text:
The prevalance, epidemiology and risk factors for onychomycosis in hemodialysis patients
Güven Kuvandik1,
Meryem Çetin2,
Gultekin Genctoy3,
Mehmet Horoz3,
Mehmet Duru1,
Cenk Akcali4,
Salim Satar5,
Ahmet A Kiykim3 &
Hasan Kaya6
BMC Infectious Diseasesvolume 7, Article number: 102 (2007) | Download Citation
Onychomycosis has a high prevalance among immunocompromised patients such as diabetics and hemodialysis patients. In the present study, we aimed to investigate the prevalence of onychomycosis among hemodialysis patients with and without diabetes mellitus, and to find out the factors likely to be associated with the development of onychomycosis among hemodialysis patients.
One hundred and nine hemodialysis patients were enrolled. Fifty-seven of hemodialysis patients had the diagnosis of diabetes mellitus. Nail scrapings were obtained from 76 patients who had dystrophic nail changes. Samples were examined with 20% potassium hydroxide solution and all of the samples were inoculated on Saboraud's dextrose agar, potateus dextrose agar and mycobiotic agar. Diagnosis of onychomycosis was based on the presence of both positive clinical signs and positive potassium hydroxide test.
Onychomycosis was diagnosed in 26.6% of hemodialysis patients. Diabetes mellitus was present in 68.9% of patients with onychomycosis. Toenail scraping cultures were reported to be positive in 19.7% of patients with dystrophic nail changes. Logistic regression analysis revealed that the presence of diabetes mellitus and the mean duration of hemodialysis were the significant predictors associated with the development of onychomycosis.
The prevalence of dystrophic nail changes and onychomycosis is increased among hemodialysis patients. The dialysis duration and the presence of diabetes mellitus are the independent risk factors associated with the development of onychomycosis in uraemic patients.
In general population, the prevalence of onychomycosis (OM) ranged between 2 to 11.1% [1–4]. Risk factors associated with the development of OM include increasing age, immunosupression, the presence of diabetes mellitus, family history, peripheral vascular disease, and disorders related to the skin such as hyperhidrosis, psoriasis, onychogriposis and nail trauma [1, 5–8].
Among diabetic patients, the reported prevalence of OM ranges between 1.2–26% [9–11]. In a multicentre study, the risk odds ratio for diabetic subjects to have toenail onychomycosis has been reported as 2.77 times compared with normal individuals [9]. Patients with chronic renal failure may exhibit various cutaneous abnormalities including pruritus, xerosis cutis, alterations in cutaneous pigmentation, actinic elastosis and Raynaud's syndrome [12]. Increased frequency of a spectrum of nail disorders such as half-and-half nails, absence of lunula and splinter hemorrhage are also reported to be increased in chronic renal failure patients [13–15]. The frequency of OM in hemodialysis (HD) patients has been shown to be higher than healthy controls with a prevalence of 6.2–52% [14, 16]. In addition, onychomycosis has been reported to be the second most frequent nail disorder in dialysis patients [16].
Although increased prevalence of OM has been noted in both patients with diabetes mellitus (DM) and patients with chronic renal failure on hemodialysis, there is no data related to the prevalence of OM among hemodialysis patients with diabetes mellitus. Therefore, in the present study, we aimed to investigate the prevalence of OM among HD patients with and without DM, and to find out the factors likely to be associated with the development of toenail OM among HD patients.
One hundred and nine (35 females and 74 males; mean age: 54.6 ± 16.7) HD patients were enrolled in the study. All HD subjects consisted of patients with end-stage renal disease (ESRD) (creatinine clearance ≤ 5 mL/min/1.73 m2BS), who underwent HD treatment thrice weekly for 4 hours/day with blood flow rates of 200–250 mL/min and dialysate flow rates of 480–500 mL/min using bicarbonate dialysate on hollow-fiber artificial kidneys. The mean dialysis duration was 2.8 ± 2.7 years. The etiology of end stage renal failure were diabetic nephropathy in 36 patients (33%) and non-diabetic nephropathy in 73 patients (67%). Among patients who had non-diabetic nephropathy, 21 patients have been diagnosed to have diabetes mellitus according to American Diabetes Association criteria revised in 2004 [17]. Eventually, a total of 57 study patients (52.3%) had the diagnosis of DM on the time of the study.
The rate of treatment with insulin and oral hypoglycemic agents among diabetic patients were 52.6% and 47.4%, respectively. The study protocol was carried out in accordance with the Helsinki Declaration as revised in 1989 and approved by the Mustafa Kemal University Medical Faculty institutional review committee. All patients were informed about the study protocol and the written consent was obtained from each one.
Exclusion criteria included the history of collagen vascular disease, active infection, malignancy, alcohol abuse, cirrhosis, human immune deficiency virus infection, and the usage of immunosuppressant.
Blood sample collection
Blood samples were drawn before a mid-week dialysis session after an overnight fasting at 08:00 pm to determine fasting blood glucose and glycosylated hemoglobin (HbA1C) levels (Beckman-Coulter Synchron LX20 Clinical. System; Beckman-Coulter, Fullerton, CA, USA).
Mycological evaluation
After a detailed examination of the fingers and toenails, nail scrapings were obtained from 76 patients who exhibited dystrophic nail changes. The mycological studies included direct microscopic examination and culture. The nails were cleaned using 70% ethanol before sampling. Samples were obtained two times for each patient on different days. Microscopic examination of the nail scrapings were performed with the use of 20% potassium hydroxide (KOH) solution. Samples were cultured on Sabouraud dextrose agar, potato dextrose agar and mycobiotic agar (Sigma Chemical Co., St. Louis, Mo., USA). Cultures were incubated at 26°C and examined twice a week for a total duration of 4 weeks. The identification of dermatophytes was based on their macroscopic examination of fungal colonies and microscopic examination with lactophenol cotton blue dye. Yeast species were identified using germ tube test, selective agar CHROMagar Candida and API system ID 32C (bioMerieux Marcy l'Etoile, France). Moulds were considered as pathogens in the presence of following findings;
- the absence of the other organisms growth at the same culture media,
- the presence of mould growth at 3 samples,
- the presence of filaments identified at direct examination,
- improvement with antifungal therapy.
The diagnosis of OM was based on the presence of both positive clinical signs (dystrophic nail changes) and positive KOH test (OM positive group). Patients with negative KOH test and patients who had no dystrophic nail changes were grouped together as OM negative patients.
The SPSS for Windows 11.0 program (SPSS Inc, Chicago, Illinois) was used for statistical analysis. A p value < 0.05 was considered statistically significant. Qualitative variables were assessed by Chi-square test. The multivariate logistic regression analysis was used to determine the association of independent variables such as age, gender, duration of dialysis, diagnosis of DM, hemoglobin A1C level, fasting blood glucose level, the presence of hypertension, the type of antidiabetic and antihypertensive medication, and the presence of diabetic nephropathy with the development of OM.
