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Casino Policies, Procedures, Rules, and Regulations Specifically it was the pictures in casino thread. Please keep in mind that sometimes the rules in place (photography for example) are regulatory issues, and therefore the casino is just enforcing the regulations which they are required to do.
High roller - Wikipedia High rollers may also be subject to exceptions from various rules and regulations; for example the high roller rooms at Crown Casino in Melbourne, Australia are the only licensed venue in the state not subject to a ban on smoking. High rollers are said to provide only a small fraction of casino business. Blackjack, Tables Games at the Casino - Crown Melbourne
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Tri County Wildlife Care Says YES to Success!
The Issue: 250 Tule Elk inside their 2600 acre fenced preserve on the northern end
of Tomales Bay DIED between 2012-2014, a loss of nearly 50% of them.
The Cause: Rainwater- dependent ponds dried up, leaving the elk with no water and no way out to find water.
The Response: WildCare, a sister wildlife rehabilitation group in northern California, gathered 2,618 signatures on a petition to present to Point Reyes National Seashore Park superintendent and ecologists at a meeting to address and solve this issue. TCWC signed the petition in support of the Tule Elk.
The Solution: A plan has been put in place by the Point Reyes National Seashore
Park personnel to closely monitor the ponds and provide supplemental water as
necessary for the elk now and in the future.
Thank you WildCare for your efforts and your success and inviting us to help the Tule Elk!
Here comes Father’s Day June 21!
Devoted dads deserve to be thanked and you can buy your thank-you gift at Amazon Smile and our PawsPartners store for Tri County Wildlife Care . A part of what you spend will be donated to help the injured wildlife dads at TCWC.
Learn more about Devoted Wildlife Dads
Thanks for your help and support!
Submitted by Bear Johnson, age 16
Click HERE, or on the image, to go to the YAP Submissions page!
PawsPartners.org is an alliance formed between A-PAL Humane Society of Amador County and Tri County Wildlife Care, the latter serving native wildlife in Amador, Calaveras, and Eastern San Joaquin Counties. Since inception we have added the Shelter Partners volunteer group, who support our local Animal Control organization, and Amador County Animal Response Team (ACART).


The One and the Many (Part 2 of 2)
Picking up where we left off, the problem of the One and the Many has also been known as the struggle between realism and nominalism. Realists sees universal categories (something similiar to Plato’s forms) as truly possessing an objective existence. Nominalists, on the other hand, believe that universals are merely the titles we give groups of things by mentally abstracting the similarities between various things (like “redness” from our observation of a fire truck, an apple, the sight of blood, etc.). Usually realists are rationalists and nominalists are empiricists.
Our own living experience tells us that both universals and particulars are needed in order to make sense out of life. Examples could be endlessly multiplied, but for the sake of space one will have to do. The classic example in teaching students of logic what a deductive argument is this:
- All men are mortal
- Socrates is a man
- Therefore, Socrates is mortal.
Both universal categories as well as empirical particulars are needed in order for this syllogism to make sense. When we look at the first premise we ask, What is a “man?” Socrates is an example of a man. But Socrates, understood by himself, severed from the category of “manness” does not make sense. What is this creature (another universal!) that stands before me? Without a class in which to place this creature called “Socrates,” I have no way of understanding him. Universals are needed. Yet, if I so exalt the form of man so that is refers to no individual men I lose the individuality of Socrates and destroy his personhood and uniqueness. The higher we go into the realm of categories and forms, the less and less we are speaking about actual, concrete, tangible realities (as in the case of Rusty).
The Christian Answer. So, how do we avoid these pitfalls? Though many philosophers no longer discuss these issues (explicitly, at least), their answers are assumed in all of our everyday endeavors. The Christian vision of life, as derived from the Bible, provides the answer that neither any secular philosophy nor any religious system can. Scripture presents us with a framework within both universals and their particular instantiations are kept significant and intelligible. Cornelius Van Til finds the solution in the biblical doctrine of the Trinity.
How is this? The Triune God is both one and many, and neither unity or plurality is more important, basic, or fundamental that the other. So the farthest thing back, the really real, God, grounds and gives worth to both unity and plurality. Van Til States:
Using the language of the One-and-Many question we contend that in God the one and many are equally ultimate. Unity in God is no more fundamental than diversity, and diversity in God is no more fundamental than unity. The persons of the Trinity are mutually exhaustive to one another. The Son and the Spirit are ontologically [i.e. in their very nature] on par with the Father. (The Defense of the Faith)
God, the one and many, creates a world with both general concepts (providing unity) and many specifics that participate in those concepts (providing rich diversity). So God has a idea of what characteristics according to which he will create all dogs (“dogness”) and he also creates each individual breed of dog (pugs) and each individual dog (“Winston”).
Thus, the Christian understanding of God solves, and indeed makes understandable at profound level, how it is that we can make sense of the world. Plurality is not absorbed into unity, and unity is not lost among plurality. God, the eternal One and Many created and formed the temporal one and many (the universe). This solves the “metaphysical” and “ontological” issues raised by the One/many problem. But, we also realized that this One and Many God has created, organized, and ordained everything that happens in this world (as mysterious as that may be), and provides the unity behind the plurality of the historical One and Many (the One being the ultimate goal and purpose of creation, the Many being the various “chapters” of history leading us there).
Here’s a helpful chart that makes this a bit more understandable.


My family and I are fellow Odysseyians (don’t know what that means, visit whitsend.org). We listen to Odyssey everyday and for some of us, it’s what we play right before we cross the Promised Land of Zees.
Last night, we sat around the table listening to the most recent adventure. No, I will not give details (go join the club and listen) but to say it all left us uplifted would be an understatement.
My mom shared with me that she has never considered Moses’ bar from Canaan was “an extreme blessing in disguise.” Mommy say what?!?!
Some of you are like, “Who is Moses” and “What is this Canaan”?
Let’s back track and unfold.
The book of Exodus (second book of the Bible) captured briefly the story of a chosen people of Yahweh, the Israelites, who were enslaved by the Egyptians for 430 years.
Moses, a fellow Israelite who grew up in the King’s palace after being taken from the river as a baby by Pharaoh’s daughter (and folks say the Bible is boring) was used by God through a movement known as “The Exodus”, to lead the Israelites from bondage to the Promised Land.
Through the mighty hand of God, the Israelites left Egypt with droves of treasures given to them by their slave masters. They were finally free from the oppression of the Egyptians. Now they were given the opportunity to worship God without fear of retaliation.
On their way to the promised land, the children of Israel grumbled and complain. Their griping was so bitter that poor Moses ended up disobeying God by striking the rock instead of speaking to the rock that would give them water. That one moment of heeding his anger caused him to miss out on the land that was promised to both he and the children of Israel.
Fast forward many years and the Lord called Moses home. He was not allowed to enter the Promised Land (God in His kindness did give him a sneak peak), but as my mom insightfully shared, he was welcomed into the Land of Promise. No longer would be have to deal with the cantankerous Israelites. Now he was welcomed into the city whose builder and maker is God.
Another example that comes to mind of God knowing best is the story of Elizabeth, the mother of John the Baptist (see Luke 1). Elizabeth as the Bible shares, was barren for many, many, many years. I am sure both she and her husband tried to conceive children, no doubt they may have prayed and fasted for children (they both came from families of priests), yet God in His Sovereignty kept her womb close.
Elizabeth had to deal with the looks of those around who were popping out children left, right and center. She had to deal with the jeers and mocking for her being “cursed”. Can you even imagine an enemy saying to her “Ha, what good has serving Yahweh done for you!”
Yet, Elizabeth and her husband Zechariah remained faithful to God’s commands. The Bible describes them as being holy and blameless (Luke 1:6). They, despite their unanswered prayer held onto their integrity. They did not cease to walk blameless before God day and night. Talk about commitment.
As her story goes on, we see that Elizabeth became pregnant in her advanced years, for you young people, she got pregnant real old. This was another Sarah miracle all over again. The Lord blessed Elizabeth with a male child, the man we call John the Baptist.
Here’s where I marvel at God’s timing. Elizabeth’s pregnancy began less than a year before Mary’s. Her pregnancy would yield the forerunner of our Lord. This child was the cousin of our Lord who would be “tilling” the soils of men’s heart heralding “Repent, prepare the way of the Lord.” John would end being the hands that baptized the Messiah and stir the hearts of the disciples in preparation for them to readily see Jesus as Lord.
God knew in advance Jesus would need John to proclaim His arrival.
Sure, the Word was written centuries prior, however before the Word which became flesh began His ministry, some physical flesh (John) needed to begin the mission of reminding the people to look out for the Lamb which would be slain.
Friends, I understand that life is hard. Sometimes downright soul-draining, bone gripping tough.
At times you may even feel like you are being strangled and grasping for air.
Sometimes my troubles are so great that I feel like I’m drowning.
Lately, I have found myself asking God “how long?”
I have even felt as though if someone looked too hard at me I would burst into tears because the weight on my shoulders have been heavy.
But tonight, I am reminded that God always comes through. Whether the blessing or promise is fulfilled in this life (as seen with Elizabeth), or the next as seen with Moses. God. Always. Comes. Through. His ways are always best and He always has our best interest in sight.
Let us look up. Let us take another step. We can trust Him just a little more.
God is in control and He is good.
Life may be really hard, but God is always good.


