text:
Where is the genesis of happiness?

Continuing on our last blog of "The morning ritual for stirring up self-belief" , it becomes an important aspect to stick to values and much of that orientation starts happening by sparing some time for self-introspection as a ritual. The integrity, the character results in an immense force within. It stands out and makes one leader in masses at home, community, and work because the vision starts changing beyond just the self. When we live for others, the greater part of consciousness starts following us, such is the power of service. See the true leaders around us, who do they work for and you will get the answer.

Ever wondered, how our role models get so much energy and they keep marching on their path where they engage into something which serves the interest beyond just them. We at GoalMantra believe, it is the beautiful communion with super-consciousness. The joy of engaging in self-less act creates an incessant ever increasing force within because it is in alignment with the purpose of creation. One needs to experience the joy by engaging into something beyond oneself, it's worth the experience in life.

We respect and bow to the leaders who take lead in making it a beautiful happy world as our experiences in life are consequence of the manifestation of collective free will of individuals and societies. Just "I" sticking to values is not enough in fact may not be practically possible. Living life by sticking to values can happen when we and the eco-system around us works in that direction and makes life a journey full of positive and beautiful experiences.

Starting from self, and then inculcating the values in our kids by becoming their role model through our actions could be the first stepping stone. It is years of investment of parents which will reap it's own benefits when kids grow and when we are not around them because the values become the guiding force.

At GoalMantra, this blog is our attempt to build a society driven by values in alignment with the purpose of creation and make it a beautiful life for all of us. The journey starts at home and rewards us back with positive experiences in society. We got to become an agent to spread the importance of "Character Building" and we appreciate your efforts in this common goal of ours.

No comments:

Post a Comment


Content-Type: application/http; msgtype=response

WARC-Identified-Payload-Type: text/html

WARC-Type: response

text:
Maintaining the image you wish to project of your business, and the values it holds in its operations is a vital part of a business. This image control is an important aspect of marketing your business, it says how you want to do things, how seriously you take business and that you are up to the job.

The devil is in the detail

If you have any areas in your business that customers, clients or consumers will see as part of the transaction, you need to be confident that it looks and feels the way you want it to to them. Reception areas, conference rooms, meeting rooms and even public area rest rooms  need to be in spotless condition, both neat and tidy, but also dust and grime free.

Systems that work

Every office should have a cleaning system that does not rely on staff having free time around their roles to conduct. Outsourcing office business cleaning means that tasks are completed regularly to schedule, are quality controlled and allows time and availability to facilities – guaranteeing all cleaning tasks get completed all the time. No tasks slip through the cracks, letting down the carefully crafted image of the business.

Focus your efforts

When we are discussing the impression your office makes on clients and customers, and the effects on your image and perception of the business values, concentrate on the areas your customers and clients will see. This may include polishing of conference room tables, keeping floral arraingements in reception areas up to date, making sure automatic airfresheners in rest rooms are re-filled regularly. Your scheduled office cleaner can complete such tasks for you. Each business will have personal requirements. During a detailed meeting with your cleaner, task lists are created to ensure your priorities are fully catered too, making sure your business image and values are protected.

Contact Us to keep it in control

You could look around your office and identify hundreds of different priorities for cleaning. The most important thing is that these tasks be completed thoroughly and reliably. In most cases the most efficient way to ensure this happens is to use a professional office cleaning service. Goddess Cleaning Group can provide an obligation free assessment of your office today. Contact Us Today at

© Domestic Goddess Home Services Pty Ltd

Designed by

warcinfo:
isPartOf: CC-MAIN-2018-34
publisher: Common Crawl
description: Wide crawl of the web for August 2018
operator: Common Crawl Admin (info@commoncrawl.org)
hostname: ip-10-165-88-201.ec2.internal
software: Apache Nutch 1.15 (modified, https://github.com/commoncrawl/nutch/)
robots: checked via crawler-commons 0.11-SNAPSHOT (https://github.com/crawler-commons/crawler-commons)
format: WARC File Format 1.1
conformsTo: http://iipc.github.io/warc-specifications/specifications/warc-format/warc-1.1/


WARC-Identified-Payload-Type: application/xhtml+xml

text:
Game Headz Product
  Loading... Please wait...
  • Image 1

*USED* Simpsons Road Rage [T] for Xbox

Product Description

Author/Artist:   Simpsons Road Rage by EA

Description 2:   Simpsons Road Rage on Xbox

Department:   XBOX

Manufacturer:   EA

Find Similar Products by Category

Product Reviews

This product hasn't received any reviews yet. Be the first to review this product!

Write your own product review

Connect with us Facebook Twitter LinkedIn

GameHeadz Logo

Loading Product Name...

Loading Sku...

Loading Price...

Fill out fields below and click the send button to request product or press cancel to cancel the request.

Click the button below to add the *USED* Simpsons Road Rage [T] for Xbox to your wish list.


text:
Game Headz Product
  Loading... Please wait...
  • Wii U Peach Wired Fight Pad

Wii U Fight Pad Peach Smash Bros

Product Description

Wii U Peach Wired Fight Pad

The Wired Fight Pad for Wii U is a new line of Classic/Classic Pro Controllers from Performance Designed Products. With minor adjustments, we have built controllers that evoke memories and feelings tied to the now classic GameCube controller. Just plug a Wired Fight Pad into an active Wii remote, and you're set!

Find Similar Products by Category

Product Reviews

This product hasn't received any reviews yet. Be the first to review this product!

Write your own product review

Connect with us Facebook Twitter LinkedIn

GameHeadz Logo

Loading Product Name...

Loading Sku...

Loading Price...

Fill out fields below and click the send button to request product or press cancel to cancel the request.

Click the button below to add the Wii U Fight Pad Peach Smash Bros to your wish list.


text:
Golf Training Center, Logo
Phone Icon (470) 205-4619

We Take Care of Your Golf Clubs

Every customer at Golf Training Center in Covington, Georgia, feels like a VIP when golfing at our range. We take care of your equipment as if it was our own. Our company offers customized fittings and repairs for your clubs.

A Golf Club and Ball

Personalize Your Clubs

Getting the best clubs for your body and form when playing this sport can mean a world of difference when you play. When a club is fitted to your specifications, it will swing like a dream. Our team looks at a variety of factors for customized clubs.

During these fittings, we determine the size of your club's shaft based off your height. People that are taller experience a harder time with clubs because they do not have the ability to choke-up on the grip. If this is your case, then you will receive clubs with a longer shaft.

We also look at your form when you are swinging your clubs. How fast you swing, as well as what tempo you swing at, can tell us a lot about what size clubs you require. Through these two measurements, we will be able to make customized golf clubs.

Club Repair for Any Damages

Come to our shop if you have a broken or damaged club. We are able to apply new grips to your club, re-shaft your clubs, and adjust them to fit your needs. The shaft of your clubs can become bent when hitting balls close to obstacles such as trees. After years of use, rust or breakage can also occur. We are able to repair all of these issues as they arise.