Dystrophic nail changes was observed in 46 (81%) diabetic and 30 (57.7%) non-diabetic HD patients p < 0.05). OM was diagnosed in 29 (26.6%; OM positive group) out of 109 HD patients according to the presence of both positive clinical signs (dystrophic nail changes) and positive KOH test. OM negative group consisted of 80 patients. DM was present in 20 (68.9%) patients of OM positive group. Three out of 29 OM positive patients (10.3%) and 8 out of 80 OM negative patients (10%) had a positive family history of OM (p > 0.05). None of the patients had a history of nail trauma, tight and high heeled or traumatic shoes, and excessive sweating of foot during activity.
Toenail scraping cultures were reported to be positive in 15 (%19.7) out of 76 patients who exhibited dystrophic nail changes. In 13 culture positive patients, the isolated fungi were dermatophyte and non-dermatophyte in 13 (86.7%) and 2 (13.3%), respectively (Table 1).
Table 1 The frequency of isolated fungi toenail scraping cultures
Logistic regression analysis revealed that the presence of DM and the mean duration of hemodialysis were the significant predictors associated with the development of OM (Table 2). The predicted probabilities of the development of OM according to the duration of dialysis were plotted in diabetic and non-diabetic subjects (Figure 1). The other independent variables such as age, gender, hemoglobin A1C level, fasting blood glucose level, the presence of hypertension, the type of antidiabetic and antihypertensive medication, and the presence of diabetic nephropathy were not correlated with the development of OM (all p > 0.05).
Table 2 Logistic regression analysis determining the significant predictors of the development of onychomycosis
Predicted probability of onychomycosis according to duration of dialysis in the diabetic and nondiabetic patients.
In the present study, in concordance with the previous reports [13, 14, 18, 19], we showed that the prevalence of abnormal appearing toenails and OM were increased among HD patients. In addition, HD patients with DM had higher dystrophic nail changes and OM prevalence compared to HD patients without DM. However, as the prevalence of dystrophic nail changes and OM prevalence among HD patients with DM have not been previously reported, we could not compare our findings with the literature findings.
In HD patients, increased susceptibility to nail disorders and OM may be due to both impaired immunity and histological changes of the skin caused by uremia. Histological alterations of the skin in uremic patients include severe microangiopathy and pericollogenous deposition of amyloid, identified as beta 2-microglobulin amyloidosis [20, 21]. In venules and arterioles, endothelial cell activation and/or necrosis, basement membrane zone thickening and reduplication of basal lamina was also noted [22].
Previous studies have demonstrated that the prevalance of nail disease increased with HD duration [16, 18]. Furthermore, Saray et al. demonstrated a possible relationship between HD duration and prevalance of OM among HD patients [19]. In concordance with those reports, in the present study, we observed that dialysis duration was an independent risk factor associated with the development of OM.
In comparison with the general population, patients with DM are predisposed to mycotic infections such as mucormycosis, and Candida infection of the mucous membranes, nails and skin folds [23]. Besides the high blood glucose levels and impaired immunity, diabetes related medical conditions may also provide contribution to the development of OM in diabetic patients [24]. For example, peripheral vascular disease results in impaired wound healing and increased risk of infection, and peripheral neuropathy results in decreased ability to detect the presence and the progression of infection [25].
Although conflicting reports [26, 27] are available, patients with DM have been reported to prone to dermatophyte infections [28, 29]. In addition, in two recent large scale studies [9, 11], the prevalence of OM has been shown to be significantly higher in diabetic patients than normal individuals and increasing age, male gender, family history of onychomycosis, concurrent intake of immunosuppressive agents and peripheral vascular disease have been shown as independent risk factors for the development of OM. In contrast, in the present study, we did not find any correlation of increasing age, male gender, and family history of onychomycosis with the development of OM. This difference may be, in part, due to distinct characteristics of our patients (uremia plus DM). As we excluded patients receiving immunosuppressive agents and we did not investigate the presence of peripheral vascular disease in our patients, we could not make a comparison regarding to the influence of those parameters on the development of OM.
In the present study, Trichophyton rubrum was the most frequently isolated organism from the cultures and it was followed by T. mentagrophytes. These findings were in concordance with the previous studies conducted in diabetics without renal disease and normal population [9, 10]. Interestingly, in the present study, Pichia etchellsii/carsonii, a non-pathogen yeast fungi, was isolated in one HD patients with DM. Although it may be an incidental colonization (not an infection) of toenail, it should be kept in mind that this non-pathogen yeast may become a potential pathogen in the presence of immunosupression caused by both DM and uremia.
The prevalence of dystrophic nail changes and OM is increased among HD patients. The dialysis duration and the presence of DM are the independent risk factors associated with the development OM in uremia patients. As fungal infections have a potential progressive nature and dangerous serious outcome including erysipelas and in long term even amputation, especially HD patients with diabetes mellitus should be periodically examined for OM. In addition, education of the diabetic hemodialysis patients about the importance of foot and nail care should be an essential components in the management of those patients.
onychomycosis
HbA1C:
glycosylated hemoglobin
KOH:
potassium hydroxide.
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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/7/102/prepub
Mustafa Kemal University, Faculty of Medicine, Department of Emergency Medicine, Hatay, Turkey
Güven Kuvandik
& Mehmet Duru
Mustafa Kemal University, Faculty of Medicine, Department of Microbyology and Clinical Microbyology, Hatay, Turkey
Meryem Çetin
Mersin University, Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Mersin, Turkey
Gultekin Genctoy
, Mehmet Horoz
& Ahmet A Kiykim
Mustafa Kemal University, Faculty of Medicine, Department of Dermatology, Hatay, Turkey
Cenk Akcali
Cukurova University, Faculty of Medicine, Department of Emergency, Adana, Turkey
Salim Satar
Mustafa Kemal University, Faculty of Medicine, Department of Internal Medicine, Hatay, Turkey
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Correspondence to Gultekin Genctoy.
GK, MC, GG, MH: Conception and design; MD, CA, SS, HK: Analysis and interpretation of the data; GG, GK, MD, HK: Drafting of the article; MC, MH, CA, SS, HK, AAK: Critical revision of the article for important intellectual content; GG, GK, MD, HK: provision of study materials or patients; GG, GK: Statistical expertise; GK, MC, MD, CA, SS: Collection and assembly of data. All authors read and approved the final manuscript.
https://doi.org/10.1186/1471-2334-7-102
Hemodialysis Patient
Human Immune Deficiency Virus
Dialysis Duration
Human Immune Deficiency Virus Infection
Toenail Onychomycosis


