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Brazilian Dental Journal
Braz. Dent. J. vol.29 no.6 Ribeirão Preto Nov./Dec. 2018
http://dx.doi.org/10.1590/0103-6440201802077
Toothache and Non-Clinical Individual and School Factors in Five-Year-Old Children: Multilevel Analysis
Monalisa Cesarino Gomes1
Érick Tássio Neves1
Matheus França Perazzo2
Saul Martins Paiva2
Fernanda Morais Ferreira2
Ana Flávia Granville-Garcia1
1Department of Dentistry, UEPB - Universidade Estadual da Paraíba, Campina Grande, Paraíba, Brazil
2Department of Pediatric Dentistry and Orthodontic, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
The objective of the present study was to evaluate the influence of individual and contextual factors on the occurrence of toothache in five-year-old children. A cross-sectional study was conducted with 756 five-year-old children from public and private preschools in a city in the countryside of the northeast of Brazil. The sample was determined through probabilistic sampling in two stages (preschools and children). The children included could not have systematic diseases, permanent tooth or orthodontic treatment. Parents/caregivers were required to spend at least 12 hours per day with their children. The history of toothache during the life of the child was reported by parents/guardians. Socioeconomic and psychological questionnaires were completed by parents/guardians. Variables related to social context were obtained from the preschools in which the children studied and the official publications of the municipal region. Unadjusted and adjusted multilevel Poisson regression models were used to investigate the association between individual and contextual characteristics and history of toothache. The history of toothache was found for 23.8% of the children. Among the individual determinants, gender of the child, order of birth, and schooling of parent/guardian were associated with toothache in children. The individual variables remained associated with the outcome after the addition of the contextual variables to the model. The type of preschool was the contextual determinant associated with toothache in the final model. Both individual (gender, order of birth and schooling of parents/guardians) and contextual (type of preschool) determinants were associated with history of toothache in five-year-old children.
Key Words: toothache; oral health; preschool children
O objetivo do presente estudo foi avaliar a influência de fatores individuais e contextuais na ocorrência de dor de dente em crianças de cinco anos de idade. Um estudo transversal foi realizado com 756 crianças de cinco anos de idade de pré-escolas públicas e privadas em uma cidade no interior do Nordeste do Brasil. A seleção da amostra foi realizada por meio de amostragem probabilística em duas etapas (pré-escolas e crianças). As crianças incluídas não poderiam ter doenças sistêmicas, dentes permanentes ou tratamento ortodôntico. Foram incluídos apenas pais/responsáveis que passavam pelo menos 12 horas por dia com seus filhos. O histórico de dor de dente durante a vida da criança foi relatado pelos pais/responsáveis. Os questionários socioeconômicos e psicológicos foram preenchidos pelos pais/responsáveis. As variáveis relacionadas ao contexto social foram obtidas na pré-escola em que as crianças estudaram e nas publicações oficiais da região municipal. Os modelos de regressão de Poisson multinível não ajustados e ajustados foram utilizados para investigar a associação entre características individuais e contextuais e histórico de dor de dente. O histórico de dor de dente foi encontrado em 23,8% das crianças. Entre os determinantes individuais, gênero da criança, ordem de nascimento e escolaridade dos pais/responsáveis foram associados com dor de dente em crianças. As variáveis individuais permaneceram associadas ao resultado após a adição das variáveis contextuais ao modelo. O tipo de pré-escola foi o determinante contextual associado ao histórico de dor de dente no modelo final. Tanto o indivíduo (gênero, ordem de nascimento e escolaridade dos pais/responsáveis) quanto os determinantes contextuais (tipo de pré-escolar) foram associados com o histórico de dor de dente em crianças de cinco anos de idade.
Toothache is a subjective indicator of oral health and can have an impact on oral health related quality of life (OHRQoL), causing functional and social impairment 1. In addition, having children with toothache results in greater absenteeism of parents from work 2, as well as increased financial expenses 3 and parental guilt 4. Due to the major impact that toothache can have on OHRQoL, one of the aims of the Global Goals for Oral Health 2020 is to reduce the prevalence of tooth pain and its consequences in the population 5. Thus, studies that evaluate the factors associated with the occurrence of toothache and help achieve this goal are required.
Literature describes the prevalence of toothache in five-year-old children as being between 9.4% and 25.0% 1,6,7,8,9,10. As cognitive ability is still developing in this age group, the evaluation of tooth pain is performed via the reports of parents 11. This data is highly reliable, as studies have shown that toothache is the most perceived symptom by parents in children at a young age 12. In terms of the psychological issues of parents, such as sense of coherence (SOC) and locus of control, previous studies have evaluated their relationship with oral health problems 13,14 but have not provided specific information about the history of toothache.
Most studies with young children evaluate toothache in terms of clinical aspects and/or socioeconomic issues addressed at the individual level 6,7,8,10. These individual clinical and socioeconomic factors have therefore already been well demonstrated in literature. Dental caries and dental trauma are the main clinical conditions presented by children in this age group, and are related to toothache 8,15. Individuals with worse socioeconomic conditions at an individual level are more exposed to risk factors for oral health problems 7. However, this socioeconomic issue needs to be better addressed within a social context. In studies with adolescents and adults a direct relationship between the context in which the individual is inserted and toothache has already been demonstrated 16,17,18. Adolescents from areas with a low Human Development Index (HDI) had a higher prevalence of toothache than those in more developed areas, regardless of individual characteristics 16. In pre-school children, there is only one study that assesses toothache through a multilevel approach 9. This study was based on data from the national oral health survey conducted in 2010 in Brazil, and identified an association between toothache and a low level of HDI and literacy in the city 9.
New studies of this topic will allow a better understanding of the relationship between the non-clinical individual and contextual determinants of children's oral health conditions. Brazil is a country with considerable social disparities, and researchers have sought to determine factors that may explain differences in the oral health status of the population 19. Type of school can be considered a contextual determinant, since this variable is sensitive for the discrimination of different oral health conditions 20. Thus, understanding the role of the school environment in children's health is important when planning preventive strategies 21,22. To date, there are no studies that evaluate toothache in preschool children based on the school context.
The aim of the present study was therefore to evaluate non-clinical individual and school factors relating to the occurrence of toothache in five-year-old children.
This study received approval from the Human Research Ethics Committee of the State University of Paraíba (38937714.0.0000.5187) and was conducted in compliance with the guidelines stipulated in the Declaration of Helsinki. All the legal guardians signed a statement of informed consent prior to the data collection process. All the preschools received clarifications regarding the study protocol and agreed to participate.
Sample Characteristics and Study Design
A cross-sectional study was conducted in public and private preschools in Campina Grande, a city located in the eastern part of the northeast of Brazil. This city has about 400,000 inhabitants and an HDI of 0.72. The present study was carried out to evaluate the oral health of five-year-old children and was conducted between August and December 2015. All stages of this study were performed in accordance with guidelines for cross-sectional studies.
Sample selection was performed through probabilistic sampling in two stages. A total of 263 preschools (129 public and 134 private) are registered with the Ministry of Education. The city is divided into six administrative districts and the preschools were randomly selected according to the total number of such preschool in each district in the first stage. Twenty-eight public and 20 private preschools were selected. The second phase consisted of the selection of children for the sample using a simple randomization procedure. The ratio of the total population enrolled in private and public preschools in each administrative district of the city was maintained in the sample distribution.
The sample size was calculated based on a 5% margin of error, a 95% confidence level and a correction factor of 1.6 to compensate for the design effect. A prevalence rate of 50% for toothache was considered to increase the power and because this value gave the largest sample regardless of the actual prevalence. The required sample size was calculated to be 615 preschool children. This value was increased to compensate for possible dropouts estimated at 20% resulting in a sample of 769 five-year-old children.
Five-year-old children with no systematic diseases (based on the reports of parents/caregivers) enrolled at public and private preschools were included in the sample. Parents/caregivers were required to spend at least 12 hours per day with their children. The exclusion criteria were the presence of one or more erupted permanent tooth and a history of orthodontic treatment.
A pilot study was conducted to test the methodology. The participants in the pilot study (n=45) were not included in the main sample. As there were no misunderstandings regarding the questionnaires or the methodology, no changes to the data collection process were deemed necessary.
Data collection was performed in preschools that were selected following contact with the principals of each school to explain the purpose of the study. Parents/guardians were previously contacted to attend a meeting at the preschool and participate in an oral health promotion activity, during which they received clarification on the study and signed an informed consent form. At the same meeting, the parents/guardians were asked to provide information related to their child's history of toothache and complete questionnaires addressing their psychological aspects and sociodemographic data. Additionally, data regarding variables related to the social context in which the children were inserted were collected. The parents/guardians who did not participate in the activity scheduled at the preschool were contacted by telephone by the researchers, who stressed the importance of the study and asked them to return the completed questionnaires.
History of toothache. This information was provided by parents/guardians and a history of toothache was recorded if this symptom was observed at some time in the child's life. The answer choices were yes or no.
Individual sociodemographic variables. The following sociodemographic variables were collected to obtain an individual profile of the child/family: child's gender, education of parents/guardians, monthly family income, order of birth and whether the child had siblings.
Psychological aspects of parents/guardians: To analyze the psychological aspects of parents/guardians, the SOC and locus of control were evaluated. The SOC of the parents/caregivers was measured using the Brazilian Sense of Coherence Scale (SOC-13), employing the version validated for use on parents of preschool children 23. This questionnaire has 13 items, each with five response options that assist in evaluating the components that compose SOC: comprehensibility, manageability and meaningfulness. The total ranges from 13 to 69 points, with higher scores indicative of a stronger SOC and greater capacity to cope with stress. For the purposes of statistical analysis, the score was dichotomized by the median, as performed in a previous study 13. Scores below the median were considered indicative of a weak SOC and scores above the median were indicative of a strong SOC.
The locus of control of the parents/caregivers was evaluated using the Multidimensional Health Locus of Control index 14, which has 18 items distributed among three subdivisions (internal/external/chance) for the evaluation of the respondent's perception of who or what determines health/illness events: the individual himself/herself (internal) or other forces (external/chance). Each item has five response options (1= fully agree; 2=agree in part; 3=neither agree nor disagree; 4=disagree in part; 5=fully disagree). The scores of the items on each subscale are totaled and can range from 6 to 30 points, with higher scores on the subscale indicating a lower degree of each factor (internal and external/chance). An internal LOC is considered when the lowest score is on the subscale of internal factors and an external LOC is considered when the lowest score is on the subscale of external or chance factors.
Contextual variables. Five variables of the children preschools were investigated to assess the influence of contextual aspects on children's toothache: type of preschool in which the child was enrolled, number of children in the preschool, average monthly income of the neighborhood in which the preschool was located and number of general and oral health teams in the administrative district where the school was located. Information on the average income of the city's districts was obtained from the Brazilian Institute of Geography and Statistics and the number of general and oral health teams from the administrative districts was obtained from the city's Department of Health. Data on pre-schools were recorded during the first visit to each preschool.
The STATA 12.0 program (Stata Corporation, College Station, TX, USA) was used for data analysis. Descriptive statistics were used for the characterization of the sample. Unadjusted and adjusted multilevel Poisson regression models were created to describe the associations between the outcomes and predictors. Multilevel Poisson regression analysis involved a fixed effects model with random intercepts to evaluate associations between the history of toothache of the children (primary outcome) and both individual and contextual covariates. This strategy enabled the estimation of prevalence ratio (PR) between comparison groups and respective 95% confidence intervals (CI). In the first step, an unconditional (null) model was used to estimate variability in the data before the individual and contextual characteristics were taken into account. The individual covariates were incorporated into model 2 and both the individual and contextual covariates were incorporated into model 3. Individual variables that achieved a p-value<0.20 in the univariate multilevel Poisson regression analysis were incorporated into model 2 and those with a p-value<0.05 in the adjusted analysis remained in the model. Next, contextual variables that achieved a p-value<0.20 in the univariate multilevel Poisson regression analysis were incorporated into model 3 and those with a p-value<0.05 in the adjusted analysis remained in the final model. The goodness-of-fit of the models was calculated based on deviance values (-2 log likelihood).
A total of 756 pairs of children/parents were included in the present study, representing a response rate of 98.3%. Thirteen children were considered losses due to incomplete questionnaires. Table 1 shows the main characteristics of the sample. A history of toothache during the child's lifetime was reported in 23.8% of cases, and the majority of children were male (52.2%), had parents/guardians with more than eight years of schooling (70.1%), and attended private preschools (61.4%).
In bivariate analysis of multilevel Poisson regression, the history of toothache was significantly associated with parents'/guardians' schooling, monthly family income, presence of siblings, order of birth, number of children, locus of control and type of pre- school (p<0.05) (Table 2).
Table 1 Individual and contextual level characteristics of the sample
n(%)/ Mean (SD)
Female 361(47.8)
Male 395(52.2)
Parent's/caregiver's schooling
≤ 8 years of study 225(29.9)
> 8 years of study 528(70.1)
Monthly household income
< US$ 80.00 361(50.0)
≥ US$ 80.00 361(50.0)
Yes 258(34.4)
No 492(65.6)
Only child 258(34.5)
Youngest child 277(37.0)
Oldest child 125(16.7)
Middle child 88(11.8)
Number of children 2.10(1.17)
Weak 317(41.9)
Strong 439(58.1)
Internal 513(68.3)
External 238(31.7)
History of toothache
Contextual-level variables
Type of preschool
Public 292(38.6)
Private 464(61.4)
Number of children in preschool 107.88(99.71)
Mean monthly income of neighborhood 1091.85(253.83)
Number of general health teams 17.50(4.60)
Number of oral health teams 8.94(2.13)
Table 2 Unadjusted assessment of the association of history of toothache among preschool children with individual and contextual-level variables
PR(95%CI)
Individual-level variable
Female 361 97(26.9) 0,098 1.29(0.95-1.73)
Male 395 83(21.0) 1.00
≤ 8 years of study 225 92(40.9) p<0.001 2.45(1.83-3.29)
> 8 years of study 528 88(16.7) 1.00
< US$ 280.00 361 115(31.9) p<0.001 1.92(1.40-2.62)
≥ US$ 280.00 361 60(16.6) 1.00
Yes 258 41(15.9) 0.007 0.61(0.43-0.88)
No 492 135(27.4) 1.00
Order of birth
Only child 258 41(15.9) 1.00
Youngest child 277 68(24.5) 0.055 1,47(0,99-2,19)
Oldest child 125 33(26.4) 0.040 1.62(1.02-2.58)
Middle child 88 35(39.8) 0.001 2.25(1.41-3.61)
Number of children - - 0.013 1.15(1.03-1,29)
Weak 317 91(28.7) 1.00
Strong 439 89(20.3) 0.072 0.76(0.56-1.03)
Internal 513 106(20.7) 0.031 0.71(0.53-0.97)
External 238 73(30.7) 1.00
Public 292 108(37.0) p<0.001 2.38(1.77-3.21)
Private 464 72(15.5) 1.00
Number of children in preschool - - 0.025 0.99(0.99-1.00)
Mean monthly income of neighborhood - - 0.220 0,99(0,99-1.00)
Number of general health teams - - 0.535 0.95(0.87-1.04)
Number of oral health teams - - 0.288 0.99(0.95-1.03)
Table 3 shows the results of the multivariate Poisson regression model. In model 2, with the inclusion of individual determinants, the variables associated with the history of toothache were lower levels of schooling of parents/guardians (PR= 2.24; CI95%: 1.64-3.06), being a middle child (PR= 1.87; CI95%: 1.17-2.99) and the female gender (PR= 1.36; CI95%: 1.01-1.82). Following adjustment for the contextual determinants, the individual variables remained associated with the result (Model 3). Attending private preschools was a protective factor in relation to the history of toothache at some time in the child's life (PR=0.61; CI95%: 0.42-0.88).
Table 3 Multilevel Adjusted Assessment of cavitation of toothache among preschool children associating individual and contextual variables
Fixed effects
Model 1 ("null")
PR (CI 95%)
Intercept 0.24(0.21-0.27) 0.11(0.08-0.17) 0.18(0.11-0.27)
Parent's/caregiver's chooling
≤ 8 years of study 2.24(1.64-3.06) 1.65(1.14-2.39)
> 8 years of study 1.00 1.00
Only child 1.00 1.00
Youngest child 1.19(0.79-1.77) 1.16(0.78-1.74)
Oldest child 1.50(0.95-2.38) 1.50(0.95-2.38)
Middle child 1.87(1.17-2.99) 1.73(1.08-2.77)
Male 1.00 1.00
Female 1.36(1.01-1.82) 1.37(1.02-1.85)
Contextual level: Preschool
Public 1.00
Private 0.58(0.40-0.84)
Random effects
Deviance (-2loglikelihood) 870.0276 817.2961 809.1280
Model 1 ("null"): represents the unconditional model; Model 2: represents individual covariates; Model 3: represents subject and contextual-level covariates.
A history of toothache was more prevalent among children living in an unfavorable social context. The schooling of parents/guardians and the type of preschool can be used as a means of intervention to improve the oral health of children and consequently decrease the prevalence of toothache. The results of the present study are therefore valid for the support of oral health policies.
According to parents/guardians, 23.8% of children had a history of toothache. This prevalence agrees with other studies conducted in the same age group 6,9. However, other reports of toothache in preschool children have found a lower prevalence 1,7,8,10. Caution should be exercised when performing comparisons with these studies, as they are based on different methodologies, especially in relation to the time considered for the reporting of toothache 7 and feature age groups, involving children under 5 years of age 1,8,10. These factors may result in a less frequent reporting of toothache.
Toothache was reported more frequently among female children. Possible, parents may tend to be more careful with their daughters, and thus, they are more attentive to the reported pain of female children. In addition to the child's gender, birth order also influenced this problem. Middle children were associated with a more prevalent history of toothache. An earlier study with pre-school children revealed that being a middle child led to an approximately ten times greater chance of suffering an impact on OHRQoL 1. Based on this, it is possible to assume that the prevalence of oral health problems, including toothache, tends to be greater among such children. One possible explanation for this relationship is the fact that when there are more than 2 children, parents tend to pay more attention to their older and younger children, while the middle children are less remembered.
A lower level of schooling of parents/guardians was an individual socioeconomic predictor that influenced the history of toothache in five-year-old children. However, the psychological aspects of the parents/guardians evaluated (SOC and control locus) were not associated with a history of toothache. This result confirms the significant influence of social inequality on the oral health of the Brazilian population. Parents/guardians with a lower educational level may have lower oral health knowledge and reduced financial conditions 24. Moreover, parents with lowest education only take their children to the dentist when problems arise 25. These factors can result in poorer oral health conditions for children. It is worth mentioning that this individual determinant remained associated with a history of toothache even after adjustment with the contextual variables. There is therefore a need for public health programs that educate parents to seek preventive oral health care on an ongoing basis, rather than in response to oral problems.
The type of preschool was the only contextual variable that presented an association with the history of toothache in children. Children in private preschools had a lower prevalence of history of toothache than children in public preschools. In Brazil, the type of preschool reflects the socioeconomic condition, and thus may possibly reflect inequalities associated with oral conditions, such as dental caries and the use of the health service. Thus, public health policies should prioritize the incorporation of measures that encourage healthy habits and the creation of healthy environments in public schools to promote health among this population 20, because on that socioeconomic context, these children are more vulnerable to oral health problems. The other contextual variables analyzed in the present study did not exhibit an association with a history of toothache, perhaps because they did not reflect the contextual differences between the environments in which the children were inserted. The results of the present study suggest that, in Brazil, type of school better represents the socioeconomic environment in which children are inserted than monthly income of the neighborhood of the school that they attend, as children often live in a different neighborhood and the income of the neighborhood in which the school is located may not reflect their actual socioeconomic status. With regard to the number of health professionals, this information only referred to those at public services, which could be considered a limitation of the present study. Moreover, for the population of the study, socioeconomic status probably had greater importance than access to healthcare services with regard to the outcome of toothache in the children.
One limitation of this research is that it is a cross-sectional study that prevents causal inferences. However, it includes a representative sample of the population, followed the norms established for cross-sectional studies, and performs differentiated analyzes to evaluate the social context. Although the history of toothache was reported by proxy measure, this is a reliable alternative for the evaluation of this condition in young children. Further studies should aim to establish the influence of the school context, such as structure, methods of teaching children, as well as the existence of health promotion actions, on the child's oral health conditions.
The results found in the present study can help to identify the individual and contextual characteristics that should be explored further, and support interventions to improve oral health. Some characteristics associated with the history of toothache are immutable factors such as gender and birth order. However, public health policies that address social inequalities can be elaborated. Especially, the present study warns of the importance of establishing healthy measures and changes in behavior in public preschools, as children in this context had a higher prevalence of toothache.
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Recebido: 19 de Janeiro de 2018; Aceito: 16 de Julho de 2018
Correspondence: Ana Flávia Granville-Garcia, 1325/410, Rua Capitão João Alves de Lira, 58428-800 Campina Grande, PB, Brasil. Tel: +55-83-3315-3326. e-mail:anaflaviagg@hotmail.com
Av. do Café, S/N
14040-904 Ribeirão Preto SP Brasil
Tel.: (55 16) 3602-3982
bdj@forp.usp.br