Small adjustments are a quick and easy fix for our team. We understand that your needs for your clubs lie and loft could be different from what we have available in store. Through evaluation of your swing, we will be able to create the perfect clubs for you.


text:
Wise Guys on WHO Radio - June 27, 2015

Brian Gongol

The WHO Radio Wise Guys airs on WHO Radio in Des Moines, Iowa on 1040 AM or streaming online at WHORadio.com. The show airs from 1 to 2 pm Central Time on Saturday afternoons. A podcast of show highlights is also available. Leave comments and questions on the Wise Guys Facebook page or e-mail them to wiseguys@whoradio.com.

Please note: These show notes may be in various stages of completion -- ranging from brainstormed notes through to well-polished monologues. Please excuse anything that may seem rough around the edges, as it may only be a first draft of a thought and not be fully representative of what was said on the air.

In the news this week

Security update

Samsung, you're not helping when you disable Windows updates. Use those updates, people!

Street-smart social media

Emojis: Do you use them? Got one you think delivers a special message? For now, they're a cute enhancement to some messages, but I don't really think they're going to be the "in" thing for long. A few people will overdose on them for now, but I think they'll become less prominent (though I don't see them going away). Hieroglyphics haven't predominated over phonetic writing, either.

Gadget of the week

It's not exactly a gadget, but it's a useful application: If you lack creativity in the kitchen and the patience to flip through a cookbook, IBM Chef Watson is for you. You input the ingredients you have in the fridge and Watson generates a recipe for you.

Dispatches from the flying-car future

Bill Gates thinks Uber will lead on self-driving cars. I think trucking companies and outside sales will push it too. Uber definitely has an incentive to push this kind of technology, but there are whole industries that could be enormous potential markets if the technology is brought up to full speed. But we should fully anticipate that self-driving cars will arrive as an evolutionary change, not a revolution -- we already have cars that can parallel park themselves and cars that start to take over if the driver drifts from his or her lane. There will be additional incremental steps from these that will result in cars taking over 20%, then 30%, then 40%, and then 50% of the actual driving. At that point, we'll probably capitulate and let them jump from 50% to 100% or something close to it. I don't see it going from where we are today to fully self-driving cars overnight, but I think we'll see the intermediate steps arriving faster and faster.

Politics of technology

French taxi drivers are really, really mad about Uber. You can always count on the workers displaced by technology to be its loudest opponents.

Listen again on-demand


text:
Skip to main content Skip to footer
Download Schedules To Your Calendar Super Scoreboard | Ticket Office

Now fans can download and install the latest Penn State schedules into their calendar! Schedules will be available near the beginning of the respective sport's season. You can either download the schedules or subscribe to the calendar to ensure you are receiving updates automatically.

  • Loading Tweets...
    1 second ago


text:
Skip to main content Skip to footer
No. 8 MT&F captures Sykes & Sabock Challenge Cup

Follow PSU Track & Field:

Feb. 3, 2018

Photo Gallery

Complete Results

- the No. 8 Penn State men's track team captured the Sykes & Sabock Challenge Cup by over 142 points as the Nittany Lions racked up 254 total points over the two-day competition. The No. 24 women's team finished second in the team competition trailing Cornell by only 18.5 points. Day two of the Sykes & Sabock Challenge Cup was also Senior Day for Penn State who honored 16 individuals.

Colin Abert added his name to the list of Penn State sub-four-minute milers as the junior from Easton, Pa. crossed the line in 3:59.51 Saturday afternoon. Abert's time is a personal best as well as currently ranked No.3 in the Big Ten and No. 9 in the NCAA.

Also recording a personal best mark in the mile was Timothy McGowan who recorded a time of 4:04.97, Owen Wing at 4:10.86, John McGowan at 4:11.54, James Abrahams at 4:15.26 and Brady Bobbitt at 4:15.71.

In the women's mile, Greta Lindsley led the way for a Penn State sweep. Lindsley took the title in a personal best of 4:43.34 followed by dual-sport athlete Marissa Sheva in a personal best 4:47.96 while Jillian Hunsberger capped the sweep with her personal best of 4:49.88. Lisa Bennatan at 4:53.18, Kathryn Munks at 4:55.46 and Alison Willingmyre at 4:58.64 also posted PR's in the event.

Tristan Daman posted a personal best in the 400-meters running 50.02 for fifth-place. He would return later in the meet to also post a personal best in the 200-meters with his time of 21.76.

In the women's 400-meters, Victoria Tachinski took the title in a personal best time of 56.32 while teammate Lauren Costa crossed the line in 57.40 for fourth-place.

Gary Ross (1:19.88), William Ashenfelter (1:21.52) and Joey Logue (1:21.64) swept the men's 600-meters collecting 24-points along the way while in the women's 600-meters Frances Bull (1:32.31) was the event winner. Teammate Elyse Skerpon (1:34.18) took fifth in a personal best time adding four points.

Penn State put four Nittany Lions in the top-eight of the men's 800-meters as Jordan Makins (1:51.19), Billy McDevitt (1:53.01), Samuel Reiser (1:53.43) and Tommy Louro finished first, third, fourth and eighth, respectively.

The women's team put three in the top-eight of the women's 800-meters led by Greta Lindsley (2:11.38) in a personal best time finishing second while Marissa Sheva (2:15.28) and Grace Trucilla (2:15.64) finished seventh and eighth, respectively.

The aforementioned Daman, who finished second in the 400-meters and won the 200-meters was joined in scoring for the 200-meters by Will Henderson (22.01, Darien Williams (22.31) and Luke Rarig (23.88) in third, sixth and eighth-place, respectively.

Once again, Penn State placed four Nittany Lions in the top-eight this time in the men's shot put. Ben Peterson threw a personal best of 18.12m (59'-9.50") for first-place, while Jon Yohman was a close second with his mark of 17.94m (58'-10.25") for second-place. David Lucas and Luke Grodeska rounded out the scoring for Penn State in the event with their fifth and sixth-place finishes.

The lone scorer in the women's 3K for Penn State was Lisa Bennatan who finished runner-up in the event running 9:45.04.

The Nittany Lions also swept the 4x400-meter relays as the men's squad posted a top time of 3:18.06 while the women's relay ran 3:47.32.

Obeng Marfo captured the women's shot put title with her heave of 15.29m (50'-2")

Penn State posted a 2-3-4 finish in the men's high jump with Devin Bradham and Chisom Ifedi clearing 2.04m (6'-8.25") and Spence Hay clearing 1.99m (6'-6.25"), respectively.

Bryce Williams took the men's triple jump title with his leap of 15.52m (50'-11") followed by Darian Alston who finished with a best of 14.38m (47'-2.25") in fourth-place. In the women's triple jump, Kelsey Vieira was the top Nittany Lion on the day with her mark of 11.88m (38'-11.75").

Penn State will split squads next week as the Nittany Lions will compete in the Spire Invitational (Geneva, Ohio), Husky Classic (Seattle, Wash.) and Iowa State Classic (Ames, Iowa).

For more on Nittany Lion track & field, log onto or follow the team on Twitter @PennStateTFXC.

  • Loading Tweets...
    1 second ago


text:
Holding On

Search By:

Search Gospel Songs by Letter:

Holding On

Artist: The Williams Brothers
Album: Holding On
Lyrics: Holding On Lyrics

Free MP3 Song Download - Holding On

Other The Williams Brothers Songs

Contact Us

All lyrics are property and copyright of their owners. All lyrics provided for educational purposes only.
Copyright © 2011-2018 All Rights Reserved.


text:
Main page content begins here

Infrastructure such as sewers and structures in the drainage system deteriorate over time. The Drainage System Rehabilitation Program covers infrastructure not included in the
Drainage Neighbourhood Renewal Program.