text:
www.cbf.org > News & Media > News Room > 2015 > All > Will Baker: Chesapeake already feeling significant impacts from climate change
Will Baker: Chesapeake already feeling significant impacts from climate change
(ANNAPOLIS, MD)—Chesapeake Bay Foundation (CBF) President Will Baker told members of the House Energy and Commerce Committee today that the Chesapeake Bay already is suffering the impacts of climate change.
"The Bay's trophy rockfish are struggling to find oxygen in warming waters. Species at the southern end of their range, like soft shelled clams and eelgrass, are being stressed by warmer waters that eventually could eliminate them from the Chesapeake Bay," Baker said. "Climate change is not just something in the Chesapeake Bay's future."
Baker was a speaker at the Committee's forum, "Climate Change at the Water's Edge" at Alumni Hall at the U.S. Naval Academy. The forum focused on local impacts of climate change.
Baker said warming water, rising water levels, and increased frequency and intensity of storms are the primary impacts of climate change on the Bay. These impacts are felt not only by aquatic life in the Bay, but often by communities and economies already hard hit by water pollution.
Scientists have documented a warming trend of about 1 degree C or nearly 2 degree F since the 1960s in the Bay. They predict warming waters to be between 2 degree C and 5 degree C by 2070 to 2099. This warming trend is due to the slow absorption of the extra heat from the warming atmosphere, caused by climate change.
With more than 11,000 miles of coastline, much of the Chesapeake Bay area, including some large population centers, lies very close to water level. Much of that land already is sinking—due to geological processes that started during the last ice age. As a result, rising sea levels are taking a particularly dramatic toll around the Chesapeake.
Many scientists estimate, conservatively, that seas will rise between 8 inches and 2 feet by the end of this century.
"We are losing Tangier Island, Smith Island, and many other low-lying lands around the Bay," Baker said. "Thousands of acres of environmentally-critical tidal wetlands are now unable to trap sediments fast enough to keep pace with rising water levels."
To make matters worse, increasingly intense storms, due to the increased and accelerated hydrological cycle caused by warming atmospheric and water temperatures, produce storm surges that compound the impacts of inexorably rising Bay waters.
"We expect to see more erosion of developed shorelines and saltwater getting into drinking water aquifers," Baker said. "And we expect impacts not only on the Eastern Shore and the imperiled communities on Smith and Tangier Islands, but also here in Annapolis and in other places such as Hampton Roads, Baltimore, Alexandria, and the Nation's Capital itself."
Baker said the multi-state effort to clean up the Bay—the Chesapeake Clean Water Blueprint—will not only reduce nitrogen, phosphorus, and sediment pollution, but also will help mitigate the effects of the changing climate. Planting winter "cover" crops, for instance, not only soaks up excess nutrient pollution, it also can sequester carbon. "Green infrastructure" in city and suburban drainage areas can trap polluted runoff, and also mitigate flooding, sequester carbon, and reduce thermal pollution. Restored oyster reefs can enhance coastal resilience to climate change by providing storm and flood protection.
Download Will Baker's testimony
CBF Investigative Report: Climate Change and the Chesapeake Bay: Challenges, Impacts, and the Multiple Benefits of Agricultural Conservation Work

