text:
Making Belgrade a Home
Belgrade Foreign Visitors Club Quiz Night in the Belgrade's IndoFood Restaurant. Along with a British colleague Jules Kovacevic (on the right) Philomena O'Brien (in the middle) runs the Belgrade Foreign Visitors Club on Facebook, aimed at helping newcomers getting settled in the town.
by Hoi Mun Yee
SIT Spring 2017
BELGRADE, Australian Philomena O'Brien had just celebrated her 39th birthday in Budapest and was on her way to Iran when her train unexpectedly left earlier than scheduled. Stranded, with some scepticism she took the advice of a booking clerk to take the next train to Belgrade and spend a few nights there instead. She never made it to Iran, but she did find a new home.
"I didn't even know Belgrade was in Serbia," said O'Brien, sunglasses tucked in her brunette hair.
She boarded the train with Serbian strangers and received a 10-hour introduction to Serbian hospitality. "They grabbed my bags for me, we chatted and ate together," she said.
After a decade of international isolation during the wars that tore apart former Yugoslavia in the 1990s, Belgrade began to open up for foreigners since early 2000s. It's no longer rare to hear foreign languages on Belgrade's streets, and according to director of the Serbian Tourist Board Marija Labovic, more than 2.5 million tourists visited Serbia in 2016. Excluding the other countries of the former Yugoslavia, some 80,000 people came from abroad to live in Serbia between 2002 and 2011, according to data from the Serbian government statistics office. Most foreigners came from Germany, Austria, Italy, Russia, Switzerland, the United States and France, the data showed.
Upon her arrival in Belgrade, O'Brien was amazed by the nightlife. She stood on the pedestrianised Knez Mihailova street at the heart of the city 10 pm and there were lights, and people flocking into bars and cafés. She fell in love.
"This is what I thought Italy was gonna be like," O'Brien said, still filled with wonder.
"I've been here now for seven years," she said.
"And two weeks."
Before winding up in Belgrade, O'Brien said she had had an increasingly dissatisfied life, despite working in the tourism industry and having had a good income.
"I was having a midlife crisis. I was living in New Zealand, had a good life and good job, but I was tired of it," she said.
"New Zealand is beautiful but boring, I could tell you what I'd be doing the next Monday or Saturday," O'Brien said. This prompted her to set off backpacking in Eastern Europe, beginning in Leipzig, Germany, thus starting a life-transforming trip.
Having decided to stay in Belgrade, Philomena, always with a smile on her face, spent months in cafés finding connections for jobs. Early life was "haphazard." She is now a project manager for a German media company and does translating jobs on the side.
Her family is supportive of her decision to stay in Belgrade, she said.
"My mom is a bit of an adventurer, but the first thing my father asked me was if I was safe," she said rather bemusedly.
O'Brien currently lives with her Serbian partner Alex she met four years ago working at an English camp.
Along with a British colleague Jules Kovacevic she runs the Belgrade Foreign Visitors Club on Facebook, aimed at helping newcomers getting settled in the town. Members post notices about housing, jobs, or any other information foreign residents need. It also organizes outdoor events or casual outings at cafés to connect members.
A group of contestants at the Quiz Night. Belgrade Foreign Visitors Club has over 7,000 members, with English speaking locals also joining the club in large numbers to meet expats and engage in social activities.
When O'Brien and Kovacevic took over the group from creator Jonathan Davis six years ago, it had about 100 members. Today, it has over 7,000 as Facebook grew in popularity, with English speaking locals also joining the club in large numbers to meet expats and engage in social activities.
The club has recently even launched a GoFundMe campaign to raise money for refugees. As of early 2017, there are around 7,000 refugees stuck in Serbia after the closure of so-called Balkan route. Most of them were fleeing conflicts in the Middle East or Afghanistan and seeking to start a new life in European Union countries, but ended up in Belgrade, many even sleeping rough in capital's parking lots and warehouses. The campaign raised 25,000 EUR which provided tents, shoes, food and drinks for refugees in Belgrade.
"Working with Philomena is great, we tend to complement each other and agree on most things," Kovacevic said. "When we don't, we seem to always compromise in the end."
O'Brien said living in Belgrade does not come without its problems.
"Jobs and houses are hard to find because there are not many ads on newspapers or the internet," she said.
"We are trying to make life easier living in Serbia (for expats)."
Life in Serbia seems to be an adventure, but what makes it special is hospitality, she said.
"I was buying chicken at Maxi [a local retail chain], and a man asked me how I was going to prepare it," she said.
"Then he invited me to his family home to prepare it together."