text:
Take a Tour Through American History Along the Kentucky Bourbon Trail
9/7/2016 — By Liza Weisstuch
August 2, 2007 was a historic day in America. On that day, the bitter partisanship that pretty much defines American politics was cast aside to pass a bill that declared bourbon to be our "National Spirit" and established September as National Bourbon Heritage Month. And here's the best part: They passed the bill unanimously. Yes, unanimously.
As further evidence of bourbon's importance to American heritage as well as the nation's economy, this isn't the first time Congress passed a law involving the industry. In 1967, it passed a bill to define bourbon as a whiskey that must be distilled from at least 51% corn and aged in a new charred American white oak barrel and just as Champagne can only be made in the region of the same name in France and Iberico ham can only come from Spain and Portugal, bourbon must be made in the USA.
Which brings us to today. The bourbon industry is exploding—there were over 6.7 million barrels aging in Kentucky in 2015, which works out to 1.5 barrels for every citizen of the state. So-called "whiskey pilgrims," from millennial enthusiasts to seasoned aficionados, have been flocking to Kentucky to visit bourbon distilleries and see how the spirit is made. But even before bourbon growth took off, the Kentucky Distillers' Association, a trade organization, founded the Kentucky Bourbon Trail in 1999. (Bourbon production increased 315% since then, from 455,078 barrels in 1999 to 1,886,821 in 2015). The KBT is an invaluable resource for anyone wanting to head to the source and see craftsmanship in action. And the best part: the guidance the KBT provides is completely free. Each distillery offers tours that show the many steps of whiskey-making, from fermenting to distilling to barreling to bottling and, of course, what would a tour be without a lesson in tasting. The distilleries charge a minimal admission fee. It's worth it.
Just go to the site and download the app. It shows the number of miles between distilleries, which ranges between eight and 70, and lot of other helpful logistical details. There are nine distilleries on the trail. They've created a neat little "passport" for you to take from stop to stop. Get it stamped at each distillery and if send it to the KDA when it's all filled in, they send you a t-shirt.
Among the stops is the iconic Maker's Mark Distillery, a National Historic Landmark. It's set up with the house of its founders replicated to period detail. You can watch workers dip the bottles in the red wax Maker's is known for and even try it for yourself in the gift shop. The massive Jim Beam Distillery is a mighty sight to behold, what with 76.5 million bottles of spirits shipped to 100 countries from there each year. This is indeed the slickest stop on the tour. The company is in its seventh generation of Beams and old-school heritage looms large in its mythology, yet it's all presented with all kinds of digital bells and whistles. The visitor center is a veritable multi-story museum, with interactive educational elements. They also offer an interactive multi-sensory tour and a decanter museum that would make an antiques collector swoon. Prepare to spend a lot of time here. Heaven Hill, the oldest family-run distillery, offers the Bourbon Heritage Center, a museum of bourbon, past to present. Wild Turkey and Four Roses have both invested vast sums in the last few years to open stunning visitor centers at their historic distilleries, each one a shrine to American heritage.
With all the tourist pouring into (sorry, no pun intended) the state, they need someplace to eat and drink after a day of touring. Louisville has become quite an urban destination. Inventive restaurants are opening at a rapid clip, and meantime, some of the longstanding institutions banded together to form the Urban Bourbon Trail, a guide to some of the most incredible bourbon bars in Louisville, which basically means the most incredible bourbon bars in the world.