This program renews drainage and sewage systems that are in poor condition. This helps to prevent infrastructure failures and minimize damage to public and private properties.

Program Scope

This program covers the following components:

  1. Trunk Sewer Rehabilitation
    This work includes assessing pipe conditions and minor repair of combined, sanitary, and storm trunk sewers.
  2. City Wide Odour Control
    This work includes construction and upgrading of drainage related odour control facilities throughout the City and addresses odour issues.
  3. Pump Station Rehabilitation
    This work includes rehabilitation of pump stations to make sure they are in good condition.
  4. Drill Drop Manhole Rehabilitation
    Drill Drop Manhole is a small diameter (600mm) corrugated steel pipe installed as drop manhole to a deep sewer tunnel. This work rehabilitates these drill drop manholes as they are prone to corrosion and deteriorate much quicker than standard concrete manholes.
  5. Storm Outfall Rehabilitation
    This rehabilitation includes inspection and repair to counteract river action, ice flow damage, erosion, and bank instability of storm outfalls. Rehabilitation is done on a priority basis.
  6. High Priority Repair
    This work provides emergency repairs to the sewer system.
  7. Local Sewer Rehabilitation
    This rehabilitation provides systematic inspection and repair of deteriorated sewers (less than 600mm in diameter), manholes, catchbasins, and catchbasin leads.
  8. Roadway/Drainage Rehabilitation Coordination
    This work provides coordination of sewer rehabilitation with the Arterial Road Reconstruction Program.
  9. Creek Erosion Protection
    Permanent Area Contribution (PAC) is being collected from developers contributing flow to Whitemud, Blackmud, and Gold Bar Creek basins on creek erosion protection.

  • reduces the amount of emergency repairs and short term maintenance required to the infrastructure
  • reduces the possibility of sewer back-ups due to sewer or service connection blockages
  • minimizes disruptions to the public through orderly execution of construction works

End of page content. Please choose between the following five options:

Back to main menu Back to current page menu and content View current page breadcrumb Back to site search Continue to page footer content


text:
Main page content begins here

The resources provided below are for informational purposes only.

The City of Edmonton does not endorse nor make any representation or warranty about the accuracy, reliability, currency or completeness of any such material or information. Links to other websites are inserted for convenience and do not constitute endorsement of material at those sites, or any associated organization, product or service.

The City of Edmonton is not liable for any loss resulting from any action taken or reliance made by you on any information or material referenced herein (including, without limitation, third party information).

For More Information

Citizen Access and Inclusion

Title Accessibility Services Liaison Officer

TTY 780-944-5555 code: DISREC

End of page content. Please choose between the following five options:

Back to main menu Back to current page menu and content View current page breadcrumb Back to site search Continue to page footer content


text:
Tri-County Youth Sports Grant
Tri-County Youth Sports Grant Winners

Mike started his volunteering back in 1977 when he coached the Little League program in Peoria Heights. Don Matthews was the director. Mike later became the director of this program. The youths involved were 7 to 12 years old.

He also coached in the Little League program at the ALF's program at the Herke Field at Central High School.

He volunteered for many years at Woodrow Wilson and Hines grade school programs.

He eventually took over the program at Woodrow Wilson and was the director.

While at Peoria Central Little League he turned that program around, including a summer's end cookout for the parents and the young players, where everyone got involved with games and activities.

The many area coaches all said if you ever asked Mike Persich to help in any basketball or baseball programs where the youth of central Illinois were involved, Mike never hesitated to pitch in and help.

Mike received a certificate from Mayor Bud Grieves a few years ago which was a commendation for all the volunteering he does for our young people.

He has worked full time for the last 23 years at United Parcel Service.

Mike has worked with the basketball program at Woodruff on recent years and now is Assistant Varsity Coach there.

Mike credits his parents and four older brothers who helped him in growing up and being the citizen he is. Mike is married to his wife, Misty, and has a young son, Noah. Misty is expecting another child in September.


text:
Thank You for your visit and support

The GPS Athletes Super Store is the home of runners who run, train and race with GPSs is the home of cyclists who ride, train and race with GPSs

In association with

Bestsellers > Books > Religion & Spirituality

Sorry, we are currently unable to process your request in a timely manner.
Please try again later.

script by MrRat


text:
Our Programs Center Around You

Welcome to the Edmund J. Gleazer School of Education at Graceland University. Our undergraduate and graduate programs have been uniquely created with our students in mind. In addition to serving traditional undergrads on the Lamoni campus, the Gleazer School of Education also offers accelerated undergraduate degree completion opportunities on both of its campuses for adult learners, as well as graduate degrees on its Independence campus. These programs that service all learner needs with their diverse options, continue to receive highest praise from accreditors and other agencies that recognize quality programs.

Our faculty are concerned with your learning experience and go the additional lengths to make certain you are being served by our program. In addition, all faculty for our programs have been selected because of the unique contribution they make to the Graceland mission.

Our programs center around you. The undergraduate teacher education programs are taught using progressive methods and a student-centered philosophy. Our Master of Education in Collaborative Learning and Teaching has garnered national praise for its unique design, in which graduate students create their own learning experiences based on the National Board for Professional Teaching Standards propositions. Our online Master of Education was recently honored with the prestigious USDLA Award for Best Practices in Distance Learning Programming. We have some very exciting experiences waiting for you.

Our unique approach allows you to decide how you would most like to learn, while giving you the strong foundation to take your professional development to National Board Certification status and beyond — to lifelong learning and enhancement of the overall quality of your life. Thank you for your interest in our programs.


text:
Saturday, March 03, 2007

River Walk

Today our family walk took us along the river's bike path. It was easy walking, but brisk and chilly! A friendly dog decided to adopt us and walked along beside and around us. He would befriend the dogs of other walkers and bike riders, and we were sure they thought this friendly dog ours and wondered why we didn't contain him more! But, he was a free-spirit and wouldn't even allow a little petting, let alone giving any attention to those who wished he'd be a little less friendly to their little dog! The exercise was invigorating and good for us, but a warmer day sure would be nice!

No comments:

Post a Comment

Thank you for commenting on my blog post. I am always happy to hear from blog readers. Your words encourage and inspire me. I am glad you stopped by to share conversation, recipes, ideas, and thoughts on creating a welcoming home.


text:
Pitanje 1:

People who win the lottery are usually advised not to ....... their address and phone number.

Pitanje 2:

The young couple in the story only meet about three times but still manage to ....... deeply in love.

Pitanje 3:

You really shouldn't ....... everything you read in the papers.

Pitanje 4:

I usually ....... up six at 6.30 a.m. every morning.

Pitanje 5:

The tortoise agreed that the hare ran as fast as the wind but claimed that he could easily ....... him in a race.

Pitanje 6:

If you think I didn't catch you ....... that young waitress, you're quite mistaken.

Pitanje 7:

Even if I ....... for a hundred years, I couldn't possibly reach your standard.

Pitanje 8:

Alethea Gibson ....... to play tennis on the streets of New York City.