text:
Suivez en direct l'étape 11 entre Albi et Toulouse — Tour de France
Les parties des Français et Woods — British Open
Les Champs-Élysées ne seront pas fermés vendredi — Algérie-Sénégal (CAN)
Tour de France: Daryl Impey devance Tiesj Benoot au sprint
Vergne conserve son titre — Formule E
Volley-Ball: les Lionnes, championnes d'Afrique arrivent au Cameroun ce jour
Le profil de la 11eme étape — Tour de France
Pampling hits hilariously disgusting tee shot
That means groups are desperate to be on the final hole when this happens so they can finish and avoid a super early Saturday start to complete the little remna...
Predictions on Premier League 2017-18
The Bosnian made the Bundesliga Best XI in 2016-17 and had the most assists by a defender during the league season. As it stands, if he refuses to sign the ...
Pep Guardiola claims Premier League spending is 'unsustainable'
Although many still believe Pep will continue with his beloved 4-3-3, the additional formation will give City some flexibility next season, and they can use it ...
Packers ask National Football League to take a look at Thursday night hits
Obviously those two hits fit in that category. "We all watch the same videos; there is emphasis each and every year about how we can make the league better, o...
Alexis Sanchez Out of Arsenal's EPL Opener Due to Abdominal Strain
Olivier Giroud completed an exhilarating comeback as Arsenal beat Leicester 4-3 on Friday to ensure Arsene Wenger's side opened the English Premier League...
Federer downs Bautista Agut to reach Rogers Cup semfinals; Haase advances
Federer responded quickly in the second set, going a break up to lead 3-2 before holding for a 4-2 lead. Federer had dominated the pair's previous meetings, w...
Watch Conor McGregor's Open Media Workout
McGregor has a real chance to beat Mayweather in their highly anticipated fight at the T-Mobile Arena in Las Vegas on August 26. "That's called really doin...
Pep Guardiola says transfer finances are 'unsustainable'
Liverpool and Tottenham push the boundaries on physical endurance as they press, press then press some more. Premier League champions Chelsea have comp...
Guardiola Predicts 'Intelligent' Bernardo Silva Making Impact at Man City
The manager said he is building for the future and has since signed goalkeeper Ederson, Bernardo Silva , Kyle Walker and Danilo. The midfielder is the ...
Coutinho Shocks Liverspool FC, Hands In Transfer Request
Juventus will decide whether to make a new bid for Liverpool star Emre Can in the next 72 hours according to reports in Italy. But now with the allure of ...
Conte: The pundits are right - Chelsea are not favourites for the title
Having patrolled the middle of the park so effectively for the Blues as they clinched the Premier League title in 2016/17, Matic was expected was to provide s...
Mo Farah & Usain Bolt prepare for final events
That's what I was taught in my early years. "I'm a very lucky person in life". I'd love to do it, it would be historic and it would mean the world to me. "I w...
Un défenseur grec dans le viseur — Lyon
Après le récent départ de Nicolas Nkoulou en prêt (Torino), les Lyonnais cherchent donc à se renforcer dans le secteur défensif. Le jeune grec intéresserait éga...
Jays catcher Russell Martin leaves in second inning against Pirates with injury
The loss was his first since a July 3 road defeat against the Yankees. The Blue Jays catcher was seen grimacing during his first inning at-bat after he appear...
Takeaways from the first New Orleans Saints preseason game
We're not there yet". He finished the half with 184 yards passing while playing second- and third-team members of the Saints defense. The 45-yarder dropped pe...
Man United Will Be Among Europe's Elite in Two Years, Says Mourinho
Mourinho had previously opened the door to the former Barcelona and Ajax striker playing for the club again, and confirmed on Friday that talks have taken place...
Morata: 'Here's why I joined Chelsea'
Conte has also penned a new Chelsea contract that did not extend his term at Stamford Bridge and he was evidently tired in the face of questions regarding fu...
Dolphins QB Ryan Tannehill finally makes a decision on treatment
The 29-year-old will aim to return to the field in 2018. But it all changed really quickly last week, when Tannehill went down untouched during practice. The ve...
Chelsea want to make 23-year-old Portugal starlet their fifth signing
Chelsea Manager Antonio Conte essentially admitted that the decision to sell midfielder Nemanja Matic to Manchester United was out of his hands. He has b...
Man United's Mourinho: Prem title more realistic than last season
Full-backs have been key to Guardiola's coaching career, and last season the four on his squad simply couldn't provide what he was asking of them. But after a...
Pedro ruled out of Chelsea's opener as Conte hints at Rudiger start
Pogba scored just the nine times in all competitions last season, only five of which were in the league, as United limped to a sixth-place finish. Morata wi...
Lobo alum takes silver medal at world championships
After an injury-interrupted buildup, LaCaze was 11th in 9:26.25 - two spots worse than her result at last year's Rio Olympics. Heading into the IAAF World Cha...
Club Are Trying Best In Transfer Market - Chelsea Boss Antonio Conte
The west London side are also expected to sell Spain global Diego Costa after Conte told the 28-year-old that he is free to leave. "If you're a manager yo...
Pumas consigue agónico empate frente a Monterrey en juego de Copa MX
Buen juego, entretenido que ganaban los Rayados del Monterrey , quienes tomaron la iniciativa del encuentro desde los primeros minutos de acción. Gracias a...
Mourinho To Make 2 Changes: Predicted Man Utd XI vs West Ham
Jose Mourinho admits Manchester United could still sign one more player, but he will not be "crying" if they do not. "It's not something urgent, it's nothi...
Conte reveals one of Chelsea's best players will miss Burnley clash
My aim is to try to improve my players, to try to improve my team. When asked if he wants more players, the Italian repeated the same message he's said all su...
Arsenal vs. Leicester City
Arsenal boss Arsene Wenger reckons that the Premier League will "soon" have a female manager in charge of one of its clubs. But Arsene Wenger's double change...
Phil Neville: Manchester United's title bid strengthened by signing of Nemanja Matic
Key to their success was a 13-game winning streak that stretched from October to January. Antonio Conte has claimed that he wants at least one new wing back...
Arsenal 4 Leicester 3: Ramsey and Giroud rescue Gunners from defeat
The Gunners will be missing the services of Alexis Sanchez as the Chilean forward will miss their first two games of the season due to an abdominal strain in ...
Arsenal offer Alexis Sanchez mammoth £300000-a-week contract
The Chile forward missed pre-season after being granted extra time off following the Confederations Cup and has been ruled out of Friday's game due to an abdomi...
Conte feels heat as Chelsea start title defence
It was the inevitable reaction to feeble title challenges that saw Guardiola's City finish 15 points behind the victorious Chelsea side in third place and Mou...
Philadelphia Eagles trade WR Jordan Matthews and draft pick for Bills cornerback
Friday. In exchange, the Bills acquired Eagles wide receiver Jordan Matthews , Rams cornerback E.J. Gaines, as well as second- and third-round picks in 20...
Pearson surges into 100m hurdles semis
The 2011 world champion and 2012 Olympic gold medallist has battled a series of wrist, achilles and hamstring injuries in recent years. "I'm just happy to be go...
Dafne Schippers wins enthralling women's 200m final at world athletics final
Schipper, 25, clocked a season best 22.05 seconds for the title, adding to her 100m bronze. "I fought for that", said Schippers. "I worked so hard in the last...
Money no object for City, but Guardiola must deliver
After the 3-0 win over West Ham in Iceland last week, Guardiola thanked the board for securing Bernardo's signature ahead of City's rivals, a clear sign he fe...
Chiefs preseason kicks off: What to know before you go
These games may not mean anything in the standings, but there is still a lot to learn from what we see tonight. "While Johnson is now tabbed to win this spot, i...
Guardiola bringing Barcelona style to Manchester City, claims Toure
They have the services of Romelu Lukaku, a like-for-like replacement for Zlatan Ibrahimovic - probably more agile. Their defensive woes have been addressed with...
Jaguars release OT Branden Albert after attempted comeback
Albert, who changed his mind about retiring earlier in the week, was released by the Jaguars on Friday from the reserved/retired list. On July 31, Albert ann...
Football Is Returning As Arsenal Prepare To Welcome Leicester To The Emirates
It took Lacazette just 94 seconds to score in the Premier League with his second touch in England's top-flight. He now has seven in five on the opening day ...
Reese wins fourth long jump world title
Reese won with a leap of 7.02 metres on her third attempt and had to endure a nerve-wracking finale after receiving a red flag on her next three jumps. Klishina...
PSG - Mercato : Henrique discute avec l'AS Monaco pour Fabinho
La venue de la pépite française serait quant à elle prévue pour l'été prochain. Une autre piste pourrait être menée en parallèle avec le club de la Principauté:...
Mancini homers twice, Miley goes 7 as Orioles top A's 7-2
Orioles catcher Wellington Castillo had a double in the fourth inning that extended his hitting streak to 10 games. The Orioles broke a 1-1 tie in the fourth ...
The David Wagner Revolution Is In Full Swing At Huddersfield Town
Who will be your team's MVP this season, and why? Wagner added with a smile: "I was more nervous when I arrived in England than now!" To embark upon this Pr...
Liverpool owners end Barcelona's Coutinho hopes
The Reds said earlier that the player is not for sale and will remain at the club when the summer transfer window closes. Barcelona are reportedly looking...
Los Angeles Rams Acquire WR Sammy Watkins from the Buffalo Bills
The Philadelphia Eagles on Friday dealt slot receiver Jordan Matthews to Buffalo in exchange for a cornerback. Gaines, a sixth-round selection in the 2014...
Marlins will be sold to Derek Jeter's group
Jeter, while wealthy by baseball player standards, could not carry the majority of cost (he's reported to be contributing $25 million to the deal). Former Ne...
Man City players happy with three at the back, says Kompany
Flop of the season some in the British media called him. Radio station Onda Cera boldly claim that Guardiola has enquired over his availability this summer,...
Pep Guardiola - Manchester City squad won't need big changes in future
Yet, a team featuring Sergio Aguero and Gabriel Jesus up front and a sprinkle of attacking midfielders like Kevin De Bruyne , David Silva , new signing Ber...
Ligue 1 : Lyon confirme à Rennes
Benjamin Bourigeaud avait réduit lécart en toute fin de match (86e). Troyes , surprenant promu victorieux à Nice . Comme à Saint-Etienne (0-1) lors de la p...
A snapshot of Guam before US-North Korea conflict and now
During World War II, brown tree snakes somehow slithered their way onto the island. Still, with just 210 square miles (543 square km) of land, it's about half t...
Arrière 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 Avant
Le bilan est assez lourd pour De Marchi après sa terrible chute
"Pour gagner du temps", un cycliste emprunte l'autoroute A9 — Perpignan
Cyclisme - Tour de France : Pinot enrage après le temps perdu !
Foot - Transferts - Que vaut Abdou Diallo, convoité par le PSG ?
OL - Mercato : Signature imminente de Genesio en Premier League !
PSG : Nasser Al-Khelaïfi va porter plainte contre Mediapart
OL : Lille ne va pas aimer, Lyon piste toujours André !
Accord trouvé avec Dario Benedetto
Beyoncé a notamment annoncé, dans une interview pour la chaîne ABC, q...

