor

Parasitflugor
educata

redpajama_set_name: RedPajamaWikipedia


On February 28th the Steuben County Task Force on Marijuana Prevention in partnership with the Hornell City School District hosted a Town Hall Meeting on "Today's Marijuana ~ How it is Affecting Our Youth". See flyer below. Stay tuned as more Town Hall meetings on a variety of Substance Abuse topics are being planned.
On September 27, 2017, our Coalition held a successful Underage Drinking Town Hall Meeting "A Community Conversation" at the Bath-Haverling High School. We would like to extend a huge "thank you" to the Bath-Haverling School District, for hosting the event and for all the services that they provided to allow for this event to take place (particularly Superintendent Joe Rumsey and Guidance Counselor, Mark Recktenwald). A thank you also goes out to University of Rochester's, Kamy Wakim for her presentation on "The Effects of Alcohol on the Developing Brain". While we did not have the participation from our community members that we had hoped for, we did get the attention of several federal, state and local elected officials as well as several media outlets. Please stay tuned for an upcoming interview on WETM relative to Underage Drinking in Steuben County.
The Steuben Prevention Coalition - Steuben Task Force on Underage Drinking will host a Town Hall Meeting on September 27, 2017 @ 6:00 p.m.
"Alcohol and the Developing Brain"


In 2008, the YMCA partnered with the LIVESTRONG Foundation to help cancer survivors begin the journey toward recovery with the LIVESTRONG at the YMCA program.
Part of the Y's commitment to strengthening community through healthy living, the program offers adults affected by cancer a safe, supportive environment to participate in physical and social activities focused on strengthening the whole person. LIVESTRONG Brochure 2018.
No one experiences cancer in the same way. Participants come to the program with different physical challenges and lifestyle goals. LIVESTRONG at the YMCA provides you with individualized attention and an approach to recovery that targets the areas you need to rebuild. There's no competition here – physical activities are tailored to match only what you're able to accomplish.
You'll also learn about wellness, stress-reduction techniques and how to continue healthful habits after the program has ended.
LIVESTRONG at the YMCA encourages a warm spirit of community – a safe, comfortable place to build companionship with others affected by cancer, and share stories and inspiration.
LIVESTRONG.ORG – We believe that unity is strength, knowledge is power, and attitude is everything. Our programs, awareness events, and advocacy work are the heart of what we do and our leaders and donors provide both the vision and the support for us to carry out our mission.
Camp Kesum – Camp Kesem recognizes and embraces the often-overlooked population of children affected by a parent's cancer.
Imerman Angels – Through our unique matching process, Imerman Angels partners anyone seeking cancer support with someone just like you – a "Mentor Angel". A Mentor Angel is a cancer survivor or survivor's caregiver who is the same age, same gender, and most importantly who has beaten the same type of cancer; a walking, talking, living proof, and inspiration that cancer can be beaten. Our service is absolutely free and helps anyone touched by any type of cancer, at any cancer stage level, at any age, living anywhere in the world.
Tuesdays & Thursdays 12:00 p.m.- 1:30 p.m.
Tuesdays & Thursdays 11:00 a.m. – 1:30 p.m.
Tuesdays & Thursdays 1:30 p.m. – 2:30 p.m.
Mondays & Thursdays 1:00 p.m. – 2:30 p.m.