Pitanje 9:

The only way to ....... with this one, Ted recommended, was to rush at the door, shove the letters through the door and go away as quickly as possible.

Pitanje 10:

Immediately Andrew started to worry. He didn't know her name. He didn't know her address and he felt strange. He ....... his pulse. He tests his mental faculties: Two and two make four.

Google Plus One

Preporucite Nas

Postanite Fan Gramatika.org portala na Facebook-u !

Web pretraživanje


text:
George Ronald Publisher

Authentic, Accurate and Inspiring Books on the Bahá'í Faith

A Feast Of ABCs

A Feast of ABCs Book Cover

by Gail Radley

An alphabetical approach to the Nineteen Day Feast, featuring children and their activities from around the world. Illustrated by Malcolm Lee.

A delightful ABC book for children about the Nineteen Day Feast by a well-known and popular writer for young people. Features children of many nationalities in its charming illustrations.
J is for joy.
The Feast is a time of joy for Josef because he feels so close to all the Bahá'ís.
'This Feast is a bringer of joy. It is the groundwork of agreement and unity. It is the key to affection and fellowship.' 'Abdu'l-Bahá

ISBN: 978-0-85398-409-2

56 pages, 26 drawings
25.5 x 17.6 cm. (l0 x 7 in)

Soft Cover - £4.95 / $9.95 - Add To Cart

Share this page


text:
Out of this World: Moon at the Royal Observatory

Events > 2018 > February > Out of this World: Moon at the Royal Observatory

About this event:

Created by Gmums HQ

The Royal Observatory

Experience this Out of this World: Moon at the Royal Observatory.

This event is suitable for: 8 - 12 years, 13 - 16 years, 16 years+

This event costs: £6

Our Moon-themed morning includes a planetarium show, interactive quiz and immersive virtual reality activity.

Join our Royal Observatory Astronomers for a series of activity packages for older children that include a planetarium show, two interactive workshops and a chance to talk to our astronomers.

Start your orientation in our state of the art digital planetarium to visit some popular destinations within our Solar System and beyond. Continue your mission with a brain-bending Moon quiz using voting keypads and featuring stunning images of our natural satellite. Finally, take a virtual step onto the Moon with our virtual reality activity to feel what it’s like to step onto the lunar surface. This will be combined with meteorite handling and a chance to ask astronomers about the possibility of humans returning to the Moon and building lunar bases.

Please note the gates to the Royal Observatory Greenwich’s Astronomy Centre only open at 10 am. On arrival please proceed to the planetarium.

Price: £6

Contact Details

Telephone: +44 (0)20 8312 6608
Email the team here!
Website URL: www.rmg.co.uk

Address Details

Location: Royal Observatory, Planetarium & Astronomy Centre

Details are subject to change so please make sure you check with the venue before setting out. Thanks!

Speak Your Mind


text:
Woodstock   |  SKU: D1256
6" x 48" A/O Sanding Belt 60 Grit, 2 pk.
Price: $13.95
Recently Added ×
You May Also Like

Woodstock - 6" x 48" A/O Sanding Belt 60 Grit, 2 pk.

click to zoom

tap to zoom

See this item in our 2018 Main Catalog!
Buy Now!
Freight:  Freight
Tariff Fee:  Tariff Fee
Oversize:  Oversize
Monthly payments as low as . Learn More
These tough Aluminum Oxide 60 grit 6" x 48" sanding belts are sized right for all of your belt sanding needs and are sold in a 2 pack.
Show More...

Accessories and Related Items: View All

You May Also Like:

Customers who purchased this item also purchased:

4 Customer Reviews (5 out of 5 stars): Sign in to write a review

Henry M
The best on the market. 3/30/2018

Grizzly carries the best and I'm very pleased with their products.

Ask A Question
Animation for D1256


text:
Since 1996, Guardian Publishing has partnered with medical societies, business associations and other professional organizations, providing free educational content to enhance membership value. Guardian experts have written numerous articles, delivered hundreds or presentations and authored over a dozen books for physicians, business owners and entrepreneurs.

Contact Guardian Publishing to learn more about our written, recorded and live material that will educate and engage your members.

Partner with Guardian

Speak with us about how you can add membership value by offering free Guardian Publishing materials and presentations.

Learn More  blue-arrow

Our Books

Order a copy of one of Guardian's many books. Order Now  blue-arrow
Free promotional copies are available for medical society and business association representatives. Contact us for details!

Sign up for our free quarterly newsletter that updates you on Guardian's latest publications, presentations and more.


text:
G200 Memorabilia

G200 Memorabilia

Gurkha 200 Stamp IssueGurkhas Comm Pack visual

This Commemorative Sheet traces the history of this famed fighting force who have served the British Crown for 200 years. Gurkhas have played a vital part in British military operations since the raising of the first Gurkha regiments in 1815. Originally part of the British Indian Army, they fought Pathans on the frontiers, dacoits in Burma and mutineers in India. With six battalions on the Western Front, four in Gallipoli and others in Mesopotamia, Egypt, Palestine, Persia and Salonika, Gurkhas were prominent in the First World War, and similarly so in the Second World War, where they served in North Africa, Italy, Malaya and Burma. After 1947, Gurkha regiments were divided between the armies of independent India and Britain, with British Gurkhas in the forefront of operations in Malaya and Borneo, and subsequently taking part in the Falklands campaign, and more recently in Bosnia, Kosovo, East Timor, Sierra Leone, Iraq and Afghanistan. Ten labels illustrate the history of Gurkhas from 1815 in the foothills of the Himalayas to recent operations in Afghanistan and the work of the Gurkha Welfare Trust. Contains ten Union Flag stamps and is a limited edition of 7500.

Obtainable from The Gurkha Museum Shop at £14.95 plus postage and packing.

Gurkha 200 Commemorative Medal

medal 1 medal 2

The Brigade of Gurkhas have issued a fine Commemorative Medal to celebrate 200 years of Gurkha history. Created by Alfred Pain FRSA, BA Hons, himself a former Gurkha Officer and a Member of the Contemporary British Silversmiths. The Medal bears a Nepali inscription “Gun, Khun, Nun” (because of quality of military heritage, blood spilled and salt [oath]) chosen by the legendary Col J P Cross summing up Gurkha Service to the Crown over 200 years.  The 57 mm Medal, cast in solid bronze, has been produced by Bigbury Mint in Devon who pride themselves on high quality workmanship with excellent service.  Available from the Gurkha Museum. Product Code 996. Price: £35 + £4.50 postage and packing.

Gurkha ChampagneGurkha Champagne

A special cuvée of Champagne has been created to mark the 200th Anniversary of The Gurkhas service to the British Crown. The Champagne is from Philippe Brugnon’s Premier Cru vineyards of Rilly la Montagne.

The profit proceeds from the sale of this Champagne are donated to The Gurkha Welfare Trust. Philippe Brugnon and his UK agent, Julian White, are pleased to be associated with this great cause – a charitable trust that supports these distinguished and valiant soldiers now retired and living back in Nepal. The Gurkha Welfare Trust is the leading Gurkha charity, providing financial, medical and community aid to Gurkha ex-servicemen of the British Crown.