Albania is a country located in Southeastern Europe bordering the Adriatic Sea and the Ionian Sea. To the south it neighbors Greece and to the north, Kosovo. In 1912, the country declared its independence from the Ottoman Empire but was quickly conquered by Germany in 1943, and then ruled by the USSR until 1960.
After gaining total independence in the 1990s, the country has suffered from a continually depressed economy. This depressed economy has caused economic hardship in the region for many of its citizens. This article’s purpose is to elaborate on the most common diseases in Albania
1. Ischemic Heart Disease
The most common disease in Albania is Ischemic heart disease. Ischemia is an illness which causes blood flow restriction in a particular part of the body. Ischemic heart disease restricts blood flow to the heart and without proper health care, the disease can lead to stroke and heart disease if left untreated. When measured in 2015, 44 percent of deaths occurred as a result of untreated Ischemic Heart Disease.
2. Lung Cancer
Another of the most common disease in Albania is lung cancer. Around 64 percent of Albanian men smoke tobacco on a daily basis which is one of the leading causes of the illness. Some effects of lung cancer include continued coughing, weight loss, chest pain and difficulty swallowing. If the disease is left untreated, it has the potential to spread to other parts of the body. This spread has the potential to cause more severe health effects which can include death. About 39.7 percent of deaths in 2015 were caused by lung cancer.
3. Chronic Kidney Disease
When measured in 2015, about 29 percent of deaths occurred from Chronic Kidney Disease. This condition describes the gradual loss of kidney function and can be extremely dangerous due to the kidney’s important role in the body. On top of filtering the waste of the body, the kidneys also filter blood. Without properly functioning kidneys, dangerous levels of fluid, electrolytes and waste can build up in the body and cause premature death.
The most common diseases in Albania take numerous lives every year, and the government is doing all it can to combat this phenomenon. The Albanian government established the WHO country office on top of increasing its funding of public health care. WHO has promoted education to the country’s citizens to help them avoid contracting these disease, and this work by WHO, alongside an increase in the government’s spending on health care, is sure to help reduce the number of deaths caused by the most common diseases in Albania.
– Nick Beauchamp


19, 2017 all Time Low.11 USD (Jan 14, 2015) 52 Week High / Low 182.88 USD /.82 USD 90 Day High / Low.50 USD /.44. What Time Frame is Most Useful? Litecoin Markets, exchange, pair, last price 24 volume, coinall. Different cryptocurrencies have differing features and potential benefits, and some may be more successful than others. Charts provide a simple, graphic depiction of market activity for easy reference. P2pb2b, lTC/BTC.,041,300, p2pb2b, lTC/USD.,252,107, oKEX, lTC/usdt.,887,053, p2pb2b, lTC/ETH.,107,592, hitbtc, lTC/usdt.,732,988, hitbtc, lTC/BTC.,830,923, digiFinex, lTC/usdt.,597,847. All cryptocurrencies have the potential to appreciate in value.
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Like many other cryptocurrencies, Litecoin uses blockchain technology as the backbone of its operations. Although some merchants already accept it as a form of payment, Litecoin has only begun to scratch the surface in terms of the retail/merchant world.
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4,747,237,495 idc forex rates USD 891,414 BTC 2,559,753,606 USD 480,659 BTC 61,452,584 LTC 84,000,000 LTC, litecoin is a peer-to-peer cryptocurrency created by Charlie Lee. Litecoin Statistics, litecoin Price.25 USD, litecoin ROI 1696.59. Market Rank #6, market Cap 4,747,237,495 USD 24 Hour Volume 2,559,753,606 USD, circulating Supply 61,452,584 LTC, total Supply 61,452,584 LTC, max Supply 84,000,000 LTC. It was created based on the Bitcoin protocol but differs in terms of the hashing algorithm used. Scrypt allows consumer-grade hardware such as GPU to mine those coins. It may, therefore, be wise to consider a number of cryptocurrencies when making a long-term investment in this arena. Diversification is the key to successful investing, as it can potentially assist in the mitigation of risk, while also potentially smoothing out portfolio volatility. Charts can potentially be a very useful tool for both short-term trading and long-term investing. If demand increases, with limited supplies, prices could increase according to the simple laws of supply and demand. Could Litecoin Increase in Value? LTC/BTC.,379,532, coinegg, lTC/BTC.,904,614, zBG, lTC/usdt.,036,756, digiFinex, lTC/BTC.,616,371.
Is it Best to Focus on a Single Cryptocurrency? In addition, due to their features and overall convenience, cyptos may also be increasingly useful for individuals to send and receive payments. That may depend on your goals. What are Some Possible Uses of Litecoin?