Everyone enjoy his life with small things which make us relax in our leisure time like entertainment center home theater music listening or swimming in pool all these things which i discuss are count in luxuries but all these thing make us refresh and cool as well as one other thing which is swing the tradition of some houses they have a swing in his house for sitting on it in leisure time. People can enjoy coffee when they sit on swing some people listen slow music having a swing with a cup coffee. Those people think that this is the best time for him and they enjoy every movement of swing with coffee and music. If you inspired with this type of feeling and you really enjoy this at your home you can with old and recycle wooden pallets. I have some ideas of up cycled pallet swing.
You can see coolest idea of pallet swing there is no much extra ordinary efforts are involve to making of pallet swing i hope you will be enjoy this type swing at your home after making with rustic wooden pallets. You can set out some beautiful cushions over this beautiful pallet swing.
Here an other very simple and coolest pallet ideas. We have bundle of ideas here you can start these pallet projects at your home. You can done this so easily you need just wooden pallets and robes for hanging the pallet you can add a headboard with pallet swing for easy to sit on the swing.
The most elegant wooden pallet swing ideas. The most beautiful and attractive design shown in above picture. You can add this in your house this will add more beauty in your house. You can made this very easily with pallet board and robe.
Here you can see how a pallet swing with old wooden pallet. Now you can made this by yourself easily beautiful pallet swing now you can enjoy these beautiful pallet swing ideas. Now you have these plans for making of pallet swings.


J. Norman Stark is a seasoned Construction Law Attorney serving clients across the U.S. from his Cleveland, Ohio headquarters, drawing upon 40+ years of experience in construction law and the commercial, industrial, institutional, and residential building industry. As a Registered Architect Emeritus and Senior ASA Appraiser, Mr. Stark truly understands the legal issues that pertain to Construction Claims, Construction Accident Claims, Construction Contracts Law, Construction Contract Disputes and Resolution, providing Litigation Support and Expert Witness services for lawyers and clients in the construction and building industry.
Attorney Stark's extensive real world knowledge of architectural practice, drawings, specifications, construction documents, codes, building General and Trades Contractors, and the construction process from inception to completion, make him an indispensable legal resource when dealing with construction-related legal matters. In addition, Attorney Stark is available to serve as a construction and building Expert Witness for legal counsel and on behalf of individuals and businesses in Ohio, Florida, and the entire United States.
Analyze, prepare and implement for new business, construction contracts and construction documents and claims coordination with Architects and Construction Engineers for Owners, General Contractors, Subtrades and suppliers.
Federal and State labor laws require specific safety measures implemented and maintained for the construction and building industry and worksites. When these mandatory guidelines are not implemented and adhered to and construction site accidents happen, Attorney J. Norman Stark's experience, training and expertise in Construction Claims and law protects the victims and assures that they receive fair treatment and just compensation for injuries and disabilities suffered in construction site accidents.
Available in Ohio, Florida and the entire U.S., to serve as a construction law expert witness and provide expert legal testimony in construction related matters. Will serve other geographic areas on a case-by-case basis.
Development of project administration procedures, programs, risk control and application of new legal developments and application of state law decisions. Advises in negotiating loan workouts, delays, acceleration, and implementing completion of projects- on time, witihin budget, and of good quality. Analyzes, implements and manages resolution strategy for completion of litigated projects.
Provide contract interpretation and dispute resolution. Develops and implements alternate dispute resolution services, including mediation and arbitration, or litigation.
Reviews and advises of risk and coverage issues.
Implement and coordinate with lead legal counsel in litigation, arbitration, mediation and resolution of construction, environmental, real estate, government, and company interests, claims and disputes.
Assist in preparation and promulgation of new construction-related laws and industry rules.
Advises regarding applicable laws, rules and regulations.
Provides assistance, media contact management, insurance and damage control.
J. Norman Stark is a Cleveland Ohio Attorney and Registered Architect, as well as a Mediator, Arbitrator and Litigator, with an emphasis on the legal practice of Construction Accident Law, Construction Accident Claims Law, Construction Contract Law, and Real Estate Litigation. Attorney Stark provides professional services and consultation for clients throughout the continental United States. J. Norman Stark also serves as a Construction Consultant, and Expert Witness.
© 2019 J. Norman Stark, Attorney. All rights reserved.