The Champagne is available from the 21st March 2015 from Julian White Agencies.
Contact Julian White – julian@julianwhite.com
44 Peel Street, Kensington, London W8 7PD
Telephone:020 7727 0780

The Price including delivery and VAT is £26 per bottle, £147 per case of six, £143 per case of six if ordering 2 or more cases. This applies to the UK Mainland excluding Scotland; please enquire for deliveries to Scotland quoting the postcode of the destination.

Cheques to Julian White Agencies or Bank transfer to
D J H WHITE WINES Lloyds Branch
Sort Code 30 97 95
Account Number 00527516

G200 Plate in white background

The Headquarters Brigade of Gurkhas (HQBG), in conjunction with the Gurkha Museum (GM) has organised the production of a bone china plate (Approx 10 ½”) showing all of the badges of the past and present units of the Gurkha Brigade with the G200 logo at the centre of the plate.  The cost of the plate is £29.95 including P&P, or £27.75 if collected direct.  Full details with picture and order form are attached.

We are prepared to arrange for bulk orders (for a group of 20 or more customers from one location/unit PRI’s) to be transported within the UK @£27.75 per plate, which includes packing.

RGR G200 Watch

Brigade of Gurkhas Watch Poster Rev

G200 watches

(Hon Sec Note:  In addition to and not to be confused with the RGR watch commemorating G200 with the RGR cap-badge (see Link here), a more general Brigade watch is also to be produced.  If any member is interested in the crossed kukri version of the watch, please submit your application direct to WO2 Prakash Rai by 24 Jul 14.)

To commemorate the 200th anniversary of the Brigade of Gurkhas serving in the British Army a limited edition watch has been designed by Breitling through Andrew Michael’s Jewellers (AMJ) and will be sold at a discounted price to all serving and retired members of the Brigade.  The design of the watch (similar to that commissioned by the RGR) can be seen by clicking here:   G200 is a Brigade event and this watch aims to encompass our current and past units, all under our current Brigade of Gurkhas capbadge.

Order Procedure

Any personnel wishing purchase this unique time piece should fill their personal details in the attached spreadsheet(click here for ordering spreadsheet) and email back to the undersigned (manprakash127@hotmail.co.uk  orPrakash.Rai321@mod.uk ). Please do not collate the details from others and send collectively. For ease of contacting personnel it is requested that each person send details individually.  A civilian email address is preferred as it is more accessible than military DII.

Preferred Watch Number

Once your order has been received individuals will be notified.  Individuals may request a preferred watch number (1 – 200) however watches will be allocated on a first come first serve basis (as they appear in my email inbox). Please do not delay.

The aim is to get 200 orders, if there are more than 200 orders Breitling will donate £4,000 to a charity of HQBG’s choice.

Sales Administration

Cut off date for the return is Thursday 24th Jul 14.  A collated order form will then be sent to the AMJ and they will contact individuals to register an account on their web portal.  AMJ will take over the entire administration and sale process from this point onwards.

Payment method is as follows:

  1. Once the AJM account has been activated, a deposit of £100 must be paid.
  2. Once the deposit has been paid it will be up to the individual to manage their own accounts.  The best way to do this is to set up a direct debit for a set sum each month so that the cost is spread.  The amount paid each month is up to the individual.
  3. The payment scheme is flexible and additional payments can be made.
  4. Any outstanding balance must be paid in full before the watches are distributed in Feb 2015.

Points of contact

Brigade of Gurkhas G200 watch

WO2 Prakash Rai GCGI EngTech MInstRE
G2 Provo Warrant Officer
Jellalabad 63
Tidworth Garrison

Email:  manprakash127@hotmail.co.uk

Tel: 01980 650750 | Fax: 01980 650870

RGR  G200 watch

Capt J K Armstrong
OC ATk, SP Coy, 2 RGR
Sir John Moore Barracks
Folkestone, Kent
CT20 3HJ

Email: 2RGR-SpCoy-ATk-Comd@mod.uk

Mil: 94281 2352 | Civ: 01303 225 2352


text:
No avatar
Experienced Customer
Online: Offline
(Based on 27 feedbacks)
In-game name: Unnamed Xp
Auctions running: 0
Items sold in-game: 0
Items bought in-game: 28
Last activity: Jan 10 2012 20:29:29
Joined: Jan 05 2011 11:42:36
User's local time: 03:32:33
Send Alexander a message.
Hide menu
Guild Wars
Please keep in mind that GW Auctions is not related to ArenaNet or NCSoft in any way. Nothing stated on this site is official Guild Wars news or policy, unless clearly quoted with an URL to the source.
All Guild Wars related material is the property of ArenaNet.

[Valid RSS] Valid CSS! Valid CSS! Valid XHTML 1.0 Transitional

This site runs best in Firefox.

This script took 0.0162 seconds to run.


text:
John Tibbs Returns To Indie Roots With Heartland EP Releasing This Fall

John Tibbs

Singer/songwriter John Tibbs returns to his independent roots in partnership with PledgeMusic and Tone Tree Music for his Heartland EP set to release this fall on Windmill & Wave Records. Through July 14, pledgers who preorder the EP at will receive an instant download of the first single from the recording, "Won't Let Me Go.
Produced by Ben Shive (Colony House, Rend Collective, Ellie Holcomb), the single has already become Tibbs' top-played song on Spotify while the song's lyric video gathered 45,000 views and 600 shares on Facebook in just the first two days following its release.
"I sing this song as a reminder to myself to spend less time worrying, and more time dreaming," says Tibbs of the new single. "I sing it in hopes that it may encourage someone else to be bold and pursue that thing that scares them to death. I think fear is only a sign that our dreams are getting close to becoming a reality."
In addition to the new single, PledgeMusic is offering a variety of limited-edition products and exclusives from Tibbs, including a Skype meeting and a walking tour of Nashville with Tibbs, an invitation to a listening party for the new album, an acoustic concert at the pledger's house by Tibbs and much more. All pledgers will also gain exclusive access to new music, videos from the studio, photos from the road, sneak peeks at unfinished tracks and more.
"Heartland is my best music yet, and I was determined to bring you guys into the process as much as possible," shares Tibbs. "I believe the purpose of music is to create meaningful connection and partnering with PledgeMusic was the perfect way to make music with a community.
"Each song in Heartland embodies the place where I learned the stuff of life -- fear, love, anger, doubt and hope," adds Tibbs. "As a proud, homegrown boy of the Midwest, I'm tipping my hat to the greats that shaped my youth, like Bruce Springsteen, John Mellencamp and Tom Petty. But more than anything, I hope that when you hear this record and listen to these songs, you hear my heart. Because I mean every last bit of it."

Tags : John Tibbs heartland john tibbs new ep john tibbs news

Hot Trends

Most Popular

popular videos


text:
Online payment methods lead to increased UK e-commerce spend

Online payment methods lead to increased UK e-commerce spend

New research has shown that online payment methods have led to an increase in UK e-commerce spend by over 25% in the past two years.

The study, carried out by the UK Cards Association found that 1.3 billion purchases were made online in 2014, and in only two years this total increased by a massive 38% to reach 1.8 billion. On average, 150 million transactions per month are now made using online payment methods.

UK online card spend totalled £154 billion in 2016, with an average of £422 million spent on e-commerce websites each day. Consumers in the UK spend more money online per household than any country in the world, with British shoppers spending over £4,500 online in 2015.