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Amber Lancaster Wiki Biography, Height, Weight, Age, Measurements, Net Worth, Family, Wiki & much more! Amber Lancaster Wiki was born on Amber Leigh Lancaster, United States 23 Sep 1983 in and her current age 36 years 8 months 22 days . Amber Lancaster Wiki Weight 50 KG and height 5 Feet 7 Inches. she is an Actress in United States. Her born home city of Amber Leigh Lancaster, United States. Her primary Profession is an Actress. Right now Amber Lancaster Wiki is a famous Actress in the world. And her Nationality is American.
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There are many ayurverdic treatments that work different but still the most preferred hair growth pill of recent times is Propecia (Finasteride). This is the main reason why people choose to buy finasteride online overnight as it was cheap and very effective in treating the problems.
Hair loss is one aspect that makes people more vulnerable to many different methods and suggestions. Obsessed with improving their hair health and stopping the thinning, many people, especially men with alopecia areata, opt for different balding methods, be it natural or chemical, to stimulate the regrowth of hair. In this article we wish to discuss how this medication is better than ayurvedic alternatives.
Are ayurvedic hair treatments better than Propecia?
The truth of the matter is that although ayurvedic treatments do bring some improvements in some people there are many aspects that make such treatments fall behind hair loss pills like Propecia:
- Recovery time: The time it takes for the ayurvedic treatments to show improvement is much longer which demands people to stay committed to using it day in and day out. But in this generation which is fast paced, no one has the time or the patience to wait for a long time to see improvements. They need quick results, which is what makes Propecia (Finasteride) the most opted hair loss pill. It shows improvement in the hair within weeks of administration and one can swiftly see their self-confidence growing.
- No guarantee: With natural or alternative treatments, there is hardly any assurance that these methods improve the hair growth. Even after using it for months, some people do not notice any improvements simply because of their body condition. Natural methods work in different ways to different people. Their efficacy depends on various factors which are still not understood clearly. But it is suggested that their performance mostly depends on how well the body is accepting the natural methods. But on the other hand, consuming Propecia is known to have excellent results in 80 % of people who consume the medicine, regardless of their body condition, unless there are suffering from some plaguing medical conditions that prevent them from using the pill.
- Accessibility: Although some natural alternative methods are available in the form of capsules or oils, most ayurvedic treatments or remedies require you to prepare the recipe at home which is time-consuming. There is also an inconvenience factor that at times these ingredients might not be available at home. But it comes in the form of pills which are ready and easy to consume. All one has to do is swallow the pill with a glass of water.
The only pitfall of propecia
Although this medication can be seen more as a viable hair regrowth option compared to natural ayurvedic methods, there is one particular facet of finasteride that makes it a bit less desirable and that is it’s potential to result in side effects. Since it is a chemical formulation, unlike natural methods which do not have any side effects, It does result in some unfavorable conditions. Improper use or higher dose intake is bound to cause ill effects. Hence it must be used with certain care and one must educate themselves about proper use of the drug. Consulting a doctor before getting cheap propecia online and starting your hair loss treatment with it is a must. Using the pill consistently for 6 months is known to show significant and visible improvement in the hair.


Kanchenjunga Circuit Trek
I’m searching for 1 – 5 trekking partners for the Kanchenjunga Circuit. I have about 28-30 days in mind.
Last year I did the Manaslu Circuit Trek and loved it, so I am coming back for another trek. My partners from last year are not available so I am looking for others that may like to join my trip. I already have a small trekking company (that I worked with last year). I plan to work with them again to set up our guide and porters.
I love to take photos while traveling and because of this my pace will sometimes be slow to moderate.
I am vegetarian. I would love to travel with others that eat similarly if possible.
I am looking for others to enhance the group dynamic, though I am also happy on my own and often like to be quiet.
The exact start date can vary slightly. I would like to do it as a teahouse trek.
Go to the following link for more information about this trek: http://kanchenjungatrek.org/Reply


2019 President: Dennis Korth, PP
The Beja SuperCycle was a twenty-four seat bicycle that entertained at area parades and events. Dressed in their white shirts, Nobles fill the seats of a motor pushed bicycle. What a fantastic approach when the SuperCycle turned the corner of the parade and came into sight. Their motto “Shriners Pedal that less Fortunate can Walk” clearly represented the motto for this group of peddlers.
The SuperCycle was retired in 2016 and the group now uses its SuperTryke and Beja Van to perform in parades. The two-person tricycle that goes every which way but straight, is extremely enjoyed by the crowds along the parade routes. At the 2013 Midwest Shrine Association conference, the SuperTryke took the Parade Marshal “Unit of the Parade” award. What a great achievement for the SuperCycle Unit and for all of Beja.


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You can’t improve what you don’t measure. Tap into your full potential with the TAP assessment, and a personal guide through the use of it by Dr. Robert Troutwine…and improve your driving mindset.
My own sweet spot is in coaching the mental game of performance and race driving, and in this webinar I’m hosting renown sports psychologist Doc Troutwine to help you improve your mindset, and drive consistently faster. We all know that the mental game is critical to our driving performance, but what we don’t know is what to do about it. The Troutwine Athletic Profile (the “TAP“) is a proven method, used by the best athletes and teams in amateur and professional football, baseball, basketball, and other sports. It identifies key strengths and weaknesses of your mental game, and then provides a plan for you to implement it.
In the Mindset Training for Drivers webinar, Dr. Troutwine shares with you what some of the best athletes in the world use to improve their mental performance. You’ll then have those tools for your own mental game.
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Please note that while registration closes on June 21st, 2020 at 11:59 PM PDT, if drivers register and can’t be on the webinar when it’s live, they will still get a full recording available to them.
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Many IRA funds invested in the stock market in recent years have experienced such volatility that the stability typically available in a real estate investment is a desirable alternative. Although IRS rules permit IRA funds to be invested in real estate, the complexity of the regulations pertaining to such investments have deterred most IRA holders. Also, because IRA custodians are not required to offer real estate investments, most IRA holders were largely unaware of the option. In order to convert your real estate investment into an IRA, establish a self-directed IRA and use a custodian offering real estate as an investment.
Open a self-directed IRA. This type of IRA allows you to decide how your funds will be invested. If the IRA custodian you currently use has an investment strategy or policy that does not include real estate as an investment option, locate an IRA custodian who does offer this option.
Convey ownership of a real estate investment to the custodian of your self-directed IRA. The real estate can be either commercial or residential property; however, tax regulations forbid using the property as your place of business, residence or vacation home. When conveying ownership of the real estate, title to the property should be in the name of the custodian of your self-directed IRA, who should have appropriate forms for this purpose.
Consult with your accountant regarding the tax consequence of your investment. Some real estate transactions using a self-directed IRA require filing certain IRS forms to report income related to the transaction.
- A sound real estate investment using your self-directed IRA will require that your IRA also include enough extra cash to cover the expenses associated with real estate, such as insurance, maintenance and taxes. IRS regulations specify that all expenses related to the real estate must be paid from your IRA.
- A real estate investment trust is also an investment option for your self-directed IRA.
- A real estate investment using a self-directed IRA is a complex investment and should not be done without careful planning with a qualified tax adviser. Violating the IRS rules regulating these types of transactions can result in adverse consequences, such as having the tax-deferred status of your IRA disallowed. This would result in having to pay taxes on the full value of your investment, as well as penalties.
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According to a new study, the electrical pulse of a Taser can cause ventricular arrhythmias, sudden cardiac arrest and death.
Use of a type of handheld electronic control device (ECD), generally known by the brand name Taser, incapacitates a person by shooting two insulated wires with small probes on the end that embed in skin and clothing and deliver a 50,000 volt electrical charge designed to override the sensory and motor functions of the nervous system.
Dr. Douglas P. Zipes, Indiana University Health cardiologist and professor emeritus at Indiana University School of Medicine, had unprecedented access to study records from police, medical and emergency response, autopsy results, electrocardiogram (ECG) and defibrillator data, along with incident data downloaded from individual tasers, for eight cases in which a healthy male lost consciousness after receiving a shock from a Taser® X26.
Results showed severely abnormal heart rhythms in six of the eight cases following shock with the Taser. Seven of the eight cases died.
“This study doesn’t say that we should abandon using Taser devices, but it does show that users should exercise caution, avoid chest shocks and monitor the person after shock to ensure there are no adverse reactions,” said Dr. Zipes. “Taser users need to be prepared for the possibility of inducing sudden cardiac arrest in those stunned and have adequate medical knowledge in such situations.”
Dr. Zipes also has a background as a paid expert advising on ECD issues in litigation and disclosed this in the study.
The study Sudden Cardiac Arrest and Death Associated with Application of Shocks from a TASER Electronic Control Device appears in the April 30, 2012 issue of Circulation, a journal of the American Heart Association. It is a peer-reviewed journal and the study underwent independent review by other cardiologists before acceptance for publication.
“There have been 3 million uses of TASER device uses worldwide with this case series reporting 8 of concern,” Steve Tuttle, spokesman for Taser International Inc. told HealthPop. “This article does not support a cause-effect association and fails to accurately evaluate the risks versus the benefits of the thousands of lives saved by police with TASER devices.”
The company has faced a number of product liability lawsuits related to its Taser products.
USA Today reports that Tuttle questioned bias in the study, Dr. Zipes having testified as an expert witness against Taser International in the past.
The New York Times says that more than sixteen thousand law enforcement agencies around the world use Tasers.
However, use of Tasers in law enforcement is controversial. The human rights organization Amnesty International called for stricter limits on police Taser use after their research showed at least 500 people in the United States have died after receiving a shock from a Taser during arrest or while in jail since 2001. A report released by the organization in 2008 found 90% of people who died following a Taser shock were unarmed and many did not appear to present a serious threat.
"Of the hundreds who have died following police use of Tasers in the United States, dozens and possibly scores of deaths can be traced to unnecessary force being used," said Susan Lee, Americas program director at Amnesty International. "This is unacceptable, and stricter guidelines for their use are now imperative.”