The Dark Knight: Greatest super hero movie ever made?
I wasn't surprised when I checked the box office stats for The Dark Knight on Monday and found it bulldozed both Spider-man 3 as well as Pirates of the Caribbean -Dead Man's Chest on its way to an earth shattering weekend box office earning of $158.3 Million! (Source: NYTimes) Add International gross and DVD sales and this might become the first Billion Dollar Batman movie! Warner Bros better keep Nolan happy now. Who knows to what heights he can take the franchise now?
This was one of greatest movies ever made and certainly the best comic book/ superhero movie ever made. There is simply NO ARGUMENT. It just is. Richard Donner's Superman 1 – 2 (yes Donner's, Lester just shot a few scenes), Spider-man 2 and Tim Burton's Batman (1989) were "good" movies, no doubt. Hell, Batman Begins was good but slightly slow paced as it had to delve into the origin story. But The Dark Knight is the Godfather 2 of the comic book genre. In fact, it has risen above the genre to be a "masterpiece"… and a Best Picture Oscar contender. Nolan's direction itself is a Best Director nominee. And then there is The Joker. The late Heath Ledger deserves the best actor Oscar…and both Michael Cain and Morgan Freeman (both Oscar winners) have said he deserves it. Christian Bale also delivers an intense performance. Gary Oldman is vintage. In fact, this could very well be the Godfather 2 of this generation. Give it the Oscars…and lets not be "snobbish" about this being a "comic book film". Roger Ebert has given it 4 stars on 4 (same as Godfather 2)…and he knows a thing or two about films.
The film is mesmerizing…and is 2hours 30minutes of non-stop adrenalin, 'edge of the seat' stuff. Not one second does the pace slacken. I don't want to go into tiny plot details as you should see it to enjoy it. If there's one movie you should watch this decade, it's The Dark Knight. You will not be disappointed. And you might just go to the box office and throw in another $1000 as the movie was worth the money and more.
Go for The Dark Knight Returns, Nolan. We want to see how you morph The Penguin & The Riddler this time.
And yes, we trust you not to involve that irritating Robin and Batgirl! Batman works best, alone.
Best Movie Poster ever created.
Heath Ledger's last performance may probably be his best. The Joker looks wicked in 'The Dark Knight' as compared to the slightly campy Jack Nicholson version.


By now we're a few days into our Feel the Difference Nutrition Challenge. If you missed out on signing up, you can still pick up some of the important knowledge about nutrition by chatting with Amy some time.
Eat meats and vegetables, nuts and seeds, some fruit, little starch and no sugar. Keep intake to levels that will support exercise but not body fat.