The average transaction value of online purchases has also recently changed. In the past, consumers would use online payment methods to carry out higher value purchases over the internet. The average value has now dropped by £9, meaning that internet shopping is becoming more commonplace for everyday purchases.

One e-commerce sector seeing a huge growth in online sales is the clothing industry, with consumers now using the internet for nearly a quarter of all clothing transactions. Event tickets are also seeing a surge in the number of internet orders, with up to 67 per cent of ticket sales now made online.

Companies who don’t provide their customers with suitable online payment methods are missing out on extra income, with previous research showing that businesses without a website are missing out on up to £20,000 per year. If they started trading online, it would lead to a boost of £8.4bn per year to the UK economy!

Make sure that your business doesn’t miss out on profits by implement online payment methods for your customers. We provide cost-effective e-commerce solutions for small business owners, starting at less than £10 per month. Get in touch today to find out how online payments could help your business grow.


text:
Not seeing a Scroll to Top Button
Product Reviews, Book Reviews, Fun Giveaways, And Life As A Mama! Supporting Our Troops And Veterans!

Monday, August 1, 2016

#BTS2016 With Dorm Co.

Decorating a dorm room with such limited space might not always be easy, but there is a one-stop-shop solution for all the college living essentials for back to school. DormCo, the leader in college dorm essentials, offers everything college bound students need for a comfortable and enjoyable dorm life - from trendy Twin XL bedding to decorative rugs, furniture, cookware, electronics security gear, and storage solutions to make the most of precious space.
You're going to find there are a lot of small dorm items that don't have a designated place in your dorm room other than the temporary home in a pile on your dorm bed. You obviously need somewhere to sleep night after night, so leaving them there won't exactly work and you can't create a junk drawer in your dorm desk. Mainly because your dorm desk may not have drawers. The simple solution is to add more dorm storage solutions to your dorm essentials! The Bright Orange Texture Mini-Trunks (Set of 2) - Block Style are small dorm essentials that can sit on top of your dorm desk or dresser and keep your smaller dorm items organized. The Texture Mini-Trunks will add to your dorm room decor while keeping your small dorm necessities in line. With orange textured fabric around the entirety of each dorm trunk and riveted details around the edges, these dorm storage solutions will add classic style and a pop of color to your dorm room decor. These dorm storage solutions have the benefit of portability, allowing you to easily take them on a weekend trip home or a mini vacation with friends. The size of these mini-trunks will allow you to easily store small dorm items such as cosmetics, art supplies, paperback books, and more. For extra dorm room decor, you could even artistically arrange all those small dorm items inside and have the lid propped open for presentation.

Check it all out at Dorm Co on Facebook, as well as Dorm Co on Twitter.

No comments:

Post a Comment

Thank you so much for taking the time to comment! I LOVE comments! :)


text:
L to R -- Vanessa Gunderson, Lexi Larsen, Lexie Holloway and Ashley Hall.

Cheering on the Cyclones

DES MOINES -- Fans were on hand cheering on the HCHS Cyclone baseball team to a 5-4 win over Boone Tuesday evening.
    The Cyclones advanced to the semi-finals of the tourney and take on Waverly-Shell Rock today at 11 a.m. at Principal Park in Des Moines.
    See sports pages today for highlights from the quarterfinal game vs. Boone and a preview of the semi-final contest.  (Photo by Mike Oeffner)

Read this story and the entire paper for only $1 online
Search back issues, email stories, flip through pages and skim headlines just as you would with a newspaper in your hands.
Create an account and buy a paper anytime you want for only $1 per issue Or buy a year subscription for $39.95

Comment Here


text:
29 June 2013

Le Tour De France 2013: A Busload of Chaos

About 30 minutes before the end of the stage today, a bus ran into the race banner at the finish line and got stuck. Better worded, there is a joke there. Too bad it was what actually happened today.

01 May 2013

WGC Narrative 2014: The Army is built, now to paint...

Now that I've finally rounded up all the models and put them together, the work has begun painting my army for the 2014 narrative.

21 November 2012

COMICS: A New Age of Brilliance

Comic Books are in a New Age of Brilliance. Not so much an earth shattering thought as a link grabbing first line. But the argument is to be made that currently comic books are seeing the apex of years of forces leading us towards so many brilliant story tellers in the medium all at once.

The cover of Uncanny X-men 217, my first regular issue of X-Men. The image is owned by Marvel Comics.


text:
The Ghosts of Notre Dame

Notre Dame is probably one of the most famous cathedrals in the world.  It took over 200 years to built and was one of the first Gothic cathedrals to feature flying buttresses.  It has witnessed the ebb and flow of history for almost a millenia.   During the French Revolution it was desecrated.  It witnessed both world wars and many other wars.   It is said to house the ghosts of kings and many great men.   As soon as you walk in front of the doors of the great old Cathedral you can almost feel the eyes of the cathedral itself staring at you.  Stone faces carved into the door look down at you with haunting eyes.

The Cathedral was restored in the 19th century and today is one of the most striking structures in Paris.  From the gargoyles that sit on top of the building looking out with their cold stone glare to the famous rose window within the church walking through the cathedral is like walking through living breathing art.   It is also like walking though history. Coils of history are twisted within the walls of Notre Dame and pictures taken here are often thick with the ghosts of those that have walked through her sacred walls.  Notre Dame is called one of the ten most haunted places in France and it is certainly the most haunting.  Out of the many buildings I saw in France, this is probably the most extraordinarily beautiful buildings I walked through.

Courtney Mroch said…
OMG! I love the pics. Especially of the gargoyles. Fantastic!
PaleMother said…
So photogenic. When I was there, I didn't have much time and it was very crowded. I had no idea it was one of the "ten most haunted." Cool.

Have you heard of this blog?

I just read an intriguing post there today (it is the second in a series). The incident happened in (northern) Michigan.

At first I thought I found the blog through you (?), but on second thought, maybe I found him while looking something up on the net -- a dream that I had of an ominous grey figure in a trench coat and an odd hat -- when I googled the description of this character, it turns out this it is known (sort of like the mothman is known ... uban legend style?) and others have reported similar experiences:

Anyway, it's an interesting blog. Thought you might enjoy it.
Hamilton Coe said…
Notre Dame is fantastic! It's a long time since I've been to France: these recent posts made me feel quite nostalgic. Do you know about the famous Versailles time slip recounted in the book 'An Adventure'? I'm very sceptical about it, but it's a good story nonetheless.
Jessica Penot said…
Palemother... I will go check that blog out. I'm always looking for new blogs. I love to read. Thanks

Hamilton... I haven't heard of the Versailles time slip but I'll look into it. I have a cousin who works there. Maybe she'll know about it!
I've been looking for information on French ghosts for some time and have found very little. I'd love to find out more about French ghosts, I've seen so little out there about them. Keep up the good work!