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NEW BRAUNFELS, TX, July 15, 2019 (GLOBE NEWSWIRE) -- The City Council approved a comprehensive solid waste management plan (CSWMP), developed by SCS Engineers on Monday, July 8, 2019. The plan addresses the City’s solid waste needs over a 20-year planning period, due much in part to rapid population growth in the City.
The Plan developed by SCS in conjunction with City staff addresses the capacities at existing waste management facilities, the City’s desire to increase waste diversion, waste reduction, and the need to control costs using a long-term financial plan. SCS experts in solid waste, sustainable materials management (SMM), and economics worked closely with the Solid Waste and Recycling Division (SWRD) as they developed the Plan.
CSWMPs are valuable because they identify short, medium and long-term goals and objectives, and the policies, programs, and facilities that will help a jurisdiction meet their goals to reduce the amount of landfilled materials, increase diversion, and the most cost-effective means for achieving those goals. Other associated benefits are reductions in greenhouse gases and longer lives for facilities. The plans require knowledge of solid waste management, reduction/reuse programs, recycling markets, collection and routing, along with a successful record of accomplishment.
Financial planning plays a significant role to maintain sufficient funding mechanisms to support the CSWMP. Communication, education, and outreach strategies encourage and expand coordination regarding solid waste issues with the public and among the agencies and private firms in New Braunfels and the region supporting residential and commercial solid waste management.
The City selected SCS Engineers because the firm has successfully designed and launched comprehensive solid waste planning for clients across the nation, and is a local firm. In recent years, SCS has completed CSWMPs for municipalities in Texas including Killeen, Waco, and the Heart of Texas Council of Governments.
The plan developed by SCS met the SWRD’s criteria and includes short, medium and long-term goals while taking into consideration the economic, social, and environmental issues of various solid waste management policies, programs, and infrastructure options unique to New Braunfels. By identifying specific interim goals, the City has the flexibility to change course if there are significant local and regional changes during the planning period. The SCS plan also supports the development of best practices to serve the current and future needs of New Braunfels in the most fiscally responsible and efficient manner possible.
SCS experts are regarded in the industry for their experience identifying and planning for nuances unique to each client, along with their goals, facilities, and demographics, to build sustainable plans. The firm employs advanced solid waste management technologies and produces flexible plans using a platform to change values and conditions to see how the various combinations affect outcomes.
An article in the New Braunfels Herald-Zeitung on July 11, 2019, describes how the plan addresses needs over the next 5, 10 and 20 years, and notes that the City does not expect any immediate rate changes.
About SCS Engineers
SCS Engineers delivers economical and environmentally sound solutions to private and public clients responsible for the environment and human wellbeing as part of doing business. SCS provides our services through a network of nationwide offices. For more information, please visit our website at www.scsengineers.com, contact Service@scsengineers.com, or follow us on social media.
Corporate Communications SCS Engineers 1-800-767-4727 Communications@scsengineers.com


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With the global student population moving to remote learning, the education sector has been a popular target for hackers. Cyber attacks on the education sector are nothing new, as evidenced by the prominent cyber attack on the Australian National University (ANU) in 2018, where 19 years worth of confidential data was compromised. Unfortunately, cyber security in higher education continues to be a concern as the pandemic exposes the cyber risk profile of Australian universities. We have seen this amplified as recently as April 2021, when Swinburne University confirmed over 5,000 individuals were affected by a data breach. The spike in cyber attacks amidst the pandemic is particularly concerning, especially with higher education institutions being a critical infrastructure that stores a massive amount of personal information.
The importance of ensuring cyber security in the higher education industry
The nature of higher education institutions has made them prime targets for cyber attacks as it grants malicious hackers access to a large amount of personal information and intellectual property.
This is mainly because higher education institutions:
- Produce valuable research
- Their databases store valuable personal data of past and current students and staff
Cyber attackers have been consistently adopting the most edge-cutting technologies and methods to exploit university systems. In an outdated system, data vulnerabilities would be further exposed, creating new areas for cyber adversaries and violation of privacy. Hence, it is important for these institutions to have a secured cyber security network and a mature cyber security policy.
How Alyne can help you secure your cyber security network
Alyne's Software as a Service helps higher education institutions to actively implement a mature level of cyber resilience to ensure that individuals and organisations remain largely resilient towards threats.
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Alyne Australia's commitment to the education sector
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The Council of Australasian University Directors of Information Technology (CAUDIT), an incorporated non-profit association owned by the Australasian universities and a number of major Australian research organisations, supports CIOs and their teams through the provision of a broad range of services, fostering collaboration, leadership and good practice among its members. Services include negotiation of collective procurement agreements, benchmarking, and professional development. CAUDIT's purpose is to support each other in leading the application of digital capabilities to transform education and research.
Learn more in our Press Release here.


Welcome to the cancel-your-holiday-in-Libya edition of Accounting Career Emergencies. In today’s edition, another Fall 2011 Big 4 associate would like to nail down a certification in addition to the CPA before starting work. Can I keep my head from exploding long enough to formulate a coherent response?
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Back to our overachiever du jour:
I am about to pass the CPA exam and have 8 months until I begin at one of the “Big Four” firms in Florida. I am excited to start at the firm as it was my first choice however, I am not certain I will be in public accounting for the long run (like most people). My question is, being uncertain about my career path, what other certification should I obtain before I start in 8 months?
I have considered the CISA, CFE, CMA, CFA, Six Sigma but, I am not sure as I am not certain of my long term path. I want something that will give me an edge if I leave the firm and/or switch careers.
What certification would you recommend?
Any suggestions are helpful.
Dear Overachiever Du Jour,
After murdering the remainder of Stranahan’s in the house, I’m better prepared to answer your query.
I appreciate your ambition and we definitely think that obtaining additional certifications is a good idea for those that move on from public accounting but I fail to see how this benefits you now before you have an inkling of what kind of career you want. HOWEVER, I’m here to help sort you out as best I can, so I’ve put aside my judgments for two.
Based on your “considerations” listed, you seem to have a case of accounting certification ADHD which is fine but there’s no clear pattern as to what your interests are. I’m not going to recommend you do something just because it may be a hot area (forensics) or in-demand (information systems) but I am going to recommend you rank these certifications based on your level interest. Want to eventually be a CFO? Then go for the CMA. Want to pile up the financial reporting bodies? Get the CFE. You get the point. The important thing is to pursue a certification you find interesting rather than one that will just puts a few letters behind your name that may (but probably not) impress someone.
But really, do you want to spend the summer prior to starting work studying for a test? Get the band back together, take a trip, something.