redpajama_set_name: RedPajamaCommonCrawl


Classes are underway and it won't be long before assignments are due and tests are looming. As you dive into studying and other activities on campus, it is a great time to take note of the supports and services that are available to students. Here are just some of the ways that you can find support on campus.
The Student Counselling Centre provides mental health support to students in groups, workshops and individual sessions. These services can help with virtually any mental health difficulty, from transition-based issues to cases that include but are not limited to anxiety, depression, suicidality and trauma. All services are free, confidential and private. The SCC is located at 474 UMSU University Centre on the Fort Garry Campus and S211 Basic Medical Sciences Building on Bannatyne Campus. Visit the Student Counselling web page for more information.
Spiritual Care offers a unique service to students in the form of confidential one-on-one counselling that examines a student's ability to make meaning during times of crisis, loss and transition. Spiritual Care allows students to talk about what is important to them and helps to normalize and encourage the spiritual aspect of life. Spiritual Care is available on both the Fort Garry and Bannatyne campuses. Visit the Spiritual Care web page for more information.
The University Health Service is a student only clinic for use by all students with paid tuition fees. The clinic is located at 104 UMSU University Centre and offers medical services, counselling, mental health services, physicals and access to a lab technician. Visit the University Health Service web page for more details, and information on how to book an appointment.
Health and wellness services are offered through Katie Kutryk, a registered nurse and health and wellness Educator. Katie is available to talk about health and wellness concerns, including those pertaining to sexual health, substance use, and relationships. The Health and Wellness office is located at 474 UMSU University Centre and appointments can be booked by telephone or email. Visit the Health and Wellness web page for more information.
The Student Advocacy office provides confidential services to help students resolve issues in which they feel they are not being treated fairly at the University. This can include help with making appeals, written requests about policies, and investigation into cases of both academic and non-academic misconduct. Student Advocacy also provides workshops on academic integrity. Appointments can be made at 520 UMSU University Centre or by phone. For more information, visit the Student Advocacy web page.
Services for Students at Bannatyne is a one-stop shop for student support on Bannatyne campus offering a wide range of services including counselling, career advising, student advocacy, student accessibility services, financial aid and awards, spiritual care, academic support and more. An interdisciplinary team of clinical supports can help understand your unique situation and connect you with the appropriate support. Visit the Services for Students at Bannatyne Campus web page or stop by S211 Basic Medical Sciences Building for more information.
Taking care of yourself is an important part of your academic success and personal well-being. If you find yourself in need of support, be sure to reach out to one of the services available on campus. They are here for you and will help connect you with the care you need.


In a county fairly brimming with citizen committees, one of the most-recently formed might carry the most importance.
The Citizens of Gulf County Recovery Team, the committee formed to spearhead the long-term recovery from Hurricane Michael, will host residents and organizations 10 a.m. until 12 p.m. ET Saturday at First United Methodist Church of Port St. Joe.
"This meeting will be used as a time for the board of directors of the recovery team to share with the community their goals and report on current and future activities," said Robyn Rennick, a member of the committee's board.
The committee, and most especially public participation, has been an emphasis for FEMA officials since Hurricane Michael.
The committee, all volunteer, was formed during a series of organizational meetings with more than 100 participants earlier this year to coordinate and collaborate with the many moving parts of recovery, from individuals to organizations.
The public is encouraged to attend as well as those agencies which will play important roles in the recovery, including faith-based, non-profit and government agencies.
Representatives from organizations such as FEMA, SBA, Catholic Charities, United Way, United Methodist Committee on Relief (UMCOR), Project Hope (Life Management Center) and Capital Area Community Action Committee will be on hand to assist residents.
And members of the public can join in the effort.
One of the first steps for the committee is a community needs assessment (see related story).
Funded with seed money from the United Way, the community needs assessment will be conducted by World Renew.
The goal of the committee is to maintain a network of organizations while working toward a coordinated long-term recovery effort.
"This organization was established to serve as a collaborative for local organizations, working together to assist in the long-term recovery for individuals affected by Hurricane Michael," Abrams said.