redpajama_set_name: RedPajamaCommonCrawl


text:
Maryland Farmers are Breaking Records
Maryland Soybean Board announces 2015 cover crop program sees best participation yet.
A small airplane is used for aerial application of cover crops on Schmidt Farms.
Applying the cover crop seeds while the original crop is still in the field allows us to take advantage of seed mixes that produce dual results for soil health.
Annapolis, Maryland (PRWEB) March 01, 2016
A small airplane swoops low over a field of golden soybeans, and then zooms back up into the air before making another round at Maryland Soybean Board member Schmidt Farms, located on the Eastern Shore of Maryland.
"What we're doing is an aerial application of cover crops," explains Hans Schmidt, on a sunny day last fall. "Applying the cover crop seeds while the original crop is still in the field allows us to take advantage of seed mixes that produce dual results for soil health."
Schmidt Farms is one of many Maryland farms which together seeded a record 492,244 acres of cover crops last fall, the Maryland Department of Agriculture has announced. Maryland farmers have exceeded the Watershed Implementation Plan milestone goals in 2011, 2013 and 2015 for cover crops and are on track to exceed the next two year milestone in 2017 with this new record enrollment acreage.
Cover crops are widely recognized as one of the most cost-effective and environmentally sustainable ways for farmers to meet nutrient and sediment reduction targets outlined in Maryland's Watershed Implementation Plan to protect and restore the Chesapeake Bay by 2025.
"Maryland farmers believe in the environmental and agronomic benefits of planting cover crops on their fields to improve the soil, recycle unused plant nutrients, control erosion, and protect local waterways," said Maryland Secretary of Agriculture Joe Bartenfelder. "This is the sixth consecutive year that farmers have planted more than 400,000 acres of cover crops on their fields."
Schmidt Farms is a third generation family farm, operated by Hans and his wife, Jennie, and Hans' brother, Alan and his wife Brenda. The farm cultivates about 2,000 acres of food and feed – high oleic soybeans used to create soybean oil, soybeans used in tofu and soy milk, green beans, tomatoes and wine grapes. In addition, they grow soy, corn and barley for animal feed.
Using a cover crop application program allows the farm to feed nutrients into the top soil, and at the same time improve the fields' soil tilth.
"Tilth is the physical condition of the soil that allows for a healthy root system to support plant growth and plant health," says Jennie. "Having soil with good tilth means that the soil has large pore spaces for oxygenation and water filtration. This all adds up to a better no-till program in the spring and a reduced use of fertilizer."
The cover crop program is not a new idea on the farm. In fact, Walter Schmidt was one of the first farmers in the country to implement cover crops, way back in the late 1960s.
"Dad wanted to ensure that the next generation of our family had healthy soils to continue our family farming legacy," says Hans. "He certainly was able to meet that goal, and Alan and I continue the practice of constantly improving our soils."
The Schmidt family goes out of its way to promote environmental stewardship and leadership for agriculture in Maryland. The farm has earned a designation of Certified Agricultural Conservation Steward under the Farm Stewardship Certification and Assessment Program (FSCAP), and Hans, who recently "retired" as volunteer chairman of the Maryland Soybean Board and from the Maryland Association of Soil Conservation Districts, has been appointed Assistant Secretary of Resource Conservation at the Maryland Department of Agriculture. Jennie is now president of the Maryland Grain Producers Utilization Board.
"It's rewarding to grow food for our neighbors, and the larger community," says Hans. "We all have an influence on the environment. As farmers, we put the safety and health of the environment first. We are not the only farmers doing this, for most, it's second nature."
About Maryland Soybean Board: The Maryland Soybean Board administers soybean checkoff funds for soybean research, marketing and education programs in the state. One-half of the checkoff funds stay in Maryland for programs; the other half is sent to the United Soybean Board. To learn more about the Maryland Soybean Board, visit http://www.mdsoy.com.
Susanne Zilberfarb
Maryland Soybean Board
Schmidt Farms is a third generation family farm, operated by Hans and his wife, Jennie, and Hans' brother, Alan and his wife Brenda. The Maryland Soybean Board administers soybean checkoff funds for soybean research, marketing and education programs in the state.


text:
San Giovanni in Persiceto is een gemeente in de Italiaanse provincie Bologna (regio Emilia-Romagna) en telt 24.790 inwoners (31-12-2004). De oppervlakte bedraagt 114,4 km², de bevolkingsdichtheid is 210 inwoners per km².

De volgende frazioni maken deel uit van de gemeente: San Matteo della Decima, Le Budrie, Castagnolo, Zenerigolo, Lorenzatico, Amola.

Demografie
San Giovanni in Persiceto telt ongeveer 10327 huishoudens. Het aantal inwoners steeg in de periode 1991-2001 met 6,6% volgens cijfers uit de tienjaarlijkse volkstellingen van ISTAT.

Geografie
De gemeente ligt op ongeveer 21 meter boven zeeniveau.

San Giovanni in Persiceto grenst aan de volgende gemeenten: Anzola dell'Emilia, Castelfranco Emilia (MO), Castello d'Argile, Cento (FE), Crevalcore, Sala Bolognese, Sant'Agata Bolognese.