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Home > England > Gloucestershire > Historic Churches > Yanworth
Yanworth, St Michael's Church
HERITAGE HIGHLIGHTS: 12th-century Norman font
St Michael's, Yanworth
The delightful country church of St Michael stands in an idyllic setting amid farm buildings - including a medieval tithe barn, on the edge of Yanworth, looking out across a wide green valley to the mansion of Stowell Park. This Grade II listed building dates to the 12th century.
At the west end of the nave is a low, castellated tower built in the 15th century. The north wall has original Norman windows, with narrow lancet openings and wide, deep splays, and there is also a blocked 12th century doorway. The 2 west windows are Perpendicular, probably from the 15th century.
One of the first things you notice on approaching the church is a lovely table tomb in Cotswold 'woolsack' style to the east of the porch. This type of tomb is common in the Cotswolds and is a reminder that much of the region's wealth came from the wool trade.
Nearby, set into the chancel wall, is a blocked 12th century priest's door, into which is set a stone lintel protecting a pair of 18th century metal plaques to Elizabeth Bicknell (d. 1745) and her husband Thomas (d. 1750). To the left of the porch entrance is a peculiar sundial with a stone gnomon (the bit that casts the shadow).
Cotswold 'woolsack' tomb
18th century Bicknell memorials
Stone sundial on the porch
The Civil War casts a long shadow in this area, and there is a sobering reminder of the war at Yanworth. Against the east wall of the north transept (around the back of the church) are a series of large pock-mark holes in the wall. These are said to have been made by Civil War musket fire. A local story suggests that 6 Royalist soldiers escaped from the Battle of Stow-on-the-Wold in March, 1646. They were killed and buried at Yanworth in a mass grave, in unconsecrated ground within the churchyard. No one knows the site of the supposed grave.
Civil War musket-ball holes
Inside the church, the first thing you see is the wonderful 12th century font at the west end of the nave. This simple font is decorated with a rope pattern around the rim of the bowl. Interestingly, according to the church guide, the font originally did not have a stem; it was set on the floor to allow adults to stand and have baptismal water poured over them.
The 12th century font
Norman decorative carving on the font
On either side of the tower arch, above the font, are a series of wall paintings. On the south side of the arch is a confusing jumble of paintings from 2 distinct periods. The most obvious feature is an early Elizabethan cross within a circle. More interesting - and easier to make out - is the painting on the north side of the arch. Here you can see a skeleton holding a scythe - a depiction of Father Time, who comes for us all.
Wall painting of Father Time
Early Elizabethan cross painting
Set on a window sill in the south wall is a carved stone cross-head, found in the churchyard and brought inside for preservation.
The barrel-vaulted nave roof is 19th century, but it is carried on lovely stone corbels of medieval date. These show human heads with a variety of fascinating expressions. Even more expressive is a wonderful carved head on the north transept arch, depicting a woman with her hair drawn back under a headdress. Near this wonderful carving is a squint allowing a view of the altar from the transept. On the other side of the 12th century chancel arch, almost hidden by a 19th century wooden screen, is a deeply incised cross cut into the stone.
13th c head of a woman
Yanworth's church is a delight, located in a spectacularly beautiful area of the Cotswolds. The church is usually open daylight hours. If you fancy a walk, do what our family did and stroll down the valley and up to Stowell Park, where the 12th century church beside the manor house has a fabulous 12th century Doom wall painting. A mile away in the direction of Chedworth stand the remains of a Roman villa (National Trust).
About Yanworth
Address: Church Lane, Yanworth, Gloucestershire, England, GL54 3LG
Location: On the southern edge of Yanworth village. Parking along the verge. Usually open daylight hours.
OS: SP079138
Carrbridge Packhorse Bridge
Kilchurn Castle, Loch Awe
Stowell, St Leonard's Church - 0.7 miles (Historic Church)
Chedworth Roman Villa - 1.6 miles (Roman Site)
Hampnett, St George's Church - 1.7 miles (Historic Church)
Coln St Dennis Church - 1.9 miles (Historic Church)
Chedworth, St Andrews - 2 miles (Historic Church)
Northleach, St Peter and St Paul - 2.1 miles (Historic Church)
Compton Abdale, St Oswald - 2.1 miles (Historic Church)
Mechanical Music Museum - 2.3 miles (Museum)
Nearest Accommodation to Yanworth:
Shrove, Chedworth - 1.9 miles
Chedworth, Gloucestershire
Brooklands, Chedworth - 1.9 miles
Calcot Peak Barn, Northleach - 2.2 miles
Northleach, Gloucestershire
More self catering near Yanworth
The Plough Inn at Ford - 9.5 miles
Ford, Gloucestershire
The Kings Arms - 10.2 miles
Stow-on-the-Wold, Gloucestershire
The Midland Inn - 10.5 miles
More Hotels near Yanworth
The Hare and Hounds - 3.5 miles
Bathurst Arms - 5.1 miles
Broadlands Guest House - 6 miles
Bourton-on-the-Water, Gloucestershire
More bed and breakfasts near Yanworth
Towns and Villages Gazetteer
Cotswold Prints
Gloucestershire Hotels
Thatched Cottage In Chipping Campden, Gloucestershire Prints
Top Historic Attractions in Gloucestershire
Sudeley Castle
Deerhurst Priory Saxon church
Tewkesbury Abbey
Gloucester Cathedral
Upper Slaughter Manor
Stoke Orchard, St James the Great Church
Guiting Power
Northleach
Self Catering in Gloucestershire
1 Church Cottages
1 The Old Curiosity Shop
1 Westcroft Cottage
13 Bowbridge Lock
16 Friday Street
Minchinhampton
More self catering in Gloucestershire