text:
The best and worst in business in 2016 - Macleans.ca
The best and worst in business in 2016
2016 Newsmakers: The people, events, and moments that reflect the best and worst of the year that was in business
by Maclean's
Bank of England Governor Mark Carney speaks with members of the public during the Future Forum at Birmingham Town Hall on October 14, 2016 in London, United Kingdom. (Chris Radburn/WPA/Getty Images)
Our annual Newsmakers issue highlights the year's highlights, lowlights, major moments and most important people. Read our Newsmakers 2016 stories here, and read on to see which people, events and moments Maclean's named as the best and worst of 2016 in business.
Newsmaker: Christine Lagarde
Best/worst of world news
Feschuk's PB and J recipes
Bill Morneau
Standing between Canadians and their houses is a recipe for political pain. But that didn't stop the federal finance minister from trying to cool overheated markets in Vancouver and Toronto. We'll thank him later.
The CEO of Thomson Reuters, a mostly Canadian firm, will relocate to Toronto from New York. It's not so much a homecoming (Smith's American) as it is a vote of confidence in Canada's rising business appeal.
Mark Carney
The Bank of England governor was "the only adult in the room" after the U.K.'s Brexit vote. As politicians ran for cover, the Canada-born Carney stood up and provided reassurance to the rest of the world. A "rock star" of central banking indeed.
Couche Tard chief executive Brian Hannasch grabs a coffee from the company's coffee truck before the company's annual meeting, Sept. 20, 2016 in Laval, Quebec. (Ryan Remiorz/CP)
Brian Hannasch
Call it a Canadian invasion. The CEO of Quebec's Alimentation Couche-Tard scooped up San Antonio-based gas and convenience store chain CST for $3.8 billion. Is a Texas-sized Sloche about to challenge the Slurpee?
Microsoft's CEO has done the impossible: make people care about Microsoft again. Shares hit a record high in 2016—eclipsing levels achieved during the 1999 dot-com bubble—as investors embraced a new focus on cloud services. Best of all: no Zunes.
RELATED: Will Microsoft be LinkedIn's saviour? Don't bet on it.
She's no shrinking violet. After Donald Trump threatened to replace her as chair of the U.S. Fed, Yellen fired back by pointing out the myriad flaws in his plan to grow the economy. Oh, and she doesn't plan to resign either.
MORE: Donald Trump won. Now the market freak-out begins.
Michael Pearson
The CEO of Valeant Pharmaceuticals was dumped in March as the once high-flying firm grappled with probes of its accounting and business practices—like buying older drugs and jacking up their prices.
Pierre Beaudoin
The Bombardier chairman is asking taxpayers to "invest" $1 billion in the ailing aerospace and rail giant. Meanwhile, the Quebec firm continues to slash jobs and anger customers fed up with delays.
RELATED: The inside story behind the bungled Bombardier C Series
In the U.S. election's wake, the Facebook chief executive was criticized for disseminating fake news that could have influenced voters. Facebook claims it is not a publisher, but the fact 44 per cent of Americans turn to it for news suggests otherwise.
John DiMichele
Despite a landmark Competition Tribunal ruling that the Toronto Real Estate Board must make more housing sales data public, its CEO DiMichele staved off much-needed transparency with an ongoing appeal.
J.K. Shin, president and CEO of Samsung Electronics, holds the Samsung Galaxy S6 Edge Plus, left, and the Samsung Galaxy Note 5 during a presentation at Lincoln Center in New York. (Mary Altaffer/AP)
J.K. Shin
The apologies are coming fast and furious over the exploding Galaxy Note 7 fiasco. The co-CEO of Samsung told shareholders he would work hard to regain their trust—and, one hopes, build smartphones that are once again safe to put in your pocket.
Yahoo! CEO Marissa Mayer.
Marissa Mayer
Despite hype and hope, Mayer failed to turn around Yahoo as chief executive. Now, with a US$4.8-billion Verizon takeover offer on the line, she's facing fallout from a massive data breach that saw hackers steal a half-billion user accounts.
BUSINESS IN 2016, BY THE NUMBERS
The ratio of household debt to disposable income in Canada. The measure climbed through the year as Canadians scrambled to enter the housing market.
$13.2 billion
The total expected deficits this year for the oil-rich, cash-poor provinces of Alberta, Saskatchewan and Newfoundland.
Value of the remaining assets of defunct Nortel. After a seven-year battle, some of the money will now go to Nortel pensioners.


text:
Trusts and Estates Section >
Trusts and Estates Section Home Page >
Trusts and Estates Section Newsletters >
VOLUME 17 | NUMBER 1 | JANUARY 2022
The Trusts and Estates eBulletin
is published monthly by the Trusts and Estates Law Section, coeditors:
Jana G. Garrotto
Lewitt Hackman
Jgarrotto@lewitthackman.com
Stefanie S. Cutler
Ruttenberg Cutler Broomer, LLP
scutler@lawrcb.com
Jessica G. Gordon
Gordon Trust Law
jessica@gordontrustlaw.com
Julie Birkel
Hill, Farrer & Burrill LLP
JBirkel@hfbllp.com
Trusts and Estates Executive Committee Officers:
Debbie Keesey, Chair
Susan Barlevav Devermont, Vice-Chair
Sarah Broomer, Secretary & Treasurer
Jana G. Garrotto, Immediate Past Chair
2022 Trusts and Estates Lecture Series
Did the "Spears" Reform Hit the Target? (Assembly Bill 1194)
Date: January 24, 2022, 12:30 p.m. to 1:30 p.m
Speakers: Hon. Mary Thornton House, Judge (Ret.), ARC for ADR
Deborah C. Keesey, Esq., Hansen Seto Keesey LLP
Marilyn Kriebel, LPF, Private Professional Fiduciary
Description: 1 hour of Gen. CLE credit.
A panel discussion of Assembly Bill 1194, and its implications on conservatorships post-Britney Spears. Via Zoom Webinar.
Click here to register or for more information.
Dog and Pony Show; Legislative and Case Updates
Date: February 11, 2022, 12:30 p.m. to 1:30 p.m
Speakers: Marshal A. Oldman, Esq., Oldman, Cooley, Sallus, Birnbaum and Coleman LLP
Marc L. Sallus Esq., Oldman, Cooley, Sallus, Birnbaum and Coleman LLP
The presenters will give an overview of the new legislation and caselaw in the area of Trust and Estates. Via Zoom Webinar.
A View from the Bench
Date: March 24, 2022, 12:15 p.m. to 1:15 p.m.
Via Zoom Webinar. More information to be announced.
The Importance of Subtrust Funding
Date: April 11, 2022, 12:30 p.m. to 1:30 p.m
Speakers: Willow A. McJilton, Esq., Willow Law Group ALC; Jacqueline D. Yu , Esq., The Law Office of Jacqueline D. Yu, P.C.
Description: 1.0 CLE credits.
A presentation regarding subtrust funding on the first and second death, as well as a discussion of the implications of subtrust funding on taxes, the step-up in basis, and beneficiaries' rights. The speakers will also discuss common errors in subtrust funding. Via Zoom Webinar.
Registration: More information to be announced.
We'd like to thank the following sponsors of our
Trusts and Estates Lecture Series.
Attention Kern County Superior Court Filers:
Effective January 1, 2022, Probate Court will move to Department J1 at the Juvenile Justice Center. A new Zoom link for that courtroom (J1) is available under the Remote Court Hearings Tab on the online site for Kern County Superior Court.
A litigant forfeited any right to disqualify an arbitrator based on the arbitrator's failure to disclose a prior case involving the parties' lawyers had settled by failing to file a notice of disqualification within 15 days of discovering that omission.
Goodwin v. Comerica Bank - filed Dec. 15, 2021, First District, Div. Four
Cite as 2021 S.O.S. 6618
Full text click here >
A litigant who appeals without citing legal authority forfeits his cause.
Singman v. IMDB - filed Dec. 20, 2021, Second District, Div. Eight
Code of Civil Procedure §1985.8(l) mandates that courts protect nonparties from undue burden or expense when ordering them to comply with a subpoena to produce electronically stored information; the plain language of §1985.8(l) grants courts discretion to determine whether the burden or the expense of complying with a third-party subpoena is undue in light of the facts of the particular case.
Park v. Law Offices of Tracey Buck-Walsh (Department of Justice) - filed Dec. 27, 2021, First District, Div. Three
A judge's ownership of stock in a parent corporation with a value in excess of $1,500 is a financial interest within the meaning of Code of Civil Procedure §170.1 in the parent's wholly owned subsidiary and requires disqualification of the judge where the wholly owned subsidiary is a party to an action.
Chaganti v. Superior Court (Cricket Communications) - filed Dec. 27, 2021, Sixth District
A residential care facility resident was not bound by an arbitration agreement her daughter signed on her behalf when placing her at the facility.
Theresa D. v. MBK Senior Living - filed Nov. 30, 2021, publication ordered Dec. 21, 2021, First District, Div. Three
Where a minor filed a request for Special Immigrant Juvenile findings under Code of Civil Procedure §155 along with unimpeached and uncontradicted evidence that required the court to enter an order with the findings the minor requested, the juvenile court erred in denying the request; the court, at a minimum, had to consider the evidence submitted and make a finding whether the evidence supported her requested SIJ findings; if the evidence supported the findings, the court's duty to enter an order with the findings was mandatory, not discretionary.
In re Scarlett V. - filed Dec. 8, 2021, Second District, Div. Seven
Former Insurance Code §2051.5 does not require an insurer to indemnify homeowners for the amount of claimed replacement costs over and above the actual cash value amount they received for their lost dwelling when they did not actually incur such costs.
Westmoreland v. Fire Insurance Exchange - filed Dec. 28, 2021, First District, Div. Three
A person who is both personal representative of a probate estate and a beneficiary of that estate can maintain in her individual capacity a claim for financial elder abuse based on allegations that she was manipulated into taking actions as personal representative that damaged her interests as a beneficiary.
Ring v. Harmon - filed Dec. 15, 2021, Fourth District, Div. Two
You are receiving this message because you are a member of the Los Angeles County Bar Association (LACBA) or one of its sections, have registered to receive correspondence through LACBA's website, or are a member of the legal profession. If you wish to be excluded from any future correspondence, please see instructions below or mail us at 200 S. Spring Street, Los Angeles, CA 90012.