Geboren

 Cesare Manganelli (1859-1941), componist, dirigent en violist
 Raffaele Pettazzoni (1883-1959), godsdiensthistoricus

Externe link
 http://www.comunepersiceto.it/

Gemeente in Bologna
Stad in Italië

redpajama_set_name: RedPajamaWikipedia


Are you dealing with frequent or intense nosebleeds? Find out what might be going on.
Most people will experience a nosebleed at some point during their lifetime. Maybe the cold weather finally nipped at your nose and dried it out, causing you to deal with nosebleeds more often during the winter months; however, if you are someone who is dealing with regular nosebleeds you may be wondering what's going on. Our Sun City and Sun City West, AZ, ENT doctors have some answers for you.
We know that young child often like to explore, and that can mean placing things they shouldn't into their noses. Everything from their fingers to marbles and other small toys can end up being lodged in little noses. If your child is suddenly dealing with a nosebleed, it could mean that perhaps they put something in their nose that they weren't supposed to.
Of course, we know this isn't a common problem for adults; however, it doesn't mean that people won't often scratch or pick at their skin, which can also cause the nose to bleed. Even on dry days when your nose feels itchy, try to avoid using your nails to scratch.
Sometimes allergies are the true culprit. If our Sun City and Sun City West otolaryngologists have told you that you suffer from allergies, then you may be prone to nosebleeds. Infections such as the common cold or sinusitis can also lead to a bloody nose.
While you may be scratching your head to try and figure out why you are getting nosebleeds, it's good to know that most of the time there is nothing to really worry about.
Even if you get a handle on how to stop nosebleeds, if you are experiencing them often then it's time to see a medical professional for a checkup. While there are certainly at-home measures you can take to reduce the frequency of your nosebleeds, if severe allergies or chronic sinusitis are to blame, these are issues that may require more aggressive treatment options that only we can provide.
If you are having issues with frequent or severe nosebleeds, then don't hesitate to get the answers you need from Arizona Ear, Nose & Throat Physicians in Sun City and Sun City West, AZ. We are happy to provide our patients with comprehensive services to meet all of their ENT needs.


Smile, Cash Out & Repeat..
Camsperformance was invented to simplify and optimize your Webcam promotion strategies. We offer you Superior Tracking, Better Promo Tools, Flexible Payout Terms and many more advantages while crushing the competition on every possible level! Try us out!


Here's one of those wedding pictures that just takes itself, honestly there's no magic involved, just pressing a button. The thing about being a Documentary Wedding Photographer is you just learn to observe, nothing fancy, just watch and take pictures without drawing attention to yourself and disturbing a moment.
No matter what I'm taking pictures of I have a keen desire for my pictures have context, context gives pictures meaning, a story or lets them form part of a set of pictures that go together that tell a story - a story of a wedding.
I love this picture because it's just one of those times you're in the right place at the right time for something like this to happen - was it pure luck, do we as photographers create our own luck or is there something more to it ? Who knows, but here it is, a perfect combination of moment, light, luck and whatever other descriptive terms you want to use. Oh, and it reminds me of some fantastic days spent with a bunch of great people too !


Each pink, oval, biconvex tablet, with "G" over "L5" on one side and scored on the other contains 5 mg of lisinopril. Nonmedicinal ingredients: corn starch, dibasic calcium phosphate, magnesium stearate, mannitol 60, talc, and red iron oxide No. 30.
Each pink, oval, biconvex tablet, with "G" over "L10" on one side and plain on the other contains 10 mg of lisinopril. Nonmedicinal ingredients: corn starch, dibasic calcium phosphate, magnesium stearate, mannitol 60, talc, and red iron oxide No. 30.
Each pink, oval, biconvex tablet, with "G" over "L20" on one side and plain on the other contains 20 mg of lisinopril. Nonmedicinal ingredients: corn starch, dibasic calcium phosphate, magnesium stearate, mannitol 60, talc, and red iron oxide No. 30.


Part of what makes Buffalo beautiful is its eclectic culture mixed with blue-collar values. Where else can you talk about art and literature over a beer while watching football and hockey? As we all wait and wonder over the future of the Sabres and the Bills, consider stepping out into some of Western New York's artistic and inventive attractions.
Get in touch with technology on the Buffalo State campus this spring. Two exciting exhibits are blurring the lines between artistry and construction by stimulating our imaginations through machinery.
The Semi-Automatic Chalkboard is the creation of Buffalo-based artist Timothy Noble, and remains on display until May 25th. Each morning a meticulously rendered chalk drawing is erased from the blackboard. Then, with implements from the modern world, Mr. Noble's open source software and servo motors kick into gear, creating a fresh representation of Charles Burchfield's preparatory sketches for Grain Elevators 1932-38. Check out this automated exhibit and witness the work that goes into the work itself.
For something a little more interactive, try Colleen Ludwig's Shiver continuing at the gallery through June 22nd. Find yourself bordered by three walls, bounded in streams of running water, and tracked by 35 infrared sensors connected to your movements within the installation. Meant to evoke a personal experience, Ms. Ludwig says on ArtBabble.org, "I love the idea that the room is reacting to your presence." Plunge into Burchfield Penney and connect with Shiver before the end of June.
The Burchfield Penney Art Center is open Tuesday, Wednesday, Friday, and Saturday: 10am-5pm. Thursday: 10am-9pm and Sunday 1-5pm. The gallery is closed on Sundays.
Head out to see what's new this year at the Museum. There probably have been a few changes since you last visited, so rediscover your scientific vision, and engage your inner Einstein.
Boasting the largest collection of mummies and mummy related artifacts, Mummies of the World promises to be one of the most unique exhibitions to come to Buffalo this year. A collection of 45 human and animal mummies from around the planet will descend on the museum starting April 12th. Organizers of the exhibit suggest that parents view the exhibition first, before deciding to bring children. Anyone under the age of 17 must be accompanied by an adult. See it twice, because this limited engagement exhibit will only be here until September.
If Mummies of the World is a little too intense for the little ones, then consider stopping in and trying out all of the museum's new kid-friendly presentations. The In Motion exhibit offers exciting car races and crash test simulators, while Bug Works presents the wonderful world of insects with seven interactive displays. These are just two of the many fun and stimulating activities for children the museum has to offer.
The Buffalo Museum of Science is open 7 days a week, 10am-4pm.
Perhaps you are looking for something heavy in substance and deep in social awareness. Among the many thought-provoking exhibits at the Albright-Knox this spring, two in particular stand out.
Millie Chen, Professor and Chair of the Department of Visual Studies at UB, brings her most current work Tour to the gallery through June 1st. This audio-video installation asks us to explore the complexities of perishable time as it relates to genocide, and our perception of human cruelty. The exhibition promises to fully touch your senses, so stand ready to be moved and engaged in the experience.
Rounding out the month of May and also ending on June 1st is the special exhibition, One Another: Spiderlike, I Spin Mirrors. A celebration of women artists, the collection studies the intricacies of relationships and the attributes of female existence. Included in the collection are a variety of mediums, from painting and sculpture, to performance and photography. Reflect and be inspired by the passion revealed in this exhibit presented on First Fridays at the Gallery.
The Albright Knox Art Gallery is open 10am-5pm Tuesday through Sunday. On First Fridays gallery hours are from 10am-10pm.
It's not often that hockey and war cross paths, but there's a first time for everything. Slapshots and soldiers, Tim Horton and Red Jacket are just a couple of the odd combinations getting together at the History Museum right now.
Hockey fans wanting to know how it all began should skate on over to Forging a Connection: Your Buffalo Sabres 1970-75 exhibit in State Court at the museum. Jerseys, hockey sticks, and other artifacts collide against the framework of eleven foot tall murals celebrating the team's infancy. Discover the origins of the French Connection, and examine the Knox brothers' initial team proposal up close, but get there soon. The collection and all its artifacts will be returned on May 25th.
By Fire & Sword: War in the Niagara Theatre, 1812-1814 exposes our region's importance in America's second war for independence. Using green screen technology and Google Nexus tablets to wed history with the present, this modern exhibit is sure to please everyone. Just because this exhibition continues until next year, doesn't mean you should wait until the last minute. Get out now and have some fun learning about Buffalo's turbulent and tortured past.
The Buffalo History Museum is open Tuesday, Thursday, Friday, and Saturday from 10am-5pm. Wednesdays 10am-8pm and Sundays 12pm-5pm. The museum is closed on Mondays.