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Home / About Lloydminster honda in Lloydminster, Ab / New Honda Models / 2022 Honda Accord in Lloydminster, AB
2022 Honda Accord in Lloydminster, AB
For 2022, the sophisticated Honda Accord features dynamic angles, a wide stance, a sharp grille design, and alloy wheels. You're ready to be the centre of attention! Boasting intuitive technology and luxurious accents, you can surround yourself with style, comfort, and functionality on the inside. It is available in six trims: SE, Sport, EX-L, Touring, Sport 2.0, and Touring 2.0. What's more, it is reasonably priced at $33,320. If you're interested in the 2022 Honda Accord, check out our available inventory at Lloydminster Honda in Lloydminster, AB.
View Our Honda Accord Inventory
Adaptive Cruise Control with Low-Speed Follow
8-inch display audio system
Heated leather-wrapped steering wheel
Wireless Apple CarPlay® and Android Auto™
Heated front and rear seats
60/40 split fold-down rear seatback
12-way power driver's seat
Which Powertrain Is Available in the 2022 Honda Accord?
You can choose from two engines available in the 2022 Honda Accord: the 1.5-liter turbocharged 4-cylinder engine or the 2.0-liter turbocharged 4-cylinder engine. The former allows you to get up and go, with enough power of about 192 hp! Meanwhile, the latter pushes out 252 hp, offering you a powerful way to conquer the road. With an available 10-speed automatic transmission, you are assured of exceptional control with improved fuel economy ratings.
If you're looking for a car that suits your style, the 2022 Honda Accord is up for it. To enjoy a more dynamic handling experience, i.e., an amped-up drive, you can opt for the Sport Mode. Meanwhile, the Normal Mode ensures a more relaxed, seamless drive. It is irritating to hold and release the brake pedal in stop-and-go traffic. Cue in the Automatic Brake Hold, which engages the brakes even at a stop after the brake pedal is released.
To take the 2022 Honda Accord for a spin, schedule a test drive at Lloydminster Honda in Lloydminster, AB!


Send an unexpected dose of good vibes to your people or treat yourself.
Feeling stressed? Strike a match and light up your new incense cone to promote relaxation and positive vibes. We recommend holding the cone over a flame until lit - it typically will burn out itself but you can also blow on it to lessen the flame.
These miniature clay sculptures can live on your desk or nightstand - to decorate a space or simply bring a smile to your face. Also adorable on your new Arlee Park brass dish!
Made with lavender and clary sage, apply this calming balm to your temples or wrists before yoga or bed to bring you peace and clarity.


If you've followed the Grit and Polish for long, you know that we love using butcher blocks for kitchen countertops (like this one). They're inexpensive, timeless and easy to install yourself, making them the perfect material for DIYers like ourselves. At the Dexter House, we decided to upgrade our usual butcher block countertops to red oak (from Uncle Dougie of course) to match the new floors we laid.
Installing the butcher block countertops took some time and precision, but overall, the process was fairly easy. First, I measured the kitchen and ordered the countertops in four pieces, each 26" deep and a couple inches longer than the length I measured. I added the extra length to the order to account for the 'old house factor'. You know, the nothing-is-ever-square-or-level-and-something-unexpected-always-seems-to-come-up factor. It's better to have too much and cut it down to size than to start with too little.
After the first coat dried, I gave the butcher blocks a quick sand with the 220 grit to cut down the raised grain, and then put on a second coat. Then I brought the butcher blocks inside to dry overnight.
After they dried, we installed the butcher blocks. There was a little more minor trimming involved in order to make sure each section fit snuggly and then we secured them to the cabinets using screws from the underside. Then we cleaned all of the butcher blocks thoroughly, sanded them again with 220 grit sandpaper, vacuumed up the dust, and sealed them with a third coat of Waterlox.
Since we have kids in the house, I rounded all of the corners with the palm sander. We haven't had any bonked noggins yet, but when we do, hopefully they'll be minor.
You may remember that we painted our lower cabinets black (you can read about that here), so we covered the countertops with thick paper to protect them from overspray. When we uncovered everything, the kitchen looked like this.
The countertops look good with those floors, right?! Would you use butcher block as a countertop? If not, what material would you use in a kitchen like this?
I promise to show you the entire kitchen renovation soon!
p.s. 1880 never looked so good! Check out this gorgeous Australian renovation.
p.p.s. My latest rug crush. I love how Julia used it in her minimalist playroom!
p.p.p.s. I'm on day 11 of clean eating and I have to say, it feels goooood! Definitely motivated to stay off sugar after watching this documentary. Watch it! This film will blow your mind!