redpajama_set_name: RedPajamaCommonCrawl


This blog post is sponsored by iHerb. However all opinions are 100% honest and my own. For more information please read my disclosure policy.
If you live in an area where temperatures change drastically between seasons, this will impact your sebum production, which is your skin's natural method of staying moisturized (source). Studies have found that the environment temperature affects our sebum production, with higher temperatures triggering more sebum, and vice versa (source). Of course it doesn't help that the colder air is naturally drier – the lower the temperature, the less its ability to hold water (source). But the good news (sort of) is that heaters don't make the dryness worse, it's just heating up the same dry air, so the absolute moisture content remains the same.
Now you can see why skin tends to get oilier in the summer, and drier in the winter, and why it makes sense to switch up our routine as seasons change! This doesn't mean we need a whole new set of products though, we just need to make sure we're using the right products! For this post I've partnered with iHerb to show how you can easily and affordably update your routine.
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Knowing how the seasons impact my skin, winter for me is all about hydration – adding more to the skin and locking it in.
Unless your skin is still oily, it's a good idea to shelf your foaming cleansers and switch to a more emollient formula: gel, cream, milk, oil, or even balm. You don't want to strip what little sebum your skin has left with anything too harsh!
This feels so gentle on the skin, smells like yummy apricots, and cleans well without leaving a film behind! While foaming cleansers leave my skin feeling a tight in the winter, this just leaves my skin soft and balanced. Ingredient wise it's excellent for the price: a lovely mix of emollient oils, humectants, and skin soothing ingredients. It also has a few antioxidants and skin brightening ingredients, but they're probably not staying on your skin long enough to have any effect.
While not as enjoyable to use as the Andalou Naturals Cleanser, the value you get for this gentle cleanser is incredible. I reviewed it in full here, but in a nutshell: excellent ingredients, low pH, super gentle, amazing price. The only downside is the bland packaging, but if you don't care for the superficial (good for you), then you won't regret trying this.
2| Make sure your products contain humectants.
Some common humectants to look for are hyaluronic acid, glycerin, aloe vera, urea, sorbitol, sodium pca, and honey, so make sure at least one of these is the key ingredient in your toner and serum! These help attract moisture to the skin and can even enhance the skin's own hydrating abilities – much needed in the dry winter air!
Yes they sell the entire Klairs range there, and this is my all-time favorite product from the brand! Full of humectants and skin-soothing ingredients, it's ridiculously hydrating without being heavy or sticky. You can even use this for lotion masking to amp up the hydration effects! Full review here. There is also an essential oil-free version which is good for sensitive skin, but I find it slightly less hydrating.
Applying this is a breeze with its fine and even mist! In addition to antioxidants and humectants, this also contains some nourishing oils to lock that moisture in the skin and prevent it from evaporating. Make sure you shake the bottle well before using to mix the water and oil layers!
Since your skin isn't producing as much sebum during the colder months, it's important that we replenish that with an external source – enter the facial oil. It not only provides our skin with additional nourishments (think antioxidants, anti-aging, and brightening properties), but it also helps reinforce our skin's moisture barrier and prevent moisture loss! There are a ton of options out there, even for those who hate the texture of a traditional oil.
Love CeraVe when it comes to gentle + inexpensive products with great ingredients that just work. This initially feels like a gel but as you massage it in, it transforms into a light oil that is then quickly absorbed. Let me tell you, this has made such a difference for my skin, especially the fine lines around my eyes, which had become more noticeable as temperatures dropped. Now that I'm using this regularly, the fine line situation is no more!
If you don't mind fragranced products, this is a beautiful oil essence hybrid that contains 61% prickly pear seed oil to nourish and repair the skin. It's the least oily-feeling oil I've ever tried, and absorbs instantly leaving skin feeling velvety soft. Now it does contain alcohol as a penetration enhancer, but for me the dryness of alcohol is canceled out by all the other emollients and moisturizers in here.
As the rest of our body already produces less sebum compared to our face, it's extra important that we properly moisturize our bodies in the colder months to prevent ashy skin. I love a thick creamy body butter for the winter – they not only feel lush on the skin, but they'll deliver the necessary oils to nourish and protect our skin from the cold dry air. Make sure you apply body butter while your skin is still damp to lock in that extra moisture!
8oz for $7? You can't beat the price! It smells exactly like the name suggests, and both are actually ingredients in this body butter, along with other nourishing oils and Shea butter. While it is thick, it spreads easily and absorbs quickly enough, leaving my skin moisturized and not one bit sticky. If you prefer fruity scents this also comes in Guava Nectar!
In addition to using a body butter, I've also started dry brushing this winter. It claims to have a lot of benefits, but I'm mainly interested in one: it helps slough off dead skin, which then improves the efficacy of moisturizers used. As with all exfoliation, you want to be gentle and you don't want to overdo it. Treat your skin with love, not like you're scrubbing a potato!
Another affordable win, no wonder it's a best-seller! Now don't expect kitten softness when using this. It's meant to exfoliate, so the bristles are going to have some roughness to them. But as long as you're brushing slowly and gently, you should be left with baby soft skin and minimal redness. I like to use this once a week before I shower, and I find the experience rather therapeutic!
So there you go, my tips on helping your skin survive the frigid weather, all without breaking the bank! I've said this before, but products in the low and mid-range prices often deliver the best value. Trust me I love my bougie lotions and potions for their aesthetics and usage experience, but often times you can find affordable options that work just as well, if not better.
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Hope you found this helpful, and let me know what your beauty must-haves are this winter!
This blog post is sponsored by iHerb. However all opinions are 100% honest and my own.This post contains affiliate links, and each purchase helps cover the cost of running this blog, so I appreciate each click! For more information please read my disclosure policy.
I will have a video on this topic up the week after next, and I agree with everything you said. Even my oily skin needs richer moisturizers and oils in winter.
I couldn't agree more about CeraVe cleanser, it's definitely not fancy but it's works amazingly well. I much prefer the original Klairs Sipple Toner too, like you I find it to be way better and more hydrating.
I do love that klairs toner, but the unscented one ^^, and I'm always curious about the Pixi Mist, it sounds really good.
I always feel like it's so hard to find products that won't break the bank! Definitely going to check these out.
what a fun post! lots of great items!
very necessary for keeping our skin hydrated.
Andalou Naturals has some pretty amazing products.