text:
N A T I O N
Telgi's parole plea order reserved
Bangalore, November 15
A fast-track court trying the multi-crore stamp paper scam today reserved orders for November 22 on an application filed by alleged kingpin of the racket Karim Lala Telgi praying for his release for a week on parole.
Sonia hosts Iftar party
New Delhi, November 15
Congress President Sonia Gandhi today exuded confidence over her party's prospects in the next month's crucial Assembly elections.
Inspector held in poet case
The CBI today arrested an Uttar Pradesh Police Inspector for allegedly "suppressing facts" in the Madhumita Shukla murder case even as Prakash Chander Pandey, the man alleged to have murdered the poetess, and two other were being brought here to undergo a lie detection test.
Accused in the Madhumita Shukla murder case, Rohit Chaturvedi (face covered), and Prakash Chandra Pandey being taken out in Lucknow on Saturday before their departure to New Delhi for further interrogation by the CBI. — PTI photo
Indian artists give finishing touches to a sand sculpture of Chanakya, India's first modern management consultant and philosopher in the fourth century BC, during the 23rd India International Trade Fair in New Delhi on Saturday. South Asia's biggest trade fair opened in New Delhi on Friday and nearly 7,500 domestic and international exhibitors are taking part.
Advani announces aid for Arunachal
Itanagar, November 15
Deputy Prime Minister L.K. Advani today said India's relations with China have progressed well which has had a direct and positive impact on Arunachal Pradesh for which he announced development assistance of Rs 250 crore.
Deputy Prime Minister L.K. Advani greets the supporters during a civic reception in Itanagar, Arunachal Pradesh, on Saturday.
— PTI photo
Digvijay issues notice to Uma Bharti
Bhopal, November 15
The Chief Minister, Mr Digvijay Singh, has sent, through his lawyer, a notice to the BJP's chief ministerial candidate, Ms Uma Bharti, asking her to withdraw, within 24 hours, the allegations of corruption that she had levelled against him or face legal action.
TDP to abide by EC's decision
Hyderabad, November 16
A day after dissolution of Andhra Pradesh Assembly, the ruling TDP appeared reconciled to the possibility of a delay in the elections, notwithstanding its preference for mid-February polls.
Dikshit, Pilot's widow enter poll fray
CBI chargesheets Mehta brothers
Hindu withdraws request for Central security
Madhumita's second 'killer' identified
Protect rights of poor children, says PM
Lie-detector test raised doubts on Madhumani
Political parties decry bid to muzzle Press
Entire LoC to be fenced: Army chief
Sentence in 'tandoor' case reserved
Cong ready for AP poll: Reddy
The Congress yesterday said it was "more than ready" for Assembly poll in Andhra Pradesh and indicated that the party was not averse to having a tie-up with Left parties or Telangana Rashtra Samiti.
Five hurt in communal clash
The police today used mild force at three places to disperse stone-pelting groups of two communities in the old city here which witnessed communal flare-up over construction of a compound wall adjoining a place of worship last night.
Man kills 'evil' daughter
Siliguri, November 15
A man allegedly killed his one-year-old daughter, claiming that she was "evil", in Uttar Dinajpur district, the police said today. Muhammad Ali was arrested on November 12 on the basis of FIR lodged by his wife Alena Khatun and was remanded in judicial custody by the Sub-Divisional Judicial Magistrate of Islampur court yesterday.
Dawood's aide arrested
Jaipur, November 15
Sayed Zulfikar Ali, alias Guddu, a key accomplice of underworld don Dawood Ibrahim, was arrested in a case of loot from the city here yesterday, a senior police official said today.
Tulsi loses memory in soap, joins BJP
Television actress Smriti Z. Irani, who shot to fame for playing Tulsi in soap opera "Kyoon Ki Saas Bhi Kabhi Bahu Thi", today joined the Bharatiya Janata Party in the runup to the December 1 Assembly elections. The announcement of the 27-year-old TV actress to join the BJP was made by party General Secretary Mukhtar Abbas Naqvi in the presence of Maharashtra BJP Chief Gopinath Munde.
Smriti Z. Irani
Judge's kin succumbs to bullet injuries
Chennai, November 15
Venkatesan, a son-in-law of a retired Madras High Court Judge, Justice A. Raman, who was shot at on October 22, succumbed to bullet injuries today. The victim, a distributor of medicines, had came out to answer the door at his residence in Tiruchirapalli when an unidentified person shot at him from point blank range with a country-made revolver and escaped under the cover of darkness.
Three held for landmine blast
Agartala, November 15
Three persons were nabbed following a massive combing operation in Dhalai district today where a Deputy Commandant of the BSF and his driver were killed and four jawans injured in a landmine blast last evening. The police said the arrested were being interrogated, while combing operations at Joshitilla and neighbouring tribal hamlets were on.
Nirankari Samagam begins
The three-day Nirankari Samagam began here today with a prayer for peace. Lakhs of devotees from across the world gathered at the samagam venue in Burari as head of the sect, Baba Hardev Singh, inaugurated the 56th annual samagam.
The head of the Nirankari Mission, Baba Hardev Singh Ji Maharaj, with his wife and mother at the opening of the Annual 56th Nirankari Sant Samagam in the capital on Saturday. — Tribune Photo by Mukesh Aggarwal.
10 killed as van, bus collide
Coimbatore, November 15
Ten persons, including two children and seven women, were killed on the spot and four injured when the van in which they were travelling collided with a private bus at Karungalpalayam in Erode today.
Raman Kumar's "Wah Wah Ramji" hits theatres today.
(28k, 56k)
Spanish actress Penelope Cruz is set to lend her support to NRI director Gautam Das's docu-drama based on the life of Mother Teresa.
TNS, PTI and UNI
Telgi has filed the application for his release to visit his ailing mother and wife at Khanapur in Belgaum district in Karnataka.
Judge Nagashetty, after hearing the counsel for Telgi, reserved orders and posted the case to November 22.
Telgi, in another application, sought a direction to jail authorities to restore the television set facility which was withdrawn from him.
NEW DELHI: Former Maharashatra Deputy Chief Minister and BJP's state unit president Gopinath Munde today demanded a CBI probe into the multi-crore Telgi stamp paper scam saying 'people did not have faith in the corrupt Congress-led government the state'.
Refuting the charges that the origin of Telgi stamp paper scam was during the Shiv-Sena-BJP government, which failed to act properly, Mr Munde said "The moment I took over I had cancelled the license of Telgi after a case of fake stamp papers worth Rs 16 lakh came to light...But the Congress regime renewed the license to him."
"Only an independent CBI probe could reach to the bottom of the case," Mr Munde told newspersons.