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A type-safe abstraction for platform-independent file system paths.
bower install purescript-pathy
Applications often have to refer to file system paths in a platform-independent way.
Many path libraries provide a single abstraction to deal with file system paths. This allows easy composition of different kinds of paths, but comes at the expense of the following distinctions:
- The distinction between relative and absolute paths.
- The distinction between paths denoting file resources and paths denoting directories.
Pathy also uses a single abstraction for file system paths, called
Path, but uses phantom types to keep track of the above distinctions.
This approach lets you write code that performs type-safe composition of relative, absolute, file, and directory paths, and makes sure you never use paths in an unsafe fashion. Bogus and insecure operations simply aren't allowed by the type system!
Many paths come from user-input or configuration data. Pathy can parse such string paths and allow you to safely resolve them to expected types.
Building path literals is easy using the following components:
rootDir– The root directory of an absolute path.
currentDir– The current directory (AKA the "working directory"), useful for building relative paths.
file– A file (in the current directory).
dir– A directory (in the current directory).
(</>)– Adds a relative path to the end of a (relative or absolute) path.
(<.>)– Sets the extension of a file path.
(<..>)– Ascends one level in a directory, then descends into the specified relative path.
All path segments (
dir) names are required to be non-empty. This is enforced by
Name being constructed from a
NonEmptyString. At compile time, we can have provably non-empty strings by using
Symbols and a bit of type class trickery:
dirFoo :: Name Dir dirFoo = dir (SProxy :: SProxy "foo")
Here we're using a symbol proxy (
SProxy) and then typing it to explicitly carry the name that we want to use for our path at runtime. There is also a
file' variation on the function that accepts normal
Name values, so if you are not constructing a path at compile-time, you'd be using these instead.
Some example compile-time path constructions:
path1 = rootDir </> dir (SProxy :: SProxy "foo") </> dir (SProxy :: SProxy "bar") </> file (SProxy :: SProxy "baz.boo") path2 = currentDir </> dir (SProxy :: SProxy "foo")
Thanks to the phantom type parameters, Pathy doesn't let you create path combinations that don't make sense. The following examples will be rejected at compile time:
rootDir </> rootDir currentDir </> rootDir file (SProxy :: SProxy "foo") </> file (SProxy :: SProxy "bar") file (SProxy :: SProxy "foo") </> dir (SProxy :: SProxy "bar")
Path a b type has two type parameters:
a– This may be
Rel, indicating whether the path is absolute or relative.
b– This may be
File, indicating whether the path is a file or directory.
You should try to make the
Path functions that you write as generic as possible. If you have a function that only cares if a path refers to a file, then you can write it like this:
myFunction :: forall a. Path a File -> ... myFunction p = ...
By universally quantifying over the type parameters you don't care about, you ensure your code will work with the most paths possible (you also are documenting the expectations of your function to other developers who read your code).
To parse a string into a
Path, you can use the
parsePath function, which expects you to handle four cases:
Path Rel File
Path Abs File
Path Rel Dir
Path Abs Dir
If you need a specific case, you can use helper functions such as
parseRelFile, which return a
parsePath function also expects a
Parser argument so that different path formats can be parsed into the common
Pathy makes it easy to create relative paths, even paths that ascend into parent directories of relative paths. With this power comes danger: if you parse a user string, the user may be able to escape any arbitrary directory.
Pathy solves this security problem by disallowing conversion from a
Path to a
String until the
Path has been sandboxed.
To sandbox a path, you just call
sandbox and provide the sandbox directory, as well as the path to sandbox:
sandbox (rootDir </> dir (SProxy :: SProxy "foo")) -- sandbox root (rootDir </> dir (SProxy :: SProxy "foo") </> dir (SProxy :: SProxy "bar")) -- path to sandbox
This returns a
Maybe, which is
Nothing if the tainted path escapes the sandbox.
After you have sandboxed a foreign path, you may call
printPath on it, which will print the path absolutely.
There is also the option to
unsafePrintPath. This is labelled as being unsafe as it may be depending on how it is used - for example, if a path was sandboxed against some path other than the current working directory, but then used when launching a command in the current working directory, it may still refer to a location that it should not have access to.
There are many other functions available to you for renaming files, renaming directories, getting parent directories, etc.
Documentation for all functions and types is published on Pursuit.


Maharashtra CM to meet Maratha committee soon, address their demands
The move comes after the Sakal Maratha Samaj formed a high-power committee to prepare a comprehensive draft the Marathas’ demands and present it to the stateUpdated: Apr 21, 2017 11:29 IST
Chief minister Devendra Fadnavis will meet representatives of the Sakal Maratha Samaj, the parent body of Maratha organisations,soon to discuss the community’s demands. The samaj was one of the organisers of the nationwide Maratha protests held to demand reservation in government jobs and education.
Revenue minister Chandrakant Patil welcomed the samaj’s decision to meet state government officials and said Fadnavis would meet with a committee of samaj members soon.
The Maratha community has held more than 40 massive protest rallies across the state between August and December last year. Their demands include a review of the Atrocities Act, the implementation of the Swaminathan Commission’s recommendations on farming and other reforms in social and economic sectors.
So far, the organisers of these rallies had refused to hold talks with the government. However, at a round-table conference of prominent Maratha leaders on Wednesday, the samaj formed a high-power committee to prepare a comprehensive draft the Marathas’ demands and present it to the state. The committee does not comprise any politicians. At the meeting, called by Kshatriya Maratha Chamber of Commerce and attended by Chhatrapati Sambhajiraje — a Rajya Sabha member and a descendent of Chhatrapati Shivaji — the samaj decided to appoint a district-level coordinator to ensure better communication at the local level.
“The government will respond to the community’s demands positively. Earlier, the protest had no particular leaders and wasn’t represented by a specific face. So, the government was confused over who to address. As a committee has been set up, it will now be easy for us to break the ice. The government has taken several decisions in the interest of the Maratha community already,” said Patil.
Following the massive silent marches across the state, the state took various steps to pacify the Maratha community. Besides submitting an affidavit comprising proof the Marathas’ backwardness, the government announced freeships for Maratha students. It reconstituted the Maharashtra State Commission for Backward Classes, giving the community significant representation. The government also performed the bhoomipujan of the Shivaji memorial in the Arabian sea two weeks ago. It has constituted a training and research institute named after Maratha king Shahu Maharaj.
First Published: Apr 21, 2017 11:29 IST