"If it wasn't for TechSoup, Microsoft, other hardware products from Cisco, and all companies who donate so we can have all of this great equipment to work with, we wouldn't be able to do what we do. It's just phenomenal!"
Caring Partners has a powerful goal: to keep children and young adults in their homes, at their schools, and out of trouble. The New Jersey–based organization serves almost 600 youth in Morris and Sussex counties with about 60 employees. An organization that provides life-transforming services to those who are most at risk does not have time to worry about accessing email remotely, having up-to-date versions of Excel, or sharing information among staff. Thankfully, with Office 365 Nonprofit working behind the scenes, Caring Partners can focus on providing the community with the very best services.
Caring Partners uses the wraparound model, which is a care management process for youths with serious or complex needs. These can include emotional, behavioral, or substance abuse issues or intellectual and developmental disabilities.
When a child enters Caring Partners, a care manager assesses the strengths, needs, values, and culture of the family in order to create an Individualized Service Plan (ISP). Caring Partners also works with the family to identify community services and support providers for the child. Supports can range from providers of mental health services to recreational services to extended family members, neighbors, friends, and coaches.
Local agencies and community organizations also participate in Caring Partners' network of support for these at-risk youth. These organizations address issues such as safety, housing, employment, or spiritual growth. Coordinating multiple clients and all of these support services can sometimes be tricky, and migrating to Office 365 has been a huge help for Caring Partners.
When care managers are with families, they need to be able to access critical information through email from their mobile phones in order to tailor services and care to their clients' needs. In the past, if the server went down, care managers were unable to access emails in the field. With Office 365, the email Exchange Server is hosted online and is therefore much more stable and easier to maintain.
Besides email, Caring Partners' staff members have already benefited from Office in the cloud, particularly SharePoint. They are able to store all their crucial client and community information in the cloud, which enables care managers to access the information anywhere and at any time. It also allows them to access vital information about doctors or support specialists.
Staff members also use the Newsfeed SharePoint app, which is sort of a mini internal social network for an organization, to coordinate care for individual youth. In the past, they did this through email, which grew to be quite cumbersome. With Office 365, instead of sending an email to 60 or so other care managers asking about a specific service or provider, they use the app to share the question with the entire staff.
Vickie Rodda, the CFO, and Amanda Thompson, the quality improvement manager, both continuously look for ways to enhance operations and improve the organization's technology.
Caring Partners' intranet platform was previously hosted by WebOffice through Cisco. When they learned that Cisco was ending support for WebOffice, they looked for an alternative. They spoke with other care management organizations, who recommended Microsoft Office 365. While they had been happy with WebOffice, accessing data from a mobile device was difficult. The care managers needed access to information when they were in the field, so this was an important feature to have in the replacement system. They discovered that Office 365 not only offers mobile access, but so much more.
"We saw the potential [of Office 365] is so much greater than what we had before," Thompson remarked.
Rodda and Thompson both used one word numerous times when talking about their experience switching over to Office 365: "plan." If you have a plan in place before you begin, the migration will go much more smoothly. They also recommended finding a consultant or expert who can help with using the new programs. Because Caring Partners' staff members were new to SharePoint, they relied on a consultant to help them learn the ins and outs of these programs. Rodda and Thompson recommend that other nonprofits interested in switching to Office 365 do the same. Or, at the very least, that you talk to individuals or organizations who can give you advice on using Office 365.
To get staff up-to-speed with Office 365, they organized multiple small group training sessions and plan to hold more soon. Thompson said that the staff uses Office 365 Newsfeed to ask questions and trade tips about using the programs. She also said she has been encouraging the care managers to use hashtags so they can find information and answers later.
It is little features like Newsfeed in Office 365 that are real time-savers for Caring Partners. "We want to work smarter, not harder, and this is a product that is helping us do that," Rodda said.
The path to getting Caring Partners' staff on Office 365 was not without its bumps, however. There was definitely a learning curve in getting Caring Partners' email migrated to Outlook. Staff members contacted a third-party consultant to help out with the migration for the staff's laptops and mobile phones. Email migration took about a week or two before everything was all done.
Thankfully, through these learning curves, Microsoft support had their back. Thompson praised Microsoft's customer service team for staying with her on the phone and helping her through these issues.
Overall, Caring Partners has been happy with the switch, and both Thompson and Rodda expressed excitement about all of the possibilities of what they can do with Office 365. Not only is Office 365 better than what they had before, it's also more cost-effective. "If it wasn't for TechSoup, Microsoft, other hardware products from Cisco, and all companies who donate so we can have all of this great equipment to work with, we wouldn't be able to do what we do," said Rodda. "It's just phenomenal."


text:
Q: When you value Flex-Basis as a percentage, why doesn't it do the same with Flex Grow? I have also examined various documents but could not understand the logic in the code below. Let's say we gave 25% for Flex-Basis. As you can see when we give Flex-Grow 0.25 to the other box with the same features, the dimensions are different, but shouldn't it be the same?
Also, what is the difference between using the flex basis as a percentage and using flexible growth? Thank you very much for your interest in advance.

html body {
  box-sizing: border-box;
  margin: 0;
  padding: 0;
}

.container {
  width: 90%;
  margin: 2em auto;
  height: 35px;
  display: flex;
  background: rgb(51, 153, 73);
}

.box {
  flex-basis: auto;
  background: rgb(160, 166, 221);
}

.second {
  flex-basis: 25%;
}

.third {
  flex-grow: 0.25;
}

First Box

Second Box

Third Box

A: You can have the same result if you define flex-basis:0 with flex-grow.
flex-basis:25% means take 25% of the total width while flex-grow:0.25 means take 25% of the free space + the initial width. If you make the initial width 0 (using flex-basis:0) then 25% of the free space will be equal to 25% of the total width

html body {
  box-sizing: border-box;
  margin: 0;
  padding: 0;
}

.container {
  width: 90%;
  margin: 2em auto;
  height: 35px;
  display: flex;
  background: rgb(51, 153, 73);
}

.box {
  flex-basis: auto;
  background: rgb(160, 166, 221);
}

.second {
  flex-basis: 25%;
}

.third {
  flex-grow: 0.25;
  flex-basis: 0;
}

First Box

Second Box

Third Box

redpajama_set_name: RedPajamaStackExchange


text:
Home NFL 2013 NFL Season, Week 3 – Indianapolis Colts vs San Francisco 49ers...
2013 NFL Season, Week 3 – Indianapolis Colts vs San Francisco 49ers Predictions
Coming off losses for both teams, it feels that the San Francisco 49ers are in much more of a must-win situation than the Indianapolis Colts heading into their encounter, partially due to them being the home team and playing in a tougher division.
However, even though shedding off disappointing results should be the main focus, part of the attention goes to Andrew Luck playing against his former head coach at Stanford, Jim Harbaugh. Unlike the Sherman – Harbaugh thing, there seems to be plenty of respect and no ill will between the two sides, heaping praise on one another before the start of the game.
But the main issue is fixing whatever went wrong for the teams in week 2, and for the 49ers it's almost everything. Colin Kaepernick played terribly, sent scrambling by the Seattle Seahawks on almost every other possession. He did run for 87 yards, but teams would rather have him try and beat them with his legs than the way he threw against the Packers in week 1.
The Colts are trying to move away from completely relying on Andrew Luck, and it's been seen with their committed approach to running the ball. The problem is the talent the team has at running back, with Luck being their second best rusher so far (76 yards) in two games. Ahmad Bradshaw has done OK with 4.1 yards per carry, but the Colts need Trent Richardson, arriving via trade from Cleveland but uncertain for this game in San Francisco, to pick up his new assignments and fast.
Two of the problems the 49ers present each week to NFL teams is their running and pass rushing. However, they're averaging only 95 rushing yards per game so far this season (Frank Gore stuck on 60 yards and 30 carries), while their best front seven player, Aldon Smith, already with 3.5 sacks this season, is having another run in with the law which will surely affect him in someway.
Prediction – The Indianapolis Colts have what it takes to cause the upset. Their secondary and run-defense aren't as bad as they were last season, and as long as Andrew Luck gets help from his running game, it should be fine. The 49ers aren't the team they were last season at this point, which means we'll probably see an upset.
Colts vs 49ers
Previous article2013 NFL Season, Week 3 – Texans vs Ravens Predictions
Next article2013 NFL Season, Week 3 – Bears vs Steelers Predictions