PUNE: MCOCA Judge S M Shembole today rejected and dismissed the bail plea of Manoj Mehta, one of the accused in the inter-state multi-crore fake stamp paper racket.
Public Prosecutor Raja Thackeray had argued yesterday that Manoj Mehta, a resident of Ghatkopar was involved in the racket from 1994 and had financial connections with the prime accused Abdul Karim Telgi as was reflected in the bank accounts.
Meanwhile, in a related case, the court today deferred the bail plea of Abdul Rashid Kulkarni, lawyer of prime accused on a point of law till November 19. The prosecution had presented its argument against the bail today.
Congress President Sonia Gandhi today exuded confidence over her party's prospects in the next month's crucial Assembly elections. Looking relaxed and chatting amiably with persons at the Iftar hosted by her, Ms Gandhi said a Congress victory in the impending Assembly poll will be an answer to the BJP's ``communal agenda.''
Maintaining that the Congress was well placed in all five states, Ms Gandhi, however, stuck a note of caution when asked to predict the outcome. ``I would rather wait for results....I am always on the cautious side,'' she said, adding that the party would do particularly well in Delhi and Rajasthan. As for Madhya Pradesh, Ms Gandhi reposed full confidence in the Chief Minister.
Like her earlier Iftars, the line-up of guests evoked as much interest as Ms Gandhi's lengthy interaction with the media, particularly since the guest list is a good indicator of political alignments and equations.
Leaders of all alliance partners,she said, were invited.However, not all turned up. Uttar Pradesh Chief Minister Mulayam Singh Yadav stayed away but was represented by Mr Amar Singh. NCP chief Sharad Pawar also chose to stay away. No senior leader from the Left parties could be spotted. BSP chief Mayawati, with whom the Congress is seeking to build bridges, was also not there. However, her party MP Rashid Alvi was present.
Significantly, National Conference leaders Farooq Abdullah and his son Omar Abdullah could be seen mingling with guests, who included a host of ambassadors, chief among them being the new Pakistan High Commissioner Aziz Ahmed Khan. Former Prime Ministers I K Gujral and V P Singh, who particularly has had a estranged relationship with the Gandhi family for several years, were among the guests present.
The CBI, which was looking for Inspector Yagya Narain Dixit, detained him at the railway station and questioned him about allegations that he had illegally "confined" some people besides suppressing "facts" after the murder, CBI sources said here.
As his replies were not convincing, Dixit was placed under arrest and later remanded to the CBI custody till November 28 to facilitate his detailed interrogation, the sources said.
The CBI has accused Dixit, who was the station in charge of the Manak Nagar police station, of trying to project that the 24-year-old poetess, Madhumita, was married to an engineering student and had also recorded the statement of a priest who had performed the so-called marriage.
However, after the CBI took over the investigations on June 24, the engineering student and the priest suo moto recorded a statement before the agency that they were allegedly forced to make such a statement by Dixit, the sources alleged.
In a related development, Pandey, his accomplice Santosh Kumar Rai and Rohit Chaturvedi were being brought here to undergo a detailed interrogation and a lie detector test, the sources added. — PTI
During the course of his speech, the Deputy Prime Minister also announced Central financial assistance of Rs 250 crore for development projects in the state and also promised to speak to Finance Minister Jaswant Singh for converting a loan of Rs 200 crore into a grant to help the state come out of financial crisis.
Mr Advani also announced that work on providing mobile telephone service to all districts of Arunachal Pradesh would be completed by December end.
Regarding financial assistance, Mr Advani said the Centre would give Rs 200 crore for the construction of a 500-bedded referral hospital, inaugurated by him near Itanagar yesterday.
Another Rs 20 crore would be provided by the Centre to upgrade the Arunachal Pradesh University and Rs 30 crore for the construction of a new assembly complex.
He said several unfinished schemes worth Rs 900 crore had been identified by the state government and the Department of North East Development would take a comprehensive view and take steps to complete them.
Central Ministers C.P. Thakur, Bijoya Chakravarty and Tapan Sikdar attended the rally. Chief Minister Gegong Apang presented a memorandum to Mr Advani on behalf of the state government for enhancing development work there.
Mr Advani said he would also talk to Railway Minister Nitish Kumar for a railway connectivity which the state had so far been deprived of. — PTI
Mr Kailash Vijayvargiya, BJP spokesman, said here today the party had not received any notice so far. "On its receipt the party would contemplate filing a criminal case against Mr Digvijay Singh," he added.
Mr Ajay Gupta, advocate, has sent the notice on behalf of Mr Digvijay Singh. The notice says, "Ms Uma Bharti had levelled "baseless" charges against Mr Digvijay Singh with the sole motive of taking advantage in the elections."
Mr Gupta says in the notice that his client had been hurt by the false allegations levelled against him as these amounted to character assassination and lowered his prestige in the eyes of the people.
Mr Digvijay Singh is said to be all prepared to file a defamation case against Ms Bharti on Monday.
The state's Advocate-General, Mr Vivek Tankha, resigned from his post yesterday to be available for arguing Mr Digvijay Singh's case against Ms Bharti in the court.
"We welcome the developments in Andhra Pradesh. We are more than ready for polls. The Congress is eager to exploit the sentiments against the misrule of the Telgu Desam Party. We consider it an opportunity to rid the state of bad government," Congress chief spokesperson S. Jaipal Reddy said.
He said the reasons given by the Chief Minister for early poll were "false and perverse".
On the reason of naxal violence, Mr Reddy said the state had been facing the problem of naxalites for the past 35 years. He said various parties in the state had dealt with it earlier and the Congress was facing a similar problem in Madhya Pradesh and Chhattisgarh.
A meeting of the party's politburo here, chaired by TDP supremo and Chief Minister N. Chandrababu Naidu, decided to abide by the decision of the Election Commission on the timing of snap polls.
Avoiding collision course with the Election Commission, the party decided not to send any representation to the poll panel on timing of the elections.
"We will entirely leave the matter to the Election Commission. Whatever decision it takes is binding on all parties," the party MP and Spokesman U. Venkateshwarulu told reporters after the meeting. — PTI
The irate mob pelted stones at the police in the Kulsumpura area.