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Greek journalist acquitted in breach-of-privacy case
ATHENS -- An Athens court on Thursday acquitted a Greek journalist accused of breaching privacy and data protection laws for publishing a list of more than 2,000 Greeks with Swiss bank accounts.
The trial, an exhausting and at times comic 11-hour spectacle, raised questions of Greece’s press freedom and failing attempts to tackle tax evasion. It also touched off debate over what pundits, politicians and defense attorneys deemed “an unapologetic” use of force and influence by the state to cover up corrupt political practices.
If convicted, Kostas Vaxevanis, a prominent investigative journalist and publisher of Hot Doc magazine, would have faced a minimum 12-month imprisonment, plus a fine of $39,000.
“The court finds you innocent,” the presiding judge told Vaxevanis, offering no legal reasoning for her decision.Since his weekend arrest, the 46-year-old journalist has insisted that the list he published was identical to a roster of names and data the Greek government was given two years ago by then-French Finance Minister Christine Lagarde to pursue tax cheats.
There was no suggestion that the 2,059 Greek holders of HSBC bank accounts in Geneva were tax cheats. Still, in the course of Thursday’s heated hearing, defense attorneys and a key political witness argued that the list had been shelved, with politicians failing to probe potential tax evasion.
“This list was a tool that could have helped the state reap hundreds of millions of euros from potential tax evasion,” said Zoe Konstantopoulou, a leftist lawmaker and member of a cross-party parliamentary commission probing possible political negligence in the case. “It could have spared the country from seeking an international bailout and signing up to the punishing terms of austerity.”
“Instead,” she said in a small, squalid courtroom packed with observers, “it was never fully exploited and the list itself has gone missing with one finance minister saying his staff misplaced it somewhere, the other laying blame on other officials.”
The government has repeatedly refused to comment on the case, and throughout Thursday’s trial the judge consistently removed or ignored any mention of politics.
Since the commission began investigating the case months ago, officials who have testified have shed little light on allegations of political malfeasance in vetting potential tax dodgers, suspected of cheating the government out of an estimated $38 billion a year.
Fearing further leaks and exposes, authorities have moved to muzzle the news media. On Wednesday, for example, a second investigative journalist and television presenter was arrested for promising to reveal hacked documents of the country’s treasury. Earlier in the week, two television presenters at the country’s state-run broadcaster, NET, were suspended for commenting on allegations of police brutality.
With tens of thousands of Greeks following protest tweets and a string of name-and-shame campaigns going viral on the Internet, the state’s arm-twisting of the news media cast a pall over the government’s bid to secure extra aid, and time, from its lenders to fix the faltering Greek economy and endemic weaknesses, such as widespread corruption and tax evasion.
What’s more, the cases have stoked public fury, with scores of crisis-crippled Greeks scrambling to the side of the prosecuted journalists, now portrayed as heroes crusading against a corrupt political establishment.
“I’m pained to be here in the cradle of democracy defending the right to press freedom,” said Jim Boumelha, president of the International Federation of Journalists. “These are questions and issues I face in Gambia, not in a Western society.”
Vaxevanis said the trial was not about him, but "all about a corrupt oligarchy of businessmen, politicians and controlled media that have long acted against the interest of the nation and its people.”
“Now,” he said, “this will allow journalists to do their job.”ALSO:
-- Anthee Carassava
Photo: Kostas Vaxevanis addresses reporters
outside the courtroom in Athens on Thursday. Credit: Orestis Panagiotou / European Pressphoto Agency


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On-Demand explainer webinar: Deliver public safety services more efficiently and improve cybersecurity on the cloud
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Doug Gartner, senior solutions architect for justice and public safety at Amazon Web Services
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Jane Got a Gun
2016, R, 98 min. Directed by Gavin O'Connor. Starring Natalie Portman, Joel Edgerton, Ewan McGregor, Rodrigo Santoro, Noah Emmerich, Boyd Holbrook.
REVIEWED By Marjorie Baumgarten, Fri., Feb. 5, 2016
Come expecting a feminist Western and you’ll be sorely disappointed. This film, which Natalie Portman produced and stars in as the titular Jane, offers little to the genre that’s new or exciting. Jane may get her own gun in this Western, but she also depends on the services of the bona fide gunfighter Dan Frost (Edgerton, who also co-authored the screenplay). Frost also happens to be Jane’s former beau, and that’s how the roiling romance story (with numerous flashbacks) begins. Jane Got a Gun is more romance in an Old West setting than Western with a romantic angle, and the story’s action is perpetually interrupted to unfold the couple’s backstory, and never lets up until they ride off into the sunset at the end.
Handsomely mounted and mildly engaging, Jane Got a Gun tells a familiar story about the struggles faced by women 150 years ago. The film opens in the New Mexico territory in 1871 as Jane’s husband Bill Hammond (Emmerich) returns home half-dead with gunshot wounds in his back, courtesy of the Bishop boys, a fearsome gang with whom the pair has had previous tangles. (Wait for the flashbacks; everything will be explained – eventually). Jane promptly parks her little girl with a neighbor, rides to Dan’s place to beseech his help, then returns home to protect her land and her husband. Before long, the Bishop gang will come to call.
To a certain extent, the film comes by its ragged nature rightly due to its troubled path to the cinema screen. The difficulties began when disagreements caused the original director Lynne Ramsay to withdraw from the film one day before shooting. Numerous male stars came, went, and swapped roles before shooting eventually began with a new director. After it was finished, Jane became a victim of the bankruptcy of Relativity, its backing studio, and then had its release delayed further once getting picked up by the Weinstein Company, which decided not to preview the film for critics. Even the film’s Paris premiere was canceled after Jane had been unfortunately scheduled to debut on the night of the terrorist attacks at the Bataclan and elsewhere in Paris. You have to feel a certain sympathy for a project as cursed as this one, but there’s no denying that Jane’s gun barely grazes its target.


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Since the Lakers lost three straight games for the first time since acquiring Pau Gasol in February of 2008, the players and coach Phil Jackson knew they’d have to answer a round of “What’s wrong” questions when arriving back in Los Angeles.
Yet after L.A.’s 96-94 loss in Orlando on Sunday afternoon, Kobe Bryant may have already summed things up.
“We didn’t win the game but I saw what I wanted to see,” he said of a game he was within an inch of tying with a late jumper. “If we play with this type of effort, it will be hard for a team to beat us four times in a series. Here we competed and we have to take this mindset and this attitude and push it forward to the rest of the season.”
Bryant echoed some of those same sentiments after Monday’s practice, adding that sometimes during the regular season in particular, the team’s issue is more mental than physical.
“We’re very talented and we know what we’re capable of doing,” he explained. “Sometimes you don’t believe you can lose until it actually happens. It sneaks up on you, and that’s something that we can’t allow to happen.”
Part of that sneaking up has to do with many of L.A.’s opponents, especially on the road, giving the defending champions their best shot.
“It’s not surprising that you’re the defending world champions, you’re the Lakers, it’s going to be higher intensity, higher pressure,” said Derek Fisher. “You’re going to have sell outs, which is (not always the case) before we get there … It’s just part of it.”
That’s not to say that the Lakers wouldn’t like to improve, especially when it comes to simple execution.
“The ball has to move more,” said Pau Gasol of L.A.’s offense. “That’s going to give us a better rhythm, better looks, easier shots.”
“We just have to execute better, knock down shots,” added Bryant. “We’re getting shots that we want, really good looks, they’re (just not) falling for us.”
The Lakers are confident that the final 18 games will provide ample opportunity to ramp things up leading into the playoffs.
“We just have to get it together on both ends of the floor,” said the Spaniard. “With this team, the players that we have here and the coaching staff, we shouldn’t lose.”
The team’s first chance to show with a result what they know in their heads they can do comes Tuesday against the Toronto Raptors at STAPLES Center.


Liquefied Petroleum Gas
This article has not been verified to be up to date for the latest version of the Discovery mod. The last edit was made on 14.01.2018 (DD/MM/YYYY). You may help by updating it, often by using the code generator.
|Liquified Petroleum Gas|
|Decay Rate||no decay|
Liquefied Petroleum Gas, or LPG, consists of a mixture of hydrocarbon gases that have been cooled to a liquid state. LPG can be used as a low density fuel source for terrestrial vehicles, generators, and machines, along with various consumer applications, and may also be used as a refrigerant. Hydrocarbon gases are often transported in a liquefied state due to volume constraints, then allowed to decompress for use as a gaseous fuel.
- The following bases either sell the item, or buy the item at a non-default price (possibly lower).
- The data listed on this page was generated from the default server configuration files on 14/01/2018. Server-side data may be changed on any server at any time, without any notice to the user community. The only authoritative source for in-game data is the game itself.


Side Slit Jacquard SweaterRegular price $274.00 Save Liquid error (product-template line 131): -Infinity%
Side Slit Jacquard Side Slit Sweater
In 1975, designer Marti Bisbal founded Aldomartins, a luxury brand specializing in womenswear with a chic, cosmopolitan edge. Designed and made in Spain, his impeccably tailored garments are distinctly European, featuring bold prints and the finest materials.
- 39% polyamide, 34% acrylic, 27% wool
- Side slits
- Pullover styling
- Hand wash
- Runs full
JS - I always want a fisherman's sweater in my closet, and here is a new and fresh way to do it. A lit bit boho, a little bit sophisticated. It just feels so new and fresh. Who doesn't want to take something tried and true and kick it up a notch or two!