Andrea Giles is the owner of Andrea Leigh Interiors, a design and decorating firm in Austin, Texas focused on residential interiors. Andrea founded the company in 2011 after practicing law and working in politics for many years. This company was born out of Andrea's passion for decorating, design, style, and all things related to where we live.
Though a native Texan, Andrea finds inspiration in many other places – from the charm of uptown New Orleans and Audubon Park to the landscapes and pueblo art of Taos, New Mexico. Her style is a mix of modern and traditional, but she creates interior spaces suited to the tastes and lifestyles of her clients.
Andrea genuinely enjoys the entire design process, from concept to install. She obsesses over the details, and she manages projects persistently. She strives to make her clients feel at ease with the design process and to create beautiful, comfortable, and functional spaces that her clients love and use.
When she's not working, Andrea enjoys spending time with her husband, Rogan, and her English bulldog, Walter, who is often found napping or greeting clients in the office.


text:
Canton es una ciudad ubicada en el condado de Fillmore en el estado estadounidense de Minnesota. En el Censo de 2010 tenía una población de 346 habitantes y una densidad poblacional de 133,19 personas por km².

Geografía
Canton se encuentra ubicada en las coordenadas . Según la Oficina del Censo de los Estados Unidos, Canton tiene una superficie total de 2.6 km², de la cual 2.6 km² corresponden a tierra firme y (0%) 0 km² es agua.

Demografía
Según el censo de 2010, había 346 personas residiendo en Canton. La densidad de población era de 133,19 hab./km². De los 346 habitantes, Canton estaba compuesto por el 99.71% blancos, el 0% eran afroamericanos, el 0% eran amerindios, el 0% eran asiáticos, el 0% eran isleños del Pacífico, el 0% eran de otras razas y el 0.29% pertenecían a dos o más razas. Del total de la población el 0.58% eran hispanos o latinos de cualquier raza.

Referencias

Enlaces externos

Ciudades de Minnesota
Localidades del condado de Fillmore (Minnesota)

redpajama_set_name: RedPajamaWikipedia


text:
namespace Cronofy
{
    using System;
    using System.Collections.Generic;
    using Cronofy.Requests;

    /// <summary>
    /// Builder for generating <see cref="CreateChannelRequest"/>s.
    /// </summary>
    public sealed class CreateChannelBuilder : IBuilder<CreateChannelRequest>
    {
        /// <summary>
        /// The callback URL for the request.
        /// </summary>
        private string callbackUrl;

        /// <summary>
        /// The request's only managed flag.
        /// </summary>
        private bool? onlyManaged;

        /// <summary>
        /// The request's calendar IDs.
        /// </summary>
        private IEnumerable<string> calendarIds;

        /// <summary>
        /// Sets the callback URL for the request.
        /// </summary>
        /// <param name="callbackUrl">
        /// The callback URL for the request, must not be empty.
        /// </param>
        /// <returns>
        /// A reference to the modified builder.
        /// </returns>
        /// <exception cref="ArgumentException">
        /// Thrown if <paramref name="callbackUrl"/> is empty.
        /// </exception>
        public CreateChannelBuilder CallbackUrl(string callbackUrl)
        {
            Preconditions.NotEmpty("callbackUrl", callbackUrl);

            this.callbackUrl = callbackUrl;

            return this;
        }

        /// <summary>
        /// Sets the only managed flag for the request.
        /// </summary>
        /// <param name="onlyManaged">
        /// A flag specifying whether only events that are managed by the
        /// application should be returned.
        /// </param>
        /// <returns>
        /// A reference to the modified builder.
        /// </returns>
        public CreateChannelBuilder OnlyManaged(bool onlyManaged)
        {
            this.onlyManaged = onlyManaged;
            return this;
        }

        /// <summary>
        /// Sets the calendar IDs for the request.
        /// </summary>
        /// <param name="calendarIds">
        /// The calendar IDs to restrict the notification channel to, must not
        /// be null.
        /// </param>
        /// <returns>
        /// A reference to the modified builder.
        /// </returns>
        /// <exception cref="ArgumentException">
        /// Thrown if <paramref name="calendarIds"/> is null.
        /// </exception>
        public CreateChannelBuilder CalendarIds(IEnumerable<string> calendarIds)
        {
            Preconditions.NotNull("calendarIds", calendarIds);

            this.calendarIds = calendarIds;
            return this;
        }

        /// <summary>
        /// Sets the calendar ID for the request.
        /// </summary>
        /// <param name="calendarId">
        /// The calendar ID to restrict the notification channel to, must not
        /// be null.
        /// </param>
        /// <returns>
        /// A reference to the modified builder.
        /// </returns>
        /// <exception cref="ArgumentException">
        /// Thrown if <paramref name="calendarId"/> is null.
        /// </exception>
        public CreateChannelBuilder CalendarId(string calendarId)
        {
            Preconditions.NotNull("calendarId", calendarId);

            return this.CalendarIds(new[] { calendarId });
        }

        /// <inheritdoc/>
        public CreateChannelRequest Build()
        {
            return new CreateChannelRequest
            {
                CallbackUrl = this.callbackUrl,
                Filters = new CreateChannelRequest.ChannelFilters
                {
                    OnlyManaged = this.onlyManaged,
                    CalendarIds = this.calendarIds,
                },
            };
        }
    }
}

redpajama_set_name: RedPajamaGithub


Despite the availability of objective measures of audio quality, listening tests are still indispensible for a thorough evaluation of new speech and audio signal processing algorithms. Compared to objective measures, they offer great flexibility and can be applied for a multitude of questions at the price of an increased demand in time and effort. Many of the commercially available systems rely on specialized hardware and are far from being platform independent.
The LIStening Test ENvironment (LisTEn) for the subjective assessment of speech and audio signal processing algorithms allows to conveniently set up different types of listening tests (e.g., absolute category rating (ACR), comparison category rating (CCR), and degradation category rating (DCR)) in accordance with the procedures that are, e.g., standardized by the ITU. Other types of listening tests that are readily available in LisTEn include ABX, rhyme and multiple stimuli with hidden reference and anchor (MUSHRA) tests.
LisTEn is still in active development, and new versions will be released every now and then. Additionally, a user's guide will be added to the downloads soon.
This user's guide and the new versions will be announced on the LisTEn mailing list.


text:
Heinrich Ehrler (ur. 14 września 1917 w Oberbalbach, obecnie część miasta Lauda-Königshofen, zm. 4 kwietnia 1945 w okolicach Stendal) – niemiecki as myśliwski z okresu II wojny światowej.

Życiorys
Służył w Luftwaffe w latach 1940-1945. Osiągnął 208 zwycięstw powietrznych w czasie około 400 misji bojowych (średnio jedno zestrzelenie na dwie misje), głównie w Europie Północnej.

Jego jednostka była częścią osłony lotniczej pancernika "Tirpitz". W czasie brytyjskiej akcji, która zakończyła się zatopieniem okrętu otrzymał sprzeczne rozkazy, na skutek których znalazł się zbyt daleko od sił brytyjskich. Skazany został za to przez sąd wojenny, ale pełnił rolę kozła ofiarnego, ponieważ wina nie leżała po jego stronie.

Przeniesiony do Niemiec latał także na myśliwcu odrzutowym Me 262.

Rankiem 4 kwietnia 1945 Ehrler odbył ostatni lot bojowy, w okolicach Scharlibbe w pobliżu Stendal, w czasie którego zestrzelił ostatnie trzy samoloty ze swoich 208. Po zestrzeleniu dwóch bombowców B-24, jego samolot nie miał już amunicji. Ehrler umyślnie staranował Me 262 kolejny bombowiec B-24 "Trouble in Mind", na skutek czego oba samoloty zostały zniszczone podczas eksplozji.

Odznaczenia
 Krzyż Rycerski Krzyża Żelaznego z Liśćmi Dębu
 Krzyż Rycerski – 4 września 1942
 Liście Dębu (nr 265) – 2 sierpnia 1943
 Krzyż Niemiecki w Złocie – 18 marca 1943
 Krzyż Żelazny I Klasy
 Krzyż Żelazny II Klasy
Brązowy Krzyż Hiszpanii z Mieczami

Zobacz też
 lista niemieckich asów myśliwskich z okresu II wojny światowej latających na samolotach odrzutowych

Przypisy

Linki zewnętrzne

Żołnierze Luftwaffe
Odznaczeni Krzyżem Rycerskim
Asy myśliwskie Niemiec II wojny światowej
Urodzeni w 1917
Zmarli w 1945