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Services for the Uninsured or Under-Insured
What is cerebral palsy and what causes it?
What are the symptoms of cerebral palsy?
What is the prognosis?
What is the risk for other family members or future babies?
What treatments/therapies/medications are recommended or available?
How will my child and our family be impacted?
My child has a diagnosis of cerebral palsy and his legs have continued to get stiffer despite braces. I thought that cerebral palsy wasn't progressive?
Will hyperbaric oxygen help my child with CP?
Here you'll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Cerebral Palsy module, which is written for primary care clinicians but also may be of help to parents and family members.
Cerebral palsy, also referred to as CP, is a term used to describe a group of chronic conditions affecting body movement and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development; before, during, or shortly after birth; or during infancy. Thus, these disorders are not caused by problems in the muscles or nerves. Instead, faulty development or damage to motor areas in the brain disrupts the brain's ability to adequately control movement and posture. "Cerebral" refers to the brain and "palsy" to muscle weakness/poor control. Cerebral palsy itself is not progressive (i.e. brain damage does not get worse); however, secondary conditions, such as muscle spasticity, can develop which may get better over time, get worse, or remain the same. Cerebral palsy is not communicable. It is not a disease and should not be referred to as such. Although cerebral palsy is not "curable" in the accepted sense, training and therapy can help improve muscle function and coordination. At this time, there is no cure for the developmental brain damage that causes cerebral palsy. Studies have found that children who receive early intervention services such as physical and occupational therapy and other support services are more likely to lead a more typical and improved quality of life.
A person with cerebral palsy may exhibit one or more of the following effects:
Muscle tightness or spasticity
Disturbance in gait or mobility
Involuntary movement
Difficulty in swallowing and problems with speech
A person with cerebral palsy may also exhibit:
Difficulty in feeding
Impairment of sight, hearing or speech
Abnormal sensation and perception
Difficulty with bladder and bowel control
Problems with breathing due to postural difficulties
Skin disorders due to pressure sores
There are several types of cerebral palsy. These include:
Spastic cerebral palsy characterized by muscle stiffness and permanent contractions
Spastic diplegia characterized by more significant impairment in the lower extremities
Spastic hemiplegia characterized by one side of the body affected much more than the other, and usually the arm more than the leg
Spastic quadriplegia characterized by whole body involvement
Athetoid or dyskinetic cerebral palsy characterized by uncontrolled, slow, writhing movements
Ataxic cerebral palsy characterized by poor coordination and balance
Mixed cerebral palsy characterized by features from more than one type
Cerebral palsy is diagnosed clinically in a child with non-progressive problems that has a physical exam consistent with the diagnosis. The child's history, either prenatal, birth, or after birth, should also be consistent with the diagnosis of cerebral palsy. In some circumstances, your child's primary care clinician may wish to perform testing to rule out other possible diagnoses.
The answer to this question depends on the type of cerebral palsy your child has and any related complications. Generally, children with more involved CP such as spastic quadriparesis may have shortened life expectancies, as children who are nonmobile and have difficulty eating by mouth by themselves are subject to illnesses such as pneumonia, although many live far into mid and late adulthood. Children with mild CP might be expected to have normal life-spans. Because the answer to this question is specific to the child, ask your primary care clinician. There are many resources for parents of children with serious illness. See Partnership for Parents.
The answer to this question is complicated and depends entirely on why your first child has cerebral palsy. Genetic conditions that may cause cerebral palsy may be inherited and lead to an increased risk for CP in subsequent children whereas environmental causes for CP are often very unlikely to happen again. Ask your provider who may refer you to a specialist such as a neurologist or geneticist for answers to this question. Also, it might be appropriate to consult with a perinatologist or high risk obstetrician prior to your next pregnancy.