About 55 persons were taken into custody in connection with communal violence in which five persons were injured, including two in police firing since last night.
While 15 persons were booked under various IPC sections for indulging in arson and damaging properties of a particular community yesterday, 40 others were taken into custody today for violating prohibitory orders and indulging in stone- pelting, police sources said.
Prohibitory orders would continue in the areas of Tappachabutra and Kulsumpura police stations limits till further orders.
However, the situation is "little tense" but totally under control, city Police Commissioner R P Singh said.
Besides deploying additional force including RAF, intense patrolling has been launched in trouble-prone areas to maintain communal peace, he added. — PTI
A man allegedly killed his one-year-old daughter, claiming that she was "evil", in Uttar Dinajpur district, the police said today.
Muhammad Ali was arrested on November 12 on the basis of FIR lodged by his wife Alena Khatun and was remanded in judicial custody by the Sub-Divisional Judicial Magistrate of Islampur court yesterday.
Alena, in her report, alleged that Ali, who wanted a male child, behaved cruelly with her and their daughter Afsana and claimed that the girl was "evil".
On the night of November 12, Alena found her daughter missing. She became suspicious of Ali's motives when she found him looking unconcerned.
Afsana's body was found floating in a pond, which was recovered by villagers, she said.
Ali, during interrogation, confessed to his crime before the police and said he still believed that Afsana was "evil". — PTI
Zulfikar, involved in at least 24 cases, including those of murder, abduction, and loot, was nabbed with two others, the Superintendent of Police (North) Anand Srivastava said.
Zulfikar was the main accused in the murder of Abdullah who was allegedly responsible for the killing of Gulshan Kumar of T-Series in Mumbai, the SP said.
Zulfikar (33) had been staying in Rajasthan since August this year.
He is a science graduate and speaks English Hindi and Urdu fluently, the SP said.
The Madhya Pradesh and Bombay Police have also confirmed Zulfikar's crime record and separate police teams would arrive here to interrogate him.
Cases of loot and under the Arms Act were filed against Zulfikar and a country-made pistol was recovered from him.
The two others arrested have been identified as Jitendra and Ikhawan Ahmed and the three had reportedly robbed a businessman after throwing chilly powder in his face. — PTI
Television actress Smriti Z. Irani, who shot to fame for playing Tulsi in soap opera "Kyoon Ki Saas Bhi Kabhi Bahu Thi", today joined the Bharatiya Janata Party in the runup to the December 1 Assembly elections.
The announcement of the 27-year-old TV actress to join the BJP was made by party General Secretary Mukhtar Abbas Naqvi in the presence of Maharashtra BJP Chief Gopinath Munde.
Smriti, he said, was the BJP's answer to the "Videshi Bahu", referring to Sonia Gandhi. She was given membership of the party by Pramod Mahajan earlier
in the day.
Asked if she had "strayed" into the BJP because Tulsi had lost her memory in the opera, Smriti shot back
saying that it was in fact her awareness about the BJP's policies that prompted her
to join the party.
In a rare show of eloquence by a new entrant to politics, she said the BJP had promised her that she would be allowed to work in areas
beneficial to women, youth and children.
Asked whey she chose to take on Congress President Sonia Gandhi, Smriti said she rejected the idea of somebody of foreign origin leading the country.
Smriti has worked in several popular serials like "Kuch Dil Se", "Ramayana", "Kavita", "Aatish" and "Zee Antakshari" and also several advertisement campaigns. — UNI
Venkatesan, who suffered a bullet injury in the right rib, was admitted to a private hospital in Tiruchirapalli before he was shifted to the Apollo Hospitals here on October 24. Despite best medical efforts, he died here this evening.
The shooting incident assumed significance as it had taken place a couple of days after the government appointed Justice Raman to probe into the controversial encounter killing of a gangster, Venkatesa Pannaiyar, who enjoyed enormous clout among the Nadar community.
Expressing deep shock and grief, Chief Minister J Jayalalithaa, in a condolence message to Justice Raman, said the unfortunate circumstances under which Venkatesan was brutally attacked and shot at and the trauma of his prolonged battle against death must have taken a heavy emotional toll on him and the family. — UNI
Top officials of the BSF and SP, Dhalai, D. Murugan are camping in the area. The Deputy Commandant of 37 Battalion BSF, Rakesh Mohan, and his driver died on the spot when a powerful landmine went off around 5.30 pm.
Four BSF jawans who were seriously wounded were today shifted from Kamalpur hospital to GB Hospital. — PTI
Baba Hardev Singh said, "Those who cannot safeguard the integrity of the country and the fabric of unity cannot be expected to serve mankind as a whole. Service to nation is service to humanity." He was accompanied by his mother, Nirankari Rajmata Kulwant Kaur, and wife, Mata Sawinder Kaur. Mr Ashok Kumar Jain, Mayor of Delhi, welcomed Baba Hardev Singh.
The victims were returning after attending a family function in Kangeyam and the bus was coming from Salem when the mishap occurred. — PTI
Former Prime Minister H. D. Deve Gowda at an Iftar party at the Tilak Nagar mosque in Bangalore on Friday. — PTI photo
CONG OFFICE ATTACKED, BJP MEN HELD
KANNUR: Six BJP activists had been taken into custody for allegedly attacking a local Congress office near here and injuring 16 party workers, police said on Saturday. The incident occurred on Friday night as group of about 15 people, allegedly belonging to the BJP, attacked the 'Indira Bhavan' located at Mamakkunnu, near here, where some Congress workers were holding a meeting in connection with the celebration of Indira Gandhi's birth anniversary that falls on November 19. — PTI
LEONID METEOR SHOWERS
HYDERABAD: Leonid meteor showers will make their annual appearance for a few days, though less spectacular this time. Those to be are seen this time would be Leonids as these appear to originate from the direction of Leo, the birth star depicted with the symbol of Lion. These meteorites are the debris of the comet Temple-Tuttle which enter the earth's atmosphere and get burnt up. — UNI
TASLIMA'S BOOK UNDER SCANNER
KOLKATA: The Kolkata police on Saturday said it was examining the contents of controversial Bangladeshi writer Taslima Nasreen's latest book following complaints but it ruled out plans to confiscate it. "Taslim Nasreen's book, 'Dikhandita' (Split into Two) has not been confiscated. We have just collected a copy and are merely verifying some complaints whether the book really contains anything objectionable," Police Commissioner Sujoy Chakraborty said. — PTI
| Business | Sports | World | Mailbag | Chandigarh | Ludhiana | National Capital |