Popular Posts


text:
Monday, December 10, 2012

Your Skin

Hey I am doing like nothing but skins because sooo many are being released by

Lara of [Mystic Canvass] for so many different events that I am going to just pile them all on one blog post!! Yippie for knockin' 'em out!
Above is the "Winter" skin and it comes with 3 styles, with cleavage options for:

Also, we have "AJ" above in a light tone with bold make ups. It comes with hair bases and cleavage options, also eye brow shaping options.
This is available @ [--] Forgotten Closet [--]
These cute earrings are from .:Bens Beauty:. for Fi*Friday and you can find them HERE:
 Here (above) we have "Benny" with her cute hearts on her cheekbones and pink eye brows and dark lipsticks. There are A cups and D cups, hair-bases, eye brows, shape, and teeth options. This is sold in the Mystic Canvass Mainshop!
 If you're into patterns on your eyes you'll enjoy "Fectious" with a darker shade (my preference), cup sizes and different color patterns. This is also available at:
 Lastly, we have two different skins, but they're kind of singles so I just combined them. Both have boob preferences! They're named "Minerva" which is available at:
and "Herotia" and can be found at:

Whew!! And there you have it! Skins out of the WAZOO and available at all the SLURLs posted NOW!
Go git 'em!

Pasties by << (red)Mint ------->>

No comments:


text:
Case Based Pediatrics For Medical Students and Residents
Department of Pediatrics, University of Hawaii John A. Burns School of Medicine
Chapter XVIII.10. Neural Tube Defects
Mari Uehara, MD
October 2002

Return to Table of Contents

A C-section is scheduled for a 16 year old G1P0 mother at 37 weeks. Prenatal care was not sought until 32 weeks gestation. Mother did not take any vitamins or folate supplements prior to that time. Initial prenatal lab studies were significant for an elevated alpha fetoprotein. A prenatal ultrasound done at 34 weeks demonstrated a meningomyelocele. No hydrocephalus was noted at that time. A neurosurgeon was consulted. A C-section is scheduled to deliver the infant as non-traumatically as possible with the availability of the neurosurgeon close by.

At delivery, the infant is delivered with Apgar scores of 7 and 8. Birthweight is 3.2 kg. A translucent membrane sac overlying the mid-lumbar region is noted. It is leaking xanthochromic fluid. Upper extremity movement is noted to be good, but lower extremity movement is not as vigorous. The infant is transferred to the NICU where vascular access is obtained and initial stabilization measures are performed. Five hours later, the infant is taken to the operating room where a neurosurgeon closes the meningomyelocele defect over the lower back. Post-operative recovery in the NICU is unremarkable. Lower extremity movement is moderate. A head ultrasound study shows mild hydrocephalus. Two months later, the hydrocephalus is worsening on ultrasound, so a VP shunt is surgically placed.

Neural tube defects (NTDs) are a group of birth defects which are associated with a defective closure of the neural tube and the subsequent development of the central nervous system (brain and spinal cord). It is one of the most common birth defects occurring in approximately 0.7-1.0 per 1000 live birth each year (1,2). There are three types of NTDs: anencephaly, encephalocele, and spina bifida. Spina bifida, the most common NTD, means "split spine" in Latin and is a result of failure of the neural tube to close during the 3rd-5th week of pregnancy. The terminology can be confusing since multiple terms have been used for various conditions depending on the extent of the involvement of the spinal cord and surrounding structures.

Spinal dysraphism and spina bifida apply to a heterogeneous group which has defects of closure affecting the spinal canal (which may encompass the meninges and spinal cord itself in addition to bony vertebral elements). Myelodysplasia refers to defects of spinal cord development, which commonly occurs with spina bifida; however not necessarily associated with failure of fusion of the arches of the vertebral spine, so this could include entities such as syringomyelia and diastematomyelia. Spina bifida occulta is the simple failure of fusion of the spinal arches (i.e., bony involvement only), such that the neural elements are covered by skin and do not protrude above the level of the back. Occult spinal dysraphism means that spina bifida occulta is present with overlying cutaneous markers such as dimple, fistula, hair patch, and hemangioma. These markers may indicate the presence of cord tethering with a lipoma or a dermoid cyst. Spina bifida cystica is the commonest type of NTD which includes meningocele, meningomyelocele/myelomeningocele, lipomyelomeningocele. A meningocele is a lesion which does not involve neural elements in the cystic outpouching of the meninges. Meningomyelocele or myelomeningocele means that dysplastic neural elements protrude through the unfused vertebral arches. It can be completely covered with meninges and skin (closed meningomyelocele) or there may be a connection of spinal fluid to outside (open meningomyelocele). Lipomeningocele and lipomyelomeningocele are closed meningomyelocele with overgrowth of fatty tissue involving the meninges alone or including the spinal cord. The term spina bifida is ambiguous in that it is often used to describe conditions from spina bifida occulta to spina bifida with myelomeningocele.

The manifestations of the spina bifida depend on the level of the spinal cord involvement at which neural tube closure was incomplete. The lesion is located in lumbosacral area in more than 80% of the cases (3).

Children with the less common thoracic lesions, have flaccid paralysis of lower extremities with variable weakness in abdominal and trunk musculature. These defects are frequently associated with serious complications (e.g., respiratory compromise). Children with high lumbar lesions (L1, L2) have flaccid paralysis of knees and ankles and may walk with extensive braces and crutches. Children with midlumbar lesions (L3) have paralyzed ankles and toes. These children can accomplish independent ambulation with braces. Children with low lumbar lesions (L4, L5) often have weak ankle and toe mobility. They are particularly prone to ankle or foot deformities and often need orthosis for independent ambulation.

Bladder and bowel problems are present in more than 90% of children with meningomyelocele regardless of the level of lesion (1). Some children may have problems with bladder emptying, while others may have problems with storing the urine adequately. Despite the type of neurogenic bladder, it is crucial to prevent urinary tract infections and protect the upper urinary tract since renal failure is one of the important causes of death among these children. Bowel continence requires normal external sphincter control, internal sphincter reflex relaxation, rectal sensation and colonic motility. Lack of sensation and inability to control external sphincters makes these children unable to sense or control stool passage. Bowel management programs with regularly scheduled toileting, use of stool softeners, and dietary measures (i.e., additional fiber) are important to avoid constipation and soiling.

Spina bifida is often not only an isolated birth defect of the spinal cord and spine, but there commonly are associated congenital malformations of the brain. Hydrocephalus is a major complication of meningomyelocele and is present at birth in 85-95% of cases as shown by ultrasonography (3,4). These children with hydrocephalus require ventriculoperitoneal shunt (VP shunt) placement. Shunt malfunction and infection are frequent complications and most children eventually require shunt revision (30-40% within one year of insertion of the shunt). Lethargy, vomiting, irritability, bulging and tense fontanelle, and headache, are common symptoms of shunt malfunction. Seizures also occur in up to 17% of the children with meningomyelocele and almost always occur in those with hydrocephalus (5).

Arnold-Chiari II malformation (the cause of the hydrocephalus) is present in the majority of children with meningomyelocele. The cerebellum and medulla oblongata are shifted caudally, so this resultant packing into the cervical spinal canal results in deformation. The symptoms are due to progressive hydrocephalus (if untreated) and dysfunction of the lower cranial nerves, respiration and swallowing. Hydrocephalus occurs in most children secondary to aqueductal stenosis or obstruction to CSF flow around the medulla.