AMD launches first Trinity APUs
May 15, 2012 | 11:27
AMD has officially launched Trinity, its second-generation A-series accelerated processing units (APUs) with a clear goal of taking on Intel in the ultra-slim laptop market.
The company claims that Trinity represents a doubling in performance per watt from the Llano platform it replaces, helped by the use of Piledriver CPU cores and Radeon HD 7000-series GPU cores on the all-in-one chip.
'The latest OEM notebooks, ultrathins, All-in-Ones and desktops based on the new AMD A-series APU enable the best video and gaming experiences, highly responsive performance with AMD Turbo Core, and accelerate an ever-increasing range of productivity and multimedia applications - in sleek, stylish designs at price points that make sense,' claimed Chris Cloran, general manager of AMD's client business unit, at the launch.
'Our 2nd-Generation AMD A-series APU is a major step forward in every performance and power dimension, allowing users to enjoy a stunning experience without having to give up the things that matter to them most. This experience doesn’t stop at mainstream notebooks. It carries over into affordable ultrathin form factors featuring the latest in AMD Radeon graphics.'
That latter point of Cloran's is a clear indication of where AMD is hoping to go with its latest A-series parts: devices which can directly compete with Intel's Ultrabook platform. With Trinity-based systems offering a claimed twelve hours of battery life on a single charge and offering thermal design profiles (TDPs) as low as 17W, the company could well have something with which to give Intel serious competition.
The Trinity family includes at launch three mainstream and two ultra-thin processors. At the top end, the A10-4600M boasts Radeon HD 7660G-equivalent graphics with 384 cores running at 497MHz and four 2.3GHz general-purpose Piledriver cores with 4MB of L2 cache. When AMD's Turbo Core technology is activated, the chip boosts performance to 3.2GHz CPU and 686MHz GPU.
For more budget-conscious OEMs, the A8-4500M features a Radeon HD 7640G-equivalent graphics processor with 256 cores running at 497MHz and four 1.9GHz Piledriver cores with the same 4MB of L2 cache. As with the A10-4600M, Turbo Core can be enabled to boost the chip to 2.8GHz and the GPU to 655MHz.
At the lower end of the mainstream Trinity range is the A6-4400M, which drops to a Radeon HD 7520G-equivalent graphics module with 192 cores running at 497MHz and two 2.7GHz Piledriver cores with 1MB of L2 cache. Turbo Core is again supported, pushing the chip to 3.2GHz and the GPU to 686MHz.
TDP on all three mainstream models is 35W, with DDR3-1600 supported on all models.
In the ultra-thin segment, the A10-4665M offers a Radeon HD 7620G-equivalent graphics module with 384 cores running at 360MHz and four 2.0GHz Piledriver cores with 4MB of L2 cache. Turbo Core pushes the chip to 2.8GHz and the GPU to 497MHz, while keeping within a 25W TDP.
The A6-4455M - the chip which gets the headline-grabbing twelve-hour 'resting' battery life - drops to a Radeon HD 7500G graphics part with 256 cores running at 327MHz and two 2.1GHz Piledriver cores with 2MB of L2 cache. Turbo Core pushes this to 2.6GHz on the CPU and 424MHz on the GPU, in a 17W TDP.
Both ultra-thin chip models top out at DDR3-1333, missing the support for high-speed memory of their mainstream brethren.
Desktop parts, both in pre-built OEM and ODM systems and as retail products, are due to follow later on in the year.


The cinacalcet randomized controlled trial: EVOLVE.
Speaking is the lead author Glen Chertow.
Disclosure: I (Joel Topf) was a primary investigator for EVOLVE.
The second trial to be presented at late breaking and high-impact trials is EVOLVE.
- Largest dialysis study
- Longest dialysis study
- Most international dialysis study
- Only double-blind dialysis study
- If you complain that nephrology does not have enough high quality studies you should pay attention to EVOLVE.
Cinacalcet was approved based on its ability to lower the PTH, the next question was, “does lowering the PTH with cinacalcet reduce mortality?” This was an investigator originated study that was sponsored by Amgen.
Dr. Chertow showed a slide with the hypothesis: “EVOLVE was designed to test the hypothesis that treatment with cinacalcet would reduce the risks of death and nonfatal cardiovascular events among patients with secondary hyperparathyroidism who were undergoing hemogdialysis.”
Patients were randomized 1:1 to cinacalcet or matching placebo. The trial was event driven, i.e., they ran the trial until they had 1,882 end-points. This was projected to take 3 years. It took 5.
The primary endpoint was a composite of all-cause mortality, or non-fatal cardiovascular event (MI, hospitalization for unstable angina, heart failure, or peripheral vascular event).
Secondary endpoints included: fracture, parathyroidectomy, CV death, stroke, and all the individual components of the primary end-point.
The next slide was a summary of the statistical approach. Note: when the authors present the statistical approach in a 12 minute presentation, buckle your seatbelt for a negative trial that, if you squint your eyes just the right way, looks positive.
Baseline characteristics looked well balanced; however, the cinacalcet group was older, 55 versus 54. Note: at a subsequent investigator meeting, the study designers shared that there was only an 8% chance that a 4,000 person study would find that large of a difference in ages. If they had to do it all over again they would put some age restrictions in so the potential age range would be smaller, decreasing the chance of the study being unbalanced. Foreshadowing: this will become more important as the story unfolds.
The first result they show are the biochemical parameters.
- Decrease in PTH (about 200 pg/ml lower)
- Decrease in calcium (about 0.4 mg/dl lower)
- Decrease in Ca x P product
- No decrease in phosphorous. Phosphorous has been about 10% lower with cinacalcet other trials. This did not materialize here.
Next slide primary endpoint: HR 0.93 P=0.112. Not significant. All-cause mortality HR 0.94 P=0.249. Not significant.
They then re-ran the data to balance the ages. Age adjusted relative hazard: 0.88 P=0.007. Multivariable (best fit) HR 0.88 P=0.008 and multivariable-adjusted (all included) 0.88 P=0.02. Wow. EVOLVE runs into an unbalanced age distribution and once the data is age adjusted they reach significance. Brutal bad luck. In terms of statistical-juke-and-jive, this is pretty mild. All they had to do was adjust the data for age and, boom, significant P-value.
Then they looked into why people stopped the drug. Time to first discontinuation of study drug for protocol-specified reason (transplant, parathyroidectomy, etc.) was balanced across both groups but for non-protocol reasons drop out was quicker and more common for placebo. This is unusual; usually side effects cause patients to drop out of the experimental group faster than the placebo group. Presumably this was due to patients dropping out of placebo due to uncontrolled PTH and doctors switching them to commercial cinacalcet. Problems only seen when doing an RCT of an approved drug.
Dr. Chertow then discussed lag-censored analysis. This is a modified approach to intension-to-treat analysis (ITT). ITT is the most rigorous approach but the designers of EVOLVE pre-specified a lag-censored approach. The idea here is that if a patient stops taking study drug, at some point in the future the effect of the drug could not explain an outcome. For example if a patient took the drug for a week, it is hard to accept that a parathyroidectomy 5 years later was due to the drug. The authors pre-specified a lag of 6 months. This means that any outcomes that occurred more than six-months after the last pill was consumed were ignored. The lag-censored analysis only censored people who stopped the drug for protocol specified reasons (transplant or parathyroidectomy were mentioned, there may be others). They found a HR for the primary outcome of 0.85 P=0.003. They found a HR for mortality of 0.83 P=0.009.
On to bone-mineral outcomes. Time to parathyroidectomy was longer with cinacalcet, HR 0.44 P<0.001. No difference in fracture risk.
Adverse events: there were a lot. 273 per 100 patient years. Wow. Serious adverse events were also found 53.3 per 100 patient years. The only ones that were significantly (P<0.001) more common with cinacalcet were unsurprisingly: All AE (273 vs 217), hypocalcemia (6.7 vs 0.9), nausea (18.3 vs 9.1), vomiting (15.4 vs 2.5).
Final thoughts, the drug failed its primary endpoint and it looks like one of the main reasons is they ran into an unbalanced distribution of ages. This was a larger, long and in terms of double blinding, unprecedented study in dialysis, there were a hundred reasons it could have failed, the fact that it was something as simple as unbalanced age distribution is kind of tragic.
Dr. Chertow mentions that EVOLVE is going to be published online in the New England Journal of Medicine and described the discussions with the editors as being “spirited” on more than one occasion. Sounds like there were some fireworks pounding the final manuscript together.
Post written by Dr. Joel Topf, eAJKD Advisory Board Member, and edited by Dr. Vinay Nair, eAKD Advisory Board member.