text:
LOOKING BEYOND Our Patients' Physical Well-Being
Carrie Beach, BSN, RN-BC 06/18/2021
Depression is something we commonly see in many of our patients with rheumatic disease. With experience, the signs become obvious. Disengagement with family and friends, poor adherence to medication, missed appointments, spotty hygiene practices, and more. Given the physical manifestations of psoriasis as well as the pain, fatigue, and joint deformities associated with arthritis, patients with psoriatic arthritis (PsA) are among our most common who deal with depression. According to one recent study, approximately 20% of patients with PsA have comorbid depression.1
So then what do we do about this? How do we help our patients whose life is spiraling downward into the depth of depression? Let's take a look at a current patient of mine to hopefully spark some ideas.
When we first met Ken, he was a 54-year-old male who arrived with complaints of joint pain and stiffness along with daily fatigue. While he denied any history of psoriasis or rash, his joint symptoms had gradually gotten worse over the past year. Prior to our appointment with us, Ken had consulted a rheumatologist outside of our practice who ordered labs to be drawn, revealing negative anti-nuclear antibodies and rheumatoid factor. No formal diagnosis was given at that time.
Upon initial exam in our office, Ken had significant synovitis of the 2nd and 3rd metacarpophalangeal joints (MCP) on his right hand. He also had dactylitis of the left great toe and complained of bilateral heel pain, previously diagnosed as plantar fasciitis. X-rays of his hands were normal, although an MRI of the right hand showed tendonitis (but no erosive disease).
Based upon all of this information, we diagnosed Ken with PsA and started him on oral methotrexate (MTX) 12.5 mg weekly.
Ken's medical history included hypertension and cardiovascular disease that led to a cardiac bypass approximately 2 years prior. He was recently divorced and described feeling "very poor as far as mood" and added that he was experiencing "major fatigue."
Until recently, Ken told us he had been very active. He was a certified scuba dive instructor and a world traveler. He worked full time as a produce manager of a local grocery store, a job that he had thoroughly enjoyed for more than three decades. While he was divorced, Ken said he was interested in dating again, but with the deteriorations in his overall quality of life that caused him to be less active, he was worried that he wouldn't be seen as a good potential partner. He was unhappy that he was unable to do the things that he had previously enjoyed most in his life. Our hope was that by improving his PsA-related symptoms, it would lift his overall mood and perspective on life as well.
"For some patients, like Ken, the pain and fatigue associated with the condition most significantly affects his well-being, while for others, the public embarrassment of psoriasis is far worse."
At his 2-month follow-up, Ken said there was some improvement in his joint pain and stiffness, but he pointed out a deformity in one of his fingernails that he was concerned about. We reassured him that nail changes were common in patients with PsA and upped his dose of MTX to 20 mg weekly, with plans to see him back in 1 month.
Unfortunately, in just that short amount of time, things went swiftly downhill. Ken's joint pain and swelling had both worsened, and he now complained of persistent lower back pain as well. We decided to add infliximab to his daily MTX, and he responded well after only a few infusions.
A few months went by before Ken came back for a routine follow-up with his latest bit of bad news. His disease had again progressed, but now in addition to increasing levels of joint pain and swelling, there was a breakout of psoriasis on several areas of his arms, legs, and trunk. It was a bit confusing for us to see how swiftly things had gone downhill after the initial success Ken had seen with infliximab. But then he told us the probable reason—his work hours had been curtailed and he could no longer afford the infusions. Embarrassed, he didn't say anything to us or the staff at the infusion center and simply stopped showing up. Our team talked to Ken about the importance of open communication with our practice and reassured him that there would be no judgment of his economic situation. We would do everything we could, we told Ken, to get him back on the right track.
Over the next 15 months, Ken cycled through all of the approved tumor necrosis factor inhibitors— from infliximab to etanercept to adalimumab to golimumab—without much success. This predated the arrival of some of our more novel biologic and small molecule drugs with different targets, so our options were more limited than they would be today. We were unfortunately never able to find another biologic that replicated the initial improvements Ken experienced with infliximab.
As his disease progressed, Ken decided to undergo dual shoulder replacement surgeries. Following the second surgery, Ken's orthopedic surgeon suggested that he file for disability. Before agreeing to do so, Ken called our office to get our opinion. He told me that really did not want to quit working because he still enjoyed his job but was concerned that he wouldn't be able to perform his regular duties if he became more significantly impaired physically. We agreed that he should keep working for as long as he felt physically able to do so, as much for his mental well-being as anything. Ken mentioned that there were times he was embarrassed at being in the public eye at work when he had a psoriatic flair that some people, he felt, probably attributed to a hygiene issue as opposed to a medical problem.
We finally began making positive progress again once Ken started on certolizumab. His disease became better controlled, and things were getting better on the personal front as well—Ken remarried and was able to share his passion for scuba diving and traveling with his new wife. He seemed much happier when I saw him for most of his follow-up visits during the next two years.
Then tragedy struck when Ken's son died unexpectedly of a brain aneurysm. Not surprisingly, that tore Ken's world apart. He missed several scheduled appointments, and his disease began to spiral out of control. Both his mental and physical health were deteriorating quickly.
Once Ken finally came back to our practice 6 months ago, we were able to get him back onto infliximab. His out-of-pocket costs for the drug are now much less than they had been when he was first prescribed infliximab. As before, infliximab worked quickly, and Ken's joint pain and swelling have improved. In the meantime, Ken's primary care provider convinced him to start on duloxetine, which has improved both his mood and pain levels. Things are certainly looking up for now, though as with many of our patients, I know how fragile the situation is.
PsA affects our patients in so many different ways. For some patients, like Ken, the pain and fatigue associated with the condition most significantly affects his well-being, while for others, the public embarrassment of psoriasis is far worse. I have had many patients who refuse to wear short-sleeved shirts or shorts when leaving the house for fear of being mocked or questioned. While psoriasis was certainly an issue for Ken, especially as he re-entered the dating world, it was just one piece affecting his health.
It's always important to assess the mental health of our patients to understand how their disease is affecting them. While looking at a swollen joint, watching a patient walk, or seeing psoriatic plaques covering a patient's body are all important parts of our physical assessment, we have to remember to always go beyond those visual observations and ask our patients how they are really handling their disease. With Ken, I know that when he starts a conversation smiling and telling me about his latest dive, that he is doing OK. There were some dark days, especially after the death of his son, when Ken didn't flash his bright smile or talk about an upcoming trip with enthusiasm. As a rheumatology nurse, I feel blessed to have a connection with patients that enables me to recognize the importance of these differences right away. I have known some of my patients for more than 15 years, and I can usually tell within the first couple of minutes of a visit how that patient is really doing. This learned sense of mental acuity is a powerful tool as rheumatology nurses to help judge the mental health of those patients we know best.
1. Mathew AJ, Chandran V. Depression in psoriatic arthritis: dimensional aspects and link with systemic inflammation. Rheumatol Ther. 2020;7(2):287-300.
AUTHOR PROFILE: Carrie Beach, BSN, RN-BC, is a rheumatology nurse with the Columbus Arthritis Center in Columbus, OH, and the President-Elect of the Rheumatology Nurses Society
Participants will receive 2.75 hours of continuing nursing contact hours, including 2.0 pharmacotherapeutic contact hours, by completing the education in our course: Rheumatology Nurse Practice: Managing the Common Comorbidities of Psoriatic Arthritis