“An employee bragged to all his colleagues that it was his last day, but failed to let his boss or the HR manager know.”
The Veterans Day holiday, which pays tribute to all men and women who have served in the U.S. military, dates back to 1919, when President Woodrow Wilson proclaimed November 11 as Armistice Day to celebrate the end of fighting exactly one year earlier in World War One - "the war to end all wars" - between Germany and the allied nations of Britain, France and the United States. The armistice famously went into effect at "the eleventh hour of the eleventh day of the eleventh month."
While the debate was supposed to be solely about foreign policy, domestic concerns were never far from the surface and the candidates took every opportunity to pivot to their stump speech attacks over the economy and tax. The same was true in the spin room afterwards where both campaign teams dispensed quickly with debate comments and moved instead to analysis of the state of the race in swing states.
Show must go on
An American actress, author, fashion designer, dancer, producer, and singer Jennifer Lopez hold the second place in the list of 10 most beautiful women of 2015. Lopez's personal relationships have attracted worldwide media attention; she has been married three times. Beside entertainment world, J. Lo enjoyed a highly successful business career, consisting of various clothing lines, accessories, fragrances, a production company, television shows and a charitable foundation among other business interests.
However, others argued that doctors' hands may be forced by an unfair system. "As a patient, I'm more concerned about whether they can cure my illness rather than how many papers they've published," another netizen said.
Ever since the 1994 World Cup, the average scoring has been on a steady downward slope. In 2010 it bottomed out at 2.27, the second lowest average in World Cup history (1990 averaged just 2.20).
The United States saw its real GDP increase at an annual rate of 3.9 per cent in the three months ended September,according to official data released last month.
In 2010, a 14-month-old child accidentally fell on a chopstick he had playfully placed into his nose. It did, indeed, puncture the roof of his nose and lodge into his brain. Neurosurgeons did successfully remove the chopstick, with little internal damage long term.
The nasal, or nasopharyngeal, swab for Covid-19 is a PCR (polymerase chain reaction) test looking for active infection, and remains the most accurate to date to assess for acutely infected individuals. This in contrast to the antigen, or rapid test, also performed as a nasopharyngeal swab, which is much less accurate, especially if the test result is negative (it has a very high false-negative rate). The antibody test, which is a blood test, is performed to detect evidence of prior infection, not active illness.
A 40-year-old woman in Iowa underwent a nasopharyngeal Covid-19 swab test as part of her preoperative clearance for an elective hernia repair. Soon after, she developed headache, nausea, vomiting, and clear watery drainage from the side of her nose where the swab had been placed. This was not the type of drainage one would get from allergies, a cold, or even a sinus infection. Picture your kitchen sink trickling out water if it’s not fully turned off. That’s what a spinal fluid leak can look like, which is what she had. In addition, the fact that a runny nose is just on one side is often a tip-off of something unusual. As published in the October issue of JAMA Otolaryngology, it turned out that she had had prior nasal polyp surgery two decades ago, as well as a history of disorder called intracranial hypertension, or increased pressure of the fluid surrounding the brain. The combination of these two entities led to a small defect in the bone between the roof of the nose and the brain, and she had developed a pocket of the brain’s lining prolapsing into the nose, known as an encephalocele. The sack of the encephalocele got nicked by the Covid-19 swab.
Radiologic imaging of her brain and sinuses demonstrated a one-inch area where there was no bony roof of her nose. Instead, there was an out-pouching of the brain’s lining, known as an encephalocele, filled with spinal fluid. The pouch got pierced by the swab, and just like piercing a water balloon that’s attached to a faucet, it immediately started leaking clear cerebrospinal fluid. Once this was identified, she underwent surgical repair of the defect in the bone, and the spinal fluid leak was controlled and repaired.
According to Dr. Jarrett Walsh, Assistant Professor of Otolaryngology-Head and Neck Surgery at the University of Iowa, and senior author of this report, “If the swab is introduced at an angle toward the skull base, then any defect in the skull base is potentially put at risk. Correct technique, following the floor of the nose, is exceptionally safe and will not cause skull base trauma.” When asked if he would recommend avoiding nasopharyngeal testing swabs in general, he thinks not: “Nasopharynx swabs, performed correctly, are safe...I think the group of patients that needs to exercise caution in testing are those who have had anterior (nasal) skull base surgery – specifically those who have had reconstruction of the anterior skull base. With missing bone between the nose and the brain, an errant swab could have significant consequences. This is the group that I would encourage considering an alternative testing technique, if it is available.”
When it comes to Covid-19 diagnostic testing, nasopharyngeal swab approach has been shown to be more accurate than oropharyngeal (oral) swab. However, in some cases, especially where a patient has had prior surgeries in the area between the nose and the brain, or prior injuries in that region, physicians will accept oropharyngeal testing for pre-procedure screening.