Any clinical changes in children with meningomyelocele should prompt a search for an underlying cause. By far, the most common cause of deterioration is shunt malfunction. Another important cause is tethering of the spinal cord. Up to one third of children with myelodysplasia may experience spinal cord tethering. A tethered spinal cord results from traction on the conus medullaris and cauda equina, which causes spinal cord stretching and ischemia with subsequent loss of neurological function. Symptoms of a tethered spinal cord include spasticity, weakness, decreased sensation in the lower extremities, changes in urinary and bowel functions, or back pain, progressive scoliosis and foot deformity. Some children with occult spinal dysraphism (i.e., no overlying meningomyelocele) are asymptomatic and truly have an occult spinal cord condition. An MRI scan will identify the spinal abnormality. Surgery is indicated in symptomatic patients. Prophylactic intervention among asymptomatic children can prevent the long-term disabilities associated with this condition.

Mastery of bowel and bladder continence is crucial to optimal functioning and is of the major importance for social acceptance. The voiding program may include medications, intermittent catheterization, and possibly operative reconstruction. Clean intermittent catheterization is the most commonly used method to help urinary continence. It is used to remove residual urine, improve urinary drainage, and provide decompression. The goal is to have this task accomplished by early school age. A child's physical abilities and psychological readiness for toileting should be assessed and continued assistance may be necessary for some children.

Children with physical disabilities are often described by their disabilities, and not by their strengths or abilities, which are also important. Children with spina bifida are often automatically placed in regular classes or classes for children with orthopedic problems. Although this is frequently the best placement, there are children whose orthopedic problems are secondary and their learning disability associated with spina bifida may be the major disability. Children with spina bifida and hydrocephalus may have problems with motor skills, attention, memory and organization. These issues should be understood and addressed in the Individualized Education Program (IEP).

Latex allergy has been common among children with spina bifida (about 20-70%) (6). Although the cause of latex allergy in children with spina bifida is not known, it may be due to the early, intense, constant exposure to rubber products among these children. Latex comes from the sap of the rubber tree Hevea brasiliensis. After the commercial purification process there are small amount of residual proteins that could cause allergy symptoms ranging from mild skin rashes or sneezing to hives, respiratory distress and anaphylactic shock. Many products contain rubber components of which we are unaware and environmental exposure to rubber products in both the community and hospital is widespread (e.g., rubber bands, erasers, gym mats, certain paints and glues, elastic waist or leg bands in clothing and disposable diapers). There are some food items (e.g., bananas, avocado, chestnuts) which can also cause cross-reactions. Prevention is the best approach. This allergic condition should be documented on medical and school records, communication devices such as medical alert bracelet should be provided as well as auto-injectable epinephrine as a part of the emergency plan for these children. In fact, it is commonly recommended that all children with spina bifida and/or myelodysplasia be kept latex free even if allergy has not yet been demonstrated.

The initial treatment for spina bifida is early surgical closure of the defect. Because of the multisystem involvement of this condition as stated above, management of this condition requires a comprehensive, multidisciplinary team approach. This team may include pediatricians, nurses, specialists (neurologists, neurosurgeons, urologists, orthopedists, developmental-behavioral pediatricians), physical therapists, occupational therapists, social workers, and special education teachers.

Alpha-fetoprotein (AFP) is elevated in maternal serum (MSAFP) and amniotic fluid (AFAFP) in open NTDs such as encephalocele, meningomyelocele and anencephaly. It is also increased in other conditions such as abdominal wall defects (gastroschisis and omphalocele). AFP becomes measurable in maternal serum at the end of first trimester. Maternal blood sample measurements are collected between 16-18 weeks of gestation to provide enough time for more definitive testing as necessary and to allow sufficient time for decision making regarding continuation or termination of an affected pregnancy. The MSAFP level is affected by gestational age and the number of fetuses. Elevated AFP level in amniotic fluid is more definitive than MSAFP, identifying 90-95% of affected fetuses with open NTDs. Acetylcholinesterase assay is more specific for neural tissue with a 99% accuracy rate. Ultrasonography also has been increasingly accurate in prenatal diagnosis of fetal anomalies.

Folic acid is a synthetic compound used in dietary supplements and fortified foods. The term folate includes all compounds that have the vitamin properties of folic acid (folic acid and naturally occurring compounds in food). The average diet in the United States contains 200 microgram of naturally occurring folate, which is less bioavailable than folic acid. Studies have demonstrated that 50% or more NTDs can be prevented if women consume a folic acid supplement before and during the early weeks of pregnancy. The American Academy of Pediatrics endorses the US Public Health Service recommendation that all women capable of becoming of pregnant consume 400 microgram of folic acid to prevent NTDs.

Studies have shown improved long term outcome regarding ambulation, urinary continence, and social continence of stool. One of the studies also showed that about 60% of children with spina bifida attended regular school programs. These outcomes depend on the level of lesion and the severity of complications.

1. True/False: Vitamin supplementation prior to pregnancy has been found to reduce the risk of neural tube defects.

2. True/False: Spina bifida patients have neurogenic bladders.

3. True/False: Hydrocephalus develops in meningomyelocele patients because of cord tethering.

4. True/False: Children with meningomyelocele have a high risk of developing latex allergy, therefore, they should not be exposed to latex from birth.

5. True/False: High meningomyeloceles result in lower extremity paralysis, but most patients with low lying meningomyeloceles are able to ambulate on their own or with assistive devices.

1. Liptak GS. Neural tube defects. In: Batshaw ML (ed). Children with disabilities, 4th edition. 1997, Baltimore: Paul H Brookes Pub Co., pp.529-552

2. American Academy of Pediatrics Committee on Genetics. Folic acid for the prevention of neural tube defects. Pediatrics 1999;104(2):325-327.

3. Jacobs RA. Myelodysplasia. In: Wolraich ML (ed). Disorders of Development and Learning, 2nd edition. 1996, St. Louis: Mosby, pp. 213-261.

4. Dias MS, Li V. Pediatric Neurosurgical Disease. Pediatr Clin North Am 1998;45(5):1539-1578.

5. Ashwal S. Congenital structural defects. In: Swaiman KF, Ashwal S (eds). Pediatric Neurology: Principles & Practice, 3rd edition. 1999, St. Louis: Mosby, pp. 234-300.

6. Kumar S. Latex allergy. Pediatr Rev 1999;20(1):35.

7. Liptak GS. Neural tube defects in children with disabilities. In: Batshaw ML (ed). Children With Disabilities, 4th edition. 1997, Baltimore: Paul H. Brookes Publishing Co., pp. 529-552.

8. Iqbal MM. Prevention of neural tube defects by periconceptional use of folic acid. Pediatr Rev 2000;21(2):58-66.

9. Spina Bifida Association of America, 4590 MacArthur Blvd., NW, Suite 250, Washington, DC 20007-4226, phone (800)621-3141, e-mail:

Answers to questions

1. True. Folate supplementation prior to pregnancy and in early pregnancy reduces the risk of neural tube defects.

2. True, in that nearly all patients with myelodysplasia have bladder/bowel dysfunction; however, patients with spinal bifida occulta may only have a vertebral anomaly, without myelodysplasia, in which case, their bladder function will be normal.

3. Controversial question, but probably false. The hydrocephalus is usually due to a Arnold Chiari malformation in the brain (the other end of the neural tube) which results in hydrocephalus. It is probably not cord tethering which causes the hydrocephalus.

4. True.

5. True.

Return to Table of Contents

University of Hawaii Department of Pediatrics Home Page