The box office turnout — or lack thereof — should have been a sign, but "Widows" getting completely shut out of the nominations was still a surprise. Director Steve McQueen's female-led heist flick earned rave reviews from critics, even though the movie never seemed to click with viewers. Still, McQueen and star Viola Davis have previously achieved awards success — and the rest of the stacked cast includes Colin Farrell, Robert Duvall, Liam Neeson, Brian Tyree Henry, Daniel Kaluuya, Michelle Rodriguez, Elizabeth Debicki and Cynthia Erivo.


text:
using UnityEngine;
using System.Collections;

public class BuildingType {

	private int _buildingID;
	public int BuildingID {
		get {
			return _buildingID;
		}
	}

	private string _typeName;
	public string TypeName {
		get {
			return _typeName;
		}
		set {
			_typeName = value;
		}
	}

	private static float _baseCost;
	public float BaseCost {
		get {
			return _baseCost;
		}
	}

	private static float _increaseByCost;
	public float IncreaseByCost {
		get {
			return _increaseByCost;
		}
	}

	private float _currentCost;
	public float CurrentCost {
		get {
			return _currentCost;
		}
	}

	private static float _generationRate;
	public float GenerationRate {
		get {
			return _generationRate;
		}
	}

	private int _count;
	public int Count {
		get {
			return _count;
		}
	}

	public BuildingType (int buildingID, string typeName, float baseCost, float increaseByCost, float generationRate)
	{
		_buildingID = buildingID;
		_typeName = typeName;
		_baseCost = baseCost;
		_currentCost = baseCost;
		_increaseByCost = increaseByCost;
		_generationRate = generationRate;
		_count = 0;
	}

	public void AddBuilding()
	{
		_currentCost += _increaseByCost;
		_count++;
	}
}

redpajama_set_name: RedPajamaGithub


text:
Krist Porte (Gent, 7 september 1968) is een Belgisch gewezen voetballer. Hij was een middenvelder die uitkwam voor onder meer AA Gent, Royal Antwerp FC en Eendracht Aalst. Zijn naam wordt vooral gelinkt aan de zware vuistslag van Gilles De Bilde die hij in december 1996 incasseerde tijdens een duel tegen RSC Anderlecht.

Clubcarrière

AA Gent
Krist Porte sloot zich op jonge leeftijd aan bij AA Gent. De middenvelder die ook als aanvaller kon ingeschakeld worden, doorliep alle jeugdafdelingen van de Oost-Vlaamse club en schopte het tot jeugdinternational. Als 18-jarige maakte hij de overstap naar het eerste elftal van de Buffalo's, dat toen bestond uit spelers als Michel De Wolf, Milan Ružić en Bruno Thoelen. Het was toenmalig trainer Han Grijzenhout die hem zijn debuut op het hoogste niveau gunde.

Na twee seizoenen zakte Porte met Gent naar tweede klasse. De middenvelder die aanvankelijk op een transfer aasde, bleef het team trouw en werd met Gent meteen vicekampioen. Zo nam Gent na een jaar afwezigheid zijn plaats in eerste klasse terug in. In 1990/91 eindigde de ploeg als derde, na RSC Anderlecht en KV Mechelen. Daardoor mocht Gent een seizoen later opnieuw deelnemen aan de UEFA Cup. De creatieve linkermiddenvelder maakte in de thuiswedstrijd tegen Eintracht Frankfurt zijn Europees debuut. Hij mocht na 82 minuten invallen voor spits Erwin Vandenbergh.

Antwerp
Na zeven seizoenen voor de Buffalo's maakte Porte de overstap naar Royal Antwerp FC. De club had net de finale van de Europacup II verloren en afscheid genomen van trainer Walter Meeuws. Onder de nieuwe coach, Urbain Haesaert, werd Porte meteen een vaste waarde. Hij speelde een sterk seizoen en eindigde met Antwerp op de vijfde plaats in de competitie. De technisch begaafde Porte won bij de Antwerpse club aan karakter bij. In 1996 sneuvelde hij met Antwerp in de halve finale van de beker.

Eendracht Aalst
In de zomer van 1996 belandde de Gentenaar bij SC Eendracht Aalst. De middenvelder werd in het team van trainer Jan Ceulemans een ploegmaat van onder meer Yves Vanderhaeghe, Harald Meyssen en Peter Van Wambeke. Op 21 december 1996, de laatste speeldag voor de winterstop, ging Aalst op bezoek bij Anderlecht. Terwijl Anderlecht een strafschop mocht omzetten, incasseerde Porte aan de rand van het strafschopgebied een vuistslag van tegenstander Gilles De Bilde. Hij brak zijn neus en oogkas, en scheurde zijn netvlies. Omdat scheidsrechter Fernand Meese niet had opgemerkt wie de vuistslag had uitgedeeld, kreeg De Bilde geen kaart. Porte werd door Ceulemans naar de kant gehaald en vervangen door Emmanuel Ebiede. Op 15 januari 1997, tijdens het gala van de Belgische Gouden Schoen, bood De Bilde via een videoboodschap zijn verontschuldigingen aan. De speler van Anderlecht werd zwaar geschorst en verkaste op 28 januari naar PSV. Porte diende ook een klacht in wegens mishandeling. In 2008 werd De Bilde veroordeeld tot het betalen van een boete van € 10.000, hoewel Porte € 200.000 had geëist.

