Texas was one of the first states to emerge from the recession and it continues to attract companies on the basis of its low tax burden, predictable regulatory environment and skilled labor force. Texas employment is expected to expand 3% annually through 2017, according to Moody’s. (Arizona’s forecasted rate is a microscopic 0.04% better). Texas has attracted a lot of attention from California companies and Governor Rick Perry has not been shy about contrasting the business climates of the two states. California firms EBay and Electronic Arts have both chosen Texas for large expansions in recent years. Austin has been a hotbed of activity this year with Accenture
We will make solid efforts to pursue the Belt and Road Initiative.
The more powerful the passions and the more uncontained the ambitions, the more likely the democratic system will collapse into despotism.
“Only once before, in 1998, has the new record been greater than the old record by this much,” the administration added.
All-cash buyers. Skittish lenders. Skyrocketing prices. Anemic listings. These realities haunt buyers, turning the house hunt into a demoralizing slog. Unfortunately, buyers will probably have to soldier through another year of a market that favors sellers.
But economists generally expect the momentum of the recent past to resume and continue once storm distortions abate. The 45 economists who responded to The Wall Street Journal's latest monthly forecasting survey saw the jobless rate falling to 7.8% by next June and 7.5% by the end of 2013. Some say job growth could accelerate from its slow pace. 'I think businesses are going to have to hire,' said Bob Baur, an economist with Principal Global Investors.[qh]
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.