For individuals interested in becoming a Certified Nursing Assistant (CNA) in South Carolina, it is necessary to meet all state requirements. The steps to meeting these requirements include completing CNA training or meeting other eligibility route requirements; if required, passing a knowledge and skills examination; and getting listing on the South Carolina Nurse Aide Registry. Successfully completing the steps expands employment opportunities to include federal and state funded facilities. The following sections will assist individuals with understanding the various steps in order to simplify the process.
The South Carolina Department of Health and Human Services (SCDHHS) is responsible for administering the laws and regulations concerning the certification and employment of nurse aides. SCDHHS has contracted with Pearson VUE to develop, score and report NNAAP examination results. NNAAP is the acronym for the National Nurse Aide Assessment Program, a nationally developed CNA exam that ensures applicants have the required knowledge and skills per federal and state laws and regulations.
The following steps are intended to guide readers through the general process of becoming a Certified Nursing Assistant in South Carolina.
There are different certification requirements depending on the applicant's status. The first step is reviewing the various paths to certification in South Carolina to determine the one that is most applicable.
Students first complete a state-approved nurse aide training program and then take a CNA examination. The training program must have been completed within 24 months of taking the certification exam.
South Carolina accepts proof of completion of a 100-hour state-approved training program completed in another state. The training must have been completed within the last 24 months. Upon acceptance, the individual can take the South Carolina certification exam.
An individual who has completed a South Carolina state-approved CNA training program, but let their certification expire for no longer than 24 months, can retake the CNA exam to renew active Registry status.
South Carolina does credential by reciprocity. CNAs registered in another state and in good standing on the out of state Registry can show proof of successful completion of a 100-hour nurse aide training program and a certificate that has not been expired for more than 24 months to apply for reciprocity.
The SCDHHS requires student nurses, individuals who successfully completed an RN or LPN program, and military people who completed various types of medical training, to submit an application to the state before applying to take the certification exam. The state must approve eligibility for testing first. A student nurse needs to have completed the Fundamentals of Nursing within the last 24 months before requesting an eligibility review.
People who need to complete training will find there are 147 CNA programs in South Carolina approved by the SCDHHS. They are located in all the major urban areas and in most of the smaller towns. Programs are offered at community colleges, training centers, technology centers, technical colleges, high schools and career centers. The federal and state laws also allow individuals to work and train at nursing homes and long-term care facilities, though it is necessary to obtain active Nurse Aide Registry status within 120 days to continue working.
If it is necessary to complete Certified Nurse Aide training, it is critical to attend only a state-approved program. South Carolina programs must offer a minimum of 100 training hours which consist of classroom, laboratory and clinical time. However, each program sets its own schedule, and there are significant differences between programs.
For example, the Carolina Nursing Assistant Program Academy in Columbia is an accelerated program that only takes four weeks to complete. Students complete 60 hours of classroom and laboratory work and 40 hours of hands-on clinical training in a long-term care facility. Upon course completion, the student can take the CNA exam within approximately 12-15 days. That is how quickly an individual can become a CNA.
The Nursing Assistant Program at Forrest College in Anderson has two options. One track is a six-month (22 weeks) certificate program, and the student earns 27 quarter college credit hours that can be applied towards an Associate Degree. The second option is a 100-hour six week CEU program that enables the student to take the certification exam much sooner in order to get to work as soon as possible. The student earns 4.5 quarter credit hours that can also be applied to an Associate Degree at a later date.
CNA Program costs and policies are different from program to program in South Carolina. The Carolina Nursing Assistant Program Academy, mentioned in step 2, charges $945 for the course. An additional fee of $55 is charged for the background check and drug test. The program allows a student to use a textbook that is returned at the end of the course or to purchase a personal copy. To make the program affordable for anyone who wants to attend, there are various payment options that include making payments or obtaining financial aid through the Department of Defense (if eligible), or a business or other private sponsor.
When reviewing program costs, remember that each program decides what is included in the tuition. At the Horry-Georgetown Technical College, the student pays the $800 tuition, and in addition must pay for the textbook, supplies, the 2-Step PPD, and scrubs. At Forrest College, the six week Nursing Assisting Continuing Education Program costs a total of $1,020.45 which includes the application fee, tuition, physical, background check, tuberculosis TST, textbooks and supplies. The six month Nursing Assisting Six Month Academic Certificate Program costs $5,869 for tuition and fees, supplies and textbooks. However, this program is eligible for Federal Financial Aid in the form of loans, grants and work-study.
Every program can change its tuition rates and policies on the purchase of other required items. It is important to verify current rates when ready to enroll.
Students who are employed at a federally funded nursing facility or long-term care facility can get free CNA training. A student who is employed while training in the facility has all training costs covered by the employer. A student who is employed by a federally funding nursing facility within 12 months of earning certification can request the employer reimburse him or her for the costs of training. A student who becomes a Certified Nurse Aide and is employed by a Medicaid-certified nursing facility can request reimbursement of tuition after working for one year.
Students may have to apply only for entrance into the CNA program. Depending on the program chosen, others may need to first get admitted to the school and then sign up for the CNA classes.
The SCDHHS approves training program curriculums in South Carolina. There are many topics and skills covered. Following is a brief list of what the core curriculum addresses.
Role of the nurse aide – identifying and reporting changes in resident condition, providing basic care services, etc.
Safety and emergency procedures – controlling bleeding, responding to urgent call lights, actions during disasters and fires, preventing falls, etc.
Promoting resident independence – maintaining dignity of residents, promote self-esteem, etc.
Respecting resident's rights – protecting confidentiality and right to privacy, understanding what constitutes abuse and neglect, avoiding need for restraints, protecting resident's personal items, living wills and advanced directives, resolving grievances, etc.
Basic nursing skills – obtaining and recording vital signs, identifying and reporting signs of acute illness, collecting and labeling specimens, therapeutic diets, etc.
Caring for residents with cognitive impairment – understanding and communicating with patients who have Alzheimer's disease, dementia, etc.
Providing personal care assistance – grooming, bathing, feeding, etc.
Providing restorative services – resident positioning in bed, motion exercises, care of prosthetics, using mechanical lifts and other assistive devices, etc.
There is a lot of information covered in a short period of time which is why students are encouraged to give training their full attention and effort.
The NNAAP exam has two parts: Written Exam and Skills Evaluation. Individuals must pass both parts of the exam within two years of completing training. It is necessary to pass the Written Exam and the Skills Evaluation within three attempts in South Carolina. If unable to pass both parts within three tries, the individual will have to complete a state-approved CNA training program and take the exam again.
There are 70 multiple-choice questions with the questions coming from information taught during Certified Nurse Aide training. Applicants should take the practice exams available online to get comfortable with the type and format of questions.
This part of the CNA exam involves performing five nurse aide skills which are assessed by a Nurse Aide Evaluator. One skill is always a measurement skill, and the other four skills are randomly chosen. However, a component of the skills evaluation is initially performing the 'Hand Hygiene' skill. All the skills were taught during the training program. Also, the person must pass all five skills in order to pass the Skills Evaluation exam.
Certification requirements say the applicant must take and pass the exam within 24 months of successfully completing a South Carolina approved training program. CNA testing sites in South Carolina include Pearson VUE regional sites and training facilities. Frequently, students are able to take the examination at the site where they completed their training.
Pearson VUE maintains the South Carolina Nurse Aide Registry. After passing both sections of the exam, the person's name is placed on the Registry. CNA certification in South Carolina is valid for two years (24 months) from the issue date on the CNA certificate.
The CNA Registry is found in the Pearson VUE Credential Management System. This system is used to record CNAs and their status. The status may indicate the person is certified (active), lapsed or revoked.
When it is time to renew CNA certification, the individual has to submit proof he or she was paid as a nurse aide for a minimum of eight hours within two years (24 months) after the last certification date. The employer provides the verification though signature on the appropriate form. Certification is renewed through Pearson VUE.
If the CNA allows their certification to remain lapsed for more than two years, the state requires the person to retrain and take the CNA exam again to renew certification. If it is lapsed for less than 24 months and the person has completed a 100-hour state-approved training program, only retesting is required to re-activate the Registry listing.
Only a Certified Nurse Aide can work in a federal or state approved nursing home and long-term care facility. The CNA designation is not required by law for a person to be eligible for employment in other healthcare facilities as a Nurse Aide. In South Carolina, nurse aides who are not certified can work in hospitals, clinics, doctor offices and other facilities, and may also work for private employers.


text:
Saving ozone may slow warming rate
Primary Author: Tim Radford
EMBARGOED until 1800 GMT on Sunday 10 November What appears to be a slowdown in the rate of atmospheric warming this century may have a simple explanation, Mexican scientists say. It could be the consequence of protecting the ozone layer. LONDON, 10 November – Scientists who looked at the whole history of climate in the 20th century have come up with a new possible explanation for the apparent slowdown in global warming. It is because, they say, of the Montreal Protocol that banned chlorofluorocarbons, also known as CFCs, and saved the ozone layer. The ozone layer was the second great atmospheric crisis of the late 20th century (the first involved the urban smog and acid rain that triggered clean air legislation in Europe and the US). CFCs were the safe, enduring gases used as refrigerants: their only problem was that – once they reached the stratosphere – they unexpectedly began to destroy the ozone layer that screens out harmful ultraviolet light. Within four years of the dramatic discovery of a huge "hole" in the ozone layer over the Antarctic, these gases were phased out, in a rare act of international agreement, by the 1989 Montreal Protocol. But CFCs had a second unexpected property. They were greenhouse gases of unusual potency: molecule for molecule, one of them was rated at more than 17,000 times more effective at trapping infra-red radiation than carbon dioxide. CFCs were released only in comparatively tiny quantities, but they were calculated to account for up to 24% of global warming. Francisco Estrada of the National Autonomous University of Mexico and colleagues report in Nature Geoscience that they spotted the signal of the missing CFCs when they used statistical analysis to examine average temperature records in the two hemispheres from 1880 to 2010.
Tentative results, clear pattern
Exercises such as these are not simple: the scientists had to find a way of eliminating natural cycles that keep the weather in a permanent pattern of change, and identify long-term trends that could be identified as evidence of human activity. In the first place, for a mix of reasons, rates of change in the two hemispheres are out of step; in the second place there are natural cycles linked to ocean and atmospheric circulation such as the Atlantic Multidecadal Oscillation that are associated with extended periods of warming and cooling; in the third place things like greenhouse gas emissions are tied into cycles of economic growth, and affected again in many cases by legislation, perhaps to reduce the aerosols that make citizens cough and splutter, but that also block sunlight and have a mild cooling effect. And to get the results that they did, the researchers had to use advanced statistical methods (for example, they say, the "Perron-Yabu testing procedure, valid with integrated or stationary noise") that would baffle most of the human race. So like all research results, the findings are tentative and published to provoke more research. But even so, the graphs in Nature Geoscience show a pattern of human influence in global average temperatures. In the last century, the planet warmed overall by 0.8°C. In the trend discernible in the sometimes dramatic oscillations of temperature, there is evidence of a slowdown in this warming during two world wars, and the Great Depression of the 1930s, when world trade came to a standstill, factories closed everywhere, and chimneys stopped smoking. The authors see a pronounced rise in both greenhouse gas emissions and in global temperatures in the 1960s – the start of sustained global warming. But they also see a distinct slowdown that begins in the 1990s in response to the Montreal Protocol, which began the phase-out of the CFCs and the slow restoration of the ozone screen.
Slowdown caused by humans
The Montreal Protocol is not the only possible explanation for the apparent slowdown. There is also evidence that at least one sector of deep ocean is warming 15 times faster than at any time in the last 10,000 years, which suggests that ocean circulation may be carrying away the heat that meteorologists expected to record in the atmosphere. Two scientists in October proposed that the slowdown in the rate of global warming could possibly be explained by a much longer-term natural cycle that nobody had yet identified: a climate signal could propagate across the northern hemisphere in a self-organising way, just as the so-called "stadium wave" propagates around a sports arena as excited spectators stand and sit down again. They say in Climate Dynamics that such a phenomenon could be linked to a brake-and-accelerator pattern of influence of northern sea ice on atmosphere and ocean circulation. If this pattern exists, it would explain why climate modellers had not predicted the present lull or slowdown in global warming. But the wave itself would have nothing to do with global warming, the two authors say. It would just offer a new perspective for climate science. The Nature Geoscience paper, however, does once again confirm the link between average temperatures and greenhouse gas emissions. "Paradoxically the recent decrease in warming, presented by global warming sceptics as proof that humankind cannot affect the climate system, is shown to have a direct human origin," the authors conclude.- Climate News Network
in Climate News Network
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Warsaw - Day 2: Extreme weather - who suffers most?