Porte werd geopereerd aan zijn neus en oogkas. Het zicht in zijn rechteroog verminderde en hij was acht maanden buiten strijd. De 29-jarige Porte kwam nadien nog terug in het eerste elftal van Aalst maar haalde zijn oude niveau niet meer.

Westerlo
In de loop van het seizoen 1997/98 verkaste hij naar KVC Westerlo. Daar werd hij in 1999 opnieuw verenigd met trainer Jan Ceulemans.

Latere carrière
In 2000 trok Porte voor het eerst naar het buitenland. Porte tekende bij het Israëlische Hapoel Tzafririm Holon. Het was Nir Levin, een gewezen ploegmaat van Porte bij AA Gent, die hem naar Israël haalde. In november ruilde de 32-jarige middenvelder Hapoel Tzafririm Holon in voor VVV-Venlo, dat toen in de eerste divisie speelde. Met de club uit Venlo sloot hij het seizoen 2000/01 af op de laatste plaats. In 2002 keerde hij terug naar België, waar hij zijn carrière afsloot bij vierdeklasser KVK Beringen.

Na zijn spelerscarrière werd Porte een verkoper van sportkledij.

Clubstatistieken

Zie ook
 Lijst van spelers van KAA Gent
 Lijst van spelers van Antwerp FC
 Lijst van spelers van KVC Westerlo
 Lijst van spelers van VVV-Venlo

Belgisch voetballer

redpajama_set_name: RedPajamaWikipedia


text:
Microsoft Was Late To The Cloud Party, But Could Grab Largest Share Of SaaS Market By 2020
by Benzinga Staff, Benzinga Staff Writer
September 13, 2016 12:50 PM | 1 min read
This year marks the beginning of the second decade of Software as a Service (SaaS) and Infrastructure as a Service (IaaS) cloud computing.
According to Pacific Crest analyst Brent Bracelin, Microsoft Corporation MSFT was late to the cloud computing game, but the company will make up for lost ground during the next decade. In fact, Bracelin believes Microsoft's Azure could triple in size by 2020 to a more than $40 billion business.
"Strong momentum with Office 365 and Azure segments, which are approaching $10 million in combined revenue yet still growing 63% and 76% y/y, respectively, increases our confidence that Microsoft should have a more meaningful role as a new leader, not laggard, in the Second Decade of SaaS," he explains.
Related Link: Jeff Bezos Has A Bigger Rocket Than Elon Musk
Pacific Crest anticipates that the annualized run-rate on cloud services could balloon from $55 billion today to $200 billion within the next four years, meaning $145 billion in new business is up for grabs. Bracelin projects that Microsoft could be the largest SaaS vendor within four years.
The firm believes artificial intelligence will play a central role in the next decade of SaaS, and Microsoft is well-positioned as a leader in artificial intelligence technology.
While Amazon.com, Inc. AMZN's AWS has dominated the first decade of the cloud game, Bracelin is expecting Microsoft to step up to the plate in a big way in coming years.
Pacific Crest maintained an Overweight rating and $65 target on Microsoft.
Posted In: AzureBrent BracelincloudPacific CrestAnalyst ColorPrice TargetAnalyst RatingsTech


Create a minty fresh promotion with promotional mints. A hugely popular choice for tradeshows and seminars!
Are you looking for promotional mint pots and tins?
Distributing promotional mint cards, tins and pots is a great way to "freshen" up your marketing strategy. Visit 4imprint and you can get a range of mint cards that can be printed with your organisation's logo and call to action.
Perfect for events like trade shows and exhibitions, free mints can help draw visitors to your stall, while restaurants could supply mints to customers as a free gift when they pay for their meal. Printed mint cards, pots and tins can also be given as a simple token of appreciation to customers who have placed a recent order.


text:
Film: 'Soldiers' Sanctuary' wins 2014 American Movie award
DACA Productions' debut documentary film, "Soldiers' Sanctuary," is the winner of the 2014 American Movie Awards, Bes...
Film: 'Soldiers' Sanctuary' wins 2014 American Movie award DACA Productions' debut documentary film, "Soldiers' Sanctuary," is the winner of the 2014 American Movie Awards, Bes... Check out this story on thespectrum.com: http://www.thespectrum.com/story/news/2014/05/15/film-soldiers-sanctuary-wins-2014-american-movie-award/9158205/
Published 9:14 p.m. MT May 15, 2014
DACA Productions' debut documentary film, "Soldiers' Sanctuary," is the winner of the 2014 American Movie Awards, Best Documentary Feature.
The news comes just weeks after the film celebrated its world premiere in Khe Sanh Vietnam and its U.S. premiere in Seattle.
At both screenings, "Soldiers' Sanctuary" was well-received and lauded by audiences for its powerful storytelling and emotional significance.
In attendance at both premiers were the filmmaker and subjects of the film, including a Southern Utah Vietnam War veteran helicopter pilot of the infamous Khe Sanh battlefield.
"We are thrilled to learn that the film has won an award so early in its tour," filmmaker Luke Hansen said.
A first-of-its-kind documentary, "Soldiers' Sanctuary" focuses on veterans of all wars and their struggle and varying degrees of desire to reconcile with former enemies.
It provides a touching tale of how both sides of war benefit from making interpersonal connections by reaching across former enemy lines to find healing, understanding and common ground.
A touching film about combat veterans healing the wounds of war, "Soldiers' Sanctuary" follows a diverse group of U.S. war veterans as they travel to the infamous battlefield at Khe Sanh, Vietnam, in hopes of finding reconciliation with former enemies of war.
Uniquely, the group includes young veterans of the Iraq and Afghanistan wars, as well as Vietnam veterans. Among veterans featured in the film is Dave Hansen of Southern Utah, who was stationed at Khe Sanh.
At Khe Sanh, the group participates in an emotional meeting with veterans of the People's Army of Vietnam.
Together, the veteran soldiers participate in an incense ceremony to honor fallen friends, and then go to work side-by-side in planting avocado trees as a symbol of giving new life to peaceful relationships.
This historic event is the foundation of the Khe Sanh Peace Garden, a world sanctuary dedicated to honoring the memory of fallen soldiers from all sides of armed conflict and providing opportunity for peaceful face-to-face reconciliation of former enemies.
"My hope is that this film will help many who are interested in moving through personal struggle by way of reconciliation within themselves and forgiveness toward their enemies," Hansen said. "While the Khe Sanh Peace Garden project is helping veterans of war in a very moving way, this film really applies to all who are looking to find personal peace and reconciliation."
Hansen returned to Vietnam in March with subjects from his film for its first official screening and world premiere.
On March 24, at Hanoi, Hansen shared "Soldiers' Sanctuary" with an audience including members of the Vietnam Union of Friendship Organizations, the Vietnam USA Society, and the Veterans Association of Vietnam. On March 27, the film celebrated its world premiere at Khe Sanh, Vietnam.
Hansen said Seattle was selected for the film's U.S. premiere because it is the hometown of many participants of the 2012 Vietnam trip that serves as the film's subject.
Additionally, PeaceTrees VietNam is headquartered in Seattle — an organization providing significant support to the film and the Khe Sanh Peace Garden project.
Approximately 150 guests attended the screening hosted at the Microsoft Auditorium in Seattle Public Library.
Kevin Espirito, senior manager of Community Engagement at Microsoft Citizenship and Public Affairs, traveled to Vietnam with the veteran delegation in 2012, and appears in the film.
"I was honored to be part of and witness this amazing event first hand," Espirito said. "I consider the friends I made on this multi-generational veterans peace trip, American and Vietnamese, my friends for life."
Information about the Khe Sanh Peace Garden project can be found at khesanhgarden.org.
Read or Share this story: http://www.thespectrum.com/story/news/2014/05/15/film-soldiers-sanctuary-wins-2014-american-movie-award/9158205/