Abused Children at Risk for Adult Obesity
A new UK study finds that children who have suffered maltreatment are 36 percent more likely to be obese in adulthood compared to non-maltreated children.
Researchers from King’s College London estimate that the prevention or effective treatment of seven cases of child maltreatment could prevent one case of adult obesity.
Experts analyzed data from 190,285 individuals across 41 studies worldwide, and have published their results in the journal Molecular Psychiatry.
Severe childhood maltreatment (physical, sexual or emotional abuse or neglect) affects approximately 1 in 5 children (under 18) in the UK and in the US.
Officials say that in addition to the long-term mental health consequences of maltreatment, there is increasing evidence that child maltreatment may affect physical health.
Dr. Andrea Danese, child and adolescent psychiatrist from King’s College London’s Institute of Psychiatry and lead author of the study says: “We found that being maltreated as a child significantly increased the risk of obesity in adult life.
“Prevention of child maltreatment remains paramount and our findings highlight the serious long-term health effects of these experiences.”
Although experimental studies in animal models have previously suggested that early life stress is associated with an increased risk of obesity, evidence from population studies has been inconsistent.
Researchers believe the new meta review provides a comprehensive assessment of the evidence from all existing population studies.
From the analysis, the authors found that childhood maltreatment was associated with adult obesity.
This association was independent of the measures or definitions used for maltreatment or obesity, childhood or adult socioeconomic status, current smoking, alcohol intake, or physical activity.
Additionally, childhood maltreatment was not linked to obesity in children and adolescents, making it unlikely that the link was explained by reverse causality (i.e. children are maltreated because they were obese).
However, the analysis showed that when current depression was taken into account, the link between childhood maltreatment and adult obesity was no longer significant, suggesting that depression might help explain why some maltreated individuals become obese.
Previous studies offer possible biological explanations for this link.
Maltreated individuals may eat more because of the effects of early life stress on areas of the developing brain linked to inhibition of feeding, or on hormones regulating appetite.
Alternatively, maltreated individuals may burn fewer calories because of the effects of early life stress on the immune system leading to fatigue and reduced activity.
According to the study authors, future research will directly assess the link between maltreatment and adult obesity.
Source: King’s College London
Nauert PhD, R. (2018). Abused Children at Risk for Adult Obesity. Psych Central. Retrieved on September 23, 2020, from https://psychcentral.com/news/2013/05/22/abused-children-at-risk-for-adult-obesity/55125.html


Nikki Richard is a multifaceted artist. Hir first book, Pretty Things, was recently published last May. Hir stories and poems have also been published in literary journals and anthologies including Mosaics, FIVE Poetry, and Skelter. Hir solo music project, STRKGRLS, infuses dreamy pop synths with hard-hitting trap beats and airy vocals. Nikki also likes to pretend ze is a sketch artist, and can never stop doodling with sharpie markers.
Born and raised in Southwest Louisiana, ze is a graduate of the MFA program of Creative Writing and Publishing Arts at the University of Baltimore. Ze currently lives in Baltimore with hir wife, daughter, and cat.
Nikki kept it raw and real with us about the struggles of gender dysphoria, self-acceptance, and hir killer personal style. Get to know Nikki and follow hir on Instagram and Soundcloud.
(bio source: nikkizrichard.com)
The Stylette: We see you’re in a band! That’s so dope. How did your music project STRKGRLS come about?
Nikki Richard: I’ve been playing music since I was thirteen, and I’ve played bass guitar for a variety of bands on all sides of the musical spectrum: pop, metalcore, church music, punk, etc. However, I’ve never been a part of a musical project that I fully considered my own. About two years ago, during the early stages of my transition, my gender dysphoria got so severe that I was hardly sleeping at night. I’d lie in bed crying and praying that God would make the pain go away. After a while of the same thing night after night, I started getting out of bed hours before the sun came up to mess around with Ableton Live (a software music sequencer) and teach myself programming. I played a lot with droning synths, electronic piano, and trap bass, and then blended them together to make these dark pop beats. From that, STRKGRLS was born. The project became an escape, a creative outlet where I could address my personal demons in a way that stared them back in the face and said, “I’m terrified of you, but I won’t let you kill me.”
TS: How would you describe your personal style and how does it reflect who you are?
Nikki: I’m definitely a melancholy soul. My personal fashion icons are Wednesday Addams and Lisbeth Salander, because they’re these alternative gals who are tough and take no sh*t. I wear a lot of black, obviously, and I tend to avoid bright colors or complex patterns. Solid prints and subtle pastels go much better with my tattoos.
Also, this may seem contradictory, but I want to be a gorgeous babe while still flying under the radar. Like, I just want to be that oddly attractive wallflower in the back of a party you’d probably miss.
TS: You published a book last May! Tell us about it.
Nikki: Pretty Things is a collection of short stories I wrote while I was in graduate school. All of the characters are dealing with some sort of major life transition: a newly recovering drug addict, a teenage victim of abuse being placed in foster care, a wife dealing with her husband’s recent gender change from male to female. Overall, the collection deals a lot with personal faith, love, and finding beauty in the messiness of life. And there’s also a vampire story. I love vampires.
TS: What has been some of your greatest challenges as an artist and how are you overcoming them?
Nikki: Rejection sucks, and it’s always hard not to internalize the “no’s.” I wrote a sci fi novel last year and was lucky enough to get connected with an amazing literary agent. She’s been working hard pitching the manuscript to a bunch of publishing agents, but so far everyone has passed. It’s easy to feel like I’m not good enough, like I’m this talentless imposter. I tend to negate my advances and only focus on my weaknesses. So whether it’s my music or my writing, when I find myself in a downward spiral of self-hatred and pity, I try to remind myself to look back at where I came from. Have I learned anything new? In what ways have I grown? I think as artists we tend to be our own worst critics. If we want to be successful, and not kill ourselves with our own scrutiny, acknowledging our growth is key.
TS: How do you find inspiration?
Nikki: I can find inspiration everywhere: books I read, city streets I walk, music I listen to, the new Netflix series I can’t stop binging. But for me, the best inspiration comes from relationships. My wife, Elise, has taught me so much about personal strength, fierce love, and unshakable faith. My daughter’s ability to laugh as she endures various procedures and treatments for her leukemia is nothing short of a miracle. A friend’s past struggles with addiction or abuse and their ability to rise above the pain leaves me awestruck. More than anything, people are my inspiration.
TS: A quote you live by?
Nikki: “To be nobody but yourself in a world which is doing its best, night and day, to make you everybody else – means to fight the hardest battle which any human being can fight; and never stop fighting.” – E. E. Cummings