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Yves rocher anti age cream. My Experience with Pond' s Age Miracle Cell ReGEN Day Cream: Along with Pond' s Age Miracle Cell ReGEN Facial Foam night cream too.
Utilizarea acestui site implică acceptarea termenilor și condițiilor, vă rugăm să le citiți aici. It is owned by the Hamburg- based company Beiersdorf Global AG.
Yves Rocher es la única marca francesa en Venta Directa que acompaña a cada mujer en cada momento del día y en todas las etapas de su vida actuando de forma respetuosa con su belleza natural y por el mundo que nos rodea. Scopuri de marketing şi statistică inclusiv publicitate personalizată ( inclusiv profilare în cadrul Yves Rocher și alte site- uri web și servicii de internet), vă rugăm să citiți aici.
NIVEA ( pronounced [ niˈveːaː] ) is a German personal care brand that specializes in body- care. Funcţionarea site- ului personalizarea conţinutului pt. The company was founded on 28 March 1882 by Paul Carl 1890 it was sold to Oscar Troplowitz. Folosim cookie- uri pt.
To take advantage of an Yves Rocher offer received in the post, use this simple online ordering system. ORDER ONLINE Track all your orders online Track orders.
Face Care by Yves Rocher Beauty solutions and face care for every skin type. Because of its nature and according to its age, your skin needs specific face care. For more than 50 years our Laboratories have developed a face care line of products, infused with actives botanical ingredients, that suit every woman. Your satisfaction is our top priority and we do our best to satisfy our customers with each order.
If your Yves Rocher product( s) does not meet your expectations, do not worry. Anti- aging creams are predominantly moisturiser- based cosmeceutical skin care products marketed with the promise of making the consumer look younger by reducing, masking or preventing signs of skin aging.
These signs are laxity ( sagging), rhytids ( ), and photoaging, which includes erythema ( redness), dyspigmentation ( brown discolorations), solar elastosis ( yellowing), keratoses ( sale of cosmetic products: body care, skin care, makeup, perfumes & fragrances. Let the nature reveal your beauty with Yves Rocher Canada!


The HD Day & Night Vision Visor will reduce blinding glare from the sun during the day while you're driving.
It also helps minimize the visual effects of the high beams that stream from headlights at night.
The HD Vision Visor will reduce blinding glare from the sun during the day while you're driving. It also helps minimize the visual effects of the high beams that stream from headlights at night.
You will experience evenly balanced colors with improved clarity and contrast. This car visor will give you peace-of-mind and an increased feeling of safety so you can keep your eyes on the road.
Day Night Car Visor is well designed to protect your eyes from the intense brightness coming from sunlight UV rays at day and car headlights at night.
It made out of two tinted colors the gray for day use and orange for a clear night vision.
Gives you a 'crystal clear', 'amazing', and High-Definition sight while driving, makes you feel comfortable and focused your attention on the road, for more safety.
Has a durable output that can last a long time for more fun in driving.
Universally designed to fit most cars and vans.


The 3 ft Safety Grip is a soft zippered cover for outdoor or indoor pool handrails (1.9" OD). This innovative product will reduce liability and promote safety in your facility. These quick to apply covers prevent slipping, assist with gripping for those with physical limitations, and prevent burning where the rails are in exposed sun. The attractive rail sleeves are soft to the touch and are available in three colors: royal blue, aqua teal & sand beige. Please specify color. Sold each.


Customizing and publicizing your organizer profile page is a great way to drive all your potential attendees to a single page listing all your public events. Start customizing your profile with photos and social media integration by using the account menu and going to "Organizer Profile".
While creating an event on Ticketgateway you can add new options just below the event description box.
After clicking on "Add new organizer" a box will appear asking for the organizer's name and description (about organizer) which also includes social media links for Facebook and Twitter.
In order to create an event, you need to complete the organizer profile.
Go to "Organizer Profile": After logging in and creating an event, access the Account Menu and select "Edit Profile".
Choose the organizer profile you want to modify, or create a new one: You can use the default organizer, or access the drop-down menu up top to select an already-existing organizer. You can also select "Create a new organizer" to create a new organizer.
Upload an organizer image, logo and banner: Select "Choose File" and choose an image from your computer, and then select "Upload".
Include a link to your website: Add a link to your personal website that will appear beneath your organizer name. Just enter the URL in the field under "Website".
Integrate your social networks: Include a link to your Facebook and Twitter pages to help promote your brand.


The project stems from the need to provide timelier data on income, poverty, and social exclusion in order to feed the discussions in the context of the European Semester (including the early alert mechanism and the MIP ).
Timeliness of survey data on income and inequality can be improved, but for maintaining an appropriate level of quality, these improvements have limits; in the best case scenario, SILC data on income year N-1 could be available early year N+1.
Therefore, for providing earlier information an approach based on modelling (nowcasting) is necessary.


Just beginning to explore the world of fostering and want to find out if it's right for you? An experienced Foster Carer looking to change agencies? A member of one of our foster families? A local authority professional, looking to place a child? A fostering expert who wants to work with us? We'd love to hear from you, wherever you fit into the fostering world.