Early Intervention and therapies are known to be helpful in optimizing abilities in children and adults with CP. Medications are available to help children with spasticity. For more information, see the Cerebral Palsy Diagnosis Module found in the Diagnoses & Conditions Section. See Cerebral Palsy.
This will depend on the severity of the child's CP. Children with mild CP may function in a typical or near typical manner. Children with severe CP may require total care. You can discuss this question with your health care primary care clinician who should be able to give you some idea of your child's prognosis.
Although certain symptoms of cerebral palsy such as contractures and stiffness tend to worsen over time, the brain lesion responsible for these symptoms does not progress. Children with cerebral palsy are able to make developmental improvements over time, although in very involved children these improvements may be very slow. If you think that your child is regressing in his abilities, this is important information for your primary care clinician to know as it is possible that the diagnosis of cerebral palsy is not correct.
There are many alternative therapies without proven medical benefit by controlled scientific studies that are offered to families of children with disabilities. As these therapies are often quite expensive, families should research potential benefits and discuss these therapies with their primary care clinician before embarking on any unproven and in some cases, potentially harmful, therapies. Also see UCP study on hyperbaric oxygen and US Dept Health & Human Services report on efficacy of hyperbaric oxygen therapy. [Pérez-Gaxiola: 2013]
Where can I go for further information?
For Parents and Patients
Cerebral Palsy Support Groups (Children's Disability Information)
A list of support groups for different types of CP and other resources
United Cerebral Palsy
National non-profit organization that provides information on a variety of topics including advocacy, conferences, insurance, sexuality, policy, and other items for the public and providers.
CP Information (MedlinePlus)
Basic information and links to many additional sources of reliable information; sponsored by the National Library of Medicine.
The National Lekotek Center
A nonprofit organization dedicated to making play accessible for children with disabilities.
CP Information (American Association for Cerebral Palsy and Developmental Medicine)
Professional association with information for providers and families.
Epilepsy Association of Utah
For individuals with epilepsy, families, and friends, this site offers newsletters, events, links, local and youth support groups, activities for kids, first aid for seizures, and more.
What is Cerebral Palsy? (mychildwithoutlimits.org)
Information about CP and other conditions; links to resources and support groups.
Cerebral Palsy Information Page from the NIH
A short description of CP; National Institutes of Health.
Cerebral Palsy Guidance
A website offering guidance and assistance to parents of a child with cerebral palsy. Topics include Cerebral Palsy, Financial Assistance, Living with Cerebral Palsy.
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Utah State Office of Recovery Services - Provo, more info...
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http://www.ors.utah.gov
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Utah State Office of Recovery Services - St George, more info...
33 North 100 West Ste 100
Utah State Office of Recovery Services - Richfield, more info...
1152 South Highway 118
http://www.hsors.utah.gov
Utah State Office of Recovery Services - Salt Lake City, more info...
See all State Financial Agencies services providers (17) in our database.
Swallow Studies
See all Swallow Studies services providers (1) in our database.
See all Vision Screening services providers (19) in our database.
For other services related to this condition, browse our Services categories or search our database.
CP Clinical Trials (ClinicalTrials.gov)
CP Registry
CP Research Trials (Centerwatch.com)
Initial publication: March 2012; last update/revision: November 2015
Author: Lynne M. Kerr, MD, PhD
Funding: The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.
Page Bibliography
Pérez-Gaxiola G.
Hyperbaric oxygen did not improve symptoms in children with cerebral palsy.
Arch Dis Child Educ Pract Ed. 2013;98(5):198. PubMed abstract