A suburb of Chicago, the village of Wheeling, Illinois, is in both Lake and Cook counties in the 60090 zip code. Home to approximately 40,000 residents, composed of roughly 8.74 square miles, Wheeling was named after Wheeling, West Virginia. Wheeling is found in the heart of Chicago's northern suburbs and is a dynamic and diverse community. This remarkable community has a perfect balance of commercial development, industry and residential neighborhoods.
In addition to these great features, Wheeling is known not only regionally, but nationally, as the home of the "Restaurant Row" of Milwaukee Avenue. Wheeling not only has great dining, but great shopping, entertainment and recreation options as well. All of these great amenities make Wheeling a wonderful place to buy a home. The real estate options in Wheeling include luxurious condos, townhomes and single family homes. At the other end of the spectrum you can also find great starter homes for the first-time homebuyer. Situated on beautiful tree-lined streets, the homes for sale in Wheeling are sure to impress even the most discerning of home buyers.
Homes for sale in Wheeling vary in price depending upon the property's age, size, style and location. Condos and townhomes in Wheeling rarely have listing prices over $500,000 and have an average listing price around $188,800. Single family homes in Wheeling also top out around $500,000, but have an average listing price around $261,200. With a great location, easy access to major thoroughfares that make commuting a breeze, and wonderful real estate options, Wheeling is a must-consider destination when looking to relocate in the Chicago Metro area.
If you would like more information regarding homes for sale in Wheeling, Illinois, please do not hesitate to contact us today.


text:
Kinetic and thermodynamic studies of the removal of murexide from aqueous solutions on to activated carbon
Ardeshir Shokrollahi
Mehrourang Ghaedi
Mojdeh Ranjbar
Ameneh Alizadeh
Department of Chemistry, University Yasouj, 75918-74831, Yasouj, Iran
The objective of this study was to assess the adsorption potential of activated carbon (AC) as
an adsorbent for the removal of Murexide (Mu) from aqueous solutions. The influence of variables
parameters including pH, amount of adsorbent, sieve size of adsorbent, temperature and contact time
on Mu removal was studied. Following optimization of variables, the relation between concentrations of
dye remained in aqueous and adsorbent has been evaluated using various adsorption isotherm models
like, Langmuir, Freundlich, Tempkin, Harkins-Jura and Dubinin–Radushkevich. Thermodynamic
parameters such as enthalpy (ΔH◦), and, entropy (ΔS◦), activation energy (Ea), sticking
probability (S*), and Gibb's free energy changes (ΔG◦) were also calculated. It was found from
evaluated different thermodynamic parameters, viz., ΔH◦, ΔS◦ and ΔG◦ that the adsorption of Mu
by AC was feasible, spontaneous and endothermic process. The kinetic studies suggest that the all
process following pseudo second order kinetics and involvement of intera- particle diffusion mechanism.
The results indicated that the intraparticle diffusion also is the rate limiting factor.
Murexide
Adsorption Isotherm
Kinetic of adsorption
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Shokrollahi, A., Ghaedi, M., Ranjbar, M., Alizadeh, A. (2010). Kinetic and thermodynamic studies of the removal of murexide from aqueous solutions on to activated carbon. Journal of the Iranian Chemical Research, 3(4), 219-235.
Ardeshir Shokrollahi; Mehrourang Ghaedi; Mojdeh Ranjbar; Ameneh Alizadeh. "Kinetic and thermodynamic studies of the removal of murexide from aqueous solutions on to activated carbon". Journal of the Iranian Chemical Research, 3, 4, 2010, 219-235.
Shokrollahi, A., Ghaedi, M., Ranjbar, M., Alizadeh, A. (2010). 'Kinetic and thermodynamic studies of the removal of murexide from aqueous solutions on to activated carbon', Journal of the Iranian Chemical Research, 3(4), pp. 219-235.
Shokrollahi, A., Ghaedi, M., Ranjbar, M., Alizadeh, A. Kinetic and thermodynamic studies of the removal of murexide from aqueous solutions on to activated carbon. Journal of the Iranian Chemical Research, 2010; 3(4): 219-235.


It sounds like there may have been a lack of pollination take place at the time of flowering. Most plum trees are not self-fertile and require another nearby plum to help pollinate the tree.
Do you have another nearby tree in your garden or nearby? this will greatly improve pollination. Each variety of plum will have an ideal pollinator tree or trees for that variety.
Ensure the soil is rich and full of organic matter and the tree receives enough water over the flowering stage. Ensure there is lots of bee attracting ornamental flowers to encourage pollinators to your garden.