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Hiking the Famous Torres del Paine W Trek in Patagonia
by James Mackender - Hiking guide and owner of Unu Raymi Expeditions
Hike across endless valleys with majestic glaciers and towering mountains as your backdrop — answering the siren call of the iconic W Trek in Torres del Paine might be your favorite adventure yet.
The legendary W Trek in Patagonia's Torres del Paine National Park gives the best hiking destinations in the world a run for their money. It threads through 74 kilometers of stunning scenery, molded by one of the largest glaciers of the Southern Hemisphere. You'll traverse the circuit trek over rugged peaks splitting the seemingly never-ending vastness of Chilean plains and past turquoise lakes reflecting the untouched beauty around them.
Torres del Paine is a UNESCO World Biosphere Reserve, tucked between the Andes Mountains and the Patagonian Steppe in southern Chile. To say that this trek overflows with photo ops is an understatement. The stark contrast between the barren valleys stretching as far as the eye can see and the icy-blue glaciers set against a backdrop of dramatic mountains will shake you to your core in the best way.
Just some of the views you'll get when visiting the Torres del Paine National Park. Photo by James Mackender
Pros and Cons of Hiking the W Trek
Iconic landscapes molded by glaciers
Vast stretches guaranteeing adventure
Unreal photo ops
Campsites fill up quickly
Due to government control, you need to stick to charted paths
Patagonia's wilderness is what drew me in
I've traveled to many places around the world. Of all the places I've been to, South America amazed me the most. Eventually, I returned to England but couldn't stop thinking about my time in Argentina, Chile and Peru. Within a year of coming back, I started my own guiding business in the city of Cusco, where I'm now based.
My mission is to provide tours that combine the best of both worlds — the knowledge of booking an expert, local guide and a sense of adventure you can only feel when you explore where others don't dare to go. Patagonia completely won me over, and you can expect the same. Here are my tips for getting the most out of your Torres del Paine hiking adventure.
5 days | 1-12 People
Hiking the Torres del Paine W Trek in Patagonia
View adventure
When is the best time of year to visit Patagonia?
The best time of year to visit Patagonia is anywhere from the beginning of November to early March. This is considered high season and when you're most likely to hike under clear, blue skies. Though the weather can change quickly in the mountains, the landscapes are gorgeous even when they're clad in mist. Ideally, the days are sunny and the nights cold, but the wind has a mind of its own. Reaching up to 80 kilometers per hour, you will feel like it's trying to knock you off of your feet. It's part of the charm and awe of this wild place.
Plan your trip between November and March, and you're most likely to hike under clear blue skies, but always be prepared for quickly changing weather. Photo by James Mackender
How long is the W Trek in Torres del Paine?
The W Trek is 74 kilometers (46 miles) and takes four to five days to complete. Most hikers hike the trail east to west. We start at the Las Torres Refugio, following a W-shaped route that inspired the trek's name. We then hike across the Ascencio Valley and French Valley with Lago Grey as the final destination. That said, many choose to break the trek up and give themselves more time to explore the Patagonia wilderness.
Extend your time in Torres del Paine: W Trek vs. O Circuit
The W Trek is definitely the crowd favorite. It takes four days to hike (but is worth spending an extra day exploring the last portion of the trail) and checks off all of Torres' highlights. It's a classic for a reason with evenly distributed trails that make this W-shaped route doable but satisfying to complete.
If you want to amp the adventure up, challenge yourself some more and take on the O Route. You can hike the 60-kilometer-long (40 miles) trek in just over a week. You do need to be a seasoned hiker or in considerably good shape. The O Circuit will take you past the all-star locations, extending to the northern end of the park. The terrain will test you at times, throwing slippery rocks and swampy patches at you, but the views will make it worth your while.
W Trek hikes are evenly stretched over four days and 40 miles, and the rewards are huge. Photo by James Mackender
Day hikes in Torres del Paine
There are plenty of day hikes you can do in Torres del Paine, but most people opt for a multi-day trek. If you're in a time crunch, there are buses and catamarans that will take you to most of the trek's highlights, like The Three Towers or the Grey Glacier. If possible, it really is best to give yourself a few days to explore Torres del Paine.
Is the Patagonia W Trek difficult?
While the W Trek technically is a walk in the park — a national park, that is — it's far more challenging than your regular stroll. You can set your own pace, and will traverse on primarily mild terrain, but you need to be in good shape. On your longest days, you'll hike six to eight hours, up and down undulating hills. Climbs lead you up to 800 meters in elevation. The finicky weather might also pose an additional challenge, but it's nothing a good thermal layer and a sturdy windbreaker can't handle.
Laguna Amarga, the entrance to the park where travellers can buy their entrance tickets. Photo by James Mackender
Hiking the Legendary W Trek in Patagonia
Torres del Paine treks in Patagonia are the perfect balance of hiking and sightseeing. The terrain doesn't pose a distraction from all of the wonderful landscapes you'll see, but it will get your lungs going. The W Trek easily takes the prize, both for breathtaking views and challenging but doable terrain. The hikes are evenly stretched over four days and the rewards are huge. Each day spent on the trail leads to a new discovery. Let's get into my expert overview of the multi-day W Trek.
A Torres del Paine W Trek map from CONAF — the department responsible for managing the regional parks.
Day One: Admire the Three Towers and hike past lagoons
Normally, hikers come to Torres del Paine a day early and spend the night. The trip starts off with a bang, an 18-kilometer hike to the base of the Three Towers, the Mirador Base Torres. The Three Towers jut up from otherwise barren and vast plains, looming overhead. Following the Ascencio River, you'll cross and hike a few kilometers up until you reach Paso de los Vientos, a viewpoint promising incomparable views of the valleys and lakes.
Continuing on, you will hike until you reach the Chilean Refugio, and then, heading through a forest of lengas, you will trek on to La Morenna, where the most difficult hiking of the day begins along a rocky path. On this out and back portion of the trail, you'll pass by a beautiful blue lagoon with scenic water contrasting with the monochromatic wilderness surrounding it. It's all worth it when you reach the base of the granite towers. You expect the Three Towers to be large, but when you see them up close, the scale will knock you off your feet. After you pick your jaw off the floor, you'll head back to the Chilean Refugio to have dinner.
The Three Towers is a famous sight on the Torres del Paine W Trek tour. Photo by James Mackender
Day Two: Trek along Lago Nordenskjöld on your way to Los Cuernos
On your second day, you'll embark on a 13.5-kilometer hike to Los Cuernos Refugio for the night. It's not uncommon to see condors or eagles flying overhead as they close in on their prey. (Sidenote: Andean Condors are the largest flying bird by combined measurement of weight and wingspan.) As you make your way to the refugio, you'll follow a path through a valley at the foot of Los Cuernos Range. These horseshoe-shaped mountains are famous for black granite running through the rock. A couple of years back, there was a forest fire that decimated the vegetation, which only adds to the ghost town vibe of the area. Lago Nordenskjöld's glassy surface reflects the beauty surrounding — a true photo op of your dreams. Be sure to bring a camera.
Day Three: Reach Paine Grande and trek past Lake Pehoe
On your third day, you'll do some climbing and catch your first glances of the Grey Glacier peeking from the horizon. You might just witness an otherwise destructive avalanche — from a safe distance. You'll be watching the glacier changing before your eyes. This is the same force of nature that molded stretches of the French Valley where you'll trek for the day. It is an understatement to say the views from Mirador Frances and Paine Grande are breathtaking. You'll get a lot of use from your camera, regardless of the weather.
After a five-hour descent, you'll trek past the incredibly scenic Lake Pehoe before heading back to the refugio or campsite.
Lake Pehoe, with its turquoise blue waters, is Torres del Paine's crown jewel. Photo by James Mackender
Day Four: Discover the majestic Grey Glacier
Just when you think it can't get better, you find yourself standing in front of an icy giant, the Grey Glacier. It will take you about four hours to hike up to the viewpoint, but give yourself an extra hour or two for enjoying the vistas along the way. Once you reach the glacier, you can take a closer look at the prism of blue hues by kayaking or taking an ice hike. Even though it's pricier than setting up camp, I recommend you have your night's rest in a hotel or Refugio Grey, as the winds can hit hard and are unpleasantly wet.
Regardless of the time of year, Torres del Paine takes the prize for challenging but doable terrain and breathtaking views, like the Grey Glacier, shown here. Photo by James Mackender
Day Five: Boat ride back
Depending on the logistics of the trip, many hikers will opt for an extra day of exploring Lago Grey. You can head back to Paine Grande and take a scenic catamaran ride across Lake Pehoe into Pudeto. There are many cafes and picnic sites where you can recharge your batteries before heading back home — the perfect conclusion to an epic adventure.
Taking in the view from the scenic catamaran ride across Lake Pehoe into Pudeto. Photo by James Mackender
Travel Tips From a Torres del Paine Guide
When I first hiked in Patagonia 15 years ago, you could practically walk in and set camp wherever you liked. It's not like that today. Planning a multi-day trek on a location that gets as much hype as Torres del Paine can seem overwhelming. Here are some tips that will make trip planning a little easier.
Do you need a guide to hike Patagonia?
You do not need a guide to hike Patagonia, but you will likely benefit from hiring one. There aren't any regulations preventing you from trekking the iconic circuits yourself, and the trails are well-mapped. Guides lessen the load on the logistic side of things. Many people can't resist Torres del Paine's allure, which entails crowds swarming in and filling the refugios and campsites fast. By booking a guide, you're paying someone to deal with planning, so you're free to focus on your adventure. Patagonia's vastness is liberating, but it can also be overwhelming, both the trodden path and hidden gems alike.
Do you need a permit to hike in Torres del Paine National Park?
Hikers in Torres del National Park need to purchase a permit. Permits are cash only and can be obtained at any of the entrance stations Laguna Amarga, Sarmiento or Serrano. You will need to provide proof of confirmed reservations at the free or paid campgrounds, refugios or hotels for overnight stays. One benefit of hiring a guide is that they handle all of the permitting for you and ensure all your documents are in order before travelling.
Many people can't resist Torres del Paine's allure. Photo by James Mackender
What should I bring to W Trek in Torres del Paine?
Like most outdoor activities, you're safest with layers. Shed them as you descend hills, or bundle up in your thermals as you make your way to Grey Glacier, the big finale of your trip. The glacier is majestic but reaching it needs to be earned. Chilly gusts of wind are almost guaranteed to be thrown at you, so wearing a high-quality outer layer is essential.
As for the gear, you'll need basic hiking equipment, quality boots, hiking poles and personal items to complete your trek. If you don't feel like bringing your own sleeping bag, they're available for rent, as well as tents and other camping equipment. It is recommended that you pack them yourself to avoid additional expenses, though. If you're hiking with a guiding service and staying in refugios along the way, a standard daypack of around 30L should suffice. If you're on your own and camping, you'll need to pack everything you need in and out.
Where should I stay when visiting Torres del Paine?
You'll find many lodging options in Torres del Paine, and where you should stay solely depends on your budget. One big downside to trekking in Patagonia is the hampering administration. Two companies run the hostel-style refugios and fee-based campsites. If you want to book your place, you'll need to reach out to them directly and reserve well in advance. If you choose to trek with a guiding service, accommodations will be booked for you.
A good rule of thumb: if you want to reserve a spot for this season, you're already late. What I mean here, is it's never too early to start planning. If you're looking for a cheaper option, the government offers free campsites. There are hotels dotted around the area, as well, but they can get pretty expensive.
There are a few different accommodation options for hiking the W Trek — free campsites, paid campsites, refugios and hotels. Photo by James Mackender
Is Torres del Paine safe?
Even though you'll feel like you're engulfed by wilderness, Torres del Paine is safe. Due to strict government regulations, you can't deviate from paths. These restrictions won't put a damper on your trip, however. All trails are well-mapped and easy to follow — it's harder to get lost than you think. There is a high possibility you'll encounter some of the native wildlife. Torres is home to pumas and prey birds, but they go about their business and don't take interest in hikers. That said, you do need to be mindful of your surroundings, just like you'd be on any outdoor adventure.
Feeling hyped up for your own Patagonia trip? Go on a 5-day guided tour of the legendary W Trek and get ready for a hike that never ceases to amaze!
James Mackender
Hiking guide and owner of Unu Raymi Expeditions
Originally from England, James went on a backpacking tour around South America about 20 years ago and never stopped thinking about it since. Three years ago, he decided to lay down roots in Peru, where he founded Unu Raymi Expeditions. He and his crew of expert guides take adventurers on trips everywhere from Machu Picchu to the depths of the Amazon Jungle.
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